NIAGARA, ON: Work to improve quality patient care in Niagara is moving forward in Year One of the Hospital Improvement Plan (HIP) with the identification of a number of initiatives that can take place at the Niagara Health System (NHS) between Spring and Fall 2009.
"The challenges we face in Niagara are not unique," says NHS President and CEO Debbie Sevenpifer. "Across Ontario, hospitals are making changes to the way patient care is delivered, both to improve quality of care and to better manage limited financial and human resources."
"Our Local Health Integration Network (HNHB LHIN) asked us to identify early HIP opportunities by the end of February on initiatives that can be rolled out in the next several months," adds Mrs. Sevenpifer. "On May 1, we will have a complete HIP implementation schedule identifying all of the changes that will take us to 2013. We are entering a period of great change, and we are committed to communicating as much as possible as details are developed."
Early opportunities were defined as those initiatives that can be implemented in the next two to four months with priority given to programs where previous recommendations for changes were made through external reviews, accreditation or previous program discussions and programs where human resources are at risk.
The initiatives are in the surgical, medicine and emergency programs, as well as three feasibility studies to be completed by this Fall. These initiatives, approved by the NHS Board of Trustees, are outlined in the attached backgrounder and in the March 2009 issue of HIP Implementation Update.
For more information, please contact:
Caroline Bourque Wiley
Consultant, Public Affairs
905-378-4647, ext. 43113
Early opportunities are the HIP changes that will be put in place over the next several months. Read on for a snapshot of the early opportunities targeted to be in place this year.
Surgical Program (Operative/Peri-Operative)
Creating centres of excellence for surgical services will help improve quality. By 2013, surgical specialties will be located at either Niagara Falls, St. Catharines or Welland sites, bringing together a critical mass or high volume of patients. This enables better clinical competency and effective use of our human resources. By grouping the same types of surgery together, we can avoid buying multiple sets of costly surgical equipment. Consolidating surgical services is being driven by quality much more than by cost savings. We are pursuing any and all opportunities to continue providing outpatient surgical clinics at all sites.
Ophthalmology – Eye surgery procedures, including cataract removal, are mostly day surgeries. As an initial step to create a centre of excellence for ophthalmology, the service is targeted to move from 5 sites to 2 sites by May 19 – to be located at Welland Hospital Site and Ontario Street Site in St. Catharines. Some purchases of surgical equipment will be necessary before this move can occur. Welland’s surgical suites will need renovations over the next 4 years to manage all of the 5,800 cases per year, and by 2013 will be the centre of excellence.
Plastic Surgery (specialized face/hand reconstruction) – Right now, Welland, Niagara Falls and St. Catharines sites offer procedures by plastic surgeons. This spring, there will be two centres – Greater Niagara General Site and St. Catharines General Site – since these cities currently have the highest volumes of emergency patients requiring this specialized surgery. By this May, cases now treated in Welland will go to Greater Niagara General Site.
Dental Surgery – Greater Niagara General Site has the highest patient volumes for dental/oral surgery and sufficient expertise of staff, so by 2013, all dental/oral surgery will be consolidated at Niagara Falls. As an interim step, on May 19, dental surgical cases from Fort Erie, Port Colborne and Welland will move to Niagara Falls.
Day Surgery Closure at Fort Erie and Port Colborne – With the ophthalmology and other centres of excellence opening and the low volume of day surgery cases at Douglas Memorial and Port Colborne sites, these surgical suites will close May 19.
New Acute Stroke Inpatient Unit – Niagara has long needed consolidated services for recovering stroke patients. Right now, all patients assessed as having a stroke or mini-stroke (TIA) are transported to Niagara Falls where they are seen by a specialty team. A funding request to our LHIN has been made to operate a specialty 10-bed inpatient stroke unit at Greater Niagara General Site. If funding is approved, a specialized stroke unit can be opened this summer. This type of service doesn’t exist in Niagara right now.
