Provincial Council for Maternal and Child Health (PCMCH) Benchmarking Report 2012

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2 Provincial Council for Maternal and Child Health (PCMCH) Benchmarking Report 2012 About The Maternal-Child Benchmarking Report The Provincial Council for Maternal and Child Health (PCMCH) 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 2012 Benchmarking Report consists of the following sections: Academic Health Sciences Centres Profiles: Services, Beds, Emergency Department, and Respiratory Therapy Clinical Indicators: Provincial Overview (PO), Hospital Descriptors (DES), Emergency Department Indicators (ED), Clinical Efficiency Indicators (CE), and Quality and Utilization Management Indicators (QUM) Operational Efficiency Indicators Community Hospitals Profiles: Services, Beds, Emergency Department, and Respiratory Therapy Clinical Indicators: Hospital Descriptors (DES), Emergency Department Indicators (ED), Clinical Efficiency Indicators (CE), and Quality and Utilization Management Indicators (QUM) Operational Efficiency Indicators (participation from community facilities for this section is optional) Population-specific Indicators Neonatal Indicators Obstetrical Indicators Mental Health Indicators Holland Bloorview Kids Rehab Hospital Indicators 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.

3 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.

4 Table of Contents EXECUTIVE SUMMARY... 1 Benchmarking Report Recommendations... 3 Report Framework... 6 List of Participating Hospitals and Acronyms... 9 ACADEMIC HEALTH SCIENCES CENTRES HOSPITAL PROFILES Service Profiles Bed Profiles Emergency Department Profiles Respiratory Therapy Profiles CLINICAL INDICATORS Provincial Overview PO LHIN Map PO Paediatric AHSCs Inpatient Discharges, Distributed by Hospital & LHIN PO Paediatric AHSCs Inpatient Discharges by LHIN Hospital Descriptors DES Inpatient and Same Day Surgery Volumes DES Neonatal and Paediatric Inpatient Case Distribution DES Patient Volume Breakdown DES Inpatient Case Age Profile DES Same Day Surgery Age Profile DES Total ALOS DES Neonatal and Paediatric ALOS DES Total Average Inpatient Weight per Case DES Percent Typical, Outlier & Other Inpatient Cases and Patient Days DES Percent Transfer From Inpatient Cases and Patient Days DES Percent Transfer To Inpatient Cases and Patient Days DES Percent of Cases and Days with Length of Stay > 30 Days Emergency Department Indicators ED ED Patient Volumes ED ED Average LOS in Hours (All Dispositions) ED ED 90 th Percentile LOS ED ED Visits (Age Profile) ED ED Visits by Triage Level ED ED Visits by Top 15 Main Problems ED ED Visits Admitted ED ED Visits Left Without Being Seen/Against Medical Advice or Other Clinical Efficiency Indicators CE Top 10 CMGs Typical Inpatient Cases CE Top 10 CMGs Typical Inpatient Cases (One and Two Day Stay) Quality and Utilization Management Indicators QUM Percentage of Paediatric Admissions Treated for Asthma QUM Percent Paediatric Admissions Treated for Diabetes QUM Percent Medical and Mental Health Admissions via ED with One & Two Days Stay QUM Percent Medical, Mental Health and Surgical Admissions via ED OPERATIONAL EFFICIENCY INDICATORS Introduction OE Hospital Net Operating Costs (in millions) OE Hospital Net Operating Costs (Percent Distribution) OE Compensation Costs per Functional Centre Category OE Compensation Costs as a Percent of Total per Functional Centre Category OE Hours per Functional Centre Category OE Hours as a Percent of Total per Functional Centre Category Operational Efficiency Comparisons OE Inpatient Only Net Operating Costs per Inpatient RIW Weighted Case OE Inpatient Net Operating Costs per Inpatient Day OE Inpatient Detailed Compensation and Hours Indicators... 65

5 6.2.4 OE Inpatient Med/Surg Only Detailed Indicators Critical Care NICU Department OE NICU Detailed Indicators OE Critical Care PCCU Detailed Indicators OE Operating Room Detailed Indicators Ambulatory Costs OE Ambulatory Clinic Detailed Indicators Emergency Department OE Emergency Department Detailed Indicators COMMUNITY HOSPITALS HOSPITAL PROFILES Service Profiles Bed Profiles Emergency Department Profiles Respiratory Therapy Profiles CLINICAL INDICATORS Hospital Descriptors DES Inpatient and Same Day Surgery Volumes DES Neonatal and Paediatric Inpatient Case Distribution DES Patient Volume Breakdown DES Inpatient Case Age Profile DES Same Day Surgery Age Profile DES ALOS DES Neonatal and Paediatric ALOS DES Total Average Inpatient Weight per Case DES Percent Typical, Outlier & Other Inpatient Cases and Patient Days DES Percent "Transfer From" Inpatient Cases and Patient Days DES Percent "Transfer To" Inpatient Cases and Patient Days DES Percent of Cases and Days with LOS > 30 Days Emergency Department Indicators ED ED Patient Volumes ED ED Average LOS in Hours ED ED 90th Percentile LOS ED ED Visits (Age Profile) ED ED Visits by Triage Level ED ED Visits by Top 10 Main Problems ED ED Visits Admitted ED ED Visits Left Without Being Seen or Against Medical Advice CE 4.0 Clinical Efficiency CE Top 10 CMGs Typical Inpatient Cases CE Top 10 CMGs Typical Inpatient Cases One and Two Day Stay Quality and Utilization Management Indicators QUM Paediatric Admissions Treated for Asthma QUM Paediatric Admissions Treated for Diabetes QUM Medical and Mental Health Admissions via ED with One & Two Days Stay QUM Medical, Mental Health and Surgical Admissions via ED OPERATIONAL EFFICIENCY INDICATORS Introduction Operational Efficiency Descriptors OE Paediatric Inpatient Unit Only Net Operating Costs per Inpatient Day OE Paediatric Inpatient Unit Only Compensation Costs per Inpatient Day OE Paediatric Inpatient Unit Only UPP Worked Hours per Inpatient Day NICU OE NICU Net Operating Costs per Inpatient Patient Day OE NICU Compensation Costs per Inpatient Patient Day OE NICU UPP Worked Hours per Inpatient Patient Day Obstetrics, Labour and Delivery (LDRP) OE Obstetrics, Labour, Delivery, Recovery, Postpartum Net Operating Costs per Inpatient Day OE Obstetrics, Labour, Delivery, Recovery, Postpartum UPP Worked Hours per Inpatient Day

