Bruyère Continuing Care is Ottawa’s largest provider of inpatient stroke rehabilitation and works with patients to help them recover as much function as possible. With more than 300 stroke patients coming through its doors each year, the centre focuses on quality care and aims to ensure that the right patient is in the right bed at the right time.
There was a time, however, when that was easier said than done.
In 2006, data from CIHI’s National Rehabilitation Reporting System (NRS) showed that stroke patients at Bruyère had an average length of stay that was 22 days longer than Canadian peer facilities. At the same time, a report from Ontario’s Ministry of Health and Long-Term Care found the centre had the most costly rehab beds in the province.
This definitely created a sense of urgency in the organization’s management.
One of the goals management set was to reduce the stroke rehab length of stay to within two days of that at peer facilities.
Staff started digging into the data and studying the processes at other institutions in Ontario to see what was working elsewhere. They then examined Bruyère’s processes, including admitting and discharging criteria, coding and training, as well as the software being used to capture the NRS data. The goal was to incorporate data into decision-making, care planning and performance measurement, as well as to link it to best practices.
Staff engagement at all levels was critical, so an NRS working group was established and an ongoing educational program formalized.
A close look at its stroke patient population using NRS data revealed that there were two outlying groups that swayed Bruyère’s overall length of stay: low-functioning patients who required intense care and high-functioning patients who should have been treated as outpatients. To address this, Bruyère closed 8 inpatient rehabilitation beds and opened 18 low-intensity stroke rehabilitation beds in its complex continuing care program and an ambulatory stroke rehabilitation outpatient program. This reorganized care into a continuum of three interconnected programs: low intensity, high intensity and ambulatory stroke rehabilitation.
Admission criteria, including data-based patient function scores, were established for each program to ensure patients would go where their needs would be best met.
With the goal of rehab being reintegration into the community, discharge is now top of mind—even at admission. Data-informed support tools were created to assist staff in monitoring patient progress, while Bruyère’s software was upgraded to incorporate flags that alert clinical staff of each patient’s current length of stay and the provincial discharge length of stay for comparable patients. It also flags when a patient length of stay is two weeks away from the point where 98% of similar patients are discharged. These software upgrades help staff to plan and project patient discharge. Today, front-line staff routinely use NRS data to assist in clinical decision-making. Management views the data as a key element in forming policy and improving efficiency and effectiveness.
What’s more, the length of stay of high-intensity stroke patients is now within two days of peer NRS facilities. Nancy Tunnicliffe, an NRS coordinator who worked on the overhaul, says that although the data is not an end unto itself, the improvements they’ve made wouldn’t have been possible without it.
“The data was instrumental in terms of demonstrating that sense of urgency and getting the key players on board to start change. There is no way to show that unless you have data.”