North York General Hospital | Davies Enterprise Award

The HIMSS 2016 Davies Enterprise Award winner, North York General Hospital (NYGH) is one of Canada’s leading community academic hospitals that serves a culturally diverse communities of North Toronto. Known for its willingness to adopt innovative technology to promote the ideal patient experience, North York embarked on a project to transform their electronic health record system (EHR) from a HIMSS stage 2 to a HIMSS stage 6. The eCare project focuses on improving the quality and safety of care by the following:

  • Improving the prevention of nosocomial Venous Thromboembolism (VTE).
  • Reducing preventable inpatient death.
  • Reducing medication errors with closed-loop medication administration system.
  • Medication reconciliation that reduces risk of unintended medication discrepancies.

NYGH had a study conducted that revealed that only 17 percent of patients received appropriate prophylaxis in their Medicine program. They introduced an evidence-based strategy to successfully meet the challenge of sustainably improving their VTE prophylaxis rates.

NYGH expectation was that by introducing health information technology to daily patient care via eCare, they could integrate orders for evidence-based VTE prophylaxis into physician workflow and improve the prophylaxis rates. But to achieve optimal compliance, they also had to introduce real-time clinical decision support to directly impact physician decision-making at the point of care.

Since the implementation of eCare, in addition to increasing the appropriate VTE prophylaxis rate to 97%, NYGH prevented approximately 40 VTE cases, including deep venous thrombosis (DVT), pulmonary embolism (PE) and combined cases of DVT and PE. This represented a calculated VTE incidence reduction rate of 39.2%.

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The Canadian Institute for Health Information (CIHI) developed a metric that determines and compares the number of preventable deaths occurring in hospitals across Canada to improve on preventable adverse events. Mandatory measurement and reporting of Hospital Standardized Mortality Ratio (HSMR) is a means to track, compare and improve quality and safety of acute patient care across Canada.

The HSMR at NYGH was worse than the national average in several large clinical areas prior to implementing CPOE with eCare. NYGH overall HSMR score was 112 for inpatients admitted to the Medicine Program and for patients with a primary diagnosis of pneumonia or COPD exacerbation, the HSMR scores were 119.6 and 140.4, respectively. The goal was to improve those scores to be better than the national average which is under a 100, with the assistance of the advanced health information system and evidence-based we were implementing with eCare.

NYGH have calculated that their clinicians saved 31 lives from pneumonia and COPD exacerbation during the timeframe of their HSMR study. NYGH are convinced that they were able to save at least another 120 more lives from these tow disease groups alone, not to mention many more lives from other common conditions treated at the hospital every day.

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Adverse events from medication errors have been an alarming problem in North Toronto and across Canada for decades. The Canadian Adverse Events Study reviews cases from acute care hospitals across the country and found that 7.5% of those had an adverse event that harmed patients. The Study suggest that about 185,000 hospital admissions likely had an adverse event and of those adverse events about 45% were related to medication services.

NYGH had approximately 2,100 admissions with harmful adverse events with approximately relating to medication services. One of NYGH first eCare initiatives was to redesign their medication administration process. Prior to eCare, the medication process left a lot of room for error, with 39 percent of errors occurring with medication prescribing and 38 percent occurring with medication administration.

NYGH designed a new workflow to solve that problem by implementing a closed-looped medication administration (CLMA).  CLMA eliminates manual entry and fires an alert if a medication about to be administered does not match the drug, dose, route, timing and/or intended patient indicated in the active orders on the electronic chart.

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Reconciling medications at transition points of care is intended to eliminate errors related to medications being omitted, duplicated or incorrectly ordered. Electronic tools for medication reconciliation can streamline the process by eliminating duplicate entry, and pulling forward documented home medications to align them with inpatient medication orders, facilitating clinical review, reconciliation and order processes.

NYGH saw a key opportunity to leverage health information technology to improve its organizational performance in this key quality and safety measure, by integrating efficient electronic medication reconciliation processes into clinician workflow.

NYGH made a significant improvement between pre-CPOE compliance rates, where only 7 to 9% of medical patients had paper-based medication reconciliation to compliance rates immediately post implementation of eCare , where 45% on admission, and 70% on discharge.

NYGH avoided $31 million in costs from averted adverse drug events, as a result of progressively improving adoption of electronic medication reconciliation via eCare.

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