2013 Ontario Hospitals Maternal-Child

PCMCH Maternal-Child Benchmarking Report 2013

Table of Contents

ABOUT PCMCH ...... 1 EXECUTIVE SUMMARY ...... 2 Benchmarking Report Recommendations ...... 3 Report Framework ...... 5 List of Participating Hospitals and Acronyms ...... 8

ACADEMIC HEALTH SCIENCES CENTRES...... 11 HOSPITAL PROFILES ...... 12 Service Profiles ...... 12 Bed Profiles ...... 19 Emergency Department Profiles ...... 21 CLINICAL INDICATORS ...... 24 1.0 Provincial Overview ...... 24 1.1.1 PO – LHIN Map ...... 24 1.1.2 PO – Paediatric AHSCs Inpatient Discharges, Distributed by Hospital & LHIN ...... 25 1.1.3 PO – Paediatric AHSCs Inpatient Discharges by LHIN...... 26 2.0 Hospital Descriptors ...... 27 DES 2.1.1 – Inpatient and Same Day Surgery Volumes ...... 27 DES 2.1.2 – Neonatal and Paediatric Inpatient Case Distribution ...... 28 DES 2.1.3 – Inpatient Case Age Profile ...... 29 DES 2.1.4 – Same Day Surgery (SDS) Age Profile ...... 30 DES 2.1.5 – Total Average Length of Stay ...... 31 DES 2.1.6 – Total Average Length of Stay (Neonatal and Paediatric) ...... 32 DES 2.1.7 – Total Average Inpatient Weight per Case ...... 33 DES 2.1.8 – Percent Typical, Outlier & Other Inpatient Cases and Patient Days...... 34 DES 2.1.9 – Percent “Transfer From” (Inpatient Cases and Patient Days) ...... 35 DES 2.1.10 – Percent “Transfer To” (Inpatient Cases and Patient Days)...... 36 DES 2.1.11 – Percent of Cases and Days with LOS > 30 Days ...... 37 3.0 Emergency Department Indicators ...... 38 ED 3.1.1 – Hospital Emergency Department Patient Volumes ...... 38 ED 3.1.2 – Emergency Department Average Length of Stay in Hours – All Dispositions...... 39 ED 3.1.3 – Emergency Department Visits (Age Profile) ...... 40 ED 3.1.4 – Emergency Department Visits by Triage Level ...... 41 ED 3.1.5 – Emergency Department Visits by Top 15 Main Problems ...... 42 ED 3.1.6 – Emergency Department Visits Admitted ...... 43 ED 3.1.7 – ED Visits Left Without Being Seen/Against Medical Advice or Other ...... 44 4.0 Clinical Efficiency Indicators ...... 45 4.1.1 CE – Top 10 CMGs Typical Inpatient Cases ...... 45 4.1.2 CE – Top 10 CMGs Typical Inpatient Cases (One and Two Day Stay) ...... 46 5.0 Quality and Utilization Management Indicators ...... 47 The most responsible diagnosis codes used in section 5.1 Appropriateness of Care are listed below: ...... 47 QUM 5.1.1 - Percentage of Paediatric Admissions Treated for Asthma ...... 48 QUM 5.1.2 – Percentage of Paediatric Admissions Treated for Diabetes ...... 49 QUM 5.1.3 – Percentage of Paediatric Admissions Treated for Gastroenteritis ...... 50 OPERATIONAL EFFICIENCY INDICATORS ...... 51 6.1 Introduction ...... 51 6.1.1 OE – Hospital Net Operating Costs (in millions) ...... 53 6.1.2 OE – Hospital Net Operating Costs (Percent Distribution) ...... 54 6.1.3 OE – Compensation Costs per Functional Centre Category ...... 55 6.1.4 OE – Compensation Costs as a Percent of Total per Functional Centre Category ...... 56 6.1.5 OE – Hours per Functional Centre Category ...... 57 6.1.6 OE – Hours as a Percent of Total per Functional Centre Category ...... 58 6.2 Operational Efficiency Comparisons ...... 59 6.2.1 OE – Inpatient Only Net Operating Costs per Inpatient RIW Weighted Case ...... 59 6.2.2 OE – Inpatient Net Operating Costs per Inpatient Day ...... 60 6.2.3 OE – Inpatient Detailed Compensation and Hours Indicators ...... 61 6.2.4 OE – Inpatient Med/Surg Only Detailed Indicators ...... 62

PCMCH Maternal-Child Benchmarking Report 2013

6.3 Critical Care NICU Department ...... 63 6.3.1 OE – NICU Detailed Indicators ...... 63 6.3.2 OE – Critical Care PCCU Detailed Indicators ...... 64 6.3.3 OE – Operating Room Detailed Indicators ...... 65 6.4 Ambulatory Costs ...... 66 6.4.1 OE – Ambulatory Clinic Detailed Indicators ...... 66 6.5 Emergency Department ...... 67 6.5.1 OE – Emergency Department Detailed Indicators ...... 67

COMMUNITY HOSPITALS ...... 68 HOSPITAL PROFILES ...... 69 Service Profiles ...... 69 Bed Profiles ...... 100 Emergency Department Profiles ...... 109 CLINICAL INDICATORS ...... 129 2.0 Hospital Descriptors ...... 129 DES 2.1.1 – Inpatient and Same Day Surgery Volumes ...... 129 DES 2.1.2 – Neonatal and Paediatric Inpatient Case Distribution ...... 131 DES 2.1.3 – Inpatient Case Age Profile ...... 133 DES 2.1.4 – Same Day Surgery Age Profile ...... 135 DES 2.1.5 – Total Average Length of Stay ...... 137 DES 2.1.6 – Total Average LOS (Neonatal and Paediatric) ...... 139 DES 2.1.7 – Total Average Inpatient Weight per Case ...... 141 DES 2.1.8 – Percent Typical, Outlier & Other Inpatient Cases and Patient Days...... 143 DES 2.1.9 – Percent "Transfer From" Inpatient Cases and Patient Days ...... 145 DES 2.1.10 – Percent "Transfer To" Inpatient Cases and Patient Days ...... 147 DES 2.1.11 – Percent of Cases and Days with Length of Stay > 30 Days ...... 149 3.0 Emergency Department Indicators ...... 151 ED 3.1.1 – ED Patient Volumes ...... 151 ED 3.1.2 – ED Average LOS in Hours ...... 152 ED 3.1.3 – ED Visits (Age Profile) ...... 153 ED 3.1.4 – Emergency Department Visits by Triage Level ...... 154 ED 3.1.5 – ED Visits by Top 15 Main Problems ...... 156 ED 3.1.6 – ED Visits Admitted ...... 160 ED 3.1.7 – ED Visits Left Without Being Seen or Against Medical Advice ...... 161 4.0 Clinical Efficiency ...... 162 CE 4.1.1 – Top 10 CMGs Typical Inpatient Cases ...... 162 CE 4.1.2 – Top 10 CMGs Typical Inpatient Cases – One and Two Day Stay ...... 166 5.0 Quality and Utilization Management Indicators ...... 170 QUM 5.1.1 - Percentage of Paediatric Admissions Treated for Asthma ...... 171 QUM 5.1.2 – Percentage of Paediatric Admissions Treated for Diabetes ...... 173 OPERATIONAL EFFICIENCY INDICATORS ...... 175 Introduction ...... 175 6.1 Operational Efficiency Descriptors ...... 176 6.1.1 OE – Paediatric Inpatient Unit Only (7*270*) Net Operating Costs per Inpatient Day (403* Trial Balance) ...... 176 6.1.2 OE – Paediatric Inpatient Unit Only (7*270*) Compensation Costs (3*) per Inpatient Day (403* Trial Balance) ...... 177 6.1.3 OE – Paediatric Inpatient Unit Only (7*270*) UPP Worked Hours (35090*/10*) per Inpatient Day (403* Trial Balance) ...... 178 6.2 NICU ...... 179 6.2.1 OE – NICU Net Operating Costs per Inpatient Patient Day ...... 179 6.2.2 OE – NICU Compensation Costs per Inpatient Patient Day ...... 180 6.2.3 OE – NICU UPP Worked Hours per Inpatient Patient Day ...... 181 6.3 Obstetrics, Labour and Delivery (LDRP) ...... 182 6.3.1 OE – Obstetrics, Labour, Delivery, Recovery, Postpartum Net Operating Costs per Inpatient Day ...... 182 6.3.2 OE – Obstetrics, Labour, Delivery, Recovery, Postpartum UPP Worked Hours per Inpatient Day...... 183 6.3.3 OE – Obstetrics, Labour, Delivery, Recovery, Postpartum Compensation Costs per Inpatient ...... 184 6.4 Obstetrics Intermediate Nursery Level II ...... 185 6.4.1 OE – Obstetrics Intermediate Nursery Level II Net Operating Costs per Inpatient Day ...... 185 6.4.2 OE – Obstetrics Intermediate Nursery Level II UPP Worked Hours per Inpatient Day ...... 186 6.4.3 OE – Obstetrics Intermediate Nursery Level II Compensation Costs per Inpatient Day ...... 187

PCMCH Maternal-Child Benchmarking Report 2013

POPULATION-SPECIFIC INDICATORS...... 188 NEONATAL INDICATORS ...... 189 Introduction ...... 189 1.0 Provincial Overview ...... 191 1.1.1 SCN – Distribution of Ontario Births by LHIN ...... 191 1.1.2 SCN – Percent Distribution by Mother’s LHIN of Residence and LHIN of Birth Hospital ...... 192 1.1.3 SCN – Percent Distribution of Births Under 32 Weeks and/or 1500 Grams ...... 193 1.2.1 SCN – Neonatal Abstinence Syndrome Trends in Ontario (most responsible diagnosis) ...... 194 1.2.2 SCN – Neonatal Abstinence Syndrome Trends in Ontario (any diagnosis)...... 195 2.0 Neonatal Distribution ...... 196 SCN 2.1.1 – Neonatal Inpatient Cases ...... 196 SCN 2.1.2 – Neonatal Average LOS ...... 198 SCN 2.1.3 – Total Average Inpatient Weight per Case ...... 199 SCN 2.1.4 – Percent Neonatal “Transfer From” Inpatient Cases and Patient Days ...... 200 SCN 2.1.5 – Percent Neonatal “Transfer To” Inpatient Cases and Patient Days ...... 201 SCN 2.1.6 – Percent Cases and Days with LOS > 30 Days ...... 202 3.0 NICU/SCN Distribution ...... 203 SCN 3.1.1 – NICU/SCN Inpatient Cases ...... 203 SCN 3.1.2 – NICU/SCN Age Profile ...... 204 SCN 3.1.3 – NICU/SCN Average LOS ...... 205 SCN 3.1.4 – Percent NICU/SCN “Transfer From” Inpatient Cases and Days...... 206 SCN 3.1.5 – Percent NICU/SCN “Transfer To” Inpatient Cases and Days ...... 207 4.0 SCN NICU/SCN Jaundice ...... 208 SCN 4.1.1 – Percent NICU/SCN Inpatient Jaundice Cases ...... 208 OBSTETRICAL INDICATORS ...... 209 Introduction ...... 209 Hospital Descriptors...... 210 OBS 1.1.1 – Obstetrical Volumes and Births ...... 210 OBS 1.1.2 – Obstetrical Age Profile ...... 211 OBS 1.1.3 – Average Length of Stay ...... 213 OBS 1.1.4 – Total Average Inpatient Weight per Case ...... 214 OBS 1.1.5 – Percent Typical, Outlier & Other Inpatient Cases and Patient Days ...... 215 OBS 1.1.6 – Percent Obstetrical “Transfer From” Inpatient Cases and Patient Days ...... 217 OBS 1.1.7 – Percent Obstetrical “Transfer To” Inpatient Cases and Patient Days ...... 218 OBS 1.1.8 – Percent Cases and Days with Length of Stay > 30 Days ...... 219 OBS 1.1.9 – Obstetrical Top 5 CMGs ...... 220 MENTAL HEALTH INDICATORS ...... 222 Introduction ...... 222 Mental Health Profiles: Academic Health Sciences Centres ...... 224 Mental Health Profiles: Community Hospitals ...... 226 1.0 Mental Health Indicators ...... 233 1.1.1 MH – Inpatient Mental Health Volumes ...... 233 1.1.2 MH – Inpatient Mental Health Age Profile...... 234 1.1.3 MH – Inpatient Mental Health Average Length of Stay ...... 236 1.1.4 MH – Inpatient Mental Health Average Weight per Case ...... 237 1.1.5 MH – Top 10 CMGs ...... 238 1.1.6 MH – Top 10 CMGs Length of Stay ...... 240 1.1.7 MH –Top 10 CMGs Average Weight per Case ...... 242 1.1.8 MH – Average Length of Stay by Age Category ...... 245 1.1.9 MH – Average Weight per Case by Age Category ...... 248 1.1.10 MH – Percent “Transfer From” Mental Health Inpatient Cases and Days ...... 249 1.1.11 MH – Percent “Transfer To” Mental Health Inpatient Cases and Days ...... 250 1.1.12 MH – Percent of Cases and Days with Length of Stay >30 Days ...... 251 1.1.13 MH – Percent of Cases 1-2 Days Length of Stay ...... 253 1.1.14 MH – Mental Health Readmissions ...... 254 2.0 Mental Health ED Indicators ...... 255 2.1.1 MH-ED – Mental Health ED Patient Volumes ...... 255 2.1.2 MH-ED – ED Mental Health Visits Patient Age Profile ...... 256 2.1.3 MH-ED – ED Mental Health Average LOS ...... 258 2.1.4 MH-ED – ED Mental Health Visits by Top 10 Main Problems ...... 259

PCMCH Maternal-Child Benchmarking Report 2013

HOLLAND BLOORVIEW KIDS REHABILITATION HOSPITAL ...... 262 Hospital Profile ...... 262 Access and Wait Times for Child Development Program Services ...... 265 Holland Bloorview Kids Rehabilitation Hospital Indicators ...... 266 1.1.1 HBV – Holland Bloorview Inpatient/Outpatient Discharge Geographic Distribution by LHIN ...... 266 1.1.2 HBV – Patient Profile – Percentage of Translation Services Used ...... 267 1.1.3 HBV – Patient Volume Breakdown...... 268 1.1.4 HBV – Percent of Inpatient Discharges by Type ...... 269 1.1.5 HBV – Percent of Inpatient Days by Type ...... 270 1.1.6 HBV – Inpatient Age Profile ...... 271 1.1.7 HBV – Inpatient Age Profile (by service) ...... 272 1.1.8 HBV – Inpatient Average Length of Stay ...... 273 1.1.9 HBV – Percent of Cases with Lengths of Stay Longer Than Expected (> 2 Sigma) ...... 274 1.1.10 HBV – Percent of Inpatient Clients Receiving Outpatient Services ...... 275 2.1.1 HBV – Percent of ALC Days ...... 277 3.1.1 HBV – Outpatient Patient Profile ...... 278 3.1.2 HBV – Referral Pattern for Outpatient Services ...... 279 3.1.3 HBV – Referral Pattern for Child Development Services ...... 280 3.1.4 HBV – Referral Pattern for Autism and Neuromotor Services ...... 281 3.1.5 HBV – Referral Pattern for Neuromotor Services ...... 282 3.1.6 HBV – Referral Pattern for Autism Services ...... 283 3.1.7 HBV – Referral Pattern for Communication and Writing Aids Services ...... 284 4.1.1 HBV – Summary of Operating Costs for Fiscal Year 2011/12 ...... 285 5.1.1 HBV – Canadian Association of Paediatric Health Centres (CAPHC) and Holland Bloorview ...... 286 GLOSSARY OF TERMS ...... 287 ACKNOWLEDGEMENTS ...... 291

PCMCH Maternal-Child Benchmarking Report 2013

About PCMCH

The Provincial Council for Maternal and Child Health has two distinct roles. First, the PCMCH generates information to support the evolving needs of the maternal-child health care system in Ontario. Secondly, the PCMCH is a resource to the maternal-child health care system in Ontario to support system improvement and to influence how services are delivered across all levels of care.

The scope of the PCMCH is primary, secondary, tertiary and quaternary services, delivered in both community and hospital settings, and includes responding to the needs of disadvantaged communities across Ontario. The work of the Council reflects the importance of relationships and interfaces among providers and organizations across the continuum of care.

The Provincial Council for Maternal and Child Health would like to acknowledge the funding support received from the Province. The views expressed in this publication are those of PCMCH and do not necessarily reflect those of the Province.

Parts of this report are based on data and information provided by the Canadian Institute for Health Information. However, the analyses, conclusions, opinions and statements expressed herein are those of the authors and not necessarily those of Canadian Institute for Health Information.

1 PCMCH Maternal-Child Benchmarking Report 2013

Executive Summary

The Provincial Council for Maternal and Child Health (PCMCH) Maternal-Child Benchmarking Report is designed to help participating organizations identify potential opportunities to improve clinical and operational efficiency and quality and utilization management processes by making available comparative data from peers. It is intended that these comparisons will help the participating organizations accelerate their rate of improvement by identifying opportunities based on demonstrated levels of performance by hospitals across Ontario. In considering these comparisons it is important to note that, independently, the analyses within this report do not provide a comprehensive picture of a hospital. Rather, the results presented are intended to enhance decision-making processes to aid in identifying potential opportunities to improve performance.

The 2013 Maternal-Child Benchmarking Report is the 10th annual report and provides data for the fiscal 2012/13 period. This initiative was led by the PCMCH Benchmarking Steering Committee and was supported by the PCMCH Secretariat and Decision Support Services Program at Hamilton Health Sciences Centre. The MIS and Health Information Work Groups continue to play an important role in the ongoing refinement of the indicators. For the 2013 Report, participation has grown to include 63 hospitals, including 8 Academic Health Sciences Centres, 54 Community Hospitals and Holland Bloorview Kids Rehabilitation Hospital.

The 2013 Report consists of the following sections:

Academic Community Population-specific Health Sciences Centres Hospitals Indicators Profiles: Services, Beds, and Profiles: Services, Beds, and Emergency Neonatal Indicators Emergency Department Department Obstetrical Indicators Clinical Indicators: Provincial Overview Clinical Indicators: Hospital Descriptors Mental Health Indicators (PO), Hospital Descriptors (DES), (DES), Emergency Department Indicators Holland Bloorview Kids Emergency Department Indicators (ED), Clinical Efficiency Indicators (CE), Rehab Hospital (ED), Clinical Efficiency Indicators and Quality and Utilization Management Indicators (CE), and Quality and Utilization Indicators (QUM) Management Indicators (QUM) Operational Efficiency Indicators Operational Efficiency Indicators (participation from community facilities for this section is optional)

The 2013 Report marked the third year of successful partnership between PCMCH and CIHI. All clinical indicators used in the Report were built via CIHI Portal by using the clinical data that each hospital submits to CIHI. All information is validated post submission. As in prior years, MIS data continues to be submitted to and analyzed by the Decision Support Team at Hamilton Health Sciences Centre.

The recommendations within this report will form the basis of the FY 2014-15 Work Plan for the Benchmarking Steering Committee and its subcommittees. We look forward to continued membership expansion and enhancement of the report in 2014.

Marilyn Booth Joanne MacKenzie Executive Director, PCMCH Chair, PCMCH Benchmarking Steering Committee

2 PCMCH Maternal-Child Benchmarking Report 2013

Benchmarking Report Recommendations

The following recommendations made by the Benchmarking Steering Committee (BSC) will continue to be addressed as part of the FY 2014/15 Work Plan:

# OVERVIEW STATUS

Project Scope The BSC recommends the 1.0 The new guidelines for the removal/inclusion of clinical development of guidelines/principles indicators were approved by the BSC on September 20th, for the removal/inclusion of clinical 2013. These guidelines may be further revised based on indicators and future analysis for the outcome of the 2014 Benchmarking Report strategic appropriate benchmarking. planning session (see item #2.0 below). Given the changing data needs within 2.0 Strategic planning session will be held in Spring 2014. the province and the continual The meeting will be comprised of representatives that development of the Benchmarking reflect the following areas of expertise and the full range Report, a strategic planning session is of participating hospitals: Program Administrators, recommended in order to review the Clinicians, Decision Support, Finance, Health Information, scope and format of the annual and LHIN leadership. Benchmarking Report.

Data Quality / Data Enhancements

3.0 Given the current data quality issues In 2012, a new Benchmarking Hospital Profile was with workload measurement units developed to address the Respiratory Therapy (RT) including applicability to paediatrics workload data collection methods, paediatric RT staffing and compliance with regards to data details, education and consultation activities, and specific capture, the BSC recommends that a patient-care interventions. The RT Profile will be working group investigate a more published every 2 years (next publication: 2014 Report). appropriate mix of indicators for Diagnostic imaging and laboratory services indicators are measurement and comparability for currently being investigated by the MIS Work Group the following key patient care using the Trial Balance submitted by Academic Health functions: Sciences Centres for FY 2013/14.

Diagnostic imaging The BSC will not be addressing other allied health Laboratory services functions at this time. Allied health Investigate, for possible future 4.0 The Mental Health Work Group (MHWG) reviewed the inclusion, the following indicators: issue of readmissions in 2012, and determined that CIHI Mental Health Readmissions. is able to produce required readmission reports, using new methodology in DAD (available for 2013 Report) and NACRS (available for 2014 Report). Prior to publication in the 2013 Benchmarking Report, the Benchmarking Health Information Work Group (HIWG) reviewed and approved the proposed CIHI

3 PCMCH Maternal-Child Benchmarking Report 2013

methodology for capturing DAD readmission data and validated results for the new indicator MH 1.1.4. Mental Health Readmissions within 30 days (page 254). In 2014, the Benchmarking Health Information Work Group will review CIHI methodology for capturing ED revisit rates for inclusion in 2014 Report.

5.0 Review and revise, where The MIS Work Group conducted a survey of appropriate, the following indicators Benchmarking MIS participants to assess the utility of ED in order to enhance benchmarking MIS indicators. opportunities for all stakeholders: Further investigation is required in order to determine a Operational Efficiencies indicators for common method for separating paediatric costs for ED. community and non-paediatric AHSCs The inclusion of this indicator will be further reviewed for ED. using the new guidelines for inclusion / exclusion of Benchmarking indicators.

6.0 In collaboration with the Ontario ONCAIPS representation will be invited to consult or Network of Child and Adolescent participate in next year’s PCMCH provincial Inpatient Psychiatric Services Benchmarking Report. ONCAIPS will share its own (ONCAIPS), review and revise the inpatient benchmarking reports and publications as these Mental Health section of the are generated. Benchmarking Report.

7.0 Due to ongoing changes in CMG+ CIHI The Benchmarking Health Information Work Group will methodology, the BSC recommends review 2013 CMG+ methodology changes prior to 2014 that a review be conducted to confirm Report data load (September 2014). the CMG code listing for following Note: Due to changes in CMG+ methodology, the following filters used in Benchmarking Report indicators will not be shown in 2013 Report: indicators: Neonatal, Obstetrical, Mental Health, Medical and Surgical. DES 2.1.3 – Patient Volume Breakdown QUM 5.2.1 – Percent Medical and Mental Health Admissions via ED with One & Two Days Stay QUM 5.2.2 – Percent Medical, Mental Health and Surgical Admissions via ED

4 PCMCH Maternal-Child Benchmarking Report 2013

Report Framework

Data Sources

The hospital descriptors, clinical efficiencies, quality and utilization management analyses and Emergency Department indicators are based on acute inpatient, same day procedure and emergency data for patients who were discharged, died or signed out during the 2012-2013 fiscal year.

All of the participating hospitals submitted data to the Canadian Institute of Health Information (CIHI) Discharge Abstract Database (DAD) and the National Ambulatory Care Reporting System (NACRS) directly. • The inpatient data is generated from the DAD database and were retrieved from the CIHI Portal. • The day surgery and emergency visits data is generated from the NACRS database and were retrieved from the CIHI Portal.

Operational Efficiency Indicators

The Operational Efficiency analysis is based on financial and statistical data provided by hospitals to the project in a trial balance format. Hospitals were requested to organize all operational data provided for the benchmarking database according to the Management Information Systems (MIS) in Canadian Health Service Organizations Guidelines, referred to as MIS Guidelines. The participating members that are “children’s hospitals-within-hospitals” created a paediatric trial balance utilizing a common allocation methodology for direct, indirect and overhead expenses. Other hospitals with a stand-alone NICU and/or paediatric department were also invited to participate in the Operational Efficiency analysis. MIS data were submitted to the Decision Support Department at Hamilton Health Sciences for analysis.

Holland Bloorview Kids Rehab Hospital

Holland Bloorview Kids Rehab Hospital provided all information detailed in the Holland Bloorview section.

OMHRS

Ontario Mental Health Reporting System (OMHRS) data were manually submitted to PCMCH.

Hospital Profile

The participating organizations have provided a profile, a history and overview of their organization in order to provide context for the clinical and operational efficiency indicators. These profiles include scope of care, academic affiliations as well as other relevant information. Hospital Profile data were manually submitted to PCMCH, including the following:

• Services Offered • Bed Profile • Emergency Department Profile • Mental Health Profile

5 PCMCH Maternal-Child Benchmarking Report 2013

Data Limitations

The 2013 Benchmarking Report includes data from the CIHI Portal for 2010/11, 2011/12 and 2012/13. As such, slight discrepancies between data years may be expected.

Inclusion and Exclusion Criteria

• For the purposes of this report, “paediatrics” was defined within the DAD as “encounters for individuals less than 18 years of age”, excluding obstetrics which was defined as “Major Clinical Category (MCC) 13 (CMG+)” and normal newborns defined as “ICD10-CA codes MRDx (Most Responsible Diagnosis) Z38.0 – Z38.8”. • All same day surgery procedures and Emergency Department visits for individuals less than 18 years of age were included. • Additional analysis was performed on the paediatric and neonatal populations. These populations were defined as: o Neonatal for patients that are 0 to 28 days of age on admission. o Paediatric for patients that are 29 days to 17 years of age on admission. • Obstetrical data was not limited by age and was defined as “CMGs within MCC 13 - Pregnancy and Childbirth”.

Comparator Data

As per recommendations made by our stakeholders, length of stay indicators in the Academic and Community sections continue to include national/provincial comparators. The academic hospital comparators are national Academic Health Sciences Centres participating in the Canadian Association of Paediatric Health Centres’ Decision Support Network (CAPHC CPDSN). The community hospital comparator is all non-academic hospitals in the province of Ontario. In future, we will look to add comparators to other data points.

National comparator data within the Academic section of the Benchmarking Report is that of the Canadian Association of Paediatric Health Centres (CAPHC). CAPHC member facilities included in the comparator are:

• Alberta Health Services – Calgary Area • Alberta Health Services – Edmonton Area • Centre Hospitalier Universitaire de Quebec • Centre Hospitalier Universitaire Sainte-Justine • Centre Hospitalier Universitaire de Sherbrooke • Children’s Hospital of Eastern Ontario • Eastern Health Authority • Hamilton Health Sciences Centre • IWK Health Centre • McGill University Health Centre • Saskatoon Health Region • The Hospital for Sick Children • Winnipeg Regional Health Authority

Provincial comparator data within the Community section of the Benchmarking Report is that of all hospitals within the province of Ontario, excluding the following Academic Health Sciences Centres:

6 PCMCH Maternal-Child Benchmarking Report 2013

• Children’s Hospital, London Health Sciences Centre • Children’s Hospital of Eastern Ontario • The Hospital for Sick Children • Kingston General Hospital • McMaster Children’s Hospital, Hamilton Health Sciences • Mount Sinai Hospital • Sunnybrook Health Sciences Centre • The Ottawa Hospital

Privacy Considerations

To ensure privacy, indicators with a total count of less than six cases were not reported. Some of the hospitals participating in the report do not have all volumes displayed given this privacy constraint. In this case, the cell is displayed as “<6”.

7 PCMCH Maternal-Child Benchmarking Report 2013

List of Participating Hospitals and Acronyms

The following multisite organizations are grouped at their highest Level of Care (LOC) delivered:

Maternal Grey Bruce Health Services Halton Healthcare Services Corporation Humber River Regional Hospital Lakeridge Health Corporation Rouge Valley Health System

Neonatal Grey Bruce Health Services Halton Healthcare Services Corporation Humber River Regional Hospital Lakeridge Health Corporation Rouge Valley Health System The Ottawa Hospital William Osler Health Centre

Other considerations: The grouping of different levels may impact data that may be different based on level of care (e.g.: ALOS, ARIW).

Academic Health Sciences Centres

Participating Hospital Acronym LHIN # LHIN LOC (Maternal) LOC (Neonatal) Children’s Hospital, London Health Sciences CH LHSC 2 South West III IIIb Centre Children’s Hospital of Does not provide CHEO 11 Champlain IIIb Eastern Ontario maternal care Kingston General KGH 10 South East III IIIb Hospital McMaster Children’s Hamilton Niagara Hospital, Hamilton MCH HHSC 4 III IIIb Haldimand Brant Health Sciences Centre Mount Sinai Hospital Mt Sinai 7 Toronto Central III IIIa The Hospital for Sick Does not provide SickKids 7 Toronto Central IIIb Children maternal care Sunnybrook Health Sunnybrook 7 Toronto Central III IIIa Sciences Centre The Ottawa Hospital General: III General: IIIa TOH 11 Champlain Civic: III Civic: IIc

Community Hospitals

Participating Hospital Acronym LHIN # LHIN LOC (Maternal) LOC (Neonatal) Almonte General Hospital AGH 11 Champlain Ib I Bluewater Health BWH 1 Erie St. Clair IIa IIa 8 PCMCH Maternal-Child Benchmarking Report 2013

Participating Hospital Acronym LHIN # LHIN LOC (Maternal) LOC (Neonatal) Brant Community Healthcare Hamilton Niagara BCHS 4 IIb IIa System Haldimand Brant Brockville General Hospital BGH 10 South East Ib I Waterloo Cambridge Memorial Hospital CMH 3 IIa IIa Wellington Collingwood General & Marine North Simcoe CMGH 12 Ib I Hospital Muskoka Cornwall Community Hospital CCH 11 Champlain Ib I North Simcoe Georgian Bay General Hospital GBGH 12 Ib I Muskoka Geraldton District Hospital GDH 14 North West Ia I Waterloo Grand River Hospital GRH 3 IIb IIb Wellington Owen Sound: IIb Owen Sound: IIb Grey Bruce Health Services GBHS 2 South West Walkerton: Ib Walkerton: I Georgetown: Ib Georgetown: I Halton Healthcare Services HHS 6 Mississauga Halton Milton: Ib Milton: I Oakville: IIb Oakville: IIa Headwaters Health Care Centre HHCC 5 Central West Ib I Health Sciences North/Horizon HSN 13 North East IIc IIc Santé-Nord Hôpital Montfort Montfort 11 Champlain IIa IIa Hotel Dieu Hospital – The Religious Hospitallers of St. HDH 10 South East III IIIb Joseph of the Hotel Dieu Hospital, Kingston Finch: IIb Finch: IIb Humber River Regional Hospital HRRH 8 Central Church: Ib Church: I Joseph Brant Hospital (formerly Hamilton Niagara known as Joseph Brant Memorial JBH 4 IIb IIa Haldimand Brant Hospital) Oshawa: IIc Oshawa: IIc Lakeridge Health LH 9 Central East Port Perry: Ib Port Perry: I Mackenzie Health MH 8 Central IIc IIc Markham Stouffville Hospital MSH 8 Central IIc IIc Corporation Middlesex Hospital Alliance – Strathroy Middlesex General MHA-SMGH 2 South West Ia I Hospital Hamilton Niagara St. Catharines: IIa St. Catharines: IIa Niagara Health System NHS 4 Haldimand Brant Welland: IIa Welland: IIa North Bay Regional Health Centre NBRHC 13 North East IIc IIc North York General Hospital NYGH 8 Central IIc IIc Northumberland Hills Hospital NHH 9 Central East Ib I North Simcoe Orillia Soldiers’ Memorial Hospital OSMH 12 IIc IIc Muskoka Peterborough Regional Health PRHC 9 Central East IIb IIb Centre Belleville: Ib Belleville: I Quinte Health Care QHC 10 South East Prince Edward Prince Edward County: Ib County: I Renfrew Victoria Hospital Renfrew 11 Champlain Ia I Riverside Health Care Facilities Inc RHCF 14 North West Ib I Ross Memorial Hospital RMH 9 Central East Ib I Ajax: IIb Ajax: IIb Rouge Valley Health System RVHS 9 Central East Centenary: IIc Centenary: IIc

9 PCMCH Maternal-Child Benchmarking Report 2013

Participating Hospital Acronym LHIN # LHIN LOC (Maternal) LOC (Neonatal) The Royal Victoria Regional Health North Simcoe RVH 12 IIc IIc Centre Muskoka Sault Area Hospital SAH 13 North East IIc IIc The Scarborough Hospital TSH 9 Central East IIb IIb Sioux Lookout Meno Ya Win Health SLMHC 14 North West Ib I Centre South Bruce Grey Health Centre SBGHC 2 South West Ib I Southlake Regional Health Centre Southlake 8 Central IIb IIb SJHC Hamiton Niagara St. Joseph’s Healthcare, Hamilton 4 IIb IIb Hamilton Haldimand Brant St. Joseph’s Health Centre, SJHC 7 Toronto Central IIb IIb Toronto Toronto St. Michael’s Hospital SMH 7 Toronto Central III IIc St. Thomas Elgin General Hospital STEGH 2 South West IIa IIa Stevenson Memorial Hospital Stevenson 8 Central Ib I Thunder Bay Regional Health TBRHSC 14 North West IIc IIc Sciences Centre Toronto East General Hospital TEGH 7 Toronto Central IIc IIc Trillium Health Partners - Credit Valley Hospital (formerly known as THP-CVH 6 Mississauga Halton IIc IIc Credit Valley Hospital) Trillium Health Partners - Mississauga Hospital (formerly THP-MH 6 Mississauga Halton IIb IIb known as Trillium Health Centre) Hamiton Niagara West Lincoln Memorial Hospital WLMH 4 Ib I Haldimand Brant West Parry Sound Health Centre WPSHC 13 North East Ib I Brampton: IIb Brampton: IIc William Osler Health System WOHS 5 Central West Etobicoke: IIb Etobicoke: IIb Winchester District Memorial WDMH 11 Champlain Ib I Hospital Windsor Regional Hospital WRH 1 Erie St. Clair IIc IIc Woodstock General Hospital WGH 2 South West Ib I

10 PCMCH Maternal-Child Benchmarking Report 2013

ACADEMIC HEALTH SCIENCES CENTRES

11 PCMCH Maternal-Child Benchmarking Report 2013

Hospital Profiles

Service Profiles

Children’s Hospital, London Health Sciences Centre

Acronym CH LHSC Main Catchment Southwestern Ontario, Thunder Bay and Sault Area Ste Marie Primary Academic Western University Affiliation Year Founded 1922 Website www.lhsc.on.ca/About_Us/Childrens_Hospital/ Subspecialties / Services Offered Paediatric Paediatric Surgical Paediatric Medical Paediatric Other Mental Health Dental / Oral Surgery Allergy & Immunology Crisis Anaesthesiology General Surgery Cardiology Eating Disorders Burns Gynecology Critical Care Psychiatry Child Protection Neurosurgery Developmental Paediatrics Psychology Complex Care Ophthalmology Emergency Medicine Dedicated Transport Team Orthopaedic Surgery Endocrinology Organ Transplantation Otolaryngology Gastroenterology Palliative Care Plastic Surgery General Paediatrics Urology Genetics / Metabolics Haematology Infectious Diseases Neonatology Nephrology Neurology Newborn Nutrition Oncology Pharmacology Respirology Rheumatology

Notes The delivery of obstetrical and neonatal care in the city of London was forever changed as perinatal patients were safely and successfully transferred from St. Joseph's Health Care, London to London Health Sciences Centre on June 5, 2011. The successful completion of the transfer marked a significant milestone for both hospital organizations consolidating 42 physical neonatal beds and 16 tertiary level labour birthing rooms, and 65 physical mother-baby dyad care beds at Victoria Hospital. Dedicated Transport Team = 0-18 years (NICU/PCCU integrated team).

12 PCMCH Maternal-Child Benchmarking Report 2013

Children’s Hospital of Eastern Ontario

Acronym CHEO Eastern Ontario, Western Quebec, parts Main Catchment of Northern and Southeastern Ontario and Area Baffin Island Primary Academic University of Ottawa Affiliation Year Founded 1974

Website www.cheo.on.ca

Subspecialties / Services Offered Paediatric Paediatric Surgical Paediatric Medical Paediatric Other Mental Health Cardiovascular Surgery Adolescent Medicine Crisis Anesthesiology Dental / Oral Surgery Allergy & Immunology Eating Disorders Child Protection General Surgery Cardiology Psychiatry Dedicated Obesity Program Gynecology Critical Care Psychology Palliative Care Neurosurgery Dermatology Transport Team Ophthalmology Developmental Paediatrics (Neonatal Only) Orthopaedic Surgery Emergency Medicine Otolaryngology Endocrinology Plastic Surgery Gastroenterology Urology General Paediatrics Genetics / Metabolics Haematology Infectious Diseases Neonatology Nephrology Neurology Nutrition Oncology Pharmacology Physical Medicine & Rehabilitation Respirology Rheumatology

13 PCMCH Maternal-Child Benchmarking Report 2013

Kingston General Hospital

Acronym KGH Main Catchment LHIN 10: South East Area Primary Academic Queen’s University Affiliation Year Founded 1835

Website www.kgh.on.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health General Surgery Adolescent Medicine Mental Health Services Anaesthesiology Gynecology Cardiology Child Protection Ophthalmology Critical Care Palliative Care Orthopaedic Surgery Developmental Paediatrics Otolaryngology Emergency Medicine Plastic Surgery Endocrinology Urology Gastroenterology General Paediatrics Genetics / Metabolics Haematology Infectious Diseases Neonatology Nephrology Neurology Nutrition Oncology Respirology

14 PCMCH Maternal-Child Benchmarking Report 2013

McMaster Children’s Hospital, Hamilton Health Sciences Centre

Acronym MCH HHSC Main Catchment LHIN 4: Hamilton Niagara Haldimand Brant Area Primary Academic McMaster University Affiliation Year Founded 1988

Website www.mcmasterchildrenshospital.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental / Oral Surgery Allergy & Asthma Adolescent Medicine Anaesthesiology General Surgery Cardiology Eating Disorders Burns Gynecology Critical Care Psychiatry Child Protection Neurosurgery Developmental Psychology Palliative Care Ophthalmology Paediatrics Transport Team (Neonatal) Orthopaedic Surgery Emergency Medicine Otolaryngology Endocrinology/Diabetes Plastic Surgery Gastroenterology Urology General Paediatrics Genetics / Metabolics Haematology Immunology Infectious Diseases Neonatology Nephrology Neurology Nutrition Oncology Physical Medicine & Rehabilitation Respirology Rheumatology

15 PCMCH Maternal-Child Benchmarking Report 2013

Mount Sinai Hospital

Acronym Mt Sinai Main Catchment Toronto Central LHIN Area Primary Academic University of Toronto Affiliation Year Founded 1923

Website www.mountsinai.on.ca

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Ophthalmology Developmental Paediatrics General Paediatrics Neonatology Newborn

Sunnybrook Health Sciences Centre

Acronym Sunnybrook Main Catchment Greater Toronto Area Area Primary Academic University of Toronto Affiliation Sunnybrook – 1948 Women’s College Hospital (NICU) – 1971

Sunnybrook and Women’s College HSC (NICU) – Year Founded 1998 Sunnybrook Health Sciences Centre (NICU) – 2006 Website www.sunnybrook.ca

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Ophthalmology Cardiology Neonatology

16 PCMCH Maternal-Child Benchmarking Report 2013

The Hospital for Sick Children

Acronym SickKids Main Catchment Toronto and GTA Area Primary Academic University of Toronto Affiliation Year Founded 1875

Website www.sickkids.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Cardiovascular Surgery Adolescent Medicine Crisis Anaesthesiology Dental / Oral Surgery Allergy & Immunology Eating Disorders Bone Marrow Transplant General Surgery Cardiology Psychiatry Burns Gynecology Dermatology Psychology Clinically Complex Paeds Neurosurgery Emergency Medicine Substance Abuse Critical Care Medicine Ophthalmology Endocrinology Palliative Care Orthopaedic Surgery Gastroenterology Poison Centre (Services Otolaryngology Paediatric Medicine Ontario and Manitoba) Plastic Surgery Genetics / Metabolics SickKids Team Obesity Urology Haematology Management Program Infectious Diseases (STOMP) - Clinic for Severe and Complex Obesity Neonatology Nephrology Solid Organ Transplant Neurology Suspected Child Abuse and Nutrition Neglected Program (SCAN) Oncology Pharmacology Physical Medicine & Rehabilitation Respirology Rheumatology

17 PCMCH Maternal-Child Benchmarking Report 2013

The Ottawa Hospital

Acronym TOH Main Catchment LHIN 11: Champlain Area Primary Academic University of Ottawa Affiliation Year Founded 1998

Website www.ottawahospital.on.ca

Subspecialties / Services Offered

Paediatric Medical General Paediatrics Neonatology

18 PCMCH Maternal-Child Benchmarking Report 2013

Bed Profiles

The table below presents the number of perinatal, neonatal and paediatric “Physical” beds - the maximum number of beds at the beginning of the year on the basis of established standards of floor area per patient to meet fire protection and safety standards. It also presents the number of perinatal, neonatal and paediatric beds “Staffed and In Operation” - beds that are open are available regardless of whether or not they are actually occupied by a patient. For detailed MIS bed definitions, please refer to page 289.

When considering paediatric beds, participating facilities were asked NOT to include adult medical / surgical beds. When entering the number of perinatal beds, participating facilities were asked NOT to provide the number of cribs/bassinets associated with mother-baby dyad care.

KGH

CHEO

CH LHSC CH Sinai Mt MCH HHSC MCH

Beds

Physical Physical Physical Physical Physical

Available Available Available Available Available

Operation Operation Operation Operation Operation

Surge Beds Beds Surge Beds Surge Beds Surge Beds Surge Beds Surge

Staffed / In In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed

a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Perinatal Level II b 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 c 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 27 27 0 0 0 0 117 86 31 Level III b 65 46 19 0 0 0 0 0 0 26 26 0 0 0 0 SUBTOTAL PERINATAL 65 46 19 0 0 0 27 27 0 26 26 0 117 86 31

a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Neonatal Level II b 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 c 12 12 0 0 0 0 14 14 0 14 14 0 20 18 2 a 0 0 0 0 0 0 0 0 0 0 0 0 41 37 4 Level III b 30 28 2 21 15 6 8 8 0 46 46 0 0 0 0 SUBTOTAL NEONATAL 42 40 2 21 15 6 22 22 0 60 60 0 61 55 6

Med/Surg 64 58 6 110 99 11 10 10 0 51 51 0 0 0 0

Level II 0 0 0 0 0 0 5 5 0 0 0 0 0 0 0 PCCU Level III 12 9 3 12 7 5 0 0 0 12 10 2 0 0 0 SUBTOTAL PCCU 12 9 3 12 7 5 5 5 0 12 10 2 0 0 0

Mental Health 16 16 0 25 24 1 8 8 0 28 28 0 0 0 0 Other 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0

TOTAL 199 169 30 168 145 23 72 72 0 181 179 2 178 141 37

Notes CH LHSC: There are 16 labour birthing rooms that are not counted in the bed count above. There are 32 bassinettes not counted associated with the 32 maternal postpartum beds to provide mother/baby couplet care. KGH: There are also 6 labour rooming beds that are not included in the perinatal count. MCH HHSC: “Other” indicates 4 PCCU stepdown beds. Mt Sinai: Perinatal bed count includes 19 LDR beds, 46 PP beds, and 32 High Risk Antenatal beds (not differentiated by risk level).

19 PCMCH Maternal-Child Benchmarking Report 2013

Bed Profiles: Academic Health Sciences Centres (cont)

TOH

Total

SickKids Sunnybrook

Beds

Physical Physical Physical Physical

Available Available Available Available

Operation Operation Operation Operation

Surge Beds Beds Surge Beds Surge Beds Surge Beds Surge

Staffed / In In / Staffed In / Staffed In / Staffed In / Staffed

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Perinatal Level II b 0 0 0 0 0 0 0 0 0 0 0 0 c 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 68 46 22 90 84 6 302 243 59 Level III b 0 0 0 0 0 0 0 0 0 91 72 19 SUBTOTAL PERINATAL 0 0 0 68 46 22 90 84 6 393 315 78

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Neonatal Level II b 0 0 0 12 12 0 0 0 0 12 12 0 c 0 0 0 0 0 0 40 31 9 86 75 11 a 0 0 0 36 29 7 12 10 2 89 76 13 Level III b 43 33 10 0 0 0 0 0 0 162 144 18 SUBTOTAL NEONATAL 43 33 10 48 41 7 52 41 11 349 307 42

Med/Surg 263 199 64 0 0 0 0 0 0 498 417 81

Level II 13 12 1 0 0 0 0 0 0 18 17 1 PCCU Level III 41 29 12 0 0 0 0 0 0 77 55 22 SUBTOTAL PCCU 54 41 13 0 0 0 0 0 0 95 72 23

Mental Health 15 13 2 8 8 0 0 0 0 100 97 3 Other 0 0 0 0 0 0 0 0 0 4 4 0

TOTAL 375 286 89 124 95 29 142 125 17 1,439 1,212 227

Notes TOH: Not all perinatal beds are level 3b obstetrical/birthing room and postpartum beds. TOH doesn’t distinguish between what level of bed they are. They may be used for a low risk patient or a high-risk patient.

20 PCMCH Maternal-Child Benchmarking Report 2013

Emergency Department Profiles

Children’s Hospital, London Health Sciences Centre

Observation / Short Stay Unit / No Assessment Unit Paediatric or Combined Paediatric Adult/Paediatric ED Paediatric ED Nurses Yes Paediatric CTAS Guidelines Yes Triage Process According to P-CTAS standards Fast Track / Quick Care / Medical Yes. There is a 5 bay emergency ambulatory care centre, from noon to Walk-in Clinic midnight, for fast track of CTAS 4-5.

Children’s Hospital of Eastern Ontario

Observation / Short Stay Unit / No Assessment Unit Paediatric or Combined Paediatric Adult/Paediatric ED Paediatric ED Nurses Yes Paediatric CTAS Guidelines Yes Triage Process CHEO uses an electronic version of the P-CTAS guidelines. CHEO also has a 2-Tier triage process. Fast Track / Quick Care / Medical CHEO has a Fast Track that is physically separate which sees all Walk-in Clinic patients with minor injury or illness.

Kingston General Hospital

Observation / Short Stay Unit / No Assessment Unit Paediatric or Combined KGH has a combined adult/paediatric Emergency Department. Adult/Paediatric ED Paediatric ED Nurses KGH combined adult/paediatric Emergency Department is staffed by adult emergency nurses with paediatric education/support. Paediatric CTAS Guidelines Yes Triage Process P-CTAS guidelines endorsed by the Canadian Paediatric Society, Canadian Association of Emergency Physicians, and the National Emergency Nurses Affiliation. Fast Track / Quick Care / Medical Yes. Fast track ambulatory care for CTAS III, IV & V. It manages a Walk-in Clinic higher proportion of level 1-3 P-CTAS cases for paediatrics because there is a children’s Outpatient Clinic and Urgent Care Centre at Hotel Dieu Hospital; however there are some level IV & V patients who present to KGH when these options are not available.

21 PCMCH Maternal-Child Benchmarking Report 2013

McMaster Children’s Hospital, Hamilton Health Sciences Centre

Observation / Short Stay Unit / No Assessment Unit Paediatric or Combined Paediatric Adult/Paediatric ED Paediatric ED Nurses Yes Paediatric CTAS Guidelines Yes Triage Process Patients are triaged using P-CTAS guidelines in an e-documentation format following a received process that activates the electronic medical record. Fast Track / Quick Care / Medical Ambulatory Care. Non urgent patients (CTAS 4 & 5 and some Walk-in Clinic appropriate 3) are sorted at Triage and, based on guidelines, are placed in Ambulatory Care Area of ED operating 1200-2400 hours.

Mount Sinai Hospital

Observation / Short Stay Unit / Yes. Short stay LOS < 72 hrs. Virtual Clinical Decision Unit (CDU) - LOS Assessment Unit < 24 hrs. Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process All patients are triaged and assessed using P-CTAS guidelines. Fast Track / Quick Care / Medical Yes. Fast track ambulatory care for CTAS IV & V. Rapid assessment Walk-in Clinic Zone (RAZ) for CTAS II-IV.

The Hospital for Sick Children

Observation / Short Stay Unit / No Assessment Unit Paediatric or Combined Paediatric Adult/Paediatric ED Paediatric ED Nurses Yes Paediatric CTAS Guidelines Yes Triage Process Triage is performed according to the 5 point P-CTAS scale. The process is: Step 1: Triage 1 - Quick sort and infectious screening to identify extremely sick or infectious patients. This is consistently done within 2 minutes. Step 2: Quick registration (Basic name, DOB, healthcare #). Step 3: Triage 2 - a comprehensive assessment and triage to confirm CTAS category. Step 4: Final / Full registration. Fast Track / Quick Care / Medical Urgent Care: Non urgent patients (CTAS 4 & 5 and some less acute 3) Walk-in Clinic are sorted at either triage 1 or 2 and, based on guidelines, are sent to Urgent Care and treated in a low acuity setting. Hours of operation are from 1100-0100 during winter season and 1200-2400 hours during summer season.

22 PCMCH Maternal-Child Benchmarking Report 2013

Sunnybrook Health Sciences Centre

Observation / Short Stay Unit / No Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Child +/- family member are assessed by a triage nurse and assigned a CTAS score. Re-assessment is conducted within the CTAS guidelines. Fast Track / Quick Care / Medical Separate minor area with a separate minor waiting area. Walk-in Clinic

The Ottawa Hospital

Observation / Short Stay Unit / Yes. This unit is not unique to paediatrics. Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process CTAS guidelines Fast Track / Quick Care / Medical Fast Track. Walk-in Clinic

23 PCMCH Maternal-Child Benchmarking Report 2013

Clinical Indicators

1.0 Provincial Overview

1.1.1 PO – LHIN Map

# LHIN 1 Erie St. Clair 2 South West Waterloo 3 Wellington Hamilton Niagara 4 Haldimand Brant 5 Central West 6 Mississauga Halton 7 Toronto Central 8 Central 9 Central East 10 South East 11 Champlain North Simcoe 12 Muskoka 13 North East 14 North West

24 PCMCH Maternal-Child Benchmarking Report 2013

1.1.2 PO – Paediatric AHSCs Inpatient Discharges, Distributed by Hospital & LHIN

This table summarizes inpatient paediatric separations by hospital distributed by patient’s residence LHIN, for the paediatric AHSCs.

Patient's Residence LHIN CH LHSC CHEO KGH MCH HHSC SickKids Total

LHIN 1 Erie St. Clair 14.7% 0.0% 0.0% 0.1% 0.9% 2.8% LHIN 2 South West 77.6% 0.0% 0.0% 0.7% 1.4% 13.5% LHIN 3 Waterloo Wellington 3.4% 0.0% 0.1% 13.9% 2.2% 4.2% LHIN 4 HNHB 1.0% 0.1% 0.1% 78.7% 2.9% 16.6% LHIN 5 Central West 0.2% 0.0% 0.0% 0.6% 11.8% 5.0% LHIN 6 Mississauga Halton 0.2% 0.0% 0.0% 4.6% 11.7% 5.7% LHIN 7 Toronto Central 0.1% 0.1% 0.2% 0.2% 17.1% 7.1% LHIN 8 Central 0.2% 0.0% 0.1% 0.4% 22.5% 9.3% LHIN 9 Central East 0.1% 0.2% 2.7% 0.2% 18.4% 7.8% LHIN 10 South East 0.1% 4.7% 94.1% 0.0% 1.2% 6.9% LHIN 11 Champlain 0.0% 72.4% 0.7% 0.0% 0.9% 12.8% LHIN 12 North Simcoe Muskoka 0.2% 0.0% 0.0% 0.0% 4.1% 1.7% LHIN 13 North East 0.6% 3.9% 1.6% 0.2% 2.5% 1.9% LHIN 14 North West 1.5% 0.1% 0.0% 0.0% 0.6% 0.5% Out of P/C Out of P?C 0.3% 18.3% 0.3% 0.3% 1.9% 4.1% Grand Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Total Paediatric AHSC Inpatient Discharges Distributed by LHIN

LHIN 1 LHIN 10 LHIN 9 LHIN 11 LHIN 3

LHIN 8

LHIN 5

LHIN 7 Other

LHIN 12 LHIN 6 LHIN 13 LHIN 14 LHIN 2 LHIN 4 Out of P/C

Notes HNHB = Hamilton Niagara Haldimand Brant Out of P/C = Out of Province / Country

25 PCMCH Maternal-Child Benchmarking Report 2013

1.1.3 PO – Paediatric AHSCs Inpatient Discharges by LHIN

This table summarizes the percent of inpatient paediatric separations by patient’s residence LHIN for the paediatric AHSCs.

Patient's Residence LHIN CH LHSC CHEO KGH MCH HHSC SickKids Total

LHIN 1 Erie St. Clair 2.4% 0.0% 0.0% 0.0% 0.4% 2.8% LHIN 2 South West 12.8% 0.0% 0.0% 0.1% 0.6% 13.5% LHIN 3 Waterloo Wellington 0.6% 0.0% 0.0% 2.7% 0.9% 4.2% LHIN 4 HNHB 0.2% 0.0% 0.0% 15.3% 1.2% 16.6% LHIN 5 Central West 0.0% 0.0% 0.0% 0.1% 4.8% 5.0% LHIN 6 Mississauga Halton 0.0% 0.0% 0.0% 0.9% 4.8% 5.7% LHIN 7 Toronto Central 0.0% 0.0% 0.0% 0.0% 7.0% 7.1% LHIN 8 Central 0.0% 0.0% 0.0% 0.1% 9.2% 9.3% LHIN 9 Central East 0.0% 0.0% 0.2% 0.0% 7.5% 7.8% LHIN 10 South East 0.0% 0.8% 5.6% 0.0% 0.5% 6.9% LHIN 11 Champlain 0.0% 12.4% 0.0% 0.0% 0.4% 12.8% LHIN 12 North Simcoe Muskoka 0.0% 0.0% 0.0% 0.0% 1.7% 1.7% LHIN 13 North East 0.1% 0.7% 0.1% 0.0% 1.0% 1.9% LHIN 14 North West 0.2% 0.0% 0.0% 0.0% 0.2% 0.5% Out of P/C 0.1% 3.1% 0.0% 0.1% 0.8% 4.1% Grand Total 16.5% 17.1% 6.0% 19.4% 40.9% 100.0%

Total Paediatric AHSC Inpatient Discharges - Distributed by Hospital

16.5%

CH LHSC 40.9% CHEO

17.1% KGH MCH HHSC SickKids 6.0%

19.4%

Notes HNHB = Hamilton Niagara Haldimand Brant Out of P/C = Out of Province / Country

26 PCMCH Maternal-Child Benchmarking Report 2013

2.0 Hospital Descriptors

DES 2.1.1 – Inpatient and Same Day Surgery Volumes

The table and charts below depict the total number of inpatient and same day surgery (SDS) cases.

Inpatient Cases SDS Cases Hospitals FY 09/10 FY 10/11 FY 11/12 FY 12/13 FY 09/10 FY 10/11 FY 11/12 FY 12/13 CH LHSC 4,472 4,517 5,551 6,025 2,764 2,717 2,629 2,767 CHEO 6,346 6,494 6,504 6,228 4,965 5,264 5,764 5,105 KGH 1,980 1,953 2,264 2,184 1,350 232 356 346 MCH HHSC 6,279 6,372 6,814 7,165 3,247 2,761 3,245 3,410 Mt Sinai 3,134 3,184 3,052 2,946 111 74 83 68 SickKids 14,055 14,389 15,235 14,966 5,138 4,977 5,129 5,149 Sunnybrook 1,223 1,166 1,477 1,669 70 74 95 71 TOH 2,465 2,412 2,529 2,536 226 125 117 234 Total 39,954 40,487 43,426 43,719 17,871 16,224 17,418 17,150

Total Inpatient and SDS Patient Volumes 70,000 60,000 50,000 17,418 17,150 17,871 16,224 40,000 30,000 20,000 10,000 39,954 40,487 43,426 43,719 0 FY 09/10 FY 10/11 FY 11/12 FY 12/13 Inpatient Cases SDS Cases

Inpatient and SDS Patient Volumes by Hospital (FY 12/13)

CH LHSC

CHEO

KGH

MCH HHSC

Mt Sinai

SickKids

Sunnybrook

TOH

- 5,000 10,000 15,000 20,000 25,000 Inpatient Cases SDS Cases

Notes KGH: Kingston General Hospital data for FY 09/10 and FY 10/11 includes records from Hotel Dieu Hospital, Kingston (HDH Kingston). In FY 2011/12 and FY 2012/13 KGH is no longer reporting together with HDH Kingston. CH LHSC: St. Joseph’s Health Centre, London moved their maternal-newborn program to CH LHSC in June 2011. TOH: Riverside campus was excluded from FY 2011/12 SDS results.

27 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.2 – Neonatal and Paediatric Inpatient Case Distribution

The table and charts below depict the distribution between Neonatal (0‐28 days) and Paediatric (29 days-17 years) inpatient cases.

Neonatal Cases Paediatric Cases Hospital FY 09/10 FY 10/11 FY 11/12 FY 12/13 FY 09/10 FY 10/11 FY 11/12 FY 12/13 CH LHSC 753 742 1,544 1,804 3,719 3,775 4,006 4,221 CHEO 789 743 729 645 5,557 5,751 5,775 5,583 KGH 717 662 792 679 1,263 1,291 1,472 1,505 MCH HHSC 1,600 1,864 1,725 1,822 4,679 4,508 5,089 5,343 Mt Sinai 3,041 3,072 2,968 2,869 93 112 81 77 SickKids 1,134 1,091 1,149 1,123 12,921 13,298 14,086 13,843 Sunnybrook 1,123 1,033 1,355 1,525 100 133 122 144 TOH 2,282 2,251 2,387 2,392 183 161 141 144 Total 11,439 11,458 12,649 12,859 28,515 29,029 30,772 30,860

Total Neonatal and Paediatric Inpatient Case Volumes 50,000

40,000

30,000

20,000 28,515 29,029 30,772 30,860 10,000 11,439 11,458 12,649 12,859 0 FY 09/10 FY 10/11 FY 11/12 FY 12/13 Neonatal Cases Paediatric Cases

Neonatal and Paediatric Inpatient Case Volumes by Hospital (FY 12/13) CH LHSC

CHEO

KGH

MCH HHSC

Mt Sinai

SickKids

Sunnybrook

TOH

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Neonatal Cases Paediatric Cases

28 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.3 – Inpatient Case Age Profile

The table and charts below provide a description of the age profile of the inpatient population in each facility. The age categories used here are according to the CMG+ age categories:

0-28 days 29-364 days 1-7 years 8-17 years

Zero volume is left blank.

Hospitals 0-28 Days 29-364 Days 1-7 Years 8-17 Years Total CH LHSC 1,804 682 1,495 2,044 6,025 CHEO 645 903 2,043 2,637 6,228 KGH 679 201 526 778 2,184 MCH HHSC 1,822 877 1,908 2,558 7,165 Mt Sinai 2,869 18 59 2,946 SickKids 1,123 2,013 5,675 6,155 14,966 Sunnybrook 1,525 17 127 1,669 TOH 2,392 33 111 2,536 Total 12,859 4,744 11,647 14,469 43,719

Total Inpatient Cases: Age Profile by Facility Total Inpatient Cases: Age Profile

CH LHSC

CHEO

KGH 14,469 12,859 29% MCH HHSC 33%

Mt Sinai

SickKids 4,744 11% Sunnybrook 11,647 27% TOH

0% 20% 40% 60% 80% 100% 0-28 Days 29-364 Days 1-7 Years 8-17 Years 0-28 Days 29-364 Days 1-7 Years 8-17 Years

29 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.4 – Same Day Surgery (SDS) Age Profile

This table and charts provide a visual description of the age profile of the same day surgery population of each hospital. A zero volume is blank and a volume less than 6 is indicated as “<6”.

Hospital 0-28 Days 29-364 Days 1-7 Years 8-17 Years Total CH LHSC 95 1,366 1,306 2,767 CHEO <6 120 2,989 1,992 5,105 KGH 18 144 184 346 MCH HHSC 108 2,053 1,249 3,410 Mt Sinai 68 68 SickKids 486 3,126 1,537 5,149 Sunnybrook 71 71 TOH <6 232 234 Total <6 827 9,680 6,639 17,150

SDS Cases: Age Profile by Facility SDS Cases: Age Profile

CH LHSC 827

CHEO 5%

KGH

MCH HHSC 6,639 39% Mt Sinai

SickKids 9,680 Sunnybrook 56%

TOH

0% 20% 40% 60% 80% 100% 0-28 days 29-364 days 1-7 years 8-17 years 0-28 days 29-364 days 1-7 years 8-17 years

30 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.5 – Total Average Length of Stay

The table and chart below depict the total average length of stay (ALOS) in days for all inpatient cases. The length of stay is calculated from the date of admission to the date of discharge. A national comparator of Canadian Paediatric Health Centres (CAPHC) member facilities has been added. For a complete list of these facilities please refer to page 8.

Total ALOS Hospital % Change vs FY 09/10 FY 10/11 FY 11/12 FY 12/13 Previous Year CH LHSC 5.7 5.7 6.2 6.7 8% CHEO 7.1 6.8 7.0 6.8 -3% KGH 7.2 6.0 6.5 6.8 5% MCH HHSC 7.2 7.2 6.9 7.3 6% Mt Sinai 7.6 7.5 7.6 7.3 -3% SickKids 7.1 6.9 6.8 6.6 -2% Sunnybrook 11.6 11.0 10.1 10.0 -1% TOH 7.0 6.9 6.6 6.6 0% CAPHC Facilities 8 7.5 7.7 7.2 -6%

Total ALOS (FY 12/13) 12 10.0 10

8 7.3 7.3 7.2 6.7 6.8 6.8 6.6 6.6

6 ALOS 4

31 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.6 – Total Average Length of Stay (Neonatal and Paediatric)

The table and chart below provide the average length of stay for neonatal (0‐28 days) and paediatric (29 days – 17 years) cases. The length of stay is calculated from the date of admission to the date of discharge and is displayed in days. A national comparator of Canadian Paediatric Health Centres (CAPHC) member facilities has been added. For a complete list of these facilities please refer to page 8.

Neonatal ALOS Paediatric ALOS Hospitals FY 09/10 FY 10/11 FY 11/12 FY 12/13 FY 09/10 FY 10/11 FY 11/12 FY 12/13

CH LHSC 7.7 6.7 8.4 9.8 5.4 5.6 5.3 5.4 CHEO 13.3 11.2 12.1 11.0 6.3 6.2 6.3 6.2 KGH 10.7 9.1 10.0 11.8 5.2 4.5 4.6 4.5 MCH HHSC 13.2 11.8 11.8 12.5 5.2 5.3 5.3 5.5 Mt Sinai 7.5 7.4 7.6 7.1 9.2 8.4 6.9 16.9 SickKids 17.6 20.0 17.3 18.7 6.2 5.8 5.9 5.6 Sunnybrook 11.9 11.3 10.3 9.8 8.8 9.3 8.1 11.4 TOH 6.9 6.8 6.5 6.5 7.9 8.2 7.5 7.2 CAPHC Facilities 9.1 8.6 9.8 10.4 5.8 5.7 5.8 5.8

Neonatal and Paediatric ALOS by Hospital (FY 12/13)

20 18.7 18 16.9 16 14 12.5 11.8 11.4 12 11.0 10.4 9.8 9.8

10 ALOS 8 7.1 7.2 6.2 6.5 5.4 5.5 5.6 5.8 6 4.5 4 2 0 CH LHSC CHEO KGH MCH HHSC Mt Sinai SickKids Sunnybrook TOH CAPHC Facilities Neonatal ALOS Paediatric ALOS

Notes KGH: Kingston General Hospital (KGH) data for FY 09/10 and FY 10/11 includes records from Hotel Dieu Hospital, Kingston (HDH Kingston). In FY 2011/12 and FY 2012/13 KGH is no longer reporting together with HDH Kingston. Mt Sinai: In FY 2012/13, the average paediatric LOS was impacted by a small number (6) of high acuity cases with an unusually high LOS (> 2.5 months). ALOS without outliers: 9.6. Sunnybrook: Calculated Pediatric Average LOS by Sunnybrook is 11.8 for FY 12/13.

32 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.7 – Total Average Inpatient Weight per Case

The average inpatient weight per case represents the inpatient Resource Intensity Weight (RIW), which is reflective of the amount of resources required by each facility to care for patients based on the CMG during their hospital stay. The value of 1.0 represents a “typical” inpatient case. Due to a change in CMG + Grouper methodology only FY 2012/13 ARIW is shown.

Hospitals Neonatal ARIW Paediatric ARIW Total ARIW CH LHSC 2.81 1.46 1.87 CHEO 3.28 1.49 1.68 KGH 2.70 1.19 1.66 MCH HHSC 3.78 1.46 2.05 Mt Sinai 1.82 4.78 1.89 SickKids 6.70 1.84 2.21 Sunnybrook 2.63 3.59 2.71 TOH 1.48 2.10 1.52

Total Average Inpatient Weight per Case 8

0 CH LHSC CHEO KGH MCH HHSC Mt Sinai SickKids Sunnybrook TOH Neonatal ARIW Paediatric ARIW Total ARIW

33 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.8 – Percent Typical, Outlier & Other Inpatient Cases and Patient Days

The table and charts below display the percentage of inpatient cases classified as “Typical”, “Outlier” or “Other”: A patient is classified as “Typical” when s/he receives the normal, or predicted, inpatient course of treatment associated with a specific CMG and is discharged. “Outlier” cases are cases that do not receive the normal or predicted course of treatment because they arrived at, or left, the facility in circumstances that made their total length of stay or costs unpredictable. The “Other” category represents deaths, sign‐outs and transfers.

Patient Cases (%) Patient Days (%) Hospitals Typical Other Outlier Typical Other Outlier CH LHSC 87% 9% 4% 67% 16% 16% CHEO 85% 8% 7% 64% 15% 20% KGH 89% 7% 4% 71% 11% 18% MCH HHSC 80% 16% 4% 57% 26% 16% Mt Sinai 70% 28% 2% 39% 53% 7% SickKids 85% 9% 5% 56% 22% 22% Sunnybrook 62% 37% 1% 28% 68% 4% TOH 82% 16% 2% 63% 33% 3%

Patient Cases (%) Patient Days (%)

CH LHSC CH LHSC

CHEO CHEO

KGH KGH

MCH HHSC MCH HHSC

Mt Sinai Mt Sinai

SickKids SickKids

Sunnybrook Sunnybrook

TOH TOH

0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100%

Typical Other Outlier Typical Other Outlier

34 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.9 – Percent “Transfer From” (Inpatient Cases and Patient Days)

The table and chart below present the percentage of cases and associated days that were recorded as “Transfer From” another acute care institution.

All "Transfers From" Neonatal "Transfers From" Paediatric "Transfers From" (Neonatal + Peadiatric) Hospitals CASES DAYS CASES DAYS CASES DAYS # Cases % Cases # Days % Days # Cases % Cases # Days % Days # Cases % Cases # Days % Days CH LHSC 150 8% 2,107 12.0% 241 6% 3,342 15% 391 6.5% 5,449 13.5% CHEO 324 50% 5,105 72.1% 148 3% 2,366 7% 472 7.6% 7,471 17.8% KGH 47 7% 853 10.7% 53 4% 457 7% 100 4.6% 1,310 8.8% MCH HHSC 348 19% 5,992 26.4% 320 6% 3,505 12% 668 9.3% 9,497 18.2% Mt Sinai 32 1% 1,438 7.1% 12 16% 735 56% 44 1.5% 2,173 10.1% Sickkids 779 69% 18,940 89.8% 602 4% 8,976 11% 1,381 9.2% 27,916 28.1% Sunnybrook 58 4% 1,877 12.6% 19 13% 976 57% 77 4.6% 2,853 17.1% TOH 98 4% 1,911 12.3% 29 20% 608 58% 127 5.0% 2,519 15.1%

"Transfer From" Inpatient Cases and Patient Days (Neonatal and Paediatric) 30% 28.1%

25%

20% 18.2% 17.8% 17.1% 15.1% 15% 13.5%

10.1% 10% 8.8% 9.3% 9.2% 7.6% 6.5% 4.6% 4.6% 5.0% 5% 1.5%

0% CH LHSC CHEO KGH MCH HHSC Mt Sinai Sickkids Sunnybrook TOH % Of All Cases Recorded As "Transfers From" % Of All Days Recorded As "Transfers From"

Notes TOH: TOH is a multi-campus facility. Babies are often transferred between campuses depending on the level of NICU care required. This will result in a higher number of both transfers to and from reported as a corporate result.

35 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.10 – Percent “Transfer To” (Inpatient Cases and Patient Days)

The table and chart below present the percentage of cases, and associated days, that were recorded as “Transfer To” another acute care institution.

