CEEH ED Presentation to Lambton County Council – Tuesday, July 13, 2010Presented by: Sue Denomy, President/CEO, Bluewater Health and Dr. John Butler, CEEH Physician

The Current Situation

• Physician ED workload is not sustainable

• Since 2009, the current physicians have increased their number of ED shifts (which is not sustainable) in hopes of recruitment.

• The current ED model requires physicians to cover 24-hour period

• Typically the physician sees 45- 65 patients in the first 12 hours, resulting in fatigue for the next 12 and impacting their ability to sustain continued 24/7 care.

The Current Situation…cont’d

• Emergency Coverage = 720 hours / month on average (30 days X 24 hours)

• Current physicians capable of covering a total of 384 to 432 hours per month. • Leaves shortfall of 288 to 336 hours/month

• Physician shortage is not unique to Petrolia. • Smaller and rural hospitals across Ontario struggle to provide 24/7 ED

coverage due to physician/human resource issues.

• Petrolia physicians committed to providing the highest level of care to patients – both to those in the ED, and those within their practices.

• Reality – Under present circumstances this commitment is putting their own health at risk.

CEEH Physician Recruitment Efforts• Dr. Butler and other physicians

• Personal calls, visits and presentations• Approached the University of Western Ontario about increasing resident trainees.

• 2010: 4 resident physicians training at CEEH, and physicians working toward becoming a formal site of permanent resident physician placement.

• Partnerships• CEEH Foundation offers financial support• Recruitment Ads posted on Health Force Ontario website• BWH has posted ads in medical journals and on line (Medical Post and Canadian Family Physician)• Town of Petrolia included a link with information for physician recruitment on its web site and provided

financial incentive for visits. • Since 2005 The Physician Recruitment Taskforce of Sarnia-Lambton has been involved in recruiting efforts. • November 2009: Dr. Butler and Petrolia representatives attended the Family Medicine Residents of

Western Fall Forum in Grand Bend • Since November ‘09 approximately 8 prospective candidates have toured the Town of Petrolia and CEEH of

Bluewater Health. (No success despite follow-up by Dr. Butler’s group.)• Petrolia Family Health Network have accepted a Physician Assistant trainee from McMaster

University.• Government of Ontario

• Financial Support for Recruitment for underserviced areas offered by the Ministry of Health and Long-Term Care (in addition to the support of the CEEH Foundation).

• Health Force Ontario application

Recruiting Challenges

• Only 8 per cent of medical students are choosing full service medicine• Finite pool of candidates being sought by many (supply

and demand)

• Not every physician wants a rural setting, or ED

• ED 24 hour model of service is undesirable by most

• Uncertainty of future of ED

• System changes in medical students’ exposure to the ED (no R2, 2 year family medicine residency)

By the Numbers…• CEEH ED volumes have increased steadily • 2009/10 - 18,194 patients seen vs. 17,738 in 2008/09 • During same period family physician resources decreased

02000400060008000

100001200014000160001800020000

Year

ED

Vis

its

The ED volume is too high to sustain 24-hour shifts

ED Visit Acuity

• CTAS – Canadian Triage Acuity Score

• This is a Nursing Assessment completed within 15 minutes of arrival

• CTAS Breakdown (1 = most acute)

• CTAS 1 (Resuscitation)

• CTAS 2 (Emergent)

• CTAS 3 (Urgent)

• CTAS 4 (Less Urgent)

• CTAS 5 (Non Urgent)

ED Volume According to CTAS

0

5000

10000

15000

20000

2006/07

2007/08

2008/09

2009/10

2006/07 11 41 1,741 12,092 1,137 15,022

2007/08 22 205 2,798 11,810 1,533 16,368

2008/09 16 220 4,311 11,627 1,564 17,738

2009/10 18 528 8,130 8,226 1,281 18,194

CTAS-1 CTAS-2 CTAS-3 CTAS-4 CTAS-5 Total

The largest growth is in CTAS level 3. The vast majority of the total volume is in CTAS 3, 4, and 5.

Annual Number of Visits by Time of Day

Proposed coverage period

0

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400600

800

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12001400

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1800

00:00

-00:

59

01:00

-01:

59

02:00

-02:

59

03:00

-03:

59

04:00

-04:

59

05:00

-05:

59

06:00

-06:

59

07:00

-07:

59

08:00

-08:

59

09:00

-09:

59

10:00

-10:

59

11:00

-11:

59

12:00

-12:

59

13:00

-13:

59

14:00

-14:

59

15:00

-15:

59

16:00

-16:

59

17:00

-17:

59

18:00

-18:

59

19:00

-19:

59

20:00

-205

9

21:00

-21:

59

22:00

-22:

59

23:00

-23:

59

Almost 90% Will be Seen in Proposed Hours

0.00%1.00%2.00%3.00%4.00%5.00%6.00%7.00%8.00%9.00%

10.00%

Proposed coverage period

CTAS Levels During Day Time Hours

CTAS Levels from 08:00 to 19:59 Hours For Fiscal Year 2009/10

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200

400

600

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08:00-08:59

09:00-09:59

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11:00-11:59

12:00-12:59

13:00-13:59

14:00-14:59

15:00-15:59

16:00-16:59

17:00-17:59

18:00-18:59

19:00-19:59

CTAS-1

CTAS-2

CTAS-3

CTAS-4

CTAS-5

CTAS Levels During Hours Proposed for Closure

CTAS LEVELS FROM 20:00 TO 07:59 HOURS FOR FISCAL YR 2009/10

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50

100

150

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20:00 -2059

21:00-21:59

22:00-22:59

23:00-23:59

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01:00-01:59

02:00-02:59

03:00-03:59

04:00-04:59

05:00-05:59

06:00-06:59

07:00-07:59

CTAS-1

CTAS-2

CTAS-3

CTAS-4

CTAS-5

Contingency Plan and Proposal

• ED coverage be modified to 12 hours of Coverage

• 8:00 am to 8:00 pm

• Almost 90% of the volume will be seen in this time frame

• Retain Emergency Department status

• Work with EMS to ensure seamless transition

• Initiate wide spread communication plan

Next Steps

• LHIN to review CEEH ED Physician Proposal over 30-60 days

• LHIN recognizes BWH needs a contingency plan and must be ready for September 2010

• Contingency Plan = the Physician Proposal

• Bluewater Health will continue to move forward and plan for 12 hour ED

• BWH will work with the LHIN to assess and ensure Quality of Care, Access and Sustainability of Services

• No changes will be permanent without MOHLTC approval