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Quality Improvement

2019-20 Surgical Quality Improvement Campaign

Ontario Surgical Quality Improvement Network Cut the Count campaign wordmark featuring icons of pills, a surgical scalpel, a patient in a hospital bed, an IV drip, handwashing and a heart monitor

Ontario surgical teams: Help your patients effectively manage pain and learn how to Cut the Count — reduce the number of opioid pills you prescribe at discharge.

Even if you choose only one procedure and make one change, you can make a big difference.

Get started:

  • Adopt a common prescribing protocol;

  • Use multimodal pain management; and/or

  • Talk to your patients about safe opioid use and other treatment options.

Cut the Count is a “Committed to Better” campaign involving 47 hospital sites across Ontario that are part of the Ontario Surgical Quality Improvement Network.


Approximately 80% of patients undergoing surgery in the province will be discharged from an Ontario Surgical Quality Improvement Network member hospital.

Between April 1, 2019, and March 31, 2020, Network hospitals, supported by Health Quality Ontario, are coming together to Cut the Count and reduce the number of opioid pills their surgical teams prescribe to patients at discharge.

Other hospitals can join the challenge too.

Here’s how to get started:

  1. Choose one surgical procedure for your hospital to focus on.

  2. Choose one of the following changes to implement:

    • Adopt a common opioid prescribing protocol: Prescribe the minimum amount of opioids required for the shortest duration possible, depending on the procedure. For more information, see the Opioid Prescribing for Acute Pain quality standard, specifically quality statement #3 (on pages 15-19);

    • Use other forms of pain management (such as non-opioid medications and non-medication strategies, like physiotherapy, massage therapy, mindfulness, etc.), many of which are outlined in the Opioid Prescribing for Acute Pain quality standard, specifically quality statement #2 (on pages 11-14); and/or

    • Talk to your patients about safe opioid use and work with them to set reasonable expectations for pain and recovery. For more information, see the Opioid Prescribing for Acute Pain quality standard, specifically quality statements #4 (on pages 20-23) and #8 (on pages 34-36).

  3. Track your progress: Collect data using the process and balancing measures below to help you determine the success of your approach and its impact on patients.


    Process Measures

    • Percentage of patients prescribed opioids according to the common opioid prescribing protocol 

    • Percentage of patients whose pain was managed using a multimodal approach

    • Percentage of patients prescribed an opioid who received supplementary information about pain management

    • Percentage of patients prescribed an opioid who received supplementary information about the potential benefits and harms of opioid therapy 


    Balancing Measures*

    • Rate of readmission 

    • Length of stay 

    • Patient satisfaction and pain rating

    *Balancing measures check to ensure changes implemented to improve one element of patient care are not causing new problems in other areas of care.

  4. Ontario Surgical Quality Improvement Network members: Indicate your participation in this campaign in your Surgical Quality Improvement Plans. The primary indicator for this campaign—number of opioid pills prescribed at discharge—will be available in the drop-down menu.

For more information on the Cut the Count campaign or to join the Ontario Surgical Quality Improvement Network, please contact ONSQIN@hqontario.ca.

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