Rouge Valley Health System s Recommended Model for Fulfilling Motion 1B Prepared by Rouge Valley Health System February 2015 Presented by Michele James, Interim Chief Operating Officer 1
Advanced Designation Synopsis of RVHS Recommended Model Advanced Service Delivery Planning and Oversight Consistent with the 2009 Clinical Services Plan recommendation that was endorsed by all LHIN hospital boards, clear accountability through designation of a single lead agency - Rouge Valley Centenary with a commitment to LHIN-wide collaboration Advanced inpatient neonatal and advanced paediatric services delivered at one site to capture the patient safety benefits of critical mass with innovative approaches to ensure LHIN-wide regional access, outreach and creating a presence across the LHIN Non-advanced services delivered at multiple sites Development of connecting mechanisms that link services and sites to optimize coordination for patients/families across the continuum of care Lead agency convenes and chairs, with a rotating co-chair from another organization a Regional multi-organizational committee for planning, coordination and oversight Role would include planning, development and siting of new programs, and monitoring and evaluation of the regional advanced maternal/child service delivery Membership would include hospital and community-based providers from across the LHIN, tertiary centres, consumers and Central East LHIN Committee would provide advice to existing governance structures 2
A hybrid model including both consolidated and distributed components Emergency Services for newborns, children and expectant mothers; links to primary care In all 3 Scarborough sites; Scarborough resident focus A continued role for all 3 Scarborough sites Alignment with consumer preference for one stop shopping approach to access Leverage the benefits of critical mass for specialty services through co-location Development of connecting mechanisms that link services and sites to optimize coordination for patients/families across the continuum of care Level 2b (and 2c above 32 weeks) neonatal and maternal care (inpatient and outpatient); General paediatric inpatient and ambulatory care In all 3 Scarborough sites; Scarborough resident focus Advanced neonatal care (2c), Advanced paediatric care, Advanced maternal care (2c, including ability to deliver and manage 30-32 week gestation age) 3
Timeline 2015 1997 4
Historical Expert and Stakeholder Support for Regional Advanced Role for RVC In 1997, Ontario s Health Services Restructuring Commission directive states that Centenary Health Centre and Toronto East General Hospital are designated to provide level II paediatric services ; Scarborough General and Scarborough Grace were directed to transfer funding for their paediatric activity ($1,485,368 and $575,402 respectively) to Centenary This clear historical direction and support, has influenced Rouge Valley s strategic agenda and investments including: High priority on our strategic plans going back to 2007 for growth and integration of women s and children s services An extensive community campaign to build the RVC Birthing and Family Centre Recruitment of an extensive number and range paediatric subspecialists Investment in maternal, newborn and child programs According to the 2005, Child Health Network report: 5
Motion 1b Collaborative Clinical Questionnaire Results - 31 respondents Expert Choice Survey Results 60% of respondents (18) identified RVHS-Centenary as their primary association 40% of respondents (12) identified TSH as their primary association 61% of respondents identified themselves as leadership/ management 29% of respondents identified themselves as clinicians 7% of respondents identified themselves as customers 10 respondents identified RVHS as the preferred site for advanced regional neonatal services (Centenary site specifically noted in most answers) 7 respondents identified TSH as the preferred site for advanced regional neonatal services (General site specifically noted in most answers) 13 respondents identified RVHS as the preferred site for advanced regional inpatient paediatric services (Centenary site specifically noted in most answers) 1 respondent identified RVHS or TSH as the preferred site for advanced regional inpatient paediatric services 2 respondents identified that advanced regional inpatient services should be distributed between RVHS and TSH 6
