From: Cheang, Melanie HE0 To: Committees LEG Cc: Vanstone, Joy He0; Kimens, Melissa HE0; Covey, June HE0 Subject: Public Accounts Committee - Ministry of Health - Follow-up Materials Date: March 9, 2020 12:06:03 PM Attachments: 1- SCA Master Evaluation Summary Report.pdf 2 - Response Times and Call Volume for all ambulance services in 2017-18.pdf 4a - Former SHR Affiliate Homes.pdf 4b - Quality Indicator"s Ministry Monitoring SHR Affiliates.pdf 6 - ED Referrals.pdf 8 - Quarterly Sick Time Hours per Paid FTE by RHAs and SCA.pdf 9 - SHA EFAP History.pdf 10 - HHR antipsychotic use, quarterly trending.pdf 11 - Antipsychotic Medication Pilot Project Santa Maria 2014-15.pdf 0. PAC Follow-up Summary.pdf 0.1 - PAC Follow-up -Key Messages Final.pdf

Good Morning,

The Standing Committee on Public Accounts asked the Ministry of Health to provide additional information during our last appearance before the Committee. Please find attached a summary of requested follow-up information, key messages and several documents that address questions raised regarding: 1. Breast Cancer Screening; 2. Cypress Ambulance; 3. Mamawetan Immunizations; 4. Saskatoon Affiliate Care Homes; 5. Saskatoon Emergency Department Wait – Times from registration/ triage; 6. Saskatoon Emergency Department – Percentage of consultant admissions; 7. Saskatoon Emergency Department – Saskatoon emergency department staffing numbers; 8. Heartland Employee absenteeism – Average sick time; 9. Heartland Employee absenteeism – Employee and Family Assistance Program; and 10. & 11. Heartland –Medication Management.

Please feel free to contact me if you are requiring anything further.

Thanks, Melanie Cheang, CPA, CA Director, Operations and Quality Assurance Financial Services Branch Ministry of Health 3475 Albert Street Regina, S4S 6X6 Bus: 306-787-7738 Email: [email protected]

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2017‐18 EMS Response Times and Call Volume by Ambulance Service

Response time measures the emergency calls (excluding cancelled calls) from the time of call to when the ambulance arrives on scene.

Out of province calls are excluded. % of Times % of Times Met < 30 Met < 8:59 minute Rural minute Urban Response Response Ambulance Services Time Target Time Target Call Volumes Beauval Ambulance Division 40.71% N/A 230 Beechy‐Demaine Emergency Services 25.00% N/A 40 Bengough Road Ambulance 89.47% N/A 108 Biggar Ambulance Service 93.56% N/A 506 Ambulance Care 59.28% N/A 625 Borderline Muni. Road Ambulance ‐ 93.33% N/A 132 Buffalo Narrows Ambulance Division 51.85% N/A 68 Cabri and District Ambulance Ser 81.82% N/A 117 Canora Ambulance Care (1996) Ltd 86.77% N/A 1,298 Consul Ambulance Division 93.75% N/A 65 Coronach Road Ambulance 90.63% N/A 92 Crestvue Ambulance Service Ltd. 89.08% 75.25% 2,706 Cupar Lions Volunteer Amb Inc. 69.83% N/A 292 Cut Knife Ambulance 90.12% N/A 424 Davidson EMS 89.84% N/A 316 Dinsmore EMS 50.00% N/A 47 Dodsland EMS 40.00% N/A 44 Duck Mtn Ambulance Care Ltd. ‐ 94.44% N/A 904 Duck Mtn. Ambulance ‐ Norquay 91.36% N/A 229 Ambulance 88.89% N/A 72 Elrose Volunteer Fire Brigade Inc. 73.08% N/A 50 Emergency Med Ser Div ‐ Regina 91.03% 84.79% 26,596 Esterhazy Emergency Services 85.71% N/A 445 Eston Ambulance 93.22% N/A 161 Fillmore Ambulance Inc. 48.53% N/A 138 Gull Lake Ambulance 89.58% N/A 178 Hudson Bay Regional Amb Service 97.33% N/A 257 Humboldt Ambulance Service (1992) 92.58% N/A 1,159 Hutch Ambulance Moosomin Inc. 93.55% N/A 580 Hutch Ambulance Service Inc ‐ Assiniboia 79.46% N/A 716 Hutch Ambulance Service Inc ‐ 69.01% N/A 129 Ile a la Crosse Ambulance Division 36.39% N/A 807 Imperial & District Volunteer Amb Inc 45.71% N/A 149 Indian Head & Dist Ambulance 76.86% N/A 710

