Download Year In Review: 2008/2009 - 2009/2010 WRHA Cardiac Sciences Program

WRHA
Cardiac Sciences Program
Year In Review:
2008/2009 - 2009/2010
Excellence in
Patient Centered Cardiac Care,
Education and Research
www.cardiacsciences.mb.ca
WRHA Cardiac Sciences Program
Table of Contents
Directors’ Message
Page 2
Program ProfilePage 3
Sites & ServicesPage 4
Program Management StructurePage 5
Program HighlightsPage 6
Patient Flow & AccessPage 6
Capacity & ResourcesPage 7
Innovation & TechnologyPage 8
Research & EducationPage 9
Statistical HighlightsPage 10
Directors’ Message
On behalf of the Winnipeg Regional Health Authority (WRHA) Cardiac Sciences Program, we are pleased to provide an overview of our achievements for the period April 1,
2008 to March 31, 2010.
The WRHA Cardiac Sciences Program is at a critical stage in its organizational development, now that six years have passed since its inception. In the past two years, much has
been accomplished in cardiac patient care, research and education. This progress has
occurred while the Program worked diligently to balance resource constraints, increased
patient volumes, infrastructure requirements and other pressing issues. As we look ahead,
we will continue building on our strengths, address the ongoing challenges and ensure our
patients receive the best cardiac care possible.
During this time, there was also a significant transition in our Program’s Leadership Team.
We bid farewell to Francis LaBossière, our former Program Director and welcomed Sheila
Bowles to this important role.
As always, the cardiac patients we serve are at the source of the decisions we make and
directions we take. It is a privilege to assist them and we take great pride in knowing we
are making a positive difference for so many people. For that, we thank our exceptional
Cardiac Sciences Program Team - the many, talented physicians, health care professionals
and staff who work tirelessly to save and improve lives every day.
Sincerely,
Dr. Alan Menkis, Medical Director
Sheila Bowles Program Director
Ken Rannard, Administrative Director
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Program Profile
VISION
Be recognized for clinical and academic excellence (locally, nationally and internationally), by providing the highest standard of patient-centered cardiac care,
education and research within a professional organization that fosters respect, collaboration and open communication.
MANDATE
Deliver comprehensive, integrated cardiac patient care for Winnipeg, the province of Manitoba and surrounding regions. This includes diagnostic, inpatient,
outpatient and rehabilitation services. Cardiac education and research focus on
the prevention, care and treatment of heart disease. Several hundred multidisciplinary cardiac clinicians, researchers, administrative and support professionals
work together to implement this mandate.
BACKGROUND
Heart disease is one of the leading causes of illness in Canada, affecting an estimated 1.3 million people and accounting for 60,000 deaths per year. These trends,
along with the prevalence of an aging population, unhealthy lifestyles and other
chronic diseases, place significant demands on the health system.
In September 2003, Manitoba Health announced the approval for an amalgamated Cardiac Sciences Program. The goal was to integrate cardiac surgery, cardiology, cardiac anesthesia, cardiac intensive care and cardiac rehabilitation. Cardiac
patient care, education and research activities would be coordinated under one
organizational structure.
Between November 2006 and January 2007, the majority of cardiac patient care
was consolidated at St. Boniface Hospital (SBH). The newly constructed Bergen
Cardiac Care Centre became the centerpiece for cardiology. Select cardiology
services continued to be available at the Health Sciences Centre (HSC) and other
Winnipeg-based community hospitals. Soon after, cardiac surgery, cardiac anesthesia and cardiac intensive care were also amalgamated at St. Boniface Hospital.
Cardiac rehabilitation is delivered by the Reh-fit Centre and the Seven Oaks Wellness Institute.
Today, more than 50,000 people per year visit the WRHA Cardiac Sciences Program for heart-related issues.