6 6.3.3 OE Obstetrics, Labour, Delivery, Recovery, Postpartum Compensation Costs per Inpatient Obstetrics Intermediate Nursery Level II OE Obstetrics Intermediate Nursery Level II Net Operating Costs per Inpatient Day OE Obstetrics Intermediate Nursery Level II UPP Worked Hours per Inpatient Day OE Obstetrics Intermediate Nursery Level II Compensation Costs per Inpatient Day POPULATION-SPECIFIC INDICATORS NEONATAL INDICATORS Introduction Provincial Overview SCN Distribution of Ontario Births by LHIN SCN Percent Distribution by Mother s LHIN of Residence and LHIN of Birth Hospital SCN Percent Distribution of Births Under 32 Weeks and/or 1500 Grams SCN Neonatal Abstinence Syndrome Trends in Ontario (most responsible diagnosis) SCN Neonatal Abstinence Syndrome Trends in Ontario (any diagnosis) Neonatal Distribution SCN Neonatal Inpatient Cases SCN Neonatal Average LOS SCN Total Average Inpatient Weight per Case SCN Percent Neonatal Transfer From Inpatient Cases and Patient Days SCN Percent Neonatal Transfer To Inpatient Cases and Patient Days SCN Percent Cases and Days with LOS > 30 Days NICU/SCN Distribution SCN NICU/SCN Inpatient Cases SCN NICU/SCN Age Profile SCN NICU/SCN Average LOS SCN Percent NICU/SCN Transfer From Inpatient Cases and Days SCN Percent NICU/SCN Transfer To Inpatient Cases and Days SCN NICU/SCN Jaundice SCN Percent NICU/SCN Inpatient Jaundice Cases OBSTETRICAL INDICATORS Introduction Hospital Descriptors OBS Obstetrical Volumes and Births OBS Obstetrical Age Profile OBS Total Average LOS OBS Total Average Inpatient Weight per Case OBS Percent Typical, Outlier & Other Inpatient Cases and Patient Days OBS Percent Obstetrical Transfer From Inpatient Cases and Patient Days OBS Percent Obstetrical Transfer To Inpatient Cases and Patient Days OBS Percent Cases and Days with Length of Stay > 30 Days OBS Obstetrical Top 5 CMGs MENTAL HEALTH INDICATORS Introduction Mental Health Profiles: Academic Health Sciences Centres Mental Health Profiles: Community Hospitals Mental Health Indicators MH Inpatient Mental Health Volumes MH Inpatient Mental Health Age Profile MH Inpatient Mental Health Average LOS MH Inpatient Mental Health Average Weight per Case MH Top 10 CMGs MH Top 10 CMGs Average LOS MH Top 10 CMGs Average Weight per Case MH Average Length of Stay by Age Category MH Average Weight per Case by Age Category MH Percent Transfer From Mental Health Inpatient Cases and Days MH Percent Transfer To Mental Health Inpatient Cases and Days MH Percent of Cases and Days with Length of Stay >30 Days MH Percent of Cases 1-2 Days Length of Stay

7 2.0 Mental Health ED Indicators MH-ED Mental Health ED Patient Volumes MH-ED Emergency Department Psychiatric Visits Patient Age Profile MH-ED Emergency Department Mental Health Average LOS MH-ED ED Mental Health Visits by Top 10 Main Problems HOLLAND BLOORVIEW KIDS REHABILITATION HOSPITAL Hospital Profile Access and Wait Times for Child Development Program Services Holland Bloorview Kids Rehabilitation Hospital Indicators HBV Holland Bloorview Inpatient/Outpatient Discharge Geographic Distribution by LHIN HBV Patient Profile Percentage of Translation Services Used HBV Patient Volume Breakdown HBV Percent of Inpatient Discharges by Type HBV Percent of Inpatient Days by Type HBV Inpatient Age Profile HBV Inpatient Age Profile (by service) HBV Inpatient Average Length of Stay HBV Percent of Cases with Lengths of Stay Longer Than Expected (> 2 Sigma) HBV Percent of Inpatient Clients Receiving Outpatient Services HBV Percent of ALC Days HBV Outpatient Patient Profile HBV Referral Pattern for Outpatient Services HBV Referral Pattern for Child Development Services HBV Referral Pattern for Autism and Neuromotor Services HBV Referral Pattern for Neuromotor Services HBV Referral Pattern for Autism Services HBV Referral Pattern for Communication and Writing Aids Services HBV Summary of Operating Costs for Fiscal Year 2011/ HBV Canadian Association of Paediatric Health Centres (CAPHC) and Holland Bloorview GLOSSARY OF TERMS

8 Executive Summary The 2012 Maternal-Child Benchmarking Report is the 9 th annual report and provides data for the fiscal 2011/12 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. In addition, the Respiratory Therapy Work Group and the Mental Health Work Group were convened in 2012 in order to identify opportunities for improvement and refinement of the report. For the 2012 Report, participation has grown to include 58 hospitals, including 8 Academic Health Sciences Centres, 50 Community Hospitals and Holland Bloorview Kids Rehabilitation Hospital. For more information, please refer to page 9. Partnership with Canadian Institute for Health Information (CIHI) The 2012 Report marked the second 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. Updated Levels of Care In 2011, PCMCH rolled-out standardized definitions of maternal and neonatal Levels of Care (LOC) across the province. The data included in Neonatal and Obstetrical sections of the report is organized according to the designations hospitals identified during the roll-out process. In 2012, these sections have been revised to include sub-levels A, B and C (if applicable) within each LOC. For more information please refer to Neonatal section (page 198) and Obstetrical section (page 218). Updated Hospital Profiles Respiratory Therapy Profile NEW for 2012! Following the recommendation from the Respiratory Therapy Work Group (RTWG), a new section was developed for Respiratory Therapy (RT). Data elements included in the new Profile address RT workload data collection methods, paediatric RT staffing details, education and consultation activities, and specific patient-care interventions. The section will be enhanced over the upcoming years based on advice from our stakeholders and in collaboration with the RTWG. For more information, please refer to page 24 (Academic Health Science Centres RT Profiles) and page 128 (Community RT Profiles). Mental Health Profile Following the recommendation from the Mental Health Work Group (MHWG), the Mental Health Profile has been revised to include new information regarding telepsychiatry services and dedicated psychiatric emergency services for children/youth. "Eating Disorders" and "Psychiatry" age sub-groups have been updated to foster useful comparisons between similar populations and different institutions. In addition, the Mental Health Profile questionnaire has been revised to simplify the data submission process. The section will be enhanced over the upcoming years based on advice from our stakeholders and in collaboration with the MHWG. For more information, please refer to page 234 (Academic Health Sciences Centres Mental Health Profiles) and page 236 (Community Mental Health Profiles). 1

