March 28, 2018 For Decision Board of Directors Item 9.0 Comprehensive Regional Cardiac Program Plan

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Lawrence Allison
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1 BRIEFING NOTE March 28, 2018 For Decision Board of Directors Item 9.0 Comprehensive Regional Cardiac Program Plan PURPOSE To provide the WWLHIN Board of Directors with a recommendation to endorse the proposed Comprehensive Regional Cardiac Program Plan. CORE CONTEXT At the May 24, 2017 WWLHIN Board of Directors Meeting discussion and presentation of item 14.0 decision on the St. Mary s General Hospital (SMGH) Stage 1-2 capital redevelopment project, the WWLHIN Board of Directors made the following motion: THAT the WWLHIN Board of Directors endorse the program and service elements outlined in the Stage 1 & 2 Part A submission for St. Mary s General Hospital (SMGH) Heart Rhythm Centre Project, with the expectation that SMGH 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, while also planning to deliver services within the confirmed (funding) fiscal framework and priorities established by MOHLTC and WWLHIN AND that, as a requirement of this endorsement, SMGH, in partnership with specialists, primary care, patients, and WWLHIN, submit a plan for developing the cardiac centre into a full service regional cardiac program for all of Waterloo Wellington by September 30, 2017 for endorsement by WWLHIN Board. The plan received from SMGH on January 30 th, 2018 identifies the requirements to expand the current Regional Cardiac Centre at SMGH into a full service regional cardiac program for all of Waterloo Wellington. RECOMMENDATION THAT the WWLHIN Board of Directors endorses the Comprehensive Regional Cardiac Program Plan and subsequent pre-capital submissions to support the development of the Waterloo Wellington Regional Cardiac Program and directs the CEO to communicate this endorsement to Healthy People. Thriving Communities. Bright Futures. 1

2 the Minister and Deputy Minister of Health and Long-term Care. BACKGROUND INFORMATION The SMGH Regional Cardiac Centre serves a population base throughout Waterloo-Wellington and from Simcoe to Goderich to Owen Sound. In St. Mary s completed the following: o 5,400 catheterizations and angioplasty procedures o 850 bypass and valve surgeries o 590 pacemaker and ICD insertions o 10,000 outpatient clinic visits The SMGH Cardiac Centre was first approved by the MOHLTC in 1999 and opened the pacemaker clinic in Low risk diagnostic cardiac catheterizations and cardiac rehab began in 2001 followed by interventional cardiology including cardiac surgery in The rapid access treatment program for patients suffering an acute heart attack (code STEMI ST segment Elevation Myocardial Infarction) launched in In 2013, SMGH began inserting implantable cardioverter defibrillators (ICD). In 2014, a partnership between SMGH and the Guelph YMCA led to the establishment of the first remote pacemaker program in Ontario. A review of the Cardiac Care Quality Indicators Report, prepared by the Canadian Institute for Health Information (CIHI) focusing on six quality outcome indicators during the three year period from to , found SMGH (along with only the Ottawa Heart Institute and Vancouver General) was one of only three hospitals performing better than the national average on all indicators. Of particular note is the mortality rate for cardiac surgery at SMGH which was less than half the national rate. The Regional Cardiac Program Plan has recognized that SMGH serves a significantly critical mass of patients reflecting the need to provide highly specialized cardiac services within the WWLHIN. Significant growth in cardiac procedures at SMGH between and demonstrates the need for capital investments to respond to increasing and anticipated continual demand for these and other cardiac services: o 11% growth in cardiac surgery o 30% growth in cardiac catheterizations o 98% growth in cardiac angioplasty (percutaneous interventions PCI) o 60% growth in pacemaker insertions o 940% growth in ICD (implantable cardioverter defibrillator) insertions In May 2017, the WWLHIN Board of Directors endorsed the stage 1 and 2 capital proposal to bring electrophysiology services to SMGH. This stage 1 and 2 proposal has been approved by 2

