en anglais seulement - document du ministère de la santé du n.-b
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Clinical Services Plan Update
Department of Health
December 2013
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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
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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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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. ==
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Design Principles
Work is based on the 7 Design Principles: . :L
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11..1 11. ,,,, ,
tv i
t 0C
Clinical Sustainability-. - 77flLw.A:JJ0/
Access .... t..a;JlJfl; .-/
S a f e t y . - 1 . ~ -
Appropriate Range of Services
Effective
Efficient ~ h
Equitable _.-,
-
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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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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 ~
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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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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.
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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.
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- Alignthenumberofbedsperfacilityaccordingtoneedsand
appropriatelyclassifythebeds.
Longterm:Facilityclosures: ~
- Facilitiesthatdonotmeetthedesignprinciples
.
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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
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