SUPPORT SERVICES

Support services are the foundation upon which health care best practices are built.

Clean linen and rooms, information about patients and patient care, quality food for patients and staff, well maintained equipment – all of these contribute significantly to a health system’s overall success. Although the review was primarily focused on clinical services, the review team met with all support services and identified the following potential areas for improvement and options for change.

5.5.1 PATIENT REGISTRATION, ADMITTING AND HEALTH RECORDS

Information from registration, admitting and health records is necessary for patient care activities, tracking patient outcomes, comparing health data with other jurisdictions and overall, for the effective management of the health system.

OBSERVATIONS

• This service is currently managed and delivered on a facility basis. It has been made more robust because of the Clinical Information System implementation. Despite the presence of a single clinical information system for the Island, registration and admitting are not managed as a single service.

• Transcription and coding are the two main health records activities undertaken in the health care system. Both Queen Elizabeth Hospital and Prince County Hospital are significantly behind in document transcription. Coding is slightly more up-to-date but both services are less than optimal (about two weeks for coding and less for transcription).

• Only a portion of all transcription is centrally provided. DI, labs, pediatrics, oncology and physical medicine each has a unique group of transcriptionists within their program. Physician outpatient clinics also transcribe their own records.

• Coders translate activities performed for every case into a standard set of metrics to enable in-hospital, between-system and cross-Canada comparisons through the Canadian Institute for Health Information. The data is not used to its full potential for PEI hospital or system management.

93

• With current delays in transcription and coding, it has been difficult to persuade physicians to complete their charts. However, when the Clinical Information System enables timely coding, the onus will shift to physicians to maintain patient charts in a timelier manner. Utilization management, another critical absence from the current system, is also informed by the timely presence of information concerning the patient encounter.

RECOMMENDED STRATEGIC DIRECTIONS – PATIENT REGISTRATION, ADMITTING AND HEALTH RECORDS

Create a single leadership model for patient information and registration. The creation and management of patient information (from presentation to post-discharge coding) should be consolidated under a single provincial structure.

Redesign core processes. The provincial lead should immediately redesign all patient registration and admitting processes to ensure the new Clinical Information System is used identically in all locations. This will enable a set of standard operating procedures to be created and adhered to in all patient interactions anywhere in the system. The provincial lead should also design a single solution for transcription, records and coding throughout PEI. Transcription capacity currently in non-health records departments should be transferred to the new provincial program.

Define a decision support role. The patient information lead should consider setting up a small-scale analytical capacity within the team to begin to gather and interpret data for broader system management.

94

5.5.2 ENVIRONMENTAL SERVICES

Environmental services include housekeeping, facilities, biomedical engineering and security.

OBSERVATIONS

• Each of the services noted above is mainly organized on a facility basis and is not integrated. In the majority of situations, the facilities have their own employees, including trades, to undertake all environmental activities. Some of these services may benefit from redesign.

• It is important to note that activities such as housekeeping are in the forefront of infection prevention and control. Hospital-acquired infections are a major problem in many institutions – a problem only resolved by close cooperation among front-line health care workers, infection prevention and control experts, and environmental services staff. Recognizing this, many organizations across Canada have been able to derive new models that cost less and maintain quality environmental services. This should be the goal in PEI.

• Biomedical engineering, responsible for the maintenance of medical equipment, should also be organized provincially. There is an opportunity to determine what maintenance should remain in-house and what can be provided by external providers.

• Utility costs are a major issue in the current environment, and their management should be consolidated under a single management structure. Consideration should be given to any new construction being LEED-compliant. LEED is the Leadership in Energy and Environmental Design Green Building Rating System™.

• Security is also a major issue. Emergency room physicians have expressed concerns about working without increased security, and facilities are now providing security services without having a budget to do so.

RECOMMENDED STRATEGIC DIRECTIONS – ENVIRONMENTAL SERVICES

Create a single leadership model for environmental services. A provincial lead should be appointed to design a single environmental services capacity for the province including housekeeping, facilities and biomedical engineering. The lead should examine all options to improve the quality of these services while achieving efficiencies.

Review security. There should be a review of security services throughout the health care system in PEI with a goal of evaluating the current and required future standards in security services and of identifying gaps and risks within the current system.

95