Ontario Wait Time Strategy - South East LHIN/media/sites/se/uploadedfiles/Home_Page...Ontario Wait Time Strategy Visit to South East LHIN ... MRI 90th Percentile Wait Time Trend 0

Ontario Wait Time Strategy

Visit to South East LHIN

May 26, 2008

Alan R. Hudson, OC, FRCSC

2

Cataract Surgery 90th Percentile Wait Time Trend

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Priority 4 Target - 182 days

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Cataract Surgery - Histogram

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Cataract Surgery Wait Times – LHIN Variation

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Cancer Surgery 90th Percentile Wait Time Trend

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Hip Replacement 90th Percentile Wait Time Trend

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Knee Replacement 90th Percentile Wait Time Trend

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MRI 90th Percentile Wait Time Trend

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CT 90th Percentile Wait Time Trend

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10

Progress to Date

11Note: Based on priority level 4 targets.

Current State (Apr 2008) - % of cases completed within target

83%

94%

100%

96%

89%84%

54%0%

100%

Cancer Surgery

Bypass Surgery

Cataract Surgery

Hip ReplacementKnee Replacement

MRI

CT

Target Actual

12

June 2007

Cardiac

Cancer

Hip and Knee Replacements

Cataract

MRI and CT Scans

March 2008

Ophthalmic Surgery

Orthopaedic Surgery

General Surgery

Paediatric Surgery PilotPaediatric Surgery Pilot

2008/09

Neurosurgery

Vascular Surgery

Otolaryngic Surgery

Ob/Gyn Surgery

Thoracic Surgery

Urologic Surgery

Plastics/Reconstruction

Oral Surgery

Paediatric SurgeryPaediatric Surgery

WTIS Phase 1-3

• 81 WT funded hospitals

• Surgeons: 1,700

• Total cases 2006/07: 1,301,069

• Total MRI and CT scans (2006/07): 1.2 million

WTIS Adult Group 2 Expansion

• ~74 WT funded hospitals (surgery only)

• Cumulative surgeons: ~3,350

• Total cumulative cases 2008/09: ~2,225,000

IMPLE

MENTED

IMPLE

MENTED

WTIS Adult Group 1 Expansion

• 74 WT funded hospitals (surgery only)

• Cumulative surgeons: 2,600

• Total cumulative cases 2007/08: 1,610,000

Paediatric (Pilot)

• London Health Sciences Centre and St. Joseph’s Health Care (London)

• All paediatric surgical procedures

All Surgery Adult & Paediatric Scope

13

South East LHIN Wait Time Trend Analysis April 2008 Data

14

South East LHIN Monthly Trend

Hip Replacement

Knee Replacement

Cataract Surgery

15

South East LHIN Hospital Performance April 2008 data

16

South East LHIN Priority Analysis – April 08 data

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LHIN #10 – South EastImpact of Concurrent ATC Hospital Implementation Activities

Impl

emen

tatio

n Ac

tiviti

es

Q2 (07/08) Q3 (07/08) Q4 (07/08) Q1 (08/09) Q2 (08/09) Q3 (08/09)

Q2 (07/08) Q3 (07/08) Q4 (07/08) Q1 (08/09) Q2 (08/09) Q3 (08/09)

Implementation Activities By Hospital in LHIN #10

WTIS – Expansion Group 1

CCIS Phase 3: Specialty ICUs

WTIS-ExpansionCardiac Module (WTIS-CCN)

SET Program Phase 2

CCIS Phase 3: (Wave 4)Specialty ICUs

WTIS-ExpansionCardiac Module (WTIS-CCN)

SET Program Phase 2

EDRS

CCIS Phase 3: (Wave 4)Specialty ICUs

SET Program Phase 2

EDRS WTIS – ExpansionGroup 2 & All Paed Sites

CCIS Phase 3: (Wave 5) Specialty ICUs

SET Program

EDRS(TBD)

CCIS Roll-out to all MSICUs

SET Program Phase 1

CCIS Roll-out to all MSICUs

WTIS – ExpansionGroup 1

CCIS ROLL-OUTKingston General Hospital

Quinte Healthcare Corporation*

Hotel-Dieu KingstonKingston General Hospital

SETP PHASE 1

Perth and Smith Falls District Hospital

CCIS ROLL-OUTBrockville General HospitalQuinte Healtcare Corporation

Quinte Healthcare Corporation

Lennox and Addington County General

CCIS ROLL-OUTKingston General Hospital

EDRSTBD

TBDWTIS-EXPANSION

SETP


Brockvill General HospitalHotel-Dieu Kingston

WTIS-EXPANSION


CCIS ROLL-OUTBrockville General HospitalQuinte Healtcare Corporation


Kingston General Hospital

Kingston General HospitalCCIS ROLL-OUT

Focus Groups/Design Sessions Underway


Brockville General HospitalHotel-Dieu Kingston

SETP PHASE 2


Quinte Healthcare Corporation*Perth and Smith Falls District Hospital


WTIS-CCN


WTIS-EXPANSION

Lennox and Addington County GeneralQuinte Healthcare Corporation


EDRSHotel-Dieu KingstonPerth and Smith Falls District HospitalQuinte Healthcare Corporation

