The opening of the Clinical Systems Investigation area at Greater Niagara General Site means that all three ERs in Niagara Health now have rapid assessment areas, with the goal of reducing patient wait times. Pictured cutting the ribbon are, from left: Davene Korince, Regional Emergency Program Educator; Lucy Díelia, Interim Charge Nurse; Dan Belford, Clinical Manager; Marlene Caldwell, Charge Nurse; and Cindy Jenkins, Registered Nurse.

With the largest urgent and emergency care program in Ontario, Niagara Health is keeping pace with provincial initiatives to enhance patient care and ensure the care provided is consistent with what is considered the gold standard.

A new rapid assessment unit in the Emergency Room at Greater Niagara General Site is designed to improve patient flow through the ER and reduce wait times for less urgent patients.

With the opening of a Clinical Systems Investigation (CSI) Unit, more patients can be assessed and treated at the same time. A nurse can speed up a patient’s assessment process using standardized medical directives to order blood tests, X-rays or other procedures. Traditionally, patients must first wait to see the physician, who then orders blood work and other tests in order to make a diagnosis. The CSI process gets the doctor the information he/she needs before seeing the patient for the first time.

Niagara Falls resident Veronica King, 15, was a patient in the new Fast Track/Clinical Systems Investigation area in Greater Niagara General’s ER when it officially opened Sept. 23. Patients who are triaged as non-emergency cases are now receiving care in this area, to receive assessments and tests faster.

“We’ve seen positive results in St. Catharines and Welland where we have introduced similar units in the ERs. The CSI Unit is a great way to give less serious patients more timely care in the ER,” says Anne Atkinson, Vice President Patient Services.

The Welland CSI opened in June 2009 and at St. Catharines General Site in October 2008. Wait times are showing a marked reduction, in some cases by 50%.

At the Greater Niagara General ER, a number of other initiatives are being introduced to improve the patient experience and wait times. This includes a new model of physician staffing in the ER that has more ER doctors seeing patients at peak-time hours.

Historically, one doctor worked a 10-hour shift and another doctor worked a 14-hour shift at the GNG ER during a 24-hour period. As an interim step, the NHS is changing to a system where two doctors will work 12-hour shifts and another ER doctor will work a 10-hour overlapping shift, so there are two ER doctors working at the same time during peak hours. Ultimately, the goal is to have two ER doctors working around the clock.

“The changes that are underway at the GNG ER are no different than changes that have already been implemented successfully at other NHS sites,” says President and CEO Debbie Sevenpifer.

Urgent Care Centre opens in Fort Erie

In late September, the ER at Douglas Memorial Site officially changed to a 24/7 Urgent Care Centre (UCC), similar to our Port Colborne UCC, established July 6.

This brings the complement of UCCs operated by Niagara Health to three with the recent name change of the Prompt Care Centre at St. Catharines’ Ontario Street Site to a UCC. This UCC is open 14 hours/day, from 8 a.m. to 10 p.m., seven days a week.

In Fort Erie, patient volumes in the first few weeks of the UCC show that an average of 46 patients are coming every day, compared to the 57 patients in 24 hours seen when it was an ER.

So far, Port Colborne patient volumes are very good. There are about 50 visits every 24 hours, which is close to the volumes when the ER was in place, and 97% of patients filling out surveys say the care was good/excellent. Wait times are also improving – down to 1.6 hours.

“We expect that the trends we’re seeing in Port Colborne will also happen at Douglas site,” Anne says. «

Patients at the site did not notice much of a change – in fact, historically most of the 56 inpatients have been receiving CCC or Alternate Level of Care services during their hospital stay.

CCC provides rehabilitation programs for medically-complex patients who need hospital-based services, regular assessment and active care management. The healthcare team providing this specialized care is led by a Hospitalist (hospital-based physician specialist) and a Nurse Practitioner.

CCC patients who are in a slow-paced recovery program have a treatment plan with the focus to independence and discharge home. As well, complex care units provide care to palliative patients and those awaiting transfer to an active rehab bed in the community or a long-term care home. There are also some patients who remain in hospital because their medical conditions are too complex for nursing home care. On average, CCC patients stay in hospital for 85 days at Port Colborne Site.

