Health Transformation Hub

  • A patient’s time is the most valuable currency in our system—every day a patient spends in the hospital should contribute to their care or their journey home.
  • Overcrowding in the emergency department is the most visible sign that a hospital needs to improve patient flow. In conjunction with community partners, the entire hospital team must focus on solutions that allow patients to return home sooner and ensure Nova Scotians have timely access to the care they deserve.
  • Initiatives to improve patient flow through the hospital will help Nova Scotia Health meet its obligations to our community, patients and our valued workforce.
  • All Nova Scotia Health care providers and leaders, across all programs, departments, sites and facilities in all four zones are responsible for improving patient flow. This requires investments and innovation, as well as coordination and integration in our hospitals and in our communities.
  • We are making changes to ensure patients get the care they need in the most appropriate setting with the right care provider. This means a commitment to new standards, and new ways of ensuring patients flow through the community and our hospitals without delays, from point of entry through to discharge home, including care in the community.

Network Overview

The Integrated Access and Flow Network membership includes:

  • Frontline providers from various disciplines
  • Leaders from across the province
  • Patient representatives
  • Partner members from other networks and government departments

Network members give advice on direction and give valuable input and feedback on the work of the Network.

Network Aims

  • Optimizing care in the community to reduce demand for hospital services.
  • Optimizing the patient journey through the hospital setting; recognizing that hospital systems are ecosystems of interconnected departments and services.
  • Ensuring patients return to best home or community environment in a timely manner, supporting home first as best first option.

Workstreams

The network workstreams focus on access and flow, with the patient and the hospital ecosystem as the center (see figure below). Five workstreams have been identified for the network.

Hospital Admission Avoidance

  • Enhancing access in primary health and community care, and identifying best practices on avoidance strategies.
  • Examples include:
    • Building primary care teams
    • Enhanced ambulatory care model
    • Community paramedicine model
    • Scope of practice of community pharmacy

Demand and Capacity

  • Understanding and planning for Patient and Organizational characteristics.
  • Examples include:
    • Employing lean management practices
    • Operational engineering
    • Complex systems analysis

Inpatient Models and Processes

  • Building and optimizing high-performing teams and evolving Inpatient Models of Care, i.e. metrics and processes.
  • Examples include:
    • Identification of base funding metrics for general medicine beds
    • Understanding the role of NPs and hospitalists, scribes and physician assistants in inpatient medicine

Optimization of Discharge and Placements

  • Enhancing home first as a philosophy by identifying and ensuring resources are available for the same.

Flow Leadership: Communicate and Coordinate

  • Ensuring a visible executive leadership (including flow leadership structure – fostering a learning culture and working with system partners, management, and championing processes).
  • Examples include:
    • The executive oversight team, committed to achieving system-wide flow, must prioritize four things:
      • Carefully craft and communicate a long-term aim and its rationale
      • Put in place structures to execute on system-wide improvement, shifting the focus from localized initiatives to hospital-wide results
      • Be ready to resolve the tough dilemmas and surges in patient demand on a timely basis
      • Focus on a few important initiatives to demonstrate organizational capability, then expand the scope to hospital-wide flow initiatives

Areas of Focus

Safer-f

SAFER-f Patient Flow Medicine Bundle is a combined set of best practices for adult inpatient units that improves patient care through:

  • Patients and families being more engaged in their care planning.
  • Patients having a better understanding of what is happening while in hospital and when to expect to return to the place they call home.
  • Patients having expedited access to investigative tests or procedures.
  • Improved discharge planning.

Interprofessional Teams

  • Patients and family having access to all team members seven days per week.
  • Increased number of home visits completed for geriatric outreach.
  • Improved flow in evenings and weekend.
  • Improving access to early community rehabilitation for persons with stroke.

Mobilization

  • Mobilized twice a day (seven days a week) to maintain mobility, enhance recovery, and return home.
  • Increase patient and family satisfaction with patient mobility.
  • Reduced rate and severity of delirium.

Transitional Care

  • Less time in acute care setting.
  • Targeted care planning and enhanced quality of life.
  • Most appropriate care provider and setting for the patient’s needs.

Colchester East Hants Health Centre IMCU/ICU

  • Patients will be cared for in the most appropriate place when acutely ill.
  • More appropriate patients on service, therefore, more appropriate use of clinical skills.

Coordinated Care Centre (C3)

  • Improved access to live data to better inform patient care plans and transitions.
  • Better coordination, smoother transitions, and improved patient access and flow.
  • Improved patient experience and helps personalize the care delivered.

Current Activities

We will connect experts, users, providers, community members and decision makers to co-design patient flow improvement initiatives. In so doing, we will improve capacity for care by doing the following:

  • Interprofessional Teams: Continue to expand and implement team positions based on zone needs (such as pharmacists in Central Zone; porter services in Northern Zone; Respiratory Techs and wound care clinics in Western Zone).
  • Provincial Mobilization: Continue to enhance teams to provide seven-days-a-week service.
  • Transitional Care Units: Model of care and patient transfer implementation for Bridges Community Transition Centre Model of Care complete. Renovation and occupancy for Hogan Court ongoing. Operational plans and timelines under development. Plan approval for Bayers Lake.
  • SAFER-f: Continue existing strategy and roll-out for phase 2.
  • Colchester East Hants Health Centre IMCU/Level 2 ICU: Went live in July 2023.
  • C3: Continue to roll out tiles.
  • Alternate Level of Care (ALC): The ALC Designation Project is designed to standardize the ALC designation process in all acute care settings within Nova Scotia Health. ALC is used to identify patients who no longer require inpatient acute care services provided at their current facility, using the ALC definition and criteria.
  • Home First: Conducting current state assessment, analyzing results, developing provincial strategy, and developing supporting resources for staff.
  • Ongoing policy rollout.

Sponsors and Leads

Leads

  • Lynn Edwards, Senior Director, Clinical Networks: Integrated Access and Flow, and Frailty and Elder Care, Nova Scotia Health
  • Dr. Tanya Munroe, Senior Medical Director, Nova Scotia Health

Executive Sponsors

  • Dr. Nicole Boutilier, Vice President, Medicine, Nova Scotia Health
  • Eileen McGibbon, Vice President, Operations, Central Zone, Nova Scotia Health

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