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Healthiest People, Healthiest Communities, Exceptional Service
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Service Alignment
How do you know service alignment is going to improve patient care?
The Institute for Healthcare Improvement (www.ihi.org) encourages standardizing care as a key strategy to improving care. There are many studies that indicate outcomes are better for patients who receive care where the volume for that type of service is high. The necessary volume varies with the type of care needed.
Consolidating certain types of care on one or two sites allows for maximized use of staff, provides higher volume at the sites, and facilitates standardizing care. These factors together combine to help us improve patient care for all Saskatoon Health Region clients, patients and families.
Maximizing the use of staff is critical. Baby boomers are retiring and there are fewer people to recruit into health care careers. Because of base staffing requirements, small programs have high patient/staff ratios. Programs that provide a higher volume of service use staff more efficiently. As an example, to staff a four-bed observation unit requires two registered nurses, but these two nurses could look after six patients safely, so it is better use of staff to have a six-bed observation unit.
Which services are moving and where are they moving to?
- The ICU consolidated from City Hospital to St. Paul’s Hospital on October 1, 2008.
- General Internal Medicine wards consolidated to St. Paul’s and RUH beginning January 19, 2009. Persons in Saskatoon hospitals who are awaiting placement in long term care will now be cared for at Saskatoon City Hospital until they are placed into a long term care facility.
- Given that most patients who use the Progressive Care Unit at City are medical patients, the PCU moved to St. Paul’s on February 2, 2009.
- Inpatient urology surgery moved from City to St. Paul’s on February 2 where most inpatient urology surgery is already planned.
A core planning team has met to plan and discuss ambulatory care changes. A full steering committee is expected to form in early 2009.
A steering committe for complex continuing care began meeting in January 2009.
How does this help with our growing and aging population?
In developing its service alignment plan, the Region recognized the demographic changes facing its communities. The population is expected to increase 10.7 per cent between 2005 and 2021. The 60 to 69 age group will nearly double, due primarily to aging baby boomers; the "less than age one" group is expected to increase by 9.6 per cent.
If Saskatoon Health Region doesn't change how it currently provides care, then the projected population changes alone would require 239 additional acute care beds in Saskatoon by 2021. It would also require additional beds for rehabilitation, palliative care and other types of care, especially for patients with multiple chronic conditions.
These increases can be partially offset by changes in practice. The hundreds of physicians, nurses and other members of the 16 clinical advisory groups involved in developing our plan identified opportunities to improve efficiency through program consolidation, increased day surgery and outpatient care, new health care and information/communications technologies, standardization of practices and other improvements. These efficiencies could reduce the need for additional acute care beds to 76 by 2021 from 239.
Is there a model similar to what you are doing here being used elsewhere in Canada?
Many centres are consolidating services to varying degrees, based on how large the organization is and the population it serves.
- Trillium Health Services in Ontario has a centre that does day procedures, has long term care patients and an urgent care centre that is not open on the night shift. There is also no ICU or intermediate care unit. The employees working in the urgent care centre rotate through a full service emergency at another facility that Trillium owns and operates.
- Vancouver has UBC hospital that provides high volume day surgery services and does not have an intensive or intermediate care unit. There is a full emergency department at that hospital.
- The Riverside Campus of The Ottawa Hospital is a free-standing, outpatient facility without an ICU, PCU or Emergency Department. Should any patient require any other services, they are transferred to the facility that provides the care they need.
The general experience of these three facilities is that transfers are seldom necessary because they are very strict on the criteria determining who receives service at these sites.
What will be the financial cost of this and how will this money be found in the budget?
Given that the population projections are to 2021, and part of the plan is to position the Region so that it can provide the care needed for decades to come, it is not possible to predict firm and total costs. However, plans will be made annually and the costs for the portion to be carried out that year will be factored into that year’s budget. Longer range plans to increase capacity will also need to be carried out and approved by the Ministry of Health. The Region’s 2008-09 operating budget allocates resources to hire two positions that will support service alignment and ambulatory care planning.