% of Times % of Times Met < 30 Met < 8:59 minute Rural minute Urban Response Response Ambulance Services Time Target Time Target Call Volumes Ambulance 90.57% N/A 307 J.T. Ambulance Care Inc. ‐ Grenfell 73.26% N/A 753 Kelvington Ambulance Care Ltd. 98.11% N/A 350 Ambulance 91.49% N/A 214 Ambulance 85.66% N/A 689 Kipling & District Ambulance Service 72.73% N/A 219 Kyle EMS 89.47% N/A 53 La Loche Ambulance Division 83.68% N/A 937 EMS 71.96% N/A 2,782 & District Ambulance 88.89% N/A 36 Langenburg Road Ambulance 82.86% N/A 269 Lanigan & Dist Amb Assoc 93.10% N/A 248 Leader Ambulance Division 68.75% N/A 204 Leroy Ambulance Service 94.59% N/A 68 M.D. Ambulance Care Ltd. 78.84% 69.01% 30,290 Macklin Ambulance Serivce 93.94% N/A 85 Maidstone Ambulance 82.30% N/A 250 Maple Creek Ambulance Division 87.50% N/A 390 Marshall's Ambulance Care Ltd. ‐ St. Walburg 32.62% N/A 1,511 Maryfield Road Ambulance 100.00% N/A 31 Meadow Lake & District Ambulance 79.60% N/A 1,907 Melfort Ambulance Care (1999) Ltd. 78.42% N/A 1,352 Melville EMS 90.50% N/A 826 Midway Amb Care Ltd. ‐ Wynyard 71.79% N/A 414 & District EMS 63.89% 80.08% 5,133 and District Ambulance 97.67% N/A 68 North‐East EMS Carrot River 47.63% N/A 667 North‐East EMS 86.08% N/A 1,890 O/A Prairie Ambulance Care Ltd. (1998) 93.75% N/A 356 Onion Lake Developments Ltd. ‐ FN 98.62% N/A 1,335 Outlook Ambulance District 84.40% N/A 427 Oxbow Area Municipal Road Amb. 94.74% N/A 208 Pangman Road Ambulance 68.66% N/A 135 Parkland Ambulance Care ‐ PA 58.67% 97.26% 10,664 Pelican Narrows Ambulance Service ‐ FN 89.73% N/A 661 Porcupine Ambulance Service 84.85% N/A 187 Quill Plains Amb Care ‐ Watson 92.31% N/A 168 R. M. of Frontier #19 75.86% N/A 82 EMS 71.43% N/A 178

