THE REAL TIME HEALTHCARE PODCAST · Jul 13 · 35:00 min

#38 - CEO Barb Collins on Clinical Apps for Safety & Quality at Humber River Hospital

In this Episode:

In this podcast, Jeff Terry talks to Barb Collins about Generation 2 of Humber River's command center. They’ll cover a quick reminder of what the command center is, walk through five big pieces of Generation 2 and how Humber has used high-reliability principles to improve safety and quality or to target safety and quality on five topics, deterioration, risk of harm, seniors care, perinatal, and COVID-19.


Jeff Terry:

Hello and welcome, I'm Jeff Terry, delighted to be joined today by Barb Collins, who's the CEO of Humber River Hospital. Good morning Barb.

Barb Collins:

Good morning Jeff.

Jeff Terry:

So we are going to talk today about Generation 2 of Humber River's command center, and we'll start with a quick reminder of what the command center is, but we're going to walk through five big pieces of Generation 2 and that's how Humber has used high-reliability principles to improve safety and quality or to target safety and quality are on five topics, deterioration, risk of harm, seniors care, perinatal, and COVID-19. But Barb, before we dive into the these pieces, maybe if you don't mind, could you remind us of the Humber Command Center journey?

** Tiles present and aggregate information gathered from other systems to improve visibility and workflow efficiency, based on hospital defined standards. Tiles do not make clinical determinations and are not intended for patient monitoring.

Barb Collins:

I will, thank you Jeff. So Humber River Hospital had the opportunity to build a brand new hospital. Construction was completed in about October of 2015. But in the years prior to that, as far back as 2008 and '09, we were looking at, if we were building a 1.8 million square foot facility, how could we become more efficient and how could we drive to high-reliability care? And we began our journey with GE really looking at efficient design. And what we discovered in the process is when you're building a large square footage, there's only so much you could do with design. And then we came really up with the idea of how to be more efficient. And that took us to really the three phases of the command center. So the first one was access and flow, how can we deal with all those issues of patients waiting at emerge, not knowing whether a room was clean, less walking around, more throughput, less delays in care and hence a more efficient operation. And that was Generation 1.

It was during Generation 1 that our staff and our physicians, who helped to plan that, really began to say, "Hey, there's a lot of stuff we could do with our interoperability of equipment, with our medical record all linking to data. We should be able to drive high quality care, high reliability care, by alerting people to certain processes that are not following the correct pathway and to look at our patients in a little bit of a different way." And that was where Generation 2 came. It was really a focus on safety and quality. And then of course the future is community reach and supporting health and wellness and virtual visits, and we are working on that component now.

Jeff Terry:

We'll put up on the screen, Barb, a picture of the command center itself, which is a beautiful space. Actually, I know many in the audience will have seen it, I hope more get a chance to go. Can you maybe just briefly comment on who is in that space? And then I also want to just also talk about how the software's use outside of that space, which is a common misperception. But first talk about what's in there.

Barb Collins:

I will. And so we built a command center, which was a large room that we set aside, put some workstations in and have 36 screens of data up on the wall that everybody can look at plus individual computer screens people work from. Now, there's only one new position that we added in 2019 to the command center, and that was the clinical expediter who looks at the deterioration Tiles and keeps her eye on that. But the rest of them were people like the booking clerks, the operating room flow manager, the diagnostic imaging team, environmental and food services, portering, all of who had staff in various places throughout the hospital. They all came together in the command center collectively. And that has really promoted relationships, it's really promoted an opportunity to turn to your colleague and say, "Hey, can you help me fix this problem or that problem?" And so this team works collectively together calling themselves the command center team.

But not to feel like everything occurs in the command center. In fact, initially people were concerned that it was big brother watching them and we did many, many tours through the command center, over 1200 staff, we had large teams of people helping us create Tiles. And then our staff in the patient care areas said, "Wait a minute, if you give me a little bit of this Tile, a little bit of the deterioration, if you give me a little bit of the flow Tile and you develop it this way for my department, then I can have a Tile up on my patient care unit and I can be the first observer of what's going on, I can see the patients that are ready to be admitted from emerge, I can see what's happening in the operating room, and then the command center becomes the backstop, the safety net for things not being observed on the unit."