9 Bed Profiles Bed Profiles have been revised to reflect the updated Levels of Care. In addition, the Profiles now include information regarding the number of Physical Beds vs. Beds Staffed and in Operation. For more information, please refer to page 20 (Academic Health Sciences Centres Bed Profiles) and 104 (Community Bed Profiles). New Clinical Indicators Several new indicators were added to the 2012 report, including the Neonatal Abstinence Syndrome trends (page 203) and the Mental Health Emergency Department Average Length of Stay (page 269). Benchmarking Report indicators will continue to be updated to reflect the changing needs of our stakeholders. The recommendations within this report will form the basis of the FY Work Plan for the Benchmarking Steering Committee and its subcommittees. We look forward to continued membership expansion and enhancement of the report in Marilyn Booth Executive Director, PCMCH Joanne MacKenzie Co-Chair, PCMCH Benchmarking Steering Committee Dr. Henry Roukema Co-Chair, PCMCH Benchmarking Steering Committee 2

10 Benchmarking Report Recommendations The following recommendations made by the Benchmarking Steering Committee (BSC) will continue to be addressed as part of the FY 2013/14 Work Plan: # OVERVIEW STATUS 1 Given the changing data needs within the province and the continual development of the Benchmarking Report, the BSC recommends the development of guidelines/principles for the removal/inclusion of clinical indicators and future analysis for appropriate benchmarking. 2 Given the current data quality issues with workload measurement units including applicability to paediatrics and compliance with regards to data capture, the BSC recommends that a working group investigate a more appropriate mix of indicators for measurement and comparability for the following key patient care functions: Diagnostic imaging Laboratory services Allied health Project Scope The new guidelines are being developed by a subcommittee and will be presented for review and approval by the BSC (Spring 2013). Data Quality Upon prioritization of the various laboratory, diagnostic imaging and allied health services, the BSC agreed to begin their investigation with respiratory therapy. The Respiratory Therapy Work Group (RTWG) was convened in 2012 in order to: 1) understand how RT workload is measured in the paediatric population, 2) identify appropriate methods for RT workload data collection, and 3) recommend optimal RT content and workload measurement indicators for the Benchmarking Report. The following recommendations were approved by the BSC and shared with the RT Society of Ontario: 1) Benchmarking Report Recommendation Development of RT Profile 2) Long-term recommendations focused on broader system change. Staff education for RT professionals to improve data entry compliance. Standardized approach to RT workload data collection. Patient-specific approach to RT workload data collection. Modifications to the current standards in the system, including various changes in terminology. Diagnostic imaging and laboratory services indicators will be investigated by the MIS Work Group in FY 2013/14. The BSC will not be addressing other allied health functions at this time. 3

11 # OVERVIEW STATUS 3 Given that the objective of the Quality and Utilization Management (QUM) section of the report is to enhance clinical practice improvement opportunities, the Benchmarking Steering Committee recommends that a review be conducted to confirm the mix of Diagnoses/Diseases and, once complete, to enhance the indicator mix including outcome indicators. 4 Monitoring patient perceptions of inpatient hospital care is a key indicator of the quality of services provided in hospitals. The National Research Corporation (NRC) + Picker acute care paediatric inpatient survey focuses on the perceptions of the parents/guardians of patients aged 0 to 17 years who had an inpatient stay in order to evaluate the services they received and their interaction with hospital staff. The BSC recommends, if appropriate, the inclusion of patient satisfaction indicators into the report for all hospitals using the paediatric survey tool. 5.1 In collaboration with the Provincial Critical Care Network, review the Critical Care Information System with regards to resource intensity methodology. 5.2 Review and revise, where appropriate, the following indicators in order to enhance benchmarking opportunities for all stakeholders: Operational Efficiencies indicators for community and nonpaediatric AHSCs for ED. Data Enhancements This recommendation will be included for review on the Child and Youth Advisory Committee Agenda (Spring 2013). A survey will be included as part of the 2013 Benchmarking Report Welcome Package in order to enhance knowledge of NRC + Picker and other paediatric-specific internal survey tools being used provincially and, if appropriate, to consider the inclusion of patient satisfaction indicators in 2014 Benchmarking Report. PCMCH Benchmarking Project Team has been invited to join the PCCAC Performance Management Working Group in A new section dedicated to Paediatric Critical Care will be developed in collaboration with the PMWG for inclusion in the 2013 Report. This recommendation will be included for review on the MIS Work Group Agenda (Spring 2013). 6.1 Investigate, for possible future inclusion, the following indicators: Mental Health Readmissions. The Mental Health Work Group (MHWG) was reconvened in 2012 to identify opportunities for improvement and refinement of the MH section of the Report. As part of this meeting, the issue of readmissions was addressed. It was determined that CIHI is able to produce some of the required readmission reports, using new methodology which includes assigning a unique identifier and tracking patients over time without relying on the readmission data element which is no longer mandatory. The Steering Committee and the Health Information Work Group are currently reviewing the CIHI methodology with the goal of including the MH readmission indicators in 2013 Report. 4

12 The following 2011 Report recommendations were reviewed and closed in 2012: # OVERVIEW STATUS 6.2 Investigate, for possible future inclusion, the following indicators: Age profile distribution e.g. adolescent population. The issue of age profile distribution has been reviewed by the Mental Health Work Group and the Health Information Work Group. The Decision was made to keep current age profile distribution as it appears to be appropriate for the purposes of the Benchmarking Report. 5

13 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 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 was retrieved from the CIHI Portal. The day surgery and emergency visits data is generated from the NACRS database and was 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 was 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 was 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 was manually submitted to PCMCH, including the following: Services Offered Bed Profile Emergency Department Profile Mental Health Profile Respiratory Therapy Profile Data Limitations The 2012 Benchmarking Report includes data from the CIHI Portal for 2010/11 and 2011/12. As such, slight discrepancies between data years may be expected. 6

14 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: 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 7

15 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. 8

16 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). FY 2011/12 data for TOH includes Civic and General Campuses only. TOH Riverside site was included in the previous Reports, and will be included in FY 2012/13 Report. Kingston General Hospital reported together with Hotel Dieu Hospital, Kingston (HDH) in the 2011 Benchmarking Report. All data reported for KGH in 2012 will exclude HDH. Windsor Regional Hospital Maternal and Neonatal Levels of Care are self-designated and subject to confirmation. Northumberland Hills Hospital data has not been validated by the facility. Academic Health Sciences Centres Participating Hospital Acronym LHIN # LHIN Children s Hospital, London Health Sciences Centre Children s Hospital of Eastern Ontario Kingston General Hospital McMaster Children s Hospital, Hamilton Health Sciences LOC (Maternal) LOC (Neonatal) CH LHSC 2 South West III IIIb CHEO 11 Champlain Does not provide maternal care KGH 10 South East III IIIb MCH HHS 4 Hamilton Niagara Haldimand Brant 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 TOH 11 Champlain Civic: III III IIIb IIIb General: IIIa Civic: IIc 9