Niagara Diabetes Centre – By 2013, the Welland site will be the centre of excellence for diabetes, with satellite clinics in Fort Erie, Grimsby, Niagara Falls, Port Colborne and St. Catharines. The centre will move to Welland by July 6.
Identification of Bed Closures – The HIP outlines the eventual closure of 82 acute medical beds by 2013. We are in the process of identifying the location of the first 30 acute-care beds to be closed, once new community services are in place for our seniors. Bed closures are contingent on Aging at Home strategy announcements expected in 2009 which will fund new programs to help seniors who need more community supports, allowing them to be discharged safely from hospital. Further details, including an impact analysis, are being developed. Currently, the NHS has 520 acute-care beds at our 6 inpatient locations. Of that total, about 150 beds or 29% are occupied by alternate level of care patients, meaning these patients are beyond the acute phase of their illness and no longer require hospital care.
Designating Alternate Level of Care (ALC) Assessment Beds in Fort Erie and Port Colborne – Right now, over 50% of the inpatients at these two sites require a different kind of care than acute hospital care. They require care in a long-term care setting, a rehabilitative setting, or returning home with support services.
By July 6, we will be changing the designation of 53 beds at Douglas Memorial (25) and Port Colborne sites (28) to better reflect the type of care these patients need while in hospital. Currently, these beds are designated acute medicine/surgery, but the reality is that most patients in these beds are beyond an acute illness and require an alternate level of care.
This clustering of ALC Assessment beds will mean we change the skill-mix of nursing staff (RN, RPN, Personal Support Worker) delivering bedside care. There will be at least 4 acute-care beds kept in place at each site to serve patients needing acute care, until the urgent care centres with their observation beds are fully up and running.
Conversion of Port Colborne Emergency Department (ED) to Urgent Care Centre (UCC) – Conversion to a 24/7 urgent care centre with a physician and registered nurses on duty to provide care is targeted for this July. As a UCC, over 95% of the patients who currently use the ED (about 21,000 cases/year) will continue to be treated at Port Colborne for urgent and non-urgent outpatient care. Renovation planning, led by an architectural team and involving staff for the new UCC is underway. Life and limb-threatening cases will go primarily to Welland site, which was built to manage 40,000 patients per year (currently has 28,000 visits/year) and has the space, access to specialist care and diagnostics to serve the approximately 1,400 more cases projected to be seen.
More information will be forthcoming on this conversion and what it means for patients. We are working closely with all partners, including Niagara Emergency Medical Services (ambulance/paramedics) and the Ministry of Health and Long-Term Care to ensure a smooth transition. Discussions include developing an appropriate funding model for physicians.
Feasibility Planning Underway
Maternal/Child Program Plan to Possibly Consolidate to 2 Sites – Right now, maternal/child services are offered in Niagara Falls, St. Catharines and Welland. By 2013, all women’s and children’s inpatient services will be offered at the new health-care complex in St. Catharines, but as with other programs, a transitional plan may be possible in the short term. The program leadership is working on a feasibility study and plan to identify the possibility of phasing in this consolidation, by moving first to 2 sites yet to be identified. This feasibility study and resulting plan will be complete by July 21.
Consolidating Addiction Recovery Services – Currently, withdrawal management (detox) services are offered at Ontario Street Site in St. Catharines, and intensive residential rehab/counselling services are offered at New Port Centre at Port Colborne site. Integrating these programs is in the best interest of clients and a feasibility study to consolidate will be completed by this Fall.
Consolidating Inpatient Mental Health to 1 or 2 Sites – Currently, 58 inpatient mental health beds are located in Niagara Falls, St. Catharines and Welland sites. A feasibility study will be completed by July that explores early consolidation of inpatient beds to 1 or 2 sites. By 2013, all inpatient mental health beds, including new tertiary or long-term care beds, will be located at the new health-care complex in St. Catharines, as the centre of excellence for mental health.