“Like an orchestra”: How teamwork and technology are coordinating care at the QEII

By Norma Lee MacLeod

Just beyond the foyer of the Halifax Infirmary site of the QEII Health Sciences Centre, there’s an unobtrusive room filled with technology and purpose. On the wall, a bank of monitors streams real time data on every patient and the myriad of tests and procedures they need before they leave hospital. Watching it all is a team of health care workers who analyze the data and intervene to match patients with empty beds or escalate tests and procedures that delay a patient leaving hospital.

This is the province’s new Care Coordination Centre, known as C3, powered by computer software that pulls patient data from every corner of the hospital and compiles it in one place. It shifts the flow of information from an antiquated system of white boards and sticky notes to a minute by minute, one stop shopping helicopter view of what’s happening in the hospital. It’s one of the projects under the province’s Action for Health plan to improve access to health care in Nova Scotia.

“There were lots of delays in accessing the beds because of how manual it was,” said Kim McMahan, director of access and flow for the Central Zone. “People would come together, and we would track our predictions for discharges and admissions, and we would write it on a white board. They would take a picture of it or transcribe it manually to a clip board and work from that all day.” The information quickly became outdated. “The units would reach out when they could, and we would call over and over to see if they had any discharges or perhaps ones they hadn’t predicted in the morning.”

The new technology integrates all information entered in various software programs in the hospital. With the click of a mouse, staff have access to the minutia of a large hospital working at full capacity - details like which inpatients are waiting for a blood test or physiotherapy, or which beds are unavailable because of staffing or maintenance. The software is supplied by GE HealthCare and has a proven track record at Humber River Hospital in Ontario.

“It’s about breaking down the silos so that patients can move easier within the system,” said Brittney MacKinnon, Director of Innovation at the Nova Scotia Health Innovation Hub and Project Lead for C3. The Innovation Hub was key to putting this project together. “The Health Innovation Hub brought the technology forward, pulled together key clinical and non-clinical leaders at the QEII to start and talked about what could this solution look like here. How could we customize the GE offering to make the most sense for Nova Scotia Health,” said MacKinnon.

The technology is the foundation of the C3, but the real brawn is in the 24-7 team tracking the information with the power to set priorities, make decisions and intervene to escalate access to services.

“These roles are like an orchestra,” said Jonathan Veale, former interim operational lead at C3*. “They need to be coordinated and so having them co-located is really the big business value here.”

That coordination involves hospital staff with expertise in access and flow and staffing, and representation from outside partners such as continuing care, EHS, and the departments of Community Services and Seniors and Long-Term Care.

“It has been more than technology,” said McMahan. “This Care Coordination Centre is about relationships; it is about line of sight and working together in a collaborative manner. We now have contact from lots of different areas that we have never worked with before and we’ve been able to make a great impact on getting patients more timely service.”

In a recent example, a patient’s release from the intensive care unit was delayed because of one test that couldn’t be scheduled for several days. The health service manager escalated the case to C3 which in turn worked with the team in the testing area to rearrange appointments. “We were able to escalate that to the right people who could make the decision and triage their workload to get the patient done within four hours,” said McMahan.

These efficiencies mean the patient goes home sooner, and that opens beds for people waiting in emergency or for patients in the community waiting for surgery. “Every minute or half hour we shave off your wait to be cared for is a win,” said Dr. Tanya Munroe, senior medical director of C3.

“This is not a single widget solution to the problem of access to and flow through health care in Nova Scotia. This is part of a basket of initiatives that when taken together should make a meaningful reduction in patients wait time for care,” said Dr. Munroe. “We are not going to eliminate wait by instituting this, but it is going to make the barriers to patient flow a whole lot more transparent and all the other work that is ongoing to address those issues can be more targeted based on this information.”

C3 also builds in accountability. “Not only does this capture some of the specifics about what’s going to happen for the patient today, it also captures what should have happened and is delayed so you are able to see what’s going on, what should be going on, and then try and move things along faster,” said Dr. Munroe.

The technology behind C3 is being activated in stages at the QEII, each adding more information on a patient’s journey through the hospital. The plan is to expand to all 42 hospitals in Nova Scotia, making it the first province wide health care command centre in Canada. Veale says that’s when the full potential of C3 will be realized. “Remember, we went from a closet where there was one person… to a team working through processes. This is the first iteration. Let’s call it 1.0 of the overall concept.”

*Jonathan Veale is now working for Build Nova Scotia as Vice President, Infrastructure, Lands, and Community Development.