17 Community Hospitals Participating Hospital Acronym LHIN # LHIN LOC (Maternal) LOC (Neonatal) Alexandra Marine & General Hospital AMGH 2 South West Ia I Bluewater Health BWH 1 Erie St. Clair IIa IIa Brant Community Healthcare Hamilton Niagara BCHS 4 System Haldimand Brant IIb IIa Brockville General Hospital BGH 10 South East Ib I Cambridge Memorial Hospital CMH 3 Waterloo Wellington IIa IIa Collingwood General & Marine North Simcoe CMGH 12 Hospital Muskoka Ib I Cornwall Community Hospital CCH 11 Champlain Ib I Credit Valley Hospital (Now known as Trillium Health Partners) CVH 6 Mississauga Halton IIc IIc Grand River Hospital GRH 3 Waterloo Wellington IIb IIb Grey Bruce Health Services GBHS 2 South West Owen Sound: IIb Owen Sound: IIb Walkerton: Ib Walkerton: I Halton Healthcare Services HHS 6 Mississauga Halton Georgetown: Ib Milton: Ib Oakville: IIb Georgetown: I Milton: I Oakville: IIa Headwaters Health Care Centre HHCC 5 Central West Ib I Health Sciences North/Horizon Santé-Nord HSN 13 North East IIc IIc Hôpital Montfort Montfort 11 Champlain IIa IIa Humber River Regional Hospital HRRH 8 Central Finch: IIb Church: Ib Finch: IIb Church: I Joseph Brant Memorial Hospital JBMH 4 Hamilton Niagara Haldimand Brant IIb IIa Lakeridge Health LH 9 Central East Oshawa: IIc Oshawa: IIc Port Perry: Ib Port Perry: I Mackenzie Health MH 8 Central IIc IIc Markham Stouffville Hospital Corporation MSH 8 Central IIc IIc Middlesex Hospital Alliance Strathroy Middlesex General Hospital MHA-SMGH 2 South West Ia I Niagara Health System NHS 4 Hamilton Niagara St. Catharines: IIa St. Catharines: IIa 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 Orillia Soldiers Memorial North Simcoe OSMH 12 Hospital Muskoka IIc IIc Pembroke Regional Hospital PRH 11 Champlain Ib I Peterborough Regional Health Centre PRHC 9 Central East IIb IIb Quinte Health Care QHC 10 South East Belleville: Ib Prince Edward County: Ib Belleville: I Prince Edward County: I Ross Memorial Hospital RMH 9 Central East Ib I Rouge Valley Health System RVHS 9 Central East Ajax: IIb Centenary: IIc Ajax: IIb Centenary: IIc The Royal Victoria Regional North Simcoe RVH 12 Health Centre Muskoka IIc IIc Sault Area Hospital SAH 13 North East IIc IIc The Scarborough Hospital TSH 9 Central East IIb IIb Sioux Lookout Meno Ya Win Health Centre SLMHC 14 North West Ib I South Bruce Grey Health Centre SBGHC 2 South West Ib I Southlake Regional Health Centre Southlake 8 Central IIb IIb 10

18 Participating Hospital Acronym LHIN # LHIN LOC (Maternal) LOC (Neonatal) St. Joseph s Healthcare, Hamilton SJHC Hamiton Niagara 4 Hamilton Haldimand Brant IIb IIb St. Joseph s Health Centre, Toronto SJHC Toronto 7 Toronto Central IIb IIb 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 Stratford General Hospital Site of Huron Perth Healthcare Alliance SGH HPHA 2 South West IIa IIa Thunder Bay Regional Health Sciences Centre TBRHSC 14 North West IIc IIc Toronto East General Hospital TEGH 7 Toronto Central IIc IIc Trillium Health Centre (prior known as Mississauga Hospital; now THC 6 Mississauga Halton IIb IIb known as Trillium Health Partners) West Lincoln Memorial Hospital WLMH 4 Hamiton Niagara Haldimand Brant Ib I West Parry Sound Health Centre WPSHC 13 North East Ib I William Osler Health System WOHS 5 Central West Brampton: IIb Brampton: IIc Etobicoke: IIb Etobicoke: IIb Windsor Regional Hospital WRH 1 Erie St. Clair III IIIa 11

19 ACADEMIC HEALTH SCIENCES CENTRES 12

20 Hospital Profiles Service Profiles Children s Hospital, London Health Sciences Centre Acronym Main Catchment Area Primary Academic Affiliation CH LHSC Southwestern Ontario, Thunder Bay and Sault Ste Marie Western University Year Founded 1922 Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Adolescent Medicine Crisis Acquired Brain Injury General Surgery Allergy & Immunology Eating Disorders Anaesthesiology Gynecology Asthma Psychiatry Autism Maxillofacial Cardiology Psychology Burns Neurosurgery Child Protection Dietetic & Lactation Support Ophthalmology Critical Care Gait Laboratory Organ Transplantation Developmental Paediatrics Radiology Orthopaedic Surgery Emergency Medicine RSV Clinic Otolaryngology Endocrinology Speech Language Pathology Plastic Surgery Gastroenterology Dedicated Transport Team Pulsed Dye Laser General Paediatrics Day School Opportunities Traumatology Genetics / Metabolics Outpatient Premature Infant Urology Haematology Breastfeeding Clinic Infectious Diseases Outpatient Bilirubin Neonatology Nephrology Neurology Newborn Nutrition Oncology Palliative Care Pharmacology Respirology Rheumatology Testing/ Follow-Up 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, 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). 13

21 Children s Hospital of Eastern Ontario Acronym Main Catchment Area Primary Academic Affiliation CHEO Year Founded 1974 Eastern Ontario, Western Quebec, parts of Northern and Southeastern Ontario and Baffin Island University of Ottawa Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Cardiovascular Surgery Adolescent Medicine Crisis Anesthesiology Dental / Oral Surgery Allergy & Immunology Eating Acquired Brain Injury General Surgery Asthma Disorders Autism Gynecology Cardiology Psychiatry Dietetic & Lactation Support Neurosurgery Child Protection Psychology Early School Age Program Ophthalmology Critical Care Radiology Orthopaedic Surgery Dermatology RSV Clinic Otolaryngology Developmental Paediatrics Speech Language Pathology Plastic Surgery Emergency Medicine Transport Team (Neonatal Urology Endocrinology Gastroenterology General Paediatrics Genetics / Metabolics Haematology Infectious Diseases Neonatology Nephrology Neurology Nutrition Oncology Dedicated Obesity Program Palliative Care Pharmacology Physical Medicine & Rehabilitation Respirology Only) Rheumatology 14