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www.cardiacsciences.mb.ca
WRHA Cardiac Sciences Program Sites & Services
CARDIAC PATIENTS
ST. BONIFACE HOSPITAL
CARDIOLOGY
Cardiology In patient Unit
Coronary Care Unit
Cardiac Catheterization
Pacemakers
Defibrillators
Electrophysiology
CARDIAC SURGERY
Operating Room
Perfusion
Patient Access Coordination
HEALTH SCIENCES
CENTRE
CARDIOLOGY
Cardiology In patients
Coronary Care Unit
Cardiac Catheterization
CARDIAC TRAUMA
SURGERY
Operating Room
Perfusion
CONCORDIA HOSPITAL REH-FIT CENTRE
GRACE HOSPITAL
MISERICORDIA
HEALTH CENTRE
SEVEN OAKS
GENERAL HOSPITAL
CARDIAC DIAGNOSTICS
Electrocardiography (EKG)
Holter/Event Recorder
Cardiac Surgery Inpatient Unit
CARDIAC ANESTHESIA
CARDIAC DIAGNOSTICS
Intensive Care Cardiac
Sciences Unit
CARDIAC
REHABILITATION
VICTORIA GENERAL
HOSPITAL
CARDIAC
ANESTHESIA
CARDIAC INTENSIVE CARE
WELLNESS
INSTITUTE
Stress Test
Echocardiography
Electrocardiography (EKG)
Holter / Event Recorder
Stress Test
CARDIAC DIAGNOSTICS
Echocardiography
Electrocardiography (EKG)
Holter / Event Recorder
Holter Reading
Stress Test
Cardiac Diagnostic Imaging (CT/MRI)
CARDIAC OUTPATIENT CLINICS
PROGRAM ADMINISTRATON
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www.cardiacsciences.mb.ca
WRHA
MANAGER
STRATEGIC
INITIATIVES
SBH MANAGER
CARDIOLOGY
PROCEDURES &
DIAGNOSTICS
SBH MANAGER
CARDIAC
CLINICS
SBH MANAGER
CARDIAC
SURGERY
INPATIENTS
WRHA DISCIPLINE
DIRECTOR
CARDIAC PHYSICIAN
ASSISTANTS
SBH MANAGER
CARDIAC
INTENSIVE CARE
WRHA MANAGER
QUALITY
INITATIVES
WRHA/SBH
PROGRAM
DIRECTOR
ST. BONIFACE
HOSPITAL (SBH)
EXECUTIVE
WRHA
PROJECT
MANAGER
WRHA
ADMINISTRATIVE
DIRECTOR
WRHA MEDICAL
DIRECTOR
CARDIAC
INTENSIVE CARE
WRHA/SBH
MEDICAL DIRECTOR
PROGRAM &
CARDIAC SURGERY
WRHA MEDICAL
DIRECTOR
CARDIOLOGY
SBH MANAGER
CARDIOLOGY
INPATIENTS
WRHA MEDICAL
DIRECTOR
CARDIAC
ANESTHESIA
CARDIAC REHAB
SEVEN OAKS
WELLNESS
INSTITUTE &
REH-FIT CENTRE
WINNIPEG
REGIONAL
HEALTH
AUTHORITY
(WRHA)
EXECUTIVE
CARDIAC
DIAGNOSTICS
WRHA HOSPITAL
SITES
Cardiac Sciences Program Management Structure
HSC MANAGER
CARDIOLOGY
HEALTH SCIENCES
CENTRE (HSC)
DIRECTOR
Program Highlights
PATIENT FLOW &
ACCESS
Highlights of cardiac patient-care, research and education activities for the 2008/2009 2009/2010 reporting period are featured below:
We have pursued new approaches to ensure timely access to cardiac patient care. Patient
demand for cardiac care is high and the burden of heart disease is growing. The Program
works to ensure it has sufficient capacity to meet these patient requirements. This includes
implementing improvements in:
-
cardiology outpatient clinic referral/intake process
cardiac patient transitions to/from primary care
cardiac inpatient flow and bed management
rapid improvement events, in conjunction with SBH Lean Transformation initiative
specific projects with the Manitoba Patient Access Network to reduce wait times
partnerships with other Programs, Hospitals and health care providers within the WRHA and throughout the province.
The Program has distinguished itself as a national leader in inpatient length of stay. Program benchmarks are below national rates. Average acute length of stay for typical postoperative cardiac surgery inpatients has decreased by approximately one full day since
2007. This is 11.5% better than the Canadian average and has exceeded national standards
for three years in a row. For cardiology inpatients, typical length of stay performance is
22% better than Canadian average and has exceeded national standards for four consecutive years.
Working with Manitoba e-Health, a new Echocardiography Scheduling System (NESS)
was implemented for cardiovascular ultrasounds at SBH and HSC. This was introduced
to enhance reporting capabilities, streamline processes and improve cardiac patient access.
These improvements were necessary to address the growing number of cardiac patients
requiring echocardiography.