So that may have not been an initial plan, but it's certainly a key component of it now and staff and physicians on the patient care units have Tiles, we have Tiles, many more in the command center and then people are able to work together that way, so it's not just a command center.

Jeff Terry:

Which is... With everybody connected by a real time thread of information where who's where waiting for what, who's at risk sort of information.

Barb Collins:

You're right. And as we go through some of the Tiles, particularly one for deterioration, we can talk about how that works. But it is real time data, nobody has to enter data. Drawn out of our medical record, drawn out of our flow processes so that the data is available and it's real-time, and it's updated constantly.

Jeff Terry:

Brilliant. And we could go on, there's so much to talk about just how it was created and how staff were engaged and the impact of Gen 1, but let's turn our attention to Gen 2 and what I'll do, we'll put up on the screen, an image of the deterioration Tile, walk the audience through it and then Barb, I'll have you unpack it if you don't mind. So you see here that the clinical deterioration Tile, like any Tile in the upper right, there's a settings button, wherever user can go click and say, "Hey, I only want to see patients with these goals of care on these units or whatever." So each caregiver, care team can tune it. Along the bottom, you see a strip of situational awareness, which is the census of critically ill patients as defined by the NEWS2 score, which is calculated in Humber's EMR.

And you can see, for example, where it says med, that means how many patients on the medicine service not in an ICU, have an elevated SP, single parameter, a score of five or six or a score of seven. And if you click on any of those numbers, it will tell you what's the patient, what's their medical record number, what bed are they in sort of thing. So you get at a glance, where are my high risk patients? And then at the top, we're showing in real time patients who are out of protocol, according to Humber's protocols. And so if you look at one of those boxes, for example in the upper left, where it says r.bon, that's be the patient's alias and then their medical record number, their location below it. And those icons tell you this patient's COVID positive, to the right of that, it tells you that patient has sepsis, and to the right of that, the green case would say that a physician or caregiver nurse has been involved with this patient recently so we know that they're well attended to.

You see to the right of that, those pills, what's contributing to the early warning score, which Humber has actually modified and now calls HEWS, the Humber Early Warning Score, and that patient's appearing there because that alert of two hours and 41 minutes is telling us, "Hey, for patients at this score, our protocol is we would have done a full vital sign assessment more recently than we have and that is why that patient is appearing there." So that's the Tile, again, in real time, pulling together information from the EMR and making it easier for caregivers to get that awareness at a glance. Barb, could you maybe unpack that a bit and from your perspective, why did we create this and what was the goal?

Barb Collins:

I will. And really what we said is we were becoming a high reliability organization is unwitnessed deterioration that leads to a cardiac arrest in a hospital is a failure, it means that somebody didn't see something. And in fact, one in 18 patients in a hospital comes to some level of harm as a result of their admission and we'll talk about that a little bit more, but what our staff and our physicians saw, as they were doing the flow work, if they just took, what we now call a Humber's News, if they took those scoring elements and they said, "Let's draw information out of the health record. What does the lab work say? What are the vital signs show us?" And you calculated a score and you showed it up on a screen, you would keep a better eye on the patient and you can click on that patient on the screen and you can get directly into their chart, you've got an idea of what is going on.

And then we monitor that things are happening quickly enough, and when they're not, that's where the command center kind of becomes the backstop. They'll call up and go, "What's happening with the patient in 712," for example, "Do you need more staff? Is it communication with the physician? What are those things I can help speed up for you?" So the opportunity really was-

...things I can help speed up for you. So the opportunity really was to display signs of impending arrests. So could we tell that a patient was deteriorating [inaudible 00:09:10]? Could we really contribute to improving the outcome for patients by making sure that there was immediate action when things changed in a patient? We were recognizing sepsis soon enough, changed vital signs, a respiratory rate change, the little things that if staff were going into a unit, and they have an opportunity to look at individual elements, they may not take the time to draw the entire picture.