What will RVC offer the community as the regional advanced centre for neonatal and paediatric care? Track Record Providing the Most Advanced Care for Neonates and Children in Scarborough Wide Range of Specialized Services and Supports including tertiary centre satellite clinics delivered in partnership with Sick Kids State of the Art Infrastructure - Physical Plant, IT Cost-Effective Expansion Potential Strategic Priority Regional Presence and Regional Access Sustainability Financial Stability, PCOP Funding 7
Track Record Providing the Most Advanced Care for Neonates and Children in Scarborough In 2011, RVHS responded to an opportunity from the Central East LHIN and PCMCH to change their level of care designation based on current activity levels and resources; RVHS chose to invest in increasing the designation at both of its sites to a more advanced level of care; moved RVC Centenary from 2b to 2c and moved RVAP from 2a to 2b Over the last 3 years (2011 to September 2014), RVC has successfully provided safe, high quality level 2c neonatal and maternal care as the only level 2c facility in Scarborough (until Fall 2014) Historical data demonstrates the advanced role played by RVC Centenary RVC Centenary has developed solid transfer relationships with CritiCall and other hospitals, including tertiary centres RVC Centenary is an active participant in PCMCH s development of best practices related to levels of care (e.g. only hospital in Scarborough to participate in the retro-transfer pilot) RVC Centenary is only community hospital represented on the GTA Obstetrics Network Strong partnership with Sick Kids through satellite clinics contributes to growth of subspecialty ambulatory clinics 8
Wide Range of Specialized Services and Supports Designated level 2C for neonatal and maternal care since 2011 20 isolette spots and one additional space for resuscitation with close proximity to the OR/C-Section room 2 negative pressure, isolation rooms Ability to manage 30 weeks gestation and up (per PCMCH and Criticall), insert and manage PICC lines, umbilical catheters, Total Parenteral Nutrition (TPN) and up to 1 CPAP and 4 ventilated babies simultaneously 3 active neonatologists on staff in addition to multiple supporting sub-specialists ICCA (fully integrated electronic documentation and monitoring system) to be implemented 2015. Ronald McDonald (RM) Family Lounge (and sleep room) to be competed and operated by RM volunteers in fall 2014 2 care by parent rooms, 1 sleep rooms, 1 breast pumping room. Electronic Security System and a closed/locked door system Central monitoring 9
Wide Range of Specialized Services and Supports (cont d) 12 single inpatient patient rooms (can accommodate 28 children if patients are colocated). 4 acute care single inpatient rooms for intensive observation with central cardiac monitoring capability 2 (4 bed) day surgery rooms Ronald McDonald Family Lounge (and sleep room) to be completed fall 2014 Cardiology, infectious disease, endocrinology and respirology provide consultation on an in and outpatient basis, with paediatric EEG and outpatient neurology services Surgery ENT, orthopaedic (including specialized scoliosis repair), plastic surgery, general surgery, dental, pulse dye laser surgery (RVC is the only hospital providing this surgery in Ontario besides Ottawa) Oncology - (Paediatric Oncology Group Ontario [POGO] ) - Sickkids satellite program) - NP/nurse run outpatient clinic, 2 dedicated inpatient rooms specific to the paediatric oncology population (in addition to the 16); 8 nurses have chemo certification training and are proficient in portacath access. Sickle Cell (SickKids satellite program) - staffed by 2 paediatric haematologists and nursing Short Stay Program rapid access to specialized paediatric care from the ED Child and Adolescent Mental health 6 inpatient beds, day hospital, crisis team, First Episode Psychosis Program and an extensive outpatient mental health clinic (Shoniker Clinic) fully supported by a multidisciplinary team of child and adolescent psychiatrists, GPs, child and youth workers, social workers, addiction workers, nurses and an occupational therapist. MOU in progress with Ontario Shores to provide acute care back-up for Ontario s only residential adolescent eating disorders program 10
Wide Range of Specialized Services and Supports (cont d) Additional Paediatric Ambulatory Clinics 1. Diabetes supported by a Paediatric endocrinologist and a team of RD/RN who provide 24/7 support to our patients. 2. Allergy and Immunology Clinic- 2 immunologists and nurses who provide assessment and immunology challenges on site 3. Paediatric Consult Clinic - 7 days a week 4. Gastroenterology Clinic - including paediatric scopes done by a paediatric gastroenterologist. 5. Asthma education Clinic 6. Constipation Clinic 7. Neonatal Follow-up Clinic 8. Nutrition Clinic 9. Haematology Clinic 10. Nephrology Clinic 11. Rheumatology Clinic 12. RSV prophylaxis Clinic 13. Genetics Clinic Note: The above list is in addition to the Oncology Clinic, Sickle Cell Clinic and several child and adolescent clinics mentioned on the previous slide 11