3 the capital branch of the MOHLTC and SMGH is currently preparing their stage 3 capital plan for submission. The electrophysiology service is anticipated to be operational in early In August 2017, the WWLHIN Board of Directors endorsed the proposal for SMGH to offer minimally invasive structural heart surgeries through a procedure called Transcatheter Aortic Valve Implantation (TAVI). In February 2018, the Provincial Priority Programs Branch informed the WWLHIN and SMGH that they have approved this proposal and will provide funding for SMGH to complete 50 TAVI cases beginning in The Waterloo Wellington Regional Cardiac Program Strategic Plan sets forth an equitable model for integrated cardiac care delivery that supports the patient throughout their care journey and across care settings. The Strategic Plan takes into consideration population characteristics, and the needs of increasingly aging and complex patients who need access to high quality, specialized cardiac services close to home. Local solutions for health care delivery will be prioritized in the sub-regions of the WWLHIN to improve access, reduce variability in care, and create a better patient experience. The priorities for service enhancements are informed by the gaps and challenges expressed by the stakeholders. Patients and health care providers have stated that access to high quality; urgent cardiac care in the region is excellent. At the same time, stakeholders identified a range of gaps and inefficiencies in care, and coordination of care between providers, particularly for complex patients and patients who are non-emergent. Planning efforts are closely aligned with the strategic directions of provincial and regional partners, including the WWLHIN and CorHealth. This is a unique opportunity to define the governance structure for the regional cardiac program, including clear roles and responsibilities for providers, and SMGH s Regional Cardiac Care Centre, the lead organization for the Waterloo Wellington Regional Cardiac Program. NEXT STEPS The Strategic Plan will be implemented through a coordinated network of providers and community partners led by SMGH s Regional Cardiac Care Centre. The strategic plan has identified a need to develop a regional governance model to develop an operational/implementation plan within the fiscal year. Components of the project implementation plan for include: Developing a patient engagement strategy Developing and implementing care pathways for cardiac rehab and heart failure Enhancing patient education resources Developing and implementing human resources, infrastructure and program plans at SMGH Developing and implementing a strategy to preserve current referral patterns to ensure the critical mass at the Regional Cardiac Care Centre 3

4 Planning and coordinating the delivery of cardiac services in the WWLHIN Developing and implementing a regional strategy for cardiovascular prevention, promotion and rehabilitation programming Develop a digital health plan for the Regional Cardiac Program to enhance patient care The addition of highly specialized cardiac services to the WW Regional Cardiac Program are anticipated to occur through a series of three phases. Appendix B describes the various funding requirements for the components to be added in each of these phases which are summarized in the table below: 2017/18 Phase Phase Phase 3 Electrophysiology Suite Cardiac Cath Lab Cardio-diagnostics (Heart Rhythm Program) Electrophysiology Recovery Hybrid Cardiac Procedure Room Outpatient Clinic TAVI Cardiac CT (computed tomography) Increased operating investment in Cardiac Surgery Recovery Space for Cath lab and hybrid procedure room Interventional Cardiology (PCI percutaneous coronary intervention) recovery beds 3 CACU Beds 2 CVICU Beds 4 CCU Beds 5 Inpatient Cardiology Beds Cardiac Rehab 2 nd Electrophysiology Suite and Recovery Space Cardiac MRI 4

5 APPENDIX A Waterloo Wellington Regional Cardiac Program Strategic Plan At a glance VISION The Waterloo Wellington Regional Cardiac Program, led by SMGH s Regional Cardiac Care Centre, supports patients and providers to ensure the delivery of high-quality and patientcentred cardiac care GOAL Create a strong culture of patient engagement to drive quality care and enhance the patient experience in the Regional Cardiac Program GOAL Expand the local delivery of quality, complex clinical services to patients with cardiovascular disease GOAL Strengthen a quality program that is integrated across the health care system Develop a comprehensive patient engagement strategy to support the ongoing delivery of regional cardiac services. Develop and implement care pathways that support the patient s journey across the continuum of care. Enhance patient education resources to improve the patient experience in the Regional Cardiac Program. INITIATIVES Develop and implement comprehensive human resources, infrastructure and program plans for all cardiac services at the Regional Cardiac Care Centre including emerging techniques, procedures and other technological advances in cardiac care to support current and future patient needs. Develop and implement a strategy to preserve current referral patterns and critical mass to ensure ongoing demand for the Regional Cardiac Care Centre to continue to offer highly specialized cardiac services. Plan and coordinate the delivery of cardiac services in the region. Develop a regional governance structure to provide ongoing leadership to the Regional Cardiac Program. Establish a quality assurance and improvement framework and tools for the Regional Cardiac Program. Develop and implement a regional strategy for cardiovascular prevention, promotion and rehabilitation programming. Develop and implement a regional strategy for congestive heart failure patients. Develop a digital health plan for the Regional Cardiac Program to enhance patient care. 5

