Rouge Valley Health System`s Recommended

Rouge Valley Health System’s Recommended
Model for Fulfilling Motion 1B
Prepared by Rouge Valley Health System
February 2015
Presented by Michele James, Interim Chief Operating Officer
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Synopsis of RVHS Recommended Model
Advanced
Designation
•
Consistent with the 2009 Clinical Services Plan recommendation
that was endorsed by all LHIN hospital boards, clear accountability
through designation of a single lead agency - Rouge Valley
Centenary – with a commitment to LHIN-wide collaboration
Advanced
Service Delivery
•
Advanced inpatient neonatal and advanced paediatric services
delivered at one site to capture the patient safety benefits of critical
mass with innovative approaches to ensure LHIN-wide regional
access, outreach and creating a presence across the LHIN
Non-advanced services delivered at multiple sites
Development of connecting mechanisms that link services and sites
to optimize coordination for patients/families across the continuum
of care
•
•
Planning and
Oversight
•
•
•
•
Lead agency convenes and chairs, with a rotating co-chair from
another organization a Regional multi-organizational committee
for planning, coordination and oversight
Role would include planning, development and siting of new
programs, and monitoring and evaluation of the regional advanced
maternal/child service delivery
Membership would include hospital and community-based providers
from across the LHIN, tertiary centres , consumers and Central East
LHIN
Committee would provide advice to existing governance structures
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
A hybrid model including
both consolidated and
distributed components

A continued role for all 3
Scarborough sites

Alignment with consumer
preference for ‘one stop
shopping approach’ to
access

Leverage the benefits of
critical mass for specialty
services through co-location

