News & Events
Appropriateness of Care Program Details
Appropriateness is defined by the CMA as providing the right care by the right providers to the right patient in the right place at the right time resulting in optimal quality care.
RQHR’s new appropriateness agenda has five elements:
- The first is to steal shamelessly from Intermountain Health’s ten projects. These include reducing iatrogenic and nosocomial events such as ventilator acquired, surgical and other nosocomial infections.
- Secondly, we are asking members of sections of departments to introduce one element of the “Choosing Wisely” strategy relevant to their section. For example the Section of General Internal Medicine has committed to reducing the use, and duration of use, of Foley catheters.
- Thirdly through Dr Carson’s great work we are pursuing the PPO strategy which allows standardisation of orders including admission orders. The fourth is the introduction of clinical pathways with particular attention to stroke care prostate and spine care.
- The fourth area of emphasis is on appropriate resource use. Here the region and its medical staff have already started working collaboratively to standardize ordering of diagnostic tests and the use of standard approaches to orthopaedic and neurosurgical procedures.
- The final area of work is to work on the appropriateness of surgical and medical interventions and on ensuring appropriateness of documentation.
RQHR will work collaboratively with the Saskatchewan Provincial Initiative on Appropriateness and indeed Dr David Kopriva will provide medical leadership with his colleagues for this provincial initiative. Saskatchewan’s health system physicians and other leaders identified improving “Appropriateness of Care” as a key system priority. Overuse, underuse, misuse and unjustified variation have been widely used to describe care that is considered “inappropriate (treatments, procedures, medications, diagnostic testing).
- A provincial framework has been developed with the intent that the framework’s processes will be broadly applied and widely utilized by clinicians
and health care organizations in SK across the continuum of care. The framework consists of:
- A quality improvement methodology to improve Appropriateness of Care at the clinical practice level;
- A stakeholder engagement and communication plan;
- A plan that outlines infrastructure requirements for capturing, analyzing and reporting essential data; and
- A toolkit with information to support groups or organizations who want to undertake improvement work in any clinical area
MRI of the lumbar spine was chosen as the pilot project to test the Appropriateness of Care framework in 2015-16, with the goal of improving appropriateness of MRI requests.
A provincial Clinical Development Team of clinical experts and patients is steering the MRI improvement work. The team includes representatives from several physician specialties in Saskatoon and Regina. These include radiologists, orthopedic surgeons, neurosurgeons, family practitioners and patients from Saskatoon Health Region and Regina Qu’Appelle Health Region. (RQHR: Dr’s Ekong, Rodwan, Goyal, Konstantynowicz SHR: Dr’s Babyn, Shepel, Woo, Fourney Patients: Cindy Dumba and Heather Thiessen)
The Clinical Development Team met several times over the past few months and after reviewing data and leading practices from other jurisdictions, a consensus emerged that there is an opportunity to improve the process for ordering an MRI for patients with low back pain with or without associated leg pain. The group recommending that a Lumbar Spine MRI Checklist be completed and accompany each freeform requisition for a lumbar spine MRI. The checklist provides an easy way to present important patient information and help better understand the reasons for ordering an MRI and whether or not these reasons conform to current guideline recommendations.
Implementation of the checklist will be phased-in, focusing on physicians in Saskatoon Health Region in September, and those in Regina Qu’Appelle Health Region in October. The Appropriateness Project team members will be communicating with the physicians and their office staff over the next several weeks to provide information about the checklist. The checklist will be required in Saskatoon Health Region as of October 1, 2015 and in Regina Qu’Appelle Health Region November 1, 2015. As of these dates, if the checklist doesn’t accompany the requisition, the medical imaging departments will consider the requisition incomplete and follow their already established processes for incomplete requisitions.
An evaluation of the checklist will be completed- revisions may be made based on feedback from physicians once the checklist has been tested for 3 months in each region. The testing time period will end January 31, 2015.