% of Times % of Times Met < 30 Met < 8:59 minute Rural minute Urban Response Response Ambulance Services Time Target Time Target Call Volumes Redvers Road Ambulance 83.72% N/A 135 Richmound Ambulance Division 85.71% N/A 42 Rosetown Ambulance District 89.73% N/A 462 & District Amb Care 95.02% N/A 1,084 S.E. Associated Ambulance ‐ 96.20% 83.43% 945 Shamrock Amb Care Inc ‐ Wadena 88.72% N/A 435 Shamrock Amb Care Inc. ‐ 84.27% N/A 354 Shamrock Amb Care Inc. ‐ Rose Valley 89.74% N/A 329 Shaunavon Ambulance Division 95.00% N/A 293 Soo Line Ambulance Association ‐ Milestone 92.45% N/A 101 Ambulance Care (1994) Ltd. 49.06% N/A 1,624 Spiritwood Ambulance Care Ltd. ‐ Big River 40.35% N/A 678 St. Joseph's Hosp/ ‐ Amb 91.18% N/A 317 Stoughton & District Volunteer Amb Inc. 98.48% N/A 165 Strasbourg Emergency Medical Services 72.67% N/A 347 Supreme Ambulance Care (1987) Limited ‐ Carlyle 93.51% N/A 604 & Dist Amb. Ser Ltd. 65.71% 86.01% 2,252 Tisdale Ambulance Care Ltd. 75.25% N/A 735 Touchwood EMS 59.09% N/A 969 Unity Ambulance Service 88.79% N/A 322 Val Marie Ambulance Inc. 84.62% N/A 25 Valley Amb. Care Ltd. ‐ Fort Qu'Appelle 89.19% N/A 1,478 & District EMS Ltd. 70.95% N/A 730 Watrous District Road Amb 89.29% N/A 289 & District Ambulance Service 90.32% N/A 95 EMS 84.13% 90.71% 1,509 Whitewood District Ambulance 78.63% N/A 328 Wilkie Ambulance Service 93.62% N/A 124 WPD Ambulance Care ‐ North 84.86% 94.93% 4,849 WPD Ambulance 90.73% 90.82% 1,362 Total Calls 129,716

Former - Affiliates 1. Bethany Pioneer Village

2. Central Haven Special Care Home

3. Circle Drive Special Care Home

4. Extendicare - Saskatoon

5. Goodwill Manor

6. Lakeview Pioneer Lodge

7. Langham Senior Citizens Home

8. Lutheran Sunset Home

9. Mennonite Nursing Home

10. Oliver Lodge

11. Porteous Lodge

12. Samaritan Place

13. Saskatoon Convalescent Home

14. Sherbrooke Community Centre

15. Spruce Manor SCH

16. St. Ann's Senior Citizens' Village

17. St. Joseph's Home

18. Stensrud Lodge

19. Sunnyside Adventist Care Home

20. Warman

Source: RAI MDS 2.0 Microstrategy Quarter 3 2018 2019 Data Former Saskatoon Health Region - Affiliates Percentage of Residents Compared to Provincial Average Provincial Average Former Saskatoon Health Region Affiliates Ministry Target 30.0% 25.3%24.7% 25.0% 22.9% 22.1% 20.0% 19.6% 14.2% 15% 15.0% 13.2% 9.00% 9.7% 10.5% 11.4% 10.0% 7.3% 7% Percentage Residents of 5.0% 3.6% 2.4% 1.9% 2% 1.7%2.2% 2% 0.0% RES01 - Residents DRG01 - Residents FAL02 - Residents PAN01 - ResidentsPRU06 - Residents PRU09- Residents CNT03 - Residents in Daily Physical on Antipsychotics Who Fell in the Whose Pain Whose Stage 2 to With a Newly Whose Bladder Restraints Without a last 30-days Worsened 4 Pressure Ulcer Occurring Stage 2 Continence Diagnosis of Worsened to 4 Pressure Worsened Psychosis Ulcer Percentage obtained by using the Former Saskatoon Health Region (SHR) Affiliates total numerator over the total denominator for the Former SHR affiliates for each 7 Quality Indicators. Included are all Former Saskatoon Health Region Affiliates (20 LTC Homes).

