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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 2 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. 3 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 4 5 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. 6 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. 7 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. 8 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. 9 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 10 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.