Dr. Jamil Bashir encountered some surprises in his effort to enhance patient experience with his Pacemaker Project. Investigating why implant patient outcomes and recuperation experiences were varied across the province, he discovered that there was no systematic standard of training.
A 2013 Cardiac Services BC (CSBC) review noted that there were no national standards for implanter training, or recommended annual operator volumes. There were also no clearly defined competencies for the device analyzer role, and the experience level of those providing device analysis was inconsistent.
“I felt like we could really improve the way the whole system delivered care, but also, how each individual patient fared with the way care was delivered,” says Dr. Bashir.
In 2015, with funding support from the Specialist Services Committee’s Quality and Innovation Initiative, Dr. Bashir, along with his fellow Physician Lead, Dr. Nat Hawkins, and CSBC assembled an expert team to determine, among other things, how much training doctors should have before they implant a pacemaker.
In addition to proposing a revision of the General Surgery Privileging Dictionary, the team identified a need for a more uniform referral and triage process province-wide; timely access to diagnostic data to assist in referrals; and consistency in referral forms and packages. They also recognized that accurate waitlists were essential; individual patients needed to be matched with their ideal pacemaker; and better post-implantation information and quality assurance were required to monitor and evaluate patients’ health.
The project found that implant training had evolved in this province organically, but also “chaotically,” says Dr. Bashir. Device implants are unique, he says, because there are five different types of surgeons who do them. “So you have this widely disparate group of people all trying to do their best in their community for their patients, but they come to it from very different backgrounds. We worked with them to figure out a way that would work and put the guidelines in place.”
“One of my best stories is of a surgeon up north who is an incredibly dedicated implanter,” recalls Dr. Bashir, Surgical Director of Laser Lead Extraction at St. Paul's Hospital. “He basically trained with a ‘see one, do one, teach one’ approach -- he saw one implant procedure, and then he was mentored to do one, and then he took over.”
Dr. Bashir worked with the College of Physicians and Surgeons and his team to establish standards for doctors to receive their implantation credentials and privileges. With support from the Specialist Services Committee, the resources were put in place to comprehensively train doctors in smaller communities in device care, particularly implantation. As of late 2018, 15 surgeons are in the process of being trained - completing more than 40 implantations with close mentorship.
Meanwhile, CSBC’s Kelly MacKay spearheaded sub-projects, including the standardization of operating room supports for implantation procedures, which had previously varied from operating room to operating room.
Dr. Bashir says the key achievement of the project is that it has established a “pacing care” system that should be fully implemented across BC within the next couple of years.
The project’s added benefit is that it has connected people province-wide, he says. “There's nobody that implants a device that I don't know and that we don't communicate with regularly. And I know that they're also communicating with each other, and so we've turned this disparate, chaotic thing into a system with a real network, and the conversation's really started.”
This project is the largest of 30 successful Quality Improvement projects supported by Specialist Services Committee’s Quality and Innovation Initiative. SSC is one of four Joint Collaborative Committees that are a partnership between the BC Ministry of Health and Doctors of BC.