Transforming the Delivery of Operative Anesthesia Services in Ontario

Size: px
Start display at page:

Download "Transforming the Delivery of Operative Anesthesia Services in Ontario"

Transcription

1 Transforming the Delivery of Operative Anesthesia Services in Ontario Report & Recommendations of the Operative Anesthesia Committee May 2006

2 TABLE OF CONTENTS SUMMARY OF RECOMMENDATIONS... 1 EXECUTIVE SUMMARY... 3 BACKGROUND AND CONTEXT... 4 OPERATIVE ANESTHESIA COMMITTEE... 6 UPDATE ON ACADEMIC ANESTHESIA SERVICES IN ONTARIO... 8 ANESTHESIA CARE TEAM Context...10 Description of ACT Model...10 Anesthesia Assistants...12 Benefits of the ACT Model...13 Challenges with the ACT Model...14 NEXT STEPS APPENDIX 1 - STATUS REPORT ON ANESTHESIA SERVICES AT ONTARIO S ACADEMIC HEALTH SCIENCE CENTRES Report & Recommendations of the Operative Anesthesia Committee

3 SUMMARY OF RECOMMENDATIONS The 2004 Physician Services Agreement provided for the formation of the Operative Anesthesia Committee (OAC) in recognition of the pressures facing operative anesthesia in Ontario s hospitals. The OAC is to provide recommendations to support stable and adequate access to anesthesia services in Ontario hospitals. The Agreement provides $5 million in new funding to support operative anesthesia, based on the Committee s recommendations. After considerable deliberation and wide ranging consultation, including the OMA Anesthesia Section meeting in September 2005, the OAC: 1) Asked Dr. Marshall to update his 2003 review of anesthesia services at Ontario s AHSCs and to gain an understanding of the current use of, support for and the potential of the Anesthesia Care Team (ACT) concept to address the anesthesia shortage. 2) Defined the ACT model, outlining roles, responsibilities and training requirements. In addition, the OAC identified the benefits and challenges associated with this new approach to providing anesthesia services. 3) Established a costing sub-committee to explore current funding of operative anesthesia, estimate the impact of investments in the 2004 Physician Services Agreement and evaluate additional options to better support operative anesthesia. Based on the work outlined above, a paper entitled Transforming the Delivery of Operative Anesthesia Services in Ontario was developed by the OAC. This document recommends: #1 Formal introduction of the ACT model Establish ACT demonstration sites in Academic Health Sciences Centres (AHSCs) and community hospitals. Evaluate the demonstration sites, modify the model and set minimum requirements for viability and expected outcomes. Explore different funding models for ACTs (e.g. APP, AFP, fee-for-service). Roll out the ACT model across the province. #2 Widespread training and use of anesthesia assistants in the delivery of anesthesia services in a variety of practice settings (e.g. AHSCs and community hospitals) Bring together a group of stakeholders to develop a common definition of anesthesia assistant, define their roles and responsibilities and agree on training requirements. Introduce and/or expand training opportunities across Ontario. #3 Changes to the Schedule of Benefits, which will allow the use of supervision in a fee-for-service practice environment and encourage the provision of operative anesthesia services Replace the anesthesia fee (base & time units) with a supervisory payment when someone other than an anesthesiologist provides anesthesia care. Reinvest the savings achieved through this change to the Schedule of Benefits in other anesthesia services. Report & Recommendations of the Operative Anesthesia Committee Page 1 of 101

4 Further support the provision of operative anesthesia services through other specified investments. The Committee agreed that the above-noted recommendations must be considered in their entirety and not as a collection of stand-alone recommendations. The Committee is now focused on costing the proposed recommendations: ACT model demonstration sites for AHSCs and community hospitals Supervisory payments Schedule of Benefit changes (e.g. triple time units for intra-operative anesthesia) The OAC plans to finalize all documents and recommendations for submission to the Physician Services Committee by June Report & Recommendations of the Operative Anesthesia Committee Page 2 of 101

5 EXECUTIVE SUMMARY For several years the Canadian anesthesiology community has been concerned about a growing shortage of anesthesia personnel. This national shortfall was made particularly relevant to Ontario in light of the provincial government s announcement of its Wait List Initiative in the Fall of Even though anesthesiologists sacrificed academic activity to ensure the provision of clinical services, surgical wait times continued to grow, operating rooms were closed and surgeries cancelled. Despite recent efforts to address the situation, including increasing medical school enrollment and anesthesia residency training positions and investing in academic anesthesia services, the anesthesia shortfall continued to grow. The Ontario Medical Association (OMA) and the Ministry of Health and Long-Term Care (MOHLTC) recognized that immediate action was required and called for the establishment of the Operative Anesthesia Committee (OAC) in the most recent Physician Services Agreement. To support stable and adequate access to anesthesia services in Ontario hospitals, the OAC is calling for the formal introduction of Anesthesia Care Teams (ACTs). The ACT is an innovative model of care which calls for a significant change to the way anesthesia services are currently provided. Specially trained other health professionals assist in the provision of anesthesia services under the direct supervision of an anesthesiologist. This model of care will provide better access to anesthesia services in a more efficient and cost cost-effective manner. It will also allow all ACT team members to fully utilize their skills and experience in the provision of anesthesia services, a key component in transforming the provision of health care. Outlined below are the Committee s 3 major recommendations. The steps suggested to implement these recommendations are detailed in the report: #1 Formal introduction of the ACT model Establish ACT demonstration sites in Academic Health Sciences Centres (AHSCs) and community hospitals. Evaluate the demonstration sites, modify the model and set minimum requirements for viability and expected outcomes. Explore different funding models for ACTs (e.g. APP, AFP, fee-for-service). Roll out the ACT model across the province. #2 Widespread training and use of anesthesia assistants in the delivery of anesthesia services in a variety of practice settings (e.g. Academic Health Sciences Centres and community hospitals) Bring together a group of stakeholders to develop a common definition of anesthesia assistant, define their roles and responsibilities and agree on training requirements. Introduce and/or expand training opportunities across Ontario. #3 Changes to the Schedule of Benefits, which will allow the use of supervision in a feefor-service practice environment and encourage the provision of operative anesthesia services Replace the anesthesia fee (base & time units) with a supervisory payment when someone other than an anesthesiologist provides anesthesia care. Reinvest the savings achieved through this change to the Schedule of Benefits in other anesthesia services. Further support the provision of operative anesthesia services through other specified investments. Report & Recommendations of the Operative Anesthesia Committee Page 3 of 101

6 BACKGROUND AND CONTEXT Shortage of Anesthesiologists The shortage of anesthesiologists is a growing concern across all jurisdictions in and outside of Canada. Many studies have examined the supply of anesthesiologists and have confirmed that there are insufficient numbers to meet current and predicted future demands. Two recent Canadian studies found the current supply of anesthesiologists to be inadequate and forecast an increasing deficit over time. While the magnitude of the problem varies from province to province and continues to worsen, Ontario appears to have the largest absolute shortfall of anesthesiologists in Canada. The Ryten Report, commissioned by the Association of Canadian University Departments of Anesthesia, identified an 8% shortfall of anesthesiologists in Canada (114 in Ontario) in This same study projected the deficit would grow to 656 anesthesiologists in Canada (459 in Ontario) by The 2002 Engen Study identified an immediate need for 228 full-time equivalent (FTE) anesthesiologists in Canada and suggested that by FTE anesthesiologists would be required. There are several factors associated with the increasing shortage of anesthesiologists in Canada: The 1991 Barer Stoddart report, Toward Integrated Medical Resource Policies for Canada, resulted in an 11.3% reduction in Canadian medical school enrollment over three years in the early 1990s. This was followed by a similar reduction in postgraduate positions in The opportunity for pursuing specialty training after becoming licensed as a physician in Ontario (re-entry) was closed with the introduction of the Regulated Health Professions Act in Prior to 1993, physicians could get a license to practice medicine in Ontario once they completed their 1-year rotating internship. Under this system, licensed physicians were able to access residency positions to complete specialty training and a significant number of residency spots were available for practicing physicians returning to training. The Act eliminated the 1-year rotating internship as a pathway to licensure and required that physicians complete either a 2-year family medicine program or a 4-5 year specialty training program in order to qualify for independent practice. In doing so, the informal pathway to reentry was closed. Effective July 1997, the Royal College of Physicians and Surgeons of Canada no longer recognized non-north American medical school training as meeting part of the requirements for its own specialty training programs thereby limiting the supply of International Medical Graduates. Impact on Operative Anesthesia The anesthesiologist shortage in Ontario has resulted in growing surgical wait times, cancelled surgeries, operating room closures and delays in diagnostic testing. The role of the anesthesiologist outside the operating room has also expanded over time and this has compounded the negative impact on operative anesthesia. The institution of same-day admission policies in the 1990s imposed the need for pre-anesthetic clinics to assess and evaluate patients before surgery. Simultaneously, the development of sophisticated post operative pain services has resulted in Report & Recommendations of the Operative Anesthesia Committee Page 4 of 101

7 multiple post-operative visits by anesthesiologists, further encouraged by fee-for-service remuneration. Recent Efforts to Address Ontario Shortfall Since the late 1990s, a number of steps have been taken to address the anesthesiologist shortage in Ontario. These efforts include: Ontario medical school enrollment has increased by 34%, growing from 526 positions in 1994 to 704 positions in Ontario anesthesia residency training positions have increased by 32%, growing from 140 positions in 1998 to 185 positions in International Medical Graduates (IMGs) are now recruited under academic certificates issued by the College of Physicians and Surgeons of Ontario. A formal re-entry program has been established beginning with 25 positions for both third year family medicine and specialties. In 2000, a further 15 spots were added bringing the total to 20 spots for family medicine and 20 spots for specialties. Physicians are required to return a maximum of two years in an under-serviced area in return for government funded training. $6 million annually was invested in academic anesthesia services beginning in 2003 resulting in the recruitment of 39 FTE anesthesiologists at Ontario s Academic Health Science Centres (AHSCs). Dr. John Marshall was asked to review anesthesia services, staffing, compensation and workload at Ontario s AHSCs and provide recommendations that led to this new investment. An Anesthesia Assistant Graduate Certificate Program was launched at the Michener Institute. This is a joint initiative involving the Michener Institute and the University of Toronto. The program, which originally offered basic or technical training, has recently expanded to include advanced or clinical training. Applicants skills and experience are assessed to determine their point of entry into the program. The Operative Anesthesia Committee was established in June Report & Recommendations of the Operative Anesthesia Committee Page 5 of 101

