Canadian Health Care Facilities Research Articles

A novel Neutrosophic-based machine learning approach for maintenance prioritization in healthcare facilities

The development of decision support tools for use in the maintenance management and renewal prioritization of healthcare facility assets is considered a highly challenging task due to the multiplicity of uncertainties and subjectivity levels available in such a decision-making process. Accordingly, this study utilizes a combination of Neutrosophic logic, Analytic Network Process (ANP) and Multi-Attribute Utility Theory (MAUT) to reduce the subjectivity pertaining to expert-driven decisions and produce a reliable ranking of hospital building assets based on their variable criticality levels and performance deficiencies. This is further integrated with the novel use of machine learning algorithms in this field, namely: Decision Trees, K-Nearest Neighbors and Naïve Bayes to automate the priority setting process and make it reproducible diminishing the need for additional expert judgments. The developed model was applied to Canadian healthcare facilities, and its corresponding predictive performance was validated by means of comparison against a previously established model, and its excelling capability was clearly demonstrated. Accordingly, the developed integrated framework is expected to aid in creating a consistent, unbiased and automated prioritization scheme for hospital asset renewals, which in turn is expected to contribute to an efficient, informed and sound resources allocation process.

Organizational culture, authentic leadership and quality improvement in Canadian healthcare facilities.

To investigate relationships among flexible and hierarchical organizational cultures, quality improvement domains, and authentic leadership competencies in Canadian healthcare facilities. Observational cross-sectional study conducted in Alberta, Canada. Nurse managers (n=226) completed a survey including validated measures of organizational culture, quality improvement and authentic leadership. Data were analyzed using descriptive statistics, Spearman's correlation coefficient and Chi-squared test (p<0.05). Quality improvement through accreditation is related to organizational culture and authentic leadership. We saw a propensity for participants who reported working in a more flexible culture also reported greater quality improvement implementation and authentic leadership practices. This study assessed and reported the relationships between flexible organizational cultures, quality improvement through the accreditation process, and authentic leadership practices of healthcare managers. Flexible organizational cultures influence the adoption of authentic leadership, participatory management model and also improves quality.

Opioid losses in terms of dosage and value, January 2012 to September 2017: a retrospective analysis of Health Canada data.

Canadian health care facilities must report losses or thefts of opioids to Health Canada. To broaden the understanding of opioid loss in Canada, we analyzed data describing these losses to estimate the amount of opioid lost, estimate the wholesale and street value, compare the distribution of loss types between facility types and compare loss trends. We analyzed Health Canada records of losses of codeine, fentanyl, hydromorphone, morphine and oxycodone reported by Canadian facilities from January 2012 to September 2017. We conducted descriptive analyses of the opioid losses by calculating milligrams of drug lost, oral morphine equivalents, daily defined doses, approximate wholesale value and approximate street value, and compared loss trends when counted by incidents, dosage units or milligrams. There were 64 963 reports of loss of codeine, fentanyl, hydromorphone, morphine or oxycodone over the study period. Over 112 kg of opioids were lost, an estimated $8.7 million in wholesale cost and $136 million in street value. The dominant loss categories varied by facility type: armed robbery (30.9 kg [31.1%]) for community pharmacies, unexplained losses (6.4 kg [55.8%]) for companies and pilferage (0.8 kg [57.4%]) for hospitals. Loss trends over the study period varied by reporting metric and facility type: community pharmacy losses increased when measured by dosage units and incidents of loss, and remained stable when measured by milligrams; hospital losses increased when measured by milligrams and showed no clear trend when measured by dosage units and incidents of loss. Companies showed no clear loss trend with any reporting metric. Large quantities of opioids were lost or stolen from community pharmacies, companies and hospitals over the study period, and these losses are valued in millions of dollars. Publishing milligrams of opioids lost annually alongside metrics such as dosage units and incidents of loss would help characterize the economic cost and the magnitude of drug losses.

Engaging in building the educational support needed to deliver precision health in Canada.

