Hamilton Niagara Haldimand Brant LHIN Third Quarter MLPA Performance Report Presentation to the HNHB LHIN Board of Directors February 22, 2011 1
HAMILTON NIAGARA HALDIMAND BRANT LHIN PERFORMANCE INDICATORS February 11, 2011 Release LHIN LHIN Provincial Starting PI No. Performance Indicator (PI) FY2010/11 13-Aug-10 12-Nov-10 11-Feb-11 Target Point or Target Baseline 90th Percentile Wait Times for Cancer Surgery 1 1 84 days 58 58 62 60 60 90th Percentile Wait Times for Cardiac By-Pass Procedures 1 2 182 days 48 48 33 27 32 90th Percentile Wait Times for Cataract Surgery 1 3 182 days 104 104 115 131 139 90th Percentile Wait Times for Hip Replacement 1 4 182 days 177 177 190 176 222 90th Percentile Wait Times for Knee Replacement 1 5 182 days 209 182 207 216 217 90th Percentile Wait Times for Diagnostic MRI Scan 1 6 28 days 100 95 112 122 126 90th Percentile Wait Times for Diagnostic CT Scan 1 7 28 days 49 43 42 45 41 Percentage of Alternate Level of Care (ALC) Days - By LHIN of Institution 2 8 9.46% 20.97% 11.00% 19.20% 16.10% 19.30% 90th Percentile ER Length of Stay for Admitted Patients 1 9 8 hours 35.50 28.30 35.37 39.93 36.78 90th Percentile ER Length of Stay for Non-Admitted Complex (CTAS I-III) 10 8 hours 8.10 7.50 7.83 7.92 7.93 Patients 1 90th Percentile ER Length of Stay for Non-Admitted Minor Uncomplicated 11 4 hours 5.10 4.50 4.80 4.78 4.72 (CTAS IV-V) Patients 1 Repeat Unplanned Emergency Visits within 30 Days for Mental Health 12 TBD 17.10% 15.40% 17.09% 16.29% 17.90% Conditions 3 Repeat Unplanned Emergency Visits within 30 Days for Substance Abuse 13 TBD 19.00% 17.10% 19.64% 21.39% 22.59% Conditions 3 90th Percentile Wait Time for CCAC In-Home Services - Application from 14 TBD TBD NA 53.00 28.00 26.00 Community Setting to first CCAC Service (excluding case management) 2, 4 Readmission within 30 Days for Selected CMGs 3 15 TBD 15.10% 14.00% 13.64% 15.19% 15.17% Indicators Source: MOHLTC February 2011 DOING WELL: LHIN has achieved target. • 1-7, & 9-11 Data Oct – Dec 2010 ATTENTION AND MONITORING NEEDED: LHIN performance has improved since • 8 & 14 July – Sept 2010 starting point but target has not been achieved. •12,13,15 Data April – June 2010 AT RISK, ACTION REQUIRED: Current LHIN performance has not improved since 2 starting point and target has not been achieved.
90 th Percentile Wait Time The 90 th percentile applied to wait time reporting identifies how long it takes (time) to • provide the service to 90 % of the individuals receiving the service. • It is the maximum time in which 9 out of 10 people waited to receive the service; one (1 ) out of 10 people waited as long or longer. An example: • In November, 2010 Niagara Health System completed 87 total knee joint replacement surgeries. • All 87 cases are sorted by their wait time from the shortest to longest. The time that the 90 th percentile case waited, i.e. case 79 (calculated as 87*.9 = 79) is • reported as the 90 th percentile wait time Wait Time in Days # of Cases Cases < 182 days 72 Cases 1 ‐ 72 The 90 th percentile 201 ‐ 300 days 13 Cases 73 ‐ 78 wait time reported Case 79 is the wait of the 79 th Cases 80 ‐ 85 case = 235 days >300 days 2 Cases 86 & 87 Total # Cases 87 Source: HNS Performance Report to the LHIN January 2011 3
90 th Percentile Wait Times for Cancer & Cataract Surgery 90th Percentile ‐ Wait Time Cancer Surgery Cancer Surgery 64 • Wait times have remained stable since Q2. • The LHIN is 2 days away from its MLPA target 60 Days • Specific cancer surgery wait times are driving the 56 LHINs wait times 52 48 Cataract Surgery Q 2 09/10 Q 3 09/10 Q4 09/10 Q1 10/11 Q2 10/11 Q3 10/11 HNHB 61 60 61 62 60 60 • In the Q2 report the LHIN projected that wait times Target 50 50 50 58 58 58 would continue to increase in Q3 as more long wait Province 62 60 62 59 62 57 cases were completed. The province is seeing a similar trend 90th Percentile Wait Time Cataract Surgery • For 2010-11, the net LHIN cataract volume funded 150 by the Wait Time Strategy was decreased – the 120 decreased volumes have impacted wait times. Days • As a mitigation strategy, in January 2011, the LHIN 90 reallocated unused total joint surgery wait time strategy funds to support an additional 610 cataract 60 Q 2 Q 3 Q4 Q1 Q2 Q3 09/10 09/10 09/10 10/11 10/11 10/11 cases, which is expected to decrease wait times in HNHB 97 107 108 115 131 139 Q4 Target 103 103 103 104 104 104 Province 107 112 111 118 127 131 Source: MOHLTC MLPA February 2011 4
