October 26, 2017
WRHA updates Healing our Health System Plan
Three weeks into the first phase of clinical consolidation, the Winnipeg Regional Health Authority (WRHA) provided an update on the implementation of the changes to health care services in the region, including some early observations of the robust strategy developed to monitor effects on patient flow, safety, patient experience and the workforce.
“Early indicators show the detailed planning and preparation that has gone into the consolidation of health care services and the efforts of staff across the region are already resulting in some improvements to the quality and timeliness of patient care,” said Kelvin Goertzen, Minister of Health, Seniors and Active Living. “While we acknowledge the implementation of such broad changes will require significant monitoring over the longer term, we are pleased that preliminary data shows significant improvements have been made to emergency wait times over the same time frame last year.”
The region is closely monitoring patient experience and patient access to services as these first changes take place across the region. To that end, a robust monitoring strategy has been developed, focused on four broad areas:
- patient flow (emergency department wait times, inpatient waits, patient transfers);
- safety (readmissions, critical transfers, critical incidents);
- patient experience (complaints, new real-time surveys);
- workforce impacts (sick time, overtime).
Wait times in Winnipeg emergency departments are measured by 90th percentile and median monitoring. Data collected between October 3 and October 22 from all emergency and urgent care sites for median wait times within the region shows wait times have decreased 13 per cent over September 2017 and 28 per cent over the same time last year.
“We are carefully monitoring wait times and patient volume at all emergency departments and urgent care centres,” said Lori Lamont, chief nursing officer and vice president with the WRHA. “Since the conversion of Victoria Hospital’s emergency department to an urgent care, the site has seen more patients each day and has been successful in addressing the needs of those patients more quickly. Since October 3, wait times at Victoria General Hospital’s urgent care have been nearly half as long as they were at the same time last year in their emergency department.”
The WRHA also implemented a central bed access program in October 2017, using a phased in approach. This program will allows for a real time region-wide picture of bed occupancy intended to improve patient access to different areas of care across the system. Since implementing central bed access, more than 40 patients have been able to move out of acute care and into sub-acute and transitional care settings.
“Receiving care in a more appropriate environment to an individual’s health needs, improves the quality of their recovery and allows more acute care patients to move from emergency departments to inpatient units,” said Lamont. “This is also a key enabler of the early improvements we have seen in the length of stay of patients in the emergency department.”
Length of stay for patients in the emergency department (from the time they register as a patient to the time they are admitted to hospital) has decreased from a median of 14.7 hours in October 2016 to 11.5 hours between October 4 and October 24, 2017. This 22 per cent decrease brings the Winnipeg wait significantly closer to the Canadian average.
Safety monitoring indicates no spike in the reporting of potential critical incidents or occurrences. The number of transfers from the Victoria General Hospital urgent care to emergency departments has decreased from an average of seven per day during the week of October 3 to an average of less than five per day at present. No transfers back to acute care hospitals have been required to date.
The region also noted that emergency department patient satisfaction results have been trending upwards since the beginning of October, with 94 per cent of respondents to a new, real-time survey reporting a positive overall care experience.
The movement of staff to align with Phase I changes continues with the introduction of standardized models of care which are critical to the success of clinical consolidation.
“We are focused on minimizing the effects of these changes on each member of our staff wherever possible and will continue to work with the various unions affected with the goal of easing these transitions,” said Karlee Blatz, senior labour relations counsel for the WRHA. “Our staff play a key role in the success of this plan, and we appreciate their continued commitment to providing quality care during a period of much change.”
The region will continue to monitor patient experience and flow as well as safety risks and workforce impacts as the implementation of Phase 1 changes is completed. Remaining changes are expected to be complete by mid-November and include:
- Victoria General Hospital will begin to accept geriatric rehabilitation patients this week to their new Geriatric Rehabilitation Unit (30 beds);
- Priority Home, an intensive, short-term home care service for patients returning to or in community, will begin in November, 2017;
- Deer Lodge Centre will welcome additional patients with special and behavioural needs to a newly converted unit beginning in late November;
- Geriatric rehabilitation unit will move from Riverview to Deer Lodge Centre (DLC);
- The transitional care unit at HSC Winnipeg will close (those patients will receive care either at River Ridge II or Victoria General Hospital).
A number of capital projects to support upcoming changes in Phase 2 have also been awarded and work is now underway.
Further consolidation of health care services will begin with Phase 2 in spring 2018. Capital investments supporting these projects include enhancements to the emergency departments at HSC and St. Boniface hospitals, expansion of the surgical recovery and intensive care units at HSC, as well as improved treatment spaces for seniors, and the consolidation and enhancement of in-patient and out-patient mental health services.
“We have had positive public feedback regarding the continued professionalism and courtesy they experience during interactions with our staff during this time of major organizational change,” said Lamont. “The early statistical indicators of improvement as well as the positive feedback we’ve received from the public to date are good indicators that these changes have been a positive first step toward improving access to health services for Manitobans.”