Women’s and Children’s Health
Creating a Centre of Excellence
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Submitted by the following Niagara Obstetricians and Gynecologists … Doctors Wojciech Bedkowski, Anthony Chan, Naheed Chaudhry, Gurnam Cheema, Andrzej Dobosiewicz, Robert Nowicki, Marquis Okon, Rathnakar Shetty, Jerzy Sternadel, Johan Viljoen, Muthulakshmi Yegappan
For the detailed Info Sheet in print format, click HERE.
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 into the future.
- This shifts our current focus on women of childbearing age to women’s care across all ages – from those who need obstetrical care, to health services for menopausal and post-menopausal women. Women’s care includes breast screening, bone densitometry, gynecology and other female-specific care, targeting the majority of our female population, which is approaching or over age 50.
- Would provide surgical and inpatient care to infants, children and youth up to age 18. The new Centre would feature a 24-bed paediatric unit, including three beds for continuous monitoring of a critically-ill child (example is a severe respiratory condition). For the first time in Niagara, four beds will be assigned for children and youth requiring hospitalization for mental health issues. Outpatient services will include day surgery, medical day care and clinics for chronic disease management, such as asthma and diabetes.
- Concentrating all care and support resources in one location will enhance the level of care for women and children. Having this critical patient mass will allow us to offer excellent physician training programs for tomorrow’s obstetricians, gynecologists and pediatricians. Having medical students and residents train in Niagara through the McMaster University Medical School is vital to recruit future specialists, particularly when the average age of our specialists now is 57.
Current Services
Our Maternal Child Program now offers a range of services to support obstetrical patients from prenatal care, through labour/delivery and post-partum care. As well as providing care to moms, our hospitals offer inpatient and outpatient care to children from birth to age 17. These services are offered at the following sites:
- Greater Niagara General Site (Niagara Falls), St. Catharines General Site, Welland Hospital Site
- There were 3,313 live births in 2002. This decreased to 2,967 live births in our last fiscal year (April/07 to March/08).
- Population projections show that by 2011 the child/youth population will decline by 6.7% and the number of women of child-bearing age (16 to 44) will decline by 2.1%.
Obstetrics
Extensive research studies show that the lower the number of deliveries in an 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 [Heller, G. et al; Moster, D. et al].
In Niagara, the number of hospital births in fiscal 2007-08 was as follows:
- Greater Niagara General Site – 968
- St. Catharines General Site – 1,285
- Welland Hospital Site – 716
- Total births – 2,967
Individually, each of these sites delivers less than the optimal threshold of 2,000 births in a single location. The combined total for all three sites was 2,967 births, well over the threshold shown to reduce risk of mortality for newborns.
The NHS Maternal Child Program underwent an external review by well-known clinical experts in December 2004 [Livingstone, Ejwunmi, Hickey] with the following key recommendations:
- Planning in consultation with the Ministry of Health and Long Term Care should begin to identify a mechanism and appropriate site for a single centre of excellence for women’s and infant’s health on one site to serve the entire NHS.
- Consideration should be given to the inclusion of gynecology in the Maternal Child Program, converting this to a Women’s and Children’s Health Program.
- Consolidate all Level II (Special Care) Nurseries at one regional site with the recruitment of a Paediatrician with additional training and expertise in neonatology to ensure delivery of appropriate levels of care at that site.
Staff Shortages in Obstetrics and Paediatrics
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. 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. We are experiencing staff shortages and looming retirements of staff in the following areas:
- physicians, RNs and RPNs specializing in labour and delivery, post-partum, special care nursery and paediatrics
Therefore, from a staffing perspective, centralizing the Maternal/Child program is really the only possible way we can continue to provide quality and safe patient care.
Travel Time
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 Throughout Niagara
Emergency care for mothers, babies, children and youth will continue to be provided within all of the NHS’s designated Emergency Departments and Prompt 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.