Quarterly Sick Time Hours per Paid FTE by RHAs and SCA, 2014‐15 to 2015‐16

2014‐15 2015‐16 RHAs / SCA Q1 Q2Q3Q42014‐15 Q1 Q2 Q3 Q4 2015‐16 Saskatchewan Cancer Agency 15.69 12.86 16.64 17.16 62.34 15.17 14.33 17.60 18.57 65.72 Sun Country 17.81 17.06 19.11 20.32 74.26 16.54 16.23 20.66 20.11 73.49 Five Hills 16.43 16.00 17.33 17.93 67.71 18.32 15.13 19.19 17.43 70.04 Cypress 17.46 14.93 18.34 17.41 68.08 15.78 14.76 17.02 18.67 66.23 Regina Qu’Appelle 21.25 20.22 22.11 22.40 86.00 20.80 20.19 21.08 22.21 84.14 Sunrise 20.29 19.15 23.46 23.99 86.83 21.88 22.71 24.03 25.63 94.24 Saskatoon 20.82 19.04 22.50 20.71 83.06 20.52 19.76 21.52 21.66 83.46 Heartland 20.06 19.38 23.01 21.19 83.65 21.19 18.98 20.57 20.79 81.52 Kelsey Trail 20.22 18.56 20.52 20.65 79.91 19.79 17.63 20.88 18.88 77.13 PA Parkland 17.87 14.98 18.15 19.15 70.09 17.95 16.87 20.43 21.24 76.44 Prairie North 17.20 15.04 16.49 17.26 65.96 16.15 16.16 17.71 18.75 68.75 Mamawetan Churchill River 18.18 18.24 19.53 19.15 75.09 23.75 20.73 22.47 23.49 90.43 Keewatin Yatthé 25.00 22.54 21.09 22.96 91.54 21.47 22.56 22.85 26.38 93.24 Saskatchewan 19.84 18.30 21.02 20.71 79.86 19.66 18.88 20.81 21.31 80.62

Quarterly Sick time Hours per Paid FTE by RHAs and SCA, 2016‐17 to 2017‐18

2016‐17 2017‐18 RHAs / SCA Q1 Q2 Q3 Q4 2016‐17 Q1 Q2 Q3 Q4 2017‐18 Saskatchewan Cancer Agency 17.47 14.12 18.21 17.73 67.56 16.30 15.31 17.07 17.54 66.22 Sun Country 19.22 18.24 21.46 20.69 79.53 17.60 15.80 21.28 20.73 75.32 Five Hills 18.56 17.09 19.24 19.13 73.99 19.09 17.71 20.63 17.79 75.16 Cypress 16.25 16.06 17.64 19.06 69.00 15.83 13.34 16.84 17.30 63.26 Regina Qu’Appelle 21.43 20.09 22.54 22.17 86.22 20.87 19.90 22.88 22.22 85.86 Sunrise 24.28 19.99 24.28 25.00 93.41 21.91 20.98 23.94 26.20 92.97 Saskatoon 20.73 20.12 23.23 22.49 86.56 20.98 19.91 22.96 22.50 86.35 Heartland 19.81 18.35 21.43 24.73 84.29 21.16 18.74 22.12 22.82 84.80 Kelsey Trail 17.46 15.67 22.16 21.30 76.51 20.14 16.73 20.97 23.23 81.14 PA Parkland 20.56 19.71 23.98 24.02 88.21 20.82 19.91 23.39 25.18 89.25 Prairie North 16.96 16.38 18.84 18.76 70.63 16.55 17.36 19.26 21.12 73.75 Mamawetan Churchill River 18.50 19.37 24.85 23.64 86.29 26.15 21.83 21.21 29.27 98.40 Keewatin Yatthé 23.15 21.79 21.33 23.44 89.67 28.24 22.85 26.66 30.14 107.76 Saskatchewan 20.30 19.08 22.18 21.99 83.52 20.20 19.03 22.15 22.31 83.65

Quarterly Sick time Hours per Paid FTE by RHAs and SCA, 2018‐19 to 2019‐20

2018‐19 2019‐20 RHAs / SCA Q1 Q2 Q3 Q4 2018‐19 Q1 Q2 Q3 Q4 2019‐20 Saskatchewan Cancer Agency 15.62 15.40 17.51 Sun Country 17.01 15.89 19.74 Five Hills 17.82 15.45 19.05 Cypress 13.79 14.31 18.49 Regina Qu’Appelle 21.59 20.98 22.86 Sunrise 23.64 21.18 26.32 Saskatoon 20.58 20.09 22.25 Heartland 19.93 19.47 21.83 Kelsey Trail 22.75 18.96 20.72 PA Parkland 22.67 20.61 24.52 Prairie North 19.26 17.67 20.66 Mamawetan Churchill River 27.66 22.82 27.16 Keewatin Yatthé 25.13 22.49 22.21 Saskatchewan 20.57 19.52 22.18

Saskatchewan Health Authority 5‐Year EFAP Usage For the Period of: April 1 2013 – March 31, 2019

