Inter-Jurisdictional Trust-Building and Power-Sharing in Health Care. Presented by:: Inter-Jurisdictional Trust-Building and Power-Sharing in Health Care. Presented by:


Acknowledgements: Acknowledgements Ministry of Health: British Columbia Alberta Saskatchewan Manitoba Western Canadian Children’s Heart Network Partners: BC Children’s Hospital Alberta Children’s Hospital Winnipeg Children’s Hospital Royal University Hospital Stollery Children’s Hospital


Objectives: Objectives This presentation will: Outline the circumstances that led to the development of WCCHN. Provide an overview of how the WCCHN functions. Illustrate success stories within the WCCHN.


Part I: The Development of the WCCHN: Part I: The Development of the WCCHN Mr. Milton Sussman


History of Cardiac Programs within Western Canada : History of Cardiac Programs within Western Canada Four of Five Centres in Western Canada offered Pediatric Cardiac Surgery services: Vancouver (ongoing) Edmonton (ongoing) Saskatoon (program closed in 2001) Winnipeg (program closed in 1994)


Saskatoon’s Program: Saskatoon’s Program Approximately 70 pediatric cardiac surgeries per year from within Saskatchewan. Following the closure of Winnipeg’s program, Saskatoon provided surgical services for Winnipeg patients. Saskatoon’s pediatric cardiac surgeon left Saskatoon in 2001. Decision not to replace.


Winnipeg’s Program: Winnipeg’s Program Approximately 100 – 120 pediatric cardiac surgeries per year. Closure of the program – 1994 Pediatric Cardiac Surgery Inquest Recommendations made within the report pertaining to various aspects. Focus: The Future of Pediatric Cardiac Surgery in Manitoba


The Future of Pediatric Cardiac Surgery in Manitoba: The Future of Pediatric Cardiac Surgery in Manitoba Recommendation made for “the Health Sciences Centre, Winnipeg Regional Health Authority and Manitoba Department of Health pursue discussions with provinces in Western Canada for the development of a Western or Prairie regional Pediatric Cardiac Surgery Program.” (page 500)


Development of the WCCHN: Development of the WCCHN 1997: Deputy Ministers of Health from four western provinces established an ad hoc steering committee (senior administrative leaders, clinicians and government representatives) 1997-2000: meetings continued 2000: The Western Canadian Children’s Heart Network formed. Six core functions identified. 2001: Funding allocated from the 4 Western provinces.


Current Services Provided: Current Services Provided Pediatric Cardiac Surgery (2 centres) Pediatric Cardiac Transplant surgery (1) Pediatric Electrophysiological Services (3 centres) Pediatric Cardiac Catheterization (Diagnostic & Interventional): All centres. Follow-up care pediatric cardiology clinics: On site services and partnership clinics Cardiac Magnetic Resonance Imaging – 3 centres with dedicated pediatric cardiac MRI services; 2 others shared with adult programs.


Part II: The Functioning of the WCCHN: Part II: The Functioning of the WCCHN Ms. Sharon Chow


Establishment of the WCCHN: Establishment of the WCCHN 2002: Full-time coordinator in hired. Home office of the WCCHN: Edmonton Support provided by Capital Health Office space. Business office support – financial monitoring, adherence to operational policies and procedures.


Organizational Chart: Organizational Chart Deputy Ministers of Health Chair, WCCHN WCCHN Steering Committee Chair, Clinical Operations Committee WCCHN Coordinator Clinical Operations Committee Additional committees


Slide15: Building the Network Partnerships:


Goals of the WCCHN: Goals of the WCCHN Share Clinical Results Collaborate on Complex Cases Education Share Patient/Family Resources Collaborate on Research Share/Discuss Plans


1. Share Clinical Results: 1. Share Clinical Results Clinical Results shared. Pediatric Cardiac Care Consortium report WCCHN Annual Report Pediatric Cardiac M & M rounds bi monthly. Establishment of an Interprovincial Pediatric Cardiology Database.


WCCHN Database : WCCHN Database Five centre specific databases within a server. Web-enabled. Connection with local patient registration systems Ownership of the patient data is determined by the primary site that provides the care for the child. Authorization must be granted to other centres before a site can view a child’s record.


2. Collaborate on Complex Cases: 2. Collaborate on Complex Cases Multiple forums exist to do this. Cardiac Surgical Conference hosted by the Stollery occurs every Tuesday for discussion of patients referred for surgery or general discussion of challenging patients to examine other options. Surgical Discussions: Vancouver and Victoria (Mondays). Clinicians have been “practicing” at other centres Transplant Clinic; Cardiac Cath, Electrophysiological studies Surgeon collaboration.


