Impact on cardiac surgery volume of a comprehensive partnership with Integrated Health Solutions.

Background: The New Brunswick Heart Centre (NBHC) entered a contractual partnership with Integrated Health Solutions (IHS) to help address increasing wait times in the province of New Brunswick. Methods: Team leaders were identified from each of the target areas, including surgeons, anesthesiologists, nurses (operating room, intensive care unit [ICU] and postoperative ward), access coordinators and administrators. The methodology used was based on Lean principles and involved exercises by stakeholders aimed at identifying opportunities for improvement. A weekly dashboard was created to monitor and facilitate improvement efforts. No additional hospital beds or operating room theatres were added during the study period. Results: After 2 years, the annual number of cardiac surgical interventions increased from 788 to 873, representing a 10.8% increase in capacity. The best median wait time for patients decreased from 52 to 35 days (35% reduction). The best 90th percentile wait time decreased from 126 to 98 days (22% reduction). The overall increase in capacity could be explained in part by the significant increase in fast tracking from the ICU to the ward (> 2-fold) or bypassing the ICU altogether (4-fold increase reaching 13%). Despite these successes, challenges persist as the number of OR cancellations remained around 7.5% of all cases, mainly because of limited ICU resources. Conclusion: The NBHC-IHS partnership on this project has resulted in excellent engagement by stakeholders and promoted team cohesiveness. Furthermore, it has allowed significant reorganization and realignment of efforts to limit wait times and maximize overall capacity.

Contexte: Le New-Brunswick Heart Centre (NBHC) a conclu une entente contractuelle avec Integrated Health Solutions (IHS) pour remédier aux temps d'attente de plus en plus longs au Nouveau-Brunswick. Méthodes: Des chefs d'équipe ont été identifiés pour chaque domaine cible, notamment la chirurgie, l'anesthésie, les soins infirmiers (en salle d'opération, aux soins intensifs et en soins postopératoires), la coordination des soins et la direction. La méthodologie utilisée se fondait sur l'approche Lean et comprenait des exercices visant à relever les possibilités d'amélioration. Un tableau de bord hebdomadaire a été créé pour suivre et faciliter les mesures d'amélioration. On n'a ajouté aucun lit d'hôpital et aucune salle d'opération pendant la période étudiée. Résultats: Après 2 ans, le nombre de chirurgies cardiaques par année est passé de 788 à 873, une augmentation de 10,8 % de la capacité. Le temps d'attente médian pour les patients est tombé de 52 à 35 jours (réduction de 35 %). Le temps d'attente au 90e centile est passé de 126 à 98 jours (réduction de 22 %). L'augmentation générale de la capacité peut s'expliquer en partie par la réduction significative du temps passé aux soins intensifs avant l'admission en soins généraux (> 2 fois) ou par l'élimination complète du passage aux soins intensifs (augmentation de 400 %; 13 % des cas). Malgré ces réussites, des défis demeurent puisque le taux d'annulation des interventions est resté autour de 7,5 % des cas, surtout en raison des ressources limitées aux soins intensifs. Conclusion: Le partenariat NBHC­IHS sur ce projet a permis de mobiliser efficacement les participants et a favorisé la cohésion au sein de l'équipe. Il a en outre permis une importante réorganisation des ressources pour réduire les temps d'attente et augmenter la capacité générale.

A commentary on access to cardiovascular services: nursing roles and initiatives.

The Canadian Council of Cardiovascular Nurses (CCCN) applauds the work done by the Canadian Cardiovascular Society in setting benchmarks for wait times. The Canadian Cardiovascular Society is to be commended for developing the benchmark documents, as well as for establishing strategies for systematic dissemination to increase awareness, advocacy and implementation of the benchmarks across Canada. Quality nursing care, as defined within the CCCN framework, includes working with health teams to ensure that patients have timely access to specialized personnel, tests and procedures as required to prevent disease, promote health, address acute and episodic interventions, and to provide rehabilitative and palliative services, depending on patient need. To extend the access to care discussion, the CCCN suggests that further engagement of all stakeholders, especially clients/patients, is needed to find solutions to wait times and define benchmarks. In addition, preventing heart disease and promoting 'health care' should be recognized and acted on as central to reducing wait times for cardiovascular care. Finally, access to cardiovascular services will be more efficient when the first point of care is broadened to include nurses and other health care professionals. Nurses occupy creative, cost-effective roles directly aimed at reducing wait times and improving care while patients wait. The expanded role of interprofessional education and health care teams, as well as the inclusion of patients and families in program improvement, are solutions that the CCCN suggests may contribute to improved access to cardiovascular care and a sustainable health care system in Canada.