Breakdown of Utilization by Percentage (# of cases/population*) *populations based on average quarterly reporting so will vary year over year. 2018‐19 average population cited below. Oct 1, 2015 – Employee Health Region March 30th 2016 2016 ‐ 2017 2017‐2018 2018‐ 2019 Population annualized % Cypress Health Region 1815 7.10% 6.78% 5.52% 5.73% Five Hills Health Region 1949 11.3% 10.26% 9.20% 9.70% Heartland Health Authority 1883 7.79% 6.85% 9.11% 6.69%

Keewatin Yatthe 367 18.52% 13.45% 13.09% 6.27%

Kelsey Trail Health Region 1721 9.86% 11.48% 9.58% 8.95% Mamawetan Churchill River 320 10.36% 11.15% 10.57% 9.69%

Prairie North Health Region 3522 9.40% 7.52% 5.72% 6.33% Prince Albert Parkland 2996 15.70% 15.45% 13.08% 13.72% Regina Qu’Appelle Health Region 11,751 14.89% 11.45% 10.60% 11.45%

Saskatoon Health Region 14,190 17.15% 15.80% 13.80% 13.70% Sun Country Health Region 2450 12.00% 8.40% 7.01% 7.88% Sunrise Health Region 2939 9.34% 7.28% 7.04% 6.98%

Saskatchewan Health Authority 5‐Year EFAP Usage For the Period of: April 1 2013 – March 31, 2019

Breakdown of Utilization by Case

Oct 1, 2015 – Employee Health Region March 30th 2016 2016 ‐ 2017 2017‐2018 2018‐2019 Population # of cases YTD Cypress Health Region 1815 65 124 101 104 Five Hills Health Region 1949 113 208 184 189 Heartland Health Authority 1883 74 132 173 126 Keewatin Yatthe 367 34 48 51 23 Kelsey Trail Health Region 1721 86 201 167 154 Mamawetan Churchill River 320 17 36 35 31 Prairie North Health Region 3522 166 270 202 223 Prince Albert Parkland 2996 234 454 390 411 Regina Qu’Appelle Health Region 11,751 863 1341 1229 1345 Saskatoon Health Region 14,190 1208 2158 1944 1944 Sun Country Health Region 2450 145 207 171 193 Sunrise Health Region 2939 136 215 205 205 Antipsychotic Use – MDS data – Heartland Health Region

’13‐‘14 ‘14‐‘15 ’15‐‘16 ’16‐‘17 ’17‐‘18 ’18‐‘19 MoH target 30.8% 29% 28% 27% 22.9% Q1 36.87 34.86 28.65 19.94 22.06 24.9 Q2 39.63 33.92 24.20 19.39 24.36 21.5 Q3 39.39 31.20 22.83 19.76 19.29 22.4 Q4 35.63 31.07 20.71 21.88 18.91 average 37.88 32.69 24.10 20.24 21.15

Summary of the Canadian Foundation for Healthcare Improvement (CFHI) Pilot Project on Reducing Potentially Inappropriate Use of Anti‐Psychotic Medications in LTC Residents Santa Maria Senior Citizens’ Home – Regina 2014‐15

The following graph demonstrates the results from the pilot in reducing inappropriate antipsychotic use:

Santa Maria Special Care Home 2nd Floor Residents Receiving Antipsychotics Without a Diagnosis 90 Baseline Actual Goal Median 80 70 60 50 40 30 20 10

0 10/8/2014 10/15/2014 10/22/2014 10/29/2014 11/5/2014 11/12/2014 11/19/2014 11/26/2014 12/3/2014 12/10/2014 12/17/2014 12/24/2014 12/31/2014 1/7/2015 1/14/2015 1/21/2015 1/28/2015 2/4/2015 2/11/2015 2/18/2015 2/25/2015 3/4/2015 3/11/2015 3/18/2015 3/25/2015 4/1/2015 4/8/2015 4/15/2015 4/22/2015 4/29/2015 5/6/2015 5/13/2015 5/20/2015 5/27/2015 6/3/2015 6/10/2015 6/17/2015 6/24/2015 7/1/2015 7/8/2015 7/15/2015 7/22/2015 7/29/2015