Also in these beds are Alternate Level of Care or ALC patients who have finished the acute care phase of their treatment and are waiting for a nursing home bed or community services at home before being discharged. The average length of stay for ALC patients in an acute care bed is 12 days.

Co-payment charges

There are two situations when patients are charged a co-payment fee. The most common is for ALC patients waiting for a bed in a long-term care home or chronic facility. Once the physician has determined that his/her patient no longer requires acute hospital-based services, the patient is deemed ALC and a co-payment maximum of $53.07 per day is charged, as set by the Ministry of Health and Long-Term Care.

This co-payment is the patient’s contribution towards accommodation and meals. It is the same rate charged to residents in nursing homes. The co-payment has been in place for many years and is changed each July.

The second situation where the fee is charged is to some CCC patients who remain in hospital because their medical conditions are too complex for nursing home care. In cases where the Complex Continuing Care unit becomes the patient’s permanent residence, the same co-payment is charged, on a scale based on income.

“It’s important to note that many low-income patients qualify for a reduction in the rate of the co-payment,” says Wendy Robb, Health Program Director for Transitional Care and Rehabilitation and Port Colborne Site. “Following Ministry guidelines, the hospital uses a sliding scale based on last year’s income tax statement. Only the patient’s income is used for this calculation – other family member’s incomes are not included.”

In both of these cases, the patient would pay the same rate as they would for a nursing home bed. To ensure fairness with other patients and residents in long-term care homes and to prevent inappropriate use of acute care resources, everyone is now charged the same rate. This allows hospitals to direct more resources to patient care, rather than accommodation.

More home-care and community-based services are being established through the Community Care Access Centre, and Niagara Health is working closely with this key partner to transition patients home.

A similar plan for Complex Continuing Care beds is being rolled out at Douglas Memorial and Niagara-on-the-Lake sites this fall. In addition, six beds at Douglas will be used for short-term acute care admissions.

Acute inpatients, such as patients with pneumonia, those recovering from surgery and patients with acute stomach conditions are now cared for at other Niagara Health locations – Greater Niagara General Site, St. Catharines General Site and Welland Site. «

Debbie Sevenpifer,
President and Chief Executive Officer

The success of the McMaster University Michael G. DeGroote School of Medicine campus in Niagara demonstrates the power of partnership.

The Niagara campus is of benefit to hospital staff, medical colleagues and medical students. Ultimately, it is the residents of Niagara who will benefit the most from the presence of the medical school in our community since the quality of healthcare increases when hospitals become teaching campuses.

The success of the Niagara medical school — in just three and a half short years since its creation was first announced by the provincial government — is testament to the power of partnership and to how organizations can work together to advance healthcare in Niagara and beyond. Niagara Health takes great pride in our positive relationships with McMaster University and Brock University, and we are very proud to be partnering with both of these institutions on this initiative.

There are currently 15 second-year and 20 first-year students learning in Niagara, and the number of students training at all sites of Niagara Health will continue to grow.

The Niagara campus is housed at the St. Catharines General Site and has full interconnectivity with classrooms and resources in Hamilton. Features are being incorporated in the new St. Catharines healthcare complex, now under construction, for it to become a learning environment when it opens in 2013. While the campus will move to a new Brock building in 2011, the new St. Catharines healthcare complex will house teaching spaces for medical students and residents, including classrooms, on-call rooms and student lounges.

The new regional health programs to be offered at the healthcare complex will provide excellent learning opportunities for students and residents. Students and residents will continue to be educated at all NHS sites in 2013 and beyond. On-call rooms, classrooms, lockers and student lounges will be available at the Welland and Niagara Falls sites, and Fort Erie, Niagara-on-the-Lake and Port Colborne will each have a classroom.

A vital component in a medical school is the calibre of teaching, and more than 170 physicians in Niagara have joined the medical school as faculty members. Almost every doctor who participated in the first year is teaching again this year, and there are hundreds more physicians interested in participating.