8 OPERATIVE ANESTHESIA COMMITTEE 2004 Physician Services Agreement The 2004 Physician Services Agreement provided for the formation of the OAC in recognition of the pressures facing operative anesthesia in Ontario s hospitals. According to Section 27.3 of the 2004 MOHLTC-OMA Physician Services Agreement: The Parties agree that there is an urgent need to address the challenges facing operative anesthesia in Ontario s hospitals. Accordingly, the Parties agree to establish a committee with representation from the OMA and MOHLTC to develop recommendations for addressing this issue in a timely fashion including opportunities for Schedule of Benefits redefinition, other physician payment strategies and the use of anaesthesia extenders. This committee will consult with the OHA as appropriate. The MOHLTC agrees to provide physician funding beginning October 1, The Agreement also provides over $52 million in annual funding for anesthesia services including increases to unit fees and base units ($26 M+), targeted fee increases ($7M+), increased and expanded hospital on-call coverage payments ($13 M) as well as new funding to support operative anesthesia ($5M). Use of funding to support operative anesthesia is to be based on the recommendations of the OAC OAC Terms of Reference The OAC is to provide recommendations to support stable and adequate access to anesthesia services in Ontario hospitals. Areas of focus include: Understanding current and anticipated service demands and workforce issues Short and longer term strategies to support the use of anesthesia assistants Applicability of various funding approaches Consideration of changes to fee-for-service payment program Discussion of longer term alternate funding approaches Impact of short and long term recommendations on the Wait Time Strategy Other longer term recruitment and retention strategies for anesthesia Potential impact on anesthesia requirements in the Local Health Integration Network environment The OAC consists of five members appointed by each of the OMA and MOHLTC (see table below for details). The Chair, Dr. Jack Kitts, was appointed jointly by the OMA and MOHLTC. Dr. David Bevan Dr. Steve Brown Dr. John Cain Dr. Geraint Lewis Operative Anesthesia Committee Membership Chair/Facilitator Dr. Jack Kitts OMA MOHLTC Support Ms. Bernita Drenth Ms. Susan Fitzpatrick Dr. Alan Hudson Mr. Hugh MacLeod Dr. John Marshall Ms. Danielle Claus, Consultant Ms. Honorata Bittner, PSC Secretariat Mr. David Mackey, PSC Secretariat Mr. Jim Simpson, OMA Ms. Peggy Taillon, The Ottawa Hospital Report & Recommendations of the Operative Anesthesia Committee Page 6 of 101

9 Committee Focus The OAC has closely examined current and planned initiatives to address the anesthesiologist shortage. While encouraging, it is clear that significant additional effort is required, effort that looks beyond existing service and funding models in order to better meet current and future service demands. After considerable deliberation and wide ranging consultation, including the OMA Anesthesia Section meeting in September 2005, the OAC: 1) Asked Dr. Marshall to update his 2003 review of anesthesia services at Ontario s AHSCs and to gain an understanding of the current use of, support for and the potential of the ACT concept to address the anesthesia shortage. 2) Clearly defined the ACT model, outlining roles, responsibilities and training requirements. In addition, the OAC identified the benefits and challenges associated with this new approach to providing anesthesia services. 3) Established a costing sub-committee to explore current funding of operative anesthesia estimate the impact of investments in the 2004 Physician Services Agreement and evaluate additional options to better support operative anesthesia. This report focuses on the ACT model. A separate paper, which deals with the funding of operative anesthesia, is currently under development. Report & Recommendations of the Operative Anesthesia Committee Page 7 of 101

10 UPDATE ON ACADEMIC ANESTHESIA SERVICES IN ONTARIO Methodology Questionnaires were sent to the Chiefs of Anesthesiology and to the Directors or Managers of Perioperative Services at each of the AHSC institutions. Following the return of the questionnaires, Dr. Marshall conducted telephone interviews with each Anesthesiology Chief and Peri-Operative Services Manager. The interviews at the two children s hospital were conducted in person, as these sites were not included in the original report. The purpose of the interviews was two-fold. First, confirm the data submitted in the returned questionnaires and clarify any ambiguity. Second, obtain an understanding as to how specific services were delivered at each site with particular focus on the roles played by anesthesia assistants and nurses in supporting anesthesia activities at each stage of the peri-operative process. Findings A summary of Dr. Marshall s findings is outlined in the chart below. There are two points of particular interest. First, it appears the anesthesiologist shortfall across Ontario AHSCs has not changed significantly between February 2003 and November This is due to an almost parallel increase in the volume of services (expressed as Daily Anesthetic Locations) and the general increase in FTE anesthesiologists, 35 and 42 respectively. This reflects the pent up demand for services met by the increasing staff complement. In the absence of the $6 million investment annually, which assisted in the recruitment of the 42 FTE anesthesiologists, the situation at AHSC would be profoundly worse. Staffing Formula Components Feb.2003 Nov.2005 Difference % Change Daily Anesthetic Locations % Required Anesthesia FTE % Actual Anesthesiologist FTE % Actual Assistant/RN Equivalent % Anesthesiologist FTE Shortfall FTE % Second, the use of other health professionals to assist in the provision of anesthesia services has grown significantly in the last two to three years. In February 2003, these individuals represented approximately 6 anesthesia FTEs, while in November 2005, they represented almost 16 FTEs, a growth of 164%. These individuals contributed significantly to reducing the anesthesia shortfall. Without anesthesia assistants and registered nurses (RNs), the anesthesiology shortage would have been 65 FTE instead of the 55 FTE. Report & Recommendations of the Operative Anesthesia Committee Page 8 of 101

11 Other Health Professionals and the Provision of Anesthesia Services As part of the review of anesthesia services within Ontario s AHSCs, Dr. Marshall also learned about the current use of and interest in professionals in the provision of anesthesia services. A synopsis of his findings is as follows: Pre-operative Assessment Unit Most AHSCs support the concept of specially trained nurses in the clinic and agree that this role could reduce the anesthesiologist workload. Very few AHSCs currently use specially trained nurses to triage patients in the preoperative assessment unit. A small number of organizations disagree with this approach claiming that all patients should be seen by an anesthesiologist (based on physician and patient preference). Intra-Operative Care Almost all AHSCs use some model of anesthesia assistant to augment services specifically, RNs and registered respiratory therapists (RRTs) in cataract rooms. That said, there is significant variation in the role of the anesthesia assistant (RRTs and RNs) and the degree to which anesthesiologists can increase clinical services. In two pilot projects, anesthesia assistants assisted in hip and knee procedures. Once regional anesthesia was established, the procedure started and the patient stabilized, the patient was monitored by an anesthetic assistant while the anesthesiologist prepared the next patient. The use of anesthetic assistants resulted in a 33% increase in productivity allowing one additional joint procedure per day (from 3 to 4 cases). Only one AHSC is using anesthesia assistants to occasionally monitor stable long cases under general anesthetic. Those organizations and anesthesiologists currently using anesthesia assistants in a clinical role are more receptive to expanding the assistant role. In AHSCs, there is widespread use of anesthesia assistants to assist in room preparation and turn over and to be on hand at induction, particularly for the more complex cases. Some believe that significant increases in productivity can be achieved by this role. Post-Operative Care Acute Pain Service A number of AHSCs use specially trained nurses to augment the Acute Pain Service. Those organizations using specially trained nurses report significantly improved patient care and variable savings in anesthesiologist time. All AHSCs endorse the use of specially trained nurses in this role but opinions vary on the extent to which specially trained nurses could reduce anesthesiologist workload. All agree that patient safety and satisfaction would be improved. Across the AHSCs, there is a general willingness to introduce some components of the ACT. The enthusiasm for such an introduction varies considerably by site. In general, it could be said that in Centres where alternative approaches have been employed the greater the willingness to consider an expansion of assistant roles. Report & Recommendations of the Operative Anesthesia Committee Page 9 of 101

12 ANESTHESIA CARE TEAM Context Support for the ACT concept is well established. The Surgical Process Analysis and Improvement Expert Panel, established by the MOHLTC in October 2004 to improve surgical efficiencies in Ontario s hospitals, recommends expanding anesthesia resources by supporting: Advance practice roles that complement and expand anesthesia services currently provided by anesthesiologists such as GP anesthetists, anesthesia assistants and acute care nurse practitioners with special training in anesthesia. Teams to provide anesthesia services. The Canadian Anesthesiologists Society (CAS) is calling for a nationally approved training program for anesthesia assistants with formal certification of successful candidates including a well-defined scope of practice. The Canadian Society of Respiratory Therapists supports this concept and is currently drafting a scope of practice for consideration of its members. According to the Council of Academic Hospitals of Ontario and the Ontario Hospital Association, it is believed that anesthesia assistants can play a valuable role in the long-term sustainability of Ontario s health care system. While ACTs have existed informally at some of Ontario s AHSCs for several years, the ability and willingness to introduce or expand the concept has been limited by several factors. By formalizing the ACT model and clearly articulating roles, responsibilities and training requirements, many of the challenges of implementing the model could be addressed and the full potential of the team concept could be realized. Description of ACT Model The ACT consists of anesthesiologists and specially trained other health professionals, RNs and RRTs, working under the supervision of anesthesiologists for a specified set of anesthesia services. The chart below outlines the functions, staff components and reporting structures of the ACT model. This model calls for a change in current reporting relationship. In the ACT model, RNs and RRTs report directly to anesthesiologists. Anesthesia Care Team Pre-Operative Care Intra-Operative Care Pre-Operative Care Anesthesiologists Anesthesiologists Anesthesiologists Clerks Specially trained RNs Technicians Anesthesia Assistants (RNs and/or RRIs) Specially trained RNs Report & Recommendations of the Operative Anesthesia Committee Page 10 of 101

