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Non-
LHIN
An E
Plan
June 9, 2
Prepared
Urgent
N:
Evidenc
2014
by Performan
t Patien
ce-Base
nce Concepts
nt Tran
ed 3rd P
s Consulting I
nsporta
Party R
Inc.
tion in
Review
n the N
& Rest
North E
tructuri
East
ring
Table of
E
A
P
B
T
C
C
D
Q
E
Q
F
G
G
H
f Contents
Executive Su
A. Ration
Patient Tran
B. Overvi
Transportati
C. Review
Centred Prin
D. Situati
Qualitative F
E. Situati
Quantitative
F. Situati
Governance
G. Finding
H. APPEN
ummary
nale for Rev
sportation i
iew of N
ion Across
w Method
nciples
ion Analys
Feedback
ion Analysi
Modeling
ion Analy
& Decision
gs & Recom
NDICES
viewing No
in North Ea
Non-Urgent
Ontario
dology &
sis – Sta
is - Evidenc
ysis -
n-making
mmendation
on-Urgent
ast LHIN
Patient
Patient
akeholder
ce Based
Funding,
ns
Pag
i
1
3
9
1
2
4
5
6
ge
i
1
3
9
12
25
48
53
67
Execu
A review
2013 by
about th
(EMS) pr
timely, s
Northeas
region.
This revie
2013-201
Transpor
region’s
2014.
A Projec
Performa
work plan
The ma
populatio
the vast
tive Sum
w of non-urge
the North E
e current sy
roviders. Th
afe and cos
stern Ontario
ew of non-u
16 Integrate
rtation is als
hub hospita
ct Advisory
ance Concep
n.
p below ill
on densities,
North East L
mary
ent patient t
East Local H
ystem expre
e review’s o
st-effective n
o, while saf
rgent patien
d Health Se
o a key ena
als) identified
Committee
pts Consulti
ustrates the
, associated
LHIN geogra
transportatio
Health Integ
essed by pa
objective was
non-urgent p
feguarding n
t transfers h
ervice Plan (
bler of the c
d in the LH
e was crea
ng Inc. was
e relatively
with non-ur
aphy.
on across N
ration Netwo
atients, hos
s to develop
patient trans
needed EM
had been ide
under the ca
care models
IN’s Clinica
ated in Jun
retained (vi
long dista
rgent inter-fa
Northeastern
ork (NE LH
spitals and E
p a model of
sfers into an
S coverage
entified as a
are transitio
and pathwa
l Services R
ne 2013 to
ia RFP) to e
ances betw
acility patien
Ontario wa
IN) in respo
Emergency
f transportat
nd out of ho
e in commun
key project
ns and coor
ays (i.e. flow
Review, com
o oversee t
execute the
ween hospita
nt transporta
as begun in
onse to conc
Medical Se
tion that pro
ospital centr
nities acros
in the NE LH
rdination prio
in and out o
mpleted in M
the review,
approved pr
als, and sp
ation flows ac
i
June
cerns
ervice
vides
res in
s the
HIN’s
ority).
of the
March
and
roject
parse
cross
ii
The revie
compone
The revie
urgent tra
current s
“map” ap
ew’s stakeho
ents:
1:1 interv8 EMS pr“hubs”;
Three rouhospitals;
Three datcovering t
Working sCentres (
Ongoing Prestructur
Final repoJune 2014
ew’s stakeho
ansportation
system perfo
ppears below
older engage
iews with maroviders in th
unds of hub-w
ta driven nonthe North Ea
session withCACCs);
Project Adviring scenario
ort with syste4.
older consult
n situation an
ormance prob
w.
ement and e
anagement he NE LHIN
wide consul
n-urgent tranast;
the 5 North
sory Commos;
em restructu
tations and
nalysis and c
blems requir
execution pro
and frontlineregion, whic
tations with
nsfer “summ
eastern Ont
ittee evaluat
uring recomm
EMS data m
construct a p
ring restruct
ocess consis
e staff represch consists o
community
mit meetings”
tario Central
tion of findin
mendations
modeling wer
patient journ
uring solutio
sted of the f
senting all 2of five geogr
and second
” with the 8 E
l Ambulance
ngs and pote
provided to
re used to co
ney “map” –
ons. The sys
following
25 hospitals araphic transf
ary/tertiary
EMS Chiefs
e Communic
ential
the LHIN CE
onduct a no
emphasizing
stem problem
iii
and fer
cation
EO in
n-
g
ms
Beyond s
data mod
Reporting
restructu
stakeholder
deling under
g system (eP
ring recomm
EMS/Nonhospital s
EMS mea
EMS tran
EMS 12-h
EMS over
LHIN-wid
qualitative fe
rtaken by Pe
PCR). Deta
mendations.
n-EMS non-uservice delive
an patient tra
sfer outputs
hour daytime
rlapping eme
e patient esc
eedback, the
erformance C
ailed modelin
Modeling re
urgent transfery Hub;
ansfer durati
s (transfer ho
e “peak” serv
ergency/non
cort costing/
e review also
Concepts us
ng (using 20
eports includ
fer volume m
ion (minutes
ours delivere
vice busyne
n-urgent call
/potential res
o incorporat
sing the EMS
12 data) info
ded the follo
mapping of I
s per transfe
ed by Hub);
ss (utilizatio
s (by ambul
structuring s
ted extensive
S Electronic
ormed the re
owing:
N/OUT trans
er by Hub);
on rate by am
ance base/c
savings estim
e quantitativ
Patient Care
eview’s
sfer flows by
mbulance ba
coverage zo
mates
iv
ve
e
y
ase);
ne);
Highlight
figures.
hubs in t
transfer h
ts of the tran
The first figu
he region. T
hours delive
nsfer flow da
ure documen
The second f
red by hub.
ta modeling
nts IN/OUT n
figure sets o
across the
non-urgent t
ut “long-hau
LHIN are co
transfer volu
ul” vs. “short-
ontained in th
ume flows by
-haul” durati
he following
y the five tra
ion non-urge
v
nsfer
ent
Additiona
factors a
ii) freque
coverage
• A“l
• Lrece
• Oba
• Sreca
The revie
have tog
system p
• Tfinpo
• Tb
• Tu
• Np
• TN
al data mode
ssociated w
ency of overla
e zone. The
Across the LHong haul” du
ong-haul noesult is erodeertain ambu
Overlapping Cases. At thevailable unit
Short-haul noesponse zonannot contin
ew’s in-depth
ether delive
performance
he current nnancial persossible with
he current nlockages at
he patient enless transp
Non-urgent trrojects were
he system nNorth East.
eling and an
ith i) EMS sy
apping eme
e following ev
HIN, there isuration categ
on-urgent traed EMS reslance bases
Code 1-2 & ese bases, Ets” problem c
on-urgent tranes. There inue to delive
h qualitative
red a rigorou
conclusions
non-urgent trspective for c
successful
non-urgent trhub hospita
scort model portation bec
ransportatione implemente
needs a perm
alysis condu
ystem “peak
rgency and
vidence-bas
s a clear sepgories for pu
nsfers repreponse times
s.
3-4 calls areEMS units archaracterize
ansfers do Ns no compe
er these loca
stakeholde
us situation
s:
ransportationcommunity hrestructuring
ransportationls.
of “care andcomes far mo
n system reled in 2013.
manent, non
ucted by Per
k” busyness
non-urgent c
sed modeling
paration of nourposes of sy
esent significs & unsustain
e creating frere drawn out
ed by unacce
NOT create rlling reason l transfers w
r consultatio
analysis tha
n system is nhospitals. Hg.
n system is a
d control” is ore reliable
iability impro
-ambulance
rformance C
(12-hour da
calls within a
g conclusion
on-urgent traystem restru
cant Code 4 nable levels
equent covet of responseptable resp
isk of drawinwhy EMS a
with existing
ons and evid
at has yielde
not sustainaowever, sign
a major prob
not sustainain/out of hub
oved signific
e solution for
Concepts exp
aytime utiliza
a given amb
ns are compe
ansfers into ucturing.
EMS respo of system b
erage breakde zones cre
ponse times.
ng EMS unitand contracte
fixed resour
dence-based
d the followi
able from a pnificant finan
blem creatin
able for comb hospitals.
cantly when
r long-haul tr
plored key ri
ation rates) a
bulance base
elling:
“short haul”
nse risk. Thbusyness at
downs at cerating a “zero
ts out of ed providersrces.
d data model
ing overall
patient care ncial savings
ng patient flo
mmunity hosp
the LHIN pil
ransfers in th
vi
isk
and
e’s
” &
he
rtain o
s
ling
or s are
ow
pitals
ot
he
System
The revie
following
1. N
2. H
3. L
4. S
5. S
1. Ne
New Ope
short-hau
transfer r
within the
route-bas
and vehic
Restructuri
ew’s non-urg
categories:
New Operatio
Hospital-Base
eadership, P
System Fund
Stakeholder C
ew Operatio
erational Mo
ul versus lon
resources in
eir existing c
sed model w
cle configura
ing Recomm
gent transpo
onal Model
ed Business
Policy & Dec
ding
Communicat
onal Model
odel recomm
ng-haul non-
Sudbury an
coverage zon
with schedule
ations are as
mendations
ortation restru
s Process Im
cision-Makin
tions
mendations w
-urgent trans
nd North Bay
nes. Long-h
ed legs serv
s follows (no
s
ucturing reco
mprovements
g
will create tw
sfers. EMS s
y, will contin
haul non-urg
viced by mult
ote – these a
ommendatio
s
wo distinct se
services acr
ue to delive
gent transfer
ti-patient veh
are bi-directi
ons are orga
ervice delive
ross the LHI
r short-haul
rs will be del
hicles. The
onal routes)
anized into th
ry channels
N, and non-
transfers tha
ivered via a
proposed le
):
vii
he
for
-EMS
at fall
egs
In two ins
transfer r
up-staffin
The New
• O
tr
re
• N
sc
2
Recomm
eliminatin
urgent pa
Leveragi
currently
North Ea
patients a
occur in 2
eliminate
used to o
3
Recomm
establish
Group to
Recomm
within the
support r
stances (We
resources ar
ng envelope
w Operationa
One or more
raditional am
eturns);
New informat
cheduling.
. Hospital–
mendations c
ng the curre
atients to hu
ng process
underway a
ast LHIN will
arriving from
2015, the us
ed over time.
offset hub ho
. Leadersh
mendations c
hing a multi-s
lead the im
mendations a
e non-urgen
recommende
est Parry So
re not warra
to deliver th
al Model will
CACCs to d
mbulance res
tion technolo
–Based Bus
concerning H
nt system of
b hospitals f
improvemen
at the Thund
phase in sta
m community
se of commu
. Patient es
ospital holdin
hip, Policy &
concerning L
stakeholder,
plementatio
also address
t patient tran
ed performa
und and Cha
nted due to
he long-haul
also feature
dispatch long
sources whe
ogy tools to c
siness Proce
Hospital–Bas
f community
for tests/pro
nt insights ga
der Bay Regi
affed patient
y hospitals.
unity hospita
cort savings
ng area cost
& Decision-M
Leadership, P
permanent
n and overs
the need fo
nsportation s
nce monitor
apleau) whe
volume, con
patient tran
e the followin
g haul non-u
en appropriat
coordinate r
ess Improv
sed Business
y hospital-fun
cedures (i.e
ained from a
ional Health
t holding are
Beginning w
al patient esc
s at commun
ts.
Making
Policy & Dec
Non-Urgent
ight of the n
or improved d
system. Imp
ring and targ
ere dedicate
nsideration s
sfers.
ng:
urgent transf
te (i.e. short
ride scheduli
vements
s Process Im
nded staff es
e. continuity o
a 2013-14 No
Sciences C
eas to provid
with a pilot p
corts should
nity hospitals
cision-Makin
t Transporta
ew system a
data manag
roved data m
get setting to
d long-haul
should be giv
fer vehicles –
t haul EMS,
ing with test
mprovement
scorts accom
of patient ca
orth West LH
Centre, hub h
de basic care
roject recom
be reduced
s will be trac
ng Model/To
ation Leaders
across the N
ement pract
managemen
oolkits.
route-based
ven to an EM
– as well as
dead head
t/procedure
ts focus on
mpanying no
are and cont
HIN pilot pro
hospitals in t
e to non-urg
mmended to
d and then
cked, and wil
ols focus on
ship Working
North East L
tices/standa
nt will, in turn
viii
d
MS
on-
rol).
oject
the
ent
ll be
n
g
HIN.
rds
n,
4
System F
transport
• Eth
• Hco
• N(lseasuoC
• Opaw
5
Recomm
understa
restructu
should be
hub hosp
ORNGE)
. System F
Funding reco
tation fundin
EMS providerheir existing
Hub hospitalsontinue to do
New funding ikely selecteervice will bembulance coupport: Parryutside the L
Chapleau.
Operational satient transp
where approp
. Stakehold
mendations c
nding of the
ring actions
e implement
pital physicia
).
Funding
ommendatio
g model def
rs will continapproved bu
s that curreno so for sho
will be direced via RFP). e added to tommunity floy Sound EMHIN; and Ma
savings fromportation respriate.
der Commu
concerning S
e review’s ch
. The recom
ted for a var
ans, hospital
ons would se
fined as follo
nue funding “udgets;
ntly fund nonrt-haul patie
cted to provid Additional
he North Baow car. EMS
MS predominanitoulin-Sud
m all affectedstructuring sh
unications
Stakeholder C
hange manag
mmendations
riety of key ta
l administrat
ee the creatio
ows:
“short-haul”
-urgent trannt transfers;
ders of the nfunded vehi
ay transfer caS up-staffingnantly “southdbury EMS t
health carehould be con
Communica
gement age
s outline com
arget audien
tive and fron
on of a new
non-urgent
nsfer service;
new schedulcle hours of ar and the Sg funding is ah bound” nontransfers in a
e partners asnsidered for
ations will im
nda, and se
mmunication
nces (e.g. th
nt-line staff, E
LHIN-wide
patient trans
s (i.e. HSN a
ed long-hauf long-haul p
Sudbury EMSalso recommn-urgent tranand out of T
ssociated witreallocation
prove stake
ecure buy-in
ns strategies
e public, com
EMS provide
non-urgent
sportation w
and NBRHC
ul transfer ropatient transfS non-mended to nsfer patternTimmins from
th non-urgenn/reinvestme
holder
to the neces
s/messages
mmunity and
ers, CACCs,
ix
within
C) will
utes fer
ns m
nt ent
ssary
that
d
,
Impleme
The revie
path imp
LATER (
Do NOW
– the Lea
provider
transport
Do SOO
phased i
transfer p
performa
The Do L
staffed p
commun
entation of C
ew sets out a
lementation
year 3).