I am pleased to hear that the medical students feel so welcomed by our healthcare team and find the experience of learning in our hospital so enjoyable. Our physicians, nurses and staff love the energy, enthusiasm and willingness the medical students bring to their role as members of the healthcare team. They enjoy working alongside their future colleagues in healthcare, benefitting from the students by sharing knowledge and experiences, and learning from them.

Recruiting physicians is a major challenge for hospitals in Ontario and across North America. There just aren’t enough of them to meet the demand. Our partnership with McMaster and Brock provides us with a valuable new physician recruitment opportunity. The program gives the students a taste of working at Niagara Health, and we have a new opportunity to attract and recruit these new graduates every year directly from the program.

The power of partnership is alive and thriving in Niagara. «

A few years ago, one of the kindest women I have ever met died suddenly of cervical cancer. She worked out regularly. She ate all the right things. She didn’t smoke. She was a mom, a wife, a devoted daughter, a career woman and a friend to many. She put herself last – last when it came to everything. Not long after my friend died, I got a call from my doctor’s office: “We need you to come in to talk about the results of your pap test.”

With October being breast cancer awareness month, I can’t help but think about the importance of routine screening for a whole host of cancers. I think of my friend and the life she was cheated out of because of cancer. I also think how lucky I was to find out through a routine screening that I too had cervical cancer.

Routine screening and early detection is essential when it comes to many of the cancers women face. Studies show that early detection of breast and cervical cancers saves lives. Timely mammography screening among women aged 40 or older could prevent 15 to 30% of all deaths from breast cancer. Detection and treatment of precancerous lesions found during a pap test can actually prevent cervical cancer, as well as find cervical cancer at an early stage when it is most curable.

I was one of the lucky ones – thanks to routine screening. My advice to everyone, man or woman, is to make sure you get the appropriate screening for cancer. Talk to your spouses, parents, children, siblings and friends about the importance of getting screened.

Remember, cancer happens. «

Christine Clark, Chief Communications Officer

NHS Chief of Radiology Dr. Amit Mehta: “Access to a digital image repository across LHINs, along with the recent acquisition of two state-of-the-art 128-slice CT scanners by Niagara Health, means patients have access to the best possible care here in Niagara.”

Niagara Health System and St. Joseph’s Healthcare Hamilton have begun archiving diagnostic images and reports to a Diagnostic Imaging Repository (DI-r), a key step towards integrating electronic patient records for hospitals in Ontario.

These are the first two hospitals in the local HNHB LHIN (the Hamilton Niagara Haldimand Brant Local Health Integration Network, also known as LHIN 4) to join the South Western Ontario Diagnostic Imaging Repository Network.

This network is part of Ontario’s larger DI-r and Picture Archiving Communication Systems (PACS) initiative. The DI-r project will connect all participating hospitals in LHINs 1, 2, 3 and 4 to the data centre housed in London, Ont., enabling caregivers to share diagnostic images and reports.

Benefits of this repository include:

• Secure, quick and easy access by clinicians and radiologists to a patient’s diagnostic imaging record, including CT scans, ultrasound, mammograms and MRI scans, allowing them to diagnose regardless of patient origin and where the images were acquired.
• Enhanced clinician collaboration and knowledge transfer, resulting in better treatment, fewer retakes and a reduction in radiation exposure.
• Treatment plans developed through collaborating with specialists located in other communities.

“Until now, our patients’ digital images have been stored in a central archive database in Niagara, allowing physicians and health professionals throughout Niagara access to MRI scans and other digital images in their office or in the hospital,” says NHS Chief of Radiology Dr. Amit Mehta.

“Access to a digital image repository across LHINs, along with the recent acquisition of two state-of-the-art 128-slice computed tomography (CT) scanners by Niagara Health, means patients have access to the best possible care here in Niagara,” says Dr. Mehta. “Images acquired in Niagara will be able to be viewed by Hamilton caregivers and eventually provincewide. This is very important as we try to minimize the radiation dose to our patients through the elimination of repeat studies.”