6 Patients and their families are active members of their health care teams and in the planning for service and program delivery. Patients have a clear understanding of their care pathways. Patients have confidence in the continuity of their care as they transition between care settings and providers. Patients are empowered to make informed decisions and manage their care as a result of access to digestible and interpreted information and resources. WHAT SUCCESS LOOKS LIKE Patients in Waterloo Wellington have access to a full service cardiovascular program that is close to home Patients benefit from cardiac care services that are responsive to changing regional needs of the subregion care communities. Patients have an easier time navigating the health care system thanks to a network of providers that is connected through a single patient portal. There is enhanced equity in care and a reduction of variation of care across the sub-regions as a result of integrated access to specialists and specialty care. A coordinated network of providers delivers integrated cardiac services across the health care continuum under the leadership of the Regional Cardiac Care Centre. A robust quality assurance and improvement framework for cardiac services ensures that patients have access to an equal standard care across the region. All residents have access to prevention and cardiovascular rehabilitation programming that is accessible in a clinical, community, home, or virtual setting based on their individual needs Patients with congestive heart failure will have better health outcomes resulting in fewer hospitalizations as a result of improvements in early detection, programs that help prevent the progression of disease, and primary care and community support to manage their disease effectively. Patients and providers are able to share information and contribute to patient care plans easily and virtually. 6

7 APPENDIX B Comprehensive Cardiac Proposal The Cardiac forecast is presented in three distinct blocks identifying Branch, Provincial Priority Programs and Operations/Base requirements for each. Depending on MOHLTC recommendations, these distinct phases identified below could be consolodated into a fewer or a single combined capital and program services request. Phase 1: Components include: Program Requirement Approval Stage Branch (Construction Costs only) Equipment (SMGH Foundation) Provincial Priority Programs Branch 1 PPPB Base Operations Electrophysiology Stage 3 $5,500,000 $6,000,000 $3,801,463 $3,379,670 $892,500 $684,000 Suite 1 Electrophysiology recovery space $2,000,000 $0 Included above N/A $0 Included above TAVI Service 2 WWLHIN Board July 2017 Waiting approval with PPPB based on CorHealth MISH working group recommendations (expected ) N/A N/A SMGH currently reviewing requirements $1,550,000 $0 $150,000 Cardiac CT 3 N/A N/A N/A N/A N/A CT operating hours TOTAL $7,500,000 $6,000,000 $3,801,463 $4,929,670 $892,500 $834,000 1 Electrophysiology Suite: Additional Priority Program Branch required for forecasted services including 168 EP studies, 59 complex ablations, 66 standard ablations, 50 ICD. Base operations funding required for EP and pacemaker clinic staffing. 2 TAVI service: SMGH is capable of providing this minimally invasive procedure ASAP and could use one of their cath labs for this work until a hybrid procedure room is available once approved funded volumes are confirmed. Current forecasted demand is 50 cases per year. 3 Cardiac CT: Use of cardiac CT has potential to decrease demand for diagnostic CATH and mitigate some risk with only 2 cardiac cath labs. Forecasted demand for 200 cases per year would result in longer P4 CT wait times without incremental base funded CT hours. 7