W work focus
adership Wo
RFP, and a
tation restruc
N work addr
mplementat
patient holdi
ance target d
LATER perio
atient “care
ity hospital p
Change/Res
a three-year
activities ar
es on estab
orking Group
dedicated p
cturing agen
resses the st
ion of transf
ng areas. B
development
od will featur
and control”
patient esco
structuring
r critical path
re categorize
lishing the n
p, the Coord
project mana
nda forward.
tart-up chall
fer legs and
Budget deve
t will also fal
re the final ro
” holding are
rt costs.
h for impleme
ed as Do NO
new decision
inating Cent
agement reso
enges of the
execution of
lopment, dat
ll into this tim
oll-out of hos
eas expected
enting chan
OW (Year 1)
n-making and
tre, the poss
ource to driv
e new opera
f capital imp
ta managem
meframe.
spital busine
d to generat
ge/restructu
, Do SOON
d system ma
sible long-ha
ve the non-u
ational mode
provements f
ment reforms
ess process
e significant
uring. The cr
(Year 2) and
anagement u
aul transfer
urgent
el, including
for hub hosp
s, and
changes aro
t savings in
x
ritical
d Do
units
pital
ound
A. RatiNor
Non-urge
two deca
logistics/
Medical S
ideas to c
of review
transport
Recently
transport
Health In
new regu
guideline
Non-urge
LHIN’s 2
a key req
the North
To provid
the LHIN
region’s 2
Central A
stakehold
principles
Performa
execute
culminati
Concepts
ionale forrth East L
ent patient tr
ades. The tr
patient risk c
Services (EM
clarify respo
ws, position p
tation in the
y the Provinc
tation provid
ntegration Ne
ulatory requi
es aimed at i
ent patient tr
013-16 Integ
quirement of
h East LHIN
de ongoing g
N struck a Pro
25 hospitals
Ambulance C
ders. The Ad
s, and a proj
ance Concep
project work
ion of the sta
s Consulting
r ReviewiLHIN
ransportation
ravel distanc
challenges (
MS) provide
onsibilities, ra
papers and l
North has n
ce has indica
ers will be fo
etwork’s (NE
rements (i.e
mproving tra
ransportation
grated Healt
f the NE LHI
initiated this
guidance in t
oject Adviso
s, 8 EMS ser
Communicat
dvisory Com
ject work pla
pts Consultin
k plan delive
akeholder dr
g Inc. is prov
ing Non-U
n has been a
ces between
(see map on
rs and local
ationalize fu
ocal advoca
ot yet occur
ated that a n
orthcoming d
E LHIN) 2013
e. Highway T
ansport safe
n restructuri
th Services P
N’s just com
s comprehen
this review o
ory Committe
rvices, the O
tions Centre
mmittee endo
an setting-ou
ng Inc. was
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riven review
viding this re
Urgent Pa
a challengin
community
n next page).
governance
nding, and i
acy, fundame
rred.
ew regulato
during 2014
3-14 review
Traffic Act re
ety and patie
ng is promin
Plan. Non-u
mpleted clinic
nsive review
of non-urgen
ee with stake
ORNGE air a
s (CACC) a
orsed: a proj
ut required a
retained to p
report’s res
of non-urge
port’s recom
Patient Tra
g issue in no
and hub ho
. Northern h
e authorities
mprove serv
ental restruc
ory framewor
. The timing
dovetails w
equirements)
ent care.
nently positio
urgent transp
cal service re
w of non-urge
nt patient tra
eholder repr
ambulance s
nd a numbe
ect charter,
analyses and
provide evid
structuring re
ent patient tr
mmendations
ansporta
orthern Onta
ospitals creat
hospitals, Em
have all we
vice quality.
cturing of no
rk for non-ur
g of the Nort
ith the Provi
) and health
oned in the N
portation res
eview. Durin
ent patient tr
ansportation
resentation d
service, 5 lan
er of commun
patient cent
d restructurin
ence-based
ecommendat
ransportation
s to the LHIN
tion in
ario for the p
te a host of
mergency
ighed in with
Despite a ra
n-urgent pat
rgent patient
th East Loca
nce’s upcom
service prov
North East
structuring is
ng Q2 2013/
ransportation
in the region
drawn from t
nd ambulanc
nity
tred review
ng deliverab
d analyses a
tions are the
n. Performan
N and its
1
past
h
ange
tient
t
al
ming
vider
s also
/14
n.
n,
the
ce
bles.
nd
e
nce
partners
restructu
Advisory
for consider
ring recomm
Committee
ration. Perfo
mendations h
prior to fina
ormance Co
have been th
lization of th
ncepts’ evid
horoughly re
his report.
dence-based
eviewed and
d analyses a
d supported b
nd system
by the Proje
2
ect
In terms
TL
To
But not:
T Further, f
code 1 a
Ontario.
B. Ove
Restruct
Non-urge
the North
considere
transport
response
In the No
staffing n
execute “
alternativ
volume 2
of scope, no
Transportatioong-Term C Stable me Requiring Ambulato Requiring
Transportatior psychiatric
Transportatio
from an EMS
nd 2 calls. S
erview of
turing Initia
ent patient tr
h West LHIN
ed across th
tation reliabi
e coverage.
orth West LH
necessary to
“long-haul” d
ve to traditio
225 km Keno
on-urgent tra
on for the follCare Homes/edical conditg a stretcher ory or semi-ag a nursing o
on of Emergec assessmen
on for medica
S perspectiv
See Append
Non-Urg
atives Provi
ransportation
N, the South
hese LHINs v
lity for non-u
HIN, the key
o safeguard e
duration non
nal land amb
ora-Winnipe
ansportation
lowing patie/patient residtion; and vehicle; or
ambulatory inor other heal
ency Departnt under the
al appointme
ve, non-urge
dix #1 for the
gent Patie
ince-wide
n restructuri
West LHIN,
vary, but the
urgent patien
restructuring
emergency c
n-urgent pati
bulance prov
g corridor is
within the c
nt groups bedences:
npatients/LTth provider e
ment patienMental Hea
ents within a
ent refers to
e definition o
ent Transp
ng is being a
and the Sou
e common re
nts achieved
g issue is su
coverage wh
ent transfers
vision of non
also being a
context of thi
etween hosp
TC residentsescort
ts requiring lth Act
a community
lower priority
of pertinent a
portation
actively cons
uth East LH
estructuring
d without com
upplementar
hen ambulan
s outside the
n-urgent tran
actively cons
is project ref
pitals, or from
s; or
access to a
y or between
y calls i.e. d
ambulance c
n Across
sidered, or is
IN. The solu
denominato
mpromising
ry funding fo
nces at remo
eir catchmen
nsfers within
sidered.
fers to:
m hospitals t
schedule 1
n communitie
ispatched as
call codes in
Ontario
s underway,
utions being
or is improve
EMS emerg
or EMS up-
ote bases m
nt areas. An
n the higher
3
to
bed
es
s
, in
ed
gency
must
n
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and exec
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e Elliot Lake
n Canada. C
g land transfe
3 “up-coding
o a broken t
nd-offs. Ma
de care by h
o provide sim
ms/delays for
ss protocol t
distance thre
ent applicatio
equire EMS
se to restore
ent escorts a
ion between
mance & dec
e ambulance
patient co-m
s most pron
rsus an Onta
e population
Concerns tha
er trips need
” acknowled
transportatio
ny commun
ub hospital s
mple orders
r EMS servic
that ORNGE
eshold. How
on of the OR
units to dro
e eroded Cod
and associa
n community
cision-makin
e base.
morbidities (p
ounced in E
ario-wide av
is composed
at elderly pa
ds to be reco
dged & expla
on system.
ity hospitals
staff, while c
.
ces, resulting
E non-urgent
wever, actua
RNGE fly/no
p Code 2 pa
de 4 coverag
ated staff sch
y hospitals, h
g when ove
patients sicke
Elliot Lake wh
verage of 40
d of individu
atient transfe
ognized.
ained as a p
s intrigued by
community h
g in late/mis
t air ambula
al MOHLTC
o fly business
atients at hub
ge. This res
heduling
hub hospitals
rlapping Cod
er than Cod
here the me
years.
uals aged 65
er demand w
atient advoc
y the Thunde
hospital
14
sed
nce
s
b
sults
s,
de 1-
e 2
dian
5+
will
cacy
er
U
p
C
a
Commun
transport
the abse
hospitals
LHIN 201
pilot in th
Hub
Stakehol
Sciences
Hospital,
performa
perspect
N
re
T
h
Universal sup
rojects; as p
Community h
nd high volu
nity hospital
tation system
nce of integ
s are strongly
13 pilot proje
he Thunder B
b Hospital P
ders across
s North, Nort
and Temisk
ance of the c
ives are as f
Non-urgent tr
equirements
There is an o
ubs to quart
Nose
Mapa
Ri
pport among
proven soluti
hospitals wan
ume transit le
stakeholder
m, character
rated planni
y supporting
ects, and the
Bay district.
Perspective
the North E
th Bay Regio
kaming Hosp
current non-u
follows:
ransportation
s.
overriding ne
terback non-
on-urgent prelection of tra
aximize utilizaramedic pilo
de home log
g community
ions to fix th
nt pilot resou
egs.
observation
rized by a fla
ng and decis
g of the impro
e currently e
on Non-urg
East LHIN’s f
onal Health
pital) share a
urgent patien
n solutions M
eed for a “ne
-urgent trans
rocedure boansport reso
zation of EMot project res
gistics out of
y hospitals fo
e current no
urces scaled
ns paint a pic
awed funding
sion-making
ovement op
volving Nort
gent Transp
five transpor
Centre, Tim
a common s
nt transporta
MUST suppo
rve centre” b
sport logistic
ookings, seleource for ride
MS non-parasources.
f the hub hos
or the North
on-urgent pa
d upwards to
cture of an u
g model, silo
g. On the po
portunities in
th West LHIN
portation Sy
rtation hub h
mins & Distr
set of perspe
ation model.
ort hub hosp
business un
cs:
ection of trae back.
amedic trans
spital for Co
East LHIN 2
atient transpo
o benefit all L
unreliable no
o-driven stak
ositive side,
nherent in th
N patient ca
ystem Perfo
hospitals (i.e
rict Hospital
ectives conc
These com
pital patient o
it within/acro
ansport reso
sfer services
ode 1 patient
2013 EMS p
ortation syst
LHIN hospita
on-urgent pa
keholders an
community
he North Eas
are and contr
ormance
e. Health
, Sault Area
cerning the
mmon
outflow
oss the LHIN
ource for rid
s, and LHIN
ts are the ke
15
ilot
tem.
als
atient
nd
st
rol
N
de in,
EMS
ey.
P
h
R
co
S
of
Im
b
S
a
h
ORN
ORNGE
where th
under a S
ORNGE
most not
patient b
Patient care &
ospitals
ExEm
Recognition o
ommunity ho
Significant log
f community
Pahu
Ph
Hu
mpact of com
ut stable” tra
SaCo
Strong suppo
ddress the c
ospital runs)
NGE Perspe
provides me
e transfer di
Standing Off
medical dire
ably by not p
y an ORNG
& control po
xample: Normergency D
of communit
ospitals on s
gistical chall
y hospital pa
atient care lub hospital h
hysical spac
ub hospital h
mmunity hos
ansfers on h
ame patient ode 3 up-cod
ort for refinin
challenges o
).
ective on No
edically nece
stance betw
fer Agreeme
ectors estab
permitting th
E paramedic
licies (impac
rth Bay policepartment v
ty hospital nu
solutions wit
enges need
atient care to
ogistics re. holding area
ce planning a
holding area
spital physici
hub hospitals
profile is a Cded in aftern
g & expandi
of the ride in
on-urgent T
essary trans
ween facilitie
ent (SOA) de
lish non-urg
he transfer o
c to an EMS
cting commu
cy to assumversus other
urse escort p
hout LHIN fu
d to be consi
o hub hospita
any future staff.
and logistics
a staffing imp
ian Code 3 “
s needs to be
Code 2 callnoon.
ing 2013 LH
and the ride
Transportati
portation for
s exceeds 2
elivers ORNG
ent patient c
of care for a l
S or transfer
unity hospita
me Code 1-2hubs.
process pro
unding.
dered in any
al staff. The
community
s for any futu
pacts and co
“up-coding”
e monitored
in the morn
HIN pilot proje
e out (both lo
ion System
r Code 1-2 p
240 km. Con
GE non-urge
care standar
low CTAS m
service non-
als) vary acro
2 patient ca
blems; trying
y system to
ese include:
hospital phy
ure holding a
osts.
of non-urgen
d.
ing when EM
ect resource
ocally and lo
Performan
patients acro
ntracted fixe
ent patient t
rds for the o
medically sta
-paramedic
oss hub
re and cont
g to work wit
transfer asp
ysician orde
areas.
nt “schedule
MS available
es/solutions
onger inter-
nce
oss the provi
ed wing aircr
ransportatio
rganization;
able Code 1-
attendant.
16
trol in
th
pects
ers to
ed
e, but
to
ince,
raft
on.
-2
Historica
ORNGE
Sciences
services
endemic
services
However
order to c
ground tr
and back
aircraft.
In Sudbu
retained
charge” E
paramed
Platinum
longer de
$350k in
patients f
these OR
lly, EMS ser
Code 1-2 pa
s Centre (TB
have been p
delays for C
(i.e. Ambutr
r, ORNGE pa
comply with
ransfers. T
k to the airpo
As well, dail
ury the ORN
to provide la
EMS airport
dic was requ
ride from th
elays. Total
2012. ORN
from the Sud
RNGE tarma
rvices in Thu
atients from
BRHSC) or H
preoccupied
Code 1-2 cal
rans in Thun
aramedics r
the medical
he time dela
ort tarmac, re
ly aircraft uti
GE detentio
and transpor
ride in 2011
ired to trave
he airport req
annual cost
NGE has now
dbury airpor
ac patients –
under Bay an
the respecti
Health Scien
d with high C
lls. During 2
nder Bay and
ode along w
l directors’ ri
ays associate
esulted in ta
ilization was
n fees incre
rtation for Co
1 permitted t
l to HSN. In
quired ORNG
ts to ORNGE
w discontinu
rt to HSN. F
– with all the
nd Sudbury
ive airport ta
ces North (H
Code 3-4 eme
2012-2013 O
d Platinum in
with the patie
sk managem
ed with the O
armac detent
negatively i
ased from $
ode 1-2 tran
he transfer t
n 2012 and 2
GE medics t
E from the P
ued its arrang
or the time b
same delay
have proven
armacs to Th
HSN) in a tim
ergency res
ORNGE relie
n Sudbury) t
ent all the wa
ment policies
ORNGE par
tion fees bei
impacted by
$150k to $18
sfers. The p
to occur at th
2013 the mo
to ride along
Platinum tran
gement with
being, Sudb
y problems e
n unreliable
hunder Bay
mely fashion
sponse work
ed on private
to move thes
ay to the TB
s on non-urg
ramedic ride
ing levied on
y tarmac dela
80k when Pla
previously d
he airport; n
ore timely pu
g, thereby cr
nsport mode
h Platinum to
bury EMS am
experienced
in moving
Regional He
n. These EM
load, promp
e transfers
se patients.
