Niagara Health System Niagara on the Lake Site Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Network (LHIN) Quality and Safety Committee December 3, 2014
Niagara Health System (NHS) – Niagara on the Lake Site (NOTL) The Niagara Health System (NHS) is • a multi-site hospital comprised of six • St. Catharines NHS sites: • Greater Niagara Larger General Hospital Sites • The Welland Hospital Three larger sites that provide a • range of acute care services including emergency department (ED) and intensive care (ICU) • Niagara on the Lake services NHS • Douglas Memorial Smaller Hospital Sites • Port Colborne Three smaller sites that provide • complex care, short stay acute care beds and urgent care services 2
NHS’ Request to Reclassify the NOTL Site NHS is requesting the LHIN approve a number of service changes at the Niagara-on-the- • Lake (NOTL) site. These changes include: • Conversion of 18 complex care beds to six acute care beds Transfer of 10 acute care beds from NOTL site to be distributed across the three • larger NHS sites (Welland Hospital, St. Catharines and Greater Niagara General) Reassignment of the NOTL site under the Public Hospitals Act (PHA) from a Group C • (general hospital with less than 100 beds) to a Group V (hospital that operates ambulatory care) hospital 3
NOTL Current Services NHS Operated Services Non NHS Operated Services 22 inpatient beds comprised of 18 NOTL Family Health Team – separately • • complex care beds and four acute governed and operated care beds Outpatient laboratory operated by Life labs • Walk-in clinic staffed by a Nurse • Internal Medicine physician who leases office • Practitioner (operates Mon-Fri 9:30AM space to 12PM, 2PM – 4:30PM). Outpatient audiology service operated by • X-ray and Ultrasound • Hotel Dieu Shaver Health and Rehabilitation Physiotherapy for both inpatients and Centre (once a month) • outpatients Massage therapy and NOTL Community • Palliative Care (at the Byron street property). 4
LHIN Role in the Approval Process Reclassification of Beds Assign/Reassign Hospital Group LHINs have the authority to reclassify hospital beds Ministry of Health and Long-Term Care (ministry) (i.e. from complex care to acute). approval is required to assign or reassign a hospital to a Group under the PHA and Reg. 964. The LHIN’s decision is expected to consider: The LHIN’s role in this process is: rationale for the change, including an • articulation that the reclassified beds will not provide a written recommendation detailing its • be needed in the immediate future, rationale for supporting or not supporting the hospital’s request. cost benefit analysis, • • The LHIN’s assessment is to consider the impact • service availability the removal will have on local programs or labour relations and the • services provided by the hospital and whether the impact of the classification of the hospital • removal is consistent with the strategic objectives under the Public Hospitals Act (PHA) Reg. of the LHIN and local health system. 964. 5
LHIN Analysis The methodology used by the LHIN to evaluate NHS’ request to reclassify and • relocate inpatient beds and reassign the NOTL to an ambulatory care site incorporated: relevant policies and guidelines • population projections and demographic profile of NOTL residents • health care services available at the NOTL site and population served • NHS’ rationale for reclassification and relocation of beds • NHS’ plan to meet the needs of the clients served at the NOTL site • financial review • NHS’ communication and community engagement plan. • 6
Population Served by NOTL Site 50% of patients discharged from NOTL inpatient beds are residents of NOTL. • In 2013-14, there were 135 reported discharges from the NOTL site complex care • program, of these 65 discharges (48.1%) were residents of NOTL. Of note, 59 or 43.7% were residents of St. Catharines. NHS’ review of the NOTL site population for period March 2013 to July 2014 revealed • that: 51% of admissions were residents of NOTL • Of 133 patients receiving care in complex care beds at the NOTL site the • majority (100) were admitted for restorative care, 10% were admitted for end of life care 7 Source: intellihealth Ontario, CCRS & NHS
NOTL Current and Future Services Current: Future: 22 inpatient beds comprised of 18 complex • Walk-in clinic staffed by a Nurse Practitioner • care beds and four acute care beds X-ray and Ultrasound • • Walk-in clinic staffed by a Nurse Practitioner • Physiotherapy for both inpatients and X-ray and Ultrasound • outpatients Physiotherapy for both inpatients and • NOTL Family Health Team • outpatients Outpatient laboratory operated by Life labs • NOTL Family Health Team • Internal Medicine physician who leases office • • Outpatient laboratory operated by Life labs space Internal Medicine physician who leases office • Outpatient audiology service operated by • space Hotel Dieu Shaver Health and Rehabilitation Outpatient audiology service operated by Centre (once a month) • Hotel Dieu Shaver Health and Rehabilitation Massage therapy • Centre (once a month) • NOTL Community Palliative Care (at the Massage therapy • Byron street property). NOTL Community Palliative Care (at the • Byron street property). 8
NHS’ Proposed Plan to Accommodate NOTL Inpatient Beds NHS’ plan to accommodate inpatient volumes transferred from the NOTL site was developed to consider: Patient Resident Perspective • Access and Patient Flow • Health Human Resources • Financial Impact • 9
Summary of Staff Analysis NHS’ business case to relocate the beds from the NOTL site to other sites aligns with: • NHS’s Hospital Improvement Plan; Dr. Kitts’ (Supervisor) report and Independent Operational • Budget Review • Will result in operational savings that is consistent with the conditions associated with the additional funding provided in 2013-14. NHS has identified a plan that • prioritizes, where possible, ensuring patients who are residents of NOTL will receive palliative care • and restorative care as close to home as possible accommodates the NOTL patient volumes/beds at existing sites while maintaining patient flow • • increases acute care capacity across the NHS optimizes local health system capacity e.g. Linhaven Home for the Aged Convalescent Care • Program, Hotel Dieu Shaver Health and Rehabilitation Centre and the community (Community Care Access Centre (CCAC) - Home First) maintains ambulatory services at the NOTL site until an appropriate transition plan has been • developed in consultation with community stakeholders. commits to work with the NOTL community to develop a Community Health Centre (CHC) for the • long term provision of community-based ambulatory services. 10
NHS Community Engagement NHS detailed a comprehensive community engagement plan including the following: • Collaborating with the NOTL Health Services Steering Committee (HSSC) on messaging and • community engagement sessions. A series of six ‘Community Dialogue Sessions’ have taken place with140 attendees. Community Dialogue Series were facilitated by an independent facilitator • Stakeholder debriefing of elected officials • Debriefing with providers currently occupying the NOTL site • Physician engagement • • Patient and family interviews The NOTL HSSC has established four working groups as follows: • • Site Selection Working Group • Collaborative Services Working Group • Corporate Start-up Working Group • Communications Working Group 11
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