Updated: Feb. 24, 2023
As a result of the anesthesiologist shortage, Niagara Health is moving after-hours emergency surgeries from Welland to the Niagara Falls Site effective Monday, Feb. 27.
Patients should continue to access care as they normally do. The operating room at the Welland site will remain in operation from 8 a.m. to 4 p.m. on weekdays for scheduled surgical procedures, including general, ophthalmology and orthopedics (including overnight hip and knee joint cases).
Going forward, about six per cent of emergency procedures performed in Welland will instead be done in Niagara Falls and St. Catharines. These are emergency surgical procedures that today occur in the evenings and weekends in Welland. Scheduled day stay cases for urology, ENT (ear, nose and throat) and gynecology will shift to the Niagara Falls Site, as will all emergent and urgent cases on evenings and weekends.
This change impacts how the NH team delivers care. We have significant experience safely stabilizing and transferring patients to the appropriate site as we have done for many years in the case of stroke, vascular, and gynecological care. We have been working with our teams and community partners, including Niagara EMS and non-urgent patient transport, to prepare for these changes and ensure a smooth transition to this new model of care.
We will continue to monitor patient safety and experiences to make improvements to our workflow as needed.
As these changes are put in place, Welland will continue to be a cornerstone for Niagara Health for generations to come. Day surgery and emergency services will continue in Welland and in the coming years, the site will undergo major updates to create a modern, ambulatory care centre with 24/7 emergency services.
If you have questions or concerns, please reach out to engage@niagarahealth.on.ca
Updated: Feb. 1, 2023
Niagara Health is finalizing a comprehensive plan to enable us to maintain operating services, scheduled surgical procedures and orthopedic cases at the Welland Site.
Niagara Health is finalizing a comprehensive plan to enable us to maintain operating services, scheduled surgical procedures and orthopedic cases at the Welland Site.
This plan, approved by our Board of Directors Tuesday, Jan. 31, is the culmination of the hard work of our dedicated staff and physicians who spent countless hours developing a solution to the former model, which was no longer working due to the ongoing health human resources shortages related to anesthesiologists. These changes, which we’re aiming to go into effect on Monday, Feb. 27, are not related to any provincial plans for private clinics or our regional model site plan approved in 2018.
The change will help us maintain patient care with minimal disruption and allow patients to continue receiving the care they need, when they need it. It will optimize our perioperative (surgical) service model to use our current staff most efficiently and patients will get the same standard of care across all our sites.
At the Welland Site, the operating room will remain in operation from 8 a.m. to 4 p.m. on weekdays for scheduled surgical procedures, including general, ophthalmology and orthopedics (including overnight hip and knee joint cases). Scheduled day stay cases for urology, ENT (ear, nose and throat) and gynecology will shift to the Niagara Falls Site, as will all emergent and urgent cases on evenings and weekends.
We have highly specialized services such as vascular and gynecological surgical procedures that are only delivered at our St. Catharines Site. We have significant experience safely stabilizing and transferring patients for many years without incident. We will continue to monitor patient safety and experiences to make improvements to our workflow as needed.
By the numbers:- 24/7... Open hours of the Welland Site Emergency Department today and moving forward
- Feb. 27 ... The day the changes will go into effect
- 8 a.m. to 4 p.m. ... Hours of the Welland Site operating room after Feb. 27, 2023
- 3,392 … Total after-hours surgical procedures at Niagara Health in 2022
- 907 … Number of after-hours cases at the Welland Site in 2022
- 57 … Number of after-hours emergency cases at the Welland Site in 2022
We are confident in our ongoing work and want to thank all of the teams who actively engaged and collaborated in designing a process that will allow us to continue providing these important surgical procedures in the safest way possible, while best utilizing our specialists.
As with any change, this is a work in progress. We’re committed to ensuring positive patient experiences and will be reaching out to hear their stories. We will learn from their input in an effort to continually improve our plan. We will continue to share updates as the plan progresses and we have enlisted the help of working groups who will make sure the plan is successful. We have committed to monitor this on a daily basis to track and improve our operational workflow. Changes will be made as necessary.
Jan. 26, 2023:
We know there are a lot of questions about what’s happening at our Welland and Niagara Falls sites. The impact is being felt across the organization as we work to manage our immediate health human resources pressures, specifically when it comes to anesthesiologists.
