2016 Ontario Hospitals Maternal-Child Services Report LHIN-level Indicators

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216 Ontario Hospitals Maternal-Child Services Report LHIN-level Indicators TAB Intro Population IP ED MH OBS LHIN map, the list of acronyms, and key definitions 1.

1 216 Ontario Hospitals Maternal-Child Services Report LHIN-level Indicators TAB Intro Population IP ED MH OBS LHIN map, the list of acronyms, and key definitions 1. Paediatric Population Overview Ontario population trends (C21-216) Paediatric population volume by LHIN (C215) Paediatric population trends by LHIN (C21-216) CONTENTS 2. Paediatric Inpatient Hospital Discharges Rate of paediatric inpatient discharges by LHIN (FY 215/16) Average LOS by LHIN (FY 215/16) Volume of paediatric paediatric discharges by LHIN (FY 215/16) Distribution of paediatric patients looking for inpatient services in/outside of their LHIN of residence (FY 215/16) Distribution of paediatric inpatient discharges by age (FY 215/16) 3. Paediatric Emergency Department Indicators Distribution of paediatric patients looking for ED services in/outside of their LHIN of residence (FY 215/16) Distribution of paediatric ED visits by LHIN (FY 215/16) Persantage of total paediatric ED visits that were admitted by LHIN (FY 215/16) Rate of paediatric ED visits by LHIN (FY 215/16) 4. Paediatric Mental Health Indicators Rate of paediatric mental health inpatient admissions and ED visits (C ) Distribution of paediatric patients looking for inpatient mental health serviced in/outside of their LHIN of residence (FY 215/16) Paediatric inpatient mental health volume and average LOS trends in Ontario (FY 211/12 - FY 215/16) Paediatric mental health inpatient volume and % admitted through ED by LHIN (FY 215/16) Rate of paediatric mental health inpatient discharges by LHIN (C215) Rate of paediatric mental health ED visits by LHIN (C215) 5. Obstetrical Indicators Distribution of patients looking for inpatient obstetrical services inside and outside of their LHIN of residence (FY 215/16) Obstetrical inpatient volume and Average Length of Stay (FY 211/12-215/16) Data Sources CIHI NACRS CIHI NACRS

216 Ontario Hospitals Maternal-Child Services Report Provincial Council for Maternal and Child Health Definitions and Acronyms Local Health Integration Networks 3 4 Erie St.

2 216 Ontario Hospitals Maternal-Child Services Report Provincial Council for Maternal and Child Health Definitions and Acronyms Local Health Integration Networks 3 4 Erie St. Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West Acronyms Definitions ALOS Average Length of Stay Low Risk C Calendar Year CIHI DAD Discharge Abstract Database ED Emergency Department FY Fiscal Year IN Inpatient LHIN Local Health Integration Networks MH Mental Health Low risk women are those whose pregnancies fall into Robson criteria 1 to 4, and who do not have any of the health conditions specified below: Maternal - autoimmune, cancer, cardiovascular, diabetes, gastrointestinal, genitourinary, haematological, hypertensive disorders in pregnancy, musculoskeletal, neurological, placental, pulmonary; Fetal anomalies or complications). NACRS National Ambulatory Care Reporting System Paediatric From birth up to 18 years of age. OBS Obstetrical 1st trimester Defined as <13 weeks gestation. Paed Paediatric

3 216 Ontario Hospitals Maternal-Child Services Report Provincial Council for Maternal and Child Health 1. Paediatric Population Overview The volume of paediatric population in Ontario - defined as days to 18 years of age - has declined by 1.9% from 21 (2,741,14) to 216 (2,69,366). Relative to the overall provincial population, the proportion of paediatric population decreased from 2.9% in 21 to 19.3% in 216. Almost 35%, or 1 in 3, of Ontario's paediatric population are residing in (272,414), (374,786), and (3,136). has highest proportion of paediatric population relative to the overall population (29,741 or 23%). 16,, Ontario Population Trends (C21-216) 14,, 12,, 1,, 8,, 1,393,961 1,529,817 1,694,853 1,841,32 1,987,33 11,124,766 11,258,421 6,, 4,, 2,, 2,741,14 2,733,744 2,717,147 2,696,75 2,685,712 2,684,936 2,69, Ontario Paeds Ontario Other 4, 35, 3, 25, 2, 15, 1, 5, - 123,563 19, , ,414 Paediatric Population Volume by LHIN (C216) 29, ,24 221, ,786 3,136 84,57 253,85 19% 2% 21% 19% 22% 21% 17% 2% 19% 17% 19% 19% 18% 2% 3 4 % Paediatric population as % of total LHIN population 88,386 99,96 47,445 LHIN 3 4 Paediatric Population Trends by LHIN (C21-216) , , ,8 367, , , , ,14 38,558 35,379 32,166 3, ,84 3,136 28,57 21,14 28,91 27,413 27,66 28,624 29, ,14 255, , , , , ,85 135,81 133, , , ,23 125, , ,444 28,37 277, , , , , ,191 93,131 18,67 5, ,759 91,989 17,379 5, ,491 91,26 15,43 49, ,697 9,58 13,455 48, ,397 89,113 11,877 48, ,839 88,599 1,797 47, ,24 88,386 99,96 47,445 91,51 197, , ,496 9,61 195, , ,916 88, , , ,531 86,84 192, ,88 162,876 85,55 191, ,84 162,4 84,934 19, , ,534 84,57 19, , ,859 : Population estimates by LHIN (29-213), and Population projections by LHIN ( ). Notes: All records in this section are presented by calendar year.

