Cortellucci Vaughan Hospital shows digital systems can improve care
May 1, 2023
VAUGHAN, ONT. – Mackenzie Health’s new site – Cortellucci Vaughan Hospital – has now been open for just over two years and is among the most computerized medical facilities in Canada. It was designed from the ground up as a “smart hospital”, one that uses information systems to improve the flow of data to achieve better medical outcomes for patients.
“We didn’t install all of this technology just because it’s cool,” said Dr. Aviv Gladman, chief medical information officer. “It’s all for the sake of the patients.”
The approach is paying off for this state-of-the-art facility, located just north of Toronto in a fast-growing, multicultural suburb. The digital systems are helping the hospital achieve its mission of becoming what president and CEO Altaf Stationwala calls a “zero harm” hospital.
Among the most forward-thinking applications used at both of Mackenzie Health’s sites – Cortellucci Vaughan Hospital and Mackenzie Richmond Hill Hospital – are electronic, “quality dashboards” in hallways that display many of the quality metrics being measured by the hospital. In addition to being viewable by staff and clinicians, the electronic dashboards can be perused by patients and their friends and families.
The boards keep tabs on pressure injuries (bedsores), patient falls, hand-washing rates by clinicians, and central line associated blood infections (CLABSI).
Of note, central-line blood infections are widely prevalent in North America. In 2020, the Public Health Agency of Canada reported that 69 percent of all device-related hospital-acquired infections (HAIs) were caused by central-line blood infections. It cautioned that healthcare-associated infections pose a serious risk to patient safety and quality. They contribute to prolonged hospital stays, antimicrobial resistance, and unnecessary deaths.
To its credit, Mackenzie Health reduced its own CLABSI rates to nearly zero over a nine-month period, said Dr. Gladman.
Much of the credit for this goes to the quality dashboards, an initiative driven by Mackenzie Health’s Quality and Patient Safety team who worked in partnership with the Digital Health team. The quality dashboards showed clinicians and the public a problem area, and focused the efforts of staff on taking the steps needed to improve.
“Full transparency is driving better performance,” asserted Purvi Desai, vice president Digital Health and CIO. She noted that a debate went on in the hospital as to whether so much information should be made visible to the public, especially if the numbers weren’t good. But in the end, the displays went up showing key metrics.
“We went for full disclosure, and it has been motivating our staff,” said Deborah Lefave, nurse educator, Critical Care. She observed that there are constant huddles around the boards in the ICU, and that when excellent results are achieved, there are quick celebrations. “We bring out the chocolate,” she said. “It really builds morale.”
Importantly, the key indicator display boards are connected to the hospital’s data warehouse. The data is collected continuously and is constantly refreshed on the quality dashboards – some of it the next day.
Dr. Gladman pointed out, moreover, that the hospital’s technological approach is based on the collection and sharing of data to smooth workflow and improve patient care.
“It’s all about ambient intelligence,” he said. “We’re taking information and putting it into the hands of the people who need it.”
CEO Altaf Stationwala added that all the hospital’s digital applications are connected to its Epic information system. That solution was acquired several years ago, becoming the first enterprise-wide Epic installation in Canada, when Epic didn’t have much of a footprint in Canada and the selection of Epic was seen by some as risky. “The choice was driven by our clinicians,” he said. “Now, 22 additional hospitals in Ontario are running on Epic.”
For its part, Mackenzie Health developed its Epic system extensively, becoming the first full-service hospital in Canada to achieve the HIMSS EMRAM Level 7 designation, the highest stage on the EMRAM ladder. Moreover, it tested and refined various applications at its 60-year-old Richmond Hill site, so they’d be ready to implement at the new Cortellucci Vaughan Hospital in nearby Vaughan.
A case in point is the hospital’s real-time location system. Staff and clinicians all wear badges that can determine their location anywhere within the walls of Cortellucci Vaughan Hospital. Equipment is also tagged in this way, making it easy to find an extra IV pump or wheelchair.
