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. 2020 Aug 28;63(5):E374-E382.
doi: 10.1503/cjs.007519.

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

Amy Watling  1 , Janine Doucet  1 , Morteza Zohrabi  1 , John Fedirko  1 , Ansar Hassan  1 , Sohrab Lutchmedial  1 , Jeffrey MacLeod  1 , Zlatko Pozeg  1 , Craig Brown  1 , Jean-Francois Légaré  1
Affiliations

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

Amy Watling et al. Can J Surg. .

Abstract
in English, French

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 NBHC–IHS 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.

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Conflict of interest statement

This study reports the results of a partnership between the New Brunswick Heart Centre and Integrated Health Solutions (IHS), which is a service produced by Medtronic Canada. M. Zohrabi and J. Fedirko were members of the IHS team. Their primary role as authors was to ensure that the IHS process was described accurately in the article. No other competing interests were declared.

Figures

Fig. 1
Fig. 1
Impact–effort analysis for operating room optimization. During the 5-day Kaizen (rapid improvement) workshop, individual projects were listed in each box and placed within the impact–effort analysis matrix on the basis of feedback from stakeholders. Cath = catheterization; DOSA = day of surgery admission; KPI = key performance indicator; OR = operating room; ORSOS = OR statistical operating system; SOP = standard operating procedure; TAVI = transcatheter aortic valve implantation.
Fig. 2
Fig. 2
Sample weekly dashboard. I/P = inpatients; NSTEMI = non-ST-elevation myocardial infarction; O/P = outpatients; OR = operating room; SICU = surgical intensive care unit; STEMI = ST-elevation myocardial infarction; TAVI = transcatheter aortic valve implantation; w = week.
Fig. 3
Fig. 3
Annual volume of cardiac surgery cases, including transcatheter aortic valve implantation, from 2006 to 2016 at the New Brunswick Heart Centre.
Fig. 4
Fig. 4
Total number of cardiac surgical cases, including transcatheter aortic valve implantation, during the baseline year (the year before the implementation of the collobaration with Integrated Health Solutions) and years 1 and 2 of the collaboration.
Fig. 5
Fig. 5
Total number of patients who were fast-tracked.
Fig. 6
Fig. 6
Ninetieth percentile wait times for patients remaining on the wait list, calculated on a monthly basis during the study period.
Fig. 7
Fig. 7
Percentage of case cancellations.
See this image and copyright information in PMC

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