Case Conferencing (Patients referred to the Stollery) : Case Conferencing (Patients referred to the Stollery) Every Tuesday Afternoon Attendance: All WCCHN centres pediatric cardiology staff, pediatric cardiac surgeons. Review of Patient History; Cardiac MRIs Echocardiograms,, cardiac catheterizations


Outcomes:: Outcomes: Discussion with all members of the team related to next steps: Surgery candidate. Wait / Reassesment required. Patient prioritized for surgery. Patient placed onto the waiting list.


Improving Patient Flow:: Improving Patient Flow: Patients are contacted with regards to the outcome of the discussion by: Local cardiologist Cardiac Surgery Coordinator Pre-Admission is booked day before surgery.


Slide24: Afterwards: Patient updates provided to all centres at next conference.


3. Education: 3. Education Sharing of educational opportunities at the pediatric cardiology residency training programs (All centres participate in giving sessions). Allied health sessions to provide educational information related other areas of pediatric cardiology (unit practices, blood transfusions, etc…..). Telehealth Main method of communication regarding patient care.


4. Share Patient/Family Resources: 4. Share Patient/Family Resources Sharing of Family Resources for teaching. Multi-centred commitment to developing pediatric cardiac transplant resources for clinicians and families.


5. Collaborate on Research: 5. Collaborate on Research Nursing: Multi-centre Family Satisfaction Survey has been completed. Other initiatives being planned.


6. Share/Discuss Plans: 6. Share/Discuss Plans Goal to maintain good communication amongst sites.


Part III: Success Stories: Part III: Success Stories Dr. Reeni Soni


Success Stories: Success Stories The following success stories will be shared to illustrate the success of the WCCHN Success stories – clinician perspective Success stories - children of Manitoba


The WCCHN:A Grassroots Perspective: The WCCHN: A Grassroots Perspective Perspective from Winnipeg (one of the 3 non surgical cardiac centers within the WCCHN) Beneficial impact from the clinician’s perspective Beneficial impact from the patient’s perspective


Cardiologist’s Perspective: Cardiologist’s Perspective Enhanced communication between centers has resulted in better care both in the non surgical referring and surgical referral centers Potentially enhanced recruitment and retention of cardiologists in non surgical centers Promotion of interprovincial sharing of specialized skills, retention of specialized skills


Historical Regionalization Model: Historical Regionalization Model Surgical Center Surgical Center Referring Center Referring Center Referring Center Referring Center


WCCHN Regionalization Model: WCCHN Regionalization Model Surgical Center Surgical Center Referring Center Referring Center Referring Center Referring Center


Improved Surgical Mortality: Improved Surgical Mortality


Cross Border Sharing of Skills: Cross Border Sharing of Skills


Radiofrequency Ablation: Radiofrequency Ablation


Illustration 1: Radiofrequency ablation: Illustration 1: Radiofrequency ablation Highly specialized technique previously only available in 2 Canadian centers Procedure used to treat electrical disturbances within the heart which cause rapid heart rhythm conditions (arrhythmias) Through WCCHN collaboration, Stollery arrhythmia specialist travels to Winnipeg on a monthly basis to perform these procedures saves families out of province travels saves the health care system costs of out of province family support


High Risk Cardiac Catheterizations: High Risk Cardiac Catheterizations


High Risk Cardiac Catheterizations: High Risk Cardiac Catheterizations Cardiac catheterizations (angiograms etc) are routinely performed in Winnipeg A subset of these should only be performed in a center with cardiac surgical back-up System now in place for Winnipeg cardiologist to travel to Edmonton to perform these procedures with appropriate back-up


Beneficial for patientsAllows cardiologist to retain skills: Beneficial for patients Allows cardiologist to retain skills


Cardiac Transplant Follow-up: Cardiac Transplant Follow-up Historically, pediatric cardiac transplant patients have had to return to the original transplant center (e.g. Edmonton/Toronto) for ongoing surveillance and follow-up WCCHN collaboration resulted in the first multicenter transplant clinic in Winnipeg where transplant experts from Edmonton, Vancouver and Toronto worked in conjunction with Winnipeg cardiologist


Vaughn: Vaughn 10 year old 1 week post cardiac surgery Uneventful postoperative recovery in surgical center Suffered cardiac arrest upon return to Winnipeg Death was certain unless patient could be placed on life support…traditionally only possible in cardiac surgical centers


Interprovincial Care of Patients on Emergency Life Support: Interprovincial Care of Patients on Emergency Life Support


Baby Xander: Baby Xander Severe cardiac abnormality detected in Winnipeg as a fetus Cardiac transplant appeared to be only viable option Collaboration with the cardiac/obstetrical team at Stollery Hospital before this child’s birth resulted in placing him on waiting list for a heart transplant before he was born


Baby Xander: Baby Xander A donor heart became available at 38 weeks gestation…he was delivered by Cesarian section and transplanted a few hours later “Youngest heart transplant recipient in Western Canada”