RHSC or HS
gent patient
e to the hosp
n the fixed w
ays.
atinum was
elayed “no
no ORNGE
urchased
reating even
el exceeded
o transfer tar
mbulances m
in 2011.
17
ealth
S
pting
SN in
pital,
wing
rmac
move
A solutio
airport ta
an opera
patient tr
ORNGE
paramed
Ove
The follo
transport
journey”
the comm
challenge
superimp
n to the airp
armac based
ational priorit
ransfer probl
expenditure
dic transfer s
rall Non-urg
wing figure “
tation system
from the com
munity hospi
es/problems
posed in red
port tarmac p
d transfer bet
ty for ORNG
lem have rep
e reduction fr
solution on th
gent Transp
“maps” the k
m across the
mmunity hos
ital (in black
s identified w
across the
patient transf
tween an OR
GE. ORNGE
portedly dec
rom the 201
he tarmac is
portation Sy
key challeng
e LHIN. This
spital to the
) following th
with the curre
process ma
fer problem
RNGE param
expenditure
creased from
2 peak is po
enacted.
ystem Perfo
ges/problems
s high-level p
hub hospita
he test/proce
ent model (a
p.
– by creatin
medic and a
es associate
m their peak
ossible if a ti
ormance Ch
s with the no
process map
l (in green),
edure at the
as identified
ng a timely/d
a land EMS p
ed with the S
of $350k in
mely/reliable
hallenges/P
on-urgent pa
p reflects the
and the retu
e hub hospita
by key stake
ependable
paramedic –
Sudbury tarm
2012. Furth
e paramedic
Problems
atient
e “patient
urn trip back
al. The
eholders) are
18
– is
mac
her
c-to-
k to
e
19
Nort
The Nort
pilot proje
commun
T
C
T
H
K
a
R
w
T
fil
th West LHI
th West LHIN
ect involving
ity hospitals
TBRHSC (hu
Code 1-2 pat
Ty
TBRHSC has
Holding area
8-wh
Ensc
Pr
Key impleme
t TBRHSC;
Region-wide
would be exp
Communistaff (e.g.
If these pto ER like
Participatto their ho
Two phase ro
lled at TBRH
IN Patient C
N is currently
g Thunder B
. The follow
b hospital) w
ients from co
ypically diag
s established
to be staff b
hour shift behile Superior
nvisioning twchedule.
rojected 1:3
ntation issue
no transfer o
re-credentia
panded to res
ity hospital p IV or meds)
atients reque any other in
ting communospital by-law
ollout is plan
HSC and Ph
Care and Co
y funding a n
ay Regional
wing pilot pro
would accep
ommunity ho
nostic imagi
d a 3 patient
by a 1FTE R
eginning at 9r North EMS
wo trained R
staff to patie
e is establish
of responsib
aling process
solve care &
physician w) for “treat &
ire emergenndividual.
nity and hubws; lawyers
nned. Phase
ase 2 for pa
ontrol Pilot
non-urgent t
Health Scie
oject facts ar
pt partial care
ospitals.
ng tests/pro
t holding are
RPN.
9-10 a.m. (paS medics stil
PN staff to e
ent ratio with
hing credent
bility to TBRH
s for physicia
& control pro
ill be able to& return” Cod
ncy care duri
b hospitals wcurrently wo
e 1 for patien
atients with o
transportatio
ences Centre
re relevant fo
e & control f
ocedures.
ea in diagnos
atients mustl on shift).
ensure cove
h frequent pa
tials for com
HSC physici
ans already
oblems.
o issue minode 1-2 patien
ing time at T
will need to morking on thi
nts with no re
order require
on patient “ca
e and a larg
or purposes
for low acuity
stic imaging
t be returned
erage across
atient turnov
mmunity hosp
ans.
underway in
or scope ordnts.
TBRHSC the
make legal ws matter in t
equirements
ements.
are and con
e portfolio o
of this revie
y “treat & ret
.
d before 7 p
s weekly wor
ver anticipate
pital physicia
n NW LHIN;
ders to TBR
ey would pro
wording chathe NW LHIN
s for orders t
20
trol”
of
ew:
turn”
.m.
rk
ed.
ans
RHSC
oceed
anges N.
to be
2013
In 2013,
traditiona
Sudbury
patient “c
radio rem
Sciences
pre-empt
car was s
per week
Manitouli
stretcher
to facilita
Espanola
Sudbury.
attendan
transmiss
origin, so
Timiskam
use, so t
performe
provider
calls betw
reassigne
The three
functionin
3 North Eas
the North Ea
al EMS para
EMS collab
community f
moved) provi
s North. The
ted from its p
staffed by tw
k.
in-Sudbury E
r vehicles de
ate the transf
a Regional H
. The pilot’s
ts who rece
sion. These
o stranding o
ming EMS ad
hat hospital
ed all in-distr
executed al
ween 1600-0
ed to EMS fo
e pilot projec
ng of the EM
st LHIN Pilo
ast LHIN imp
medic-base
orated with
low car”. Th
ided short ha
e vehicle wa
patient trans
wo Sudbury E
EMS deliver
eployed Mon
fer of Code
Hospital and
s two non-am
ived enhanc
e vehicles ro
of patient an
dapted the S
staff could d
rict non-eme
l of the out-o
0700 daily.
or completio
cts have del
MS emergen
t Projects
plemented t
d model for
Health Scien
his vehicle (p
aul patient tr
s not include
sfer work by
EMS param
red a non-pa
nday-Friday 0
1-2 patients
Health Cen
mbulance tra
ced training o
utinely waite
d escort wer
SW LHIN Pa
determine th
ergency calls
of-district no
Calls that th
on.
ivered signif
cy response
hree pilot pr
delivering no
nces North (
previously an
ransfers of p
ed in the EM
ambulance
edics, and d
aramedic tra
0800-1900 d
from the two
tre, to-and-f
ansfer vehicle
on stretchers
ed in Sudbur
re significan
atient Transp
he most appr
s between 07
n-emergenc
he private tra
ficant and m
e system and
rojects to exp
on-urgent pa
(HSN) to del
n ambulance
primarily Cod
MS deployme
dispatch (C
deployed on
nsfer service
daily. The p
o Manitoulin
from Health
es are staffe
rs, patient mo
ry to return p
tly reduced.
port Decision
ropriate tran
700-1600 da
cy calls 24 h
ansfer provid
measurable im
d the non-ur
plore alterna
atient transp
liver a non-a
e, but with m
de 1 patients
ent plan and
ACC). The
a 12-hour s
e consisting
prime functio
n Health Cen
Sciences No
ed by non-pa
obility and d
patients to th
n Guide (alg
nsport solutio
aily. A priva
ours a day,
der was not
mprovement
rgent transpo
atives to the
portation.
ambulance
markings and
s out of Hea
d could not b
community
shift, seven d
of two dual
n of the pilo
ntre facilities
orth in
aramedic firs
disease
he facility of
orithm) for th
on. EMS
te transfer
and in-distri
able to do w
ts in the
ortation mod
21
d
alth
be
flow
days
t was
s, and
st-aid
heir
ct
were
del.
Almost 5
originally
urgent tra
overwork
delays at
Problema
hospital p
commun
and the v
The follo
,200 EMS e
y intended by
ansfer workl
ked Manitou
t the Health
atic up-codin
physicians h
ity hospital m
virtual elimin
wing table c
emergency c
y EMS deplo
oad (i.e. cal
lin-Sudbury
Sciences No
ng of schedu
has largely d
medical and
nation of the
contains high
coverage hou
oyment plan
l volume) wa
EMS bases
orth emerge
uled non-urg
dissipated ac
administrat
highly probl
hlights of pilo
urs have bee
s. Overall, E
as reduced t
. Both the fr
ency departm
gent procedu
ccording to E
ive staff iden
ematic stran
ot project pe
en recovered
EMS system
to more man
requency an
ment were re
ures (to urge
EMS leaders
ntified enthu
nded patient
erformance in
d and re-dep
m “busyness”
nageable lev
nd duration o
educed by 12
ent status) by
ship. EMS s
usiastic supp
t escort.
ndicator data
ployed as
” due to non
vels at
of patient off
2 percent.
y community
surveys of
port for the p
a.
22
n-
fload
y
pilots,
The pilot
aspects o
dependa
Ove
EMS pro
independ
transport
T
f
s
i
T
a
o
p
projects hav
of the restru
ble non-urge
rall Stakeho
viders, com
dently advan
tation model
The non-urge
from patient-
significant fin
mplementat
The non-urge
a major prob
offload delay
patients and
ve provided
cturing solut
ent patient tr
older Obser
munity hosp
nced the follo
:
ent patient s
-centred or f
nancial savin
ion of the re
ent patient t
blem for hub
y in emergen
escorts with
the Perform
tion/model th
ransportatio
rvations
pitals and hu
owing overa
system that p
financial pers
ngs at comm
commended
ransportatio
hospitals; c
ncy departm
hin the hub h
mance Conce
hat will be re
n system.
b hospitals a
ll observatio
pre-dated th
spectives fo
munity hospit
d new non-u
on system tha
reating patie
ents, and re
hospitals.
epts team fu
equired LHIN
across the N
ons about the
he 2013 pilot
r community
tals are poss
urgent transp
at pre-dated
ent flow bloc
esulting in str
undamental i
N-wide to cre
North East L
e non-urgen
t projects is
y hospitals.
sible with su
portation mo
d the 2013 p
ckages, cont
randed com
insights into
eate a stable
HIN
nt patient
not sustaina
However,
uccessful
odel.
ilot projects
tributing to
munity hosp
23
key
e,
able
was
pital
T
c
t
b
S
p
r
The regional
community h
ransportatio
becomes sca
System relia
projects were
resources fo
hubs mode
hospitals fac
on becomes
alable for an
bility and the
e implement
r long-haul p
el of non-urge
ing aging de
far more rel
nticipated inc
e patient exp
ted in 2013.
patient trans
ent patient c
emographic
iable in/out o
creases in tr
perience imp
Scalable an
sfers betwee
care will not
pressures –
of hub hospi
ransfer volum
proved signi
nd permane
en hospitals
be financial
– unless patie
itals and the
mes.
ficantly whe
ent non-amb
are necessa
ly sustainab
ent
e system
en the pilot
ulance
ary.
24
ble for
E. Situ
In order t
hospital s
quantitat
pre-dated
calendar
Sudbury
As noted
vehicle h
overlapp
to unders
For purpo
of output
approach
of the LH
A mini-hu
In/Out an
uation An
to test the pe
stakeholders
ive modeling
d the 2013 p
r year data fr
(Platinum).
d in the follow
hour outputs,
ing calls. EM
stand Code
oses of mod
t, an In/Out m
h focuses on
HIN’s four hu
ub in New Li
nalysis.
nalysis - E
erspectives
s, the Perfor
g of the EMS
pilot projects
rom EMS pro
wing figure, m
, EMS syste
MS base-sp
3-4 patient r
deling LHIN-w
modeling ap
n community
ub hospitals
iskeard (feat
Evidence
and observa
rmance Con
S (and privat
s. The quant
oviders, as w
modeling ha
m “busynes
ecific analys
risk posed b
wide pattern
proach has
y hospital/fac
located in S
turing a CT s
Based Q
ations of the
cepts projec
te provider)
itative mode
well as the e
as been cond
s” by base, a
sis has been
y Code 1-2 w
ns of Code 1
been used b
cility Code 1
udbury, Nor
scanner) ha
Quantitati
e various EM
ct team has
non-urgent
eling has bee
existing priva
ducted LHIN
and overlap
n undertaken
workload.
-2 transfer v
by Performa
-2 non-urge
rth Bay, Sau
s also been
ive Model
MS, commun
undertaken
transportatio
en conducte
ate transfer s
N-wide on tra
ping Code 1
n where app
volumes and
ance Concep
nt “traffic” flo
lt Ste. Marie
modeled to
ling
ity and hub
extensive
on system th
ed using 201
supplier in
ansfer volum
1-2 and 3-4
propriate, in o
d vehicles ho
pts. The In/O
owing in and
e, and Timm
complete th
25
hat
2
mes,
order
ours
Out
d out
ins.
he
The figur
analysis
the facilit
re below pro
documents
ty/residence
ovides a conc
patient Code
of origin.
ceptual illust
e 1-2 flow (b
tration of the
by any EMS
e In/Out ana
service) into
alysis across
o a hub hosp
s the LHIN. T
pital and bac
26
The
ck to
IN/O
The follo
(i.e. high
Health S
from the
Current H
Sudbury
The total
The Cod
deploying
Sciences
OUT Analysi
wing table h
est volume i
ciences Nor
Sudbury Air
Hospital (95)
y “IN” Flow
number of 2
e 1-2 transfe
g for the tran
s North. The
is – Sudbur
highlights the
institutions a
rth originate
rport (200), E
), and North
of Code 1-2
2012 Sudbu
er duration (
nsfer patient
e same “stop
ry Hub
e 2012 Sudb
and hospitals
at Elliot Lak
Espanola Ho
Bay Region
2 Transfers
ury hub “IN” C
i.e. transfer
t pick-up, an
p watch” app
bury hub’s “IN
s). The larg
ke Saint Jose
ospital (181)
nal Health Ce
Code 1-2 tra
minutes) “st
d does not t
plies to all 5
N” flow of Co
est flows of
eph Hospita
), Mindemoy
entre (91).
ansfers is 1,9
top watch” is
turn off until
transportatio
ode 1-2 non
inter-hospita
l (250), ORN
ya Hospital (
941.
s turned on b
ambulance
on hub IN/O
n-urgent tran
al transfers t
NGE patients
115), Little
by an ambul
arrival at He
OUTS.