Niagara Health is working on a plan to maintain operating services, scheduled surgeries and orthopedic cases at the Welland Site. The current model is unsustainable.
Here’s the challenge:
- The Department of Anesthesia at Niagara Health has continued to recruit new anesthesiologists. There is a national and provincial shortage of anesthesiologists despite very successful recruitment in the past. Because of the shortage, we have been unable to replace recent departures and have expected future retirements.
- We are looking at ways to mitigate the impact of the anesthesiologist shortage on patients and best utilize our team. We currently have 25 anesthesiologists with 20 available for on-call work. Of those, up to six are eligible to retire this year. In order to maintain the current level of service, we need 30 of these specialists.
- We need to adapt the way we provide care in a way that allows us to:
- Continue emergency and scheduled surgical care for our community
- Retain the anesthesiologists we have and recruit new members to our Department
- Continue building on our strengths to recruit new specialists to Niagara Health
- Are working tirelessly to recruit and to make our organization as attractive as possible. From a recruitment perspective, peer organizations with single sites, and therefore lower call frequencies for the anesthesia team, are a draw to highly in-demand anesthesiologists. We have had a number of physicians leave Niagara Health to join single-site hospitals.
- Have explored all avenues, including looking at opportunities within and outside of Canada and other models including the use of anesthesia assistants, supervised nurse sedation, and GP anesthesia to expand our blended-care model. It is important to note that expanding care models requires time to implement.
- Patient care and safety is our number one priority
- We must find a sustainable health human resource service model
- Our approach will be based on standardization and evidence-based practice
- While not-yet-finalized, we are working on a model that will allow us to continue operating at the Welland Site Monday to Friday from 8 a.m. to 4 p.m.
- Our emergency departments and medical services in Welland, Niagara Falls and St. Catharines will remain open at all times.
- The Welland Site operating room will close from 4 p.m. to 8 a.m. during weekdays and around the clock on Saturdays and Sundays.
- Emergent and urgent surgical cases from the Welland Site will be transferred to the Niagara Falls Site overnight and on weekends. The St. Catharines Site will continue to receive transfers for vascular surgery and obstetrics cases at all times.
Addressing concerns:
We have heard lots of questions and concerns, all of which we take very seriously.
How can you ensure patients are receiving care safely?
NH is working with physicians and staff to address concerns about specific clinical scenarios and conditions. We have strong experience with patient stabilization and transfers because vascular surgeries, stroke, women in labour, and other clinical services are only provided at a specific site, so if a patient arrives at another site, there is a process and protocol for immediate transfer.
Why are you changing the services at the Welland and Niagara Falls sites?
Niagara Falls and St. Catharines have greater capacity to manage increasing patient volumes but we still need the Welland operating rooms to continue to be used at their current capacity for scheduled surgery.
Do you already have a plan?
The plan is a work in progress aimed at figuring out how best to deal with operational issues while ensuring patients across the Niagara region get the care they need. While details of the plan are still being worked out, we’re aiming to have the new model in place by Monday, Feb. 27 because after that date, we will no longer have anesthesiologists on-call at night and on the weekends in Welland.
Is this a part of a bigger plan to move toward a two acute care site model with an ambulatory care site, or the result of the provincial government’s announcement around private surgical clinics?
No, this is about immediate HHR pressures. This is not about any plans for private clinics or about the regional model identified in our 2023-28 Strategic Plan. Changes to the Welland Site have been communicated regularly since 2016 and then again in 2018 after the new South Niagara Site hospital was approved. You can find more information about the redevelopment on the South Niagara Site webpage.
Will these additional transfers from the Welland Site to the Niagara Falls Site tie up ambulances and make ambulance off-load times and ambulance availability worse?
The clinical team determines which type of transportation is required for patients. EMS will only be used when emergency transportation is required. In most cases, the hospital will use non-urgent patient transfer. We do not anticipate that this will increase offload hours.
Some are suggesting that, even though there is a shortage of anesthesiologists, the Welland Site should continue to provide emergency surgery overnight and on weekends. Why isn’t NH doing this?
Our current anesthesiologist group is unable to continue to provide call coverage at three sites given the number of vacancies. If we continue with the current call schedule, we expect more of our anesthesiologists to take jobs at other hospitals with less on-call burden. As we know, most hospitals in the province are heavily recruiting anesthesiologists. If we lose more of our anesthesia team, we would likely need to reduce access to surgical services, including scheduled care for which we currently have a backlog.
