Public Reporting

1. Public Reporting Ontario Hospitals February 23, 2009

2. Public Reporting Patient Safety Indicators

3. Background • Amendments to the Hospital Management regulation under the Public Hospitals Act filed in July 2008 imposed new reporting requirements for patient safety indicators. • Under the amendments, all Ontario hospitals are required to disclose indicators of the quality of health care provided by the hospital relating to the diagnosis of hospital-acquired infections and activities undertaken by the hospital to reduce hospital-acquired infections and mortality.

4. Background (cont’d) • On September 30, 2008, all Ontario hospitals were required to initiate public reporting on eight patient safety indicators as part of a comprehensive plan to create an unprecedented level of transparency in Ontario hospitals. • As part of this comprehensive initiative, Dr. Michael Baker, physician-in-chief at the University Health Network, was appointed Executive Lead – Patient Safety to oversee the government’s patient safety agenda.

5. Patient Safety Indicators Clostridium difficle (C. difficile) • Public Report date Sept. 30, 2008 • C. difficile is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis. • It is the most common cause of infectious diarrhea in hospitalized patients in the industrialized world. • The use of antibiotics increases the chances of developing C. difficile diarrhea. • Treatment with antibiotics alters the normal levels of ‘good bacteria’ found in the intestines and colon – when there are fewer of these good bacteria, C. difficile can thrive and produce toxins that can cause an infection. • Presence of C. difficile + number of people receiving antibiotics in hospitals can lead to outbreaks.

6. Patient Safety Indicators Methicillin-resistant Staphylococcus aureus (MRSA) • Public Report date Dec. 31, 2008 • Staphylococcus aureus is among the normal bacteria that many people have and is commonly found on the skin and in the nose. • Some strains of MRSA have become resistant to the most commonly used antibiotics. • The ministry is posting each hospital’s quarterly rate and case count of new MRSA bacteraemia on the ministry website. • Bacteraemia is the presence of bacteria in the bloodstream and is referred to as a bloodstream infection. The ministry is posting each hospital’s quarterly rate and case count of new MRSA bacteraemia on the ministry website. • Bacteraemia is the presence of bacteria in the bloodstream and is referred to as a bloodstream infection.

7. Patient Safety Indicators Vancomycin-Resistant Enterococci (VRE) • Public Report date Dec. 31, 2008 • Enterococci are bacteria found in the stomach and bowels of 19 out of every 20 healthy people – can be present in or on the body but not cause illness. • Enterococci can get into open wounds or skin ulcers and cause infection. • Vancomycin is an antibiotic that is used to treat enterococcal infections. • Some strains of Enterococci have developed resistance against vancomycin and are said to be VRE. • The ministry is posting each hospital’s quarterly rate and case count of new VRE bacteraemia on the ministry website. • Bacteraemia is the presence of bacteria in the bloodstream and is referred to as a bloodstream infection.

8. Patient Safety Indicators Hospital Standardized Mortality Ratio (HSMR) • Public Report date Dec. 31, 2008 • HSMRA is a measure that provides a starting point to assess mortality rates and identify areas for improvement. • Calculated as the ratio of the actual number of deaths to the expected number of deaths among hospital patients. • Public reporting of HSMR is calculated by the Canadian Institute of Health Information (CIHI) and results are posted annually on their website. • Only certain hospitals are included in the CIHI reporting – i.e. hospital results not included if less than 2,500 qualifying cases a year.

9. Patient Safety Indicators Ventilator-Associated Pneumonia (VAP) • Public Report date April 30, 2009 • VAP is a serious lung infection that can occur in patients who need to be on a ventilator. • When the ventilator tube becomes contaminated, it can act as a pathway for bacteria or secretions to enter the respiratory tract, paving the way to ventilator-associated pneumonia.

10. Patient Safety Indicators Central Line Infections (CLI) • Public Report date April 30, 2009 • Patients who need frequent intravenous medications, blood, fluid replacement and/or nutrition may have a central line placed into a vein – can also used for monitoring and testing of the heart and blood. • A central line infection occurs when bacteria grows in the lines and spreads to the patient’s bloodstream.

11. Patient Safety Indicators Surgical Site Infection (SSI) Prevention For Hip and Knee Surgeries • Public Reporting date April 30, 2009 • Risk of developing an infection after joint replacement depends on several factors – i.e. presence of rheumatoid arthritis and/or diabetes, older age, previous infection in the joint replacement, prior surgery and wound complications. • Timely prophylactic antibiotic administration is a key component of perioperative care and reduction of surgical site infection.

12. Patient Safety Indicators Hand Hygiene Compliance • Public Report date April 30, 2009 • A multi-faceted hand hygiene program for all Ontario hospitals – ‘Just Clean Your Hands’ – was launched in March 2008. • Government provided hospitals with tools and materials and an audit process to evaluate the program’s impact. • Designed to highlight the need for all hospital staff to be engaged in rigorous hand washing practices.