Development of connecting
mechanisms that link
services and sites to
optimize coordination for
patients/families across the
continuum of care
Emergency Services for newborns, children and
expectant mothers; links to primary care – In all
3 Scarborough sites; Scarborough resident
focus
Level 2b (and 2c above 32
weeks) neonatal and maternal
care (inpatient and outpatient);
General paediatric inpatient and
ambulatory care – In all 3
Scarborough sites; Scarborough
resident focus
Advanced neonatal care (2c),
Advanced paediatric care,
Advanced maternal
care (2c, including ability
to deliver and manage
30-32 week
gestation age)
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Timeline
2015
1997
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Historical Expert and Stakeholder Support for Regional Advanced Role
for RVC
•
•
In 1997, Ontario’s Health Services Restructuring
Commission directive states that “Centenary Health
Centre and Toronto East General Hospital are
designated to provide level II paediatric services”;
Scarborough General and Scarborough Grace
were directed to transfer funding for their paediatric
activity ($1,485,368 and $575,402 respectively) to
Centenary
This clear historical direction and support, has
influenced Rouge Valley’s strategic agenda
and investments including:
– High priority on our strategic plans going
back to 2007 for growth and integration of
women’s and children’s services
– An extensive community campaign to build
the RVC Birthing and Family Centre
– Recruitment of an extensive number and
range paediatric subspecialists
– Investment in maternal, newborn and child
programs
According to the 2005, Child Health Network report:
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Motion 1b Collaborative Clinical
Questionnaire Results - 31 respondents
Expert Choice Survey Results
• 60% of respondents (18) identified RVHS-Centenary as
their primary association
• 40% of respondents (12) identified TSH as their primary
association
• 61% of respondents identified themselves as leadership/
management
• 29% of respondents identified themselves as clinicians
• 7% of respondents identified themselves as customers
• 10 respondents identified RVHS as the preferred site
for advanced regional neonatal services (Centenary
site specifically noted in most answers)
• 7 respondents identified TSH as the preferred site
for advanced regional neonatal services (General
site specifically noted in most answers)
• 13 respondents identified RVHS as the preferred site
for advanced regional inpatient paediatric services
(Centenary site specifically noted in most answers)
• 1 respondent identified RVHS or TSH as the
preferred site for advanced regional inpatient
paediatric services
• 2 respondents identified that advanced regional
inpatient services should be distributed between
RVHS and TSH
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What will RVC offer the community as the regional
advanced centre for neonatal and paediatric care?
 Track Record Providing the Most Advanced Care for
Neonates and Children in Scarborough
 Wide Range of Specialized Services and Supports
including tertiary centre satellite clinics delivered in
partnership with Sick Kids
 State of the Art Infrastructure - Physical Plant, IT
 Cost-Effective Expansion Potential
 Strategic Priority
 Regional Presence and Regional Access
 Sustainability – Financial Stability, PCOP Funding
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Track Record Providing the Most Advanced Care for Neonates and
Children in Scarborough
•
In 2011, RVHS responded to an opportunity from the Central East LHIN and
PCMCH to change their level of care designation based on current activity levels
and resources; RVHS chose to invest in increasing the designation at both of its
sites to a more advanced level of care; moved RVC Centenary from 2b to 2c and
moved RVAP from 2a to 2b
•
Over the last 3 years (2011 to September 2014), RVC has successfully provided
safe, high quality level 2c neonatal and maternal care as the only level 2c facility
in Scarborough (until Fall 2014)
•
Historical data demonstrates the advanced role played by RVC Centenary
•
RVC Centenary has developed solid transfer relationships with CritiCall and
other hospitals, including tertiary centres
–
RVC Centenary is an active participant in PCMCH’s development of best practices related to levels
of care (e.g. only hospital in Scarborough to participate in the retro-transfer pilot)
–
RVC Centenary is only community hospital represented on the GTA Obstetrics Network
–
Strong partnership with Sick Kids through satellite clinics contributes to growth of subspecialty
ambulatory clinics
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Wide Range of Specialized Services and Supports
 Designated level 2C for neonatal and maternal care since 2011
 20 isolette spots and one additional space for resuscitation with close proximity to the
OR/C-Section room
 2 negative pressure, isolation rooms
 Ability to manage 30 weeks gestation and up (per PCMCH and Criticall), insert and
manage PICC lines, umbilical catheters, Total Parenteral Nutrition (TPN) and up to 1
CPAP and 4 ventilated babies simultaneously
 3 active neonatologists on staff in addition to multiple supporting sub-specialists
 ICCA (fully integrated electronic documentation and monitoring system) to be
implemented 2015.
 Ronald McDonald (RM) Family Lounge (and sleep room) to be competed and operated
by RM volunteers in fall 2014
 2 care by parent rooms, 1 sleep rooms, 1 breast pumping room.
 Electronic Security System and a closed/locked door system
 Central monitoring
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Wide Range of Specialized Services and Supports (cont’d)
 12 single inpatient patient rooms (can accommodate 28 children if patients are colocated).
 4 acute care single inpatient rooms for intensive observation with central cardiac monitoring
capability
 2 (4 bed) day surgery rooms
 Ronald McDonald Family Lounge (and sleep room) to be completed fall 2014
 Cardiology, infectious disease, endocrinology and respirology provide consultation on an in
and outpatient basis, with paediatric EEG and outpatient neurology services
 Surgery – ENT, orthopaedic (including specialized scoliosis repair), plastic surgery, general surgery,
dental, pulse dye laser surgery (RVC is the only hospital providing this surgery in Ontario besides
Ottawa)
