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Ontario Wait Time Strategy Visit to Champlain June 25, 2008. Alan R. Hudson, OC, FRCSC. Cataract Surgery 90 th Percentile Wait Time Trend. Cataract Surgery Wait Times – LHIN Variation. Hip Replacement 90 th Percentile Wait Time Trend. Cancer Surgery 90 th Percentile Wait Time Trend.

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slide10

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

Note: Based on priority level 4 targets.

champlain lhin ranking 2007 08
Champlain LHIN Ranking 2007/08
  • Champlain LHIN has ranked within the bottom 3 LHINs across the priority wait time service area in 2007/08

Other Provincial Programs

champlain lhin s current wait time performance is still significantly higher than the province
Champlain LHIN’s current wait time performance is still significantly higher than the Province
other atc and mlaa performance and ranking 2007 08
Other ATC and MLAA Performance and Ranking-2007/08
  • Thus far, the Champlain LHIN has had positive performance in the other ATC initiatives
  • Other MLAA indicators highlight the fact that ALC (and specifically LTC within the ALC population) continues to be a challenging factor for the LHIN.
champlain lhin makes up approximately 10 of the provincial volumes for the priority service areas
Champlain LHIN makes up approximately 10% of the Provincial volumes for the priority service areas.
  • TOH is the only adult tertiary care center
    • 65% of the adult surgery is provided by TOH
    • Second largest provider of cancer surgery in the province
    • Largest provider of cataract surgery in the province
slide18
Significant proportion of patients currently waiting for a priority surgery are in the Champlain LHIN
  • Long waits at the Champlain LHIN are expected to continue
slide19
Champlain LHIN has not seen a significant reduction in the number of patients waiting compared to the Province.
  • This is particularly evident for hip replacements, where the Province has seen an 12% decrease in the number of patients on the wait list since July 2007.
slide20
Champlain LHIN did not meet their 2007/08 Wait Time Performance Targets for 6 of the 7 service areas.
  • Champlain LHIN set some of the highest targets compared to other LHINs for 2007/08
    • Significantly higher than the Provincial Targets
      • Within performance corridor for 4 of the 7 services
slide21
For service areas where the Province has seen a significant shift in performance, Champlain LHIN still has a skewed wait time distribution

PROVINCE

CHAMPLAIN LHIN

cataract surgery champlain is the only lhin above the provincial target

350

300

trendline

250

200

Priority 4 Target - 182 days

Wait Days

150

100

50

0

Jan 08

Mar 08

Apr-08

Oct 07

Dec 07

Feb 08

Sep 07

Aug 07

Nov 07

Jun-Jul 06

Jun-Jul 07

Oct-Nov 05

Apr-May 06

Oct-Nov 06

Apr-May 07

Feb-Mar 06

Feb-Mar 07

Dec-Jan 06

Dec-Jan 07

Aug-Sep 05

Aug-Sep 06

Cataract Surgery-Champlain is the only LHIN above the Provincial Target

Cataract Surgery 90th Percentile Wait Time Trend –Provincial

Cataract Surgery 90th Percentile Wait Time By LHIN

slide23

At the Provincial level, less percentage of high priority surgical patients are seen within target. However, this is much more evident in the Champlain LHIN.

PROVINCE

CHAMPLAIN LHIN

Hip Replacement Surgery is circled as an example; however, all service areas apply

slide25

Significant variation in Surgeon wait times across the Champlain LHIN.

Provincial vs. Champlain LHIN Surgeon Wait Time Variation

Hip Replacement-Q4 2007/08

slide26

Significant variation in Surgeon wait times across the Champlain LHIN. (cont’d)

Provincial vs. Champlain LHIN Surgeon Wait Time Variation

Knee Replacement-Q4 2007/08

slide27
Any performance improvements in the Champlain LHIN wait times would improve the Provincial wait times
summary
Summary
  • The Champlain LHIN makes up a large proportion of the Province’s wait time volumes and the current queue for all service areas.
  • With a large volume and poor overall performance, the LHIN has a significant impact to the Province’s wait time performance.
    • This also applies to other MLAA indicators and other cancer service areas.
    • Since the LHIN has a large number of patients currently waiting for surgical and DI services, the trend of poor performance will continue.
  • The LHIN is currently below the Provincial target for all service areas and is not meeting the access targets of urgent patients.
  • The targets set with the MOHLTC are considerably higher than the targets set by other LHINs.
the er strategy calls for system wide improvements