Was any input given by doctors, nurses or other Region staff on how to improve services in Saskatoon Health Region?
There have been and continue to be many venues where all staff can make suggestions to improve care and ask questions about the planning process. Most units, programmes and/or departments have regular staff meetings and manager meetings where ideas can be brought forward. Many areas have improvement programs of varying sophistication where improvement ideas are generated and implemented. In regards to service alignment, hundreds of physicians, nurses and other staff have provided input at various stages over the past several years and continue to be involved in planning the consolidations. For example, more than 70 people were members of the six working groups on the two-site ICU consolidation project. These 70 people represent front line staff who work in ICU and departments whose work is influenced by the operation of ICU.
Saskatoon City Hospital
What will happen if a patient at Saskatoon City Hospital requires emergency care or acute care?
Some services have always been delivered at only one hospital, so all hospitals have had plans for transferring patients who need to go to another hospital for their care. There continues to be a variety of staff such as nurses, doctors and respiratory therapists at Saskatoon City Hospital with skills to manage emergency situations. Plans are in place to rapidly transport a patient to another hospital if they require care that is not available at City Hospital once the intensive care unit (ICU) and progressive care unit (PCU) move. The statistics indicate that once ICU, PCU and acute medicine have moved, this situation would occur approximately one to two times per month.
Are there any dangers for people living close to City Hospital not having an emergency room?
At present there is no plan to close the City Hospital Emergency Department which has been open from 9:00 a.m. to 8:30 p.m. for several years. As the role of City Hospital changes, we expect there will be different patterns of use for the City Emergency Department. This may create some change in the role City Emergency plays in Saskatoon Health Region. All residents of Saskatoon will continue to have access to the same 911 and ambulance services. Ambulances will continue to operate as they always have in taking people to hospital when required.
What is ambulatory care?
The recently accepted report on ambulatory care from Corpus Sanchez proposes the following definition:
“Ambulatory care is defined as a broad range of services, including prevention, assessment, diagnosis, treatment and rehabilitation that are most effectively delivered in an outpatient setting where hospitalization is not desired or required. These services will include specialty clinics; non-specialty clinics; community-based programs and services; day surgery; other primary health care services and private practice. These services will be patient-centred and delivered through a network of clinical and research sites, including, but not limited to, hospital-based outpatient clinic settings.”
While many people participated in visioning sessions with Corpus Sanchez to arrive at that definition the report suggests that “Saskatoon Health Region engage a broader group in a dialogue on the definition of ambulatory care and the vision to create a world-class centre at the Saskatoon City Hospital site as the hub for that vision, and the principles that will guide decisions on siting.”
Will SCH have an intermediate care unit?
A working group under the two-site ICU steering committee has been set up to evaluate the care needed by the inpatients who remain at City Hospital and create plans for providing care to those patients who require more care than a general ward bed. The progressive care unit will remained at City Hospital until February 2, 2009, when the acute medical beds move to St. Paul’s.
Will the surgical observation unit at SCH be only for surgical patients?
Yes. Patients requiring critical care or further general medical management will be transferred to either of the acute in-patient sites according to transfer guidelines.
What kinds of coverage will exist at SCH?
There will be critical care associate (CCA) and respiratory therapist (RT) coverage at SCH 24 hours per day, seven days per week. This will be assessed periodically. General internal medicine consultation will also be available, along with ongoing coverage from surgical specialists.
Other Topics
How will you improve the parking situation across the region?
There is widespread recognition that the supply of parking spaces needs to increase. The Region is in the early phases of working on a parking strategy.
At all three Saskatoon hospitals the access control systems are being overhauled. This technology will provide much greater information around usage patterns which will in turn allow the Region to issue more permits to fully utilize the available space. It has also made the physical entry and exit controls more reliable.
Clients are able to pay through new automated equipment or can deal with a person at a booth if they prefer a human touch.
There have been numerous upgrades and repairs to drainage systems, lighting and so forth. The Region is planning a significant multi-million dollar set of much needed repairs that will see new surface membranes installed, replaced expansion joints, concrete repairs and so forth.
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