Neonatal "Transfers To" Paediatric "Transfers To" All "Transfers To" (Neonatal + Peadiatric) Hospitals CASES DAYS CASES DAYS CASES DAYS # Cases % Cases # Days % Days # Cases % Cases # Days % Days # Cases % Cases # Days % Days CH LHSC 179 9.9% 3,256 18.5% 90 2.1% 1,407 6.2% 269 4.5% 4,663 11.6% CHEO 76 11.8% 951 13.4% 114 2.0% 1,464 4.2% 190 3.1% 2,415 5.7% KGH 42 6.2% 1,066 13.3% 14 0.9% 113 1.6% 56 2.6% 1,179 7.9% MCH HHSC 607 33.3% 8,024 35.4% 42 0.8% 649 2.2% 649 9.1% 8,673 16.6% Mt Sinai 712 24.8% 10,471 51.6% 9 11.7% 420 32.3% 721 24.5% 10,891 50.4% SickKids 342 30.5% 5,945 28.2% 202 1.5% 2,213 2.8% 544 3.6% 8,158 8.2% Sunnybrook 534 35.0% 9,992 66.9% 13 9.0% 285 16.7% 547 32.8% 10,277 61.8% TOH 273 11.4% 3,344 21.5% 11 7.6% 197 18.7% 284 11.2% 3,541 21.3%

"Transfer To" Inpatient Cases and Patient Days (Neonatal and Paediatric) 70% 61.8% 60%

50.4% 50%

40% 32.8% 30% 24.5% 21.3% 20% 16.6% 11.6% 11.2% 9.1% 10% 7.9% 8.2% 4.5% 5.7% 3.1% 2.6% 3.6% 0% CH LHSC CHEO KGH MCH HHSC Mt Sinai SickKids Sunnybrook TOH % Of All Cases Recorded As "Transfers To" % Of All Days Recorded As "Transfers To"

36 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.11 – Percent of Cases and Days with LOS > 30 Days

The percentage of all inpatient cases and associated days with a total LOS greater than 30 days is displayed in the table and chart below.

Neonatal Paediatric Total Hospitals CASES DAYS CASES DAYS CASES DAYS # % # % # % # % # % # % CH LHSC 139 8% 9,340 53% 91 2% 5,897 26% 230 4% 15,237 38% CHEO 51 8% 2,927 41% 158 3% 9,468 27% 209 3% 12,395 29% KGH 70 10% 4,329 54% 11 1% 591 9% 81 4% 4,920 33% MCH HHSC 153 8% 12,632 56% 117 2% 6,899 23% 270 4% 19,531 37% Mt Sinai 154 5% 10,080 50% 15 19% 1,093 84% 169 6% 11,173 52% SickKids 169 15% 13,286 63% 380 3% 23,350 30% 549 4% 36,636 37% Sunnybrook 136 9% 8,229 55% 14 10% 1,003 59% 150 9% 9,232 55% TOH 76 3% 3,922 25% 7 5% 307 29% 83 3% 4,229 25%

Percent Cases and Days with LOS >30 Days (Neonatal and Paediatric) 60% 55% 52% 50%

40% 38% 37% 37% 33% 29% 30% 25%

20%

9% 10% 6% 4% 3% 4% 4% 4% 3%

0% CH LHSC CHEO KGH MCH HHSC Mt Sinai SickKids Sunnybrook TOH Total Cases (%) Total Days (%)

Note TOH: TOH is a multi-campus facility. Babies are often transferred between campuses depending on the level of NICU care required. This will result in a higher number of both transfers to and from reported as a corporate result.

37 PCMCH Maternal-Child Benchmarking Report 2013

3.0 Emergency Department Indicators

ED 3.1.1 – Hospital Emergency Department Patient Volumes

The chart and table below present the volume of Emergency Department visits.

ED Patient Volume (cases) Hospital % Change vs. FY 09/10 FY 10/11 FY 11/12 FY 12/13 Previous Year CH LHSC 39,166 37,414 37,534 36,549 -2.6% CHEO 57,543 59,990 66,232 65,912 -0.5% KGH 22,108 22,589 6,646 6,590 -0.8% MCH HHSC 24,090 25,938 32,170 35,575 10.6% Mt Sinai 782 762 949 925 -2.5% Sunnybrook 2,392 2,396 2,750 2,497 -9.2% SickKids 57,639 57,482 63,642 63,583 -0.1% TOH 2,432 2,296 2,376 2,172 -8.6% Total 206,152 208,867 212,299 213,803 0.7%

ED Patient Volumes 70,000

60,000

50,000 CH LHSC CHEO 40,000 KGH MCH HHSC 30,000 Mt Sinai Sunnybrook SickKids 20,000 TOH

10,000

0 FY 09/10 FY 10/11 FY 11/12 FY 12/13

Note KGH: Kingston General Hospital (KGH) data for FY 09/10 and FY 10/11 includes records from Hotel Dieu Hospital, Kingston (HDH Kingston). In FY 2011/12 and FY 2012/13 KGH is no longer reporting together with HDH Kingston.

38 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.2 – Emergency Department Average Length of Stay in Hours – All Dispositions

The chart presents the ED average LOS in hours, regardless of the discharge disposition. The average LOS is defined as the difference between the earlier of the registration or triage date/time and the discharge disposition date/time in hours divided by total visits. Excluded are cases where the patient left without being seen by a physician (Disposition Codes 02-03), and cases where Date/Time Patient left ED is missing.

Average LOS in Hours (All Dispositions) 5

3.97 4 3.83

3.37 3.24 3.35 3.05 3 2.75 2.62

0 CH LHSC CHEO KGH MCH HHSC Mt Sinai SickKids Sunnybrook TOH

Note Sunnybrook: Calculated ED Average LOS by Sunnybrook is 3.41 FY 12/13.

39 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.3 – Emergency Department Visits (Age Profile)

The table and chart below provide a visual description of the age profile of Emergency Department visits according to the following age categories: 0‐28 days 29 -364 days 1-7 years 8-17 years

Hospitals 0-28 Days 29-364 Days 1-7 Years 8-17 Years CH LHSC 690 3,751 16,866 15,242 CHEO 1,404 9,130 32,808 22,570 KGH 147 718 2,645 3,080 MCH HHSC 634 4,989 17,857 12,095 Mt Sinai 46 78 149 652 SickKids 1,220 8,753 35,437 18,173 Sunnybrook 16 90 556 1,835 TOH 9 67 461 1,635 Total 4,166 27,576 106,779 75,282

ED Visits (Age Profile) 100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0% CH LHSC CHEO KGH MCH HHSC Mt Sinai SickKids Sunnybrook TOH 0-28 Days 29-364 Days 1-7 Years 8-17 Years

40 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.4 – Emergency Department Visits by Triage Level

The table and chart below depict the CTAS triage level of all patients presenting to an Emergency Department. The triage levels/scores are: 1: Resuscitation; 2: Emergent; 3: Urgent; 4: Less Urgent; 5: Non‐urgent. Beginning in 2007/08 CIHI has requested that for “Visit Disposition ’02’ – Client Registered then Left”, the triage level should be left blank. In the report, blanks have been assigned the value of “Left before triage/ Other”. Hospitals with less than 6 cases are indicated as “<6”.

Left Before Triage Level Hospital Triage/Other 1 2 3 4 5 CH LHSC 253 4,101 14,844 17,007 344 CHEO 483 5,432 33,139 23,830 3,028 KGH <6 12 1,163 3,752 1,548 114 MCH HHSC <6 284 5,539 15,432 12,036 2,279 Mt Sinai <6 155 420 316 30 SickKids 266 574 14,226 26,773 20,613 1,131 Sunnybrook 95 451 1,315 619 17 TOH 9 391 1,012 663 97

ED Visits by Triage level 100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0% CH LHSC CHEO KGH MCH HHSC Mt Sinai SickKids Sunnybrook TOH

Left Before Triage/Other Level 1 Level 2 Level 3 Level 4 Level 5

41 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.5 – Emergency Department Visits by Top 15 Main Problems

This table displays the Top 15 main problems/most responsible diagnoses in each facility. The Top 15 are highlighted in RED. Numbers less than 6 are indicated as “<6”.

Main Problem ICD10

KGH TOH

Total

CHEO

SickKids

CH LHSC CH Mt Sinai

MCH HHSC MCH Sunnybrook

J069 Acute URTI unspecified 2,091 4,596 307 2,213 30 3,568 51 64 12,920 B349 Viral infection unspecified 1,135 4,154 317 1,880 22 4,244 20 42 11,814 H669 Otitis media unspecified 1,537 2,936 231 1,395 7 2,091 19 53 8,269 R509 Fever unspecified 761 1,748 161 941 18 3,140 48 23 6,840 R104 Other and unspecified abdominal pain 740 1,439 171 844 35 2,179 98 81 5,587 A099 Gastroe & colitis of unspec origin 554 1,856 98 968 10 1,845 27 39 5,397 S099 Unspecified injury of head 698 1,386 154 953 32 1,557 89 45 4,914 J050 Acute obstructive laryngitis [croup] 1,045 1,639 186 909 <6 1,047 14 21 4,863 J189 Pneumonia unspecified 945 1,455 160 722 1,180 20 13 4,495 J4500 Predom allgry asthma wo stat asthma 686 2,183 82 511 <6 1,007 <6 4,471 K590 Constipation 619 1,506 47 914 <6 1,245 9 10 4,355 A084 Viral intestinal infection unspecified 786 834 45 644 7 1,372 <6 <6 3,698 N390 Urinary tract infection site not spec 643 846 69 483 9 1,239 14 29 3,332 R112 Vomiting alone 370 623 70 555 <6 1,224 18 6 2,868 S0180 Open wounds oth parts head, uncomplicate 668 799 58 390 18 616 91 51 2,691 J219 Acute bronchiolitis unspecified 373 1,000 49 420 <6 715 <6 <6 2,565 S060 Concussion 477 858 55 419 6 309 29 29 2,182 J029 Acute pharyngitis unspecified 335 683 68 418 16 493 21 32 2,066 J988 Other specified respiratory disorders 302 274 36 367 <6 893 <6 <6 1,876 S909 Superficial injury of ankle & foot NOS 306 492 63 235 6 282 6 6 1,396 S9349 Sprain and strain of ankle, unspecified 228 501 32 221 14 203 61 51 1,311 R458 Oth symptoms signs inv emotional state 430 255 44 190 <6 86 50 9 1,068 R55 Syncope and collapse 190 312 67 204 15 220 28 14 1,050 S0100 Open wound of scalp uncomplicated 214 354 30 160 <6 215 19 23 1,018 R074 Chest pain unspecified 101 194 27 147 6 385 32 23 915 F329 Depressive episode unspecified 147 436 46 93 <6 112 35 7 878 T784 Allergy unspecified 152 205 28 216 <6 222 30 15 871 S52590 Unspec fx of lower end of radius, closed 93 145 17 191 <6 299 35 16 798 Z098 F/U exam after oth Rx for oth cond 49 31 10 641 <6 12 <6 749 R060 Dyspnoea 94 233 20 144 9 177 14 11 702 S6100 Opn wnd finger w/o damage nail, uncomp 183 179 36 123 <6 86 27 29 666 F419 Anxiety disorder unspecified 71 256 13 127 14 124 15 11 631 F100 Ment/beh disrd dt alcohol use ac intox 82 138 21 83 20 36 17 9 406 F101 Ment/beh disrd dt harmful alcohol use <6 17 <6 <6 14 <6 <6 43

42 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.6 – Emergency Department Visits Admitted

This chart and table present the percentage of Emergency Department visits that were admitted to a bed based on the following visit disposition categories: 06 (Admit to Facility CCU or OR) 07 (Admit to Facility Inpatient Unit).

Hospital FY 09/10 FY 10/11 FY 11/12 FY 12/13 CH LHSC 6.1% 6.5% 6.7% 7.3% CHEO 7.1% 6.9% 6.3% 6.0% KGH 2.8% 3.0% 12.6% 12.4% MCH HHSC 11.5% 10.5% 10.3% 10.5% Mt Sinai 2.9% 3.9% 2.4% 2.7% SickKids 10.3% 11.2% 10.5% 10.2% Sunnybrook 3.9% 5.0% 4.7% 5.8% TOH 3.8% 3.7% 3.3% 3.5%

Emergency Department Visits Admitted (FY 12/13) 14% 12.4% 12%

10.5% 10.2% 10%

8% 7.3%

6.0% 5.8% 6%

4% 3.5% 2.7%

0% CH LHSC CHEO KGH MCH HHSC Mt Sinai SickKids Sunnybrook TOH

Note KGH: Kingston General Hospital data for FY 09/10 and FY 10/11 includes records from Hotel Dieu Hospital, Kingston (HDH Kingston). In FY 2011/12 and FY 2012/13 KGH is no longer reporting together with HDH Kingston.

43 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.7 – ED Visits Left Without Being Seen/Against Medical Advice or Other

This chart and table present the percent of Emergency Department visits that either a) left without being seen by a physician/against medical advice or b) other. This includes the following disposition categories: 02 (registered and left) 03 (registered, triaged and left) 04 (registered, triaged, assessed and left) 05 (registered, triaged, assessed and left against advice).

Hospital FY 09/10 FY 10/11 FY 11/12 FY 12/13 CH LHSC 2.8% 3.0% 1.9% 2.5% CHEO 4.0% 2.6% 3.9% 2.7% KGH 2.3% 1.9% 4.5% 3.1% MCH HHSC 7.2% 4.2% 3.1% 1.9% Mt Sinai 3.7% 3.4% 1.6% 2.9% SickKids 6.1% 4.0% 3.6% 2.5% Sunnybrook 7.9% 6.1% 6.9% 5.1% TOH 6.1% 7.4% 5.8% 5.1%

ED Visits Left Without Being Seen/Against Medical Advice or Other (FY 12/13) 6.0%

5.1% 5.1% 5.0%

4.0%

3.1% 2.9% 3.0% 2.7% 2.5% 2.5%

2.0% 1.9%

1.0%

0.0% CH LHSC CHEO KGH MCH HHSC Mt Sinai SickKids Sunnybrook TOH

44 PCMCH Maternal-Child Benchmarking Report 2013

4.0 Clinical Efficiency Indicators

4.1.1 CE – Top 10 CMGs Typical Inpatient Cases

This table displays the total volume of each individual CMG in each facility. The Top 10 CMGs of each facility are highlighted in RED. Numbers less than 6 are indicated as “<6”.

CMG+ Description

TOH

KGH

Total

CHEO

CH LHSC CH SickKids

Mt Sinai Mt

MCH HHSC MCH Sunnybrook

601 Newborn/Neonate 2500+ grams, Other Minor 407 68 151 261 731 91 289 562 2,560 638 Chemotherapy/RadiotherapyProblem Admission for 206 213 45 144 10 576 1,194 594 Newborn/NeonateNeoplasm 2500+ grams, Jaundice 69 30 57 152 244 42 140 308 1,042 593 Newborn/Neonate 2500+ grams, Short Gestation 188 67 63 196 140 257 911 Newborn/Neonate 2500+ grams, Other Respiratory 591 128 9 62 127 281 7 62 149 825 Problem 141 Upper/Lower Respiratory Infection 103 272 39 185 170 769 138 Viral/Unspecified Pneumonia 191 174 56 145 182 748 Reduction/Fixation/Repair Upper Body/Limb except 739 88 171 24 136 286 <6 706 Fixation/Repair of Shoulder 257 Symptom/Sign of Digestive System 87 105 44 149 <6 236 <6 623 040 Seizure Disorder, except Status Epilepticus 53 89 54 96 326 618 Newborn/Neonate 2000-2499 grams, Gestational 588 110 <6 22 39 148 7 108 113 548 Age 37+ Weeks 693 Depressive Episode without ECT 153 200 21 141 30 545 234 Simple Appendectomy 66 161 27 97 <6 171 9 8 543 086 Oral Cavity/Pharynx Intervention 52 192 <6 71 <6 222 539 147 Asthma 83 164 29 126 116 518 Newborn/Neonate 2000-2499 grams, Gestational 587 92 <6 33 45 127 <6 80 113 496 Age 35-36 Weeks 249 Non-severe Enteritis 62 70 37 132 148 449 258 Other Gastrointestinal Disorder 75 99 17 58 <6 122 372 806 Convalescence 72 37 17 33 186 345 Newborn/Neonate 2500+ grams, Other Congenital 598 81 <6 7 36 56 <6 35 87 308 Anomaly 163 Major Cardiothoracic Intervention with Pump 40 263 303 634 Hemoglobinopathy <6 38 <6 23 197 <6 264 696 Childhood/Adolescence Disorder 15 24 119 77 7 242 Newborn/Neonate 2500+ grams, Major Respiratory 589 52 32 6 45 35 18 <6 40 231 Complication Newborn/Neonate 2000-2499 grams, Gestational 586 57 32 7 11 <6 7 90 205 Age <35 Weeks Newborn/Neonate 2500+ grams, Other Moderate 600 43 25 14 23 14 20 11 26 176 Problem Newborn/Neonate 1500-1999 grams, Gestational 584 28 13 <6 6 <6 67 116 Age 32-34 Weeks Newborn/Neonate 2500+ grams, Aspiration 590 14 <6 6 7 40 10 29 108 Syndrome/Fetal Asphyxia Newborn/Neonate 1500-1999 grams, Gestational 585 15 11 7 31 7 35 106 Age 35+ Weeks

45 PCMCH Maternal-Child Benchmarking Report 2013

4.1.2 CE – Top 10 CMGs Typical Inpatient Cases (One and Two Day Stay)

This table displays the total volume of each individual CMG with one and two day stays in each facility. Top 10 CMGs with one and two day stays for typical cases are highlighted in RED, in order to provide a sense of the number of admissions and resulting days that might be potentially avoided. This indicator is provided to help institutions analyze and utilize best practice opportunities. Hospitals with less than 6 cases are indicated as “<6”.

CMG+ Description

TOH

KGH

Total

CHEO

CH LHSC CH SickKids

Mt Sinai Mt

MCH HHSC MCH Sunnybrook Newborn/Neonate 2500+ grams, Other Minor 601 270 23 96 72 539 66 209 244 1,519 Problem Reduction/Fixation/Repair Upper Body/Limb except 739 82 164 22 126 283 <6 678 Fixation/Repair of Shoulder 086 Oral Cavity/Pharynx Intervention 48 184 <6 57 <6 206 497 234 Simple Appendectomy 58 137 24 85 <6 161 9 7 485 594 Newborn/Neonate 2500+ grams, Jaundice 42 18 28 21 145 34 71 109 468 257 Symptom/Sign of Digestive System 57 76 39 116 <6 163 <6 453 Newborn/Neonate 2500+ grams, Other Respiratory 591 79 6 39 37 145 6 29 59 400 Problem Chemotherapy/Radiotherapy Admission for 638 67 82 25 43 <6 134 354 Neoplasm 040 Seizure Disorder, except Status Epilepticus 32 42 39 56 184 353 593 Newborn/Neonate 2500+ grams, Short Gestation 106 25 10 94 61 51 347 806 Convalescence 72 37 17 33 185 344 147 Asthma 56 69 23 99 84 331 141 Upper/Lower Respiratory Infection 43 63 21 103 95 325 138 Viral/Unspecified Pneumonia 71 35 33 73 81 293 249 Non-severe Enteritis 42 36 31 96 74 279 Newborn/Neonate 2000-2499 grams, Gestational 588 72 13 <6 79 6 49 48 272 Age 37+ Weeks 081 Hard/Soft Palate/Gingiva Intervention 44 36 <6 33 108 225 097 Influenza/Acute Upper Respiratory Infection 21 23 12 68 83 207 Newborn/Neonate 2500+ grams, Other Congenital 598 58 <6 <6 11 42 <6 26 57 203 Anomaly 078 Other Musculoskeletal Intervention on Head 39 19 6 <6 113 8 190 815 Cancelled Intervention 21 <6 6 152 <6 <6 182 437 Diabetes 35 41 10 48 45 <6 180 770 Other Fracture/Dislocation of Arm/Shoulder 61 9 <6 43 34 <6 <6 151 778 Poisoning/Toxic Effect of Drug 19 34 11 47 29 <6 145 Newborn/Neonate 2000-2499 grams, Gestational 587 37 <6 <6 12 43 <6 22 14 137 Age 35-36 Weeks Newborn/Neonate 2500+ grams, Major Respiratory 589 14 <6 13 23 9 <6 11 73 Complication Newborn/Neonate 2500+ grams, Aspiration 590 <6 <6 <6 25 <6 14 50 Syndrome/Fetal Asphyxia Closed Knee Intervention except Fixation without 325 <6 14 <6 7 9 34 Infection Newborn/Neonate 2500+ grams, Cardiovascular 597 11 <6 <6 <6 6 <6 <6 <6 32 Anomaly

46 PCMCH Maternal-Child Benchmarking Report 2013

5.0 Quality and Utilization Management Indicators

The Quality and Utilization Management (QUM) section is intended to assist hospitals in identifying opportunities to improve quality and utilization management processes. The indicators selected provide real, demonstrated levels of performance. This section should be considered in conjunction with other information such as hospital results on the clinical and operational efficiency indicators.

A hospital’s quality and management performance may be affected by many factors, such as the population served and other types of care available in the community. As a result, indicator results may vary from hospital to hospital. In addition, it is difficult to ensure consistency in clinical documentation and health record coding between hospitals. These differences in clinical documentation standards may also affect the comparability of the result of the selected indicators.

QUM indicators may best be thought of as screening tests and, as in medicine, do not provide a final diagnosis, but can identify cases that need follow-up. QUM indicators in isolation should not be taken as a definitive assessment of the quality of care at a given hospital. Rather, they are a first step in a quality assurance and improvement process that requires more detailed analysis.

The most responsible diagnosis codes used in section 5.1 Appropriateness of Care are listed below:

Indicator ICD10-CA code Short Description QUM 5.1.1 - Percentage of Paediatric J4500 Predom allgry asthma w/o stat asthma Admissions Treated for Asthma J4501 Predom allgry asthma w stat asthma J4510 Noallgy asthma w/o stat asthma J4511 Noallgy asthma w stat asthma J4580 Mixed asthma w/o st status asthmaticus J4581 Mixed asthma w st status asthmaticus J4590 Asthma, unspec w/o st status asthmaticus J4591 Asthma, unspec w st status asthmaticus QUM 5.1.2 – Percentage of Paediatric The most responsible diagnosis codes E10 to E14 Admissions Treated for Diabetes QUM 5.1.3 – Percentage of Paediatric K520 Gastroenteritis & colitis dt radiation Admissions Treated for K521 Toxic gastroenteritis and colitis Gastroenteritis K522 Allergic & diet gastroenteritis colitis K528 Oth spec nonifect gastroenteritis colitis K529 Noninfect gastroenteritis & colitis NOS

As recommended during the 2008 report data validation process, this section does not include neonatal cases (0-28 days). All indicators are for paediatric cases (29 days – 17 years) only.

47 PCMCH Maternal-Child Benchmarking Report 2013

QUM 5.1.1 - Percentage of Paediatric Admissions Treated for Asthma

The following chart and tables present the percentage of acute care paediatric (29 days – 17 years) inpatient and Emergency Department patients that received care for the treatment of Asthma.

Asthma Cases as Percentage of Total Paediatric Inpatient Cases (FY 2012/13) 4% 3.5%

3% 2.4% 2.5% 2.3% 2%

1.0% 1%

0% CH LHSC CHEO KGH MCH HHSC SickKids

Inpatient Cases Rate of Asthma Cases per 1,000 Paediatric Asthma Paediatric Inpatient Cases Hospitals Inptient Cases FY 09/10 FY 10/11 FY 11/12 FY 12/13 FY 09/10 FY 10/11 FY 11/12 FY 12/13 CH LHSC 101 83 89 95 27 22 22 23 CHEO 220 247 174 198 40 43 30 35 KGH 29 40 35 36 23 31 24 24 MCH HHSC 121 103 148 132 26 23 29 25 SickKids 130 140 173 140 10 11 12 10

Emergency Admissions Rate of Asthma ED Admissions per 1,000 Asthma ED Admissions Hospitals Paediatric Asthma ED Visits FY 09/10 FY 10/11 FY 11/12 FY 12/13 FY 09/10 FY 10/11 FY 11/12 FY 12/13 CH LHSC 99 74 78 84 116 107 104 120 CHEO 246 277 225 247 142 134 112 113 KGH 14 34 27 30 44 95 196 242 MCH HHSC 102 89 118 117 251 198 219 207 SickKids 112 121 138 106 90 97 125 103

48 PCMCH Maternal-Child Benchmarking Report 2013

QUM 5.1.2 – Percentage of Paediatric Admissions Treated for Diabetes

The following chart and tables present the percentage of acute care paediatric (29 days – 17 years) inpatient and Emergency Department patients that received care for the treatment of Diabetes.

Diabetes Cases as Percentage of Total Paediatric Inpatient Cases (FY 12/13) 2.0%

1.5% 1.4% 1.4% 1.3%

1.0% 1.0%

0.5% 0.5%

0.0% CH LHSC CHEO KGH MCH HHSC SickKids

Inpatient Cases Rate of Diabetes Cases per 1,000 Paediatric Diabetes Inpatient Cases Hospitals Inpatient Cases FY 09/10 FY 10/11 FY 11/12 FY 12/13 FY 09/10 FY 10/11 FY 11/12 FY 12/13 CH LHSC 30 25 30 42 8 7 7 10 CHEO 64 65 50 77 12 11 9 14 KGH 10 21 17 19 8 16 12 13 MCH HHSC 65 68 68 76 14 15 13 14 SickKids 75 64 57 76 6 <6 <6 <6

Emergency Admissions Rate of Diabetes ED Admissions per 1,000 Diabetes ED Admissions Hospitals Paediatric Diabetes ED Visits FY 09/10 FY 10/11 FY 11/12 FY 12/13 FY 09/10 FY 10/11 FY 11/12 FY 12/13 CH LHSC 19 19 24 32 204 302 296 471 CHEO 44 51 40 61 289 415 296 386 KGH 7 16 11 15 259 410 786 882 MCH HHSC 40 48 51 54 435 490 447 486 SickKids 38 28 30 40 317 211 250 299

49 PCMCH Maternal-Child Benchmarking Report 2013

QUM 5.1.3 – Percentage of Paediatric Admissions Treated for Gastroenteritis

The following chart and tables present the percentage of acute care paediatric (29 days – 17 years) inpatient and Emergency Department patients that received care for the treatment of Gastroenteritis.

Gastroenteritis Cases as % of Total Paediatric Inpatient Cases (FY 12/13) 0.6%

0.5% 0.47%

0.4%

0.3% 0.21% 0.2% 0.13% 0.13% 0.11% 0.1%

0.0% CH LHSC CHEO KGH MCH HHSC SickKids

Inpatient Cases Rate of Gastro Cases per 1,000 Gastro Inpatients Cases Hospitals Paediatric Inpatient Cases FY 10/11 FY 11/12 FY 12/13 FY 10/11 FY 11/12 FY 12/13 CH LHSC 8 7 9 2.1 1.7 2.1 CHEO 8 <6 7 1.4 0.3 1.3 KGH <6 7 7 0.8 4.8 4.7 MCH HHSC 8 15 7 1.8 2.9 1.3 SickKids 25 12 15 1.9 0.9 1.1

Emergency Admissions Rate of Gastro ED Admissions per Gastro ED Admissions Hospitals 1,000 Paediatric Gastro ED Visits FY 10/11 FY 11/12 FY 12/13 FY 10/11 FY 11/12 FY 12/13 CH LHSC 6 6 <6 261 261 222 CHEO <6 6 <6 118 162 143 MCH HHSC 8 16 <6 94 400 188 SickKids 14 22 14 350 400 333

Note KGH: Kingston General Hospital data for FY 09/10 and FY 10/11 includes records from Hotel Dieu Hospital, Kingston (HDH Kingston). In FY 2011/12, and FY 2012/13 KGH is no longer reporting together with HDH Kingston.

50 PCMCH Maternal-Child Benchmarking Report 2013

Operational Efficiency Indicators

6.1 Introduction

Operational efficiency section uses financial and statistical data from the organization’s MIS Trial Balance. “Efficiency” is defined as the ratio of inputs (costs, hours, etc.) to outputs (cases, weighted cases, days). This report analyzes hospital and functional centre grouping efficiency using both labour hours and/or net costs as the input variable.

Data was submitted according to CIHI’s Management Information Systems (MIS Standards) chart of accounts for those patients 0-17 years, excluding obstetrics and normal newborns. This report focuses on indicators related to net operating cost, compensation and hours in the following functional centre groupings: Inpatient Units, Emergency Department, Clinics, and Operating Room.

Cases, weighted cases, patient days, visits, OR hours, treatments and workload have been calculated using the following criteria: age 0-17 excluding Obstetrics (MCC 13) and (MRDX codes Z38 category), and used as the output ratios.

Three categories of data were provided for each functional centre:

• Hours: includes Management and Operational Support (MOS) and Unit Producing Personnel (UPP) worked, Nurse Practitioner (NP), benefit and purchased services (P/S) hours. • Dollars: includes revenues, recoveries, and expenses by various labour and other expense categories. • Statistical: related to patient volume, payroll hours and functional centre workload. This data allows indicator and productivity related comparisons.

While the use of functional centre groupings minimizes the impact of comparison differences, the need to improve MIS compliance in the future exists. As demonstrated, there are a number of ways to organize, deliver and account for hospital services. Care must be taken when comparing the results.

Descriptive indicators, such as Net Operating Expenses, Total Compensation and Total Hours, are meant to highlight relative organization size only. Benchmarking opportunities are identified through the ratio of inputs to outputs using these descriptive values.

Medical Staff Accounts (390*) and Revenue Accounts (110* & 140*-190*) are removed from the categories due to different treatment and provincial funding policies; Research 7*7 and Marketed/Undistributed 7*9 and 8*9 functional centres were also excluded due to significantly different treatment across institutions and the inability to accurately allocate to paediatrics; Funds 1, 2, and 3 were added together for analysis and to give a more complete picture of paediatric services.

For paediatric hospitals-within-hospitals, many of the costs and hours are allocated based on workload/statistics in a consistent manner agreed upon by the hospitals. When it was not possible to segregate paediatric data for a hospital-within-a-hospital, the indicator has been excluded from the report.

Mount Sinai Hospital and Sunnybrook Health Sciences Centre are included in the community OE indicators because they are not tertiary paediatric centres.

51 PCMCH Maternal-Child Benchmarking Report 2013

Functional Centres

Included Account Number Description 7*270* Inpatient Pediatric Fund 1,2,3 Inpatient Intensive Care Unit Neonatal Level III 7*24050* Nursery (NICU)

7*24070* Inpatient Intensive Care Unit - Pediatric (PICU) Inpatient Obstetrics Labour, Delivery, Recovery, 7*25090* Postpartum 7*2508020 Inpatient Obstetrics - General Nursery Inpatient Obstetrics - Intermediate Nursery 7*2508040 (Level II) Excluded Account Number Description 7*7 Research 7*9 Marketed Services 8*9 Undistributed Accounting Centres

Secondary Accounts – Financials Secondary Accounts - Statistical

Included Included Account Number Description Account Number Description 30* Employee Future Benefits Compensation 1* Workload Management and Operational Support 2* Staff Activity 31* Compensation 3* Earned Hours 35* Unit Producing Personnel Compensation 4* Service Recipient Activity Accounts 38* Nurse Practitioner Personnel Compensation 5* Community Service Activity 12* Recoveries 6* Personnel Profile - Head Count 4* Supplies Expenses 7* Functional Centre Profile 5* Service Recipient Specific Supplies 8* Health Service Organization Profile 6* Sundry Expenses 9* Specialty and Priority Program Profile 7* Equipment Expenses Excluded 8* Contracted Out Services Account Number Description 9* Buildings and Grounds Expenses 39* Earned Hours - Medical Personnel Excluded 19* Non Service Recipient Workload Units Account Number Description 39* Medical Personnel Compensation 11* Revenue - Service Recipient Services 14* Donations 15* Grants 16* Investment Revenue 17* Revenue Transferred from Other Funds 19* Other Revenue

52 PCMCH Maternal-Child Benchmarking Report 2013

6.1.1 OE – Hospital Net Operating Costs (in millions)

The table presents each hospital’s net operating costs in millions. This is a descriptive indicator showing the net operating costs of each hospital in the major functional centre groupings as defined by MIS. It is presented to show the relative size, in expenditures of each institution. Due to differences in the treatment of some secondary accounts, all medical staff remuneration (390*) has been excluded. Net Operating Costs are defined as total expenses less recoveries, so revenues in secondary accounts 110* and 140*-190* have not been netted.

FY 12/13 MIS Functional Centres CH LHSC CHEO HDH KGH MCH HHSC Sickkids Inpatient (7*2) 44.5 50.2 0.0 12.4 50.2 148.8 Ambulatory (7*3) 15.0 25.6 3.4 3.1 19.4 54.8 Diagnostic & Therapeutic (7*4) 17.6 50.1 2.0 3.1 35.3 102.1 Community (7*5) 0.0 22.7 0.6 0.2 23.1 3.6 Education (7*8) 1.9 2.5 0.0 0.2 1.1 7.7 Admin & Support (7*1) 27.4 53.7 2.1 5.8 19.6 125.8 Total 2012/13 106.4 204.8 8.1 24.8 148.7 442.8

FY 11/12 MIS Functional Centres CH LHSC CHEO HDH KGH MCH HHSC Sickkids Inpatient (7*2) 40.7 47.8 12.1 52.2 141.5 Ambulatory (7*3) 18.9 25.8 2.8 15.6 52.1 Diagnostic & Therapeutic (7*4) 11.9 48.4 2.5 34.1 102.7 Community (7*5) 2.5 23.9 0.0 20.8 3.1 Education (7*8) 0.6 2.4 0.3 1.1 7.4 Admin & Support (7*1) 16.4 52.4 5.3 19.3 121.6 Total 2011/12 91.0 200.7 23.0 143.1 428.4

Percentage Change 16.9% 2.0% 7.8% 3.9% 3.4%

Notes St. Joseph’s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June 2011, which included a Neonatal Intensive Care Unit.

In FY 2011/12 London Health Sciences Centre (LHSC) implemented the provincial case costing methodology along with a new information system and this more timely and robust data was used to allocate paediatric proportion for the FY 2012/13 MIS submission to PCMCH. These reasons explain most of the differences between FY 2011/12 and FY 2012/13 in the report.

53 PCMCH Maternal-Child Benchmarking Report 2013

6.1.2 OE – Hospital Net Operating Costs (Percent Distribution)

This table and chart display the cost of the major functional centre groupings as defined by MIS as a percent of net operating costs. Due to differences in the treatment of some secondary accounts, all medical staff remuneration (390*) has been excluded. Net operating costs are defined as total expenses less recoveries, so revenues in secondary accounts 110* and 140*-190* have not been netted.

Functional Centre CH LHSC CHEO HDH KGH MCH HHSC Sickkids Inpt 7*2 41.8% 24.5% 0.0% 50.0% 33.8% 33.6% Ambulatory 7*3 14.1% 12.5% 42.3% 12.4% 13.0% 12.4% Diag & Therapy 7*4 16.5% 24.5% 24.7% 12.5% 23.7% 23.1% Community 7*5 0.0% 11.1% 7.6% 0.9% 15.5% 0.8% Education 7*8 1.8% 1.2% 0.0% 0.9% 0.7% 1.7% Admin & Support 25.8% 26.2% 25.4% 23.3% 13.2% 28.4%

Hospital Net Operating Costs - % Distribution

CH LHSC

CHEO

HDH

KGH

MCH HHSC

Sickkids

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Inpt 7*2 Ambulatory 7*3 Diag & Therapy 7*4 Community 7*5 Education 7*8 Admin & Support

54 PCMCH Maternal-Child Benchmarking Report 2013

6.1.3 OE – Compensation Costs per Functional Centre Category

This table summarizes the compensation (3*) costs by MIS functional centre category (in millions), including fringe benefits, for each hospital. Due to differences in the treatment of some secondary accounts, all medical staff remuneration (390*) has been excluded.

FY 2012/13 MIS Functional Centres MCH CH LHSC CHEO HDH KGH HHSC Sickkids Inpatient (7*2) 36.9 39.7 0.0 10.4 41.2 109.0 Ambulatory (7*3) 13.2 26.2 2.5 1.8 16.5 43.5 Diagnostic & Therapeutic (7*4) 15.8 31.3 1.8 2.6 31.8 79.3 Community (7*5) 0.0 15.8 0.6 0.3 12.0 3.4 Education (7*8) 1.8 1.9 0.0 0.2 1.2 6.5 Admin & Support (7*1) 15.9 29.1 1.3 4.2 12.3 78.5 Total 2012/13 83.6 144.0 6.2 19.5 115.0 320.2

FY 2011/12 MIS Functional Centres MCH CH LHSC CHEO HDH KGH HHSC Sickkids Inpatient (7*2) 33.7 37.8 9.9 43.1 103.2 Ambulatory (7*3) 13.8 25.3 2.0 14.2 42.7 Diagnostic & Therapeutic (7*4) 10.7 36.6 2.1 29.6 77.7 Community (7*5) 1.5 16.7 0.0 10.3 2.9 Education (7*8) 0.6 1.9 0.3 1.1 6.2 Admin & Support (7*1) 9.7 27.9 3.5 12.6 77.8 Total 2011/12 70.0 146.2 17.8 110.9 310.5

Percentage Change 19.4% -1.5% 9.6% 3.7% 3.1%

Notes St. Joseph’s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June 2011, which included a Neonatal Intensive Care Unit.

55 PCMCH Maternal-Child Benchmarking Report 2013

6.1.4 OE – Compensation Costs as a Percent of Total per Functional Centre Category

This table and chart display compensation (3*) costs by MIS functional centre category, including fringe benefits, as a percent for each hospital. All medical staff remuneration (390*) has been excluded.

Functional Centre CH LHSC CHEO HDH KGH MCH HHSC SickKids

Inpatient (7*2) 44.1% 27.6% 0.0% 53.4% 35.8% 34.0% Ambulatory (7*3) 15.8% 18.2% 40.3% 9.1% 14.3% 13.6% Diagnostic & Therapeutic (7*4) 18.9% 21.7% 29.1% 13.5% 27.7% 24.8% Community (7*5) 0.0% 11.0% 9.1% 1.7% 10.4% 1.1% Education (7*8) 2.2% 1.3% 0.0% 1.0% 1.1% 2.0% Admin & Support (7*1) 19.0% 20.2% 21.5% 21.3% 10.7% 24.5%

Compensation Costs - Distribution by Functional Centre Category

CH LHSC

CHEO

HDH

KGH

MCH HHSC

SickKids

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Inpatient (7*2) Ambulatory (7*3) Diagnostic & Therapeutic (7*4) Community (7*5) Education (7*8) Admin & Support (7*1)

56 PCMCH Maternal-Child Benchmarking Report 2013

6.1.5 OE – Hours per Functional Centre Category

This table summarizes the total hours (MIS 3*) by MIS functional centre category for each hospital (in thousands). It is presented to show the relative size in hours of each institution. All medical staff remuneration (390*) has been excluded.

MIS Functional Centres FY 2012/13 MCH CH LHSC CHEO HDH KGH HHSC Sickkids Inpatient (7*2) 766.6 811.5 0.0 211.7 817.8 2,326.1 Ambulatory (7*3) 281.8 577.6 51.4 29.1 356.4 937.9 Diagnostic & Therapeutic (7*4) 338.1 652.4 38.5 56.9 667.6 1,743.8 Community (7*5) 0.0 348.8 12.6 7.2 304.4 67.5 Education (7*8) 30.9 40.1 0.0 3.2 22.1 128.0 Admin & Support (7*1) 427.6 730.6 38.3 112.0 269.7 1,915.4 TOTAL 1,845.0 3,161.0 140.8 420.1 2,438.0 7,118.7 2012/13 FTE (using 1950 hours) 946 1,621 72 215 1,250 3,651

MIS Functional Centres FY 2011/12 MCH CH LHSC CHEO HDH KGH HHSC Sickkids Inpatient (7*2) 704.1 779.5 199.5 859.7 2,223.6 Ambulatory (7*3) 304.2 559.5 40.9 311.2 920.9 Diagnostic & Therapeutic (7*4) 238.7 772.0 44.7 635.1 1,723.3 Community (7*5) 32.5 360.3 0.0 291.6 63.4 Education (7*8) 14.4 40.2 5.8 21.9 123.5 Admin & Support (7*1) 272.2 703.0 99.1 280.2 1,942.7 TOTAL 1,566.1 3,214.5 390.0 2,399.7 6,997.4 2011/12 FTE (using 1950 hours) 803 1,648 200 1,231 3,588

Percentage Change (2012/13 FTE vs 17.8% -1.7% 7.7% 1.6% 1.7% 2011/12 FTE)

Notes St. Joseph’s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June 2011, which included a Neonatal Intensive Care Unit.

57 PCMCH Maternal-Child Benchmarking Report 2013

6.1.6 OE – Hours as a Percent of Total per Functional Centre Category

The chart and table below present the same total hours (MIS 3*) data as a percent by the major functional centre groupings as defined by MIS. All medical staff remuneration (390*) has been excluded.

MCH Functional Centre CH LHSC CHEO HDH KGH Sickkids HHSC Inpt 7*2 41.6% 25.7% 0.0% 50.4% 33.5% 32.7% Ambulatory 7*3 15.3% 18.3% 36.5% 6.9% 14.6% 13.2% Diag &Therapy 7*4 18.3% 20.6% 27.3% 13.5% 27.4% 24.5% Community 7*5 0.0% 11.0% 8.9% 1.7% 12.5% 0.9% Education 7*8 1.7% 1.3% 0.0% 0.8% 0.9% 1.8% Admin & Support 23.2% 23.1% 27.2% 26.7% 11.1% 26.9%

Hours (MIS 3*) - Distribution by Functional Centre Category

CH LHSC

CHEO

HDH

KGH

MCH HHSC

Sickkids

0% 20% 40% 60% 80% 100% Inpt 7*2 Ambulatory 7*3 Diag &Therapy 7*4 Community 7*5 Education 7*8 Admin & Support

58 PCMCH Maternal-Child Benchmarking Report 2013

6.2 Operational Efficiency Comparisons

6.2.1 OE – Inpatient Only Net Operating Costs per Inpatient RIW Weighted Case

This chart presents the inpatient (7*2*) net operating cost per inpatient weighted case (CMG+). The denominator used is the total RIW as reported on the CIHI DAD. This can be used as a measure of efficiency for inpatient functional centres.

Net Operating Costs per Weighted Case

CH LHSC 3,963

CHEO 4,805

KGH 3,440

MCH 3,353 HHSC

Sickkids 4,504

0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 5,000

Notes Cost allocation for Kingston General Hospital (KGH) may be understated for inpatient ward. The method used is percent patient days and does not reflect variability of cost in mixed ward (i.e. including Obstetric cases)

The Religious Hospitallers of St. Joseph of the Hotel Dieu of Kingston (HDH) did not have any inpatients in Fiscal 2012/13 as the inpatient program transferred to KGH in June 2011.

59 PCMCH Maternal-Child Benchmarking Report 2013

6.2.2 OE – Inpatient Net Operating Costs per Inpatient Day

This chart displays the inpatient (7*2*) net operating cost per inpatient day (Trial Balance). This calculation is a measure of the average cost per day on the inpatient functional centres. This indicator does not take acuity into account.

Net Operating Costs per Inpatient Day

CH LHSC 1,185

CHEO 1,171

KGH 845

MCH 1,125 HHSC

Sickkids

0 200 400 600 800 1,000 1,200 1,400

The Religious Hospitallers of St. Joseph of the Hotel Dieu of Kingston (HDH) did not have any inpatients in Fiscal 2012/13 as the inpatient program transferred to KGH in June 2011.

60 PCMCH Maternal-Child Benchmarking Report 2013

6.2.3 OE – Inpatient Detailed Compensation and Hours Indicators

This table displays the inpatient (7*2*) detailed compensation and hours indicators.

CH LHSC CHEO KGH MCH HHSC Sickkids

Compensation costs (3*) per 3,287 3,795 2,884 2,749 3,299 inpatient weighted case Compensation costs (3*) per 983 925 709 922 1,068 inpatient day Hours (3*) per inpatient 68 78 58 55 70 weighted case

Hours (3*) per inpatient days 20 19 14 18 23

UPP hours (35090*/10*) per 44 55 45 36 47 inpatient weighted case UPP hours (35090*/10*)per 13 13 11 12 15 inpatient day Inpatient days (403* Trial 37,579 42,914 14,731 44,664 102,037 Balance)

CMG+ Inpatient weighted cases 11,240 10,456 3,619 14,983 33,034

The Religious Hospitallers of St. Joseph of the Hotel Dieu of Kingston (HDH) did not have any inpatients in Fiscal 2012/13 as the inpatient program transferred to KGH in June 2011.

61 PCMCH Maternal-Child Benchmarking Report 2013

6.2.4 OE – Inpatient Med/Surg Only Detailed Indicators

The table and chart provide inpatient medical/surgical (7*210/20*/30*/70*) units net operating cost per inpatient census day, compensation per inpatient day, and the UPP worked hours per inpatient day on those units. Patient acuity is not taken into consideration.

CH LHSC CHEO KGH MCH HHSC Sickkids

Net operating costs per 964 758 721 644 903 inpatient day Compensation costs (3*) 827 624 632 575 715 per inpatient day UPP worked hours (35090*/10*) per inpatient 11.52 10.17 9.95 10.55 11.02 day Inpatient days (403* Trial 17,106 27,330 5,821 19,950 70,453 Balance)

UPP Worked Hours per Inpatient Day

CH LHSC

CHEO

KGH

MCH HHSC

Sickkids

0 2 4 6 8 10 12

62 PCMCH Maternal-Child Benchmarking Report 2013

6.3 Critical Care NICU Department

6.3.1 OE – NICU Detailed Indicators

This table and chart display the NICU (7*24050*) net operating cost per inpatient census day, compensation per inpatient day and the UPP worked hours per inpatient day on those units. Patient acuity is not taken into

consideration.

KGH

CHEO

Sickkids

CH LHSCCH MCHHHSC

Net operating costs per 987 1,273 943 1,284 1,400 inpatient day Compensation costs (*3) per 891 1,126 836 1,086 1125 inpatient day UPP worked hours 11.65 15.87 12.55 16.15 16.16 (35090*/10*) per inpatient day Inpatient days (403* Trial 13,543 5,126 6,415 14,542 12,089 Balance)

NICU/ICU UPP Worked Hours per Inpatient Day

CH LHSC

CHEO

KGH

MCH HHSC

Sickkids

0 5 10 15 20

Notes St. Joseph’s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June 2011, which included a Neonatal Intensive Care Unit.

63 PCMCH Maternal-Child Benchmarking Report 2013

6.3.2 OE – Critical Care PCCU Detailed Indicators

This table and chart display the Paediatric Critical Care Units’ (7*240*, PICU and NICU combined) net operating cost per inpatient census day, compensation per inpatient day and the UPP worked hours per inpatient day on those units. Patient acuity is not taken into consideration.

KGH

CHEO

Sickkids

CH LHSCCH MCHHHSC Net operating costs per inpatient 1,213 1,699 945 1,482 1,746 day Compensation costs (*3) per 1,082 1,467 837 1,244 1,380 inpatient day UPP worked hours (35090*/10*) 14.27 20.46 12.57 19.07 20.01 per inpatient day

Inpatient days (403* Trial Balance) 15,882 7,283 6,429 17,210 24,354

PCCU UPP Worked Hours per Inpatient Day

CH LHSC CHEO KGH MCH HHSC Sickkids

0 5 10 15 20 25

64 PCMCH Maternal-Child Benchmarking Report 2013

6.3.3 OE – Operating Room Detailed Indicators

These table and charts present the operating room net operating cost per OR Hour, compensation per OR Hour, UPP worked hours per OR Hour, and Average OR Hour per case. Hours were self-reported by the participants as they are not part of the MIS trial balance.

CH LHSC CHEO KGH MCH HHSC Sickkids Net operating cost per OR 699 887 1,038 827 1,070 hour Compensation costs (3*) 239 360 350 363 374 per OR hour UPP worked hours 2.80 5.44 5.76 6.51 4.68 (35090*/10) per OR hour OR hours 6,784 9,955 1,074 6,627 24,964 OR cases 3,614 7,605 596 3083 11,906 OR Average hours per 1.88 1.31 1.80 2.15 2.10 case

Operating Room UPP Worked Hours Operating Room Average Hours per per OR Hour Case

CH LHSC CH LHSC

CHEO CHEO

KGH KGH

MCH HHSC MCH HHSC

Sickkids Sickkids

0 2 4 6 8 0 1 2 3

65 PCMCH Maternal-Child Benchmarking Report 2013

6.4 Ambulatory Costs

6.4.1 OE – Ambulatory Clinic Detailed Indicators

This table and chart present the ambulatory clinic unit operating cost per visit, compensation per visit and the UPP worked hours per clinic visits.

CH LHSC CHEO HDH KGH MCH HHSC Sickkids Net operating costs 6,595,437 11,730,657 1,126,121 127,046 9,479,906 29,439,622 Compensation costs 5,714,518 13,790,258 925,808 116,652 9,048,477 24,044,771 Worked UPP & PS 65,083 133,208 16,267 1,102 122,993 219,178 (35010*/90*) hours Visits (5*) and/or 68,912 94,739 19,315 501 107,616 190,019 (45024*/25*/27*/28*) Compensation costs 83 146 48 233 84 126 per visit Net operating costs per 96 124 58 253 88 155 visit UPP worked hours per 0.94 1.41 0.84 2.20 1.14 1.15 visit

Ambulatory Clinics UPP Worked Hours per Visit

CH LHSC

CHEO

HDH

KGH

MCH HHSC

Sickkids

0.0 0.5 1.0 1.5 2.0 2.5

66 PCMCH Maternal-Child Benchmarking Report 2013

6.5 Emergency Department

6.5.1 OE – Emergency Department Detailed Indicators

This table and chart present the Emergency Department net operating cost per visit, compensation per visit, hours per visit, and the UPP worked hours per visit as defined by MIS visits (448*/49*/50*/51*).

CH LHSC CHEO HDH KGH MCH HHSC Sickkids Net operating costs 5,717,926 9,376,874 917,780 1,521,123 6,427,507 10,734,953 Compensation costs (3*) 4,840,641 8,107,492 756,864 1,235,799 5,007,631 8,198,355 Total Hours (3*) 103,328 172,829 15,114 18,759 85,218 180,560 Worked UPP & PS 61,684 117,344 13,133 13,388 85,218 113,270 (35010*/90*) hours Visits (448*/49*/50*/51*) 37,059 66,131 15,186 6,594 40,564 63,638 Compensation Costs per visit 96 123 50 187 123 129 Net operating costs per visit 124 142 60 231 158 169 Total Hours per visit 2.79 2.61 1.00 2.84 2.10 2.84 UPP worked hours per visit 1.66 1.77 0.86 2.03 2.10 1.78

Emergency Department UPP Worked Hours per Visit

CH LHSC

CHEO

HDH

KGH

MCH HHSC

Sickkids

0.0 0.5 1.0 1.5 2.0 2.5

PCMCH Maternal-Child Benchmarking Report 2013

COMMUNITY HOSPITALS

68 PCMCH Maternal-Child Benchmarking Report 2013

Hospital Profiles

Service Profiles

Almonte General Hospital

Acronym AGH Main Catchment Mississippi Mills, Arnprior, Carleton Place Area and West Carleton Primary Academic Not Affiliated Affiliation Year Founded 1900’s

Website www.almontegeneral.com

Bluewater Health

Acronym BWH Main Catchment Sarnia Lambton County Area Primary Academic Western University Affiliation 1944 - St. Joseph’s Hospital 1896 - Sarnia General Hospital Year Founded 1911 - Charlotte Eleanor Englehart Hospital 2003 - Amalgamation to Bluewater Health Website www.bluewaterhealth.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental /Oral Surgery Adolescent Medicine Eating Disorders Child Protection General Surgery Emergency Medicine Psychiatry Orthopaedic Surgery Endocrinology Substance Abuse General Paediatrics Neonatology Nutrition

69 PCMCH Maternal-Child Benchmarking Report 2013

Brant Community Healthcare System

Acronym BCHS Main Catchment Brant County Area Primary Academic McMaster University Affiliation Year Founded 1884

Website www.bchsys.org

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental / Oral Surgery Emergency Medicine Child Protection General Surgery General Paediatrics Otolaryngology Newborn

Brockville General Hospital

Acronym BGH Main Catchment South East Ontario Area Primary Academic

Affiliation Year Founded 1881 Website www.bgh-on.ca

Subspecialties / Services Offered Paediatric Paediatric Mental Paediatric Surgical Paediatric Other Medical Health Dental / Oral Surgery General Paediatrics Infant & Child Development Program General Surgery Newborn Otolaryngology

70 PCMCH Maternal-Child Benchmarking Report 2013

Cambridge Memorial Hospital

Acronym CMH Main Catchment Cambridge, North Dumfries Area Primary Academic McMaster University Affiliation Year Founded 1953

Website www.cmh.org

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health General Paediatrics

Collingwood General and Marine Hospital

Acronym CGMH Collingwood, Wasaga Beach, Clearview, Main Catchment Area Blue Mountain Primary Academic

Affiliation Year Founded 1887

Website www.cgmh.on.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental/Oral Surgery General Surgery Orthopaedic Surgery

71 PCMCH Maternal-Child Benchmarking Report 2013

Cornwall Community Hospital

Acronym CCH Stormont, Dundas and Glengarry Main Catchment Area Counties Primary Academic University of Ottawa Affiliation Year Founded 2004

Website www.cornwallcommunityhospital.ca

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental/Oral Surgery Emergency Medicine Child Protection General Paediatrics Newborn

Georgian Bay General Hospital

Acronym GBGH North West subplanning area of North Main Catchment Simcoe Muskoka LHIN: Midland, Area Penetanguishene, Tiny, Tay and Christian Island Primary Academic

Affiliation Year Founded 1976

Website www.gbgh.on.ca

72 PCMCH Maternal-Child Benchmarking Report 2013

Geralton District Hospital

Acronym GDH Main Catchment Greenstone Municipality Area Primary Academic

Affiliation

Year Founded 1963

Website www.geraldtondh.com

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Emergency Medicine Newborn

Grand River Hospital

Acronym GRH Main Catchment Waterloo Wellington Area Primary Academic McMaster University/University of Affiliation Waterloo Year Founded 1995

Website www.grandriverhospital.on.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health General Paediatrics Psychiatry Juvenile Diabetes Education Clinic Psychology POGO Satellite

73 PCMCH Maternal-Child Benchmarking Report 2013

Grey Bruce Health Services

Acronym GBHS Main Catchment Grey and Bruce Counties Area Primary Academic McMaster Affiliation Year Founded 1998

Website www.gbhs.on.ca

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other General Paediatrics

Hotel Dieu Hospital – The Religious Hospitallers of Saint Joseph of the Hotel Dieu of Kingston

Acronym HDH Main Catchment Southeastern Ontario Area Primary Academic Queen’s University Affiliation Year Founded 1845

Website www.hoteldieu.com

Subspecialties / Services Offered Paediatric Paediatric Surgical Paediatric Medical Paediatric Other Mental Health Dental/Oral Surgery Allergy & Immunology Eating Disorders Anaesthesiology General Surgery Adolescent Medicine Psychiatry Child Protection Gynecology Cardiology Crisis Opthalmology Dermatology Psychology Orthopaedic Surgery Developmental Otolaryngology Paediatrics Urology Endocrinology Gastroenterology General Paediatrics / Paediatric Medicine Genetics / Metabolics Haematology Infectious Diseases Neurology Respirology Rheumatology

74 PCMCH Maternal-Child Benchmarking Report 2013

Halton Healthcare Services

Acronym HHS Main Catchment Halton Hills, Milton, Oakville, Clarkson Area Primary Academic McMaster Affiliation 1950 August 1,1998 – Amalgamation with Year Founded Milton District Hospital January 2, 2006 – Transfer of Georgetown Hospital Website www.haltonhealthcare.com

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other General Surgery General Paediatrics Eating Disorders – Out Patient Otolaryngology Emergency Medicine Psychiatry Newborn

Headwaters Health Care Centre

Acronym HHCC Main Catchment Dufferin/Caledon Area Primary Academic

Affiliation Year Founded 1912

Website www.headwatershealth.ca

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery General Paediatrics Diabetes Care General Surgery Otolaryngology

75 PCMCH Maternal-Child Benchmarking Report 2013

Health Sciences North/Horizon Santé-Nord

Acronym HSN Main Catchment LHIN 13 Area Primary Northern Ontario School of Medicine Academic (NOSM) Affiliation 1997 incorporated - prior to this there were 3 separate hospitals (Laurentian Hospital, General Hospital (now St. Joseph Year Founded Health Centre), Memorial Hospital and one mental health and community service facility, Sudbury Algoma Hospital) Website www.hsnsudbury.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health General Surgery General Paediatrics Crisis Child Protection Newborn Eating Disorders Dedicated Obesity Program Psychiatry Psychology Substance Abuse

Hôpital Montfort

Acronym Montfort Main Catchment Ottawa Area Primary Academic University of Ottawa and La Cité collégiale Affiliation Year Founded 1953 Website www.hopitalmontfort.com

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health General Paediatrics Haematology Newborn Nutrition

76 PCMCH Maternal-Child Benchmarking Report 2013

Humber River Regional Hospital

Acronym HRRH North to Steeles Avenue West; Main Catchment South to St. Clair Avenue West; Area East to Dufferin St; West to Hwy 427 Primary Academic University of Toronto Affiliation 1997 Amalgamation / Hospital Year Founded Restructuring Website www.hrrh.on.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental / Oral Surgery Allergy & Immunology Psychiatry General Surgery Cardiology Orthopaedic Surgery Emergency Medicine Otolaryngology General Paediatrics Neonatology Neurology Newborn

Joseph Brant Hospital (formerly known as Joseph Brant Memorial Hospital)

Acronym JBH Main Catchment Burlington Area Primary Academic McMaster University Affiliation

Year Founded 1961

Website www.josephbranthospital.ca

Subspecialties / Services Offered Paediatric Paediatric Surgical Paediatric Medical Paediatric Other Mental Health Orthopaedic Surgery Emergency Medicine Diabetes Program Otolaryngology General Paediatrics/Paediatric Regional Centre for Urology Medicine Suspected Child Abuse & Newborn Neglect

77 PCMCH Maternal-Child Benchmarking Report 2013

Lakeridge Health

Acronym LH Main Catchment Durham Region Area Queen’s University, University of Ontario Primary Academic Institute of Technology (UOIT), and Durham Affiliation College Year Founded 1988 www.lakeridgehealth.on.ca Website

Subspecialties / Services Offered Paediatric Paediatric Surgical Paediatric Medical Paediatric Other Mental Health ENT Emergency Medicine Crisis Neo-Natal Follow-up Clinic General Surgery General Paediatrics Eating Disorders Gynecology Genetics/Metabolitcs Psychiatry Opthalmology Neonatology Psychology Orthopaedic Surgery Newborn Plastic Surgery Urology

Mackenzie Health

Acronym MH Main Catchment York Region Area Primary Academic University of Toronto Affiliation Year Founded 1963

Website www.mackenziehealth.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental / Oral Surgery Allergy Psychiatry Anaesthesiology General Surgery Cardiology Clinical Genetics Gynecology Developmental Paediatrics Neonatal Follow Up Clinic Orthopaedic Surgery Emergency Medicine Otolaryngology Endocrinology Urology General Paediatrics Neonatology Nephrology Neurology Newborn Respirology

78 PCMCH Maternal-Child Benchmarking Report 2013

Markham Stouffville Hospital Corporation

Acronym MSH Main Catchment Markham, Stouffville, Unionville and Area Uxbridge Primary Academic Queen's University and University of Affiliation Toronto Year Founded 1990

Website www.msh.on.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental / Oral Surgery Cardiology Outpatient Paediatric Diabetes General Surgery Developmental Paediatrics Psychiatry Education Clinic Plastic Surgery Endocrinology Programs (i.e. child Urology General Paediatrics & Adolescent Neonatology Program and Newborn Adolescent Day Nutrition Hospital (Commencing Oct/13)

Middlesex Hospital Alliance – Strathroy Middlesex General Hospital

Acronym MHA-SMGH Main Catchment Southwest Middlesex Area Primary Academic University of Western Ontario Affiliation Year Founded 1914

Website www.mhalliance.on.ca

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other General Surgery Emergency Medicine Otolaryngology

79 PCMCH Maternal-Child Benchmarking Report 2013

Niagara Health System

Acronym NHS Main Catchment Niagara Region – Welland, St. Catherines, Area Niagara Falls Primary Academic Support satellite McMaster Medical School Affiliation Year Founded 1909

Website www.niagarahealth.on.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental / Oral Surgery Emergency Medicine Psychiatry Anaesthesiology General Surgery General Paediatrics Gynecology Neonatology Orthopaedic Surgery Otolaryngology Plastic Surgery Urology

North Bay Regional Health Centre

Acronym NBRHC Nipissing, Parry Sound, Mattawa, West Main Catchment Nipissing, Temiskaming, Englehart, Area Kirkland Lake (30,700 sq. km area servicing 129,000 people) Primary Academic Northern Ontario School of Medicine Affiliation Year Founded 1995

Website www.nbrhc.on.ca

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Child Protection

80 PCMCH Maternal-Child Benchmarking Report 2013

North York General Hospital

Acronym NYGH Main Catchment North York and South York Region Area Primary Academic University of Toronto Affiliation Year Founded 1968

Website www.nygh.on.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental/Oral Surgery Allergy & Immunology Eating Disorders Anaesthesiology General Surgery Adolescent Medicine Psychiatry Complex Care Clinic Cardiology Crisis Dedicated Obesity Program Dermatology Psychology Neonatal Follow-Up Clinic Developmental Substance Abuse Paediatrics Endocrinology Gastroenterology General Paediatrics Genetics/Metabolics Gynecology Haematology Infectious Diseases Neonatology Nephrology Neurology Newborn Nutrition Respirology Rheumatology

81 PCMCH Maternal-Child Benchmarking Report 2013

Northumberland Hills Hospital

Acronym NHH Main Catchment West Northumberland County Area Primary Academic Queen’s University; Toronto University Affiliation Year Founded 1996

Website www.nhh.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental / Oral Surgery Adolescent Medicine Emergency Medicine General Paediatrics Neonatology

82 PCMCH Maternal-Child Benchmarking Report 2013

Orillia Soldiers’ Memorial Hospital

Acronym OSMH LHIN 12, Areas outside LHIN include Alliston, Burks Falls, Durham County, Haliburton/ Main Catchment Area Minden County, Kawartha Lakes, District of Parry Sound. Primary Academic University of Toronto Affiliation 1908 Hospital Opened Year Founded 1952 OBS Opened 1953 Paediatrics Opened Website www.osmh.on.ca Subspecialties / Services Offered Paediatric Paediatric Surgical Paediatric Medical Paediatric Other Mental Health Dental / Oral Surgery Cardiology Eating Disorder Anaesthesiology General Surgery Developmental Psychiatry Children’s Complex Care Gynecology Paediatrics Crisis Navigation Program Ophthalmology Emergency Medicine Psychology Exercise & Nutrition Orthopaedic Surgery Endocrinology Social Work Neonatal Follow-up Otolaryngology General Paediatrics Regional Centre Suspected Plastic Surgery Genetics / Metabolics Child Abuse & Neglect Urology Haematology Neonatology Neurology Newborn Nutrition Oncology Physical Medicine & Rehabilitation Respirology

83 PCMCH Maternal-Child Benchmarking Report 2013

Peterborough Regional Health Centre

Acronym PRHC

Main Catchment Central East LHIN Area Primary Academic Queen's University, Kingston Affiliation Year Founded 1950 (Civic site)

Website www.prhc.on.ca

Subspecialties / Services Offered Paediatric Paediatric Surgical Paediatric Medical Paediatric Other Mental Health Dental / Oral Surgery Adolescent Gynecology Crisis Anaesthesiology General Surgery Emergency Medicine Eating Disorders Child Protection Orthopaedic Surgery General Paediatrics Psychiatry Clinical Genetics Otolaryngology Newborn Psychology Diabetes and Diabetes Transition Plastic Surgery Nutrition Clinic Urology Pharmacology Personal Health Improvement Team (PHIT) Childhood Obesity Clinic Regional Neonatal Follow Up

Quinte Health Care

Acronym QHC Main Catchment Hastings and Prince Edward County Area Primary Academic Queens University Affiliation Year Founded 1998

Website www.qhc.on.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental / Oral Surgery General Paediatrics Newborn

84 PCMCH Maternal-Child Benchmarking Report 2013

Renfrew Victoria Hospital

Acronym Renfrew The RVH catchment area extends from the Township of Whitewater in the North to McNab/Braeside Township in the South, Greater Madawaska Township to the West and to the Quebec border in the East. The RVH catchment area covers 3,085.11 square Main Catchment kilometers of Renfrew County out of a total of Area 7,600 square kilometers which represents 40.6% of Renfrew County. This includes the Town of Renfrew, Townships of Admaston/Bromley, Bonnechere Valley, Greater Madawaska, Horton, McNab/Braeside and Whitewater. Statistics Canada 2006 Primary Academic None Affiliation Year Founded 1897

Website www.renfrewhosp.com

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Newborn

Riverside Health Care Facilities Inc.