ER

The ER Strategy calls for System-wide Improvements

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

Reducing Demand for Services

Increasing Supply of Services

Improving Processes within the ER

Alternate Levels

Alternate Levels

OR

of Care

of Care

Community

and home-based services

ED

ER

Home

Home

Home

H

H

Rehabilitation

Rehabilitation

Rehabilitation

Rehabilitation

Complex and Continuing

Care

Long Term

Long Term

Care

Long Term

Long Term

Care

Care

Care

  • Aging at Home
  • Family Health Care for All
  • Chronic Disease Prevention and Management (Diabetes)
  • Mental Health and Addiction
  • Emergency Room Strategy
  • HHR - Emergency Department Coverage
  • Aging at Home (ALC)
  • High Growth Hospital Funding

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

slide30

Michael Schull, MD – Chair, ER Expert Panel

Kevin Smith, D. Phil – Expert Lead, ALC

Hugh MacLeod, MA – OMA Negotiations

Sarah Kramer, MSc – IM/IT

slide31

ER

Transfer

ALC

Institution

Communities

*

*

*

Booked Admission

*

*

percent of acute care beds occupied by alc patients by lhin
Percent of Acute Care Beds Occupied by ALC PatientsBy LHIN

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

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

number of patients in emergency waiting for an in patient bed by lhin at any given point in time
Number of Patients in Emergency Waiting for an In-patient BedBy LHIN(at any given point in time)

Ontario = 849

Source: OHA April 2008 ALC Survey Results

slide36
Number of Patients in Emergency Waiting for an In-patient Bed Since December 2007 (at any given point in time)

17% increase

ALC Survey Results – December 2007 to April 2008

Source: OHA April 2008 ALC Survey Results

slide37

ALC

Long-Term Care Home

15,587 IP Acute Beds (*)

8.84%

Other

Community / Home care

2.18%

Rehabilitation

13.71%

Complex Continuing Care unit

7.39%

81.43% IP Acute Beds

18.57% IP Acute Beds

57.89%

Palliative care unit or hospice

5.35%

12.1% admissions/year (**)

Sub-acute or convalescent care

3.39%

Home

1.24%

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

(*) “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.

ED

slide41

EDRS Implementation Timeline

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

Technical Development

Beta Testing

Hospital Training

All Hospitals submitting data to EDRS

Wave 1 and Wave 2 Implementation

Public Reporting of ED Wait Times

slide42

EDRS

Quality/Safety Indicators

ALC

WTIS is part of a broader agenda to improve access to care

Neurosurgery

Emergency

Room

Colon Cancer Screening

Screening

Other

Specialized Services

(Systemic; Radiation)

CCIS

ICU

WTIS – Wait 1pilot

Wait 2

adult & paeds

After Care

(i.e. Rehab,

Home Care)

Primary

Provider

Specialist

OR

Nursing

Unit

SETP

MRI/CT

Other

Diagnostic

Procedures

Client Registry

proposed er strategy timeline

Hospitals selected for Expert Teams (Apr. 2010)

ER HHR plan complete, implementation begins (Nov. 2008)

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

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

Increase ER/CCAC resources (Apr. 2009)

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

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

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

ER wait times publicly reported (Feb. 2009)

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

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

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

Hospitals selected for Expert Teams (Oct. 2008)

Online ED patient flow Toolkit and expert program launched (Nov. 2008)

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

Pay-for-Results Y2 allocation including expanded list of hospitals (Mar. 2009)

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

Hospitals selected for Expert Teams (Apr. 2009)

Hospitals selected for

Expert Teams (Apr. 2011)

Pay-for-Results Y4

allocation (Apr.2011)

Proposed ER Strategy Timeline

ER wait time goals achieved (Jul. 2011)

Provincial election

(Oct. 2011)

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

January

2011

January

2012

January

2010

January

2008

July

2008

July

2009

July

2011

July 2010

January

2009

patient satisfaction survey
Patient Satisfaction Survey

Ontario Emergency Department by Hospital Location in LHIN

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

Survey Results Summary (2005-2006):