22 Kingston General Hospital Acronym Main Catchment Area Primary Academic Affiliation KGH Year Founded 1835 LHIN 10: South East Queen s University Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other General Surgery Adolescent Medicine Mental Health Services Anaesthesiology Gynecology Cardiology Radiology Ophthalmology Child Protection Orthopaedic Surgery Critical Care Otolaryngology Developmental Paediatrics Plastic Surgery Emergency Medicine Urology Endocrinology Gastroenterology General Paediatrics Genetics / Metabolics Haematology Infectious Diseases Neonatology Nephrology Neurology Nutrition Oncology Palliative Care Respirology Notes 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, KGH is no longer reporting together with HDH Kingston. 15

23 McMaster Children s Hospital, Hamilton Health Sciences Acronym Main Catchment Area Primary Academic Affiliation MCH HHS Year Founded 1988 LHIN 4: Hamilton Niagara Haldimand Brant McMaster University Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Adolescent Medicine Eating Acquired Brain Injury General Surgery Allergy & Immunology Disorders Anaesthesiology Gynecology Asthma Psychiatry Autism Neurosurgery Cardiology Psychology Burns Ophthalmology Child Protection Dietetic & Lactation Support Orthopaedic Surgery Critical Care Early School Age Program Otolaryngology Dermatology Exercise and Nutrition Plastic Surgery Developmental Paediatrics Radiology Traumatology Emergency Medicine RSV Clinic Urology Endocrinology Speech Language Pathology Gastroenterology Transport Team (Neonatal) General Paediatrics Genetics / Metabolics Haematology Infectious Diseases Neonatology Nephrology Neurology Newborn Nutrition Oncology Palliative Care Pharmacology Physical Medicine & Rehabilitation Respirology Rheumatology 16

24 Mount Sinai Hospital Acronym Main Catchment Area Primary Academic Affiliation Mt. Sinai Year Founded 1923 Toronto Central LHIN University of Toronto Teaching Hospital Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Other Ophthalmology Developmental Paediatrics Dietetic & Lactation Support General Paediatrics Neonatology Newborn Sunnybrook Health Sciences Centre Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website Sunnybrook Greater Toronto Area University of Toronto Sunnybrook 1948 Women s College Hospital (NICU) 1971 Sunnybrook and Women s College HSC (NICU) 1998 Sunnybrook Health Sciences Centre (NICU) Subspecialties / Services Offered Paediatric Surgical Ophthalmology Paediatric Medical Cardiology Neonatology 17

25 The Hospital for Sick Children Acronym Main Catchment Area Primary Academic Affiliation SickKids Year Founded 1875 Toronto and GTA University of Toronto Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Cardiovascular Surgery Adolescent Medicine Eating Disorders Anaesthesiology Dental / Oral Surgery Allergy & Immunology Psychiatry Bone Marrow Transplant General Surgery Cardiology Psychology Burns Gynecology Dermatology Substance Abuse Critical Care Medicine Neurosurgery Emergency Medicine Palliative Care Ophthalmology Endocrinology Solid Organ Transplant Orthopaedic Surgery Gastroenterology Trauma Otolaryngology General Paediatrics Plastic Surgery Genetics / Metabolics Urology Haematology Infectious Diseases Neonatology Nephrology Neurology Nutrition Oncology Pharmacology Physical Medicine & Rehabilitation Respirology Rheumatology 18

26 The Ottawa Hospital Acronym Main Catchment Area Primary Academic Affiliation TOH Year Founded 1998 LHIN 11: Champlain University of Ottawa Website Subspecialties / Services Offered Paediatric Medical General Paediatrics Neonatology 19

27 Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation CH LHSC CHEO KGH MCH HHS Mt Sinai SickKids Sunnybrook TOH Total PCMCH Maternal-Child Benchmarking Report 2012 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 300. 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. Beds Level I a b a Perinatal Level II b c Level III a b SUBTOTAL PERINATAL Level I a b a Neonatal Level II b c Level III a b SUBTOTAL NEONATAL Med/Surg Level II PCCU Level III SUBTOTAL PCCU Mental Health Other TOTAL ,425 1,282 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 HHS: 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). 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

28 Emergency Department Profiles Children s Hospital London Health Sciences Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Paediatric Yes Yes According to P-CTAS standards Yes. There is a 5 bay emergency ambulatory care centre, from noon to midnight, for fast track of CTAS 4-5. Children s Hospital of Eastern Ontario Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Paediatric Yes Yes CHEO uses an electronic version of the P-CTAS guidelines. CHEO also has a 2-Tier triage process. CHEO has a Fast Track that is physically separate which sees all patients with minor injury or illness. Kingston General Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No KGH has a combined adult/paediatric Emergency Department. KGH combined adult/paediatric Emergency Department is staffed by adult emergency nurses with paediatric education/support. Yes P-CTAS guidelines endorsed by the Canadian Paediatric Society, Canadian Association of Emergency Physicians, and the National Emergency Nurses Affiliation. The KGH Emergency Department does not currently have a Fast Track System. It manages more level 1-3 P-CTAS cases for paediatrics; however there are some level 4-5 patients as well. KGH Emergency Department is participating in the pay for results program with the Ministry of Health to improve throughput and is soon to undertake a lean process review. 21

29 McMaster Children s Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Paediatric Yes Yes Patients present to the received area and health card is utilized to activate their electronic medical record. They are then triaged based on observational presentation. N/A Mt Sinai Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic Yes. Short stay LOS < 72 hrs. Clinical decision making unit (CDU) - LOS < 24 hrs. Combined No Yes All patients are triaged and assessed using P-CTAS guidelines. Yes. Fast track ambulatory care for CTAS IV & V. Rapid assessment Zone (RAZ) for CTAS III. SickKids Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Paediatric Yes Yes 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. Urgent Care: Non urgent patients (CTAS 4 & 5 and some less acute 3) 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 Monday to Friday and from 1100 to 2400 Saturday, Sunday and Holidays. 22

30 Sunnybrook Health Sciences Centre Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes Child +/- family member are assessed by a triage nurse and assigned a CTAS score. Re-assessment is conducted within the CTAS guidelines. Separate minor area with a separate minor waiting area. The Ottawa Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic Yes. This unit is not unique to paediatrics. Combined No Yes CTAS guidelines Fast Track. 23