13 Pre-operative Assessment Unit Specially trained nurses, under the supervision of an anesthesiologist, would conduct chart reviews, where indicated, initiate investigation using a series of protocols and algorithms and evaluate/assess patients. Technicians would collect blood work and conduct electrocardiograms. Anesthesiologists would oversee the clinic and provide consultation services as required. Staffing suggestions: 1 FTE specially trained RN for every 5000 clinic patients (Approximately 20 patients per day) 1 FTE anesthesiologist for every 3500 clinic patients who require a consultation (Approximately patients per day) The assumption is that an anesthesiologist may need to see approximately 30% of all clinic patients, seen by the physician only. Note: there may be other flagged patients that the nurse asks the anesthesiologist to see. These flagged patient visits will be much shorter as the nurse has already seen the patient. Note: staff to patient ratios may vary depending on the acuity of the case mix Intra-Operative Care Specially trained anesthesia assistants (RNs and/or RRTs) would provide both technical and clinical assistance to anesthesiologists. The technical role would involve preparation of equipment, facilitating vascular access and insertion of regional nerve blocks as well as assisting with airway management. The clinical role would include assisting the anesthesiologist in the care of stable patients during anesthesia. Anesthesiologists would continue to provide a full range of services in the operating room. Staffing suggestions: 1 FTE anesthesia assistant for every 2 operating rooms The assumption is that this staffing ratio could result in a 20% increase in operating room efficiency and that this increase in efficiency could result in more operative cases Note: to fully utilize the ACT model, anesthesia assistants should be available 24 hours a day, seven days a week Post-operative Care - Acute Pain Service Specially trained nurses would provide patient monitoring and documentation and carry out therapeutic adjustments of both drugs and devices under agreed protocols. These RNs would also have a very active role in patient and unit staff education under the supervision of an anesthesiologist. Anesthesiologists would supervise the acute pain service and have a consultant role when conventional pain management fails. Staffing suggestions: 1 FTE specially trained RN for every 1500 post operative pain patients 0.5 FTE anesthesiologist for every 5000 post operative pain patients The assumption is that the majority of patients could be cared for by the nurse under the supervision of an anesthesiologist. This staffing approach could reduce the anesthesiologist workload by at least 60% Note: to fully utilize the ACT model, specially trained nurses should be available 24 hours a day, seven days a week. Report & Recommendations of the Operative Anesthesia Committee Page 11 of 101

14 Anesthesia Assistants The ACT model calls for the use of RNs and/or RRTs in extended roles for which they have appropriate training. As previously mentioned, it is necessary to achieve an agreed upon definition of anesthesia assistant, their roles and required training for these individuals. The OAC defines an anesthesia assistant as: A specially trained health professional that participates in the care of the surgical patient. Anesthesia assistants will not be a substitute for anesthesiologists nor will they be certified to work independently in environments without the direct supervision of a licensed anesthesiologist. Currently, there are only 2 post-graduate anesthesia assistant training programs in Canada: Caribou College (BC) Michener Institute (Ontario) An overview of the Michener program is provided below. For specific details, refer to the Michener web site Admission requirements: RN or RRT 2 years critical care or operating room experience within the past 4 years Completion of basic level anesthesia assistant training program or equivalent Course competencies include: Evaluating the pre-, peri- and post-operative patient Advanced airway management Assisting with pharmacologic therapy Maintaining fluid therapy Assisting with the administration of peripheral nerve blocks, spinal anesthetics and epidural Assisting with the administration and maintenance of general anesthesia for stable patients Managing special anesthetic considerations Program Duration: For those individuals who have completed basic level training, the program is approximately 22 weeks in length (15 weeks coursework and 6 weeks clinical rotation). For those individuals who have not completed basic level training, the program is approximately 37 weeks in length (30 weeks coursework and 6 weeks clinical rotation). Report & Recommendations of the Operative Anesthesia Committee Page 12 of 101

15 Benefits of the ACT Model There are several benefits associated with this innovative model of care. They range from improved access to services to greater patient safety and include more cost-effective care. The ACT concept also provides a better work environment for all team members as physicians will have assistance and other health professionals will be given an opportunity to fully utilize their skills and experience. Listed below is a brief synopsis of the benefits: Access Access to service improves because other health professionals assist in the provision of anesthesia services thereby freeing up anesthesiologists to provide additional clinical and other services. Appropriateness In the ACT approach, anesthesiologists provide surgical services with the clinical and technical support of anesthesia assistants where deemed appropriate. Specially trained nurses provide routine services in pre and post-operative care under the supervision of an anesthesiologist. Capacity System capacity improves as a result of freeing up additional time for anesthesiologists, incorporating the use of assistants and making operative anesthesia more attractive to anesthesiologists. Cost Effectiveness This model is cost effective because it uses a mix of other health professional and anesthesiologists to provide anesthesia services. Patient Safety The addition of staff, trained for specific roles, in all three environments has the potential to increase patient safety. In the operating room, during preparation, induction of anesthesia and extubation, the assistant provides support to the anesthesiologist. On the acute pain service, the nurse under the supervision of the anesthesiologist becomes an important resource to the unit staff thus improving the quality of care. In the pre-anesthetic clinic, systematic review and patient preparation by specially trained nursing staff and anesthesiologists will continue to reduce the possibility of ill-prepared patients and operating room cancellations. Patient Satisfaction By using specially trained nurses in the pre-admission facility, patients could be seen in a timelier manner. Acute pain service nurses could see patients more promptly as the RNs would be dedicated to this service. Intra-operative anesthesia assistants would improve efficiency and turnover, resulting in fewer cancelled cases. Report & Recommendations of the Operative Anesthesia Committee Page 13 of 101

16 Physician & Other Health Professional Satisfaction Anesthesia assistants will improve efficiency and reduce workload for the specialist anesthesiologist in the pre, intra and post operative domains. The anesthesiologist will have access to technical and clinical support resulting in better working conditions. Anesthesia assistants will also improve the working conditions of operating room nurses who, until now, have been supporting the anesthesiologist. Specially trained nurses on the Acute Pain Service will improve the working conditions of ward staff as there will be a dedicated resource to the pain service available 24 hours a day, 7 days a week. In addition to establishing a career path, the new positions created by this model provide other health professionals with an opportunity to fully utilize their skills and training. Productivity The throughput in some operating rooms could be increased if anesthesia assistants were used. Quality of Care In addition to protocols, care maps, and algorithms, anesthesiologists supervise the work of the other health professionals thereby ensuring quality of patient care. Sustainability This model does not eliminate the need for additional anesthesiologists but it does reduce the pressure on the system and helps the system manage more effectively with existing physician resources. Challenges with the ACT Model There are several significant challenges associated with the ACT model that must be addressed in considering widespread implementation. These challenges range from costing the model to understanding its potential impacts. Details are provided below. Perceptions of the ACT Model While there is broad support across AHSCs for components of the ACT model, the commitment to and interest in implementing all components varies significantly. The ability to implement core components of this model depends upon the culture of the hospital and the physicians practicing there. The extent to which the ACT model is supported depends on the degree to which other health professionals are currently being used. Recommendations: #1 Initiate a consultation process. Circulate the report to stakeholders, receive and review feedback. Report & Recommendations of the Operative Anesthesia Committee Page 14 of 101

17 Impact and Viability of the ACT Model There is also a wide range of opinions on the extent to which other health professionals can make anesthesiologists available to perform operative services. The precise potential of the ACT model, particularly in terms of cost effectiveness and increased system capacity, is unknown and there is significant variation in the estimates. There is, however, a fairly general belief that the quality of services would be greatly improved through standardizing and supporting this model. While this paper attempts to estimate the impact of the ACT model, it is only through implementing the ACT model at demonstration sites that the ability of the model to increase efficiency and productivity while maintaining and, indeed, enhancing the quality of care be better understood. Further, the minimum requirements for an ACT model to be viable are not understood. Is this model only viable in AHSCs? What about community hospitals, large and small, urban and rural? Do all three components of the ACT model have to be in place for the model to be of benefit or can one or two components stand alone. If so, which components are they? To better understand minimum requirements, components of the ACT model need to be tested in different practice settings (demonstration sites). Recommendations: #2 Establish an ACT Implementation & Evaluation Committee composed of stakeholders: Create minimum requirements for demonstration sites Develop an evaluation framework Select demonstration sites #3 Issue an Indication of Interest. Hospitals seeking consideration as an ACT demonstration site would submit a proposal (similar to the Family Health Team Strategy). #4 Create a coaching team(s) to support the development of ACT proposals and to assist with the implementation of the ACT model at the demonstration sites. #5 Choose demonstrations sites in AHSCs and community hospitals using a transparent selection process. #6 Develop contracts for the demonstration sites which contain accountability agreements that address productivity, quality, patient and staff satisfaction. #7 Staff demonstration sites on the basis of the assumptions outlined in the report. #8 Evaluate the demonstration sites using the framework developed by the Committee. #9 Set minimum requirements for ACT model viability and expected outcomes prior to rolling out the ACT model across the province, based on evaluation of demonstration sites. #10 Explore different funding models for ACTs (e.g. APP, AFP, fee-for-service). Report & Recommendations of the Operative Anesthesia Committee Page 15 of 101

