>>The Emergency Department is in many ways the face of the hospital. I think people
are attracted to emergency medicine because it's a real opportunity to make
a difference.
My name is Glen Bandiera. I'm the chief of Emergency Medicine here at St.
Michael's Hospital.
We see about 200 to 230 patients a day, and each of those patients requires
multiple decisions during their stay. Each of these individual decisions will
generate cost. We wanted to get a sense of how aware people were of the costs
of medications used the Emergency Department, so we ran a contest. We just
asked them - "what do you think the annual cost of these medications are in our
Emergency Department?" - and people didn't do very well. We realize that people are
not very cost aware. For example, two simple antibiotics for urinary tract
infections. One of them is nitrofurantoin and the other one is co-trimoxazole.
They were both very effective. The nitrofurantoin is about $7 a course and
the co-trimoxazole is about 30 cents a course. So there is about a twentyfold difference in the cost
between these two drugs, and over the course of a year you can imagine what an
impact that would have. I think doctors have a social obligation to consider the cost
of the treatment that they recommend. Our obligation is obviously to give the best
care we can to an individual patient, but when there are a number of ways to get
where you want to go and they're equally effective than I think cost should be one
of the considerations.
>> St. Mike's was founded in 1892 as we all know by the Sisters of St. Joseph, and
we've had a fabulous tradition of providing care through the ages.
Now we have a new challenge.
My name is Anne Trafford. I'm the vice-president of Quality and Performance at
St. Michael's Hospital.
Our province is under tremendous financial challenge. Health system spending is the
number one expense on the provincial budget. It's not sustainable
to continue to increase that funding, and so the ministry has actually developed a
new way of looking at how hospitals and other providers in the health system are funded.
As a leader in health care in Ontario, St. Michael's has to be part of
the change. And that means that every single one of us, all 5600 staff
physicians, residents, volunteers have a role to play. Our financial fluency
program is one way that we're going to start to help you understand how you can
contribute to the changes that health system funding reform is bringing to us as an
organization. In the Cath Lab they've had great success in working with their
frontline staff to organize their supplies to make decisions about the
supplies used in a very different way.
It was really important to work with clinicians and frontline staff to
ensure that they have the right product at the right time and the right quantities
available to them to do the procedures.
My name is Victoria Buczek. I'm a clinical leader-manager in the Cardiac
Cath Lab at St. Michael's Hospital. We had a lot of product on hand, and we
didn't really have a way to standardize
the variety of products that we had. We also had a lot of wastage. Our wastage for the last fiscal
year was just over $100,000. This was perfectly good product that we
could have used, but it wasn't used in time because of the way we stored it in the lab.
The wastage was happening
mainly because the product wasn't rotated as it should have been, so
as the same as in the grocery store you see milk that is close to expiration in
front of you.
Our catheters for example were stored at the back. Supplies that are close to
expiration have typically a 'use first'
sticker. It's just a visual aid to remind staff that this product needs to
be used first.
>> This is a conversation that needs to be ongoing in the hospital. I think there
are lots of opportunities to improve our cost awareness, improve efficiency and
still deliver very high quality care. >> Delivering quality care is our top
priority, remains our top priority.
We're all accountable, and this is the beginning of a series of conversations.