31 CH LHSC CHEO KGH MCH HHS Mt. Sinai SickKids Sunnybrook TOH PCMCH Maternal-Child Benchmarking Report 2012 Respiratory Therapy Profiles The table below summarizes Respiratory Therapy profile information for AHSCs. Question Percent of time spent by paediatric RTs on supporting transport activities for neonatal and paediatric populations includes outside transport and internal hospital transport Percent of time spent by paediatric RTs on academic support to inter-professional and other colleagues includes formal and clinical education activities/meetings/workshops. 1. Data Collection Method 1.1 Paper-based method 20% 0% 0% 0% 0% 0% 5% 80% 1.2 Workload collection software 80% 100% 100% 100% 100% 100% 95% 20% 2. Staffing Model 2.1 Dedicated paediatric RTs YES YES No YES YES YES YES YES 2.2 Number of paediatric RTs (FTE) Paediatric RT Clinical Care Intubations assisted/performed 544 n/a n/a 634 YES n/a Bronchoscopies assisted/attended 30 n/a n/a n/a High frequency oscillation initiations / year BiPAP/CPAP initiations ( in ICU and outside ICUs) 240 n/a n/a 85 [A] n/a 192 n/a n/a Nitric oxide initiations / year 51 [B] [A] n/a Ventilation hours / year 134,979 n/a n/a n/a 223, , , Ventilated patients / year n/a 203 n/a , Dedicated transport team for neonates and / or children % of time spent by paediatric RTs on supporting transport activities for neonatal/paediatric patients YES (0-17 y.o.) YES (neonatal) NO YES (neonatal) NO YES NO NO 16% [C] 0% 30% 40% 2% 30% 35% 4. Paediatric RT Academic / Research / Inter-Professional Activities % of time spent by paediatric RTs on academic support to physicians 1% 10% n/a 0% 15% 7% 10% 15% % of time spent by paediatric RTs on academic support to interprofessional 1% 10% n/a 0% 10% 5% 10% 10% and other colleagues Number of paediatric RT students supported annually Number of paediatric RTs involved in research Number involved in funded research activities Medical learner days / year 0 [D] 0 n/a Notes [A] Refers to NICU only; data not available for PCCU. [B] ~ 4000 hours of use/year. [C] External: ~ 350 hrs per year, average time per transport 2 hours. Internal: not available. [D] 5 to 8 days for every staff member. Comments submitted by participating facilities to RT Profile are provided on the next page. 24

32 RT Data Collection Method The following table shows the percentage of paediatric Respiratory Therapy data which each AHSC collects using workload collection software, and the percentage it collects using paper-based methods. CH LHSC CHEO KGH MCH HHS Mt. Sinai SickKids Sunnybrook TOH 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Paper-based method Workload collection software Notes CH LHSC: The above values are calculated by using the Victoria Hospital RRT FTE's only. The dedicated RRTs are in the NICU and the transport areas. The RRTs that support the PCCU may be assigned to different areas. CH LHSC calculated the full time work associated to pediatrics, and included that number as an FTE in the dedicated area. The RRT students that are listed are trained as both adult and paediatric. CHEO: Provincial Workload Measurement Tool is used to collect data. The answer provided for #4.1 (paediatric RT academic activities) was an estimate. Multi-discipline team approach, ongoing daily support to physicians/nursing staff for better outcomes for paediatric patients is a big part of RT role at CHEO. KGH: Database with paediatric information was not available at the time of the survey. MCH HHS: Score Respiratory Therapy interventions using GRASP methodology. No dedicated pediatric transport. Mt Sinai: The numbers provided are underestimated as Mt Sinai does not have an accurate way of capturing RT specific data. The program used - INFOMED - cannot extract this specific information and Mt Sinai does not have the resources to accurately capture this workload from the daily worksheets. SickKids: Workload is entered each shift by the RTs. Current workload system is GRASP. The RT FTEs included and the data collected is solely for front line RTs, and does not include data from non-front line RT resources such as Managers, Educators, and Director. The estimated % of time spent by Paediatric RTs on supporting transport activities does not include the RTs who are ACTS Clinicians and work on the dedicated transport team. The ventilation data provided includes both invasive ventilation and non-invasive ventilation. 25

33 Clinical Indicators 1.0 Provincial Overview 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 26

34 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 HHS SickKids Total LHIN 1 Erie St. Clair 15.2% 0.0% 0.0% 0.2% 0.7% 2.7% LHIN 2 South West 78.1% 0.0% 0.0% 1.0% 1.6% 12.8% LHIN 3 Waterloo Wellington 2.9% 0.1% 0.0% 13.3% 2.3% 3.9% LHIN 4 HNHB 1.0% 0.1% 0.1% 78.8% 3.1% 16.1% LHIN 5 Central West 0.3% 0.0% 0.1% 0.6% 11.3% 4.9% LHIN 6 Mississauga Halton 0.0% 0.0% 0.1% 4.8% 11.2% 5.6% LHIN 7 Toronto Central 0.1% 0.0% 0.2% 0.1% 17.4% 7.4% LHIN 8 Central 0.3% 0.1% 0.3% 0.2% 22.9% 9.7% LHIN 9 Central East 0.1% 0.3% 2.3% 0.3% 17.6% 7.7% LHIN 10 South East 0.0% 5.3% 94.4% 0.0% 1.2% 7.3% LHIN 11 Champlain 0.0% 71.4% 0.7% 0.0% 0.8% 13.2% LHIN 12 North Simcoe Muskoka 0.2% 0.0% 0.0% 0.2% 4.3% 1.9% LHIN 13 North East 0.5% 4.3% 1.3% 0.3% 2.7% 2.1% LHIN 14 North West 1.0% 0.0% 0.0% 0.0% 0.6% 0.4% Out of P/C 0.2% 18.2% 0.4% 0.2% 2.3% 4.3% Grand Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Total Paediatric AHSC Inpatient Discharges Distributed by LHIN LHIN 9 LHIN 10 LHIN 11 LHIN 1 LHIN 3 LHIN 8 LHIN 5 LHIN 7 Other LHIN 12 LHIN 6 LHIN 13 LHIN 4 LHIN 2 LHIN 14 Out of P/C Notes HNHB = Hamilton Niagara Haldimand Brant Out of P/C = Out of Province / Country 27

35 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 HHS SickKids Total LHIN 1 Erie St. Clair 2.3% 0.0% 0.0% 0.0% 0.3% 2.7% LHIN 2 South West 11.9% 0.0% 0.0% 0.2% 0.7% 12.8% LHIN 3 Waterloo Wellington 0.4% 0.0% 0.0% 2.5% 1.0% 3.9% LHIN 4 HNHB 0.2% 0.0% 0.0% 14.6% 1.3% 16.1% LHIN 5 Central West 0.0% 0.0% 0.0% 0.1% 4.8% 4.9% LHIN 6 Mississauga Halton 0.0% 0.0% 0.0% 0.9% 4.7% 5.6% LHIN 7 Toronto Central 0.0% 0.0% 0.0% 0.0% 7.3% 7.4% LHIN 8 Central 0.0% 0.0% 0.0% 0.0% 9.6% 9.7% LHIN 9 Central East 0.0% 0.1% 0.1% 0.1% 7.4% 7.7% LHIN 10 South East 0.0% 1.0% 5.9% 0.0% 0.5% 7.3% LHIN 11 Champlain 0.0% 12.8% 0.0% 0.0% 0.3% 13.2% LHIN 12 North Simcoe Muskoka 0.0% 0.0% 0.0% 0.0% 1.8% 1.9% LHIN 13 North East 0.1% 0.8% 0.1% 0.0% 1.1% 2.1% LHIN 14 North West 0.2% 0.0% 0.0% 0.0% 0.2% 0.4% Out of P/C 0.0% 3.3% 0.0% 0.0% 0.9% 4.3% Grand Total 15.3% 18.0% 6.2% 18.6% 42.0% 100.0% Total Paediatric AHSC Inpatient Discharges - Distributed by Hospital 15.3% 42.0% 18.0% CH LHSC CHEO KGH MCH HHS SickKids 18.6% 6.2% Notes HNHB = Hamilton Niagara Haldimand Brant Out of P/C = Out of Province / Country 28

