June 14, 2017

WRHA provides timeline for change

Victoria Hospital, Misericordia Health Centre see first changes this fall

Building upon previously announced broad changes, the Winnipeg Regional Health Authority today provided a detailed update on progress towards the consolidation of health care services, with improved quality and timeliness of patient care at the forefront.

When compared to the national average in key measurements such as emergency room wait times, lengths of stay and access to diagnostics and specialty services, Winnipeg’s health care system consistently falls behind its counterparts in other regions of Canada. The changes announced in April 2017 closely follow the recommendations of independent consultant Dr. David Peachey’s Clinical and Preventive Services Planning for Manitoba study, on the allocation and delivery of health care services.

“Despite having more hospital beds, more personal care home beds and more health care spending than other similarly sized jurisdictions,” said Lori Lamont, vice president and chief nursing officer. “We know that Winnipeggers experience some of the longest Emergency Department wait times in Canada – up to five hours to see an emergency physician, which is the longest wait of all 25 health organizations that annually report data to the Canadian Institute for Health Information. As well, their in-patient length of stay in hospital is 23 per cent longer than the national average.”

In the weeks since the reconfiguration of the health system was announced, a detailed implementation plan has been in development, aimed at addressing those challenges while delivering safe, quality patient care.

To support that patient focus, a number of open staff forums have taken place at each health care site to educate front line staff about the details of the plan, to enable them to ask questions and offer feedback. In total, about 3,000 staff members took part in this initial phase of staff engagement, with additional forums in administrative support areas and community service offices to follow in the coming weeks. These staff forums will be an ongoing element of the implementation and will occur regularly as changes take place.

An emphasis has also been placed on ensuring active engagement with union leaders. This permits information sharing and allows for dialogue about the staffing impact of consolidation within the context of collective agreements. These meetings will be ongoing and are slated to continue monthly.

“There is widespread agreement that the current system – marked by excessive wait times, frequent medical transfers between hospitals and limited physician resources spread across too many sites – is in need of change if it is to become more effective, efficient and sustainable over the long term,” said Lamont. “While this plan is based on a wealth of research or best practices and has been successful in other jurisdictions, we acknowledge that change can be difficult. We are committed to providing regular updates to patients and staff in order to help Manitobans understand why these changes are necessary and how they will deliver a better health system.”

Today’s update revealed the implementation timeline relative to the first phase of the plan, with the following changes taking place in October 2017:

  • Victoria Hospital Emergency Department will convert to an Urgent Care Centre;
    • Victoria Emergency Department currently sees 88 patients daily on average, half of whom could be appropriately treated at an Urgent Care Centre. Capacity is being created at St. Boniface, Grace and HSC in advance of the change to handle any additional patient intake.
  • Misericordia Urgent Care Centre will begin conversion to the Community IV Clinic;
    • Misericordia currently sees 106 patients daily on average, half of whom would be appropriately treated by a Primary Care Physician. Of the 29,000 who present from outside the downtown area, patients can be seen by their primary care provider, community clinic, Emergency Department or Urgent Care Centre closest to their home. In advance of the change, additional capacity is being created at St. Boniface, Grace and HSC to handle any additional patient intake.
  • New clinical assessment units will open at the Grace and St. Boniface Hospitals with an accompanying expansion of assessment services at Health Sciences Centre. These units will support emergency department patients who require longer assessment and observation, thereby freeing up space and staff resources within the Emergency Departments to deal with patient intake;
  • The Intensive Care capacity currently located at Victoria Hospital will relocate to Grace and St. Boniface Hospitals;
  • New special needs behaviour beds will open at Deer Lodge Centre;
  • Inpatient beds at Victoria Hospital will shift their focus to transitional and complex continuing care;
  • Medicine beds across the WRHA will begin to be defined and grouped in order to match specific patient needs such as acute medicine, complex continuing care, and transitional care;
  • Geriatric Rehabilitation will move from its current locations at St. Boniface Hospital and Riverview Health Centre to Victoria Hospital and Deer Lodge Centre, providing an environment that will allow for appropriate, personalized patient care;
  • Enhanced home care services will begin, and are expected to immediately reduce dependency on hospital beds by ensuring resources are available to support people in the community which will reduce the region’s personal care home admission rates; and
  • Transitional capacity will be developed outside the hospital environment to reduce reliance on hospital beds for patients who could be better cared for in the community.

To prepare for these changes and to ensure capacity is created in other areas of the health system prior to any changes to Victoria Hospital Emergency Department or Misericordia Urgent Care Centre, the following will occur over the summer and early fall of 2017:

  • Roles of hospital units will change so that patients are better grouped according to the care they require. Staff will be engaged to prepare for these changes and training will be delivered where needed to ensure the delivery of more appropriate, personalized care;
  • Lab and diagnostic services will be redeployed to ensure appropriate resources are available in the right place;
  • Ambulance protocols will be updated to ensure paramedics are fully informed and educated of the appropriate hospitals that they should be transporting patients to, depending on the care required in each individual case;
  • A public education campaign will help inform patients and their families regarding what is an emergency medical situation and where to go if one happens; and
  • A model for emergency capacity to respond to urgent changes in patient condition is being developed and will be implemented at Misericordia Health Centre this fall and in the future, at Concordia Hospital.

Phase II changes will occur in spring/summer, 2018 and the public will be kept informed as to the changes that may be expected. They include:

  • The opening of the new and expanded Grace Emergency Department;
  • The conversion of Seven Oaks Emergency Department to an Urgent Care Centre;
  • Building capacity to transition Concordia Emergency Department services to other sites;
  • Seven Oaks and Concordia medicine beds will refocus to transitional care and complex continuing care; ICU services will shift to the three acute sites at Health Sciences Centre, St. Boniface and Grace;
  • Inpatient surgical services will shift from Seven Oaks to other sites; and
  • Mental Health services will move from Grace and Seven Oaks to Victoria, Health Sciences Centre and St. Boniface Hospital.

A focus on sustainability has already begun to show improvements across the system. Savings so far include:

  • Use of Constant Care has decreased 31% year-over-year ($500K)
  • Heavy Workload has decreased 25% year-over-year ($750K)
  • Overtime premiums have decreased 43% year-over-year ($1.75M)
  • Medical Surgical supply costs are down 7.8% ($2M)

Ensuring patients, their families, staff and sites have the information they need to understand the changes and make appropriate care decisions is also an important part of the Healing our Health System plan. A public education campaign was launched when the plan was announced in April 2017 but was temporarily suspended during the provincial by-election blackout period.

Going forward, education and awareness materials will be back in the public realm to assist patients in understanding how these changes will impact them. This includes an online component with an interactive map indicating where services are available and when and how changes are taking place. Sites will also be provided with materials, such as an interactive map to share with patients about changes taking place specific to hospitals and health centres.

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