So we actually called together some physicians and some staff to say, "Hey, help us plan this," and we were quite surprised when about 45, 50 people showed up in the auditorium at the end of one day to walk through panels with us to help try to develop this. And GE played a key role in walking staff through what was reasonable to look at and what kind of actions would you expect?

So we really did plan to identify patients throughout the hospital who were at the highest risk of deterioration and then really monitor that they were getting care. And we were escalating quickly enough and really trying to look at patients who were declining faster than we were reacting to. And the outcome measures... and each time we developed one of these tiles, we said, "Let's look at what are the outcome measures because that really drives you to create the right thing."

So we wanted to accelerate patient rescue and care escalation on the medical surgical units., The intensive care unit is a little bit different. It's one-on-one and we may go there someday, but that is not needed as much. That staff is able to, on the one-on-one situation, determine the challenges with the patient. It's much harder on a medical surgical unit. We wanted to reduce unplanned ICU transfers and adverse patient outcomes. And really, as I said, the goal was no patient should code on a medical surgical unit.

Jeff Terry:

The tile doesn't replace your patient monitoring equipment. You have monitors at the bedside. This is not... the EMR is still there. This is collecting information that already exists and giving an easy picture of it and making sure that we're doing things according to protocol. So just to say, it doesn't replace any of those other elements of the care bundle, I guess.

Barb Collins:

You're right. And, Jeff, we should just use the cardiac monitor or the vital signs monitor as an example. So we have a vital signs monitor which is linked to the patient in the room, so it's registered to that patient. I'm the healthcare worker. I'm registered to care for that patient. I take the vital signs, provided I just note once they're taken, and it's an automatic system. Once they're taken, it's put into the record. That automatically begins to calculate the new score. So it doesn't replace staff thinking about it, but it guides them for what to look at, and I think that's the difference.

Jeff Terry:

So outcome? So maybe... I know there's been some sort of anecdotal patient stories. Could you share some of those?

Barb Collins:

I can. And I think towards the end of this presentation, we'll show you kind of the overall improvement since we began our journey with command centers, but really, we had, for example, a 45 year old patient, prior COVID. So a patient who was no on COVID had a trach, had left the ICU, was on the medical surgical floor, and started to flag on the deterioration tile with an elevated score due to O2 sats dropping. The charge nurse followed up with the assigned nurse, so this is where that screen was on the patient care unit, and they actually didn't need intervention from the command center. The charge nurse, herself, at the station looks up notices that we've got deteriorating saturations and works with the assigned nurse who was a relatively new nurse, and all of us experienced that and helped her to suction and reposition the patient. New vital signs were taken, and the patient stabilized. So a simple example of how one other set of eyes on that data help to probably prevent what could have been a real harm for this patient.

Another patient who was an older patient was lethargic and started flagging on deterioration. They had elevated scores. The charge nurse followed up with the assigned nurse in the MRP, and blood work was drawn. The patient had a low blood sugar, dextrose was administered, and the patient was stabilized. Now, often, these are patients that you won't necessarily make that link for until they've had a real reaction. And this particular nurse just needed a hand in getting all of that drawn together.

We had a dialysis patient who started to flag on deterioration with sats dropping and a respiratory rate that was high. Again, this was recognized in the nursing unit. The charge nurse reviewed it. She assigned the nurse in the MRP to have a review. A stat chest x-ray was ordered, and that patient had gone into pulmonary edema. Urgent dialysis was ordered, and the patient stabilized and often, it's the pulmonary edemas and the subtle changes in dextrose and sugar that are not always noticed, and this allows it to be drawn to the front and become something that staff can pay attention to.

Jeff Terry:

Amazing. Thank you, Barb. And then, so those are brilliant examples. And what numbers have we seen? I think we've got some we can put up for the audience, actually.

So these are the process measures, a reduction in the time between full vital sign assessments on the different units?