% of Residents on antipsychotics without a diagnosis Date Prepared: 07/31/2015 Report Contact: Tyler Chiddenton Source: Santa Maria Special Care Home Public Accounts Committee Ministry of Health February 26, 2019 Requested Follow up Information

Saskatchewan Cancer Agency

1. Breast Cancer Screening ‐ summary reports for the Early Detection Coordinators for 2018-19 Quarter 1, 2 and 3 – See attached document 1 – Master Evaluation Summary Report. (Page 459 – Hansard Verbatim Report, No. 22 – February 26, 2019)

Saskatchewan Health Authority

2. Cypress Ambulance – Ambulance response data province wide – See attached document 2 - Response times and call volume for all ambulance services in 2017‐18. (Page 467 – Hansard Verbatim Report, No. 22 – February 26, 2019)

3. Mamawetan Immunizations – Whooping cough urban area statistics:

Pertussis (whooping cough) is a cyclical disease, which peaks at four to five year intervals. The number of reported cases of pertussis in Saskatchewan for 2017 was 425 cases (a rate of 35.5 cases per 100,000 population) and represented the peak of the recent cycle of pertussis that began in 2015. Of the 425 Saskatchewan cases, about 18% (77 cases) were residents of the urban cities of Regina, Saskatoon and Prince Albert. The residents of Saskatoon comprised about 10% of the total Saskatchewan cases. Very preliminary results that are subject to change indicate that pertussis peaked in early 2017 and has declined considerably as expected in 2018. (Page 472 – Hansard Verbatim Report, No. 22 – February 26, 2019)

4. Saskatoon – Affiliate Care Homes – Updated figure of 4 and 5 in Audit – See attached documents 4a - Former Saskatoon Health Region (SHR) Affiliate Homes and 4b – Quality Indicators Ministry Monitoring SHR Affiliates. (Page 477 – Hansard Verbatim Report, No. 22 – February 26, 2019)

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5. Saskatoon – ED waits –Saskatoon area – Time from registration/triage to physician initial assessment (all triage levels combined):  2013-14 Baseline 195 minutes;  2014‐15 goal 195 minutes, actual 159 minutes;  2015‐16 goal 156 minutes, actual 169 minutes;  2016‐17 goal 127 minutes, actual 197 minutes;  2017‐18 goal 127 minutes, actual 176 minutes; and  2018‐19 goal 127 minutes, actual 169 minutes. (Page 480 – Hansard Verbatim Report, No. 22 – February 26, 2019)

6. Saskatoon – ED waits – Percentage of Consultant Admissions, up to date – See attached document 6 - Saskatoon ED Consultant Visits 2016‐19. (Page 482 – Hansard Verbatim Report, No. 22 – February 26, 2019

7. Saskatoon – ED waits – Saskatoon emergency department staffing numbers:  2018-19 totaled 240.6 full time equivalents (FTEs); and  2019-20 year-to-date totals 248.2 FTEs. (Page 482 – Hansard Verbatim Report, No. 22 – February 26, 2019)

8. Heartland – Employee Absenteeism – Average sick time FTE statistics – See attached document 8 - Quarterly sick time hours per paid FTE by RHAs and SCA. (Page 487 – Hansard Verbatim Report, No. 22 – February 26, 2019)

9. Heartland – Employee Absenteeism – EFAP information going back 5 years, province wide– See attached document 9 - SHA EFAP history. (Page 488 – Hansard Verbatim Report, No. 22 – February 26, 2019)

10. Heartland – Medication Management in LTC – SHA antipsychotics prescription without a psychosis diagnosis information – former Heartland – See attached document 10 - HHR antipsychotic use, quarterly trending. (Page 491 – Hansard Verbatim Report, No. 22 – February 26, 2019)

11. Heartland – Medication Management in LTC – Santa Maria Special Care Home antipsychotics prescription without a psychosis diagnosis information – See attached document 11 - Antipsychotic medication pilot project Santa Maria 2014‐15. (Page 491 – Hansard Verbatim Report, No. 22 – February 26, 2019)

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Public Accounts – Key Messaging

1. Page 459 – Hansard Verbatim Report, No. 22 – February 26, 2019 Topic: Breast Cancer Screening

Screening rate is at 39% in 2014 – has it improved since then or are we still the 5th lowest?