Acronym RHCF Rainy River District in spectacular Main Catchment Northwestern Ontario including Fort Area Frances and Emo Community Primary Academic Affiliation Year Founded

Website www.riversidehealthcare.ca

Subspecialties / Services Offered Paediatric Paediatric Mental Paediatric Medical Paediatric Other Surgical Health General Paediatrics/Paediatric General Surgery Medicine

85 PCMCH Maternal-Child Benchmarking Report 2013

Ross Memorial Hospital

Acronym RMH Main Catchment City of Kawartha Lakes Area Primary Academic None Affiliation

Year Founded 1902 Website www.rmh.org

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other General Surgery

Rouge Valley Health System – Rouge Valley Ajax Pickering and Rouge Valley Centenary

Acronym RVHS Main Catchment East Scarborough and West Durham Area Primary Academic University of Toronto Affiliation Year Founded RVC – 1965; RVAP – 1954

Website www.rougevalley.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental / Oral Surgery Allergy & Immunology Crisis Anaesthesiology General Surgery Adolescent Medicine Psychiatry Child Protection Gynecology Cardiology Psychology Exercise & Nutrition Ophthalmology Emergency Medicine Orthopaedic Surgery Endocrinology Otolaryngology Gastroenterology Plastic Surgery General Paediatrics Genetics/Metabolics Haematology Infectious Diseases Neonatology Nephrology Neurology Newborn Nutrition Oncology Pharmacology Respirology Rheumatology

86 PCMCH Maternal-Child Benchmarking Report 2013

Royal Victoria Regional Health Centre

Acronym RVH Main Catchment Barrie & PSA (Essa, Innisfil, Oro- Area Medonte & Springwater) Primary Academic University of Toronto and Georgian Affiliation College Year Founded 1891

Website www.rvh.on.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental / Oral Surgery Developmental Eating Disorders Exercise & Nutrition Paediatrics Outpatient Mental Health Neonatal Follow-up Clinic General Paediatrics Assessment Clinic Neonatology Newborn Nutrition Physical Medicine & Rehabilitation

Sault Area Hospital

Acronym SAH Main Catchment Algoma District Area Primary Academic Northern Ontario School of Medicine & Affiliation Sault College Year Founded

Website www.sah.on.ca

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery General Paediatrics Psychiatry General Surgery Neonatology Gynecology Newborn Orthopaedic Surgery

87 PCMCH Maternal-Child Benchmarking Report 2013

Sioux Lookout Meno Ya Win Health Centre

Acronym SLMHC Main Catchment Sioux Lookout, Pickle Lake, Savant & 28 Area Northern Communities Primary Academic Northern Ontario School of Medicine Affiliation Year Founded 1951

Website www.slmhc.on.ca

Subspecialties / Services Offered Paediatric Paediatric Surgical Paediatric Medical Paediatric Other Mental Health Dental / Oral Surgery Adolescent Medicine Anaesthesiology General Surgery Emergency Medicine Child Protection Otolaryngology General Paediatrics Palliative Care Physical Medicine & Rehabilitation

South Bruce Grey Health Centre

Acronym SBGHC Main Catchment Grey and Bruce Counties Area Primary Academic No formal affiliation Affiliation 1998 - Merged Chesley, Durham, Year Founded Kincardine & Walkerton into one organization Website www.sbghc.on.ca

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Newborn Otolaryngology

88 PCMCH Maternal-Child Benchmarking Report 2013

Southlake Regional Health Centre Acronym Southlake Main Catchment Northern York Region and South Simcoe, Area and north-west Durham Region Primary Academic None Affiliation Year Founded 1920s

Website www.southlakeregional.org

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental / Oral Surgery Allergy & Immunology Crisis Child Protection General Surgery Adolescent Medicine Eating Disorder Exercise & Nutrition Ophthalmology Developmental Paediatrics Psychiatry Neonatal Follow-Up Clinic Orthopaedic Surgery Emergency Medicine Psychology Palliative Care Otolaryngology Endocrinology Plastic Surgery Gastroenterology Urology General Paediatrics Haematology Neonatology Nephrology Newborn Nutrition Oncology Respirology

89 PCMCH Maternal-Child Benchmarking Report 2013

St. Joseph’s Health Centre, Toronto

Acronym SJHC Toronto

Main Catchment South West Toronto Area Primary Academic University of Toronto (Community Affiliation Hospital Affiliation) Year Founded 1921

Website www.stjoe.on.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health General Surgery Allergy Psychiatry Developmental Paediatrics Emergency Medicine Neonatal Follow-Up Clinic Endocrine General Paediatrics Neonatology Newborn Nutrition Pharmacology

St. Joseph’s Healthcare, Hamilton

Acronym SJHC Hamilton Main Catchment Hamilton, Niagara, Haldimand, Brant Area (LHIN 4) Primary Academic McMaster University Affiliation

Year Founded 1890

Website www.stjoes.ca

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental/Oral Surgery General Paediatrics Otolaryngology Newborn

90 PCMCH Maternal-Child Benchmarking Report 2013

St. Michael’s Hospital

Acronym SMH The main catchment for our Obstetrical, Main Catchment Neonatal and Paediatric population is Area focused on Southeast Toronto and includes the rest of GTA. Primary Academic University of Toronto Affiliation Year Founded 1892

Website www.stmichaelshospital.com

Subspecialties / Services Offered Paediatric Paediatric Paediatric Medical Paediatric Other Surgical Mental Health Adolescent Medicine Eating Disorders Fetal Alcohol Spectrum Diagnostic Allergy & Immunology Psychiatry Immigrant Health/Refugee Cardiology Dermatology Developmental Paediatrics General Paediatrics Haematology Infectious Diseases Neonatology Newborn Nutrition

St. Thomas Elgin General Hospital

Acronym STEGH Main Catchment Elgin County Area Primary Academic Western Affiliation Year Founded 1954

Website www.stegh.on.ca

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery General Paediatrics Maxillofacial Neonatology Otolaryngology Newborn

91 PCMCH Maternal-Child Benchmarking Report 2013

Stevenson Memorial Hospital

Acronym Stevenson The hospital’s primary service area Main Catchment includes the Township of Adjala- Area Tosorontio, Canadian Forces Base Borden (CFBB), Essa, Innisfil and New Tecumseth Primary Academic None Affiliation Year Founded 1928

Website www.smhosp.on.ca

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery

The Scarborough Hospital

Acronym TSH Main Catchment North and South Scarborough Area Primary Academic University of Toronto Affiliation 1999 through Restructuring and Year Founded Amalgamation Website www.tsh.to

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental/Oral Surgery Allergy & Immunology Crisis Anaesthesiology Ophthalmology Cardiology Psychiatry Burns Orthopaedic Surgery Developmental Paediatrics Psychology Child Protection Otolaryngology Emergency Medicine Immigrant Health/Refugee Plastic Surgery General Paediatrics Palliative Care Genetics / Metabolics Infectious Diseases Neonatology Neurology Newborn Nutrition Pharmacology Respirology

92 PCMCH Maternal-Child Benchmarking Report 2013

Thunder Bay Regional Health Sciences Centre

Acronym TBRHSC

Main Catchment Thunder Bay and Northwestern Ontario Area Area Primary Academic Northern Ontario School of Medicine, Affiliation Lakehead University Founded in 1995, amalgamated to new Year Founded facility 2004

Website www.tbrhsc.com

Subspecialties / Services Offered Paediatric Mental Paediatric Paediatric Surgical Paediatric Medical Health Other Dental / Oral Surgery Cardiology (Paed Outpatient clinic) Crisis General Surgery General Paediatrics Psychology Orthopaedic Surgery Neonatology Otolaryngology Oncology Urology

93 PCMCH Maternal-Child Benchmarking Report 2013

Toronto East General Hospital

Acronym TEGH West: Etobicoke/High Park North West: Davenport/Bloor South West: West Downtown/Parkdale North Central: Midtown/Leaside/North

Main Catchment Riverdale/Forest Hill Area South East: East Downtown/South Riverdale East: Old East York/East End/The Beach North East: Flemingdon/Thorncliffe/ Crescent Town/Oakridge Primary Academic University of Toronto Affiliation Year Founded 1929

Website www.tegh.on.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental / Oral Surgery Allergy/Immunology Crisis Dedicated Obesity Program Gynecology Cardiology Psychiatry Ophthalmology Developmental Paediatrics Psychology Otolaryngology General Paediatrics Neonatology Neurology Newborn Nutrition Respirology

94 PCMCH Maternal-Child Benchmarking Report 2013

Trillium Health Partners - Credit Valley Hospital (formerly known as Credit Valley Hospital)

Acronym THP - CVH Main Catchment Mississauga-Halton LHIN Area Primary Academic University of Toronto Affiliation Year Founded 1985

Website www.trilliumhealthpartners.ca

Subspecialties / Services Offered Paediatric Paediatric Surgical Paediatric Medical Paediatric Other Mental Health Dental / Oral Surgery Cardiology Psychiatry Child Welfare and Protection General Surgery Emergency Medicine Psychology Program Ophthalmology Endocrinology Clinical Genetics Orthopaedic Surgery General Paediatrics Complex Care Clinic Otolaryngology Haematology Neonatal Follow-Up Plastics Neonatology Palliative Care Urology Nephrology Nutrition Oncology Respirology Rheumatology

Trillium Health Partners - Mississauga Hospital (formerly known as Trillium Health Centre)

Acronym THP - MH Main Catchment Halton-Peel Area Primary Academic University of Toronto, Mississauga Affiliation Year Founded 1998 (prior Mississauga Hospital)

Website www.trilliumhealthpartners.ca

Subspecialties / Services Offered Paediatric Paediatric Surgical Paediatric Medical Paediatric Other Mental Health ENT Cardiology Psychiatry Child Protection General Surgery Developmental Paediatrics Fetal Alcohol Spectrum Orthopaedic Surgery Emergency Medicine Diagnostic Plastics Endocrinology Neonatal Follow-Up General Paediatrics Neonatology Neurology Newborn Nutrition

95 PCMCH Maternal-Child Benchmarking Report 2013

West Lincoln Memorial Hospital

Acronym WLMH Main Catchment Grimsby, West Lincoln, Lincoln Area Primary Academic McMaster University Affiliation Year Founded 1946

Website www.wlmh.on.ca

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Otolaryngology

West Parry Sound Health Centre

Acronym WPSHC

Main Catchment District of Parry Sound Area Primary Academic Northern Ontario School of Medicine and Affiliation Canadore College Year Founded 1995

Website www.wpshc.com

Subspecialties / Services Offered

Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other General Paediatrics

96 PCMCH Maternal-Child Benchmarking Report 2013

William Osler Health System

Acronym WOHS

Located in the Central West LHIN. Our Main Catchment catchment area includes Brampton, Area Etobicoke and surrounding area. Affiliated with McMaster University, Primary Academic University of Toronto, Ryerson, Humber Affiliation College and students from many other academic facilities. Brampton Civic Hospital: October 28, 2007 Year Founded Etobicoke General Hospital: 1972 Peel Memorial Hospital: 1998 Website www.williamoslerhs.on.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health Dental / Oral Surgery Adolescent Medicine Crisis Anaesthesiology General Surgery Allergy & Immunology Psychiatry Child Protection Ophthalmology Cardiology Psychology Exercise & Nutrition Otolaryngology Emergency Medicine Substance Abuse Palliative Care Plastic Surgery Endocrinology Urology Gastroenterology General Paediatrics Haematology Infectious Diseases Neonatology Nephrology Newborn Neurology Nutrition Pharmacology Respirology

97 PCMCH Maternal-Child Benchmarking Report 2013

Winchester District Memorial Hospital

Acronym WDMH Main Catchment North South Dundas, North South Stormont, Area Russell, Greely, Metcalfe, Osgoode Primary Academic University of Ottawa Affiliation Year Founded 1948

Website www.wdmh.on.ca

Subspecialties / Services Offered Paediatric Mental Paediatric Surgical Paediatric Medical Paediatric Other Health General Paediatrics/ Dedicated Obesity Paediatric Medicine Program Newborn

Windsor Regional Hospital

Acronym WRH Main Catchment Windsor and Essex County Area Primary Academic University of Windsor, St. Clair College, Affiliation Schulich School of Medicine Year Founded 1928

Website www.wrh.on.ca

Subspecialties / Services Offered Paediatric Paediatric Surgical Paediatric Medical Paediatric Other Mental Health Dental / Oral Surgery Allergy & Immunology Crisis Anaesthesiology General Surgery Adolescent Medicine Eating Disorders Burns Gynecology Cardiology Psychiatry Child Protection Maxillofacial Dermatology Psychology Neonatal Follow-up Program Ophthalmology Development Paediatrics Substance Abuse Palliative Care Orthopaedic Surgery Emergency Medicine Otolaryngology Endocrinology Plastic Surgery Gastroenterology Urology General Paediatrics Genetics / Metabolics Infectious Diseases Neonatology Neurology Newborn Nutrition Oncology Pharmacology Respirology 98 PCMCH Maternal-Child Benchmarking Report 2013

Woodstock Hospital

Acronym WGH

Main Catchment Oxford County Area Primary Academic Schulich School of Medicine & Dentistry, Affiliation UWO

Year Founded 1893

Website www.wgh.on.ca

Subspecialties / Services Offered Paediatric Paediatric Surgical Paediatric Medical Paediatric Other Mental Health Dental / Oral Surgery Development Paediatrics Anaesthesiology General Surgery General Paediatrics/Paediatric Child Protection Gynecology Medicine Maxillofacial Newborn Ophthalmology Orthopaedic Surgery Otolaryngology Urology

99 PCMCH Maternal-Child Benchmarking Report 2013

Bed Profiles

The table below presents the number of perinatal, neonatal and paediatric beds “Staffed and In Operation” - beds that are open are available regardless of whether or not they are actually occupied by a patient. It also presents the number of perinatal, neonatal and paediatric “Physical” beds - the maximum number of beds at the beginning of the year on the basis of established standards of floor area per patient to meet fire protection and safety standards. For detailed MIS definition of “Staffed and In Operation” beds, please refer to page 289.

AGH BCHS BGH BWH CCH CGMH

Beds

Physical Physical Physical Physical Physical Physical

Operation Operation Operation Operation Operation Operation

Staffed / In In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed

a 0 0 0 0 0 0 0 0 0 0 5 5 Level I b 7 7 0 0 12 12 0 0 10 10 0 0 a 0 0 0 0 0 0 14 21 0 0 0 0 Perinatal Level II b 0 0 20 20 0 0 0 0 0 0 0 0 c 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL PERINATAL 7 7 20 20 12 12 14 21 10 10 5 5

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 5 5 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Neonatal Level II b 0 0 10 10 0 0 3 6 0 0 0 0 c 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL NEONATAL 5 5 10 10 0 0 3 6 0 0 0 0

Med/Surg 0 0 0 0 1 1 10 10 7 7 0 0 Level II 0 0 0 0 0 0 0 0 0 0 0 0 PCCU Level III 0 0 0 0 0 0 0 0 0 0 0 0 Mental Health 0 0 0 0 0 0 0 0 0 0 0 0 Other 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 12 12 30 30 13 13 27 37 17 17 5 5

Notes BGH: The unit can take more paediatric patients depending on the number of other patients already admitted. There are no reserved beds except for the 4 LDRP. The other beds consist of 4 private rooms, and 1 semi-private, and one 3-bed ward. CCH: The whole unit takes 17 patients - 10 funded obstetrical beds (sometimes used for medical or surgical patients) and 7 funded paediatric beds. LDRP has 3 birthing suites and 2 assessment rooms. CCH is a Level 1 perinatal, staffed with 2 RNs for L&D , 2 for paediatric and 2 for the postpartum. CCH is a neonatal Level 1, no NICU beds. Babies and mothers stay together. Postpartum, antepartum, gynecological and medical surgical occupy the 10 funded beds.

100 PCMCH Maternal-Child Benchmarking Report 2013

Bed Profiles (cont)

CMH GBGH GBHS GDH GRH HHCC

Beds

Physical Physical Physical Physical Physical Physical

Operation Operation Operation Operation Operation Operation

Staffed / In In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed

a 0 0 5 5 0 0 1 1 0 0 6 11 Level I b 0 0 0 0 0 0 0 0 0 0 0 0 a 10 10 0 0 0 0 0 0 0 0 0 0 Perinatal Level II b 0 0 0 0 10 10 0 0 41 41 0 0 c 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL PERINATAL 10 10 5 5 10 10 1 1 41 41 6 11

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 0 0 0 0 0 0 0 0 0 0 a 6 8 0 0 0 0 0 0 0 0 0 0 Neonatal Level II b 0 0 0 0 6 6 0 0 22 22 0 0 c 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL NEONATAL 6 8 0 0 6 6 0 0 22 22 0 0

Med/Surg 0 0 0 0 5 5 3 3 18 24 3 5 Level II 0 0 0 0 0 0 0 0 0 0 0 0 PCCU Level III 0 0 0 0 0 0 0 0 0 0 0 0 Mental Health 0 0 0 0 0 0 0 0 13 13 0 0 Other 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 16 18 5 5 21 21 4 4 94 100 9 16

101 PCMCH Maternal-Child Benchmarking Report 2013

Bed Profiles (cont)

HHS HRRH HSN JBH LH MH

Beds

Physical Physical Physical Physical Physical Physical

Operation Operation Operation Operation Operation Operation

Staffed / In In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 15 15 0 0 0 0 0 0 5 5 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Perinatal Level II b 19 19 42 50 0 0 16 19 0 0 0 0 c 0 0 0 0 20 20 0 0 26 35 22 22 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL PERINATAL 34 34 42 50 20 20 16 19 31 40 22 22

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Neonatal Level II b 8 8 13 16 0 0 6 6 0 0 0 0 c 0 0 0 0 10 11 0 0 14 18 8 12 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL NEONATAL 8 8 13 16 10 11 6 6 14 18 8 12

Med/Surg 7 7 12 20 12 15 6 6 12 14 6 6 Level II 0 0 0 0 0 0 0 0 0 0 0 0 PCCU Level III 0 0 0 0 0 0 0 0 0 0 0 0 Mental Health 10 10 6 6 2 2 0 0 8 10 0 0 Other 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 59 59 73 92 44 48 28 31 65 82 36 40

Note JBH: Perinatal Beds: Includes Labour and Delivery beds in the L&D Suite (6) and post-natal beds (13). Neonatal Beds: Includes 6 bassinets in the Level 2B Nursery. Med/Surg Beds: Includes 6 Paediatric beds.

102 PCMCH Maternal-Child Benchmarking Report 2013

Bed Profiles (cont)

MHA - SMGH Montfort MSH NBRHC NHH NHS

Beds

Physical Physical Physical Physical Physical Physical

Operation Operation Operation Operation Operation Operation

Staffed / In In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed

a 2 2 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 0 0 0 0 0 0 12 12 0 0 a 0 0 27 35 0 0 0 0 0 0 28 53 Perinatal Level II b 0 0 0 0 0 0 0 0 0 0 0 0 c 0 0 0 0 28 42 10 10 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL PERINATAL 2 2 27 35 28 42 10 10 12 12 28 53

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 4 9 0 0 0 0 0 0 16 16 Neonatal Level II b 0 0 0 0 0 0 0 0 0 0 0 0 c 0 0 0 0 10 15 8 8 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL NEONATAL 0 0 4 9 10 15 8 8 0 0 16 16

Med/Surg 0 0 0 0 5 8 6 6 2 2 23 48 Level II 0 0 0 0 0 0 0 0 0 0 0 0 PCCU Level III 0 0 0 0 0 0 0 0 0 0 0 0 Mental Health 0 0 0 0 0 0 2 2 0 0 0 0 Other 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 2 2 31 44 43 65 26 26 14 14 67 117

Notes NHH: The number of staffed/open beds and the staff-to-patient ratio can vary depending upon whether the mother is in labour or is postpartum. If all are post partum, we can accommodate 12. If they are in labour, the ratio is 1:1. As for the neonatal beds, there are 12 that could stay in the mother's room and be accommodated with current staffing. However if the baby requires closer monitoring, the unit could accommodate only 1-2 (based on what else is happening in the unit such as laboring mothers etc). NHS: Perinatal beds identified in the table above service both adult and paediatric patients.

103 PCMCH Maternal-Child Benchmarking Report 2013

Bed Profiles (cont)

NYGH OSMH PRHC QHC Renfrew RHCF

Beds

Physical Physical Physical Physical Physical Physical

Operation Operation Operation Operation Operation Operation

Staffed / In In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed

a 0 0 0 0 0 0 0 0 3 3 0 0 Level I b 0 0 0 0 0 0 17 17 0 0 2 2 a 0 0 0 0 0 0 0 0 0 0 0 0 Perinatal Level II b 0 0 0 0 21 25 0 0 0 0 0 0 c 51 55 10 13 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL PERINATAL 51 55 10 13 21 25 17 17 3 3 2 2

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Neonatal Level II b 0 0 0 0 10 16 0 0 0 0 0 0 c 20 20 12 15 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL NEONATAL 20 20 12 15 10 16 0 0 0 0 0 0

Med/Surg 15 15 8 12 8 12 10 10 0 0 2 2 Level II 0 0 0 0 0 0 0 0 0 0 0 0 PCCU Level III 0 0 0 0 0 0 0 0 0 0 0 0 Mental Health 6 6 0 0 0 0 0 0 0 0 0 0 Other 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 92 96 30 40 39 53 27 27 3 3 4 4

Note RHCF: 2 paediatric beds are general medical/surgical beds.

104 PCMCH Maternal-Child Benchmarking Report 2013

Bed Profiles (cont)

RMH RVH RVHS SAH SBGHC SJHC Hamilton

Beds

Physical Physical Physical Physical Physical Physical

Operation Operation Operation Operation Operation Operation

Staffed / In In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 11 11 0 0 0 0 0 0 6 6 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Perinatal Level II b 0 0 0 0 12 16 0 0 0 0 39 45 c 0 0 37 37 19 28 10 14 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL PERINATAL 11 11 37 37 31 44 10 14 6 6 39 45

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Neonatal Level II b 0 0 0 0 2 4 0 0 0 0 15 20 c 0 0 12 18 20 20 10 10 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL NEONATAL 0 0 12 18 22 24 10 10 0 0 15 20

Med/Surg 0 0 8 8 14 21 8 8 0 0 0 0 Level II 0 0 0 0 0 0 0 0 0 0 0 0 PCCU Level III 0 0 0 0 0 0 0 0 0 0 0 0 Mental Health 0 0 0 0 6 7 2 3 0 0 0 0 Other 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 11 11 57 63 73 96 30 35 6 6 54 65

105 PCMCH Maternal-Child Benchmarking Report 2013

Bed Profiles (cont)

SJHC Toronto SLMHC SMH Southlake STEGH Stevenson

Beds

Physical Physical Physical Physical Physical Physical

Operation Operation Operation Operation Operation Operation

Staffed / In In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 5 5 5 5 0 0 0 0 4 4 a 0 0 0 0 0 0 0 0 11 11 0 0 Perinatal Level II b 32 32 0 0 0 0 22 31 0 0 0 0 c 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 27 27 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL PERINATAL 32 32 5 5 32 32 22 31 11 11 4 4

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 4 4 0 0 Neonatal Level II b 14 20 0 0 0 0 12 19 0 0 0 0 c 0 0 0 0 20 22 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL NEONATAL 14 20 0 0 20 22 12 19 4 4 0 0

Med/Surg 8 8 4 4 0 0 10 18 6 6 0 0 Level II 0 0 0 0 0 0 0 0 0 0 0 0 PCCU Level III 0 0 0 0 0 0 0 0 0 0 0 0 Mental Health 6 6 0 0 0 0 9 12 0 0 0 0 Other 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 60 66 9 9 52 54 53 80 21 21 4 4

Notes SMH: perinatal unit has level 3 maternal capabilities. STEGH: SCN data is not captured in CIHI / DAD. STEGH will have data representation in the next benchmarking report.

106 PCMCH Maternal-Child Benchmarking Report 2013

Bed Profiles (cont)

TBRHSC TEGH THP- CVH THP-MH TSH WDMH

Beds

Physical Physical Physical Physical Physical Physical

Operation Operation Operation Operation Operation Operation

Staffed / In In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 0 0 0 0 0 0 0 0 8 8 a 0 0 0 0 0 0 0 0 0 0 0 0 Perinatal Level II b 0 0 29 29 0 0 25 32 55 55 0 0 c 18 25 3 3 35 37 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL PERINATAL 18 25 32 32 35 37 25 32 55 55 8 8

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Neonatal Level II b 0 0 12 12 0 0 12 18 20 20 0 0 c 14 14 2 2 35 37 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL NEONATAL 14 14 14 14 35 37 12 18 20 20 0 0

Med/Surg 12 12 8 8 24 28 12 14 16 16 0 0 Level II 0 0 0 0 0 0 0 0 0 0 0 0 PCCU Level III 0 0 0 0 0 0 0 0 0 0 0 0 Mental Health 8 8 6 6 0 0 0 0 0 0 0 0 Other 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 52 59 60 60 94 102 49 64 91 91 8 8

Note TEGH: Maternal beds reduced by 1 to create a recovery room for maternal patients.

107 PCMCH Maternal-Child Benchmarking Report 2013

Bed Profiles (cont)

WGH WLMH WOHS WPSHC WRH Total

Beds

Physical Physical Physical Physical Physical Physical

Operation Operation Operation Operation Operation Operation

Staffed / In In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed In / Staffed

a 0 0 0 0 0 0 0 0 0 0 22 27 Level I b 7 7 11 11 0 0 2 2 0 0 139 139 a 0 0 0 0 0 0 0 0 0 0 90 130 Perinatal Level II b 0 0 0 0 89 89 0 0 0 0 472 513 c 0 0 0 0 0 0 0 0 41 51 330 392 a 0 0 0 0 0 0 0 0 0 0 27 27 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL PERINATAL 7 7 11 11 89 89 2 2 41 51 1,080 1,228

a 0 0 0 0 0 0 0 0 0 0 0 0 Level I b 0 0 0 0 0 0 0 0 0 0 5 5 a 0 0 0 0 0 0 0 0 0 0 30 37 Neonatal Level II b 0 0 0 0 9 9 0 0 0 0 174 212 c 0 0 0 0 33 33 0 0 20 20 248 275 a 0 0 0 0 0 0 0 0 0 0 0 0 Level III b 0 0 0 0 0 0 0 0 0 0 0 0 SUBTOTAL NEONATAL 0 0 0 0 42 42 0 0 20 20 457 529

Med/Surg 0 0 0 0 30 30 0 0 20 20 349 424 Level II 0 0 0 0 0 0 0 0 0 0 0 0 PCCU Level III 0 0 0 0 0 0 0 0 0 0 0 0 Mental Health 0 0 0 0 14 14 0 0 6 6 104 111 Other 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 7 7 11 11 175 175 2 2 87 97 1,990 2,292

108 PCMCH Maternal-Child Benchmarking Report 2013

Emergency Department Profiles

Almonte General Hospital

Bluewater Health

Observation / Short Stay The Short Stay Unit for the paediatric population would be for the Unit / Assessment Unit children that have received procedural sedation for the repair of a laceration or the reduction of a fracture. Will also observe children with croup and other respiratory ailments. Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process CTAS guidelines, separate Paediatric assessment tool. Fast Track / Quick Care / Currently developing a “See and Treat” Pathway through EDPIP for Medical Walk-in Clinic levels 4 & 5.

Brant Community Healthcare System

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process All paediatric patients are weighed and have a full set of vitals taken. Nurses are certified in both adult and paediatric triage. Fast Track / Quick Care / The hospital has a RADAR unit – rapid assessment and discharge Medical Walk-in Clinic area. Quick Care is available for paediatric patients following assessment in the ED.

109 PCMCH Maternal-Child Benchmarking Report 2013

Brockville General Hospital

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process All ER nurses have the triage training and the majority have PALS training. The paeds triage is electronic and triage guidelines are followed as well as triage protocols. Fast Track / Quick Care / Fast Track is used if possible when the 2nd physician comes in Medical Walk-in Clinic which is from 5PM to 9PM. A formal Fast Track program is in development, but no target dates have been set yet for implementation.

Cambridge Memorial Hospital

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process All pediatric patients are seen by a triage nurse and registered, just as the adult patients are. CMH has a few medical directives ie. Tylenol/Advil for fever, etc. Pediatric patients are seen in both the sub-acute and main ED. Fast Track / Quick Care / CMH has a sub-acute/Fast Track area with 5 stretchers and 6 Medical Walk-in Clinic chairs. The Nurse Practitioners work in this area from 1000-2200 hours, 7 days/week. An Emergency Physician and RN also see patients in this area. This area sees CTAS 3,4 & 5 patients. This has improved ED flow and efficiencies.

Collingwood General and Marine Hospital

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines No Triage Process Paediatric Patients are triaged based on the CTAS guidelines Fast Track / Quick Care / See and Treat Area. Medical Walk-in Clinic

110 PCMCH Maternal-Child Benchmarking Report 2013

Cornwall Community Hospital

Observation / Short Stay Yes Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Paediatric patients presenting to adult/paediatric combined ED are triaged as per the pediatric CTAS guidelines. Fast Track / Quick Care / The ED have implemented a See and Treat model of care where Medical Walk-in Clinic CTAS 3, 4, 5 ambulatory patients not requiring cardiac monitoring are directed.

Georgian Bay General Hospital

Geralton District Hospital

111 PCMCH Maternal-Child Benchmarking Report 2013

Grand River Hospital

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process: Assessment – vital signs, cap refill, weight, subjective and objective assessment triage based on presentation and vital signs according to the CTAS guidelines. Fast Track / Quick Care / See Triage Process. Medical Walk-in Clinic:

Grey Bruce Health Services

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process All patients are triaged electronically using CTAS guidelines. Fast Track / Quick Care / Fast Track area operational 1000-2300 hours Monday-Friday. Medical Walk-in Clinic Note: Will expand to 7 days per week in early 2013.

Hotel Dieu - The Religious Hospitallers of Saint Joseph of the Hotel Dieu of Kingston

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined There are two Urgent Care Sites at HDH; Pediatric in the Children’s Adult/Paediatric ED Outpatient Department that is open Monday-Friday 900-1600 hours with approximately 8000 visits a year and Adult/Pediatric UCC that is open 365 days a year 800-2200 hours seeing 41,500 patients a year. Paediatric ED Nurses No Paediatric CTAS Guidelines Yes according to the Canadian Triage and Acuity Scale. Triage Process All patients are triaged according to CTAS guidelines. Fast Track / Quick Care / None Medical Walk-in Clinic

112 PCMCH Maternal-Child Benchmarking Report 2013

Halton Healthcare Services

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No - however ENPC and/or PALS supported. Paediatric CTAS Guidelines Yes Triage Process All patients are triaged first by an RN trained in Triage/Paediatric CTAS. Triage process includes utilizing P-CTAS guidelines and includes a full set of vital signs. Fast Track / Quick Care / There is an RPN dedicated to fast track at the OTMH site which Medical Walk-in Clinic typically sees CTAS 4’s and 5’s (adults and pediatrics) from 1200- 2400h. The Rapid Assessment Zone (RAZ) operates 0900-2400h and is staffed by RN and RPN staff. RAZ typically sees CTAS 3 and some CTAS 2 patients. MDH and GH sites operate a Rapid Assessment Fast Track (RAFT) which is staffed by RN/RPN and MD. CTAS 4 and 5 patients, including paediatric patients, are seen in RAFT. RAFT operates 7 days per week at the MDH and GH sites, from 1200-2200 hours at the MDH site and during peak evening hours (1400 -2200 hours) at the GH sites. HHS also has a Post- Emergency Paediatric Clinic operating at the OTMH site 7 days per week, receiving referrals from the 3 ED sites.

Headwaters Health Care Centre

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Meditech system for electronic documentation - special triage screen for pediatric patients. Fast Track / Quick Care / "See and Treat Zone" in the Emergency Department for stable, Medical Walk-in Clinic non-complicated patients. Patients are brought to room, assessed by RN if MD not immediately available & medical directives initiated if applicable, MD assessment, patient moved out of room for diagnostic tests (ambulates by self to x-ray and back), returns to chairs within department while tests completed, returns for room for results/MD treatments.

113 PCMCH Maternal-Child Benchmarking Report 2013

Health Sciences North/Horizon Santé-Nord

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Triaged by ED RN using Paediatric CTAS guidelines and placed appropriately within department based on acuity. Triage occurs at point of entry prior to registration, same as adults. Fast Track / Quick Care / See and Treat for ambulatory CTAS 3, 4, 5 for 12 hours/day, 7 days Medical Walk-in Clinic per week.

Hôpital Montfort

Humber River Regional Hospital

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Paediatric patients are triaged based on CTAS guidelines. Fast Track / Quick Care / There is a Rapid Assessment area and an ED Fast Track where Medical Walk-in Clinic Paediatric patients are moved through the system quickly. A Paediatric Outpatient Clinic operates during daytime to see Paediatric patients who do not require admission but need a follow-up by a paediatrician the day following their visit to the ED.

114 PCMCH Maternal-Child Benchmarking Report 2013

Joseph Brant Memorial Hospital - (formerly Joseph Brant Memorial Hospital)

Observation / Short Stay Yes Unit / Assessment Unit Clinical Decision Unit - Patients who meet the unit's protocols are admitted to the unit for observation. Max LOS < 24 hours. Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Paediatric triage is completed in area used for all presenting patients. Fast Track / Quick Care / EMAaT (Emergency Minor Assessment and Treatment Area) open Medical Walk-in Clinic from 10:00 to 22:00 daily.

Lakeridge Health

Mackenzie Health

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Patients are assessed by the triage nurse, vital signs are taken, including a weight. Each patient given a CTAS level and sent to appropriate area for treatment. Fast Track / Quick Care / There is a triaging process that separates patients based on zones Medical Walk-in Clinic and level of urgency (green, blue, yellow and red) to facilitate the less complex cases to move through in a timely manner. Green zone reflects Fast Track lower complexity patient area.

115 PCMCH Maternal-Child Benchmarking Report 2013

Markham Stouffville Hospital Corporation

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No. ED staff are supported by NICU/Peds staff via consultation and best practice. Paediatric CTAS Guidelines Yes Triage Process Paediatric patients are triaged in the main ED and directed to the appropriate area of the emergency department to be seen by a physician and nurse. Based on the CTAS guidelines, patients requiring urgent consult are seen within the designated timeframes. Consultation with paediatrician/neonatologist as required 24/7. Fast Track / Quick Care / Green zone area services CTAS level IV and V patients. It has a Medical Walk-in Clinic dedicated nurse and physician. The proposed Paediatric Ambulatory Clinic was opened in October 2013 and supports consultation and follow-up.

Middlesex Hospital Alliance – Strathroy Middlesex General Hospital

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process: Triaged using paediatric guidelines through same process as adults. Fast Track / Quick Care / Green zone area to Fast Track Level IV and V, dedicated nurse and Medical Walk-in Clinic: geographical area.

Niagara Health System

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Levels 1 and 2 are triaged into Paediatric Assessment/Treatment Room in acute care area of ED reserved for acutely ill children. All others are triaged with the rest of patients in order of priority and then arrival. Fast Track / Quick Care / All paediatric patients are triaged and seen by a RN and then cared Medical Walk-in Clinic for by the ERP. Based upon this initial assessment, the ERP will determine if a paediatric consult is required.

116 PCMCH Maternal-Child Benchmarking Report 2013

North Bay Regional Health Centre

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Present to triage nurse and complaints follow the CTAS guidelines. Fast Track / Quick Care / Go through the See and Treat area. Physician starts at noon until Medical Walk-in Clinic 2200.

North York General Hospital

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Every Patient is triaged according to the Canadian Triage Acuity Scale. This includes Paediatric modifiers. Fast Track / Quick Care / Yes. At Triage, patients are highlighted for our Ambulatory Care Medical Walk-in Clinic area. This area is staffed by Registered Nurse, Orthopedic Technologist and ED Physician. There are inclusion and exclusion criteria for the area to ensure the right patients are seen by this team.

Northumberland Hills Hospital

Observation / Short Stay Yes. CDU. Held in CDU (Clinical Decision Unit) up to 24 hours. In Unit / Assessment Unit order to qualify for the CDU the patient must have one of the following conditions: Head Injury; Allergic Reaction; Paediatric Asthma, Vomiting and Diarrhea. The patient is then either admitted as in inpatient to our facility, discharged home, or transferred out to another facility. Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Triaged by an RN and seen by a physician based on presenting acuity. Fast Track / Quick Care / Rapid Assessment area for low acuity visits and ambulatory CTAS Medical Walk-in Clinic 3 patients.

117 PCMCH Maternal-Child Benchmarking Report 2013

Orillia Soldiers’ Memorial Hospital

Observation / Short Stay Yes. <12 hour LOS on Paeds unit (Paediatric Day Care Clinic). Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses Some ED nurses with PALS and ED certificate with a Paediatric Module Paediatric CTAS Guidelines Yes Triage Process Levels 1, 2, 3 are triaged into Paediatric Assessment/Treatment Room in the acute care area of ED reserved for acutely ill children. Support provided by Paeds/NICU staff (RT/RN/MD). All others are triaged with the rest of the patients in order of priority and their arrival. Fast Track / Quick Care / Community walk- in clinics, rapid access family physicians, direct Medical Walk-in Clinic admission to acute care paediatrics (bypassing the emergency department).

Peterborough Regional Health Centre

Observation / Short Stay Yes. PRHC has a 5 bed virtual Clinical Decision Unit. A CDU is a Unit / Assessment Unit unit to which emergency department patients may be formally assigned following their initial ED assessment and care. The purpose of a CDU is to allow for short term monitoring, investigation and treatment to support disposition decisions. The main benefits of a CDU are improved patient safety and quality of care, improvements in functioning and throughput of the ER, and decreasing inpatient admission rates. It is well documented that certain patient groups within the ER may benefit from a brief extended stay in the ER in order to complete diagnostic assessments and/or observe trial of therapy. Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process CTAS guidelines with adult and paediatric modifiers and paediatric assessment triangle are used. Fast Track / Quick Care / Fast Track (Green Zone) Rapid assessment area for patients with Medical Walk-in Clinic low acuity. The Green Zone operates 0800-2400 hours. Access to PRHC Pediatric Outpatient Clinic 7 days per week.

118 PCMCH Maternal-Child Benchmarking Report 2013

Quinte Health Care

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process CTAS Guidelines – No specific paediatric triage forms. Paediatric patients are triaged in the main ED and directed to the appropriate area of the emergency department to be seen by a physician and nurse. Fast Track / Quick Care / Fast Track areas during certain times of day in both the Belleville Medical Walk-in Clinic and Trenton emergency departments of Quinte Health Care.

Renfrew Victoria Hospital

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Use the CTAS Guidelines: Fast Track / Quick Care / Partnership with CHEO - use evidence-based pathways i.e. croup; Medical Walk-in Clinic asthma; vomiting & diarrhea; bronchiolitis. Also have access to the CHEO

Riverside Health Care Facilities Inc.

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process In accordance with CTAS Guidelines: Fast Track / Quick Care / None Medical Walk-in Clinic

119 PCMCH Maternal-Child Benchmarking Report 2013

Ross Memorial Hospital

Observation / Short Stay Yes Unit / Assessment Unit 24 hour observation short stay unit in ED for any child the ED physician feels can benefit from treatment or continued observation. These children, upon discharge, are followed up by a paediatrician in an outpatient clinic or with their Family Physician. If the child does not show improvement in 24 hours, they are referred to the appropriate level of care in another hospital. Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process All children present to RN who performs complete set of vitals and child’s weight on arrival to the ED then triage score is assigned Fast Track / Quick Care / RMH flows CTAS 4 & 5 children to a different area; RMH opens Medical Walk-in Clinic "See and Treat" clinics several times a week where there is an additional physician that only cares for CTAS 4 & 5 patients.

Rouge Valley Health System – Rouge Valley Ajax Pickering and Rouge Valley Centenary

Observation / Short Stay Yes, Centenary site has a unit for paediatric patients who meet a Unit / Assessment Unit set criteria and require short term treatment and/or a longer observation/assessment period are accommodated on the paediatric unit during the hours of 0800-2300. Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses Yes Paediatric CTAS Guidelines Yes Triage Process All patients are triaged according to Paediatric CTAS Guidelines on a priority basis. Fast Track / Quick Care / There is an Ambulatory Care Area adjacent to the Emergency Medical Walk-in Clinic Department, where CTAS IV & V are sent to be fast tracked through the Emergency Department. Non-acute Paediatric patients may also receive care authorized by the use of paediatric medical directive for: Acetaminophen Administration, Oral Rehydration, Peripheral Radiology Studies.

120 PCMCH Maternal-Child Benchmarking Report 2013

Royal Victoria Regional Health Centre

Observation / Short Stay Yes. Unit / Assessment Unit Max Los= 24 hours, Treatable medical conditions most likely to benefit from admission to CDU are: Respiratory, Asthma, Pneumonia, Gastroenteritis/dehydration, Abdominal pain, Ingestions. Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process According to the Canadian Triage and Acuity scale. Fast Track / Quick Care / Minor Exam-dedicated Doctor and 2 RPN’s. Open 0800-2400 hrs, 7 Medical Walk-in Clinic days a week. Have a number of medical walk-in clinics in Barrie.

Sault Area Hospital

Observation / Short Stay Yes. Unit / Assessment Unit Stable patients that are waiting for further diagnostic testing, or fluid therapy/antibiotic therapy, repeat lab work (to determine discharge or admission). They cannot stay longer than 23 hours at which time they are then a full hospital admission. Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Based on the Canadian Paediatric Triage and Acuity Scale (P- CTAS). Nurse uses the 3- step assessment which includes: Initial impression, evaluation of the presenting complaint, assessment of behavior and age related physiological measurements. Triage level is based on presentation but takes into consideration the information and comments by the family and the nurses draw on their experience and expertise. Paediatric patients are reassessed frequently while waiting to be seen. Fast Track / Quick Care / Fast Track and See and Treat unit. Medical Walk-in Clinic

121 PCMCH Maternal-Child Benchmarking Report 2013

Sioux Lookout Meno Ya Win Health Centre

South Bruce Grey Health Centre

Southlake Regional Health Centre

Observation / Short Stay Yes Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process The paediatric patients are triaged using CTAS Paed guidelines. All patients presenting to the ED are seen by a nurse and triaged based on critical look and presenting complaint. Children are weighed and vital signs are recorded as part of their triage assessment. Fast Track / Quick Care / Fast Track area is open 7 days a week from 1100-2300. Medical Walk-in Clinic

122 PCMCH Maternal-Child Benchmarking Report 2013

St. Joseph’s Health Centre, Toronto

Observation / Short Stay Yes. Unit / Assessment Unit 36 hours – admitting physician is Emergency Physician Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process: Electronic triage system with paeds CTAS incorporated into it. Fast Track / Quick Care / Fast Track and Medical Directives Medical Walk-in Clinic

St. Joseph’s Healthcare, Hamilton

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses Yes Paediatric CTAS Guidelines Yes Triage Process All paediatric patients (direct referrals or not) are triaged using the CTAS guidelines. Fast Track / Quick Care / CTAS IV &V are mostly seen in ambulatory area at both (King Medical Walk-in Clinic Campus) Urgent Care and (Charlton Campus) ED. This could be described as a "Fast Track" or "Rapid Assessment Area". The triage nurses identify if the patient is suitable for ambulatory and the nurses working in that area will take the patients from the waiting room and place them in the area for assessment. There are medical directives, so the nurses can begin certain interventions prior to the physician seeing the patient to speed up the process.

St. Michael’s Hospital

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines No Triage Process Consult the paediatric CTAS scale and use clinical judgment to increase the acuity and reduce time to assessment by an MD when appropriate. Fast Track / Quick Care / St. Michael’s Hospital is not a Paediatric ED but available to Medical Walk-in Clinic Paediatric Patients and has access to the Paediatrics on call for consultation. Nurse Practitioner Fast Track area is open from 10am-10pm weekdays.

123 PCMCH Maternal-Child Benchmarking Report 2013

St. Thomas Elgin General Hospital

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Follow Paediatric CTAS guidelines. Integrated triage with adult population. Fast Track / Quick Care / Rapid Assessment Zone open 7 days per week from 0930-2130h. Medical Walk-in Clinic From 1100-1800h Monday to Friday and on some weekends we have a 3rd physician that runs this unit.

Stevenson Memorial Hospital

Observation / Short Stay Yes. Paediatric patients are admitted for observation depending on Unit / Assessment Unit CTAS level and acuity. Patient may be transferred to level 2 or 3 facility. Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process: The following guidelines are used: Paediatric Pain Scale, Paediatric Coma Scale, and Paediatric Vital Sign guidelines. Fast Track / Quick Care / Fast Track and use a ‘See and Treat’ Program. Medical Walk-in Clinic

The Scarborough Hospital

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Combined Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Assessed by triage RN, taken to the appropriate patient care area based on triage score, care provided, transferred or discharged. Fast Track / Quick Care / Rapid Assessment Zone (RAZ) and PaedLink Clinic where children Medical Walk-in Clinic can be transferred.

124 PCMCH Maternal-Child Benchmarking Report 2013

Thunder Bay Regional Health Sciences Centre

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Following registration patients are either fast tracked (CTAS levels 3-5) or are cared for in the paediatric resuscitation room (CTAS 1 and 2). Fast Track / Quick Care / Fast Track area where all uncomplicated patients are seen for Medical Walk-in Clinic quick assessment and treatment. Do not triage to walk-in clinics.

Toronto East General Hospital

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process All patients are assessed on arrival and more acute patients are seen first. At triage, a history is taken from caretaker/patient based on the CIAMPEDS acronym. Afterwards vital signs and weight of child are collected and focused physical assessment completed and patient sent to appropriate care area. Fast Track / Quick Care / CTAS 4 & 5 patients are seen in our ambulatory Green Zone. Here Medical Walk-in Clinic the charts are kept separate from the CTAS 3 charts and in chronological order so that it is easily visible to all working how many are waiting and for what length of time. Each MD for the last 2 hours of their shift will dedicate their time to these patients.

125 PCMCH Maternal-Child Benchmarking Report 2013

Trillium Health Partners - Credit Valley Hospital (formerly known as Credit Valley Hospital)

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Paediatric CTAS guidelines are followed from presentation at the triage desk upon arrival to the ED and throughout the entire visit. After initial assessment by the triage nurse, the child is registered and sent to the most appropriate care area of the ED according to the P-CTAS score. Fast Track / Quick Care / Paediatric patients triaged at levels 4 and 5 are less urgent and Medical Walk-in Clinic cared for either in RAZ (Rapid Assessment Zone) or the Fast Track area. These areas provide initiation of care and/or investigation and/or education often through medical directives; and standard protocols. Age appropriate distraction can be made available in these areas to assist in care.

Trillium Health Partners - Mississauga Hospital (formerly known as Trillium Health Centre)

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process Children are triaged by a CTAS trained RN using CTAS guidelines and placed in the appropriate treatment areas. We have specific Paediatric Triage Assessment Forms (different than adult) which incorporate the PAT – “Paediatric Assessment Triangle” based on P-CTAS guidelines. Fast Track / Quick Care / Paediatric patients will be seen in our Minor Treatment/Fast Medical Walk-in Clinic Track area as appropriate. Most children are assessed and treated in either the Minor Treatment area or our Rapid Assessment Zone (RAZ – or ambulatory zone). We do not Triage away from the Emergency Department. We have a standalone Urgent Care Centre at the Queensway Health Centre which follows the same ED processes with Paediatric specific triage.

In addition to Emergency Department services, there is a standalone “Kidz Klinic” that is open seven days a week (evening hours) that is operated by Paediatricians at the Mississauga Hospital Family Care Centre (operates as a paediatric walk-in clinic).

126 PCMCH Maternal-Child Benchmarking Report 2013

West Lincoln Memorial Hospital

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines No Triage Process Patient presents to Triage, Patient assessed and triaged according to CTAS guidelines. If CTAS 4 or 5 will wait in the waiting room for room placement/treatment with the general population. Fast Track / Quick Care / Currently working on medical directives. There is a second Medical Walk-in Clinic physician on call with parameters for calling in due to large volumes.

West Parry Sound Health Centre

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process CTAS guidelines & paediatric 1st & 2nd order modifiers and enhanced based tools (e.g. CIAMPEDS) Fast Track / Quick Care / During high volume time periods, Fast Track is used for peak Medical Walk-in Clinic times. Standardized back up MD is utilized for other high volume times.

William Osler Health System

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses Yes Paediatric CTAS Guidelines Yes Triage Process Use paediatric P-CTAS guidelines to place appropriately within the department based on acuity. Fast Track / Quick Care / There is Ambulatory Care Treatment Centre in both EDs. Lower Medical Walk-in Clinic acuity CTAS 4, 5 patients and rapid turnaround CTAS 3 patients go to these areas. Brampton Civic Hospital site has an Urgent Care Centre for paediatric patients.

127 PCMCH Maternal-Child Benchmarking Report 2013

Winchester District Memorial Hospital

Observation / Short Stay No Unit / Assessment Unit Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process: Triage both adults and paeds together but use the P-CTAS guidelines. Fast Track / Quick Care / Fast Track Process Medical Walk-in Clinic

Windsor Regional Hospital

Observation / Short Stay Yes. Emergency Medical Paediatric Program operated Monday- Unit / Assessment Unit Friday from 0800-1500 allowing children who meet criteria to bypass the ED and be assessed by Paediatricians and Paediatric ward. Paediatric Short Stay virtual unit on paediatric ward for children who need to be admitted for less than 24 hours. Paediatricians re-assess children on a regular basis and if needed can admit for further treatment. Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses No Paediatric CTAS Guidelines Yes Triage Process: All Paediatric patients that come to the ED are triaged using CTAS levels. Fast Track / Quick Care / All CTAS 4 and 5 are assessed and treated in our ambulatory hall Medical Walk-in Clinic by NPs and Emergency Room doctors. This runs 24/7.

Woodstock General Hospital

Observation / Short Stay Yes, does not have a formal clinical decision unit, but routinely Unit / Assessment Unit holds patients for further observation when required. Paediatric or Combined Combined Adult/Paediatric ED Paediatric ED Nurses Yes Paediatric CTAS Guidelines Yes Triage Process: Patients present at Emergency Triage and are triaged according to CTAS. Full set of vitals, weight and documentation of presenting symptoms. Fast Track / Quick Care / Fast Track Medical Walk-in Clinic

128 PCMCH Maternal-Child Benchmarking Report 2013

Clinical Indicators

2.0 Hospital Descriptors

DES 2.1.1 – Inpatient and Same Day Surgery Volumes

The following chart and table display inpatient and same day surgery volumes. Hospitals that joined the Benchmarking project in 2013 do not have data for FY 11/12 and FY 10/11. Hospitals that joined the Benchmarking project in 2012 do not have data for FY 10/11.

Inpatient Cases SDS Cases Hospital FY 10/11 FY 11/12 FY 12/13 FY 10/11 FY 11/12 FY 12/13 AGH 90 24 BCHS 1,196 1,298 1,145 637 603 554 BGH 187 244 281 303 BWH 852 1,034 1,004 623 686 657 CCH 645 593 505 193 519 502 CGMH 149 113 98 116 CMH 1,463 1,476 1,382 741 781 682 GBGH 112 109 GBHS 791 801 775 611 716 733 GDH 34 GRH 2,871 3,013 3,237 1,250 1,299 1,224 HDH 1,210 HHCC 480 541 557 245 270 238 HHS 2,227 2,348 2,138 950 1,140 974 HRRH 1,891 1,902 1,849 1,337 1,229 1,110 HSN 1,452 1,520 1,396 994 979 931 JBH 1,155 1,082 910 875 825 710 LH 2,244 2,670 3,001 1,605 1,502 1,434 MH 1,635 1,800 1,844 682 707 733 MHA-SMGH 58 68 76 186 190 179 Montfort 1,204 944 883 50 42 45 MSH 1,587 1,569 1,497 676 740 616 NBRHC 989 1,012 922 472 579 438 NHH 220 205 171 196 183 199 NHS 3,402 3,149 3,050 1,506 1,523 1,414 NYGH 3,971 4,184 4,249 3,161 3,179 2,906 OSMH 1,051 1,111 1,110 461 464 474 PRHC 1,712 1,578 1,351 1,306 1,413 1,136 QHC 1,203 1,186 1,066 578 728 654 Renfrew 22 56 RHCF 125 120 RMH 194 194 142 92 67 76 RVH 1,226 1,237 1,218 1,363 1,431 1,419 RVHS 2,800 3,006 3,071 1,785 1,965 1,934 SAH 803 862 888 341 411 499 SBGHC 99 86 127 109 SJHC Hamilton 1,082 1,109 1,203 300 286 231 SJHC Toronto 2,113 2,064 2,074 732 443 431 SLMHC 210 307 419 401 654 444 SMH 1,236 1,480 1,240 63 55 73 Southlake 2,282 2,224 2,195 742 655 940 STEGH 631 536 548 525 478 507 Stevenson 141 134 142 644 556 651 TBRHSC 2,214 2,293 2,282 975 1,002 950 TEGH 1,932 1,843 1,903 961 995 914 THP-CVH 3,299 1,672 THP-MH 2,323 1,006 TSH 3,337 3,216 3,107 1,472 1,417 1,272 WDMH 97 40 WGH 219 160 WLMH 176 177 161 220 273 221 WOHS 5,913 7,373 7,684 2,000 2,049 1,977 WPSHC 96 100 46 55 WRH 2,874 2,674 2,371 2,264 2,329 1,969

129 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.1 – Inpatient and Same Day Surgery Volumes (cont)

Inpatient and Same Day Surgery Distribution (FY 12/13)

AGH BCHS BGH BWH CCH CGMH CMH GBGH GBHS GDH GRH HDH HHCC HHS HRRH HSN JBH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRHC QHC Renfrew RHCF RMH RVH RVHS SAH SBGHC SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THP-CVH THP-MH TSH WDMH WGH WLMH WOHS WPSHC WRH

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Inpatient Cases 12/13 SDS Cases 12/13

130 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.2 – Neonatal and Paediatric Inpatient Case Distribution

This chart and table display the distribution between neonatal (0-28 days) and paediatric (29 days-17 years) inpatient cases. Hospitals that joined the Benchmarking project in 2013 do not have data for FY 11/12 and FY 10/11. Hospitals that joined the Benchmarking project in 2012 do not have data for FY 10/11. Hospitals whose volume is less than 6 are indicated in the table as “<6”.

Neonatal Cases Paediatric Cases Hospital FY 10/11 FY 11/12 FY 12/13 FY 10/11 FY 11/12 FY 12/13 AGH 88 <6 BCHS 435 520 466 761 778 679 BGH 71 128 116 116 BWH 264 315 352 588 719 652 CCH 162 195 149 483 398 356 CGMH 85 78 64 35 CMH 786 794 749 677 682 633 GBGH 46 66 GBHS 308 295 285 483 506 490 GDH 34 GRH 1509 1,501 1,661 1362 1,512 1,576 HHCC 84 89 154 396 452 403 HHS 1156 1,115 984 1071 1,233 1,154 HRRH 1049 974 1,007 842 928 842 HSN 449 515 469 1003 1,005 927 JBH 609 603 464 546 479 446 LH 1128 1,306 1,374 1116 1,364 1,627 MH 917 967 1,023 718 833 821 MHA-SMGH 12 21 27 46 47 49 Montfort 1182 932 864 22 12 19 MSH 963 988 897 624 581 600 NBRHC 406 417 369 583 595 553 NHH 156 137 110 64 68 61 NHS 1079 1,140 1,134 2323 2,009 1,916 NYGH 2521 2,774 2,995 1450 1,410 1,254 OSMH 425 469 551 626 642 559 PRHC 708 677 593 1004 901 758 QHC 721 711 665 482 475 401 Renfrew 9 13 RHCF 28 97 RMH 126 135 88 68 59 54 RVH 551 526 531 675 711 687 RVHS 1397 1,472 1,525 1403 1,534 1,546 SAH 275 278 339 528 584 549 SBGHC 61 68 38 18 SJHC Hamilton 1019 1,038 1,164 63 71 39 SJHC Toronto 1278 1,212 1,222 835 852 852 SLMHC 63 134 204 147 173 215 SMH 1141 1,383 1,134 95 97 106 Southlake 919 804 744 1363 1,420 1,451 STEGH 253 195 204 378 341 344 Stevenson 62 62 73 79 72 69 TBRHSC 817 815 839 1397 1,478 1,443 TEGH 1169 1,051 1,233 763 792 670 THP-CVH 1,608 1,691 THP-MH 1,206 1,117 TSH 2029 1,937 2,021 1308 1,279 1,086 WDMH 85 12 WGH 158 61 WLMH 166 167 159 10 10 <6 WOHS 2714 3,950 4,325 3199 3,423 3,359 WPSHC 36 37 60 63 WRH 1044 1,058 1,018 1830 1,616 1,353

131 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.2 – Neonatal and Paediatric Inpatient Case Distribution (cont)

Neonatal and Paediatric Inpatient Case Distribution (FY 12/13)

AGH BCHS BGH BWH CCH CGMH CMH GBGH GBHS GDH GRH HHCC HHS HRRH HSN JBH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRHC QHC Renfrew RHCF RMH RVH RVHS SAH SBGHC SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THP-CVH THP-MH TSH WDMH WGH WLMH WOHS WPSHC WRH 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Neonatal Paediatric

132 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.3 – Inpatient Case Age Profile

The following table and chart provide the age profile of the inpatient population of each hospital. The age categories are according to the CMG+ age categories: 0-28 days, 29-364 days, 1-7 years and 8-17 years. A zero volume is blank and a volume less than 6 is indicated as “<6”.

Hospital 0-28 Days 29-364 Days 1-7 Years 8-17 Years Total AGH 88 <6 90 BCHS 466 159 290 230 1,145 BGH 128 30 55 31 244 BWH 352 108 288 256 1,004 CCH 149 77 182 97 505 CGMH 78 <6 33 113 CMH 749 148 334 151 1,382 GBGH 46 <6 <6 62 112 GBHS 285 70 231 189 775 GDH <6 8 23 34 GRH 1,661 212 447 917 3,237 HHCC 154 40 170 193 557 HHS 984 126 392 636 2,138 HRRH 1,007 140 330 372 1,849 HSN 469 151 291 485 1,396 JBH 464 77 199 170 910 LH 1,374 217 648 762 3,001 MH 1,023 131 392 298 1,844 MHA-SMGH 27 33 16 76 Montfort 864 <6 18 883 MSH 897 104 298 198 1,497 NBRHC 369 82 198 273 922 NHH 110 <6 31 28 171 NHS 1,134 382 841 693 3,050 NYGH 2,995 256 423 575 4,249 OSMH 551 121 257 181 1,110 PRHC 593 184 344 230 1,351 QHC 665 98 186 117 1,066 Renfrew 9 <6 9 22 RHCF 28 9 38 50 125 RMH 88 54 142 RVH 531 110 232 345 1,218 RVHS 1,525 195 571 780 3,071 SAH 339 78 171 300 888 SBGHC 68 <6 <6 12 86 SJHC Hamilton 1,164 18 21 1,203 SJHC Toronto 1,222 151 298 403 2,074 SLMHC 204 61 74 80 419 SMH 1,134 32 74 1,240 Southlake 744 195 484 772 2,195 STEGH 204 54 150 140 548 Stevenson 73 <6 20 44 142 TBRHSC 839 245 512 686 2,282 TEGH 1,233 98 208 364 1,903 THP-CVH 1,608 352 830 509 3,299 THP-MH 1,206 206 558 353 2,323 TSH 2,021 193 546 347 3,107 WDMH 85 12 97 WGH 158 20 41 219 WLMH 159 <6 161 WOHS 4,325 634 1,435 1,290 7,684 WPSHC 37 6 10 47 100

WRH 1,018 184 474 695 2,371

133 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.3 – Inpatient Case Age Profile (cont)

Inpatient Case Age Profile (FY 12/13)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0-28 Days 29-364 Days 1-7 Years 8-17 Years

134 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.4 – Same Day Surgery Age Profile

This chart and table provide a description of the age profile of the same day surgery (SDS) population of each hospital. A zero volume is blank and a volume less than 6 is indicated as “<6”.

Hospital 0-28 days 29-364 days 1-7 years 8-17 years Total AGH 14 <6 6 24 BCHS 295 259 554 BGH 78 225 303 BWH <6 329 327 657 CCH <6 302 198 502 CGMH 36 80 116 CMH <6 <6 445 232 682 GBGH 36 73 109 GBHS 6 421 306 733 GRH <6 800 422 1,224 HDH 26 665 519 1,210 HHCC <6 149 88 238 HHS <6 8 460 504 974 HRRH <6 565 543 1,110 HSN <6 9 531 389 931 JBH <6 368 341 710 LH <6 11 793 627 1,434 MH <6 419 312 733 MHA-SMGH 119 60 179 Montfort 45 45 MSH 9 336 271 616 NBRHC <6 245 191 438 NHH 118 81 199 NHS <6 820 589 1,414 NYGH 90 2,101 715 2,906 OSMH 279 195 474 PRHC 9 706 421 1,136 QHC <6 410 243 654 Renfrew 31 >6 24 56 RHCF <6 99 20 120 RMH 24 52 76 RVH 901 518 1,419 RVHS 9 967 958 1,934 SAH 255 244 499 SBGHC <6 66 42 109 SJHC Hamilton 107 124 231 SJHC Toronto <6 244 186 431 SLMHC 388 56 444 SMH 73 73 Southlake 149 18 322 451 940 STEGH <6 322 184 507 Stevenson <6 <6 486 159 651 TBRHSC 7 439 504 950 TEGH 9 606 299 914 THP-CVH 10 33 994 635 1,672 THP-MH 8 564 434 1,006 TSH 21 715 536 1,272 WDMH 40 40 WGH 48 112 160 WLMH <6 157 63 221 WOHS <6 1,173 801 1,977 WPSHC <6 13 41 55 WRH 10 1,211 748 1,969

135 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.4 – Same Day Surgery Age Profile (cont)

Same Day Surgery Age Profile (FY 12/13)

AGH BCHS BGH BWH CCH CGMH CMH GBGH GBHS GRH HDH HHCC HHS HRRH HSN JBH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRHC QHC Renfrew RHCF RMH RVH RVHS SAH SBGHC SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THP-CVH THP-MH TSH WDMH WGH WLMH WOHS WPSHC WRH

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0-28 days 29-364 days 1-7 years 8-17 years

136 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.5 – Total Average Length of Stay

The following table and chart illustrates the total average length of stay in days for all inpatient cases. The length of stay is calculated from the date of admission to the date of discharge. Hospitals that joined the Benchmarking project in 2013 do not have data for FY 11/12 and FY 10/11. Hospitals that joined the Benchmarking project in 2012 do not have data for FY 10/11. A provincial comparator of all Ontario hospitals (excluding paediatric Academic Health Sciences Centres) has been added.

ALOS Hospital % Change vs FY 10/11 FY 11/12 FY 12/13 Previous Year AGH 2.5 BCHS 3.2 3.2 3.3 3.5% BGH 2.0 2.1 5.6% BWH 3.1 3.0 2.9 -1.6% CCH 2.2 2.2 2.0 -12.3% CGMH 2.0 1.5 -22.9% CMH 2.6 2.7 2.9 6.0% GBGH 2.3 GBHS 3.6 3.9 3.8 -2.8% GDH 2.0 GRH 4.2 4.4 4.3 -1.5% HHCC 2.1 1.9 2.2 16.2% HHS 3.7 3.5 3.4 -1.6% HRRH 4.1 3.9 4.0 2.8% HSN 4.0 4.1 4.8 16.6% JBH 2.3 2.7 2.9 7.4% LH 3.5 3.5 3.7 4.3% MH 3.0 2.9 2.9 1.1% MHA-SMGH 1.5 1.6 1.5 -5.7% Montfort 2.8 3.3 3.0 -7.6% MSH 2.8 2.8 3.1 9.1% NBRHC 3.8 3.7 4.0 9.0% NHH 2.4 2.2 2.0 -8.9% NHS 2.9 2.9 3.1 7.0% NYGH 3.6 3.5 3.4 -2.2% OSMH 5.1 4.4 4.5 0.6% PRHC 3.3 3.5 3.7 5.2% QHC 2.9 3.1 3.2 4.4% Renfrew 2.0 RHCF 2.5 RMH 2.2 2.2 2.1 -6.3% RVH 4.4 4.1 4.7 13.2% RVHS 3.9 4.1 3.9 -2.8% SAH 3.7 3.8 3.9 2.3% SBGHC 2.0 1.9 -4.7% SJHC Hamilton 6.5 6.5 6.1 -6.7% SJHC Toronto 3.9 4.0 3.9 -0.2% SLMHC 2.4 2.4 2.6 12.0% SMH 6.2 5.8 6.3 8.9% Southlake 4.0 4.1 4.1 0.6% STEGH 3.1 2.8 3.1 8.4% Stevenson 1.5 1.7 1.7 -0.3% TBRHSC 5.0 4.7 4.9 5.7% TEGH 4.1 4.3 4.5 3.0% THP-CVH 5.0 THP-MH 3.3 TSH 3.2 3.4 3.3 -0.8% WDMH 2.2 WGH 1.9 WLMH 2.1 2.0 1.8 -10.7% WOHS 4.0 3.7 3.4 -6.1% WPSHC 2.1 2.2 6.2% WRH 4.3 4.5 4.8 7.7% ON Community Hospitals 3.6 3.6 3.7 2.8%

137 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.5 – Total Average Length of Stay (cont)

Total ALOS (FY 12/13)

CGMH 1.5 MHA-SMGH 1.5 Stevenson 1.7 WLMH 1.8 WGH 1.9 SBGHC 1.9 CCH 2.0 GDH 2.0 NHH 2.0 Renfrew 2.0 RMH 2.1 BGH 2.1 WDMH 2.2 WPSHC 2.2 HHCC 2.2 GBGH 2.3 AGH 2.5 RHCF 2.5 SLMHC 2.6 JBH 2.9 CMH 2.9 BWH 2.9 MH 2.9 Montfort 3.0 STEGH 3.1 MSH 3.1 NHS 3.1 QHC 3.2 THP-MH 3.3 TSH 3.3 BCHS 3.3 WOHS 3.4 HHS 3.4 NYGH 3.4 LH 3.7 PRHC 3.7 ON Community Hospitals 3.7 GBHS 3.8 SAH 3.9 SJHC Toronto 3.9 RVHS 3.9 HRRH 4.0 NBRHC 4.0 Southlake 4.1 GRH 4.3 TEGH 4.5 OSMH 4.5 RVH 4.7 HSN 4.8 WRH 4.8 TBRHSC 4.9 THP-CVH 5.0 SJHC Hamilton 6.1 SMH 6.3 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0

138 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.6 – Total Average LOS (Neonatal and Paediatric)

The following charts and table provide the average length of stay (ALOS) for neonatal (0-28 days) and paediatric (29 days-17 years) cases. The length of stay is calculated from the date of admission to the date of discharge and is displayed in days. Hospitals that joined the Benchmarking project in 2013 do not have data for FY 11/12 and FY 10/11. Hospitals that joined the Benchmarking project in 2012 do not have data for FY 10/11. A provincial comparator of all Ontario hospitals (excluding paediatric Academic Health Science Centres) has been added.

Neonatal ALOS Paediatric ALOS

Hospital % Change vs % Change vs FY 10/11 FY 11/12 FY 12/13 FY 10/11 FY 11/12 FY 12/13 Previous Year Previous Year AGH 2.5 3.0 BCHS 5.5 5.2 5.4 4.2% 2.0 1.9 1.9 -1.2% BGH 2.7 2.4 -11.8% 0.0 1.6 1.8 14.2% BWH 5.1 4.9 4.2 -14.5% 2.2 2.1 2.2 3.9% CCH 2.7 2.5 2.1 -15.4% 2.1 2.1 1.9 -10.0% CGMH 1.8 1.6 -7.1% 0.0 2.3 1.3 -43.3% CMH 3.0 3.1 3.5 13.2% 2.2 2.3 2.2 -6.1% GBGH 2.1 2.0 GBHS 4.9 4.9 5.8 17.2% 2.8 3.4 2.7 -19.8% GDH 2.0 GRH 4.5 4.7 4.4 -5.4% 4.0 4.1 4.2 2.2% HHCC 2.9 2.5 2.5 -1.2% 1.9 1.8 2.1 18.3% HHS 3.6 3.4 3.4 -0.5% 3.7 3.6 3.5 -2.6% HRRH 4.2 4.3 4.1 -3.5% 3.9 3.4 3.8 10.4% HSN 6.3 5.7 6.1 6.9% 3.0 3.2 3.9 20.4% JBH 3.0 3.6 4.0 11.1% 1.6 1.6 1.9 18.8% LH 4.2 4.1 4.0 -3.7% 2.9 2.9 3.3 13.9% MH 3.4 3.6 3.4 -3.7% 2.6 2.1 2.3 8.4% MHA-SMGH 2.1 2.6 2.0 -23.6% 1.3 1.2 1.3 7.9% Montfort 2.8 3.3 3.0 -7.6% 3.1 2.6 2.7 3.9% MSH 3.4 3.4 3.7 10.4% 1.9 1.9 2.1 12.1% NBRHC 5.7 5.4 5.7 5.2% 2.5 2.5 3.0 16.8% NHH 2.3 2.3 2.1 -6.7% 2.6 2.1 1.8 -12.7% NHS 4.6 4.3 4.4 2.0% 2.2 2.1 2.3 10.7% NYGH 3.9 3.6 3.4 -4.7% 3.2 3.4 3.5 3.3% OSMH 8.0 6.8 6.4 -6.8% 3.2 2.7 2.4 -10.9% PRHC 4.8 4.9 5.3 7.4% 2.2 2.4 2.4 -0.2% QHC 3.3 3.5 3.7 4.3% 2.2 2.4 2.4 0.0% Renfrew 2.4 1.8 RHCF 2.9 2.4 RMH 2.3 2.3 2.2 -6.3% 1.9 1.9 1.9 -2.2% RVH 6.4 6.4 7.1 10.8% 2.8 2.5 2.8 13.9% RVHS 4.6 4.6 4.6 -2.0% 3.3 3.5 3.3 -5.0% SAH 5.1 5.2 4.9 -6.0% 2.9 3.2 3.3 4.4% SBGHC 1.8 1.8 1.0% 2.3 2.2 -5.4% SJHC Hamilton 6.3 6.3 5.9 -6.5% 9.1 10.2 12.6 24.3% SJHC Toronto 3.9 4.0 4.0 0.0% 3.9 3.8 3.8 -0.5% SLMHC 2.4 2.0 2.3 15.4% 2.4 2.7 3.0 12.5% SMH 6.0 5.6 5.9 4.6% 8.3 8.9 11.4 27.7% Southlake 4.7 5.0 4.9 -1.1% 3.5 3.6 3.7 3.2% STEGH 4.8 4.2 4.9 18.1% 1.9 2.1 2.0 -4.7% Stevenson 1.7 2.0 1.7 -16.4% 1.3 1.4 1.7 19.4% TBRHSC 6.7 6.6 6.4 -3.1% 4.0 3.6 3.6 -0.7% TEGH 4.2 4.5 4.5 0.9% 4.1 4.1 4.3 5.2% THP-CVH 6.8 3.4 THP-MH 4.1 2.4 TSH 3.8 4.1 3.9 -4.7% 2.2 2.3 2.4 1.9% WDMH 2.1 2.7 WGH 1.9 1.8 WLMH 2.1 2.0 1.8 -12.4% 1.9 1.4 2.0 42.9% WOHS 4.6 3.9 3.5 -9.4% 3.5 3.4 3.4 -2.1% WPSHC 2.5 2.7 8.2% 1.8 1.7 -3.0% WRH 6.2 5.8 6.1 6.0% 3.2 3.6 3.7 3.1% ON Community 4.3 4.3 4.3 0.3% 2.9 3.0 3.1 4.8% Hospitals

139 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.6 – Total ALOS (Neonatal and Paediatric) (cont)

Neonatal ALOS FY 12/13 Paediatric FY ALOS 12/13

CGMH 1.6 MHA-SMGH 1.3 Stevenson 1.7 CGMH 1.3 WLMH 1.8 Stevenson 1.7 SBGHC 1.8 WPSHC 1.7 WGH 1.9 Renfrew 1.8 MHA-SMGH 2.0 BGH 1.8 WDMH 2.1 WGH 1.8 CCH 2.1 NHH 1.8 GBGH 2.1 JBH 1.9 NHH 2.1 RMH 1.9 RMH 2.2 CCH 1.9 SLMHC 2.3 BCHS 1.9 BGH 2.4 STEGH 2.0 Renfrew 2.4 GBGH 2.0 HHCC 2.5 GDH 2.0 AGH 2.5 WLMH 2.0 HHCC WPSHC 2.7 2.1 MSH RHCF 2.9 2.1 CMH 2.2 Montfort 3.0 SBGHC 2.2 HHS 3.4 BWH 2.2 NYGH 3.4 MH 2.3 MH 3.4 NHS 2.3 WOHS 3.5 TSH 2.4 CMH 3.5 RHCF 2.4 QHC 3.7 THP-MH 2.4 MSH 3.7 QHC 2.4 TSH 3.9 PRHC 2.4 JBH 4.0 OSMH 2.4 LH 4.0 WDMH 2.7 SJHC Toronto 4.0 Montfort 2.7 THP-MH 4.1 GBHS 2.7 HRRH 4.1 RVH 2.8 BWH 4.2 NBRHC 3.0 ON Community Hospitals 4.3 SLMHC 3.0 NHS 4.4 AGH 3.0 GRH 4.4 ON Community Hospitals 3.1 TEGH 4.5 LH 3.3 RVHS 4.6 SAH 3.3 SAH 4.9 RVHS 3.3 Southlake 4.9 WOHS 3.4 STEGH 4.9 THP-CVH 3.4 PRHC 5.3 HHS 3.5 BCHS 5.4 NYGH 3.5 NBRHC 5.7 TBRHSC 3.6 GBHS 5.8 Southlake 3.7 SMH 5.9 WRH 3.7 SJHC Hamilton 5.9 HRRH 3.8 HSN 6.1 SJHC Toronto 3.8 WRH 6.1 HSN 3.9 OSMH 6.4 GRH 4.2 TBRHSC 6.4 TEGH 4.3 THP-CVH 6.8 SMH 11.4 RVH 7.1 SJHC Hamilton 12.6 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0

140 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.7 – Total Average Inpatient Weight per Case

The average inpatient weight per case represents the inpatient Resource Intensity Weight (RIW), which is reflective of the amount of resources required by the hospitals to care for patients based on the CMG during their hospital stay. The value of 1.0 represents a "typical" inpatient case. Due to a change in CMG & Grouper methodology only 12/13 ARIW is shown.

