Transitioning to a System of Rehabilitative Care in Waterloo Wellington

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1 Transitioning to a System of Rehabilitative Care in Waterloo Wellington Presented to the WWLHIN Board of Directors January 31, 2013 Item 20.0

2 Agenda Stroke and Rehabilitative Care System Initiatives.. 1) Where We Started 2) Implementing a Quality Stroke System of Care in the WWLHIN 3) Next Steps your role 4) Feedback/Suggestions

3 Where We Started Challenges Accessing Rehab 2009 Stroke Services Review Contribution to ALC/Expert Panel Aug 2011 Rehabilitation Services Review WW Rehabilitative Care System Best Practices

4 Rehab Best Practices & Standards of Care Best Practice Implementation in WWLHIN? Fractured Hip Total Joint Arthroplasty Stroke Elder Care 7 day a week rehabilitation Variable Referral to rehab on post-op day #3 if not progressing Referral to rehab on post-op day #5 if required Not Measured 7 day a week rehabilitation Variable Referral to rehab on post-op day #3 if not progressing Orthopedic Quality Scorecard - 90% (+/- 10%) discharge rate to home from acute care hospitals. ALPHA FIM completed on day #3 Onset to rehab - Day 5 (Ischemic Strokes) or Day 7 (Hemorrhagic) No Not Measured 7 day a week admission process to rehabilitation No Severe strokes (Alpha FIM <40) require access to restorative care with process to ensure regular re-assessment for in-patient rehab No 7 day a week rehabilitation No Establish the infrastructure and requirements for a Senior Friendly Hospital as it relates to acute and inpatient rehabilitation supports required A common rehabilitation/activation framework which may reduce the functional and cognitive decline of hospitalized elderly patients Yes No No No No 4

5 Ontario Stroke Report Card: Local Health Integration Network Report Ontario Stroke Report Card: Local Health Integration Network Report FY11-12 Grand River Hospital FY and LEGEND Poor Performance Acceptable performance Exemplary performance Benchmark not available 5

6 Indicator WW LHIN FY (FY10-11)

7 7

8 Implementing a Quality Stroke System of Care in the WWLHIN Access to specialized, timely, cross continuum stroke care for all stroke patients in Waterloo Wellington Relocation of stroke beds to achieve critical mass Development of designated stroke units that have trained and dedicated stroke staff Admit a greater number of patients post severe stroke into high intensity rehab Redirect patients with mild stroke to outpatient rehabilitation programs post acute care discharge Partnerships with WWCCAC and other community providers 8

9 Canadian Best Practice Recommendations for Stroke Care 9

10 Developing Recommendations to Support a Quality Stroke System of Care in the WWLHIN Centre of Excellence Care Close to Home 10

11 Developing Recommendations to Support a Quality Stroke System of Care in the WWLHIN Distribution of Acute Stroke Beds WWLHIN Hospitals F 2010/11 Acute Plus ALC 95% occupancy) Cambridge Memorial Hospital 4.7 Grand River Hospital Waterloo District Stroke Centre 11.1 Groves Memorial Hospital 0.8 Guelph General Hospital 3.3 North Wellington Health Care Centre 0.6 St. Mary's General Hospital 1.1 Total 24.2 CIHI, DAD 11

12 Developing Recommendations to Support a Quality Stroke System of Care in the WWLHIN Stroke In Patient Rehabilitation (2010/11) CMH (Rehab + CCC) SJHCG (Rehab + CCC) Freeport (Rehab + CCC) Admissions % Occupancy SOURCE: CIHI CCRS, NRS 12

13

14 The Stroke Stream of Care Recommendations 1. All acute stroke services will be provided at Grand River Hospital 2. In Patient rehabilitative care will be provided at GRH s Freeport site and St. Joseph s Health Centre Guelph 14

15 The Stroke Stream of Care 15

16 Next Steps February 2013 A business case, including information about the process followed to develop the proposed voluntary integration and the detailed organizational implications of the integration, will be provided to the WWLHIN and Health Service Provider Boards for review and consideration March 2013 The business case will be presented to Health Service Provider Boards and a request will be made for a motion to support the voluntary integration March 28, 2012 The business case and the results of the Health Service Provider motions will be presented to the WWLHIN Board

17 Due Diligence of Board Members When considering your decision regarding the proposed stroke services integration, consideration should be given to ensure.that the decision has been made on an informed basis, honestly, in good faith and in the best interest of the corporation..that the Board acts not only in the essence of its mission and vision but that it also discharges its accountability to its stakeholders and in consideration of other health service providers and the health system as a whole. Guide to Good Governance, Second Edition

18 Due Diligence of Board Members The primary functions that a hospital Board should perform include: Approve goals and strategic direction Establish a framework for performance oversight Oversee quality of care Oversee financial condition and resources Oversee enterprise risk management Supervise leadership Oversee stakeholder relationships Manage the Board s own governance Guide to Good Governance, Second Edition

19 Feedback/Suggestions What additional information do you need in order to make an informed decision in March 2013 regarding the proposed integration of stroke services? How would you prefer to receive communications/ updates between now and March 2013? What information does your community need regarding these proposed changes?

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