36 2.0 Hospital Descriptors DES Inpatient and Same Day Surgery Volumes The table and chart below depict the total number of inpatient and same day surgery (SDS) cases. Hospitals Inpatient Cases SDS Cases 09/10 10/11 11/12 09/10 10/11 11/12 CH LHSC 4,472 4,517 5,551 2,764 2,717 2,629 CHEO 6,346 6,494 6,504 4,965 5,264 5,764 KGH 1,980 1,953 2,264 1, MCH HHS 6,279 6,372 6,814 3,247 2,761 3,245 Mt Sinai 3,134 3,184 3, SickKids 14,055 14,389 15,235 5,138 4,977 5,129 Sunnybrook 1,223 1,166 1, TOH 2,465 2,412 2, Total 39,954 40,487 43,426 17,871 16,224 17,418 Inpatient and SDS Patient Volumes (FY 2011/12) CH LHSC CHEO KGH MCH HHS Mt Sinai SickKids Sunnybrook TOH - 5,000 10,000 15,000 20,000 25,000 Inpatient Cases SDS Cases Notes 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, KGH is no longer reporting together with HDH Kingston. St. Joseph s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June

37 2.1.2 DES 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. Hospital Neonatal Cases Paediatric Cases 09/10 10/11 11/12 09/10 10/11 11/12 CH LHSC ,544 3,719 3,775 4,006 CHEO ,557 5,751 5,775 KGH ,263 1,291 1,472 MCH HHS 1,600 1,864 1,725 4,679 4,508 5,089 Mt Sinai 3,041 3,072 2, SickKids 1,134 1,091 1,149 12,921 13,298 14,086 Sunnybrook 1,123 1,033 1, TOH 2,282 2,251 2, Total 11,439 11,458 12,649 28,515 29,029 30,772 Neonatal and Paediatric Inpatient Case Volumes (FY 11/12) CH LHSC CHEO KGH MCH HHS Mt Sinai SickKids Sunnybrook TOH 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Neonatal Paediatric Notes 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, KGH is no longer reporting together with HDH Kingston. St. Joseph s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June

38 2.1.3 DES Patient Volume Breakdown This table provides the case volume broken down by: Inpatient cases (including medical, mental health, neonatal and surgical), and SDS cases The data comes from the DAD and does not include OMHRS data. A zero volume or hospitals reporting mental health cases through OMHRS will appear blank, and a volume less than 6 is indicated as <6. Hospitals Inpatient Cases Total Inpatient Total SDS Mental Health Neonatal Medical Cases Surgical Cases Cases Cases Cases Cases CH LHSC 2, ,544 1,270 5,551 2,629 CHEO 3, ,766 6,504 5,764 KGH 1, , MCH HHS 3, ,724 1,384 6,814 3,245 Mt Sinai 38 2, , SickKids 8, ,149 5,491 15,235 5,129 Sunnybrook 43 <6 1, , TOH 77 2, , Total 18,802 1,611 12,648 10,363 43,426 17,418 The charts below display FY 11/12 Inpatient and SDS cases, broken down by facility. Total Inpatient Cases (FY 2011/12) Total SDS Cases (FY 2011/12) Sunnybrook 3.4% TOH 5.8% CH LHSC 12.8% Mt Sinai 0.5% SickKids 29.4% Sunnybrook 0.5% TOH 0.7% SickKids 35.1% CHEO 15.0% KGH 5.2% MCH HHS 18.6% CH LHSC 15.1% Mt Sinai 7.0% MCH HHS 15.7% KGH 2.0% CHEO 33.1% 31

39 2.1.4 DES 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, days, 1-7 years and 8-17 years. Zero volume is left blank. Hospitals 0-28 Days Days 1-7 Years 8-17 Years Total CH LHSC 1, ,510 1,892 5,551 CHEO 729 1,026 2,072 2,677 6,504 KGH ,264 MCH HHS 1, ,984 2,278 6,814 Mt Sinai 2, ,052 SickKids 1,149 2,104 5,777 6,205 15,235 Sunnybrook 1, ,477 TOH 2, ,529 Total 12,654 4,812 11,862 14,098 43,426 Total Inpatient Cases: Age Profile by Facility Total Inpatient Cases: Age Profile CH LHSC CHEO KGH MCH HHS 14,098 33% 12,654 29% Mt Sinai SickKids Sunnybrook TOH 11,862 27% 4,812 11% 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16, Days Days 1-7 Years 8-17 Years 0-28 Days Days 1-7 Years 8-17 Years 32

40 2.1.5 DES Same Day Surgery Age Profile This chart provides 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 Days 1-7 Years 8-17 Years Total CH LHSC 77 1,323 1,229 2,629 CHEO < ,357 2,283 5,761 KGH < MCH HHS <6 95 1,895 1,254 3,244 Mt Sinai Sunnybrook SickKids 465 3,052 1,612 5,129 TOH < Total < ,756 6,877 17,409 SDS Cases: Age Profile by Facility SDS Cases: Age Profile CH LHSC CHEO 780 4% KGH MCH HHS Mt Sinai 6,877 40% Sunnybrook SickKids 9,756 56% TOH 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-28 days days 1-7 years 8-17 years 0-28 days days 1-7 years 8-17 years 33

41 ALOS PCMCH Maternal-Child Benchmarking Report DES Total ALOS This table and chart illustrate 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 7. Hospital FY 09/10 FY 10/11 ALOS ALOS ALOS FY 11/12 % Change vs Previous Year CH LHSC % CHEO % KGH % MCH HHS % Mt Sinai % SickKids % Sunnybrook % TOH % CAPHC Facilities % 14 Total ALOS CH LHSC CHEO KGH MCH HHS Mt Sinai SickKids Sunnybrook TOH CAPHC Facilities FY 09/10 FY 10/11 FY 11/12 Notes 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, KGH is no longer reporting together with HDH Kingston. St. Joseph s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June