ARIW (FY 12/13) Hospital Neonatal Paediatric Total AGH 0.34 0.60 0.34 BCHS 0.85 0.57 0.69 BGH 0.41 0.57 0.49 BWH 0.67 0.61 0.63 CCH 0.43 0.55 0.52 CGMH 0.27 0.64 0.38 CMH 0.60 0.57 0.59 GBGH 0.31 0.83 0.62 GBHS 1.03 0.72 0.84 GDH 0.69 0.69 GRH 0.81 0.96 0.88 HHCC 0.40 0.56 0.51 HHS 0.60 0.82 0.72 HRRH 0.73 0.77 0.75 HSN 1.18 1.01 1.07 JBH 0.67 0.57 0.62 LH 0.74 0.92 0.84 MH 0.80 0.62 0.72 MHA-SMGH 0.29 0.42 0.37 Montfort 0.52 0.96 0.53 MSH 0.78 0.64 0.73 NBRHC 0.91 0.73 0.80 NHH 0.29 0.57 0.39 NHS 0.74 0.60 0.65 NYGH 0.64 1.02 0.75 OSMH 1.29 0.76 1.02 PRHC 0.91 0.59 0.73 QHC 0.63 0.65 0.64 Renfrew 0.40 0.67 0.56 RHCF 0.53 0.61 0.59 RMH 0.28 0.71 0.44 RVH 1.27 0.80 1.00 RVHS 0.81 0.88 0.85 SAH 0.81 0.94 0.89 SBGHC 0.31 0.63 0.38 SJHC Hamilton 1.01 2.31 1.05 SJHC Toronto 0.80 0.85 0.82 SLMHC 0.32 0.66 0.49 SMH 1.05 2.41 1.17 Southlake 0.89 0.85 0.86 STEGH 0.92 0.62 0.73 Stevenson 0.29 0.53 0.41 TBRHSC 1.07 0.84 0.93 TEGH 0.92 0.95 0.93 THP-CVH 1.15 0.74 0.94 THP-MH 0.69 0.60 0.64 TSH 0.67 0.60 0.64 WDMH 0.31 0.62 0.35 WGH 0.31 0.58 0.38 WLMH 0.32 0.68 0.32 WOHS 0.66 0.72 0.69 WPSHC 0.29 0.57 0.46 WRH 1.46 0.96 1.18

141 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.7 – Total Average Inpatient Weight per Case (cont)

Total Average Inpatient Weight Per Case FY 12/13

0.0 0.2 0.4 0.6 0.8 1.0 1.2

142 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.8 – Percent Typical, Outlier & Other Inpatient Cases and Patient Days

This table and charts display the percentage of inpatient cases classified as typical, outlier or other. A patient is classified as “Typical” when s/he receives the “Normal”, or “Predicted”, inpatient course of treatment associated with a specific CMG and is discharged. “Outlier” cases are cases that do not receive the normal or predicted course of treatment because they arrived at or left the facility in circumstances that made their total length of stay or costs unpredictable. The “Other” category represents deaths, sign-outs and transfers. Zero volumes are shown as blank.

Patient Cases (%) Patient Days (%) Hospital Typical Other Outlier Typical Other Outlier AGH 85.6% 14.4% 91.6% 8.4% BCHS 84.9% 10.8% 4.3% 67.9% 15.7% 16.4% BGH 92.6% 6.1% 1.2% 89.2% 5.1% 5.7% BWH 92.9% 4.1% 3.0% 74.5% 6.3% 19.2% CCH 90.9% 8.5% 0.6% 91.4% 7.0% 1.6% CGMH 63.7% 35.4% 0.9% 72.1% 24.4% 3.5% CMH 90.8% 7.2% 2.0% 79.5% 12.0% 8.5% GBGH 83.9% 15.2% 0.9% 90.8% 8.3% 0.9% GBHS 88.1% 9.0% 2.8% 74.8% 14.2% 11.0% GDH 67.6% 32.4% 79.1% 20.9% GRH 89.5% 9.0% 1.5% 74.0% 21.2% 4.8% HHCC 85.5% 12.4% 2.2% 74.5% 17.0% 8.4% HHS 90.0% 8.2% 1.8% 79.2% 12.5% 8.3% HRRH 85.2% 11.7% 3.1% 71.7% 15.0% 13.4% HSN 87.0% 9.4% 3.7% 76.8% 12.7% 10.5% JBH 91.4% 7.1% 1.4% 79.8% 13.1% 7.1% LH 90.8% 8.2% 1.1% 76.1% 13.3% 10.6% MH 94.2% 5.1% 0.7% 78.9% 16.3% 4.8% MHA-SMGH 93.4% 6.6% 95.7% 4.3% Montfort 91.8% 6.9% 1.2% 88.0% 6.0% 6.0% MSH 92.7% 6.3% 1.0% 80.4% 14.7% 4.9% NBRHC 84.3% 10.1% 5.6% 63.8% 14.5% 21.7% NHH 86.0% 13.5% 0.6% 85.3% 10.1% 4.6% NHS 88.7% 8.7% 2.7% 74.0% 16.3% 9.7% NYGH 93.2% 5.6% 1.1% 75.2% 20.3% 4.5% OSMH 84.6% 14.5% 0.9% 69.8% 26.6% 3.5% PRHC 89.5% 6.7% 3.8% 71.4% 15.0% 13.6% QHC 89.8% 7.3% 2.9% 69.2% 19.9% 10.9% Renfrew 100.0% 100.0% RHCF 89.6% 9.6% 0.8% 90.0% 8.4% 1.6% RMH 90.1% 9.9% 93.2% 6.8% RVH 89.4% 7.8% 2.8% 70.1% 20.8% 9.2% RVHS 90.7% 7.7% 1.6% 68.7% 24.6% 6.6% SAH 90.7% 6.7% 2.6% 81.5% 9.3% 9.2% SBGHC 84.9% 15.1% 89.0% 11.0% SJHC Hamilton 80.4% 15.4% 4.2% 53.5% 31.7% 14.8% SJHC Toronto 91.2% 7.1% 1.7% 75.6% 15.7% 8.7% SLMHC 88.7% 9.5% 1.9% 87.2% 6.8% 6.0% SMH 85.6% 12.8% 1.6% 58.0% 36.2% 5.8% Southlake 90.0% 8.0% 2.0% 76.5% 15.8% 7.7% STEGH 90.0% 7.5% 2.6% 60.0% 24.8% 15.2% Stevenson 81.7% 16.9% 1.4% 81.9% 13.2% 4.9% TBRHSC 89.2% 6.2% 4.6% 78.2% 7.7% 14.1% TEGH 88.7% 8.9% 2.4% 68.9% 20.8% 10.3% THP-CVH 88.5% 8.1% 3.4% 66.3% 23.6% 10.2% THP-MH 93.7% 3.6% 2.7% 82.2% 7.3% 10.4% TSH 93.2% 4.9% 1.8% 77.1% 14.5% 8.4% WDMH 80.4% 18.6% 1.0% 85.3% 12.3% 2.4% WGH 88.1% 11.0% 0.9% 89.5% 6.3% 4.1% WLMH 70.8% 29.2% 82.1% 17.9% WOHS 93.5% 4.8% 1.8% 81.9% 10.3% 7.9% WPSHC 83.0% 17.0% 88.5% 11.5% WRH 87.5% 10.8% 1.7% 81.9% 12.3% 5.7%

143 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.8 – Percent Typical, Outlier & Other Inpatient Cases and Patient Days (cont)

Patient Cases (%) Patient Days (%)

AGH AGH BCHS BCHS BGH BGH BWH BWH CCH CCH CGMH CGMH CMH CMH GBGH GBGH GBHS GBHS GDH GDH GRH GRH HHCC HHCC HHS HHS HRRH HRRH HSN HSN JBH JBH LH LH MH MH MHA-SMGH MHA-SMGH Montfort Montfort MSH MSH NBRHC NBRHC NHH NHH NHS NHS NYGH NYGH OSMH OSMH PRHC PRHC QHC QHC Renfrew Renfrew RHCF RHCF RMH RMH RVH RVH RVHS RVHS SAH SAH SBGHC SBGHC SJHC Hamilton SJHC Hamilton SJHC Toronto SJHC Toronto SLMHC SLMHC SMH SMH Southlake Southlake STEGH STEGH Stevenson Stevenson TBRHSC TBRHSC TEGH TEGH THP-CVH THP-CVH THP-MH THP-MH TSH TSH WDMH WDMH WGH WGH WLMH WLMH WOHS WOHS WPSHC WPSHC WRH WRH

0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100%

Cases Typical Cases Other Cases Outlier Cases Typical Cases Other Cases Outlier

144 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.9 – Percent "Transfer From" Inpatient Cases and Patient Days

This table and chart present the number and percentage of cases and associated days that were recorded as “transferred from” another acute care institution within CIHI coding. Zero volumes are blank and a volume less than 6 is indicated as “<6”.

All Cases Neonatal Cases Paediatric Cases All Cases Neonatal Cases Paediatric Cases Hospital # Cases # Days # Cases # Days # Cases # Days % Cases % Days % Cases % Days % Cases % Days AGH <6 <6 <6 <6 2.2% 0.9% 2.3% 0.9% BCHS 58 543 48 488 10 55 5.1% 14.2% 10.3% 19.4% 1.5% 4.2% BGH <6 14 <6 14 1.2% 2.7% 2.3% 4.6% BWH 13 174 7 82 6 92 1.3% 5.9% 2.0% 5.6% 0.9% 6.3% CCH 7 20 <6 12 <6 8 1.4% 2.0% 2.7% 3.8% 0.8% 1.2% CGMH <6 <6 <6 <6 2.7% 2.3% 3.8% 3.1% CMH 44 513 39 490 <6 23 3.2% 12.8% 5.2% 18.5% 0.8% 1.7% GBGH <6 <6 <6 <6 0.9% 1.2% 2.2% 3.1% GBHS 29 365 23 294 6 71 3.7% 12.3% 8.1% 17.9% 1.2% 5.4% GRH 183 2600 109 1776 74 824 5.7% 18.7% 6.6% 24.2% 4.7% 12.5% HHCC 9 31 <6 13 <6 18 1.6% 2.5% 3.2% 3.4% 1.0% 2.1% HHS 82 866 59 673 23 193 3.8% 11.8% 6.0% 20.3% 2.0% 4.8% HRRH 97 1041 74 583 23 458 5.2% 14.2% 7.3% 14.0% 2.7% 14.4% HSN 68 773 18 235 50 538 4.9% 11.6% 3.8% 8.2% 5.4% 14.3% JBH 29 338 24 265 <6 73 3.2% 12.7% 5.2% 14.4% 1.1% 8.8% LH 161 1323 69 904 92 419 5.4% 12.0% 5.0% 16.5% 5.7% 7.6% MH 40 961 27 647 13 314 2.2% 17.7% 2.6% 18.4% 1.6% 16.6% MHA-SMGH <6 <6 <6 <6 1.3% 0.9% 3.7% 1.9% Montfort 14 81 13 74 <6 7 1.6% 3.0% 1.5% 2.8% 5.3% 13.7% MSH 43 607 29 381 14 226 2.9% 13.2% 3.2% 11.5% 2.3% 17.8% NBRHC 62 490 11 184 51 306 6.7% 13.1% 3.0% 8.8% 9.2% 18.8% NHH <6 <6 <6 <6 1.2% 1.1% 1.8% 1.7% NHS 115 1377 91 1172 24 205 3.8% 14.5% 8.0% 23.4% 1.3% 4.6% NYGH 155 2960 99 2176 56 784 3.6% 20.2% 3.3% 21.3% 4.5% 17.8% OSMH 106 1213 90 1124 16 89 9.5% 24.5% 16.3% 31.7% 2.9% 6.3% PRHC 70 887 52 764 18 123 5.2% 17.9% 8.8% 24.5% 2.4% 6.7% QHC 24 343 17 212 7 131 2.3% 10.0% 2.6% 8.7% 1.7% 13.6% RHCF <6 <6 <6 <6 0.8% 0.6% 1.0% 0.9% RVH 63 1096 42 736 21 360 5.2% 19.3% 7.9% 19.5% 3.1% 18.7% RVHS 143 2935 77 1823 66 1112 4.7% 24.2% 5.0% 26.2% 4.3% 21.5% SAH 38 360 12 157 26 203 4.3% 10.3% 3.5% 9.4% 4.7% 11.2% SJHC Hamilton 155 2433 138 1988 17 445 12.9% 33.2% 11.9% 29.1% 43.6% 90.3% SJHC Toronto 102 1239 63 900 39 339 4.9% 15.1% 5.2% 18.3% 4.6% 10.4% SLMHC <6 12 <6 12 0.7% 1.1% 1.4% 1.9% SMH 122 2775 89 1916 33 859 9.8% 35.3% 7.8% 28.8% 31.1% 70.8% Southlake 118 1569 65 1093 53 476 5.4% 17.4% 8.7% 29.8% 3.7% 8.9% STEGH 33 527 29 464 <6 63 6.0% 31.3% 14.2% 46.0% 1.2% 9.3% Stevenson <6 <6 <6 <6 0.7% 0.8% 1.4% 1.6% TBRHSC 90 889 27 390 63 499 3.9% 7.9% 3.2% 6.7% 4.4% 9.3% TEGH 131 2041 97 1701 34 340 6.9% 24.0% 7.9% 30.4% 5.1% 11.7% THP-CVH 168 3895 107 2484 61 1411 5.1% 23.4% 6.7% 22.7% 3.6% 24.8% THP-MH 30 476 22 394 8 82 1.3% 6.3% 1.8% 8.0% 0.7% 3.1% TSH 76 1486 54 1066 22 420 2.4% 14.3% 2.7% 13.6% 2.0% 16.4% WGH <6 <6 <6 <6 0.5% 0.5% 0.6% 0.7% WLMH <6 <6 <6 <6 0.6% 0.4% 0.6% 0.4% WOHS 174 2561 111 1679 63 882 2.3% 9.7% 2.6% 11.1% 1.9% 7.8% WPSHC <6 9 <6 7 <6 <6 4.0% 4.1% 8.1% 6.9% 1.6% 1.7% WRH 112 1146 23 403 89 743 4.7% 10.0% 2.3% 6.5% 6.6% 14.3%

145 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.9 – Percent "Transfer From" Inpatient Cases and Patient Days (cont)

% "Transfer From" Inpatient Cases and Patient Days

AGH BCHS BGH BWH CCH CGMH CMH GBGH GBHS GRH HHCC HHS HRRH HSN JBH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRHC QHC RHCF RVH RVHS SAH SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THP-CVH THP-MH TSH WGH WLMH WOHS WPSHC WRH

0% 5% 10% 15% 20% 25% 30% 35% 40%

% Cases % Days

146 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.10 – Percent "Transfer To" Inpatient Cases and Patient Days

This table and chart present the number and percentage of cases, and associated days, that were recorded as “transferred to” another acute care institution within CIHI coding. Zero volumes are blank and a volume less than 6 is indicated as “<6”.

All Cases Neonatal Cases Paediatric Cases All Cases Neonatal Cases Paediatric Cases Hospital # Cases # Days # Cases # Days # Cases # Days % Cases % Days % Cases % Days % Cases % Days AGH 11 17 11 17 12.2% 7.6% 12.5% 7.8% BCHS 75 181 30 80 45 101 6.6% 4.7% 6.4% 3.2% 6.6% 7.7% BGH 10 13 7 8 <6 <6 4.1% 2.5% 5.5% 2.6% 2.6% 2.4% BWH 25 73 15 58 10 15 2.5% 2.5% 4.3% 3.9% 1.5% 1.0% CCH 25 38 18 20 7 18 5.0% 3.8% 12.1% 6.3% 2.0% 2.7% CGMH 36 37 36 37 31.9% 21.5% 46.2% 29.1% CMH 70 153 37 69 33 84 5.1% 3.8% 4.9% 2.6% 5.2% 6.2% GBGH 11 11 10 10 <6 <6 9.8% 4.3% 21.7% 10.2% 1.5% 0.6% GBHS 43 106 20 35 23 71 5.5% 3.6% 7.0% 2.1% 4.7% 5.4% GDH 9 12 9 12 26.5% 17.9% 26.5% 17.9% GRH 127 616 63 258 64 358 3.9% 4.4% 3.8% 3.5% 4.1% 5.4% HHCC 64 209 14 19 50 190 11.5% 17.1% 9.1% 5.0% 12.4% 22.5% HHS 102 219 67 113 35 106 4.8% 3.0% 6.8% 3.4% 3.0% 2.6% HRRH 122 258 109 222 13 36 6.6% 3.5% 10.8% 5.3% 1.5% 1.1% HSN 74 374 24 157 50 217 5.3% 5.6% 5.1% 5.5% 5.4% 5.8% JBH 40 112 27 81 13 31 4.4% 4.2% 5.8% 4.4% 2.9% 3.7% LH 81 226 40 115 41 111 2.7% 2.1% 2.9% 2.1% 2.5% 2.0% MH 42 98 14 26 28 72 2.3% 1.8% 1.4% 0.7% 3.4% 3.8% MHA-SMGH <6 <6 <6 <6 6.6% 4.3% 18.5% 9.3% Montfort 47 107 46 100 <6 7 5.3% 4.0% 5.3% 3.8% 5.3% 13.7% MSH 54 183 37 152 17 31 3.6% 4.0% 4.1% 4.6% 2.8% 2.4% NBRHC 38 155 15 96 23 59 4.1% 4.2% 4.1% 4.6% 4.2% 3.6% NHH 19 22 16 19 <6 <6 11.1% 6.3% 14.5% 8.1% 4.9% 2.7% NHS 159 536 66 257 93 279 5.2% 5.7% 5.8% 5.1% 4.9% 6.2% NYGH 84 283 56 179 28 104 2.0% 1.9% 1.9% 1.8% 2.2% 2.4% OSMH 71 246 34 127 37 119 6.4% 5.0% 6.2% 3.6% 6.6% 8.4% PRHC 38 78 16 41 22 37 2.8% 1.6% 2.7% 1.3% 2.9% 2.0% QHC 59 154 36 101 23 53 5.5% 4.5% 5.4% 4.1% 5.7% 5.5% RHCF 10 23 <6 <6 8 21 8.0% 7.3% 7.1% 2.4% 8.2% 9.1% RMH 12 18 11 13 <6 <6 8.5% 6.1% 12.5% 6.7% 1.9% 4.9% RVH 34 144 14 68 20 76 2.8% 2.5% 2.6% 1.8% 2.9% 4.0% RVHS 99 547 52 284 47 263 3.2% 4.5% 3.4% 4.1% 3.0% 5.1% SAH 20 39 7 11 13 28 2.3% 1.1% 2.1% 0.7% 2.4% 1.5% SBGHC 12 17 11 13 <6 <6 14.0% 10.4% 16.2% 10.4% 5.6% 10.3% SJHC Hamilton 58 332 52 186 6 146 4.8% 4.5% 4.5% 2.7% 15.4% 29.6% SJHC Toronto 47 178 30 109 17 69 2.3% 2.2% 2.5% 2.2% 2.0% 2.1% SLMHC 35 65 13 15 22 50 8.4% 5.9% 6.4% 3.2% 10.2% 7.8% SMH 45 343 38 273 7 70 3.6% 4.4% 3.4% 4.1% 6.6% 5.8% Southlake 53 169 26 96 27 73 2.4% 1.9% 3.5% 2.6% 1.9% 1.4% STEGH 14 109 6 52 8 57 2.6% 6.5% 2.9% 5.2% 2.3% 8.5% Stevenson 24 41 14 14 10 27 16.9% 16.9% 19.2% 11.3% 14.5% 22.7% TBRHSC 61 208 19 96 42 112 2.7% 1.8% 2.3% 1.6% 2.9% 2.1% TEGH 47 111 34 82 13 29 2.5% 1.3% 2.8% 1.5% 1.9% 1.0% THP-CVH 97 445 53 255 44 190 2.9% 2.7% 3.3% 2.3% 2.6% 3.3% THP-MH 50 198 31 119 19 79 2.2% 2.6% 2.6% 2.4% 1.7% 3.0% TSH 68 151 38 75 30 76 2.2% 1.5% 1.9% 1.0% 2.8% 3.0% WDMH 16 24 15 19 <6 <6 16.5% 11.4% 17.6% 10.6% 8.3% 15.6% WGH * 37 22 22 <6 15 11.0% 9.0% 13.9% 7.4% 3.3% 13.4% WLMH 45 49 45 49 28.0% 17.2% 28.3% 17.4% WOHS 172 493 106 312 66 181 2.2% 1.9% 2.5% 2.1% 2.0% 1.6% WPSHC 13 15 <6 <6 9 10 13.0% 6.9% 10.8% 5.0% 14.3% 8.5% WRH 141 502 24 130 117 372 5.9% 4.4% 2.4% 2.1% 8.6% 7.1%

147 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.10 – Percent "Transfer To" Inpatient Cases and Patient Days (cont)

% "Transfer To" Inpatient Cases and Patient Days

AGH BCHS BGH BWH CCH CGMH CMH GBGH GBHS GDH GRH HHCC HHS HRRH HSN JBH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRHC QHC RHCF RMH RVH RVHS SAH SBGHC SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THP-CVH THP-MH TSH WDMH WGH WLMH WOHS WPSHC WRH

0% 5% 10% 15% 20% 25% 30% 35%

% Cases % Days

148 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.11 – Percent of Cases and Days with Length of Stay > 30 Days

This table and chart present the number and percentage of all inpatient cases and associated days with a total length of stay greater than 30 days. A zero volume is blank and hospitals with less than 6 cases are indicated as “<6”.

All Cases Neonatal Cases Paediatric Cases All Cases Neonatal Cases Paediatric Cases Hospital # Cases # Days # Cases # Days # Cases # Days % Cases % Days % Cases % Days % Cases % Days BCHS <6 73 <6 73 0.2% 1.9% 0.4% 2.9% BWH 7 307 <6 172 <6 135 0.7% 10.4% 1.1% 11.7% 0.5% 9.2% CMH <6 103 <6 103 0.2% 2.6% 0.4% 3.9% GBHS <6 198 <6 198 0.6% 6.7% 1.8% 12.1% GRH 27 1014 20 774 7 240 0.8% 7.3% 1.2% 10.6% 0.4% 3.6% HHS 14 542 <6 171 9 371 0.7% 7.4% 0.5% 5.2% 0.8% 9.2% HRRH 26 1043 21 853 >6 190 1.4% 14.2% 2.1% 20.4% 0.6% 6.0% HSN 32 1563 16 589 16 974 2.3% 23.6% 3.4% 20.5% 1.7% 25.9% JBH <6 104 <6 104 0.3% 3.9% 0.6% 5.7% LH 36 2034 19 760 17 1274 1.2% 18.5% 1.4% 13.9% 1.0% 23.1% MH 23 979 19 802 <6 177 1.2% 18.1% 1.9% 22.8% 0.5% 9.3% Montfort <6 31 <6 31 0.1% 1.2% 0.1% 1.2% MSH 6 237 <6 140 <6 97 0.4% 5.2% 0.4% 4.2% 0.3% 7.6% NBRHC 11 428 7 250 <6 178 1.2% 11.5% 1.9% 11.9% 0.7% 10.9% NHS 7 258 7 258 0.2% 2.7% 0.6% 5.2% NYGH 60 2522 43 1805 17 717 1.4% 17.2% 1.4% 17.7% 1.4% 16.2% OSMH 31 1223 28 1098 <6 125 2.8% 24.7% 5.1% 31.0% 0.5% 8.8% PRHC 8 437 6 277 <6 160 0.6% 8.8% 1.0% 8.9% 0.3% 8.8% QHC <6 155 <6 98 <6 57 0.3% 4.5% 0.3% 4.0% 0.2% 5.9% RVH 24 1015 17 720 7 295 2.0% 17.8% 3.2% 19.1% 1.0% 15.4% RVHS 62 2791 40 1642 22 1149 2.0% 23.0% 2.6% 23.6% 1.4% 22.2% SAH 8 344 6 233 <6 111 0.9% 9.9% 1.8% 14.0% 0.4% 6.1% SJHC Hamilton 35 1492 32 1327 <6 165 2.9% 20.4% 2.7% 19.4% 7.7% 33.5% SJHC Toronto 28 1102 21 760 7 342 1.4% 13.5% 1.7% 15.4% 0.8% 10.5% SMH 61 2533 43 1851 18 682 4.9% 32.2% 3.8% 27.9% 17.0% 56.2% Southlake 24 1384 9 366 15 1018 1.1% 15.4% 1.2% 10.0% 1.0% 19.1% STEGH <6 216 <6 169 <6 47 0.9% 12.8% 2.0% 16.8% 0.3% 7.0% TBRHSC 29 1517 20 863 9 654 1.3% 13.5% 2.4% 14.7% 0.6% 12.1% TEGH 34 1412 25 1009 9 403 1.8% 16.6% 2.0% 18.0% 1.3% 13.9% THP-CVH 89 3865 63 2715 26 1150 2.7% 23.2% 3.9% 24.8% 1.5% 20.2% THP-MH 13 513 13 513 0.6% 6.8% 1.1% 10.4% TSH 32 1384 26 1059 6 325 1.0% 13.3% 1.3% 13.5% 0.6% 12.7% WOHS 75 2903 51 1893 24 1010 1.0% 11.0% 1.2% 12.5% 0.7% 9.0% WRH 51 2477 41 1871 10 606 2.2% 21.7% 4.0% 30.0% 0.7% 11.6%

149 PCMCH Maternal-Child Benchmarking Report 2013

DES 2.1.11 – Percent of Cases and Days with Length of Stay > 30 Days (cont)

% of Cases and Days with LOS > 30 Days

BCHS

BWH

CMH

GBHS

GRH

HHS

HRRH

HSN

JBH

Montfort

MSH

NBRHC

NHS

NYGH

OSMH

PRHC

QHC

RVH

RVHS

SAH

SJHC Hamilton

SJHC Toronto

SMH

Southlake

STEGH

TBRHSC

TEGH

THP-CVH

THP-MH

TSH

WOHS

WRH

0% 5% 10% 15% 20% 25% 30% 35% % Cases % Days

150 PCMCH Maternal-Child Benchmarking Report 2013

3.0 Emergency Department Indicators

ED 3.1.1 – ED Patient Volumes

The table and chart below present the volume of ED visits by hospital. Hospitals that joined the Benchmarking project in 2013 do not have data for FY 11/12 and FY 10/11. Hospitals that joined the Benchmarking project in 2012 do not have data for FY 10/11.

ED Patient Volume (Cases) ED Patient Volume (FY 12/13) Hospital % Change vs FY 10/11 FY 11/12 FY 12/13 Previous Year AGH AGH 4,060 BCHS BCHS 12,193 13,936 12,708 -9% BGH BGH 4,568 4,586 0% BWH BWH 18,014 19,083 18,141 -5% CCH CCH 9,520 10,158 10,606 4% CGMH CGMH 7,029 6,277 -11% CMH CMH 11,631 11,841 11,191 -5% GBGH GBGH 8,472 GBHS GBHS 19,532 20,566 19,219 -7% GDH GDH 1,978 GRH GRH 12,925 13,087 12,901 -1% HDH HDH 15,296 HHCC HHCC 8,652 9,412 9,437 0% HHS HHS 29,367 30,157 28,822 -4% HRRH HRRH 16,273 16,879 16,306 -3% HSN HSN 8,550 8,915 8,381 -6% JBH JBH 7,279 LH LH 26,260 27,617 27,422 -1% MH MH 16,865 18,078 17,932 -1% MHA-SMGH MHA-SMGH 4,967 5,319 4,797 -10% Montfort Montfort 1,723 1,898 2,086 10% MSH MSH 18,058 18,959 18,469 -3% NBRHC NBRHC 8,698 10,331 9,323 -10% NHH NHH 5,567 5,592 5,080 -9% NHS NHS 16,723 16,402 16,564 1% NYGH NYGH 21,914 21,461 21,333 -1% OSMH OSMH 10,656 11,059 10,027 -9% PRHC PRHC 12,935 14,263 12,640 -11% QHC QHC 19,765 20,155 20,198 0% Renfrew Renfrew 4,935 RHCF RHCF 4,925 RMH RMH 8,621 8,904 8,391 -6% RVH RVH 13,226 13,803 13,613 -1% RVHS RVHS 23,600 25,932 26,312 1% SAH SAH 10,951 11,608 11,160 -4% SBGHC SBGHC 11,186 10,233 -9% SJHC Hamilton SJHC Hamilton 18,136 14,858 13,795 -7% SJHC Toronto SJHC Toronto 17,670 18,849 18,256 -3% SLMHC SMH SLMHC 3,415 3,545 3,851 9% Southlake SMH 1,243 1,480 1,322 -11% STEGH Southlake 16,607 18,550 18,910 2% Stevenson STEGH 8,260 9,382 9,590 2% TBRHSC Stevenson 6,650 6,879 7,041 2% TEGH TBRHSC 18,883 20,060 21,129 5% THP-CVH TEGH 11,407 12,190 11,992 -2% THP-MH THP-CVH 20,819 TSH THP-MH 26,307 WDMH TSH 18,768 19,971 18,872 -6% WGH WDMH 4,495 WLMH WGH 7,299 WOHS WLMH 4,994 4,910 4,465 -9% WPSHC WOHS 36,664 38,623 39,192 1% WRH WPSHC 4,099 3,600 -12% WRH 14,197 13,584 14,001 3% 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000

151 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.2 – ED Average LOS in Hours

This table and chart present the ED average LOS in hours, regardless of the discharge disposition. The average LOS is defined as the difference between the earlier of the registration or triage date/time and the discharge disposition date/time in hours divided by total visits. Excluded are cases where the patient left without being seen by a physician (Disposition Codes 02-03), and cases where Date/Time Patient left ED is missing.

Hospital ALOS Average ED LOS in Hours (All Dispositions) AGH 1.37 BCHS 2.67 AGH BGH 2.40 BCHS BWH 1.55 BGH CCH 2.38 BWH CGMH 2.09 CCH CMH 3.00 CGMH GBGH 1.71 CMH GBHS 1.71 GBGH GDH 1.84 GBHS GRH 4.70 GDH HDH 1.77 GRH HHCC 1.94 HDH HHCC HHS 2.72 HHS HRRH 3.14 HRRH HSN 3.68 HSN JBH 2.95 JBH LH 2.51 LH MH 3.00 MH MHA-SMGH 2.11 MHA-SMGH Montfort 3.02 Montfort MSH 2.36 MSH NBRHC 2.45 NBRHC NHH 2.86 NHH NHS 3.02 NHS NYGH 2.54 NYGH OSMH 1.86 OSMH PRHC 2.50 PRHC QHC 2.12 QHC Renfrew 1.82 Renfrew RHCF RHCF 1.57 RMH RMH 2.06 RVH RVH 3.15 RVHS RVHS 2.23 SAH SAH 2.29 SBGHC SBGHC 1.23 SJHC Hamilton SJHC Hamilton 1.98 SJHC Toronto SJHC Toronto 2.64 SLMHC SLMHC 2.07 SMH SMH 3.62 Southlake Southlake 2.45 STEGH STEGH 1.74 Stevenson Stevenson 2.28 TBRHSC TBRHSC 2.49 TEGH TEGH 3.04 THP-CVH THP-CVH 2.80 THP-MH TSH THP-MH 2.74 WDMH TSH 2.77 WGH WDMH 2.46 WLMH WGH 2.25 WOHS WLMH 2.47 WPSHC WOHS 3.24 WRH WPSHC 2.39 WRH 3.13 0 1 2 3 4 5

152 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.3 – ED Visits (Age Profile)

This table and chart provide a visual description of the age profile of ED visits according to the age categories: 0-28 days, 29-364 days, 1-7 years and 8-17 years.

Hospital 0-28 days 29-364 days 1-7 years 8-17 years ED Visits (Age Profile) AGH 42 333 1,941 1,744 BCHS 178 1,272 5,375 5,883 BGH 42 364 1,910 2,270 AGH BWH 101 1,259 7,861 8,920 BCHS CCH 130 877 4,879 4,720 BGH CGMH 42 426 2,513 3,296 BWH CCH CMH 118 896 5,178 4,999 CGMH GBGH 45 579 3,377 4,471 CMH GBHS 180 1,484 8,582 8,973 GBGH GDH 17 169 807 985 GBHS GRH 336 1,508 5,870 5,187 GDH HDH 314 1,552 7,005 6,425 GRH HHCC 177 788 3,802 4,670 HDH HHCC HHS 378 2,219 13,007 13,218 HHS HRRH 297 1,616 7,602 6,791 HRRH HSN 110 712 3,147 4,412 HSN JBH 108 606 3,072 3,493 JBH LH 356 2,238 11,433 13,395 LH MH 213 1,097 7,881 8,741 MH MHA-SMGH 35 314 1,902 2,546 MHA-SMGH Montfort 21 119 675 1,271 Montfort MSH MSH 381 1,499 8,628 7,961 NBRHC NBRHC 77 709 4,013 4,524 NHH NHH 40 324 2,192 2,524 NHS NHS 275 1,619 6,877 7,793 NYGH NYGH 546 1,789 9,719 9,279 OSMH OSMH 113 804 4,233 4,877 PRHC PRHC 125 1,115 5,300 6,100 QHC QHC 179 1,671 8,642 9,706 Renfrew RHCF Renfrew 24 307 2,190 2,414 RMH RHCF 33 447 2,295 2,150 RVH RMH 52 660 3,473 4,206 RVHS RVH 241 1,272 5,513 6,587 SAH RVHS 450 2,357 11,798 11,707 SBGHC SAH 113 976 4,848 5,223 SJHC Hamilton SBGHC 74 819 4,902 4,438 SJHC Toronto SJHC Hamilton 89 700 5,321 7,685 SLMHC SMH SJHC Toronto 359 1,748 9,623 6,526 Southlake SLMHC 59 527 1,424 1,841 STEGH SMH 37 94 325 866 Stevenson Southlake 262 1,387 7,508 9,753 TBRHSC STEGH 80 785 4,404 4,321 TEGH Stevenson 51 518 3,150 3,322 THP-CVH TBRHSC 188 1,973 9,082 9,886 THP-MH TEGH 268 1,192 5,522 5,010 TSH WDMH THP-CVH 467 1,948 9,338 9,066 WGH THP-MH 410 2,019 11,825 12,053 WLMH TSH 331 1,986 9,221 7,334 WOHS WDMH 37 347 1,912 2,199 WPSHC WGH 102 628 3,100 3,469 WRH WLMH 54 363 2,005 2,043 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% WOHS 792 3,768 17,653 16,979 WPSHC 24 252 1,381 1,943 0-28 days 29-364 days 1-7 years 8-17 years WRH 246 1,487 6,512 5,756

153 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.4 – Emergency Department Visits by Triage Level

The following chart and table depict the CTAS triage level of all patients presenting to ED. The triage levels/scores are: 1 – Resuscitation; 2 – Emergent; 3 – Urgent; 4 – Less Urgent; 5 – Non-urgent. Hospitals with less than 6 cases are indicated as <6. Beginning in 2007/08 CIHI has requested that for "Visit Disposition '02' - Client Registered then Left", the triage level should be left blank. In the report, blanks have been assigned the value of "Left before triage" and other. Hospitals with less than 6 cases are indicated as “<6”.

Emergency Department Visits Triage Level

154 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.4 – ED Visits by Triage Level (cont)

Left Before Triage Level Hospital Triage/Other 1 2 3 4 5 AGH 24 <6 96 1,264 2,497 178 BCHS 20 2,159 6,255 4,049 225 BGH 15 9 525 2,048 1,829 160 BWH 96 15 973 5,000 9,895 2,162 CCH 15 644 6,137 3,752 58 CGMH 19 620 3,230 2,224 184 CMH 30 1,178 5,738 4,079 166 GBGH <6 37 650 3,183 4,228 369 GBHS 85 31 1,662 8,379 8,772 290 GDH 156 31 278 910 603 GRH 69 2,922 6,697 3,119 94 HDH 6 6 609 2,794 10,851 1,030 HHCC 11 760 4,590 3,913 163 HHS <6 150 3,801 13,199 10,434 1,236 HRRH 7 52 3,391 9,229 3,570 57 HSN 66 2,429 3,942 1,706 238 JBH 72 17 1,130 3,243 2,718 99 LH <6 52 3,263 12,911 10,204 988 MH 290 4,734 7,301 5,238 369 MHA-SMGH <6 222 1,716 2,795 61 Montfort 27 392 434 1,194 39 MSH <6 81 2,420 7,594 7,599 774 NBRHC 28 14 487 2,919 5,263 612 NHH 27 595 2,191 2,146 121 NHS 138 4,722 8,894 2,640 170 NYGH 167 5,215 8,690 7,182 79 OSMH 31 805 2,560 6,412 219 PRHC <6 29 2,246 5,126 5,099 135 QHC <6 39 2,266 9,179 8,214 498 Renfrew <6 6 138 958 3,014 814 RHCF 268 132 1,772 2,296 457 RMH 9 631 3,421 4,177 153 RVH 55 2,643 6,111 4,581 223 RVHS <6 55 3,001 13,155 9,253 845 SAH <6 132 1,695 5,906 3,318 108 SBGHC 68 <6 157 1,636 6,099 2,269 SJHC Hamilton <6 8 1,122 6,373 6,000 290 SJHC Toronto 69 2,785 12,086 3,080 236 SLMHC 19 6 218 1,424 1,857 327 SMH 6 32 186 528 518 52 Southlake <6 145 2,325 7,894 8,202 343 STEGH 30 64 1,281 3,311 4,821 83 Stevenson 18 563 2,609 3,764 87 TBRHSC <6 252 3,416 10,403 6,339 717 TEGH 28 44 1,708 7,138 3,000 74 THP-CVH 128 516 4,240 10,363 5,515 57 THP-MH <6 96 2,659 9,803 13,521 227 TSH <6 99 3,286 11,028 4,246 210 WDMH 7 <6 255 1,860 2,334 36 WGH 33 752 2,414 3,974 126 WLMH 7 <6 173 1,365 2,817 100 WOHS <6 278 7,060 22,638 8,293 921 WPSHC 19 8 119 1,036 2,269 149 WRH 34 41 3,400 6,576 3,748 202

155 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.5 – ED Visits by Top 15 Main Problems

This chart displays the Top 15 most responsible diagnoses for each of the participants (highlighted in RED). Organizations will have more than 15 in their list if more than one most responsible diagnosis has the same number of cases. Numbers less than 6 are indicated as “<6”.

Main Problem ICD10

BGH CCH GRH

AGH GDH HDH

BWH CMH

BCHS GBHS

GBGH HHCC CGMH

J069 Acute URTI unspecified 356 801 313 1,572 741 326 377 574 1,748 161 623 1,250 440 H669 Otitis media unspecified 227 791 301 1,401 885 255 379 526 1,449 113 322 749 497 R509 Fever unspecified 78 371 107 247 216 123 338 118 293 33 701 278 215 S099 Unspecified injury of head 46 294 84 340 273 212 271 133 173 19 512 205 348 R104 Other and unspecified abdominal pain 32 298 140 412 178 152 351 155 211 38 319 266 238 B349 Viral infection unspecified 108 327 67 335 322 161 588 432 481 10 309 779 169 A099 Gastroe & colitis of unspec origin 72 315 55 218 220 90 218 140 395 22 282 178 233 J189 Pneumonia unspecified 52 193 106 471 409 126 337 245 249 27 210 449 148 S0180 Open wounds oth parts head, 38 182 67 288 81 95 273 83 148 9 237 150 152 J050 Acuteuncomplicate obstructive laryngitis [croup] 74 230 86 356 183 133 202 139 292 7 251 159 210 J029 Acute pharyngitis unspecified 95 352 147 608 233 116 188 420 597 70 105 256 121 N390 Urinary tract infection site not spec 80 177 69 397 214 133 159 221 390 53 148 238 143 J4500 Predom allgry asthma wo stat asthma 33 189 83 88 77 11 93 195 242 <6 177 150 171 R112 Vomiting alone 11 113 51 99 108 67 139 42 70 <6 186 86 75 S9349 Sprain and strain of ankle, unspecified 8 146 41 81 110 75 105 95 210 22 56 152 109 R05 Cough 56 133 40 147 127 74 156 91 159 29 230 141 75 K590 Constipation 22 127 37 205 169 33 103 82 146 15 153 184 124 J020 Streptococcal pharyngitis 155 163 96 237 160 89 86 30 350 13 50 197 93 R21 Rash and other nonspecific skin eruption 46 140 71 236 164 59 105 95 249 36 109 143 69 S060 Concussion 33 101 49 112 58 95 86 40 148 <6 73 102 106 T784 Allergy unspecified <6 52 25 44 26 32 91 83 42 20 74 25 77 J209 Acute bronchitis unspecified 42 184 19 323 53 28 52 50 312 22 50 20 74 J219 Acute bronchiolitis unspecified <6 189 16 71 100 16 109 42 75 <6 133 60 89 H109 Conjunctivitis unspecified <6 108 46 211 75 91 73 158 276 25 25 109 43 S6100 Opn wnd finger w/o damage nail, uncomp 37 74 25 104 48 39 75 51 92 7 73 81 77 S909 Superficial injury of ankle & foot NOS 6 57 14 182 59 14 68 <6 47 <6 99 230 49 A084 Viral intestinal infection unspecified 14 38 10 31 47 7 9 16 76 <6 26 150 19 S699 Unspecified injury of wrist and hand 33 86 9 249 42 76 45 32 94 15 47 110 68 S0100 Open wound of scalp uncomplicated 18 68 29 75 53 27 102 42 85 8 74 70 45 S609 Unspec superficial injury wrist & hand <6 54 13 218 15 17 40 6 55 6 74 200 29 J988 Other specified respiratory disorders 11 92 14 33 15 67 145 <6 103 6 61 171 47 J039 Acute tonsillitis unspecified 34 131 88 392 108 26 100 88 291 <6 31 52 87 S999 Unspecified injury of ankle and foot 22 65 <6 195 38 33 43 20 92 21 26 125 75 R458 Oth symptoms signs inv emotional state 6 69 31 124 20 22 43 25 46 17 347 16 55 S008 Superficial injury of oth parts of head 88 58 17 29 44 22 75 17 92 72 69 15 S52580 Other fx of lower end of radius, closed 26 62 12 43 21 15 38 <6 34 80 93 41 S52590 Unspec fx of lower end of radius, closed <6 29 23 36 33 63 61 41 106 14 18 42 Z480 Attention to surg dressings & sutures 27 40 10 110 64 31 37 38 128 59 21 74 17 R060 Dyspnoea 7 56 9 29 26 10 36 9 20 <6 161 8 23 S0110 Open wound eyelid & periocular area unco 30 59 12 13 34 19 12 16 40 <6 39 55 39 L010 Impetigo [any organism] [any site] 16 59 14 137 50 30 34 64 105 31 12 75 16 Z478 Other spec orthopaedic follow-up care 18 16 15 60 15 17 28 45 164 10 24 80 35 S809 Superficial injury of lower leg NOS 27 <6 81 10 10 17 <6 29 <6 40 76 24 F430 Acute stress reaction <6 53 <6 101 <6 15 24 9 41 <6 87 9 20 L309 Dermatitis unspecified 11 44 7 45 41 15 17 33 62 28 11 70 15 J22 Unspec acute lower respiratory infection 10 27 <6 153 24 24 114 20 75 27 16 26 F100 Ment/beh disrd dt alcohol use ac intox <6 40 9 37 8 12 11 6 21 15 27 <6 20 Z512 Other chemotherapy 6 10 10 11 20 15 31 24 126 <6 14 23 6 J00 Acute nasopharyngitis [common cold] 6 28 13 6 8 15 24 <6 81 12 6 25 16 L237 All contct dermatitis dt plants ex food 19 6 <6 19 13 23 <6 122 49 <6 17 6 F101 Ment/beh disrd dt harmful alcohol use <6 <6 <6 11 14 <6 <6 13 <6 <6 Z5188 Other specified medical care NEC <6 <6 35 <6 11 <6 50 32 <6 Z099 F/U exam after unspec Rx for oth cond <6 <6 <6 <6 <6 73 <6 H608 Other otitis externa 10 <6 <6 12 <6 Z532 Proc not done pt decn oth/unspec reason 81

156 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.5 – ED Visits by Top 15 Main problems (cont)

Main Problem ICD10 LH

JBH MH

HHS HSN NHS

MSH NHH

HRRH MHA-

SMGH NYGH

OSMH

NBRHC Montfort J069 Acute URTI unspecified 1,190 1,167 425 391 1,417 675 271 149 1,098 690 356 911 1,567 1,093 H669 Otitis media unspecified 993 617 158 189 1,053 428 407 93 621 482 320 503 446 531 R509 Fever unspecified 1,083 507 293 303 674 721 65 20 542 151 82 595 815 121 S099 Unspecified injury of head 1,278 427 201 354 854 672 115 30 639 84 122 750 641 166 R104 Other and unspecified abdominal pain 1,031 545 360 292 731 501 55 45 607 263 104 571 655 214 B349 Viral infection unspecified 641 419 152 106 599 329 85 64 854 156 146 318 580 257 A099 Gastroe & colitis of unspec origin 532 601 136 115 801 463 61 26 384 133 96 381 594 180 J189 Pneumonia unspecified 553 270 105 66 386 314 96 19 581 350 46 205 398 99 S0180 Open wounds oth parts head, 695 412 134 192 541 422 91 46 337 96 76 300 610 99 J050 Acuteuncomplicate obstructive laryngitis [croup] 689 188 164 217 650 335 105 21 309 178 118 420 299 138 J029 Acute pharyngitis unspecified 323 166 81 64 288 127 127 42 188 245 96 199 197 105 N390 Urinary tract infection site not spec 375 147 150 95 344 200 78 24 243 154 71 182 183 197 J4500 Predom allgry asthma wo stat asthma 306 399 102 88 438 247 57 <6 197 39 33 252 241 103 R112 Vomiting alone 417 311 112 134 220 282 20 15 293 65 35 286 428 61 S9349 Sprain and strain of ankle, unspecified 306 169 137 63 283 227 80 45 278 95 65 117 190 120 R05 Cough 325 134 84 78 191 131 37 25 114 127 64 216 231 50 K590 Constipation 259 230 41 72 344 126 48 14 129 78 29 195 104 86 J020 Streptococcal pharyngitis 151 77 26 16 150 87 94 8 230 114 55 94 123 194 R21 Rash and other nonspecific skin eruption 270 165 63 51 163 101 38 16 109 90 46 111 176 132 S060 Concussion 231 72 113 37 324 149 56 18 154 81 57 145 136 82 T784 Allergy unspecified 194 168 31 87 148 238 24 13 178 28 17 115 218 41 J209 Acute bronchitis unspecified 133 84 7 57 199 116 36 12 134 92 31 176 70 30 J219 Acute bronchiolitis unspecified 181 111 42 36 129 138 7 <6 119 55 11 200 134 45 H109 Conjunctivitis unspecified 102 51 18 21 87 46 27 8 94 83 14 61 71 140 S6100 Opn wnd finger w/o damage nail, uncomp 198 98 54 50 182 117 31 27 120 55 35 92 171 54 S909 Superficial injury of ankle & foot NOS 321 82 <6 19 168 188 46 15 118 23 33 42 113 62 A084 Viral intestinal infection unspecified 376 113 38 43 207 161 25 <6 41 65 7 51 87 79 S699 Unspecified injury of wrist and hand 303 71 44 92 153 87 29 6 87 28 48 160 209 9 S0100 Open wound of scalp uncomplicated 220 147 60 46 186 136 33 30 107 46 31 84 171 20 S609 Unspec superficial injury wrist & hand 289 72 <6 14 240 134 59 7 101 26 41 64 65 61 J988 Other specified respiratory disorders 155 117 62 35 126 101 23 18 143 58 35 34 80 43 J039 Acute tonsillitis unspecified 73 48 <6 17 132 61 30 10 51 66 31 108 18 31 S999 Unspecified injury of ankle and foot 235 68 45 98 106 58 22 <6 51 35 44 102 184 <6 R458 Oth symptoms signs inv emotional state 121 60 156 26 103 46 9 <6 22 48 15 217 80 25 S008 Superficial injury of oth parts of head 75 139 32 28 247 101 17 9 47 79 7 40 183 32 S52580 Other fx of lower end of radius, closed 178 65 40 13 108 235 51 <6 144 23 34 49 297 61 S52590 Unspec fx of lower end of radius, closed 129 93 60 19 107 78 8 22 72 37 10 70 69 Z480 Attention to surg dressings & sutures 41 48 17 21 82 51 28 <6 52 45 17 38 83 14 R060 Dyspnoea 151 88 52 42 118 91 9 <6 58 23 21 103 94 13 S0110 Open wound eyelid & periocular area unco 110 72 31 34 78 119 8 15 106 11 25 34 107 44 L010 Impetigo [any organism] [any site] 43 16 17 6 47 8 23 <6 35 59 14 10 20 70 Z478 Other spec orthopaedic follow-up care 49 14 79 6 78 106 46 <6 45 38 37 40 52 41 S809 Superficial injury of lower leg NOS 132 20 <6 6 80 91 28 <6 72 13 19 16 53 37 F430 Acute stress reaction 89 13 62 196 21 <6 37 <6 26 21 40 L309 Dermatitis unspecified 34 19 13 6 46 31 17 <6 42 25 17 25 37 50 J22 Unspec acute lower respiratory infection 51 21 16 50 17 <6 45 97 28 38 13 28 F100 Ment/beh disrd dt alcohol use ac intox 52 35 29 41 45 32 7 <6 19 22 10 73 34 13 Z512 Other chemotherapy 56 <6 <6 <6 49 13 8 <6 16 27 10 25 11 12 J00 Acute nasopharyngitis [common cold] 53 20 10 <6 42 9 7 <6 13 12 8 54 11 10 L237 All contct dermatitis dt plants ex food <6 <6 14 <6 <6 <6 <6 <6 43 <6 <6 35 F101 Ment/beh disrd dt harmful alcohol use 13 13 11 <6 15 7 <6 9 8 7 <6 Z5188 Other specified medical care NEC <6 6 41 <6 14 <6 <6 <6 <6 Z099 F/U exam after unspec Rx for oth cond 9 <6 <6 <6 <6 12 10 <6 H608 Other otitis externa <6 <6 Z532 Proc not done pt decn oth/unspec reason <6

157 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.5 – ED Visits by Top 15 Main problems (cont)

Main Problem ICD10

RVH SAH

QHC SJHC SJHC SMH

RMH

PRHC RHCF RVHS

SBGHC

SLMHC

Toronto

Renfrew

Hamilton Southlake J069 Acute URTI unspecified 811 1,547 613 373 482 840 1,891 950 1,118 1,294 1,389 223 74 922 H669 Otitis media unspecified 859 1,282 404 401 784 479 1,011 780 902 617 881 185 23 694 R509 Fever unspecified 248 434 66 54 123 423 902 294 112 243 754 53 32 401 S099 Unspecified injury of head 195 370 33 57 188 512 1,145 249 132 185 591 53 36 777 R104 Other and unspecified abdominal pain 202 440 99 79 155 473 923 336 151 240 573 68 56 673 B349 Viral infection unspecified 299 614 47 183 281 277 633 126 274 391 453 110 30 332 A099 Gastroe & colitis of unspec origin 301 342 71 73 142 265 942 174 192 251 508 53 20 622 J189 Pneumonia unspecified 152 337 104 119 108 243 360 189 152 114 388 190 7 252 S0180 Open wounds oth parts head, 217 211 46 32 60 223 626 119 72 236 424 21 18 365 J050 Acuteuncomplicate obstructive laryngitis [croup] 267 294 79 56 172 317 370 156 150 113 442 17 <6 516 J029 Acute pharyngitis unspecified 355 598 177 135 299 157 229 453 358 281 191 50 6 230 N390 Urinary tract infection site not spec 241 377 98 81 173 174 257 204 176 179 250 75 19 221 J4500 Predom allgry asthma wo stat asthma 232 208 38 48 83 152 751 138 165 97 367 35 <6 272 R112 Vomiting alone 148 121 22 6 97 226 401 99 35 84 291 9 16 162 S9349 Sprain and strain of ankle, unspecified 181 176 61 48 109 136 214 119 72 97 116 20 15 295 R05 Cough 67 188 36 33 130 155 223 207 105 95 211 25 <6 93 K590 Constipation 115 206 30 34 112 110 347 71 46 92 155 16 8 189 J020 Streptococcal pharyngitis 162 426 134 104 182 117 13 107 186 141 142 36 <6 134 R21 Rash and other nonspecific skin eruption 111 264 85 52 81 107 208 109 122 131 189 22 7 124 S060 Concussion 162 128 34 30 53 161 71 58 51 51 109 17 6 184 T784 Allergy unspecified 75 81 25 15 21 108 262 50 34 66 167 25 10 148 J209 Acute bronchitis unspecified 133 153 95 44 95 50 246 47 158 90 84 12 <6 160 J219 Acute bronchiolitis unspecified 82 91 13 17 38 113 220 91 30 33 115 27 <6 155 H109 Conjunctivitis unspecified 80 153 114 84 68 71 91 128 196 122 102 32 7 72 S6100 Opn wnd finger w/o damage nail, uncomp 72 126 28 26 36 95 181 69 55 114 89 8 19 117 S909 Superficial injury of ankle & foot NOS 45 162 17 20 169 <6 35 434 82 8 8 88 A084 Viral intestinal infection unspecified 36 66 13 <6 13 57 120 12 29 30 105 8 <6 9 S699 Unspecified injury of wrist and hand 29 97 9 <6 40 87 153 71 58 21 135 27 11 149 S0100 Open wound of scalp uncomplicated 82 89 18 6 24 71 141 41 30 106 120 10 7 99 S609 Unspec superficial injury wrist & hand 70 191 <6 18 24 191 <6 26 418 79 11 86 J988 Other specified respiratory disorders 51 140 16 16 32 123 44 50 66 42 98 49 <6 50 J039 Acute tonsillitis unspecified 158 116 34 53 49 46 92 155 155 85 56 22 94 S999 Unspecified injury of ankle and foot 20 78 6 6 41 50 154 57 44 14 116 23 <6 123 R458 Oth symptoms signs inv emotional state 26 65 8 17 26 112 193 98 9 41 55 68 10 155 S008 Superficial injury of oth parts of head 88 74 46 <6 59 51 64 39 32 241 85 <6 11 29 S52580 Other fx of lower end of radius, closed 57 48 15 <6 28 35 179 19 10 80 77 <6 <6 64 S52590 Unspec fx of lower end of radius, closed 39 59 <6 12 18 85 42 32 27 64 99 <6 <6 172 Z480 Attention to surg dressings & sutures 41 95 36 58 27 35 39 65 77 115 180 22 8 71 R060 Dyspnoea 19 55 7 12 24 50 226 19 15 15 105 10 6 59 S0110 Open wound eyelid & periocular area unco 51 59 <6 13 21 57 81 29 21 22 77 <6 17 94 L010 Impetigo [any organism] [any site] 64 156 26 80 38 25 14 56 63 51 32 105 <6 30 Z478 Other spec orthopaedic follow-up care 31 71 15 86 10 34 51 26 57 22 11 16 <6 73 S809 Superficial injury of lower leg NOS 25 79 <6 6 9 75 <6 17 170 37 <6 8 32 F430 Acute stress reaction 63 13 <6 <6 <6 98 18 60 <6 167 15 <6 <6 160 L309 Dermatitis unspecified 42 44 28 52 31 27 35 56 61 39 52 48 <6 42 J22 Unspec acute lower respiratory infection 15 41 <6 34 55 31 37 17 92 8 8 53 24 F100 Ment/beh disrd dt alcohol use ac intox 30 20 <6 14 9 30 42 18 <6 <6 35 23 21 29 Z512 Other chemotherapy 20 48 18 66 <6 18 19 18 27 <6 41 37 <6 85 J00 Acute nasopharyngitis [common cold] 55 <6 91 11 12 8 12 33 16 12 <6 <6 <6 L237 All contct dermatitis dt plants ex food 40 92 33 13 38 11 <6 <6 13 8 <6 <6 F101 Ment/beh disrd dt harmful alcohol use <6 <6 <6 <6 <6 9 <6 <6 <6 <6 21 <6 Z5188 Other specified medical care NEC <6 <6 <6 <6 <6 <6 7 8 <6 <6 Z099 F/U exam after unspec Rx for oth cond <6 <6 <6 <6 18 43 <6 45 <6 H608 Other otitis externa <6 <6 <6 <6 Z532 Proc not done pt decn oth/unspec reason 17

158 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.5 – ED Visits by Top 15 Main problems (cont)

Main Problem ICD10

TSH

WRH Total

TEGH WGH

STEGH WOHS

WLMH

WDMH

TBRHSC WPSHC

THP-MH

THP-CVH Stevenson J069 Acute URTI unspecified 813 554 2,216 796 1,243 2,236 1,194 374 663 245 2,212 335 676 46,766 H669 Otitis media unspecified 670 616 1,401 395 492 708 524 246 472 304 895 236 442 31,439 R509 Fever unspecified 187 133 313 316 1,002 758 1,106 60 145 121 1,500 70 517 19,457 S099 Unspecified injury of head 153 89 415 315 746 740 536 74 177 148 1,543 81 510 19,293 R104 Other and unspecified abdominal pain 180 123 350 369 795 723 616 72 184 78 1,503 75 580 18,880 B349 Viral infection unspecified 294 99 544 263 658 1,011 610 129 347 53 1,143 92 605 18,692 A099 Gastroe & colitis of unspec origin 211 117 537 305 692 934 706 58 115 100 527 53 366 15,618 J189 Pneumonia unspecified 194 108 451 129 466 513 240 114 105 60 781 46 175 12,607 S0180 Open wounds oth parts head, 146 86 223 343 441 726 477 57 118 98 675 33 237 12,184 J050 Acuteuncomplicate obstructive laryngitis [croup] 214 149 317 262 366 325 170 91 144 127 487 46 323 12,127 J029 Acute pharyngitis unspecified 205 147 582 101 172 280 251 91 97 94 510 64 211 11,880 N390 Urinary tract infection site not spec 154 118 422 136 254 260 160 77 145 64 536 111 171 9,998 J4500 Predom allgry asthma wo stat asthma 82 105 146 214 304 234 471 52 72 62 749 41 127 9,263 R112 Vomiting alone 98 33 143 184 533 342 510 25 88 37 393 19 240 8,092 S9349 Sprain and strain of ankle, unspecified 120 119 165 147 187 358 202 37 61 58 447 43 89 7,077 R05 Cough 89 61 112 112 134 211 350 46 108 40 312 18 135 6,564 K590 Constipation 107 96 156 76 191 193 169 59 45 45 426 30 235 6,514 J020 Streptococcal pharyngitis 110 225 305 53 63 80 39 133 149 81 93 95 95 6,548 R21 Rash and other nonspecific skin eruption 121 73 246 72 148 158 233 44 108 34 291 37 105 6,335 S060 Concussion 106 51 125 112 175 238 56 45 37 43 197 22 64 5,046 T784 Allergy unspecified 45 59 108 74 173 312 173 14 36 14 498 20 206 4,913 J209 Acute bronchitis unspecified 24 129 107 44 46 208 136 24 34 17 218 12 103 4,877 J219 Acute bronchiolitis unspecified 62 23 95 90 158 174 106 14 35 20 405 10 98 4,438 H109 Conjunctivitis unspecified 64 76 206 35 57 170 87 20 55 38 121 44 29 4,388 S6100 Opn wnd finger w/o damage nail, uncomp 69 70 107 75 120 171 104 34 43 31 240 38 66 4,270 S909 Superficial injury of ankle & foot NOS 60 34 252 83 77 230 68 <6 52 56 144 6 <6 4,206 A084 Viral intestinal infection unspecified 52 41 37 86 57 89 53 49 12 22 1,296 11 67 4,121 S699 Unspecified injury of wrist and hand 16 21 67 34 115 174 121 28 21 37 223 20 75 4,075 S0100 Open wound of scalp uncomplicated 47 52 81 101 145 171 122 24 46 50 227 16 82 4,021 S609 Unspec superficial injury wrist & hand 67 34 242 77 79 171 80 <6 74 40 148 <6 19 4,058 J988 Other specified respiratory disorders 89 36 148 68 166 109 272 7 15 21 282 13 170 3,972 J039 Acute tonsillitis unspecified 32 42 67 20 21 149 20 13 71 8 104 53 73 3,902 S999 Unspecified injury of ankle and foot 16 17 40 30 82 142 101 30 19 29 166 14 61 3,298 R458 Oth symptoms signs inv emotional state 18 <6 125 42 50 61 9 8 28 14 170 9 90 3,260 S008 Superficial injury of oth parts of head 83 41 114 125 38 123 82 9 26 15 85 11 48 3,261 S52580 Other fx of lower end of radius, closed 71 7 16 114 108 55 113 <6 18 9 196 9 3,104 S52590 Unspec fx of lower end of radius, closed <6 27 82 50 155 196 60 27 17 40 283 <6 49 2,892 Z480 Attention to surg dressings & sutures 53 13 239 15 20 62 30 9 30 <6 345 34 17 2,938 R060 Dyspnoea 19 10 35 38 118 102 96 11 14 9 381 <6 96 2,816 S0110 Open wound eyelid & periocular area unco 28 37 34 49 91 111 43 15 7 32 169 15 41 2,386 L010 Impetigo [any organism] [any site] 47 28 310 11 12 36 17 14 27 9 31 26 14 2,337 Z478 Other spec orthopaedic follow-up care 47 22 68 18 37 25 32 32 23 21 116 7 13 2,128 S809 Superficial injury of lower leg NOS 33 17 123 46 47 93 60 <6 42 13 100 8 9 1,946 F430 Acute stress reaction 21 95 23 86 31 <6 <6 42 46 <6 40 1,875 L309 Dermatitis unspecified 21 12 99 17 35 74 52 7 38 <6 61 16 18 1,776 J22 Unspec acute lower respiratory infection 34 <6 91 <6 7 10 21 <6 7 <6 22 6 29 1,578 F100 Ment/beh disrd dt alcohol use ac intox 15 <6 83 32 31 28 19 <6 13 10 66 <6 40 1,256 Z512 Other chemotherapy 24 50 121 <6 10 9 <6 21 11 15 17 <6 23 1,254 J00 Acute nasopharyngitis [common cold] 10 42 7 <6 18 17 6 10 <6 <6 27 <6 914 L237 All contct dermatitis dt plants ex food 9 10 <6 <6 <6 8 <6 10 <6 7 <6 716 F101 Ment/beh disrd dt harmful alcohol use <6 41 21 <6 <6 <6 <6 8 <6 7 290 Z5188 Other specified medical care NEC <6 <6 <6 <6 12 18 <6 12 299 Z099 F/U exam after unspec Rx for oth cond <6 <6 10 <6 <6 <6 <6 <6 <6 269 H608 Other otitis externa <6 <6 16 <6 67 <6 122 Z532 Proc not done pt decn oth/unspec reason 99

159 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.6 – ED Visits Admitted

This chart and table present the percentage of ED visits that were admitted to a bed based on the following visit disposition categories: 06 (Admit to Facility CCU or OR) and 07 (Admit to Facility Inpatient Unit). Hospitals that joined the Benchmarking project in 2013 do not have data for FY 11/12 and FY 10/11. Hospitals that joined the Benchmarking project in 2012 do not have data for FY 10/11.

Hospital FY 10/11 FY 11/12 FY 12/13 ED Visits Admitted (FY 12/13) AGH 0.02% BCHS 5.58% 5.15% 5.23% BGH 1.97% 1.81% AGH BWH 2.65% 2.99% 3.50% BCHS CCH 3.17% 3.27% 2.74% BGH CGMH 0.80% 0.46% BWH CMH 4.28% 4.41% 4.38% CCH GBGH 0.76% CGMH GBHS 2.21% 2.20% 2.51% CMH GDH 1.31% GBGH GRH 8.44% 9.80% 9.89% GBHS GDH HHCC 3.28% 3.46% 2.99% GRH HHS 2.98% 3.14% 3.18% HHCC HRRH 3.20% 3.42% 3.55% HHS HSN 8.13% 7.66% 7.27% HRRH JBH 5.55% HSN LH 2.54% 3.12% 3.77% JBH MH 3.50% 3.73% 3.74% LH MHA-SMGH 0.22% 0.28% 0.27% MH Montfort 0.87% 0.37% 0.67% MHA-SMGH MSH 3.04% 2.25% 2.44% Montfort NBRHC 4.76% 4.20% 4.27% MSH NHH 1.06% 0.89% 0.77% NBRHC NHH NHS 10.73% 10.35% 9.92% NHS NYGH 4.24% 4.39% 4.14% NYGH OSMH 3.26% 2.73% 2.32% OSMH PRHC 5.94% 5.00% 4.70% PRHC QHC 2.12% 2.11% 1.75% QHC Renfrew 0.28% Renfrew RHCF 1.89% RHCF RMH 0.75% 1.04% 0.87% RMH RVH 4.89% 5.10% 5.03% RVH RVHS 4.17% 4.28% 4.06% RVHS SAH 4.16% 4.46% 4.37% SAH SBGHC SBGHC 0.36% 0.14% SJHC Hamilton SJHC Hamilton 0.40% 1.15% 0.20% SJHC Toronto SJHC Toronto 3.62% 3.34% 3.97% SLMHC SLMHC 3.89% 4.23% 5.19% SMH SMH 3.38% 3.31% 2.95% Southlake Southlake 6.61% 6.10% 6.28% STEGH STEGH 2.86% 2.64% 2.30% Stevenson Stevenson 1.13% 1.02% 0.84% TBRHSC TBRHSC 5.51% 5.64% 5.12% TEGH TEGH 5.13% 4.82% 4.29% THP-CVH THP-CVH 7.11% THP-MH THP-MH 3.52% TSH WDMH TSH 3.83% 3.09% 2.71% WGH WDMH 0.16% WLMH WGH 0.82% WOHS WLMH 0.22% 0.22% 0.04% WPSHC WOHS 7.20% 7.37% 7.27% WRH WPSHC 1.41% 1.67% 0% 2% 4% 6% 8% 10% WRH 7.00% 6.01% 4.23%

160 PCMCH Maternal-Child Benchmarking Report 2013

ED 3.1.7 – ED Visits Left Without Being Seen or Against Medical Advice

This chart presents the percentage of ED visits that left without being seen by a physician or against medical advice. They are disposition categories: 02 (registered & left), 03 (registered, triaged & left), 04 (registered, triaged, assessed & left), or 05 (registered, triaged, assessed & left against advice or other). Hospitals that joined the Benchmarking project in 2013 do not have data for FY 11/12 and FY 10/11. Hospitals that joined the Benchmarking project in 2012 do not have data for FY 10/11.

Hospital FY 10/11 FY 11/12 FY 12/13 ED Visits Left Without Being Seen or AGH 1.92% BCHS 9.70% 7.77% 8.50% Against Medical Advice (FY 12/13) BGH 8.98% 7.26% AGH BWH 3.44% 2.92% 2.07% BCHS CCH 11.25% 5.54% 4.61% BGH CGMH 2.62% 1.98% BWH CMH 4.92% 5.69% 5.53% CCH GBGH 2.11% CGMH GBHS 2.41% 1.94% 2.24% CMH GDH 2.63% GBGH GRH 11.85% 11.19% 11.32% GBHS HDH 1.41% GDH HHCC 3.77% 2.29% 2.45% GRH HDH HHS 4.94% 4.67% 4.86% HHCC HRRH 5.37% 4.80% 3.48% HHS HSN 8.41% 9.19% 5.91% HRRH JBH 8.27% HSN LH 5.95% 6.10% 6.14% JBH MH 5.00% 4.91% 5.20% LH MHA-SMGH 4.67% 5.60% 4.57% MH Montfort 8.30% 6.64% 6.14% MHA-SMGH MSH 4.97% 2.95% 2.52% Montfort NBRHC 4.85% 3.24% 4.41% MSH NHH 7.40% 8.15% 6.83% NBRHC NHS 9.72% 7.59% 7.81% NHH NHS NYGH 4.93% 4.49% 3.45% NYGH OSMH 2.67% 1.93% 2.02% OSMH PRHC 4.70% 5.84% 3.54% PRHC QHC 4.68% 3.82% 4.05% QHC Renfrew 4.34% Renfrew RHCF 3.35% RHCF RMH 4.51% 4.69% 3.11% RMH RVH 8.07% 7.53% 4.86% RVH RVHS 3.04% 2.51% 1.91% RVHS SAH 5.52% 4.69% 3.72% SAH SBGHC 1.80% 1.81% SBGHC SJHC Hamilton 2.78% 2.50% 2.48% SJHC Hamilton SJHC Toronto 1.53% 1.62% 1.27% SJHC Toronto SLMHC SLMHC 2.14% 3.64% 4.36% SMH SMH 4.34% 6.22% 6.43% Southlake Southlake 5.36% 2.52% 1.87% STEGH STEGH 3.50% 3.39% 2.72% Stevenson Stevenson 5.23% 4.70% 3.58% TBRHSC TBRHSC 1.90% 1.90% 2.01% TEGH TEGH 4.20% 4.89% 3.97% THP-CVH THP-CVH 2.93% THP-MH THP-MH 3.20% TSH TSH 5.60% 4.34% 3.58% WDMH WDMH 4.52% WGH WGH 4.38% WLMH WOHS WLMH 6.00% 6.46% 7.23% WPSHC WOHS 5.30% 4.74% 4.23% WRH WPSHC 5.49% 3.89% WRH 8.70% 9.35% 6.16% 0% 2% 4% 6% 8% 10% 12%

161 PCMCH Maternal-Child Benchmarking Report 2013

4.0 Clinical Efficiency

CE 4.1.1 – Top 10 CMGs Typical Inpatient Cases

This table displays the Top 10 CMGs and the total volume of each individual CMG in each facility (highlighted in RED). The last column provides the number of hospitals with that CMG within their top 10.

