Meeting Date: July 26, 2017 Action: Decision Topic: Item 13.0 Grand River Hospital MRI and Nuclear Medicine Replacement Pre-Capital Submission

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George Roberts
5 years ago
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1 BRIEFING NOTE Mission: To make it easy for you to be healthy and to get the care and support you need. Vision: Healthy People. Thriving Communities. Bright Futures. Core Value: Acting in the best interest of our residents health and well-being. Meeting Date: July 26, 2017 Action: Decision Topic: Item 13.0 Grand River Hospital MRI and Nuclear Medicine Replacement Pre-Capital Submission PURPOSE To provide an overview and recommendation related to the Pre-Capital Submission for the Magnetic Resonance Imaging (MRI) and Nuclear Medicine replacement at Grand River Hospital (GRH). CORE CONTEXT GRH is faced with an urgent need to replace its MRI and nuclear medicine imaging equipment, which are at the end of their useful lives. On June 29 th, 2017 WWLHIN received a Pre-Capital Submission request from the hospital. LHIN board endorsement is required as part of the provincial capital process (Appendix A). The total project cost is estimated at $12 million. GRH and its foundation are committing to fund the equipment (estimated at $4.5 million), with the remainder related to construction expenses and renovations (estimated at $7.5 million being requested through the capital process from the MOHLTC Health Capital Branch. WWLHIN staff working with GRH to ensure a risk mitigation plan is in place related to potential equipment failure or extensive down-time which includes consultation with appropriate system partners. WWLHIN staff working with Ministry to try to expedite request given urgency. RECOMMENDATION THAT the WWLHIN Board of Directors endorse the program and service elements outlined in the Pre-Capital Submission for Magnetic Resonance Imaging (MRI) and Nuclear Medicine replacement at Grand River Hospital (GRH), with the expectation that GRH aligns the program and service elements with the WWLHIN Integrated Health Service Plan (IHSP), design and plan the service and space with clinical leaders and patients to ensure integrated care for the residents of Waterloo Wellington. 1

2 BACKGROUND Impact on Residents GRH is faced with an urgent need to replace its MRI and nuclear medicine imaging equipment, which are at the end of their useful lives. The existing MRI scanner is approximately 15 years old and unable to provide optimal image quality. Additionally, the scheduled and unscheduled maintenance is completed at a significant cost and restricts patients access to MRI scans. The nuclear medicine SPECT/CT and SPECT cameras (single-photon emission computerized tomography scan which lets your physician analyze the function of some of your internal organs) are also approaching the end of their useful lives, and require extensive maintenance. These three pieces of medical imaging equipment cannot be replaced in their existing rooms due to constraints that cannot accommodate the new imaging equipment, patients and their stretchers within current standards. On June 29 th, 2017 WWLHIN received the Pre-Capital Submission. Both WWLHIN and MOHLTC Health Capital Branch staff recently completed a tour the space. A review was completed using the LHIN Decision-making Framework, Capital Review Guidelines checklist and engagement with key stakeholders. Key considerations in that review are outlined below: Both MRI and Nuclear Medicine play important roles in the diagnosis and treatment of disease. They are sophisticated tools supporting disease screening, early detection of a disease at a more easily-treatable stage, and monitoring, as well as delivering direct intervention and treatment. The MRI at GRH is one of four MRIs in the WWLHIN. It supports hospital inpatient, outpatient, Emergency Department and critical care patients, and key regional programs (Stroke, Renal, and Cancer). It is also the only MRI in WWLHIN that provides anaesthesia support to paediatric patients, who would otherwise have to travel to London or Hamilton to receive this service. Demand for MRI service has been steadily increasing over the last number of years, with 9.8% growth in , followed by another 9.3% climb in , but has since leveled off at 5% in due to machine hours achieving a maximum of 24 hours per day, 7 days per week, which essentially caps any further growth in volumes of tests. High levels of both planned and unplanned maintenance downtimes for these machines are costly both in terms of financial resources and in patient wait times. Patient throughput could be further improved through the installation of a new MRI, with a projected impact of an additional 1000 scans per year. Faster scan times improve patient experience as they are required to remain still during scans and some patients requiring sedation The total project cost is estimated at $12 million. GRH and its foundation are committing to fund the equipment (estimated at $4.5 million), with the remainder related to construction 2