13. Public Reporting Time Spent in the Emergency Department

14. Background • Building on the success with public reporting and reducing the wait times for adult and paediatric surgeries and diagnostic services, the government is moving forward with public reporting of time spent in the ER in Ontario. • The reporting is provided through the ministry’s ontariowaittimes.com website and features sections for patients and health care providers.

15. Background (cont’d) • As part of the government’s plan to improve ER performance, provincial targets for time spent in the ER were announced on February 19th, 2009. • It will provide patients with information on how long they may have to spend in the ER and will help monitor progress in improving emergency care. • The data is reported provincially, by Local Health Integration Network (LHIN) and by hospital ER site.

16. Time Spent in ER • Time spent in the ER begins when a patient registers until the patient leaves the ER to a hospital bed, or is discharged home or to another health care setting. During that time, health providers are diagnosing or treating a patient's condition, ordering tests and waiting for results in order to determine the best course of treatment.

17. Time Spent in ER (cont’d) • The site provides information on the maximum time that 9 out of 10 patients spent in the ER (commonly referred to as ED Length of Stay), in hours, for two categories: patients who are very sick and have conditions that may require complex treatment or admission to a hospital bed and patients with minor, uncomplicated conditions.

18. Time Spent in ER (cont’d) • The wait times data is being collected through the Emergency Department Reporting System (EDRS) which gathers information from 128 hospital ERs in Ontario. This represents approx. 90 per cent of all ER visits throughout the province. • The data was first reported through EDRS in April 2008 which will become the baseline for the ER wait times reporting. • The data on the website is not real-time information and is four months old.

19. Public Reporting The ALC Challenge and Public Education

20. The ALC Challenge • Alternate level of care remains a significant issue across the province. • According to the Ontario Hospital Association, acute care hospitals reported in January 2009 that about 3,021 patients are waiting in an acute bed for an alternate level of care on any given day. This represents about 19% of all acute beds in operation.

21. The ALC Challenge (cont’d) Investments 2008/09 • $94 million as part of the Aging at Home Strategy –an initiative to provide support to seniors and their caregivers to stay healthy and live with dignity and independence • $38.5 million for increased home care personal support and homemaking services and enhanced integration between hospitals and Community Care Access Centres • $22 million in new priority funding for Ontario’s 14 Local Health Integration Networks (LHINs) to invest in local solutions to further address ALC pressures • $4.25 million for new nurse-led outreach teams to provide more care to patients in long-term care homes to avoid transfers to the ER

22. Public Education • Ontarians have said that they don’t know much about what their immediate options are for accessing health care or when they should use them. • Yet, people are willing to seek health care in places other than ERs, such as walk-in clinics and Urgent Care Centre's, if it means they will be treated sooner. • That is why the government has announced some public education initiatives, including the new website, to help people understand and find the different sources of health care available to them.

23. Health Care Connect • As part of its public education campaign the government has launched Health Care Connect -a new program devoted to increasing access to family health care. • The Health Care Connect program refers patients without a family doctor to a family health care provider in their community, ensuring those most in need are assisted first.

24. How does Health Care Connect Work? • Unattached patients call a special number at Telehealth Ontario to sign up to a patient database. Patients on the database will be prioritized based on their health care needs. • Care Connectors are nurses from the local Community Care Access Centre. They contact family health care providers to learn about their practice and their ability to take on new patients. • The Care Connectors review a patient’s information in order to provide a proper fit to a provider’s practice. • When a provider agrees to accept a patient referred by the Care Connector, the patient will be given the practice information to schedule their first appointment.

25. Health Care Connect (cont’d) • Priority for referral to a family health care provider will be based on need for health care services. Health Care Connect is intended only for individuals without a family health care provider and participation is not a guarantee of access. • Through the program, assistance will be provided to those most in need first and not necessarily those who have been registered in the program the longest.

26. Public Reporting Emergency Department Patient Satisfaction

27. Background • May 30, 2008, the government announced Ontario’s Emergency Room (ER) Strategy and several initiatives to address ALC pressures within the system. • The ER/ALC Strategy is part of the ‘bigger plan’ to reduce ER wait times and to increase public satisfaction in the health care system. • Public reporting of patient satisfaction results for ER’s are key components of the plan.

28. Patient Satisfaction Surveying • The OHA is working closely with the MOHLTC to foster and enhance participation in patient satisfaction surveying and ensure public reporting of ER patient satisfaction results. • Initial target for public reporting of patient satisfaction results will be those hospitals that are part of the Emergency Department Reporting System (EDRS). • As part of the ER Pay-for Results Program, 23 hospitals are currently required to participate in ER surveying.

29. Patient Satisfaction Surveying • NRC Picker Canada currently conducts the patient satisfaction surveying for the now completed Hospital Report series – will continue to be the Vendor for patient satisfaction surveying. • Data submission timelines and minimum survey numbers will be shifting to allow more frequent reporting – 70 days after each month end – than the previous approach used by Hospital Report. • This becomes effective immediately for January 2009 with a submission deadline of April 10, 2009 of the January files.