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MEMO

Date: July 9, 2019

To: Winnipeg Regional Health Authority and Shared Health staff


From: Lanette Siragusa, Chief integration officer, health services and chief nursing officer,
Shared Health
Krista Williams, Chief operating officer, Winnipeg Regional Health Authority

Re: Update on WRHA Clinical Consolidation Plan

The emergency department at Seven Oaks General Hospital (SOGH) will become a 24/7
Urgent Care Centre on July 22, 2019. The decision to convert at this time is based on clinical
input from system and site leadership as well as front-line staff.

Careful analysis of the staffing resources available for the emergency department at SOGH
beyond July has been completed. Patient safety is our highest priority. Staff resources are in
place to operate a fully functioning Urgent Care. We are confident converting to an Urgent Care
Centre at this time will mitigate risks associated with sustaining an emergency department, such
as nursing vacancies and gaps in physician coverage.

Planned changes to inpatient services, including the closure of the intensive care unit, will occur
Sept. 20 to support SOGH’s role as a community hospital.

A newly established advisory team, which includes clinical leadership from Shared Health and
the Winnipeg Regional Health Authority, has been overseeing planning and engagement efforts
over the last few weeks. Members of the advisory team have been meeting with staff and
physicians at SOGH, as well as with site and clinical leadership from each of Winnipeg’s acute
hospitals. This team will support the transition on-site at SOGH and across the system as other
sites accommodate shifting patient volumes resulting from this change. They will also focus on
increasing engagement with – and gathering input from – nurses and physicians, as well as
allied health and site-based leadership.

Feedback from staff and physicians has been honest and productive and a number of
suggestions are now being reviewed for inclusion in the overall plan. Staff have voiced concerns
about their lack of engagement and have asked specific questions about plans to ensure patient
safety, appropriate staff resourcing and to deal with vacancies and staff fatigue. Please know
your concerns have been heard and are being acted upon – both immediately and for
implementation over the longer term. Efforts to ensure your awareness, involvement and
opportunities for feedback will continue. We recognize these changes affect how and where we
deliver care and we ask for your continued support and commitment to patient care as we seek
necessary improvements to patient flow and wait times.

Patient safety is our focus


The conversion of SOGH’s emergency department to an Urgent Care Centre, along with the
completion of the labour adjustment changes currently underway at SOGH, will help stabilize
the demands on nursing staff at the site. Accompanying changes to EMS protocols will further
decrease the acuity of patients seen at SOGH and allow for improvements in patient flow and
wait times.

SOGH and the staff who provide excellent patient care at the site each and every day have a
key role in the performance of our overall system. SOGH has a long and proud history of caring
for medically complex renal patients and providing services to geriatric and rehabilitation patient
populations. It has also been one of our region’s highest performing sites in terms of wait times
and we are committed to ensuring these successes are maintained over the long term.

Site readiness – Seven Oaks General Hospital


Our focus remains on the continued provision of safe, high quality patient care for the
community served by SOGH. Quality and patient safety monitoring, including close attention to
patient experience, will accompany these changes and necessary adjustments will be made in
order to ensure the continued safety of our patients.
Efforts to improve patient flow both at the site and across the system are ongoing. Plans and
preparation are underway or have already been implemented to support site readiness. These
include:

 Staff resources are in place to operate a fully functioning Urgent Care at SOGH
beginning July 22, 2019. The Urgent Care will handle the urgent, same-day health needs
of the residents of northwest Winnipeg and will remain open to low-acuity EMS arrivals.

 Discussions with physicians and staff have highlighted the need to stream and assess
lower acuity patients in order to free up treatment space in the Urgent Care and allow for
improved patient flow and wait times. Work is now underway to develop a rapid
assessment zone in the Urgent Care with detailed planning and further clinical input to
occur over the summer months.

 In recognition of SOGH’s continued role in the treatment of renal patients, including


medically complex patients requiring more intensive treatment, a three-bed renal pod
option is being developed in collaboration with site clinicians. The renal pod would serve
renal patients from SOGH as well as those from other hospitals in Winnipeg.

 The renal pod option also includes planning for a physician assistant who would support
the Urgent Care physician in providing code response for SOGH.

 Vulnerable patients in the neighbourhoods around SOGH are in the process of being
identified. Site and community staff are working together to create a support strategy for
these individuals, which will include connections to Family Doctor Finder, engagement
with community resources (i.e. EPIC) and efforts to attach them to primary care clinics. A
similar approach supported the patient population affected by the closure of Misericordia
Health Centre in 2017, ensuring patients had care plans in place and were aware of
neighbourhood primary care locations as well as other community resources and
supports. SOGH staff will receive support to ensure the safe and effective planning for
this patient population in preparation for conversion to an Urgent Care.

System readiness
Across the system, clinical and site feedback has informed planning efforts. Preparation and
readiness of Winnipeg’s three remaining emergency departments (Health Sciences Centre
Winnipeg, St. Boniface Hospital and Grace Hospital) to safely care for shifting patient volumes
following the Seven Oaks conversion have also been considered. We thank the leadership and
staff at sites across Winnipeg for your ongoing work in preparing for these transitions.