 Oncology - (Paediatric Oncology Group Ontario [POGO] ) - Sickkids satellite program) NP/nurse run outpatient clinic, 2 dedicated inpatient rooms specific to the paediatric oncology
population (in addition to the 16); 8 nurses have chemo certification training and are proficient in
portacath access.
 Sickle Cell – (SickKids satellite program) - staffed by 2 paediatric haematologists and nursing
 Short Stay Program – rapid access to specialized paediatric care from the ED
 Child and Adolescent Mental health – 6 inpatient beds, day hospital, crisis team, First Episode
Psychosis Program and an extensive outpatient mental health clinic (Shoniker Clinic) fully supported
by a multidisciplinary team of child and adolescent psychiatrists, GPs, child and youth workers, social
workers, addiction workers, nurses and an occupational therapist.
 MOU in progress with Ontario Shores to provide acute care back-up for Ontario’s only residential
adolescent eating disorders program
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Wide Range of Specialized Services and Supports (cont’d)
Additional Paediatric Ambulatory Clinics
1. Diabetes – supported by a Paediatric endocrinologist and a team of RD/RN who provide 24/7
support to our patients.
2. Allergy and Immunology Clinic- 2 immunologists and nurses who provide assessment and
immunology challenges on site
3. Paediatric Consult Clinic - 7 days a week
4. Gastroenterology Clinic - including paediatric scopes done by a paediatric gastroenterologist.
5. Asthma education Clinic
6. Constipation Clinic
7. Neonatal Follow-up Clinic
8. Nutrition Clinic
9. Haematology Clinic
10. Nephrology Clinic
11. Rheumatology Clinic
12. RSV prophylaxis Clinic
13. Genetics Clinic
Note: The above list is in addition to the Oncology Clinic, Sickle Cell Clinic and several child and
adolescent clinics mentioned on the previous slide
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State of the Art Infrastructure with Cost-Effective
Expansion Potential
•
The newest NICU in Scarborough is located at RVC; opened
only 5 years ago it offers patients/families state of the art
facilities built at current standards with ample space for optimal
care
•
The Scarborough community raised millions of dollars for this
much needed facility
•
The NICU is immediately adjacent to the new birthing centre
•
Galaxy 12 is a suite of several paediatric clinics that gains
efficiency through co-location with sharing of nursing and clerical
resources
•
RVC offers the only birthing centre and NICU in Scarborough
with a electronic health record for mothers and newborns
(ObTraceVue)
•
Capacity to expand in a timely way without the need for major
renovations is possible because we have maintained the space
previously used for inpatient obstetrics before our new birthing
centre opened– e.g. capacity for an additional 15 isolette spaces
in nursery space on 4th level of RVC
•
The RVHS model allows us to value past investment of taxpayer
dollars and build on what exists
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Strategic Priority
With limited resources, it is not possible for hospitals to give equal focus to the growth and development of all
clinical areas; strategic plans are a commonly used to communicate what the hospital’s strategic priorities are;
strategic priority and commitment of both Board and leadership are critical enablers of success
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Regional Presence and Regional Access
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To be successful, a regional centre must have a strong regional presence that includes a deep
understanding of the regional community, regional providers and regional stakeholders
•
RVHS has a presence in both Scarborough (RVC) and Durham (RVAP) and has a strong regional
orientation; plans underway for physical presence in Seaton (north Pickering)
•
We already have established relationships with stakeholders in two of the regional municipalities in
Central East LHIN
•
Our existing presence in Durham (i.e. links to family physicians, paediatricians, political
representatives, hospitals, community agencies, etc ) will save time and mean that scarce resources will
not have to be expended on establishing relationships in Durham and can be used for other things
•
A few examples of our collaborative relationships beyond Scarborough include:
– Signed Memorandum of Understanding with Ontario Shores (Whitby) to provide acute care back up
for the first residential adolescent eating disorder program in Canada
– Regional Code Stemi program
– Cardiac rehabilitation program involving Lakeridge, Ross Memorial Hospital and Peterborough
– Several long-standing partnerships with Lakeridge in Human Resources and IT
– Lean education provided to staff of Grandview Children’s Centre (Oshawa), Ross Memorial and
Ontario Shores
The region of Durham is projected to experience the highest growth in births and the paediatric
population in Central East LHIN; patient/families with advanced care needs which require urgent access
and/or multiple visits over a long time period want the most timely access possible -- even saving minutes
on travel time can make a difference to these families
•
•
Centenary’s location in east Scarborough is physically closer to the rest of Central East LHIN
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Sustainability
• Financial stability
– 6 consecutive years of
budget surpluses to
support investment in
infrastructure, equipment
and strategic priorities
• Post-construction Operating
Plan (PCOP) funding from
new NICU and birthing centre
• Have applied Lean in the
Birthing Centre, NICU,
Paediatric Clinics since 2008
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In Summary….
leverage verb:
“to use something valuable to achieve a desired result” Merriam Webster Dictionary
• The RVHS model is about leveraging excellence for patients and
families by building on what exists -- leveraging resources, expertise,
experience and commitment
• The RVHS model is evidence-based – it is consistent with expert studies
over many years and the views of local stakeholders
• The RVHS model aligns very closely with the CE LHIN decision making
framework in that it builds upon system alignment, performance, CE
LHIN values, sustainability and integration
• The RVHS model offers our community a less expensive and faster
approach to implementation – our patients have waited long enough
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