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Celebrate TOH’s 12 Big Ideas

Celebrate TOH’s 12 Big Ideas

At TOH, we never stop looking for innovative ways to improve the delivery of patient care. We constantly seek new ways to make the hospital experience of our patients and their families easier and more compassionate. In fact, we’re recognized leaders on many fronts.

As 2013 came to a close, we highlighted 12 game-changing ideas – we’re calling them “Big Ideas” – that have improved patient care or experience at TOH.

Here is the first of our 12 Big Ideas.

Big Idea #1: Schedule the OR with surgical precision

What’s the Big Idea?

Patients needing urgent surgery are getting it faster than ever at TOH – due to changes in how the surgical program is organized. Since January, when a new method of scheduling surgeries was introduced, wait times for urgent procedures have fallen dramatically. With very few exceptions, nine out of 10 patients requiring urgent surgery are now being sent to the operating room (OR) within 24 hours of admission. Previously, some patients waited up to 72 hours. These changes are just one example of how TOH is redesigning the way services are delivered to provide the highest quality of patient care for less cost.

What’s the impact on patients?

For some urgent surgeries, TOH is outperforming the wait-time targets set by the Ontario government. For example, patients with fractured hips, who previously waited up to two days for surgery, now get to the operating room within 24 hours, which is faster than the provincial standard of 48 hours. In any given week, TOH performs about 120 urgent surgeries, with hip fractures, acute gall-bladder inflammation and appendicitis being the most common.

The speedier route to surgery eliminates the need for patients to spend days in hospital waiting for an operating room. It also allows them to recover more quickly.

“The whole flow of patients is much better,” said Paula Doering, Senior Vice-President of Clinical Programs and Diagnostics. “Patients are now getting their surgery during the day, when we’re better staffed. They are going to the right ward after surgery. There are no more backlogs of patients waiting for beds in the recovery areas, which used to cause regular surgical delays.”

Why should you care?

At many hospitals, urgent-surgery delays and bed-occupancy challenges are caused, not by the random distribution of injuries and illnesses, but by the way elective surgeries are managed and assigned. The changes to the surgical program involve setting aside more operating-room time specifically for urgent surgeries. They also involve spreading elective surgeries more evenly throughout the week. “There’s more predictability, less overtime costs for staffing and less chaos,” said Doering.

The changes allow TOH to treat more patients without adding extra beds or operating rooms, said Dr. Sudhir Sundaresan, Chief of Surgery. “By speeding access to the OR and eliminating inappropriate inpatient admissions, it saves the hospital money.”

At a glance: Scheduling surgeries differently ends delays and improves patient care

Indicator 2010-2011 2013-2014
Cancelled surgeries 604 0
Emergency Dept. wait times 6 to 24 hours average 3 hours average
Surgery-bed occupancy 104 to 114% daily 86 to 96% daily
Emergency Dept. access to OR up to 4 days 7.3 hours average
Overtime high minimal
Mortality rate 3.9% 3% or 40 avoidable deaths


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