Barb Collins:

So it is really interesting. As staff become busy in the course of their day, we did find... we learned as a result of this exercise that people were not necessarily doing their full vital signs assessment as frequently as they should. And of course, as a hospital administrator, thought policies were being followed and changes were being made as required. That, in fact, was not the case. And one of the benefits of seeing all of this in the command center is you walk in there, and you find there are lists of patients who not only have some issues in their care in terms of their vital signs or their oxygen saturation, but they're not being assessed as frequently as they should.

And so, one of the things this helped us to do was to work with the staff and get them back to doing a full vital sign assessment as it was supposed to be done based on hospital policy. And you can see, we've improved the time from by 30, as much as 32%. And typically, medical units are very heavy, and staff can get delayed and tied up with a family or another patient and not necessarily get to the vital signs. And yet, it's key to determining whether you have a problem with the patient, so we're very happy with these outcomes.

Jeff Terry:

So I'm going to shift to our next cohort or our next focus area which was a risk of harm. I'll put another tile up on the screen here. It looks a little bit like the care progression or the Delays in Care tile also in use at Humber.

But this one focuses specifically on situations where a patient may be at risk. The same type of tile upper-right is the settings, so someone can filter it to only certain units or only certain types of risks they're worried about. And then what you'd see in sort of the main areas, every rectangle is a patient who is out of protocol right now for one of these topics. And you can see in that left panel, we've got things like, "Hey, this patient... their pain meds are delayed based on recent pain scores. We've got a risk of pressure injury. We've got a risk of fall. We've got risk of delirium based on some medicine combinations."

In the middle column, we have either a delay in recognizing symptoms of sepsis and making a diagnosis decision or a delay in administering treatment after a decision's been made, something like [inaudible 00:16:44] antibiotics. And then in the right column, some more lab-oriented risks, things like low potassium and no treatment administered or no retest after treatment, low calcium, electrolytes, different things. So a collection of risks that were selected and the way that Barb mentioned with the team, what do we want to monitor? And then in real time, whenever there's a deviation on one of those topics, it's made visible for the staff.

Barb, would you unpack that a bit more, your perspective, why it was done? What the goal was?

Barb Collins:

Sure. And this is really... quality of care, of course, was the most important part for us. But 1 in 18 patients admitted to a hospital will experience some kind of a harm, and that's a Canadian national number. It's not terribly different in other countries of the world. 37% of those are sort of healthcare or medication associated conditions. 37% of them are things like infections that we don't pick up quickly enough. Another 23% of them are procedure associated conditions. And then, of course, just patient falls.

And some of these tiles we developed, we're really trying to get out that experience and that problem. And really, what we wanted to do with the tile was to really begin to look at how we could prevent patients from experiencing harm at Humber.

... prevent patients from experiencing harm at Humber. And we knew that 5.1% of the patients when we started this journey experienced harm during their hospital stay. Medication and infection associated condition were the key areas for us and sepsis was present in nearly 40 of our thousand discharges, not always picked up quickly enough. So really what we wanted to do was draw that information out of the health record. So was the patient showing an elevated white blood cell count? Were blood cultures done? Were they reported back quickly enough? Was their action fast enough? Different elements that we were looking at included sepsis, pressure injury prevention. Was the patient turned frequently enough? Was the right diet ordered and were they having enough intake? Pain goal not being met, we know that pain management is one of the key issues that will result in patient satisfaction in healing and mobilization and in a faster discharge. And so we really monitor very closely, Is there any delay in responding to the patient's pain status?

So these were all the different items we wanted to look at. We really defined those patients that were at the highest risk of deterioration. And really again, it's prompted response and escalate care. And another part of the Tile, particularly pain management, that the surgical floor for example was very focused on pain management, and them having that piece of Tile available at the unit level really helped them as they were rounding, as they were providing care. So we really worked on this over a period of time. It gained significant input from our physicians and our staff and many people came to the table to help with it, really wanted to be able to prevent injury, rescue faster. It has reduced unplanned ICU transfers and adverse patient outcomes, and it does reduce hospital morbidity and mortality as we will show you.

We have a CCRT team, which is a team that monitors significantly deteriorating patients throughout the hospital and help to intervene, and staff on that team will tell you the introduction of these two Tiles, they are busy and they see more patients, but way less are admitted to the intensive care unit. And that was the driver here.

