Dr. Brendan Parfrey
Heart patients throughout Newfoundland and Labrador are benefiting from remarkable advances in cardiac care delivery that have been achieved in recent months through a special project focusing on improving capacity and reducing wait times.
Eastern Health’s Health Sciences Centre in St. John’s has the only cardiac catheterization laboratory, or cath lab, in the province. Many patients have to travel long distances to get there, sometimes by road and air ambulance. Until recently, difficulties with scheduling and utilization in the cath lab often led to lengthy wait times for patients and the uncertainty of not knowing when they would have their procedures.
“We had the expertise, the equipment and committed staff but lacked some of the processes to deliver the service that we know we could,” says Dr. Sean Connors, clinical chief of cardiology for Eastern Health’s Cardiac Surgery Program. “It was like having a Cadillac in the driveway with no gas to drive it.”
Distressing as the delays were for patients and their families, they were also intensely frustrating for health-care providers who were unable to deliver the care their patients needed when they needed it. The problems in the cath lab were felt across the province as patients waiting for catheterization took up beds in other hospitals.
“Physicians often had to apologize for delays,” says Collette Smith, vice president of clinical services at Eastern Health. “Wait times weren’t meeting acceptable benchmarks and weren’t consistent. It was very stressful for our team because they couldn’t meet the needs of patients across the province. This made it hard to attract and retain the right physicians, nurses and other professionals.”
All of that has changed over the past few months as a result of an innovative partnership between Eastern Health and Medtronic Integrated Health Solutions (Medtronic), to improve the cath lab’s performance.
“The difference is dramatic,” Smith says. “Not only have we reduced wait times and made them more consistent, but we’ve created capacity to increase the likelihood that we can get patients into the cath lab right away when necessary, instead of waiting in a bed or in the ER. Now everyone is proud of what they can achieve with their patients. There’s very little turnover and our employee engagement scores are much higher.”
The partnership with Medtronic began in December 2017. Eastern Health approached Medtronic because they already had a strong relationship and were impressed by the company’s approach to operational performance improvement, as well as their project management and data analytics expertise.
Following Lean Six Sigma methodology, the project started by identifying issues, goals and key areas of focus. Collaborative teams facilitated by Medtronic subject matter experts worked to understand the root causes of the challenges. Solutions were proposed and initiated to address operational challenges and capacity issues. Metrics were identified and reviewed to measure successes and shortfalls. Based on the outcome measures of the new strategies, either adjustments were made, or the new strategies were implemented across the program.
“It was important for the entire team in the cath lab that we work together to implement positive changes to meet patient needs and, ultimately, to improve their overall health experience,” says Dr. Connors. “Delivering treatment sooner to some of our most critical patients can lead to improved long-term health outcomes. That’s the kind of patient-focused care that we strive to provide cardiac patients right across the province.”
Improving the cath lab’s processes “was a long journey and required a major culture shift,” says Smith. “Our team was wary because the problem had been going on for so long. But slowly trust developed in the process and the teams involved. The changes had to come from the front line, as people learned from their own experience and created their own solutions. There was permission to try new things. As we made progress, we found we could create capacity.”
Based on this work, a new approach was launched on October 9, 2018. Staffing schedules are now created to make maximum use of clinic rooms, an on-call team has been created, and overtime has been reduced.
The results speak for themselves. Over the next five months, the outpatient wait list shrank by 15 per cent while utilization of the cath lab grew by 37 per cent.
Reductions in wait times have been even more impressive in January 2019 compared to fiscal year 2017–2018, ranging from a 44 per cent reduction at Labrador-Grenfell Health to a 72 per cent reduction at Western Health (see Table 1).
|Table 1: Average Number of Inpatient Wait Days, 2019 vs. FY2017-2018
The following list shows the average number of inpatient wait days (from date of acceptance to date of procedure) for the province’s four health regions in January 2019, compared with fiscal year 2017–18 (April 1, 2017 to March 31, 2018).
|Region||Fiscal 2017–2018||January 2019||Improvement|
|Eastern Health||4 days||1.95 days||51 per cent|
|Central Health||8 days||3.27 days||59 per cent|
|Western Health||10 days||2.8 days||72 per cent|
|Labrador-Grenfell Health||11 days||6.2 days||44 per cent|
Some additional costs were incurred, but the savings achieved are anticipated to balance them out. Meanwhile, in keeping with Lean Six Sigma principles, the process of continuous incremental improvement continues.
“We have a huge board in the cath lab for suggestions,” Smith says. “People are really good about using it. We’re trying to move the boards into other areas, hoping the problem-solving approach will move as well.
“To others facing challenges like we had, I would say it’s an approach you should try. Our solution can’t be transferred elsewhere — it was created by our team to address our specific needs — but the approach can be. For us, it wasn’t a quick fix but a long-term solution that has lasting benefits for our patients across the province.”
Dr. Brendan Parfrey, is the Director of the Cardiac Cath. Lab at Eastern Health.