Niagara Health began using the repository in mid-September, and physicians in Niagara will be trained on the new technology over the next few months.

Other hospitals in HNHB LHIN will be connected to the DI-r over the next two years, including Hamilton Health Sciences by early 2010. The goal is for 100% of images taken in the delivery of hospital-based healthcare to Ontario patients to be digitally stored and shareable among healthcare providers in the province. «

Since the mid-1990s, hospitals throughout Ontario have been challenged to deal with budget deficits and hold the line on expenses. Niagara Health’s financial health is one of the key factors affecting our ability to provide quality care.

The Hospital Improvement Plan

While Niagara Health has a yearly budget of approximately $380 million, it is not enough to cover all of the costs associated with the way we currently provide services.

This is one of the key reasons the NHS developed a Hospital Improvement Plan (HIP) in July 2008. The HIP is a framework for the Niagara Health System to enhance the quality of hospital care across Niagara over the long term while at the same time balance financial pressures, the needs of our aging population and the challenges of the ongoing shortage of doctors, nurses and other health professionals.

Hospitals must balance budgets

The HIP identified more than $28 million in savings to be achieved over the five-year period beginning in 2008 through to 2014.

Savings were identified by creating Centres of Excellence and improving quality and efficiency.

Through the HIP, we are also reducing costs by minimizing the unnecessary duplication of services. This eliminates the need to duplicate equipment and health professionals and infrastructure across our seven sites.

“Approximately $16 million has already been achieved in savings related to HIP changes that have gone into effect since 2008,” says Chief Financial Officer Angela Zangari. “These savings come mainly from the consolidation of surgical services, bed closures and conversion of acute care services to complex continuing care.

All hospitals in the province are obligated to balance their finances and cannot run a deficit. “We must continue to use our resources wisely and explore all possible cost saving and revenue generating strategies that do not have a direct impact on patient care,” says Angela.

While NHS is performing better than 85% of its hospital peers with respect to efficiency, cost pressures continue to out-pace funding due to increasing expenses.

All aspects of NHS’s operations have been reviewed compared to industry best practice guidelines. Since amalgamation in 2000, the NHS has demonstrated its operations are efficiently run. The 2007/08 operational review by an independent third party clearly documented that Niagara Health was leading the way compared to other Ontario hospitals when it came to cost controls.

What’s ahead

As Ontario’s economy recovers from the recession, hospitals can expect that government funding will not be enough to cover increasing expenses. Although funding planning targets for the next fiscal year 2010/11 have not yet been identified by the Ministry of Health and Long-Term Care, all indications are the HIP funding assumption of a 3% economic adjustment will not be received for 2010/11.

Hospitals have been asked to identify the impact of base funding increases of 0%, 1% and 2%. Each of these scenarios represents a funding shortfall for Niagara Health because our costs will continue to rise at a greater rate. The rising costs are largely due to negotiated increases in labour contracts (more than 75% of our budget goes to salaries) and ongoing increases in supply and utility costs.

“Niagara Health remains committed to working through the HIP changes and cost savings associated with this plan,” says Angela. “However, it is most likely that the HIP savings will not be enough to achieve our financial target for 2010/11 and other cost reductions will be required due to the economic climate in Ontario.” «

Co-chairs Bala Kathiresan, Chief Operating Officer, and Lynne Pollard, Executive Assistant to the President and CEO.

Message from our co-chairs

Dear Niagara Health Friends and Colleagues,

As this year’s United Way Campaign Co-chairs, we are pleased to outline for you some of the planning that has taken place for what we hope will be another successful workplace campaign at the NHS. We are also very excited about having teamed up with our colleagues from the hospital foundations to raise funds for the It’s Our Time Campaign. We are launching, for the first time, our United for Families Campaign with the goal of raising funds for both United Way and the It’s Our Time Campaign.

The member agencies of the United Way depend on financial support from everyone throughout Niagara to collectively meet the social services needs of families. As employees of the NHS, we also believe that it is important to give back to the community by participating in fundraising initiatives to help benefit the other important service providers.

