compassion accountability rights and responsibilities excellence donna kearney, bscn, rn(ec),...

Compassion Accountability Rights and Responsibilities Excellence

Donna Kearney, BScN, RN(EC), MHST

Rosseau Nursing Station

Nurse Practitioner - Manager

Meeting Community Needs Meeting Community Needs Through Integrated CareThrough Integrated Care


Rural Indicators of Health

“Geography is an Indicator of Health” Roy Romanow 2002

Advanced AgeSeasonal & Low Income

Minimal EducationFew Employment &Social Opportunities

Few Support ServicesHigh Dependency


Age Demographics

Ontario 2006

District of Parry Sound 2006


Rural versus Urban Parry Sound

Rural Parry Sound 2006

Town of Parry Sound 2006


Primary Care Providers by Region

RegionBy Postal Code

Number of Primary Care FP/NP’s

2006 Census Pop. change since 2001 census

Town of Parry Sound 15 FP’s1 NP @ FHT

5818 Down 5%

Georgian BayTownship

1 part-time NP@Moose Deer Point

2340 Up 17.5%

Seguin Township 1 NP@Rosseau

4276 Up 15.6%

Whitestone 1 NP @ Whitestone

1030 Up 20.8%

Archipelago 1 NP@ Pointe auBaril

576 Up 14.1%

Unorganized Central West

1 NP@Britt

1212 Up 10.3%

Unorganized Central East

1 NP@ Argyle 1212 Up 10.3%

McDougall 0 2704 Up 3.7%


Nursing Stations: An Extension of Nursing Stations: An Extension of the Hospitalthe Hospital

Hospital

Nursing Stations


Nursing Stations - ModelNursing Stations - Model

Buildings, Donations, In-Buildings, Donations, In-kindkind

FundingFunding,,

GrantsGrants

OperationOperationss

NP Station


Scope of PracticeScope of Practice

Diagnosis and Treatment

NP MD RN Specialist

Allied Health Care Providers


Research: Purpose

1) To evaluate a model of primary health care delivery appropriate for rural populations.

2) To determine the scope and collaborative nature of NP practice in a rural nursing station setting.


3) To define the level of importance of hospital affiliation in reducing cost of care.

4) To show the impact on ER usage, hospital admissions, and wait times for primary health care.

Research: Purpose


Research: Process

• 12 month data collection period (March 1, 2009 – February 28, 2010)

• Used electronic reporting tool developed for the project to improve consistency and accuracy by all 6 nursing stations

• Used hospital statistics for ER usage & acuity, admission, and re-admission rates


Research: Variables

• Moose Deer Point nursing station decreased services from 5 days to 2 days per week due to lack of patients.

• H1N1 Pandemic

• NP vacation time, education time, and sick leaves not replaced consistently

• One station dropped out of the study


Research Findings: Demographics

Totals: 48% Adults (16-64), 44% Seniors (65+), 8% Children (0-15)


Patients Without a Family Doctor


New Patients


Type of Care Provided: Nursing Stations


Referral Rates from Nursing Stations

Total Referral Rate = 11%, Consult Rate = 19%


Patient Volumes: Nursing Stations


Patient Volumes: ER/Nursing Stations


Patient Acuity: ER/Nursing Stations

ER Triage Score(7% Unknown)

Percent Nursing Station Acuity

Percent

1 - Resuscitation .02% 1 – Life Threatening 0%

2 - Emergent 5% 2 - Emergent .09%

3 - Urgent 27% 3 - Urgent 2%

4 – Semi-Urgent 53% 4 - Complicated 21%

5 – Non-Urgent 7% 5 – Episodic/Chronic

77%

Total Patients seen in the ER

22,126 Total Patients seen in Nursing Stations

19,240

Triage/Acuity Level 4 & 5: 60% in ER 98% in Nursing Stations


ER Usage by Postal Code and Age

Region by Postal Code

# NP’s/MD’s

2006 Census

ER Visits

% Pop using ER

Child(0-15)