27
nsfers
to
s
lance
ealth
Sudbury
The table
highest v
The large
to Elliot L
Espanola
Hospital
The total
y “OUT” Flo
e above high
volume instit
est flows of i
Lake Saint J
a Hospital (2
(49), and No
number of 2
ow of Code
hlights the 20
utions and h
inter-hospita
oseph Hosp
201), Mindem
orth Bay Reg
2012 Sudbu
1-2 Transfe
012 Sudbury
hospitals).
al transfers o
pital (318), th
moya Hospit
gional Healt
ury hub “Out”
ers
y “OUT” flow
outwards fro
he Sudbury A
tal (126), Litt
h Centre (46
” Code 1-2 t
w of Code 1-
m Health Sc
Airport for O
tle Current H
6).
ransfers is 2
-2 non-urgen
ciences Nort
ORNGE trans
Hospital (119
2,915.
nt transfers (
th are traveli
sport (269),
9), Kirkland
28
(i.e.
ing
Lake
IN/O
The follo
transfers
The large
West Nip
Temiska
predomin
North Ba
The tota
The follo
transfers
OUT Analysi
wing table h
s (i.e. highes
est flows of i
pissing Gene
ming Hospit
nantly origina
ay “IN” Flow
al number of
wing table h
s (i.e. highes
is – North B
highlights the
t volume ins
inter-hospita
eral Hospital
al (61), and
ate at the M
w of Code 1
2012 North
highlights the
t volume ins
Bay Hub
e 2012 North
stitutions and
al transfers to
l (171), ORN
Health Scie
attawa Gene
1-2 Transfer
Bay hub “IN
e 2012 North
stitutions and
h Bay hub’s
d hospitals).
o North Bay
NGE patients
ences North
eral Hospita
rs
N” Code 1-2
h Bay hub “O
d hospitals).
“IN” flow of
y Regional H
s from the Ja
(47). Ruthe
al.
transfers is
OUT” flow of
Code 1-2 no
Health Centre
ack Garland
erglen (relay)
731.
f Code 1-2 n
on-urgent
e originate a
Airport (98)
) calls
non-urgent
29
at
),
North Ba
The large
are trave
Garland A
Hospital
The total
IN/O
The follo
(i.e. high
The large
with inco
ay “OUT” F
est flows of i
eling to West
Airport to lin
(36).
number of 2
OUT Analysi
wing table h
est volume i
est flows of i
oming ORNG
Flow of Code
inter-hospita
t Nipissing G
nk-up with O
2012 North B
is – Sault H
highlights the
institutions a
inter-hospita
GE patients (
e 1-2 Trans
al transfers o
General Hos
RNGE (85),
Bay hub’s “O
Hub
e 2012 Sault
and hospitals
al transfers to
(143), Blind
fers
outwards fro
pital (263), H
Temiskamin
OUT” Code
t hub’s “IN” f
s).
o Sault Area
River Hospit
m North Bay
Health Scien
ng Hospital
1-2 transfers
flow of Code
a Hospital or
tal (90), and
y Regional H
nces North (9
(84), and Ma
s is 1,290.
e 1-2 non-urg
riginate at th
d Thessalon
Health Centr
91), Jack
attawa Gene
gent transfe
he Sault Airp
Hospital (62
30
re
eral
rs
port
2).
Sault “IN
The total
Sault “O
The follo
(i.e. high
The large
the Sault
Hospital
The total
N” Flow of C
number of 2
OUT” Flow o
wing table h
est volume i
est flows of i
t Airport (152
(46).
number of 2
Code 1-2 Tr
2012 Sault h
of Code 1-2
highlights the
institutions a
inter-hospita
2) for conne
2012 Sault h
ransfers
hub’s “IN” Co
Transfers
e 2012 Sault
and hospitals
al transfers o
ctions to OR
hub’s “OUT”
ode 1-2 tran
t hub’s “OUT
s).
outwards fro
RNGE, Blind
Code 1-2 tr
nsfers is 584
T” flow of Co
m Sault Are
River Hosp
ransfers is 1
.
ode 1-2 non-
a hospital a
pital (92), and
,210.
-urgent trans
re traveling
d Thessalon
31
sfers
to
n
IN/O
The follo
(i.e. high
Timmins
The large
the Timm
(159), Ki
Hearst H
The total
The table
urgent tra
The large
traveling
Anson G
Memoria
Chapleau
OUT Analysi
wing table h
est volume i
s “IN” Flow
est flows of i
mins Airport f
rkland Lake
Hospital (51),
number of 2
e on the nex
ansfers (i.e.
est flows of i
to the Timm
eneral (218)
l (73), Smoo
u Hospital (2
is – Timmin
highlights the
institutions a
of Code 1-2
inter-hospita
for ORNGE
Hospital (13
, Chapleau H
2012 Timmin
xt page highl
highest volu
inter-hospita
mins Airport (
), Kirkland la
oth Rock Fal
20).
ns Hub
e 2012 Timm
and hospitals
2 Transfers
al transfers in
(408), Kapu
36), Lady Mi
Hospital (35)
ns hub’s “IN
ights the 20
ume institutio
al transfers o
(373) for con
ake Hospital
lls (68), Hea
mins hub’s “I
s).
s
nto Timmins
uskasing Hos
nto Hospital
), and Engle
” Code 1-2 t
12 Timmins
ons and hos
outwards fro
nnection to O
(166), Lady
arst (50), Eng
N” flow of C
s and District
spital (182),
l (116), Bing
ehart District
transfers is 1
hub’s “OUT
spitals).
m Timmins a
ORNGE, Ka
y Minto Hosp
glehart Distr
ode 1-2 non
t Hospital (T
Anson Gen
gham Memo
Hospital (17
1,686.
T” flow of Co
and District
puskasing H
pital (113), B
rict Hospital
n-urgent tran
TDH) origina
eral Hospita
rial Hospital
7).
ode 1-2 non-
Hospital are
Hospital (221
Bingham
(21) and
32
nsfers
te at
al
(72),
e
1),
The total
Timmins
IN/O
The follo
transfers
New Lisk
The large
at the Kir
Hospital
number of 2
s “OUT” Flo
OUT Analysi
wing table h
s (i.e. highes
keard “IN” F
est flows of i
rkland Lake
(84), and Su
2012 Timmin
ow of Code
is – New Lis
highlights the
t volume ins
Flow of Cod
inter-hospita
Hospital (16
udbury’s Hea
ns hub’s “OU
1-2 Transfe
skeard Hub
e 2012 New
stitutions and
de 1-2 Tran
al transfers in
69), Engleha
alth Science
UT” Code 1-
ers
b
Liskeard hu
d hospitals).
sfers
nto New Lisk
art and Distri
es North (24)
-2 transfers
ub’s “IN” flow
keard’s Tem
ct Hospital (
). Airport ca
is 2,199.
w of Code 1-2
miskaming H
(76), North B
all volume is
2 non-urgen
ospital origin
Bay General
minor (7).
33
nt
nate
The total
New Lisk
The follo
transfers
The large
the Kirkla
Hospital
The total
Und
The follow
North East
As docume
significant
volumes:
number of 2
keard “OUT
wing table h
s (i.e. highes
est flows of i
and Lake Ho
(60), Health
number of 2
derstanding
wing table su
t LHIN’s five
ented within
margin in e
2012 New L
T” Flow of C
highlights the
t volume ins
inter-hospita
ospital (223)
Sciences N
2012 New L
IN/OUT Tra
mmarizes IN
e transportat
n the table, th
ach hub. Th
iskeard hub
Code 1-2 Tra
e 2012 New
stitutions and
al transfers o
, Englehart a
North (15), E
iskeard hub
ansfer Volum
N/OUT Code
ion hubs.
he OUT tran
here are a n
’s “IN” Code
ransfers
Liskeard hu
d hospitals).
outwards fro
and District
arlton Airpor
’s “OUT” Co
me Varianc
e 1-2 non-urg
nsfer volume
umber of rea
e 1-2 transfe
ub “OUT” flow
m Temiskam
Hospital (11
rt (18) and T
ode 1-2 trans
ces
gent patient
es exceed th
asons for th
ers is 455.
w of Code 1
ming Hospita
1), North Ba
TDH (6).
sfers is 590.
t transfer flow
e IN transfe
is pattern of
-2 non-urge
al are traveli
ay General
ws across th
r volumes b
f transfer
34
nt
ng to
he
y a
Ptra
O
Cho
Non-urge
the challe
Summar
Physician up-ransfers are bout the clin
Over-triaged
Code 3-4 tranospital & the
ent transport
enge posed
ry of IN/OUT
Notes:
1) Nort
vehicle
2) Prev
presen
remove
hospita
individu
-coded transbest unders
nical impact o
Code 3 tran
nsfer patienten return as
tation restru
by significan
T Non-urgen
h Bay data doe
trips, because
viously in this re
ted. In the cons
ed (i.e. in some
al’s transfer “ou
ual hospitals’ in
sfers are notstood as “urgof delayed te
sfers (DCPI
ts whose conCode 1 tran
cturing reco
nt Code 1 pa
nt Transfer
es not include 5
e trip volumes a
eport, hub hosp
solidated summ
e instances one
ut”), and thus th
n/out volume.
t included in gent” Code 2ests due to t
2 algorithm
ndition impronsfers
mmendation
atient repatr
r Volumes
500+ North Ba
are not tracked
pital-specific in
mary table abo
e hospital’s tran
he numbers are
“sending ho2 patients, btransfer ride
m) who return
oves signific
ns in this rep
riation OUT v
y Hospital non
d on in/out basi
n/out informatio
ove, duplicate c
nsfer “in” may a
e not strictly a s
ospital” totalsased on phy
e delays)
n as Code 1
cantly via tre
port will need
volumes.
-paramedic tra
s.
on has been co
cases have bee
also be anothe
summation of t
s (these Codysician judgm
transfers
atment at hu
d to recogniz
ansfer
orrectly
en
er
the
35
de 3 ment
ub
ze
Parr
The prev
West Pa
primarily
Muskoka
not show
following
A totSold(15),
Thes
Recomm
found in
Mod
The Perf
expresse
durations
The follo
non-urge
Bay hub,
New Lisk
The IN/O
with aver
durations
Sudbury
Timmins
ry Sound No
vious In/Out
rry Sound H
moving pati
a, Simcoe Co
w up in the IN
Parry Soun
tal of 167 londiers Memori, and Huntsvse transfer v
mendations in
Parry Sound
deling Non-u
formance Co
ed as Code 1
s have been
wing table s
ent transfer o
, 1,910 hours
keard hub. T
OUT transfer
rage duratio
s of 90+ min
hub, 939 ho
hub, and 1,
on-Urgent T
analysis doc
ealth Centre
ients outside
ounty, and th
N/OUT analy
nd “OUT” vol
ng-haul Codial Hospital (ville District Hvolumes con
n this review
d.
urgent Tran
oncepts proje
1-2 vehicle h
used to calc
sets out the t
output hours
s in the Sau
These outpu
rs feature du
ns less than
utes (one w
ours in the N
211 hours in
Transfer Re
cuments pat
e has a uniq
e of the Nort
he GTA. Th
yses. Howev
lume transfe
e 1-2 transfe(24), Royal VHospital (18sumed a tot
w will address
nsportation
ect team has
hours of serv
culate vehic
total 2012 C
s range from
lt hub, 4,910
ut hour totals
urations that
n an hour (on
ay). Long-h
North Bay hu
n the New Li
eferral Patte
tient movem
ue referral p
th East LHIN
herefore, Par
ver Performa
er pattern for
ers to WaypVictoria Hos). tal of 283 lon
s the unique
Service De
s modeled 2
vice. IN/OU
le hours of s
ode 1-2 tran
6,477 in the
0 hours in th
s include bot
fall into two
ne way), and
haul transfer
b, 1,015 hou
iskeard hub.
ern
ent flows wi
pattern for its
N to destinat
rry Sound E
ance Conce
r 2012:
point Mental pital (18), So
ng-haul trans
e Code 1-2 t
elivery Outp
2012 EMS no
T transfer vo
service acros
nsfer output
e Sudbury h
he Timmins h
th IN and OU
distinct cate
d long-haul t
output hour
urs in the Sa
.
thin the LHI
s Code 1-2 t
ion hub hos
MS transfer
epts has doc
Health Centouth Musko
sfer hours.
ransfer refer
puts – EMS
on-urgent tra
olumes and
ss all 5 trans
hours by hu
ub, 1,727 ho
hub, and 1,3
UT transfer v
egories – sh
transfers wit
rs range from
ault hub, 3,5
N. However
transfers –
pitals locate
workload do
cumented the
tre (74), Orilka Memoria
rral patterns
Vehicle Hou
ansfer outpu
average tra
sportation hu
b. The total
ours in the N
392 hours in
volumes.
ort haul tran
h average
m 4,357 in th
510 hours in
36
r,
ed in
oes
e
lia l
s
urs
uts –
ansfer
ubs.
l
North
the
nsfers
he
the
Summar
The follo
(by trans
Long-ha
ry of EMS C
wing table fo
portation hu
aul Code 1-2
Ne
Code 1-2 Tra
ocuses on lo
ub).
2 Transfer V
Hub
Sudbury
North Bay
Sault
Timmins
ew Liskeard
Total
ansfer Outp
ong-haul pat
Volumes & M
2012 EMSLong-HauTransfer Volumes
2,230
934
573
1,893
918
5,548
put Hours
tient transfer
Mean Durat
S ul
s
2012Long
TranHo
4,3
93
1,0
3,5
1,2
11,
r volumes, o
tion
2 EMS g- Haul nsfer
ours
MHa
357
39
015
510
211
,032
output hour
Mean Long-aul Transfer Duration (Hours)
2.01
1.26
1.77
1.87
1.46
---
rs, and dura
37
ation
The Sud
2.01 hou
1.26 hou
1.77 hou
of 1.87 h
duration
return tim
transfer l
Longer in
risk, acco
suggeste
ambulan
Mod
EMS sys
for non-u
emergen
also nega
System b
UHU calc
actively r
Consultin
Code 1-2
been furt
Peak day
executed
calculatio
bury hub ex
rs. The Nor
rs. The Sau
rs. The Tim
ours. The N
of 1.46 hour
me for empty
eg.
nter-hospital
ording to EM
ed that short
ces need no
deling EMS
stem “busyne
urgent patien
ncy call cove
atively impa
busyness in
culates the p
responding t
ng has calcu
2 non-urgent
ther refined o
ytime UHU is
d during this
ons in order
perienced 2
rth Bay hub
ult hub expe
mmins hub ex
New Liskeard
rs. These du
y ambulance
Code 1-2 tr
MS and comm
-haul Code
ot leave their
System Bus
ess” is an im
nt transporta
erage and re
cted by exce
the Ontario
percentage o
to a Code 1-
ulated two di
t calls, and C
on the basis
s the key me
twelve-hour
to assess th
,230 long-ha
experienced
rienced 573
xperienced 1
d hub exper
urations mea
es to return t
ransfers repr
munity hosp
1-2 transfers
r Code 3-4 e
syness – U
mportant met
ation. Exces
sponse time
essive ambu
EMS sector
of a deploye
-4 call. For m
stinct UHU d
Code 3-4 em
s of a “peak d
etric becaus
r window. T
he risk posed
aul Code 1-2
d 934 long-h
long-haul tr
1,893 long-h
ienced 918
asure patien
o base follow
resent signif
pital stakehol
s do not rep
emergency c
Unit Hour Uti
tric to review
ssive system
es. Code 1-2
ulance syste
r is measure
ed vehicle ho
modeling pu
data sets for
mergency ca
daytime” twe
se the vast m
his report w
d by system
2 transfers w
aul transfers
ransfers with
haul transfer
long-haul tra
nt transfer tim
wing a comp
ficant EMS C
lders. Stake
resent comp
coverage zo
tilization (UH
w when cons
m busyness n
2 response r
em busyness
ed using unit
our of servic
urposes, Per
r all EMS ba
alls. These tw
elve-hour pe
majority of Co
ill focus on t
busyness.
with an avera
s with an ave
h an average
rs with an av
ansfers with
me – they do
pleted IN or
Code 3-4 res
eholders hav
parable risk
nes to execu
HU) by Bas
sidering restr
negatively im
reliability (i.e
s.
t hour utilizat
ce that is con
rformance C
ases in the N
wo UHU sce
eriod defined
ode 1-2 tran
the “peak da
age duration
erage durati
e duration of
verage durat
an average
o NOT includ
OUT patien
sponse cove
ve also
since
ute this work
e
ructuring op
mpacts Code
e. promptnes
tion or UHU
nsumed by
oncepts
North East LH
enarios have
d as 7am to
nsfers are
aytime” UHU
38
n of
ion of
f
tion
e
de
t
erage
k.
tions
e 3-4
ss) is
.
