HNHB LHIN Board of Directors June 2011
� Background � Current State � Directional Future State � Recommendations � Questions
� Vascular Surgery – a distinct primary specialty ◦ Vascular Services - scope beyond surgery V l S i b d ◦ Strong connection with virtually all medical and surgical programs � Previous planning documents indicating gap in service ◦ Hay Group 2006 – WW LHIN and HNHB LHIN ◦ Hay Group 2006 WW LHIN and HNHB LHIN ◦ HNHB LHIN Vascular Planning Group 2008 � Rationalization of Vascular Services primarily b been driven by physician manpower issues d i b h i i i
� Activity ◦ 1% of all HNHB LHIN inpatient activity and 2% of same day surgery activity; around 1100 admissions admissions � Expected growth over next 15 years ◦ 40% inpatient and 33% same day � Type of Care ◦ 80% - 5 CMG’s: abdominal aortic interventions, arterial/venous bypass, carotid endartectomy, other arterial/venous bypass, carotid endartectomy, other vascular procedures, deep vein thrombophlebitis
� Level of Care ◦ 50% tertiary/quaternary 50% t ti / t ◦ Recent growth at HHS and Niagara* � Market Share ◦ 98% of HNHB LHIN hospital activity serving HNHB residents � Provision of Tertiary and Quaternary Care ◦ 69% of all HNHB Vascular inpatient care provided in p p Hamilton (HHS = 85% of this), Niagara hospitals provide 16% (same pattern for all levels of care) � Residents served in same county ◦ 95% Hamilton, 50% Niagara and Burlington, 20% for Brant, Haldmand, Norfolk ◦ Hamilton hospitals only one serving HNHB resident outside of resident county f id t t
� Access to Care ◦ 6% of HNHB residents cared for outside HNHB LHIN ◦ Surgical Wait times meet provincial mean wait time targets* - exception NHS priority 2 arterial non- targets exception NHS priority 2 arterial non bypass surgery � Efficiency ◦ Low rate of hospitalization (16% reduction from 2002 – 2007), High RIW’s ◦ 72% of all hospital activity is same day surgery ◦ 72% of all hospital activity is same day surgery ◦ LOS less than ELOS and 14% reduction from 2002- 2007
� Utilization ◦ Utilizing less invasive procedures with lower cost/case and decreased LOS ◦ Only 20% of hospital based procedures ◦ Only 20% of hospital based procedures performed in diagnostic imaging � Quality of Care ◦ Raw mortality rates some variation between hospitals
� Estimated only 5-10% of patients require y p q operative procedures � No centralized intake or wait list management � Limited capacity for non-invasive vascular imaging imaging
� Non-invasive vascular imaging g g ◦ Diagnostic and image-guided minimally invasive interventions, safe and cost effective � Angiography A i h ◦ Opportunities to improve access and capacity � Interventional Radiology � Interventional Radiology ◦ Percutaneous peripheral procedures increasing with new vascular surgeons
� Access to protected vascular beds � Budget for endovascular procedures � Lack of surgeon access to interventional radiology (lack of hybrid operating endovascular radiology (lack of hybrid operating, endovascular suite) � Physician manpower (numbers, matching skill set to need) ◦ SJHH =1 FT, HHS =4 FT (total in Hamilton = 5 FT) ◦ NHS = 1 FT, 2 PT ◦ Brant = 1 General Surgeon (retiring) ◦ Burlington = 1 General Surgeon
� No formalized Regional call schedule � Insufficient capacity for non-invasive vascular imaging ◦ Hamilton completes about 40 studies/week relative to Hamilton completes about 40 studies/week relative to London, TGH, Ottawa, Sunnybrook at 100 -250 studies/week � Clinic time and centralized intake/triage/wait list � Clinic time and centralized intake/triage/wait list management � Data collection and quality of care monitoring � No plan to meet anticipated growth needs � Coordination across the LHIN � Best practice standards � Best practice standards
� Regional Vascular Service Program at multiple sites � LHIN wide Vascular Surgeon Group with cross � LHIN wide Vascular Surgeon Group with cross privileges ◦ Surgeons move to patient! � Regional funded bed to facilitate “No Refusal Policy” � Siting � Siting ◦ Primary Sites: NHS and HHS ◦ Secondary Sites: SJHH, JBMH ◦ Amputations consolidate at BCHS A i lid BCHS
