Ontario’s Critical Care Strategy: Progress and evolution

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In 2006, Ontario’s Critical Care Strategy, was initiated to make system-wide improvements in access to high quality critical care across Ontario. Since that time, tremendous progress has been made in transforming how health-care providers and health system planners regard critical care resources and the provision of care to critically ill patients. Whether its working to fulfill accountabilities for the Wait Time Strategy or understanding patient flow in emergency departments, hospitals have a better appreciation regarding the importance of access to critical care resources and how even just a few extra unexpected critical care patients can bottleneck access to services across the rest of the hospital, the Local Health Integration Networks (LHINs), or the province.

The transformation in organizations with the respect to the delivery of critical care services across Ontario did not happen overnight, but the success and progress has mostly occurred due to the involvement and support of many different levels of stakeholders and the partnerships that have been nurtured. Ontario’s Critical Care Strategy and its activities continue to be supported by the Ministry of Health and Long-Term Care’s Critical Care Secretariat. Extensive partnerships exist with the LHINs and the hospital organizations. Our coaches bring front-line leadership and ideas to peer organizations and bring back learning to their local environments. The Provincial Critical Care LHIN Leaders Committee continues to bring front line expertise to advise on strategic direction and each Critical Care LHIN leader has an integral role working in partnership with each hospital on all elements of the strategy in their respective LHINs. Many hospital and LHIN administrators, clinicians and other stakeholders advise and support the initiatives of the strategy through subcommittees and focus groups that report to the Critical Care Secretariat. The Critical Care Secretariat has also formed key partnerships with other organizations both internal and external to the ministry.

As provincial lead I am proud to highlight a number of notable milestones:

• Eighty-six new critical care beds were funded to support expanded capacity. These beds have been opened across 35 hospital corporations in all 14 LHINs. Twenty of these beds have specifically been targeted to support chronically ventilated patients.

• Funding was provided to support over six hundred and fifty nurses get trained in critical care. Much of the reported funding was used to give nurses access to the E-learning program developed in partnership with Durham College which also adheres to the Critical Care Nurse Training standards that were developed.

• The number of post graduate training opportunities for critical care physicians was more than doubled.

• Twenty seven adult Critical Care Response Teams (CCRTS) have been mobilized across 24 hospital corporations for a minimum of one year in operation. CCRTs help to treat patients who show early signs of potential deterioration but are located outside of the critical care unit. This can result in a patient avoiding the need for intensive care unit (ICU) admission or having a shorter length of stay in the ICU.

• Four pediatric Critical Care Response Teams have been providing 24/7 assistance to any physician in the province caring for a critically ill pediatric patient.

• Performance Improvement Coaching Teams have been deployed more than 90 times to empower critical care units to develop unique solutions related to a broad range of issues including patient flow, communications and end of life issues.

• Four hundred and forty community physicians were offered ACES level training courses and 100 clinicians were trained in End of Life Communications in Partnership with the Canadian Resuscitation Institute.

• Implementation of wave seven of the Critical Care Information System is complete. We are now collecting information on ICU resources in the province from 199 critical care units.

• The provincial implementation of the Surge Capacity Management Program commenced in April 2009. This program will provide hospitals with a common framework to better manage surges of critically ill patients locally, will promote system integration across regions and will allow for a coordinated provincial response to any increase in patient volumes where demand exceeds resources.

Ontario’s Critical Care Strategy has achieved key success in a relatively short period of time. These accomplishments have been recognized at international health-care policy and scientific meetings and several jurisdictions are looking to Ontario as a leader in health-care system transformation. It is clear that the benefits of improving the critical care system are not only evident in critical care units, but are widespread across a patient’s continuum of care. The successes that have been realized are shared by the numerous partners across that continuum of care who partner with Ontario’s Critical Care Strategy to improve patient care in Ontario. Moving forward, Ontario’s Critical Care Strategy will continue to find success built on these partnerships and keep the strategy rooted in its “ground up” architecture.