CMG+

CCH HHS

AGH BGH GDH GRH

CMH

BCHS BWH

GBHS HHCC

GBGH CGMH

601 Newborn/Neonate 2500+ grams, Other Minor Problem 27 94 52 144 31 8 359 <6 66 656 60 299 594 Newborn/Neonate 2500+ grams, Jaundice 24 60 21 27 19 <6 56 13 21 122 15 198 591 Newborn/Neonate 2500+ grams, Other Respiratory Problem <6 50 6 25 12 <6 90 <6 16 188 <6 75 593 Newborn/Neonate 2500+ grams, Short Gestation 27 <6 28 19 9 28 7 15 112 11 69 141 Upper/Lower Respiratory Infection 73 17 61 40 60 25 <6 69 19 60 138 Viral/Unspecified Pneumonia 35 23 38 50 91 <6 55 <6 47 11 87 588 Newborn/Neonate 2000-2499 grams, Gestational Age 37+ 20 11 9 6 19 <6 13 77 12 44 147 AsthmaWeeks 31 8 58 33 <6 21 18 67 9 33 249 Non-severe Enteritis 50 13 29 30 70 21 31 11 36 086 Oral Cavity/Pharynx Intervention 30 21 <6 <6 42 19 118 84 693 Depressive Episode without ECT <6 <6 <6 6 <6 <6 252 <6 116 234 Simple Appendectomy 15 <6 27 15 8 26 10 17 66 26 112 Newborn/Neonate 2000-2499 grams, Gestational Age 35-36 587 15 <6 7 7 17 <6 15 62 13 36 Weeks 598 Newborn/Neonate 2500+ grams, Other Congenital Anomaly 8 11 7 9 <6 25 <6 6 50 23 687 Stress Reaction/Adjustment Disorder 11 <6 <6 <6 <6 <6 128 <6 69 Newborn/Neonate 2500+ grams, Major Respiratory 589 8 8 8 17 <6 19 <6 54 <6 11 Complication 040 Seizure Disorder, except Status Epilepticus 12 <6 15 11 20 11 30 <6 13 257 Symptom/Sign of Digestive System 39 <6 36 10 13 <6 13 <6 30 8 14 600 Newborn/Neonate 2500+ grams, Other Moderate Problem <6 23 <6 20 <6 <6 8 11 26 <6 16 487 Lower Urinary Tract Infection 13 <6 8 6 22 <6 <6 26 <6 19 Newborn/Neonate 2000-2499 grams, Gestational Age <35 586 12 <6 <6 <6 <6 28 16 Weeks 661 Other/Unspecified Viral Illness <6 12 19 16 9 15 9 19 602 Newborn/Neonate 2500+ grams, Haemolytic Disease <6 6 6 <6 10 <6 <6 17 <6 13 Newborn/Neonate 2500+ grams, Septicemia/Other Neonatal 592 13 <6 7 <6 10 41 26 <6 18 Infection 097 Influenza/Acute Upper Respiratory Infection 35 <6 8 9 13 9 21 6 12 437 Diabetes 11 <6 9 <6 <6 21 9 38 13 <6 Reduction/Fixation/Repair Upper Body/Limb except 739 11 <6 8 <6 <6 <6 17 32 9 Fixation/Repair of Shoulder 778 Poisoning/Toxic Effect of Drug 14 <6 16 <6 <6 7 <6 9 21 <6 16 Newborn/Neonate 2500+ grams, Aspiration Syndrome/Fetal 590 8 <6 9 <6 <6 11 <6 8 18 <6 11 Asphyxia 806 Convalescence 6 <6 14 <6 <6 <6 <6 17 <6 Newborn/Neonate 1500-1999 grams, Gestational Age 32-34 584 6 <6 <6 <6 17 8 Weeks 148 Other Respiratory Disorder <6 <6 <6 <6 7 <6 <6 15 <6 8 233 Complicated Appendectomy 6 <8 7 11 <6 6 7 <6 21 <6 18 103 Tonsillitis/Pharyngitis 6 <9 25 <6 12 <6 <6 14 6 Newborn/Neonate 1500-1999 grams, Gestational Age 35+ 585 <6 <6 <6 <6 <6 <6 8 <6 <6 Weeks 811 General Symptom/Sign 8 <6 <6 <6 6 <6 <6 8 <6 10 407 Other Disease/Disorder of Skin/Subcutaneous Tissue <6 <6 <6 <6 8 <6 <6 7 <6 078 Other Musculoskeletal Intervention on Head 673 Eating Disorder <6 <6 <6 <6 <6 729 Replacement/Fixation/Repair of Tibia/Fibula/Knee <6 <6 <6 <6 <6 136 Bacterial Pneumonia <6 <6 <6 <6 <6 6 Newborn/Neonate 2500+ grams, Anomaly of 595 <6 <6 <6 <6 Nervous/Respiratory/Digestive System 780 Post-Operative Complication except Hemorrhage <6 <6 <6 <6 <6 <6 <6 <6 <6 080 Other Ear Intervention <6 <6 <6 815 Cancelled Intervention <6 <6 <6 <6 718 Non-Extensive Burn <6 <6 <6 144 Pneumothorax <6 <6 <6 082 Mastoid Intervention

Note JBH: Joseph Brant hospital data has been excluded from the Clinical Efficiency section of the Benchmarking Report.

162 PCMCH Maternal-Child Benchmarking Report 2013

CE 4.1.1 – Top 10 CMGs Typical Inpatient Cases (cont)

CMG+ LH

HSN NHS

MSH NHH

HRRH PRHC

NYGH

OSMH

NBRHC

Montfort MHA-SMGH 601 Newborn/Neonate 2500+ grams, Other Minor Problem 306 107 543 249 17 261 279 133 36 410 1,451 109 195 594 Newborn/Neonate 2500+ grams, Jaundice 89 26 202 172 <6 128 119 67 20 137 237 27 26 591 Newborn/Neonate 2500+ grams, Other Respiratory Problem 62 35 105 176 108 79 23 17 81 409 55 101 593 Newborn/Neonate 2500+ grams, Short Gestation 96 43 91 55 <6 44 68 22 7 81 131 55 44 141 Upper/Lower Respiratory Infection 45 41 70 62 27 38 <6 196 67 66 81 138 Viral/Unspecified Pneumonia 60 27 49 60 62 27 6 112 57 15 61 588 Newborn/Neonate 2000-2499 grams, Gestational Age 37+ 66 38 38 51 55 45 <6 <6 42 128 21 16 147 AsthmaWeeks 70 37 86 58 21 20 <6 110 42 28 58 249 Non-severe Enteritis 43 23 90 65 <6 18 23 <6 173 31 23 52 086 Oral Cavity/Pharynx Intervention 62 <6 181 <6 27 <6 112 19 12 38 93 58 37 693 Depressive Episode without ECT 16 35 110 16 29 72 7 234 Simple Appendectomy 50 22 89 73 <6 7 41 7 9 42 29 11 27 Newborn/Neonate 2000-2499 grams, Gestational Age 35-36 587 42 16 49 24 <6 29 49 7 28 68 20 35 Weeks 598 Newborn/Neonate 2500+ grams, Other Congenital Anomaly 25 14 41 30 27 39 8 <6 18 84 7 <6 687 Stress Reaction/Adjustment Disorder <6 39 73 <6 9 58 47 <6 Newborn/Neonate 2500+ grams, Major Respiratory 589 6 12 30 80 67 11 <6 <6 33 45 9 10 Complication 040 Seizure Disorder, except Status Epilepticus 33 24 34 20 14 14 54 29 12 25 257 Symptom/Sign of Digestive System 22 16 43 29 <6 10 19 <6 69 18 11 17 600 Newborn/Neonate 2500+ grams, Other Moderate Problem <6 35 22 22 14 23 9 <6 21 19 21 18 487 Lower Urinary Tract Infection 20 13 19 25 <6 16 <6 35 33 9 20 Newborn/Neonate 2000-2499 grams, Gestational Age <35 586 28 24 32 25 10 24 8 16 26 7 17 Weeks 661 Other/Unspecified Viral Illness 15 26 25 24 8 <6 53 21 10 24 602 Newborn/Neonate 2500+ grams, Haemolytic Disease <6 13 18 24 25 23 9 13 73 9 <6 Newborn/Neonate 2500+ grams, Septicemia/Other Neonatal 592 18 7 13 19 <6 12 <6 22 20 21 14 Infection 097 Influenza/Acute Upper Respiratory Infection 6 23 17 14 <6 23 33 47 12 15 437 Diabetes 7 25 34 13 <6 21 43 <6 28 24 Reduction/Fixation/Repair Upper Body/Limb except 739 11 23 <6 17 <6 26 9 39 12 <6 <6 Fixation/Repair of Shoulder 778 Poisoning/Toxic Effect of Drug <6 14 13 10 10 <6 38 16 6 <6 Newborn/Neonate 2500+ grams, Aspiration Syndrome/Fetal 590 7 6 23 18 <6 <6 11 <6 26 43 39 12 Asphyxia 806 Convalescence 11 <6 23 19 <6 <6 7 <6 18 8 <6 18 Newborn/Neonate 1500-1999 grams, Gestational Age 32-34 584 15 13 16 10 <6 24 6 <6 20 11 <6 Weeks 148 Other Respiratory Disorder 7 12 25 17 8 <6 14 21 <6 <6 233 Complicated Appendectomy <6 10 11 12 <6 22 15 7 6 9 11 103 Tonsillitis/Pharyngitis 6 <6 17 11 <6 <6 9 18 <6 <6 12 Newborn/Neonate 1500-1999 grams, Gestational Age 35+ 585 <6 <6 12 <6 6 7 <6 17 <6 <6 Weeks 811 General Symptom/Sign <6 26 <6 <6 <6 8 11 <6 <6 <6 407 Other Disease/Disorder of Skin/Subcutaneous Tissue <6 14 9 9 <6 <6 17 11 <6 6 078 Other Musculoskeletal Intervention on Head <6 9 <6 <6 27 <6 673 Eating Disorder 13 6 <6 <6 29 6 <6 729 Replacement/Fixation/Repair of Tibia/Fibula/Knee <6 6 <6 <6 <6 6 <6 8 <6 <6 136 Bacterial Pneumonia <6 <6 <6 <6 <6 <6 <6 34 Newborn/Neonate 2500+ grams, Anomaly of 595 <6 <6 <6 <6 <6 <6 <6 <6 8 <6 Nervous/Respiratory/Digestive System 780 Post-Operative Complication except Hemorrhage <6 <6 <6 <6 7 <6 <6 080 Other Ear Intervention <6 <6 <6 <6 8 <6 <6 <6 <6 815 Cancelled Intervention <6 <6 <6 <6 <6 <6 <6 718 Non-Extensive Burn <6 <6 <6 <6 <6 <6 <6 144 Pneumothorax <6 <6 <6 <6 082 Mastoid Intervention <6 <6

163 PCMCH Maternal-Child Benchmarking Report 2013

CE 4.1.1 – Top 10 CMGs Typical Inpatient Cases (cont)

CMG+

SAH

QHC RVH SJHC

RMH SMH

RHCF

RVHS

SBGHC

SLMHC

Renfrew

Hamilton

Southlake SJHC Toronto SJHC 601 Newborn/Neonate 2500+ grams, Other Minor Problem 291 <6 7 42 98 593 73 13 214 456 121 405 187 594 Newborn/Neonate 2500+ grams, Jaundice 32 <6 <6 10 48 111 70 6 184 128 34 101 95 591 Newborn/Neonate 2500+ grams, Other Respiratory Problem 76 <6 <6 54 128 27 6 135 132 <6 134 70 593 Newborn/Neonate 2500+ grams, Short Gestation 34 <6 11 46 100 40 <6 71 108 7 83 83 141 Upper/Lower Respiratory Infection 44 <6 6 28 66 26 <6 51 11 97 138 Viral/Unspecified Pneumonia 35 <6 8 31 111 21 57 60 45 588 Newborn/Neonate 2000-2499 grams, Gestational Age 37+ 22 <6 7 28 80 20 6 70 62 6 81 40 147 AsthmaWeeks 29 <6 29 89 19 81 <6 54 249 Non-severe Enteritis 25 <6 <6 19 50 16 <6 29 <6 58 086 Oral Cavity/Pharynx Intervention 12 46 66 1 10 <6 38 693 Depressive Episode without ECT <6 <6 <6 7 111 26 42 <6 222 234 Simple Appendectomy 22 <6 6 11 32 33 15 <6 <6 33 <6 <6 51 Newborn/Neonate 2000-2499 grams, Gestational Age 35-36 587 26 <6 <6 <6 23 68 19 <6 38 45 <6 52 32 Weeks 598 Newborn/Neonate 2500+ grams, Other Congenital Anomaly 31 <6 36 50 8 11 33 11 <6 14 30 687 Stress Reaction/Adjustment Disorder <6 26 86 45 49 47 Newborn/Neonate 2500+ grams, Major Respiratory 589 29 <6 <6 22 86 7 <6 76 17 <6 6 6 Complication 040 Seizure Disorder, except Status Epilepticus 16 <6 12 48 7 22 <6 22 257 Symptom/Sign of Digestive System 9 8 <6 12 18 20 <6 15 <6 <6 37 600 Newborn/Neonate 2500+ grams, Other Moderate Problem 11 <6 19 12 7 <6 26 20 9 <6 13 487 Lower Urinary Tract Infection 11 <6 12 18 11 <6 15 <6 <6 15 Newborn/Neonate 2000-2499 grams, Gestational Age <35 586 <6 <6 23 30 8 28 36 34 18 Weeks 661 Other/Unspecified Viral Illness 7 <6 12 17 11 10 <6 29 602 Newborn/Neonate 2500+ grams, Haemolytic Disease <6 <6 <6 36 <6 13 24 <6 <6 18 Newborn/Neonate 2500+ grams, Septicemia/Other Neonatal 592 9 <6 9 24 8 22 13 <6 9 Infection 097 Influenza/Acute Upper Respiratory Infection <6 <6 15 <6 18 <6 <6 24 437 Diabetes <6 <6 <6 23 41 7 <6 <6 29 Reduction/Fixation/Repair Upper Body/Limb except 739 <6 <6 20 35 11 <6 9 <6 23 Fixation/Repair of Shoulder 778 Poisoning/Toxic Effect of Drug <6 <6 <6 21 22 7 <6 10 8 <6 19 Newborn/Neonate 2500+ grams, Aspiration Syndrome/Fetal 590 <6 <6 <6 8 <6 <6 6 21 <6 13 9 Asphyxia 806 Convalescence <6 <6 <6 38 12 7 <6 10 Newborn/Neonate 1500-1999 grams, Gestational Age 32-34 584 <6 9 17 <6 13 18 22 10 Weeks 148 Other Respiratory Disorder 10 <6 <6 <6 <6 <6 6 <6 21 233 Complicated Appendectomy 10 <6 <6 <6 11 13 <6 <6 <6 7 6 103 Tonsillitis/Pharyngitis <6 13 10 <6 <6 <6 11 Newborn/Neonate 1500-1999 grams, Gestational Age 35+ 585 <6 <6 20 <6 10 <6 15 7 Weeks 811 General Symptom/Sign <6 <6 <6 <6 <6 <6 8 <6 7 10 407 Other Disease/Disorder of Skin/Subcutaneous Tissue <6 <6 <6 <6 <6 <6 6 6 11 078 Other Musculoskeletal Intervention on Head 16 11 <6 673 Eating Disorder 8 7 <6 12 729 Replacement/Fixation/Repair of Tibia/Fibula/Knee <6 <6 8 7 <6 <6 <6 6 136 Bacterial Pneumonia <6 <6 <6 <6 <6 Newborn/Neonate 2500+ grams, Anomaly of 595 <6 <6 <6 <6 <6 <6 7 Nervous/Respiratory/Digestive System 780 Post-Operative Complication except Hemorrhage <6 <6 <6 <6 <6 080 Other Ear Intervention <6 <6 <6 <6 815 Cancelled Intervention <6 718 Non-Extensive Burn <6 <6 144 Pneumothorax <6 <6 <6 <6 <6 082 Mastoid Intervention

164 PCMCH Maternal-Child Benchmarking Report 2013

CE 4.1.1 – Top 10 CMGs Typical Inpatient Cases (cont)

CMG+

TSH

TEGH WGH WRH Total

STEGH

WOHS

WLMH

WDMH WPSHC

TBRHSC

THP-MH

THP-CVH Stevenson

601 Newborn/Neonate 2500+ grams, Other Minor Problem 52 15 264 389 327 543 744 17 50 21 2,134 20 315 13,289 594 Newborn/Neonate 2500+ grams, Jaundice 24 6 91 113 251 101 268 15 17 27 420 <6 49 4,041 591 Newborn/Neonate 2500+ grams, Other Respiratory Problem 23 7 83 104 117 65 198 9 12 250 <6 74 3,439 593 Newborn/Neonate 2500+ grams, Short Gestation 13 9 52 88 120 86 137 20 24 10 289 <6 112 2,619 141 Upper/Lower Respiratory Infection 22 <6 84 15 93 95 63 165 58 2,049 138 Viral/Unspecified Pneumonia 31 6 65 22 147 95 103 <6 143 <6 78 2,044 588 Newborn/Neonate 2000-2499 grams, Gestational Age 37+ 7 6 21 77 142 75 138 6 8 <6 221 <6 66 1,918 147 AsthmaWeeks 12 <6 29 22 141 84 97 <6 <6 235 40 1,783 249 Non-severe Enteritis 10 66 19 106 79 79 235 <6 34 1,670 086 Oral Cavity/Pharynx Intervention 27 <6 76 58 37 41 63 20 159 16 1,641 693 Depressive Episode without ECT 135 55 <6 51 <6 58 1,390 234 Simple Appendectomy 10 <6 15 12 63 105 26 9 <6 130 <6 57 1,385 Newborn/Neonate 2000-2499 grams, Gestational Age 35-36 587 <6 <6 25 66 85 59 65 6 6 <6 146 49 1,378 Weeks 598 Newborn/Neonate 2500+ grams, Other Congenital Anomaly 10 <6 21 62 23 14 24 <6 13 <6 68 36 950 687 Stress Reaction/Adjustment Disorder 34 53 <6 <6 103 <6 36 940 Newborn/Neonate 2500+ grams, Major Respiratory 589 7 <6 17 17 49 13 28 <6 20 47 20 922 Complication 040 Seizure Disorder, except Status Epilepticus 10 <6 45 18 55 27 46 152 <6 15 887 257 Symptom/Sign of Digestive System 30 <6 38 9 57 22 36 <6 84 <6 27 871 600 Newborn/Neonate 2500+ grams, Other Moderate Problem 9 104 14 21 11 17 <6 <6 37 61 729 487 Lower Urinary Tract Infection <6 <6 25 16 54 34 28 136 <6 29 725 Newborn/Neonate 2000-2499 grams, Gestational Age <35 586 <6 16 25 52 32 36 52 33 713 Weeks 661 Other/Unspecified Viral Illness <6 16 9 53 22 25 108 24 664 602 Newborn/Neonate 2500+ grams, Haemolytic Disease <6 <6 36 20 13 122 66 12 662 Newborn/Neonate 2500+ grams, Septicemia/Other Neonatal 592 6 8 22 38 24 12 143 19 645 Infection 097 Influenza/Acute Upper Respiratory Infection 7 <6 23 9 46 23 19 85 18 609 437 Diabetes 7 11 18 20 7 <6 44 <6 24 557 Reduction/Fixation/Repair Upper Body/Limb except 739 <6 34 22 20 13 12 31 24 502 Fixation/Repair of Shoulder 778 Poisoning/Toxic Effect of Drug <6 <6 23 <6 25 10 22 <6 66 <6 <6 482 Newborn/Neonate 2500+ grams, Aspiration Syndrome/Fetal 590 <6 7 9 <6 27 21 6 <6 42 10 474 Asphyxia 806 Convalescence 15 <6 24 14 31 51 22 <6 <6 20 11 451 Newborn/Neonate 1500-1999 grams, Gestational Age 32-34 584 10 21 48 14 26 43 26 449 Weeks 148 Other Respiratory Disorder <6 45 10 25 9 20 74 19 419 233 Complicated Appendectomy 7 <6 12 10 16 10 <6 24 <6 15 370 103 Tonsillitis/Pharyngitis <6 13 <6 16 19 8 37 <6 17 323 Newborn/Neonate 1500-1999 grams, Gestational Age 35+ 585 <6 <6 13 36 22 21 <6 46 9 318 Weeks 811 General Symptom/Sign 6 28 <6 8 <6 <6 <6 24 <6 <6 243 407 Other Disease/Disorder of Skin/Subcutaneous Tissue <6 9 <6 14 <6 10 31 9 232 078 Other Musculoskeletal Intervention on Head 33 <6 28 <6 <6 8 155 673 Eating Disorder <6 <6 <6 <6 8 117 729 Replacement/Fixation/Repair of Tibia/Fibula/Knee <6 <6 <6 10 <6 <6 <6 <6 8 116 136 Bacterial Pneumonia <6 <6 <6 <6 <6 <6 90 Newborn/Neonate 2500+ grams, Anomaly of 595 <6 <6 <6 <6 <6 <6 <6 70 Nervous/Respiratory/Digestive System 780 Post-Operative Complication except Hemorrhage <6 <6 <6 <6 <6 <6 <6 57 080 Other Ear Intervention <6 <6 <6 <6 8 52 815 Cancelled Intervention <6 7 <6 <6 <6 <6 43 718 Non-Extensive Burn <6 <6 <6 <6 <6 34 144 Pneumothorax <6 <6 <6 30 082 Mastoid Intervention <6 <6

165 PCMCH Maternal-Child Benchmarking Report 2013

CE 4.1.2 – Top 10 CMGs Typical Inpatient Cases – One and Two Day Stay

This table displays the Top 10 CMGs with one and two day stays for typical cases, in order to provide a sense of the number of admissions and resulting days that might be potentially avoided. This indicator is provided to help institutions analyze and utilize best practice opportunities. Top 10 are highlighted in RED.

CMG+

CCH HHS

AGH BGH GDH GRH

CMH

BCHS BWH

GBHS HHCC

GBGH CGMH

601 Newborn/Neonate 2500+ grams, Other Minor Problem 14 51 41 93 20 <6 222 <6 30 445 50 233 594 Newborn/Neonate 2500+ grams, Jaundice <6 46 11 17 10 <6 29 <6 16 82 11 126 591 Newborn/Neonate 2500+ grams, Other Respiratory Problem <6 27 <6 12 11 <6 54 <6 10 114 <6 57 086 Oral Cavity/Pharynx Intervention 30 21 <6 <6 42 19 118 84 147 Asthma 31 8 51 33 <6 17 11 53 7 31 141 Upper/Lower Respiratory Infection 53 14 46 37 48 16 <6 50 12 46 593 Newborn/Neonate 2500+ grams, Short Gestation 11 <6 16 16 9 <6 <6 7 48 <6 40 249 Non-severe Enteritis 45 10 24 23 58 18 29 8 31 234 Simple Appendectomy 13 <6 22 11 8 22 10 16 60 21 101 138 Viral/Unspecified Pneumonia 23 19 26 32 50 <6 34 <6 20 7 67 Newborn/Neonate 2000-2499 grams, Gestational Age 37+ 588 10 8 8 <6 6 <6 6 47 7 26 Weeks 040 Seizure Disorder, except Status Epilepticus 11 <6 14 9 15 10 25 <6 12 598 Newborn/Neonate 2500+ grams, Other Congenital Anomaly <6 8 <6 <6 <6 18 <6 6 37 18 257 Symptom/Sign of Digestive System 31 <6 31 9 11 <6 11 <6 26 <6 14 661 Other/Unspecified Viral Illness <6 10 17 12 <6 12 6 17 Reduction/Fixation/Repair Upper Body/Limb except 739 11 <6 7 <6 <6 <6 17 32 7 Fixation/Repair of Shoulder 097 Influenza/Acute Upper Respiratory Infection 30 <6 6 7 12 6 17 <6 9 Newborn/Neonate 2500+ grams, Major Respiratory 589 <6 <6 6 12 <6 6 <6 25 <6 <6 Complication 778 Poisoning/Toxic Effect of Drug 13 <6 15 <6 <6 7 <6 6 20 <6 15 806 Convalescence 6 <6 14 <6 <6 <6 17 <6 Newborn/Neonate 2000-2499 grams, Gestational Age 35-36 587 <6 <6 <6 <6 <6 <6 17 <6 10 Weeks 437 Diabetes 8 <6 <6 <6 <6 11 9 29 7 <6 104 Croup 11 <6 17 <6 11 <6 14 7 14 687 Stress Reaction/Adjustment Disorder 9 <6 <6 <6 <6 <6 53 <6 36 148 Other Respiratory Disorder <6 <6 <6 6 <6 <6 11 <6 7 693 Depressive Episode without ECT <6 <6 <6 <6 43 <6 26 602 Newborn/Neonate 2500+ grams, Haemolytic Disease <6 <6 9 <6 <6 12 10 103 Tonsillitis/Pharyngitis 6 <6 23 <6 10 <6 <6 11 6 776 Open Wound/Other/Unspecified Minor Injury 9 9 <6 18 7 <6 8 Newborn/Neonate 2500+ grams, Aspiration Syndrome/Fetal 590 <6 <6 7 <6 <6 <6 <6 7 <6 8 Asphyxia 600 Newborn/Neonate 2500+ grams, Other Moderate Problem <6 <6 <6 <6 <6 <6 <6 15 9 811 General Symptom/Sign 8 <6 <6 <6 <6 <6 <6 7 <6 9 233 Complicated Appendectomy <6 <6 <6 <6 <6 <6 <6 6 <6 11 405 Cellulitis <6 <6 <6 <6 <6 <6 <6 6 078 Other Musculoskeletal Intervention on Head 407 Other Disease/Disorder of Skin/Subcutaneous Tissue <6 <6 <6 <6 <6 <6 <6 <6 <6 258 Other Gastrointestinal Disorder <6 <6 <6 <6 <6 <6 747 Reduction/Fixation/Repair of Ankle/Foot <6 <6 <6 7 729 Replacement/Fixation/Repair of Tibia/Fibula/Knee <6 <6 <6 <6 <6 597 Newborn/Neonate 2500+ grams, Cardiovascular Anomaly <6 <6 <6 <6 <6 080 Other Ear Intervention <6 <6 <6 136 Bacterial Pneumonia <6 <6 <6 <6 <6 815 Cancelled Intervention <6 <6 <6 <6 065 Other Ophthalmology Disorder <6 <6 <6 <6 <6 <6 780 Post-Operative Complication except Hemorrhage <6 <6 <6 <6 <6 698 Psychoactive Substance Use, Acute Intoxication <6 <6 <6 <6 678 Schizotypal/Delusional Disorder <6 <6 <6 <6 <6 <6 179 Cardiac Conduction System Intervention 082 Mastoid Intervention

166 PCMCH Maternal-Child Benchmarking Report 2013

CE 4.1.2 – Top 10 CMGs Typical Inpatient Cases – One and Two Day Stay (cont)

CMG+ LH

HSN NHS

MSH NHH

HRRH PRHC

NYGH

OSMH

NBRHC

Montfort MHA-SMGH 601 Newborn/Neonate 2500+ grams, Other Minor Problem 245 80 401 209 9 146 232 98 18 273 1,192 96 130 594 Newborn/Neonate 2500+ grams, Jaundice 53 14 120 150 <6 47 93 47 16 81 180 16 20 591 Newborn/Neonate 2500+ grams, Other Respiratory Problem 29 20 64 147 51 49 13 10 35 302 32 59 086 Oral Cavity/Pharynx Intervention 62 <6 178 <6 27 <6 110 19 12 37 91 58 36 147 Asthma 57 30 73 49 19 16 <6 89 39 26 50 141 Upper/Lower Respiratory Infection 28 23 49 46 21 23 <6 126 51 53 46 593 Newborn/Neonate 2500+ grams, Short Gestation 63 26 44 34 16 46 8 <6 33 62 22 12 249 Non-severe Enteritis 30 21 78 59 <6 16 20 <6 136 28 23 45 234 Simple Appendectomy 49 20 79 60 <6 6 40 <6 9 36 29 10 27 138 Viral/Unspecified Pneumonia 42 17 31 37 31 17 <6 39 43 6 33 Newborn/Neonate 2000-2499 grams, Gestational Age 37+ 588 49 30 18 33 30 36 <6 <6 26 73 12 7 Weeks 040 Seizure Disorder, except Status Epilepticus 32 21 34 18 12 13 52 27 12 22 598 Newborn/Neonate 2500+ grams, Other Congenital Anomaly 19 11 29 28 20 32 8 <6 16 72 <6 <6 257 Symptom/Sign of Digestive System 15 11 39 28 <6 9 13 <6 61 12 11 16 661 Other/Unspecified Viral Illness 12 20 19 18 6 <6 33 16 7 18 Reduction/Fixation/Repair Upper Body/Limb except 739 11 22 <6 16 <6 26 9 37 11 <6 <6 Fixation/Repair of Shoulder 097 Influenza/Acute Upper Respiratory Infection <6 19 12 13 <6 20 22 42 11 12 Newborn/Neonate 2500+ grams, Major Respiratory 589 <6 <6 16 65 28 6 <6 15 29 <6 <6 Complication 778 Poisoning/Toxic Effect of Drug <6 12 12 10 10 <6 34 16 6 <6 806 Convalescence 11 <6 21 19 <6 <6 7 <6 18 8 <6 18 Newborn/Neonate 2000-2499 grams, Gestational Age 35-36 587 20 <6 16 8 <6 <6 25 <6 <6 27 <6 7 Weeks 437 Diabetes 6 23 31 11 <6 12 22 <6 20 23 104 Croup 14 9 16 12 <6 8 31 11 12 687 Stress Reaction/Adjustment Disorder <6 11 19 <6 <6 47 30 <6 148 Other Respiratory Disorder 6 10 20 17 7 <6 12 19 <6 <6 693 Depressive Episode without ECT 7 29 <6 16 16 <6 602 Newborn/Neonate 2500+ grams, Haemolytic Disease 10 12 10 12 12 <6 7 32 <6 103 Tonsillitis/Pharyngitis <6 <6 14 8 <6 <6 7 13 <6 <6 11 776 Open Wound/Other/Unspecified Minor Injury 9 <6 9 6 <6 7 22 8 <6 <6 Newborn/Neonate 2500+ grams, Aspiration Syndrome/Fetal 590 <6 <6 14 10 <6 <6 6 <6 12 28 22 <6 Asphyxia 600 Newborn/Neonate 2500+ grams, Other Moderate Problem <6 6 <6 13 6 8 <6 7 8 <6 <6 811 General Symptom/Sign <6 22 <6 <6 <6 <6 10 <6 <6 233 Complicated Appendectomy <6 <6 <6 <6 <6 15 8 <6 <6 <6 <6 405 Cellulitis <6 <6 <6 7 <6 <6 <6 10 <6 <6 078 Other Musculoskeletal Intervention on Head <6 9 <6 26 <6 407 Other Disease/Disorder of Skin/Subcutaneous Tissue <6 8 6 <6 <6 <6 8 <6 <6 258 Other Gastrointestinal Disorder <6 <6 <6 <6 <6 11 9 <6 <6 747 Reduction/Fixation/Repair of Ankle/Foot <6 <6 <6 8 <6 9 <6 729 Replacement/Fixation/Repair of Tibia/Fibula/Knee <6 <6 <6 <6 6 <6 <6 <6 <6 597 Newborn/Neonate 2500+ grams, Cardiovascular Anomaly <6 <6 <6 <6 <6 <6 <6 <6 <6 080 Other Ear Intervention <6 <6 <6 <6 8 <6 <6 <6 <6 136 Bacterial Pneumonia <6 <6 <6 <6 <6 20 815 Cancelled Intervention <6 <6 <6 <6 <6 <6 <6 065 Other Ophthalmology Disorder <6 <6 <6 <6 <6 <6 780 Post-Operative Complication except Hemorrhage <6 <6 <6 <6 <6 698 Psychoactive Substance Use, Acute Intoxication <6 <6 <6 <6 <6 <6 678 Schizotypal/Delusional Disorder <6 179 Cardiac Conduction System Intervention 082 Mastoid Intervention <6 <6

167 PCMCH Maternal-Child Benchmarking Report 2013

CE 4.1.2 – Top 10 CMGs Typical Inpatient Cases – One and Two Day Stay (cont)

CMG+

SAH

QHC RVH SJHC

RMH SMH

RHCF

RVHS

SBGHC

SLMHC

Renfrew

Hamilton

Southlake SJHC Toronto SJHC 601 Newborn/Neonate 2500+ grams, Other Minor Problem 202 <6 <6 28 46 442 51 13 112 407 85 274 116 594 Newborn/Neonate 2500+ grams, Jaundice 18 <6 <6 <6 25 74 24 <6 82 103 20 58 61 591 Newborn/Neonate 2500+ grams, Other Respiratory Problem 47 <6 <6 25 83 16 6 75 99 63 31 086 Oral Cavity/Pharynx Intervention 12 46 65 <6 10 <6 36 147 Asthma 22 <6 25 75 16 68 <6 40 141 Upper/Lower Respiratory Infection 25 <6 <6 21 42 20 36 <6 69 593 Newborn/Neonate 2500+ grams, Short Gestation 15 <6 6 12 59 15 <6 15 63 <6 44 36 249 Non-severe Enteritis 21 <6 <6 16 37 11 <6 26 <6 47 234 Simple Appendectomy 20 <6 <6 11 31 31 14 <6 <6 31 <6 <6 43 138 Viral/Unspecified Pneumonia 22 <6 <6 24 71 16 39 21 29 Newborn/Neonate 2000-2499 grams, Gestational Age 37+ 588 11 7 22 48 13 <6 32 43 <6 45 17 Weeks 040 Seizure Disorder, except Status Epilepticus 15 <6 11 40 7 19 <6 20 598 Newborn/Neonate 2500+ grams, Other Congenital Anomaly 22 27 42 <6 10 24 10 <6 10 25 257 Symptom/Sign of Digestive System 9 6 <6 10 16 18 <6 13 <6 <6 26 661 Other/Unspecified Viral Illness 6 <6 8 12 7 9 23 Reduction/Fixation/Repair Upper Body/Limb except 739 <6 <6 20 35 10 <6 8 <6 21 Fixation/Repair of Shoulder 097 Influenza/Acute Upper Respiratory Infection <6 <6 13 <6 14 <6 <6 21 Newborn/Neonate 2500+ grams, Major Respiratory 589 21 7 66 <6 <6 39 9 <6 <6 <6 Complication 778 Poisoning/Toxic Effect of Drug <6 <6 <6 18 17 6 <6 9 6 <6 17 806 Convalescence <6 <6 <6 37 12 7 <6 10 Newborn/Neonate 2000-2499 grams, Gestational Age 35-36 587 <6 <6 <6 <6 <6 23 <6 <6 9 18 <6 22 9 Weeks 437 Diabetes <6 <6 20 37 <6 <6 <6 14 104 Croup 9 <6 <6 7 12 <6 15 31 687 Stress Reaction/Adjustment Disorder <6 17 44 13 <6 25 148 Other Respiratory Disorder 8 <6 <6 <6 <6 <6 <6 18 693 Depressive Episode without ECT <6 <6 <6 <6 53 <6 16 <6 63 602 Newborn/Neonate 2500+ grams, Haemolytic Disease 19 8 12 <6 9 103 Tonsillitis/Pharyngitis <6 13 6 <6 <6 <6 9 776 Open Wound/Other/Unspecified Minor Injury <6 <6 <6 11 <6 <6 Newborn/Neonate 2500+ grams, Aspiration Syndrome/Fetal 590 <6 <6 <6 <6 <6 <6 19 <6 <6 <6 Asphyxia 600 Newborn/Neonate 2500+ grams, Other Moderate Problem <6 <6 <6 <6 <6 <6 7 10 <6 <6 <6 811 General Symptom/Sign <6 <6 <6 <6 <6 <6 6 <6 <6 <6 233 Complicated Appendectomy 6 <6 <6 <6 7 8 <6 <6 <6 <6 405 Cellulitis <6 <6 <6 10 <6 10 <6 078 Other Musculoskeletal Intervention on Head 16 10 <6 407 Other Disease/Disorder of Skin/Subcutaneous Tissue <6 <6 <6 <6 <6 6 <6 11 258 Other Gastrointestinal Disorder <6 <6 <6 <6 <6 <6 9 747 Reduction/Fixation/Repair of Ankle/Foot <6 <6 <6 <6 <6 <6 729 Replacement/Fixation/Repair of Tibia/Fibula/Knee <6 <6 6 <6 <6 <6 <6 597 Newborn/Neonate 2500+ grams, Cardiovascular Anomaly 10 <6 <6 <6 <6 <6 <6 080 Other Ear Intervention <6 <6 <6 <6 136 Bacterial Pneumonia <6 <6 <6 815 Cancelled Intervention <6 065 Other Ophthalmology Disorder <6 <6 <6 <6 <6 780 Post-Operative Complication except Hemorrhage <6 <6 <6 <6 698 Psychoactive Substance Use, Acute Intoxication <6 <6 678 Schizotypal/Delusional Disorder <6 <6 <6 179 Cardiac Conduction System Intervention <6 8 082 Mastoid Intervention

168 PCMCH Maternal-Child Benchmarking Report 2013

CE 4.1.2 – Top 10 CMGs Typical Inpatient Cases – One and Two Day Stay (cont)

CMG+

TSH

TEGH WGH WRH Total

STEGH

WOHS

WLMH

WDMH WPSHC

TBRHSC

THP-MH

THP-CVH Stevenson

601 Newborn/Neonate 2500+ grams, Other Minor Problem 38 12 110 331 205 461 569 10 35 15 1,874 6 258 10,040 594 Newborn/Neonate 2500+ grams, Jaundice 15 <6 33 95 139 61 213 <6 7 14 294 <6 33 2,587 591 Newborn/Neonate 2500+ grams, Other Respiratory Problem 18 <6 35 64 47 29 117 <6 6 156 41 2,081 086 Oral Cavity/Pharynx Intervention 27 <6 76 58 37 41 63 20 158 15 1,627 147 Asthma 10 <6 18 20 104 68 84 <6 <6 208 34 1,496 141 Upper/Lower Respiratory Infection 16 <6 57 11 47 53 43 112 45 1,400 593 Newborn/Neonate 2500+ grams, Short Gestation 8 6 14 70 44 59 87 15 17 8 180 <6 76 1,394 249 Non-severe Enteritis 10 58 17 71 58 75 188 <6 28 1,375 234 Simple Appendectomy 9 <6 10 12 61 98 22 8 <6 117 <6 49 1,246 138 Viral/Unspecified Pneumonia 16 <6 36 15 68 42 71 76 <6 55 1,196 Newborn/Neonate 2000-2499 grams, Gestational Age 37+ 588 6 6 7 62 62 41 98 <6 <6 <6 142 51 1,175 Weeks 040 Seizure Disorder, except Status Epilepticus 10 <6 33 16 46 18 42 126 <6 12 773 598 Newborn/Neonate 2500+ grams, Other Congenital Anomaly 6 <6 15 57 15 11 22 <6 11 <6 61 35 768 257 Symptom/Sign of Digestive System 22 <6 29 8 48 19 32 <6 77 <6 22 733 661 Other/Unspecified Viral Illness <6 11 6 37 17 19 90 21 504 Reduction/Fixation/Repair Upper Body/Limb except 739 <6 34 22 19 13 11 30 22 484 Fixation/Repair of Shoulder 097 Influenza/Acute Upper Respiratory Infection 6 <6 14 6 37 18 16 65 12 483 Newborn/Neonate 2500+ grams, Major Respiratory 589 <6 <6 <6 8 22 <6 <6 <6 16 20 <6 474 Complication 778 Poisoning/Toxic Effect of Drug <6 <6 23 <6 24 9 22 <6 62 <6 <6 444 806 Convalescence 15 <6 23 14 31 51 22 <6 <6 18 10 443 Newborn/Neonate 2000-2499 grams, Gestational Age 35-36 587 <6 <6 <6 36 21 18 24 <6 <6 <6 42 19 440 Weeks 437 Diabetes 6 7 11 15 6 25 <6 11 398 104 Croup <6 14 9 20 16 8 43 <6 396 687 Stress Reaction/Adjustment Disorder 12 15 24 <6 7 387 148 Other Respiratory Disorder <6 32 8 22 8 17 65 17 355 693 Depressive Episode without ECT 23 <6 <6 10 <6 <6 351 602 Newborn/Neonate 2500+ grams, Haemolytic Disease <6 22 7 6 74 33 <6 343 103 Tonsillitis/Pharyngitis <6 6 <6 13 14 7 27 <6 13 259 776 Open Wound/Other/Unspecified Minor Injury <6 17 <6 14 <6 14 30 <6 <6 254 Newborn/Neonate 2500+ grams, Aspiration Syndrome/Fetal 590 <6 <6 <6 10 10 <6 <6 30 <6 251 Asphyxia 600 Newborn/Neonate 2500+ grams, Other Moderate Problem <6 <6 6 <6 6 10 <6 <6 19 19 214 811 General Symptom/Sign 6 12 7 <6 <6 21 <6 <6 184 233 Complicated Appendectomy <6 <6 10 7 <6 7 <6 18 <6 184 405 Cellulitis <6 6 10 6 7 19 7 147 078 Other Musculoskeletal Intervention on Head 33 <6 25 <6 <6 8 146 407 Other Disease/Disorder of Skin/Subcutaneous Tissue <6 <6 <6 10 <6 6 19 <6 140 258 Other Gastrointestinal Disorder <6 6 <6 <6 <6 <6 <6 14 6 117 747 Reduction/Fixation/Repair of Ankle/Foot 6 <6 <6 <6 <6 <6 <6 <6 83 729 Replacement/Fixation/Repair of Tibia/Fibula/Knee <6 <6 <6 6 <6 <6 <6 <6 81 597 Newborn/Neonate 2500+ grams, Cardiovascular Anomaly <6 <6 <6 <6 <6 <6 <6 71 080 Other Ear Intervention <6 <6 <6 <6 8 52 136 Bacterial Pneumonia <6 <6 <6 45 815 Cancelled Intervention <6 7 <6 <6 <6 <6 44 065 Other Ophthalmology Disorder <6 <6 <6 32 780 Post-Operative Complication except Hemorrhage <6 <6 <6 <6 <6 29 698 Psychoactive Substance Use, Acute Intoxication <6 <6 <6 21 678 Schizotypal/Delusional Disorder <6 <6 <6 20 179 Cardiac Conduction System Intervention 11 082 Mastoid Intervention <6 <6

169 PCMCH Maternal-Child Benchmarking Report 2013

5.0 Quality and Utilization Management Indicators

The most responsible diagnosis codes used in section 5.1 Appropriateness of Care are listed below:

As recommended during the 2008 report data validation process, this section does not include neonatal cases (0-28 days). All indicators are for paediatric cases (29 days – 17 years) only.

170 PCMCH Maternal-Child Benchmarking Report 2013

QUM 5.1.1 - Percentage of Paediatric Admissions Treated for Asthma

The following chart and tables present the percentage of acute care paediatric (29 days – 17 years) inpatient cases that received care for the treatment of Asthma.

Rate of Asthma Cases per Asthma Paediatric Asthma Paediatric Inpatient Cases 1,000 Paediatric Inpatient Hospital Inpatient Cases Per 1000 Paediatric Inpatient Cases (FY 12/13) Cases FY 10/11 FY 11/12 FY 12/13 FY 10/11 FY 11/12 FY 12/13 BCHS BCHS 54 48 32 71 62 47 BGH BGH 9 8 78 68 BWH BWH 34 54 58 58 75 89 CCH CCH 60 36 35 124 90 98 CGMH CGMH <6 29 CMH CMH 54 36 22 80 53 35 GBHS GBHS 20 26 19 41 51 39 GRH GRH 46 62 68 34 41 43 HHCC HHCC 11 11 9 28 24 22 HHS HHS 33 35 34 31 28 29 HRRH 59 58 71 79 63 84 HRRH HSN 43 47 38 43 47 41 HSN JBH 26 15 15 48 31 34 JBH LH 64 60 92 57 44 56 LH MH 57 62 68 76 MH Montfort <6 45 MSH MSH 31 33 21 50 57 35 NBRHC NBRHC 19 17 23 33 29 42 NHH NHH 7 <6 <6 109 74 49 NHS NHS 157 121 113 68 60 59 NYGH NYGH 65 46 43 45 33 34 OSMH OSMH 31 35 29 50 55 52 PRHC PRHC 83 67 62 83 74 82 QHC QHC 51 37 34 106 78 85 RHCF RHCF <6 31 RMH RMH <6 19 RVH RVH 38 24 30 56 34 44 RVHS RVHS 94 109 95 67 71 61 SAH 20 23 19 38 39 34 SAH SJHC Hamilton <6 16 SJHC Toronto SJHC Toronto 86 99 84 103 116 99 SLMHC SLMHC <6 <6 <6 7 12 9 Southlake Southlake 79 65 59 58 46 41 STEGH STEGH 28 26 12 74 76 35 Stevenson Stevenson <6 <6 <6 25 28 58 TBRHSC TBRHSC 41 45 34 29 30 24 TEGH TEGH 47 37 27 62 47 40 THP-CVH THP-CVH 150 89 THP-MH THP-MH 84 75 TSH TSH 109 124 101 83 97 93 WDMH WDMH <6 83 WGH WGH <6 16 WOHS WOHS 278 277 241 87 81 72 WRH WPSHC <6 17 WRH 67 52 43 41 32 32 0 20 40 60 80 100 120

171 PCMCH Maternal-Child Benchmarking Report 2013

QUM 5.1.1 - Percentage of Paediatric Admissions Treated for Asthma (cont)

The following chart and tables present the percentage of acute care paediatric (29 days – 17 years) Emergency Department cases that were admitted for the treatment of Asthma.

Rate of Asthma ED Asthma ED Admissions Asthma ED Admissions Admissions per 1,000 per 1,000 Paediatric Asthma ED Visits (FY 12/13) Hospital Paediatric Asthma ED Visits FY 10/11 FY 11/12 FY 12/13 FY 10/11 FY 11/12 FY 12/13 BCHS BCHS 35 38 31 147 146 152 BGH BGH 10 6 112 69 BWH BWH 22 12 18 102 55 115 CCH CCH 15 20 24 92 106 123 CGMH CGMH <6 16 CMH CMH 27 21 11 129 137 96 GBHS GBHS 14 17 15 50 62 55 GRH GRH 35 35 38 180 160 157 HHCC HHCC 6 14 6 33 81 34 HHS 16 15 17 32 34 41 HHS HRRH HRRH 38 41 52 78 87 102 HSN HSN 31 28 17 223 246 155 JBH JBH 11 111 LH LH 36 26 67 75 56 138 MH MH 40 43 167 169 Montfort <6 34 MSH MSH 16 25 14 71 129 66 NBRHC NBRHC 17 10 16 155 103 178 NHH NHH <6 <6 <6 57 60 41 NHS NHS 89 81 71 258 229 225 NYGH NYGH 44 40 40 114 132 126 OSMH OSMH 13 11 8 73 78 65 PRHC PRHC 70 40 51 267 172 202 QHC QHC 33 30 22 103 114 70 RHCF RHCF <6 48 RMH RMH <6 9 RVH RVH 25 17 20 143 93 120 RVHS RVHS 76 89 79 86 104 99 SAH 14 11 8 80 60 47 SAH SJHC Toronto SJHC Toronto 67 83 69 127 174 158 SLMHC SLMHC <6 <6 <6 26 167 24 Southlake Southlake 59 57 52 215 196 167 STEGH STEGH 13 15 6 107 144 71 Stevenson Stevenson <6 <6 <6 28 9 22 TBRHSC 38 44 29 154 186 141 TBRHSC TEGH 29 32 23 108 123 90 TEGH THP-CVH 98 234 THP-CVH THP-MH 66 171 THP-MH TSH 72 60 52 122 102 99 TSH WDMH <6 14 WDMH WGH <6 10 WGH WOHS 214 215 209 223 237 234 WOHS WPSHC <6 25 WRH 33 30 9 160 146 44 WRH 0 50 100 150 200 250

172 PCMCH Maternal-Child Benchmarking Report 2013

QUM 5.1.2 – Percentage of Paediatric Admissions Treated for Diabetes

The following chart and tables present the percentage of acute care paediatric (29 days – 17 years) inpatient cases that received care for the treatment of Diabetes.

Rate of Diabetes Cases per Diabetes Paediatric Inpatient Cases Per Diabetes Inpatient Cases 1,000 Paediatric Inpatient Hospital Cases 1000 Paediatric Inpatient Cases (FY 12/13) FY 10/11 FY 11/12 FY 12/13 FY 10/11 FY 11/12 FY 12/13 BCHS BCHS 18 13 12 24 17 18 BGH <6 <6 9 9 BGH BWH 16 15 9 27 21 14 BWH CCH <6 <6 5 6 CCH CGMH <6 <6 16 29 CGMH

CMH 14 25 21 21 37 33 CMH

GBHS 18 9 9 37 18 18 GBHS GRH 30 36 38 22 24 24 GRH HHCC 20 21 15 51 46 37 HHCC HHS <6 14 <6 4 11 3 HRRH <6 8 8 7 9 9 HHS HSN 24 29 27 24 29 29 HRRH JBH 14 9 13 26 19 29 HSN LH 23 30 41 21 22 25 JBH

MH 6 16 7 19 LH MHA-SMGH <6 21 MH MSH <6 7 <6 8 12 7 MSH NBRHC 15 10 24 26 17 43 NHH <6 31 NBRHC NHS 55 43 47 24 21 25 NHS NYGH 7 14 7 5 10 6 NYGH OSMH 35 31 30 56 48 54 OSMH PRHC 21 14 26 21 16 34 PRHC

QHC 12 10 <6 25 21 12 QHC RHCF <6 21 RHCF RMH <6 19 RMH RVH 22 23 27 33 32 39 RVHS 29 32 45 21 21 29 RVH SAH 7 8 7 13 14 13 RVHS SBGHC <6 56 SAH SJHC Toronto <6 <6 6 5 4 7 SBGHC SLMHC <6 11 SJHC Toronto

SMH <6 10 Southlake Southlake 21 26 29 15 18 20 STEGH STEGH 6 <6 7 16 12 20 TBRHSC Stevenson <6 28 TBRHSC 17 23 12 12 16 8 THP-CVH TEGH <6 3 THP-MH THP-CVH 18 11 TSH THP-MH 22 20 WGH

TSH 8 12 7 6 9 6 WOHS

WGH <6 16 WPSHC WOHS 49 45 45 15 13 13 WRH WPSHC <6 <6 17 32 0 10 20 30 40 50 60 WRH 39 35 28 24 22 21

173 PCMCH Maternal-Child Benchmarking Report 2013

QUM 5.1.2 – Percentage of Paediatric Admissions Treated for Diabetes (cont)

The following chart and tables present the percentage of acute care paediatric (29 days – 17 years) Emergency Department cases that were admitted for the treatment of Diabetes.

Rate of Diabetes ED Rate of Diabetes ED Admissions per 1,000 Diabetes ED Admissions Admissions per 1,000 Hospital Paediatric Diabetes ED Visits Paediatric Diabetes ED Visits (FY 12/13) FY 10/11 FY 11/12 FY 12/13 FY 10/11 FY 11/12 FY 12/13 BCHS BCHS 16 11 11 500 355 393 BGH BGH <6 <6 333 77 BWH 9 13 7 643 520 778 BWH CCH <6 <6 250 133 CCH CGMH <6 <6 91 125 CGMH CMH 8 21 12 500 808 600 CMH GBHS 17 6 9 486 158 360 GBHS GRH 24 33 27 750 733 600 GRH

HDH <6 250 HHCC HHCC 18 19 11 545 576 407 HHS HHS <6 <6 <6 143 135 111 HRRH HRRH <6 6 7 150 286 318 HSN HSN 16 17 15 593 739 682 JBH 8 471 JBH LH 17 24 25 354 338 379 LH MH <6 12 278 480 MH MSH <6 6 <6 263 261 154 MSH NBRHC <6 6 12 444 667 600 NBRHC

NHH <6 250 NHS

NHS 43 37 37 632 661 685 NYGH NYGH 6 16 <6 429 571 227 OSMH OSMH 12 6 8 800 600 727 PRHC PRHC 16 14 21 615 519 808 QHC 10 8 <6 333 444 278 QHC RHCF <6 333 RHCF RMH <6 83 RMH RVH 20 22 23 465 500 575 RVH RVHS 24 24 28 511 511 528 RVHS

SAH <6 7 6 625 538 500 SAH

SBGHC <6 250 SBGHC SJHC Toronto <6 <6 <6 308 300 444 SJHC Toronto SMH <6 333 Southlake Southlake 18 21 24 563 583 571 STEGH <6 <6 7 400 286 467 STEGH Stevenson <6 <6 500 143 TBRHSC TBRHSC 13 20 7 520 741 318 THP-CVH TEGH <6 143 THP-MH THP-CVH 16 533 TSH THP-MH 20 526 WGH

TSH 7 8 6 333 286 375 WOHS WGH <6 125 WPSHC WOHS 42 35 38 568 412 594 WRH WPSHC <6 <6 250 500 0 200 400 600 800 1000 WRH 20 25 11 625 581 393

174 PCMCH Maternal-Child Benchmarking Report 2013

Operational Efficiency Indicators

Introduction

Trial Balances from Community Hospital members follow MIS guidelines in 3 MIS functional areas:

inpatient acute pediatric wards, neonatal ICU (NICU)

Due to differences in the treatment by institutions in MIS Reporting, revenues (not recoveries) and medical staff fees are excluded, research functional centres and undistributed functional centres are removed – this helps to make benchmarking more comparable.

Funds 1, 2, and 3 are included.

Mount Sinai Hospital, Sunnybrook Health Sciences Centre and St. Michael’s Hospital are included in the community OE indicators because they are not tertiary paediatric centres.

175 PCMCH Maternal-Child Benchmarking Report 2013

6.1 Operational Efficiency Descriptors

6.1.1 OE – Paediatric Inpatient Unit Only (7*270*) Net Operating Costs per Inpatient Day (403* Trial Balance)

Hospital Cost Paediatric Inpatient Net Operating Costs per BCHS 789 Inpatient Day BWH 942 CCH 996 CMH 962 BCHS BWH GRH 910 CCH HSN 749 CMH JBH 489 GRH LH 761 HSN MH 563 JBH MSH 952 LH MH NBRHC 798 MSH NHS 759 NBRHC NYGH 691 NHS OSMH 816 NYGH PRHC 690 OSMH QHC 1,054 PRHC QHC RVH 476 RVH RVHS 743 RVHS SAH 937 SAH SJHC Toronto 1,106 SJHC Toronto Southlake 542 Southlake TBRHSC 679 TBRHSC TEGH TEGH 830 THP THP 775 TSH TSH 1,081 WOHS WOHS 793 WRH WRH 907 0 200 400 600 800 1,000 1,200

176 PCMCH Maternal-Child Benchmarking Report 2013

6.1.2 OE – Paediatric Inpatient Unit Only (7*270*) Compensation Costs (3*) per Inpatient Day (403* Trial Balance)

Hospital Cost Paediatric Inpatient Compensation Costs per BCHS 693 Inpatient Day BWH 858 CCH 887 CMH 863 GRH 821 BCHS HSN 608 JBH 422 BWH LH 647 CCH MH 514 CMH MSH 894 GRH NBRHC 714 HSN NHS 682 NYGH 616 JBH OSMH 737 LH PRHC 690 MH QHC 943 MSH RVH 452 RVHS 638 NBRHC SAH 841 NHS SJHC Toronto 950 NYGH Southlake 463 OSMH TBRHSC 624 PRHC TEGH 765 THP 695 QHC TSH 1,007 RVH WOHS 697 RVHS WRH 785 SAH SJHC Toronto Southlake TBRHSC TEGH THP TSH WOHS WRH

0 200 400 600 800 1,000 1,200

177 PCMCH Maternal-Child Benchmarking Report 2013

6.1.3 OE – Paediatric Inpatient Unit Only (7*270*) UPP Worked Hours (35090*/10*) per Inpatient Day (403* Trial Balance)

UPP Worked Paediatric Inpatient UPP Worked Hours per Hospital Hours Inpatient Day BCHS 10.0 BWH 12.7 CCH 13.5 BCHS CMH 11.0 BWH GRH 10.5 CCH HSN 8.1 JBH 6.0 CMH LH 8.6 GRH MH 7.9 HSN MSH 15.8 JBH NBRHC 10.3 NHS 9.2 LH NYGH 9.9 MH OSMH 11.2 MSH PRHC 11.5 QHC 13.1 NBRHC RVH 8.2 NHS RVHS 7.7 NYGH SAH 13.8 OSMH SJHC Toronto 11.1 Southlake 7.8 PRHC TBRHSC 7.9 QHC TEGH 11.4 RVH THP 9.5 RVHS TSH 14.4 WOHS 10.2 SAH WRH 10.4 SJHC Toronto Southlake TBRHSC TEGH THP TSH WOHS WRH

0.0 5.0 10.0 15.0 20.0

178 PCMCH Maternal-Child Benchmarking Report 2013

6.2 NICU

6.2.1 OE – NICU Net Operating Costs per Inpatient Patient Day

The following table and chart present the NICU (7*24050*) net operating costs per inpatient patient day (403* Trial Balance).

Net Operating Costs per LOC Hospital NICU Net Operating Costs per Inpatient Day Inpatient Day IIc LH 839 IIc NBRHC 738 IIc RVHS 691 LH - IIc IIc SAH 1005 IIc TBRHC 801 IIc WRH 956 NBRHC - IIc IIIa Mt Sinai 1077 IIIa Sunnybrook 1168 RVHS - IIc

SAH - IIc

TBRHC - IIc

WRH - IIc

Mt Sinai - IIIa

Sunnybrook - IIIa

0 500 1000 1500

Note RVHS: RVHS only includes Rouge Valley Centenary Site.

179 PCMCH Maternal-Child Benchmarking Report 2013

6.2.2 OE – NICU Compensation Costs per Inpatient Patient Day

The following table and chart present the NICU (7*24050*) compensation costs (3*) per inpatient patient day (403* Trial Balance).

NICU Compensation Costs LOC Hospital NICU Compensation Costs per Inpatient Day per Inpatient Day IIc LH 745 IIc NBRHC 640 IIc RVHS 644 LH - IIc IIc SAH 865 IIc TBRHC 697 NBRHC - IIc IIc WRH 860 IIIa Mt Sinai 868 RVHS - IIc IIIa Sunnybrook 1013 SAH - IIc

TBRHC - IIc

WRH - IIc

Mt Sinai - IIIa

Sunnybrook - IIIa

0 200 400 600 800 1000 1200

Note RVHS: RVHS only includes Rouge Valley Centenary Site.

180 PCMCH Maternal-Child Benchmarking Report 2013

6.2.3 OE – NICU UPP Worked Hours per Inpatient Patient Day

The following table and chart present the NICU (7*24050*) UPP Worked Hours per Inpatient Patient Day (403* Trial Balance).

NICU UPP Worked Hours LOC Hospital NICU UPP Worked Hours per Inpatient Day per Inpatient Day IIc LH 9.90 IIc NBRHC 10.12 IIc RVHS 9.54 LH - IIc IIc SAH 12.39

IIc TBRHC 10.19 NBRHC - IIc IIc WRH 10.74 IIIa Mt Sinai 12.10 RVHS - IIc IIIa Sunnybrook 13.89 SAH - IIc

TBRHC - IIc

WRH - IIc

Mt Sinai - IIIa

Sunnybrook - IIIa

0.00 5.00 10.00 15.00

Note RVHS: RVHS only includes Rouge Valley Centenary Site.

181 PCMCH Maternal-Child Benchmarking Report 2013

6.3 Obstetrics, Labour and Delivery (LDRP)

6.3.1 OE – Obstetrics, Labour, Delivery, Recovery, Postpartum Net Operating Costs per Inpatient Day

The table and chart below present the Obstetrics, Labour, Delivery, Recovery, Postpartum (LDRP) (7*25090 / 7*2508020) net operating costs per inpatient day (403* Trial Balance).

Obstetrics, LDRP Net Operating Costs per Inpatient Day Net Operating FY 12/13 LOC Hospital Costs per Renfrew Inpatient AGH Ia Renfrew 1688 BGH Ib AGH 574 CCH HHCC Ib BGH 738 NHH Ib CCH 850 QHC Ib HHCC 748 RHCF Ib NHH 736 RMH Ib QHC 892 SLMHC Ib RHCF 903 WDMH Ib RMH 1050 WGH Ib SLMHC 574 WLMH Ib WDMH 750 WPSHC Ib WGH 614 BWH Ib WLMH 575 CMH Ib WPSHC 1789 Montfort IIa BWH 822 NHS IIa CMH 752 BCHS IIa Montfort 747 JBH IIa NHS 840 PRHC IIb BCHS 797 SJHC Hamilton IIb JBH 2180 SJHC Toronto IIb PRHC 661 Southlake IIb SJHC Hamilton 661 THP IIb SJHC Toronto 760 TSH IIb Southlake 712 WOHS IIb THP 753 HSN IIb TSH 618 LH IIb WOHS 763 MH IIc HSN 795 MSH IIc LH 719 NBRHC IIc MH 817 NYGH IIc MSH 668 OSMH IIc NBRHC 783 RVH IIc NYGH 553 RVHS IIc OSMH 896 SAH IIc RVH 768 TBRHC IIc RVHS 821 TEGH IIc SAH 708 WRH IIc TBRHC 317 KGH IIc TEGH 653 MCH HHSC IIc WRH 785 Mt Sinai III KGH 810 Sunnybrook III MCH HHSC 845 0 500 1000 1500 2000 2500 III Mt Sinai 762 III Sunnybrook 788

Note RVHS: RVHS includes both Rouge Valley Ajax and Rouge Valley Centenary Site.

182 PCMCH Maternal-Child Benchmarking Report 2013

6.3.2 OE – Obstetrics, Labour, Delivery, Recovery, Postpartum UPP Worked Hours per Inpatient Day

The table and chart below present the Obstetrics, Labour, Delivery, Recovery, Postpartum (LDRP) (7*25090 / 7*2508020) UPP worked hours per inpatient day (403* Trial Balance).

Obstetrics, LDRP UPP Worked Hours UPP Worked Hours per Inpatient Day (FY 12/13) LOC Hospital per Inpatient Day Renfrew Ia Renfrew 23.6 AGH Ib AGH 7.9 BGH Ib BGH 10.5 CCH Ib CCH 11.4 HHCC Ib HHCC 9.8 NHH QHC Ib NHH 9.6 RHCF Ib QHC 10.9 RMH Ib RHCF 12.9 SLMHC Ib RMH 12.3 WDMH Ib SLMHC 8.8 WGH Ib WDMH 10.5 WLMH Ib WGH 7.9 WPSHC Ib WLMH 8.7 BWH Ib WPSHC 25.7 CMH IIa BWH 10.4 Montfort IIa CMH 9.3 NHS IIa Montfort 10.0 BCHS IIa NHS 11.7 JBH IIb BCHS 9.5 PRHC IIb JBH 32.9 SJHC Hamilton IIb PRHC 7.8 SJHC Toronto IIb SJHC Hamilton 7.7 Southlake IIb SJHC Toronto 8.9 THP IIb Southlake 8.8 TSH IIb THP 9.7 WOHS IIb TSH 7.6 HSN IIb WOHS 9.0 LH IIc HSN 9.5 MH IIc LH 8.8 MSH IIc MH 9.3 NBRHC IIc MSH 8.6 NYGH IIc NBRHC 8.9 OSMH IIc NYGH 6.9 RVH IIc OSMH 11.8 RVHS IIc RVH 9.3 SAH IIc RVHS 9.8 TBRHC IIc SAH 8.9 TEGH IIc TBRHC 4.5 WRH IIc TEGH 8.9 KGH IIc WRH 8.7 MCH HHSC III KGH 9.9 Mt Sinai III MCH HHSC 12.8 Sunnybrook III Mt Sinai 8.7 0 5 10 15 20 25 30 35 III Sunnybrook 9.2

Notes RVHS: RVHS includes both Rouge Valley Ajax and Rouge Valley Centenary Site.

183 PCMCH Maternal-Child Benchmarking Report 2013

6.3.3 OE – Obstetrics, Labour, Delivery, Recovery, Postpartum Compensation Costs per Inpatient

The table and chart below present the Obstetrics, Labour, Delivery, Recovery, Postpartum (LDRP) (7*25090 / 7*2508020) compensation costs per inpatient (403* Trial Balance).

Compensation Obstetrics, LDRP Compensation Costs per Inpatient FY 12/13 LOC Hospital Costs per Inpatient Renfrew AGH Ia Renfrew 1466 BGH Ib AGH 479 CCH Ib BGH 676 HHCC Ib CCH 763 NHH Ib HHCC 649 QHC Ib NHH 618 RHCF Ib QHC 758 RMH Ib RHCF 783 SLMHC Ib RMH 939 WDMH Ib SLMHC 471 WGH Ib WDMH 640 WLMH Ib WGH 540 WPSHC Ib WLMH 507 BWH Ib WPSHC 1648 CMH IIa BWH 720 Montfort IIa CMH 675 NHS IIa Montfort 658 BCHS IIa NHS 770 JBH IIb BCHS 681 PRHC IIb JBH 1865 SJHC Hamilton IIb PRHC 543 SJHC Toronto IIb SJHC Hamilton 560 Southlake IIb SJHC Toronto 629 THP IIb Southlake 629 TSH IIb THP 674 WOHS IIb TSH 536 HSN IIb WOHS 635 LH IIc HSN 659 MH IIc LH 630 MSH IIc MH 674 NBRHC IIc MSH 585 NYGH IIc NBRHC 644 OSMH IIc NYGH 464 RVH IIc OSMH 782 RVHS IIc RVH 660 SAH TBRHC IIc RVHS 710 TEGH IIc SAH 613 WRH IIc TBRHC 295 KGH IIc TEGH 566 MCH HHSC IIc WRH 703 Mt Sinai III KGH 668 Sunnybrook III MCH HHSC 746 III Mt Sinai 666 0 200 400 600 800 1000 1200 1400 1600 III Sunnybrook 637

Note RVHS: RVHS includes both Rouge Valley Ajax and Rouge Valley Centenary Site.

184 PCMCH Maternal-Child Benchmarking Report 2013

6.4 Obstetrics Intermediate Nursery Level II

6.4.1 OE – Obstetrics Intermediate Nursery Level II Net Operating Costs per Inpatient Day

The table and chart below present the obstetrics intermediate nursery Level II net operating costs per inpatient day (403* Trial Balance).

Net Operating Costs Obstetrics Intermediate Nursery Level II LOC Hospital Net Operating Costs per Inpatient Day per Inpatient Day II MCH HHSC 663 II Mt Sinai 705 IIa BCHS 672 MCH HHSC IIa CMH 609 Mt Sinai IIa JBH 490 BCHS IIa Montfort 941 CMH IIa NHS 659 IIa QHC 760 JBH IIb GRH 728 Montfort IIb PRHC 901 NHS IIb RVHS 942 QHC IIb SJHC Hamilton 648 GRH IIb SJHC Toronto 803 IIb Southlake 804 PRHC IIb THP 789 RVHS IIb TSH 724 SJHC Hamilton IIc HSN 1006 SJHC Toronto IIc MH 796 IIc MSH 649 Southlake IIc NYGH 838 THP IIc OSMH 675 TSH IIc RVH 830 HSN IIc TEGH 699 IIc WOHS 844 MH MSH NYGH OSMH RVH TEGH WOHS 0 500 1000 1500

Note RVHS: RVHS only includes Rouge Valley Ajax Site and as such, the LOC has been dropped to IIb.

185 PCMCH Maternal-Child Benchmarking Report 2013

6.4.2 OE – Obstetrics Intermediate Nursery Level II UPP Worked Hours per Inpatient Day

The table and chart below present the obstetrics intermediate nursery Level II (7*2508040) UPP worked hours per inpatient day (403* Trial Balance).

Obstetrics Intermediate Nursery Level II UPP Worked Hours LOC Hospital UPP Worked Hours per Inpatient Day per Inpatient Day MCH HHSC II MCH HHSC 11.5 Mt Sinai II Mt Sinai 8.8 BCHS IIa BCHS 8.8 CMH IIa CMH 8.1 JBH IIa JBH 6.0 IIa Montfort 14.6 Montfort IIa NHS 9.3 NHS IIa QHC 10.0 QHC IIb GRH 8.9 GRH IIb PRHC 10.3 PRHC IIb RVHS 14.9 RVHS IIb SJHC Hamilton 8.1 SJHC Hamilton IIb SJHC Toronto 9.2 IIb Southlake 10.7 SJHC Toronto IIb THP 9.6 Southlake IIb TSH 9.7 THP IIc HSN 13.3 TSH IIc MH 10.8 HSN IIc MSH 8.2 MH IIc NYGH 10.6 MSH IIc OSMH 9.4 IIc RVH 10.5 NYGH IIc TEGH 9.0 OSMH IIc WOHS 10.4 RVH TEGH WOHS

0 5 10 15 20

Note RVHS: RVHS only includes Rouge Valley Ajax Site and as such, the LOC has been dropped to IIb.

186 PCMCH Maternal-Child Benchmarking Report 2013

6.4.3 OE – Obstetrics Intermediate Nursery Level II Compensation Costs per Inpatient Day

The table and chart below present the obstetrics intermediate nursery Level II (7*2508040) compensation costs per inpatient day (403* Trial Balance).