18 Composition of the ACT Model (physician and other health professional) At present, there is no standard approach to staffing ACTs (physician/other health professional/patient ratios). If the model is to be introduced widely, a standard approach is required. Staffing suggestions, outlined in this report, are an attempt to address this issue. There is little evidence that further study will yield more appropriate standards. Evaluation of the demonstration sites can provide data to support the ratios recommended in the report or to suggest modifications to the model. Recommendations: #11 Modify the ACT model, if necessary, based on the evaluation of the demonstration sites. Anesthesia Assistants Currently, there is no minimum standard of training required for anesthesia assistants. Some organizations provide on-site programs while others require anesthesia assistant training while still others fund conscious sedation education in the United States. There is also no commonly recognized definition of the roles and responsibilities (clinical and/or technical) of an anesthesia assistant. While the College of Respiratory Therapists of Ontario believes the anesthesia assistant role falls within the scope of practice for RRTs, the College of Nurses of Ontario does not recognize the role of monitoring patients under general anesthesia. The CAS is calling for a nationally approved training program with formal certification of successful candidates including a well-defined scope of practice for anesthesia assistants. The Canadian Society of Respiratory Therapists supports this concept and is currently drafting a scope of practice for consideration of its members. The challenge will be reaching consensus on roles and responsibilities as the work of anesthesia assistant varies considerably within and across institutions and provinces. Furthermore, RRTs are only regulated in 4 provinces (Ontario, Quebec, Alberta and Manitoba). Recommendations: #12 Bring together a stakeholder group to: develop a common definition of anesthesia assistant define roles and responsibilities agree on the training requirements It would be important that this work not delay the implementation of demonstration sites. This work could be done in parallel. #13 Establish training requirements for anesthesia assistants. From this time on, individuals wishing to become anesthesia assistants must successfully complete an advanced level anesthesia assistant training program. #14 Assess the skills of those individuals currently performing anesthesia assistant functions to determine if additional training is required. Report & Recommendations of the Operative Anesthesia Committee Page 16 of 101

19 There are only two anesthesia assistant training programs in Canada (Caribou College and the Michener Institute) at present. These programs have limited enrollment and takes several months to complete. Recommendations: #15 Introduce and/or expand anesthesia assistant training opportunities at other institutions across Ontario, using the standards established at the Michener Institute. CAS Guidelines to the Practice of Anesthesia While the CAS has identified the need for a nationally approved training program with formal certification of successful candidates, including a well-defined scope of practice for anesthesia assistants, the current CAS guidelines state that: Simultaneous administration of general, spinal, epidural or other major regional anesthesia by one anesthesiologist for concurrent diagnostic or therapeutic procedures on more than one patient is unacceptable. The CAS Other health Professions Committee is developing a draft document on the scope of practice for anesthesia assistants. This document will be presented to the Board for discussion at its February 2006 meeting. Recommendations: #16 Review the February 2006 Scope of Practice document being developed by the CAS Allied Health Professions Committee to see if it reflects core components of the ACT model. Currently, the CAS guidelines do not support some components of the ACT model wherein anesthesia assistants provide patient care and monitor stable patients during spinal, regional and general anesthesia allowing the supervising anesthesiologist to perform other duties. Potential Role of the ACT Model in Community Hospitals Further research is needed to assess the interest in and the applicability of the ACT Model in large urban community hospitals as well as rural and northern settings. Recommendations: #17 Conduct a survey of Ontario s community hospitals to determine: The extent to which the hospitals are using specially trained nurses and anesthesia assistants to assist in the provision of anesthesia services If RNs and anesthesia assistants are being utilized, how are they being used by the hospitals What kind of specialized training, if any, have the assistants and/or RNs received. If assistants have received training, what training and from where The receptivity to introducing specially trained nurses and anesthesia assistants to assist in the provision of anesthesia services Report & Recommendations of the Operative Anesthesia Committee Page 17 of 101

20 Schedule of Benefits Currently, the Schedule of Benefits does not include payment for supervision or delegation of services as envisaged in the ACT model. The Ontario Schedule of Benefits remunerates physician services provided in direct contact with the patient. The Schedule includes fee codes for physician supervision of the performance of a limited set of diagnostic and therapeutic procedures, the technical component of diagnostic procedures and simple office laboratory procedures. There is no payment for delegation of assessments, time-based services or major procedures. As well, there are strict limits on the circumstances where delegation is paid under the Ontario Health Insurance Plan (OHIP) for office-based services. Services in hospital are not included under the current Schedule s delegation scope and are not considered insured services when delegated, as the alternate provider is typically an employee of the hospital, not the physician. To facilitate the use of anesthesia assistants in a fee-for-service environment, changes are needed to the Schedule of Benefits to permit and remunerate physician supervision. Recommendations: #18 Replace the anesthesia fee (base & time units) with a supervisory payment when someone other than an anesthesiologist provides anesthesia care. #19 Reinvest the savings achieved through this change to the Schedule of Benefits in other anesthesia services. #20 Establish a Working Group to further examine the issue of supervision and delegation. #21 Further support the provision of operative anesthesia services through other specified investments. Report & Recommendations of the Operative Anesthesia Committee Page 18 of 101

21 NEXT STEPS 1. Following the circulation of the report to various stakeholder groups, an ACT Implementation and Evaluation Committee should be established to oversee the selection and evaluation of ACT demonstration sites. 2. Concurrently, changes should be made to the Schedule of Benefits to incent operative anesthesia and facilitate the implementation of the ACT model. 3. Anesthesia assistant training programs should be established to facilitate the roll-out of the ACT model across the province. 4. Once the demonstration sites have been evaluated and the model adjusted accordingly, the ACT model should be rolled-out across the province using the minimum requirements and expected outcomes set by the Committee. Report & Recommendations of the Operative Anesthesia Committee Page 19 of 101

22 APPENDIX 1 Status Report on Anesthesia Services at Ontario s Academic Health Science Centres Submitted to: Operative Anesthesia Committee, April 2006 Prepared by: Dr. John Marshall & Ms. Danielle Claus Report & Recommendations of the Operative Anesthesia Committee Page 20 of 101

23 Table of Contents TABLE OF CONTENTS EXECUTIVE SUMMARY BACKGROUND SECTION 1: ANESTHESIA SERVICES AT AHSCS SECTION 2: PERCEPTIONS OF ACT MODEL AT ONTARIO AHSCS SECTION 3: SECTION 4: CURRENT USE OF OTHER HEALTH PROFESSIONALS IN SUPPORT OF ANESTHESIA SERVICES OPPORTUNITIES FOR INTRODUCING AND/OR EXPANDING THE ACT MODEL AT AHSCS IN ONTARIO SECTION 5: CONSIDERATIONS ON PRODUCTIVITY AND ACCOUNTABILITY. 40 SECTION 6: INTRODUCING THE ACT MODEL Appendix 1 Questionnaires...46 Appendix 3 DAL Calculation...51 Appendix 4 Overview of Anesthesia Services at AHSCs by Site...53 Appendix 5 Overview of Anesthesia Services at AHSCs by Site...54 Appendix 6 Hospital Specific Information...55 Children s Hospital of Eastern Ontario...56 Hamilton Health Sciences...60 Hamilton St. Joseph s Health Care...64 Hospital for Sick Children...68 Kingston Health Sciences Centre...72 London Health Sciences Centre...76 St. Michael s Hospital...80 Sunnybrook & Women s College Health Sciences Centre...84 The Ottawa Hospital...88 University Health Network & Mount Sinai Hospital...92 University of Ottawa Heart Institute...96 Report & Recommendations of the Operative Anesthesia Committee Page 21 of 101

24 Executive Summary The purpose of this report is two-fold. First, update the 2003 review of anesthesia services at Ontario s Academic Health Sciences Centres (AHSCs). Second, gain an understanding of the current use of, support for and the potential of the anesthesia care team (ACT) concept to address the anesthesia shortage. To fully address these complex and multi-faceted issues, the report has been organized into the following sections: A picture of the current supply of and demand for anesthesia services at Ontario s AHSCs An overview of the perceptions of the ACT model, as well as a description of the perceived barriers to ACT implementation A summary of the current use of Other Health Professionals in support of anesthesia services in AHSCs An assessment of the opportunities for introducing ACTs at the AHSCs An examination of productivity and accountability measures that could be utilized in the delivery of perioperative anesthesia services A summary of the steps required to introduce the ACT model in AHSCs Anesthesia Services at Ontario s AHSCs As seen in the table below, the overall supply of anesthesia services has increased considerably since the original 2003 review, from to daily anesthetic locations (DALs). During the same period, the actual number of anesthesiologists grew from full time equivalents (FTEs) to FTEs. Despite the addition of almost 42 anesthesiologist FTEs, the shortfall has remained the same because the demand for services has kept pace with the supply of anesthesiologists. Staffing Formula Components Feb.2003 Nov.2005 Difference % change Daily Anesthetic Locations (DALs) % Required Anesthesia FTE % Actual Anesthesiologist FTE % Shortfall FTE % Report & Recommendations of the Operative Anesthesia Committee Page 22 of 101