3 expenses and renovations (estimated at $7.5 million), which is being requested through the capital process from the MOHLTC Health Capital Branch. Strategic Considerations Despite almost achieving 24/7 operations, GRH is unable to meet 90 th percentile provincial wait time targets. The existing MRI scanner has a slower throughput than contemporary scanners. Further decline in wait time performance impacts treatment pathways that are dependent on the availability of diagnostic imaging results. WWLHIN hospitals scan the most patients per operating hour and have the best room turnaround times in Ontario, and the WWLHIN is the only LHIN in Ontario to have met target on all 5 MRI Key Performance Indicators and consistently has the highest MRI demand per operating hour of any LHIN in Ontario. 1 Nuclear medicine has increase by approximately 3.5% per year over year for the past three years, with this growth rate anticipated to remain in place through the five to ten year planning horizon, although rate of growth is expected to accelerate past that horizon with aging population and enhanced services for patients with cancer. Community Engagement While work is underway locally and provincially to identify and support best practices which will ensure that referrals for MRI are appropriate, for example with reducing/ eliminating MRIs for Knee Pain through the work on Musculoskeletal care and implementation of Central Intake and Assessment Centres for Hip and Knee Replacements, ongoing demand for MRI continues to exceed supply. Risk Assessment The submission identifies needs for capital funding in excess of current hospital resources, due to the expanded scope and related constraints with nuclear medicine. The failure of both key diagnostic services could result in costly contingency and back-up plans (i.e. patients transported to other hospitals) that would put an increased strain on other services, like ambulance, and would not be financially sustainable in the longer term. Summary The LHIN s role in the Pre-Capital phase is to review the Pre-Capital submission in relation to the local health system integration plan (see Appendix A). It is the opinion of the WWLHIN staff that the review of the program and service elements of the Pre-Capital for MRI and Nuclear Medicine Replacement provided by GRH demonstrates addressing projected future demand for advanced diagnostic services, aligns with the principles of the local health system plan and the Patients First Act. 1 MRI Efficiency Dashboard 3

4 NEXT STEPS LHIN staff will communicate the WWLHIN Board decision in writing to the Director, Health Capital Investment Branch (HCIB). Pending LHIN endorsement, the MOHLTC will review the Pre-Capital submission and work with the WWLHIN and GRH to clarify the need for additional information. LHIN staff will follow-up with GRH to ensure a risk mitigation plan is in place related to potential equipment failure or extensive down-time which includes consultation with appropriate system partners. 4

5 APPENDIX A Appendix A: Capital Planning Process The objective of a Pre-Capital Submission is to identify a program/service need that requires the support of new or renovated capital infrastructure. Upon identification of the initiative requiring the support of capital infrastructure, the HSP should undertake planning to enable the completion of the Pre-Capital Submission form. Upon completion of Part A, the HSP will submit to the LHIN for review. Upon receiving written support from the LHIN, the HSP will complete Part B and submit both parts to the Ministry. The Ministry and LHIN then liaise to determine whether the HSP will be given approve to proceed to Stage 1. Depending on the outcome of the review, the LHIN Board has three options at the Pre-Capital, Stage 1 and Stage 2 steps in the capital planning process: a) Endorsement represents the LHIN support for the program and service elements of an initiative and allows the Ministry to finalize its review of Part B (Physical and Cost elements); b) Endorsement with Conditions means that the LHIN requires additional planning to be undertaken by the HSP to address specific program and service issues identified by the LHIN; c) Rejection means that the LHIN does not support the program and service elements of a capital initiative. Overview of Capital Planning Process Planning Grants: 3 possible approval milestones: proposal development, functional program, design development Construction Grant Pre-Capital Stage 1 Proposal Stage 2 Functional Program Stage 3 Preliminary Design Or Output Specifications Stage 4 Working Drawings Or Output Specifications Stage 5 Implementation Review and support of Pre-Capital Submission. Proposal Development grant Review and approval Review and approval of Stage 1 Submission. of Stage 2 Functional Program Functional Program. grant. Design Development grant Requires Government approval to plan Review and approval of blocks and sketch plans; approval to proceed to working drawings OR blocks/output specifications Requires Government approval to construct Review and approval to tender & implement/issue RFP OR approval to award construction contract/ Project Agreement. 5

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