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

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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.

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ration Netwo

atients, hos

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care models

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retained (vi

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ork (NE LH

spitals and E

p a model of

sfers into an

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ne 2013 to

ia RFP) to e

ances betw

acility patien

Ontario wa

IN) in respo

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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

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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

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ority).

of the

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and

roject

parse

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compone

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urgent tra

current s

“map” ap

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Working sCentres (

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ew’s stakeho

ansportation

system perfo

ppears below

older engage

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session withCACCs);

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w.

ement and e

anagement he NE LHIN

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sory Commos;

em restructu

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blems requir

execution pro

and frontlineregion, whic

tations with

nsfer “summ

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ittee evaluat

uring recomm

EMS data m

construct a p

ring restruct

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e staff represch consists o

community

mit meetings”

tario Central

tion of findin

mendations

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patient journ

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senting all 2of five geogr

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” 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-

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ms

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data mod

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restructu

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EMS/Nonhospital s

EMS mea

EMS tran

EMS 12-h

EMS over

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qualitative fe

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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

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urgent transfery Hub;

ansfer durati

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ergency/non

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e review also

Concepts us

ng (using 20

eports includ

fer volume m

ion (minutes

ours delivere

vice busyne

n-urgent call

/potential res

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sing the EMS

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ded the follo

mapping of I

s per transfe

ed by Hub);

ss (utilizatio

s (by ambul

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ted extensive

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ormed the re

owing:

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er by Hub);

on rate by am

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savings estim

e quantitativ

Patient Care

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sfer flows by

mbulance ba

coverage zo

mates

iv

ve

e

y

ase);

ne);

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figures.

hubs in t

transfer h

ts of the tran

The first figu

he region. T

hours delive

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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

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ontained in th

ume flows by

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he following

y the five tra

ion non-urge

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nsfer

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al data mode

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ong-haul noesult is erodeertain ambu

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ether delive

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he current nnancial persossible with

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Non-urgent trrojects were

he system nNorth East.

eling and an

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apping eme

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HIN, there isuration categ

on-urgent traed EMS reslance bases

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on-urgent tranes. There inue to delive

h qualitative

red a rigorou

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non-urgent trspective for c

successful

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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

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stakeholde

us situation

s:

ransportationcommunity hrestructuring

ransportationls.

of “care andcomes far mo

n system reled in 2013.

manent, non

ucted by Per

k” busyness

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paration of nourposes of sy

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e creating frere drawn out

ed by unacce

NOT create rlling reason l transfers w

r consultatio

analysis tha

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with existing

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at has yielde

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not sustainain/out of hub

oved signific

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the LHIN pil

ransfers in th

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rtain o

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following

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2. H

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System Fund

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odel recomm

ng-haul non-

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wo distinct se

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vii

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for

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patients a

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cheduling.

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ast LHIN will

arriving from

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al Model will

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mbulance res

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pital physicia

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ssociated witreallocation

prove stake

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sportation w

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th non-urgenn/reinvestme

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mmunity and

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necessary to

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225 km Keno

on-urgent tra

on for the follCare Homes/edical conditg a stretcher ory or semi-ag a nursing o

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lity for non-u

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duration non

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ambulatory inor other heal

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al appointme

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dix #1 for the

gent Patie

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n restructuri

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vary, but the

urgent patien

restructuring

emergency c

n-urgent pati

bulance prov

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within the c

nt groups bedences:

npatients/LTth provider e

ment patienMental Hea

ents within a

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ts requiring lth Act

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uth East LH

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transportatio

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mple orders

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that ORNGE

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and associa

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morbidities (p

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ario-wide av

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staff, while c

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patients sicke

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d of individu

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atients at hub

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heduling

hub hospitals

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here the me

years.

uals aged 65

er demand w

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hospital

14

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tation system

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b Hospital P

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and Temisk

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observation

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pital) share a

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gistics out of

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15

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16

trol in

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services

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17

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18

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20

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rk

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2013

In 2013,

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21

d

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flow

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22

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commended

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n system.