25 The use of other health professionals in the provision of anesthesia services has also increased significantly during this period. In February 2003, registered nurses and anesthesia assistants provided the services of almost 6 FTE anesthesiologists and in November 2005, the work of these other health professionals represented almost 16 FTE anesthesiologists. By employing other health professionals in anesthesia service delivery, the anesthesia shortfall is reduced from 65 to 55 anesthesiologist FTEs. Staffing Formula Components Feb.2003 Nov.2005 Difference % change Daily Anesthetic Locations (DALs) % Required Anesthesia FTE % Actual Anesthesiologist FTE % Actual Assistant/RN Equivalent Anesthesiologist FTE % Shortfall FTE % Perceptions of the ACT Model The Chiefs of Anesthesia at the AHSCs were interviewed and their views were sought on the level of acceptance of the concepts inherent in the ACT model for the delivery of anesthesia services. They were asked to express both their own opinions and to indicate how these opinions aligned with others in their department. To summarize, there was a universal willingness to consider introducing of the ACT model. The enthusiasm for such an introduction varied considerably by site and, in general, it could be said that the more the concepts inherent in the model had been already introduced to a site, the greater the willingness of that site to consider expanding the assistant roles. Use of Allied Health Professionals in the Delivery of Anesthesia Services The current use of anesthesia assistants and nurses to support the delivery of anesthesia service at Ontario s AHSCs is relatively modest. As seen in the table below, there is significant variation between sites in both the number of other health professionals supporting anesthesia service delivery and the roles these individuals play. Hospital Pre-Operative Intra-Operative Post-Operative Total Hamilton Health Sciences Hamilton St. Joseph's Health Care Kingston London Health Sciences Centre Ottawa Heart Institute St. Michael's Hospital Sunnybrook & Women's The Ottawa Hospital UHN/MSH Children's Hospital of Eastern Ontario Hospital for Sick Children Total Report & Recommendations of the Operative Anesthesia Committee Page 23 of 101

4.09. Hospitals Management and Use of Surgical Facilities. Chapter 4 Section. Background. Follow-up on VFM Section 3.09, 2007 Annual Report

4.09. Hospitals Management and Use of Surgical Facilities. Chapter 4 Section. Background. Follow-up on VFM Section 3.09, 2007 Annual Report Chapter 4 Section 4.09 Hospitals Management and Use of Surgical Facilities Follow-up on VFM Section 3.09, 2007 Annual Report Background Ontario s public hospitals are generally governed by a board of directors

More information

STATEMENT ON THE ANESTHESIA CARE TEAM

STATEMENT ON THE ANESTHESIA CARE TEAM Committee of Origin: Anesthesia Care Team (Approved by the ASA House of Delegates on October 18, 2006, and last amended on October 21, 2009) Anesthesiology is the practice of medicine including, but not

More information

Hospitals Voice Their Opinions: Core Recommendations for the 2012 Physician Services Agreement. November 2011

Hospitals Voice Their Opinions: Core Recommendations for the 2012 Physician Services Agreement. November 2011 Hospitals Voice Their Opinions: Core Recommendations for the 2012 Physician Services Agreement November 2011 Table of Contents Background 1 Guiding Principles 1 Core Recommendations for the 2012 Physician

More information

Position Paper on Anesthesia Assistants: An Official Position Paper of the Canadian Anesthesiologists Society

Position Paper on Anesthesia Assistants: An Official Position Paper of the Canadian Anesthesiologists Society Can J Anesth/J Can Anesth (2018) Appendix 5 Position Paper on Anesthesia Assistants: An Official Position Paper of the Canadian Anesthesiologists Society Background Medical and surgical care has become

More information

Anesthesiology. Anesthesiology Profile

Anesthesiology. Anesthesiology Profile Updated March 2018 Click on any of the contents below to navigate to the slide. Please click the home icon located at the top right of each slide to return to the table of contents slide. TABLE OF CONTENTS

More information

1. Introduction. 1 CMS section

1. Introduction. 1 CMS section 1. Introduction Anesthesiology is the practice of medicine including, but not limited to, preoperative patient evaluation, anesthetic planning, intraoperative and postoperative care and the management

More information

Registered Nurse: Surgical First Assist (RN- SFA) Pilot Project Update

Registered Nurse: Surgical First Assist (RN- SFA) Pilot Project Update Registered Nurse: Surgical First Assist (RN- SFA) Pilot Project Update August 2009 Background In May 2006, the Surgical First Assist (SFA) role was announced as part of the HealthForceOntario strategy.

More information

Survey of Nurse Employers in California 2014

Survey of Nurse Employers in California 2014 Survey of Nurse Employers in California 2014 Conducted by UCSF Philip R. Lee Institute for Health Policy Studies, California Institute for Nursing & Health Care, and the Hospital Association of Southern

More information

Full-time Equivalents and Financial Costs Associated with Absenteeism, Overtime, and Involuntary Part-time Employment in the Nursing Profession

Full-time Equivalents and Financial Costs Associated with Absenteeism, Overtime, and Involuntary Part-time Employment in the Nursing Profession Full-time Equivalents and Financial Costs Associated with Absenteeism, Overtime, and Involuntary Part-time Employment in the Nursing Profession A Report prepared for the Canadian Nursing Advisory Committee

More information

Partial Dissent of Independent Assessment Committee Report Orillia Soldiers Memorial Hospital and Ontario Nurses Association

Partial Dissent of Independent Assessment Committee Report Orillia Soldiers Memorial Hospital and Ontario Nurses Association In my expert opinion, the nursing staffing model in the OSMH Pre-Admission Clinic should be two (2) Registered Nurses. I strongly disagree with the recommendation of my colleagues on the Independent Assessment

More information

Part 4. Change Concepts for Improving Adult Cardiac Surgery. In this section, you will learn a group. of change concepts that can be applied in

Part 4. Change Concepts for Improving Adult Cardiac Surgery. In this section, you will learn a group. of change concepts that can be applied in Change Concepts for Improving Adult Cardiac Surgery Part 4 In this section, you will learn a group of change concepts that can be applied in different ways throughout the system of adult cardiac surgery.

More information

APPLIES TO: x SummaCare, Inc. x Apex Health Solutions PRODUCT LINE(S): (Check all that apply)

APPLIES TO: x SummaCare, Inc. x Apex Health Solutions PRODUCT LINE(S): (Check all that apply) POLICY NAME: ANESTHESIA PAYMENT POLICY POLICY NUMBER: ISSUING DEPT.: Claims EFFECTIVE DATE: 9/25/2017 APPROVED BY: APPLIES TO: x SummaCare, Inc. x Apex Health Solutions PRODUCT LINE(S): (Check all that

More information

Workload Models. Hospitalist Consulting Solutions White Paper Series

Workload Models. Hospitalist Consulting Solutions White Paper Series Hospitalist Consulting Solutions White Paper Series Workload Models Author Vandad Yousefi MD CCFP Senior partner Hospitalist Consulting Solutions 1905-763 Bay St Toronto ON M5G 2R3 1 Hospitalist Consulting

More information

INDEPENDENT ASSESSMENT COMMITTEE REPORT SUMMARY

INDEPENDENT ASSESSMENT COMMITTEE REPORT SUMMARY INDEPENDENT ASSESSMENT COMMITTEE REPORT SUMMARY Employer: Lakeridge Health Oshawa, Emergency Department (Oshawa Site) Board: Chair: Leslie Vincent; ONA Nominee: Cindy Gabrielli; Employer Nominee: Susan

More information

Working in the Public Interest Ensuring Proficiency, Skil s and Competence

Working in the Public Interest Ensuring Proficiency, Skil s and Competence May 15, 2017 via email to: ksharma@cpso.on.ca Kavita Sharma Project Coordinator, Quality Management Division The College of Physicians and Surgeons of Ontario 80 College Street Toronto, Ontario, M5G 2E2

More information

The ASA defines anesthesiology as the practice of medicine dealing with but not limited to:

The ASA defines anesthesiology as the practice of medicine dealing with but not limited to: 1570 Midway Pl. Menasha, WI 54952 920-720-1300 Procedure 1205- Anesthesia Lines of Business: All Purpose: This guideline describes Network Health s reimbursement of anesthesia services. Procedure: Anesthesia

More information

Collaborative. Decision-making Framework: Quality Nursing Practice

Collaborative. Decision-making Framework: Quality Nursing Practice Collaborative Decision-making Framework: Quality Nursing Practice SALPN, SRNA and RPNAS Councils Approval Effective Sept. 9, 2017 Please note: For consistency, when more than one regulatory body is being

More information

ORGANIZATIONAL INFORMATION BRIEF SUMMARY OF THE PROBLEM

ORGANIZATIONAL INFORMATION BRIEF SUMMARY OF THE PROBLEM F E L L O W P R O J E C T Implementation of a Contractual Relationship for Anesthesia Services in an Acute Care Facility Marcia Taylor, R.N., M.B.A., FACHE, director of surgical service, Rapid City Regional

More information

Health System Funding Reform: Driving Change using Technology Presentation to Canadian Health Informatics Association

Health System Funding Reform: Driving Change using Technology Presentation to Canadian Health Informatics Association Health System Funding Reform: Driving Change using Technology Presentation to Canadian Health Informatics Association April 2014 Ministry of Health and Long-Term Care V2.4 (2014-04-28) Session Objectives

More information

ROLE OF THE ANESTHETIST IN ORGANIZING AMBULATORY SURGERY. Dr. Paul Vercruysse M.D. Belgium

ROLE OF THE ANESTHETIST IN ORGANIZING AMBULATORY SURGERY. Dr. Paul Vercruysse M.D. Belgium ROLE OF THE ANESTHETIST IN ORGANIZING AMBULATORY SURGERY Dr. Paul Vercruysse M.D. Belgium DISCLOSURES - Conflicts of interest? I am an anesthesiologist... TRADITIONAL ROLE OF THE ANESTHESIOLOGIST EVOLVING

More information

uncovering key data points to improve OR profitability

uncovering key data points to improve OR profitability REPRINT March 2014 Robert A. Stiefel Howard Greenfield healthcare financial management association hfma.org uncovering key data points to improve OR profitability Hospital finance leaders can increase

More information

Access to Health Care Services in Canada, 2003

Access to Health Care Services in Canada, 2003 Access to Health Care Services in Canada, 2003 by Claudia Sanmartin, François Gendron, Jean-Marie Berthelot and Kellie Murphy Health Analysis and Measurement Group Statistics Canada Statistics Canada Health