The Cardiac Pre-Admission Clinic assesses patients prior to cardiac surgery. A nurse practitioner and cardiac anesthetist work together to examine patients and ensure all pre-operative
testing is performed. Before this clinic started, this process took as long as 6 hours. Now, the
patients’ average stay is 2 hours and overall patient satisfaction has dramatically improved.
The Program has other successful nurse practitioner-run clinics for pre-operative assessment, post-operative discharge and anticoagulation management. This helps the Program
transition patients to/from the community.
A diabetes/cardiac sciences pilot project was initiated with the Youville Centre, WRHA
Chronic Disease, WRHA Home Care (Wound Care Team), and St. Boniface Hospital Endocrinology. The purpose was to redesign service delivery for cardiac surgery patients with
diabetes. This patient population is at increased risk for post-operative wound infections,
which has serious implications for their outcomes. The project partners are collaborating to
reduce the incidence of post-operative infections by improving patient access to care and
educational/community support.
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Program Highlights cont’d
CAPACITY &
RESOURCES
Cardiac patient volumes are an ongoing priority. This growth, along with clinical practice
changes and new technology, has increased the costs to deliver high quality, evidence-informed care. Since there are limitations to the financial and human resources available, the
Program strives for efficiency and accountability in all areas, including improved supplier
contracting, inventory management, practice standardization and extended hours of operation.
Bergen Cardiac Care Centre: $23 million invested by Manitoba Health and donors from
the public and private sectors. The initial and final phases of construction at St. Boniface
Hospital were respectively completed in October 2006 and October 2009. A large proportion of the Program’s cardiology services are dedicated at the Bergen Centre.
I.H. Asper Institute: $40.3 million invested by Manitoba
Health and multiple partners, including the Manitoba
Government, Western Economic Diversification, the
Asper Foundation, the St. Boniface Hospital Foundation
and other donors. Construction at St. Boniface Hospital
began in March 2009 and is expected to open for patients
in Spring 2011. The Program will occupy nearly 41,000
square feet of new space, with more private rooms for patients, natural light, a quieter care environment and space
for family and visitors.
Plans to expand our inpatient cardiology bed base and Coronary Care Units (CCU) are
underway. The proposed changes will help improve the management of cardiology inpatient care, secondary to tertiary transition and further contribute to reductions in regional
length of stay.
Heart catheterization facilities and equipment were completely upgraded at St. Boniface
Hospital. Heart catheterization procedures (e.g. angiography, percutaneous coronary intervention) are increasing by 7% per annum. A replacement laboratory at Health Sciences
Centre is also approved and implementation planning is underway.
For recruitment and retention, the Program strives to hire the “best and brightest” cardiac medical, nursing, allied health and administrative professionals. Twenty-five new
physicians and surgeons have
joined the Program over
the last four years. Moving forward, recruiting new
cardiologists and securing cardiac nurses (especially those
with intensive care unit and
advanced assessment credentials) are among the highest
priorities.
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www.cardiacsciences.mb.ca
Program Highlights cont’d
INNOVATION &
TECHNOLOGY
The Program is working to improve quality of life and reduced mortality with state of the
art technology and procedures, including advances in echocardiography, electrophysiology,
cardiac imaging, heart catheterization, pacemakers, defibrillators, and ventricular assist devices. In electrophysiology, a new mapping system was introduced which delivers the full
complement of diagnostic and therapeutic procedures, including atrial fibrillation.
Each year, 1,500 individuals are treated for heart attacks in the Winnipeg region. The
CODE STEMI was implemented as a new, life-saving rapid response system for these
patients. It provides a mechanism to immediately diagnose and treat heart attacks on the
scene and when the ambulance is on route to the hospital. The patient’s electrocardiogram
(EKG) is transmitted from the field via a mobile device to a cardiologist, who then consults with paramedics and advises them of the treatment plan. Incoming patients bypass
the hospital’s emergency and go directly to the heart catheterization lab for their required
procedure. This saves a significant amount of time, can reduce heart damage and thereby
improve patient outcomes and chances of survival. In just a few years, survival rates have
increased from 85% to 96%. This initiative is a partnership between the Cardiac Sciences
Program, Emergency Medicine, the Winnipeg Fire and Paramedic Service and Manitoba
Telecom Services.
