Wait Times
Best Practices
Updated on August 28, 2017
“By changing nothing, nothing changes.”
Tony Robbins
Wait time for nursing services and wait time for personal support services for complex patients in the home are priority indicators for the QIP. In Ontario 93.7% of home care patients receive nursing services within the five day target and 85.4% of home care patients with complex needs receive personal support within five days.
Below are best practices for reducing wait time for these home care services. They are graded according to Type of Evidence. Evidence-informed best practices are based on quality evidence, they can optimize outcomes and should be implemented into practice where possible.
Measurement
Updated on August 28, 2017
“While all changes do not lead to improvement, all improvement requires change”
Institute for Healthcare Improvement
How do we know if a change is an improvement? Measurement is a critical step in QI to assess the impact of a change. Quality indicators are used in the QIPs to measure how well something is performing. There are three types of quality indicators used to measure QI efforts:
- Outcome Indicators: capture clinical outcomes and or system performance,
- Process Indicators: track the processes that measure whether the system is working as planned, and
- Balancing Indicators: ensure that changing one part of the system does not cause new problems in another.
| Indicator | Percentage of home care patients who received their first nursing visit within five days of service authorization |
| Topic | Wait Times |
| Quality Dimension | Timely |
| Type of Indicator | Process |
| Measure | Percentage (%) |
| Data Source | Client Health and Related Information System (CHRIS), Home Care Database (HCD) |
| Data Collection Instrument | Collected by the Ministry of Health and Long-Term Care (MOHLTC), and Health Shared Services Ontario (formerly the Ontario Association of Community Care Access Centres (OACCAC)) |
| How to Calculate | The percentage is calculated as: (Numerator/Denominator) x 100 Numerator: # of home care patients who received their first nursing service visit within five days of the date they were authorized for nursing services by the CCAC Denominator: # of adult home care patients who received in-home nursing services |
| Target | Higher is better (Provincial Benchmark is 95%) |
| Range | 0 – 100% |
| HQO Reporting Tool | Public Reporting, and Quality Improvement Plans (QIPs) |
| Indicator | Percentage of home care patients with complex needs who received their personal support visit within five days of service authorization |
| Topic | Wait Times |
| Quality Dimension | Timely |
| Type of Indicator | Process |
| Measure | Percentage (%) |
| Data Source | Client Health and Related Information System (CHRIS), Home Care Database (HCD) |
| Data Collection Instrument | Collected by the Ministry of Health and Long-Term Care (MOHLTC), and Health Shared Services Ontario (formerly the Ontario Association of Community Care Access Centres (OACCAC)) |
| How to Calculate | The percentage is calculated as: (Numerator/Denominator) x 100 Numerator: # of complex home care patients who received their first personal support service visit within 5 days of the date they were authorized for personal support services by the CCAC Denominator: # of adult complex home care patients who received in-home personal support services |
| Target | Higher is better (Provincial Benchmark is 95%) |
| Range | 0 – 100% |
| HQO Reporting Tool | Public Reporting, and Quality Improvement Plans (QIPs) |
This data can be presented using Run Charts to track improvement over time. To read more about general measurement in QI refer to Measurement for Quality Improvement or the QI Getting Started Section.
Tools & Resources
Updated on August 28, 2017
- Canadian Home Care Association
The Canadian Home Care Association (CHCA) represents its members who are home care providers across Canada. - Community Care Information Management (CCIM)
CCIM supports the information management needs of the home and community care sectors providing resources and support. - Health Shared Services Ontario
Health Shared Services Ontario (HSSOntario) is an agency of the Government of Ontario that supports Ontario's 14 Local Health Integration Networks - Home Care Ontario
Home Care Ontario is a member-based organization representing providers of quality home care services from across Ontario. - Ontario PSW Association (OPSWA)
The Association of personal support workers in the province of Ontario - Ontario Community Support Association
OCSA is the voice of home and community support, representing hundreds of agencies, 25,000 staff, and 100,000 volunteers across Ontario. - RNAO Vision on Home Care
The RNAO’s vision for home care nursing between now and 2030 - Quality Improvement Plan Reports
Health Quality Ontario’s Quality Improvement Plan Reports specific to each sector
Background
Updated on August 28, 2017
Issue
Providing home care to patients in a timely manner is key to ensuring they receive the right care when they need it. The consequences of delayed access to nursing or personal support worker (PSW) services may include increased confusion and stress for patients and caregivers and potential re-hospitalization (HQO 2016). Wait times in home care are measured using two priority indicators. The first indicator measures the time to first visit to any patient from a nurse. The second indicator measures the time to first visit to complex patients from a personal support worker.
In 2013, Ontario created a five-day target for all patients waiting for nursing service, as well as for all complex patients waiting for personal support service. Complex patients are those who need a high level of care, usually because they have one or more health conditions combined with complicating factors such as physical, cognitive or other limitations (CCAC, 2014). The personal support service they receive may include personal service such as bathing, helping with eating and other activities of daily living (ADL), as well as homemaking and cleaning (HQO 2016).
Ontario provides 6.9 million nursing visits and 28.7 million hours of personal support and homemaking to approximately 650,000 people per year (MOHLTC 2016). In 2015/16 93.7% of home care clients received nursing services within five days of discharge to home care and 85.4% of complex patients received personal support within 5 days of admission to home care (Figure 1). The majority of home care clients receive services within the target period.
Data source: Home Care Database provided to the Ministry of Health and Long-Term Care by the Ontario Association of Community Care Access Centres
The wait time for service is measured from the date a service is authorized to the date it is first provided. However, before a service is authorized, it must first be applied for by a health care provider, the patient or their caregiver, and a home care coordinator must determine whether the patient is eligible for the service. The time required for the application process and determination of eligibility is not included in the wait time target.
When considered by LHIN (Figure 2) there is quite a bit of variability in timeliness of personal support services for complex patients. Timely nursing services remains fairly constant across LHINs and there may be a ceiling effect being encountered for this indicator.
Data source: Home Care Database provided to the Ministry of Health and Long-Term Care by the Ontario Association of Community Care Access Centres
Call to Action
Ontario was the First province to provide home care related wait times, and there have not been substantial changes since 2013/14 (HQO2016; WTA 2015). For personal support services the percentage who receive care within five days has slowly increased to 85% over the past three years. The median current performance on this indicator is 85% (range of 74% to 92%). For in-home nursing the percentage has been steady at 93%. The median performance is 94% (range 88% to 96%) which is approaching the provincial benchmark of 95%.
While performance on nursing visits is high which we are looking to maintain, there remains room for improvement for the personal support services. With appropriate supports, many individuals of all ages can remain in their homes, return home more quickly from hospital, or delay or even avoid the need for admission to a hospital or long-term care home (Home and Community Care Expert Panel 2015).