Our participation rate remains at 39%.The self-reported data suggests our participation rate is much higher, however in our current state, the SCA is not able to obtain data on screening outside the program. We do not know nationally if we are still the 5th lowest. CPAC has not recently requested any breast screening data from the SCA to do the comparison with other provinces.

Do we have a way to collect the data on how many women in their eligibility age group are having a screening mammogram outside the program?

We currently do not have a way of collecting screening mammogram data outside of our program, however, the Breast Pathway work is underway to determine strategies on how to obtain this data.

Did we get updated software?

Work is underway to upgrade the current screening software. At this time, we are in the planning (determining system/program(s) requirements) stage.

2. Page 467 – Hansard Verbatim Report, No. 22 – February 26, 2019 Topic: Ambulance response data province wide

KEY MESSAGES:  Patient-centred, safe and reliable ground ambulance service is a priority for our government.  Health care coverage by the Saskatchewan government extends far beyond hospital and physician services.  The province covers about 70% of the cost of ground ambulance services through funding to the Saskatchewan Health Authority and various assistance programs for seniors, lower income families and northern residents.  In 2018-19, the Saskatchewan Health Authority’s former health regions spent approximately $86.0M on ambulance services – almost double what was spent in 2006-07 ($43.5M).  About 81% of emergency ambulance calls in Saskatchewan’s 10 largest urban centres received a response in less than nine minutes.  Approximately 77% of rural emergency ambulance calls received a response within 30 minutes. This does not factor in when a volunteer medical first responder arrives on scene prior to an ambulance.

RESPONSE TIMES Background  Emergency response times are measured from the “time of call” to the time an ambulance arrives “on scene”. It does not consider when a medical first responder arrives on scene prior to an ambulance.  In 2018-19, ground EMS responded to a total of 131,326 calls, of which 43% required an emergency response (lights and sirens), the remaining 57% were non-emergency calls (e.g. treatment and transfer of a stable patient, diagnostic transfers, treatment/no transport, etc.).  In 2018-19, on a province-wide basis, the target of less than 30 minutes for rural emergency responses was met on 77% of the calls, and the target of eight minute 59 seconds or less for urban emergency response times was met on 81% of the calls.  Rural patients often receive support from volunteer medical first responders until an ambulance arrives. Medical first responder support is not factored in to response time data. Urban centres include the cities of Saskatoon, Regina, Prince Albert, Moose Jaw, , , Swift Current, Lloydminster, Weyburn and Estevan.  Regina and Saskatoon are the two largest urban ambulance services, handling 73 and 84 calls per day respectively, accounting for 44% of the total provincial ground ambulance call volume.  There is significant variation within the province in response times for both rural and urban emergency calls. o Achievement of the 8 minute 59 second urban emergency response time target, varied among the 10 largest urban centres from 97% to only 68% in 2018-19 (97% to 69% in 2017-18). o Among the 104 services, the achievement of the 30-minute target for rural emergency calls ranged from 99% to only 30% in 2018-19 (100% to 25% 2017-18).

4. Page 477 – Hansard Verbatim Report, No. 22 – February 26, 2019 Topic: Saskatoon Affiliate Care Homes

How do these stats compare from last year?

Compared to last year, the province has seen improvement in two of the seven Quality Indicators; Daily Physical Restraints, and Antipsychotics without a Diagnosis of Psychosis. Three Quality Indicators stayed relatively the same; Falls in the Last 30 days, Pressure Ulcers Worsened, and Newly Occurring Pressure Ulcers. Two Quality Indicators are higher compared to last year: Pain Worsened and Bladder Continence Worsened.

What are we doing to address these issues with affiliate partners?

All facilities, including affiliates are required to submit a corrective action plan to the Ministry if they are over the target. The plans are submitted quarterly.

Are we meeting the ministry targets? If not, why? If yes, what actions have we done to meet those targets?