United for families

That’s why, every year, we participate in the United Way’s annual workplace campaign. Each year, the doctors, nurses and other healthcare staff in the Niagara Health System family are asked to assist other families and people in need by contributing to the social service programs provided by the Niagara Falls/Fort Erie, South Niagara and the St. Catharines & District United Ways. These community agencies focus on building communities, strengthening families, nurturing independence and positively impacting our youth.

The NHS, like all hospitals in the province, relies on the generosity and financial support of its communities to address the challenges we face in delivering timely quality care to those who need it. Through our local foundations and the It’s Our Time Campaign, we raise funds to meet state-of-the-art equipment and new/renovated facility needs required for all of our current hospital sites and the new healthcare complex.

While the Ontario Government approves all new equipment, we must totally finance it through donations raised through our local hospital site and regional foundations. Therefore, support from all of our doctors, nurses and all of our other healthcare staff is important in two very crucial ways: 1) to provide your personal financial support and 2) through your giving you inspire others in the community to also give!

Campaign goal $80,000

This year, the NHS United Way Committee campaign kicks off on Thurs., Oct. 15. Our fundraising goal is again set at $80,000 and the majority of this will be raised through payroll deduction. Last year, more than $60,000 was pledged through payroll deduction by Niagara Health staff and those funds are being directed as the donor wishes. Let’s beat that amount this year!

The remaining funds are generated with events and raffles, and we’ve had a lot of fun during the last couple of years with our workplace events. Special lunches, bake sales, barbeques, draws and raffles, and competitions like the Naked Piggy Challenge and Staff Pet Photo Contest have allowed us to be creative, while challenging our colleagues to be the best across the NHS sites. As a result of your generosity last year, the United Way of St. Catharines named the NHS in the top 12 accounts!

Exciting activities for ’09

This year, we have Luc Guilbault and his colleagues launching our United Way activities with a pasta kick-off luncheon on Oct. 15. We are bringing back the Choose a Cruise Super Raffle, to be followed by various raffles and other events. And for those pet lovers (which, at NHS there are many!), we will again be holding our Staff Pet Photo Contest.

As mentioned, we will also be teaming up with our colleagues from the hospital foundations in launching our United for Families Campaign for giving through pledges and payroll deduction. Stay tuned for more details!

So, why should YOU give?

When you make a donation, you can contribute towards something that YOU feel is important. Giving to the United Way and to your local site foundation provides you with an opportunity to direct your funds to a specific area in the community – i.e., strengthening families, building communities, nurturing independence, after-school programs, our various NHS site needs or to other Niagara registered charities that are important to you.
Helping others improves your self-worth in many ways. Once you’ve given to a charity that you truly believe in, YOU feel good about it. Your generosity will go towards a cause beyond what most of us have to even consider in our daily life. And when we ALL contribute, that is what truly makes the difference in a life that is less fortunate than ours.

Giving to a charity is NOT a sign of whether you’re a good person or not. A person should only give to a charity if they truly feel it is the right thing to do with their money. But don’t close your mind or your heart to the idea. When the right reason comes to you, provide that gift, and just watch what happens!

A safe, supportive community is EVERYONE’S responsibility. Everyone has something to contribute. Every little bit counts! «

Bala Kathiresan and Lynne Pollard

At the most famous of the spectacular Alaska glaciers around Juneau, Sydnie (left) and Tanya Fiocca hiked through knee-deep creeks and scrambled free-hold over rocks to get to the Mendenhall Glacier. They were only the seventh and eighth visitors to the western side of the glacier this year and Sydnie, at age 14, the youngest ever.

For the lucky winner, it’s a one-time opportunity that brings loved ones closer together with unique shared experiences.

That was the case for Tanya Fiocca from Finance, the lucky winner of last year’s Choose a Cruise Super Raffle. Tanya and her 14-year-old daughter Sydnie had an amazing trip, choosing to take an Alaskan cruise in August and as well opting for a four-night land trip to seeing the highlights of the incredible northern landscape.

“We spent a little more than the $3,500 I won with the raffle to do both the land portion and the cruise, but we wouldn’t have been able to do this at all without my major win,” Tanya says.