Compensation Obstetrics Intermediate Nursery Level II LOC Hospital Costs per Inpatient Compensation Costs per Inpatient Day Day MCH HHSC II MCH HHSC 618 II Mt Sinai 631 Mt Sinai IIa BCHS 589 BCHS IIa CMH 574 CMH IIa JBH 435 JBH IIa Montfort 795 IIa NHS 601 Montfort IIa QHC 652 NHS IIb GRH 646 QHC IIb PRHC 684 IIb RVHS 898 GRH IIb SJHC Hamilton 596 PRHC IIb SJHC Toronto 667 RVHS IIb Southlake 729 SJHC Hamilton IIb THP 711 IIb TSH 647 SJHC Toronto IIc HSN 878 Southlake IIc MH 706 THP IIc MSH 551 IIc NYGH 761 TSH IIc OSMH 589 HSN IIc RVH 716 MH IIc TEGH 643 MSH IIc WOHS 732 NYGH OSMH RVH TEGH WOHS

0 200 400 600 800 1000

Note RVHS: RVHS only includes Rouge Valley Ajax Site and as such, the LOC has been dropped to IIb.

187 PCMCH Maternal-Child Benchmarking Report 2013

POPULATION-SPECIFIC INDICATORS

188 PCMCH Maternal-Child Benchmarking Report 2013

Neonatal Indicators

Introduction

Included in the 2013 Report are the updated standardized PCMCH Neonatal Levels of Care as identified by each hospital. All neonatal data have been organized according to these levels to help organizations identify peers in order to benchmark their data.

The following multisite organizations are grouped at the highest Level of Care (LOC) delivered:

Grey Bruce Health Services Halton Healthcare Services Corporation Humber River Regional Hospital Lakeridge Health Corporation Rouge Valley Health System The Ottawa Hospital William Osler Health Centre

Neonatal hospital admissions (infants admitted from 0-28 days of age) have a bimodal distribution. A neonate’s hospital journey, in the perinatal period, is related to birth. Most neonates are well and are cared for at the mother’s bedside, whereas others are either at-risk or sick and are cared for at the mother’s bedside for minor problems or in a Neonatal Intensive Care Unit/Special Care Nursery (NICU/SCN) setting for more significant problems. The important aspect about neonates is that the clustering of care is by the perinatal capabilities of the hospital, i.e. Level I, Level II, or Level III for Obstetrics and Neonatology, as opposed to broader paediatric abilities.

Neonates beyond the perinatal period have been discharged home and require admission to hospital only if they are ill. Neonates readmitted beyond the perinatal period are clustered for care around paediatric services. The distinction between the two populations of neonates is important in being able to make meaningful comparisons.

Notes WGH: Woodstock General Hospital data has been excluded from the Neonatal section of the 2013 Benchmarking Report. CIHI DAD and NACRS reports will be updated for the 2013/14 year to include WGH neonatal cases. STEGH: St. Thomas of Elgin General Hospital data has been excluded from Neonatal sections SCN 3.0 and SCN 4.0 of the 2013 Benchmarking Report. STEGH SCN data is not captured in CIHI / DAD. STEGH will have data representation in the next Benchmarking Report.

189 PCMCH Maternal-Child Benchmarking Report 2013

Section Framework

SCN 1.0 Provincial Overview

Indicators 1.1.1 through 1.1.3 utilize BORN Ontario data to provide an overview of births within the province. These data are very specific to the perinatal period and focus on information related to the hospital of birth, such as birth characteristics and the level of care available in the hospital where the birth occurs.

Indicators 1.2.1 and 1.2.2 utilize CIHI data to provide an overview of Neonatal Abstinence Syndrome (NAS) trends in Ontario for FY 2003/04 – FY 2012/13.

SCN 2.0 Neonatal Distribution

This section utilizes CIHI DAD data, excluding normal newborns as defined by most responsible diagnosis Z38, to give more specific information about the in-hospital course of neonates. While this dataset may contain both normal and non-normal neonates, by excluding most responsible diagnosis Z38, it focuses primarily on non-normal neonates and their hospital characteristics irrespective of the location of their stay.

SCN 3.0 NICU/SCN Distribution

This section utilizes CIHI DAD data and also location code data to focus on babies cared for specifically in Neonatal Intensive Care Units (NICUs) and Special Care Nurseries (SCNs) – location codes 50, 51, 52 and 53. Restricting the location code filters the population such that only babies with significant illness are included. Since neonates admitted to NICUs and SCNs are almost exclusively neonates who have never been discharged home, this allows a sub-analysis of neonates specifically admitted in the perinatal period. In some cases, Level II SCNs may have a portion of their volume related to repatriated patients (also referred to as retro-transfers) from Level III NICUs. Many of these patients are repatriated after 28 days of age and are therefore categorized as paediatric patients.

SCN 4.0 NICU/SCN Jaundice

This section utilizes CIHI data for a specific analysis of term neonates with a primary diagnosis of jaundice. The Neonatal Work Group had considerable debate as to whether jaundice was a significant enough diagnosis to be considered non-normal, and this analysis will help answer that question.

190 PCMCH Maternal-Child Benchmarking Report 2013

1.0 Provincial Overview

1.1.1 SCN – Distribution of Ontario Births by LHIN

This table and chart present the distribution of total live births in Ontario by mothers’ LHIN of residence.

Volume Volume Mother's LHIN of Residence Unknown LHIN, 1% (#) (%) North West, 2% Erie St. Clair, 4% Erie St. Clair 6,027 4.4 North East, 4% North Simcoe South West# 9,512 6.9 Muskoka, 3% South West, 7% Waterloo Wellington 8,110 5.9 Waterloo South East, 3% Wellington, 6% Hamilton Niagara 13,005 9.4 CentralHaldimand West Brant 11,091 8.0 Champlain, 10% Mississauga Halton 11,787 8.5 Toronto Central 13,443 9.7 Hamilton Niagara Haldimand Brant, Central 19,166 13.9 9% Central East 15,801 11.4 Central East, 11% South East 4,202 3.0 Central West, 8% Champlain 13,085 9.5 North Simcoe Muskoka 3,908 2.8 Mississauga North East 5,209 3.8 Central, 14% Halton, 9% North West 2,456 1.8 Toronto Central, Unknown LHIN$ 1,255 0.9 10% TOTAL 138,057 100%

Data Source BORN Ontario FY 2012-13

Notes This analysis includes birth weight ≥ 300 grams with all hospital live births for Ontario residents only. Numbers also include 273 records with missing birth weight where gestational age was ≥ 20 weeks $Note that some records are missing both postal code and city and BORN is currently unable to match these records to a LHIN.

191 PCMCH Maternal-Child Benchmarking Report 2013

1.1.2 SCN – Percent Distribution by Mother’s LHIN of Residence and LHIN of Birth Hospital

This table presents the percent distribution of 138, 057 total live births in Ontario by location where mothers residing within each LHIN gave birth. A zero volume or volume less than 6 is blank.

Birth Hospital LHIN

Mother's LHIN of Residence

Erie St. Clair St. Erie West South Wellington Waterloo Niagara Hamilton Brant Haldimand West Central Halton Mississauga Central Toronto Central East Central East South Champlain Muskoka Simcoe North East North West North Erie St. Clair 97.9 3.1 0.1 0.1 0.1 South West# 0.4 92.6 1.8 0.9 0.1 0.1 0.1 0.1 0.1 1.5 0.1 Waterloo Wellington 0.2 2.3 94.2 2.9 0.9 0.5 0.2 0.1 0.1 0.6 0.1 Hamilton Niagara Haldimand Brant 0.1 0.8 1.0 93.0 0.2 4.9 0.4 0.1 0.2 0.1 0.2 0.1 Central West 0.1 0.6 0.2 87.1 14.1 4.8 5.7 0.5 0.7 0.1 Mississauga Halton 0.1 0.8 1.2 3.5 77.4 7.1 1.1 0.4 0.1 0.1 Toronto Central 0.1 0.1 0.1 0.9 1.5 57.8 5.3 2.3 0.1 0.1 0.2 Central 0.1 0.1 0.2 6.8 1.1 19.1 72.8 9.8 0.1 1.3 0.1 Central East 0.1 0.1 0.3 0.2 8.6 11.7 84.4 1.3 0.1 2.0 0.1 South East 0.1 0.6 95.4 1.7 0.1 Champlain 0.1 0.1 0.1 1.6 97.5 0.1 0.1 North Simcoe Muskoka 0.1 0.1 0.2 0.1 0.6 1.4 0.1 0.1 90.2 0.3 North East 0.3 0.6 0.1 2.2 97.7 0.7 North West 0.1 0.2 97.6 Unknown LHIN$ 1.3 0.8 1.0 1.3 0.0 0.1 0.7 1.7 1.5 0.7 0.3 0.9 1.3 1.3 TOTAL 100 100 100 100 100 100 100 100 100 100 100 100 100 100

Data Source BORN Ontario FY 2012-13

Notes This analysis includes birth weight ≥ 300 grams with all hospital live births for Ontario residents only. Numbers also include 273 records with missing birth weight where gestational age was ≥ 20 weeks. $ Note that some records are missing both postal code and city and BORN is currently unable to match these records to a LHIN.

192 PCMCH Maternal-Child Benchmarking Report 2013

1.1.3 SCN – Percent Distribution of Births Under 32 Weeks and/or 1500 Grams

The optimal site for birth of infants less than 32 weeks gestation and a birth weight of under 1,500 grams is in a hospital with a Level III NICU. It is well documented in the literature that the morbidity and mortality rate is higher for these infants when born outside a designated Level III perinatal centre. When possible, women in labour with a fetus less than 32 weeks gestation should be transferred to a Level III unit with fetus in utero.

Note: Some Level IIc units deliver infants at 30 and 31 weeks gestation based on historical practice. This is not yet broadly applied for all Level IIc units.

This graph displays the percent distribution of infants less than 32 weeks gestation and/or a birth weight of under 1,500 grams born at each level of care.

Place of Birth Level Cases % Level 1 46 2.3 Level 1 Level 2 700 35.0 2% Level 3 1,255 62.7 Total 2,001 100.0%

Level 3 Data Source 63% BORN Ontario FY 2012-13

Notes Level 2 This analysis includes birth of infants less than 32 weeks 35% gestation and/or greater than or equal to 300 grams and less than or equal to 1500 grams. Level II includes Level IIa, Level IIb, and level IIc. Level III includes Level IIIa and Level IIIb. A total of 275 records were excluded because birth weight was missing.

193 PCMCH Maternal-Child Benchmarking Report 2013

1.2.1 SCN – Neonatal Abstinence Syndrome Trends in Ontario (most responsible diagnosis)

The table and chart below show the number of infants* with NAS as the most responsible diagnosis, the associated Average Length of Stay and the total number of NAS beds per day** utilized across the province.

Number of infants with Beds per day utilized Top 3 LHINs by FY LOS (AVG) NAS as MRDx across the province Case Volume HNHB = 25 2003-04 105 12.9 3.7 TC = 14 CE = 12 TC = 19 2004-05 124 12.8 4.4 HNHB = 18 NSM = 13 HNHB = 29 2005-06 167 14.2 6.5 NW = 24 TC = 21 NW = 29 2006-07 166 15.6 7.1 HNHB = 27 NSM = 16 HNHB = 46 2007-08 234 14.8 9.5 NW = 41 TC = 27 NW = 60 2008-09 254 15.3 10.6 HNHB = 42 SW = 22 NW = 71 2009-10 360 15.2 15.0 HNHB = 51 ESC = 34 NW = 132 2010-11 489 13.6 18.2 HNHB = 86 ESC = 38 NW = 151 2011-12 593 13.9 22.5 HNHB = 94 NE = 67 NW = 124 2012-13 626 14.1 24.2 HNHB = 99 NSM = 50

700 30

600 25

500 20

400 15 300

10 Day Per BedsNAS 200

5 Number of Infantsof MRDXNAS with Numberas 100

0 0 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13

Beds per day utilized across the province Number of infants With NAS as MRDx

Notes * Represents admissions for patients aged 0 to 28 days. ** NAS Beds Per Day = (NAS Cases * NAS TOTAL LOS Days AVG)/365.

194 PCMCH Maternal-Child Benchmarking Report 2013

1.2.2 SCN – Neonatal Abstinence Syndrome Trends in Ontario (any diagnosis)

The table and chart below show the number of infants* with NAS as any diagnosis**, the associated Average Length of Stay and the total number of NAS Beds per day *** utilized across the province.

Number of infants with Beds per day utilized Top 3 LHINs by FY LOS (AVG) NAS as any Dx across the province Case Volume HNHB = 40 2003-04 168 12.0 5.5 TC = 27 CE = 18 HNHB = 41 2004-05 198 14.0 7.6 TC = 36 CE = 17 HNHB = 51 2005-06 264 13.1 9.5 TC = 40 NW = 34 HNHB = 40 2006-07 248 15.4 10.4 NW = 35 TC = 29 HNHB = 71 2007-08 360 14.4 14.2 NW = 57 TC = 54 NW = 80 2008-09 375 14.7 15.1 HNHB = 58 SW = 47 NW = 87 2009-10 493 14.7 19.9 HNHB = 77 SW = 51 NW = 156 2010-11 654 13.1 23.4 HNHB = 112 SW = 59 NW = 175 2011-12 797 13.3 29.0 HNHB = 128 NE = 75 NW = 162 2012-13 855 13.7 32.1 HNHB = 135 NSM = 81

900 35

800 30 700 25 600

500 20

400 15

300 Day Per BedsNAS 10 200

Number of Infants with NAS as AnyNASInfantsof Dx with as Number 5 100

0 0 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13

Beds per day utilized across the province Number of infants With NAS as Any Dx

Notes * Represents admission for patients aged 0 to 28 days. **Any diagnosis, not just the most responsible *** NAS Beds Per Day = (NAS Cases * NAS TOTAL LOS Days AVG)/365.

195 PCMCH Maternal-Child Benchmarking Report 2013

2.0 Neonatal Distribution

This section includes all neonatal inpatient cases of the participating hospitals, with the exclusion criteria applied. The charts display neonatal cases (0‐28 days) only.

SCN 2.1.1 – Neonatal Inpatient Cases

This table presents the total number of neonatal cases and neonatal cases as percent of all inpatient cases 0‐17 years of age. The cases are also broken into typical and non‐typical cases. Non‐typical cases are those representing unusual or exceptional circumstances during the patient care episode. These cases include: deaths, long stays, transfer to/or from other acute care institutions and sign outs.

Typical Neonatal Cases Non-Typical Neonatal Neonatal Cases as % of LOC Hospital Neonatal Cases as % of Total Neonatal Cases as % of Total Total Inpatient Cases Cases Neonatal Cases

I AGH 88 98% 85% 15% I BGH 128 52% 89% 11% I CCH 149 30% 84% 16% I CGMH 78 69% 47% 53% I GBGH 46 41% 72% 28% I HHCC 154 28% 87% 13% I MHA-SMGH 27 36% 81% 19% I NHH 110 64% 83% 17% I QHC 665 62% 89% 11% I Renfrew 9 41% 100% 0% I RHCF 28 22% 93% 7% I RMH 88 62% 88% 13% I SBGHC 68 79% 82% 18% I SLMHC 204 48% 93% 7% I Stevenson 73 51% 78% 22% I WDMH 85 88% 80% 20% I WLMH 159 99% 70% 30% I WPSHC 37 37% 81% 19% IIa BCHS 466 41% 77% 23% IIa BWH 352 35% 90% 10% IIa CMH 749 54% 89% 11% IIa JBH 464 51% 88% 12% IIa Montfort 864 98% 92% 8% IIa NHS 1,134 37% 84% 16% IIa STEGH 204 37% 80% 20%

196 PCMCH Maternal-Child Benchmarking Report 2013

SCN 2.1.1 – Neonatal Inpatient Cases (cont)

Typical Neonatal Cases Non-Typical Neonatal Neonatal Cases as % of LOC Hospital Neonatal Cases as % of Total Neonatal Cases as % of Total Total Inpatient Cases Cases Neonatal Cases

IIb GBHS 285 37% 81% 19% IIb GRH 1,661 51% 89% 11% IIb HHS 984 46% 86% 14% IIb HRRH 1,007 54% 78% 22% IIb PRHC 593 44% 85% 15% IIb SJHC Hamilton 1,164 97% 81% 19% IIb SJHC Toronto 1,222 59% 91% 9% IIb Southlake 744 34% 86% 14% IIb THP-MH 1,206 52% 92% 8% IIb TSH 2,021 65% 93% 7% IIc HSN 469 34% 88% 12% IIc LH 1,374 46% 92% 8% IIc MH 1,023 55% 95% 5% IIc MSH 897 60% 91% 9% IIc NBRHC 369 40% 83% 17% IIc NYGH 2,995 70% 94% 6% IIc OSMH 551 50% 79% 21% IIc RVH 531 44% 85% 15% IIc RVHS 1,525 50% 90% 10% IIc SAH 339 38% 90% 10% IIc SMH 1,134 91% 88% 12% IIc TBRHSC 839 37% 90% 10% IIc TEGH 1,233 65% 87% 13% IIc THP-CVH 1,608 49% 86% 14% IIc WOHS 4,325 56% 94% 6% IIc WRH 1,018 43% 92% 8% IIIa Mt Sinai 2,869 97% 69% 31% IIIa Sunnybrook 1,525 91% 60% 40% IIIa TOH 2,392 94% 83% 17% IIIb CH LHSC 1,804 30% 80% 20% IIIb CHEO 645 10% 43% 57% IIIb KGH 679 31% 80% 20% IIIb MCH HHSC 1,822 25% 53% 47% IIIb Sickkids 1,123 8% 27% 73%

197 PCMCH Maternal-Child Benchmarking Report 2013

SCN 2.1.2 – Neonatal Average LOS

These table present the average length of stay for all neonatal (0‐28 days of age) inpatients. The length of stay is calculated from the date of admission to the date of discharge in days. Hospitals that joined the Benchmarking project in 2012 do not have data for FY 10/11. Hospitals that joined the Benchmarking project in 2013 do not have data for FY 11/12.

LOC Hospital FY 2010/11 FY 2011/12 FY 2012/13 LOC Hospital FY 2010/11 FY 2011/12 FY 2012/13 I AGH 2.5 IIb GBHS 4.9 4.9 5.8 I BGH 2.7 2.4 IIb GRH 4.5 4.7 4.4 I CCH 2.6 2.5 2.1 IIb HHS 3.4 3.4 I CGMH 1.8 1.6 IIb HRRH 4.3 4.1 I GBGH 2.1 IIb PRHC 4.8 4.9 5.3 I HHCC 2.9 2.5 2.5 IIb SJHC Hamilton 6.3 6.3 5.9 I MHA-SMGH 2.1 2.6 2.0 IIb SJHC Toronto 3.9 4.0 4.0 I NHH 2.3 2.3 2.1 IIb Southlake 4.7 5.0 4.9 I QHC 3.3 3.5 3.7 IIb THP-MH 4.1 I Renfrew 2.4 IIb TSH 3.8 4.1 3.9 I RHCF 2.9 IIc HSN 6.3 5.7 6.1 I RMH 2.3 2.3 2.2 IIc LH 4.1 4.0 I SBGHC 0.0 1.8 1.8 IIc MH 3.6 3.4 I SLMHC 2.4 2.0 2.3 IIc MSH 3.4 3.4 3.7 I Stevenson 1.7 2.0 1.7 IIc NBRHC 5.7 5.4 5.7 I WDMH 2.1 IIc NYGH 3.9 3.6 3.4 I WLMH 2.1 2.0 1.8 IIc OSMH 8.0 6.8 6.4 I WPSHC 0.0 2.6 2.7 IIc RVH 6.4 6.4 7.1 IIa BCHS 5.5 5.2 5.4 IIc RVHS 4.6 4.6 4.6 IIa BWH 5.1 4.9 4.2 IIc SAH 5.1 5.2 4.9 IIa CMH 3.0 3.1 3.5 IIc SMH 6.0 5.6 5.9 IIa JBH 3.0 3.6 4.0 IIc TBRHSC 6.7 7.2 7.0 IIa Montfort 3.3 3.0 IIc TEGH 4.2 4.5 4.5 IIa NHS 4.6 4.3 4.4 IIc THP-CVH 6.8 IIa STEGH 4.8 4.2 4.9 IIc WOHS 4.6 3.9 3.5 IIc WRH 6.2 5.8 6.1 IIIa Mt Sinai 7.4 7.6 7.1 IIIa Sunnybrook 11.3 10.3 9.8 IIIa TOH 6.5 6.5 IIIb CH LHSC 8.4 9.8 IIIb CHEO 11.2 12.1 11.0 IIIb KGH 0.0 10.0 11.8 IIIb MCH HHSC 11.8 11.8 12.5 IIIb Sickkids 17.3 18.8

Notes CH LHSC: St. Joseph’s Health Centre, London moved their maternal-newborn program to CH LHSC in June 2011. TOH: Level 3 Neonatal Intensive Care unit includes a newborn observation area and includes level 1 neonatal patients. This may dilute some of the indicator values for NICU reported by our facility such as ALOS and ARIW.

198 PCMCH Maternal-Child Benchmarking Report 2013

SCN 2.1.3 – Total Average Inpatient Weight per Case

This table presents the ARIW for all inpatient neonatal cases. The ARIW per case is reflective of the amount of resources required by the hospitals to care for patients based on the CMG during their total hospital stay.

LOC Hospital Neonatal ARIW LOC Hospital Neonatal ARIW

I AGH 0.34 IIc HSN 1.18 I BGH 0.41 IIc LH 0.74 I CCH 0.43 IIc MH 0.80 I CGMH 0.27 IIc MSH 0.78 I GBGH 0.31 IIc NBRHC 0.91 I HHCC 0.40 IIc NYGH 0.64 I MHA-SMGH 0.29 IIc OSMH 1.29 I NHH 0.29 IIc RVH 1.27 I QHC 0.63 IIc RVHS 0.81 I Renfrew 0.40 IIc SAH 0.81 I RHCF 0.53 IIc SMH 1.05 I RMH 0.28 IIc TBRHSC 1.07 I SBGHC 0.31 IIc TEGH 0.92 I SLMHC 0.32 IIc THP-CVH 1.15 I Stevenson 0.29 IIc WOHS 0.66 I WDMH 0.31 IIc WRH 1.46 I WLMH 0.32 IIIa Mt Sinai 1.82 I WPSHC 0.29 IIIa Sunnybrook 2.63 IIa BCHS 0.85 IIIa TOH 1.48 IIa BWH 0.67 IIIb CH LHSC 2.81 IIa CMH 0.60 IIIb CHEO 3.28 IIa JBH 0.67 IIIb KGH 2.70 IIa Montfort 0.52 IIIb MCH HHSC 3.78 IIa NHS 0.74 IIIb Sickkids 6.70 IIa STEGH 0.92 IIb GBHS 1.03 IIb GRH 0.81 IIb HHS 0.60 IIb HRRH 0.73 IIb PRHC 0.91 IIb SJHC Hamilton 1.01 IIb SJHC Toronto 0.80 IIb Southlake 0.89 IIb THP-MH 0.69 IIb TSH 0.67

Notes TOH: Level 3 Neonatal Intensive Care unit includes a newborn observation area and includes level 1 neonatal patients. This may dilute some of the indicator values for NICU reported by our facility such as ALOS and ARIW. Mt Sinai: Mt Sinai is completing a comprehensive analysis to determine factors associated with the reported ARIW which does not appear to be reflecting the complexity/acuity of the population served.

199 PCMCH Maternal-Child Benchmarking Report 2013

SCN 2.1.4 – Percent Neonatal “Transfer From” Inpatient Cases and Patient Days

The table below presents the percentage of neonatal cases, and associated days that were recorded as “Transferred From” another acute care institution within CIHI coding. Hospitals with less than 6 cases are indicated as “<6”.

Neonatal Neonatal "Transfers Neonatal Neonatal "Transfers LOC Hospital "Transfers From" Cases as % of "Transfers From" Days as % of Total From" Cases Total Neonatal Cases From" Days Neonatal Days I AGH <6 2% <6 1% I BGH <6 2% 14 5% I CCH <6 3% 12 4% I CGMH <6 4% <6 3% I GBGH <6 2% <6 3% I HHCC <6 3% 13 3% I MHA-SMGH <6 4% <6 2% I NHH <6 2% <6 2% I QHC 17 3% 212 9% I Stevenson <6 1% <6 2% I WLMH <6 1% <6 0% I WPSHC <6 8% 7 7% IIa BCHS 48 10% 488 19% IIa BWH 7 2% 82 6% IIa CMH 39 5% 490 19% IIa JBH 24 5% 265 14% IIa Montfort 13 2% 74 3% IIa NHS 91 8% 1,172 24% IIa STEGH 29 14% 464 46% IIb GBHS 23 8% 294 18% IIb GRH 109 7% 1,776 24% IIb HHS 59 6% 673 20% IIb HRRH 74 7% 583 14% IIb PRHC 52 9% 764 24% IIb SJHC Hamilton 138 12% 1,988 29% IIb SJHC Toronto 63 5% 900 18% IIb Southlake 65 9% 1,093 30% IIb THP-MH 22 2% 394 8% IIb TSH 54 3% 1,066 14% IIc HSN 18 4% 235 8% IIc LH 69 5% 904 17% IIc MH 27 3% 647 18% IIc MSH 29 3% 381 11% IIc NBRHC 11 3% 184 9% IIc NYGH 99 3% 2,176 21% IIc OSMH 90 16% 1,124 32% IIc RVH 42 8% 736 20% IIc RVHS 77 5% 1,823 26% IIc SAH 12 4% 157 9% IIc SMH 89 8% 1,916 29% IIc TBRHSC 27 3% 390 7% IIc TEGH 97 8% 1,701 30% IIc THP-CVH 107 7% 2,484 23% IIc WOHS 111 3% 1,679 11% IIc WRH 23 2% 403 6% IIIa Mt Sinai 32 1% 1,438 7% IIIa Sunnybrook 58 4% 1,877 13% IIIa TOH 98 4% 1,911 12% IIIb CH LHSC 150 8% 2,107 12% IIIb CHEO 324 50% 5,105 72% IIIb KGH 47 7% 853 11% IIIb MCH HHSC 348 19% 5,992 26% IIIb Sickkids 779 69% 18,940 90%

200 PCMCH Maternal-Child Benchmarking Report 2013

SCN 2.1.5 – Percent Neonatal “Transfer To” Inpatient Cases and Patient Days

The table below presents the percentage of neonatal cases and associated days that were recorded as “Transferred To” another acute care institution within CIHI coding Hospitals with less than 6 cases are indicated as “<6”.

Neonatal Neonatal "Transfers Neonatal Neonatal "Transfers LOC Hospital "Transfers To" To" Cases as % of Total "Transfers To" To" Days as % of Total Cases Neonatal Cases Days Neonatal Days I AGH 11 13% 17 8% I BGH 7 5% 8 3% I CCH 18 12% 20 6% I CGMH 36 46% 37 29% I GBGH 10 22% 10 10% I HHCC 14 9% 19 5% I MHA-SMGH <6 19% <6 9% I NHH 16 15% 19 8% I QHC 36 5% 101 4% I RHCF <6 7% <6 2% I RMH 11 13% 13 7% I SBGHC 11 16% 13 10% I SLMHC 13 6% 15 3% I Stevenson 14 19% 14 11% I WDMH 15 18% 19 11% I WLMH 45 28% 49 17% I WPSHC <6 11% <6 5% IIa BCHS 30 6% 80 3% IIa BWH 15 4% 58 4% IIa CMH 37 5% 69 3% IIa JBH 27 6% 81 4% IIa Montfort 46 5% 100 4% IIa NHS 66 6% 257 5% IIa STEGH 6 3% 52 5% IIb GBHS 20 7% 35 2% IIb GRH 63 4% 258 4% IIb HHS 67 7% 113 3% IIb HRRH 109 11% 222 5% IIb PRHC 16 3% 41 1% IIb SJHC Hamilton 52 4% 186 3% IIb SJHC Toronto 30 2% 109 2% IIb Southlake 26 3% 96 3% IIb THP-MH 31 3% 119 2% IIb TSH 38 2% 75 1% IIc HSN 24 5% 157 5% IIc LH 40 3% 115 2% IIc MH 14 1% 26 1% IIc MSH 37 4% 152 5% IIc NBRHC 15 4% 96 5% IIc NYGH 56 2% 179 2% IIc OSMH 34 6% 127 4% IIc RVH 14 3% 68 2% IIc RVHS 52 3% 284 4% IIc SAH 7 2% 11 1% IIc SMH 38 3% 273 4% IIc TBRHSC 19 2% 96 2% IIc TEGH 34 3% 82 1% IIc THP-CVH 53 3% 255 2% IIc WOHS 106 2% 312 2% IIc WRH 24 2% 130 2% IIIa Mt Sinai 712 25% 10471 52% IIIa Sunnybrook 534 35% 9992 67% IIIa TOH 273 11% 3344 22% IIIb CH LHSC 179 10% 3256 18% IIIb CHEO 76 12% 951 13% IIIb KGH 42 6% 1066 13% IIIb MCH HHSC 607 33% 8024 35% IIIb Sickkids 342 30% 5945 28%

Note SAH: Reported 11 total ‘Transfers to’ another facility with a total LOS days of 53. <6 cases ‘Transferred to’ Children’s Aid Society or Foster Care facility.

201 PCMCH Maternal-Child Benchmarking Report 2013

SCN 2.1.6 – Percent Cases and Days with LOS > 30 Days

This table shows the percentage of all neonatal inpatient cases and associated days with a total length of stay greater than 30 days. Hospitals with less than 6 cases are indicated as “<6”. Hospitals with 0 cases are excluded.

Neonatal Cases with Neonatal Days with LOS Neonatal Cases with Neonatal Days with LOS LOC Hospital LOS > 30 Days as % of > 30 Days as % of Total LOS > 30 Days > 30 Days Total Neonatal Cases Neonatal Days

I QHC <6 0.3% 98 4.0% IIa BCHS <6 0.4% 73 2.9% IIa BWH <6 1.1% 172 11.7% IIa CMH <6 0.4% 103 3.9% IIa JBH <6 0.6% 104 5.7% IIa Montfort <6 0.1% 31 1.2% IIa NHS 7 0.6% 258 5.2% IIa STEGH <6 2.0% 169 16.8% IIb GBHS <6 1.8% 198 12.1% IIb GRH 20 1.2% 774 10.6% IIb HHS <6 0.5% 171 5.2% IIb HRRH 21 2.1% 853 20.4% IIb PRHC 6 1.0% 277 8.9% IIb SJHC Hamilton 32 2.7% 1,327 19.4% IIb SJHC Toronto 21 1.7% 760 15.4% IIb Southlake 9 1.2% 366 10.0% IIb THP-MH 13 1.1% 513 10.4% IIb TSH 26 1.3% 1,059 13.6% IIc HSN 16 3.4% 589 20.5% IIc LH 19 1.4% 760 13.9% IIc MH 19 1.9% 802 22.8% IIc MSH <6 0.4% 140 4.2% IIc NBRHC 7 1.9% 250 11.9% IIc NYGH 43 1.4% 1,805 17.7% IIc OSMH 28 5.1% 1,098 31.3% IIc RVH 17 3.2% 720 19.1% IIc RVHS 40 2.6% 1,642 23.6% IIc SAH 6 1.8% 233 14.0% IIc SMH 43 3.8% 1,851 27.9% IIc TBRHSC 20 2.4% 863 16.1% IIc TEGH 25 2.0% 1,009 18.0% IIc THP-CVH 63 3.9% 2,715 24.8% IIc WOHS 51 1.2% 1,893 12.5% IIc WRH 41 4.0% 1,871 30.0% IIIa Mt Sinai 154 5.4% 10,080 49.6% IIIa Sunnybrook 136 8.9% 8,229 55.1% IIIa TOH 76 3.2% 3,922 25.3% IIIb CH LHSC 139 7.7% 9,340 53.0% IIIb CHEO 51 7.9% 2,927 41.4% IIIb KGH 70 10.3% 4,329 54.1% IIIb MCH HHSC 153 8.4% 12,632 55.7% IIIb Sickkids 169 15.0% 13,286 63.4%

202 PCMCH Maternal-Child Benchmarking Report 2013

3.0 NICU/SCN Distribution

SCN 3.1.1 – NICU/SCN Inpatient Cases

This table presents inpatient cases based on the following locations in the CIHI DAD abstract: 50 NICU (NICU undifferentiated/general), 51 NICU Level 1, 52 NICU Level 2, and 53 NICU Level 3. The table further breaks down cases by typical and non-typical cases. Non‐typical cases are those representing unusual or exceptional circumstances during the patient care episode. These cases include: deaths, long stays, transfer to/or from other acute care institutions and sign outs. Hospitals with 0 cases are excluded.

Typical NICU/SCN Non-typical Total NICU/SCN Typical NICU/SCN Cases as % of Total Non-typical NICU/SCN Cases as % LOC Hospital Inpatient Cases Cases NICU/SCN Inpatient NICU/SCN Cases of Total NICU/SCN Cases Inpatient Cases IIa BCHS 301 198 65.8% 103 34.2% IIa JBH 202 147 72.8% 55 27.2% IIa Montfort 396 331 83.6% 65 16.4% IIa NHS 429 266 62.0% 163 38.0% IIb GBHS 203 152 74.9% 51 25.1% IIb GRH 637 452 71.0% 185 29.0% IIb HHS 222 132 59.5% 90 40.5% IIb HRRH 310 186 60.0% 124 40.0% IIb PRHC 332 252 75.9% 80 24.1% IIb SJHC Hamilton 490 260 53.1% 230 46.9% IIb SJHC Toronto 407 302 74.2% 105 25.8% IIb Southlake 411 304 74.0% 107 26.0% IIb THP-MH 540 457 84.6% 83 15.4% IIb TSH 651 520 79.9% 131 20.1% IIc HSN 272 215 79.0% 57 21.0% IIc LH 394 287 72.8% 107 27.2% IIc MH 345 292 84.6% 53 15.4% IIc MSH 281 199 70.8% 82 29.2% IIc NBRHC 82 52 63.4% 30 36.6% IIc NYGH 450 284 63.1% 166 36.9% IIc OSMH 322 215 66.8% 107 33.2% IIc RVH 295 211 71.5% 84 28.5% IIc RVHS 700 549 78.4% 151 21.6% IIc SAH 135 111 82.2% 24 17.8% IIc SMH 482 324 67.2% 158 32.8% IIc TBRHSC 439 352 80.2% 87 19.8% IIc TEGH 436 291 66.7% 145 33.3% IIc THP-CVH 793 559 70.5% 234 29.5% IIc WOHS 1375 1120 81.5% 255 18.5% IIc WRH 438 363 82.9% 75 17.1% IIIa Mt Sinai 1215 410 33.7% 805 66.3% IIIa Sunnybrook 819 215 26.3% 604 73.7% IIIa TOH 1557 1141 73.3% 416 26.7% IIIb CH LHSC 819 563 68.7% 256 31.3% IIIb CHEO 379 37 9.8% 342 90.2% IIIb KGH 426 299 70.2% 127 29.8% IIIb MCH HHSC 1266 444 35.1% 822 64.9% IIIb Sickkids 660 26 3.9% 634 96.1%

203 PCMCH Maternal-Child Benchmarking Report 2013

SCN 3.1.2 – NICU/SCN Age Profile

This table and chart present the age profile for inpatients (neonatal 0‐28 days and paediatrics 29 days and over at date of admission) in the following NICU/SCN locations in the CIHI DAD abstract: 50 NICU (NICU undifferentiated/ general), 51 NICU Level 1, 52 NICU Level 2, and 53 NICU Level 3. Hospitals with less than 6 cases are indicated as “<6”. Hospitals with 0 cases are excluded.

29 Days and NICU/SCN Age Profile LOC Hospital 0-28 Days Over BCHS IIa BCHS 297 <6 JBH IIa JBH 198 <6 Montfort NHS IIa Montfort 395 <6 GBHS IIa NHS 417 12 GRH IIb GBHS 200 <6 HHS IIb GRH 608 29 HRRH IIb HHS 220 <6 PRHC IIb HRRH 300 10 SJHC Hamilton IIb PRHC 328 <6 SJHC Toronto IIb SJHC Hamilton 472 18 Southlake IIb SJHC Toronto 393 14 THP-MH IIb Southlake 397 14 TSH IIb THP-MH 535 <6 HSN IIb TSH 637 14 LH IIc HSN 255 17 MH IIc LH 383 11 MSH IIc MH 334 11 NBRHC IIc MSH 264 17 NYGH IIc NBRHC 80 <6 OSMH IIc NYGH 424 26 RVH IIc OSMH 320 <6 RVHS IIc RVH 281 14 SAH IIc RVHS 670 30 SMH IIc SAH 134 <6 TBRHSC TEGH IIc SMH 450 32 THP-CVH IIc TBRHSC 411 28 WOHS IIc TEGH 426 10 WRH IIc THP-CVH 751 42 Mt Sinai IIc WOHS 1,347 28 Sunnybrook IIc WRH 423 15 TOH IIIa Mt Sinai 1,197 18 CH LHSC IIIa Sunnybrook 802 17 CHEO IIIa TOH 1,527 30 KGH IIIb CH LHSC 807 12 MCH HHSC IIIb CHEO 356 23 Sickkids

IIIb KGH 416 10 80% 85% 90% 95% 100% IIIb MCH HHSC 1,255 11 0-28 Days 29 Days and Over IIIb Sickkids 595 65

204 PCMCH Maternal-Child Benchmarking Report 2013

SCN 3.1.3 – NICU/SCN Average LOS

This table and chart present the Average LOS for all inpatient cases based on the following NICU/SCN locations in the CIHI DAD abstract: 50 NICU (NICU undifferentiated/general), 51 NICU Level 1, 52 NICU Level 2, and 53 NICU Level 3. The LOS is calculated from the date of admission to the date of discharge, in days. Hospitals that joined the Benchmarking project in 2012 do not have data for FY 09/10 and FY 10/11. Hospitals with 0 cases are excluded.

LOC Hospital FY 10/11 FY 11/12 FY 12/13 NICU Average LOS in Days (FY 12/13)

IIa BCHS 7.2 6.7 6.1 BCHS IIa JBH 4.5 5.5 6.2 JBH IIa Montfort 3.1 0.9 2.6 Montfort IIa NHS 8.1 7.4 7.7 NHS IIb GBHS 6.4 6.9 6.4 GBHS IIb GRH 8.9 9.4 8.3 GRH IIb HHS 8.4 7.3 HHS IIb HRRH 7.6 6.8 9.0 HRRH IIb PRHC 6.4 6.6 6.9 PRHC IIb SJHC Hamilton 10.8 11.6 10.9 SJHC Hamilton IIb SJHC Toronto 9.6 9.1 8.3 SJHC Toronto IIb Southlake 6.9 7.2 6.7 Southlake IIb THP-MH 6.2 THP-MH IIb TSH 7.3 8.0 7.6 TSH IIc HSN 9.2 7.8 7.9 HSN LH IIc LH 7.7 8.5 8.0 MH IIc MH 5.9 6.7 6.9 MSH IIc MSH 7.3 7.2 8.0 NBRHC IIc NBRHC 9 9.6 8.7 NYGH IIc NYGH 12.9 12.4 12.1 OSMH IIc OSMH 9.7 8.2 8.9 RVH IIc RVH 8.8 9.9 10.2 RVHS IIc RVHS 7.9 9.0 8.0 SAH IIc SAH 8.5 7.8 7.8 SMH IIc SMH 11.5 12.3 12.2 TBRHSC IIc TBRHSC 8.7 8.1 7.8 TEGH IIc TEGH 9.7 9.6 8.7 THP-CVH IIc THP-CVH 12.0 WOHS IIc WOHS 8.9 8.2 7.2 WRH IIc WRH 11.6 11.8 12.2 Mt Sinai IIIa Mt Sinai 15.5 15.5 13.9 Sunnybrook IIIa Sunnybrook 19.6 18.6 17.0 TOH IIIa TOH 8.2 7.9 CH LHSC IIIb CH LHSC 16.3 16.0 CHEO IIIb CHEO 12.9 13.6 12.8 KGH MCH HHSC IIIb KGH 12 15.8 15.1 Sickkids IIIb MCH HHSC 16.5 16.0 15.2 IIIb Sickkids 19.1 16.3 17.2 0 5 10 15 20

205 PCMCH Maternal-Child Benchmarking Report 2013

SCN 3.1.4 – Percent NICU/SCN “Transfer From” Inpatient Cases and Days

This chart presents the proportion of all inpatient cases that were recorded as “transferred from” another institution that spent time in a NICU, locations 50 NICU (NICU undifferentiated/general), 51 NICU Level 1, 52 NICU Level 2, and 53 NICU Level 3 in the CIHI DAD abstract.

Inpatient Cases: "Transfers Inpatient Cases: "Transfers From" other Institutions From" other Institutions to to NICU / SCN (as % of all NICU/SCN cases) NICU / SCN LOC Hospital As % Of All Total BCHS NICU/SCN Number JBH Cases Montfort IIa BCHS 51 17% NHS IIa JBH 27 13% GBHS IIa Montfort 14 4% GRH IIa NHS 94 22% HHS IIb GBHS 25 12% HRRH IIb GRH 132 21% PRHC IIb HHS 61 27% SJHC Hamilton IIb HRRH 79 25% SJHC Toronto IIb PRHC 51 15% Southlake IIb SJHC Hamilton 156 32% THP-MH IIb SJHC Toronto 68 17% TSH IIb Southlake 75 18% HSN IIb THP-MH 26 5% LH IIb TSH 64 10% IIc HSN 27 10% MH IIc LH 75 19% MSH IIc MH 37 11% NBRHC IIc MSH 45 16% NYGH IIc NBRHC <6 6% OSMH IIc NYGH 108 24% RVH IIc OSMH 87 27% RVHS IIc RVH 52 18% SAH IIc RVHS 96 14% SMH IIc SAH 9 7% TBRHSC IIc SMH 119 25% TEGH IIc TBRHSC 38 9% THP-CVH IIc TEGH 108 25% WOHS IIc THP-CVH 142 18% WRH IIc WOHS 133 10% Mt Sinai IIc WRH 31 7% Sunnybrook IIIa Mt Sinai 44 4% TOH IIIa Sunnybrook 74 9% CH LHSC IIIa TOH 121 8% CHEO IIIb CH LHSC 90 11% KGH IIIb CHEO 342 90% MCH HHSC IIIb KGH 48 11% Sickkids IIIb MCH HHSC 345 27% 0% 20% 40% 60% 80% 100% IIIb Sickkids 638 97%

206 PCMCH Maternal-Child Benchmarking Report 2013

SCN 3.1.5 – Percent NICU/SCN “Transfer To” Inpatient Cases and Days

This chart and table present the proportion of all inpatient cases that were recorded as “transferred to” another institution that spent time in a NICU, locations 50 NICU (NICU undifferentiated/general), 51 NICU Level 1, 52 NICU Level 2, and 53 NICU Level 3 in the CIHI DAD abstract.

Inpatient Cases: "Transfers To" other Institution Inpatient Cases: "Transfers To" NICU/SCN (As % Of All NICU/SCN Cases) other Institution NICU/SCN LOC Hospital As % Of All BCHS Total Number NICU/SCN JBH Cases Montfort IIa BCHS 41 14% NHS IIa JBH 25 12% GBHS IIa Montfort 44 11% GRH IIa NHS 60 14% HHS IIb GBHS 25 12% HRRH IIb GRH 59 9% PRHC IIb HHS 22 10% SJHC Hamilton IIb HRRH 24 8% SJHC Toronto IIb PRHC 24 7% Southlake IIb SJHC Hamilton 77 16% THP-MH IIb SJHC Toronto 36 9% TSH IIb Southlake 30 7% HSN IIb THP-MH 28 5% LH IIb TSH 41 6% MH IIc HSN 39 14% MSH IIc LH 38 10% NBRHC IIc MH 14 4% NYGH IIc MSH 38 14% OSMH IIc NBRHC 11 13% RVH IIc NYGH 59 13% IIc OSMH 40 12% RVHS IIc RVH 25 8% SAH IIc RVHS 48 7% SMH IIc SAH 10 7% TBRHSC IIc SMH 44 9% TEGH IIc TBRHSC 32 7% THP-CVH IIc TEGH 37 8% WOHS IIc THP-CVH 55 7% WRH IIc WOHS 97 7% Mt Sinai IIc WRH 32 7% Sunnybrook IIIa Mt Sinai 719 59% TOH IIIa Sunnybrook 540 66% CH LHSC IIIa TOH 291 19% CHEO IIIb CH LHSC 184 22% KGH IIIb CHEO 120 32% MCH HHSC IIIb KGH 53 12% Sickkids IIIb MCH HHSC 665 53% 0% 10% 20% 30% 40% 50% 60% 70% IIIb Sickkids 360 55%

207 PCMCH Maternal-Child Benchmarking Report 2013

4.0 SCN NICU/SCN Jaundice

SCN 4.1.1 – Percent NICU/SCN Inpatient Jaundice Cases

This chart and table present the percent of jaundice cases (CMG 594) that spent time in a NICU, locations 50 NICU (NICU undifferentiated/general), 51 NICU Level 1, 52 NICU Level 2, and 53 NICU Level 3 in the CIHI DAD abstract. Hospitals with less than 6 cases are indicated as “<6”.

% of NICU/SCN Jaundice Inpatient Cases NICU/SCN Total % of NICU/SCN Jaundice Inpatient Jaundice LOC Hospital BCHS Inpatient Jaundice Inpatients JBH Cases Cases Cases Montfort NHS IIa BCHS 17 63 27% GBHS IIa JBH <6 70 6% GRH IIa Montfort 36 129 28% HHS IIa NHS <6 139 3% HRRH IIb GBHS <6 22 9% PRHC IIb GRH <6 123 2% IIb HHS <6 199 2% SJHC Hamilton IIb HRRH 11 103 11% SJHC Toronto IIb PRHC <6 28 11% Southlake IIb SJHC Hamilton 8 190 4% THP-MH IIb SJHC Toronto <6 131 4% TSH IIb Southlake 8 97 8% HSN IIb THP-MH 27 103 26% LH IIb TSH 9 272 3% MH IIc HSN <6 27 4% MSH IIc LH <6 203 2% NBRHC IIc MH <6 175 1% NYGH IIc MSH <6 119 4% OSMH IIc NBRHC <6 71 6% RVH IIc NYGH 6 240 3% RVHS IIc OSMH <6 28 11% SAH IIc RVH <6 48 6% SMH IIc RVHS 34 113 30% IIc SAH 11 71 15% TBRHSC IIc SMH 22 102 22% TEGH IIc TBRHSC 6 91 7% THP-CVH IIc TEGH <6 116 1% WOHS IIc THP-CVH 11 253 4% WRH IIc WOHS 51 423 12% Mt Sinai IIc WRH <6 49 2% Sunnybrook IIIa Mt Sinai 27 250 11% TOH IIIa Sunnybrook 42 143 29% CH LHSC IIIa TOH 119 309 39% CHEO IIIb CH LHSC 6 73 8% KGH IIIb CHEO <6 37 14% MCH HHSC IIIb KGH 10 59 17% Sickkids IIIb MCH HHSC 22 160 14% IIIb Sickkids 7 48 15% 0% 10% 20% 30% 40% 50%

208 PCMCH Maternal-Child Benchmarking Report 2013

Obstetrical Indicators

Introduction

The data included in this section encompasses normal deliveries and obstetrical procedures. This section is organized by the new Maternal Levels of Care, self-identified by each organization, to help better benchmark their data. The following multisite organizations are grouped at the highest Level of Care (LOC) delivered:

Grey Bruce Health Services Halton Healthcare Services Corporation Humber River Regional Hospital Lakeridge Health Corporation Rouge Valley Health System

Data Sources

CIHI data is the traditional data source used for the PCMCH Benchmarking Report through the DAD database. Obstetrical discharge data are available to be used for both an assessment of hospital stay characteristics and resource utilization.

Inclusion and Exclusion Criteria

For the purposes of the benchmarking exercise, obstetrics was defined in DAD as encounters for individuals of all ages. There were no exclusions made as obstetrical cases were defined by CMGs within MCC 13 - Pregnancy and Childbirth.

Case Mix Groups (CMGs)

CMG CMG Description 530 Major Intervention related to Obstetric Diagnosis 531 Major Intervention not related to Obstetric Diagnosis 532 Fetal Intervention 556 Antepartum Diagnosis With Non-Major Obstetric/Gynecologic Intervention 557 Antepartum Diagnosis treated Medically 558 Primary Caesarean Section, with induction 559 Primary Caesarean Section, no induction 560 Caesarean Section with uterine scar, no induction 561 Caesarean Section with uterine scar, and induction 562 Vaginal Birth with Anaesthetic and Non-Major Obstertric/Gynecologic Intervention 563 Vaginal Birth with Anaesthetic without Non-Major Obstertric/Gynecologic Intervention 564 Vaginal Birth without Anaesthetic with Non-Major Obstertric/Gynecologic Intervention 565 Vaginal Birth without Anaesthetic without Non-Major Obstertric/Gynecologic Intervention 999 Ungroupable - Includes the following CMGs that are masked in the CIHI Portal: 546 Ectopic Preg with Ectopic or Non-Major Obstetric/Gynecologic Intervention 547 Ectopic Pregnancy treated Medically 548 Abortive Diagnosis with Abortive or Non-Major Obstetric/Gynecologic Intervention and Fetal Anomaly 549 Abortive Diagnosis with Fetal Anomaly Treated Medically 550 Abortion Diagnosis with Abortive or Non-Major Obstetric/Gynecologic Intervention 551 Abortion Diagnosis Treated Medically 552 Postpartum Diagnosis with Postpartum or Non-Major Obstetric/Gynecologic Intervention 553 Postpartum Diagnosis treated Medically 554 Post Abortion Diagnosis with Postabortive or Non-Major Obstetric/Gynecologic Intervention 555 Post Abortion Diagnosis treated Medically

209 PCMCH Maternal-Child Benchmarking Report 2013

Hospital Descriptors

OBS 1.1.1 – Obstetrical Volumes and Births

This table and chart depict total inpatient obstetrical volumes, total inpatient deliveries, and percentage of obstetrical admissions with a delivery. Deliveries are defined as: CMGs 558-565.

Total OBS Total % of LOC Hospital Cases Deliveries Deliveries Percent of Admissions with a Delivery Ia GDH 10 6 60% Ia MHA - SMGH 120 106 88% GDH Ia Renfrew 61 58 95% MHA - SMGH Renfrew Ib AGH 427 403 94% AGH Ib BGH 381 351 92% BGH Ib CCH 572 504 88% CCH Ib CGMH 502 474 94% CGMH Ib GBGH 247 204 83% GBGH Ib HHCC 755 683 90% HHCC Ib NHH 521 493 95% NHH Ib QHC 1,536 1,384 90% QHC Ib RHCF 214 183 86% RHCF Ib RMH 354 307 87% RMH Ib SBGHC 333 324 97% SBGHC Ib SLMHC 489 413 84% SLMHC Ib Stevenson 395 326 83% Stevenson Ib WDMH 660 637 97% WDMH Ib WGH 934 825 88% WGH Ib WLMH 1,105 1,049 95% WLMH Ib WPSHC 141 108 77% WPSHC IIa BWH 1,052 964 92% BWH IIa CMH 1,531 1,398 91% CMH IIa Monfort 3,402 3,066 90% Monfort IIa NHS 2,920 2,552 87% NHS IIa STEGH 749 690 92% STEGH IIb BCHS 1,525 1,411 93% BCHS GBHS IIb GBHS 812 728 90% GRH IIb GRH 4,551 4,084 90% HHS IIb HHS 3,681 3,435 93% HRRH IIb HRRH 3,873 3,459 89% JBH IIb JBH 1,543 1,443 94% PRHC IIb PRHC 1,690 1,535 91% SJHC Hamilton IIb SJHC Hamilton 3,702 3,361 91% SJHC Toronto IIb SJHC Toronto 3,397 3,088 91% Southlake IIb Southlake 2,864 2,604 91% THP - MH IIb THP - MH 4,027 3,772 94% TSH IIb TSH 5,407 4,914 91% WOHS IIb WOHS 8,546 7,525 88% HSN IIc HSN 1,976 1,826 92% LH IIc LH 3,046 2,820 93% MH IIc MH 2,742 2,441 89% MSH IIc MSH 3,158 3,002 95% NBRHC IIc NBRHC 1,022 866 85% NYGH IIc NYGH 6,383 5,989 94% OSMH IIc OSMH 1,022 889 87% RVH IIc RVH 2,172 1,964 90% RVHS IIc RVHS 4,166 3,721 89% SAH IIc SAH 1,051 944 90% TBRHSC TEGH IIc TBRHSC 1,679 1,512 90% THP - CVH IIc TEGH 3,817 3,386 89% WRH IIc THP - CVH 5,509 5,056 92% LHSC IIc WRH 4,050 3,660 90% KGH III LHSC 6,294 5,521 88% MCH HHSC III KGH 2,140 1,936 90% Mt Sinai III MCH HHSC 3,223 2,716 84% SMH III Mt Sinai 8,453 6,592 78% Sunnybrook III SMH 3,331 3,027 91% TOH III Sunnybrook 4,682 3,981 85% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% III TOH 7,436 6,345 85%

210 PCMCH Maternal-Child Benchmarking Report 2013

OBS 1.1.2 – Obstetrical Age Profile

This table provides the distribution of cases by age category of the inpatient obstetrical cases of each hospital. The age categories are: <20 years, 20-24, 25-29, 30-34, 35-39, 40-44, 45+ years. Zero volumes are shown as blank and a volume less than 6 is indicated as “<6”.

20-24 25-29 30-34 35-39 40-44 LOC Hospital <20 Years 45+ Years Years Years Years Years Years Ia GDH <6 <6 <6 <6 <6 Ia MHA - SMGH <6 21 41 42 13 <6 Ia Renfrew 21 19 13 <6 <6 Ib AGH 16 55 141 146 55 14 Ib BGH 40 82 126 92 34 7 Ib CCH 73 175 182 87 46 7 <6 Ib CGMH 21 108 158 141 63 11 Ib GBGH 16 75 73 55 21 6 <6 Ib HHCC 31 95 223 249 123 33 <6 Ib NHH 16 82 194 169 54 6 Ib QHC 111 301 553 422 122 26 <6 Ib RHCF 25 48 62 55 22 <6 Ib RMH 28 83 112 88 33 10 Ib SBGHC 12 56 132 108 22 <6 <6 Ib SLMHC 87 166 133 70 21 11 <6 Ib Stevenson 16 68 144 104 52 11 Ib WDMH 22 113 224 221 68 11 <6 Ib WGH 51 191 339 256 80 16 <6 Ib WLMH 7 131 384 397 164 21 <6 Ib WPSHC 13 32 45 32 13 6 IIa BWH 69 202 380 297 94 10 IIa CMH 65 276 455 485 213 32 <6 IIa Monfort 50 301 988 1342 611 109 <6 IIa NHS 176 578 862 848 392 59 <6 IIa STEGH 58 132 246 211 89 13 IIb BCHS 114 319 454 436 167 32 <6 IIb GBHS 36 173 281 218 82 21 <6 IIb GRH 146 554 1371 1620 707 145 8 IIb HHS 33 172 827 1544 930 168 7 IIb HRRH 123 597 1122 1200 648 174 9 IIb JBH 18 93 378 659 349 46 IIb PRHC 74 293 559 513 208 42 <6 IIb SJHC Hamilton 164 557 1148 1200 509 119 <6 IIb SJHC Toronto 84 302 753 1217 820 211 8 IIb Southlake 52 247 799 1105 556 101 <6 IIb THP - MH 53 356 1070 1493 856 186 13 IIb TSH 102 601 1820 1760 876 232 16 IIb WOHS 149 984 2698 2970 1395 330 20 IIc HSN 116 427 642 559 191 39 <6 IIc LH 137 438 931 1034 420 83 <6 IIc MH 23 144 649 1105 636 174 11 IIc MSH 17 109 645 1374 838 163 12 IIc NBRHC 61 253 340 241 104 23 IIc NYGH 36 356 1478 2629 1508 359 17 IIc OSMH 59 200 324 292 115 30 <6 IIc RVH 83 292 668 712 347 65 <6 IIc RVHS 94 495 1255 1444 727 146 <6 IIc SAH 94 210 330 282 115 16 <6 IIc TBRHSC 166 371 489 439 172 40 <6 IIc TEGH 71 445 959 1304 817 208 13 IIc THP - CVH 41 406 1413 2192 1173 266 18 IIc WRH 207 632 1200 1289 588 125 9 III LHSC 277 901 1937 2078 897 182 22 III KGH 91 352 662 684 301 47 <6 III MCH HHSC 114 381 855 1113 612 140 8 III Mt Sinai 115 405 1403 3259 2528 679 64 III SMH 51 251 722 1253 873 171 10 III Sunnybrook 47 221 810 1934 1211 402 57 III TOH 202 727 1774 2616 1685 406 26

211 PCMCH Maternal-Child Benchmarking Report 2013

This chart provides the distribution of cases by age category of the inpatient obstetrical cases of each hospital.

Obstetrical Age Profile

GDH MHA - SMGH Renfrew AGH BGH CCH CGMH GBGH HHCC NHH QHC RHCF RMH SBGHC SLMHC Stevenson WDMH WGH WLMH WPSHC BWH CMH Monfort NHS STEGH BCHS GBHS GRH HHS HRRH JBH PRHC SJHC Hamilton SJHC Toronto Southlake THP - MH TSH WOHS HSN LH MH MSH NBRHC NYGH OSMH RVH RVHS SAH TBRHSC TEGH THP - CVH WRH LHSC KGH MCH HHSC Mt Sinai SMH Sunnybrook TOH

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

<20 Years 20-24 Years 25-29 Years 30-34 Years 35-39 Years 40-44 Years 45+ Years

212 PCMCH Maternal-Child Benchmarking Report 2013

OBS 1.1.3 – Average Length of Stay

This table and chart present the total average length of stay for all inpatient obstetrical cases. The length of stay is calculated from the date of admission to the date of discharge.

LOC Hospital ALOS Ia GDH 1.4 Total Average LOS Ia MHA-SMGH 2.1 GDH Ia Renfrew 2.0 MHA-SMGH Ib AGH 2.3 Renfrew Ib BGH 1.9 AGH Ib CCH 1.9 BGH Ib CGMH 1.8 CCH Ib GBGH 2.6 CGMH Ib HHCC 2.1 GBGH Ib NHH 2.1 HHCC Ib QHC 2.1 NHH Ib RHCF 1.9 QHC Ib RMH 2.1 RHCF Ib SBGHC 1.9 RMH Ib SLMHC 2.0 SBGHC Ib Stevenson 1.8 SLMHC Ib WDMH 2.0 Stevenson Ib WGH 2.0 WDMH WGH Ib WLMH 1.9 WLMH Ib WPSHC 2.8 WPSHC IIa BWH 2.1 BWH IIa CMH 2.1 CMH IIa Monfort 2.2 Monfort IIa NHS 2.1 NHS IIa STEGH 1.7 STEGH IIb BCHS 2.1 BCHS IIb GBHS 2.0 GBHS IIb GRH 1.9 GRH IIb HHS 1.9 HHS IIb HRRH 1.9 HRRH IIb JBH 2.0 JBH IIb PRHC 2.1 PRHC IIb SJHC Hamilton 2.3 SJHC Hamilton IIb SJHC Toronto 1.7 SJHC Toronto IIb Southlake 2.2 Southlake THP-MH IIb THP-MH 1.9 TSH IIb TSH 1.9 WOHS IIb WOHS 1.9 HSN IIc HSN 1.9 LH IIc LH 2.3 MH IIc MH 1.9 MSH IIc MSH 1.9 NBRHC IIc NBRHC 2.0 NYGH IIc NYGH 2.0 OSMH IIc OSMH 1.9 RVH IIc RVH 2.2 RVHS IIc RVHS 2.0 SAH IIc SAH 2.3 TBRHSC IIc TBRHSC 2.8 TEGH IIc TEGH 1.9 THP-CVH IIc THP-CVH 2.0 WRH LHSC IIc WRH 2.2 KGH III LHSC 2.7 MCH HHSC III KGH 2.3 Mt Sinai III MCH HHSC 3.3 SMH III Mt Sinai 2.8 Sunnybrook III SMH 2.3 TOH III Sunnybrook 3.2 0 1 2 3 4 III TOH 2.7

213 PCMCH Maternal-Child Benchmarking Report 2013

OBS 1.1.4 – Total Average Inpatient Weight per Case

This table and chart present the ARIW for all inpatient obstetrical cases. The average inpatient weight per case represents the inpatient Resource Intensity Weight (RIW) which is reflective of the amount of resources required by the hospitals to care for patients based on the CMG during their hospital stay.

LOC Hospital ARIW Ia GDH 0.32 Total Average Inpatient Weight per Case Ia MHA-SMGH 0.47 GDH Ia Renfrew 0.40 MHA-SMGH Ib AGH 0.52 Renfrew Ib BGH 0.51 AGH Ib CCH 0.57 BGH Ib CGMH 0.47 CCH Ib GBGH 0.50 CGMH Ib HHCC 0.55 GBGH Ib NHH 0.53 HHCC Ib QHC 0.56 NHH Ib RHCF 0.47 QHC Ib RMH 0.51 RHCF Ib SBGHC 0.42 RMH Ib SLMHC 0.47 SBGHC Ib Stevenson 0.50 SLMHC Ib WDMH 0.52 Stevenson Ib WGH 0.51 WDMH WGH Ib WLMH 0.52 WLMH Ib WPSHC 0.49 WPSHC IIa BWH 0.51 BWH IIa CMH 0.53 CMH IIa Monfort 0.51 Monfort IIa NHS 0.51 NHS IIa STEGH 0.49 STEGH IIb BCHS 0.52 BCHS IIb GBHS 0.51 GBHS IIb GRH 0.54 GRH IIb HHS 0.54 HHS IIb HRRH 0.53 HRRH IIb JBH 0.55 JBH IIb PRHC 0.53 PRHC IIb SJHC Hamilton 0.53 SJHC Hamilton IIb SJHC Toronto 0.55 SJHC Toronto IIb Southlake 0.54 Southlake THP-MH IIb THP-MH 0.52 TSH IIb TSH 0.51 WOHS IIb WOHS 0.53 HSN IIc HSN 0.54 LH IIc LH 0.53 MH IIc MH 0.53 MSH IIc MSH 0.53 NBRHC IIc NBRHC 0.52 NYGH IIc NYGH 0.55 OSMH IIc OSMH 0.56 RVH IIc RVH 0.56 RVHS IIc RVHS 0.56 SAH IIc SAH 0.52 TBRHSC IIc TBRHSC 0.52 TEGH IIc TEGH 0.53 THP-CVH IIc THP-CVH 0.53 WRH LHSC IIc WRH 0.58 KGH III LHSC 0.61 MCH HHSC III KGH 0.56 Mt Sinai III MCH HHSC 0.65 SMH III Mt Sinai 0.64 Sunnybrook III SMH 0.54 TOH III Sunnybrook 0.68 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 III TOH 0.57

Note Mt Sinai: Mt Sinai is completing a comprehensive analysis to determine factors associated with the reported ARIW which does not appear to be reflecting the complexity/acuity of the population served.

214 PCMCH Maternal-Child Benchmarking Report 2013

OBS 1.1.5 – Percent Typical, Outlier & Other Inpatient Cases and Patient Days

This table displays the percentage of inpatient obstetrical cases classified as typical, outlier or other. A patient is classified as “typical” when that patient receives the normal, or predicted, inpatient course of treatment associated with a specific CMG and is discharged. Outlier cases are cases that do not receive the normal or predicted course of treatment because they arrived at, or left, the facility in circumstances that made their total length of stay or costs unpredictable. The “other” category represents deaths, sign-outs and transfers.

% Cases % Days LOC Hospital Typical Outlier Other Typical Outlier Other Ia GDH 80.0% 0.0% 20.0% 85.7% 0.0% 14.3% Ia MHA-SMGH 95.0% 0.8% 4.2% 95.6% 2.4% 2.0% Ia Renfrew 96.7% 0.0% 3.3% 96.8% 0.0% 3.2% Ib AGH 98.1% 0.9% 0.9% 97.2% 2.0% 0.8% Ib BGH 98.4% 0.5% 1.0% 98.2% 1.2% 0.5% Ib CCH 98.1% 0.5% 1.4% 97.3% 1.6% 1.1% Ib CGMH 97.6% 0.6% 1.8% 97.1% 1.7% 1.2% Ib GBGH 94.3% 2.4% 3.2% 89.9% 8.5% 1.6% Ib HHCC 97.9% 1.6% 0.5% 91.3% 8.5% 0.3% Ib NHH 99.0% 0.2% 0.8% 98.8% 0.5% 0.7% Ib QHC 96.4% 1.7% 2.0% 92.8% 5.6% 1.5% Ib RHCF 97.2% 0.9% 1.9% 96.2% 2.5% 1.3% Ib RMH 97.5% 0.8% 1.7% 96.8% 2.4% 0.8% Ib SBGHC 98.2% 0.0% 1.8% 98.9% 0.0% 1.1% Ib SLMHC 93.7% 3.1% 3.3% 86.8% 11.2% 2.1% Ib Stevenson 97.2% 0.3% 2.5% 97.8% 0.8% 1.4% Ib WDMH 98.8% 0.0% 1.2% 98.9% 0.0% 1.1% Ib WGH 97.4% 0.7% 1.8% 95.8% 3.0% 1.2% Ib WLMH 98.4% 0.0% 1.6% 98.8% 0.0% 1.2% Ib WPSHC 95.0% 2.8% 2.1% 91.9% 6.1% 2.0% IIa BWH 99.0% 0.6% 0.4% 98.2% 1.6% 0.2% IIa CMH 98.3% 0.6% 1.1% 97.4% 2.0% 0.6% IIa Monfort 98.8% 0.7% 0.6% 97.5% 2.2% 0.3% IIa NHS 97.5% 0.7% 1.8% 95.8% 2.7% 1.4% IIa STEGH 98.4% 0.4% 1.2% 97.6% 1.3% 1.1% IIb BCHS 97.5% 0.9% 1.6% 94.5% 3.3% 2.2% IIb GBHS 98.0% 0.5% 1.5% 94.9% 4.0% 1.1% IIb GRH 97.6% 1.5% 0.8% 90.3% 9.0% 0.7% IIb HHS 98.1% 0.9% 1.0% 95.4% 3.7% 0.9% IIb HRRH 98.4% 0.6% 1.0% 96.7% 2.4% 0.9% IIb JBH 97.9% 0.8% 1.2% 93.8% 5.1% 1.1% IIb PRHC 97.0% 1.2% 1.8% 93.1% 5.4% 1.5% IIb SJHC Hamilton 97.3% 1.6% 1.1% 93.5% 5.6% 0.9% IIb SJHC Toronto 98.3% 1.0% 0.7% 94.3% 5.1% 0.6% IIb Southlake 98.0% 1.0% 0.9% 94.9% 4.4% 0.7% IIb THP-MH 98.3% 1.1% 0.6% 93.2% 6.3% 0.5% IIb TSH 98.3% 0.9% 0.7% 94.8% 4.7% 0.5% IIb WOHS 98.0% 1.3% 0.7% 93.0% 6.4% 0.5% IIc HSN 97.1% 1.2% 1.7% 89.7% 8.8% 1.5% IIc LH 97.6% 1.1% 1.2% 94.0% 5.1% 0.9% IIc MH 98.2% 1.1% 0.7% 94.1% 5.1% 0.8% IIc MSH 98.4% 1.1% 0.5% 93.0% 6.6% 0.4% IIc NBRHC 95.9% 1.3% 2.8% 92.4% 4.3% 3.3% IIc NYGH 98.6% 1.0% 0.4% 93.8% 5.9% 0.3% IIc OSMH 93.5% 0.8% 5.7% 89.9% 3.3% 6.7% IIc RVH 97.2% 1.7% 1.0% 91.3% 8.0% 0.7% IIc RVHS 97.8% 1.6% 0.5% 91.4% 8.2% 0.4% IIc SAH 96.7% 1.1% 2.2% 93.2% 5.3% 1.5% IIc TBRHSC 92.6% 4.6% 2.8% 83.8% 13.9% 2.3% IIc TEGH 98.0% 1.2% 0.8% 92.0% 7.2% 0.7% IIc THP-CVH 98.0% 1.2% 0.7% 93.9% 5.5% 0.6% IIc WRH 96.1% 3.2% 0.7% 78.5% 20.8% 0.7% III LHSC 94.0% 4.1% 1.9% 71.3% 26.7% 2.0% III KGH 94.9% 2.1% 2.9% 86.6% 9.9% 3.5% III MCH HHSC 86.2% 6.2% 7.6% 69.9% 22.4% 7.6% III Mt Sinai 92.7% 5.2% 2.1% 71.7% 25.6% 2.7% III SMH 98.0% 1.3% 0.7% 93.6% 5.7% 0.7% III Sunnybrook 88.0% 7.8% 4.3% 61.4% 34.4% 4.3% III TOH 93.6% 3.4% 3.1% 85.5% 11.6% 2.9%

215 PCMCH Maternal-Child Benchmarking Report 2013

These charts display the percentage of inpatient obstetrical cases classified as Typical, Outlier or Other.

