Rick Balliett, a patient of Pasqua Hospital’s Heart Function Clinic since it opened in 2008, said the clinic has changed for the better in recent months.
“Once I get here – it’s really fast,” he said. “All our stuff’s right on schedule.”
“You go to one section for the ECG (electrocardiogram) and walk about 40 feet away and everything else gets done. The doctor, the pharmacist and Brenda (the registered nurse) are all right there.”
Rick Balliett, patient
What Balliett is noticing is the result of a January 2014 rapid process improvement workshop (RPIW) at the clinic. The RPIW helped reduce patient waits for appointments, increased patients’ access to health care providers and reduced the amount of time a patient spends walking and waiting during an appointment. The project was one of six highlighted during recent gemba (workplace) tours offered during the Region’s Quarterly Review on January 27 and 28.
“We are seeing more patients and there are far fewer cancelled appointments and clinics,” said Deborah Huys, manager of the Heart Function Clinic.
In 2012, 59 out of 145 (40 per cent) of available clinic days were cancelled. That number dropped considerably in 2014 when 22 out of 126 (17 per cent) available days were cancelled. And, in the past three months, not one clinic has been cancelled. Clinics are held three half days a week.
“Staff and physicians are now collaborating to find alternate clinic days, rather than cancelling appointments,” said Huys, noting there is some urgency to increase the clinic’s capacity as the demand for services grows and the pressures on Emergency continue. “There is also a semi-retired cardiologist who is available to fill in when others aren’t available. This has been an asset to the clinic.”
Patients are waiting less for appointments, too.
The number of people on the wait list at any given time has dropped from about 40 in 2014 to between 19 in October 2014 and 27 in December 2014. The wait for an appointment (from the time the referral is made until the patient is assessed at the clinic) has dropped from between four and six weeks to four weeks or less. Four weeks is the national benchmark timeframe.
“This equates to more timely, evidenced-based care and management of a client’s chronic condition,” said Vicki Ehrlich, director of Cardiosciences and Critical Care. “By optimizing clinic flow, we are better positioning ourselves as we strive to meet the provincial goal of reducing inpatient hospital usage for congestive heart failure. Improved patient access gives residents of southern Saskatchewan the opportunity for more out-patient community-based care which helps them remain in their own homes as long as possible.”
“Improved patient access gives residents of southern Saskatchewan the opportunity for more out-patient community-based care which helps them remain in their own homes as long as possible.”
Vicki Ehrlich, director, Cardiosciences and Critical Care
Client access to health care providers has improved. Each client now has 10 minutes with a pharmacist, a dietitian (when requested), a nurse and a cardiologist at every appointment. Prior to the improvement project, pharmacists met with about a third of all patients per clinic. The dietitian met with patients once a year while the nurse, who saw all clients at every appointment, directed the overall care plan, reinforcing information provided by other disciplines and helping clients navigate the health care system.
Increasing clients’ access to the pharmacist, in particular, has proven valuable because “the pharmacist can pick up trouble the client may have with a medication,” said Huys. “These patients are on multiple drugs and not all patients tolerate them the same – there’s a lot of fine tuning to get their heart functioning optimally.”
The nurse now focuses her time with patients on nursing issues and providing education in “in bits and pieces” rather than in longer sessions which frequently would be overwhelming.
“Teaching, as with all services provided at the Heart Function Clinic, is tailored to suit each client and focuses on health care and lifestyle changes meant to achieve a better quality of life,” said Brenda Hiebert, a registered nurse.
Rather than moving from room to room during their appointments, patients are assigned a room and the nurse, dietitian, pharmacist and cardiologist come to them.
“These patients are living with chronic diseases. They are easily fatigued and overwhelmed. “Bringing the care providers to them has reduced the number of steps clients take per appointment from 400 to about 100 steps. This is significant for people who find just coming to the Heart Function Clinic exhausting.”
Deborah Huys, manager, Heart Function Clinic
The team, which included the RPIW members, Heart Function staff, pharmacists, dietitians and cardiologists, worked tenaciously to bring about these changes, said Marcia Pilon, who served as kaizen support on the RPIW. “They went through several versions of standard work before they found something that worked. They never gave up.”