Compassion Accountability Rights and Responsibilities Excellence
Donna Kearney, BScN, RN(EC), MHST
Rosseau Nursing Station
Nurse Practitioner - Manager
Meeting Community Needs Meeting Community Needs Through Integrated CareThrough Integrated Care
Compassion Accountability Rights and Responsibilities Excellence
Rural Indicators of Health
“Geography is an Indicator of Health” Roy Romanow 2002
Advanced AgeSeasonal & Low Income
Minimal EducationFew Employment &Social Opportunities
Few Support ServicesHigh Dependency
Compassion Accountability Rights and Responsibilities Excellence
Age Demographics
Ontario 2006
District of Parry Sound 2006
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Rural versus Urban Parry Sound
Rural Parry Sound 2006
Town of Parry Sound 2006
Compassion Accountability Rights and Responsibilities Excellence
Primary Care Providers by Region
RegionBy Postal Code
Number of Primary Care FP/NP’s
2006 Census Pop. change since 2001 census
Town of Parry Sound 15 FP’s1 NP @ FHT
5818 Down 5%
Georgian BayTownship
1 part-time NP@Moose Deer Point
2340 Up 17.5%
Seguin Township 1 NP@Rosseau
4276 Up 15.6%
Whitestone 1 NP @ Whitestone
1030 Up 20.8%
Archipelago 1 NP@ Pointe auBaril
576 Up 14.1%
Unorganized Central West
1 NP@Britt
1212 Up 10.3%
Unorganized Central East
1 NP@ Argyle 1212 Up 10.3%
McDougall 0 2704 Up 3.7%
Compassion Accountability Rights and Responsibilities Excellence
Nursing Stations: An Extension of Nursing Stations: An Extension of the Hospitalthe Hospital
Hospital
Nursing Stations
Compassion Accountability Rights and Responsibilities Excellence
Nursing Stations - ModelNursing Stations - Model
Buildings, Donations, In-Buildings, Donations, In-kindkind
FundingFunding,,
GrantsGrants
OperationOperationss
NP Station
Compassion Accountability Rights and Responsibilities Excellence
Scope of PracticeScope of Practice
Diagnosis and Treatment
NP MD RN Specialist
Allied Health Care Providers
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Research: Purpose
1) To evaluate a model of primary health care delivery appropriate for rural populations.
2) To determine the scope and collaborative nature of NP practice in a rural nursing station setting.
Compassion Accountability Rights and Responsibilities Excellence
3) To define the level of importance of hospital affiliation in reducing cost of care.
4) To show the impact on ER usage, hospital admissions, and wait times for primary health care.
Research: Purpose
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Research: Process
• 12 month data collection period (March 1, 2009 – February 28, 2010)
• Used electronic reporting tool developed for the project to improve consistency and accuracy by all 6 nursing stations
• Used hospital statistics for ER usage & acuity, admission, and re-admission rates
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Research: Variables
• Moose Deer Point nursing station decreased services from 5 days to 2 days per week due to lack of patients.
