Osler's 2016/17 Quality Improvement Plan

Our Quality Improvement Plan (QIP), plays a part in demonstrating specific things we are focusing on as an organization over the next year to improve the care we provide to our community. To promote accountability, the compensation of Osler's executives is tied to the achievement of the improvement targets outlined in the QIP.

The QIP consists of 4 parts:

  • PART A: Overview of our hospital's Quality Improvement Plan 
  • PART B: Our improvement targets and initiatives 
  • PART C: The link to performance-based compensation of our executives 
  • 2015-16QIP Accountability Signoff

Click here to download Osler's 2016-17 QIP or see what our targets are below.

Indicator

What the indicator means

Target

Current Performance

Reduce hospital acquired infection rates
Clostridium difficile infection (CDI) rate per 1000 patient days (number of patients newly diagnosed with hospital-acquired CDI)

What is the rate of hospital acquired Clostridium difficile infection (CDI)?  This includes CDI related to antibiotic use and person to person transmission. Are we taking proper measures to prevent the spread of hospital-acquired infection?

0.27 per 1,000 patient days

0.16 per 1,000 patient days (Jan 2015 - Dec 2015)

Increase proportion of patients receiving medication reconciliation upon admission Percentage of Best Possible Medication History (BPMH) completed on admitted patients through the emergency department

What percentage of inpatients admitted via the Emergency Department has a comprehensive medication history completed at admission?

77.5%

67.4% (Jan 2015 - Dec 2015)

Indicator

What the indicator means

Target

Current 
Performance

30-day all-cause readmission rate for patients with Congestive Heart Failure

What percentage of patients with congestive heart failure are readmitted to hospital within 30 days?

19.18%

20.19%

Indicator

What the indicator means

Target

Current 
Performance

Reduce wait times in the ED
90th percentile Emergency Department (ED) length of stay for admitted patients

What is the maximum amount of time that nine out of ten ED patients spend waiting for an inpatient bed after registration?

34.7 hours (5% improvement)

36.5 hours

Indicator

What the indicator means

Target

Current 
Performance

Improve patient satisfaction - Emergency Dept
Would you recommend this hospital to family and friends - top box only (ie, "yes, definitely") for the Emergency Department

Do our patients and families in the Emergency Department feel we are improving the healthcare experience? Are patients and families inspired to tell their families and friends about our hospital based on the care they receive?

75.1% (5% improvement)

71.5% (Jan-Dec 2015)

 Improve patient satisfaction - Inpatients
Would you recommend this hospital to family and friends - top box only (ie "yes, definitely") for inpatients
 Do our inpatients feel we are improving the healthcare experience? Are patients and families inspired to tell their families and friends about our hospital based on the care they receive?  85.7%  82.3% (Jan-Dec 2015)

Indicator

What the indicator means

Target

Current 
Performance

Reduce unnecessary hospital readmission
Percentage of patients readmitted to any facility for any reason within 30 days for selected inpatient groups (HIG's). 

What is the percentage of select Osler inpatients who are readmitted to any hospital for any condition within 30-days post discharge?

14.49%

15.25% (July 2014 - June 2015)

Reduce unnecessary time spent in acute care
Percentage of total inpatient days that are designated as Alternate Level of Care (ALC) days divided by the total number of patient days for open, discharged and discontinued cases in the same period

What is the percentage of days that beds are being used inappropriately because patients are waiting for another type of service, such as a bed in a Long Term Care facility?

5% 

5% (July-Sept 2015)

 

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