Infection prevention and control for diverse vulnerable populations: From an emergency response to the COVID-19 pandemic to sustainable improvement.

At the onset of the COVID-19 pandemic in early 2020, organizations providing residential and respite care for individuals with developmental disabilities and complex care needs in the Greater Toronto Area were largely unprepared. As case numbers surged, they lacked the expertise and resources needed to prevent spread across populations that are highly vulnerable to infection and poor outcomes. This article describes how these organizations, led by Safehaven, responded to an unprecedented emergency, and how the response is leading to sustainable improvements in care and safety for diverse vulnerable groups in congregate care settings. As the pandemic advanced, the Safehaven Program evolved with the solidification of the role of Infection Prevention and Control Champion lead role in Ontario and partnership with Reena in York Region.

Home First: reducing ALC and achieving better outcomes for seniors through inter-organizational collaboration.

Like many hospitals, those in the Mississauga Halton Local Health Integration Network (MH LHIN) have used inter-professional collaboration to maximize system processes. Process improvements previously occurring in silos have started crossing hospital programs and systems within and beyond the hospital. The challenge is that few healthcare organizations consider, never mind implement, process improvements that traverse the LHIN. This article discusses an innovation with a unique feature: concentration not only on inter-professional collaboration but on inter-organizational collaboration by professionals and providers throughout the LHIN. The Home First approach exemplifies what is possible when culture is adapted to necessitate and enable intra- and inter-organizational collaboration and partnerships based on trust and respect. This approach has been spread and sustained successfully across the LHIN, with alternative level of care patients being reduced by 50% or greater.

Saving costs using an ounce of prevention: introduction of a regional stroke prevention clinic.

Trillium Health Centre (THC) is one of Canada's largest community hospitals and a regional provider of tertiary-level cardiac, neuroscience, and orthopedic care. In 2001, it was named one of nine Regional Stroke Centres in Ontario, with a mandate to coordinate stroke services across the continuum of care in keeping with best practices in the west Greater Toronto Area (GTA). Within its role as a Regional Stroke Centre, THC has successfully implemented an innovative approach to the delivery of stroke prevention services in its regional catchment area. Building on best practices, it has introduced a specialized and interdisciplinary team to provide timely and effective primary and secondary prevention services. The rapid growth in utilization to more than 2000 patients in the last fiscal year (2004-2005), suggests that the clinic is meeting a real need in the community for stroke prevention services. Many of these patients now benefit from appropriate medical management, stroke awareness education, lifestyle counselling, and expedited referrals to other specialists. The Regional Stroke Prevention Clinic (RSPC) may be the first step in preventing a stroke, thus avoiding the social costs to people with strokes and their families, and the financial burden on the health care system.

Best practices in stroke care.

In 2001, the Ontario Ministry of Health and Long-Term Care introduced the Ontario Stroke Strategy by designating regional stroke centres across the province. The primary role of these centres is to coordinate stroke care within the region and across the care continuum in keeping with best practices. Concurrently, Trillium Health Centre was identifying best practice projects to support its ongoing quest for excellence. With Trillium designated as a regional stroke centre, acute ischemic stroke care was an obvious choice for a best practice project. The aim of the project was to improve access to care and quality of care for stroke patients from emergency through acute care to in-patient rehabilitation. The team chose the rapid cycle change methodology. This approach to quality improvement advocates the testing of a series of small changes (i.e., process improvement ideas) in tandem with measurements to assess the impact of the change to drive further process improvements. The project was deemed a success, resulting in significant improvements in the timeliness and quality of care.

Bringing innovation to stroke care: development of a comprehensive stroke unit.

Much work has been done in the past 10 years to research and document best practices in stroke care along the continuum of care. The challenge now for stroke care practitioners is to turn those best practices into reality in a clinical setting. In spite of a general understanding and acceptance of the benefits to the patient, an organization's culture and limited access to resources can frustrate our best efforts to introduce best practices at the bedside. Trillium Health Centre, a community hospital serving a diverse community of more than one million people, has turned best practice stroke care guidelines into reality by developing a 14-bed comprehensive stroke unit. This innovative approach to care uses specialized stroke teams, an interdisciplinary approach to care, and a single unit where the patient remains in the same bed throughout the acute and rehabilitation stages of care. Commitment to the new delivery model by formal leaders, informal leaders, and front-line staff and a supportive organizational structure contributed to an expedited and successful implementation. All changes were implemented without an increase in the overall resources assigned to the unit. Early results show that the average length of stay is shorter than the national standard and that provider and patient satisfaction have improved.

Presentation, delay, and contraindication to thrombolytic treatment in females and males with myocardial infarction.

BACKGROUND: This study seeks to explore gender-relevant factors of medical history, sociodemographics, symptom presentation, and delay on thrombolysis administration (or recorded contraindication) in a sample of men and women with confirmed myocardial infarction (MI). METHODS: Cross-sectional examination of self and nurse-report data collected in the coronary care unit (CCU) from 12 hospitals across south-central Ontario, Canada. A total of 482 MI patients (347 males, 135 females; 63% response rate) were recruited. MAIN FINDINGS: There was no gender difference in the report of chest pain (chi(2)(1) = 3.78, p =.052), or in prehospital delay time (median = 96.5 minutes). Thrombolysis was administered in 158 males (68.4%) and 50 females (50.0%) without reported contraindication. Females (median = 27 minutes) had a significantly longer interval between diagnostic electrocardiogram (ECG) and administration of a thrombolytic than males (median = 22, U = 3,056). No contraindication was indicated for not administering a thrombolytic (i.e., too late, risk of bleed) in approximately 40% of females. In accordance with clinical practice guidelines, thrombolysis was more often administered in participants with a shorter time interval between symptom onset and hospital arrival. For females, thrombolysis was more often administered in younger participants (Kruskal Wallis = 5.88). CONCLUSIONS: Reducing gender, age, and socioeconomic disparities in access to thrombolysis treatment is imperative. Hospital delays with female cardiac patients may be precluding thrombolysis administration.

Learning needs of patients with congestive heart failure.

BACKGROUND: It is suggested that more effective and efficient educational intervention can be created by matching the program to patient learning needs. Previous attempts to determine the learning needs of patients with congestive heart failure (CHF) find all types of information endorsed as very important to learn. OBJECTIVES: To increase differentiation between patients' ratings of information needs by modifying the CHF Patient Learning Needs Inventory (CHFPLNI) and examined predictors of learning needs. METHODS: Thirty-four inpatients with CHF from the Toronto General Hospital, Toronto, Ontario completed the modified CHFPLNI and rank ordered the perceived importance of eight categories of CHF knowledge measured by the CHFPLNI. Patients also completed measures of emotional distress, fatigue, health beliefs, locus of control and current CHF knowledge. RESULTS: Ratings across all information categories were similar (M=4.4-5.3/7) and highly correlated (r=0.52-0.87). Patients indicated information on medication, cardiovascular anatomy and physiology, and treatment were the most important to learn on both the CHFPLNI and by rank ordering. Higher fatigue was correlated with information needs on diet (r=0.37), activity (r=0.37), psychological (r=0.38) and risk (r=0.37) factors. No other variables consistently predicted learning needs. CONCLUSIONS: Changing the format of the CHFPLNI did not increase the differentiation of patients' ratings across information categories. The assessment of patients' learning needs using extensive questionnaires does not appear warranted because simple rank ordering obtained similar information. Individuals who are more fatigued wanted more information on those aspects of care that they managed on a day-to-day basis.