SW LHIN Stroke Capacity Assessment and Best Practice Implementation Project. Presenters: IDEAS Applied Learning Project

Transcription

1 SW LHIN Stroke Capacity Assessment and Best Practice Implementation Project Presenters: Paula Gilmore (Southwestern Ontario Stroke Network) Kelly Simpson (South West LHIN) IDEAS Participants: Cathy Vandersluis, Paula Gilmore, Carrie Jeffreys, Doris Noble (Cohort 1) IDEAS Applied Learning Project

2 The Case for Change in Stroke Care in the South West LHIN 2

3 Project Objectives 3

4 Planning Principles HQO s Core Planning Principles of Quality, Client Focus and Efficiency informed the criteria for project decision-making, which guided the goals and objectives. The Project s Planning Approach has been to: 4

5 Key Project Inputs: Quality and Performance Driver Diagram 5

6 Stroke Reporting Outcome Process Balancing Crude 30 day In-hospital Mortality Rates % of mod. and severe stroke survivors treated on a inpt. rehab. unit % of stroke survivors who receive tpa % of stroke survivors arriving in ED within 3.5 hours Crude 30 day readmission rates through the ED % of TIA/minor stroke with a referral to a SSPC % of stroke survivors with Alpha FIM score by Day 3 Average LOS on inpatient Acute Stroke Unit Inpatient Rehab FIM Efficiency % of stroke survivors referred to specialized stroke outpatient program or CSRT % of stroke survivors treated at Designated Stroke Centre on an ASU Percent meeting LOS targets for inpatient rehabilitation by RPG % discharged alive from acute to LTC/CCC (when admitted from home) % of acute hospital days spent in ALC status Average days waiting for CSRT % pt with CT done within 24 hours % of pt with family physician follow up within 7 days Patient experience (TBD) Legend: Data Available Limited Ability Potential Future Ability Data Unavailable

7 Key Project Inputs: Quality and Performance Hospital Stroke Services Survey 7

8 Key Project Inputs: Client Focus Experienced Based Design Approach Project Governance All hospitals invited to participate Cross-functional Physician Advisory Council EMS representation Local HSFR Partnership consultation Patient and Family Interviews 26 interviews conducted across the South West LHIN Project Team calibrated to identify common trends Current State Process Mapping Mapping sessions held with 28 hospitals and EMS where available Maps were consolidated based on the type of stroke care each group provides: 1. Designated Stroke Centers (LHSC: University Hospital, HPHA: Stratford site, GBHS: Owen Sound site) 2. Designated Telestroke Centre (Alexandra Marine & General Hospital in Goderich) Strokes Annually Non-Designated Sites Strokes Annually Non-Designated Sites Strokes Annually Non-Designated Sites 6. Designated Rehabilitation Site and Outpatient services (St. Joseph s Parkwood Institute inpatient, outpatient and CSRT 8

9 Key Project Inputs: Client Focus Current State Process Concerns 9

10 Key Project Inputs: Client Focus Voice of the Stroke Patient and Caregiver 10

11 Key Project Inputs: Client Focus 1. Health Equity Impact Assessment completed 2. Driving Distance Considerations 11

12 Key Project Inputs: Efficiency Quality Best Practices: Minimum number of ischemic strokes = 165 cases annually; DAD analysis Minimum standards outstanding for Rehabilitation. Evaluation of the project s alignment to the Ontario Medical Association (OMA) and Ontario Hospital Association s (OHA) Framework for the Redistribution of Hospital Services document. Current Acute Care Costs: Estimated to be $13.7 million annually At the 27 acute hospital sites within the LHIN, stroke admissions range from 11 to 613 per year Current Inpatient Rehabilitation Costs: Approx. $7.4 million 351 admissions to a designated inpatient rehabilitation bed. On average, these patients remain in inpatient rehabilitation for a mean of 34.8 days WHAT IS THE OPPORTUNITY, ie. IF WE IMPLEMENT, WHAT ARE ESTIMATED ANNUAL COST SAVINGS FOR ACUTE AND REHAB? Economic Impact Assessment What is the potential high level impact? QBP exempt: reduced volumes, no funding reduction? Divesting QBP Sites: reduced volumes, reduced funding? Stroke Centres: increased volume, increased funding? 12

13 Directional Recommendations Final stages of data analysis regarding volumes, system capacity, financial implications and desired models of care Weighing options against decision-making criteria: - patient driven care - best practice care - data informed - system capacity - aligning with local and provincial initiatives - cost neutral 13

14 Directional Recommendations: Critical Success Factors 1. Best Practice stroke care, as described within the Future State of Stroke Care Definitions document must be achieved before realignment proceeds 2. Implementation is staged and gated in each district before full roll-out to ensure success; 3. Determination of the most effective model for post hospital stroke rehabilitation needs within the South West LHIN; Coordinated Access for Rehabilitation and Complex Continuing Care cannot impede flow to inpatient rehabilitation services including increasing length of stay; 4. Robust exit strategies such as increased community support services (Day programs) for stroke survivors discharged from formal rehabilitation services; Timely access to Urgent TIA/Secondary Stroke Prevention Clinics 14

15 Adaptive Leadership Project has created high heat and the project team has implemented ways to lower the heat to ensure partners remain in the productive zone Strategies have included Robust governance structure of senior leaders from hospitals/ccac/physicians/lhin/ems Collaboration agreement Patient Experience Video Open dialogue supported by data and evidence Engagement and re-engagement of all organizations Education of best practices Lessons Learned 15