Qualitycast North

Depression is a common and debilitating mental health condition affecting millions of people worldwide. Despite the availability of various treatment options, a significant proportion of individuals
with depression do not achieve adequate symptom relief. One promising newer treatment is ketamine infusion therapy, but its current availability is relatively limited.
Dr. Darren Jakubec is a GP anesthetist practicing in Smithers, where in addition to supporting surgeries at Bulkley Valley Regional Hospital, he provides pain management, counselling, and runs a dream clinic. Dr. Jakubec saw a unique quality improvement opportunity to use his skills and experience with anesthesia and mental health to bring ketamine infusion therapy to patients experiencing refractory depression in his local area of Northwest BC. The QI project was a true team effort that included patient partners, a patient peer advocate, a psychiatrist, clerical and nursing support. The project achieved positive patient outcomes and received very positive patient feedback. Dr. Jakubec shares the successes and challenges of this innovative approach to supporting mental health, and also discusses the joys of hockey, impromptu dance parties, and the value of paying attention to our dreams.

One of the most important aspects of quality in healthcare is patient safety. We often read or hear media reports of healthcare failures in patient safety, system errors and patients falling between the gaps but there is another piece to patient and public safety which is ensuring that our licensed physicians are safe to practice medicine in the first place. This role usually falls to the Provincial and Territorial Colleges and is a crucial one when it comes to protecting the public. In this episode, we are joined by Dr. Patrick Rowe, who has practiced emergency medicine in Northern BC and provided leadership for emergency medicine and trauma programs in Northern Health for many years before recently taking on a new role as the Registrar of the College of Physicians and Surgeons of BC. Dr. Rowe provides some insights into what the College of Physicians and Surgeons of BC does to protect the safety of patients accessing medical care in BC, the various quality programs it oversees, and the upcoming initiatives the CPSBC is engaged in to maintain and improve the quality of care in BC.

In this episode we’re talking about a topic which every practicing clinician seems to have an opinion on, whether good or bad. Healthcare IT systems and electronic medical records or ‘EMR’s. Over the last few decades, we’ve seen a massive expansion in the number and reach of these IT systems into every aspect of medicine and across our entire healthcare infrastructure. And although bringing benefits to the care we provide to patients; a new IT system somehow always seems to receive a mixed reception from front line clinical staff.  Here today to talk about healthcare IT and EMRs, our guest today is Dr. Bill Clifford. Dr. Clifford is that rare combination of both physician and software developer, previously awarded the Order of BC and the Doug Cochrane Leadership in Quality Award for his leadership work as the (now retired) Chief Medical Information Officer for Northern Health and creator of the no. 1 ranked, Electronic Medical Record in Canada ‘MOIS’ (which stand for medical office information system).

Dr. Clifford shares his experiences with medical information and technology, which interestingly began with a career in forestry and inspiration from forestry growth and yield modelling. We also chat about the future role of emerging technologies such as AI (artificial intelligence) and machine learning in improving healthcare quality.

You can read more about Dr. Clifford's work and achievements here: Bill Clifford - Health Quality BC 

Drones, which are basically autonomous flying robots, have a variety of applications from controversial military operations to agriculture, cinematography, and package deliveries. Can this technology support improved healthcare services and healthcare equity in rural locations? Northern British Columbia comprises a vast geographical area the size of France, with a significantly smaller and dispersed population. Road links and municipal infrastructure to many of the smaller communities is limited and the harsh Canadian winters compound challenges to living during 6 months of the year. These challenges especially impact remote Indigenous communities, where accessing simple diagnostics or a pharmacy is greatly limited. These obstacles may seem intractable when it comes to providing healthcare, but rural physicians have responded by exploring the use of drone technology in their pursuit of healthcare equity. In this episode, we hear from Dr. John Pawlovich and project manager Sandy Lee about the UBC Drone Transport Initiative (DTI), an innovative project trialing the use of drone technology to improve geographic health equity in rural Northern BC that has developed in partnership between the Stellat’en First Nation, the Village of Fraser Lake, and the UBC Faculty of Medicine. Our guests share the joys of practicing and supporting medicine in rural and Indigenous communities, the importance and reward of community-led initiatives, and love for living and working in the beautiful province of BC.