HIN:
e
7pm.
U
The follo
across th
calculate
Minutes”
(minutes
initial tran
base. A
Code 1-2
(but usua
The UHU
ambulan
negative
ambulan
gap that
wing table s
he LHIN. It a
ed by creatin
denominato
) consumed
nsfer travel t
caveat - the
2 call is assu
ally occurs).
U results are
ce daytime b
ly impacted
ce bases wh
seriously co
sets out the “
also present
g a ratio def
or. The resu
by Code 1-
time, patient
e formula cal
umed to inclu
The same
e best unders
bases versu
by an inordi
here long-ha
ompromises
“peak daytim
ts a consolid
fined by a “T
ulting ratio is
2 workload.
t offload time
lculates a “h
ude return ti
ratio calcula
stood by sep
us multi-amb
nately high
aul Code 1-2
Code 3-4 co
me” Code 1-2
dated Code 1
Time on Call
s a percentag
The “Time
e at the dest
igh end of a
me to base
ation formula
parating EM
ulance dayt
UHU. The s
2 transfers cr
overage and
2 and Code
1-4 UHU. Th
s” numerato
ge of daytim
on Calls” nu
tination hosp
accurate” UH
– a situation
a applies to t
S bases into
ime bases.
system busy
reate a “zero
d response ti
3-4 UHUs fo
he Code 1-2
or and a “Da
me deployed
umerator cal
pital, and ret
HU value, be
n that does n
the Code 3-4
o two catego
Both base c
yness risk is
o units availa
imes.
or EMS base
UHU is
ytime Deplo
vehicle time
culation incl
turn time to
ecause each
not always o
4 UHU pane
ories; single
categories a
acute for sin
able” covera
39
es
oyed
e
ludes
occur
el.
are
ngle
age
2012 Peak D
Daytime Unit HHour Utilizationn (UHU) – Codee 1-2, 3-4, 1-4 T
Transfers
40
There are
high Cod
Timmins
system b
UHU of 6
urgent tra
deployme
primarily
Vehicles
long-hau
ambulan
occurring
There are
Code 1-2
(16%), E
Code 1-2
services
closer to
bases).
a daily ba
When Co
bases, th
e a number
de 1-2 UHU
(33%), Mind
busyness ris
65% somew
ansfers are a
ent plan. EM
to Code 3-4
at these bas
l inter-hospi
ce bases, re
g.
e a number
2 UHU ratios
spanola (21
2 UHU ratios
often respon
the exposed
The net resu
asis.
ode 3-4 UHU
he risk mana
of multi-am
ratios. Kapu
demoya (37%
k threshold o
hat exagger
actually up-s
MS deploym
4 emergency
ses are ofte
tal transfers
educed eme
of single-am
s. Examples
%), West Ni
s suggest fre
nd to “zero a
d bases (the
ult is a signif
U workload i
agement res
mbulance da
uskasing (65
%), and Kirk
of 30 percen
rates the “on
staffed with
ment plan veh
y coverage,
n being rem
. While “zer
rgency resp
mbulance d
s include Blin
ipissing (22%
equent “zero
available uni
ereby provid
ficant risk “s
s combined
ult is even m
aytime base
5%), Elliot La
kland Lake (4
nt. It should
n-the-ground
ambulance
hicle hours t
are being co
oved from th
ro available
onse capaci
daytime bas
nd River (17
%) and Engl
o units availa
its” by movin
ing sub-optim
pike” re. em
with Code 1
more problem
es across the
ake (55%), I
43%) all fea
be noted th
d” system bu
resources n
that are supp
onsumed by
heir emerge
units” may n
ity (below pl
ses across th
7%), Thessa
ehart (18%)
able” emerge
ng ambulanc
mal emerge
mergency res
1-2 UHU wo
matic.
e LHIN with
Iroquois Fall
ture UHU ra
hat Kapuskas
usyness beca
ot budgeted
posed to be
y Code 1-2 w
ncy coverag
not be the re
anned levels
he LHIN with
lon (41%), L
). At all of the
ency covera
ces from an
ncy coverag
sponse capa
rkload for th
inappropriat
ls (41%),
atios exceed
sing’s daytim
ause many n
d in the
devoted
workload.
ge zones for
esult at multi
s) is frequen
h alarmingly
Little Current
ese bases, t
ge gaps. EM
adjacent ba
ge for both
ability on virtu
ese at-risk
41
tely
ing a
me
non-
r
-
ntly
high
t
the
MS
ase
ually
ModWor
The follo
overlapp
3-4 emer
coverage
2 call is a
zone. Th
ambulan
Overlapp
emergen
units ava
available
units red
emergen
system li
catchme
2012 Ov
EMS ServicAlgoma
Algoma
Algoma
Algoma
Algoma
Cochrane
Cochrane
Cochrane
Cochrane
Cochrane
Cochrane
Cochrane
Cochrane
Parry SounParry SounParry SounParry SounParry Soun
deling EMS rkload
wing table (2
ing Code 1-2
rgency call o
e and respon
a long-haul t
he overlappi
ce at any giv
ping calls are
ncy readines
ailable”. How
e” is the prac
eployed from
ncy response
ke Sudbury
nt area.
verlapping C
ce
d
d
d
d
d
E
Blind River E
Hornepayne
Thessalon ‐Wawa ‐ S
Hearst Base
Kapuskasing
Cochrane ‐Iro
Matheson Smooth Roc
South PTim
Pa
Burks Falls Seguin ‐ S
South RiverPowassan ‐
Emergency
2 panels) do
2 and Code
overlaps with
nse times ca
transfer rem
ng call risk s
ven time.
e more frequ
s is negative
wever, at the
ctical reality f
m adjacent b
e times. The
EMS where
Call Risk Ev
EMS Base ‐ Single Ambulan
Elliot Lakee ‐ Single Ambula
‐ Single Ambulan
Single Ambulance
‐ Single Ambula
g ‐ Single Ambula
‐ Single Ambulan
oquois Falls‐ Single Ambulan
k ‐ Single Ambula
Porcupine Basemmins Basearry Sound ‐ Single Ambulan
Single Ambulance
r ‐ Single Ambula
‐ Single Ambulan
y Coverage
ocuments a s
3-4 calls wit
h a Code 1-2
an be negativ
oving an am
spikes when
uent at base
ely impacted
e 12-hour sin
for all overla
bases to min
e overlappin
e multiple un
vent by EMS
Overlapp
nce 36
108
nce 1
nce 198
e 5
nce 46
nce 446
ce 15
260
nce 4
ance 8
73
141
192
nce 8
e 8
ane 6
nce 13
Risk Assoc
significant ris
thin a given
2 transfer alr
vely impacte
mbulance fro
n the EMS ba
s with more
d but the situ
ngle unit bas
apping calls
nimize risk si
g call model
its service a
S Base
pedCalls Code
6
85 1
8
6
6 1
5
0
3 1
19 3
2 1
3
ciated with
sk event for
base’s cove
ready in prog
ed. This is e
m its emerg
ase in quest
than one am
uation does n
ses across a
involving lon
imply canno
ling is not ap
a single busy
e 3‐4 Calls Ove
594
1840
78
542
358
624
1038
472
535
226
230
1265
3699
1691
678
297
616
654
Code 1-2 N
EMS servic
erage zone.
gress, EMS
especially tru
ency respon
tion only dep
mbulance de
not always e
all 5 hubs, “z
ng-haul Cod
ot avoid unac
pplicable in a
y Code 4 res
erlap % Code 3‐46%
59%
1%
37%
1%
7%
43%
3%
49%
2%
3%
6%
38%
11%
1%
3%
1%
2%
Non-Urgent
ce providers
When a Co
emergency
ue if the Cod
nse coverag
ploys one
eployed – ov
equate with “
zero units
e 1-2 transfe
cceptably lon
a large urba
sponse
42
–
ode
de 1-
e
verall
“zero
ers –
ng
an
EMS ServicMan‐Sud
Man‐Sud
Man‐Sud
Man‐Sud
Man‐Sud
Man‐Sud
Man‐Sud
Man‐Sud
Man‐Sud
Man‐Sud
NIPISSING
NIPISSING
NIPISSING
NIPISSING
Sault
Sault
Timiskamin
Timiskamin
Timiskamin
Algoma E
profile –
a single d
represen
faced 1,0
faced 36
Cochrane
Code 3-4
Timmins
negative
Parry So
daytime (
non-urge
ce
G
G
G
G
ng
ng
ng
Noelville Hagar ‐ Gogama Foleyet ‐Chapleau
Little CurreM
Massey ‐Wikweikon
Espanola Mattawa
N
W NipissinNB Ferris
Garden RivOld Ga
Englehart
K
Temi
EMS feature
Elliot Lake, T
daytime (12
nting 37% of
085 overlapp
overlapping
e EMS overs
4 call volume
. The single
ly impacted
und EMS ha
(8 and 12 ho
ent transfers
EMS Base ‐ Single Ambula
Single Ambulanc
‐ Single Ambualn
‐ Single Ambulan
‐ Single Ambula
nt ‐ Single Ambu
Mindemoya
‐ Single Ambulan
ng ‐ Single Ambu
‐ Single Ambula
‐ Single Ambula
B Main Baseg ‐ Single Ambul
s‐ Single Ambula
er ‐ Single Ambu
arden River Roadt‐ Single Ambula
irkland Lakeskaming Shores
es two bases
Thessalon a
hour) ambu
its Code 3-4
ping call eve
g calls impac
sees three m
e impacted b
e ambulance
by Code 1-2
as one base
our) deploye
negatively i
Overlap
nce
ce
nce
nce
nce
ulance 5
2
nce
lance
nce 5
nce
10
lance 2
nce
ulance
d 16
nce 3
5
2
s with a high
and Blind Riv
lance, and i
4 call volume
ents represen
cting 6% of i
multi-ambula
by overlappi
e Hearst bas
2 overlappin
that is signi
ed ambulanc
mpact appro
ppedCalls Cod
1
5
1
7
3
55
244
6
10
52
12
052
206
26
7
663
34
564
269
h-risk profile,
ver respectiv
n 2012 face
e. The mult
nting 59% of
ts Code 3-4
ance bases (
ng Code 1-2
se deals with
g transfers.
ificantly impa
ces. At the P
oximately on
de 3‐4 Calls O
456
355
249
55
247
556
678
557
769
774
311
4969
1390
1521
539
9297
525
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, and one ba
vely. Algom
ed 198 overla
i-ambulance
f its Code 3-
call volume
(daytime) wi
2 calls – Kap
h 7% of its an
acted – the
Parry Sound
ne-in-ten em
Overlap % Code 30%
1%
0%
13%
1%
10%
36%
1%
1%
7%
4%
21%
15%
2%
1%
18%
6%
46%
20%
ase with a m
ma’s Thessalo
apping call e
e (daytime) E
-4 call volum
e.
ith a high pe
puskasing, Ir
nnual emerg
Parry Sound
d base, overl
mergency cal
3‐4
moderate risk
on base dep
events
Elliot Lake b
me. Blind Riv
ercentage of
roquois Falls
gency calls b
d base with t
lapping Cod
lls.
43
k
ploys
base
ver
s and
being
two
e 1-2
Manitoul
(daytime
incidents
Nipissing
and the M
deployme
Sault EM
urban ba
Temiska
bases –
call even
EMS
The follo
generate
in-Sudbury E
) bases – M
s at these tw
g EMS faces
Main Base in
ent base, wh
MS has an 18
ase – 1,663 t
ming EMS d
Kirkland Lak
nts in 2012.
S Quantitati
wing figure h
ed by Perform
EMS deals w
indemoya (3
o bases tota
s significant o
n North Bay
hile the Nort
8% rate of ov
total calls in
deals with sig
ke and Temi
Temiskamin
ive Modeling
highlights re
mance Conc
with significa
36%) and Lit
al 244 and 5
overlapping
(21%). Wes
th Bay base
verlapping C
2012.
gnificant ove
skaming Sh
ng Shores (2
g Conclusio
elevant non-u
cepts quantit
ant overlapp
ttle Current (
5 respective
call burdens
st Nipissing
is a multi-am
Code 3-4 cal
erlapping ca
ores. Kirkla
20%) faced 2
ons
urgent patien
tative model
ing call burd
(10%). Ann
ely.
s at two bas
is a single-a
mbulance (d
lls at its mult
ll risk at two
and Lake (46
269 overlapp
nt transporta
ling of EMS
dens at two m
ual 2012 ov
es – West N
ambulance d
daytime) bas
ti-ambulance
multi-ambu
6%) faced 56
ping call eve
ation restruc
data.
multi-ambula
erlapping ca
Nipissing (15
daytime
se.
e Old Garde
lance (dayti
64 overlappi
ents in 2012
cturing insigh
44
ance
all
5%)
en
me)
ing
.
hts
The IN/O
categorie
Sle
Loutim
The risk
emergen
system b
LHIN.