% Typical, Outlier & Other Patient Cases % Typical, Outlier & Other Patient Days

GDH GDH MHA-SMGH MHA-SMGH Renfrew Renfrew AGH AGH BGH BGH CCH CCH CGMH CGMH GBGH GBGH HHCC HHCC NHH NHH QHC QHC RHCF RHCF RMH RMH SBGHC SBGHC SLMHC SLMHC Stevenson Stevenson WDMH WDMH WGH WGH WLMH WLMH WPSHC WPSHC BWH BWH CMH CMH Monfort Monfort NHS NHS STEGH STEGH BCHS BCHS GBHS GBHS GRH GRH HHS HHS HRRH HRRH JBH JBH PRHC PRHC SJHC Hamilton SJHC Hamilton SJHC Toronto SJHC Toronto Southlake Southlake THP-MH THP-MH TSH TSH WOHS WOHS HSN HSN LH LH MH MH MSH MSH NBRHC NBRHC NYGH NYGH OSMH OSMH RVH RVH RVHS RVHS SAH SAH TBRHSC TBRHSC TEGH TEGH THP-CVH THP-CVH WRH WRH LHSC LHSC KGH KGH MCH HHSC MCH HHSC Mt Sinai Mt Sinai SMH SMH Sunnybrook Sunnybrook TOH TOH

0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100%

Typical Outlier Other Typical Outlier Other

216 PCMCH Maternal-Child Benchmarking Report 2013

OBS 1.1.6 – Percent Obstetrical “Transfer From” Inpatient Cases and Patient Days

This table presents the percentage of cases and associated days that were recorded as transferred from another acute care institution for all inpatient obstetrical cases. A volume less than 6 is indicated as “<6”.

"Transfers From" % "Transfers "Transfers From" % "Transfers LOC Hospital Inpatient OBS From" Inpatient Inpatient OBS From" Inpatient Cases OBS Cases Days OBS Days Ib GBGH <6 0.4% 3 0.5% Ib QHC 8 0.5% 24 0.7% Ib WPSHC <6 0.7% 3 0.8% IIa BWH <6 0.1% 2 0.1% IIa CMH <6 0.1% 1 0.0% IIa Monfort <6 0.1% 12 0.2% IIa NHS 10 0.3% 29 0.5% IIa STEGH <6 0.1% 2 0.2% IIb BCHS 14 0.9% 37 1.2% IIb GBHS 6 0.7% 12 0.7% IIb GRH 7 0.2% 17 0.2% IIb HHS 17 0.5% 84 1.2% IIb HRRH 15 0.4% 47 0.7% IIb JBH 9 0.6% 21 0.7% IIb PRHC 17 1.0% 48 1.4% IIb SJHC Hamilton 14 0.4% 33 0.4% IIb SJHC Toronto <6 0.1% 10 0.2% IIb Southlake 14 0.5% 69 1.1% IIb THP-MH <6 0.1% 9 0.1% IIb TSH 11 0.2% 38 0.4% IIb WOHS <6 0.1% 22 0.1% IIc HSN 13 0.7% 51 1.3% IIc LH 14 0.5% 29 0.4% IIc MH 7 0.3% 20 0.4% IIc MSH <6 0.1% 16 0.3% IIc NBRHC 22 2.2% 70 3.4% IIc NYGH 7 0.1% 64 0.5% IIc OSMH 50 4.9% 125 6.3% IIc RVH <6 0.2% 13 0.3% IIc RVHS 6 0.1% 21 0.2% IIc SAH <6 0.4% 11 0.5% IIc TBRHSC 25 1.5% 73 1.6% IIc TEGH 7 0.2% 33 0.5% IIc THP-CVH 14 0.3% 88 0.8% IIc WRH 20 0.5% 164 1.8% III LHSC 131 2.1% 1,068 6.4% III KGH 58 2.7% 291 5.8% III MCH HHSC 289 9.0% 1,573 14.6% III Mt Sinai 211 2.5% 1,640 7.0% III SMH 18 0.5% 110 1.4% III Sunnybrook 317 6.8% 2,480 16.8% III TOH 218 2.9% 1,003 4.9%

Note OSMH: The number of transfers in only includes those by ambulance, but does not include transfers from other facilities by private vehicle.

217 PCMCH Maternal-Child Benchmarking Report 2013

OBS 1.1.7 – Percent Obstetrical “Transfer To” Inpatient Cases and Patient Days

This table presents the percentage of cases and associated days that were recorded as transferred to another acute care institution for all inpatient obstetrical cases. A volume less than 6 is indicated as “<6”.

"Transfers To" % "Transfers To" "Transfers To" % "Transfers To" LOC Hospital Inpatient OBS Cases Inpatient OBS Cases Inpatient OBS Days Inpatient OBS Days

Ia GDH <6 20.0% 2 14.3% Ia MHA-SMGH <6 4.2% 5 2.0% Ia Renfrew <6 3.3% 4 3.2% Ib AGH <6 0.7% 5 0.5% Ib BGH <6 0.8% 3 0.4% Ib CCH <6 0.9% 9 0.8% Ib CGMH 8 1.6% 10 1.1% Ib GBGH <6 2.0% 5 0.8% Ib HHCC <6 0.4% 3 0.2% Ib NHH <6 0.8% 8 0.7% Ib QHC 19 1.2% 24 0.7% Ib RHCF <6 1.4% 4 1.0% Ib RMH <6 1.1% 4 0.5% Ib SBGHC 6 1.8% 7 1.1% Ib SLMHC 15 3.1% 19 2.0% Ib Stevenson 10 2.5% 10 1.4% Ib WDMH <6 0.5% 3 0.2% Ib WGH 17 1.8% 29 1.5% Ib WLMH 16 1.4% 22 1.1% Ib WPSHC <6 1.4% 5 1.3% IIa BWH <6 0.3% 3 0.1% IIa CMH 15 1.0% 17 0.5% IIa Monfort 12 0.4% 14 0.2% IIa NHS 33 1.1% 43 0.7% IIa STEGH <6 0.7% 7 0.6% IIb BCHS 13 0.9% 44 1.4% IIb GBHS 7 0.9% 7 0.4% IIb GRH 27 0.6% 82 0.9% IIb HHS 17 0.5% 20 0.3% IIb HRRH 18 0.5% 21 0.3% IIb JBH 13 0.8% 37 1.2% IIb PRHC 12 0.7% 14 0.4% IIb SJHC Hamilton 22 0.6% 41 0.5% IIb SJHC Toronto 13 0.4% 20 0.3% IIb Southlake 13 0.5% 20 0.3% IIb THP-MH 17 0.4% 29 0.4% IIb TSH 24 0.4% 47 0.5% IIb WOHS 46 0.5% 69 0.4% IIc HSN 9 0.5% 18 0.5% IIc LH 21 0.7% 37 0.5% IIc MH 11 0.4% 21 0.4% IIc MSH 16 0.5% 51 0.8% IIc NBRHC <6 0.4% 4 0.2% IIc NYGH 24 0.4% 50 0.4% IIc OSMH 10 1.0% 17 0.9% IIc RVH 18 0.8% 49 1.0% IIc RVHS 16 0.4% 52 0.6% IIc SAH 13 1.2% 13 0.5% IIc TBRHSC 13 0.8% 32 0.7% IIc TEGH 21 0.6% 28 0.4% IIc THP-CVH 31 0.6% 67 0.6% IIc WRH 8 0.2% 60 0.7% III LHSC 18 0.3% 288 1.7% III KGH <6 0.1% 16 0.3% III MCH HHSC 12 0.4% 85 0.8% III Mt Sinai 39 0.5% 479 2.0% III SMH 9 0.3% 30 0.4% III Sunnybrook 43 0.9% 592 4.0% III TOH 41 0.6% 65 0.3%

218 PCMCH Maternal-Child Benchmarking Report 2013

OBS 1.1.8 – Percent Cases and Days with Length of Stay > 30 Days

The percentage of all inpatient cases and associated days for all inpatient obstetrical cases with a total length of stay greater than 30 days is displayed in this chart. A volume less than 6 is indicated as “<6”.

Inpatient OBS Cases Inpatient OBS Days Inpatient OBS Cases Inpatient OBS Days with Duration >30 for Cases with LOC Hospital with Duration >30 for Cases with Days - as % of Total Duration >30 Days - Days Duration >30 Days OBS Cases as % of Total OBS Ib HHCC <6 0.13% 35 2.20% Ib QHC <6 0.07% 36 1.11% IIb GRH <6 0.04% 73 0.83% IIb JBH <6 0.06% 62 2.04% IIb SJHC Hamilton <6 0.03% 32 0.38% IIb Southlake <6 0.03% 47 0.76% IIb WOHS <6 0.04% 147 0.90% IIc HSN <6 0.15% 118 3.08% IIc LH <6 0.07% 76 1.10% IIc MSH <6 0.03% 47 0.78% IIc NYGH 6 0.09% 256 2.03% IIc OSMH <6 0.10% 49 2.47% IIc RVH <6 0.05% 32 0.66% IIc RVHS <6 0.02% 35 0.41% IIc TBRHSC <6 0.06% 38 0.81% IIc TEGH <6 0.03% 34 0.48% IIc THP-CVH <6 0.02% 58 0.52% IIc WRH 11 0.27% 486 5.41% III LHSC 35 0.56% 1874 11.16% III KGH <6 0.09% 80 1.60% III MCH HHSC 12 0.37% 506 4.71% III Mt Sinai 45 0.53% 1922 8.15% III SMH <6 0.06% 89 1.17% III Sunnybrook 29 0.62% 1295 8.78% III TOH 6 0.08% 235 1.15%

Note LHSC: Over 70% of these patients live more than 1 hour from CH LHSC. There may be a lack of tertiary antenatal and or neonatal resources available in their community. Therefore, CH LHSC may be unable to transfer patients to their home hospital or may need to keep them in Level 3 hospital until they deliver.

219 PCMCH Maternal-Child Benchmarking Report 2013

OBS 1.1.9 – Obstetrical Top 5 CMGs

This table displays the Top 5 CMGs (highlighted in RED) and the total volume of each individual CMG in each hospital. A volume less than 6 is indicated as “<6”.

CMG+

BGH CCH

GDH AGH NHH QHC

RMH

WGH RHCF

GBGH HHCC

CGMH

WDMH

Renfrew MHA-SMGH Vaginal Birth with Anaesthetic without Non- 563 8 6 142 143 83 66 53 59 125 83 250 42 63 Major Obstertric/Gynecologic Intervention Vaginal Birth with Anaesthetic and Non-Major 562 10 27 136 164 66 76 97 64 175 77 421 22 40 Obstertric/Gynecologic Intervention Vaginal Birth without Anaesthetic without 565 6 39 44 76 146 220 113 89 89 195 114 122 191 63 90 Non-Major Obstertric/Gynecologic Caesarean Section with uterine scar, no 560 <6 12 28 45 98 38 42 93 29 82 81 175 19 41 induction 559 Primary Caesarean Section, no induction <6 6 22 87 74 53 30 55 48 78 64 156 9 44

557 Antepartum Diagnosis treated Medically <6 <6 10 25 11 86 13 22 39 19 36 16 118 19 29 Vaginal Birth without Anaesthetic with Non- 564 12 17 33 52 84 29 31 70 62 68 41 114 19 14 Major Obstertric/Gynecologic Intervention 558 Primary Caesarean Section, with induction <6 9 12 28 38 17 17 47 17 41 24 74 9 15

999 Ungroupable <6 <6 16 7 23 9 8 25 9 35 12 32 7 16 Antepartum Diagnosis With Non-Major 556 <6 <6 <6 <6 <6 <6 <6 <6 Obstetric/Gynecologic Intervention Caesarean Section with uterine scar, and 561 <6 <6 <6 <6 <6 induction 532 Fetal Intervention

Major Intervention not related to Obstetric 531 Diagnosis Major Intervention related to Obstetric 530 <6 Diagnosis

CMG+

NHS GRH HHS

BWH CMH

BCHS GBHS

HRRH

STEGH

SBGHC WLMH

SLMHC

WPSHC

Monfort Stevenson

Vaginal Birth with Anaesthetic without Non- 563 <6 <6 73 307 <6 91 204 937 519 127 314 198 1,085 1,023 489 Major Obstertric/Gynecologic Intervention Vaginal Birth with Anaesthetic and Non-Major 562 <6 <6 62 209 <6 172 278 620 500 145 269 132 822 828 669 Obstertric/Gynecologic Intervention Vaginal Birth without Anaesthetic without 565 195 214 94 204 45 264 347 596 619 225 353 157 889 488 886 Non-Major Obstertric/Gynecologic Caesarean Section with uterine scar, no 560 22 11 23 124 18 74 162 276 328 39 145 64 400 456 572 induction 559 Primary Caesarean Section, no induction 25 87 41 101 11 77 155 354 271 50 160 79 480 396 380

557 Antepartum Diagnosis treated Medically <6 24 51 30 19 55 74 143 232 21 62 42 250 134 196 Vaginal Birth without Anaesthetic with Non- 564 65 83 9 54 19 207 150 141 208 72 124 62 192 105 324 Major Obstertric/Gynecologic Intervention 558 Primary Caesarean Section, with induction 11 14 24 50 10 74 97 141 103 30 45 36 213 137 139

999 Ungroupable <6 46 16 24 12 31 35 187 114 37 45 42 208 108 196 Antepartum Diagnosis With Non-Major 556 <6 6 <6 <6 <6 <6 22 6 20 6 8 <6 21 Obstetric/Gynecologic Intervention Caesarean Section with uterine scar, and 561 <6 <6 <6 <6 <6 <6 <6 <6 induction 532 Fetal Intervention

Major Intervention not related to Obstetric 531 <6 <6 Diagnosis Major Intervention related to Obstetric 530 <6 <6 <6 <6 Diagnosis

220 PCMCH Maternal-Child Benchmarking Report 2013

OBS 1.1.9 – Obstetrical Top 5 CMGs (cont)

CMG+ LH

JBH MH

TSH

HSN

SJHC SJHC SJHC MSH

PRHC

NYGH

WOHS OSMH

NBRHC

Toronto THP-MH

Hamilton Southlake

Vaginal Birth with Anaesthetic without Non- 563 355 387 1,033 733 905 1,119 1,142 1,946 463 742 724 843 63 2,193 164 Major Obstertric/Gynecologic Intervention Vaginal Birth with Anaesthetic and Non-Major 562 423 403 830 686 725 615 1,009 1,353 360 512 574 656 127 1,153 152 Obstertric/Gynecologic Intervention Vaginal Birth without Anaesthetic without 565 207 284 570 528 280 887 1,205 1,410 406 611 373 577 240 835 185 Non-Major Obstertric/Gynecologic Caesarean Section with uterine scar, no 560 152 174 310 347 277 416 566 1,072 144 361 318 371 121 751 150 induction 559 Primary Caesarean Section, no induction 172 143 281 459 254 393 468 958 241 269 276 309 136 701 173

557 Antepartum Diagnosis treated Medically 57 100 162 169 169 125 287 576 91 109 132 80 95 209 95 Vaginal Birth without Anaesthetic with Non- 564 63 81 167 143 60 185 314 391 124 176 91 143 121 113 35 Major Obstertric/Gynecologic Intervention 558 Primary Caesarean Section, with induction 69 61 164 187 103 156 194 381 81 145 83 103 58 241 28

999 Ungroupable 37 49 173 119 82 122 185 407 56 100 162 69 61 171 33 Antepartum Diagnosis With Non-Major 556 <6 6 6 20 9 6 19 35 <6 17 7 6 10 <6 Obstetric/Gynecologic Intervention Caesarean Section with uterine scar, and 561 <6 <6 6 <6 <6 16 14 7 <6 <6 <6 <6 induction 532 Fetal Intervention

Major Intervention not related to Obstetric 531 <6 <6 <6 <6 Diagnosis Major Intervention related to Obstetric 530 <6 <6 <6 <6 <6 <6 Diagnosis

CMG+

RVH SAH KGH TOH

SMH

WRH Total

RVHS TEGH

TBRHSC

CH LHSC CH Mt Sinai

THP-CVH

MCH HHSC MCH Sunnybrook Vaginal Birth with Anaesthetic without Non- 563 492 1,021 195 87 1,094 1,537 1,244 1,612 433 717 1,809 1,023 1,166 1,710 33,449 Major Obstertric/Gynecologic Intervention Vaginal Birth with Anaesthetic and Non-Major 562 475 1,019 145 133 793 1,276 893 1,623 412 598 1,722 539 858 1,390 27,543 Obstertric/Gynecologic Intervention Vaginal Birth without Anaesthetic without 565 322 436 250 601 550 768 440 831 413 327 574 549 443 1,008 23,283 Non-Major Obstertric/Gynecologic Caesarean Section with uterine scar, no 560 245 529 108 159 388 634 405 456 187 404 972 301 415 780 15,012 induction 559 Primary Caesarean Section, no induction 233 396 121 125 319 438 416 518 224 435 953 414 783 801 14,806

557 Antepartum Diagnosis treated Medically 127 308 74 88 214 199 268 453 120 262 1,161 195 478 702 8,892 Vaginal Birth without Anaesthetic with Non- 564 86 130 81 325 122 209 97 208 167 92 115 102 97 279 6,778 Major Obstertric/Gynecologic Intervention 558 Primary Caesarean Section, with induction 108 185 42 76 112 191 162 251 99 138 433 97 209 371 6,001

999 Ungroupable 74 119 28 77 196 240 111 293 78 222 506 88 168 354 5,688 Antepartum Diagnosis With Non-Major 556 <6 16 <6 <6 19 11 11 25 6 22 141 18 49 31 636 Obstetric/Gynecologic Intervention Caesarean Section with uterine scar, and 561 <6 <6 <6 6 8 <6 <6 22 <6 <6 14 <6 10 6 189 induction 532 Fetal Intervention 42 <6 <6 44 Major Intervention not related to Obstetric 531 <6 <6 <6 <6 <6 9 <6 <6 <6 32 Diagnosis Major Intervention related to Obstetric 530 <6 <6 <6 <6 <6 <6 <6 28 Diagnosis

221 PCMCH Maternal-Child Benchmarking Report 2013

Mental Health Indicators

Introduction

Section 1

Until 2011, the Mental Health section included only mental health data for children and adolescents in inpatient beds considered acute beds. The 2011 report was revised to include both DAD data from CIHI and Ontario Mental Health Reporting System (OMHRS) data from applicable organizations – mental health data for children and adolescents residing in adult inpatient mental health beds that are reported through OMHRS. For the 2013 year, the OMHRS data continues to be submitted by self‐report to PCMCH for indicators comparable to the current DAD indicators.

A new indicator measuring Mental Health Readmissions has been included on page 254. Mental Health indicators will continue to be updated to reflect the changing needs of our stakeholders.

Section 2

In order to correspond with the CIHI Portal data holdings, the Mental Health Emergency Department data continues to be collected based on the Comprehensive Ambulatory Care Classification System (CACS) that was revised in 2011.

Data Sources

CIHI is the traditional data source used for the PCMCH Benchmarking Report through the DAD and NACRS databases. Mental Health discharge data are available to be used for both an assessment of hospital stay characteristics and resource utilization. Self-report OMHRS data were provided for selected indicators by the participating hospitals.

Note WGH: Woodstock General Hospital indicators have been excluded from the Mental Health section of the 2013 Benchmarking Report. CIHI DAD and NACRS reports will be updated for the 2013/14 year to include WGH neonatal cases.

222 PCMCH Maternal-Child Benchmarking Report 2013

Case Mix Groups (CMGs)

CMG CMG Description

672 Miscellaneous Mental Disorder 673 Eating Disorder 674 Puerperal Disorder 675 Other Behavioural Syndrome 676 Schizophrenia with ECT 677 Schizophrenia without ECT 678 Schizotypal/Delusional Disorder 679 Schizoaffective Disorder with ECT 680 Schizoaffective Disorder without ECT 681 Gender Identity/Sexual Preference Disorder 682 Habit/Impulse Disorder 683 Disorder of Adult Personality Behaviour 684 Obsessive Compulsive Disorder 685 Somatoform/Dissociative Disorder 686 Anxiety Disorder 687 Stress Reaction/Adjustment Disorder 688 Bipolar Disorder with ECT 689 Bipolar Disorder without ECT 690 Bipolar Disorder, Severe Depression with ECT 691 Bipolar Disorder, Severe Depression without ECT 692 Depressive Episode with ECT 693 Depressive Episode without ECT 694 Mood [Affective] Disorder 695 Mental Retardation/Disorder of Development 696 Childhood/Adolescence Disorder 697 Mixed Disorder of Conduct/Emotion 698 Psychoactive Substance Use, Acute Intoxication 699 Psychoactive Substance Use, Harmful Use 700 Psychoactive Substance Use, Dependence Syndrome 701 Psychoactive Substance Use, Withdrawal State 702 Psychoactive Substance Use, Withdrawal/Delirium 703 Psychoactive Substance Use, Residual/Late-onset/Psychotic Disorder 704 Psychoactive Substance Use, Amnesic/Other/Unspecified

Comprehensive Ambulatory Care Classification System Case Mix Groups (CACS)

CACS CACS Description B055 Mental Health Intervention and Other Counselling B170 Mental Health & Psychosocial Condition

223 PCMCH Maternal-Child Benchmarking Report 2013

Mental Health Profiles: Academic Health Sciences Centres

The table below summarizes Mental Health profile information for AHSCs.

CH LHSC CHEO KGH

Inpatient Beds Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other

Number of Inpatient Beds 5 11 6 19 0 8

Age Groups Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other

0-7 years No No YES YES N/A YES 8-12 years YES YES YES YES N/A YES 13-17 years YES YES YES YES N/A YES

Cases Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other

# of Inpatient Cases 26 246 67 447 6 280 # of Inpatient Weighted Cases 125.6 378.4 339 721 26.973 542.978 Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Offers dedicated psychiatric No 0 YES 1408 N/A 0 Ambulatoryemergency Services service for children / Funding # of Visits Funding # of Visits Funding # of Visits Psychiatry Clinic Funds 1 and 2 5,330 Funds 1 and 3 15,231 N/A 0 Psychiatric Urgent Care Clinic N/A 0 Funds 1 and 2 1,049 N/A 0 Psychiatric Day Treatment Funds 1 and 2 1,582 N/A 0 N/A 0 Eating Disorder Clinic Funds 1 and 2 1,186 Funds 1 and 2 2,058 N/A 0 Eating Disorder Day Hospital Funds 1 and 2 587 Funds 1 and 2 1,336 N/A 0 Substance Abuse N/A 0 N/A 0 N/A 0 Telepsychiatry Services Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYS-funded Ontario Child N/A 0 YES 160 No 0 and Youth Telepsychiatry HasProgram? capacity/equipment to provide MH consultations via YES YES YES Ontario Telehealth Network Schedule(OTN)? 1 Facility YES YES YES

Southwest LHINs Regional Mandate YES 1 + 2 (for Eating YES Champlain LHIN No 0 Disorders)

224 PCMCH Maternal-Child Benchmarking Report 2013

Mental Health Profiles: Academic Health Sciences Centres (cont)

MCH HHSC SickKids Sunnybrook

Inpatient Beds Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other

Number of Inpatient Beds 6 22 10 3 0 8

Age Groups Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other

0-7 years YES YES YES YES No No 8-12 years YES YES YES YES No No 13-17 years YES YES YES YES No YES

Cases Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other

# of Inpatient Cases 83 590 100 95 3 113 # of Inpatient Weighted Cases 388 990 450 143 3.875 144.195 Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Offers dedicated psychiatric YES 148 YES 259 No 0 Ambulatoryemergency Services service for children / Funding # of Visits Funding # of Visits Funding # of Visits Psychiatry Clinic Funds 1 and 3 11,618 Fund 1 7,880 Funds 1 and 2 874 Psychiatric Urgent Care Clinic Fund 1 827 Fund 1 524 Fund 2 45 Psychiatric Day Treatment Fund 1 1,218 Fund 1 408 N/A 0 Eating Disorder Clinic Fund 2 3,617 Fund 1 1,203 N/A 0 Eating Disorder Day Hospital Fund 2 102 Fund 2 1,688 N/A 0 Substance Abuse N/A 0 Fund 2 1,316 N/A 0 Telepsychiatry Services Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYS-funded Ontario Child YES 0 YES 1,471 N/A 0 and Youth Telepsychiatry HasProgram? capacity/equipment to provide MH consultations via YES YES N/A Ontario Telehealth Network Schedule(OTN)? 1 Facility YES No YES

Hamilton Niagara Haldimand Brant Toronto Central Regional Mandate YES YES No 0 & Waterloo LHIN and GTA Wellington

Note MCH HHSC: Dedicated psychiatric emergency service began in February 2013 and Eating Disorder Day Hospital began service in February 2013. MCH HHSC offers telepsychiatry and it has been used in the past. There are accessibility issues within the community, with only certain areas having access to this service.

225 PCMCH Maternal-Child Benchmarking Report 2013

Mental Health Profiles: Community Hospitals

The tables below summarize Mental Health profile information for Community Hospitals.

BWH CCH GBHS GRH

Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Inpatient Beds Disorders Other Disorders Other Disorders Other Disorders Other Number of Inpatient Beds 0 3 0 0 0 0 0 13 Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Age Groups Disorders Other Disorders Other Disorders Other Disorders Other 0-7 years YES YES No No YES N/A N/A Yes 8-12 years YES YES No No YES N/A N/A Yes 13-17 years YES YES No YES YES N/A N/A Yes Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Cases Disorders Other Disorders Other Disorders Other Disorders Other # of Inpatient Cases 1 14 0 7 6 19 0 656 # of Inpatient Weighted Cases 4 20 0 7.7 0 0 0 849

Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Availability # of Visits

Dedicated psychiatric emergency service No 0 No 0 No 0 No 0 for children/youth (e.g.: Crisis Team)?

Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Funding # of Visits

Psychiatry Clinic Funds 1 and 2 0 N/A 0 N/A 0 Funds 1 and 3 8833

Psychiatric Urgent Care Clinic N/A 0 N/A 0 N/A 0 N/A 0

Psychiatric Day Treatment N/A 0 N/A 0 N/A 0 Funds 2 1222

Eating Disorder Clinic Funds 1 and 2 0 N/A 0 N/A 0 N/A 0 Eating Disorder Day Hospital N/A 0 N/A 0 N/A 0 N/A 0 Substance Abuse Funds 1 and 2 0 N/A 0 N/A 0 Funds 2 40 Telepsychiatry Services Availability Volume Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYS- funded Ontario Child and Youth No 0 No 0 No 0 No 0 Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth YES YES YES No Network (OTN)? Schedule 1 Facility (Paediatrics) YES N/A N/A Yes

Waterloo Regional Mandate YES ESC LHIN N/A 0 No 0 Yes Wellington

Note CCH: CCH has an adult inpatient psychiatric unit; youth between 16 and 17 years of age are admitted at times. Number of Inpatient Weighted Cases (Psychiatry Other) includes 3.64 weighted cases or 18.08 weighted days. GBHS: No funded beds for eating disorders or adolescent mental health; these cases are treated as inpatient cases in the regular paediatric unit where GBHS has 5 general paediatric beds.

226 PCMCH Maternal-Child Benchmarking Report 2013

Mental Health Profiles: Community Hospitals (cont)

HDH HHS HRRH HSN

Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Inpatient Beds Disorders Other Disorders Other Disorders Other Disorders Other Number of Inpatient Beds 0 0 0 10 0 6 0 2 Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Age Groups Disorders Other Disorders Other Disorders Other Disorders Other 0-7 years N/A N/A No YES No YES YES YES 8-12 years N/A N/A No YES No YES YES YES 13-17 years N/A N/A No YES No YES YES YES Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Cases Disorders Other Disorders Other Disorders Other Disorders Other # of Inpatient Cases 0 0 0 260 0 118 13 136 # of Inpatient Weighted Cases 0 0 0 445 0 222 55 163

Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Availability # of Visits

Dedicated psychiatric emergency service No 0 No 0 No 0 YES 938 for children/youth (e.g.: Crisis Team)?

Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Funding # of Visits

Psychiatry Clinic Fund 1 5091 Funds 1 and 2 7625 Funds 1 and 2 1516 Fund 1 1033

Psychiatric Urgent Care Clinic Fund 1 464 Funds 1 510 N/A N/A N/A 0

Psychiatric Day Treatment N/A 126 N/A 504 Funds 1 and 2 893 N/A 0

Eating Disorder Clinic Fund 1 888 Funds 1 and 2 1505 N/A N/A Fund 2 317 Eating Disorder Day Hospital N/A 0 N/A 0 N/A N/A N/A 0 Substance Abuse N/A 0 N/A 0 N/A N/A Fund 2 272 Telepsychiatry Services Availability Volume Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYS- funded Ontario Child and Youth No 0 No 0 No 0 No 0 Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth YES YES YES YES Network (OTN)? Schedule 1 Facility (Paediatrics) No YES YES YES

Regional South Eastern Eating Regional Mandate YES YES Halton YES GTA YES Disorders for Ontario entire Northeast LHIN

Notes HDH: The Urgent Consult Clinic has been in operation since October 2012 .Total Visits 464 October 2012-March 2013 HSN: Crisis and Ambulatory service visits reflect pediatric volumes only. Adults (18 and over) have been excluded. Additional Child/Adolescent Psychiatrist recruited this past year.

227 PCMCH Maternal-Child Benchmarking Report 2013

Mental Health Profiles: Community Hospitals (cont)

JBH LH MSH NHS

Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Inpatient Beds Disorders Other Disorders Other Disorders Other Disorders Other Number of Inpatient Beds 0 0 0 10 N/A N/A 0 0 Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Age Groups Disorders Other Disorders Other Disorders Other Disorders Other 0-7 years N/A N/A N/A YES N/A N/A N/A YES 8-12 years N/A N/A N/A YES N/A N/A N/A YES 13-17 years N/A N/A N/A YES N/A N/A N/A YES Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Cases Disorders Other Disorders Other Disorders Other Disorders Other # of Inpatient Cases 0 0 0 280 N/A N/A 0 221 # of Inpatient Weighted Cases 0 0 0 413 N/A N/A 0 833

Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Availability # of Visits

Dedicated psychiatric emergency service No 0 YES 1535 yes 144 No 0 for children/youth (e.g.: Crisis Team)?

Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Funding # of Visits Psychiatrist = 419; SW = 283; Psychiatry Clinic Funds 1 and 2 Funds 1 and 2 3590 Fund 1 4,285 Funds 1 and 3 3345 Telephone = 13; Psychiatric Urgent Care Clinic N/A 0 Fund 1 3949 N/A 0 N/A 0

Psychiatric Day Treatment N/A 0 Fund 1 1469 N/A 0 N/A 0

Eating Disorder Clinic N/A 0 Fund 2 584 N/A 0 Fund 2 380 Eating Disorder Day Hospital N/A 0 N/A 0 N/A 0 N/A 0 Substance Abuse N/A 0 Fund 2 830 N/A 0 Fund 2 160 Telepsychiatry Services Availability Volume Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYS- funded Ontario Child and Youth No 0 No 0 No N/A No 0 Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth No YES Yes YES Network (OTN)? Schedule 1 Facility (Paediatrics) N/A YES N/A N/A

Durham Regional Mandate N/A 0 N/A No 0 No 0 Region

Notes JBH: JBH has a Specialty Child/Adolescent Consultation Clinic, with the physician compensation coming from both direct Ministry Specialty Clinic funds and a seasonal from Fund 2. The Social Workers and Clerical staff are funded from the hospital's global budget. NHS: Inpatient beds service both adult and some paediatric patients; therefore, they have not been identified in Section 1.

228 PCMCH Maternal-Child Benchmarking Report 2013

Mental Health Profiles: Community Hospitals (cont)

NYGH OSMH PRHC RVH

Eating Psychiatry Psychiatry Eating Psychiatry Eating Psychiatry Inpatient Beds Eating Disorders Disorders Other Other Disorders Other Disorders Other Number of Inpatient Beds 0 6 0 0 0 0 0 0 Eating Psychiatry Psychiatry Eating Psychiatry Eating Psychiatry Age Groups Eating Disorders Disorders Other Other Disorders Other Disorders Other 0-7 years YES YES YES YES N/A N/A YES YES 8-12 years YES YES YES YES N/A N/A YES YES 13-17 years YES YES YES YES N/A N/A YES YES Eating Psychiatry Psychiatry Eating Psychiatry Eating Psychiatry Cases Eating Disorders Disorders Other Other Disorders Other Disorders Other # of Inpatient Cases 7 304 5 36 0 0 9 96 # of Inpatient Weighted Cases 30 511 22 67 0 0 31 110

Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Availability # of Visits

Dedicated psychiatric emergency service No 0 No 0 YES 248 No 0 for children/youth (e.g.: Crisis Team)?

Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Funding # of Visits

Psychiatry Clinic Funds 2 and 3 4762 Fund 3 22 Fund 3 144 Fund 2 0

Psychiatric Urgent Care Clinic Fund 2 65 N/A 0 Fund 1 153 N/A 0 Funds 1, 2, Psychiatric Day Treatment Fund 2 443 Funds 1 and 2 21 472 N/A 0 and 3 Eating Disorder Clinic Fund 2 2013 Fund 2 742 Fund 2 1764 Fund 2 1191 Eating Disorder Day Hospital Fund 2 1511 N/A 0 N/A 0 N/A 0 Substance Abuse Fund 2 92 N/A 0 N/A 0 N/A 0

Telepsychiatry Services Availability Volume Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYS- funded Ontario Child and Youth No 0 No 0 No 0 No 0 Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth No YES YES YES Network (OTN)? Schedule 1 Facility (Paediatrics) YES N/A N/A N/A North East North Simcoe North Simcoe Cluster of Regional Mandate No 0 YES Muskoka YES YES Muskoka Central East LHIN 12 LHIN LHIN

Note PRHC: Youth 16 and over are admitted to the Adult Mental Health Inpatient Unit. Occasional admission to the Paediatric Maternal Child Unit of individuals with mental health or eating disorder as primary diagnosis.

229 PCMCH Maternal-Child Benchmarking Report 2013

Mental Health Profiles: Community Hospitals (cont)

RVHS SAH SJHC Hamilton SMH

Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Inpatient Beds Disorders Other Disorders Other Disorders Other Disorders Other Number of Inpatient Beds 0 6 0 3 0 0 0 0 Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Age Groups Disorders Other Disorders Other Disorders Other Disorders Other 0-7 years No YES YES YES No YES N/A N/A 8-12 years No YES YES YES No YES N/A N/A 13-17 years No YES YES YES No YES N/A N/A Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Cases Disorders Other Disorders Other Disorders Other Disorders Other # of Inpatient Cases 0 1954 6 124 0 11 0 0 # of Inpatient Weighted Cases 0 N/A 0 170 0 291 0 0

Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Availability # of Visits

Dedicated psychiatric emergency service YES 915 No 0 No 0 No 0 for children/youth (e.g.: Crisis Team)?

Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Funding # of Visits

Psychiatry Clinic Funds 1 and 2 13,000 N/A 0 Fund 1 152 Fund 1 0

Psychiatric Urgent Care Clinic N/A 0 N/A 0 N/A 0 N/A 0

Psychiatric Day Treatment Fund 1 908 N/A 0 N/A 0 N/A 0

Eating Disorder Clinic N/A 0 Funds 1 and 2 272 N/A 0 N/A 0 Eating Disorder Day Hospital N/A 0 N/A 0 N/A 0 N/A 0 Substance Abuse N/A 0 N/A 0 N/A 0 N/A 0

Telepsychiatry Services Availability Volume Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYS- funded Ontario Child and Youth No 0 NO 0 No 0 No 0 Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth YES YES YES N/A Network (OTN)? Schedule 1 Facility (Paediatrics) YES YES N/A No

Algoma Regional Mandate YES 0 YES YES LHIN 4 No 0 District

Notes SAH: SAH is currently working on a plan with NBRHC to expand and provide an additional "tertiary" mental health bed for this district. The parameters of admission criteria have not yet been established and it is only in the planning stage. SJHC Hamilton: SJHC Hamilton has a dedicated psychiatric emergency service but it is not dedicated for children & youth. It's primary purpose is to serve the adult population; however, SJHC Hamilton currently serves children & youth as well. In 2012-2013 there were 445 visits of patients 17 years and under to Psychiatry Emergency Services and 285 mental health paediatric visits to the general ED. Effective January 2013, all pediatric PES visits have moved to the McMaster Children's Hospital and are no longer seen at SJHC Hamilton.

230 PCMCH Maternal-Child Benchmarking Report 2013

Mental Health Profiles: Community Hospitals (cont)

Southlake TBRHSC TEGH WGH

Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Inpatient Beds Disorders Other Disorders Other Disorders Other Disorders Other Number of Inpatient Beds 2 7 0 8 0 6 0 0 Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Age Groups Disorders Other Disorders Other Disorders Other Disorders Other 0-7 years NO YES N/A YES No YES N/A No 8-12 years YES YES N/A YES YES YES N/A YES 13-17 years YES YES N/A YES YES YES N/A YES Eating Psychiatry Eating Psychiatry Eating Psychiatry Eating Psychiatry Cases Disorders Other Disorders Other Disorders Other Disorders Other # of Inpatient Cases 14 406 0 0 6 172 0 43 # of Inpatient Weighted Cases 67 597 0 0 18 290 0 90

Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Availability # of Visits

Dedicated psychiatric emergency service YES 963 No 0 YES 151 No 0 for children/youth (e.g.: Crisis Team)?

Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Funding # of Visits

Psychiatry Clinic Funds 1 and 2 3106 N/A 0 N/A 3413 Fund 2 2922

Psychiatric Urgent Care Clinic Fund 3 210 N/A 0 N/A 100 N/A 0

Psychiatric Day Treatment Fund 2 241 N/A 0 N/A 1124 N/A 0

Eating Disorder Clinic Funds 1 and 2 2238 N/A 0 N/A 0 Funds 1 and 2 16 Eating Disorder Day Hospital Fund 1 574 N/A 0 N/A 0 N/A 0 Substance Abuse N/A 0 N/A 0 N/A 0 N/A 0

Telepsychiatry Services Availability Volume Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYS- funded Ontario Child and Youth No 0 No 0 No 0 No 0 Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth YES No N/A N/A Network (OTN)? Schedule 1 Facility (Paediatrics) YES YES YES N/A

North East Metro Oxford Regional Mandate YES York Region YES western YES YES Toronto County Ontario

Notes Southlake: Eating Disorders services have a bi-regional mandate; serving both York Region and Simcoe County. TBRHSC: The Child Adolescent Mental Health Unit at TBRHSC has not had a Child Psychiatrist since 2007. Patients are diagnosed by Paediatrician MRP in consultation with child psychologist and medications are prescribed by the Paediatrician MRP. Most patients do not receive a psychiatric assessment.

231 PCMCH Maternal-Child Benchmarking Report 2013

Mental Health Profiles: Community Hospitals (cont)

WLMH WOHS WRH

Eating Psychiatry Eating Psychiatry Eating Psychiatry Inpatient Beds Disorders Other Disorders Other Disorders Other Number of Inpatient Beds 0 0 0 14 0 6 Eating Psychiatry Eating Psychiatry Eating Psychiatry Age Groups Disorders Other Disorders Other Disorders Other 0-7 years No No YES YES No No 8-12 years No No YES YES No YES 13-17 years No No YES YES No YES Eating Psychiatry Eating Psychiatry Eating Psychiatry Cases Disorders Other Disorders Other Disorders Other # of Inpatient Cases 0 0 2 381 6 261 # of Inpatient Weighted Cases 0 0 9 651 23 429

Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits

Dedicated psychiatric emergency service No 0 No 0 YES 520 for children/youth (e.g.: Crisis Team)?

Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits

Psychiatry Clinic Fund 2 100 Funds 1 and 3 4851 N/A 653

Psychiatric Urgent Care Clinic N/A 0 N/A 0 N/A 0

Psychiatric Day Treatment N/A 0 Funds 1 and 2 1586 N/A 0

Eating Disorder Clinic N/A 0 Funds 1 and 2 315 N/A 0 Eating Disorder Day Hospital N/A 0 N/A 0 N/A 0 Substance Abuse N/A 0 N/A 0 N/A 0

Telepsychiatry Services Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYS- funded Ontario Child and Youth No 0 N/A 0 No 0 Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth No N/A YES Network (OTN)? Schedule 1 Facility (Paediatrics) No YES YES

Regional Mandate N/A 0 N/A 0 No 0

Note WRH: Number of Inpatient Cases & Inpatient Weighted Cases: The 6 inpatient cases with Eating Disorders were not utilizing Mental Health beds. Patients with Eating Disorders are not treated in Mental Health beds. Emergency Services: Depending on the patient's diagnosis, some patients can be discharged with community follow up, but others may need to be transferred to Maryvale. If Mayrvale is full, the patient is admitted to paediatrics until a spot becomes available at Maryvale. Ambulatory Services: WRH doesn’t have an Eating Disorder service for patients. However, WRH has a dietitian that is available to follow up with the patient as an outpatient service or the patients are referred to the Health Unit or Maryvale. The Psychiatric Clinic is available 3 days a week and the doctor sees between 3 and 4 visits per day.

232 PCMCH Maternal-Child Benchmarking Report 2013

1.0 Mental Health Indicators

1.1.1 MH – Inpatient Mental Health Volumes

This table and graph depict inpatient mental health volumes. A zero volume is blank and a volume less than 6 is indicated as “<6”.

DAD OMHRS Hospital Inpatient Inpatient DAD and OMHRS Inpatient Mental Health Cases Cases Cases MCH HHSC BCHS 33 GRH BWH 8 229 CHEO CCH <6 <6 Southlake CGMH 7 WOHS CH LHSC 370 CH LHSC CHEO 514 LH CMH 7 RVHS GBGH 17 HHS GBHS 15 WRH GDH 11 KGH GRH 573 TBRHSC HHCC 15 NYGH HHS 310 272 SickKids HRRH 95 100 TEGH HSN 163 136 SJHC Toronto JBH <6 22 NHS KGH 288 HSN SAH LH 338 <6 HRRH MCH HHSC 672 RVH MH <6 NBRHC MHA-SMGH <6 OSMH MSH <6 15 BCHS NBRHC 67 33 GBGH NHS 166 221 GBHS NYGH 272 HHCC OSMH 41 38 SLMHC PRHC <6 GDH Renfrew <6 WPSHC RHCF <6 BWH RMH <6 CGMH RVH 85 83 CMH RVHS 326 PRHC SAH 133 RHCF SBGHC <6 THP-MH SickKids 219 THP-CVH SJHC Hamilton 11 MH CCH SJHC Toronto 186 159 JBH SLMHC 13 Renfrew SMH <6 Stevenson Southlake 420 TSH STEGH <6 MHA-SMGH Stevenson <6 MSH Sunnybrook <6 116 RMH TBRHSC 285 284 SBGHC TEGH 204 <6 SMH THP-CVH <6 STEGH THP-MH <6 Sunnybrook TSH <6 SJHC Hamilton WOHS 396 0 100 200 300 400 500 600 700 WPSHC 11 WRH 292 267 DAD Inpatient Cases OMHRS Inpatient Cases

Note WGH: Woodstock General Hospital data has been excluded from the Mental Health section of the 2013 Benchmarking Report. CIHI DAD and NACRS reports will be updated for the 2013/14 year to include WGH mental health cases. 233 PCMCH Maternal-Child Benchmarking Report 2013

1.1.2 MH – Inpatient Mental Health Age Profile

This table and graph provide the distribution of cases by age category of the inpatient mental health cases of each hospital. The age categories are: 0-7 years, 8-12 years and 13-17 years. A zero volume is blank and a volume less than 6 is indicated as “<6”.

DAD Inpatient Mental Health Age Profile 13-17 Inpatient Mental Health Age Distribution (DAD) Hospital 0-7 years 8-12 years Total years BCHS <6 32 33 BCHS BWH <6 <6 <6 8 BWH CCH <6 <6 <6 CCH CGMH CGMH 7 7 CH LHSC CH LHSC 6 41 323 370 CHEO CHEO 8 31 475 514 CMH CMH <6 <6 <6 7 GBGH GBGH <6 16 17 GBHS GBHS <6 <6 9 15 GDH GDH <6 9 11 GRH GRH 6 41 526 573 HHCC HHCC <6 14 15 HHS HHS <6 29 278 310 HRRH HRRH <6 11 82 95 HSN HSN <6 15 147 163 JBH JBH <6 <6 KGH KGH 14 47 227 288 LH MCH HHSC LH <6 19 318 338 MH MCH HHSC 8 77 587 672 MHA-SMGH MH <6 <6 MSH MHA-SMGH <6 <6 NBRHC MSH <6 <6 NHS NBRHC 13 54 67 NYGH NHS 6 37 123 166 OSMH NYGH <6 21 250 272 PRHC OSMH <6 <6 32 41 Renfrew PRHC <6 <6 RHCF Renfrew <6 <6 RMH RHCF <6 <6 RVH RMH <6 <6 RVHS SAH RVH 12 73 85 SBGHC RVHS <6 18 306 326 SickKids SAH <6 7 124 133 SJHC Toronto SBGHC <6 <6 SLMHC SickKids <6 38 176 219 SMH SJHC Toronto <6 25 160 186 Southlake SLMHC <6 12 13 STEGH SMH <6 <6 Stevenson Southlake <6 33 383 420 Sunnybrook STEGH <6 <6 TBRHSC Stevenson <6 <6 TEGH Sunnybrook <6 <6 THP-CVH TBRHSC 35 250 285 THP-MH TSH TEGH 19 185 204 WOHS THP-CVH <6 <6 <6 <6 WPSHC THP-MH <6 <6 WRH TSH <6 <6 WOHS 6 39 351 396 0% 20% 40% 60% 80% 100% WPSHC <6 9 11 0-7 years 8-12 years 13-17 years WRH <6 46 244 292

234 PCMCH Maternal-Child Benchmarking Report 2013

This table and chart provide the distribution of cases by age category of the OHMRS mental health cases of each hospital. The age categories are: 0-7 years, 8-12 years and 13-17 years. A zero volume is blank and a volume less than 6 is indicated as “<6”.

OMHRS Inpatient Mental Health Age Profile Inpatient Mental Health Age Distribution (OHMRS) 13-17 Hospital 0-7 years 8-12 years Total years BWH BWH <6 19 206 229 CCH CCH <6 <6 HHS HHS <6 26 244 272 HRRH HSN HRRH <6 12 86 100 JBH HSN <6 13 122 136 LH JBH <6 21 22 MSH LH <6 <6 NBRHC MSH 15 15 NHS NBRHC <6 29 33 OSMH NHS 11 210 221 RVH OSMH 38 38 SJHC Hamilton SJHC Toronto RVH 83 83 Sunnybrook SJHC Hamilton 11 11 TBRHSC SJHC Toronto <6 21 137 159 TEGH Sunnybrook 116 116 WRH TBRHSC 37 247 284 0% 20% 40% 60% 80% 100% TEGH <6 <6 0-7 years 8-12 years 13-17 years WRH <6 39 226 267

235 PCMCH Maternal-Child Benchmarking Report 2013

1.1.3 MH – Inpatient Mental Health Average Length of Stay

This table and chart illustrate the average length of stay for all inpatient mental health cases. The length of stay is calculated from the date of admission to the date of discharge.

ALOS ALOS Hospital Inpatient Mental Health Average Length of Stay DAD OMHRS BCHS 1.9 BCHS BWH 1.6 6.1 BWH CCH 1.0 5.0 CCH CGMH 1.6 CGMH CH LHSC 12.9 CH LHSC CHEO 16.9 CHEO CMH 1.9 CMH GBGH 3.8 GBGH GBHS 6.4 GBHS GDH 1.7 GDH GRH 6.3 GRH HHCC HHCC 3.9 HHS HHS 7.9 8.8 HRRH HRRH 14.9 14.7 HSN HSN 8.8 6.2 JBH JBH 1.0 1.4 KGH KGH 8.3 LH LH 7.2 1.0 MCH HHSC MCH HHSC 12.1 MH MH 1.0 MHA-SMGH MHA-SMGH 7.0 MSH MSH 1.0 6.7 NBRHC NHS NBRHC 5.6 NYGH NHS 2.6 3.0 OSMH NYGH 6.1 PRHC OSMH 7.0 5.5 Renfrew PRHC 33.4 RHCF Renfrew 1.0 RMH RHCF 2.2 RVH RMH 1.0 RVHS RVH 4.9 7.0 SAH RVHS 4.6 SBGHC SAH 5.9 SickKids SJHC Hamilton SBGHC 1.0 SJHC Toronto SickKids 19.7 SLMHC SJHC Hamilton 21.3 SMH SJHC Toronto 8.9 10.6 Southlake SLMHC 2.1 STEGH SMH 6.0 Stevenson Southlake 6.5 Sunnybrook STEGH 1.0 TBRHSC Stevenson 2.0 TEGH Sunnybrook 1.0 14.0 THP-CVH TBRHSC 8.2 8.4 THP-MH TSH TEGH 9.1 7.0 WOHS THP-CVH 10.3 WPSHC THP-MH 4.4 WRH TSH 4.5 WOHS 10.6 0 5 10 15 20 25 30 35 WPSHC 1.7 ALOS DAD ALOS OMHRS WRH 6.7 7.1

236 PCMCH Maternal-Child Benchmarking Report 2013

1.1.4 MH – Inpatient Mental Health Average Weight per Case

This table and chart present the ARIW for all inpatient DAD mental health cases. The average inpatient weight per case represents the inpatient Resource Intensity Weight (RIW) which is reflective of the amount of resources required by the hospitals to care for patients based on the CMG during their hospital stay.

Hospital DAD ARIW Inpatient Mental Health Average Weight per Case BCHS 1.07 BWH 1.30 SickKids CCH 1.27 PRHC CGMH 1.08 GBHS CH LHSC 2.14 CH LHSC CHEO 2.06 THP-MH CMH 0.86 KGH GBGH 1.53 CHEO GBHS 3.06 MCH HHSC GDH 1.07 HRRH GRH 1.35 NYGH HHCC 0.99 OSMH TEGH HHS 1.46 SAH HRRH 2.04 WOHS HSN 1.41 SJHC Toronto JBH 0.24 WRH KGH 2.12 RVH LH 1.46 TBRHSC MCH HHSC 2.05 GBGH MH 0.97 LH MHA-SMGH 0.83 HHS MSH 0.21 Southlake NBRHC 1.36 HSN NHS 1.26 RVHS NYGH 2.01 NBRHC OSMH 2.00 GRH PRHC 3.13 BWH Renfrew 1.00 CCH NHS RHCF 1.19 THP-CVH RMH 1.06 RHCF RVH 1.58 SMH RVHS 1.37 CGMH SAH 1.71 GDH SBGHC 0.45 BCHS SickKids 3.40 RMH SJHC Toronto 1.65 Sunnybrook SLMHC 0.85 Renfrew SMH 1.12 TSH Southlake 1.42 HHCC STEGH 0.45 MH Stevenson 0.86 Stevenson Sunnybrook 1.02 CMH TBRHSC 1.58 SLMHC TEGH 1.72 MHA-SMGH WPSHC THP-CVH 1.23 SBGHC THP-MH 2.13 STEGH TSH 1.00 JBH WOHS 1.66 MSH WPSHC 0.78 WRH 1.64 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5

237 PCMCH Maternal-Child Benchmarking Report 2013

1.1.5 MH – Top 10 CMGs

This table displays the Top 10 CMGs in each hospital (marked RED). Volumes less than 6 are indicted as “<6”.

CMG LH

CCH GRH HHS HSN JBM KGH NHS

GHD MSH

BCHS BWH CMH

CHEO GBHS HHCC HRRH

GBGH NYGH

CGMH OSMH

NBRHC

CH LHSC

MCH HHSC MHA-SMGH

693 Depressive Episode without ECT 8 <6 <6 166 249 <6 8 <6 <6 279 7 132 18 47 <6 23 124 186 20 46 79 9 687 Stress Reaction/Adjustment Disorder 12 <6 <6 44 60 <6 <6 <6 138 <6 74 <6 46 34 77 80 <6 12 65 51 <6 696 Childhood/Adolescence Disorder <6 17 26 <6 <6 44 17 10 16 125 26 88 8 24 39 8 686 Anxiety Disorder <6 <6 <6 <6 30 10 <6 <6 21 <6 22 <6 6 27 13 78 <6 6 15 12 <6 673 Eating Disorder <6 33 67 <6 <6 <6 7 <6 6 14 12 6 83 <6 <6 36 7 678 Schizotypal/Delusional Disorder <6 <6 16 20 <6 <6 <6 11 <6 6 <6 15 10 23 <6 <6 <6 <6 694 Mood [Affective] Disorder <6 23 30 29 10 <6 7 28 17 <6 <6 695 Mental Retardation/Disorder of Development <6 15 <6 12 6 8 <6 19 <6 14 <6 18 <6 689 Bipolar Disorder without ECT 7 8 8 11 <6 <6 7 9 15 <6 <6 697 Mixed Disorder of Conduct/Emotion 25 <6 16 <6 <6 683 Disorder of Adult Personality Behaviour <6 <6 <6 <6 <6 <6 <6 <6 <6 7 31 <6 <6 <6 685 Somatoform/Dissociative Disorder 13 <6 <6 <6 <6 6 20 <6 <6 699 Psychoactive Substance Use, Harmful Use <6 <6 <6 7 <6 <6 <6 <6 6 <6 7 <6 6 Psychoactive Substance Use, Residual/Late- 703 <6 <6 <6 <6 <6 <6 <6 8 <6 <6 <6 onset/Psychotic Disorder 684 Obsessive Compulsive Disorder <6 7 <6 <6 <6 <6 <6 <6 8 <6 8 677 Schizophrenia without ECT <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 Psychoactive Substance Use, Dependence 700 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 Syndrome 698 Psychoactive Substance Use, Acute Intoxication <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 672 Miscellaneous Mental Disorder <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 682 Habit/Impulse Disorder <6 <6 <6 10 <6 <6 Psychoactive Substance Use, 704 <6 <6 <6 <6 <6 <6 Amnesic/Other/Unspecified 680 Schizoaffective Disorder without ECT <6 <6 <6 <6 <6 701 Psychoactive Substance Use, Withdrawal State <6 <6 <6 <6 <6

238 PCMCH Maternal-Child Benchmarking Report 2013

1.1.5 MH – Top 10 CMGs (cont)

CMG

TSH

RVH SAH

SMH

RHCF RMH TEGH WRH Total

PRHC RVHS

STEGH WOHS

SBGHC

SLMHC WPSHC

TBRHSC

SickKids THP-MH

Renfrew

THP-CVH

Southlake

Stevenson

Sunnybrook SJHC Toronto

693 Depressive Episode without ECT <6 <6 <6 7 122 30 33 44 7 <6 245 <6 148 65 <6 <6 63 <6 79 2,266 687 Stress Reaction/Adjustment Disorder <6 30 92 48 21 53 <6 50 39 55 <6 <6 125 <6 46 1,283 696 Childhood/Adolescence Disorder <6 13 36 14 7 16 32 47 20 50 <6 62 755 686 Anxiety Disorder <6 14 6 8 7 <6 22 18 19 <6 <6 63 <6 48 472 673 Eating Disorder <6 9 <6 7 101 <6 14 <6 6 <6 <6 9 442 678 Schizotypal/Delusional Disorder <6 <6 <6 7 7 10 <6 <6 11 8 16 <6 <6 206 694 Mood [Affective] Disorder 9 <6 <6 <6 <6 <6 8 7 184 695 Mental Retardation/Disorder of Development <6 8 <6 <6 7 <6 6 14 17 171 689 Bipolar Disorder without ECT <6 10 <6 14 <6 6 10 18 <6 141 697 Mixed Disorder of Conduct/Emotion <6 <6 38 <6 6 93 683 Disorder of Adult Personality Behaviour <6 <6 <6 8 <6 10 <6 <6 <6 <6 92 685 Somatoform/Dissociative Disorder <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 7 <6 80 699 Psychoactive Substance Use, Harmful Use <6 7 <6 <6 <6 <6 <6 <6 70 Psychoactive Substance Use, Residual/Late- 703 <6 <6 9 <6 <6 11 63 onset/Psychotic Disorder 684 Obsessive Compulsive Disorder <6 <6 <6 <6 <6 <6 55 677 Schizophrenia without ECT <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 46 Psychoactive Substance Use, Dependence 700 <6 8 <6 <6 <6 <6 38 Syndrome 698 Psychoactive Substance Use, Acute Intoxication <6 <6 <6 <6 <6 <6 <6 <6 37 672 Miscellaneous Mental Disorder 7 <6 <6 <6 <6 29 682 Habit/Impulse Disorder <6 <6 <6 20 Psychoactive Substance Use, 704 <6 <6 <6 <6 20 Amnesic/Other/Unspecified 680 Schizoaffective Disorder without ECT <6 <6 <6 <6 13 701 Psychoactive Substance Use, Withdrawal State <6 7

239 PCMCH Maternal-Child Benchmarking Report 2013

1.1.6 MH – Top 10 CMGs Length of Stay

This chart illustrates the acute average length of stay for all inpatient cases within the Top 10 CMGs listed in MH 1.1.5. The length of stay is calculated from the date of admission to the date of discharge.

CMG LH

JBH MH

CCH GRH HHS HSN KGH NHS

GHD MSH

BWH CMH

BCHS GBHS

CHEO GBGH HHCC HRRH

NYGH

CGMH

NBRHC

CH LHSC CH

MCH HHSC MCH MHA-SMGH

693 Depressive Episode without ECT 2.3 4.0 1.3 7.6 13.1 2.0 1.8 3.0 1.0 7.1 3.7 10.0 14.2 4.8 1.0 8.2 6.7 9.5 5.5 3.0 4.9 687 Stress Reaction/Adjustment Disorder 2.0 1.0 2.5 5.7 7.1 3.0 2.0 1.0 4.2 1.0 4.0 5.4 4.5 4.9 5.6 6.2 1.0 4.3 2.2 3.0 696 Childhood/Adolescence Disorder 1.4 6.9 12.2 1.0 1.0 4.9 4.5 12.2 3.0 7.4 2.8 9.1 4.1 1.9 4.2 686 Anxiety Disorder 1.0 1.0 1.0 1.0 7.1 8.8 1.0 4.0 4.6 5.5 6.8 12.8 3.7 9.0 4.9 10.6 1.0 3.2 2.7 4.9 673 Eating Disorder 3.0 56.8 46.0 3.0 13.0 9.0 8.4 3.0 4.5 39.6 17.8 9.3 27.1 28.7 3.5 15.5 678 Schizotypal/Delusional Disorder 1.0 1.0 21.3 7.9 1.5 1.0 1.5 15.2 12.0 18.0 17.2 13.7 13.0 21.0 9.0 1.5 7.0 694 Mood [Affective] Disorder 4.0 4.9 18.2 5.9 11.8 13.0 4.0 7.3 9.3 5.0 1.0 Mental Retardation/Disorder of 695 15.0 11.1 13.0 5.1 6.5 16.5 3.0 7.9 6.0 15.7 4.7 5.3 Development 689 Bipolar Disorder without ECT 9.4 18.9 13.9 6.6 18.5 15.0 16.1 17.8 15.3 2.0 7.8 697 Mixed Disorder of Conduct/Emotion 15.5 6.5 9.6 5.5 1.0 683 Disorder of Adult Personality Behaviour 2.0 1.0 17.0 1.5 8.0 1.0 18.5 7.0 1.7 2.9 7.9 2.3 5.0 2.0 685 Somatoform/Dissociative Disorder 5.6 5.3 6.0 5.5 1.0 5.7 11.1 1.0 1.5 699 Psychoactive Substance Use, Harmful Use 4.8 5.0 1.0 6.6 14.0 1.0 7.0 2.8 4.8 5.0 6.9 3.0 4.0 Psychoactive Substance Use, Residual/Late- 703 2.5 26.0 4.2 9.0 18.0 20.0 9.0 10.6 16.6 1.0 12.4 onset/Psychotic Disorder 684 Obsessive Compulsive Disorder 44.5 13.7 1.0 1.0 5.8 16.0 5.0 15.0 9.4 6.5 5.1 677 Schizophrenia without ECT 24.0 4.0 21.0 74.0 15.0 17.0 18.5 18.0 19.4 20.0 Psychoactive Substance Use, Dependence 700 1.0 10.3 4.7 1.0 15.5 5.0 1.0 5.5 6.0 5.0 Syndrome Psychoactive Substance Use, Acute 698 1.0 1.0 1.0 1.0 1.0 42.0 3.5 1.0 1.5 1.0 1.0 1.0 3.0 Intoxication 672 Miscellaneous Mental Disorder 2.0 92.5 1.0 4.0 2.0 1.0 8.5 5.0 39.0 2.0 682 Habit/Impulse Disorder 1.0 10.5 5.0 7.8 1.0 3.0 Psychoactive Substance Use, 704 1.0 2.0 6.3 4.3 8.0 1.0 Amnesic/Other/Unspecified 680 Schizoaffective Disorder without ECT 11.5 26.0 38.5 11.0 4.0 Psychoactive Substance Use, Withdrawal 701 1.0 1.0 2.0 3.0 7.0 State

240 PCMCH Maternal-Child Benchmarking Report 2013

1.1.6 MH – Top 10 CMGs Length of Stay (cont)

CMG

TSH

RVH SAH

SMH

RMH WRH

PRHC RHCF RVHS TEGH

OSMH STEGH WOHS

SBGHC

SLMHC

TBRHSC WPSHC

SickKids

THP-MH

Renfrew

THP-CVH

Southlake

Stevenson

Sunnybrook SJHC Toronto SJHC 693 Depressive Episode without ECT 0.91 1.06 1.06 1.06 1.06 1.05 1.07 1.42 1.29 0.89 1.12 1.08 0.70 1.26 1.28 0.40 1.06 1.25 1.06 1.09 687 Stress Reaction/Adjustment Disorder 0.85 0.93 0.96 0.92 1.10 0.93 1.10 0.32 0.99 1.04 1.06 0.93 0.93 1.10 0.93 1.03 696 Childhood/Adolescence Disorder 2.06 4.98 2.11 2.27 1.76 2.35 2.56 2.25 2.35 2.33 2.35 0.18 2.23 686 Anxiety Disorder 1.52 1.52 1.75 1.79 1.76 1.52 1.52 1.51 1.48 1.61 1.52 1.52 1.69 1.52 1.31 673 Eating Disorder 4.60 2.33 4.24 0.16 6.66 4.66 6.57 4.79 4.50 3.07 4.50 4.50 4.05 678 Schizotypal/Delusional Disorder 2.42 2.42 2.42 2.42 2.34 2.11 3.92 0.52 2.42 3.57 2.63 2.46 0.18 2.69 694 Mood [Affective] Disorder 1.20 1.20 1.20 1.20 1.20 1.20 1.20 1.47 Mental Retardation/Disorder of 695 2.84 0.22 3.52 3.67 12.07 3.16 3.46 2.88 3.46 3.06 Development 689 Bipolar Disorder without ECT 2.70 2.70 3.95 1.94 3.95 2.33 3.75 2.68 2.70 697 Mixed Disorder of Conduct/Emotion 1.21 2.49 1.42 1.21 1.21 683 Disorder of Adult Personality Behaviour 1.02 1.02 1.02 1.02 1.60 1.05 1.02 1.02 1.02 1.02 685 Somatoform/Dissociative Disorder 0.43 1.21 1.21 1.21 1.21 1.21 1.21 1.53 3.84 1.85 2.18 1.21 699 Psychoactive Substance Use, Harmful Use 0.90 0.82 0.90 1.47 0.76 0.90 0.90 0.65 Psychoactive Substance Use, Residual/Late- 703 1.02 1.42 1.39 1.42 2.17 1.79 onset/Psychotic Disorder 684 Obsessive Compulsive Disorder 3.19 0.43 2.59 2.59 2.59 2.59 677 Schizophrenia without ECT 5.89 2.98 2.98 2.98 0.17 2.98 3.69 2.98 2.98 3.77 Psychoactive Substance Use, Dependence 700 1.06 1.06 1.06 1.46 0.60 2.26 Syndrome Psychoactive Substance Use, Acute 698 0.45 0.45 0.45 0.45 1.10 0.45 1.02 0.59 0.45 Intoxication 672 Miscellaneous Mental Disorder 0.94 7.96 1.13 1.18 1.47 1.47 682 Habit/Impulse Disorder 1.08 0.85 2.32 Psychoactive Substance Use, 704 0.93 0.93 0.93 2.05 Amnesic/Other/Unspecified 680 Schizoaffective Disorder without ECT 3.66 3.66 3.66 3.66 Psychoactive Substance Use, Withdrawal 701 1.90 State

241 PCMCH Maternal-Child Benchmarking Report 2013

1.1.7 MH –Top 10 CMGs Average Weight per Case

This table presents the ARIW for all inpatient mental health cases within the Top 10 CMGs listed in MH 1.1.5. The average inpatient weight per case represents the inpatient Resource Intensity Weight (RIW) which is reflective of the amount of resources required by the hospitals to care for patients based on the CMG during their hospital stay.

CMG

CCH HHS HSN JBM

GHD GRH

CMH

BCHS BWH

CHEO GBHS HHCC HRRH

GBGH

CGMH CH LHSC CH

672 Miscellaneous Mental Disorder 1.47 50.07 1.13 1.13 1.13 0.21 673 Eating Disorder 4.50 6.36 5.06 0.46 5.51 4.50 3.24 0.48 1.84 4.26 674 Puerperal Disorder 677 Schizophrenia without ECT 2.98 3.30 2.98 2.98 2.42 2.06 678 Schizotypal/Delusional Disorder 1.30 2.42 2.92 1.77 1.43 3.26 2.42 2.58 2.69 2.42 1.86 680 Schizoaffective Disorder without ECT 1.51 3.66 3.66 681 Gender Identity/Sexual Preference Disorder 682 Habit/Impulse Disorder 1.08 1.08 1.08 1.21 683 Disorder of Adult Personality Behaviour 1.02 1.02 1.02 1.02 1.02 1.02 2.85 1.02 1.02 684 Obsessive Compulsive Disorder 2.59 2.33 2.59 2.59 3.07 2.87 1.78 685 Somatoform/Dissociative Disorder 1.26 1.41 1.21 1.21 1.21 686 Anxiety Disorder 1.52 1.52 1.52 1.52 1.58 1.65 1.52 1.52 1.59 1.36 1.47 1.52 1.38 687 Stress Reaction/Adjustment Disorder 0.90 0.97 0.93 1.00 1.05 1.59 0.75 0.93 0.99 0.93 1.00 0.93 0.89 689 Bipolar Disorder without ECT 3.06 2.30 2.72 2.48 2.70 2.70 690 Bipolar Disorder, Severe Depression with ECT 691 Bipolar Disorder, Severe Depression without ECT 693 Depressive Episode without ECT 0.60 1.06 1.06 1.23 1.38 0.49 1.01 1.06 1.06 1.14 0.97 1.27 1.32 0.90 0.24 694 Mood [Affective] Disorder 0.60 1.19 2.31 1.30 1.35 1.20 1.02 695 Mental Retardation/Disorder of Development 3.46 3.98 3.84 3.21 3.46 3.85 3.46 696 Childhood/Adolescence Disorder 1.56 2.32 2.33 2.27 2.27 2.30 2.35 2.27 2.05 697 Mixed Disorder of Conduct/Emotion 1.92 698 Psychoactive Substance Use, Acute Intoxication 0.45 1.02 1.02 0.28 0.45 6.73 699 Psychoactive Substance Use, Harmful Use 0.90 1.20 0.90 1.34 2.07 0.90 0.90 0.90 700 Psychoactive Substance Use, Dependence Syndrome 1.06 1.06 1.06 1.06 1.06 1.06 701 Psychoactive Substance Use, Withdrawal State 0.83 0.83 0.83 Psychoactive Substance Use, Residual/Late- 703 1.42 4.05 1.36 1.42 1.42 1.42 onset/Psychotic Disorder Psychoactive Substance Use, 704 0.93 0.93 0.93 0.77 Amnesic/Other/Unspecified

242 PCMCH Maternal-Child Benchmarking Report 2013

1.1.7 MH – Top 10 CMGs Average Weight per Case (cont)

CMG LH

NHS RVH SAH

KGH

MSH RMH

RHCF

PRHC RVHS

NYGH

OSMH

NBRHC

Renfrew

MCH HHSC MCH MHA-SMGH 672 Miscellaneous Mental Disorder 1.13 1.13 4.95 1.13 0.94 673 Eating Disorder 4.43 4.50 4.68 4.50 2.54 3.80 4.60 2.33 4.24 0.16 6.66 674 Puerperal Disorder 1.61 1.61 677 Schizophrenia without ECT 2.98 2.98 2.66 2.98 5.89 2.98 678 Schizotypal/Delusional Disorder 2.15 2.59 2.86 1.42 0.27 2.84 2.42 2.42 2.42 2.42 2.34 680 Schizoaffective Disorder without ECT 5.89 3.66 681 Gender Identity/Sexual Preference Disorder 682 Habit/Impulse Disorder 1.08 1.08 1.08 683 Disorder of Adult Personality Behaviour 0.90 1.21 0.85 1.02 1.02 1.02 1.02 1.02 1.02 684 Obsessive Compulsive Disorder 2.59 2.04 2.59 3.19 3.19 0.43 685 Somatoform/Dissociative Disorder 1.43 2.06 0.21 0.70 0.43 1.21 1.21 1.21 686 Anxiety Disorder 1.59 1.47 1.79 1.52 1.81 1.52 1.79 1.52 1.52 1.75 1.79 687 Stress Reaction/Adjustment Disorder 0.94 0.98 1.01 0.93 0.78 0.93 0.97 0.85 0.93 0.96 0.92 1.10 689 Bipolar Disorder without ECT 2.91 2.11 2.93 2.70 3.53 2.70 2.70 3.95 690 Bipolar Disorder, Severe Depression with ECT 691 Bipolar Disorder, Severe Depression without ECT 5.18 693 Depressive Episode without ECT 1.10 1.13 1.22 1.08 0.97 1.15 0.91 1.06 1.06 1.06 1.06 1.05 1.07 694 Mood [Affective] Disorder 1.20 1.25 0.60 1.20 1.20 1.20 695 Mental Retardation/Disorder of Development 3.40 6.54 3.28 3.58 4.39 2.84 0.22 3.52 3.67 696 Childhood/Adolescence Disorder 2.40 2.25 2.41 1.76 2.07 2.28 2.06 4.98 2.11 2.27 1.76 697 Mixed Disorder of Conduct/Emotion 0.83 1.91 1.43 0.27 1.21 698 Psychoactive Substance Use, Acute Intoxication 0.70 0.45 0.45 0.45 0.45 0.45 0.79 0.45 0.45 0.45 699 Psychoactive Substance Use, Harmful Use 0.90 0.90 1.12 0.90 0.90 0.90 0.82 0.90 700 Psychoactive Substance Use, Dependence Syndrome 1.06 1.18 3.69 1.06 1.06 1.06 1.06 701 Psychoactive Substance Use, Withdrawal State 0.83 0.83 Psychoactive Substance Use, Residual/Late- 703 1.42 1.62 2.78 1.42 2.11 1.02 onset/Psychotic Disorder Psychoactive Substance Use, 704 0.93 0.93 0.93 0.93 Amnesic/Other/Unspecified

243 PCMCH Maternal-Child Benchmarking Report 2013

1.1.7 MH – Top 10 CMGs Average Weight per Case (cont)

CMG

TSH

SMH

WRH

TEGH

STEGH WOHS

SBGHC

SLMHC

WPSHC

TBRHSC

SickKids

THP-MH

THP-CVH

Southlake

Stevenson

Sunnybrook SJHC Toronto SJHC 672 Miscellaneous Mental Disorder 7.96 1.13 1.18 1.47 1.47 673 Eating Disorder 4.66 6.57 4.79 4.50 3.07 4.50 4.50 4.05 674 Puerperal Disorder 677 Schizophrenia without ECT 2.98 2.98 0.17 2.98 3.69 2.98 2.98 3.77 678 Schizotypal/Delusional Disorder 2.11 3.92 0.52 2.42 3.57 2.63 2.46 0.18 2.69 680 Schizoaffective Disorder without ECT 3.66 3.66 3.66 3.66 681 Gender Identity/Sexual Preference Disorder 1.31 682 Habit/Impulse Disorder 0.85 2.32 683 Disorder of Adult Personality Behaviour 1.60 1.05 1.02 1.02 1.02 1.02 684 Obsessive Compulsive Disorder 2.59 2.59 2.59 2.59 685 Somatoform/Dissociative Disorder 1.21 1.21 1.21 1.53 3.84 1.85 2.18 1.21 686 Anxiety Disorder 1.76 1.52 1.52 1.51 1.48 1.61 1.52 1.52 1.69 1.52 1.31 687 Stress Reaction/Adjustment Disorder 0.93 1.10 0.32 0.99 1.04 1.06 0.93 0.93 1.10 0.93 1.03 689 Bipolar Disorder without ECT 1.94 3.95 2.33 3.75 2.68 2.70 690 Bipolar Disorder, Severe Depression with ECT 6.46 691 Bipolar Disorder, Severe Depression without ECT 2.69 2.69 693 Depressive Episode without ECT 1.42 1.29 0.89 1.12 1.08 0.70 1.26 1.28 0.40 1.06 1.25 1.06 1.09 694 Mood [Affective] Disorder 1.20 1.20 1.20 1.20 1.20 1.47 695 Mental Retardation/Disorder of Development 12.07 3.16 3.46 2.88 3.46 3.06 696 Childhood/Adolescence Disorder 2.35 2.56 2.25 2.35 2.33 2.35 0.18 2.23 697 Mixed Disorder of Conduct/Emotion 2.49 1.42 1.21 1.21 698 Psychoactive Substance Use, Acute Intoxication 0.45 1.10 0.45 1.02 0.59 0.45 699 Psychoactive Substance Use, Harmful Use 1.47 0.76 0.90 0.90 0.65 700 Psychoactive Substance Use, Dependence Syndrome 1.46 0.60 2.26 701 Psychoactive Substance Use, Withdrawal State 1.90 Psychoactive Substance Use, Residual/Late- 703 1.42 1.39 1.42 2.17 1.79 onset/Psychotic Disorder Psychoactive Substance Use, 704 0.93 2.05 Amnesic/Other/Unspecified

244 PCMCH Maternal-Child Benchmarking Report 2013

1.1.8 MH – Average Length of Stay by Age Category

This table illustrates the acute length of stay for all inpatient DAD mental health cases by age category. The length of stay is calculated from the date of admission to the date of discharge. The age categories are: 0-7 years, 8-12 years and 13-17 years. A zero volume is blank.