Today, the practice of modern medicine has changed and is now far more intense, complex and demanding of physicians than ever before. It may not come as
a surprise to find, therefore, that physicians are now burning out at an ever increasing rate. The issue is one that often remains hidden or unrecognized but has implications for the resilience and sustainability of our healthcare system. 
On todays episode we’re talking about Physician wellness and burnout, and the inspirational work local physicians are engaging in to tackle this growing issue. Dr. Ingrid Cosio is a family physician who has been practicing in Prince George for over 18 years. In addition to being an award-winning family doctor and providing medical leadership to the Northern Gender Clinic, in Summer 2022, she successfully applied on behalf of the PGMSA for the Physician Peer Support Pilot Project, a Physician Health Program initiative. The Prince George Physician Peer Support Program was created as a way to combat burnout and support the mental well-being of other physicians. She also shares her own strategies for self-care such as early morning running and the drawing from stoic philosophy.

It is well established that Indigenous peoples accessing the health system are subject to harm, and a lower quality of care. Many healthcare organizations are acknowledging this truth and making commitments to address systemic anti-Indigenous racism and improve cultural safety within the healthcare system. In this episode, we’re hearing from Northern Healths collaborative medical leads for Indigenous Health Drs Todd Alec and Sheona Mitchell-Foster. Dr. Alec is an Indigenous physician originally from Nak'azdli Whut'en, Beaver Clan. He currently practices family medicine with Carrier Sekani Family Services, located on the traditional territories of the Lheidli T’enneh (colonially known as Prince George), and also provides care through the First Nations Health Authority's Virtual Doctor of the Day program. 
Dr. Sheona Mitchell-Foster is a settler obstetrician-gynecologist also based on unceded Lheidli T’enneh territory. In addition to providing high risk obstetrical care and full spectrum surgical gynecology, she teaches with the Northern Medical Program and has research interests in low-barrier options of cervical cancer screening for Indigenous women in the north.
Drs Alec and Mitchell-Foster share their experiences and learnings, and discuss how healthcare providers can strive to deliver culturally safe care, to uphold Indigenous people’s rights to self- determined health and wellness. They also share how they live their values, and find joy in sharing time  and staying active with their families in Northern BC.
We’d like to note that Indigenous is a general term inclusive of First Nations, Métis, and Inuit. We acknowledge that inclusive terms have the potential to diminish diversity and the unique realities of different peoples. The use of Indigenous in this case is intended as an inclusive commitment to improving health outcomes for each group. 

We're back with our 3rd season of Qualitycast North, with a great episode on improvement in the Ultrasound department.
Ultrasound departments everywhere have never been busier and patients with complaints involving all parts of the body visit the department every day. 
Ultrasound is the first line choice for visualization of the appendix when diagnosing possible appendicitis in children, young adults and pregnant women. When the appendix is not visualized on ultrasound, the patient may be scheduled for a CT which introduces additional radiation and may delay diagnosis and therefore delay treatment. At the University Hospital of Northern BC (UHNBC), finding the appendix was proving to be challenging and the department was visualizing the appendix at rates much lower than expected based on the literature.  Karina Hansen, the former ultrasound supervisor of the UHNBC ultrasound department and Carly Phinney, a Northern Health Quality Improvement Facilitator, teamed up with a local radiologist to tackle the problem. They were able to support the department to improve their appendix visualization  and brought the rate up to 76.9%, representing a total increase in visualization of 42.4% from baseline. The change ideas they trialed were so successful, they have been adopted as routine practice by the sonographers, and are being spread to other facilities throughout Northern BC.

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.