Approximately 10% of the population (which translates to around 500,000 people in BC) believes they have a penicillin allergy and are labelled as such in their patient records, but in reality, more that 90% of these patients do not have a true penicillin allergy.  These false penicillin allergy labels can have serious consequences to both individual patients and the system; a false allergy label can lead to the use of an alternative antibiotic, which may have increased side effects, increased costs, and can lead to antibiotic resistance. Proactively ‘de-labelling’ patients that have an inaccurate penicillin allergy label can help avoid these risks. Dr. Tiffany Wong is a pediatric allergist based at BC Women’s and Children’s Hospital and is an advocate for choosing the best medications for patients, which involves proving or refuting true drug allergies. Dr. Wong and her team have developed a mobile de-labelling tool to support healthcare providers to do this work in their own settings with their patients. This involves a risk assessment and follow-up processes to accurately diagnose patients deemed as high-risk in a way that is safe, standardized, and evidence based. She has also been working with patient partners to co-design patient resources, so patients and caregivers can be empowered to understand penicillin allergies. These resources are available at https://www.dropthelabel.ca/. This work is also currently being adopted at the University Hospital of Northern BC, with support from the Spreading Quality Improvement Initiative, so the benefits of penicillin allergy de-labelling, and associated improvements to patient care, will be realized in the North. Dr. Wong also shares how having a pet and participating in family based activities with her children and husband out in nature helps her to avoid burnout.

Links:

Drop the Label resources for providers, patients, and caregivers: https://www.dropthelabel.ca/

Assessment of multiple-opinion referrals and consults at the BC Children’s Hospital Allergy Clinic
Allergy, Asthma & Clinical Immunology Adam P. Sage and Elliot James and Megan Burke and Edmond S. Chan and Tiffany Wong DOI: 10.1186/s13223-023-00806-2
06/2023

In this episode, we are featuring the Physician Quality Improvement (PQI) program’s provincial alumni co-leads, Dr. Lawrence Yang and Dr. Hussein Kanji. Dr. Yang practices in a ‘family-family’ practice alongside his wife and brothers, providing cradle-to-grave care in Surrey, BC. Dr. Kanji is a critical care physician that works primarily in the ICU at Vancouver General Hospital and is passionate about developing the ECMO (extracorporeal membrane oxygenation) programming there. Both Drs Yang and Kanji came to the PQI program though a need to solve their own frustrations with the healthcare system. After graduating from their respective level 3 PQI cohorts (which is equivalent to the Virtual Action Learning, aka ‘VALS’, series offered by Northern Health PQI) and engaging with PQI for several years, they collectively took on the roles of provincial alumni co-leads. All physicians in BC that graduate from the PQI trainings join the provincial alumni network, which provides these physicians who are now experienced and knowledgeable in quality improvement methodologies and tools, to continue to apply their skills and passions to ongoing system improvement, while also engaging in a province-wide community.

As provincial alumni co-leads, Drs Yang and Kanji work together (Kanji describes himself as the ‘yin’ to Lawrence's ‘Yang’) to support, embody, and connect with all quality improvement enthusiasts across the province, and facilitate ‘cross-pollination’ of ideas to drive positive change. They also share their love of all of the spectacular nature we are blessed to have in BC and share their strategies for preventing burn-out and maintaining mental health while working in such fast paced careers.

Dr. Shannon Douglas grew up in the Omineca area of Northern BC and has been dog sledding in the Fort St James area since her youth. She now practices medicine in the same region and is the Medical Director for the Lakes Omineca region and loves the diversity of patients she cares for everyday. This region includes Vanderhoof, Fraser Lake, Fort St. James, Burns Lake, Southside and Granisle. Chronic pain is a debilitating, complex condition that effects >60,000 people within the Northern Health region, and many patients use opioids to manage their pain. In 2016-2017 it became apparent that that opioid prescribing for chronic pain was contributing to the  opioid overdose public health crisis. There was a need for improved processes for patients to access their medication in a way that was safe, timely, and evidence based. Dr. Douglas initiated an improvement project aimed at redefining the way chronic pain patients were supported in primary care. She worked together with the local interprofessional team to create a new pathway and screening process, that ensured prescription renewals became comprehensive care episodes. Changing the approach required self-reflection and challenging the status quo of 'the way it's always been done’. The project was successful, and patients really enjoyed the new approach, since getting medication can be really challenging for chronic pain patients. Ultimately the patients were able to manage their pain in a safe and supported way, and many were empowered to eventually transition away from opioids.

The Northern Medical Program (NMP) is an inspiring Northern success story based on community action.  The NMP is a unique medical undergraduate program that educates future doctors with a focus on rural health. Dr. Paul Winwood is the current Regional Associate Dean of the program, a position he has had for over 10 years. Originally from the United Kingdom, Dr. Winwood settled in Prince George to practice gastroenterology, academic medicine, and provide leadership to the NMP. He loves the community here and especially enjoys spending time outdoors with his family, skiing in the winter and boating in the summer. In this episode Dr. Winwood shares the history of the NMP and describes the various ways the program ensures the quality of education,  performance, and learning experiences of the students. We discuss how the profile of medical learners has changed to improve the diversity of physicians entering medical practice, and how the program has influenced physician retention in the North, especially in Indigenous communities.

In this episode, Qualitycast North is leaving the snowy North (yes we still have snow in March) and heading South to showcase some of the excellent Quality Improvement work being done by  2 physicians in the Fraser Valley area; Dr. Diala El-Zammar and Dr. Raj Johal.  Dr. El-Zammar and her family came to Surrey, BC, Canada from Lebanon when she was 9. A self-described ‘nerd’, her love of sciences led her to medicine, and she now practices in the Emergency Department at Chilliwack General Hospital. Dr. Johal also grew up in Surrey and was influenced to pursue medicine by his parents who worked in healthcare and the sciences. He is currently a family physician in his hometown of Surrey and is the provincial PQI champion for publishing.

