Hospital Improvement Plan Implementation

Niagara Health System

• Developing the Plan
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    • The Hospital Improvement Plan
    • Emergency Care in Fort Erie/Port Colborne
    • Women’s & Children’s Health
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    • HIP Addendum – December 2008
    • HIP Addendum & Site Charts – November 2008
    • Kitts Review & Recommendations – October 2008
    • Consultation Summary Report – October 2008
    • Draft Hospital Improvement Plan – July 2008
    • Health Experts Say …
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• Implementing the HIP
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  • Site & Services – Now and by 2013
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  • Effective Use of Patient Care Equipment
  • HIP Implementation Steering Committee
• Stakeholder Relations
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March 02 2009 Community Advisory Forum

Held at Welland Hospital Site Auditorium from 4-6 p.m.

Summary of Questions and Answers

Can the necessary enablers to convert Port Colborne’s Emergency Department (ED) to an Urgent Care Centre be in place by July?

There are a number of enablers or key components to be put in place, and the one that must be resolved before the Urgent Care Centre opens is the question of how physicians are compensated.

Right now, rather than the fee-for-service model which compensates physicians based on how many patients they treat, we use an Emergency Department Alternate Funding Arrangement, paying our small ED physicians an hourly rate to compensate for the low volumes of patients they see through the night. Converting an ED to an Urgent Care Centre does not mean that the current funding model will automatically transfer. A 24-hour Urgent Care Centre is a new concept in Ontario and we must have discussions with the Ministry of Health and Long-Term Care to establish an appropriate method of funding for physicians who will work in the new Urgent Care Centres. We cannot open the Port Colborne or Douglas Memorial Urgent Cares Centre until that funding method for physicians is in place.

Other enablers (or key components) for the conversion to Urgent Care at Port Colborne and Douglas Memorial include working with Niagara Emergency Medical Services (EMS) to ensure standards and protocols are appropriate for transferring patients from Urgent Care. As well, we must provide frequent and ongoing education to the local communities regarding when to use the Urgent Care Centre or an Emergency Department and when to call 911 for ambulance assistance.

Fortunately, the NHS has had experience in transitioning an ED to an Urgent/Prompt Care Centre at the Ontario Street Site in St. Catharines, and is now reviewing those transition plans for Port Colborne. Some of these plans may include having ambulances onsite at Port Colborne Site for the first few weeks to provide swift transport to a larger ED for those patients who present with a life-threatening condition.

No changes to the services provided will be implemented until it is safe to do so.

Wait times are a concern, as is the funding model for physicians. What can we do as community leaders to assist the NHS in ensuring these enablers or key components are in place and the community gets the care they need quickly?

The NHS is grateful for any support our community leaders and partners can provide. We need to work with all our partners to ensure that preparations are complete, such as community education and physician funding, and we welcome your input.

Are there plans to move the location of the Urgent Care Centre at Port Colborne to another part of the building?

This is one possibility. One of the options our functional planning team (staff/physicians at Port Colborne Site) is looking at is moving the Urgent Care Centre up to the main floor (1 West), where there is more space, more light, less renovation work/cost needed, and access from the front entrance. Until now, we’ve focused on renovating the existing ED, but treating patients in the same area that you are renovating is very difficult, and the current space does not meet Ministry square footage requirements, based on the fact that we will continue to treat more than 20,000 outpatient/year at Port Colborne. To stay on the lower level and expand the space, Diagnostic Imaging and Health Records space would have to be relocated, which is costly.

No final decisions have been made, but our Emergency staff members are actively involved with the architects in reviewing the pros and cons of both locations from a patient and staff perspective.

In Petrolia, the LHIN there chose to listen to the community, and not convert their ED to an Urgent Care Centre. Why is that option not being reconsidered?

The decision made in Petrolia/Sarnia emergency services was made in circumstances different from Niagara. The ED in Sarnia is very undersized and therefore wouldn’t be able to handle the additional cases from Petrolia, Wyoming and other neighbouring communities. There is currently a new hospital under construction in Sarnia. It is slated for completion in a few years, and at that time, the status of the Petrolia ED will be re-examined.

In Niagara, we have ample capacity at Welland’s ED to manage the 1,400 additional cases that will come from Port Colborne and similarly at the new Niagara Falls ED, there is capacity to absorb 1,800 visits from the Fort Erie community at the Greater Niagara ED.

Is dialysis still coming to Greater Niagara General Site? What about stroke care and diabetes?

Yes – we plan to locate a satellite dialysis clinic at our Greater Niagara Site, similar to the new outpatient dialysis centre we opened at Welland Site last year. As well, we are planning to locate the Centre of Excellence for Stroke Care at the Greater Niagara Site. The development of the 10-bed specialized stroke centre is dependent upon our receipt of new funding to support the centre. This specialized acute stroke centre will be a much-needed first for Niagara.

The administrative offices for the Niagara Diabetes Centre are being relocated from the Ontario Street in St. Catharines to the Welland Site. This move will take place in July, 2009 and outpatient diabetes education clinics will continue at our other locations.

From the Niagara Region Public Health perspective, we are committed to working through the many issues, including Niagara EMS and mental health challenges. To get Niagara the services we need and deserve, such as the new stroke inpatient unit and other services, we need to strategically support these critical initiatives and show our support to the LHIN. How can we work together to do this?

We are gratified to hear your support and willingness to advocate on behalf of our patients. We would welcome letters and other methods of support and will bring to the next meeting some ideas for discussion on how Niagara, speaking with one voice on healthcare, can have a positive impact on our funders.

In Wainfleet, our volunteer firefighters are now expected to remain on the scene of an accident until Niagara EMS arrives and sometimes accompany them to Welland Site. Are there any plans to offer expense reimbursement for mileage and time?

Off-load delays in our EDs are an issue for EMS, our own staff, and for our partners such as your example. We are working to reduce off-load delays and we’ve received special funding for that, but we’re not aware of any funding available to compensate partners for that additional time and mileage.
The Dr. Kitts recommendations noted that our local fire departments are using protocols that are not being used elsewhere in the province, and recommended that these protocols be revisited.

Is there any funding available to be transferred to the communities to help with education on Urgent Care versus ED use?

Unfortunately, we haven’t received any additional funds to implement HIP so far. We must roll out these initiatives within our existing budget and we’ve been fortunate to garner sponsorship from Sun Media for space in the daily newspapers, so that will help in our community education. We are working on a number of communication tactics to reach residents and welcome any support and partnerships offered.

Regarding the Centre of Excellence for Women’s and Children’s Health in St. Catharines, it will be wonderful to have a place that’s offering first-rate care in a great new environment. Is there something you can communicate to the naysayers out there who persist in talking about mothers delivering babies in the back of a cab?

Having a baby is a planned event. In nearly all cases there is plenty of time to teach expectant mothers about the signs and symptoms for the on-set of a baby’s birth. Very rarely has it been the case that expectant mothers deliver their babies en route to hospital but if a delivery is imminent, calling 911 should be the first course of action

Are you going to be speaking to the family physicians who still deliver babies and who are concerned about not being able to conveniently do this in Welland or Niagara Falls, once the new hospital in St. Catharines opens?

Yes, we are happy to have discussions with them. Any kind of change to a physician’s practice patterns is difficult, but by no means should this change be impossible for those family physicians. We want them to continue seeing their pre-natal patients in their home communities, and when it is time to deliver the baby, there should be a way that the family physician can get to St. Catharines in time to manage the delivery. It’s also important to note that routine diagnostic services for pregnant women, such as ultrasound, will still be available at all three large sites.