Meeting Wednesday, August 26, 2009 City Hall, Port Colborne, Ontario.

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1 Meeting Wednesday, August 26, 2009 City Hall, Port Colborne, Ontario.

2 Based upon local Physician Consultation Report Trying to protect Services at the Port Colborne Rural Small Hospital Site One hospital with 7 entrances into the Niagara Hospital System.

3 The H remains on the PCGH site subject to changes in government policy. PCGH remains one of 7 sites of the Niagara Health System. Government policy will not change until the Small Rural framework panel has given direction and advice to the MOH.

4 The UCC must have a 24/7 open status. The 24/7 status will remain unchanged. The HIP is a legal binding document and must be implemented as such, which states that the UCC must be 24/7. There will be no changes unless a formal evaluation process gives a recommendation to the LHIN that this status should change, which would take at least 2 years to evaluate.

5 EMS /PARAMEDICS Policy describing the destination model used by Central Ambulance Communication Centres (CACC) needs to be amended to allow ambulances triaged by CACC as CTAS 3, 4 and 5 to be routed and taken to the Port Colborne REC. The NHS is being urged by the LHIN to work this out immediately.

6 PHYSICIAN FUNDING MODEL FOR UCC A funding model is critical to moving forward with Physician involvement. Current AFA has been approved by OMA and physicians until Dec 31, Ongoing discussions (critical enabler) with physicians to ensure best practice. A funding model needs to recognize that the Port Colborne UCC physicians have priority with scheduling.

7 Definition of Port Colborne General Hospital as a Rural Small Hospital Site Emergency Services: The NHS HIP proposed Urgent Care Centre should be re-designated as a Rural Emergency Centre (REC). There needs to be an education program initiated to inform the public and allied health personnel of current ER practices and how these changes will affect them on a go forward basis. Ideally, this should be done by non NHS personnel

8 Patients should be triaged at the new REC, and then either treated at the REC or sent to an onsite Nurse Practitioner led clinic with Physician coverage offered by our local physicians The ability to treat CTAS 3, 4 and 5 remains unchanged, as does the ability to triage and stabilize CTAS 1 and 2 appropriately.

9 A funding model needs to recognize that the Port Colborne REC physicians have priority with scheduling. A funding model is critical to moving forward with Physician involvement. A Courtesy Privilege needs to be re-defined and addressed for REC coverage in order for current physicians to be able to staff accordingly. A hospitalist position for monitored beds in the Port Colborne REC is required

10 24/7 days a week walk-in treatment for non-life or limb threatening injuries and illness Ability to treat, stablize and transfer Same, with renovated modern trauma and resuscitation room, with glidescopes for easier intubation. BEFORE AFTER

11 Ambulances takes patients to ED for treatment Surgical and medical outpatient clinics Lab, x-ray and ultrasound, pharmacy No ambulance service Same Same BEFORE AFTER

12 46 Complex continuing Care beds with Hospitalist coverage Road signs on area highways indicating directions to hospital BEFORE Same Road signs to be removed by MTO AFTER

13 Clinics: blood transfusions, medication infusions, lumps and bumps, specialist consultations Clerical support 24 hours per day BEFORE Same Clerical support 16 hours per day AFTER

14 Minor Procedure beds, infusion suite to keep physician engagement productive (specifics discussed further in Out-Patient Department). The new REC should keep its ventilator, intubation kit, tracheotomy kit, fibre optic bronchoscope for difficult intubation, and thrombolytic for cardiac care. Port Colborne s citizens need equitable access airway management for respiratory and cardiac arrest (non ambulance referral).

15 A capital budget is required for specifics such as radiology, lab services including arterial blood gas monitoring, which would assist the attending physician to appropriately monitor patients in the Clinical Decision Unit and or transfer to another Hospital site. A Primary Care Clinic needs to be on-site at the Port Colborne site.

16 Out-Patient Department to include: small procedure rooms, (including suturing, casting, catheter insertion, trach-care, foreign body removal) geriatric services (palliative care, hospice), infusion suite, (Remicade infusions, dialysis, IVIG, transfusions)

17 MINOR PROCEDURE SUITE: Renovations RENOVATED TRAUMA/ RESUSCITATION ROOM RENOVATED CLEAN AREA GLIDESCOPES TO PROVIDE EASIER INTUBATION ENHANCED OUTPATIENT CLINICS WILL BE ONGOING WITH CORPORATION INPUT TO BE DISCUSSED FOR FUTURE PCG SITE: PRIMARY CARE SERVICES: CHC/FHT/FHO NURSE PRACTITIONER CLINIC

18 Improved privacy for patients Floor space more than doubles Improved patient flow and sight lines Dedicated ventilation system for infection control Wheelchair accessible with accessible washrooms Modern trauma and resuscitation room Dedicated suture room with high intensity lighting

19 A Multi-site Family Health Team to be located in the City of Port Colborne: A Nurse Practitioner s Unit to be located within the Township of Wainfleet as a support for this rural small health care community is also proposed. Health Promotion & Education

20 Where are we headed? Project initiatives Additional health care services Newest physician recruits Medical Education Healthy lifestyles New Health and Wellness Centre Safe Communities Possible Collaborations

21 CREATION OF: Community Activities Network: A Network aimed at integrating resources to ensure the community maximizes its ability to offer programming and recreational activities. The City s desire is to create a culture of activity through robust programming, utilizing the current inventory of facilities, organizations and human resources.

22 EDUCATION PROGRAM INITIATION The City of Port Colborne should and could be a part of the process with the NHS. South Niagara Health Care Corporation will be critical to success of this educational process. There needs to be an education program initiated to inform the public and allied health personnel of current ER practices and how these changes will affect them on a go forward basis.

23 PHYSICIAN INPUT Common Credentialing is a goal for all parties. The ER chiefs are currently working towards adopting best practice procedures. A task force is in place for compensation models. SNHCC and City Staff will continue to meet with our local physicians to ensure input from them is communicated to MOH, LHIN and NHS.

24 HEALTH PROMOTION We would like to review with the group the current plan to remove the full-time Community Health Promoter from the Port Colborne Hospital site. We believe this is a very short-sighted decision and we ask that the LHIN and the MOHLTC consider funding this service as a community provided service under the auspices of either the South Niagara Heath Care Corporation or the CHC. We have prepared an estimated budget for this service.

25 Our LHIN has a lower rate of General Practitioners per 100,000 population than that of Ontario (86) Hamilton 85 Burlington 84 Brant 72 Niagara 69 Haldimand 59 * data obtained from HNHB CSP Bulletin June 2009

26 Date to be determined

Community and Hospital Profile

1 Community and Hospital Profile Scope of Services ACUTE CARE Emergency Department (~33,000 visits) Intensive Care Unit (Level 2: 6 beds) Medicine/Surgical Inpatient (40 beds) Surgical Services (3 ORs;