Dr. El-Zammar shares her very successful  and innovative quality improvement work in implementing a virtual follow up process for emergency department patients. Integral to quality improvement is sharing the work and results through a variety of media including publishing.  Also in today’s episode, Dr. Johal discussing the topic of QI publishing, including the why and how of publishing QI work, and what supports are available to PQI teams, and we’ll hear about Dr. El-Zammar’s experience publishing her QI work in the ‘BMJ Open Quality’ journal. They also share what they enjoy most about living and working in BC.

You can read Dr. El-Zammar and Dr. Johal published article here:

El-Zammar D, Johal R, Eng J, Schultz, T. Implementation of an emergency department virtual follow-up care process in a community-based hospital: a quality improvement initiative. BMJ Open Quality 2022;11:e001782. doi: 10.1136/bmjoq-2021-001782

Dr. Magda Du Plessis is passionate about maternal care, providing the best patient care possible, and quality improvement. She is part of the multidisciplinary team at the Chickadee Maternity Collaborative in Dawson Creek, BC, that includes other physicians, nurses, midwives, pharmacists, and administrative staff. Dr. Du Plessis led the team through a quality improvement project that aimed to have 100% of eligible pregnant patients in the South Peace registered with the Chickadee Maternity Collaborative, to ensure comprehensive, wrap-around care, while also seeking to decrease the rate of caesarean sections and patient safety events. With support from a physician quality improvement coach and a practice support coach, and the use quality improvement tools, the team met their goals; within the first year of operation 100% of eligible patients were registered within the collaborative, the caesarean section rate dropped from 33% to 25%, and there were zero patient safety reports. Dr. Du Plessis credits this success to teamwork, coaching, and the passion of the team. While there were challenges, patients ultimately appreciated the new, team-based, collaborative model of care that includes longer appointment times, and supportive discussions throughout the reproductive health experience. She also shares how her and her family enjoy all of the recreational activities the South Peace has to offer, from fishing, to skiing, to snowmobiling. 

Growing up, Dr. Danette Dawkin didn’t initially see herself pursuing medicine, but after receiving a pamphlet for UBCs rural medicine program, she was inspired to apply, and is now a family physician that has provided services in many rural and Indigenous communities across the North. Implicit biases are unconscious assumptions that can affect how patients are treated based on characteristics such as race, gender, weight, drug-use, and marital status. Dr. Dawkin recently developed a reflective-practice based course to improve cultural safety in healthcare services in the Northeast community of Chetwynd, BC. She brought together an interdisciplinary, dynamic team to learn, discuss and reflect on the internal, implicit biases that we all carry, with the goal of providing care that is rooted in humility and curiosity. Dr. Dawkin shares her experiences with the uncomfortable and difficult work of confronting our own implicit biases, why this approach is so challenging, and how it can ultimately make care safer for everyone. 

Have you ever wondered what the CEO of a large, complex, healthcare organization does, or how leadership and governance supports quality care? In this episode of Qualitycast North we further explore the relationship between quality and healthcare leadership through a conversation with the longest serving Health Authority CEO in recent provincial (BC) history, the current CEO of Northern Health, Cathy Ulrich. Cathy shares her journey through her early career in rural nursing, to rural operational leadership, to strategic leadership. Cathy also discusses her love of gardening, her appreciation for the people within our organization and the people we serve and outlines her top 4 lessons for successful leadership.

Dr. Helene Smith is a Family Practitioner based in Quesnel BC, and also the Chair of the Northern Health Medical Advisory Committee, also referred to as NH-MAC. Originally from South Africa, she found her niche in rural family practice, and eventually became more involved in leadership roles.

Since late 2020, provincial healthcare has been making efforts to improve cultural safety for Indigenous patients and healthcare workers. In this episode, we explore the relationship between medical leadership, cultural safety and humility, and quality. Dr. Smith shares her vision for cultural safety and the commitment that medical leaders have made to a cultural safety action plan. She also provides an informative overview of the purpose and structure of the Northern Health Medical Advisory Committee, and how it influences physician quality in Northern Health. 

Dr. Breanne Abbott is a primary care physician at the Stikine Health Centre, which is located on the traditional territory of the Tahltan Nation, in the community of Dease Lake. The Stikine Health Center is one of Northern Health’s most remote clinics and services an area the size of France, with the closest critical care facility nearly 600 kilometers away. Dr. Abbott first visited the area as a medical student and was amazed by the opportunities for recreation, the natural beauty, and the friendly community. After completing medical school and returning to Dease Lake to practice, she now shares the experiences of the area with her husband and son, who all love their time there. 

Maintaining clinical skills and competencies is key for providing quality health care, especially in urgent, life-threatening situations in remote locations. When Dr. Abbott became interested in doing a Physician Quality Improvement (PQI) project, she saw an opportunity to focus on supporting the Stikine Health Centers small but mighty team to maintain their life support skills. The aim of her project was to improve the comfort and competence of health care professionals providing cardiac emergency care in the Stikine area by 50%. To meet this goal, she acquired a cardiopulmonary resuscitation (CPR) meter and facilitated the funding and logistics to have trainers travel to Dease Lake to provide on site basic life support (BLS),  advanced cardiac life support (ACLS) and pediatric life support (PALS) training tailored for the local, remote context. Overall, her project was a resounding success! Not only was the project a great opportunity for team building, but the team was also able to see improvements in all measured areas of the project. Dr. Abbott has since put her PQI training to use on further projects, such as remote airway training, and improving availability of blood products.  You can learn more about Dr. Abbotts project and view her storyboard here.