90 th Percentile Wait Times for Total Joint Replacement Surgery (Hip &Knee) Total Joint Replacement Surgery • Wait times for knee surgery remained stable in Q3, 90th Percentile Wait Times Total Knee Replacement while wait times for hip replacement surgery increased Surgery by 46 days 250 200 • In the Q2 report the LHIN projected that wait times DAYS 150 would increase in Q3 as LHIN hospitals targeted long wait cases (2 Hamilton hospitals reported 20 - 25% of 100 their completed cases were long wait cases) 50 Q 2 09/10 Q 3 09/10 Q4 09/10 Q1 10/11 Q2 10/11 Q3 10/11 HNHB 220 213 201 207 216 217 • Two LHIN hospitals (Hamilton Health Sciences Centre Target 182 182 182 182 182 182 and Joseph Brant Memorial Hospital) returned wait Province 177 180 176 183 201 203 time strategy funding for these services due to bed availability – patient flow pressures 90th Percentile Wait Times Total Hip Replacement Surgery • Hamilton hospitals experienced increase patient flow 250 pressure from increased emergency room visits and 200 outbreaks at 7 long term care homes preventing Days discharge of individuals 150 • The LHIN expects wait times will remain stable in Q4 100 Q 2 09/10 Q 3 09/10 Q4 09/10 Q1 10/11 Q2 10/11 Q3 10/11 HNHB 168 182 174 190 176 222 Target 182 182 182 177 177 177 Province 160 162 161 170 175 195 Source: MOHLTC MLPA February 2011 5
90 th Percentile Wait Times for MRI Service MRI Services 90th Percentile Wait Times MRI • Wait times increased slightly in Q3, consistent with provincial trends 140 • In the Q2 report the LHIN projected wait times 120 would decrease by March 31, 2011 Days 100 • The LHIN has received additional funding to 80 support 3,053 additional MRI hours. This 60 funding is targeted for elective MRI cases Q 2 09/10 Q 3 09/10 Q4 09/10 Q1 10/11 Q2 10/11 Q3 10/11 HNHB which have the longest wait times. 99 101 106 112 122 126 Target 87 87 87 95 95 95 Province 107 114 116 114 122 121 • The LHIN expects wait times to decrease by Source: MOHLTC MLPA February 2011 the end of Q4 • The LHIN Chiefs of Diagnostic Imaging (DI) agreed to begin to adopt standardization protocols for CT and MRI. 6
Percentage Alternate Level of Care • The Q3 performance report is based on July – September Acute ALC Rate 2010 data. 30 25 • Acute ALC Rate (DAD Data) is the length of time an 20 individual waits in an acute care bed starting from the time Days 15 their acute care treatment ended to the time they were 10 discharged to their most appropriate destination (e.g., 5 rehab, complex care, long term care (LTC)) 0 Q 1 Q 2 Q 3 Q4 Q1 Q2 09/10 09/10 09/10 09/10 10/11 10/11 • In the Q2 report the LHIN projected that the Acute ALC ALC (DAD Data) 23.24 23.11 18.07 19.2 16.1 19.3 Rate (DAD Data) would increase in Q3. ALC (LHIN Internal Data ‐ last month 21.8 17.1 15.2 14.3 13.3 15.3 of the quarter) • This is a result of placing 89 individuals waiting longer Target 14 14 14 11 11 11 than 40 days in hospital to LTC care during this period. Of the 89 individuals placed, 25 accumulated 10,666 ALC Note: Percentage Alternate Level of Care Days is Calculated days . using HNHB LHIN Hospital Discharge Abstract Database and is not the same methodology used to calculate and report on current LHIN performance. • The LHIN anticipates the ALC (DAD) will continue to Data Source: CIHI DAD, Hospital Weekly ALC Reports increase in the next quarter as hospitals discharge more individuals with long waits. 7
ALC – Achievements Hospital Patients Discharged to LTCH from all Hospital Beds 140 120 106103 96 100 88 87 82 Number 76 80 71 70 • The number of individuals newly identified 62 48 54 60 51 51 as needing to wait in hospital for long term 44 44 41 40 33 33 40 care home (LTCH) admission is lower than 20 20 the number of individuals that are 0 discharged from hospital to LTCH Months Source: HNHB CCAC ALC Report 2011 • For the LHIN to sustain and continue to reduce the ALC rate the number of Newly Designated ALC-LTC in Acute Care Beds individuals newly identified must be lower 180 156 than the number discharged to LTCH 160 131 140 109 120 100 Number 84 85 74 72 80 69 68 65 63 62 60 59 55 59 53 48 60 47 43 44 40 20 0 Months 8 Source: HNHB CCAC ALC Report 2011
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