CCIS ROLL-OUT

WTIS-CCNKingston General Hospital


SETP PHASE 2




Brockville General HospitalHotel-Dieu KingstonKingston General HospitalLennox and Addington County General

Quinte Healthcare CorporationPerth and Smith Falls District Hospital

EDRS

EDRS

Perth and Smith Falls District Hospital

Hotel-Dieu KingstonKingston General HospitalLennox and Addington County General

SETP PHASE 2Brockville General Hospital


Hotel-Dieu KingstonKingston General HospitalLennox and Addington County General

Brockville General Hospital

* Belleville General, Trenton Memorial, and Prince Edward County Memorial only.

Brockville General HospitalHotel-Dieu KingstonKingston General HospitalLennox and Addington County General

Quinte Healthcare CorporationPerth and Smith Falls District Hospital

EDRS

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The infrastructure and resources to reduce demand and increase supply cannot be put in place overnight, therefore, efforts must start early and will take time to show results

The ER Strategy calls for System-wide Improvements

Increasing Supply of ServicesImproving Processes within the ERReducing Demand for Services

OR

HH

EREDER HomeHome

RehabilitationRehabilitation

Long Term Care

Long Term Care

Alternate Levels of Care

HomeCommunityand home-based services

RehabilitationRehabilitation

Long Term Care

Long TermCare

Alternate Levels of Care

Complex and Continuing

Care

Reducing ER Wait Times and Improving Public Satisfaction can only be achieved by making improvements across the entire system

Therefore, accountability for improvement must rest with Hospital Boards and CEOs, LHIN Boards and CEOs and community partners such as

CCACs

• Aging at Home• Family Health Care for All• Chronic Disease Prevention and

Management (Diabetes)• Mental Health and Addiction

• Aging at Home (ALC)• High Growth Hospital Funding

• Emergency Room Strategy• HHR - Emergency Department

Coverage

19

ER

Transfer

Institution Communities

Booked Admission

*****

ALC

http://www.brooks.edu/careers.htm

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21

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Number of Patients in Emergency Waiting for an In-patient BedBy LHIN (at any given point in time)

26

28

28

31

31

42

45

49

55

71

82

104

121

136

Central West

North Simcoe Muskoka

North West

Erie St. Clair

South East

North East

Waterloo Wellington

Champlain

South West

Central East

Mississauga Halton

Central

Toronto Central

Hamilton Niagara Haldimand Brant

Ontario = 849

Source: OHA April 2008 ALC Survey Results

23

Number of Patients in Emergency Waiting for an In-patient BedSince December 2007 (at any given point in time)

723

791

819

849

700

720

740

760

780

800

820

840

860

Dec-07 Jan-08 Feb-08 Mar-08 Apr-08

ALC Survey Results – December 2007 to April 2008

17% increaseSource: OHA April 2008 ALC Survey Results

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0%

5%

10%

15%

20%

25%

1999 2000 2001 2002 2003 2004 2005 2006

% A

LC D

ays

Erie St. Clair South West Waterloo Wellington HNHBCentral West Mississauga Halton Toronto Central CentralCentral East South East Champlain North SimcoeNorth-East North-West

% ALC days in hospitals by LHIN

Most LHINs are experiencing their highest levels of ALC days in recent years

Data source: Inpatient Discharges Table, Ontario Provincial Health Planning Database (PHPDB), V. 17.07

25

Percent of Acute Care Beds Occupied by ALC PatientsBy LHIN

19%

11%

12%

12%

12%

15%

15%

16%

17%

19%

20%

22%

25%

29%

33%

Ontario

Erie St. Clair

Toronto Central

Central West

South East

South West

North Simcoe Muskoka

Mississauga Halton

Central

Central East

Champlain

North West

Hamilton Niagara Haldimand Brant

Waterloo Wellington

North East

Percent of Acute Care Beds Occupied by ALC Patients = Number of patients in an acute care bed waiting for an ALC

