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THE NORTHEAST AVALON COMMUNITY HEALTH NEEDS ASSESSMENT NORTHEAST AVALON COMMUNITY HEALTH NEEDS ASSESSMENT

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Access – Charting the Course: The Northeast Avalon Community Health Needs Assessment was the third report completed as part of Eastern Health’s mandate under the Regional Health Authorities Act to assess health and community service needs on an ongoing basis. These assessments help Eastern Health understand what a community feels it needs in order to be healthier.

Findings After listening to the communities involved in a needs assessment, Eastern Health prioritizes the issues identified and recommends actions to address the issues. Based on initial feedback from a telephone survey, and subsequent focus groups and key informant interviews, three main areas were prioritized for recommendations and action planning in Northeast Avalon:   

Wait times in the Emergency Department Access to Specialists Access to Diagnostic Imaging

Further, there were common challenges within these main areas: access to data, waitlist management, improving communications, and monitoring progress.

Communities Covered

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Progress Based on the report’s recommendations from August 2010, the following progress has been made in each of the priority areas:

Wait times in the Emergency Department:     

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Hired Nurse Practitioners for emergency rooms and opened the “fast track” at the Health Sciences Centre to decrease wait times for less acutely ill patients. Developed an Emergency Department Score Card to track the volume and acuity of clients by day of week and hour of day. The data is used to assist with appropriate staffing levels and help ensure alignment of shift times with patient flow. Increased nursing resources at Health Sciences Centre and St. Clare's Mercy Hospital sites. Developed a Physician Human Resources Plan and added resources. Emergency Departments, in collaboration with Decision Support and Clinical Efficiency, is developing the Emergency Department Information System. An electronic “bed board”, which notifies the availability of hospital beds, will be a part of that system. This is a provincial initiative undertaken by Department of Health and Community Services and will begin with sites within Eastern Health. The Eastern Health website, www.easternhealth.ca is being re-designed, and this includes providing information about wait times and the processes involved in an Emergency Department visit. Information on this website will also explain the importance of visiting a family physician for care when possible. The Eastern Health website now has a section entitled “Looking for a doctor?” under “Contacts,” which includes information about how to find physicians in the greater St. John's area that are accepting new patients. There is also a link to the College of Physicians and Surgeons webpage for the same purpose. An initiative is being developed to follow up with clients who leave the ER before being seen by a physician. Discussions continue around which model of care might be utilized to address availability of less urgent care in the community. A pilot project is ongoing with 50 clients who are frequent visitors to the Emergency Department Room and will involve an evaluation component (in conjunction with Eastern Health’s Research Department). A Primary Health Care nurse has been assigned as a case manager for a specific group of clients with chronic illnesses (excluding cancer clients or clients with mental health issues) and preliminary findings indicate that a significant number of the clients have not had a return visit to the Emergency Department since being assessed and followed by the case manager.

Evidence of progress in Emergency Department wait times: The percentage of people who leave the Emergency Room without being seen by a physician decreased from 11 per cent to 5.5 per cent at the Health Sciences Centre and from 9 per cent to 4.5 per cent at St. Clare’s during the 2011-12 fiscal year.

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Access to Specialists 

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Working with the Provincial Health Services Utilization committee, the Clinical Efficiency Program of Eastern Health is continually reviewing waitlist strategies, availing of lessons learned and examining best practices to improve wait times. One initiative specific to orthopedic specialists is the referral to service rather than an individual specialist. This has been communicated to General Practitioners and is working well towards reducing wait times to see an orthopedic specialist. Similar initiatives are being utilized for rheumatology. Eastern Health’s Chronic Disease Prevention and Management Strategy was released to the public in July 2012. The development of this strategy included consultations with key stakeholders and potential partners. As the strategy is implemented, and will help to increase partnerships with community groups and to improve approaches for the care and management of patients having multiple chronic conditions. To improve communication between Eastern Health and family physicians, a new discharge summary has been implemented throughout the region, which notifies family physicians when their patients have been discharged from hospital. This comprehensive summary is getting to family doctors in a timely manner. Additionally, an Emergency record is now sent to all family physicians regarding their patients’ visits. Eastern Health is in the preliminary stages of working with the Newfoundland and Labrador Medical Association (NLMA) and a consultant regarding a new electronic referral process to improve efficiency in this area. In an effort to improve communication about wait times and access to specialists, an Eastern Health website devoted to wait times is planned for 2012 and will be available to the public. Eastern Health’s Communications Department is also working with the Clinical Issues group to make patient education materials online. The Communications Department has also developed a three-year communications strategy to promote the organization’s strategic priorities, which include a focus on access to programs and services. Each of the communications professionals has responsibility for one of the four Eastern Health Strategic Priorities (Quality & Safety, Access, Sustainability, and Population Health). A key focus of this plan is to increase open and transparent communications.

Evidence of progress in access to Specialists: The median wait times for highest priority orthopedic patients has decreased by 69 per cent (reduced from 325 days to 101 days) and by 47 per cent (reduced from 325 days to 174 days) for lower priority patients by implementing a central intake system for orthopedic patients. The number of total joint replacement surgeries has increased by 220 by establishing a best practices working group to focus on improving pre-surgical preparation of patients, decreasing inpatient length of stay and adding additional operating room capacity at the Janeway Children’s Health and Rehabilitation Centre.

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Surgical capacity has increased through two new operating suites within the Children and Women’s Health Program, resulting in the completion of almost 800 additional Orthopedic, Plastic and General Surgery procedures.

Access to Diagnostic Imaging (DI) 

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A new urgency classification system has been developed and all requisitions are reviewed by a radiologist to prioritize requests. There is also an auditing process to determine the effectiveness of this system and make changes as needed. The “Lean” philosophy and management system is being applied to a number of areas, which is a method for continuous improvement and employee engagement. The Lean approach helps to streamline operations, eliminate waste and preserve value in various processes. For example, a Lean Team is currently examining missed appointments (“no shows”) and gathering data to improve processes. A lean process is also being examined around central appointments, specifically to determine how to improve access and better flow patients though DI. This includes discussing theories and strategies with a queuing expert. GE Healthcare Performance Solutions has completed a patient flow and workflow review for MRI services. The report is finalized and the DI program has developed an action plan for the implementation of the recommendations, which will improve efficiency and make optimal use of people and resources. A third MRI machine became operational at St. Clare's Mercy Hospital, which will extend to 16 hours of operation between Monday and Friday. This additional MRI is focusing on the backlog of patients awaiting MRI. DI has issued communications to ordering physicians and the public informing them that they may use DI services anywhere in the region to access the shortest wait times.

Evidence of progress in access to Diagnostic Imaging: Wait times for diagnostics services have been reduced by adding technologists and expanding operating hours resulting in CT services median wait time reduction from 75 days in 2009-10 to 38 days in 2011-12 and ultrasound services reduction from 133 days in 2009-10 to 53 days in 2011-12.

For More Information The full Northeast Avalon Needs Assessment report, along with four other community health needs assessments completed within the Eastern Health region between 2006 and 2012, is available on the Eastern Health website, www.easternhealth.ca, or through local libraries. For more information, please contact Gillian Janes, Planning Specialist, Eastern Health, at 7776773 or gillian.janes@easternhealth.ca.

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The Northeast Avalon Community Health Needs Assessment, A Two-Year Update  

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