Top 4 quality improvement initiatives affecting physicians

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Top 4 quality improvement initiatives affecting physicians


Appropriateness of Care Initiative

You have likely heard about the Appropriateness of Care initiative sweeping across Canada. The Canadian Medical Association defines Appropriateness of Care as: “The right care provided by the right providers, to the right patient, in the right place, at the right time, resulting in optimal quality care.” 1 With permission from the CMA, Saskatchewan has adopted this definition as the guiding principle for our work. The high-level provincial objectives are:

  • By March 31, 2018, 80% of clinicians in at least 3 selected clinical areas within two or more service lines will be utilizing agreed upon best practices.
  • At least one clinical area will deploy care standards and be using measurement and feedback to inform improvement by March, 2016.

The majority of Department Heads have submitted projects that their departments will champion. Some have already commenced work on their projects, others are in the queue. Stay tuned for updates.

[1] Canadian Medical Association 2013


Auditing use of Inpatient Medicine Pre-Printed Orders (PPO)

Comprehensiveness of patient orders and consistency of application of plans of care are well-established ways to improve quality and the efficiency of care. Pre-Printed Orders are powerful tools for achieving comprehensiveness and consistency.

The PPO development process is rigorous involving applicable best evidence and the involvement of all users. When completed a PPO ought to be fully acceptable to everyone treating patients for whom the PPO is designed. Of course PPOs, like all aspects of our work, can and therefore should be improved with use. It is not acceptable just to ignore them. Patients and our healthcare system are then denied the benefits that flow from the use of a PPO. Everyone who might use any PPO has been offered the opportunity to participate in creating it. One cannot now logically decline to use it.

Two audits of Inpatient Medical Admissions to the Clinical Teaching Unit (CTU), General Internal Medicine (GIM), Hospitalist and Family Medicine Services at the Pasqua and the General Hospitals have been conducted since January 1st this year.

The audits have revealed that there is virtual full implementation of the PPO within the Hospitalist and the CTU groups. There is approximately 50% implementation by the A Team, RAHD and the Family Medicine groups and little implementation by the General Internal Medicine Services at both the Pasqua and the General sites.

The goal is 100% implementation in order to reduce variation in care and to ensure important clinical benefits including those from vaccination, thromboembolism prophylaxis and care standardisation are realised. The Medicine Inpatient Program will continue to work with the physician leaders to ensure that these potential clinical deficiencies are addressed.

The data from the last audit conducted on February 10th are as follows:

Clinical RPIW Activity Update

1.Antimicrobial Stewardship

The focus for this RPIW is to create a prospective audit and feedback process for RQHR as it relates to Antimicrobial Stewardship. Prep work started Feb 8th and will continue until March 4th. After that the team will move into what is called Event Week which will run March 7-11. During the prep and event weeks you may be approached by members of the RPIW team so that they can gather information and data on RQHR’s current state regarding prospective audit and feedback. This may also include members of the team shadowing you as you go about your day. The area of focus for this RPIW is RGH 6F. If you have input, comments or suggestions please do not hesitate to share these with any member of the RPIW team.

2.Rural to RGH Medicine “to meets” patients

This RPIW has been very successful in reducing the delay in time for decision making for patients arriving on referral from rural Saskatchewan. Over 80% of patients have their disposition decisions made within the four-hour standard.

This has resulted in considerable out of pocket savings for patients and families as waiting time for their ambulance has greatly reduced.

3.Physician On-call Scheduling

The preparation phase for this RPIW is underway. There has been at times great confusion in regard to the development, management and publication and reimbursement for on-call services. The purpose of the RPIW is to come up with a timely and reliable process to ensure that on-call schedules are consistent, timely and reliable.

4.Medication Reconciliation on Discharge

RPIW #83, which focused on Medication Reconciliation on Discharge for hospitalists and Regina Area Hospital Doctors on Unit 5E at RGH, continues to be green after 90 days with medication reconciliation on discharge occurring 100% of the time for this physician group. Although there have been some minor challenges to replicate this RPIW to extend to all MRP physicians on RGH 5E, nursing staff and physicians have partnered to ensure that medication reconciliation is being performed on most discharges and transfers from 5E. Defining when to complete medication reconciliation on “transfers” has posed some confusion, and education is being provided to all team members to identify when to complete medication reconciliation at the appropriate time in care transition.

The Ministry of Health has recently updated the SK Discharge/Transfer Medication Reconciliation form being used on 5E, adding a “Pre-admission Medications” section. The Clinical Nurse Educator on 5E is educating nursing staff and physicians on this new section which should be embedded into practice over the next few weeks.

RPIW #95 will also focus on Medication Reconciliation from Admission to Discharge at William Booth Convalescent Care Unit in Long Term Care. It is hoped that learning acquired from this RPIW will assist in the replication of medication reconciliation to all Long Term Care sites.

To ensure that medication reconciliation from admission through care transitions is implemented across RQHR in a safe and seamless manner to support patient safety, a steering committee will be developed to oversee this replication initiative.  

Health Records Completion

There is continuing good news on the records completion front. The most recent departmental statistics are as follows:



  December 14   

   February 1    

Change Change %
Family Medicine 91 73 -18 -20%
Medicine 279 199 -80 -29%
Ob/Gyn 479 418 -61 -15%
Paediatrics 52 22 -30 -58%
Psychiatry 65 5 -60 -93%
Surgery 372 218 -154 -30%
Total 1338 935 -403 -30%