Our two most recent blog stories on BCPSLS Central provided updates on exciting new tools that were launched in 2017.
In August, we outlined early successes of BCPSLS re:act, highlighting its Leading Practice award for Excellence in Patient Engagement for Patient Safety. Then we went back to school in September with a show-and-tell of our Medical Imaging report form, including a quiz on correctly reporting safety events.
Let’s make it a hat trick, shall we?
The new provincial trauma mortality review process was launched in August 2017, aimed at identifying and addressing factors connected with injury-related preventable death. One year later, we’re excited to share initial results and future directions.
Tracking trauma mortalities
Trauma-designated sites in BC are now able to report and review mortalities in a standardized way using the BCPSLS module. In addition, sites can monitor how many trauma mortalities have taken place and, more importantly, determine how many were considered preventable using a standardized form, definition, and process.
From August 2017 to October 2018, 362 cases were reported in BCPSLS, with an increase in reporting shown over time.
To encourage use of the module, Trauma Services BC (TSBC) visited each of BC’s eleven trauma-designated sites either in person or virtually to provide education on BCPSLS and the new module. Feedback from users has been ongoing, and many have shared that they appreciate the system and find it helpful for standardizing their processes, sharing information, and tracking mortality cases at the site and regional levels.
“I love the fact that the trauma mortality review module is within the PSLS database,” says Lisa Whitman, Trauma Nurse Coordinator at Royal Inland Hospital in Kamloops, BC. “It allows all sites and partners involved in trauma care provincially to speak the same language, share confidential information and obtain reports that allow health authority comparisons. I support the vision that every trauma death occurring in this province deserves a review.”
Also, for the first time, mortality review information can be confidentially stored and shared between TSBC, the health authorities, and BC Emergency Health Services, to facilitate provincial reviews on system issues where appropriate.
“The ability to have a shared review platform among internal and external partners for in-hospital trauma mortalities has not only enhanced our local quality assurance programs in the north, but has matured our Trauma Program regionally and brought a provincial lens to system-wide areas of improvements and shared learnings”, adds Jordan Oliver, Executive Lead, Emergency/Trauma Program, Northern Health. “Our goal is for ALL Northern Health in-hospital mortalities to be reviewed in this module by 2019.”
Dashboards and data
Reports have now been shared with each trauma-designated site across the province, showing site-specific number of mortalities along with review status. In addition, aggregate reports have been provided to health authorities for analysis at the regional level.
Leaders at TSBC have access to a provincial dashboard that enables them to examine a more complete picture of trauma mortalities across the province.
“Standard provincial review of trauma mortalities provides invaluable data for trauma programs to better monitor performance trends and identify areas for quality improvement,” says Beide Bekele, Program and Project Lead, TSBC. “Our hope is that the provincial review process and reporting support informed decision making to improve trauma care in BC.”
System-level case review
The review process for case-specific trauma mortalities in BC is now three-tiered: first, the site review is initiated with a standardized mortality review form. Data is collected, a review is conducted, and recommendations made. If further review is required, a regional mortality review is facilitated, potentially resulting in additional action items and recommendations.
The third tier is facilitated by TSBC’s Performance Improvement and Patient Safety (PIPS) program. After a case has undergone regional review, the regional trauma lead may submit a request for provincial review to PIPS, if the case has provincial system-level implications. The provincial review process includes multi-agency discussions and has the potential to generate opportunities for system-level improvement.
The value of this process is twofold: first, all three levels of review use one form with standard definitions. This streamlines communication and helps to highlight system-level issues. Secondly, the provincial BCPSLS platform enables sharing of records, so the different levels of review can stay focused on key issues and potential improvements.
Several cases were brought forward for provincial review over the past year and opportunities for improvement were identified. TSBC is currently finalizing recommendations and plans to implement action items within the next year.
Ongoing feedback is encouraged to make the module more user-friendly and support further adoption.
TSBC is also exploring ways of streamlining the provincial review process to promote expedient, simultaneous review of multiple cases, build rigour around loop closure, and monitor implementation of provincial recommendations.
Congratulations to the trauma community in BC for making this initiative a success!