Designing and evaluating a balanced scorecard for a health information management department in a Canadian urban non-teaching hospital.

This report is a description of a balanced scorecard design and evaluation process conducted for the health information management department at an urban non-teaching hospital in Canada. The creation of the health information management balanced scorecard involved planning, development, implementation, and evaluation of the indicators within the balanced scorecard by the health information management department and required 6 months to complete. Following the evaluation, the majority of members of the health information management department agreed that the balanced scorecard is a useful tool in reporting key performance indicators. These findings support the success of the balanced scorecard development within this setting and will help the department to better align with the hospital's corporate strategy that is linked to the provision of efficient management through the evaluation of key performance indicators. Thus, it appears that the planning and selection process used to determine the key indicators within the study can aid in the development of a balanced scorecard for a health information management department. In addition, it is important to include the health information management department staff in all stages of the balanced scorecard development, implementation, and evaluation phases.

Survey of Institutional Policies for Provision of "CMV-Safe" Blood in Ontario.

OBJECTIVES: Debate continues on whether leukoreduction alone (LR) is sufficiently similar to leukoreduced cellular products drawn from cytomegalovirus (CMV)-seronegative (SN) donors to minimize the risk of transfusion-transmitted CMV (TT-CMV). We sought to determine the policy, inventory, and practice landscape of the province for TT-CMV mitigation. METHODS: A web-based survey was distributed to hospitals in Ontario by Canadian Blood Services to collect data on their policies with respect to TT-CMV prevention. RESULTS: TT-CMV mitigation practices varied by patient population, hospital size, and region. Smaller institutions remain committed to dual prevention, whereas academic hospitals favor a single-measure approach. Although smaller institutions attempt to align their policies with leadership sites, emulation is often inaccurate. The demands for SN products also appear to be significantly lower than the current screening practices of Canadian Blood Services. CONCLUSIONS: Standardization is lacking on practices to prevent TT-CMV. Although there are barriers to harmonizing practices, the apparent shift to policies acknowledging LR as a sufficient protection is likely to continue.

Evaluation of a regional ST-elevation myocardial infarction primary percutaneous coronary intervention program at the Rouge Valley Health System.

BACKGROUND: ST-elevation myocardial infarction (STEMI) remains the second leading cause of death in Canada. Primary percutaneous coronary intervention (PCI) has been recognized as an effective method for treating STEMI. Improved access to primary PCI can be achieved through the implementation of regional PCI centres, which was the impetus for implementing the PCI program in an east Toronto hospital in 2009. As such, the purpose of this study was to measure the efficacy of this program regional expansion. METHODS: A retrospective review of 101 patients diagnosed with STEMI from May to Sept 2010 was conducted. The average door-to-balloon time for these STEMI patients was calculated and the door-to-balloon times using different methods of arrival were analyzed. Method of arrival was by one of three ways: paramedic initiated referral; patient walk-ins to PCI centre emergency department; or transfer after walk-in to community hospital emergency department. RESULTS: The study found that mean door-to balloon time for PCI was 112.5 minutes. When the door-to-balloon times were compared across the three arrival methods, patients who presented by paramedic-initiated referral had significantly shorter door-to-balloon times, (89.5 minutes) relative to those transferred (120.9 minutes) and those who walked into a PCI centre (126.7 minutes) (p = 0.047). CONCLUSIONS: The findings suggest that the partnership between the hospital and its EMS partners should be continued, and paramedic initiated referral should be expanded across Canada and EMS systems where feasible, as this level of coverage does not currently exist nationwide. Investments in regional centres of excellence and the creation of EMS partnerships are needed to enhance access to primary PCI.

Is there a relation between emergency department and inpatient lengths of stay?

INTRODUCTION: Emergency departments (EDs) are key entry points to hospital care, and issues of overcrowding and poor patient flow have become a priority in Canada. Studies have sought to determine factors that influence ED wait times in an effort to improve patient flow. We sought to identify the impact of factors such as patient age, triage level, comorbid factor level and sex to determine their effects on length of stay (LOS) and the role that they play in the ED and in an inpatient setting. METHODS: We analyzed 2 years of data from 2007 to 2009. We conducted a repeated-measures analysis of variance to measure the effects of age, triage level, comorbid level and sex as they relate to ED and inpatient LOS. RESULTS: Our analysis resulted in a final sample of 4743 patient visits. A longer LOS in the ED was correlated with a longer inpatient LOS. Age, comorbidity level and sex were shown to have an influence on LOS. CONCLUSION: Continued efforts to further reduce ED LOS are crucial, because this has the potential to influence outcomes, efficiency of EDs and succession to inpatient status, which may affect costs to the health care system. Patient-specific factors need to be considered when formulating and refining policies and processes to improve patient flow.

Where Are Ontario's Respiratory Therapists Working?

Registered respiratory therapists (RRTs) aid in the diagnosis and treatment of respiratory illness and cardiopulmonary disorders, conditions that are increasingly being managed in settings other than the hospital sector. However, analysis of a longitudinal data set of Ontario's RRTs (2,903) from 1996 to 2007 demonstrates that the majority of RRTs work full-time in the hospital sector, where retention is high. Despite a policy direction encouraging the shift of the site of care from the hospital sector to the community/home, this has had little impact on where RRTs work, raising the question of who is providing respiratory services in the community.

