For the past several weeks, hospital units within Saskatoon Health Region have been reporting ‘red’ on patient flow, indicating that we are in overcapacity and experiencing challenges in meeting demand. And, according to the Region’s predictive model, which has an over 95 per cent accuracy rate, several surges in demand are ahead over the next three months.

Predictive Model

Saskatoon Health Region’s Predictive Model is forecasting high demand for service in the coming months.

“Last week, we pulled together a team of leaders to create a temporary, short-term situation management team dedicated to stabilizing our operations through this period of forecasted, unprecedented capacity,” says Dan Florizone, President and CEO, Saskatoon Health Region. “Over the past week, the team worked to create and implement short-term measures to address forecasted peaks of patient demand. They used tools we created during our 14 Day Challenge and 90 Days of Innovation from earlier this year and built on the successes that came out of that important work.”

Last February, the Region was confronted with chronic overcapacity in Saskatoon’s three hospitals – patients were being cared for in inappropriate spaces, a large number of admitted patients were waiting long hours before being moved from the emergency department to a hospital bed, and a large number of patients who no longer required hospital care had to remain in hospital because they had nowhere else to go to receive the right care.

Because of these challenges related to overcapacity, Saskatoon Health Region’s CEO Dan Florizone ‘stopped the line’ this past February when he saw the high surge taking place in Royal University Hospital’s emergency department, and embarked on a 14-day initiative (the Better Every Day 14 Day Challenge) to improve patient flow across the Region. The initiative, which alleviated short-term pressure in our hospitals, also resulted in the development of a high-level predictive model to help the Region prepare for changes in demand, and expanded service of the Mental Health Transition Team to include weekends, preventing clients from needing to return to the emergency department for care.

Other achievements included the launch of a community paramedicine pilot project in Saskatoon at more than half a dozen long term care homes so that residents experiencing non-emergent health issues can be treated at home. The Region also began a new pilot at Lighthouse Supported Living to increase available beds and to expand services.

Successes of Better Every Day 14 Day Challenge

  • Reduced overcapacity
  • Developed a high level predictive model to help the Region prepare for changes in demand
  • Established a new admission process that provides patients with an up-front estimated date range for when they will leave the hospital
  • Successfully piloted a new process for returning rural and out-of-region patients to their home hospitals to improve the transition experience for patients and staff
  • Expanded service of the Mental Health Transition Team to include weekends, preventing clients from needing to return to the emergency room for care
  • Launched a paramedicine pilot project at two long-term care homes so that residents experiencing a non-emergent health issue can be treated in their own home
  • Began a new pilot at the Lighthouse Supported Living to increase available beds and expand services

This work continued to build through March when the Region launched a 90-day patient flow initiative (90 Days of Innovation: Ready Every Day). Teams dedicated to this work created additional community capacity, resulting in a significant drop in overcapacity beds from 110 in February to 75 at the outset of the initiative and then to 31 at the end of the 90-day cycle, a total decrease of 58 per cent.

“A follow-on plan was developed at the end of those 90 days to operationalize initiatives, and implementation of that plan continues today,” says Florizone. “However, despite ongoing work for these longer-term solutions, the Region continues to experience higher than projected demand, in part due to our growing population. Our predictive model is telling us that forecasted overcapacity is expected to remain high through to January. We needed to take some immediate action to once again stabilize our system.”

Over the last five years, Saskatoon and area’s population has increased 15.3 per cent and demand for Saskatoon Health Region healthcare services has also grown, including a 17.3 per cent increase in hospital stays, a 12.1 per cent increase in hospital births and a 10 per cent increase in surgeries. The resulting higher demand for healthcare services contributes to overcapacity which is linked to increased staffing costs such as overtime, sick time and turnover and also associated with increased safety-related incidents.

