HNHB LHIN Board of Directors June 2011 Background Current State - - PowerPoint PPT Presentation

HNHB LHIN Board of Directors June 2011

Background Current State Directional Future State Recommendations Questions

Vascular Surgery – a distinct primary specialty

V l S i b d

• Vascular Services - scope beyond surgery
• Strong connection with virtually all medical and

surgical programs

Previous planning documents indicating gap

in service

• Hay Group 2006 – WW LHIN and HNHB LHIN
• Hay Group 2006

WW LHIN and HNHB LHIN

• HNHB LHIN Vascular Planning Group 2008

Rationalization of Vascular Services primarily

b d i b h i i i been driven by physician manpower issues

Activity

• 1% of all HNHB LHIN inpatient activity and 2% of

same day surgery activity; around 1100 admissions admissions

Expected growth over next 15 years

• 40% inpatient and 33% same day

Type of Care

• 80% - 5 CMG’s: abdominal aortic interventions,

arterial/venous bypass, carotid endartectomy, other arterial/venous bypass, carotid endartectomy, other vascular procedures, deep vein thrombophlebitis

Level of Care

50% t ti / t

• 50% tertiary/quaternary
• Recent growth at HHS and Niagara*

Market Share

• 98% of HNHB LHIN hospital activity serving HNHB residents

Provision of Tertiary and Quaternary Care

• 69% of all HNHB Vascular inpatient care provided in

p p Hamilton (HHS = 85% of this), Niagara hospitals provide 16% (same pattern for all levels of care)

Residents served in same county

• 95% Hamilton, 50% Niagara and Burlington, 20% for Brant,

Haldmand, Norfolk

• Hamilton hospitals only one serving HNHB resident outside

f id t t

• f resident county

Access to Care

• 6% of HNHB residents cared for outside HNHB LHIN
• Surgical Wait times meet provincial mean wait time

targets* - exception NHS priority 2 arterial non- targets exception NHS priority 2 arterial non bypass surgery

Efficiency

• Low rate of hospitalization (16% reduction from

2002 – 2007), High RIW’s

• 72% of all hospital activity is same day surgery
• 72% of all hospital activity is same day surgery
• LOS less than ELOS and 14% reduction from 2002-

2007

Utilization

• Utilizing less invasive procedures with lower

cost/case and decreased LOS

• Only 20% of hospital based procedures
• Only 20% of hospital based procedures

performed in diagnostic imaging

Quality of Care

• Raw mortality rates some variation between

hospitals

Estimated only 5-10% of patients require

y p q

• perative procedures

No centralized intake or wait list

management

Limited capacity for non-invasive vascular

imaging imaging

Non-invasive vascular imaging

g g

• Diagnostic and image-guided minimally

invasive interventions, safe and cost effective

A i h

Angiography

• Opportunities to improve access and capacity

Interventional Radiology Interventional Radiology

• Percutaneous peripheral procedures increasing

with new vascular surgeons

Access to protected vascular beds Budget for endovascular procedures Lack of surgeon access to interventional

radiology (lack of hybrid operating endovascular radiology (lack of hybrid operating, endovascular suite)

Physician manpower (numbers, matching skill set

to need)

• SJHH =1 FT, HHS =4 FT (total in Hamilton = 5 FT)
• NHS = 1 FT, 2 PT
• Brant = 1 General Surgeon (retiring)
• Burlington = 1 General Surgeon

No formalized Regional call schedule Insufficient capacity for non-invasive vascular

imaging

• Hamilton completes about 40 studies/week relative to

Hamilton completes about 40 studies/week relative to London, TGH, Ottawa, Sunnybrook at 100 -250 studies/week

Clinic time and centralized intake/triage/wait list Clinic time and centralized intake/triage/wait list

management

Data collection and quality of care monitoring No plan to meet anticipated growth needs Coordination across the LHIN Best practice standards Best practice standards

Regional Vascular Service Program at multiple sites LHIN wide Vascular Surgeon Group with cross LHIN wide Vascular Surgeon Group with cross

privileges

• Surgeons move to patient!

