Fraser Health Authority (BC)

  • Minnie Downey, Program Director, Cardiac Services, Fraser Health Authority, New Westminster, British Columbia

Cardiac Services and Diagnostic Cardiology Integration; From Complexity to Optimization

The Fraser Health Authority was experiencing many challenges in providing timely care to their pacemaker patients. Patients were fasting for several days waiting for an implant, outpatients were waiting several months, cases were frequently cancelled due to resource issues and patients were not being properly prepared for the procedures. A further review of these problems identified a series of issues that were contributing to the problems, these include:

  • Capacity to perform 900 cases per year, and actually doing 1400,
  • Budget for 1000 implants but doing 1400,
  • Inconsistent processes and service was fragmented across the 13 regional hospitals,
  • Inconsistent physician availability.

The intervention project took a system wide approach to addressing the issues. The project team included professionals from all departments and programs that had any interaction within the service, including house keeping and other support areas. The approach was a bottom up, where the front line teams were empowered to find evidence informed solutions to address the issues, as well as adapt to the current environment of Fraser Health. A consolidated, integrated and standardize model was used to frame to Implantable Cardiac Electrical Device (ICED) project, and thus the new care delivery model. The objectives of the project were to:

  • Improve patient access to services,
  • Consolidate implant sites, ensuring quality practice and resource availability,
  • Enhance efficiency of scheduling, improving the patient experience,
  • Standardize pre and post patient care for all patients across the region,
  • Optimize the clinical and physician expertise.

Early Results
The initial evaluation results after nine months in operation are very positive, including:

  • No cancelled days due to resource availability,
  • Positive staff and patient feedback on the care model and services,
  • Increase from 22 implants to 30 per week,
  • Outpatient waitlist has been reduced from 110 to 40,
  • No delays in patient transportation and similar patient flow access points,
  • The mean wait time for inpatients is 4 days, with a range of 2 days, with 71% of patients receiving their implant within 4 days and 53% within 3 days,
  • Outpatients received their implant within six weeks 80% of the time,
  • The procedure results are closing the gaps towards national standards, which will continue to improve now that the outpatient back log of patients has been addressed.

The ICED model design is scalable to other hospitals and health regions. The model provides equitable and quality access to the service irrespective of geographic location. It uses both peer review evidence, national surveys of Canadian current practices and subject matter expert input in its design ensuring standards are met, however, flexibility to adapt to local environments. The model has been shared with other BC health regions that are looking to integrate their services, either their resources or their inpatient and outpatient models.