Better services should result for Huron Perth residents thanks to integration
It is still early days for the amalgamation of three major community support service providers in Huron and Perth Counties, but great things are expected from the resulting organization: ONE CARE Home & Community Support Services.
Executive director Kathy Scanlon shared the ONE CARE story with attendees of a board to board engagement session held by the South West LHIN in Zurich on February 23rd. Kathy noted it was one of the new organization’s first presentations and the story is still unfolding.
ONE CARE is the amalgamation of Town and Country Support Services, Midwestern Adult Day Services and Stratford Meals on Wheels & Neighbourly Services – all charitable not-for profit community support service organizations with volunteer boards of directors providing support to seniors and adults with physical disabilities including individuals at risk of, or living with chronic disease.
What role do community services play in the overall system?
“I really believe that community services are the best kept secret in the health care system,” Kathy says. Unfortunately, she adds, theyare often under-utilized.
Hip fracture improvement project gets underway
Hip fracture wait times – the amount of time it takes for a patient to make it into surgery from the time they are admitted into an emergency department with a broken hip - have been in the sights of local health care leaders. In the first six months of 2009/10, only 78 per cent of patients in South West LHIN hospitals received their surgery within 48 hours of being admitted for a hip fracture. A lot of work still needs to be done as we know that people who have their hip repaired within 48 hours have better outcomes.
Working under the direction of the Ontario Orthopaedic Expert Panel, the Bone and Joint Health Network (BJHN) released care maps and other research-based recommendations to assist Ontario hospitals to meet the target of 90 per cent of patients receiving surgery within 48 hours of their hip fracture.
Improvements are underway across the South West LHIN as the BJHN care plans are implemented at hospitals that perform hip fracture repairs. They include: London Health Sciences Centre, St. Thomas Elgin General Hospital, Strathroy Middlesex General Hospital, Stratford General Hospital, and Grey Bruce Health Services - Owen Sound site. It is expected that Woodstock General Hospital will begin implementing the expert panel guidelines soon.
In addition, the South West LHIN Hospitals and South West CCAC Leadership Forum identified the need for a project that would increase access to hip fracture care and decrease the amount of time patients spend in acute care hospital beds who do not need to be there. The South West LHIN provided nearly $225,000 in one-time funds to LHSC to lead a project that focuses on improving the percentage of hip fracture repairs that are done within 48 hours and also improving patient flow within the system and between hospitals in the LHIN.
This project is in the early stages of implementation. Its purpose is to improve hospitals’ ability to meet the provincial target of hip fracture surgery within 48 hours of emergency department admission and diagnosis. It will also assess and implement other opportunities for improvement across the system that include the consideration of shared orthopaedic on-call coverage in communities where this could improve access. Patients with a hip fracture often arrive at an emergency department of a hospital that doesn’t do hip fracture surgery and need to be transferred to another hospital for the operation. For this reason, the South West LHIN Patient Access and Flow (one number) inter-hospital patient transfer protocols will also play a key role, enabling more timely movement of patients between hospitals.
Hip fractures represent significant risk for people, particularly for seniors. Hip fracture rates increase with age and represent the most common type of injury requiring hospitalization among people aged 65 years or older. The average age of those hospitalized in the South West LHIN in 2008/09 for a hip fracture was 81 for women and 73 for men. Hip fractures are associated with significant rates of mortality (as high as 30 per cent) and morbidity. In 2005-06, approximately 7 per cent of seniors admitted with a hip fracture died in hospital within 30 days of admission. The risk of death within 12 months of a hip fracture is estimated to be as high as 35 per cent.
thehealthline.ca redeveloped to serve broader needs
It sounds a little dry – the South West LHIN Program and Services Inventory. But the reality is an exciting step forward for thehealthline.ca
“This project will lay the foundation for a powerful integrated health service information system, capable of adapting and scaling up to meet service provider and LHIN needs,” says Gillis. “People will have access to more information about how to find services, providers will have more information to guide their clients and make better referrals, and planning staff will have more information about the services available in the LHIN.”
Input sought on rural and northern health care
The Ministry of Health and Long-Term Care recently held consultations in 11 communities across the province to gather feedback on the 12 recommendations in the Rural and Northern Health Care Framework released in November 2010. The feedback gathered at these sessions and other engagements will be used to complete the framework by the summer of 2011.
Linda Stevenson, of the South West LHIN’s Board of Directors, was on hand to introduce MPP Sandals and welcome the participants to the event on behalf of the LHIN, which includes the area around Hanover. “The South West LHIN covers a huge swath of largely rural Ontario and we work hard to stay engaged with the needs and concerns of the residents and our health care partners in these areas,” Stevenson added.
After a brief overview of the report, the 12 recommendations contained in the framework were the subject of discussion roundtables. Topics for discussion included transportation, community engagement, integration and more. By creating a focused conversation, each table could delve deeper into an issue, but the format also allowed everyone the opportunity to provide additional comments as the other tables reported back to the whole group.
“We’re looking for input from Ontarians on the best way to make sure that those living in rural and northern communities get the care they need, when they need it, as close to home as possible,” commented MPP Sandals.
More information on the Rural and Northern Health Care Framework is available at www.ontario.ca/ruralandnorthernhealth.
Physicians focus on quality
DuVall, president of the Ontario College of Family Physicians, talked about the Excellent Care for All Act and how it affects health service providers. She discussed specific quality initiatives like the Quality Improvement and Innovation Partnership, and then explained what kind of impact all of these things will have on family doctors.
