Integrated Health Services Medicine Service Line/ Practitioner - - PowerPoint PPT Presentation

Integrated Health Services Medicine Service Line/ Practitioner Staff Affairs Portfolio

• Dr. David McCutcheon

Vice President May 13, 2016

Medicine Service Line/ Practitioner Staff Affairs Portfolio (MSL/PSA)

• Portfolio consists of 4 distinct program areas

– Medicine Inpatient Units: 200 beds – EMS and Emergency Departments: over 100,000 ED Visits; over 31,000 EMS responses – Critical Care and Cardiosciences – Practitioner Staff Affairs

• FTE (15/16) - 1124.95 plus 684 physicians
• Budget (15/16) – $212.7 million

Provincial Priorities and Accountability MSL/PSA

• ED waits
• Appropriateness
• Wait 1 initiative
• Alternative Level of Care- Collaboration with Patient Flow
• Seniors Care

– Collaboration with Mental Health/Long Term Care and Primary Health Care – Implementation of Gentle Persuasive Approach – Delirium Pathway – Geriatrician Recruitment

Region Priorities and Accountabilities MSL/PSA

• Quality and Safety

– Handwashing – Falls Management – Audits including: Foley Catheter Use Antimicrobial Stewardship – Manager Patient Rounding Compliance – ICU 92% Cardiosciences 82%; Medicine – 74.3%

• System Sustainability

– Daily Visual Management – Unit-based Standard Work for Managers

• Access and Patient Flow

– Daily Bed Management – Daily Rounding – Accountable Care Unit – Medical Surveillance Unit (38% isolation rates since Jan 15/16) – General Internal Medicine Program Renewal

Service Line Priorities and Accountabilities MSL/PSA

• Emergency Department

– ED wait times – ED budget – Code Burgundy Management

• Medical Inpatient Unit Geographic Bed Distribution

– Accountable Care Unit (ACU) – Medical Surveillance Unit (MSU)

• Critical Care and Cardiosciences

– Project Implementation – Program Development

• Senior Medical Office Reform

– Physician Rules and Regulations – Physician leadership renewal and development – Department Head Administrative support – Medical Quality Program – Credentialing Privileging and Physician Performance Management – Modernization of complaints process

Cross functional Priorities MSL/PSA

• We do not work alone!!:

– Surgery- operating room allocation; rules – Clinical support services- Lab and Medical Imaging Dyad – Primary Care- Physician recruitment – Seniors Friendly Hospital: we work with Michael and Karen.

Quality, Safety and Accreditation Accountabilities MSL/PSA

• Quality and Transformation

– SUN Regularization – Antimicrobial Stewardship – Infection Prevention & Control

• Accreditation

– Medication Reconciliation – EMS – Protocol Revisions – SMART IV pump roll out – over 900+ pumps changed out regionally – MSL large component

• f this work

Key Pressure Points/Needs: MSL/PSA

• Growing population and location of growth within RQHR

– ED bed pressure– Daily census reaches 200% of capacity weekly and occasionally higher. – Inpatient bed pressure – MIU Q4 capacity RGH 122%, PH 112% – EMS service delivery- challenged to make < 9 minute response time in peripheral neighborhoods. – ICU Q4 capacity regionally – 85% ; Cardiosciences RGH 80%

• Inpatient Units

– Integrated timelines for Hospitalist Model of Care – Staffing – Manager rounding – New manager mentorship and orientation – Pediatric consolidation of services – H1N1 total ICU patient admissions Q4 – 86 suspect cases ( 8 pediatric population) 12 deaths recorded during this period.

• New Program Challenges:

– TAVI – LAA – Trauma program

• Physician Challenges

– Payment funding challenges in PSA – Appropriate accountability for physicians

Trends MSL/PSA

Increasing Challenges:

– Equipment- funding program to replace old/broken – IV Drug Use: A harm reduction strategy – The need for Outpatient IV antibiotic treatment

• Fewer General Practitioners and Family Physicians with full privileges

in RQHR

• Increased acuity of Primary Care, Long term Care and Convalescent

Care

• Hospitalist Model of Care

– General Internal Medicine: changing to Hospitalist Model of Care – Cardiology, Nephrology, Psychiatry, ACU, MSU all have adopted the Hospitalist Model of Care – Increased acuity of Inpatient care

• EMS – Location and Physical Condition of Response Stations,

burnout and PTSD

• ED: QWL Issues: Physical work environment, fire safety, burnout, to

meets and trauma decision delay

Go Forward MSL/PSA: We have a Plan

• Integrated time line MSL/PSA and the VP!!
• Physician Resource Plan
• Standardised nursing practice
• MSU and ACU replication if validated
• Computerised Practitioner Order Entry (CPOE) and electronic charting
• Patient call system
• Point of care testing
• Physician performance

– Medical Quality Plan – Hand Hygiene – Paging system – Physician on call schedule – Changing Practice: Rounds, SSIB, Transfusion ad Infusions, Antimicrobial Stewardship and Medication Reconciliation

• Physician Engagement