randy penney - south renfrew health link may 1 2013 (2)

Randy Penney, President & CEO

Renfrew Victoria Hospital &

St. Francis Memorial Hospital

May 1, 2013

Clinics• Internal Medicine• Surgical• Respirology• Dietician

• Shared Radiologists, and PACS Administration

• 2 separate corporations– Boards of Directors– Budgets

SFMH Voluntary partnership with Renfrew Victoria Hospital since 1999.

• Shared Chief Executive Officer

• Information Technology• Shared clinical programs

– Dialysis– Mammography– Bone Density– CT Scan

PARTNERSHIP

PARTNERS

Pre Dialysis 1993Pressures on patients and their families

• Sick, elderly patients driving in excess of 300 kilometres 3 times per week• 3-5 hours total driving time from various communities in Renfrew County• After treatment feeling fatigued• Cost of gas, parking, meals• Driver needed• Driving in all kinds of weather i.e. snowstorms, ice storms• Unable to keep a job due to treatment time• Ottawa at over-capacity• No treatment - you die• Everyone left Renfrew County for dialysis services

Fast Forward 2013• Renfrew Victoria Hospital designated by the Ministry of Health

& Long Term Care as the Regional Centre for Renfrew County Nephrology Services.

• 12 station Hemodialysis Unit at Renfrew Victoria Hospital • 6 station Satellite Unit at St. Francis Memorial Hospital,

Barry’s Bay• 6 station Satellite Unit at Pembroke Regional Hospital• Peritoneal Dialysis offered (home dialysis)• PRI (prevention) clinics• Today, very few leave Renfrew County for their treatment

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1993 1994 1995 1996 1997 1998 1999 2000 2001 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Number of Hemodialysis Treatments Number of Hemodialysis Treatments

RVH Regional Dialysis Program

• 2 Nephrologists, Dr. Nicole Delbrouck & Dr. Amtul Musawir• General Practitioners educated with additional knowledge and

experience in hemodialysis in Renfrew, 2 General Practitioners in Barry’s Bay

• Nurse Manager, Janice Verch-Whittington• 29 Registered Nurses • 9 Registered Practical Nurses • 2 Dialysis Bio Medical Technologists• 2 Dietitians• 1 Social Worker• Pharmacist Support

Unbelievable knowledge and expertise in Renfrew County

• Renfrew Victoria Hospital• Primary Care Physicians

in Renfrew County• Ministry of Health• Patient Focus Groups• Ontario Renal Network• The Ottawa Hospital

Vascular Access Program• The Ottawa Hospital

Transplant Program• CCAC, PD Case Manager

and Palliative Care Services for end of life support

• Kidney Foundation of Canada, Eastern Ontario Branch, Patient Services Committee

• Regional Clinical Practice Committees for Hemodialysis and Peritoneal Dialysis

• Champlain LHIN Regional Chronic Kidney Disease

• St. Francis Memorial Hospital – Satellite

• Pembroke Regional Hospital - Satellite

How Did We Get There?

Linkages & Partnerships

Stage 2 Chronic Kidney Disease• Nephrology Clinics• Initial assessment, diagnosis

and early intervention to slow progress of kidney disease

Stage 3 & 4Chronic Kidney Disease• Progressive Renal

Insufficiency (PRI) clinic– Dietitian– Social Worker– Nephrologist– Nurse– Pharmacist

Goal to slow progression of kidney disease

PATIENT CONTINUUM OF CARE

Stage 5 – 4 Options

Option 1Home Peritoneal Dialysis • Home training at RVH• RVH support 24/7• Surgical insertion PD

catheter by The Ottawa Hospital

Option 2In-centre Hemodialysis- 3 sites available- Vascular access creation/

insertion at The Ottawa Hospital

PATIENT CONTINUUM OF CARE

Stage 5 – 4 Options

Option 3Transplant • Complete pre-transplant

workup at RVH• Transplant and post-

transplant care at The Ottawa Hospital

Option 4Treatment without Dialysis- Nephrology palliative care- Working with family

physician

PATIENT CONTINUUM OF CARE

Pre Dialysis 1993Pressures on patients and their families

• Sick, elderly patients driving in excess of 300 kilometres 3 times per week• 3-5 hours total driving time from various communities in Renfrew County• After treatment feeling fatigued• Cost of gas, parking, meals• Driver needed• Driving in all kinds of weather i.e. snowstorms, ice storms• Unable to keep a job due to treatment time• Ottawa at over-capacity• No treatment - you die• Everyone left Renfrew County for dialysis services

VISION

The patient must be at the centre of health care.

• Provide seamless access to the continuum of care in a timely manner.

• Be based on need • Take into consideration the individual needs

and preferences of the patient and his/her family.

• Treat the patient with respect and dignity.

LESSONS LEARNED

• Provide services that are appropriate, respectful of individual choice and delivered in a manner that is timely, safe, effective and based on the latest evidence.

QUALITY

• The health system must support residents in the Champlain LHIN in the prevention of illness and the enhancement of their well being.

• The health care system has a duty to provide and advocate access to quality care sensitive to the challenges of rural Renfrew County.

IMPROVE POPULATION HEALTH

ONE TAXPAYER

• There are significant financial challenges for all health care providers

• Increasing demands

• Less resources

• How can we provide services to maintain or improve access especially in rural communities?