“I’m encouraged by the level of participation I’ve seen here and the work that’s going on in the LHIN,” DuVall said in reference to initiatives like the FLO Collaborative, Partnerships for Health and Residents First taking place in the South West. “The quality agenda is really being embraced here and it’s not going away.”
It’s just in time, she said. In a recent Commonwealth Fund study, Canada ranked sixth out of seven countries in quality of care.
“On an international level, we don’t look very good,” she continued, explaining improvements in health care quality are not only necessary, they’re coming - regardless of whether or not family physicians are ready for them.
“Nobody likes being told what to do in their own practice, but there are conversations going on right now with the Ontario College of Family Physicians and the Ministry about what should be done at the primary care level.”
“We need to look at process indicators ... how satisfied are patients with the services they get. Access will be an important indicator. It may be a year or two or three until it gets rolled out in earnest, but this is all coming down the pipe.”
Technology will play a role in helping physicians cope, but DuVall cautioned against reading too much into things like Electronic Medical Records (EMRs).
“An EMR by itself isn’t a quality improvement – but it certainly helps,” she said.
DuVall’s comments were followed by three break-out sessions. Brad Holman, Vice Chair of the Hanover and District Hospital, Maureen Solecki, CEO of Grey Bruce Health Services and Dr. Robert Servers, Chief of Staff at Grey Bruce, talked about the role physicians can play in influencing their hospital’s quality agenda and heard concerns from doctors about who will be setting the standards and determining the right indictors to measure.
Centralized access was discussed by Dr. Rob Annis, Chair of the Regional Primary Care and Cancer Network, and Susan Warner of the South West LHIN, and the LHIN’s Chief Information Officer and eHealth Lead, Glenn Lanteigne, was joined by SPIRE Project Manager Jason Langdon to talk about eHealth as an enabler.
Quality discussion front-and-centre at forum
More than 400 people have already registered to take part in the first annual South West LHIN Quality Symposium: Building a healthier system through quality and innovation. Considerable interest is being expressed over both the main and governance sessions of the event, which will feature keynote speakers Jim Easton of the UK National Health Service, health policy analyst Steven Lewis and The Hon. Deb Matthews, Minister of Health and Long-Term Care (invited).
South West LHIN hospitals developing standards for non-urgent patient transportation
When hospital patients need to be moved between hospitals and an ambulance is not needed, non-urgent transportation services are often used. These services may include anything from a private car to something that may look like an ambulance, but without the lights and sirens. These forms of service are provided by many hospitals in the South West LHIN.
Non-urgent patient transportation may be used to move medically stable patients between hospital facilities. In the past, many of these patients may have travelled by ambulance, but as demand for ambulance services has increased and the ability for Emergency Medical Services (EMS) to respond to calls for non-urgent transportation decreased, private businesses providing non-urgent transportation have become more available and visible.
Unlike ambulance services, there are no regulations to govern the quality of services provided by non-urgent patient transportation providers in Ontario. This puts hospitals in a challenging situation in determining who can best meet their service needs.
In the fall of 2010, there was considerable discussion among the hospitals in the South West LHIN about potential patient safety concerns and the liability and risk that hospitals assume when they enter into a contract with non-urgent medical transportation providers. In early January 2011, the South West LHIN announced $123,000 in funding for the project that will result in the creation of high quality non-urgent transportation service standards that will be applied consistently across the South West.
In addition, a standard decision guide will be created for hospital staff to use in weighing their options about what form of vehicle or service to request when transferring a patient. Given the demand on ambulances and the importance of making the best use of health care dollars, it is essential the most appropriate form of transportation be used.
Watch future editions of Exchange for updates on the non-urgent patient transportation project in the South West LHIN.
Nicole Robinson joins the South West LHIN team
ENITS helps trauma patients, saves millions
Trauma patients across the South West LHIN now have access to a neurosurgeon 24 hours a day, 7 days a week as the province connected its 100th and final acute care centre to the Emergency Neuro Image Transfer System (ENITS).
“This is a significant milestone for improving patient care in Ontario through eHealth,” Deb Matthews, Minister of Health and Long-Term Care Deb Matthews said of the centralized online system that makes remote neuro-consultations easier, faster and more accurate than ever before.
“It means that people right across the province will benefit from neurological specialists regardless of geography. It also means that unnecessary transfers will be avoided, sparing families needless travel, expense and worry.”
Through ENITS, 70 neurosurgeons at 13 neurosurgical centres provide online consultations to acute care sites throughout the system, including those in the South West. In the past, head trauma cases were sent either to the USA (38 per cent) or to a neurosurgical centre within the province (62 per cent). According to the MOHLTC, the average cost of each out-of-country neurosurgery transfer is between $75,000 and $100,000.
ENITS significantly reduces the need for patients to travel for treatment. Since January 2009, 2,404 head trauma neurosurgical cases have been referred to ENITS and 1,558 patient transfers have been avoided, saving the system more than $50 million.
“ENITS provides the critical infrastructure physicians require to eliminate unnecessary transfers by connecting them to specialized neurosurgeons across the province in real time,” said Greg Reed, President and CEO of eHealth Ontario. This is a perfect example of how collaboration within the health care system is changing the way patients receive care.”
For more information on ENITS and the Picture Archiving and Communications System (PACS) that makes it possible, click here.