Canadian healthcare facilities are poised to benefit from the tools of precision health. To do so effectively, however, it is crucial that we align changes in how healthcare professionals are educated in order to ensure they have the skills, knowledge, and training to fully engage with its tools. Here, we propose that the design, development, and delivery of novel educational programs focused on precision health should be prioritized for healthcare professionals, and we suggest some essential curricular considerations to that end. Additionally, it is crucial to see engagement on the part of health leaders, who will ultimately be most responsible for managing the changing needs of frontline staff as the tools of precision health become increasingly available. By engaging directly with educators in establishing new programs for precision health, we can ensure that its promise is fully for healthcare facilities, practitioners, and patients.

A Canadian Academic Hospital's Initial MAID Experience: A Health-Care Systems Review.

Following the Supreme Court of Canada's Carter Decision, medical assistance in dying (MAID) became possible with individual court orders in February 2016. Subsequently, on June 17, 2016, legislation was passed that eliminated the need for court orders, essentially making physicians the arbiters of these requests. Canadian health-care facilities now face the challenge of addressing this unprecedented patient health-care need. To describe the manner in which London Health Sciences Center has approached local and regional requests for MAID, including the administration, ethics, privacy, and clinical process. A health-care systems descriptive study. Between June 6, 2016, and May 30, 2018, London Health Sciences Center's MAID Internal Resource Committee triaged and referred 260 cases. Ninety-six received the requisite assessments were deemed eligible for and received MAID. The procedure was completed in hospital 59 (61%) times, and 37 (39%) times in the community (either private residence or long-Term Care facility). Nineteen patients did not meet MAID criteria and 63 patients died while awaiting the procedure. The median wait time between first request and referral was 1 day. The median time between referral and the procedure was 12.0 days. The ratio of referrals to completed cases is 96 of 260 (or 37% conversion rate). Our MAID processes, including our committee structure, referral triage process, and physical site have all undergone extensive review and improvement cycles throughout these first 2 years with the aim of ensuring that this procedure is managed in a respectful, confidential, safe, efficient, and patient-centered manner.

Geographic variation in the provider of screening colonoscopy in Canada: a population-based cohort study.

Screening colonoscopy for the detection of colorectal carcinoma is provided by several specialties. Few studies have assessed geographic variation in the delivery of this care. Our objective was to investigate how geographic and socioeconomic factors affect who provides screening colonoscopy in Canada. This was a population-based cohort of all screening colonoscopy procedures performed at publicly funded Canadian health care facilities (excluding those in Quebec) between April 2008 and March 2015. The main outcome of interest was the proportion of colonoscopy procedures performed by surgeons versus gastroenterologists at the neighbourhood level. Predictors of interest included socioeconomic and geographic variables. We used spatial analysis to evaluate significant clustering of practitioner services and multinomial logistic regression to model predictors. We identified 658 113 screening colonoscopy procedures performed by 1886 providers (1169 surgeons and 717 gastroenterologists) over the study period, of which 353 165 (53.7%) were performed by surgeons. A total of 24.2% of neighbourhoods were located within clusters predominantly served by gastroenterologists, and 19.5% were within surgeon clusters; the remainder were in mixed clusters. Rural neighbourhoods had a significantly increased relative risk of being within a surgeon cluster (relative risk [RR] 5.38, 95% confidence interval [CI] 3.48-8.01) compared to mixed clusters and nearly 100 times higher relative risk of being in a surgeon cluster compared to gastroenterologist clusters (RR 98.95, 95% CI 15.3-427.2). Neighbourhoods with the highest socioeconomic status were 1.74 (95% CI 1.14-2.56) times likelier to be in gastroenterologist clusters than in mixed clusters. Surgeons provide a large proportion of colonoscopy procedures in Canada and are essential for access to care, particularly in rural regions. Most Canadians are served relatively equally by surgeons and gastroenterologists. This emphasizes the importance of both specialties to the delivery of colonoscopy care across the country.

Exploring Canadians' and Europeans' Health Care Professionals' Perception of Biological Risks, Patient Safety, and Professionals' Safety Practices.

