TAMING OF THE INTERVENTIONAL CARDIOLOGY QUEUE; THE NEW BRUNSWICK HEART CENTRE EXPERIENCE. Dora Nicinski President & CEO April 2008

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1 TAMING OF THE INTERVENTIONAL CARDIOLOGY QUEUE; THE NEW BRUNSWICK HEART CENTRE EXPERIENCE Dora Nicinski President & CEO April 2008

2 NB Heart Centre 1991 to 2004 Growing demand on the program Funding buried in the global budget Long wait list (>500) for interventional cardiology leading to long wait time (>9 months for elective patients) Some regions in the province sought interventional cardiology services out of province Tension between regions with regards to equitable access

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4 Recommendation 4: Access Coordination for the NB Heart Centre The wait times for access to invasive cardiac services are overly long and all efforts must be made to correct this problem. Wait list management must occur not only for patients awaiting interventional procedures in hospital but also for outpatients. An appropriate triage system must include dedicated personnel to appropriately handle triage, to communicate with hospitals and with patients (Higginson, Cox, Pilote & Sherrard, 2004)

5 Province invests $2.45 million into New Brunswick Heart Centre February 8,

6 Third Cardiac Cath Lab Opened April 21, 2006

7 ACCESS COORDINATION COMPONENTS

8 INTERVENTIONAL CARDIAC TRIAGE THEN

9 Current NBHC Access Co-ordination Process Wait Time Management Inpatient Referrals Outpatient Referrals Access Coordination: - Referral info complete - Urgency rating - Communicate Inpatient Transfer (H-H) Outpatient Appointment (OPCC) Other test/consult Access Coordination: -Collect, audit, analyze data -Communicate with stakeholders -Disseminate reports

10 Triage Tools Maximum Recommended Wait Time TIMI Risk Scoring Ontario Urgency Rating System Wait Time Alliance Benchmarks -Cardiac Care-

11 Cardiac Access Management Team & many others!

12 WAIT TIME MEASUREMENT & MONITORING: GUIDING TOOLS Wait Time Alliance for Timely Access August 2005 Canadian Cardiovascular Society

13 Purpose of Access Management Managing Waitlists Managing Wait Time Managing Processes (changing) Managing Resources Managing Expectations Communicate, Communicate, Communicate..

14 DATA COLLECTION Elements of Access Management DATA MANAGEMENT (AUDITING, ANALYSIS & PROTECTING INTEGRITY OF DATA) REPORTING/DISSEMINATION MONITOR & ACT ON THE TRENDS

15 Data Collection & Management Wait time data collection is ongoing and is compared to other Canadian heart centers Benchmark the NBHC wait time data with the Cardiac Care Network of Ontario (CCNO): (17 sites) Reports are generated weekly, monthly, quarterly, and yearly

16 Quarterly Report: NBHC Website & Newsletter

17 Reporting: Weekly Community Waitlist Date # of available slots for the following week # of unfilled slots for the current week Total # on the list requiring assessment for cardiac cath Total # on the list requiring additional tests & assessment for cath # of referrals that have exceeded recommended wait times April 4/ March 28/ March 20/ March 14/ As of April 1 st, 2007 Number of outpatient slots left unfilled Total number of OPCC patients seen since April 1 st, 2007 Number of outpatient slots left unfilled for fiscal year Total number of OPCC patients seen in the fiscal year 2006/

18 Reporting: Weekly Hosp-Hosp Waitlist Date # of inpatients referred in current week # of names on list Total # of names in a pending mode # of transfers coordinated for next working day # of referrals who have exceeded recommended wait time April 4/ March 28/ March 20/ March 14/ Total number of inpatient interventional cardiology referrals for the fiscal year (April 1/07-Feb 29/08) Total number of inpatient interventional cardiology referrals for the fiscal year

19 This binder was created to help communicate with NB Heart Centre stakeholders Given to each referring facilities/units Contains: Contact Info Memos Policies & Procedures NBHC HeartBeat Wait time Statistics

20 NB Heart Centre Today: Has an access management process that: Is well established but flexible enough to allow for changes in practice. Is truly a living process. Uses objective clinical criteria Utilizes published tools (TIMI Risk Scoring, Ontario Urgency Ratings, & Wait Time Alliance) by experts in the cardiovascular domain Is comparable to other Canadian centers Has dedicated, capable personnel Has effective communication with all NBHC stakeholders Is fair and transparent Is seen as a resource not a barrier A Triage process that we are proud of!

21 Publication/Communication of the Triage process Wait time data reviewed quarterly with the NB Cardiac Services Advisory Committee members

22 Lessons Learned The process must be flexible so that it can be adjusted to the changing practices; transparent; prioritization based on objective clinical criteria Ongoing auditing of data ensures data integrity Ability to compare wait time with similar centers adds significant value Early identification of problems prevents crisis Ongoing communication with stakeholders is invaluable Provides a foundation for other services: EP & Cardiac Surgery wait time

23 Key Factors to this success story: Excellent communication between NBHC clinicians and senior administration Responsiveness of our senior administration team for an external financial review then government agreement to an external program review Allocation of resources by government to address the space, equipment and personnel issues The ongoing monitoring and reporting of wait time data to all stakeholders.

24 NB Heart Centre TAMING OF THE INTERVENTIONAL CARDIOLOGY QUEUE AT THE NB HEART CENTRE IS A SUCCESS STORY One that we are proud to share