More information

Anesthesia Elective Curriculum Outline

Anesthesia Elective Curriculum Outline Department of Internal Medicine Texas Tech University Health Sciences Center Odessa, Texas Anesthesia Elective Curriculum Outline Revision Date: July 10, 2006 Approved by Curriculum Meeting September 19,

More information

NON-HOSPITAL MEDICAL AND SURGICAL FACILITIES ACCREDITATION PROGRAM Accreditation Standards. Overnight Stay

NON-HOSPITAL MEDICAL AND SURGICAL FACILITIES ACCREDITATION PROGRAM Accreditation Standards. Overnight Stay NON-HOSPITAL MEDICAL AND SURGICAL FACILITIES ACCREDITATION PROGRAM NON-HOSPITAL MEDICAL AND SURGICAL FACILITIES ACCREDITATION PROGRAM INTRODUCTION Overnight stay is considered a post-anesthesia level of

More information

Supervising Support Personnel

Supervising Support Personnel College of Occupational Therapists of British Columbia 2011 Supervising Support Personnel COTBC practice guidelines are published by the college to assist occupational therapists in meeting the Essential

More information

Benchmarking variation in coding across hospitals in Canada: A data surveillance approach

Benchmarking variation in coding across hospitals in Canada: A data surveillance approach Benchmarking variation in coding across hospitals in Canada: A data surveillance approach Lori Kirby Canadian Institute for Health Information October 11, 2017 lkirby@cihi.ca cihi.ca @cihi_icis Outline

More information

Disclosure. Do One More Case. Focusing on turnover time will improve OR throughput. Myths in Economics of Anesthesia Confirmed, Plausible, or Busted?

Disclosure. Do One More Case. Focusing on turnover time will improve OR throughput. Myths in Economics of Anesthesia Confirmed, Plausible, or Busted? Disclosure ECG Consultants Technical Advisor Focus on Staffing Models Amr Abouleish, MD, MBA Department of Anesthesiology The University of Texas Medical Branch Galveston, Texas aaboulei@utmb.edu throughput.

More information

Stable Physician Workforce Recommendations to stabilize the physician workforce in Nova Scotia

Stable Physician Workforce Recommendations to stabilize the physician workforce in Nova Scotia ROAD MAP TO A Stable Physician Workforce Recommendations to stabilize the physician workforce in Nova Scotia Doctors Nova Scotia September 2018 1 Doctors Nova Scotia 2018 ROAD MAP TO A STABLE PHYSICIAN

More information

EXECUTIVE COMPENSATION PROGRAM

EXECUTIVE COMPENSATION PROGRAM EXECUTIVE COMPENSATION PROGRAM 2 Background In 2010, the Province legislated a two-year compensation freeze for all non-unionized employees in the Broader Public Sector (BPS) which prohibited increases

More information

Methodology Notes. Cost of a Standard Hospital Stay: Appendices to Indicator Library

Methodology Notes. Cost of a Standard Hospital Stay: Appendices to Indicator Library Methodology Notes Cost of a Standard Hospital Stay: Appendices to Indicator Library February 2018 Production of this document is made possible by financial contributions from Health Canada and provincial

More information

CA-1 Curriculum Acute Pain Service and Regional Anesthesia West Virginia University Department of Anesthesiology

CA-1 Curriculum Acute Pain Service and Regional Anesthesia West Virginia University Department of Anesthesiology CA-1 Curriculum Acute Pain Service and Regional Anesthesia West Virginia University Department of Anesthesiology Description of Rotation or Educational Experience The Regional/Acute Pain Services occurs

More information

Department of Critical Care Restricted Registration Proposal for Call Coverage by Residents in TOH Intensive Care Units

Department of Critical Care Restricted Registration Proposal for Call Coverage by Residents in TOH Intensive Care Units Department of Critical Care Restricted Registration Proposal for Call Coverage by Residents in TOH Intensive Care Units Background: In 2004, the CPSO adopted a model for a pilot project to institute limited

More information

Report of the Auditor General to the Nova Scotia House of Assembly

Report of the Auditor General to the Nova Scotia House of Assembly November 22, 2017 Report of the Auditor General to the Nova Scotia House of Assembly Performance Independence Integrity Impact November 22, 2017 Honourable Kevin Murphy Speaker House of Assembly Province

More information

ENHANCE HEALTHCARE CONSULTING E. COUNTRY CLUB DRIVE, SUITE 2810 AVENTURA, FL

ENHANCE HEALTHCARE CONSULTING E. COUNTRY CLUB DRIVE, SUITE 2810 AVENTURA, FL In today s healthcare environment, anesthesia groups have many issues to deal with, including ACO s, pressure on reimbursement, quality tracking, the surgical home, and pressure on hospital subsidies.

More information

Goals and Objectives University of Minnesota Department of Anesthesiology Senior Resident Supervising Rotation

Goals and Objectives University of Minnesota Department of Anesthesiology Senior Resident Supervising Rotation UM Anesthesiology Page 1 June, 2007 Introduction Goals and Objectives University of Minnesota Department of Anesthesiology Senior Resident Supervising Rotation The ABA defines the attributes of consultant

More information

Hospital Improvement Plan Niagara Health System

Hospital Improvement Plan Niagara Health System Hospital Improvement Plan Niagara Health System Presentation to Hamilton Niagara Haldimand Brant Local Health Integration Network (HNHB LHIN) Board of Directors November 25, 2008 HNHB LHIN Staff Health

More information

The goal of Ontario s Wait Time Strategy launched in

The goal of Ontario s Wait Time Strategy launched in Special Report Evaluating Outcomes in Ontario s Wait Time Strategy: Part 4 Joann Trypuc, Alan Hudson and Hugh MacLeod The goal of Ontario s Wait Time Strategy launched in November 2004 was to improve access

More information

Kingston Health Sciences Centre EXECUTIVE COMPENSATION PROGRAM

Kingston Health Sciences Centre EXECUTIVE COMPENSATION PROGRAM Kingston Health Sciences Centre EXECUTIVE COMPENSATION PROGRAM Background In 2010, the Province of Ontario legislated a two-year compensation freeze for all non-unionized employees in the Broader Public

More information

Access to the Best Care Urgent Care Centre

Access to the Best Care Urgent Care Centre 1 Access to the Best Care Urgent Care Centre Overview Earlier this year, Hamilton Health Sciences (HHS) introduced 'Access to the Best Care.' This is a multi-faceted, four-year plan designed to ensure

More information

Nursing and Midwifery Story. .Policy.Research.Practice.

Nursing and Midwifery Story. .Policy.Research.Practice. Nursing and Midwifery Story.Policy.Research.Practice. Dr Siobhan O Halloran Chief Nursing Officer @chiefnurseire Compassionate Mindful Healthcare Bon Secours September 2016 (Wilde) The significant problems

More information

Delegated Functions. Guidelines for Registered Nurses. College of Registered Nurses of Nova Scotia

Delegated Functions. Guidelines for Registered Nurses. College of Registered Nurses of Nova Scotia Delegated Functions Guidelines for Registered Nurses College of Registered Nurses of Nova Scotia Delegation Functions: Guidelines for Registered Nurses 31 October 2017, 2012, College of Registered Nurses

More information

244 CMR: BOARD OF REGISTRATION IN NURSING

244 CMR: BOARD OF REGISTRATION IN NURSING 244 CMR 4.00: THE PRACTICE OF NURSING IN THE EXPANDED ROLE Section 4.01: Authority 4.02: Purpose 4.03: Citation 4.04: Scope 4.05: Definitions 4.06: Gender of Pronouns 4.07: Number (4.08 through 4.10: Reserved)

More information

Hospital Improvement Plan Niagara Health System Staff Report December 16, Hamilton Niagara Haldimand Brant Local Health Integration Network

Hospital Improvement Plan Niagara Health System Staff Report December 16, Hamilton Niagara Haldimand Brant Local Health Integration Network Hospital Improvement Plan Niagara Health System Staff Report December 16, 2008 Hamilton Niagara Haldimand Brant Local Health Integration Network Question: Emergency Medical Services (EMS) The EMS stated

More information

Assignment Of Client Care: Guidelines for Registered Nurses

Assignment Of Client Care: Guidelines for Registered Nurses Assignment Of Client Care: Guidelines for Registered Nurses May 2014 Approved by the College and Association of Registered Nurses of Alberta (CARNA) Permission to reproduce this document is granted; please

More information

South East Local Health Integration Network Integrated Health Services Plan EXECUTIVE SUMMARY

South East Local Health Integration Network Integrated Health Services Plan EXECUTIVE SUMMARY South East Local Health Integration Network Integrated Health Services Plan DISCUSSION DRAFT July, 2006 1.0 Background and Objectives The Government of Ontario has established the South East Local Health

More information

Background: As described below, 70 years of RN effectiveness makes it clear that RNs are central to a high-performing health system.

Background: As described below, 70 years of RN effectiveness makes it clear that RNs are central to a high-performing health system. Background: Nurses are the largest group of regulated health professionals in Canada, accounting for about half the health-care workforce. This includes more than 115,000 Ontario registered nurses (RN)

More information

Improving Hospital Performance Through Clinical Integration

Improving Hospital Performance Through Clinical Integration white paper Improving Hospital Performance Through Clinical Integration Rohit Uppal, MD President of Acute Hospital Medicine, TeamHealth In the typical hospital, most clinical service lines operate as

More information

POLICIES AND PROCEDURES

POLICIES AND PROCEDURES POLICIES AND PROCEDURES POLICY: 535.10 TITLE: EFFECTIVE: 4/13/17 REVIEW: 4/2022 SUPERCEDES: APPROVAL SIGNATURES ON FILE IN EMS OFFICE PAGE: 1 of 14 I. AUTHORITY Division 2.5, California Health and Safety

More information

Alberta Health Services. Strategic Direction

Alberta Health Services. Strategic Direction Alberta Health Services Strategic Direction 2009 2012 PLEASE GO TO WWW.AHS-STRATEGY.COM TO PROVIDE FEEDBACK ON THIS DOCUMENT Defining Our Focus / Measuring Our Progress CONSULTATION DOCUMENT Introduction

More information

UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL ANESTHESIOLOGY RESIDENCY PROGRAM GOALS AND OBJECTIVES

UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL ANESTHESIOLOGY RESIDENCY PROGRAM GOALS AND OBJECTIVES UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL ANESTHESIOLOGY RESIDENCY PROGRAM GOALS AND OBJECTIVES CA-2/CA-3 REQUIRED ROTATIONS IN PEDIATRIC ANESTHESIOLOGY The Department of Anesthesiology has established

More information

Staffordshire and Stoke on Trent Partnership NHS Trust. Operational Plan

Staffordshire and Stoke on Trent Partnership NHS Trust. Operational Plan Staffordshire and Stoke on Trent Partnership NHS Trust Operational Plan 2016-17 Contents Introducing Staffordshire and Stoke on Trent Partnership NHS Trust... 3 The vision of the health and care system...

