CEO Message: Building back to serve Islanders consultation draft

Dear PCH Staff,

Firstly, I want to thank you for your dedication and hard work every day. Some of you will see this email in other forms in other groups you are a part of, but I want to be sure everyone is aware of the work we are doing directly. 

For the past weeks and months, we have been working closely with staff, physicians, and partners across the healthcare system to stabilize critical care. This has included plans to transfer the most ill patients from the PCH to the QEH. At the same time, we all know there is a need to build back stable and sustainable critical care at PCH, and work is underway to get us to that point.

Through work with staff, we have developed a roadmap to rebuild the service and identified key milestones required to achieve success. The highlights of the plans are presented at the end of this email for your feedback and ongoing consultation. This message is being shared with partners broadly, including local leaders, community members, physicians, staff, unions and foundations.

Further consultation is being arranged with several groups, including your own. This is a dynamic situation and new insights emerge regularly.

The planning starting point below represents three distinct phases: Stabilizing Critical Care Immediately; Rebuilding Critical Care Capacity at PCH; and Enhancing Critical Care at PCH.

Today at 7 p.m., there will be a town hall in Summerside at the Credit Union Place, and we intend to be clear to everyone that concrete steps are being taken to support staff and physicians, and ultimately patients, who need critical care services.

These phases all require many people to work together to optimize our system. They also require success in attracting and retaining healthcare workers, and each element is predicated on our ability to safely staff and resource the service. 


While the road to improved services is challenging, I am confident we can achieve these goals collaboratively as a province.

Thank you,
Corinne

 
PCH CRITICAL CARE PLAN:
Building back to serve Islanders

PHASE 1: STABILIZING CRITICAL CARE IMMEDIATELY         

GOAL:  To stabilize critical care at PCH and ensure 4 PCU beds are maintained.

  • Staffing shortages of internal medicine physicians, nurses, respiratory therapists and supporting staff have made it impossible to continue to deliver care as we have in the past right now.

  • To maintain a safe level of care for staff to provide, the level of care provided must be adjusted.

  • The number of critical care beds has been reduced, from 8 to 4. This results in the sickest patients (approx. 4 or 5 per week) being transferred to another hospital for care. This may be the QEH for some patients. As always, a portion of these patients will require out-of-province specialty care.

  • Two additional beds are in the process of being staffed at QEH to support these transfers.

  • To maintain this level of care at PCH and QEH over the short term, Health PEI requires:

    • Internal Medicine Physicians;

    • Hospitalist Physicians;

    • Nursing Staff; and

    • Respiratory Therapists.

  • Recruitment and retention initiatives are underway for all staff including locums.

  • Temporary reassignments, travel nursing , and locum physician support will be needed to stabilize this service for the next several months.

  •  Island EMS is providing planning and co-ordination for critical care transfers.

  •  We will be instituting a system-wide operational directive for enhanced patient flow across the province.

ACTIONS TAKEN TO DATE:

  • An internal medicine physician has made a verbal commitment and is in the final stages of the hiring process to practice at PCH;

  • One long-term Locum Internal Medicine Physician has committed to working at PCH;

  • One retired physician has committed to working once per month at PCH;

  • Additional Nursing staff has been secured through reassignment and engaging agency nurses;

PHASE 2: REBUILDING CRITICAL CARE CAPACITY AT PCH  

GOAL:    To increase critical care beds back to 8 beds at PCH.

  • Prince County and all of PEI needs PCH to have strong critical care capacity.

  • This care needs to be delivered sustainably so we do not burn out our valued staff.

  • To increase the capacity, Health PEI requires the right staffing to safely care for critical care patients.

  • Required staff for Phase 2:

    • 5 full-time-equivalent Internal Medicine Physicians (current staffing is 2)

    • Critical Care trained nursing (need 15-16 FTE, current staffing 7.8)

    • 24/7 respiratory therapy on-site for all hospital services;

  • Recruitment is ongoing for these roles and has been a major priority.

  • It is important to note that many highly-trained staff may require several months to transition to these roles,  due to their existing work requirements and time to move.

  • During this phase, reliance on travel agencies is anticipated to maintain services. 

ACTIONS TAKEN TO DATE:

  • 4 Respiratory Therapist positions have been posted for PCH, 3 Permanent Positions and 1 Casual Position

  • Health PEI is currently working with Unions and stakeholders to address retention of RTs

  • Nursing Positions have been posted at PCH for Critical Care

  • Internal Medicine Positions are posted at PCH

  • Recruitment Initiatives for vacancies include:

    • Attending local and national recruitment events

    • Hosting recruitment events at NBCC, Dalhousie 

PHASE 3: ENHANCING CRITICAL CARE AT PCH

GOAL:   To evolve Critical Care at PCH

The population of Prince Edward Island is growing everywhere. Demand for services at PCH will only increase in the future, and services will need to be enhanced. However, we need to ensure services are sustainable before they are reintroduced.  

PCH needs a long-term hospital development plan to guide the revitalization of the hospital and acute care in western PEI.  This work is currently underway as part of the acute care master planning.  The RFP for consultation services for PCH and Hospitals West will be released in the coming weeks.

This planning will include clinical staff engagement and in-depth consultation, partner consultation with the City and local communities, the PCH Foundation and local auxiliaries, and public consultation and engagement.  The planning will guide the future of PCH services in alignment with community services development.

NEXT STEPS TO SUPPORT THE LONG-TERM PLANNING FOR PHASE 3:

  • Increase the level of care intensity offered in all acute care beds (including PCU beds and medical beds) following safe staffing.

  • Identify opportunities to bring enhanced services and new services to PCH as a provincial resource.

  • Associate Physicians and Physician Assistants are being interviewed and hired to support the system.

  • Creating a simulation environment to support physicians, nurses, and other healthcare providers in upgrading and maintaining skills required for critical care and other services.

    • There is currently a proposal from PCH Foundation to create a simulation environment.  The Department of Health and Wellness has advanced this proposal after a recent meeting with the Foundation and anticipates supporting the proposal. 

  • Enhancing leadership team supports

  • Dedicated recruitment personnel (PCH + region)

  • Establish a provincial community of practice/ program model for specialized clinical services such as respiratory therapy and critical care nursing

  • Continuing to build community-based services such as primary care and home care to alleviate pressure on the hospital through prevention and earlier discharge.

 

Please send questions, comments, or submissions for these notes to emclean@gov.pe.ca, subject line “CEO Notes”.

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