State of the Art Infrastructure with Cost-Effective Expansion Potential The newest NICU in Scarborough is located at RVC; opened only 5 years ago it offers patients/families state of the art facilities built at current standards with ample space for optimal care The Scarborough community raised millions of dollars for this much needed facility The NICU is immediately adjacent to the new birthing centre Galaxy 12 is a suite of several paediatric clinics that gains efficiency through co-location with sharing of nursing and clerical resources RVC offers the only birthing centre and NICU in Scarborough with a electronic health record for mothers and newborns (ObTraceVue) Capacity to expand in a timely way without the need for major renovations is possible because we have maintained the space previously used for inpatient obstetrics before our new birthing centre opened e.g. capacity for an additional 15 isolette spaces in nursery space on 4th level of RVC The RVHS model allows us to value past investment of taxpayer dollars and build on what exists 12
Strategic Priority With limited resources, it is not possible for hospitals to give equal focus to the growth and development of all clinical areas; strategic plans are a commonly used to communicate what the hospital s strategic priorities are; strategic priority and commitment of both Board and leadership are critical enablers of success 13
Regional Presence and Regional Access To be successful, a regional centre must have a strong regional presence that includes a deep understanding of the regional community, regional providers and regional stakeholders RVHS has a presence in both Scarborough (RVC) and Durham (RVAP) and has a strong regional orientation; plans underway for physical presence in Seaton (north Pickering) We already have established relationships with stakeholders in two of the regional municipalities in Central East LHIN Our existing presence in Durham (i.e. links to family physicians, paediatricians, political representatives, hospitals, community agencies, etc ) will save time and mean that scarce resources will not have to be expended on establishing relationships in Durham and can be used for other things A few examples of our collaborative relationships beyond Scarborough include: Signed Memorandum of Understanding with Ontario Shores (Whitby) to provide acute care back up for the first residential adolescent eating disorder program in Canada Regional Code Stemi program Cardiac rehabilitation program involving Lakeridge, Ross Memorial Hospital and Peterborough Several long-standing partnerships with Lakeridge in Human Resources and IT Lean education provided to staff of Grandview Children s Centre (Oshawa), Ross Memorial and Ontario Shores The region of Durham is projected to experience the highest growth in births and the paediatric population in Central East LHIN; patient/families with advanced care needs which require urgent access and/or multiple visits over a long time period want the most timely access possible -- even saving minutes on travel time can make a difference to these families Centenary s location in east Scarborough is physically closer to the rest of Central East LHIN 14
Sustainability Financial stability 6 consecutive years of budget surpluses to support investment in infrastructure, equipment and strategic priorities Post-construction Operating Plan (PCOP) funding from new NICU and birthing centre Have applied Lean in the Birthing Centre, NICU, Paediatric Clinics since 2008 15
In Summary. leverage verb: to use something valuable to achieve a desired result Merriam Webster Dictionary The RVHS model is about leveraging excellence for patients and families by building on what exists -- leveraging resources, expertise, experience and commitment The RVHS model is evidence-based it is consistent with expert studies over many years and the views of local stakeholders The RVHS model aligns very closely with the CE LHIN decision making framework in that it builds upon system alignment, performance, CE LHIN values, sustainability and integration The RVHS model offers our community a less expensive and faster approach to implementation our patients have waited long enough 16