Patient safety has become a worldwide concern in relation to infectious diseases (Ebola/severe acute respiratory syndrome/flu). During the pandemic, different sanitary responses were documented between Europe and North America in terms of vaccination and compliance with infection prevention and control measures. The purpose of this study was to explore the health care professionals' perceptions of biological risks, patient safety, and their practices in European and Canadian health care facilities. A qualitative-descriptive design was used to explore the perceptions of biological risks and patient safety practices among health care professionals in 3 different facilities. Interviews (n = 39) were conducted with health care professionals in Canada and Europe. The thematic analysis pinpointed 3 main themes: risk and infectious disease, patient safety, and occupational health and safety. These themes fit within safety cultures described by participants: individual culture, blame culture, and collaborative culture. The preventive terminology used in the European health care facility focuses on hospital hygiene from the perspective of environmental risk (individual culture). In Canadian health care facilities, the focus was on risk management for infection prevention either from a punitive perspective (blame culture) or from a collaborative perspective (collaborative culture). This intercultural dialogue described the contextual realities on different continents regarding the perceptions of health care professionals about risks and infections.

Differences in access to services in rural emergency departments of Quebec and Ontario.

IntroductionRural emergency departments (EDs) are important safety nets for the 20% of Canadians who live there. A serious problem in access to health care services in these regions has emerged. However, there are considerable geographic disparities in access to trauma center in Canada. The main objective of this project was to compare access to local 24/7 support services in rural EDs in Quebec and Ontario as well as distances to Levels 1 and 2 trauma centers.Materials and MethodsRural EDs were identified through the Canadian Healthcare Association's Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities. There were 26 rural EDs in Quebec and 62 in Ontario meeting these criteria. Data were collected from ministries of health, local health authorities, and ED statistics. Fisher’s exact test, the t-test or Wilcoxon-Mann-Whitney test, were performed to compare rural EDs of Quebec and Ontario.ResultsAll selected EDs of Quebec and Ontario agreed to participate in the study. The number of EDs visits was higher in Quebec than in Ontario (19 322 ± 6 275 vs 13 446 ± 8 056, p = 0.0013). There were no significant differences between Quebec and Ontario’s local population and small town population density. Quebec’s EDs have better access to advance imaging services such as CT scanner (77% vs 15%, p < .0001) and most the consultant support and ICU (92% vs 31%, p < .0001). Finally, more than 40% of rural EDs in Quebec and Ontario are more than 300 km away from Levels 1 and 2 trauma centers.ConclusionsConsidering that Canada has a Universal health care system, the discrepancies between Quebec and Ontario in access to support services are intriguing. A nationwide study is justified to address this issue.

Results of a Survey to Benchmark Canadian Health Facility Libraries

&lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; A benchmarking survey of Canadian health facility libraries was conducted to provide statistical data to support health librarians in the anagement of their libraries. The objectives were to determine the status of&lt;br /&gt;hospital libraries in Canada and to evaluate whether libraries meet the 2006 CHLA/ABSC Standards for Library and Information Services in Canadian Healthcare Facilities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; An online survey of 63 questions, with headings of institutional profile, administration, staffing, environment, resources, and services, was created and distributed to 250 heads of hospital libraries and to Canadian library email listservs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Many libraries are meeting some aspects of the Standards for administration and organization, management, traditional promotion, and accessibility. Areas of improvement include services, nontraditional promotion, library environment, and staffing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion:&lt;/strong&gt; There are no current benchmarking data available for Canadian hospital libraries and there have been many political, economic, and technological changes in past years that have had a substantial impact on libraries. Anecdotal data suggest that librarians have responded to these changes through library closures, mergers, consortial affiliations, and modifications to services. Librarians will be able to use the collected data to compare services, establish best practices, make management decisions, and prepare self-studies for accreditation purposes.&lt;/p&gt;

Comparison of access to services in rural emergency departments in Quebec and British Columbia.