Demonstrating how they can identify equipment on a computer screen, the team noticed that a smart bed had made its way from the second floor ICU up to the seventh floor. “A patient was probably transported in the bed,” said Purvi. A note was made to retrieve it – ending the mystery of the missing smart bed.
The RTLS has been especially useful during the COVID pandemic. “There have been supply chain problems in the last few years, and with equipment hard to come by, we don’t want it sitting idle,” said Felix Zhang, chief technology officer. Thanks to the computerized locating system, staff can quickly obtain the equipment they need without spending much time searching.
As Purvi observed, “It saves a tremendous amount of time for clinicians. They can focus on patients, instead of rounding up equipment.”
The system also helps patients, too. For example, when staff and clinicians enter a patient room in the ICU, a monitor in the room shows the identity of the person who just entered. That helps patients and their families, as they quickly know who they’re working with.
The locating system also shows who is using the hand-hygiene unit upon entering and exiting a room, as it’s tied into the data warehouse. To its credit, hand-washing rates are high at the hospital, but if and when they dip, various care units can be reminded to pay more attention to this basic infection control technique.
A major part of the hospital’s communication solution is the Vocera system, which enables quick messages between staff, doctors and nurses – all on smartphones across both hospitals.
For their part, nurses make use of a pool of iPhones. Each day, upon arriving, a nurse will pick up an iPhone, tap it with their tag, and the phone will automatically populate with the nurse’s patient list for the day.
Physician phones work in a similar way, showing their daily worklist. Doctors, however, tend to use their own smart phones as part of the hospital’s BYOD program. Zhang mentioned that the phones are set up so that hospital information is walled off from personal data. “At the end of each day, the patient data is wiped from the phone, so the doctor never takes it out of the hospital,” he said.
The phones are particularly effective in assembling teams when different codes are sounded – such as blue for a patient in cardiac arrest or white for a potentially violent patient or visitor.
In these cases, messages are sent to the appropriate teams to come immediately to the patient room or an area of the hospital where they’re needed. If a doctor or nurse doesn’t respond, the message is routed to the next appropriate person.
At the same time, overhead alarms sound in the unit – Dr. Gladman says that it’s still a fire safety regulatory requirement. And a light flashes over the appropriate room, guiding staff to the right location.
As a project for the future, the hospital is testing the use of cameras to provide remote observation in some patient rooms. This could help with security by identifying people who should not be in a patient’s room – and with patient safety.
Zhang observed that the system works, it’s just that there are legal and social hurdles. The public worries, for example, that they’re being tracked when they see cameras in rooms.
In the future, however, the issue may become whether the benefits outweigh the privacy liabilities – just as outdoor cameras are effectively used on streets for traffic and security purposes.
Each of the ICU rooms in Cortellucci Vaughan Hospital is large and bright. Patients and their families can adjust the lighting and temperature from their bedside tablets. Moreover, they’re single-patient rooms, which of course is much better for infection control. And a computer panel outside each room summarizes the conditions of the patient inside – alerting nurses to infections, to pay special attention to falls, or even that a patient is potentially violent.
A large TV screen is mounted on the wall inside each room, as well as tablet beside the bed, with each providing entertainment and education and enabling the patients to order their own meals through a solution supported by GetWell.
The Hillrom smart beds can alert nurses when the patient has gotten out of the bed or is even trying – all the better for avoiding falls. “When an alarm goes off on a nurse’s phone, it won’t stop until the nurse goes into the room to check on the patient,” commented Lefave, explaining that this is important for patient safety.
The bed itself is programmed to know whether the patient needs extra precautions. For example, it will alert the nurse to use the guardrail for certain patients, such as frail or elderly.
Another area where Mackenzie Health is ahead of the curve is in linking all its medical monitors into the hospital’s Epic electronic record. For example, bedside monitors in all patient rooms at both hospitals are all connected to the EHR so that nurses don’t need to transcribe vital signs.
The solution for this was special middleware supplied by the hospital’s main equipment vendor, Philips.