More information

NURSING WORKLOAD AND WORKFORCE PLANNING PAEDIATRIC QUESTIONNAIRE

NURSING WORKLOAD AND WORKFORCE PLANNING PAEDIATRIC QUESTIONNAIRE NURSING WORKLOAD AND WORKFORCE PLANNING PAEDIATRIC QUESTIONNAIRE INSTRUCTIONS FOR COMPLETION IN EXCEL Please complete this questionnaire electronically. Questions should be answered by either entering

More information

Your Anesthesiologist, Anesthesia and Pain Control

Your Anesthesiologist, Anesthesia and Pain Control You can reduce your pain level after surgery by planning ahead. For example, if you know that you are going to be getting up to do your exercises with the therapist, ask for pain control medication in

More information

Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Post Anesthesia Care Unit (CA-1, CA-2, CA-3)

Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Post Anesthesia Care Unit (CA-1, CA-2, CA-3) Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Post Anesthesia Care Unit (CA-1, CA-2, CA-3) Goals GOALS AND OBJECTIVES To analyze and interpret

More information

THE COLLEGE OF LE COLLÈGE DES FAMILY PHYSICIANS MÉDECINS DE FAMILLE OF CANADA DU CANADA A VISION FOR CANADA

THE COLLEGE OF LE COLLÈGE DES FAMILY PHYSICIANS MÉDECINS DE FAMILLE OF CANADA DU CANADA A VISION FOR CANADA THE COLLEGE OF FAMILY PHYSICIANS OF CANADA LE COLLÈGE DES MÉDECINS DE FAMILLE DU CANADA A VISION FOR CANADA Family Practice The Patient s Medical Home September 2011 The College of Family Physicians of

More information

Chapter F - Human Resources

Chapter F - Human Resources F - HUMAN RESOURCES MICHELE BABICH Human resource shortages are perhaps the most serious challenge fac Canada s healthcare system. In fact, the Health Council of Canada has stated without an appropriate

More information

Negotiating a Hospital Anesthesia Financial Support Agreement

Negotiating a Hospital Anesthesia Financial Support Agreement Negotiating a Hospital Anesthesia Financial Support Agreement Negotiating a Hospital Anesthesia Financial Support Agreement 1 SUMMARY AT A GLANCE: Most anesthesia groups need to create or update agreements

More information

Changing Scope of Practice A Physician s Guide

Changing Scope of Practice A Physician s Guide Changing Scope of Practice A Physician s Guide In accordance with the annual renewal form, physicians must report to the College when they have changed their scope of practice or that they intend to change

More information

Patient-Centred Care. Health System Planning and Physician Practice. Aura Hanna, Ph.D.

Patient-Centred Care. Health System Planning and Physician Practice. Aura Hanna, Ph.D. Patient-Centred Care Health System Planning and Physician Practice Aura Hanna, Ph.D. Topics 2 Health Care System Integration Access Funding Chronic Disease Focus Physician Practice Communicating with patients

More information

Variability in the Surgical Management of Carpal Tunnel Syndrome: Implications for the Effective Use of Healthcare Resources

Variability in the Surgical Management of Carpal Tunnel Syndrome: Implications for the Effective Use of Healthcare Resources Ideas at Work Variability in the Surgical Management of Carpal Tunnel Syndrome: Implications for the Effective Use of Healthcare Resources Amr ElMaraghy and Moira W. Devereaux Abstract Medicine has been

More information

2006 SURVEY OF ORTHOPAEDIC SURGEONS IN ONTARIO

2006 SURVEY OF ORTHOPAEDIC SURGEONS IN ONTARIO ARTHRITIS COMMUNITY RESEARCH & EVALUATION UNIT (ACREU) University Health Network 2006 SURVEY OF ORTHOPAEDIC SURGEONS IN ONTARIO MARCH 2007 Prepared by: Elizabeth Badley Paula Veinot Jeanette Tyas Mayilee

More information

Clinical Fellowship: Cardiac Anesthesia

Clinical Fellowship: Cardiac Anesthesia Anesthesia and Perioperative Medicine Western University Cardiac Anesthesia Program Director Dr. Anita Cave Please visit the Cardiac Anesthesia Fellowship site for most up-to-date information: http://www.schulich.uwo.ca/anesthesia/education/fellowship/fellowships_offered/cardiac_anesthesia.html

More information

Briefing on Shaping Our Future urgent care work stream progress

Briefing on Shaping Our Future urgent care work stream progress Briefing on Shaping Our Future urgent care work stream progress 1. Purpose The purpose of this paper is to describe, update and clarify on the Cornwall and the Isles of Scilly s Shaping Our Future urgent

More information

EMERGENCY MEDICINE TRAINING AND PRACTICE IN CANADA: Celebrating the Past and Evolving the Future

EMERGENCY MEDICINE TRAINING AND PRACTICE IN CANADA: Celebrating the Past and Evolving the Future EMERGENCY MEDICINE TRAINING AND PRACTICE IN CANADA: Celebrating the Past and Evolving the Future CWG-EM Final Report Presentation and Discussion June 6, 2016 The Collaborative Working Group on the Future

More information

April Background. demands on. Increasing. and other. expansion of. team should. care. Education

April Background. demands on. Increasing. and other. expansion of. team should. care. Education The College of Family Physicians of Canada Position Statement Physician Assistants Background Increasing demands on the health care system are affecting the practice of family medicine in Canada. While

More information

Perioperative Nurse Coordinator Lead [Surgical]

Perioperative Nurse Coordinator Lead [Surgical] Date : July 2017 Job Title : Perioperative Nurse Coordinator Lead Note: Lead role is equivalent to Associate Clinical Charge Nurse Level [SN 4] Department : Surgical and Ambulatory Services Otorhinolaryngology

More information

Nursing Policy Secretariat Priority Recommendations

Nursing Policy Secretariat Priority Recommendations Nursing Policy Secretariat Priority Recommendations January 24, 2018 Prepared by: David W. Byres, RN, DNP, MSN, CHE Chief Nurse Executive Assistant Deputy Minister Clinical Integration, Regulation and

More information

Intensive Psychiatric Care Units

Intensive Psychiatric Care Units NHS Lothian St John s Hospital, Livingston Intensive Psychiatric Care Units Service Profile Exercise ~ November 2009 NHS Quality Improvement Scotland (NHS QIS) is committed to equality and diversity. We

More information

80/20 Staffing Model Pilot in a Long-Term Care Facility

80/20 Staffing Model Pilot in a Long-Term Care Facility 45 newfoundland and labrador 80/20 Staffing Model Pilot in a Long-Term Care Facility Trudy Stuckless, RN Vice-President, Professional Standards & Chief Nursing Officer Central Health, Newfoundland and

More information

Nunavut Nursing Recruitment and Retention Strategy November 06, 2007

Nunavut Nursing Recruitment and Retention Strategy November 06, 2007 Nunavut Nursing Recruitment and Retention Strategy November 06, 2007 Page 1 of 10 I. PREFACE The Nunavut Nursing Recruitment and Retention Strategy is the product of extensive consultation with nursing

More information

Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario

Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario 3/31/2016 This document is intended to provide health care organizations in Ontario with guidance as to how they can develop

More information

How the Quality Improvement Plan and the Service Accountability Agreement Can Transform the Health Care System

How the Quality Improvement Plan and the Service Accountability Agreement Can Transform the Health Care System How the Quality Improvement Plan and the Service Accountability Agreement Can Transform the Health Care System Local Health Integration Network (LHIN) Health Quality Ontario (HQO) Quality Improvement Task

More information

SAFE STAFFING GUIDELINE

SAFE STAFFING GUIDELINE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline title SAFE STAFFING GUIDELINE SCOPE 1. Safe staffing for nursing in accident and emergency departments Background 2. The National Institute for

More information

MINISTRY OF HEALTH PATIENT, P F A A TI MIL EN Y, TS C AR AS EGIVER PART AND NER SPU BLIC ENGAGEMENT FRAMEWORK

MINISTRY OF HEALTH PATIENT, P F A A TI MIL EN Y, TS C AR AS EGIVER PART AND NER SPU BLIC ENGAGEMENT FRAMEWORK MINISTRY OF HEALTH PATIENT, FAMILY, CAREGIVER AND PUBLIC ENGAGEMENT FRAMEWORK 2018 MINISTRY OF HEALTH PATIENT, FAMILY, CAREGIVER AND PUBLIC ENGAGEMENT FRAMEWORK 2018 Executive Summary The Ministry of Health

More information

Pediatric Anesthesia Fellowship The Hospital for Sick Children

Pediatric Anesthesia Fellowship The Hospital for Sick Children Pediatric Anesthesia Fellowship The Hospital for Sick Children Fellowship overview: The Pediatric Anesthesia Fellowship at the Hospital for Sick Children is a twelvemonth education and training program

