Horizon boasts 'significant' improvements in access to services

Horizon Health Network says it has made "significant progress" in the past six months to improve access to services, including a decrease in ambulance offload delays in Moncton, Saint John and Fredericton, an increase in some surgeries, and a drop in the wait list for mental health services.

There are more than 70 process improvement projects underway at 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 that's pretty exceptional," she said, noting Horizon has invested millions in the changes, including the launch of "patient flow centres" in the ERs 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, said Johnston.

"You'll hear more of that in coming days," she said.

But it won't be a cookie-cutter approach, she stressed. It will be based on the demographics of each community and could include a wide range of professionals, such as lab technicians, dietitians and social workers, as well as virtual care. "So it's not a one-and-done project. It's systemic change that will take time."

Recruitment and retention 'greatest concern'

Despite these improvements, there is still work to do, acknowledged Margaret Melanson, interim president and CEO, citing the recruitment and retention of health-care workers as Horizon's "greatest concern."

"As you know, the viability of our entire health-care system is predicated on having our staff that are trained and available to to be with our patients and families," she said.

"And so the continued efforts toward recruitment as well as the efforts we're making to improve the culture of our organization to be retaining our staff, appreciating them, respecting them, listening to them, is obviously the biggest issue that we are dealing with at this time."

During an eight-slide presentation, Melanson said Horizon has hired 1,130 nursing staff and "hundreds" of other health-care workers in the past six months.

She could not immediately tell CBC how many nurses and other workers it lost during that period.

Horizon spokesperson Kris McDavid later clarified the total number of new hires is actually 1,283, but that's in the past 10 months, not six. Horizon has lost 686 employees during that time, for a net gain of 597, he said.

The breakdown includes:

• Registered nurses: 381 departures vs. 473 hired (+92).
• Licensed practical nurses: 156 departures vs. 328 hired (+172).
• Patient care attendants: 149 departures vs. 482 hired (+333).

Melanson said nurses who leave have identified schedules that don't provide a work-life balance as one of the problems. Horizon hopes a new pilot that allows nurses to self-schedule will help. It has also added business managers to patient units to handle administrative tasks and free-up nurse managers and charge nurses to deal with patients and their families, she said.

4 'critical action priorities'

Six months ago, Horizon introduced four "critical action priorities."

• Improving access to services, specifically surgery, emergency care and addictions and mental health services.
• Retention and recruitment of physicians, nurses and staff.
• Improving patient flow at health-care facilities.
• Improving overall patient experience.

Since then, the length of time it takes to transfer patients from an ambulance to a hospital has been trending down in the major centres, said Melanson.

Moncton Hospital, for example, has seen offload delays decrease to 94 minutes, from a high of about 213 minutes, she said.

"There's obviously work able to be continued here, but definitely this shows a significant improvement and the team is congratulated for this work."

Offload delays at the Saint John Regional Hospital have dropped to about 31 minutes, from a high of roughly 58 minutes, while at the Dr. Everett Chalmers Regional Hospital in Fredericton, they've decreased to about 36 minutes from roughly 64 minutes, and at the Upper River Health Valley Hospital in Waterville, they've decreased to 20 minutes from 30.

Melanson credits physicians, nurses, pharmacists and other care providers "working together collaboratively like never before" to quickly address the needs of these patients, quickly identify their care plan and have them introduced as quickly as possible.

Patient flow centres key

It's also directly related to the patient flow centres in the Fredericton, Moncton and Saint John emergency departments, she said.

Patient flow centres are not a physical location with the ERs, said Melanson. They're "better described really as an improved co-ordination of the workflow improvements that allows the overall emergency department team to make the most of their staffing and resources available onsite to ensure that patients with lower acuity, for example, have their medical needs able to be met quickly to receive triage, testing and care in the shortest turnaround time possible.

The average time saved for patients served through the Chalmers flow centre since it was launched in November is 3.6 hours and "only" two per cent of 1,802 patients left without being seen. By comparison, 11 per cent of Chalmers ER patients overall left without being seen in January, according to data provided by McDavid.

Horizon aims to further reduce ambulance offload times by working with support services to expedite diagnostic care, such providing after-hours access to CT scans, said Melanson.

In addition, a new director of patient flow is trying to identify ways to get admitted patients out of emergency beds and into hospital beds, she said.

Other highlights from the update include:

• Sackville Memorial Hospital's ER is expected to reopen within the next week or two following repairs to fix flood damage from Hurricane Fiona last September, but there is no date yet to restore 24/7 service because while the necessary nursing staff is in place, physician recruitment is not progressing as quickly as hoped.
• A pilot project to add patient monitors to the ER waiting rooms in Fredericton, Moncton, Saint John, Miramichi and Waterville, launched in August following the death of a man while waiting for care at the the Dr. Everett Chalmers Regional Hospital in Fredericton, is now permanent. The patient monitors check vital signs, provide comfort and monitor well-being.
• Social workers have been added to the four largest emergency departments to support patients who don't need to be admitted.

• $6.4 million is being invested to expand surgical services, including enhancements to surgery programs in Horizon's smaller community hospitals. This will result in 1,100 more hip and knee surgeries per year. Upper River Valley Hospital, for example, which began offering knee surgeries in December, is expected to begin offering hip surgeries in the coming months.
• A program designed to reduce patient stays after surgery and improve patient outcomes has helped 700 hip and knee replacement patients in Saint John as well as 160 bowel surgery patients in Moncton and will expand to other areas "soon."
• 70 per cent reduction in Horizon's wait list for mental health services through introduction of single-session/one-at-a-time therapy.
• This program will soon be piloted for seniors in the Moncton area.
• 83 per cent of people who received mental health support last year did so without visiting a hospital, thanks to the mobile crisis teams.
• A pilot after-hours psychiatric clinic will soon be launched in Moncton, which could serve as a model for other sites.