Respnse t Recmmendatins in Reprt: Salt Spring Island Health Services Review The Salt Spring Island Health Services Review was cmmissined by Island Health (Vancuver Island Health Authrity) in Nvember 2009. The review was carried ut by Grant Hllett, Island Health s Crprate Directr fr Planning and Cmmunity Engagement. The review cntained 24 recmmendatins, rganized int the fllwing categries: 1. Elderly Care 2. Mental Health Care 3. Operating Rm, Surgery and Endscpy 4. Lady Mint Hspital Infrastructure 5. Health Human Resurces 6. Miscellaneus The fllwing table lists the 24 recmmendatins and the status f the implementatin f each f these recmmendatins as f Octber 2013. The respnses and related actins will cntinue t be updated t reflect prgress. ELDERLY CARE Imprve physitherapy and rehabilitatin services at Lady Mint Hspital t help senirs transitin frm hspital back t their hmes and t ther cmmunity-based services Explre pprtunities fr Island Health and the cmmunity t cllabrate t find ways t keep senirs healthy and in their wn hmes fr as lng as pssible. Strategies may include: Increase and enhance rehabilitatin services such as physitherapy and ccupatinal therapy Increase and enhance hme care and hme supprt services ISLAND HEALTH RESPONSE AND ACTIONS Cmpleted. An Occupatinal Therapist (18.75 hurs per week) and a Rehab Assistant (25 hurs per week) were hired 2010. Hwever, the staff invlved have subsequently chsen t mve n t ther pprtunities. As f Octber 2013, these psitins are vacant with active recruitment underway t fill the vacancies. Island Health remains cmmitted t prviding rehabilitatin and physitherapy services t help individuals recver at hme. This area remains a pririty and staff recruitment is active as utlined abve. Island Health cntinues t actively recruit staff fr this service. Health care assistants in BC are required t be certified and registered with the BC Care Aide & Cmmunity Health Wrker Registry. Attracting certified Health Care Assistants is challenging due t the cst f certificatin, travel and the cst f living n Salt Spring. Page 1 f 5
Cnsider hme care nursing clinics t prevent hspital admissins and prmte earlier discharges. Explre having visiting geriatricians and gerntlgists. Invlve Salt Spring Island s extensive vlunteer base in supprting elderly peple t remain functinal in their hmes. See abve Onging. Island Health is fully supprtive f this initiative; hwever there is limited interest by practitiners. Island Health will cntinue t wrk with physicians in this regard. Island Health has a rbust Vlunteer Services prgram. Our vlunteers are active in a variety f rles. In terms f the wrk that vlunteers perfrm, careful attentin is required t make sure vlunteers are skilled, trained and supprted fr the jb they are perfrming. Many f the services that supprt senirs t remain in their hmes are clinical in nature and require special skills and educatin. Fr vlunteer pprtunities at Lady Mint, please cntact Barb Brindamur: PHONE (250) 538-4809 EMAIL: Barbara.Brindamur@viha.ca 3. Establish research partnerships with institutins such as the University f Victria s Centre n Aging t determine service mdels that wuld keep the Island s generally healthy elderly ppulatin functinal in their cmmunity as they age. 4. Initiate planning fr future residential care requirements fr the Suthern Gulf Islands. MENTAL HEALTH CARE Imprve services at Lady Mint Hspital by establishing mental health nursing t supprt care, discharge planning and cntinuity f care fr mentally ill patients. Explre pprtunities t increase integratin between cmmunity services and Island Health in areas such as sharing data, creating a shared psitin and develping a shared infrmatin release frm. Island Health has an active partnership with the Centre n Aging as it relates t research and analysis f prgrams and service t supprt the grwing and aging senirs ppulatin. Island Health has develped ptins t address the functinal and physical deficiencies in residential care facilities n Salt Spring. A preferred apprach has nt been determined and wuld be subject t priritizatin with ther majr capital and peratinal needs. It wuld als be subject t Island Health s brader bed planning fr residential care and t a public tendering prcess. Cmpleted. A full-time mental health nurse was hired in September 2010 at Lady Mint Hspital. In additin, sme funding is prvided fr an after-hurs crisis respnse nurse wh wrks in the Emergency Department and the cmmunity. Onging. The mental health nurse maintains a relatinship with patients until Cmmunity Services is able t assume care. Data sharing is cnstrained by Infrmatin Access and Privacy regulatins. As the IHealth electrnic health recrd and care plan initiative mves ahead data sharing with affiliate care prviders will be further explred. Page 2 f 5
