Breaking away from the ordinary
- June 2002
When 52-year-old Catherine Bodnar fell in her kitchen in April, she didn't think she had broken anything. Although it hurt her to walk, she continued to go to her job as a legal secretary.
After two days, the Niagara Falls resident was still in a fair bit of pain, and thought she may need an x-ray. "I was really quite surprised to find out my hip was broken," she said. Catherin had the good luck to go to the Niagara Health System's Greater Niagara General Site in Niagara Falls, where a Fractured Hip Clinical Pathway is in place to co-ordinate and guide her care by a virtual army of health care professionals.
Most hospitals these days have clinical pathways or care maps for specific procedures and conditions, such as fractured hip, gall bladder removal, total knee replacement, total hip replacement, stroke, etc. Clinical pathways literally guide the patient and health care professionals down a pathway to treat the condition in a way that is considered ‘best practice'. The pathway booklets explain what treatments (physiotherapy, follow-up x-rays or bloodwork) the patient will have at a certain phase, when to start planning for discharge, and what kind of post-hospital care will be required.
A major challenge facing the Niagara Health System today is to consolidate its patient care programs to deliver health care that is consistent at all its sites. In this case, the challenge was to come up with a Fractured Hip Clinical Pathway that could be implemented at the three hospitals that perform orthopaedic surgery.
Enter the Utilization Management Department, whose job it is to develop clinical programs and pathways in partnership with the expertise of health care professionals. These pathways assist in co-ordinating care and preventing potential delays in treatment, thereby improving the quality of patient care delivery. To develop the framework for the regional Fracture Hip Pathway, Regional Director Patty Welychka, along with Utilization Managers Monica Koepke and Wendy Robb, worked under the direction of orthopaedic surgeons, one each from Welland, St. Catharines and Niagara Falls hospitals. Also at the table were Case Managers, Occupational Therapists, Physiotherapists, Charge Nurses, Clinical Managers, and health care professionals from Rest/Retirement Homes, Long-Term-Care Facilities, and Community Care Access Niagara.
"Each of our sites which perform orthopaedic surgery already had a Fractured Hip Clinical Pathway, but each one was slightly different," Patty explained. "It was up to the team to take the best from each pathway and create a new ‘best practice' pathway for fractured hip. This was very challenging, to say the least, but our surgeons, Drs. Luis Flores from Niagara Falls, Brian Rittenhouse from Welland, and David Martin from St. Catharines, were committed to making this work."
Eventually the team determined that, with a few minor changes, the Greater Niagara General Fractured Hip Pathway was the one to be implemented across the NHS, and all three sites are now following the same pathway.
Patient Catherine Bodnar's experience when she had her fractured hip operated on was "amazing," she said. "I feel like I got a lot of attention, and having the clinical pathway booklet was wonderful, because I knew what was going to happen the next day as part of my recovery. I'm really glad that pathway is around. I wish they'd had it for my gallbladder surgery years ago."
In addition to providing education for patients, clinical pathways streamline the timing of care from a wide variety of hospital departments. "Avoiding delays in treatment, enhanced communication with community partners, co-ordinating care plans to reduce variation and proactive discharge planning are all utilization initiatives," explains Patty. "It only makes sense to have patients with the same diagnosis treated equally and appropriately using best practices at all our hospital sites. The recent introduction of the Fractured Hip Clinical Pathway across all NHS sites and into the community is one of many initiatives that the Orthopedic Surgeons agreed upon. Holding Community Forums with our own Orthopedic Physicians as speakers, education days for our staff and involvement in planning for community rehabilitation with Community Care Access Niagara are just some of our other initiatives so far. The recent Canadian Best Practice Award for Orthopedics to the Niagara Health System validates the fact that utilization and best practice go hand in hand and we are recognized worldwide for our efforts."
Next in line for integrating clinical pathways across all hospital sites is stroke, and then myocardial infarction, or heart attack. "These are complex problems, but even though our sites are spread out geographically, when our patients come through our doors they expect to receive consistent, high quality care," Patty said. "By making these changes we can improve outcomes for our patients. That's our bottom line."