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External Review of London Emergency Dept.

External Review of London Emergency Dept.

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Published by: The London Free Press on Jun 23, 2011
Copyright:Attribution Non-commercial


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June 22, 2011Michael Barrett, CEOSouth West Local Health Integration Network201 Queens Avenue, Suite 700London, ON N6A 1J1Dear Mr. Barrett:Attached please find my review for the London Emergency Departments and Urgent Care Centre.Thank you for the opportunity to better understand the strengths and challenges facing the LHIN and specifically London.The professionalism and candor which we received from all organizations and individuals was exemplary. I would especially like to thankMr. Mark Brintnell for his thoughtful guidance and knowledge of local issues and overall support. I would also like to sincerely thank mycolleague at St. Joseph
s Health System, Mr. Brian Guest, without whom this report would not have been possible.Should you, your Board or hospital partners have any questions or concerns, I would be only too happy to chat.In closing, I am confident with the implementation of 
these recommendations, all drawn from local intelligence, the South West LHIN’s
Urgent and Emergent care system will find greater stability and enhanced patient and provider satisfaction.Sincerely,Dr. Kevin SmithPresident and CEOSt. Joseph's Health System
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The South West Local Health Integration Network (LHIN)
instituted an external review of the St. Joseph’s
Health Care London and London HealthSciences Centre Emergency Departments as a result of a challenge to clinical coverage in Urgent Care.On May 24
, 2011 a series of meetings were held in London with representatives of the Board, Executive Management Teams and MedicalLeadership
of St. Joseph’s Health C
are London (SJHC) and London Health Sciences Centre (LHSC) as well as the South West LHIN.On June 6, 2011 meetings were held at SJHC and the University and Victoria campuses of LHSC with both the nursing and physician staff whowork in the Urgent Care Centre (UCC) and Emergency Departments (ED). In addition, we were fortunate to receive numerous emails fromstaff who were unable to meet with us during our on-site meetings.
While the inability to staff the UCC with qualified ED physician support over the past year has resulted in a gradual erosion of hours of service to thecommunity and most recently the plan to close the UCC for both weekend days commencing in June 2011, the underlying pathology appears to berelated to flow issues in the ED. As a result of the inability to offer what physicians and nurses perceive to be high-quality clinical care, the numberof those choosing to practice as full time ED physicians has declined and the capacity to cover additional shifts as well as UCC coverage eroded.Though much is being done to address flow issues by both hospital corporations, the sooner planned bed openings might be realized and expandedcapacity for Long Term Care created, the more likely the hospitals will be successful in recruiting an adequate complement of physicians to ensurefull coverage of all sites. While this review has focused on the London hospitals, the issue of access to urgent and emergent care must increasinglybe viewed across the entire LHIN and consideration of how limited human resources may most effectively be deployed to serve the broaderpopulation of the South West LHIN.
It is challenging to arrive at definitive conclusions based on two extended site visits but due to the urgency of this review the following observationsform the basis for the recommendations in this report:All parties are committed to finding a solution based on the best interests of the community;There is a very strong and supportive patient-focused bond between the UCC/ED nursing, allied health professionals and physician staff;There is a divergent opinion as to the relevance of urgent care by some physicians. As urgent care serves approximately 50,000 patient visitsa year, the possibility of the two busy emergency rooms absorbing even a modest percentage of these visits and improving quality of careand timely access to care is unlikely. The community would be well served by the LHIN and hospital boards making clear the full support forthe continuum of urgent and emergent care as soon as possible (copies of statistical profiles of the EDs and UCC are attached and providecontext to this review);It is our understanding from SJHC administration and physician leads that in excess of 80% of previously open shifts in the UCC have beenassigned and all days have at least one physician confirmed and available. This coupled with the recruitment of, and successful deploymentof nurse practitioners gives us confidence that services (7 days/week) will be uninterrupted over the summer months. However these shortterm solutions will not alleviate ongoing coverage challenges unless the larger systemic flow issues and quality of work life are appropriatelyaddressed and recruitment needs fulfilled;The two separate and distinct payment schemes for ED physicians- Alternate Funding Arrangement (AFA) at LHSC and Fee for Service at theSJHC
UCC contributes to “the problem”
in that work is not equally valued. It was noted that other departments (e.g. anaesthesia) have putin place city wide payment schemes in order to assure that all necessary work is appropriately valued regardless of site*;Hospital top-ups to ensure UCC coverage are unsustainable in the current model*;Lack of clarity in administrative management responsibilities are perceived by many individuals within the organizations, perhaps notsurprisingly as a number of changes have recently occurred;The ED physician staffing for the UCC was significantly impacted by the recent addition of a total of thirty-two (32) additional monthly shiftsawarded to the two LHSC EDs. While a provincial issue, as a broader policy change the MOHLTC should consider additional shifts be fundedwhen appropriate recruitment is in place and in a phased model to ensure that destabilization of the regional system does not occur*;

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