Imprve cmmunicatin and cntinuity f care between mental health services n Vancuver Island and thse n Salt Spring Island. OPERATING ROOM, SURGERY AND ENDOSCOPY Cease surgery prcedures at Lady Mint Hspital requiring a full perating rm. Maintain endscpies at Lady Mint Hspital thrugh visiting specialists. Ensure Salt Spring Island residents have equitable and timely access t surgical services at ther hspitals. Explre using Lady Mint Hspital t minimize endscpy waitlists at ther Island Health facilities. 12. Ensure staff wh supprt endscpies receive apprpriate training. 13. Maintain the minr prcedure rm and ther required infrastructure fr endscpies. 14. Reallcate resurces previusly used fr surgery t ther high needs areas at Lady Mint Hspital (e.g. mental health nursing, physitherapy, rehabilitatin). 15. Re-purpse the pst anesthetic recvery rm and perating rm fr ther functins. LADY MINTO HOSPITAL INFRASTRUCTURE Address shrt-term issues by Identifying dedicated space fr ultrasund services Imprving the psychiatric bservatin rm Creating a separate entrance t the extended Page 3 f 5 Effective cmmunicatin links are in place and infrmatin is shared as apprpriate between Island Health services. Depending n the care required, services are prvided either lcally r n Vancuver Island. A re-rganizatin within Island Health s Mental Health and Substance Use Services has assigned a specific manager t versee mental health services in the Gulf Islands/Salt Spring Island. This has resulted in imprved cmmunicatin and cntinuity f service. This recmmendatin has been fully implemented. The vlume f endscpies, an in-demand service n Salt Spring Island, cntinues t grw. In 2012/2013, 462 endscpic prcedures were dne. Surgens at Cwichan District Hspital are very supprtive f the endscpy prgram at Lady Mint. Access t surgery is priritized based n clinical need as determined by a patient s physician. Surgical prcedures fr Salt Spring Island residents take place at several ther Island Health sites. This is a practice in many smaller cmmunities where residents wuld have t travel fr a mre specialized prcedure such as surgery. Cwichan District Hspital is the preferred chice fr Salt Spring Island residents due t prximity and a strng relatinship between physicians. Sme patients frm ther areas have their endscpies dne at Lady Mint Hspital, hwever the uptake frm ff-island residents is nt substantial. Training and educatin is available t staff n an nging basis. Endscpy prcedures are perfrmed in the main perating rm; the minr prcedure rm is used fr jint injectins. Resurces have been reallcated t ccupatinal therapy, rehabilitatin services, mental health nursing and crisis nursing. Cmpleted. The perating rm is used fr endscpies. Lady Mint has been identified as needing significant infrastructure upgrades/replacement. Renvatin f the pst anesthetic recvery rm will need t be cnsidered within that cntext. Lady Mint Hspital has been identified as needing significant upgrades/replacement. Optins have been develped t address space issues at Lady Mint Hspital. This includes an ptin t relcate ultrasund services and the birthing rm and t imprve