DAD Inpatient Length of Stay by Age Category Hospital 0-7 years 8-12 years 13-17 years BCHS 1.0 1.9 BWH 1.5 1.5 1.8 CCH 1.0 1.0 CGMH 1.6 CH LHSC 35.8 8.4 13.0 CHEO 10.1 23.5 16.1 CMH 2.0 2.0 1.8 GBGH 6.0 1.8 GBHS 13.0 1.8 8.2 GDH 1.0 1.9 GRH 2.5 4.6 6.4 HHCC 3.0 3.9 HHS 1.3 6.8 8.1 HRRH 22.0 12.0 15.1 HSN 2.0 10.2 7.8 JBH 1.0 KGH 10.1 8.8 8.1 LH 1.0 3.5 7.2 MCH HHSC 20.0 11.9 11.9 MH 1.0 MHA-SMGH 7.0 NBRHC 3.5 6.1 NHS 3.0 2.7 2.5 NYGH 10.0 4.2 6.2 OSMH 2.6 3.3 7.0 PRHC 33.4 Renfrew 1.0 RHCF 2.2 RMH 1.0 RVH 1.9 5.4 RVHS 3.0 2.3 4.7 SAH 6.0 2.7 6.1 SBGHC 1.0 SickKids 12.6 23.2 18.1 SJHC Toronto 6.0 8.5 9.0 SLMHC 1.0 2.2 SMH 6.0 Southlake 1.8 8.3 6.4 STEGH 1.0 Stevenson 2.0 Sunnybrook 1.0 TBRHSC 7.9 7.8 TEGH 8.1 9.2 THP-CVH 5.0 1.0 17.5 THP-MH 4.4 TSH 4.5 WOHS 7.8 9.9 10.7 WPSHC 1.0 1.9 WRH 17.0 5.6 6.9

Note CH LHSC: LOS is longer because children with Eating Disorders are included. CH LHSC is the regional provider of this service (i.e. children who cannot be served in their own communities come to CH LHSC).

245

PCMCH Maternal-Child Benchmarking Report 2013

These charts illustrate the acute length of stay for all inpatient DAD mental health cases by age category.

DAD Length of Inpatient Stay - 0-7 years 40 35 30 25 20 15 10 5 0

DAD Length of Inpatient Stay - 8-12 years 25

SAH

CCH

HHS

CVH

NHS HSN

RVH

KGH

GRH

GDH

CMH

WRH BWH

RVHS

TEGH

GBHS

CHEO

HHCC

HRRH

NYGH

GBGH

OSMH

WOHS

NBRHC

SLMHC

WPSHC

TBRHSC

SickKids

CH LHSC CH

THP

Southlake MCH HHSC MCH SJHC TorontoSJHC

DAD Length of Inpatient Stay - 13-17 years 40

JBH

TSH

SAH

CCH

HHS

NHS HSN -

RVH

CVH

KGH

GRH

GDH

SMH

CMH

RMH

WRH BWH

RHCF BCHS

RVHS

PRHC

TEGH

GBHS

CHEO

HHCC

HRRH

NYGH

GBGH

SMGH

OSMH

WOHS

CGMH

STEGH

SBGHC

NBRHC

SLMHC

WPSHC

TBRHSC

SickKids

THP

CH LHSCCH

Renfrew

THP

Southlake

Stevenson

MCH HHSC MCH

MHA Sunnybrook SJHCToronto

246

PCMCH Maternal-Child Benchmarking Report 2013

This table and chart illustrate the length of stay for all inpatient OMHRS mental health cases by age category.

OMHRS Inpatient Length of Stay by Age Category Hospital 0-7 years 8-12 years 13-17 years BWH 5.0 6.5 6.1 CCH 5.0 HHS 1.5 7.4 9.0 HRRH 22.0 11.6 14.9 HSN 6.0 6.6 6.1 JBH 1.0 1.4 LH 1.0 MSH 6.7 NBRHC 4.0 5.0 NHS 2.5 3.1 OSMH 5.5 RVH 7.0 SJHC Hamilton 21.3 SJHC Toronto 6.0 11.4 10.5 Sunnybrook 14.0 TBRHSC 8.6 8.3 TEGH 7.0 WRH 17.0 6.7 7.0

OMHRS Inpatient Length of Stay by Age Category 25

0-7 years 8-12 years 13-17 years

247

PCMCH Maternal-Child Benchmarking Report 2013

1.1.9 MH – Average Weight per Case by Age Category

This table and chart present the ARIW for all inpatient DAD mental health cases by age category. The average inpatient weight per case represents the inpatient Resource Intensity Weight (RIW) which is reflective of the amount of resources required by the hospitals to care for patients based on the CMG during their hospital stay. A zero volume is shown as blank.

13-17 Total Hospitals 0-7 Years 8-12 Years ARIW - All Inpatient DAD Mental Health Cases Years ARIW BCHS 2.52 1.02 1.07 SickKids BWH 1.25 1.72 1.11 1.30 PRHC CCH 1.52 1.02 1.27 GBHS CGMH 1.08 1.08 CH LHSC CH LHSC 17.83 1.90 1.88 2.14 THP-MH CHEO 3.76 2.52 2.01 2.06 KGH CMH 2.69 0.41 0.62 0.86 CHEO GBGH 0.93 1.56 1.53 MCH HHSC GBHS 3.84 1.69 3.74 3.06 HRRH GDH 0.93 1.10 1.07 NYGH GRH 2.32 1.63 1.31 1.35 OSMH HHCC 1.52 0.95 0.99 TEGH HHS 1.52 1.85 1.41 1.46 SAH HRRH 3.36 1.61 2.06 2.04 WOHS HSN 2.52 1.94 1.34 1.41 SJHC Toronto JBH 0.24 0.24 WRH RVH KGH 3.01 2.57 1.97 2.12 TBRHSC LH 0.17 1.49 1.47 1.46 GBGH MCH HHSC 3.46 2.31 1.99 2.05 LH 0.97 0.97 MH HHS 0.83 MHA-SMGH 0.83 Southlake MSH 0.21 0.21 HSN NBRHC 1.33 1.36 1.36 RVHS NHS 2.74 1.32 1.16 1.26 NBRHC NYGH 2.81 2.84 1.93 2.01 GRH OSMH 1.85 2.31 1.99 2.00 BWH PRHC 3.13 3.13 CCH Renfrew 1.00 1.00 NHS RHCF 1.19 1.19 THP-CVH RMH 1.06 1.06 RHCF RVH 1.46 1.60 1.58 SMH RVHS 3.02 1.88 1.33 1.37 CGMH SAH 3.40 1.24 1.71 1.71 GDH SBGHC 0.45 0.45 BCHS SickKids 13.28 4.47 2.88 3.40 RMH SJHC Toronto 1.35 1.72 1.64 1.65 Sunnybrook SLMHC 0.24 0.90 0.85 Renfrew SMH 1.12 1.12 TSH HHCC Southlake 1.79 1.82 1.38 1.42 MH STEGH 0.45 0.45 Stevenson Stevenson 0.86 0.86 CMH 1.02 1.02 Sunnybrook SLMHC 1.69 1.56 TBRHSC 1.58 MHA-SMGH TEGH 1.78 1.72 1.72 WPSHC THP-CVH 1.47 1.52 0.96 1.23 SBGHC THP-MH 2.13 2.13 STEGH TSH 1.00 1.00 JBH WOHS 2.31 2.17 1.60 1.66 MSH WPSHC 0.62 0.82 0.78 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 WRH 3.83 1.88 1.58 1.64

248

PCMCH Maternal-Child Benchmarking Report 2013

1.1.10 MH – Percent “Transfer From” Mental Health Inpatient Cases and Days

This chart presents the percentage of cases and associated days that were recorded as transferred from another acute care institution for all inpatient DAD mental health cases. Hospitals whose volumes are less than 6 are indicated as “<6”.

Mental Health Mental Health % "Transfer From" MH Inpatient Cases and "Transfer From" "Transfer From" Days Hospital CASES DAYS CH LHSC # % # % CHEO CH LHSC 15 4.1% 513 10.8% GRH CHEO <6 0.8% 39 0.4% HHS GRH 35 6.1% 279 7.7% HHS 16 5.2% 153 6.2% HRRH HRRH 7 7.4% 169 11.9% HSN HSN 14 8.6% 81 5.6% KGH KGH 9 3.1% 82 3.4% LH LH 11 3.3% 64 2.6% MCH HHSC MCH HHSC 113 16.8% 1,137 13.9% NBRHC NBRHC 13 19.4% 59 15.8% NYGH 18 6.6% 76 4.6% NYGH OSMH <6 4.9% <6 1.8% OSMH RVHS 17 5.2% 50 3.3% RVHS SAH 14 10.5% 67 8.6% SAH SickKids 22 10.0% 688 15.9% SickKids SJHC Toronto <6 1.6% 30 1.8% SJHC Toronto Southlake 25 6.0% 239 8.8% TBRHSC 22 7.7% 243 10.4% Southlake TEGH 14 6.9% 147 8.0% TBRHSC THP-CVH <6 25.0% <6 4.9% TEGH WOHS 24 6.1% 261 6.2% THP-CVH WRH 48 16.4% 292 14.8% WOHS WRH

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

% Cases % Days

249

PCMCH Maternal-Child Benchmarking Report 2013

1.1.11 MH – Percent “Transfer To” Mental Health Inpatient Cases and Days

This table and chart present the percentage of cases and associated days that were recorded as transferred to another acute care institution for all inpatient DAD mental health cases. Hospitals whose volumes are less than 6 are indicated as “<6”.

Mental Health Mental Health % "Transfer To" Mental Health Inpatient "Transfer To" "Transfer To" Hospital Cases and Days CASES DAYS # % # % BCHS BCHS 12 36.4% 29 46.8% CH LHSC CH LHSC 15 4.1% 135 2.8% CHEO CHEO 61 11.9% 765 8.8% CMH CMH <6 57.1% 9 69.2% GBHS GBHS <6 6.7% <6 2.1% GDH GDH <6 9.1% <6 5.3% GRH HHCC GRH 12 2.1% 183 5.1% HHS HHCC 8 53.3% 48 82.8% HRRH 7 2.3% 55 2.2% HHS HSN HRRH <6 1.1% <6 0.1% JBH HSN 14 8.6% 27 1.9% KGH JBH <6 100.0% <6 100.0% LH KGH <6 0.7% <6 0.2% MCH HHSC LH 7 2.1% 20 0.8% MSH MCH HHSC <6 0.4% 67 0.8% NBRHC MSH <6 100.0% <6 100.0% NHS NBRHC <6 1.5% 8 2.1% NYGH NHS 31 18.7% 123 28.9% OSMH NYGH <6 1.5% 25 1.5% PRHC OSMH <6 12.2% 33 11.6% RHCF RVH PRHC <6 20.0% <6 0.6% RVHS RHCF <6 20.0% <6 18.2% SickKids RVH <6 5.9% 26 6.3% SJHC Toronto RVHS <6 0.6% <6 0.1% SLMHC SickKids 8 3.7% 39 0.9% SMH SJHC Toronto <6 0.5% <6 0.1% Southlake SLMHC <6 23.1% 7 25.9% Stevenson SMH <6 100.0% 6 100.0% TEGH Southlake <6 0.5% 16 0.6% WOHS Stevenson <6 50.0% <6 75.0% WPSHC TEGH <6 0.5% 15 0.8% WRH WOHS <6 1.0% 10 0.2% 0% 20% 40% 60% 80% 100% WPSHC <6 27.3% <6 15.8% % Cases % Days WRH 20 6.8% 44 2.2%

250

PCMCH Maternal-Child Benchmarking Report 2013

1.1.12 MH – Percent of Cases and Days with Length of Stay >30 Days

This table and chart show the percentage of all inpatient cases and associated days for all inpatient mental health cases with a total length of stay greater than 30 days. Hospitals whose volumes are less than 6 are indicated as “<6”.

DAD % of Cases & Days with Length of % of Cases and Days with LOS >30 Days: DAD Stay >30 Days Hospital % Cases % Days Inpatient Inpatient CH LHSC LOS >30 LOS >30 Cases Days CHEO Days Days CH LHSC 32 2,223 8.6% 46.7% GRH CHEO 58 3,457 11.3% 39.8% HHS GRH <6 113 0.5% 3.1% HRRH HHS 9 371 2.9% 15.1% HRRH <6 190 4.2% 13.4% HSN HSN 11 675 6.7% 46.9% KGH KGH <6 139 1.4% 5.8% LH LH 14 672 4.1% 27.5% MCH HHSC 45 2,234 6.7% 27.4% MCH HHSC NBRHC <6 85 3.0% 22.7% NBRHC NYGH <6 143 1.5% 8.7% NYGH OSMH <6 85 4.9% 29.8% PRHC <6 160 40.0% 95.8% OSMH RVH <6 141 3.5% 34.1% PRHC RVHS 6 411 1.8% 27.2% RVH SickKids 53 2,621 24.2% 60.8% SJHC Toronto 6 306 3.2% 18.4% RVHS Southlake 12 870 2.9% 31.9% SickKids TBRHSC 6 466 2.1% 20.0% SJHC Toronto TEGH 6 279 2.9% 15.1% THP-CVH <6 33 25.0% 80.5% Southlake WOHS 11 480 2.8% 11.5% TBRHSC WRH <6 135 0.7% 6.9% TEGH

THP-CVH

WOHS

WRH

0% 20% 40% 60% 80% 100%

% DAD Cases % DAD Days

251

PCMCH Maternal-Child Benchmarking Report 2013

1.1.12 MH – Percent of Cases and Days with Length of Stay >30 Days (cont)

This table and chart show the percentage of all inpatient cases and associated days for all inpatient OHMRS mental health cases with a total length of stay greater than 30 days. Hospitals whose volumes are less than 6 are indicated as “<6”.

OMHRS % of Cases & Days with Length % of Cases and Days with LOS >30 Days: OMHRS of Stay >30 Days Hospital % Cases % Days Inpatient Inpatient LOS >30 LOS >30 BWH Cases Days Days Days HHS BWH <6 83 0.4% 6.0% HHS 9 371 3.3% 15.5% HRRH HRRH <6 190 4.0% 13.0% HSN HSN <6 57 0.7% 6.8% MSH <6 39 2.6% 39.0% MSH RVH <6 17 0.02% 2.8% RVH SJHC Hamilton <6 101 18.2% 43.2% SJHC Toronto 7 342 4.4% 20.4% SJHC Hamilton Sunnybrook 14 641 12.1% 39.4% SJHC Toronto TBRHSC 6 466 2.1% 19.6% Sunnybrook WRH <6 71 0.4% 3.8% TBRHSC

WRH

0% 10% 20% 30% 40% 50%

% Cases LOS >30 Days % Days LOS >30 Days

252

PCMCH Maternal-Child Benchmarking Report 2013

1.1.13 MH – Percent of Cases 1-2 Days Length of Stay

This table and chart represent the percent of inpatient mental health cases with one and two day stays. This indicator is provided to help institutions analyze and utilize best practice opportunities. A zero volume is blank and a volume less than 6 is indicated as “<6”.

DAD OMHRS % of Cases with 1-2 Days Length of Stay Hospital % Cases 1-2 % Cases 1-2 Days Stay Days Stay BCHS BCHS 72.7% BWH BWH 87.5% 32.8% CCH CCH 100.0% 67.0% CGMH CGMH 85.7% CH LHSC CH LHSC 17.6% CHEO CHEO 12.1% CMH CMH 85.7% GBGH GBGH 82.4% GBHS GBHS 40.0% GDH GRH GDH 90.9% HHCC GRH 25.8% HHS 46.7% HHCC HRRH 31.6% 23.9% HHS HSN HRRH 5.3% JBH HSN 31.9% 21.3% KGH JBH 100.0% 81.8% LH KGH 14.2% MCH HHSC LH 31.7% 100.0% MH MCH HHSC 11.8% MSH MH 100.0% NBRHC MSH 100.0% 53.3% NHS NBRHC 37.3% 3.0% NYGH NHS 68.7% 54.0% OSMH NYGH 31.6% PRHC OSMH 43.9% 31.6% Renfrew PRHC 40.0% RHCF Renfrew 100.0% RMH RVH RHCF 80.0% RVHS RMH 100.0% SAH RVH 56.5% 0.2% SBGHC 52.5% RVHS SickKids 24.1% SAH SJHC Hamilton SBGHC 100.0% SJHC Toronto SickKids 12.3% SLMHC SJHC Hamilton 19.9% 9.1% Southlake SJHC Toronto 19.9% 8.2% STEGH SLMHC 61.5% Stevenson Southlake 32.9% Sunnybrook STEGH 100.0% TBRHSC Stevenson 50.0% TEGH Sunnybrook 100.0% 8.6% THP-CVH TBRHSC 20.0% 18.0% THP-MH TEGH 15.2% TSH THP-CVH 50.0% WOHS THP-MH 40.0% WPSHC TSH 50.0% WRH WOHS 16.2% 0% 20% 40% 60% 80% 100% 81.8% WPSHC DAD OMHRS WRH 13.7% 7.9%

Note BWH: One LOS day is counted if a case is admitted and discharged on the same day.

253

PCMCH Maternal-Child Benchmarking Report 2013

1.1.14 MH – Mental Health Readmissions

This table depicts the number of patients who were readmitted to any of the Ontario facilities within 30 days of discharge from any of the Benchmarking Report participating facilities. Numbers less than 6 are indicated as “<6”.

Hospitals Cases

Hamilton Health Sciences—McMaster University Medical Centre 89 St Joseph’s Hc London—Regional Mental Health Care London 43 Children’s Hospital of Eastern Ontario 40 Grand River Hosp—K-W Health Centre 36 Rouge Valley HSys—Centenary Site 36 Southlake Regional Health Centre 29 Toronto East General Hospital 28 Halton HcSvc—Oakville-Trafalgar Memorial Hospital 27 Lakeridge Health—Oshawa Site 27 William Osler HSys—Brampton Civic Hospital 27 London Health Sciences Centre 25 Windsor Reg Hosp—Maryvale 24 Kingston General Hospital 20 Hospital for Sick Children 20 North York Gen Hosp—General Site 19 Thunder Bay Regional Health Sciences Centre 17 St. Joseph’s Health Centre Toronto 10 Royal Ottawa HcGrp—Royal Ottawa Mental Health Centre 10 Humber River Hosp—Keele Street Site 9 Sault Area Hosp—Sault Area Hospital 6 Brant Com HcSys—Brantford General Hospital 6 Health Sciences North / Horizon Santé-Nord <6 Royal Victoria Regional Health Centre <6 Grey Bruce HSvc—Owen Sound Hospital <6 Niagara HSys—St. Catharines General Site <6 North Bay Reg HCtr—North Bay Site <6 Windsor Reg Hosp—Metropolitan Campus <6 Chatham-Kent Health Alliance—Public General Hospital <6 Orillia Soldiers’ Memorial Hospital <6 Niagara HSys—Greater Niagara General Site <6 Stevenson Memorial Hospital <6 Georgian Bay Gen Hosp—Midland Site <6 St. Joseph’s General Hospital [Elliot Lake] <6 Headwaters Health Care Centre <6 West Parry Sound Health Centre <6 Humber River Hosp—Church Street Site <6 William Osler Health System —Etobicoke General Hospital <6 Niagara Health System—Welland Hospital Site <6 North Wellington HcCorp—Palmerston and District Hospital <6 Sioux Lookout Meno Ya Win HCtr—Sioux Lookout Meno Ya Win <6 Health Centre Weeneebayko Area HA—Moose Factory Site <6 Centre for Addiction and Mental Health <6 Health Sciences Ctr—Paediatric <6 Victoria Regional Mental Health Centre <6

254

PCMCH Maternal-Child Benchmarking Report 2013

2.0 Mental Health ED Indicators

2.1.1 MH-ED – Mental Health ED Patient Volumes

This table and chart depict mental health ED patient volumes.

Hospital ED Visits AGH 31 Mental Health ED Patient Volumes BCHS 231 BGH 89 CHEO BWH 347 LH CCH 155 CH LHSC CGMH 90 WOHS CH LHSC 988 SickKids CHEO 1,990 MCH HHSC CMH 296 RVHS SJHC Hamilton GBGH 108 Southlake GBHS 227 HHS 40 GDH WRH GRH 465 GRH HDH 156 NHS HHCC 108 TBRHSC HHS 510 THP-MH HRRH 322 THP-CVH HSN 309 KGH JBH 178 BWH KGH 350 HRRH LH 1,039 SJHC Toronto MCH HHSC 678 RVH MH 254 PRHC HSN MHA-SMGH 51 NYGH Monfort 35 CMH 181 MSH TEGH Mt Sinai 65 MH NBRHC 234 QHC NHH 72 NBRHC NHS 447 BCHS NYGH 298 SAH OSMH 227 GBHS PRHC 310 OSMH QHC 238 RMH Renfrew 62 MSH RHCF 77 JBH HDH RMH 183 CCH RVH 318 SLMHC RVHS 612 Sunnybrook SAH 230 STEGH SBGHC 84 TSH SickKids 843 GBGH SJHC Hamilton 604 HHCC SJHC Toronto 320 CGMH SLMHC 153 SMH SMH 90 BGH Southlake 600 SBGHC STEGH 120 RHCF Stevenson 31 NHH Sunnybrook 130 Mt Sinai Renfrew TBRHSC 424 TOH TEGH 280 MHA-SMGH 371 THP-CVH GDH THP-MH 379 WPSHC TOH 55 Monfort TSH 109 WLMH WDMH 33 WDMH WLMH 34 AGH WOHS 941 Stevenson WPSHC 40 0 500 1,000 1,500 2,000 WRH 497

255

PCMCH Maternal-Child Benchmarking Report 2013

2.1.2 MH-ED – ED Mental Health Visits Patient Age Profile

This chart provides the distribution of visits by age category of the mental health ED visits of each hospital. The age categories are: 0-7 years, 8-12 years and 13-17 years.

ED Psychiatric Visits Patient Age Profile

AGH BCHS BGH BWH CCH CGMH CH LHSC CHEO CMH GBGH GBHS GDH GRH HDH HHCC HHS HRRH HSN JBH KGH LH MCH HHSC MH MHA-SMGH Monfort MSH Mt Sinai NBRHC NHH NHS NYGH OSMH PRHC QHC Renfrew RHCF RMH RVH RVHS SAH SBGHC SickKids SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson Sunnybrook TBRHSC TEGH THP-CVH THP-MH TOH TSH WDMH WLMH WOHS WPSHC WRH 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0-7 Years 8-12 Years 13-17 Years

256

PCMCH Maternal-Child Benchmarking Report 2013

This table provides the distribution of visits by age category of the mental health ED visits of each hospital. The age categories are: 0-7 years, 8-12 years and 13-17 years. Hospitals whose volume is less than 6 are indicated as “<6”.

Hospital 0-7 years 8-12 years 13-17 years Total AGH <6 <6 23 31 BCHS <6 29 197 231 BGH <6 9 76 89 BWH 14 56 277 347 CCH 12 25 118 155 CGMH <6 13 76 90 CH LHSC 36 145 807 988 CHEO 124 345 1,521 1,990 CMH 18 28 250 296 GBGH <6 9 95 108 GBHS 13 38 176 227 GDH <6 <6 34 40 GRH 15 70 380 465 HDH 30 40 86 156 HHCC <6 15 88 108 HHS 27 83 400 510 HRRH 8 37 277 322 HSN 9 36 264 309 JBH <6 17 157 178 KGH 9 42 299 350 LH 39 138 862 1,039 MCH HHSC 58 131 489 678 MH 8 36 210 254 MHA-SMGH <6 <6 45 51 Monfort <6 <6 33 35 MSH 13 22 146 181 Mt Sinai <6 <6 62 65 NBRHC 13 21 200 234 NHH <6 9 62 72 NHS 28 60 359 447 NYGH 8 41 249 298 OSMH 11 31 185 227 PRHC 14 42 254 310 QHC 18 21 199 238 Renfrew 10 8 44 62 RHCF <6 11 63 77 RMH 6 13 164 183 RVH 9 32 277 318 RVHS 31 75 506 612 SAH 15 29 186 230 SBGHC 10 12 62 84 SickKids 136 231 476 843 SJHC Hamilton 14 84 506 604 SJHC Toronto 14 47 259 320 SLMHC <6 19 131 153 SMH <6 <6 85 90 Southlake 29 127 444 600 STEGH <6 16 99 120 Stevenson <6 8 18 31 Sunnybrook <6 <6 127 130 TBRHSC 9 40 375 424 TEGH 14 50 216 280 THP-CVH 17 40 314 371 THP-MH 16 55 308 379 TOH 55 55 TSH 8 9 92 109 WDMH <6 <6 30 33 WLMH <6 <6 31 34 WOHS 20 119 802 941 WPSHC <6 35 40 WRH 34 124 339 497

257

PCMCH Maternal-Child Benchmarking Report 2013

2.1.3 MH-ED – ED Mental Health Average LOS

This table and chart present the mental health ED average LOS in hours. Excluded are cases where the patient left without being seen by a physician (Disposition Codes 02-03), and cases where Date/Time Patient left ED is missing.

Hospital ED Mental Health ALOS ED Mental Health Average LOS AGH 2.4 BCHS 3.5 BGH 3.1 AGH BWH 2.3 BCHS CCH 3.8 BGH CGMH 2.8 BWH CCH CH LHSC 3.5 CGMH CHEO 4.0 CH LHSC CMH 4.5 CHEO GBGH 2.7 CMH GBHS 3.0 GBGH GDH 3.2 GBHS GRH 5.5 GDH HDH 1.8 GRH HHCC 3.0 HDH HHS 3.6 HHCC HRRH 4.0 HHS HSN 3.4 HRRH JBH 4.7 HSN KGH 3.2 JBH KGH LH 5.1 LH MCH HHSC 4.4 MCH HHSC MH 5.8 MH MHA-SMGH 2.8 MHA-SMGH Monfort 5.9 Monfort MSH 4.7 MSH Mt Sinai 4.1 Mt Sinai NBRHC 3.2 NBRHC NHH 4.0 NHH NHS 3.6 NHS NYGH 4.5 NYGH OSMH 2.2 OSMH PRHC 5.2 PRHC QHC 2.9 QHC Renfrew Renfrew 2.4 RHCF RHCF 3.5 RMH RMH 3.3 RVH RVH 3.5 RVHS RVHS 2.4 SAH SAH 3.9 SBGHC SBGHC 1.8 SickKids SickKids 5.5 SJHC Hamilton SJHC Hamilton 5.0 SJHC Toronto SJHC Toronto 6.2 SLMHC SLMHC 2.1 SMH SMH 5.2 Southlake Southlake 3.8 STEGH STEGH 2.4 Stevenson Sunnybrook Stevenson 2.5 TBRHSC Sunnybrook 5.5 TEGH TBRHSC 4.1 THP-CVH TEGH 5.4 THP-MH THP-CVH 3.4 TOH THP-MH 7.2 TSH TOH 4.3 WDMH TSH 4.2 WLMH WDMH 3.5 WOHS WLMH 3.7 WPSHC WOHS 6.1 WRH WPSHC 2.7 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 WRH 4.1

Note MSH: ED ALOS is affected by the ability to transfer patients requiring admission to a facility with paediatric inpatient mental health beds.

258

PCMCH Maternal-Child Benchmarking Report 2013

2.1.4 MH-ED – ED Mental Health Visits by Top 10 Main Problems

This table displays the Top 10 main problems/most responsible diagnosis for each hospital’s mental health ED visits (highlighted in RED). Hospitals with fewer than 6 visits of any particular diagnosis had those cases removed from the count. Therefore some hospitals do not have 10 CMGs listed.

Main Problem ICD10 LH

JBH

CCH

AGH BGH GRH HHS HSN KGH

CMH GDH

BCHS BWH

CHEO GBHS HHCC

GBGH HRRH

CGMH CH LHSC

F329 Depressive episode unspecified 8 20 10 38 20 9 121 306 37 12 28 83 12 117 30 38 30 39 141 R458 Oth symptoms signs inv emotional state 21 22 17 10 13 263 202 31 11 10 11 98 13 49 56 75 16 32 52 F419 Anxiety disorder unspecified 20 26 25 70 241 28 19 18 30 22 64 35 17 23 11 106 F430 Acute stress reaction 45 91 15 50 260 23 6 36 73 18 71 13 58 62 178 F100 Ment/beh disrd dt alcohol use ac intox 33 9 36 8 12 78 123 10 6 21 11 20 19 47 33 25 35 21 38 F432 Adjustment disorders 8 14 12 24 52 24 35 44 10 20 8 16 39 84 R4688 Oth sym signs inv appearance behaviour 22 7 51 18 6 7 27 7 6 9 8 10 F919 Conduct disorder unspecified 11 9 10 31 124 6 7 13 F410 Panic disrd [ep paroxysmal anxiety] 12 28 68 7 7 7 9 22 F101 Ment/beh disrd dt harmful alcohol use 10 17 14 6 10 11 11 13 F439 Reaction to severe stress unspecified 8 29 8 7 6 22 18 22 F900 Disturbance of activity and attention 9 37 32 13 F322 Sev depressive episode wo psych symptoms 23 39 11 R454 Irritability and anger 6 21 7 11 7 20 F99 Mental disorder not otherwise specified 183 F121 Ment/beh disrd dt cannab use harmf use 7 12 9 7 F191 Ment/beh dis harmf use mult dr & psyact 7 14 10 F29 Unspecified nonorganic psychosis 12 8 10 8 F39 Unspecified mood [affective] disorder 15 17 13 F509 Eating disorder unspecified 11 14 6 6 F959 Tic disorder unspecified 10 17 F913 Oppositional defiant disorder 23 11 F840 Childhood autism 10 7 F938 Other childhood emotional disorders F412 Mixed anxiety and depressive disorder 14 11 R452 Unhappiness 24 12 15 6 Z638 Oth spec probs rel to prim support grp 8 23 F609 Personality disorder unspecified F911 Unsocialized conduct disorder 10 8 F445 Dissociative convulsions 7 R451 Restlessness and agitation 7 F438 Other reactions to severe stress 29 8 F341 Dysthymia F489 Neurotic disorder unspecified 13 Z032 Obs suspected mental & behavioural disrd F321 Moderate depressive episode 10 F109 Ment/beh disrd dt alco ment/beh dis NOS 6

259

PCMCH Maternal-Child Benchmarking Report 2013

2.1.4 MH-ED – ED Mental Health Visits by Top 10 Main Problems (cont)

Main Problem ICD10

SAH

NHS QHC RVH

MSH NHH RMH

PRHC RHCF

RVHS

NYGH

OSMH

SBGHC

NBRHC

Monfort Mt Sinai

Renfrew

MCH HHSC MHA-SMGH

F329 Depressive episode unspecified 61 34 9 26 23 10 53 43 33 47 28 14 11 21 27 119 29 22 R458 Oth symptoms signs inv emotional state 139 34 10 25 7 95 42 11 22 36 8 15 25 116 18 F419 Anxiety disorder unspecified 113 27 8 8 28 11 21 58 25 29 44 43 7 8 18 39 77 20 14 F430 Acute stress reaction 36 19 32 20 14 36 61 11 92 17 58 F100 Ment/beh disrd dt alcohol use ac intox 80 25 6 19 20 21 10 63 32 13 30 17 13 9 29 41 18 F432 Adjustment disorders 15 23 8 60 11 26 26 9 30 11 52 13 R4688 Oth sym signs inv appearance behaviour 37 10 13 17 9 10 10 8 F919 Conduct disorder unspecified 8 8 8 9 18 6 F410 Panic disrd [ep paroxysmal anxiety] 26 14 7 6 6 9 7 11 F101 Ment/beh disrd dt harmful alcohol use 8 13 7 7 9 F439 Reaction to severe stress unspecified 16 F900 Disturbance of activity and attention 7 13 6 F322 Sev depressive episode wo psych symptoms R454 Irritability and anger 11 12 6 6 14 F99 Mental disorder not otherwise specified F121 Ment/beh disrd dt cannab use harmf use 6 6 6 7 F191 Ment/beh dis harmf use mult dr & psyact F29 Unspecified nonorganic psychosis F39 Unspecified mood [affective] disorder 6 7 7 F509 Eating disorder unspecified 12 F959 Tic disorder unspecified 7 F913 Oppositional defiant disorder F840 Childhood autism 6 7 F938 Other childhood emotional disorders F412 Mixed anxiety and depressive disorder 6 7 R452 Unhappiness 6 Z638 Oth spec probs rel to prim support grp F609 Personality disorder unspecified 14 F911 Unsocialized conduct disorder F445 Dissociative convulsions 17 R451 Restlessness and agitation 6 F438 Other reactions to severe stress F341 Dysthymia F489 Neurotic disorder unspecified Z032 Obs suspected mental & behavioural disrd 6 F321 Moderate depressive episode F109 Ment/beh disrd dt alco ment/beh dis NOS

260

PCMCH Maternal-Child Benchmarking Report 2013

2.1.4 MH-ED – ED Mental Health Visits by Top 10 Main Problems (cont)

Main Problem ICD10

TSH

TOH

SMH

WRH

TEGH TOTAL

WOHS

SLMHC STEGH WLMH

WDMH WPSHC

SickKids TBRHSC

THP-MH

THP-CVH

Southlake

Stevenson

Sunnybrook

SJHC Toronto SJHC Hamilton

F329 Depressive episode unspecified 95 43 51 22 116 18 25 59 35 52 71 6 17 <6 179 7 53 2,558 R458 Oth symptoms signs inv emotional state 77 25 52 47 8 46 7 32 28 31 39 42 9 7 <6 124 42 2,221 F419 Anxiety disorder unspecified 116 39 33 7 7 71 24 13 13 40 21 55 50 9 25 7 8 95 8 79 2,073 F430 Acute stress reaction 20 156 14 121 20 10 83 20 85 28 42 35 2,029 F100 Ment/beh disrd dt alcohol use ac intox 35 35 21 21 26 14 15 82 27 30 27 17 10 57 38 1,486 F432 Adjustment disorders 43 46 12 19 19 7 42 14 15 7 147 18 1,063 R4688 Oth sym signs inv appearance behaviour 103 17 10 8 13 6 16 13 478 F919 Conduct disorder unspecified 12 7 11 <6 43 341 F410 Panic disrd [ep paroxysmal anxiety] 33 6 11 22 <6 318 F101 Ment/beh disrd dt harmful alcohol use 19 41 17 8 <6 7 228 F439 Reaction to severe stress unspecified 59 41 8 244 F900 Disturbance of activity and attention 13 21 7 11 7 <6 176 F322 Sev depressive episode wo psych symptoms 21 49 11 9 18 181 R454 Irritability and anger 8 6 135 F99 Mental disorder not otherwise specified 183 F121 Ment/beh disrd dt cannab use harmf use 16 11 87 F191 Ment/beh dis harmf use mult dr & psyact 7 8 6 15 67 F29 Unspecified nonorganic psychosis 7 18 63 F39 Unspecified mood [affective] disorder 6 6 16 93 F509 Eating disorder unspecified 14 12 75 F959 Tic disorder unspecified 51 85 F913 Oppositional defiant disorder 11 8 53 F840 Childhood autism 14 7 6 7 64 F938 Other childhood emotional disorders 25 74 99 F412 Mixed anxiety and depressive disorder 9 7 54 R452 Unhappiness 63 Z638 Oth spec probs rel to prim support grp 31 F609 Personality disorder unspecified 14 F911 Unsocialized conduct disorder 27 45 F445 Dissociative convulsions 9 33 R451 Restlessness and agitation 13 F438 Other reactions to severe stress 7 10 54 F341 Dysthymia 18 6 24 F489 Neurotic disorder unspecified 13 Z032 Obs suspected mental & behavioural disrd 6 F321 Moderate depressive episode 10 F109 Ment/beh disrd dt alco ment/beh dis NOS 6

261

PCMCH Maternal-Child Benchmarking Report 2013

Holland Bloorview Kids Rehabilitation Hospital

Paediatric Rehabilitation Analysis

Data for Fiscal Year 2012/13

Hospital Profile

Acronym HBKRH Main Catchment Toronto, GTA, Ontario Area Primary Academic University of Toronto Affiliation Year Founded 1899 Website www.hollandbloorview.ca Subspecialties / Services Offered Rehabilitation & Interventional Child Development Complex Participation and Inclusion Diagnostic Services Continuing Care Autism (Satellites included) Acquired Brain Communications & Writing Radiology Cleft Lip & Palate Injury Aids Dental/Oral Surgery / Amputee Community Based Services Maxillofacial Chronic Pain Life Skills Developmental Paediatrics Orthopaedics Nursery Schools Feeding Respite Student Support Services Hypertonia Sleep Studies Lifespan Clinic Spinal Cord Neuromotor Neuromuscular Psychopharmacology Saliva Management Specialized Seating Services Spina Bifida

Beds Staffed and in Operation as of April 2004 Rehab CCC Respite TOTAL 36 21 7 64

Definition: The number of inpatient beds that are resourced and available for patient accommodation, whether or not they are actually occupied by a patient at the time. The CCC beds include 1 budgeted bed for sleep studies

262

PCMCH Maternal-Child Benchmarking Report 2013

How We Measure Up

263

PCMCH Maternal-Child Benchmarking Report 2013

How We Measure Up (cont)

264

PCMCH Maternal-Child Benchmarking Report 2013

Access and Wait Times for Child Development Program Services

What’s Important?

Neuromotor has sustained performance for over two years Autism has sustained performance for 15 months at the main site Autism at satellites has sustained performance for 6 months Performance has exceeded the target with most services accessed within 3 months

Access Defined as the time from when the referral is received to when the client receives their first service.

80th percentile Wait Time WHAT was the 80th longest wait (in days). The use of percentile measures eliminates the variation seen with outliers, and provides a stable measure of access.

265

PCMCH Maternal-Child Benchmarking Report 2013

Holland Bloorview Kids Rehabilitation Hospital Indicators

1.1.1 HBV – Holland Bloorview Inpatient/Outpatient Discharge Geographic Distribution by LHIN

The summary below presents the clients catchment area based on residence of our inpatient and outpatient population. Clients of Holland Bloorview are from across all of Ontario with greater than two- thirds from 3 LHIN areas (highlighted in red).

Summary of Discharges by LHIN by Inpatients Outpatients percentage for Fiscal Years 2010 to 2013 FY 2011-12 FY 2012-13 FY 2011-12 FY 2012-13 1 – Erie St. Clair 0.7% 0.2% 0.3% 0.3% 2 – South West 1.2% 1.3% 0.6% 0.9% 3 – Waterloo Wellington 2.1% 2.6% 1.5% 1.5% 4 – Hamilton Niagara Haldimand Brant 3.0% 3.3% 1.4% 1.5% 5 – Central West 7.2% 10.0% 5.9% 6.4% 6 – Mississauga Halton 6.0% 6.5% 5.6% 5.4% 7 – Toronto Central 13.9% 19.3% 24.9% 23.6% 8 – Central 29.0% 31.4% 24.8% 24.8% 9 – Central East 26.2% 18.1% 20.7% 21.8% 10 – South East 0.7% 0.4% 0.6% 0.5% 11 – Champlain 0.0% 0.2% 0.2% 0.1% 12 – North Simcoe Muskoka 3.0% 1.5% 3.0% 3.1% 13 – North East 3.5% 3.5% 6.4% 5.5% 14 – North West 0.5% 0.2% 2.1% 1.9% Unknown 3.0% 1.8% 2.1% 2.8% Total 100% 100% 100% 100%

266

PCMCH Maternal-Child Benchmarking Report 2013

1.1.2 HBV – Patient Profile – Percentage of Translation Services Used

The table below summarizes the ‘top ten’ languages self identified by clients as their primary language of conversation for fiscal years 2011 through 2013. Over the course of the year, 91 different languages were identified through registration services. The chart depicts the percentage of families who utilized translation services to assist in their understanding or execution of care in fiscal year 2012/13. Newly identified this fiscal year as service needs are those speaking Farsi and Bengali. While families have identified language, not all families utilized translation services.

Summary of ‘top ten’ self identified primary languages of clients

Rank Fiscal Year 2011/12 Fiscal Year 2012/13 1. Spanish Tamil 2. Tamil Urdu 3. Urdu Cantonese 4. Cantonese Spanish 5. Mandarin Mandarin 6. French French 7. Arabic Arabic 8. Tagalog Somali 9. Arabic Farsi 10. Portuguese Bengali

267

PCMCH Maternal-Child Benchmarking Report 2013

1.1.3 HBV – Patient Volume Breakdown

The indicator provides a breakdown of hospital inpatient volumes into Complex Continuing Care discharges, Day Patient discharges, Rehabilitation discharges which is compiled of Brain Injury Rehabilitation Team (BIRT) and Specialized Orthopaedic Developmental Rehabilitation (SODR), and Respite Service discharges categories.

Fiscal Year Complex Rehabilitation Respite Total Inpatient Day Grand Continuing Service* Patient Total Care BIRT SODR FY 2012-13 13 124 122 283 542 46 588

Rehabilitation (BIRT and SODR): The child and adolescent rehabilitation service provides comprehensive rehabilitation care to clients, from birth to age 18, with a variety of congenital, acquired and traumatic injuries. Diagnostic groups include, but are not limited to, clients with acquired brain injuries, arthritis, burns, cerebral palsy, complications of prematurity, complex epilepsy and seizure disorders, orthopedic conditions, respiratory conditions and spinal cord injuries.

Respite*: The respite care service supports families by providing short-term, inpatient care for children with disabilities or complex medical needs. Families may access up to six weeks of respite care each year. This is a high volume, low length of stay service which displays peak periods of occupancy during the summer and holiday months.

Complex Continuing Care: The complex continuing care service meets the needs of clients with unstable chronic illnesses and/or multi- system diseases. Many clients have tracheostomies or require mechanical ventilation. Although clients may be admitted to the respiratory/complex continuing care unit for extended periods, the goal is to facilitate discharge to the community. Transitioning children continues to be a ‘system’ challenge with Holland Bloorview engaged in multiple strategies: Internal transition strategy; Provincial engagement in WTIS ALC data collection TC-LHIN Strategy for long stay ALC Rehab patients TC – CCAC partnership Inter-facility discussions with monthly updates and tours

While ALC remains a provincial strategy, Holland Bloorview continues to work with all stakeholders to ensure safe and appropriate transition of clients across the continuum of care.

Day Patient: Day patients are clients who visit hospital daily for intensive therapy with a defined treatment period and do not occupy an inpatient bed.

Note Holland Bloorview Kids Rehabilitation Hospital serves a significantly large paediatric population through the outpatient programs and services. In 2012/13 a total of 6,658 clients were served, through more than 55,973 client encounters. An encounter is generated when a client is registered at the centre to receive one or more services. As per MIS guidelines, only one encounter is recorded per day, irrespective of the number of services received.

268

PCMCH Maternal-Child Benchmarking Report 2013

1.1.4 HBV – Percent of Inpatient Discharges by Type

This section provides the percentage distribution of discharges by type of inpatient service. The distribution is broken down by Specialized Orthopaedic Developmental Rehabilitation (SODR), Brain Injury Rehabilitation Team (BIRT), Respite Services and Complex Continuing Care (CCC). The distribution of inpatients across both SODR and BIRT is similar in profile with CCC comprising the lowest distribution.

269

PCMCH Maternal-Child Benchmarking Report 2013

1.1.5 HBV – Percent of Inpatient Days by Type

This section provides the percentage distribution of inpatient beds by type of inpatient service. The distribution is broken down by Rehabilitation (SODR and BIRT), Complex Continuing Care and Respite Care. Overall there has been relative stability in the distribution of services over the past 3 fiscal years with a marginal increase in CCC days.

Number of Type of inpatient service Inpatient Days FY

2012/13 Rehabilitation (SODR and BIRT) 13,478

Complex Continuing Care 6,935 Respite 1,208

Total 21,621

270

PCMCH Maternal-Child Benchmarking Report 2013

1.1.6 HBV – Inpatient Age Profile

This chart illustrates an age profile to further describe the clinical inpatient populations served by Holland Bloorview Kids Rehabilitation Hospital. Age is captured at the time of admission. The age profiles of inpatient and day patient discharges are shown continuously from less than 1 year to over 19 years of age. While Holland Bloorview serves the paediatric population, we continue to provide services until transition into the adult health system. Transitioning children continues to be a ‘system’ challenge with Holland Bloorview engaged in multiple strategies working with all stakeholders to ensure safe and appropriate transition of clients across the continuum of care.

271

PCMCH Maternal-Child Benchmarking Report 2013

1.1.7 HBV – Inpatient Age Profile (by service)

This chart illustrates an age profile by service (CCC, Rehab and Respite) to further describe the clinical inpatient populations served by Holland Bloorview Kids Rehabilitation Hospital. Age is captured at the time of admission. The age profiles of inpatient and day patient discharges are shown continuously from less than 1 year to over 19 years of age. Illustrated is the later age of children requiring respite services versus the continuous distribution of rehabilitation services.

272

PCMCH Maternal-Child Benchmarking Report 2013

1.1.8 HBV – Inpatient Average Length of Stay

The average length of stay is a measure to provide information as to ‘the average number of days’ a bed is occupied by a client in an inpatient services. Length of stay is calculated from the date of admission to the date of discharge. Below is the average length of stay for the past three fiscal years – 2010/11, 2011/12 and 2012/13 in SODR and BIRT.

273

PCMCH Maternal-Child Benchmarking Report 2013

1.1.9 HBV – Percent of Cases with Lengths of Stay Longer Than Expected (> 2 Sigma)

The chart below displays the percentage of inpatient rehabilitation cases as typical or outlier for the past two years. A client is classified as typical when s/he receives the predicted course of intervention and is discharged within the predicted timeframe. Outliers are those clients who exceed what would be considered typical, and who exhibit variation in their stay that cannot be explained by chance. Outlier cases do not receive the ‘normal’ or ‘predicted course of treatment’. The graph below also depicts that most of HBKR clients within each service are within expected courses of care based on best practice.

274

PCMCH Maternal-Child Benchmarking Report 2013

1.1.10 HBV – Percent of Inpatient Clients Receiving Outpatient Services

The chart below provides the percentage of clients from inpatients who continue receiving services on an outpatient basis. The chart reflects the activity since fiscal 2009 through until 2013, demonstrating an increase in the number of clients accessing outpatient services. The increase is a reflection of the need that, as clients transition across the continuum of care, specialized services can and should be delivered on an outpatient basis to maximize functional recovery.

275

PCMCH Maternal-Child Benchmarking Report 2013

2.0 Alternate Level of Care (ALC) Days

Alternate level of care (ALC) is a term used by Ministry of Health and Long Term Care (MOHLTC) to describe the classification of inpatients that have needs that can be met in another environment but for various reasons the discharge is delayed. The definition applies to all patient populations waiting in all patient care beds in an acute or post-acute care hospital in Ontario.

Definition: When a patient is occupying a bed in a hospital and does not require the intensity of resources/services provided in this care setting (Acute, Complex Continuing Care, Mental Health or Rehabilitation), the patient must be designated Alternate Level of Care (ALC)1 at that time by the physician or her/his delegate. The ALC wait period starts at the time of designation and ends at the time of discharge/transfer to a discharge destination2 (or when the patient’s needs or condition changes and the designation of ALC no longer applies).

Note 1: Note 2:

The patient’s care goals have been met or Discharge/transfer destinations may include, but are not limited to: progress has reached a plateau or the patient has reached her/his home (with/without services/programs), potential in that program/level of rehabilitation (facility/bed, internal or external), care or complex continuing care (facility/bed, internal or external), an admission occurs for supportive transitional care bed (internal or external), care because the services are not long term care home, accessible in the community (e.g. group home, “social admission”). convalescent care beds, palliative care beds, retirement home, shelter, supportive housing.

At Holland Bloorview the definition is clearly applied in the following manner - Clients admitted under Complex Continuing Care are classified as ALC if: their medical and nursing needs can be met in the home by a parent, guardian or caregiver but the family situation is not conducive to discharge home; or their medical and nursing needs can be met in the community and they are waiting placement in another facility.

Clients admitted for rehabilitation are classified as ALC if: their medical and nursing needs can be met in the home/community, and; they do not require intensive rehabilitation, and; resources/care in the home/ community/ are not available.

Clients admitted for Respite Services are classified as ALC if: they are unable to return home after the booked respite stay.

Holland Bloorview has been involved in ALC data collection congruent with the guidelines of the Wait Time Strategy, Provincial ALC Definition Initiative since July 1st, 2009. The ALC data captured through this provincial initiative will assist in building capacity for clients requiring alternative levels of care which includes our clients who will require specialized adult services.

276

PCMCH Maternal-Child Benchmarking Report 2013

2.1.1 HBV – Percent of ALC Days

Alternate level of care (ALC) is a term used by MOHLTC to describe the classification of inpatients that have needs that can be met in another environment but for various reasons the discharge is delayed. The chart below indicates the distribution of ALC days. The needs related to paediatric to young adult complex continuing care transitioning remains a ‘system challenge’ however we continue to partner with adult facilities, group homes, assisted living and other health agencies to resolve the system wide challenges.

277

PCMCH Maternal-Child Benchmarking Report 2013

3.1.1 HBV – Outpatient Patient Profile

The chart below illustrates an age profile to further describe the outpatient populations served by Holland Bloorview Kids Rehabilitation Hospital. Age is captured at the time of registration or first visit. The age profiles of outpatients are shown from less than 1 year to 19 years and older.

278

PCMCH Maternal-Child Benchmarking Report 2013

3.1.2 HBV – Referral Pattern for Outpatient Services

The chart below displays the referral pattern for all of Outpatient Services for the fiscal years 2011/12 and 2012/13 (highest volume services). Of note is the significant volume of Autism referrals when compared to other services, which has increased over twofold since 2010.

279

PCMCH Maternal-Child Benchmarking Report 2013

3.1.3 HBV – Referral Pattern for Child Development Services

The chart below displays the referral pattern for Child Development Services over the past three years. Child Development Services includes those children with neuromotor conditions, autism spectrum disorder, spina bifida, psychopharmacology needs and all developmental delays. Highlighted are the increased annual number of referrals received and appointments attended for specialized review for both neuromotor and autism programs and the subsequent decline in wait. Of note the volumes portrayed in 2012/13 include additional satellite services not included in previous fiscal years. With data adjusted for comparison, the volumes of referrals and attended appointments continues to increase.

280

PCMCH Maternal-Child Benchmarking Report 2013

3.1.4 HBV – Referral Pattern for Autism and Neuromotor Services

The charts below display the referral pattern, attendances and wait lists for Autism (including psychopharmacology) and Neuromotor services for the past two years. Highlighted are the annual number of referrals received, attendances and the current wait list for these specialized reviews (highlighting the growing demands for these services). Of note is the substantive increase in demand and the challenge of balancing capacity to reduce wait lists.

281

PCMCH Maternal-Child Benchmarking Report 2013

3.1.5 HBV – Referral Pattern for Neuromotor Services

The chart below displays the referral pattern for Neuromotor services over the past four years. These referrals are for children with queries of motor delay, or neuromotor disorders who are significantly complex requiring specialized review. Of note is the stability of referral from the previous year.

282

PCMCH Maternal-Child Benchmarking Report 2013

3.1.6 HBV – Referral Pattern for Autism Services

The charts below display the referral pattern for Autism Spectrum Disorder (ASD) Assessment over the past 3 years capturing volume at our main site as well as our satellite clinics. These referrals are for children with queries of autism spectrum disorder who are significantly complex requiring specialized review (main site), complex review (satellite clinics) as well as those children requiring pharmacological management of the disorder (main site). Of note is the continued and substantive increase in the number of referrals received for assessment and diagnosis of ASD.

283

PCMCH Maternal-Child Benchmarking Report 2013

3.1.7 HBV – Referral Pattern for Communication and Writing Aids Services

The charts below display the referral pattern over serveral years for services for children who require augmentative and alternative communication. This program services children where their speech does not meet their daily communication needs and who require augmentative and alternative technology in order to communicate. In the writing aids stream children are seen who are able to speak, but cannot write with a pen or pencil and require technology to support their written communication.

284

PCMCH Maternal-Child Benchmarking Report 2013

4.1.1 HBV – Summary of Operating Costs for Fiscal Year 2011/12

The chart below displays the operating costs for the organization categorized in key categories as percentage of total operating costs. These costs only reflect the ‘global funding’, and not revenue from external or third party payer sources. Of note is that Diagnostic and Therapeutics captures outpatient activity from professional health disciplines from a clinical care standpoint.

Inpatient: This functional centre framework section pertains to the nursing services provided to inpatients/residents and their significant others to meet their physical and psychosocial needs.

Ambulatory Care: Ambulatory Care (AC) functional centres are primarily intended to capture nursing expenses and activities, although in some unique functional centres the primary care giver may not be a nurse e.g. dental clinics.

Diagnostic and Therapeutic: This includes nutrition, physiotherapy, occupational therapy, speech pathology, social work, psychology, therapeutic recreation and child life.

Community and Social Services: Social and Community Services reflect all services provided outside of the hospital environment.1

1 Adapted from the Ontario Healthcare Reporting Standards - 2012

285

PCMCH Maternal-Child Benchmarking Report 2013

5.1.1 HBV – Canadian Association of Paediatric Health Centres (CAPHC) and Holland Bloorview

The Canadian Network for Child and Youth Rehabilitation (CN-CYR) is a network of partners and members within the Canadian Association of Paediatric Health Centres. CN-CYR consists of individuals and organizations within the Canadian Association of Paediatric Health Centres (CAPHC), a community that shares an interest in the delivery of child development and rehabilitation services. The majority of organizations are outpatient rehabilitation and child development centres followed by acute care hospitals, rehabilitation hospitals and community and home service providers. Over 80% of the organizations offer specialized services such as assistive technology and or seating services.

Holland Bloorview Kids Rehabilitation Hospital has been a founding member of the CN-CYR group whose aim has been that of advancing the coordination, quality and outcome of rehabilitation services for children with disability across Ontario and Canada.

Benchmarking Performance: In Canada, there is no concerted or organized way of measuring and tracking the impact of disability in children. That means that we don’t have a consistent way to describe and measure outcomes for this population. The inability to measure creates the potential to compromise our ability to effectively plan health care services to meet needs now and in the future for children with disability.

CN-CYR is working to answer these questions. Rehabilitation services have a unique contribution within the health system to enhance function for meaningful living. The creation of a National Data Set (NDS) for Pediatric Rehabilitation is key to the understanding of how best to use finite resources, strategically align health systems that ultimately will optimize the child’s functionality and support a fulfilling and meaningful life for children with disabilities and their families. Objectives for the NDS are represented in the figures below.

5. Evaluation to support benchmarking (2014-2015)  Better organized services

 More consistency in care across Canada

 Improved access to services 4. Implement Across Canada 3. Second Pilot the NDS at three sites (2014)  An assurance that time and energy is being spent across Canada (timeline Sept 2013) on the right therapies and intervention that will make a meaningful difference 2. Complete feasibility study (complete September 2012)  Fiscal stewardship 1. National Agreement on framework + indicators for National Data  Pan-National strategic planning Set completed; Identified potential data capture partners (2011)

Holland Bloorview has been an instrumental leader in the development, refinement and piloting of the NDS. We currently co-chair both the Outcomes & Benchmarking Committee and the Operations Committee of CN- CYR to advance this work.

286

PCMCH Maternal-Child Benchmarking Report 2013

Glossary of Terms

Average Inpatient Weight per Day The average weight per day is the total weight for all cases divided by the total number of inpatient days. It is a daily estimate of the variable patient weight.

Average Length of Stay (ALOS) The length of stay is calculated from the date of admission to the date of discharge and is displayed in days. The average length of stay is calculated from total patient days divided by total discharges.

Average Resource Intensity Weight (ARIW) The average weight per case represents the inpatient Resource Intensity Weight, which is reflective of the average amount of resources required by the hospital to care for patients during their hospital stay. The value of 1.0 represents a “typical” inpatient case. Since 2000, the RIW calibration (which is a relative value) has been based exclusively on Canadian cost data.

The Canadian Classification of Health Interventions (CCI) The CCI is the national standard for classifying health care interventions.

Canadian Institute for Health Information (CIHI) CIHI is an independent, not-for-profit organization that provides essential data and analysis on Canada’s health system and the health of Canadians.

Case Mix Group (CMG) CMG categorizes patients into statistically and clinically homogeneous groups, based on the collection of clinical and administrative data.

Canadian Triage and Acuity Scale (CTAS) CTAS is a tool that assists Emergency Department staff in prioritizing patient care requirements by the type and severity of presenting signs and symptoms. The triage level assigned using CTAS is a mandatory data element in coding ER cases for CIHI.

Canadian Paediatric Triage and Acuity Scale (P-CTAS) P-CTAS was developed to facilitate application of the CTAS to children.

Diagnosis Type Diagnosis Type is a one-digit code used to indicate the relationship of the diagnosis to the patient’s stay in hospital. Diagnosis type M, 1 and 2 are defined as follows: Most Responsible Diagnosis (MRDx or M) - The Most Responsible Diagnosis is an ICD-10-CA code identifying the diagnosis considered by the physician to be the most responsible for the patient’s stay in the institution – the one diagnosis that describes the most significant condition of a patient that causes his/her stay in hospital. In the case where multiple diagnoses may be classified as the most responsible, the diagnosis that is responsible for the greatest length of stay is used. Type 1 – Pre-admission co-morbidities, conditions already present at admission. Type 2 – Post-admission co-morbidities, conditions arising after admission to hospital.

Discharge Abstract Database (DAD) The CIHI DAD contains data on hospital inpatient discharges across Canada.

287

PCMCH Maternal-Child Benchmarking Report 2013

Discharge Disposition Discharge Disposition is the status of the patient upon leaving the hospital:

Disposition Title Type 01 Transferred to an acute care inpatient institution (includes other acute, sub-acute, acute psychiatric, acute rehabilitation, acute cancer centre, acute paediatric centre etc.) 02 Transferred to continuing care (a facility that provides continuing supervisory care by medical and allied medical staff) 03 Transferred to other (includes ambulatory care, palliative care facility/hospice, addiction treatment centre, jails, infants and children discharged/detained by social services) 04 Discharged to home or a home setting with support services (senior’s lodge, attendant care, home care, meals on wheels, homemaking, supportive housing etc.) Example of discharge to a home setting with support: A facility where supervisory care is not required on a continuing basis. A patient is discharged and is able to function independently within a group setting. Community services would be brought in to provide support, when necessary. Example of discharge home with support services: A patient is discharged home with the support of home care which is providing daily dressing changes and wound care. 05 Discharged home (no support service required) 06 Left against medical advice (with or without sign-out, AWOL) 07 Died 08 Cadaveric donor admitted for organ/tissue retrieval 09 Stillbirth

Expected Length of Stay (ELOS) ELOS is based on a national level length of stay predictor used as an indicator in hospital utilization management analyses.

Emergency Department Visit An Emergency Department Visit is generally an unscheduled assessment, diagnostic and/or treatment service provided in an emergency or urgent care centre.

ICD-10-CA ICD-10-CA is the Canadian coding classification for reporting clinical diagnoses for diseases, injuries and causes of death, as well as external causes of injury and poisoning.

Inpatient A patient who is admitted to an acute care facility for treatment is registered as an inpatient.

Local Health Integration Network (LHIN) Created by the Ontario government in March 2006, there are 14 LHINs that work with local health providers and community members to determine the health service priorities of each LHIN region.

288

PCMCH Maternal-Child Benchmarking Report 2013

Major Clinical Category (MCC) MCCs are used in CMG methodology and defined by the MRDx. Each MCC identifies a body system or other specific type of clinical problem.

MIS Bed Definitions

Physical Beds: This number reflects the maximum number of beds/cribs (MIS Statistical Account 710) and bassinets (MIS Statistical Account 711) at the beginning of the year on the basis of established standards of floor area per patient to meet fire protection and safety standards. These are often referred to as rated beds. This information is relevant for the measurement of potential healthcare capacity and municipal taxes. This does not refer to internally budgeted beds, MOHLTC submission beds or pandemic planning capacity.

Beds Staffed and In Operation: This cumulative number of beds/cribs (MIS Statistical Account 720) and bassinets (MIS Statistical Account 721) reflects beds available and staffed for admission each day in the period. This shows the facility’s true capacity to provide care. Beds which cannot be staffed i.e. due to nursing shortage or beds closed for renovations or cost reduction are not available for service and therefore not included. Beds are not considered “Staffed and in Operation” when the Admitting department has been formally notified of a bed closure. Beds that cannot be staffed due to nursing shortages, for example, must be closed for a minimum of half a month. If a room is being painted and is closed for 3 days, then this would not affect the Beds Staffed and in Operation.

National Ambulatory Care Reporting System (NACRS) CIHI’s NACRS captures ambulatory care activity - day surgery, mandated medical day care and outpatient clinics, and emergency departments.

Neonatal Neonatal patients are aged between 0 and 28 days on date of admission.

Outlier Cases Patients are outliers if they were discharged from hospital after an extended length of stay (identified by applying statistical trim points).

Other Cases The category “Other” represents deaths, sign-outs and transfers.

Paediatric Paediatric patients are aged between 29 days and 17 years of age on date of admission.

Resource Intensity Weight (RIW) RIW is a value assigned which is reflective of the average amount of resources required by the hospital to care for patients during their hospital stay. The value of 1.0 represents a “typical” inpatient case. Since 2000, the RIW calibration (which is a relative value) has been based exclusively on Canadian cost data.

Same Day Surgery (SDS) Same Day Surgery covers all surgical, diagnostic and endoscopic procedures performed where the patient attends for three to twelve hours on average, where the patient is not admitted to an inpatient bed, and is discharged within the same calendar day or within 12 hours if discharge is after midnight. SDS is reported in NACRS and is MIS functional center specific.

289

PCMCH Maternal-Child Benchmarking Report 2013

“Transfer From” “Transfer From” refers to a patient being transferred from one acute care facility to the reporting acute care facility for further treatment or hospitalization.

“Transfer To” “Transfer To” refers to a patient being transferred to another acute care facility from the reporting acute care facility for further treatment or hospitalization.

Typical Cases A patient is classified as “typical” when he/she receives a course of treatment in a single institution and is discharged within the applicable trim point for length of stay.

Visit Disposition Visit Disposition is the client’s type of separation from the ambulatory care service after registration to that service for the NACRS-related indictors (ED and SDS):

Type Visit Disposition Discharged to Place of Residence (private dwelling, not an institution; no support 01 services) 02 Client registered, left without being seen or treated by a service provider Client triaged, then left the Emergency Department before further assessment by a 03 service provider Client triaged, registered and assessed by a service provider and left without 04 treatment Client triaged, registered and assessed by a service provider, treatment initiated, left 05 against medical advice before treatment completed Admitted into Reporting Facility as an in-patient to critical care unit or operating 06 room directly from an ambulatory care visit functional centre Admitted into Reporting Facility as an in-patient to another unit of the reporting 07 facility directly from the ambulatory care visit functional centre Transferred to another acute care facility directly from an ambulatory care visit. Can include by ambulance. Includes transfers to another acute care facility with entry 08 through the Emergency Department Transferred to another non-acute care facility directly from an ambulatory care visit 09 functional centre. Can include by ambulance Death after arrival (DAA) – used for clinic or day surgery visit functional centres OR 10 Death in Emergency (DIE) DOA (includes in ER) – no vital signs apparent and minimal or no intervention 11 initiated 12 Intra-facility transfer to day surgery 13 Intra-facility transfer to the Emergency Department 14 Intra-facility transfer to clinic Discharged to place of residence (Institution i.e. Nursing or Retirement Home or 15 Chronic Care); Private Dwelling with Home Care, VON, Meals on Wheels, etc. or Jail

290

PCMCH Maternal-Child Benchmarking Report 2013

Acknowledgements

PCMCH would like to acknowledge and thank all of our partners who supported the production of the annual Benchmarking Report by providing data and reviewing content.

Development of this Benchmarking Report was lead by a project management / communication team from PCMCH that included:

Anna Shynlova-Bucciarelli, MBA Sr. Project Manager (project lead)

Doreen Day, MHSc, CHE Sr. Project Manager

Carla Siciliano Administrative Assistant

PCMCH acknowledges and thanks the many dedicated individuals who contributed to this report, including:

Benchmarking Steering Committee: Cathie Badeau (NYGH), Jackie Barrett (SJHC), Ladan Dadgar (SickKids), Barb Fisher (CHEO), Sheri Ferkl (PRHC), Wendy Gerrie (MCH HHSC), Jackie Hubbert (SickKids), Donna LaForce (MCH HHSC), Joanne MacKenzie, Chair (Mt Sinai) and Cindy McDonald (HHS).

Benchmarking Health Information Work Group: Kathryn Barber (CH LHSC), Michael Chow (SickKids), Elviera Janzen (MCH), Sandra Perry (CHEO), Debi Senger (co-chair; SickKids), Anna Jane Woodman (co-chair; KGH) and Dorota Zienkiewicz (CVH).

Benchmarking MIS Work Group: Lana Cassidy (KGH), Mei Ling Chong (SickKids), Debi Clark (Bluewater), Mario DiGiosia (CHEO), Sally Jenkins (Bluewater), Jennifer McCallum (CH LHSC), Suzanne Murphy (Lakeridge), Karen Orescanin, Chair (MCH HHSC), Zenaida Rebello (WOHS), and Eley Wisniewski (MCH HHSC).

Members of the following organizations, which provided data for the report: BORN Ontario (Daniel Bedard) and Canadian Institute of Health Information (Colleen Dixon and Lisa Feng).

291