Of special significance, too, is Mackenzie Health’s closed-loop medication management system, using Omnicell technology. These devices, the size of refrigerators, are robotic and can assemble the meds of each patient as instructed by clinicians. But to access the medication closet in the unit, a clinician must first use a fingerprint scanner that logs who entered the system to dispense meds.
As well, the system knows which drawers a nurse can open, based on his or her patient list. And access to narcotics is highly controlled – for some drugs, two persons are required to access the system.
That’s all to reduce the misuse of medications and to boost patient safety. At the same time, the system can reduce the time needed to dispense medications, as a nurse can tell the system what they need from a smartphone at the bedside instead of keying in the information at the medication station.
At the point-of-care, the nurse scans the medication and the patient wristband; that tells him or her whether it’s the right medication, dose, time and patient. Alerts sound if there are any discrepancies, enabling the nurse to check with another clinician. Moreover, all this information is logged into the system – again, a major method of tracking and raising patient safety.
Many of these systems were trialled first at Mackenzie Richmond Hill Hospital. Zhang noted that the tests “allowed us to identify where we needed to adapt technology to fit our processes and workflows to meet the needs of our patients,” as solutions don’t always perform as advertised and must also be adjusted to the ways that staff work.
In some cases, moreover, “things were not worth the cost”, he said. In others, solutions didn’t work out the way they were expected to. “We tested BlackBerries, and then moved to Android phones, and finally we settled on the iPhone. They’re super-stable,” said Zhang.
Dr. Gladman asserted that many of the refinements of the system have been driven by front-line staff. “We always ask people, what do you need to do and what would you like to see next?”
For example, in the MAR, staff said they’d like to see blood sugar numbers automatically populate – so the team incorporated this capability into the record. Responding to the needs and requests of staff is an important way to make sure that electronic systems are relevant to the way people actually work.
While it isn’t a technological component, a nice feature of this high-tech hospital, and one that catches the attention of a visitor upon entering is the public library on the first floor. It’s the first hospital-based library in Ontario that’s part of a municipal library system, and it’s a great resource for patients and their families.
“When families visit a mom who is expecting, and she goes into labour, the dad and kids can wait in the library,” said Zhang. As well, patients and staff can order books, CDs and DVDs from any library in the Vaughan library system, and they will be delivered to the Mackenzie Health Vaughan Library at Cortellucci Vaughan Hospital.
And as a bonus, every child born in the hospital automatically gets a library card. It may take a few years to learn how to read, but he or she is set up and ready to go. The card can be used at any public library in Vaughan region.
On the digital side, the hospital is actively adding new solutions. “We’re turning on new features every month,” said Stationwala.
He observed that Mackenzie Health is also reaching out to the community, to tie the continuum of health into its digital systems. It has been working to connect its Epic system to local long-term care partners who use the PointClickCare patient record system, so there are tighter connections between the hospital and long-term care homes.
“We want to improve the warm handoffs, so it’s seamless from the patient perspective,” said Stationwala, referring to the transfer of patients from hospital to long-term care, or visa versa.
In the past, many of these transfers were done using paper forms, in which the necessary information was missing, sometimes delaying the transfer or making it more difficult. With digital connections, the goal is to deliver all the needed data with less effort, making the transfers easier for clinicians, administrators and patients.
“They’ve done this in the U.S., but not so much in Canada,” said Stationwala. “We’ve now got some sites fully implemented.”
And on another front, Mackenzie Health is bringing electronic systems and tracking into the area of the supply chain. Stationwala observed that the grocery sector, for example, can trace products right back to the manufacturer using barcodes and other systems. Healthcare hasn’t been able to do that, but the COVID pandemic showed the importance of being able to track and trace products to fix problems with important supplies, such as PPE.
“We’d like to be able to do that in healthcare,” said Stationwala. To that end, Stationwala is himself working with supply chain organizations, to bring their solutions and approaches into the Canadian healthcare sector.
However, in the end, said Stationwala, improvement is all about change management. Staff and clinicians must be on board, and they must want to adapt: “To make meaningful changes, you have to have the users involved.”