Evaluating acceptance of an electronic data management system at a tertiary care institution.

This research reports on satisfaction with the introduction of an electronic document management system in a tertiary hospital environment. A buffet of training and familiarization options were offered: one-on-one training, open house, drop-in, e-learning, classroom training, and self-study. It was found that professions differ in their pattern of satisfaction with training and they also differ in their satisfaction with both the usefulness and the ease of use of the system. Satisfaction among administrators was highest and that among nurses lowest. There was an association between attendance at the open house event and satisfaction with the system.

Menopausal Women's Access Path to Bioidentical Hormone Replacement Therapy: An Exploratory.

The objective of this exploratory qualitative study was to describe (1) the key factors affecting women's initial decision to explore the use of bioidentical hormone, (2) where women gather their information on bioidentical hormones, (3) the enablers and barriers to obtaining bioidentical hormones, and (4) how to improve the bioidentical hormone replacement therapy access path. The study was conducted in a compounding pharmacy located in a large urban area in southern Ontario, Canada. The participants included four postmenopausal women between the ages of 46 and 72 who self-identified as users of bioidentical hormone replacement therapy and with comprehensive provincial healthcare coverage. Participants were recruited at a compounding pharmacy with the use of tri-fold brochures, tear-sheets, and posters. The women participated in an audio-taped mini focus group. Discussion was guided by six open-ended questions. Verbatim quotes were analyzed using an affinity diagram. Participants identified three key factors related to their initial decision: (1) symptoms unalleviated by synthetic hormone replacement therapy, (2) side effects from synthetic hormone replacement therapy, and (3) personal preference. They obtained information and support from many sources, including: family/friends, publications, and specialists in menopausal health. Once participants had made a decision, they obtained a prescription and accessed bioidentical hormone replacement therapy at a compounding pharmacy. Knowledgeable primary care physicians and compounding pharmacists were seen as enablers. Lack of support/Information and costs were identifies as barriers. Improvements to bioidentical hormone replacement therapy access path were suggested. The results of this study suggest that there may be value in implementing strategies to further encourage family physicians and other specialists in menopausal health to discuss options regarding hormone replacement therapy with patients. For example, the preparation and distribution of updated consumer decision aids that summarize the evidence on the options regarding hormone replacement therapy, including bioidentical hormone replacement therapy, could be considered.

Process evaluation of a school-based intervention to increase physical activity and reduce bullying.

Increases in schoolyard bullying and physical inactivity have become important issues to many stakeholders. Peers Running Organized Play Stations (PROPS) is a program designed to address these two issues in elementary schools. Using a "train the trainer" approach, PROPS was introduced to 41 schools. Results of a process evaluation indicate that the implementation rate was 39%. Resources were identified by some respondents as an implementation facilitator. A variety of barriers to implementation were identified: The PROPS program was not a component of anyone's job at the school level, teachers or parent volunteers are needed to run the program, and there is no funding to purchase equipment or storage bins for the equipment. In addition, support for PROPS is vulnerable to changing environments. This process evaluation points to some needed changes for long-term sustainability of the program while highlighting challenges associated with implementing a program in the elementary school setting.

The ontario new graduate nursing initiative: an exploratory process evaluation.

OBJECTIVE: To conduct an exploratory process evaluation of the Ontario Ministry of Health and Long-Term Care's (MOHLTC) New Graduate Nursing Initiative implemented by one home care agency. METHODS: Qualitative data were gathered online, stored electronically and then analyzed using an Affinity Diagram. RESULTS: Seven groupings of participants' comments were created: advertising and external information dissemination; orientation; internal dissemination; impact of the program; transition to the workforce; pay/benefits; and retention. Participants viewed many aspects of the program favourably but identified the following areas for improvement: comprehensibility of the Health Force Ontario website (advertising and external information); orientation of new graduates (orientation); and communication of information about the initiative to existing staff (internal dissemination). CONCLUSIONS: This exploratory study points to both strengths and weaknesses of the New Graduate Nursing Initiative. Further study of the implementation of this policy is recommended.

The need for a national emergency health services database.

OBJECTIVE: In February 2007, the Health Council of Canada, in its third annual report, emphasized the need for pan-Canadian data on our health care system. To date, no studies have examined the strengths and weaknesses of emergency health services (EHS) administrative databases, as perceived by researchers. We undertook a qualitative study to determine, from a researcher's perspective, the strengths and weaknesses of EHS administrative databases. The study also elicited researchers' suggestions to improve these databases. METHODS: We conducted taped interviews with 4 Canadian health services researchers. The transcriptions were subsequently examined for common concepts, which were finalized after discussion with all the investigators. RESULTS: Five common themes emerged from the interviews: clinical detail, data quality, data linkage, data use and population coverage. Data use and data linkages were considered strengths. Clinical detail, data quality and population coverage were considered weaknesses. CONCLUSION: The 5 themes that emerged from this study all serve to reinforce the call from the Health Council of Canada for national data on emergency services, which could be readily captured through a national EHS administrative database. We feel that key stakeholders involved in emergency services across Canada should work together to develop a strategy to implement an accurate, clinically detailed, integrated and comprehensive national EHS database.