Bundling Care for Cardiac Surgery Patients.

Patients returning to the community after surgery often experience a disconnect when transitioning from hospital to community home care. Many receive little organized/planned care following discharge sometimes resulting in unplanned expensive care in hospital emergency departments and inpatient readmissions. Trillium Health Partners, a large community/teaching hospital, in partnership with community care provider Saint Elizabeth Health Care, designed and implemented a seamless "bundled care program" for cardiac surgery patients extending from hospitalization to 30 days after discharge. With a risk/gain sharing model, the bundled care program enabled a novel integrated clinical patient care model. This included integrated care coordinators embedded within the hospital team, 24/7 patient phone line, integrated medical records and a tracking board that enabled performance monitoring and improvement. Evaluation results revealed: a 16% reduction in post-operative length of stay; a 38% reduction in readmission rates; and a 13% decrease in total system cost per patient, together with markers of improved patient experience.

Fifty years of infection control and healthcare design.

The examination of 1962 perspectives on healthcare provided by Ross Graham and Shannon Sibbald in their article "Looking Back 50 Years in Hospital Administration" provides an opportunity to see not only what happened 50 years ago, but how modern attitudes and concerns both match and differ from those of the past. Focusing on infection prevention and hospital design, this commentary explores the changes in procedure, policy and attitudes since 1962, and how they are affecting healthcare today.

Uniting board to bedside: the use of driver diagrams in quality monitoring and improvement at Trillium Health Centre.

Boards of directors of healthcare organizations are increasingly being urged to extend their governance activities beyond financial matters to include the quality of patient care. Recently, Trillium Health Centre identified four big dot indicators and generated corollary driver diagrams aimed at helping its board understand and measure the organization's quality improvement plans, efforts and results. In addition to keeping board members up to date on these developments, the driver diagrams have supported quality improvements in their own right--for example, with hospital-acquired pressure ulcers--and have helped staff to focus and become more deeply engaged in Trillium's patient-centred quality improvement initiatives.