Capacity Analysis in a Specialized Service: Mapping the Future

Transcription

1 Capacity Analysis in a Specialized Service: Mapping the Future Presenters: Judy Costello and Zsolt Hering Co-authors: Sabrina Bennett and Marnie #NHLC2018

2 PURPOSE Provide background on specialized services for malignant hematology Describe stem cell access crisis in Ontario Outline action plan for Princess Margaret Cancer Centre Describe volume modelling approach for expansion Highlight ambulatory treatment model Outline results to date Lessons learned

3 UNIVERSITY HEALTH NETWORK - OUR HOSPITALS Toronto General 446 beds 154,750 inpatient days 317,905 clinic visits 52,425 ED visits Princess Margaret 135 beds 46,939 inpatient days 284,415 clinic visits Toronto Western 285 beds 98,891 inpatient days 368,469 clinic visits 70,153 ED visits Toronto Rehab 384 beds 133,126 inpatient days 9,935 clinic visits

4 PRINCESS MARGARET COMPREHENSIVE CANCER CENTER 4 Clinical Programs Surgical Oncology, Medical Oncology and Hematology, Radiation Medicine, Supportive Care 11 Multidisciplinary Disease Groups Breast, Central Nervous System, Endocrine, Gastrointestinal, Genitourinary, Gynecology, Head and Neck, Leukemia, Lung, Lymphoma/Myeloma, Ocular, Skin, Sarcoma

5 SPECIALIZED SERVICES: WHAT IS MALIGNANT HEMATOLOGY? Princess Margaret has the largest most comprehensive Malignant Hematology (MH) program in Canada Cancers of the blood Diseases: leukemia, lymphoma, myeloma and other blood disorders Treatment Chemotherapy followed, in a subset of cases, by a stem cell transplant (SCT) Two types of SCT: Autologous (Auto) in which the patient receives his or her own stem cells Allogeneic (Allo) in which stem cells are donated by another person (related, unrelated) Some of the most acute patients at UHN; lengthy treatment pathways High complexity and intensity patients with a major impact on inpatient and outpatient resources Variable funding rates aligned to patient pathway

6 2015 A CALL TO ACTION IN ONTARIO Complex Malignant Hematology Initiative Improving Complex Malignant Hematology and Stem Cell Transplant Services

7 THE CHALLENGE: CRISIS AND OPPORTUNITY Increased capacity required for the province Limited capacity and growing wait lists at the 3 key centers Expansion plans requested by Ministry of Health Princess Margaret had highest volumes and expertise yet longstanding resource limitations (space, HHR, funding) Small group met and brainstormed options for space Clinical teams reviewed patient pathways and developed new approaches Capacity assessment and a financial impact analysis completed

8 ALLO STEM CELL TRANSPLANT CAPACITY MODEL Patients / Year # Beds 2015/ / / / / /21 Inpatient Capacity 14B C A Total Outpatient Capacity MH Day Unit a 50 b c Total Eligible Allo SCT Patients Waitlist >80 >80 >80 > a 16 patients are inpatient/day unit mix with no increase in incremental volume b 50 patients are inpatient/day unit mix with no increase in incremental volume c 20 patients are incremental volume to a total of patients are inpatient/day unit mix Model Approach 3 options to expand Patient care needs and past experience analyzed Acuity and length of stay considered 2 additional units could be opened Shift to allogeneic outpatient transplant

9 MALIGNANT HEMATOLOGY DAY UNIT VISION All malignant hematology patients Comprehensive assessment, symptom management and interventional care chemotherapy, intravenous treatments, transfusions, etc. 12 hours per day 7 days/week availability Capacity for walk-ins to avoid Emergency room visits Nurse practitioner led interprofessional team

10 MALIGNANT HEMATOLOGY DAY UNIT: VOLUME MODEL APPROACH Interprofessional team reviewed current outpatient MH activity Identified patient populations and reviewed treatment and care needs Activity was forecasted over 5 years including move to outpatient autologous and allogeneic transplant Projected growth based on changing treatment landscape

11 MODEL

12 MODEL BENEFITS Enabled informed decision-making Informed UHN/PM space transformation plan including clinic space requirements Able to test assumptions and change inputs to identify impact

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14 MODEL OUTCOMES Complexity and acuity shifted due to changing eligibility criteria Transformed patient journey for MH services Informed and enabled model of care transitions

15 WHERE ARE WE TODAY? 12 bed inpatient unit opened; lab and pharmacy expansion completed On the path to 208 allogeneic transplants/year Model of care has shifted for allogeneic stem cell patients Ministry of Health approval to expand to 320 allogeneic transplants PM space transformation underway

16 WHERE ARE WE TODAY: TRANSPLANT VOLUMES 98% increase in total SCT volumes (from 10/11 to 17/18) FY10-11 FY11-12 FY12-13 FY13-14 FY14-15 FY15-16 FY16-17 FY17-18 FY18-19 FCST Phase 2 Expansion ALLO AUTO Total SCT

17 LESSONS LEARNED Diverse planning team/experts and process Use of the model assisted the team to test and validate assumptions Predicted versus actual results Documentation and validation of assumptions Changes in eligibility criteria and treatment Account for variability in patient flow through the system Foundational element for planning Focused and highly engaged team

18 THANK YOU

19 ADDITIONAL SLIDES

20 PM Plan of Action for Stem Cell Crisis in Ontario Collaboration with Hamilton and Ottawa to discuss approach Inpatient and MHDU volume modeling and assumptions Lean process Improvement Completed for ALLO Additional Staff Hired 12 new beds opened, Pharmacy and Lab expansion Bioethics priority-setting framework developed Phase I expansion planning initiated Accelerate Recruitment; open unfunded beds Capacity Evaluation and shifting patients to most appropriate care setting Completed 20% more ALLO Tx Phase 1 plans implemented Changes in model of care for post ALLO patients Completed 42% more ALLO Tx

21 Malignant Hematology Day Unit (MHDU) Timeline Initial visioning exercise MH Retreat MHDU established as key priority of program Multidisciplinary working group formed Modeling Initiated Auto Transplant outpatient program initiated TFC Realignment under MH Program Post Discharge support for ALLO patients in TFC Hem Clinic Optimization Outpatient ALLO program to begin MHDU expected to open