Although emergency departments (EDs) in Canada's rural areas serve approximately 20% of the population, a serious problem in access to health care services has emerged. The objective of this project was to compare access to support services in rural EDs between British Columbia and Quebec. Rural EDs were identified through the Canadian Healthcare Association's Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities (using the rural and small town definition from Statistics Canada). Data were collected from ministries of health, local health authorities, and ED statistics. A telephone interview was administered to collect denominative user data statistics and determine the status of services. British Columbia has more rural EDs (n = 34) than Quebec (n = 26). EDs in Quebec have higher volumes (19,310 versus 7,793 annual visits). With respect to support services, 81% of Quebec rural EDs have a 24/7 on-call general surgeon compared to 12% for British Columbia. Nearly 75% of Quebec rural EDs have 24/7 access to computed tomography versus only 3% for British Columbia. Rural EDs in Quebec are also supported by a greater proportion of intensive care units (88% versus 15%); however, British Columbia appears to have more medevac aircraft/helicopters than Quebec. The results suggest that major differences exist in access to support services in rural EDs in British Columbia and Quebec. A nationwide study is justified to address this issue of variability in rural and remote health service delivery and its impact on interfacility transfers and patient outcomes.

Wheelchair cleaning and disinfection in Canadian health care facilities: “That's wheelie gross!”

Wheelchairs are complex equipment that come in close contact with individuals at increased risk of transmitting and acquiring antibiotic-resistant organisms and health care-associated infection. The purpose of this study was to determine the status of wheelchair cleaning and disinfection in Canadian health care facilities. Acute care hospitals (ACHs), chronic care hospitals (CCHs), and long-term care facilities (LTCFs) were contacted and the individual responsible for oversight of wheelchair cleaning and disinfection was identified. A structured interview was conducted that focused on current practices and concerns, barriers to effective wheelchair cleaning and disinfection, and potential solutions. Interviews were completed at 48 of the 54 facilities contacted (89%), including 18 ACHs, 16 CCHs, and 14 LTCFs. Most (n = 24) facilities had 50-200 in-house wheelchairs. Respondents were very concerned about wheelchair cleaning as an infection control issue. Specific concerns included the lack of reliable systems for tracking and identifying dirty and clean wheelchairs (71%, 34/48), failure to clean and disinfect wheelchairs between patients (52%, 25/48), difficulty cleaning cushions (42%, 20/48), lack of guidelines (35%, 27/48), continued use of visibly soiled wheelchairs (29%, 14/48) and lack of resources (25%, 12/48). Our results suggest that wheelchair cleaning and disinfection is not optimally performed at many Canadian hospitals and LTCFs. Specific guidance on wheelchair cleaning and disinfection is necessary.

Benchmarking: how do Canadian hospital libraries compare?

In her remarks at the CHLA Conference in May 2007, Susan Powelson, the Chair of the Standards for Library and Information Services in Canadian Healthcare Facilities 2006 Taskforce, noted that standards need to be backed up with benchmarking data. Heeding this expert advice, the Canadian Health Libraries Association / Association des bibliotheques de la sante du Canada (CHLA / ABSC) Board contacted the Medical Library Association (MLA) to see whether Canadian health libraries could take part in the third MLA Benchmarking Survey. The MLA had conducted comprehensive surveys of health libraries in the United States in 2001 and 2004, and was generous in embracing the idea of including Canadian libraries in the survey. The mission of the MLA Benchmarking Task Force was ‘‘to define, develop, and evaluate a coordinated and comprehensive Web-based medical library benchmarking tool that will enable members to establish best practices, compare important operations, and define appropriate statistics for negotiating with administrators’’ [1]. The benchmarking data from the 2001 and 2004 surveys have been used by libraries “to successfully address issues with their administrations” [1].

