Clinical Leadership – key to building Critical Care Networks in Ontario

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In May 2006, The Government of Ontario appointed Critical Care LHIN Leaders in each Local Health Integration Network (LHIN) across the province. These positions were formally established to support the implementation of the province’s Critical Care Strategy.

Critical Care LHIN Leaders are experts in intensive care medicine who work collaboratively with hospitals, LHIN CEOs and the Ministry of Health and Long-Term Care. Reporting to the Assistant Deputy Minister, Health System Accountability and Performance Division, and their respective LHIN CEOs, their mandate is to assist with:

  • Critical care service delivery planning and coordination;
  • Critical care performance measurement and improvement;
  • Critical care surge capacity planning, rehearsal and event management;
  • Demand forecasting, resource allocation and priority setting; and
  • Representing their LHIN at the critical care provincial table focused on addressing operational issues in critical care.

  • Since their appointment, CC LHIN Leaders have been engaged in four key tasks:
  • Conducting a province-wide inventory of critical care services;
  • Enhancing surge capacity response plans in hospitals across the LHINs;
  • Working with the Canadian Resuscitation Institute (CRI) to conduct a province-wide training and education needs assessment for critical care providers; and Supporting the implementation of a clinical information system in all Ontario hospitals housing an ICU bed to give real-time data regarding ICU bed utilization and performance measurement.

LHIN Critical Care service inventory

The CC LHIN Leaders have completed the first-ever inventory of Ontario’s critical care services. By establishing this baseline of services, they have provided an essential point of reference to evaluate current and future service delivery plans and to determine where change and investment in service expansion are required to meet future demand.

Work is now underway to create a similar inventory of paediatric critical care capacity.

Critical Care Surge Capacity planning

CC LHIN Leaders are working closely with Dr. Chris Mazza, Lead, Critical Care Surge Capacity, to enhance the critical care dimension of their hospital’s emergency planning procedures. Based on recommendations set out in the 2005 Ontario Critical Care Steering Committee Final Report, Dr. Mazza and the Critical Care LHIN Leaders will assist hospitals with the particular accountability, human resources, equipment and technologies, physical plant and standard operating procedures required in order to meet minor, moderate and major surge conditions across a LHIN.

Critical Care education and training

Critical Care LHIN Leaders are working collaboratively with CRI as they lead a province-wide LHIN level training needs assessment. This assessment will identify additional training and educational opportunities to expand the capacity of existing critical care health service providers and provide insight into priority setting for future program development and delivery.

Building a CC network in the South West

The South West LHIN encompasses an area of 22,000 sq. kilometers with an adult population of 696,150 and is served by 28 acute care hospitals, of which all but four small community hospitals offer critical care services.

The South West LHIN has identified and is working on a number of key initiatives to strengthen critical care system integration and improve patient care and safety, including: Improving patient transfers from centres that are not resourced to care for patients who are critically ill to regional referral centres, including the development of patient transfer criteria, based on a hospital’s limitations to provide for patient’s needs.

Educational programs for staff in community hospitals that may not have the breadth of experience required to care for people who are critically ill.

The development of a repatriation policy that would ensure that a patient who is critically ill is returned to their “home” hospital as soon as it is safe to do so.

Examining and developing strategies to address patient transfer issues related to the geography and rural distribution of our population.

Promoting dialogue between community hospitals and regional referral centres on topics that are relevant to each hospital’s needs.

Performance measurement and management

Ontario’s Critical Care information system

In February 2007, London Health Sciences Centre went ‘live’ as one of the nine pilot sites for implementation of the Critical Care Information System (CCIS) in its adult medical/surgical ICU. The launch of this new information system was extremely successful, reflecting the excellent project leadership of the Critical Care Secretariat (CCS) and the strong organizational commitment shown by the hospital.

The remaining hospitals in LHIN 2 with Level 3 critical care beds have been scheduled to implement the CCIS in the third wave of the roll-out in late 2007.

As we move forward with the CCIS implementation we will be using the data and reports it produces to guide our development of a Performance Management Framework to support improved utilization and management of critical care capacity.

By engaging clinical leaders in the development of critical care “networks” within LHINs we can begin to plan for, think about, and deliver critical care services not only as a local resource, but as a regional and provincial resource as well. In so doing, we can ensure that patients who are critically ill or seriously injured, receive the care they need, when and where they need it.

For more information, visit www.health.gov.on.ca/criticalcare