In contra
coverage
fixed-cos
covered
OUT quantita
es of non-urg
hort-haul traeave their res
ong-haul tranits to leaveme.
profile assoc
ncy performa
busyness, an
st, short-hau
e risk; there
st ambulance
by their exis
ative modelin
gent patient
ansfers (lessspective bas
ansfers (typice their base’s
ciated with lo
ance across
nd emergenc
ul non-urgen
is no quantit
es executing
sting bases.
ng exercises
transfers:
s than an hose emergenc
cally approacs emergency
ong-haul no
the North Ea
cy coverage
nt transfers d
tative model
g this medica
s have confir
ur) that typiccy response
ching 90 miny response c
n-urgent tra
ast LHIN. R
e breakdown
delivered by
ling case tha
ally necessa
rmed the exi
cally DO NOe coverage z
nutes or mocoverage zo
nsfers is sig
Risk associat
s, spikes at
EMS create
at justifies th
ary work with
istence of tw
OT require EMzones.
re) that DO ones for exte
gnificant – im
ted with day
certain base
e materially
he replaceme
hin the local
wo distinct
MS units to
require EMSended period
mpacting EM
ytime EMS
es across th
less emerge
ent of efficie
communitie
45
S ds of
S
e
ency
ent
s
Patie
The table
Concepts
patient e
The cost
1. Cb
2. Mlo
3. A(
4. Mp
The three
range of
data alre
ent Escort C
e on the nex
s project tea
scorts for lo
ing scenario
Compile 201by hub;
Multiply a paong-haul ca
Add total lon(yielding tota
Multiply totalpatient escor
e costing sce
$1.82 M to $
eady cited in
Costing An
xt page conta
am regarding
ng-haul non
os are mode
2 EMS Cod
atient escort ll volume to
g-haul transal required p
required part costing for
enarios yield
$2.48 M, usi
this report.
alysis
ains three co
g community
-urgent patie
led using the
e 1-2 and up
“in hospital”calculate tot
sport hours tatient escort
atient escort r each hub, a
d an estimat
ing the 2012
osting scena
y hospital co
ent transfers
e following fo
p-coded Cod
time estimatal annual “in
o total “in hot hours);
hours by a $across each
ted annual c
2 long-haul p
arios develop
osts associat
s.
formula:
de 3 long-ha
ate (4/5/6 hon hospital” p
ospital” esco
$45/hour coh of the three
community h
patient trans
ped by the P
ted with the
aul transport
our scenariospatient escor
ort hours for
ost factor to ee costing sce
ospital patie
sfer volumes
Performance
provision of
t hours/volum
s) by the hubrt hours;
each hub
establish a toenarios.
ent escort co
/hours mode
46
e
mes
b’s
otal
ost
eling
Community
y Hospital Patieent Escort Cossting Scenarioss
47
F. Situ
Syst
The fund
years, ur
commun
sector pa
overburd
Commun
patients,
their own
transfer f
item” for
Urban ho
Health S
predomin
these ho
Consortiu
consisten
initiative
model. C
standard
Large ho
dependa
budget ro
“free” am
small hos
uation An
tem Fundin
ding of non-u
rban Ontario
ity hospitals
atient transfe
dened urban
nity hospitals
while secon
n patient flow
funding with
this service.
ospital fundin
ciences Nor
nantly directe
spitals.
ums of hosp
nt private co
in the South
Contractor st
ized across
ospitals in the
ble rides for
oom to utilize
mbulance tra
spitals with l
nalysis – F
ng re. the No
urgent patien
o has been s
and second
er services.
EMS provid
s are funding
ndary/tertiary
w reasons. U
in their exist
.
ng of non-ur
rth and the N
ed towards s
pitals are ban
ontractor pur
hwest LHIN h
taff qualifica
the Southw
e Southwest
r patients. H
e the fee-for
nsfers. The
imited budg
Funding,
on-Urgent P
nt transporta
steadily evolv
dary/tertiary
Private sect
ders to delive
g the transpo
y hospitals a
Urban hospi
ting base bu
rgent patient
North Bay Re
short-haul tr
nding togeth
chasing arra
has generate
ation and veh
est LHIN.
t LHIN are m
However, sm
r-service priv
Southwest L
ets may opt
Governa
Patient Tran
ation is not c
ving towards
hospitals in
tor contracto
er timely/dep
ortation and
are funding p
tals across O
dgets - budg
t transfers al
egional Hea
ransfers that
her in some p
angements a
ed a high-qu
hicle configu
making use o
maller commu
vate contrac
LHIN’s hosp
for “free & f
ance & De
nsportation
onsistent ac
s a hospital-
urban Onta
ors are a nec
pendable no
escort costs
post-procedu
Ontario are s
gets that do
lready exists
lth Centre. T
t create posi
parts of Onta
and pricing.
uality fee-for
uration servic
of the contra
unity hospita
ctor, and are
pital funded m
fast” EMS tra
ecision-M
System
cross the Pro
funded mod
rio have fun
cessity, give
on-urgent tra
s of their “tre
ure patient re
somehow fin
not have a d
s in the Nort
This funding
itive patient
ario to provid
As an exam
r-service sing
ce levels hav
actor to secu
als reportedl
instead opt
model is dem
ansfers via u
Making
ovince. In re
del. Both
ded private
en the inabili
ansfer servic
eat and retur
epatriation f
nding non-ur
designated “
h East LHIN
g is
flow impacts
de efficient a
mple, a recen
gle contracto
ve been
ure timely,
y cannot find
ting for conti
monstrating
up-coded Co
48
ecent
ty of
ces.
rn”
for
rgent
“line
N – at
s for
and
nt
or
d
nued
that
ode 3
requests
for them
hospitals
Reinvest
contracte
A “non-u
urban ho
unavoida
staffing to
an EMS
Sudbury
In one sc
not requi
quo trans
continue
non-urge
schedule
“chase th
transfers
Alternativ
integrate
urgent pa
of a front
same ve
minute sc
North We
and achie
from some
to secure no
s could be re
ted patient e
ed providers
rgent transfe
ospital funde
able and nec
o preserve C
non-parame
EMS (param
cenario, a no
ring busines
sfer-provider
to chase sc
ent ride woul
ed procedure
he single pat
s.
vely in a sec
ed with new/r
atient transp
t-end financi
hicle during
cheduled rid
est LHIN’s T
eve financia
physicians.
on-paramed
educed by co
escort financ
.
er-provider”
d model. Pr
cessary EMS
Code 3-4 cov
edic transfer
medic staffed
on-urgent tra
ss process c
r funding mo
cheduled pro
d be a react
e at a hub ho
tient” model
cond scenari
restructured
portation. Bu
al investmen
transport. T
de could be r
Thunder Bay
al savings.
A LHIN sub
ic transfer re
ontrolling the
ial savings c
funding mod
resumably, a
S paramedic
verage. A tr
model, a pr
d) non-ambu
ansfer-provid
changes or im
odel, non-urg
ocedures arr
tive “one-off”
ospital for a
has historic
io, a non-urg
business pr
usiness proc
nt by creatin
The practice
re-assessed
y “holding are
bsidy for sma
esources. P
e required nu
could be use
del represen
a transfer-pr
c costs assoc
ransfer-prov
rivate sector
ulance flow c
der based fu
mprovement
gent transfer
ranged by ho
” arrangeme
single patien
cally eroded
gent transfer
rocesses to
cess improve
ng ongoing c
of “chasing
d. Non-trans
eas” pilot co
all hospitals
Potential cos
umber of es
ed to partially
nts a viable/p
rovider fundi
ciated with n
vider funding
provider mo
car.
unding mode
ts at particip
r rides in the
ospitals in a
ent to accom
nt. It should
EMS capab
r-provider fu
improve the
ements coul
capacity for m
the schedu
sportation pr
ould eliminate
would seem
sts for small
cort staffed
y fund non-p
preferred alt
ing model co
non-urgent t
g model coul
odel, or inno
el could stan
pating hospit
e North East
separate sil
mmodate a se
d be noted th
bility to servic
nding mode
e cost-effecti
d reduce the
multiple pati
led procedu
rocess chang
e stranded p
m to be requ
community
transfers.
paramedic
ternative to t
ould support
ransfer up-
d also supp
ovations like
nd independe
tals. In a sta
t LHIN would
lo. The fund
eparately
hat this reac
ce non-urge
el could be
veness of no
e dollar amo
ents on the
re” with a la
ges as per t
patients/esco
49
ired
the
t
ort
the
ently,
atus-
d
ded
tive
nt
on-
ount
st
he
orts
In essen
a broade
derived
service le
Long
The curre
independ
A
o
sc
lin
co
A
sy
sy
th
fo
se
a
a
ta
re
ex
Performa
Indicator
planning
ce, a non-ur
er non-urge
results targ
evel contrac
g-Haul Syst
ent non-urge
dent, non-int
Absence of a
perational st
cheduling an
ne of busine
onsistent pa
Absence of s
ystem plann
ystem used
he province
or system pla
ervice delive
lthough beg
s part of the
argets derive
eport card to
xist.
ance Concep
rs (KPI) to in
and reportin
rgent transfe
ent transpor
gets, transpa
t would beco
tem-Wide P
ent patient tr
tegrated bus
a staffed LHI
teering & res
nd long-haul
ess. Allocatio
atient algorith
ystem-wide,
ning, operatio
by MOHLTC
(originally po
anning and r
ery unit costs
inning steps
e three 2013
ed from histo
o share perfo
pts Consultin
form future s
ng.
er-provider fu
rtation chang
arent result
ome part an
Planning & O
ransportation
siness proce
N-wide “nerv
sults reportin
l transportat
on of the “rig
hm, could be
, reliable per
onal steering
C to collect/r
opulated wit
reporting pu
s, process e
s towards pe
pilot project
oric data tren
ormance dat
ng has deve
stakeholder
unding mode
ge manage
ts reporting
d parcel of t
Operations
n “system” is
esses. For e
ve centre” m
ng. A nerve
ion provision
ght” transpo
e achieved a
rformance m
g, and result
report ambu
h local CAC
rposes. Key
execution, an
erformance m
ts. Given the
nds do not y
ta and drive
eloped the fo
discussion/f
el would bec
ement initiati
against ta
the provider
Using Key
s characteriz
example:
mandated to
e centre coul
n sides of th
rtation vehic
across LHIN
measuremen
ts reporting.
lance Code
CC dispatch d
y Performan
nd quality fo
measuremen
e absence o
yet exist. A p
continuous
ollowing set o
finalization o
come a critic
tive. Perfor
rgets, and
based fundi
Performanc
zed by a ser
provide inte
ld coordinate
he non-urgen
cle solution,
hospitals.
nt data to info
The curren
1-4 call data
data) is clea
nce Indicator
r patients do
nt were requ
of KPI, future
public, trans
improvemen
of Key Perfo
of results ba
cal compone
rmance indi
a fee-for-re
ing model.
ce Indicator
ries of
egrated plann
e the proced
nt patient ca
using a
orm long-ha
nt ADRS dat
a from acros
arly inadequa
rs (KPI) of
o not yet exis
uired by the L
e performan
sparent resul
nt also does
ormance
sed busines
50
ent of
icator
esults
rs
ning,
dure
re
ul
a
ss
ate
st -
LHIN
ce
lts
s not
ss
Service
a) A
Busi
b) %-
c) %m
d) P
Patie
e) %ct
This port
the long-
service w
system in
non-trans
monitorin
patient e
Delivery Ou
Annual Code
# long-ha
# “on the
UHU by l
% stretch
Cost per
Cost per
Cost per
iness Proce
% Code 1-2 - as originally
% Code 1-2 mandated pa
Patient esco
ent Impact
% Code 1-2community hransfer patie
tfolio of KPI w
-haul non-urg
will be tracke
n generating
sportation ch
ng the overa
xperience.
utputs & Eff
e 1-2 long-ha
aul Code 1-2
e road” long-
long-haul ro
her “seats” o
deployed lo
delivered lo
long-haul tr
ess Executio
long-haul lay scheduled
long-haul traatient escort
rt hours per
2 long-haul hospital/LTCents)
will provide
gent patient
ed. The on-t
g cost reduct
hange mana
all length of t
ficiency
aul transfers
2 transfer pa
haul transfe
ute leg (% d
occupied for
ong-haul tran
ong-haul tran
ansfer patie
on
nd transfers (3-year tren
ansfers featut (3-year tren
100 long-ha
transfers f facility by n
a comprehe
transfer sys
time success
tion via redu
agement cha
he “treat and
s by LHIN fu
atients delive
r vehicle hou
deployed veh
each long-h
nsfer vehicle
nsfer hour
nt
s where patiend line)
uring patientnd line)
aul transfer p
featuring “sano later than
ensive “dash
stem. The a
s rate will be
uced use of p
allenge. Fina
d return” cyc
nded route l
ered
urs delivered
hicle hours s
haul route/leg
e hour
ent arrives o
t delivery wit
patients (3-y
ame day” r8 p.m. (app
board” for p
mount/cost/
e tracked. T
patient esco
ally, patient
cle – a critica
leg (3-year t
d versus pla
spent deliver
g
on-time for th
thout a hub
year trend lin
return of paplied only to
lanning and
/utilization of
The performa
orts will be tra
impact will b
al element o
trend lines)
anned
ring patients
he test/proce
hospital
ne)
atient to or“treat and re
monitoring
f transport
ance of the
acked – a ke
be tracked b
of the overall
51
s)
edure
riginal eturn”
of
ey
by
l
Sho
Short ha
that can
measure
previousl
reduction
delivered
Hori
To date,
compose
non-urge
place. T
the provi
such, no
Stakehol
On a pos
beginning
However
necessar
In order t
ORNGE,
bureaucr
ideal; wit
making a
rt-Haul Tran
ul non-urgen
be impleme
e EMS system
ly consumed
ns, and redu
d is also a m
izontal Lead
the non-urg
ed of a range
ent “system”
his silo-base
nce. The no
r has it been
ders recogn
sitive note, th
gs of coordin
r, leadership
ry horizontal
to provide ho
CACCs and
ratic setting.
th an overrid
and operatio
nsfers - Key
nt transfers d
nted for syst
m performan
d by long-ha
ced UHU ar
eaningful ef
dership & P
ent patient t
e of health c
has actually
ed reality is n
on-urgent pa
n managed o
nize this prob
hen NE LHIN
nated opera
p and policy-
l system lea
orizontal sys
d private sec
An empow
ding patient-c
nal levels.
y Performan
delivered by
tem manage
nce benefits
aul non-urgen
re examples
fficiency indi
Policy-Makin
transfer syst
care actors b
y been a non
not unique to
atient transp
or funded wi
blem, and th
N’s three 20
tions and co
making are
dership and
stem-wide le
ctor provider
wered workin
centred man
nce Indicato
y EMS also r
ement and a
generated b
nt transfers.
of relevant
cator.
ng Authority
em across t
budgeting an
n-system wit
o North Eas
ortation line
th the focus
e need for d
13 pilot proje
ohesion amo
not yet prop
d manageme
eadership, co
rs will need t
g group (sta
ndate to prov
ors
require perfo
accountability
by freeing up
EMS Code
indicators.