Jeff Terry:

And we'll put up here on the screen. We see big reduction in from the Tile went live to now, or till descent measured in December, in the time that these alerts are present. So that the time that these problems persist has been cut in half for critical labs and no treatment and on down the line.

Barb Collins:

Right. And it is addressed in, Jeff, because you believe, much of your data will tell you when you're doing it retrospectively, that you are dealing with your critical lab results, that you are retesting and somebody's looking at that report and you're getting a new order. You'll believe that your pain medication administration delay is not bad, but the benefit of real time data and the benefit of seeing it on the screen is really that you realize things don't happen as quickly as they might. And I think all of us know, we find this after an adverse outcome review. And so if you just look at sepsis. Sepsis risk and no assessment at 38% improvement. And if you figure that is that 37% of the one in 18 get harmed, it's as a result of the sepsis unrecognized. We've significantly changed that.

And the other one is critical lab results and treatment ordered but not administered. And that's that time between there's the result. How much time did it take to recognize it? I get the physician order, but there's still time where I don't get the drug administered. And so we've improved that by 91%.

Jeff Terry:

The next cohort that the team targeted was seniors, was geriatric patients, particularly those that aren't on a dedicated geriatric ward. And this Tile you see on the screen, similar concept along the bottom, you've got the census of seniors patients, where they are in the hospital. If you click on one of those numbers, it'll give you the location, the alias, the medical record number, et cetera. And then in the sort of main area in the Tile up above, it's alerting when any seniors patient is out of compliance with protocols related to diet, ambulation and medication. And you see an example there where based on the meds, the patient is already on that high risk med has been prescribed. So that's presented here. So Barb, do you want to comment on this Tile and cohort?

Barb Collins:

I will. In seniors care, of course, I don't think our hospital is terribly different than others, but patients 65 and older were really 65% of our census at any given time. And nothing like putting a senior in a bed and not ambulating them, making sure they don't have the right diet, or putting them on multiple medications that cause confusion and deterioration. And we saw that time and time again, and we wanted to prevent that. And of course the idea was not only to have them recover faster and discharge, but also to have them leave the hospital healthier than when they came in. So that was the opportunity. It was recognized. We really screened seniors for restorative care eligibility in a timely fashion, but we also make sure that they are always ambulated as frequently as they're supposed to. They have the right diet. The little heart symbol you saw on that chart is that's a heart health assessment team is seeing them.

And then we rapidly respond to any declining patient condition or function. We really look at medication administration. We can tend to over medicate our seniors, particularly if there's a little bit of confusion. And then of course they're falling or they're in bed. And these were all the kinds of things that we really wanted to resolve. We wanted to reduce readmissions and repeat visits for this targeted patients, and really improve the rate of discharge and the length of stay that they stay at home. So the readmission rate. And part of this will be even further improved when we get to phase three of the command center, which is monitoring some of these special cases in their home, so that we can continue to ensure that particularly seniors who live alone are able to be observed in some manner and we know if there's any kind of deterioration in them.

Jeff Terry:

I should say that Humber is working now to extend Gen 3 into the home. That work is ongoing. So we'll hopefully be back to talk about that.

Barb Collins:

It's not for every patient, but there are patients who you want to really be able to keep at home and help to manage them.

Jeff Terry:

Brilliant. I know we don't have results to share on the seniors cohort, but we wanted to share the work. Another cohort where there's been a great focus on, And we did a podcast focused specifically on this, but this is the perinatal, of moms in labor and new baby cohort. I'll show the Tile to the audience quickly. The left side is focused on moms in labor, the right side on new babies. You see along the top of each is some census information, how many C-sections are scheduled today, what's our census by the Ontario Obstetrical Triage Score? What stage of labor are the moms in? And then over to the right similar census information, where are our new babies?

And then the next section you see below that on the left side are, is where are we late with a physician assessment or a nurse assessment for the mom based on her triage score? And to to the right, you see, we're alerting for new babies based on the new baby early warning score that again comes out of the EMR. we're getting visibility to it here.