Ventricular Assist Devices (VADs) are surgically-inserted cardiac pumps that keep congestive heart failure patients alive while awaiting heart transplant. More than 7,000 Manitobans have some form of heart failure. In advanced cases, VADs can be used as a life-saving
intervention. The Program introduced the leading edge technology in 2008 and has completed more than 42 procedures since that time. An expert team of physicians, surgeons,
nurses, social workers, home care coordinators and allied health professional work together
to manage the care of these highly complex patients. Community outreach relationships
are also in place with the Winnipeg Fire and Ambulance Service and cardiac rehabilitation
specialists at the Reh-fit Centre and Wellness Institute.
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Program Highlights cont’d
RESEARCH &
EDUCATION
Multiple cardiac patient education initiatives were undertaken, including:
- Heart Failure Awareness Day: held annually, in partnership with the Reh-fit Centre. This free seminar is for congestive heart failure patients, their families and the general
public. Information is provided about treatment options, symptom management and
resources/support available.
- Next Steps Heart Fair: a monthly educational session held at St. Boniface Hospital in
partnership with the Wellness Institute and Reh-fit Centre. This is offered to all patients
diagnosed with heart disease. The purpose is to promote cardiac rehabilitation so patients
understand its positive impact on recovery, quality of life and preventing further heart issues.
- Cardiac Surgery Video: a 20 minute, bilingual patient education video, entitled Your
Heart, Your Health. A Patient’s Guide to Heart Surgery. Developed by the Cardiac Sciences Program with the support of the St. Boniface Hospital Foundation, the video is provided to patients prior to their heart surgery. It helps them to anticipate what to expect,
planning for recovery and leading a heart healthy lifestyle.
The Program recognizes the value of collaborating across the continuum of cardiac care, i.e.
from disease prevention, heart health promotion and primary care to early detection, treatment
and palliation. Connections with chronic disease management, especially diabetes, can improve
how patient care issues are approached and coordinated by multiple disciplines. One example
was the Diabetes Annual Awareness Day, where Program cardiologists and their medical colleagues in Endocrinology and Nephrology gathered to review cardiac involvement in diabetes
management.
The Cardiac Sciences Research Symposium is an annual peer-reviewed forum for cardiac
specialties in basic sciences, clinical and translational research. The event provides cardiac residents and trainees an opportunity to present their research findings to local/guest judges and
be recognized for their efforts. The event keeps growing, with more participants being involved
every year.
The Future of Heart Health Symposium is an educational conference held every second year,
hosted by WRHA Cardiac Sciences Program and International Academy of Cardiovascular
Sciences. A distinguished group of international experts shed light on important local, national
and global cardiovascular and health issues.
Cardiovascular Health and Research in Manitoba (CHaRM) is a Program-initiated research
forum with local, national and international counterparts in basic sciences, clinical, translation
and outcomes research. CHaRM now has more than 54 multidisciplinary members representing organizations such as the National Research Council, Institute of Cardiovascular Sciences
and Manitoba Centre for Health Policy.
Since CHaRM was established in 2006, a significant number of research studies have occurred in
all areas of the Program, with hundreds of cardiac patients participating. In cardiac anesthesia,
751 patients were enrolled in the multinational BAGRECALL clinical trial. The study examined
the utility of intraoperative depth of anesthesia monitoring, with results expected to be published
in the prestigious New England Journal of Medicine. In cardiology, the cardiorenal study accounted for 81 patient visits in 2009/2010 with another 240 visits anticipated in the next year.
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www.cardiacsciences.mb.ca
Statistical Highlights
Selected WRHA Cardiac Sciences Program activities (Annual totals for 2009/2010)
NUMBER
1276
6,988
2,136
15, 828
218
806
257
23, 245
50, 754
PATIENT SERVICE PROVIDED
cardiac surgery operating room visits
cardiac catheterization exams
cardiology/coronary care unit/cardiac surgery admissions
echocardiography exams
defibrillator implants
pacemakers implants
electrophysiology cases
cardiac outpatient clinic visits
TOTAL PATIENT VISITS
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For more information, please contact:
WRHA Cardiac Sciences Program
Main Floor, I.H. Asper Institute
Winnipeg, Manitoba R2H 2A6
Phone: (204) 258.1089
Fax: (204) 233.6065
Web: www.cardiacsciences.mb.ca
The WRHA Cardiac Sciences Program gratefully acknowledges all those who
contributed and helped in developing this publication.