ty
he North Ea
nd operating
th little horiz
st Ontario; it
of business
necessary t
dedicated lea
ects have su
ong the 30+
perly structur
ent.
ommunity ho
to work toge
affed by seni
vide leaders
ormance me
y reporting.
p vehicle ho
e 3-4 respon
EMS cost pe
ast LHIN has
within vertic
zontal co-ord
is the norm
s has not bee
to ensure su
adership and
ucceeded in
EMS and ho
red/focused
ospitals, hub
ether in a fle
ior managem
ship on plann
asurement t
The key is t
ours of servic
nse time
er transfer h
s been
cal silos. Th
dination talki
across mos
en recognize
uccess.
d policy-mak
n building the
ospital actor
to provide th
b hospitals, E
xible, non-
ment) would
ning, policy-
52
tools
to
ce
hour
he
ng
t of
ed as
king.
e
rs.
he
EMS,
be
G. Find
Findings
1
2
3
4
5
6
1. Ne
The reco
and over
existence
addresse
(dispatch
Performa
problems
2013 pilo
The key
recomme
1-1 Sh
LH
ex
1-2 Lo
mu
an
1-3 Lo
an
dings & R
and recomm
. New Oper
. Hospital B
. System Le
. System Fu
. Stakehold
. Implemen
ew Operatio
ommended n
rlapping calls
e of distinct s
es long-haul
hed by CACC
ance Concep
s. The new
ot projects.
components
ended as fol
hort-haul Co
HIN. CACCs
xisting proce
ong-haul Cod
ulti-patient v
nd “dead hea
ong-haul Cod
nd multi-patie
Recomme
mendations
rational Mod
Based Busine
eadership, P
unding
er Commun
tation Critica
onal Model
new operatio
s modeling.
short-haul a
transfers –
C) intact for
pts’ quantita
model is con
s of a restruc
lows:
de 1-2 trans
s and/or hos
sses.
de 1-2 transf
vehicles, para
ad” ambulan
de 1-2 transf
ent transfer
endations
have been o
el
ess Process
Policy & Dec
nications
al Path
onal model is
The new op
nd long-hau
leaving the e
short-haul tr
tive evaluati
nsistent with
ctured opera
sfers should
spitals will co
fers to be de
ramedic flow
nce units (ac
fers to be de
vehicles (rec
s
organized int
s Improveme
ision-Making
s evidence-b
perational m
ul non-urgent
existing land
ransfers. Th
ion of the cu
h many of the
ational mode
continue wit
ontinue to dis
elivered via a
w cars, poten
ross the ent
elivered via r
commended
to the follow
ents
g
based; it dra
model recogn
t transfer clu
d ambulance
he new long-
urrent transfe
e improveme
el for non-urg
th EMS & pr
spatch these
a new blend
ntial contract
tire LHIN).
regularly sch
d detailed ro
wing categori
ws from the
nizes the dat
usters. The
e-based deli
-haul model
er system’s
ent insights
gent transpo
rivate contra
e transfers a
d of EMS non
ted private tr
heduled tran
utes outlined
ies:
IN/OUT, UH
ta-supported
new model
very approa
is derived fr
performance
provided by
ortation are
actors across
according to
n-paramedic
ransfer servi
nsfer legs/ro
d across all
53
HU,
d
ach
rom
e
y the
s the
the
c
ices
utes
5
LH
ho
pre
1-4 The
ope
to a
pat
am
1-5 In a
tran
a)
HIN hospital
ospitals and
edictable fas
e following s
erational mo
an initial per
tient volume
mbulance res
addition to th
nsportation s
) Expand th
dual stret
transportatio
return them
shion.
specific two-
odel. The re
riod of opera
s merit addi
sources. Spl
he eight sche
service level
he annual op
tcher/wheelc
on hubs). R
to communi
way routes/l
commended
ations – for in
itional transp
lit shifts can
eduled non-
l and staff co
perating hou
chair transfer
Routes shoul
ity hospitals
/legs are reco
d initial resou
nstance wee
port capacity
also be imp
urgent trans
onfiguration
urs of the cur
r vehicle to 1
ld be design
in a timely,
ommended
urce deploym
ekend routes
y beyond cur
plemented as
sportation ro
adjustments
rrent North B
12 hours M-
ned to move
cost-effectiv
for the restr
ment can be
s can be con
rrent EMS a
s required o
utes, the foll
s are recomm
Bay Regiona
-F. The adde
patients into
ve and
ructured
e refined sub
nsidered if
and non-
on 8-hour rou
llowing
mended:
al Health Ce
ed 4 hours p
54
o hub
bject
utes.
entre
per
b)
c)
1-6 Giv
ass
the
a)
b)
day (1,04
Based on
deployed
) Reconfigu
consist of
qualified i
compared
required.
) Deliver th
Hospital l
(funded a
ven the some
sociated with
following se
) Parry Sou
urgent tra
volumes/p
“one off” r
) EMS up-s
WPSHC l
recomme
funding co
derived re
40 annual ho
n North Bay h
on weekend
ure the staffi
f a primary c
in advanced
d to the 2013
The 12-hou
he relatively l
long-haul Co
as per 1-6 b)
ewhat uniqu
h the West P
ervice delive
und EMS am
ansfer servic
patterns, this
reactive tran
staffing costs
long-haul Co
nded non-ur
omponent sh
esults target
ours) would b
hospital fore
ds and adjus
fing of the Su
care parame
d first aid. Th
3 pilot projec
ur, 7 days/we
low annual v
ode 1-2 trans
below).
ue out-of-LHI
Parry Sound
ery/funding re
mbulances sh
ces for patien
s service wil
nsportation m
s associated
ode 1-2 non-
rgent transp
hould be tied
ts, and annu
be delivered
ecasts, these
sted on sele
udbury EMS
dic (PCP) an
his configura
ct, while still
eek deploym
volume of Ch
sfers using e
IN pattern of
Health Cen
ecommenda
hould contin
nts at WPSH
ll not be rout
model now in
d with provid
-urgent trans
ortation prov
d to an MOU
ual results rep
d as long-hau
e long-haul t
cted weekda
S non-ambula
nd a non-pa
ation will hav
providing pa
ment pattern
hapleau Hos
existing EMS
f non-urgent
tre (i.e. sout
ations are ap
nue to provid
HC. Due to a
te based, bu
n place.
ding required
sfers will be
vider-based
U setting out
porting requ
ul non-urgen
transfer hour
ays.
ance commu
aramedic driv
ve a lower u
aramedic ca
would rema
spital - Timm
S ambulance
t IN/OUT tra
th-bound ref
ppropriate:
de long-haul
annual trans
ut will continu
d Code 3-4 c
funded as p
funding mo
t performanc
uirements.
nt transfer ho
rs may be re
unity flow ca
ver attendan
nit cost
apability as
ain unchang
mins & Distri
e resources
nsfers
ferral pattern
Code 1-2 no
sfer
ue the existi
coverage du
per the
del. This un
ce indicator
55
ours.
e-
ar to
nt
ed
ict
ns),
on-
ing
uring
nique
1-7 Per
con
a
b)
c)
rformance C
nfiguration op
) The follow
the Leade
implemen
) Although are none transfer s
Vulne Class Immu First A Traini
mainte Traini Traini
during Traini Traini Traini Traini
) For all of inventory
Stretcneces
Stair C Linen
Concepts has
ptions from
wing staffing
ership Worki
ntation phase
qualificationfor the prop
service shoul
erable PersonF Driver’s L
nization for HAid, CPR aning for stretcenance ing for safe ming in basic rg transport ing in use of ing in documing in basic iing in WHMI
the risk-basis recomme
cher(s) and cssary). Chair and Blanke
s considered
a risk manag
g configuratio
ing Group (s
e of restruct
ns for Paramosed Driver/ld feature th
ns BackgrouLicense with Hepatitis and AED certif
cher, stair ch
movement, hresponse pro
f communicamentation reqisolation preIS, infection
ed staffing cended:
certified mou
ts (sufficient
d long-haul t
gement pers
on options a
see Recomm
uring:
medics, PSW/Attendant. e following:
und Check a clean driv
nd Influenzafication
hair and oxyg
handling androcedures in
ations equipmquirements
ecautions control and
configuration
unting system
t quantities t
transfer vehi
spective.
re recomme
mendation 3-
Ws and RPNsAt a minimu
ving record
gen delivery
d positioningthe event of
ment
vehicle/equi
ns the follow
m(s) (Baria
to exchange
icle staffing
ended for de
-1) during th
s are well esum, all emplo
y equipment
g of patients f a medical e
ipment clean
wing vehicle e
atric capabili
e after each t
and equipm
etailed review
he upcoming
stablished, thoyees of the
use and
emergency
ning
equipment
ity if deemed
transfer)
56
ent
w by
g
here e
d
d
e
f)
Toiletipatien
Basic Fire e Winte Radio AVL (
confirm First A Autom Bag/V “M” O “D” Ox
hospit
) For mode
suppleme
Blood Pulse Isolati Portab Selec
) For highe
suppleme
Monito Symp BLS R C-Spi CPAP
The proce
configura
North Eas
Inclem Long Isolati
ing Suppliesnt normally c
disinfectionextinguisher er Survival Kio communica(automated vrmation Aid kit mated ExternValve/Mask m
Oxygen Cylinxygen Cylindtal
erate risk veh
ent the basic
d Pressure COximeter
ion Suppliesble Suction ation of oxyge
er risk vehicle
ent the basic
or/Defibrillatptom Relief MResponse Kiine Collars (pP
ess for settin
tions should
st LHIN’s lon
ment winter wtransfer roution from hos
s (Bed pan(scarried) and cleanin
Kit ating on provvehicle locat
nal Defibrillamanual resuder, Regulader, Regulat
hicle staffing
c equipment
Cuff and Stet
s and accessoen administr
e staffing co
c equipment
tor (instead oMedications it potential pat
ng long-haul
d address the
ng-haul trans
weather te distances/spitals during
s), urinal(s),
ng supplies
vincial CACCting) technol
ator uscitator (sintor and Flowtor and Flow
g configuratio
listed above
thoscope
ories ration suppli
onfigurations
listed above
of AED) and Glucom
tients encou
l “within vehi
e northern/re
sfer environm
s/travel timesg transfers
toilet paper,
C frequencielogy to allow
ngle use) andwmeter wmeter for tra
ons, the follo
e:
ies
s, the followin
e:
meter
untered)
icle” staffing
emote risk fa
ment:
s
wipes, one
es, and celluw immediate
d oral airway
ansportation
owing equip
ng equipmen
g and equipm
actors found
each for ev
ular telephonlocation
ys
n to and from
ment should
nt should
ment
d across the
57
very
ne
m
d
The curre
lack of co
CACC/E
recomme
problem.
1-8 Cre
ma
sch
a)
b)
c)
d)
1-9 Util
tes
a)
ent non-urge
oordination a
MS process
endations ad
eate a North
anagement th
heduling and
) Coordinat
the entire
delivery o
Leadersh
deliver se
boundarie
) The Coor
flow team
) South We
by CACC
to decide
d) Coordinat
vehicle re
lize informat
st/procedure
) Construct
the LHIN
ent patient tr
across hosp
for deliverin
ddress this fu
h East “Coord
hat integrate
d patient ride
tion Centre s
North East
option for the
ip Working G
eamless syst
es.
rdination Cen
ms, EMS and
est LHIN ride
C Coordinatio
on patient tr
tion Centre d
esources & fl
tion technolo
scheduling
t a web hos
to documen
ransportation
ital based te
ng timely/reli
undamental
rdination Cen
es the parall
e scheduling
staffing/adm
region unde
e Coordinatio
Group, with
tem planning
ntre willprov
d non-EMS tr
e selection a
on Centre sta
ransport mo
dispatches a
flows any am
ogy tools to i
and ride pro
ted databas
nt schedule
n system ac
est/procedur
iable transpo
“no air traffi
ntre” for long
el processes
g.
ministration id
er a fee-for-s
on Centre fu
an onus on
g/delivery no
vide leaders
ransfer prov
algorithm to b
aff with no re
ode using the
all long-haul
mbulance de
integrate sys
ovision.
se/application
ed “long-ha
cross the No
re scheduling
ortation. Th
ic controller”
g-haul non-u
s of non-urg
deally delive
service contr
unction can b
rigorous gua
ot impacted
ship region-w
viders, and o
be adopted
equirement
e algorithm.
non-ambula
ad head ride
ystem operat
n for comm
ul” non-urg
rth East LHI
g processes
e following
” system ma
urgent transp
gent procedu
ered by a sin
ract. A multi
be considere
arantees by
by CACC E
wide with hub
other North E
& adjusted f
for commun
ance non-urg
es to CACCs
tions data fo
unity & hub
gent proced
N suffers fro
s, and the
anagement
portation sys
ure/test
ngle CACC fo
tiple CACC
ed by the
CACCs to
EMS dispatch
b hospital pa
East CACCs
for internal u
nity hospital s
rgent transfe
s.
or both
hospitals a
dures/tests.
58
om a
stem
or
h
atient
s.
use
staff
r
cross
b)
c)
2
Non-urge
the logist
patient d
long-hau
internal h
fashion.