Adult(16-64)

Senior(65+)

Town of Parry Sound

1 NP15

MD’s

5818 11,069 190% 1435(13%)

6829(62%)

2805(25%)

Georgian Bay

1 P/T NP

2340 1097 6% 146(13%)

699(64%)

252(23%)

Seguin 1 NP 4276 2746 64% 455(17%)

1644(60%)

647(23%)

Whitestone 1 NP 1030 739 72% 52(7%)

422(57%)

265(36%)

Archipelago 1 NP 576 222 38% 22(10%)

149(67%)

51(23%)

Central West

1 NP 1212 482 40% 61(13%)

248(51%)

173(36%)

Central East

1 NP 1212 0 0 0 0 0

McDougall 0 2704 6024 223% 411(7%)

5033(84%)

580(9%)


Hospital Admissions/Re-Admissions

Region by Postal Code

Hospital Admissions 65+ years

% Population Re-Admissions Within 30 Days

% Re-Admits

Town of Parry Sound

484 8.3% 19 3.9%

Georgian Bay(MDP)

42 1.8% 4 9.5%

Seguin(Rosseau)

77 1.8% 0 0

Whitestone(Whitestone)

42 4% 3 7%

Archipelago(PAB)

11 1.9% 0 0

Central West(Britt)

32 2.6% 0 0

Central East(Argyle)

0 0 0 0

McDougall 81 3% 5 6%


Cost Analysis

6 Nursing Stations

Budget: 1.3 million total

Staff: 1 NP, 1 Admin

Hours: 5 days (7.5 hours)

Patient Volume: 19,240

Acuity Rates: 98% level 4 & 5

Cost per Patient Visit: $70

WPSHC Emergency Room

Budget: 3.3 million total

Staff: 1 MD, 4+ RN’s, 1 Admin

Hours: 7 days (24 hours)

Patient Volume: 22,126

Acuity Rates: 60% level 4 & 5 33% level 1,2,3

Cost per Patient Visit: starts at $152

Cost Analysis information is not available for FHT’s or NP Led

Clinics to date, therefore comparisons are not possible.


• Reduced:Reduced:• Wait times for primary careWait times for primary care• Visits to the ERVisits to the ER• Hospitalizations for chronic illnessHospitalizations for chronic illness

• IncreasedIncreased• Access to health care for rural seniorsAccess to health care for rural seniors• Opportunities to ‘Age in Place’ Opportunities to ‘Age in Place’ • Monitoring for compliance with treatments and health Monitoring for compliance with treatments and health

outcomesoutcomes• Collaboration with all health care providersCollaboration with all health care providers• Opportunities for health teaching and illness preventionOpportunities for health teaching and illness prevention• Continuity of care and advocacyContinuity of care and advocacy• Understanding of patients living conditions and support Understanding of patients living conditions and support

systemsystem

ConclusionsConclusions


Recommendations: Local Level

• Create permanent NP positions in the ER at WPSHC.

• Provide after hours primary care services to residents in the Town of Parry Sound.

• Relief funding is needed to replace NP’s at the nursing stations during absences.

• Increase operating budgets of nursing stations to allow hiring of additional staff (RPN’s, NP’s), and to provide mentorship opportunities to prepare new NP’s to work full scope in rural nursing stations.


• Change FP title to ‘Primary Care Specialist’ to promote top-of-scope functioning of all health care providers.

• Implement this model of primary care delivery in rural areas throughout Canada for a collaborative, sustainable, and accessible method of entering the health care system.

Recommendations: Provincial/National


Questions – Thank you!Questions – Thank you!

Donna Kearney, BScN, RN(EC), MHSTWest Parry Sound Health Centre

[email protected]

compassion accountability rights and responsibilities excellence donna kearney, bscn, rn(ec),...

Documents

purpose slide

integrated care slide

study slide

parttime np

archipelago1 np

whitestone1 np

rural nursing station

seguin township1 np