George and Fay Yee Centre for Healthcare Innovation and WRHA release interim evaluation of Healing our Health System plan
Winnipeg Regional Health Authority
Published Wednesday, January 31, 2018
The Winnipeg Regional Health Authority (WRHA) today released an interim evaluation of the first three months of the region's phase one of clinical consolidation.
Conducted in partnership with the George and Fay Yee Centre for Healthcare Innovation (CHI), the interim evaluation builds upon the robust monitoring of the patient experience and access to services that the region has undertaken since phase one began in October, 2017. It makes 19 recommendations aimed at improving the patient experience and access to services, improving the labour adjustment processes and enhancing communication with both patients and staff.
"This evaluation reinforces that wait times in emergency and urgent care departments continue to show improvements across WRHA facilities, in spite of the impact of an early and challenging flu season," said Kelvin Goertzen, Minister of Health, Seniors and Active Living. "The addition of staff and treatment spaces to emergency departments across the region - along with capital improvements to St. Boniface Hospital's emergency department - have allowed better patient flow across the region. Investment in new services and models of care, including those outside hospital through Priority Home and River Ridge Transitional Care, are allowing patients to leave hospital more quickly, with the appropriate supports in place."
The evaluation cites a number of improvements from in the first three months of consolidation, including:
- improved wait times in emergency departments and urgent care centres across the region which are between nine and 31 percent better than the same time the previous year. The regional average was reported to be 1.47 hours, which is down from 1.82 hours in 2016-17, bringing the region halfway towards meeting the Canadian median emergency wait time of 1.1 hours.
- reduced lengths of stay in emergency departments and urgent care lengths of stay, down six per cent for admitted patients and 14 per cent for non-admitted patients.
- a reduced inpatient length of stay region-wide, which is down 4.6 per cent, equivalent to freeing up 84 inpatient beds.
- a significant reduction in the number of patients waiting in hospital for personal care home (PCH) placement. Only nine patients were awaiting placement over the last three weeks, down from an average waitlist of 80 patients.
"The early results show great strides towards achieving the Canadian average in a number of areas, and these improvements have been critical in handling increased admissions and patient volumes with the onset of flu," said Lori Lamont, acting chief operating officer and vice-president of nursing and health professions for the region. "In addition to improved wait times in emergency departments, our efforts to improve inpatient capacity have allowed us to address long-standing bottlenecks and improve patient care."
Lamont credits efforts to reduce hospital stays, improve the coordination of resources across the region and the use of real-time bed management software with the first steps towards improving inpatient capacity.
The evaluation was designed by the CHI research team, with input from clinical and operations leaders in the region and the leadership of Shared Health. The evaluation team was embedded in the planning and implementation structure of the Winnipeg region and was provided unlimited access to internal planning and implementation documents, including staff and patient surveys, chart reviews and clinical reviews of specific cases.
The team also analyzed data from a number of secondary sources that reviewed patient volumes, patient flow, safety and quality indicators, admission, discharge and transfer summary information, as well as overtime, sick time and vacancy data.
Safety monitoring throughout phase one shows no spike in the reporting of critical incidents or occurrences and no complaint trends identified through WRHA Quality and Patient Safety as related to consolidation, Lamont added.
Patient readmissions were also monitored and showed no spikes in the general readmission rates across Winnipeg. The evaluation looked specifically at transfers from Victoria General Hospital (VGH) as well to review its transition to an urgent care centre. The audit conducted at VGH showed 51 per cent of transfers would still have occurred had the facility still had an emergency department, due to the specialized needs of those patients. It also indicated the vast majority of transfers from Victoria were appropriate to address the care needs of each patient.
The evaluation also identifies several areas for improvement. Two examples include: opportunities to improve processes used by clinical care teams as patients move between levels of care; and the need to add sub-acute capacity across the region. Both sub-acute units created in phase one have been consistently at capacity and are seeing longer than desired length of stay as well as growing wait lists.
"The Healing our Health System plan identified the creation of sub-acute capacity as a key to improving the performance of our hospitals and the waits experienced by our patients," said Lamont. "Phase two of our plan includes the creation of sub-acute capacity at both Concordia Hospital and Seven Oaks which will create capacity in acute medicine beds which are currently occupied by sub-acute patients. This will allow us to further reduce the average length of stay in shorter-stay units such as clinical assessment units."
The evaluation also reviews the effects on the region's second-largest audience: its staff. The workforce impacts reported in the evaluation are largely on par with the region's expected numbers, with 99 nursing jobs available at the time the report was written, compared to 31 nurses still on layoff. As a whole, staff indicated they felt supported by their direct supervisor or manager but did indicate a desire for improved communication and for earlier and increased opportunities for engagement and feedback.
"We are truly grateful to our staff who have continued to do exemplary work during this time of change within our system, and who continue to generate positive responses from patients regarding the compassionate care they offer," said Lamont. "We regret we were not able to be more forthcoming about the changes related to phase one since they came together before clinical consolidation was announced publicly. We look forward to engaging in more robust and open discussions as we continue planning for phase two and continue to seek actively to engage with staff and stakeholders going forward."
The interim evaluation identifies the need for increased physical capacity in the region's acute emergency departments to manage the expected increased number of patients that will follow the closure of Concordia's emergency department and the conversion of Seven Oaks to an urgent care centre.
"Addressing the capacity of our emergency departments is already included in the capital plans we have announced to support phase two. We are seeking to move up construction timelines for improvements in St. Boniface Hospital's emergency department as we give further consideration to the timing of a new emergency department at that site." said Lamont. "We continue to create capacity within our existing space for the time being as construction of the new emergency department at Grace Hospital wraps up and their capacity is expanded, and as sub-acute services ramp up across the system."
Careful planning continues for phase two of consolidation efforts. Initial plans for phase two focuses on what processes and changes need to be in place in order to make consolidation a success. The results of this evaluation will be used alongside clinical advice and best practice models to finalize phase two planning. The region is committed to making consolidation efforts successful and proceeding deliberately, and thoughtfully, towards the implementation of phase two.
"The goal of consolidation is to improve access to and the quality of health services within Winnipeg," said Lamont. "As we continue to improve the performance of our system, we improve health outcomes for our patients and create a more satisfying work environment for our employees."