And then down along the bottom, a number of alerts are presented when they are present, such as for the moms, abnormal fetal heart rate, risk of gestational hypertension, at risk for postpartum hemorrhage, lack of anti-natal record. And for the new babies, things like issues with cord bilirubin, yellow bilirubin, glucose, head circumference, weight loss, or RSP screening. So that's the Tile. Barb, please.

Barb Collins:

Yeah. So I always smile when Jeff is introducing this one because it's actually my favorite Tile. Having been a director of an obstetrical program and a CEO of a hospital that delivers around 6,000 births a year, I think many of the administrators in the group will know that obstetrical care is one of the things that really is a huge percentage of our claim costs. And sometimes it's about a failure to identify and manage the patient that really contributes to that. The real truth is it's very sad to have had somebody go through a normal well pregnancy and then deliver a baby that is going to have some problems throughout their entire life.

Barb Collins:

And so we really wanted to be able to work through this one and be able to look at what are those things that we could change? What can we do to more accurately assess the fetal monitoring strip? And so we have linked that to the record. So yes, there's a bit of an art and science to fetal heart monitoring, but the work that comes out of the monitoring system-


Barb Collins:

... the heart monitoring, but the work that comes out of the monitoring system itself allows us to calculate what kind of response we're seeing. That draws in all the things like the mom's previous history with obstetrics or hypertension, any medication she may be on and really helps us to pull together and have an early warning that maybe everybody on the team isn't seeing the same thing, maybe it's gotten very busy, there's a couple of C-sections going on and a new problem in a room and some patients have fallen through the cracks. And this is one that we've seen a great improvement in, and we don't have specific data, but we know that from our claims and from the post reviews that we have done, that we are responding in a timely manner to mothers and to babies, whether they're in utero or once they're born and we're making sure all the proper lab work and assessments are done. So one that we're very excited about. It's one of our newer Tiles, but we are very excited about what it's doing.

Jeff Terry:

So what we covered now actually are all those things, perinatal deterioration, risk of harm to seniors, went live sort of about a year, 15 months ago, right before COVID. And the last Tile we wanted to mention was the COVID Tile. So when COVID hit, we quickly implemented another Tile using the command center and beyond to try to manage the COVID cohort, obviously super important. I'll just orient to you, similar deal up in the upper right, you can filter however you want it. But then this one has four quadrants that can be turned on or off. But the upper left quadrant is where are my COVID patients, so it's unit by unit, and then it'll alert if there's a COVID positive patient based on a new lab test that's not in a bed that we targeted for COVID positive patients.

And then you can see unit by unit, how many patients are in tests, how many patients are negative, how many are positive. In the upper right, we see if we need capacity, where is our COVID eligible capacity of beds? And in some cases it'll highlight, for example, where it says 611A, hey, there's a patient in an ICU. Maybe he doesn't need to be an ICU, so if we're in a pinch, maybe we could downgrade that patient. In the lower left, we sort of see the epidemiological curve of COVID tests for Humber and in the lower right, we see another helpful place if we need capacity in a pinch, where are the critical care beds that are being cleaned? Maybe we can expedite one of those. Barb, you want to comment on this Tile?

Barb Collins:

I will. I would say that this Tile got created without me even knowing about it because the command center team and staff and the physicians of the hospital become so focused on how can we do this easier? Provincially, just as you would have seen anywhere around the world, massive number of patients being admitted, confusion as to where there were critical care beds, where there were beds to put patients to, and the last place you want them to be sitting as in Emerg with their COVID positive diagnosis. And so really the team came together and created this very quickly with the GE team and their entire goal was flow through the hospital, but also the many, many reports that we had to make through to the command center for COVID, the provincial command center for COVID, which is not digital.

It's a group of people that make a plan around beds, et cetera. We were able to relieve all of that by simply having the data here and we would send off screenshots and know what was going on in our organization. And how well has it worked? I know one of the comments by the command center chief is the only hospital that actually always knows their data is Humber and we do because it's real time, it's live and it's right there to look at.