More information

Business Case Advanced Physiotherapy Practitioners in Primary Care

Business Case Advanced Physiotherapy Practitioners in Primary Care 1 Business Case Advanced Physiotherapy Practitioners in Primary Care 1.0 Introduction This scheme supports the sustainability of primary care and the move towards a first line prudent multi-professional

More information

2017 National Survey of Canadian Nurses: Use of Digital Health Technology in Practice Final Executive Report May, 2017

2017 National Survey of Canadian Nurses: Use of Digital Health Technology in Practice Final Executive Report May, 2017 2017 National Survey of Canadian Nurses: Use of Digital Health Technology in Practice Final Executive Report May, 2017 Table of contents Section Heading Background, methodology and sample profile 3 Key

More information

Z: Perioperative Nursing Specialty

Z: Perioperative Nursing Specialty Z: Perioperative Nursing Specialty Alberta Licensed Practical Nurses Competency Profile 263 Major Competency Area: Z Perioperative Nursing Specialty Priority: One Competency: Z-1 HPA Authorizations and

More information

Anesthesia Services Policy

Anesthesia Services Policy Anesthesia Services Policy Policy Number Annual Approval Date 3/14/2018 Approved By Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare Medicare

More information

4.10. Organ and Tissue Donation and Transplantation. Chapter 4 Section. Background. Follow-up to VFM Section 3.10, 2010 Annual Report

4.10. Organ and Tissue Donation and Transplantation. Chapter 4 Section. Background. Follow-up to VFM Section 3.10, 2010 Annual Report Chapter 4 Section 4.10 Ministry of Health and Long-Term Care Organ and Tissue Donation and Transplantation Follow-up to VFM Section 3.10, 2010 Annual Report Chapter 4 Follow-up Section 4.10 Background

More information

Peri-operative Pain Management - a multi-disciplinary team-based approach

Peri-operative Pain Management - a multi-disciplinary team-based approach Peri-operative Pain Management - a multi-disciplinary team-based approach Dr Steven Wong Chief of Service Department of Anaesthesiology & OT Services Queen Elizabeth Hospital Outline Development of postoperative

More information

CONSULTANT REPORT ON THE IMPLEMENTATION OF SELF-REGULATION FOR PARAMEDICS MAY 2017 REG TOEWS, CONSULTANT

CONSULTANT REPORT ON THE IMPLEMENTATION OF SELF-REGULATION FOR PARAMEDICS MAY 2017 REG TOEWS, CONSULTANT CONSULTANT REPORT ON THE IMPLEMENTATION OF SELF-REGULATION FOR PARAMEDICS MAY 2017 REG TOEWS, CONSULTANT TERMS OF REFERENCE The Minister of Health, Seniors and Active Living announced in November 2016

More information

ROLE OF OUT-OF-HOURS NURSE CO-ORDINATORS IN A CHILDREN S HOSPITAL

ROLE OF OUT-OF-HOURS NURSE CO-ORDINATORS IN A CHILDREN S HOSPITAL Art & science The synthesis of art and science is lived by the nurse in the nursing act JOSEPHINE G PATERSON ROLE OF OUT-OF-HOURS NURSE CO-ORDINATORS IN A CHILDREN S HOSPITAL Amy Hensman and colleagues

More information

GENERAL PROGRAM GOALS AND OBJECTIVES

GENERAL PROGRAM GOALS AND OBJECTIVES BENJAMIN ATWATER RESIDENCY TRAINING PROGRAM DIRECTOR UCSD MEDICAL CENTER DEPARTMENT OF ANESTHESIOLOGY 200 WEST ARBOR DRIVE SAN DIEGO, CA 92103-8770 PHONE: (619) 543-5297 FAX: (619) 543-6476 Resident Orientation

More information

Why Focus on Perioperative Services?

Why Focus on Perioperative Services? 1 Why Focus on Perioperative Services? 80% 60% 40% 20% 0% Perioperative Services are key to a hospital/system's success 68% % better performers revenue from perioperative services Perioperative Services

More information

RECOMMENDATION STATUS OVERVIEW

RECOMMENDATION STATUS OVERVIEW Chapter 2 Section 2.01 Community Care Access Centres Financial Operations and Service Delivery Follow-Up on September 2015 Special Report RECOMMENDATION STATUS OVERVIEW # of Status of Actions Recommended

More information

Emergency admissions to hospital: managing the demand

Emergency admissions to hospital: managing the demand Report by the Comptroller and Auditor General Department of Health Emergency admissions to hospital: managing the demand HC 739 SESSION 2013-14 31 OCTOBER 2013 4 Key facts Emergency admissions to hospital:

More information

LOUISIANA MEDICAID PROGRAM ISSUED: 02/01/12 REPLACED: 02/01/94 CHAPTER 5: PROFESSIONAL SERVICES SECTION 5.1: COVERED SERVICES PAGE(S) 11

LOUISIANA MEDICAID PROGRAM ISSUED: 02/01/12 REPLACED: 02/01/94 CHAPTER 5: PROFESSIONAL SERVICES SECTION 5.1: COVERED SERVICES PAGE(S) 11 Anesthesia Services Surgical anesthesia services may be provided by anesthesiologists or certified registered nurse anesthetists (CRNAs). Maternity-related anesthesia services may be provided by anesthesiologists,

More information

Provincial Dialysis Capacity Assessment Executive Summary. April 2012

Provincial Dialysis Capacity Assessment Executive Summary. April 2012 Provincial Dialysis Capacity Assessment 2011-2020 Executive Summary April 2012 Table of Contents Introduction... 2 Planning Process... 2 Methodology... 3 Dialysis Planning Support Model... 3 Data... 3

More information

TRAUMA CENTER REQUIREMENTS

TRAUMA CENTER REQUIREMENTS California Trauma Center Level III Criteria California Code of Regulations,, Chapter 7 - Trauma Care System with American College of Surgeons (Green Book) references; includes FAQ clarifications TRAUMA

More information

Practice-Based Research and Innovation Strategic Plan

Practice-Based Research and Innovation Strategic Plan Practice-Based Research and Innovation Strategic Plan 2012-2017 PBRI Strategic Plan 2 Executive Summary Practice-based research and innovation (PBRI) is the systematic approach to creating new understandings

More information

Canadian Hospital Experiences Survey Frequently Asked Questions

Canadian Hospital Experiences Survey Frequently Asked Questions January 2014 Canadian Hospital Experiences Survey Frequently Asked Questions Canadian Hospital Experiences Survey Project Questions 1. What is the Canadian Hospital Experiences Survey? 2. Why is CIHI leading

More information

Collaborative. Decision-making Framework: Quality Nursing Practice

Collaborative. Decision-making Framework: Quality Nursing Practice Collaborative Decision-making Framework: Quality Nursing Practice December 7, 2016 Please note: For consistency, when more than one regulatory body is being discussed in this document, the regulatory bodies

More information

Specialized Nursing Postgraduate Diploma, Faculty of Nursing, University of Iceland, Reykjavik, Iceland

Specialized Nursing Postgraduate Diploma, Faculty of Nursing, University of Iceland, Reykjavik, Iceland Specialized Nursing Postgraduate Diploma, Faculty of Nursing, University of Iceland, Reykjavik, Iceland Program director: Thorunn Sch. Eliasdottir, CRNA, PhD Specialized Nursing Postgraduate Diploma Faculty

More information

BCNU REPORT TO BC s SELECT STANDING COMMITTEE ON HEALTH

BCNU REPORT TO BC s SELECT STANDING COMMITTEE ON HEALTH BCNU REPORT TO BC s SELECT STANDING COMMITTEE ON HEALTH INTRODUCTION The BC Nurses Union represents over 40,000 registered nurses, licensed practical nurses, registered psychiatric nurses and other health

More information

3.11. Physician Billing. Chapter 3 Section. 1.0 Summary. Ministry of Health and Long-Term Care

3.11. Physician Billing. Chapter 3 Section. 1.0 Summary. Ministry of Health and Long-Term Care Chapter 3 Section 3.11 Ministry of Health and Long-Term Care Physician Billing 1.0 Summary As of March 31, 2016, Ontario had about 30,200 physicians (16,100 specialists and 14,100 family physicians) providing

More information

Comparison of ACP Policy and IOM Report Graduate Medical Education That Meets the Nation's Health Needs

Comparison of ACP Policy and IOM Report Graduate Medical Education That Meets the Nation's Health Needs IOM Recommendation Recommendation 1: Maintain Medicare graduate medical education (GME) support at the current aggregate amount (i.e., the total of indirect medical education and direct graduate medical

More information

September YEARS. of Success in an Evolving Health-Care Environment. HealthForceOntario Marketing and Recruitment Agency

September YEARS. of Success in an Evolving Health-Care Environment. HealthForceOntario Marketing and Recruitment Agency September 2017 10 YEARS of Success in an Evolving Health-Care Environment HealthForceOntario Marketing and Recruitment Agency Letter from the Chair and Executive Director September 2017 It s hard to believe

More information

STANDING COMMITTEE ON PUBLIC ACCOUNTS

STANDING COMMITTEE ON PUBLIC ACCOUNTS STANDING COMMITTEE ON PUBLIC ACCOUNTS PHYSICIAN BILLING (SECTION 3.11, 2016 ANNUAL REPORT OF THE OFFICE OF THE AUDITOR GENERAL OF ONTARIO) 2 nd Session, 41 st Parliament 67 Elizabeth II ISBN 978-1-4868-1079-6

More information

Anesthesia Services Clinical Coverage Policy No.: 1L-1 Amended Date: October 1, Table of Contents

Anesthesia Services Clinical Coverage Policy No.: 1L-1 Amended Date: October 1, Table of Contents Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements... 2 2.1 Provisions... 2 2.1.1 General... 2 2.1.2 Specific... 2 2.2 Special

More information