Total acute care beds

Source: OHA April 2008 ALC Survey Results

About 2,900 patients are waiting daily in acute care for ALC

26

South East LHINPercentage ALC Days per Quarter

0.00

5.00

10.00

15.00

20.00

25.00

South EastLHIN

14.80 17.43 21.48 20.28 16.89 16.59 14.11

Provincial 10.73 11.37 12.57 13.72 12.64 12.96 14.28

Q1 Q2 Q3 Q4 Q1 Q2 Q3

2006-07 2007-08

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ALC

15,587 IP Acute Beds (*)

81.43% IP Acute Beds 18.57% IP Acute Beds

5,216,000 visits/year (***)

12.1% admissions/year (**)

Rehabilitation

Complex Continuing Care

unit

Palliative care unit or hospice

Other

Long-Term Care Home

Community / Home care

Sub-acute or convalescent

care

13.71%

7.39%

5.35%

3.39%

2.18%

1.24% Home

57.89%

8.84%

ED

(*) “Alternate Level of Care ALC”, OHA ALC Survey Results, Feb 2008(**) “Review of ED Services in Waterloo Wellington”, Waterloo Wellington LHIN, Dec 2006(***) “Hospital Report : Emergency Department Care”, HRRC 2007.

28

ER visits in FY2006

11%

38%

40%

11%CTAS 2

CTAS 3

CTAS 4

CTAS 5

Figure 3: Number of ED visits by age group

1,293,34725%

1,407,29427%

1,323,18025%

859,21716%

364,3007%

000-019020-039040-059060-079080+

1 visit per year (63%)

2 visits per year (20%)



5 or more visits per year(5%)

Figure 3: Number of times Ontarians visit ER per year

Figure 1: Number of ER visits in FY2006 by CTAS Figure 2: Number of ER visits by age group

Total number of unique visitors – 2,860,598

Total visits in FY2006 = 5,247,338

29

Emergency Department Lengths of Stay in FY2006

ED LOS Distribution

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

000-0

3003

1-060

061-0

9009

1-120

121-1

5015

1-180

181-21

0211

-240

241-2

7027

1-300

301-3

3033

1-360

361-3

9039

1-420

421-4

5045

1-480

OVER 480

Time spent in ED (minutes)

Num

ber o

f vis

its

Source: NACRS, 2006

30

Distribution of ED Lengths of Stay in FY2006, by CTAS level

ED LOS Distribution, CTAS 1

0

500

1,000

1,500

2,000

2,500

3,000

3,500

000-0

3003

1-060

061-0

9009

1-120

121-1

5015

1-180

181-2

1021

1-240

241-2

7027

1-300

301-3

3033

1-360

361-3

9039

1-420

421-4

5045

1-480

OVER 480


Num

ber o

f vis

its

Source: NACRS, 2006


0

20,000

40,000

60,000

80,000

100,000

120,000

000-0

3003

1-060

061-0

9009

1-120

121-1

5015

1-180

181-2

1021

1-240

241-2

7027

1-300

301-3

3033

1-360

361-3

9039

1-420

421-4

5045

1-480

OVER 480


Num

ber o

f vis

its

Source: NACRS, 2006


0

50,000

100,000

150,000

200,000

250,000

000-0

3003

1-060

061-0

9009

1-120

121-1

5015

1-180

181-2

1021

1-240

241-2

7027

1-300

301-3

3033

1-360

361-3

9039

1-420

421-4

5045

1-480

OVER 480


Num

ber o

f vis

its

Source: NACRS, 2006


0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,00000

0-030

031-0

6006

1-090

091-1

2012

1-150

151-1

8018

1-210

211-2

4024

1-270

271-3

0030

1-330

331-3

6036

1-390

391-4

2042

1-450

451-4

80OVER 48

0


Num

ber o

f vis

its

Source: NACRS, 2006

31


0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

000-0

3003

1-060

061-0

9009

1-120

121-1

5015

1-180

181-2

1021

1-240

241-2

7027

1-300

301-3

3033

1-360

361-3

9039

1-420

421-4

5045

1-480

OVER 480


Num

ber o

f vis

its

Source: NACRS, 2006

Distribution of ED Lengths of Stay in FY2600, by CTAS level (cont’d)

32

Academic centres and large community hospitals have the worst ER-Length of Stay across all urgency (triage) levels

* Recommended LOS Goals per ER Expert Panel, JPPC ER-LOS Goals: CTAS I/II – within 8 hours

CTAS III – within 6 hoursCTAS IV/V – within 4 hours

0

10

20

30

40

50

60

70

<70%

70-90%

>90%

<70%

70-90%

>90%

<70%

70-90%

>90%

<70%

70-90%

>90%

All Patients Resuscitation-Emergent

Urgent Less/Non-Urgent

Triage Level / Percentage Within ER-LOS goal

Num

ber o

f ED

s (T

otal

N=1

00)