Jeff Terry:

That's brilliant. The last thing I'll mention, just for the audience I'll put up, Barb mentioned a few times something how the unit said, "Hey, give me a little bit of this Tile, a little bit of that Tile." So that became what's called the ward link or the unit link Tile. You see it on the screen. And basically in the upper left, you get some basic census information. Who's my patient? You get some information about outliers and where are patients that should have been a medicine unit, but aren't? Whose inbound in my unit? Who's leaving my unit? And then bed by bed, it organizes everything the command center knows about your patients, whether they're flow issues or risk issues, the things we just walked you through. So that has the effect of combining all the information. The command center knows, bed by bed, for the unit team so they can have that same awareness of what's going on with their patients. And I think that's been a big hit is fair to say.

Barb Collins:

Fair to say.

Jeff Terry:

Brilliant. Well, I think with that, Barb, the last thing we wanted to share, which is really pretty remarkable was obviously, Humber's done a lot of things digital, design, culture, all sorts of things, so by no means, should we say the Tiles that we showed are the sole driver of this, but they're a piece of it and the data that CIHI, which is the Canadian Institute for Health Information and the Canadian Patient Safety Institute measure looks at the rate of harm in hospitals and has for years in a systemic way. And so we'll put up on the screen, the trend line bar. Maybe you can share how that's played out.

Barb Collins:

I will. So this is the CIHI and the Canadian Patient Safety Council's own information. It's their evaluation of harms that occur in the hospital and they categorize it as three. What's happening in the province of Ontario blue line, what's happening in the central LHIN, or the region that Humber River is part of and that includes Humber data, and then what is the experience at the Humber River Wilson site? And if you look at it, this data really is from 2015 straight through to the close of 2019-20. And Humber was very similar to the other hospitals, somewhere around accrued overall rate of about a 4.4 compared to the central LHIN at 4.5. What's interesting is if you fast forward to 19-20, where we had many of the Tiles that Jeff and I just spoke to you about in place, the overall rate of harm for cases at Humber is 2.2 compared to the province at 5.7, which has stayed relatively steady.

So what you notice is that Ontario blue line hasn't changed a lot and either gone up or down much. What you see as a dramatic change at Humber. And then our numbers are included in the central LHIN and then therefore, the LHIN looks like it's dropped, but it's attributed, as we know in a more detailed review, it's attributed to the Humber numbers. So we are very pleased with this outcome and we do believe in many ways, development of the command center, focusing on processes, resolving some people's niggling problems around overcrowded Emerges and to all kinds of pressure to get patients admitted, so that's the flow piece, combined with getting people to focus, not only in talking about it, but in data in front of their face, to look at deterioration of patients, to look at all the things that cause harm. We are having a very, very good outcome from it and we are very pleased with those numbers.

Jeff Terry:

I mean, those numbers are amazing, Barb.

Barb Collins:

Yeah, they are.

Jeff Terry:

That's not a blip, right? That's a five-year sustained. Something is different and it's remarkable. And I should mention something because we serve you and have for years, we also serve people that we've only known for a year and we're months into programs. So you can see there when an executive said something last week at another organization, she said, "Now that we've turned on our first Tile, we realize how many people in the organization had a craving for real time information that they were trying to piece together and they couldn't get, and having it at their fingertips is a game changer and enables the types of things we've talked about." So yeah, it's amazing to see that.

Barb Collins:

Amazing and it's also amazing the culture change you create because I mean, every day people stop me in the hallway and go, "We need a Tile on. You know, we should do." And so you really get an organization to begin to think in that way and very much participate in this. It's not anything that bothers them now. They welcome the intervention and they welcome the help.

Jeff Terry:

And we've loved working with your team, obviously, John V. and Dr. Tory and Jane and on down the line. Well, Barb, thank you very much for joining today. It's great stuff and thank you as always for letting us work for you.

Barb Collins:

Thank you for the opportunity, Jeff. Thank you.

Jeff Terry:

Yes, ma'am.

Disclaimer:

The information presented here involves technologies and concepts in development that are not products and may never become products. None of these technologies or concepts are being offered for sale.”



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