care unit Imprving dedicated space fr the birthing rm 17. Develp a medium-term space plan that cnsiders alternate uses fr the perating and pst anesthetic recvery rms (e.g. expanding emergency department, medical imaging, creating a private rm fr families, expanding labratry space and setting aside space fr private psychiatric patient interviews.) 18. Begin lng-term planning fr a new replacement facility that cnsiders an integrated hub f hspital and cmmunity services that might include physician and primary health care clinics, utpatient services and cmmunity services. HEALTH HUMAN RESOURCES 19. Develp strategies t imprve primary health care delivery and sustainability. Strategies may include: Develping integrated primary health care mdels that build n existing successes (e.g. Integrated Health Netwrks, Divisins f Family Practice). Creating a Nurse Practitiner psitin Advcating t include Salt Spring Island in the rural general practitiner lcum arrangement. Reviewing the Lady Mint Hspital staffing mdel t ensure knwledge and skills f staff are ptimized. psychiatric bservatin. A separate entrance has been created fr Extended Care. These changes are subject t priritizatin with ther Island Health capital pririties. Please see answer abve. These issues have been cnsidered as part f the ptins develped t address space issues at Lady Mint. Any infrastructure changes and imprvements are subject t Island Health s capital planning prcess and budget pririties. The integratin f primary care services and hspital based services is a majr fcus and directin f Island Health acrss ur service area and wuld feature prminently in future directins f health care services fr Salt Spring Island. Initial thughts t this apprach have already been made, hwever detailed planning is subject t priritizatin with ther capital pririties acrss the regin. Island Health cntinues t wrk with general practitiners n shared-practice clinics. Salt Spring Island physicians nw have a Divisin f Family Practice. These Divisins are grups f physicians wh wrk t create lcal slutins t health care issues in their cmmunities. Divisins are a psitive step twards a strnger primary health care system. Please see the answer abve fr further infrmatin. Island Health recgnizes and values the Nurse Practitiner rle in health care delivery and we have placed Nurse Practitiners in cmmunities acrss the island as ppulatin health care needs require and as resurces allw. Island Health has a rigrus prcess t identify the need and pprtunity fr Nurse Practitiners within the care mdel. This includes cnsideratin f the lcal cmmunity needs, links t existing services, and receptiveness f the lcal cmmunity and practitiners t the Nurse Practitiner service. Given ther cmpeting pririties, a Nurse Practitiner n Salt Spring is nt currently being cnsidered. Onging. Funding has been put in place fr a Registered Nurse t be a Care Delivery Mdel practice lead. Page 4 f 5
Supprt targeted educatin and training that aligns with the hspital s cre rle, functins and services. 20. Wrk with the cmmunity t explre imprvements t recruitment and retentin f staff n the Island, fr example thrugh creating staff accmmdatin and shared staff mdels. MISCELLANEOUS 21. Imprve partnerships between Lady Mint Hspital and ther Island Health services, particularly thse nt lcated n Salt Spring Island. 22. Imprve infrmatin sharing and engagement with the Salt Spring Island cmmunity. 23. Review feasibility f prviding telehealth services t Island residents and care prviders. 24. Explre pprtunities t increase invlvement f Salt Spring Island s vlunteer base t supprt senir s care. The Lady Mint Hspital Fundatin has generusly supprted staff educatin by funding abut $20,000 a year. All mandated curses are available. Island Health pays fr an apartment fr visiting physicians and ther health care prfessinals. A cmmittee is wrking with the medical cmmunity t integrate health services and attract physicians. This wrk is nging. Gd relatinships exist with Residential Services, Mental Health and Substance Use Services and Surgical Services at Cwichan District Hspital. Over the past few years, Island Health has fcused n building strng relatinships and critical cllabratins that imprve care in all areas f the regin, including Salt Spring Island. In Nvember 2013, Island Health will be engaging with residents, patients, clients, cmmunity leaders, physicians, and staff in cmmunities acrss the island t learn hw we can wrk tgether t imprve the health f ur ppulatin. Telehealth services came t Salt Spring Island in June 2012. Varius telehealth prgrams are available t the cmmunity including Mental Health/Psychiatry, Onclgy, Genetics, Thracics, etc. Telehealth uses videcnferencing technlgy t cnnect patients t health care services regardless f where they live. Fr mre infrmatin abut Telehealth visit ur website at www.viha.ca/telehealth r call 250-519-1944 See Recmmendatin #2. Page 5 f 5