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Clinical Services Plan Update

Department of Health

December 2013

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WORK IN PROGRESS - ADVICE TO MINISTER


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Overview

Terms of Referencel Mandate

Context
Dependencies
Design Principles
Work identified and progress

Potential initiatives
Other considerations
Next steps
Questions

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Terms of Reference
PURPOSE

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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

1 group V.e. providers, public, government).

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FUNCTIONS

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

To identify relevant measurable


process and outcome-oriented.

indicators~h the design-principles that are

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

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Context

Population shift: t"in urban areas,

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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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Costs:

- number of hospital sites delivering services vs. delivering J


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sustainable programs.
- Share of hospital expenditures in NB are 100/0 higher than best
performing provinces.
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Design Principles

Work is based on the 7 Design Principles:


Clinical Sustainability-. -

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Access .... t..a;JlJfl;'.-/ .


Safety.-1".~ Appropriate Range of Services
Effective
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Efficient
Equitable _.-, /5

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The Clinical Service Plan will provide advice regarding
what clinical services are needed where based on the
design principles.
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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 readmission rates.
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Availability of LIe/ specialty beds~ :;:~
Alignment of capital, equipment and renovation
priorities.

Alignment of human resources recruitment


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prioritie~

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Clinical Sustainability - Volume Evidence

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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 etc.)~
The amount varies from 4-5 physicians for ~'Ji
each program.-2~~D'- ()(J./JV

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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 al Nature 1997
- Arnedt et al 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 al 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

Work Identified & Progress

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Work identified

Progress

1) Update of the plan based on most


recent data.

1) To be completed early 2014"

2) Development of Clinical Services


Profiles (based on design principles)

2) Completed Profile for ER, rest will


follow in 2014.

3) Identification of KPl's

3) To be discussed and completed in Q1


2014.

4) Communication plan-,

4) Initial discussions have started, to be


finalized in 2014.

5) Development of an implementation
framework and related processes

5) Initial discussions have started, to be


finalized in 2014.

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Potential Initiatives

Short term: remove pressure on acute care beds:


- Primary care and mental health strategies
- Patients who are awaiting placement elsewhere
- Appropriate bed utilization

Medium term: Acute care clinical realignments:

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- Transfer from services to clinically sustainable programs.

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- Appropriate clustering of programs.
- Organize programs in a provincial network.Jf f"L ~

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- Align the number of beds per facility according to needs and

appropriately classify the beds.

Long term: Facility closures:

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- Facilities that do not meet the design principles .'

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Recommendations

ERs

119

Family practice

122

19 (13)*
13

Internai Medicine

16

Cardiology

Nephrology

Haemotologyl medical oncology 13

12

General surgery

15

Obs and Gynaecology

10

Orthopedie surgery

12

* Number of programs when access considerations are taken into account


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Recommendations (2)

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Urology

114

Otolaryngology

13

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Ophthalmology

111

13

Plastic Surgery

111

13

Vascular Surgery

o (2)

Neurosurgery

Thoracic surgery

o (1)

Cardiac Surgery

Paediatrics

Neonatology

Psychiatry

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Other considerations

System of hospitals based on design principles:


definition and description of types of hospitals.
Define Urgent Care concept.
Bed classification.
Common understanding of the work plan and
communications plan for the next 8 months by ail
partners.

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