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Woman speaking with her physicianLetter from the region
Building on
our success
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Réal Cloutier
Interim President and CEO
Winnipeg Regional Health Authority
Summer 2018

The Winnipeg Regional Health Authority is in the midst of a remarkable transformation.

Just 15 months ago, in April 2017, we unveiled Healing Our Health System, a bold plan to enhance the delivery of care by consolidating emergency services in three of Winnipeg's six hospitals and expanding our capacity to provide patients with urgent-care options.

The first phase of the plan took effect last October, with the decision to convert the emergency department at Victoria General Hospital to an urgent-care centre and discontinue urgent-care services at Misericordia Health Centre. We also added 65 transitional home-care beds and created the Priority Home service to help expedite the discharge of older hospital patients. For those elderly patients who need more recovery time, we added a new sub-acute category of beds.

These changes, along with a number of other moves, contributed to a series of improvements in the delivery of care, not least of which is a 15 per cent reduction in wait times at city emergency departments. In May, we announced our intention to build on this success by implementing phase two of our plan, with the goal of reducing emergency department wait times by an additional 15 per cent.

As with the first phase, much of phase two centres on our efforts to change the way we deliver emergency and urgent-care services. To that end, we are moving forward with previously announced plans to consolidate emergency services at Grace Hospital, St. Boniface Hospital and Health Sciences Centre Winnipeg. We are also converting Seven Oaks General Hospital's emergency department to an urgent-care centre and repurposing the emergency department at Concordia Hospital to a Walk-In Connected Care clinic.

To support these changes, we are expanding capacity at the three remaining hospital emergency departments. Grace Hospital, for example, recently opened a new $43.8 million emergency department, which is triple the size of the old one and capable of handling 60,000 people a year. We are also spending $1.2 million to enhance the mid- to low-acuity treatment area at HSC Winnipeg (to be completed by Jan. 2019), and $5 million for new triage, waiting area and mid-acuity treatment space at St. Boniface Hospital (to be finished by the summer of 2019).

Once this work is completed and we have seen additional improvements in emergency department wait times, we will proceed with plans to convert the emergency departments at Concordia and Seven Oaks in June 2019 and September of 2019, respectively.

By the time phase two wraps up, we will have invested close to $50 million dollars to in construction and renovation to consolidate and expand emergency department services within the city.

These changes reflect a major clinical design shift in the way we think about providing emergency care. As I have noted in this column before, emergency care has previously been spread across six hospitals located around the city. This resulted in uneven access to care and longer than necessary wait times to see a physician or have a diagnostic test. Too often, patients needed to be transferred between emergency departments to get the specialized assessment and diagnostic testing needed to determine the most appropriate course of care.

Attempting to provide six one-stop shops for emergency care also resulted in waiting rooms filled with patients experiencing a wide range of health issues, from the serious to the less urgent, which also contributed to longer than necessary wait times. The problem was compounded by the fact that hospitals did not have a specific focus, and acute-care beds were often filled by patients who were either convalescing or waiting for home care or placement in a personal care home.

The Healing Our Health System plan addresses these issues in the following ways:

  • The consolidation of emergency health services in three hospitals ensures access to care and diagnostic tests are provided much more evenly across the system.
  • Building a new state-of-the-art emergency department at the Grace and expanding facilities at St. Boniface and HSC Winnipeg creates the capacity needed to provide care in a timely manner.
  • The creation of two urgent-care centres in the north and south ends of the city and the expansion of sub-acute spaces in our hospital emergency departments will ensure patients receive the level of care that is most appropriate for their needs.
  • The creation of 65 additional transitional home-care beds and the new Priority Home service means we are able to expedite the discharge of older hospital patients and provide care in their home environment.

As noted above, we're already seeing positive results from the plan. Over the last year, we have seen a dramatic drop in the number of patients waiting for home care or personal care home placements, resulting in an overall reduction in how long patients are staying in hospital. This, in turn, has freed up space for patients who require an admission to a hospital bed.

The decision to convert Victoria's emergency department to urgent care has also proven successful. Wait times have decreased by nearly one-third, while the length of stay is down by about 25 per cent. And it is important to note that these improvements have been achieved even though the traffic volume at Victoria is up 28 per cent.

Cynthia Posner, a nurse at Victoria's urgent-care centre, says the improvement in patient experience has been dramatic, in part because the staff now focuses on patients with less serious health issues as opposed to a mix of emergency and urgent-care patients.

"The patients, for the most part, are not as acutely ill as they were when we were an [emergency department]," Posner says in a Q&A posted on our website, which you can read here.

This has led to quicker care for patients.

"In the waiting room, even when it's full, we seem to have a higher turnover, so that the doctors, nurse practitioners, and our physician assistants are able to see the patients a lot quicker due the decrease in acuity," she says. "When we were an [emergency department], my recollection is that we used to see 80 to 90 people every 24 hours. I don't have the exact statistics, but I know that we see up to 135 people now, so things are moving along a lot quicker and we're seeing a lot more patients."

These improvements are reflected in some of the written comments we have received from patients.

"The new system worked for me," wrote one patient. "I arrived at 8:30 a.m. and was talking to a physician before 9 a.m."

Another wrote: "Came to urgent care yesterday in the afternoon and was pleasantly surprised at how quick, efficient and thorough the whole process was from start to finish."

The experience at Victoria is a good indicator of what we can expect in the future.

Currently, our emergency departments receive about 278,000 patients a year. By the time phase two is completed, we expect our emergency departments will receive about 193,000 patients a year, while our urgent-care centres will take in an estimated 85,000 patients a year.

In other words, the new alignment will allow us to handle about the same number of patients as we do today. The difference is that our emergency departments will be able to provide the specialized consultation and testing services that patients require, and our urgent-care centres will be focused on treating patients in need of less serious health care. And, thanks to the expansion at Grace Hospital, our system will be able to handle future patient growth.

There is, of course, more to this plan than a reorganization of emergency medical services. In fact, it is fair to say this plan will affect virtually every aspect of the health-care system.

In the area of mental health, for example, we are moving to consolidate inpatient services. This will involve moving mental health beds from Grace and Seven Oaks to Victoria, where we are planning to open 52 mental health beds by the end of this year. This will enhance our on-site treatment and counselling spaces at Victoria, and improve on-site access to psychiatrists. There will also be a small increase in the number of mental health beds at HSC Winnipeg and St. Boniface Hospital to ensure that there is no loss of mental health inpatient bed capacity. The beds vacated at Grace and Seven Oaks will be used to accommodate additional activity in other clinical areas, such as surgery and sub-acute care.

Efforts to revamp services or enhance capacity are also planned or underway in a number of other areas, including cardiac care, intensive care, medicine, and surgery. You can read more about our plans in these areas here.

As we continue working to implement these initiatives in the weeks and months ahead, it is important to remember that all of these changes are all being undertaken with one goal in mind: to create a modern health-care system, one that is capable of providing our patients with the right care, at the right time, in the right place. Our patients depend on us to provide safe, good quality patient services. In order to meet that expectation, we need a health-care system that is better organized and more focused. As we enter phase two of the Healing Our Health System plan, it is clear that we are one step closer to achieving that objective.