Regional funded bed to facilitate “No Refusal Policy”

Siting Siting

• Primary Sites: NHS and HHS
• Secondary Sites: SJHH, JBMH

A i lid BCHS

• Amputations consolidate at BCHS

Niagara Health System

• Comprehensive vascular care
• Venous disease, vascular access, carotid

disease, aortic aneurismal and occlusive disease BCHS

• Outpatient vascular clinic with on-site

vascular (non-invasive lab)

• -Pre and post op management of vascular

amputations and full perioperative

• Non-invasive imaging
• Support to hemodialysis program
• Undergraduate and post graduate medical

education and participation in clinical research NHS management of non-vascular related amputations for Brant and Haldimand Norfolk & Haldimand Norfolk associated with BCHS on amputations JBMH

• Surgical activity

appropriate to and i h i l SJHH

• Hemodialysis and renal

Hamilton Health Sciences

• Comprehensive vascular

care including venous disease, vascular access, carotid disease and aortic aneurismal and occlusive disease

• Aortic arch reconstructions,

thoracoabdominal aneurysms

contingent on hospital supports

• Access to an

interventional suite and non-invasive imaging

• Outpatient clinic activity
• site for undergraduate

and post graduate medical education

• Hemodialysis and renal

transplant programs

• Future development of a

peripheral endovascular program

• Site for undergraduate and

post graduate medical education

• Research focus on surgical

education and surgical i i

thoracoabdominal aneurysms

• Advanced endovascular

interventions

• Co-operative role with

cardiac and trauma

• Outpatient vascular center

with an integrated non- invasive vascular lab

• Primary site for education

d h

Haldimand Norfolk innovation Regional Vascular Program Infrastructure

• Administrative Structure and

and research

Governance Needs

• Human Resources
• Clinical Resources
• System Infrastructure and Connectivity
• System Patient Flow
• Measurement Quality and outcomes
• Research and education

Legend HHS – Hamilton Health Sciences – General Site NHS – Niagara Health System SJHH – St. Joseph’s Healthcare Hamilton JBMH – Joseph Brant Memorial Hospital BCHS – Brant Community Healthcare System

Shared access to diagnostic imaging – (Hybrid OR at

g g g

( y NHS, SJHH current capacity)

Data and Clinical Information Data and Clinical Information

• Regional vascular registry
• Central intake and wait list management
• Clinical connect, PAC’s

Clinical connect, PAC s

Research/Education

• All physicians in group will be appointed to the Division of

Vascular Surgeon at McMaster University

Primar Primary Recommendation Recommendation: Formally establish a single Regional single Regional Vascular Service with inpatient, outpatient and emergency patient t ti it t lti lti l it it ithi th management activity at mu multi ltiple s e sit ites es within the HNHB LHIN. The regional vascular service will be committed to establishing, implementing, monitoring and improving standardized best practices across and improving standardized, best practices across the HNHB LHIN.

Supporting Recommendations

• 1. Establishment of a Regional Vascular committee

2 HHS Lead site; NHS primary: SJHH and JBMH

• 2. HHS Lead site; NHS primary: SJHH and JBMH

secondary, BCHS – primary amputations 3 R i l l b d( ) HHS NHS (f ?)

• 3. Regional vascular bed(s) at HHS, NHS (future?)
• 4. Regional Physician Call model and cross privileges

with visiting physician concept

Supporting Recommendations

• 5. Best practices and standards for diagnosis,

investigation & treatment with education provided investigation & treatment with education provided to Primary Care Physicians, ED physicians and general surgeons

• 6. Improve unmet access in the HNHB LHIN by

investing in tertiary and quaternary cases at HHS and NHS, including EVAR and NHS, including EVAR

• 7. Increase access to interventional radiology
• 8. Resources to support centralized intake process
• 9. Hybrid interventional suite

Questions

L:\C. Initiatives (Operations)\P - I (IHSP)\Vascular\Presentations )\HNHB LHIN Regional Vascular Services Plan Presentation for Board of Directors June 2011 g