Successes of 90 Days of Innovation: Ready Every Day

  • Completed a system-wide service re-alignment of bed designation to match patient needs based on historical and predictive needs
  • Fully operationalized the new acute stroke unit at Royal University Hospital
  • Ensured all acute care units have a predictive model with signals warning of potential surges
  • Expanded home IV therapy to reduce the need for acute care stays for minor procedures
  • Expanded the Direct Client Funding program to help those who require support to remain in their home longer
  • Opened community transitional beds for acute care patients waiting for more appropriate services in the community
  • Continued to increase the number of approved community mental health homes and enhanced support to these homes
  • Established a new HIV hospice and therapy home to improve access to care for patients and reduce readmissions
  • Improved access to non-emergent tests to seven days a week to reduce the need for hospital admissions
  • Established standardized new approaches to meet demand for specialty beds to reduce waits for admission
  • Worked with other health regions to build on the process for patients being transferred to their home hospital (e.g. repatriation)
  • Worked with physicians and residents on their workflow to improve daily rounding
  • Worked with all units to operationalize the Region’s new staffing principles to improve staffing strategies and to reduce overtime.

“We know that as demand increases and pressure mounts in our hospitals, the potential for safety-related incidents rises,” says Florizone. “Our Safer Every Day initiative is developing some innovative solutions to improve safety over the longer term and to prevent harm for our patients, residents, families, staff and physicians. But we also know that despite this important work, if we do not stabilize and improve our patient flow, safety is at risk.”

Using data from the predictive model, and information and recommendations from those working on patient flow follow-on, the situation management team focused on short-term actions to address overcapacity issues before wrapping up their efforts on October 21. Activities begun by the team will now be integrated into daily operations and monitored closely by the Region’s Senior Leadership Team (CEO and vice presidents) at their daily meeting. The situation management team may be called to act again in the future, if needed.

As part of the patient flow follow on initiative, led by Vice President Corey Miller and Dr. George Pylypchuk, a sub-team led by Vice Presidents Patti Simonar and Jackie Mann will develop a medium term approach to manage flow during the Region’s next, and busiest, three months which occur over influenza season.

“Over the last number of days, we were able to safely stabilize our system and prepare for near-term forecasted increases in demand,” explains Florizone. “We focused on neurology and mental health services, which are experiencing high surges in demand for patient care. And we are in the process of transferring to rural hospitals some willing patients waiting for long-term care in Saskatoon hospitals. We have some beautiful rural facilities, with talented care teams, that have available capacity to care for these patients in improved care settings in order to help us ease the pressure in the city.”

Other short-term actions included working with physicians to ensure that we are maximizing their capacity to care for patients in hospital and utilizing all of our available beds. The team also worked to ensure that those patients admitted to hospital are placed in areas that aren’t already experiencing a surge, where staff and physicians are stretched. 

Our aim
To be a world class organization isn’t a goal, it’s a process. We will improve every day, and work together to support each other in providing exceptional and safe care to our patients, clients and residents and their families. We will become the best place for care, the best place to work, and the most innovative place in creating optimal health for the people of Saskatchewan.

“A medium-term plan to manage flow during the height of influenza season is being created with the goal to implement actions in November before our next predicted peak,” says Florizone. “We will know more about what this looks like in the coming days.”

These medium term solutions will utilize the data within the predictive model, which will provide teams with insight on how to best manage those surges on the horizon while the patient flow follow-on team continues to build capacity in the community and operationalize ways to use that capacity.

“Thankfully, the work we have done over the last eight months has put us in a much better position to predict and deal with our immediate surges. In fact, there’s no way we could do what we’re doing now without the work that has already been completed,” says Florizone. “We used information from the predictive model, from daily cascading calls and site vists to stabilize over the past week, and come up with strategies to prepare for what’s coming.”

But there is more work to do because being a world class organization isn’t a goal, it’s a process.

“Our aim is to provide excellent health care at all levels and in all ways. We want to be the best, and that means an unrelenting focus on those we serve, and being part of a team that is not only supportive of each other, but remains committed to that higher goal,” Florizone said. “I cannot say thank you enough to all our employees and physicians who, each day, are working in sometimes difficult circumstances while providing exceptional care. Know that we are listening every day to what is happening on your units, now that we have stabilized, and will be doing what we need to do to prepare for what we know is ahead.”

For more information about the Region’s initiatives, visit www.saskatoonhealthregion.ca/news.