4 216 Ontario Hospitals Maternal-Child Services Report Provincial Council for Maternal and Child Health 2. Paediatric Inpatient Hospital Discharges In FY 215/16, there were 129,874 paediatric inpatient discharges in Ontario. Of those, 58,48 (45%) were neonatal patients (-28 days). Approximately 2% of the volume (or 1 in 5 paediatric patients) is attributed to. The Average Length of Stay (ALOS) for paediatric patients was 4.6 (ALOS=5.2 for neonates, and ALOS=4.1 for patients over the age of 28 days). ALOS for age -28 days group is longer than age years group across all the LHINs except in the. The highest neonatal ALOS was seen in (ALOS=8.1) and the highest ALOS for patients over 28 days was seen in (ALOS=5.3). One in four paediatric patients in Ontario were looking for inpatient services outside of their LHIN of residence. Of those, 762 peadiatric patients used services outside of the province. The majority of this volume is attributed to the North West LHIN, where around six hundred cases were transferred to Winnipeg Rate of paediatric IP discharges by LHIN per 1,* (FY 215/16) Ontario Average Length of Stay by LHIN (FY 215/16) Ontario Days 29 Days - 17 Years 3 4 Volume of paediatric IP discharges by LHIN (FY 215/16) 2, 4, 6, 8, 1, 12, 14, 16, 18, - 28 Days 29 Days - 17 Years 3 4 Distribution of paediatric patients looking for IP services in/outside of their LHIN of residence (FY 215/16) % 1% 2% 3% 4% 5% 6% 7% 8% 9% 1% % Inside LHIN % outside LHIN % outside Province Distribution of paediatric IP discharges by age (FY 215/16) 71,392 58,48-28 Days 29 Days - 17 Years 1 in 4 paediatric patients in Ontario are looking for inpatient services outside of their LHIN of residence. Of those, 762 peadiatric patients used services outside of the province. Discharge Abstract Database (DAD), provided by the Canadian Institute of Health Information (CIHI). : Population estimates by LHIN (29-213), and Population projections by LHIN ( )

5 216 Ontario Hospitals Maternal-Child Services Report Provincial Council for Maternal and Child Health 3. Paediatric Emergency Department Indicators In FY 215/16, there were 1,217,115 paediatric ED visits registered in Ontario. Approximately one third of this volume (34%) came from, and (11%, 11% and 12% respectively). This represents and average of 453 ED visits per 1, children between the ages of and 18 years. The highest rate of ED visits was observed in, 13 and 14 (72, 794 and 84 per 1, respectively). 14% of paediatric patients were looking for ED services outside of their LHIN of residence. This represents a total of 148,65 children. Of note, approximately 1 in every 3 paediatric patients in Central and 1 in every 4 paediatric patients in Central West LHIN are included in this group. On average, 4% of paediatric patients were admitted to ED. LHINS 4, 5 and 7 saw the highest volume of ED admissions (5.3%, 6.3% and 7.8% respectively). Distribution of patients looking for ED services in/outside of their residential LHIN (FY 215/16) North West North East North Simcoe Muskoka Champlain South East Central East Central Toronto Central Mississauga Halton Central West Hamilton Niagara Haldimand Brant Waterloo Wellington South West Erie St. Clair % 1% 2% 3% 4% 5% 6% 7% 8% 9% 1% Distribution of paediatric ED visits by LHIN (FY 215/16) 4% 3 7% 12% 5% 9% 1% 4 3% 4% 9% 11% 7% 11% 4% 4% % Inside LHIN % outside LHIN Percentage of total paediatric ED visits that were admitted by LHIN (FY 215/16) 9.% 8.% 7.8% 7.% 6.3% 6.% 5.% 4.% 3.% 2.3% 3.1% 4.4% 5.3% 3.8% 3.% 3.2% 2.2% 3.4% 2.4% 2.9% 3.9% 4.% 2.% 1.%.% 3 4 Ontario Rate* of paediatric ED visits by LHIN (FY 215/16) Ontario National Ambulatory Care reporting System (NACRS), provided by the Canadian Institute of Health Information (CIHI). : Population estimates by LHIN (29-213), and Population projections by LHIN ( ). Notes: *Rate per 1, paediatric Population