BCHS Niagara Health System • Outpatient vascular clinic with on-site • Comprehensive vascular care vascular (non-invasive lab) • Venous disease, vascular access, carotid • -Pre and post op management of vascular disease, aortic aneurismal and occlusive amputations and full perioperative disease management of non-vascular related • Non-invasive imaging amputations for Brant and Haldimand • Support to hemodialysis program Norfolk & Haldimand Norfolk associated • Undergraduate and post graduate medical with BCHS on amputations education and participation in clinical research NHS JBMH • Surgical activity SJHH appropriate to and • Hemodialysis and renal • Hemodialysis and renal contingent on hospital i h i l Hamilton Health Sciences transplant programs supports • Comprehensive vascular • Future development of a • Access to an care including venous peripheral endovascular interventional suite and disease, vascular access, program non-invasive imaging • Site for undergraduate and carotid disease and aortic • Outpatient clinic activity post graduate medical • site for undergraduate aneurismal and occlusive education and post graduate medical disease • Research focus on surgical education • Aortic arch reconstructions, education and surgical thoracoabdominal aneurysms thoracoabdominal aneurysms i innovation i • Advanced endovascular interventions • Co-operative role with cardiac and trauma • Outpatient vascular center Haldimand Norfolk with an integrated non- invasive vascular lab Regional Vascular Program Infrastructure • Primary site for education • Administrative Structure and and research d h Governance Needs • Human Resources • Clinical Resources • System Infrastructure and Connectivity Legend • System Patient Flow HHS – Hamilton Health Sciences – General Site • Measurement Quality and outcomes NHS – Niagara Health System • Research and education SJHH – St. Joseph’s Healthcare Hamilton JBMH – Joseph Brant Memorial Hospital BCHS – Brant Community Healthcare System
� Shared access to diagnostic imaging – (Hybrid OR at g g g ( y NHS, SJHH current capacity) � Data and Clinical Information � Data and Clinical Information ◦ Regional vascular registry ◦ Central intake and wait list management ◦ Clinical connect, PAC’s Clinical connect, PAC s � Research/Education ◦ All physicians in group will be appointed to the Division of Vascular Surgeon at McMaster University
Primar Primary Recommendation Recommendation: Formally establish a single Regional single Regional Vascular Service with inpatient, outpatient and emergency patient management activity at mu t ti it t multi ltiple s lti lti l e sit it it ites es within the ithi th HNHB LHIN. The regional vascular service will be committed to establishing, implementing, monitoring and improving standardized best practices across and improving standardized, best practices across the HNHB LHIN.
Supporting Recommendations 1. Establishment of a Regional Vascular committee 2 2. HHS Lead site; NHS primary: SJHH and JBMH HHS Lead site; NHS primary: SJHH and JBMH secondary, BCHS – primary amputations 3. Regional vascular bed(s) at HHS, NHS (future?) 3 R i l l b d( ) HHS NHS (f ?) 4. Regional Physician Call model and cross privileges with visiting physician concept
Supporting Recommendations 5. Best practices and standards for diagnosis, investigation & treatment with education provided investigation & treatment with education provided to Primary Care Physicians, ED physicians and general surgeons 6. Improve unmet access in the HNHB LHIN by investing in tertiary and quaternary cases at HHS and NHS, including EVAR and NHS, including EVAR 7. Increase access to interventional radiology 8. Resources to support centralized intake process 9. Hybrid interventional suite
� Questions L:\C. Initiatives (Operations)\P - I (IHSP)\Vascular\Presentations )\HNHB LHIN Regional Vascular Services Plan Presentation for Board of Directors June 2011 g
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