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spectives fo

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23

key

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able

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pital

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c

t

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ransportatio

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patient trans

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ulance

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24

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25

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26

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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

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‐ Single Ambula

g ‐ Single Ambula

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k ‐ Single Ambula

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y Coverage

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Risk Assoc

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nimize risk si

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its service a

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6

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594

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Code 1-2 N

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all 5 hubs, “z

ng-haul Cod

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Non-Urgent

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EMS Base ‐ Single Ambula

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nt ‐ Single Ambu

Mindemoya

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ng ‐ Single Ambu

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irkland Lakeskaming Shores

es two bases

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456

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ase with a m

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gency calls b

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43

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ive Modeling

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2012.

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call burdens

st Nipissing

is a multi-am

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erlapping ca

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20%) faced 2

ons

urgent patien

tative model

ing call burd

(10%). Ann

ely.

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and Lake (46

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dens at two m

ual 2012 ov

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ambulance d

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multi-ambu

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multi-ambula

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daytime

se.

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lance (dayti

64 overlappi

ents in 2012

cturing insigh

44

ance

all

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en

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.

hts

The IN/O

categorie

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Loutim

The risk

emergen

system b

LHIN.

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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

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independ

A

o

sc

lin

co

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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

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form future s

ng.

er-provider fu

rtation chang

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ome part an

Planning & O

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siness proce

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opulated wit

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pilot project

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d parcel of t

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n “system” is

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ght” transpo

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rformance m

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report ambu

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rposes. Key

execution, an

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ts. Given the

nds do not y

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the provider

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stem. The a

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hicle hours s

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patient esco

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dership & P

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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-

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An empow

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fficiency indi

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transfer syst

care actors b

y been a non

not unique to

atient transp

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blem, and th

N’s three 20

tions and co

making are

dership and

stem-wide le

ctor provider

wered workin

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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

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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

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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

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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)

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to) Coord

on the ap

) Build func

hospitals

seats” wh

schedulin

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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

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oute “open

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extends beyo

adjust existi

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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

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ntal in highli

address the

tation (i.e. el

ip, policy, an

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hospitals,

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business

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rm after pilot

stimated 20%

ty hospitals

stimated 90%

ty hospitals

nted and hub

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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

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plan with pe

savings to pa

t project end

% reduction

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% reduction

(3 year time

b hospital ma

Policy, & D

tation system

t served pati

benefits of an

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making.

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ransfer inten

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Decision-Ma

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n integrated

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Urgent Transp

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aking

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portation Le

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unity hospita

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s are made c

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ACC, 5 trans

als (one per

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haul transfer

ss NE LHIN

letely

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a vertical, s

have been

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rgent patien

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fer liaison.

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and

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p

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new “non-urg

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mber of sche

commended

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Performance

a publicly re

risk-based l

posed route/

vehicle equ

the risk man

Funding

N should imp

sting of the fo

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verning bodi

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ospital fundin

acted provide

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red to fund l

dedicated to

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transfers ac

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following com

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as per this re

ng arrangem

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Bay Regiona

long-haul tra

o short haul w

r provider” fu

ross the Nor

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region. Provi

FP process.

(KPI) include

hboard.

ansfer vehicl

figurations (i

pproach not

ew “hybrid” fu

mponents:

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ation will hav

to cancel hig

eview’s reco

ments for sho

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al Health Ce

ansfers using

work exclusi

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rth East. Fu

e hours for de

viders will be

ed in this rep

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ted above.

funding mod

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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

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or each prop

del for non-ur

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t impact on E

ambulance t

ns.

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the non-par

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cted provider

the City of G

put in place

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ransfer leg ro

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posed route/l

rgent patient

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transfer

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r (i.e. service

Greater Sudb

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the annual

outes

ar term – mo

61

nce

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t

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g-

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rvices (i.e. n

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financial s

d work collab

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non-ambulan

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68

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OF A NEW

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to provide

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TRANSFO NESS M

TTEE

27, 2013.

uidance and

at meets the

hospital cent

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gent patient

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69

e NE

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ilitate

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SCOPE

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In Sc

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project p

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Transportatiossessment u

of Scope:

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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

uration of the

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

e any other

tee will rema

e project w

the Advisory

he NE LHIN

aff time, info

ef Executive

nsensus is

hose membe

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.