A Snapshot of the Auditor General’s 2019 Annual Report

On Wednesday, December 4, the Office of the Auditor General of Ontario released its 2019 Annual Report. This year’s report includes four volumes focused on (1) 13 value-for-money audits, (2) reports on the environment, (3) reports on correctional services and court operations and (4) follow-up work on previously issued recommendations by the Office.

Although a large portion of Auditor General Bonnie Lysyk’s report highlights important findings from the government’s environmental plan, the 1,200-page report includes a number of significant health care recommendations specifically in the areas of patient safety, addictions treatment, chronic kidney disease management and long-term care.

Acute-Care Hospital Patient Safety and Drug Administration

Key findings from the report:

  • “Nearly six of every 100 patients experienced some form of harm during treatment in an acute-care hospital in Ontario.”
  • Preventable incidences “occurred a total of 214 times over the last four years in six of the 13 hospitals that we audited; somewhat surprisingly, the other seven hospitals we visited did not even track this data.”
  • Due to current laws, it can be costly and time-consuming for hospitals to fire physicians and nurses found to “lack competence.”

A snapshot of recommendations in this area:

  • Hospitals should explicitly incorporate the words “patient safety” in their mission, vision, and/or as one of their core values.
  • Hospitals should work with internal and external partners to leverage an existing system that can accumulate and track hospital never-event data (i.e. incidents that could cause serious patient harm or death and that are preventable using organizational checks and balances).
  • Hospitals should set a formal target to eliminate the occurrence of never-events and include this target in their Quality Improvement Plans.
  • Hospitals should identify gaps in the current information available to prospective employers regarding past performance issues and terminations.

Read the full value-for-money audit on acute-care patient safety here.

Addictions Treatment Programs

Key findings from the report:

  • “Currently, the Ministry of Health allocates funding for addictions treatment services without determining the need for each type of service across the province and without evaluating the effectiveness of addictions treatment service providers.”
  • There needs to be a review of “unusual or suspicious instances of opioid dispensing—such as opioids ‘prescribed by’ physicians and dentists with inactive licenses.”
  • “Emerging areas such as cannabis legalization and vaping require a formal assessment to identify whether additional prevention and treatment services are needed.”

A snapshot of recommendations in this area:

  • The Ministry of Health should analyze wait times for addictions treatment to identify regions or programs with long wait times and work with those service providers to take corrective actions.
  • The Ministry of Health should implement a needs-based funding model for existing and new programs.
  • The Ministry of Health should collect information on addictions treatment service provider programs (withdrawal management, non-residential and residential) to understand differences in their operations and service delivery.
  • The Ministry of Health should develop and implement a centralized access centre model for addictions services that minimizes variations in accessibility across the province.

Read the full value-for-money audit on addictions here.

Chronic Kidney Disease Management

Key findings from the report:

  • There is a “need for improvements to the referral process, the alignment of dialysis capacity to regional needs, and lengthy kidney transplant wait times.”
  • “In the last five years, the average wait time for the approximately 1,200 patients waiting each year for a deceased-donor kidney transplant was about four years, too long for those who became too ill for a transplant or died while waiting.”

A snapshot of recommendations in this area:

  • The Ontario Renal Network should work with the Ministry of Health to share lab data from the Ontario Laboratory Information System with the Regional Renal Programs to help them identify and follow up on patients who are eligible for referral to a nephrologist.
  • The Ontario Renal Network should collect information on the composition and staffing level of the multidisciplinary team at each Multi-Care Kidney Clinic from the Regional Renal Programs on an annual basis to identify teams that do not meet best practices and make changes accordingly.
  • The Ontario Renal Network should work with the Regional Renal Programs to fully investigate the reasons for late referrals to the Multi-Care Kidney Clinics.

Read the full value-for-money audit on chronic kidney disease management here.

Food and Nutrition in Long-Term-Care Homes

Key findings from the report:

  • “Mealtime service is affected when personal support workers tend to other responsibilities or do not report to work.”
  • “Long-term-care homes’ registered dietitians do not spend sufficient time proactively monitoring residents.”
  • “Menus do not have recommended nutrients for residents compared to the recommendations in the Dietary Reference Intakes.”
  • “Group purchasing has not been fully explored to help long-term-care homes realize higher savings to allocate to potentially higher-quality food.”
  • “The Ministry does not require long-term care homes to report on performance indicators related to food and nutrition.”

 A snapshot of recommendations in this area:

  • Long-term-care homes should develop ways to ensure that all direct-care staff have timely access to the most current plans of care.
  • The Ministry of Long-Term Care should confirm during its inspection process that all direct-care staff are able to know the residents’ plans of care for food.
  • The long-term-care homes’ registered dietitians make appropriate menu changes to achieve compliance with the current Canada’s Food Guide and Dietary Reference Intakes requirements.
  • The Ministry of Long-Term Care should clarify to long-term-care homes that alternative staffing options exist that can be used to provide assistance to residents during peak demand times such as mealtimes; for example, part-time staff, volunteers or students trained in feeding residents with dementia.

Read the full value-for-money audit on food in long-term care homes here.