Targets are being met for Daily Physical Restraints, Falls in the Last 30 days, Pressure Ulcers Worsened, and Newly Occurring Pressure Ulcers. For daily physical restraints there has been increased awareness and action taken when restraints are first used to ensure restraint use is quickly resolved, focus on education for staff and family, and exploring other ways to keep a resident safe. Significant work was done in the area of falls prior to the Quality Indicator Initiative through the Falls Collaborative, facilities continue to focus on strategies such as fall assessments, reducing antipsychotic use, and assessing the resident’s environment. In the area of pressure ulcers, facilities routinely do skin assessments, and frequent repositioning to prevent new pressure ulcers and to prevent current ulcers getting worse.

Targets are not being met for Antipsychotics without a Diagnosis of Psychosis, Pain Worsened, and Bladder Continence Worsened. Although considerable progress has been made in decreasing the use of antipsychotics without a diagnosis of psychosis, it continues to be above the target, some challenges include: multi-disciplinary team needed to do medication reviews, changing prescribing practices, and a lengthy process to reduce the dosage and then not always appropriate to eliminate the medication. The Pain Worsened Quality Indicator has fluctuated over the years because any resident who has increased pain is captured, and this includes episodes of pain such as a headaches, or increased arthritic pain. These types of episodes of pain are unforeseeable and the pain is managed as it appears. For Bladder Continence Worsened, challenges to meeting the target may include an absence of a toileting plan, insufficient resources to adhere to the plan or plans may be ineffective due to a decline in health or cognitive status.

5. Page 480 – Hansard Verbatim Report, No. 22 – February 26, 2019 Topic: Saskatoon Emergency Goals

General overview As part of the Emergency Department Waits and Patient Flow Initiative, provincial improvement targets were set for various performance metrics. These included:  ED Length of Stay ED LOS admitted) for admitted patients,  ED Length of Stay (ED LOS discharged) for discharged patients,  Time Waiting for an Inpatient Bed (TWIB), and  Time to physician Initial Assessment (PIA).

All measures were reported at the 90th percentile and the 2013-14 times for these measures were selected for the baseline against which to measure improvement. The measure reported for PIA in Saskatoon, covered all acuity levels, and was felt to most accurately reflect the experience of 90 percent of patients.

The focus of the Initiative was on the provincial hospitals in Regina, Saskatoon and Prince Albert. Each of these cities and the hospitals within each city began with different metric values at baseline and as a result their planned improvements during the years of initiative were individual. Those individual values were then rolled up and informed provincial level reporting.

Setting of Targets Actual targets were set collaboratively at the level of executive leadership and reflect anticipated improvement measured against the baseline. The review, and adjustment, of targets did occur throughout the Initiative. This approach results in the specific yearly targets for Saskatoon seen in the public accounts document. That document also reflects that actual wait times in Saskatoon for PIA, exceeded the targets suggested in any given year but for 2014-15.

What are we doing to achieve targets? Throughout the ED Waits initiative, expert consensus was that all the ED wait time metrics were symptoms of broader flow and capacity issues within acute care and gaps in community care which kept patients in acute beds longer than necessary. As a result, all improvement efforts during the initiative focused on improving patient flow, both within acute wards and at the community level. This work led to the development of the Connected Care Strategy as the system approach to address patient flow and capacity problems in the system. As this strategy implements broadly across the system, it is anticipated that wait times will improve. These metrics continue to be monitored as part of the reporting on the Connected Care Strategy 8. Page 487 – Hansard Verbatim Report, No. 22 – February 26, 2019 Topic: Employee Absenteeism – average sick time FTE statistics

 The SHA has identified attendance management within their ongoing system sustainability work relative to workforce costs.  The SHA and former RHAs have been monitoring and working to reduce the sick leave for a number of years with some success.  The SHA is planning to develop and implement a provincial attendance program in conjunction with development of the attendance module of the AIMS project which will be in place in the fall of 2020.  In the interim, steps to provincially standardize how initial attendance meetings are conducted is being implemented.  In additional, a review of attendance metrics is also under way to determine the most meaningful metrics and develop consistent tracking methods within the limitations of our current systems and manual processes.