8 Phase 2: Components include: Program Requirement Approval Stage Branch Cardiac Catheterization Lab 1 Hybrid Procedure Room 2 Pre- anticipated Pre- anticipated Equipment (SMGH Foundation) Provincial Priority Programs Branch 1 PPPB Base Operations $1,350,000 $0 $2,311,350 $1,928,618 $0 $350,000 $1,329,240 $0 $3,801,463 N/A N/A N/A Cardiac Operating Rooms 3 Recovery Space for third cath lab and hybrid procedure room 4 PPPB submission anticipated Pre- anticipated N/A $0 $0 $1,172,500 N/A N/A $396,000 $0 $178,794 N/A N/A $750,000 PCI Recovery Beds 5 Pre- anticipated $139,860 $0 $119,196 N/A N/A $500,000 Contingency $803,775 $1,602,700 (25%) TOTAL $4,018,875 $0 $8,013,503 $3,101,118 $0 $1,600,000 1 Cardiac Catheterization Lab: Additional Priority Program Branch required for forecasted services including 337 PCI & 713 Cath. Base operations funding required for 3 FTE RN. Significant System Clinical Risk to provide current and future volume in only 2 cardiac cath labs resulting in urgent funding requirements. 2 Hybrid Procedure Room: Bundled with the project for the third cath lab to gain efficiencies related to co-located prep and recovery space and staffing. See additional funding requests for PPPB and base operations for TAVI as the Hybrid procedure room would enable this work to relocate from the cath lab and facilitating the ability for future MISH demand. 3 Additional 67 cardiac surgical procedures (anticipated surgical growth mitigated by spread and adoption of MISH and PCI). 4 Recovery Space: Base operations for 4.8 FTE RN 5 PCI Recovery Beds: Growth from current 7 beds to 10 beds, base operations for 3 FTE RN 8

9 Phase 3: Components include: Program Requirement Approval Stage Branch Equipment (SMGH Foundation) Provincial Priority Programs Branch 1 PPPB Base Operations Cardio-diagnostics 1 Pre-capital request $1,500,000 $0 $460,882 N/A $0 $425,000 anticipated Outpatient Clinic 1 Pre-capital request $1,800,000 $0 $177,283 N/A $0 anticipated 3 (three) CACU Beds 2 Pre-capital request $461,168 $0 $208,202 N/A N/A $750,000 anticipated 2 (two) CV ICU Beds 3 Pre- anticipated $351,360 $0 $171,268 N/A N/A $1,000,000 4 CCU Beds 4 Pre- anticipated $614,880 $0 $257,586 N/A N/A $1,000,000 5 Inpatient Cardiology Pre- anticipated $614,880 $0 $304,720 N/A N/A $750,000 Beds Cardiac Rehab request to follow N/A $0 N/A N/A N/A $3,500,000 the CorHealth white paper recommendations for funding of cardiac, vascular and stroke rehab 2 nd Electrophysiology Pre-capital request $3,026,000 $0 $3,801,463 TBD $0 Suite and Recovery Space 6 anticipated Cardiac MRI Pre-capital request anticipated $7,191,600 $0 $3,000,000 MRI operating hours Contingency $3,899,972 $2,095,351 25% TOTAL $19,449,860 $0 $10,476,755 $0 $0 $7,425,000 Phase 3: Components include: 1 Cardio-diagnostics and outpatient clinics includes $75,000 for Physician Lead for ongoing ECHO and other accreditation requirements in the system 2 Three CACU beds funded at $250,000 per bed (Increase hospital compliment of CACU beds from three to six) 3 Two CVICU beds funded at $500,000 per bed (Increase hospital compliment of CVICU beds from eight to ten) 4 Four CCU beds funded at $250,000 per bed (Increase hospital compliment of CCU beds from six to ten) 5 Five In-patient Cardiology beds funded at $150,000 per bed (Increase hospital compliment from 23 to 28) 6 2nd Electrophysiology Suite and Recovery Space based on the anticipation that the EP suite currently at stage 3 in the MOHLTC approvals process will be at capacity due to local demand once it opens. TOTAL Planning Summary Program Requirement Approval Stage Branch Equipment (SMGH Foundation) Provincial Priority Programs Branch 1 PPPB Base Operations TOTAL $30,968,735 $6,000,000 $22,291,721 $7,138,288 $892,500 $9,859,000 9

The Regional Cardiac Care Program at Southlake

The Regional Cardiac Care Program at Southlake The Future Vision of Regional Cardiac Services Serving the Populations of York, Simcoe, Muskoka, and Dufferin Regions Copyright 2009. Southlake Regional Health