6 216 Ontario Hospitals Maternal-Child Services Report Provincial Council for Maternal and Child Health 4. Paediatric Mental Health Indicators In FY 215/16, there were 8,69 paediatric mental health inpatient discharges in Ontario. This represents a ~46% increase from 5 years ago. Of those, almost 2% (or 1 in 5 paediatric mental health inpatient discharges) were registered in. Of note, more than one third (4%) of paediatric patients in were looking for inpatient mental service outside their residential LHIN. While the mental health inpatient volume has been growing steadily since FY211/12, the Average LOS continues to decline, from ALSO=9.9 in FY 211/12 to ALSO=8.1 in FY 215/16. The rate of paediatric ED visits for mental health problems also continues to grow, with 8.5 / 1, population ED visits registered in FY 215/16. The highest rate was observed in LHINs 13 and 14 (15 / 1, and 19/ 1, respectively). Near six thousand mental health patients were admitted through ED. Of those, 22% case came from Rate* of paediatric MH IP admissions and ED Visits (C211-C215) C211 C212 C213 C214 C Distribution of paediatric patients looking for IP MH serviced in/outside of their LHIN of residence (FY 215/16) % 1% 2% 3% 4% 5% 6% 7% 8% 9% 1% ED IP % Inside LHIN % outside LHIN 1, 9, 8, 7, 6, 5, 4, 3, 2, 1, Paediatric IP MH volume and average LOS trends in Ontario (FY 211/12 - FY 215/16) 7,974 8,16 8,69 6,998 5, Volume ALOS 2, 1,8 1,6 1,4 1,2 1, Paediatric MH IP volume and % admitted through ED by LHIN (FY 215/16) 532 1, % 69% 5% 74% 74% 79% 68% 74% 77% 51% 79% 84% 72% 67% % 569 Paediatric MH IP volume admitted through ED as % of total paediatric MH IP volume Rate* of paediatric IP MH discharges by LHIN (C215) Rate* of paediatric MH ED visits by LHIN (C215) National Ambulatory Care Reporting System (NACRS) provided by the Canadian Institute of Health Information (CIHI). Discharge Abstract Database (DAD) provided by the Canadian Institute of Health Information (CIHI). : Population estimates by LHIN (29-213), and Population projections by LHIN ( ). Notes: *Rate per 1, paediatric population

7 Volume Average LOS 216 Ontario Hospitals Maternal-Child Services Report Provincial Council for Maternal and Child Health 5. Obstetrics Indicators In FY 215/16, there were 15,251 obstetrical inpatient discharges in Ontario. This represents a small decline (-3.%) from 5 years ago. Of those, almost 4% of cases (56,488 cases) came from (23,78 cases), (16,751 cases) and (16,29 cases). The Average LOS also decline slightly, from 2.3 in FY 211/12 to 2.1 in FY 215/16. 16% of obstetrical patients in Ontario were looking for inpatient services outside of their LHIN of residence. Of note, 1 in 3 obstetrical patients from and are looking for inpatient services outside of their LHIN of residence. 3 4 Distribution of patients looking for IP OBS services in/outside of their LHIN of residence (FY 215/16) % 1% 2% 3% 4% 5% 6% 7% 8% 9% 1% 1 in 7 obstetrical patients in Ontario are looking for inpatient services outside of their LHIN of residence. The Average Length of Stay for obstetrical patients in FY 215/16 was 2.1 % Inside LHIN % outside LHIN OBS IP volume and Average Length of Stay (FY 211/12-215/16) 156, 155, 154, 153, 152, 151, 15, 149, 148, 147, 146, 145, Volume Avg LOS DAD, provided by CIHI (21-215).

2015 Ontario Hospitals Maternal-Child Services Report LHIN-level Indicators

2015 Ontario Hospitals Maternal-Child Services Report LHIN-level Indicators 215 Ontario Hospitals Maternal-Child Services Report LHIN-level Indicators TAB Intro Population IP ED MH OBS LHIN map, the list of acronyms, and key definitions 1. Paediatric Population Overview Ontario