The need
patient ca
hospitals
approach
“care and
2-1 Ph
pat
LH
a)
b)
) Ensure fu
to) Coord
on the ap
) Build func
hospitals
seats” wh
schedulin
. Hospital B
ent patient c
tics of ride p
ischarge pra
l non-urgent
hospital busi
d for hospita
are and con
s have all ac
h (mandated
d control” rec
ased implem
tients (buildi
HIN). Pilot “h
) Initial pilo
) Holding a
reduced p
unctionality s
dination Cent
plicable non
ctionality into
across the L
hen schedul
ng slot and ri
Based Busi
are restructu
provision. Ho
actices (and
t patient tran
ness proces
al driven cha
trol process
knowledged
d by hub hos
commendat
mentation of
ing on the Th
holding area”
ot site selecti
area hub hos
patient escor
so scheduled
tre CACC st
n-urgent tran
o the web ho
LHIN to view
ling procedu
ide.
iness Proce
uring is a ch
ospitals and
other intern
nsportation s
ss refinemen
nge manage
es. Stakeho
d that the cur
spital policies
ion is offered
f hub hospita
hunder Bay
” to feature t
ion/impleme
spital staffing
rt spending
d tests or pro
taff for purpo
nsfer vehicle
osted databa
w available
ures/tests, th
ess Improve
ange manag
physicians
al business
system work
nts will need
ement exten
olders from E
rrent commu
s) is not cos
d:
al staffed “ho
pilot project
the following
ntation by Q
g funded by
(i.e. savings
ocedures ca
oses of reser
and route.
ase/applicati
non-urgent
hereby ensur
ements
gement chal
will need to
process) to
k. Transport
to proceed
nds to comm
EMS, comm
unity hospita
st-effective.
olding areas”
t approach u
g:
Q3 2014/15
community
s).
an be viewed
rving space
ion for comm
t transfer ro
ring a match
llenge that e
review and
make a sch
tation restruc
in a coordin
munity hospit
munity hospit
al patient esc
Therefore th
” for non-urg
underway in
hospitals ex
d (i.e. forwar
for the patie
munity & hub
oute “open
h between
extends beyo
adjust existi
hedule driven
cturing and
nated, paralle
tal/hub hosp
tals and hub
cort system
he following
gent transfer
the North W
xperiencing
59
rded
ent
b
ond
ing
n
el
ital
r
West
c)
d)
e
3
The curre
based “n
instrume
order to a
transport
leadersh
3-1 Cre
a)
b)
c)
) Track pat
longer ter
d) Secure es
communit
) Secure es
communit
implemen
. System L
ent non-urge
on-system”
ntal in highli
address the
tation (i.e. el
ip, policy, an
eate a perma
) Represen
hospitals,
contracte
) Implemen
inadequa
performan
) Adopt res
business
tient escort s
rm after pilot
stimated 20%
ty hospitals
stimated 90%
ty hospitals
nted and hub
Leadership,
ent transport
that has not
ghting the b
need for int
iminating sil
nd decision-
anent North
ntation could
5 rotating tr
d long-haul
nt system-wi
te ADRS/EP
nce measure
sults-based s
plan with pe
savings to pa
t project end
% reduction
in Year 1 of
% reduction
(3 year time
b hospital ma
Policy, & D
tation system
t served pati
benefits of an
egrated, “sy
los), the follo
making.
East Non-U
d include the
ransfer inten
transfer prov
ide data man
PCR data se
ement/repor
system plann
erformance i
artially fund
ds.
in patient es
f pilot, via red
in patient es
eframe), as h
andated pat
Decision-Ma
m is beginnin
ents well. T
n integrated
ystem based
owing recom
Urgent Transp
Coordinatio
nsive commu
viders, and
nagement re
ets. Use data
rting.
ning, featuri
indicator der
hub hospita
scort expend
duced durati
scort expend
holding area
tient escorts
aking
ng to evolve
The 2013 pilo
approach to
” manageme
mmendations
portation Le
on Centre CA
unity hospita
1 EMS short
eforms to im
a for busine
ing an annua
rived targets
al “holding ar
ditures acros
ion of long-h
ditures acros
s are compl
are eliminat
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ot projects h
o patient tran
ent of non-u
s are made c
eadership W
ACC, 5 trans
als (one per
rt-haul transf
mprove on ex
ss planning
al long-haul
s. Do so by
reas” in the
ss NE LHIN
haul transfer
ss NE LHIN
letely
ted.
a vertical, s
have been
nsportation.
rgent patien
concerning
Working Group
sfer hub
hub), all
fer liaison.
xisting
and
transportatio
operationaliz
60
rs.
ilo-
In
nt
p
on
izing
d)
e)
4
The Nort
transport
4-1 “Sta
Cod
unle
res
4-2 “Sta
via
veh
long
cap
4-3 A n
hau
num
rec
like
the Key P
trends in
d) Establish
each prop
) Establish
based on
. System F
th East LHIN
tation consis
atus quo” EM
de 1-2 trans
ess their gov
ources being
atus quo” ho
i) the contra
hicle operate
ger be requi
pacity to be d
new “non-urg
ul Code 1-2
mber of sche
commended
ely by way of
Performance
a publicly re
risk-based l
posed route/
vehicle equ
the risk man
Funding
N should imp
sting of the fo
MS cost-sha
sfers. This re
verning bodi
g replaced a
ospital fundin
acted provide
ed by North B
red to fund l
dedicated to
gent transfer
transfers ac
eduled/deplo
across the r
f an open RF
e Indicators (
eported dash
long-haul tra
/leg.
uipment conf
nagement a
plement a ne
following com
ared funding
ecommenda
ies choose t
as per this re
ng arrangem
er at Health
Bay Regiona
long-haul tra
o short haul w
r provider” fu
ross the Nor
oyed vehicle
region. Provi
FP process.
(KPI) include
hboard.
ansfer vehicl
figurations (i
pproach not
ew “hybrid” fu
mponents:
for Code 3-
ation will hav
to cancel hig
eview’s reco
ments for sho
Sciences N
al Health Ce
ansfers using
work exclusi
unding mode
rth East. Fu
e hours for de
viders will be
ed in this rep
le staffing co
i.e. policy) fo
ted above.
funding mod
-4 emergenc
ve no budget
ghly utilized
ommendation
ort-haul non-
North, and ii)
entre. Health
g its contrac
ively within t
el should be
unding will be
esignated tr
selected for
port. Compil
onfigurations
or each prop
del for non-ur
cy coverage
t impact on E
ambulance t
ns.
-urgent trans
the non-par
h Sciences N
cted provider
the City of G
put in place
e based on
ransfer leg ro
r a multi-yea
ile performan
s (i.e. policy)
posed route/l
rgent patient
and short-h
EMS service
transfer
sfers deliver
ramedic tran
North will no
r (i.e. service
Greater Sudb
e to fund long
the annual
outes
ar term – mo
61
nce
) for
/leg
t
aul
es
red
nsfer
o
e
bury).
g-
ost
4-4 OR
iden
ser
ope
ser
am
urg
will
rec
fea
trad
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Tracking
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provide f
importan
that re-in
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4-5 The
and
par
follo
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RNGE should
ntify and imp
rvices (i.e. n
erational sav
rvice to/from
bulance res
ent patient t
execute tim
ommended
turing an en
ditional land
macs across
g System Fi
clear that the
for easy syst
t to steer on
nvest a portio
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e recommen
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owing:
) EMS vehi
for emerg
as commu
) EMS ope
volume tr
financial s
d work collab
plement opp
non-ambulan
vings at ORN
the airport w
ources that
transportatio
mely paramed
Sudbury flow
hanced non
ambulance
s the Provinc
inancial & O
e current mix
tem perform
ngoing restru
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integration w
nded Leader
al efficiencies
nitiatives wh
icle hours tra
gency respon
unity parame
rating costs
ransfer legs t
savings.
boratively wi
portunities re
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NGE and flo
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have historic
on. The enh
dic-to-param
w car servic
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“best effort”
ce.
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ance monito
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aditionally us
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traditionally
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ith Sudbury
e. Sudbury E
Sudbury airp
w car fundin
the existing
cally resulte
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oring. Howe
isions, and e
ngs associa
ssary to supp
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riate. Efficie
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ployed for ot
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“best efforts
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bury EMS flo
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rrangement
service leve
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es: The exec
hospital data
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port the follo
ould docume
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encies could
-urgent trans
ther emergin
with non-urg
d by District
ACC and M
edic commun
ssions could
ments. Prom
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ant delays in
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at the airport
would be a
el that does
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m efficiency tr
stem funding
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owing recom
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sportation th
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rgent transpo
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ortation in hi
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62
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63
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66
H. APP
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T
PENDICE
1 – Definitio
2 – Terms o
Transportati
ES
ons of Land
of Referenc
on Review
d Ambulanc
e and Mem
Project Adv
ce Dispatch
bership of t
visory Com
h Codes 1-4
the Non-Urg
mmittee
gent Patiennt
67
APPEN
NDIX #1
68
APPEN
A
PURPOS
The purp
LHIN and
safe and
Ontario
commun
OBJECT
The Advi
1) Ap
2) Sfe
3) A4) R
NDIX #2
REVIEW
AND DEV
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SE
pose of the
d the project
cost-effectiv
while safe
ities across
TIVES
isory Comm
Assist in the croviding inpu
a. Analyb. Identif
transfc. Devel
standad. Identif
non-uSuggest stakeedback.
Assist in projeReview and p
W OF NOIN N
VELOPM
PROJE
Reviewed by
Advisory Co
t consultant
ve non-urge
eguarding n
the region.
ittee’s objec
completion out regarding
sis of the cufication of opfer business opment of cards fication of inrgent patieneholder con
ect communprovide feed
ON-URGNORTH MENT O
CT ADVTerms
y the Adviso
ommittee is
re. the deve
nt patient tra
needed Em
ctives will be
of the major :
urrent state pportunities and service
clinically driv
tegration annt transfers insultation me
nications actiback on the
GENT PAEAST O
OF A NEW
VISORY Cof Referery Committe
to provide
elopment of
ansfers into
mergency M
to:
project task
and challene model en process
nd coordinatin the North Eechanisms a
ivities. draft projec
ATIENT TONTARIOW BUSIN
COMMITence ee on June 2
strategic gu
a model tha
and out of h
Medical Ser
ks, per the P
ges for a fut
maps and tr
ion mechaniEast
and review th
ct report.
TRANSFO NESS M
TTEE
27, 2013.
uidance and
at meets the
hospital cent
rvices (EMS
roject Chart
ture non-urg
ransfer vehic
isms to supp
he resulting
FERS
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d input to th
needs for ti
tres in North
S) coverag
er, such as
gent patient
cle/staff
port and faci
stakeholder
69
e NE
mely,
East
ge in
ilitate
r
SCOPE
What ele
In Sc
TL
Ta
Out o
T A
tr
COMMIT
The Com
project p
H L E C C O O
It is reco
participat
ements are w
cope:
TransportatioTCHs/patien
o Stableo Requio Ambuo Requi
Transportatiossessment u
of Scope:
TransportatioAddressing hransportation
TTEE MEMB
mmittee mem
artner secto
Hospitals (larTCHs
EMS DesignaCertified LandCentral AmbuORNGE Other TBD
ognized that
ting on beha
within/outside
on for the follnt residencee medical coiring a stretc
ulatory or semiring a nursin
on of ED patiunder the Me
on for medicaospital cost
n
BERSHIP
mbership (o
ors:
rge and sma
ated Deliveryd Ambulanceulance Comm
t some mem
alf of their ow
e the bound
lowing paties:
ondition; andcher vehicle;mi-ambulatong or other hients requirinental Health
al appointmepressures re
of no more
all)
y Agents (i.ee Operatorsmunications
mbers may
wn individua
aries of the
nt groups be
d or
ory inpatientshealth providng access to
h Act
ents within aelated to the
than 15) w
e. municipali Centres
have multip
l organizatio
project?
etween hosp
s/LTC resideder escort o a schedule
a communitye use of prof
will include r
ities or DSSA
ple roles. C
ons.
pitals, or from
ents; or
e 1 bed or ps
y or betweenfessional sta
representatio
ABs)
Committee m
m hospitals t
sychiatric
n communitieaff during pa
on from the
members are
70
to
es tient
e key
e not
Consider
Committe
Ex officio
appropria
MEMBER Jean GuyElaine BlNancy BoDon BrisJean CarHeather Sandra FTracy FreNicole HaRobin JoJo-Ann LMichael MJosee MJoe NichPierre OzMarc PicDon PierDr. JasonRob SmiGrace StJim StewSteve TrMike Tro MOHLTC Jack Cru NE LHIN KathleenMichelinePhilip KilKristen T
ration will be
ee members
o members
ate, and the
RS
y Belzile – Nlakeboroughoody – Mattabane – Comrriere – CochCranney – C
Fox – Commench – Kirklaaley – Espa
oanisse – SaLennon-MurpMacIsaac – itron – Hôpitolls – City ozolins – St. J
card – North rce – Sudburn Prpic – Noth - ORNGEt. Jean – He
wart – Nipissinier – Cochdd – Timiska
C (ex-officio
uikshank
N (ex-officio
n Bain e Beaudry bertus (Cha
Taus
e given to b
s.
will include
third party p
Nipissing EMh – Sault Areawa Genera
mmunity Memhrane EMS Canadian Re
munity Memband & Districnola Region
ault Area Hosphy – West NManitoulin-Stal Notre-Daf Greater SuJoseph’s GeBay CACC ry CACC
orth East BasE alth Scienceing EMS rane EMS aming EMS
o)
)
irperson)
both sectora
the MOHLT
project consu
MS ea Hospitalal Hospital mber
ed Cross ber ct Hospital
nal Hospital aspital Nipissing GeSudbury EMme Hospital
udbury EMSeneral Hospi
se Hospital
es North (Su
al and geogr
TC, NE LHIN
ultant.
and Health C
eneral HospS l (Hearst)
tal (Elliot La
udbury)
raphic repre
N ED Physic
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ital
ake)
esentation in
cian Lead, N
n the selecti
NE LHIN sta
71
on of
aff as
ROLES A
Members
necessar
Advisory
logistics)
REPORT
The Advi
DECISIO
Advisory
chairpers
will be ne
will const
CONFID
Members
informati
confident
all Comm
documen
East LHI
MEETING
Monthly
occurring
AND RESPO
s are expe
ry and appr
Committee
) as appropri
TING RELAT
isory Comm
ON–MAKING
Committee
son may call
eeded to res
titute a quor
ENTIALITY
s will respec
on or views
tial until the
mittee mem
ntation. All
N.
G FREQUE
meetings w
g via email in
ONSIBILITIE
cted to pro
ropriate (e.g
with the su
iate.
TIONSHIP /
ittee will add
G
decisions w
l a vote. A s
solve or app
rum.
ct the privac
s expressed
re is genera
mbers must
materials pr
NCY
will be held o
n between m
ES
ovide resour
g. time, expe
pport of its
ACCOUNT
dress its adv
will be base
simple majo
prove any iss
y of Advisor
by individu
al agreemen
agree to n
roduced by t
over the du
meetings.
rces to the
ertise, inform
planning res
TABILITY
vice to the N
d on conse
rity favourab
sue requiring
ry Committe
uals during m
nt and conse
not disclose
the Committ
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e work of t
mation). Th
sources (sta
E LHIN Chie
nsus. If co
ble vote of th
g a vote. A
ee participan
meetings.
ensus to ma
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tee will rema
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the Advisory
he NE LHIN
aff time, info
ef Executive
nsensus is
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A simple maj
nts and agre
Deliberation
ake them pu
r confidentia
ain the prop
ith additiona
y Committe
N will provid
rmation, me
e Officer.
not possible
ers in attend
ority of mem
ee not to dis
ns should re
blic. In add
al informatio
perty of the N
al project ac
72
ee as
e the
eeting
e, the
dance
mbers
close
emain
dition,
on or
North
ctivity
Most me
meetings
PROJEC
It is expe
eetings will
s may be req
CT COMPLE
ected that the
be held by
quired (likely
ETION
e Advisory C
y teleconfe
y in Sudbury
Committee w
rence/video
as a centra
will conclude
conference
al location wi
e its work in t
e although
thin the regi
the fall of 20
1-2 face-to
ion).
013 or before
73
o-face
e.
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