The duo first flew to Seattle and then up to Anchorage, Alaska, to do their land tour by panoramic train journey, going on hiking, kayaking and bicycling adventures. They then boarded ship for the cruise portion, heading southbound along the Canadian west coast. After seven days and frequent stops to see some amazing land and seascapes, they disembarked at Vancouver.

Tanya says half the fun of the trip was in the planning. “Before booking our trip, my daughter and I did all kinds of research into what we should see and where we should go. The staff at Cruise Ship Centers were excellent and we really had an amazing time. I’m planning to buy more tickets this year!”

The United Way Committee is anticipating higher ticket sales this year and is ordering 1,000 tickets for the Choose a Cruise Super Raffle. Tickets will again be available at the discount price of just $20 for a $3,500 travel voucher. Details on ticket sellers and when tickets will be available are being finalized. «

The Niagara Health System Board of Trustees is made up of volunteers who live and work in Niagara. The Board is responsible for governing the NHS and providing strategic direction to the hospital system in Niagara to ensure it meets the healthcare needs of the community within available resources.

Niagara Health Now is publishing a series of question-and-answer profiles on individual members of the Board to help our readers get better acquainted with them. This issue’s profile is of Steve Hudson.

Where were you born?
Moncton, New Brunswick, with most summers spent in a little fishing village outside Halifax.

Number of years living in Niagara:
I moved to St. Catharines in 1993, after a number of years living all over Canada but the previous decade in Toronto and Barrie.

Occupation:
I’ve changed occupations a few times, but I still identify myself as an engineer. I graduated from Royal Military College and spent a number of years in the military. Since leaving, I have worked in a university, with school boards, and at Niagara College, where I am currently Vice-president Academic.

What are the greatest rewards from your job?
There are many rewards with working at the College. We get to see students graduate every year ready for careers they enjoy. We also get to work with great employers and community agencies in developing our programs and keeping us connected to what our students need to know.

What influenced you to become a member of the NHS Board of Trustees?
The healthcare system impacts everyone in the community, and the system is going through some profound changes. The opportunity to be involved in this process was very compelling.

How many years have you served on the NHS Board?
Four years

What is your greatest achievement or reward as a member of the Board?
Working with many Board members and administration to ensure that the government and others understand the enormous financial strains under which NHS has been operating and commit to work with us to improve our funding.

What is the greatest opportunity for the NHS?
To continue to improve the quality of services provided to our community.

What is its greatest challenge?
Undoubtedly, financial constraints and human resources constraints are both great challenges. The shortage of staff limits what services can be effectively provided, even if we have the funds to hire staff. Lack of appropriate funding has been a significant focus for the Board, as it affects everything from hiring to equipment renewal.

Other involvement as a member of a volunteer Board, past or present?
Niagara Community Foundation and other local activities.

How would you describe yourself to someone who doesn’t know you?
Pretty focused, analytical, and someone who wishes they were a better basketball player.

What is your greatest personal achievement?
Finishing my doctorate two years ago. «

Chat with the Hamilton Niagara Haldimand Brant LHIN board and staff about the healthcare system and share your thoughts and ideas for a healthier future.

Oct 19, 2009
Our Lady of the Holy Rosary Church Hall
21 Queen Street South, Thorold
3 – 7 p.m. (presentation at 6 p.m.)

Please advise by Oct. 18 if you have special needs. 905-945-4930 or 1-866-363-5446; www.hnhblhin.on.ca

Niagara open houses were also held Oct. 8 in Welland and Oct. 13 in Fort Erie

Men’s Health Forums

Learn from the experts about men’s health issues.

October 21, 2009
Club Roma, Vansickle Road, St. Catharines
6 – 8:30 p.m. Presentation at 7 p.m.
Osteoporosis: Dr. Brenda Rempel
Sexual Health: Dr. Michael Greenspan

Fundraising Events

A growing number of fundraising events are scheduled to benefit our hospital foundations.

Go to www.niagarahealth.on.ca and click on the Foundations link for events.