• H1N1 Pandemic
• NP vacation time, education time, and sick leaves not replaced consistently
• One station dropped out of the study
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Research Findings: Demographics
Totals: 48% Adults (16-64), 44% Seniors (65+), 8% Children (0-15)
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Patients Without a Family Doctor
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New Patients
Compassion Accountability Rights and Responsibilities Excellence
Type of Care Provided: Nursing Stations
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Referral Rates from Nursing Stations
Total Referral Rate = 11%, Consult Rate = 19%
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Patient Volumes: Nursing Stations
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Patient Volumes: ER/Nursing Stations
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Patient Acuity: ER/Nursing Stations
ER Triage Score(7% Unknown)
Percent Nursing Station Acuity
Percent
1 - Resuscitation .02% 1 – Life Threatening 0%
2 - Emergent 5% 2 - Emergent .09%
3 - Urgent 27% 3 - Urgent 2%
4 – Semi-Urgent 53% 4 - Complicated 21%
5 – Non-Urgent 7% 5 – Episodic/Chronic
77%
Total Patients seen in the ER
22,126 Total Patients seen in Nursing Stations
19,240
Triage/Acuity Level 4 & 5: 60% in ER 98% in Nursing Stations
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ER Usage by Postal Code and Age
Region by Postal Code
# NP’s/MD’s
2006 Census
ER Visits
% Pop using ER
Child(0-15)
Adult(16-64)
Senior(65+)
Town of Parry Sound
1 NP15
MD’s
5818 11,069 190% 1435(13%)
6829(62%)
2805(25%)
Georgian Bay
1 P/T NP
2340 1097 6% 146(13%)
699(64%)
252(23%)
Seguin 1 NP 4276 2746 64% 455(17%)
1644(60%)
647(23%)
Whitestone 1 NP 1030 739 72% 52(7%)
422(57%)
265(36%)
Archipelago 1 NP 576 222 38% 22(10%)
149(67%)
51(23%)
Central West
1 NP 1212 482 40% 61(13%)
248(51%)
173(36%)
Central East
1 NP 1212 0 0 0 0 0
McDougall 0 2704 6024 223% 411(7%)
5033(84%)
580(9%)
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Hospital Admissions/Re-Admissions
Region by Postal Code
Hospital Admissions 65+ years
% Population Re-Admissions Within 30 Days
% Re-Admits
Town of Parry Sound
484 8.3% 19 3.9%
Georgian Bay(MDP)
42 1.8% 4 9.5%
Seguin(Rosseau)
77 1.8% 0 0
Whitestone(Whitestone)
42 4% 3 7%
Archipelago(PAB)
11 1.9% 0 0
Central West(Britt)
32 2.6% 0 0
Central East(Argyle)
0 0 0 0
McDougall 81 3% 5 6%
Compassion Accountability Rights and Responsibilities Excellence
Cost Analysis
6 Nursing Stations
Budget: 1.3 million total
Staff: 1 NP, 1 Admin
Hours: 5 days (7.5 hours)
Patient Volume: 19,240
Acuity Rates: 98% level 4 & 5
Cost per Patient Visit: $70
WPSHC Emergency Room
Budget: 3.3 million total
Staff: 1 MD, 4+ RN’s, 1 Admin
Hours: 7 days (24 hours)
Patient Volume: 22,126
Acuity Rates: 60% level 4 & 5 33% level 1,2,3
Cost per Patient Visit: starts at $152
Cost Analysis information is not available for FHT’s or NP Led
Clinics to date, therefore comparisons are not possible.
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• Reduced:Reduced:• Wait times for primary careWait times for primary care• Visits to the ERVisits to the ER• Hospitalizations for chronic illnessHospitalizations for chronic illness
• IncreasedIncreased• Access to health care for rural seniorsAccess to health care for rural seniors• Opportunities to ‘Age in Place’ Opportunities to ‘Age in Place’ • Monitoring for compliance with treatments and health Monitoring for compliance with treatments and health
outcomesoutcomes• Collaboration with all health care providersCollaboration with all health care providers• Opportunities for health teaching and illness preventionOpportunities for health teaching and illness prevention• Continuity of care and advocacyContinuity of care and advocacy• Understanding of patients living conditions and support Understanding of patients living conditions and support
systemsystem
ConclusionsConclusions
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Recommendations: Local Level
• Create permanent NP positions in the ER at WPSHC.
• Provide after hours primary care services to residents in the Town of Parry Sound.
• Relief funding is needed to replace NP’s at the nursing stations during absences.
• Increase operating budgets of nursing stations to allow hiring of additional staff (RPN’s, NP’s), and to provide mentorship opportunities to prepare new NP’s to work full scope in rural nursing stations.
Compassion Accountability Rights and Responsibilities Excellence
• Change FP title to ‘Primary Care Specialist’ to promote top-of-scope functioning of all health care providers.
• Implement this model of primary care delivery in rural areas throughout Canada for a collaborative, sustainable, and accessible method of entering the health care system.
Recommendations: Provincial/National
Compassion Accountability Rights and Responsibilities Excellence
Questions – Thank you!Questions – Thank you!
Donna Kearney, BScN, RN(EC), MHSTWest Parry Sound Health Centre
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