Capital improvements – including enhancements to emergency departments and improved


treatment spaces for seniors, mental health patients, and low acuity patients – are supporting
the overall clinical consolidation plan to ensure appropriate space and treatment for the most
seriously ill patients at city hospitals. A number of improvements have already been completed,
including the opening of the new Grace Hospital emergency department, the opening of a mid-
to-low acuity treatment area to expand the HSC emergency department, and renovations to
create a new triage, waiting area and mid-acuity treatment space at St. Boniface. The expanded
Surgical Intensive Care Unit at HSC and further renovations to the high-acuity and expanded
resuscitation space at St. Boniface will open soon.

Plans and preparation are also underway to support system readiness, including patient
analysis and redistribution planning, capital improvements to allow for accommodation of
increased patient volumes at acute sites, workforce and recruitment strategies, and renewed
emphasis on improving patient flow, such as:

 Analysis has confirmed the additional number of patients anticipated to be seen by


Winnipeg’s three acute emergency departments post conversion at SOGH. This
redistribution of patients will be achieved in part by changes to EMS protocols and
ongoing public education about where to go for care.

 Education regarding updated ambulance protocols will occur in advance of the


conversion to ensure paramedics are fully informed of the appropriate destination
hospital, depending on the care required. In many instances, as was the case with the
conversion of Victoria and Concordia Emergency Departments to Urgent Care Centres,
ambulance protocols will remain the same. For example, St. Boniface Hospital will
remain the destination for most cardiac patients.

 Sixteen additional cardiac beds will open at St. Boniface in mid-July, increasing capacity
on the inpatient cardiology unit from 32 to 48 as cardiac care is consolidated at St.
Boniface. Of note: the majority of additional patients anticipated to be seen at St.
Boniface following conversion will require cardiac care.

 HSC will open a low-acuity area to support the existing emergency department in
improving patient flow and accommodating increased volumes. This area will open July
9 and allow for the relocation of treatment space for CTAS 4 and 5 patients who meet
established criteria (ambulatory, normal vital signs). The area is anticipated to see 30-50
patients per day, freeing up space in the main department for more acute patients.

 Forty-two additional stabilizer beds have been approved across Grace, St. Boniface,
HSC and Concordia. Recruitment to staff these beds has begun. The beds will open as
soon as they can be reliably staffed.

 Efforts are underway to identify and address site and system-wide barriers to reducing
access block in our emergency departments.

 WRHA and Shared Health are working with the other regional health authorities to
expedite repatriation of patients.

 Further examination of options to support the safe transition of ALC patients from
hospitals to the most appropriate community settings is underway. Similarly,
opportunities to utilize existing personal care home vacancies to create additional
capacity for special needs have been identified and are being implemented, freeing up
space for individuals waiting in hospital for this specialized longer term care.

 The development of a “multi-site” medical model is also underway. This model would
allow urgent care physicians to spend time working at an acute emergency department,
thereby enabling them to maintain their skill set and credentials as emergency
physicians. The model is being explored initially for application within Winnipeg but could
be extended provincially over time.

 A system-wide strategy to expedite the hiring of nurses into vacant positions is also in
development and will include engagement in the coming days with the Manitoba Nurses
Union. There are many nurses who have expressed interest in working in our system.
Efforts are underway to streamline processes for the hiring and filling of vacant positions.

The Healing our Health System plan was envisioned to create clear roles for each of Winnipeg's
hospitals, including recognition of the specialized services offered by our three community
hospitals. Following the conversion of SOGH, Winnipeg will support three acute-care
emergency departments (Health Sciences Centre, St. Boniface Hospital and Grace Hospital).
Three urgent care centres (Seven Oaks General Hospital, Concordia Hospital, and Victoria
Hospital) will provide 24/7 care for non-life threatening health concerns requiring same-day
treatment.

Similar to the conversion of emergency department’s at Victoria and Concordia Hospitals, the
move to urgent care at Seven Oaks will position the hospital to play a vital role in improving wait
times across Winnipeg to support our goal of reaching the national average. Just as Victoria
Hospital was established with specific expertise to support mental health patients and innovative
day surgery, and Concordia retained its role as a specialized centre for orthopedic surgery,
Seven Oaks will remain at the forefront of specialized renal care, including medically complex
patients, and will continue to care for geriatric and rehabilitative patient populations.

This consolidation of clinical services brings Winnipeg in line with how care is successfully
provided in other cities of the same size. Our goal throughout implementation has been to
deliver excellent care to patients in the best possible environment. This includes enhancing
capacity in the community and improving access to diagnostics and specialists in the acute care
setting. We acknowledge that efforts to phase in the changes have resulted in disruption,
uncertainty and anxiety for staff. We are confident, however, that this remains the right plan and
that our collective efforts will ensure improved outcomes.
We remain focused on minimizing impact to patient care and improving our efforts to engage
site leadership, staff and physicians in ongoing planning, implementation and monitoring of
changes.

We remain grateful for the passion and dedication of the physicians and staff who work across
our system and whose efforts provide care and comfort to all the patients and families we serve.
Our continued work together is a critical part of creating a health care system in Manitoba that
empowers our physicians, nurses, staff and partners to deliver better care, now and for
generations to come.