The ICU team at Abbotsford Regional Hospital & Cancer Centre

When the new Abbotsford Regional Hospital & Cancer Centre (ARHCC) opened its doors to the Fraser Valley community in late 2008, the Intensive Care Unit (ICU) experienced an increase in the volume of severely sick patients with complex health issues. As the new regional ICU, staff quickly became aware that internal process changes were needed in order to meet the specialized needs of a rising number of patients requiring advanced treatment.

“I began working in the ICU in 2009,” says Cathy Wiebe, Health Services Manager. “The hospital had recently opened, but already we could see that the number of ventilator-dependant patients, those unable to breathe on their own, was growing steadily.”

Patients requiring a ventilator to breathe are severely ill and often have an extremely lengthy stay in hospital. One treatment that can provide some comfort and prevent the possibility of infection (e.g. Pneumonia) is a Tracheostomy.  But, as Cathy explains, the ICU was unable to perform this procedure in a timely manner.

“At the time, ARHCC had just one Ear, Nose & Throat (ENT) specialist and he was the only physician on site to perform all Tracheostomies, and this was done in the Operating Room (OR) only,” she says. “Given the high volume of surgical procedures on any given day at ARHCC, the OR was extremely busy and it could take weeks to schedule OR time.”

Time for change

Cathy recalls one patient who waited for a Tracheostomy for more than five weeks. He eventually went to Surrey Memorial Hospital (SMH) for the procedure however, as Cathy explains, this solution would not be sustainable for the long-term. “That situation was the real tipping point for me,” she says. “Our staff accompanied the patient to SMH, but they had no familiarity with the hospital, which made the procedure far more complicated and longer than necessary. Ultimately, the patient and our staff suffered and the entire process did not align with Fraser Health’s (FHA) ongoing commitment to patient safety.”

The payoff

The positive outcome from this unfortunate event, however, was that ARHCC ICU was able to review policies in place at other hospitals (SMH, Royal Columbian, St. Paul’s) and adapt them to suit their needs. Specifically, with support from ARHCC leadership and the ENT specialist, two on-site Intensivists with the skills to perform Percutaneous Tracheostomies at the bedside were engaged to ease and support a change in practice in the ICU. “Our entire staff was so pleased when this happened,” explains Cathy. “We immediately began training our Respiratory Therapists (RTs) to work alongside the Intensivists, reducing patient wait times and length of stay. We’ve changed our Tracheostomy processes completely and now these procedures are built into a typical day in the ICU.”

Upon review of their BC PSLS data, there have been no adverse events reported since the new practice has been in place. “We’ve had no safety events and zero infections reported,” says Cathy. “Our new guidelines help to identify those patients who DO need this procedure done in the OR and, in over a year’s time, we’ve had just one patient who couldn’t receive the procedure in the comfort of their own room.”

A safer and more efficient ICU

Abbotsford Regional Hospital & Cancer Centre

Cathy describes her approach to BC PSLS and patient safety saying, “If it raises the hair on the back of your head, it’s a patient safety event! BC PSLS is the simplest system I’ve ever used. I remind our staff to stick to the facts, don’t use any names and close the loop with Reporters. It can be hard sometimes, but we have a very open culture when it comes to patient safety. In my opinion, we have a can do attitude that I’m proud of and it’s my job to support our staff with keeping it that way.”

Congratulations to ARHCC ICU staff. You recognized an opportunity to improve patient safety and improve care – thank you and well done!

Cathy Wiebe is Health Services Manager for the Intensive Care Unit at Abbotsford Regional Hospital & Cancer Centre. For more information about this initiative please contact her at cathy.wiebe@fraserhealth.ca