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Counting on surgical teams

When it comes to taking opioids for the first time, it is not surprising that this frequently occurs after having surgery.

Opioids have become the go-to class of medications for controlling pain and after surgery, many patients require drugs to help deal with pain as they recover from a procedure. This has been documented in a major report by Health Quality Ontario released in 2017 – showing that surgeries are second only to dentists’ offices for the percentage of opioids prescribed to patients who had never used opioids before.

Now, 47 hospitals in Ontario who are part of the Ontario Surgical Quality Improvement Network have launched a campaign to reduce the quantity of opioids that surgical teams prescribe after surgery. These hospitals are responsible for almost 80% of the surgical operations that take place in the province annually.

Measuring what matters in hospitals

Hallway health care – gurneys with sick patients lining hospital corridors – is one of the most graphic representations of the pressures on Ontario’s health system today. We know that the equivalent of more than 10 large, 400-bed hospitals are filled to capacity each day by patients who don’t need the level of services hospitals are designed to provide. They are waiting for more appropriate placement in long-term care, rehabilitation, home care and assisted living.

Tackling these and other system challenges requires an accurate assessment of their scope and scale. Every health care system needs to measure how it is doing so it can improve and so Ontarians know whether the system is moving in the right direction and if they are getting good value for their money.

To properly support the priorities for the system, it is important that what we measure helps us identify and focus our efforts on the most pressing concerns. It is also important not to overwhelm health care professionals with a burdensome requirement to measure too much. As health quality guru Dr. Don Berwick wrote in 2016, excessive and mandatory measurement “is as unwise and irresponsible as is intemperate health care”. Measurement should provide meaningful information on performance, so providers can begin the quality improvement process, if required.

Measuring Up 2018: Complex Challenges

Anna Greenberg

Hospital overcrowding and hallway health care are realities facing today’s health care system in Ontario. The fact that they represent both a source and a symptom of the pressures that patients and frontline clinicians face underscores the complexity of the challenges to improve the situation.

This is one of the main messages to come from Measuring Up 2018, Health Quality Ontario’s yearly report on the performance of the province’s health system.

The report documents the cascading effects of hospital overcrowding such as longer wait times for admission to hospital from the emergency room; longer wait times to transfer out of hospital to other types of care – such as long-term care, home care; and insufficient access to mental health and addictions care. At a time when more and more patients have complex health needs, these stressors on the system are also contributing to rising levels of distress among unpaid caregivers.

Wait Times: A Metric to Watch

Dr. Joshua Tepper

Earlier this summer, Health Quality Ontario revamped its public reporting on wait times to make it more user-friendly. We also added reporting on the wait time between a specialist receiving the referral from the patient's family doctor, to the patient's first surgical or specialist appointment, to gain a fuller picture of the patient experience.

Since then, the data has been used on numerous occasions to document how well or badly one hospital is doing compared to the rest of the province. There have also been almost 100,000 page views of the wait times pages on the Health Quality Ontario website since their launch. Interest in the information remains strong and there were more than 13,000 page views of the nine wait times measures pages between mid-November and mid-December.

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