Percentage of patients meeting ER-LOS goals* by triage level Best performing hospitals (>=95% of patients are treated within LOS goals)

• Carleton Place and District Memorial Hospital

• Glengarry Memorial Hospital• Haldimand War Memorial Hospital• Niagara Health System – Port Colborne Site• Perth & Smiths Falls District – Perth Site• Perth & Smiths Falls District – Smiths Falls• Quinte Healthcare Corporation – Picton• Renfrew Victoria Hospital• Sensenbrenner Hospital• Stevenson Memorial Hospital Alliston• Temiskaming Hospital• West Parry Sound Health Centre

Worst performing hospitals (<70% of patients are treated within LOS goals)

• Grand River Hospital Corp – Waterloo• Hopital Montfort• Humber River Regional Hospital – Humber

Memorial• Humber River Regional Hospital – York-

Finch• Mount Sinai Hospital• North York General Hospital• Ottawa Hospital – Civic Site• St Joseph’s Health Care System – Hamilton• St Michael’s Hospital• Sunnybrook Health Sciences• Toronto East General Hospital• University Health Network – General• University Health Network – Western

All ERs with Annual Volumes >= 20,000, Ontario, NACRS 2006-07

CTAS I/II CTAS III CTAS IV/VAll Patients

33

EDRS Indicators – Process Flow Diagram

34

EDRS Implementation Timeline

All Hospitals submitting data to EDRS

Beta Wave 1 Wave 2

% of EDRS hospitals 6% 55% 26%

Q2 07/08 Q3 07/08 Q4 07/08 Q1 08/09 Q2 08/09 Q3 08/09 Q4 08/09

Public Reporting of ED Wait Times

Technical Development

Beta Testing

Hospital Training

Wave 1 and Wave 2 Implementation

35

Patient Satisfaction SurveyOntario Emergency Department by Hospital Location in LHIN

Source: National Ambulatory Care Reporting System 2005-2006, CIHI

Overall Impressions – Patients’ assessments, overall, of their hospital stays. 74.4

Communication – Patients’ assessments of how well information was communicated to them or family during ER stay. 66.9

Consideration – Patients’ assessments of whether they were treated with respect and courtesy by doctors, nurses and other staff during their stays in the ED.

72.8

Responsiveness – Patients’ assessments of the amount of time they waited to see doctors and nurses and receive test results; assessments of pain management; assessments of team work; and the staff’s responsiveness to their needs.

65.4

Survey Results Summary (2005-2006):

36

Proposed ER Strategy Timeline

January2008

July2008

January2009

January2010

January2011

July2009

July 2010

July2011

January2012

Provincial election(Oct. 2011)

Readiness to announce multi-year ER-LOS targets (Dec. 2008)

Premier commits to reduce ER wait times (Oct. 2007)

ER wait time goals achieved (Jul. 2011)

Pay-for-Results Y1 allocation (Jul. 2008)

ER wait times publicly reported (Feb. 2009)Pay-for-Results Y2 allocation including expanded list of hospitals (Mar. 2009)

Pay-for-Results Y3 allocation (Apr. 2010)

Pay-for-Results Y4allocation (Apr.2011)

Hospitals submit public satisfaction survey results (Jan. 2009 and quarterly from Jul. 2009)

Increase ER/CCAC resources (Apr. 2009)

CCAC demonstration projects for ER diversion begin (Jul. 2008)

Expand CCAC/ER diversion demonstration projects (Jul. 2009)

ER HHR plan complete, implementation begins (Nov. 2008)Online ED patient flow Toolkit and expert program launched (Nov. 2008)

Hospitals selected for Expert Teams (Apr. 2009)

Hospitals selected forExpert Teams (Apr. 2011)

Hospitals selected for Expert Teams (Apr. 2010)

Public awareness campaign begins (Aug. 2008-Jul. 2009)

Target Communication to key stakeholders (Jul. 2008-Jan.2009)

Hospitals selected for Expert Teams (Oct. 2008)

Minister announces ER/ALC policy changes to public and stakeholders (Apr. 2008)

Preliminary EDIS results available; re-calibrate ER Strategy (Oct. 2008)

37

www.ontariowaittimes.com

Documents

Ontario Wait Time Strategy - South East LHIN/media/sites/se/uploadedfiles/Home_Page...Ontario Wait Time Strategy Visit to South East LHIN ... MRI 90th Percentile Wait Time Trend 0