Today, we answer three more of your questions. And, once again, your questions impress us with just how much you truly care about our patients and finding creative solutions for meeting a growing demand with finite resources.

Don’t forget that our first Vancouver All-Staff Forum of 2014 will be held on Wednesday, January 29 (3 to 4 pm). Join us at the VGH Paetzold Auditorium or via webcast at one of our satellite locations or personal workstation. For details, visit us on CCRS.

Seating and webcast connections are limited so register with CCRS to reserve your spot.

In the meantime, we continue to receive and answer your questions. If you have a question you’d like to ask, email us.

Today’s answered questions

Q. Why has VGH and other coastal health Emergency Departments not moved to use physiotherapists to decrease the wait time and costs in the ER. Other hospitals in the country use physios to diagnose, treat and discharge patients from the ER, as a large proportion of injuries in the ER (often 1/3 to ½) are musculoskeletal in origin and best diagnosed and treated by physiotherapists. Other hospitals have decreased costs, improved care and decreased wait times by using physios to treat these patients. This allows the physicians to treat the other patients that are more acute or only one flagged by the PT as needing physician assistance. Just a consideration when looking at quality of care and budget limitations, as physiotherapists are able to diagnose and treat patients as primary care providers and this may be a good use of those skills in Vancouver Coastal.

A. This is an interesting question! We don’t know of any Canadian facilities where physiotherapists treat and discharge patients from the ED as a “primary care provider”. If you can refer us to literature on this subject, we would be very interested in reading it.

Currently, the VGH ED has physiotherapy (PT) services on a part-time basis (half of a fulltime equivalent position). PT services are scheduled for half a day, Mondays through Fridays. Ideally, the ED would have access to PT services all day, every day of the week. Although we don’t have the financial flexibility to add resources, discussions are underway to determine how we can increase the hours of PT coverage.

In addition, we’ll gain a better understanding of what resources are required to support and facilitate safe and timely discharges when the ED team begins collaborating with Community’s Quick Response Team and adopts iCARE in late January.

Q. I have a concern which I think falls into the category of the Forum.  I think it is fair to say everyone is feeling the cost of unavoidable budget restraints, including the Paris staff who are overwhelmed with requests from different services having different departmental requirements.  My experience is that Paris does have very good capabilities for organizing and reporting on a very large amount of data.

There are many services within VCH that need to work together and there is an ongoing need for documentation to be added to Paris to achieve this.  The Paris “workarounds” are becoming more prevalent and this is resulting in the loss of organization, accurate reporting and case managers losing the ability to have up-to-date and accurate documentation for their growing caseloads.

Unfortunately I can’t see a resolution that doesn’t involve more funding, but some cost could be saved if the mandatory ½ day Paris courses were attended only if the team manager deemed it necessary for fulfilling the “need to know” condition.  Often a colleague or the CBT’s or Paris Quick Steps could fill this need more efficiently (and cost effectively) than generic Paris education.

A. You’re right. There’s a cost to delivering training, but there’s also a cost to insufficient training, not the least of which is unnecessary stress on staff. That’s why we’re trying to strike the right balance and reduced the mandatory student PARIS course from 1 day to half a day. In order to meet core PARIS learning objectives, as well as VCH privacy and security requirements, this half-day course remains a must-do for all staff before they can access PARIS.

You may also be interested to know that we’ve streamlined the content of all PARIS classes to be simpler and more clinically relevant, and we’re looking to shorten other PARIS classes too. And, when possible, clinical education delegates can offer an alternative to classes after the mandatory PARIS training is complete.

In addition to these training enhancements, the following has been accomplished over the past year:

• 78 usability improvements, including Integrated Client Viewer, a new PARIS form providing at-a-glance client-specific information, a new Informed Consent Module for immunizations, and a review of the immunization rules in PARIS to better support clinical decision-making

• a new governance model to manage PARIS requests and standardize documentation across multiple services  so client information is easier to view

• 2 more regional clinical system support educator positions to support staff

We recognize that working with PARIS has been a challenge for some and we want you to know that a team remains hard at work to resolve issues. We don’t need to tell you that it will take time, but we do hope you begin to feel benefits from the work underway soon — if not already.

Q. In order to save time from computer choirs, the Integrated Client Information Viewer is coming on stream. It is designed to reduce the time required to access material on clients available in PARIS.

Another issue that needs to be addressed is to extend the connection of PARIS through a bridge to Patient Care Information System and CareConnect.

What is required is a simple artificial intelligence component constrained on a “need to know” basis to focus attention of community case managers to ongoing activities such as hospital admission, transfer, registration and discharging.

Operationally the task seems not that complicated and could both save time and increase reliability of patient care.  Why is notification of transfer, etc. still initiated as a new task when a systematic procedure could speed up the process and avoid complications?

A. You’re not alone in your thinking. Now that we’ve implemented the PARIS Integrated Client Viewer, there’s interest in leveraging this work to add PARIS clinical information to CareConnect.

Clinicians have also expressed interest in having community PARIS client information available in Cerner (that’s the clinical information system we’re building through the Clinical and Systems Transformation Project or CST) and vice versa to support continuity of care.  CareConnect also has a role in supporting the viewing of Community and Acute information by clinicians.

Using the acute and community systems to automatically alert clinicians during client transition points is a great idea. It’s our understanding from the PARIS team that the technical solution to accomplish this would be complex, but possible. This request, like all other requests, will be assessed and potentially prioritized as future work through the PARIS governance structure. Please stay tuned.