Women’s and Children’s Health


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About Women’s and Children’s Health – Creating a Centre of Excellence

Submitted by Niagara Obstetricians and Gynecologists … Doctors Bedkowski, Chan, Chaudhry, Cheema, Dobosiewicz, Nowicki, Okon, Shetty, Sternadel, Viljoen, Yegappan

Creating a Centre of Excellence for Women’s and Children’s Health at the future health-care complex in St. Catharines is one of the elements of our overall vision to improve patient care across Niagara.

The proposed Centre would expand the focus to women’s care across all ages and would provide surgical and inpatient care to infants, children and youth up to age 18. A 24-bed paediatric unit would include three beds for continuous monitoring of a critically-ill child. For the first time in Niagara, four beds will be assigned for children and youth with mental health issues. Outpatient services will include day surgery, medical day care and outpatient clinics.

Having this critical patient mass in one location will allow us to offer excellent physician training programs for tomorrow’s obstetricians, gynecologists and pediatricians. This opportunity is vital to recruit future specialists, particularly when the average age of our specialists now is 57.

Currently, our Maternal Child Program offers full obstetrical care to women of child-bearing age and inpatient/ outpatient care to children from birth to age 18 at Greater Niagara General Site, St. Catharines General Site and Welland Hospital Site.

Extensive research studies show that the lower the number of deliveries in a single obstetrical unit, the higher the risk for both mother and baby. A 10-year research study in Germany and Norway concludes that the chance of neonatal death increases if the number of low-risk deliveries is below 2,000 per year in a single delivery unit.

Population projections show that by 2011 the Niagara child/youth population will decline by 6.7% and the number of women of child-bearing age will decline by 2.1%. In Niagara, the number of hospital births last year was as follows:

While the number of births at each site is below the threshold, the combined total is well over the threshold shown to reduce risk of mortality for newborns.

The NHS Maternal Child Program also underwent an external review by well-known clinical experts in 2004 with the following key recommendations:

The Canadian Nursing Association reports that last year, there were 9,447 nursing graduates in Canada, compared to the need for 12,000 graduates each year. Ensuring adequate nursing and physician coverage for each shift is becoming difficult, as our staff nears retirement age and recruitment becomes more challenging provincially, nationally and internationally.  From a staffing perspective, centralizing the Maternal/Child program is the only possible way we can continue to provide quality and safe patient care.

Of course, quick access to care is essential for labouring mothers and mapping methodology shows that travel time for 90% of Niagara residents to the new health-care complex in St. Catharines will be 30 minutes or less – shorter than travel times to hospitals for many patients in the greater Toronto area and elsewhere in Ontario.

Emergency care for mothers, babies, children and youth will continue to be provided within all of the NHS’s designated Emergency Departments and Prompt/Urgent Care Centres. Currently, 96 per cent of paediatric patients coming to our Emergency Departments are treated and released the same day.

Our vision is ambitious, but we feel that this is the health care Niagara deserves and needs. Over the next five years, we will be working with our partners to accomplish a better-care model.

We welcome the public’s feedback on the vision for change we’ve proposed … fill in the Your Input survey.

For a print version, click HERE.

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Letter to the Editor: Niagara Health System Proposal for Hospital Improvement – September 5, 2008

I have had an opportunity to review the Proposal for Hospital Improvement submitted by the Niagara Health System (NHS) to the Local Health Integration Network on July 15th 2008. I note that this proposal has been well received by many users and providers of health care in the region, but has been seen by some as an unwelcome and perhaps unnecessary upset of the status quo. As I was involved in an external review of the Women’s and Infant’s Health Care (WICH) component at the request of NHS in 2004 I would like to offer what I feel is an independent perspective on the issue.

Back in 2000 the three hospitals providing WIHC in the region were amalgamated under one board by order of the Ontario Hospitals Restructuring Committee. This was but a first step towards true amalgamation, with little attention at that time to detailed implementation, and the real advantages of amalgamation were not fully realized. Hoped-for advantages had been elimination of duplication with cost savings redirected to improved patient care; creation of centres of excellence on specific sites; development of standardized and constantly updated treatment methods across the region; improved ability to recruit new doctors and nurses; and closer ties with McMaster Medical Centre.

The situation was felt to be unsatisfactory by the NHS leadership who in 2004 requested an independent external review by the group of which I was a part about how Women’s and Infants’ Health Care was being provided and how it might be improved.

As a reviewer, I was immediately struck at that time by the wide dispersal of limited resources and staff over three relatively small, low-volume units, all within a 30-minute driving radius. Experience in other parts of Canada had already shown advantages to quality of care and clinical outcomes in WIHC by program consolidation on a single central site.

I am convinced that consolidation of WIHC on one site in the Niagara region will facilitate the development of a more sophisticated, advanced and comprehensive program making the region more attractive for recruitment of specialists thereby reducing the need for referral of patients out of the region for high risk pregnancy, intensive care of the premature newborn, gynecological cancer and the advanced techniques now available for the treatment of infertility. The more effective use of resources should reduce wait times and improve patient safety.

I do recognize that any proposal to consolidate will not be popular with patients who might have to travel a little farther to clinics and hospital, and with some physicians who may have to relocate their practices.  However, experience elsewhere clearly indicates that implementation of this proposal will enhance the quality and accessibility of WIHC in the Niagara region.

Dr. Ron Livingstone
Obstetrician and Gynecologist, Toronto
Professor Emeritus, University of Toronto

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