En Anglais seulement - Document du ministère de la Santé du N.-B.

8/10/2019 En Anglais seulement - Document du ministre de la Sant du N.-B.

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Clinical Services Plan Update

Department of Health

December 2013

/ ~ / / : : ; : : : .

WORK

N

PROGRESS - ADVICE TO MINISTER

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Brnjwlck

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Overview

Terms of Referencel Mandate

ontext

Dependencies

Design Principles

Work identified and progress

Potential initiatives

Other considerations

Next steps

Questions

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Terms of Reference

PURPOSE

~ ~

To develop an implementation plan for the CSP that supports a logical, sequential and

integrated approach; and includes a communication plan specific to each stakeholder

group V e providers, public, government).

FUNCTIONS /

[

Ta review and update the CSP based on mast recent data and evTdence.

To identify relevant measurable

i n d i t o r s ~ h

the design-principles that are

process and outcome-oriented.

To develop a communications plan ('The Story") to support CSP with emphasis on

evidence, simple vocabulary and supported by clinicians.

To develop an implementation framework and processes

WORK N PROGRESS ADVICE TO MINISTER

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Context

Population shift: t in urban areas, ~ n rural areas

Age distribution:

1

of

of

population 65 years of age

and older

in

zones 4,5,6 and 7.

Beds: increased availability of beds in zones 4, 5, 6 and

7 which yield very high hospitalization rates for COPD,

Heart Failure, Angina and Mental Health.

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J d - / ~ ~ )

Costs: v W r q ( ~

o -

- number of hospital sites delivering services vs. delivering

J .

sustainable programs.

- Share of hospital expenditures

in

NB are

100 0

higher than best

performing provinces. ==

WOR IN PROGRESS - ADVICE TO MINISTER

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Design Principles

Work is based on the 7 Design Principles: . :L

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11..1 11. ,,,, ,

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Clinical Sustainability-. - 77flLw.A:JJ0/

Access .... t..a;JlJfl; .-/

S a f e t y . - 1 . ~ -

Appropriate Range of Services

Effective

Efficient ~ h

Equitable _.-,

-

-

/ r ; A ~ ; :

The Clinical Service Plan will provide advice regarding

what clinical services are needed where based

on

the

design principles.

WORK N PROGRESS - ADVICE TO MINISTER

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r ~

Dependencies

Community

Health

Needs Assessments compTete or

scheduled

in

near

future

and required services

identified.

Hospitals

optimize

bed utilization: the

right

bed for the

right patient.

Mental

Health

and

Primary

Care Strategies in

place for

conditions

that

drive

high hospitalization rates

and

re-

admission rates.

i51l*s

Availability of LIe specialty

e d s ~

; ~

Alignment of capital equipment and renovation

priorities.

Alignment of human resources recruitment

p r i o r i t i e ~

. WORK IN PROGRESS ADVICE TO MINISTER ruhswlck


7/14

Clinical Sustainability - Volume Evidence

Volume - outcome ratio:

need to

perform a

minimum

number

of

surgeries/procedures

to

ensure competence,

reduce mortality and

adverse

effects

2)

The

number

of physicians

needed depends

on

the specialty 24 hour rotations, on cali

e t c . ) ~

The amount varies from 4-5 physicians for

J i

9

each program.--

2 ~ ~ D

J./JV-

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PROGRESS - ADVICE TO MINISTER

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Clinical Sustainability: Safety Evidence

Even moderate levels of fatigue

produce

levels of

impairment

similar

or higher than proscribed levels of alcohol intoxication

- Dawson et

l

Nature 1997

- Arnedt et l JAMA 2005

Less than

5

hours

sleep in 24

hours

and less

than

12

hours

sleep in 48 hours is inconsistent with safe

work.

- Dawson et l 2005

- University of South Australia

One

sleepless

night =

25

reduction in cognitive ability while

2 concurrent

sleepless nights 40

reduction

in

cognitive

ability

- LIFE curriculum Duke University


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Work Identified Progress

Work identified

1 U pdate

of

the plan based on most

recent data.

2) Development of Clinical Services

Profiles (based on design principles)

3) Identification of KPl s

4) Communication

plan-

5) Development

of

an implementation

framework and related processes

Progress t

1) To be completed early 2014

l p

2) Completed Profile for ER, rest will

follow in 2014.

3) To be discussed and completed

in Q

2014.

4) Initial discussions have started, to be

finalized in 2014.

5) Initial discussions have started, to be

finalized in 2014.

WORK N PROGRESS - ADVICE TO

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r

Potential Initiatives

Shortterm: removepressure

on

acutecarebeds:

- Primarycareand mentalhealthstrategies

- Patientswhoareawaitingplacementelsewhere

- Appropriatebed utilization

Mediumterm:Acutecareclinical realignments:

'.

...

- Transferfromservicestoclinicallysustainableprograms.

- Appropriateclustering

of

programs.

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- Organizeprograms

in

aprovincialnetwork.

f

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- Alignthenumberofbedsperfacilityaccordingtoneedsand

appropriatelyclassifythebeds.

Longterm:Facilityclosures: ~

- Facilitiesthatdonotmeetthedesignprinciples

.

WORK INPROGRESS- ADVICETOMINISTER rCUgwlck
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11/14

Recommendations

ERs

119

9

13)*

F amily practice 122 13

Internai Medicine

9 16

Cardiology

6 6

Nephrology

3

2

Haemotologyl medical oncology 13 12

General surgery 15 6

Obs and Gynaecology 10 5

Orthopedie surgery

12

6

*

Number of programs when access considerations are taken into account

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Recommendations (2)

i i U ~ J i I I I ; ; r . , . , . ~ I ~ ' - ' _. . . . . . . ; ; . . . . . , ; - ~ . . , . . . , . . . . . . . .

tI-- J

Urology

4

Otolaryngology

13 :

Ophthalmology 1

11

13

Plastic Surgery

111

13

Vascular Surgery

Neurosurgery

Thoracic surgery

Cardiac Surgery

Paediatrics

Neonatology

Psychiatry

4

2

3

1

8

3

8

o

(2)

2

o (1)

1

6

1

8

j

BrelitlswIck

ORK N PROGRESS - ADVICE TO MINISTER

En Anglais seulement - Document du ministère de la Santé du N.-B.

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