Infection prevention and control practices related to Clostridium difficile infection in Canadian acute and long-term care institutions

Clostridium difficile is an important pathogen in Canadian health care facilities, and infection prevention and control (IPC) practices are crucial to reducing C difficile infections (CDIs). We performed a cross-sectional study to identify CDI-related IPC practices in Canadian health care facilities. A survey assessing facility characteristics, CDI testing strategies, CDI contact precautions, and antimicrobial stewardship programs was sent to Canadian health care facilities in February 2005. Responses were received from 943 (33%) facilities. Acute care facilities were more likely than long-term care (P < .001) and mixed care facilities (P = .03) to submit liquid stools from all patients for CDI testing. Physician orders were required before testing for CDI in 394 long-term care facilities (66%)-significantly higher than the proportions in acute care (41%; P < .001) and mixed care sites (49%; P < .001). A total of 841 sites (93%) had an infection control manual, 639 (76%) of which contained CDI-specific guidelines. Antimicrobial stewardship programs were reported by 40 (29%) acute care facilities; 19 (54%) of these sites reported full enforcement of the program. Canadian health care facilities have widely varying C difficile IPC practices. Opportunities exist for facilities to take a more active role in IPC policy development and implementation, as well as antimicrobial stewardship.

Pressure Ulcer Awareness and Prevention Program

The Canadian Association of Wound Care funded a study to determine the extent of pressure ulcers in Canada and discovered that the mean prevalence rate was 26%. Recognizing this as a significant health-related problem, the Canadian Association of Wound Care created a continuous quality improvement program known as the Pressure Ulcer Awareness and Prevention program to support a culture shift in healthcare settings, that is, shifting the emphasis on management from treatment of existing ulcers to their prevention. This program has been pilot tested, revised, and is being implemented in many Canadian healthcare facilities. The program is described and results are presented that demonstrate a reduction rate up to 57% (prevalence) and 71% (incidence).

Abstract 8: Influence of Receiving Hospital Characteristics on Survival after Cardiac Arrest

Hospital management of out-of-hospital cardiac arrest (OHCA) patients after return of spontaneous circulation (ROSC) can influence patient survival via interventions such as hypothermia and cardiac catheterization (CATH). This study tested the hypothesis that survival differed between different types of hospitals for subjects with ROSC after OHCA. Methods: Adult (≥ 18 years) subjects with paramedic-documented ROSC or who lived &gt;1 day after OHCA were identified with their receiving hospital in a prospective database from 9 regions in the US and Canada. Hospitals were characterized using the American Hospital Directory or the Guide to Canadian Healthcare Facilities. Hospitals were categorized by bed number (large &gt;400; medium 250 – 400; small &lt;250) and CATH capability. Associations between clinical variables, hospital categories, survival time, and survival to hospital discharge were determined using Cox regression and analysis of variance. Results: Between December 2005 and July 2007, 3644 OHCA subjects were treated in 254 hospitals, with similar numbers in large (1026), medium (1094) and small (1276) hospitals. CATH hospitals treated 2123 (58%) subjects, and patient features (63% male, 42% VF/VT, 67% witnessed collapse, and mean call-arrival interval of 5.7 (SD 2.8) minutes) did not differ between hospital categories. CATH hospitals had higher survival than non-CATH hospitals in large (35.1% vs. 27.7%), medium (34.4% vs. 30.7%) and small (38.6% vs. 26.5%) categories (F=19.55; p&lt;0.001). VF/VT (p &lt; 0.001), age (p &lt; 0.001) and witnessed collapse (p &lt; 0.001) were associated with survival time. When adjusted for initial rhythm, call-arrival interval, witnessed collapse, age, sex, region, teaching institution, and trauma center level, there was no significant effect of CATH. However, the interaction of large hospital and CATH was associated with lower hazard of death (0.71, 95% CI [0.54, 0.93]). Conclusions: Transport to a CATH hospital is associated with increased probability of survival to discharge after OHCA. These data cannot determine whether cardiac catheterization was performed or if CATH hospital is a surrogate for more comprehensive cardiac care. Therefore, further work should examine what aspects of in-hospital care affected outcome.

