Horizon Health Network says it has made “significant strides” in the past six months to improve access to services, including a reduction in ambulance offload delays in Moncton, Saint John and Fredericton, an increase in some surgeries and a Decrease in the waiting list for mental health services.
There are more than 70 process improvement projects in eight hospitals, 31 community sites and 17 departments, trustee Suzanne Johnston told reporters Monday during Horizon’s first-ever report to its communities.
“We think this is pretty extraordinary,” she said, noting that Horizon has invested millions in the changes, including introducing “patient flow centers” in the emergency rooms of its three largest hospitals so patients can be seen, tested and treated more quickly.
Horizon is also developing a “comprehensive primary and community care strategy” — a renewed interdisciplinary team-based care model to improve access to primary care, Johnston said.
“You’ll be hearing more about that over the next few days,” she said.
But it won’t be a cookie-cutter approach, she insisted. It is based on the demographics of each community and could include a wide range of professionals such as laboratory technicians, nutritionists and social workers, as well as virtual caregivers. “So it’s not a one-off project. It is a systemic change that will take time.”
Recruitment and retention ‘top concern’
Despite these improvements, there is still work to be done, admitted Margaret Melanson, interim president and CEO, citing hiring and retention of healthcare workers as Horizon’s “top concern”.
“As you know, the viability of our entire healthcare system depends on our staff being trained and available to be with our patients and families,” she said.
“So the ongoing hiring efforts, as well as the efforts we are making to improve the culture of our organization to retain, value, respect and listen to our employees is obviously the biggest issue we are dealing with deal with us at this time.”
During an eight-slide presentation, Melanson said that Horizon hired 1,130 nurses and “hundreds” of other healthcare workers over the past six months.
She couldn’t immediately tell CBC how many nurses and other staff she’d lost during that time.
Horizon spokesman Kris McDavid later clarified that the total number of new hires is actually 1,283, but that was in the last 10 months and not six. Horizon lost 686 employees during that time, for a net gain of 597, he said.
The breakdown includes:
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Registered nurses: 381 departures vs. 473 new hires (+92).
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Licensed practical nurses: 156 departures versus 328 recruitments (+172).
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Nurses: 149 departures vs. 482 new hires (+333).
Melanson said nurses who go have identified schedules that don’t offer work-life balance as one of the problems. Horizon is hoping a new pilot that allows nurses to schedule themselves will help. It has also added business managers to patient units to handle administrative tasks and free up care managers and assign nurses to look after patients and their families, she said.
4 “critical action priorities”
Six months ago, Horizon introduced four “critical action priorities.”
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Improving access to services, particularly surgeries, emergency care, and addiction and psychiatric services.
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Retaining and recruiting doctors, nurses and staff.
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Improving patient flow in healthcare facilities.
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Improving the overall patient experience.
Since then, the time it takes to get patients from an ambulance to a hospital has tended to decline in major centers, Melanson said.
Moncton Hospital, for example, has seen discharge delays drop from a peak of about 213 minutes to 94 minutes, she said.
“There is obviously room for improvement here, but this definitely shows a significant improvement and we congratulate the team on this work.”
Discharge delays at Saint John Regional Hospital have dropped to about 31 minutes from a peak of about 58 minutes, while at Dr. Everett Chalmers Regional Hospital in Fredericton have dropped from about 64 minutes to about 36 minutes At Upper River Health Valley Hospital in Waterville they have dropped from 30 to 20 minutes.
Melanson credits doctors, nurses, pharmacists and other care providers with working “together like never before” to quickly address these patients’ needs, quickly identify their care plan, and implement it as quickly as possible.
Patient flow center key
It also ties directly to the patient flow centers in the Fredericton, Moncton and Saint John emergency rooms, she said.
Patient flow centers are not a physical location with the emergency rooms, Melanson said. They are “Better described as improved workflow coordination that enables the entire emergency department team to make the most of their staff and the resources available on-site to ensure that patients with reduced visual acuity, for example, can have their medical needs met quickly, triage, testing and supply in the shortest possible processing time.
The average time saved for patients treated through the Chalmers Flow Center since it launched in November is 3.6 hours, and “only” 2 percent of 1,802 patients have gone unseen. In comparison, 11 percent of Chalmers ER patients walked out of the hospital overall in January without being seen, according to data from McDavid.
Horizon aims to further reduce ambulance unloading times by working with support services to expedite diagnostic care, such as: B. Access to CT scans outside of business hours, Melanson said.
Additionally, a new patient flow director is trying to find ways to get admitted patients out of emergency beds and into hospital beds, she said.
Other highlights of the update are:
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A program to reduce post-surgery patient stays and improve patient outcomes has served 700 hip and knee replacement patients in Saint John and 160 bowel surgery patients in Moncton and will be expanded to other areas “soon”.
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70% reduction in Horizon’s mental health service waiting list by introducing one-on-one sessions/therapy.
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This program will soon be trialed for seniors in the Moncton area.
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83 percent of people who received psychiatric support in the past year managed without a hospital visit thanks to the mobile crisis teams.
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A pilot outpatient psychiatric clinic will soon open in Moncton, which could serve as a model for other locations.
