By Shauna Mazenes
Mindy Kim and Jessica Cheng knew there was a problem, and it was their job to fix it.
The two advanced practice nurse educators were told too many patients on their units at UHN's Toronto General Hospital (TGH) were getting post-operative pneumonia — a respiratory infection following a surgical procedure that can lead to more serious complications.
"It really increased our sense of urgency. We knew we had to do something fast," says Mindy.
"We needed to get to the root cause and find a solution our teams could use," adds Jessica.
Led by Tiffany Tram and Mikha Alegria, quality improvement specialists in UHN's Sprott Department of Surgery, the pair implemented a project with their teams that significantly reduced those rates on their units — 72 per cent on General Surgery over two years, and 100 per cent on Surgical Oncology over four months. The initiative is called Stop the POP.
Now, they've shown other surgical teams how they can do the same at UHN's first health care hackathon.
A health care hackathon is an event that brings multidisciplinary teams together to collaborate and solve a problem in a short period of time to improve patient care. Led by the Sprott Centre for Quality & Safety, this hackathon focused on how to successfully increase the uptake and sustainability of Stop the POP on all surgical inpatient units across UHN.
"We've been working hard on this event for a year," says Alexandra Boasie, Senior Manager of Transformation & Quality, who spearheaded the hackathon, which was held on Nov. 15.
"We're excited to launch an initiative that ensures the safest care for all surgical patients being looked after at Sprott, while equipping teams with practical quality improvement skills for future change."
Stop the POP is an evidence-backed pneumonia prevention bundle consisting of five patient interventions: using incentive spirometers, maintaining oral hygiene, practicing deep breathing and safe coughing, staying elevated while in bed, and getting up and moving more frequently.
Building on TGH General Surgery's successful piloting of Stop the POP over the past two years, the goal of the hackathon was to rapidly spread and scale these proven strategies by showing other teams how they did it, and how to do the same — but in ways specific to their team and unit.
"The hackathon is a novel approach to quality improvement that we're adopting here in the Sprott Department of Surgery," says Dr. Thomas Forbes, Surgeon-in-Chief at UHN. "Patient care and patient experience is our primary focus at UHN and quality improvement is a constant priority.
"This is a new and innovative opportunity to improve patient outcomes, speed-up recovery time, prevent further complications and reduce the burden on the health care system."
The Sprott Centre for Quality & Safety developed a roadmap for each of the seven surgical teams attending the hackathon to articulate the problem, then adapt and adjust solutions according to local challenges and patient needs respective to their clinical spaces.
While Gifty Mahama, currently a nurse manager at UHN's Toronto Western Hospital, successfully carried out Stop the POP on General Surgery in 2017, the project didn't last for various reasons, such as lack of resources, documentation issues and competing priorities on the unit.
Tiffany, Mikha, Jessica and Mindy worked closely with their teams to tackle these barriers and maintain engagement by creating contests for staff to compete in, distributing checklists for patients to keep them involved and consistent, using graphics and videos to communicate Stop the POP for those with language barriers, and putting the materials together in a central package that nurses could hand to patients at once, saving time.
Jessica says finding innovative ways to keep staff and patients engaged is at the core of this work.
"We truly believe that's the key to supporting the successful implementation of Stop the POP on nuanced units," she said at the event.
Mindy says sharing the results with her team was another key component in keeping staff engaged.
"It builds a sense of confidence when our nurses, the ones who are on the floor delivering these interventions, see the work they're doing is making a difference," Mindy told hackathon participants.
By the end of the hackathon, each team developed their own ideas and action plans to implement Stop the POP on their units, such as educating patients and families about the importance of oral health, documenting data in one central flow sheet to save time and measure results, getting patients up for breakfast every morning, and leveraging the support of personal support workers.
Dr. Keyvan Karkouti, Anesthesiologist-in-Chief at UHN, says spreading awareness about quality improvement techniques is invaluable in this space, but more important is the teamwork.
"Effort and collaboration are necessary to make change," he says. "These are tough issues that require multiple processes, stakeholders and collaboration.
"Without that teamwork, we're not going to have an impact. That is the greatest value in all of this."
UHN Patient Partner David Johnston, a retired industry-leading quality improvement expert, attended the hackathon. He says it was interesting to see the same frameworks he used in the private sector being applied to improve patient care.
"I tell people all the time that I'm just glad to be here. Four years ago, I didn't think I would be," says David, who survived Stage 3 prostate cancer at UHN.
"It's opportunities like this — not only sharing, listening and learning from each other, but using measurable data and guided strategies — that can really make a difference in a patient's life, if not save one altogether."