Standards for Library and Information Services in Canadian Healthcare Facilities 2006

Standards for Library and Information Services in Canadian Healthcare Facilities 2006

Cost-effectiveness of surgery plus radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression

A recent randomized clinical trial has demonstrated that direct decompressive surgery plus radiotherapy was superior to radiotherapy alone for the treatment of metastatic epidural spinal cord compression. The current study compared the cost-effectiveness of the two approaches. In the original clinical trial, clinical effectiveness was measured by ambulation and survival time until death. In this study, an incremental cost-effectiveness analysis was performed from a societal perspective. Costs related to treatment and posttreatment care were estimated and extended to the lifetime of the cohort. Weibull regression was applied to extrapolate outcomes in the presence of censored clinical effectiveness data. From a societal perspective, the baseline incremental cost-effectiveness ratio (ICER) was found to be $60 per additional day of ambulation (all costs in 2003 Canadian dollars). Using probabilistic sensitivity analysis, 50% of all generated ICERs were lower than $57, and 95% were lower than $242 per additional day of ambulation. This analysis had a 95% CI of -$72.74 to 309.44, meaning that this intervention ranged from a financial savings of $72.74 to a cost of $309.44 per additional day of ambulation. Using survival as the measure of effectiveness resulted in an ICER of $30,940 per life-year gained. We found strong evidence that treatment of metastatic epidural spinal cord compression with surgery in addition to radiotherapy is cost-effective both in terms of cost per additional day of ambulation, and cost per life-year gained.

Making Canadian Healthcare Facilities 100% Smoke-Free: A National Trend Emerges

When the Calgary Health Region, the Mental Health Centre in Penetanguishene and Capital Health in Nova Scotia declared their sites 100% smoke-free (both buildings and grounds) in May of 2002 and May of 2003 respectively, the change was considered radical and foolish by some. Since then, the move to 100% smoke-free healthcare facilities has become a national trend in Canada, with many facilities following suit and many others planning to make the change. In this article, the authors reflect on what they have learned in these three jurisdictions and offer some advice for healthcare facilities preparing to implement smoke-free property policies.

Community‐Acquired Methicillin‐Resistane Staphylococcus aureus: Getting over It

There are three sure things in life: death, taxes and antimicrobial resistance appearing on the heels of the introduction and widespread use of an antimicrobial agent. Staphylococcus aureus has always been a poster child for the emergence of antimicrobial resistance (1). Penicillin‐resistant strains of S aureus surfaced immediately following the introduction of penicillin in the late 1940s; within a few years, most hospital strains were penicillin resistant. There was also the rapid emergence of methicillin‐resistant S aureus (MRSA) following the introduction of methicillin in the 1960s. While the replacement of nosocomial methicillin‐susceptible S aureus by MRSA has proceeded at different rates in different regions, the overall global progression has been relentless. MRSA became common in Canadian health care facilities later than in the United States; however, since the early 1990s, nosocomial MRSA in Canada has steadily and irrevocably increased (2).

A demand-based assessment of the Canadian anesthesia workforce — 2002 through 2007

The number of anesthesia providers required by the Canadian health care system remains controversial. Questions persist regarding both the adequacy of the current supply and what the future demand will be. The purpose of this study was to quantify the number and adequacy of anesthesia providers in 2002, and predict the same for the year 2007. All licensed health care facilities potentially employing anesthetic services were identified. On February 1(st), 2002 a questionnaire was mailed to each institution. On April 1(st), a second mailing was sent to non-responders. Those facilities that did not respond to either mailing were contacted by telephone. Responses were obtained from 831 of 891 (93%) health care facilities. Four hundred and twenty-six of the facilities employed anesthetic services. There were 1,610 operating rooms (ORs) in use daily, and 2,134 full-time equivalent (FTE) anesthesia providers were available to the institutions surveyed. Respondents identified an immediate need for 228 additional FTEs. Hospitals with less than five ORs or five FTEs reported higher vacancy rates than hospitals with greater than five ORs or five FTEs (P < 0.0001). Ontario (n = 85) and Quebec (n = 69) had the largest absolute deficits of FTEs and significantly greater odds of vacancies than western provinces (Ontario OR = 1.84, Quebec OR = 2.50). The projected need for 2007 was an additional 560 FTEs. This is the first study to survey a national census of "consumers" of anesthetic services: Canadian health care facilities. The results indicate substantial current and worsening future shortages of anesthesia providers in Canada.