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 of 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: Physician Challenges – – TAVI Payment funding challenges in PSA – LAA – – Appropriate accountability Trauma program 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