42 2.1.7 DES Neonatal and Paediatric ALOS This table and charts 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 7. Neonatal Paediatric FY 09/10 FY 10/11 FY 11/12 FY 09/10 FY 10/11 FY 11/12 Hospitals % Change vs % Change vs ALOS ALOS ALOS ALOS ALOS ALOS Previous Year Previous Year CH LHSC % % CHEO % % KGH % % MCH HHS % % Mt Sinai % % SickKids % % Sunnybrook % % TOH % % CAPHC Facilities % % Neonatal ALOS Paediatric ALOS CH LHSC CH LHSC CHEO CHEO KGH KGH MCH HHS MCH HHS Mt Sinai Mt Sinai SickKids SickKids Sunnybrook Sunnybrook TOH TOH CAPHC Facilities CAPHC Facilities FY 09/10 FY 10/11 FY 11/ FY 09/10 FY 10/11 FY 11/12 35

43 2.1.8 DES 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 11/12 ARIW is shown. Hospitals Neonatal ARIW Paediatric ARIW Total ARIW CH LHSC CHEO KGH MCH HHS Mt Sinai SickKids Sunnybrook TOH Total Average Inpatient Weight per Case CH LHSC CHEO KGH MCH HHS Mt Sinai SickKids Sunnybrook TOH Neonatal ARIW Paediatric ARIW Total ARIW 36

44 2.1.9 DES Percent Typical, Outlier & Other Inpatient Cases and Patient Days This chart displays 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. Hospitals Patient Cases (%) Patient Days (%) Typical Other Outlier Typical Other Outlier CH LHSC 87% 10% 3% 68% 19% 14% CHEO 83% 9% 8% 59% 18% 24% KGH 88% 7% 5% 72% 14% 14% MCH HHS 81% 15% 4% 58% 26% 15% Mt Sinai 71% 27% 2% 44% 50% 6% SickKids 84% 10% 6% 56% 22% 23% Sunnybrook 66% 32% 1% 36% 62% 3% TOH 81% 17% 2% 61% 36% 3% Patient Cases (%) Patient Days (%) CH LHSC CH LHSC CHEO CHEO KGH KGH MCH HHS MCH HHS Mt Sinai Mt Sinai SickKids SickKids Sunnybrook Sunnybrook TOH TOH 0% 20% 40% 60% 80% 100% Typical Other Outlier 0% 20% 40% 60% 80% 100% Typical Other Outlier 37

45 DES 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 Transferred 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 % 2,677 21% 234 6% 2,921 14% 384 7% 5,598 16% CHEO % 6,540 74% 205 4% 3,377 9% 552 8% 9,917 22% KGH 47 6% 1,181 15% 47 3% 436 6% 94 4% 1,617 11% MCH HHS % 4,688 23% 303 6% 3,870 14% 595 9% 8,558 18% Mt Sinai 35 1% 1,092 5% <6 5% 69 12% 39 1% 1,161 5% Sickkids % 18,064 91% 705 5% 12,180 15% 1,527 10% 30,244 29% Sunnybrook 54 4% 1,950 14% 7 6% % 61 4% 2,413 16% TOH 115 5% 1,952 13% 35 25% % 150 6% 2,521 15% 35% "Transfer From" Inpatient Cases and Patient Days (Neonatal and Paediatric) 30% 25% 20% 15% 10% 5% 0% CH LHSC CHEO KGH MCH HHS Mt Sinai SickKids Sunnybrook TOH % Of All Cases Recorded As "Transfers From" % Of All Days Recorded As "Transfers From" 38

46 DES 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 Transferred 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 127 8% 2,505 19% 87 2% 1,382 7% 214 4% 3,887 11% CHEO 95 13% 1,243 14% 141 2% 2,027 6% 236 4% 3,270 7% KGH 37 5% 567 7% 21 1% 167 2% 58 3% 734 5% MCH HHS % 7,937 39% 61 1% 714 3% 602 9% 8,651 18% Mt Sinai % 10,734 48% <6 6% % % 10,886 47% Sickkids % 5,435 27% 201 1% 2,366 3% 547 4% 7,801 8% Sunnybrook % 7,790 56% 7 6% % % 7,940 53% TOH % 3,795 24% 9 6% % % 3,997 24% 60% "Transfer To" Inpatient Cases and Patient Days (Neonatal and Paediatric) 50% 40% 30% 20% 10% 0% CH LHSC CHEO KGH MCH HHS Mt Sinai SickKids Sunnybrook TOH % Of All Cases Recorded As "Transfers To" % Of All Days Recorded As "Transfers To" 39

47 DES Percent of Cases and Days with Length of Stay > 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. Hospitals with less than 6 cases are indicated as <6. Neonatal Paediatric Total Hospitals CASES DAYS CASES DAYS CASES DAYS # % # % # % # % # % # % CH LHSC 100 6% 6,373 49% 84 2% 5,195 24% 184 3% 11,568 34% CHEO 61 8% 4,047 46% 169 3% 10,445 29% 230 4% 14,492 32% KGH 64 8% 3,988 50% 15 1% % 79 3% 4,821 33% MCH HHS 137 8% 10,930 54% 104 2% 6,375 24% 241 4% 17,305 37% Mt Sinai 166 6% 11,012 49% <6 6% % 171 6% 11,321 49% SickKids % 11,701 59% 410 3% 26,646 32% 589 4% 38,347 37% Sunnybrook 125 9% 7,845 56% 7 6% % 132 9% 8,370 56% TOH 73 3% 3,874 25% 7 5% % 80 3% 4,208 25% 60% Percent Cases and Days with LOS >30 Days (All Cases) 50% 40% 30% 20% 10% 0% CH LHSC CHEO KGH MCH HHS Mt Sinai SickKids Sunnybrook TOH Total Cases (%) Total Days (%) 40

48 3.0 Emergency Department Indicators ED ED Patient Volumes The chart and table below presents the volume of Emergency Department visits. Hospital FY 09/10 FY 10/11 FY 11/12 Cases Cases Cases % Change vs. FY 10/11 CH LHSC 39,166 37,414 37,534 0% CHEO 57,543 59,990 66,232 10% KGH 22,108 22,589 6,646-71% MCH HHS 24,090 25,938 32,170 24% Mt Sinai % Sunnybrook 2,392 2,396 2,750 15% SickKids 57,639 57,482 63,642 11% TOH 2,432 2,296 2,376 3% Total 206, , ,299 2% 70,000 ED Patient Volumes 60,000 50,000 40,000 30,000 20,000 10,000 0 CH LHSC CHEO KGH MCH HHS Mt Sinai Sunnybrook SickKids TOH FY 09/10 FY 10/11 FY 11/12 Notes 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, KGH is no longer reporting together with HDH Kingston. St. Joseph s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June

49 3.1.2 ED ED Average LOS in Hours (All Dispositions) This 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. 5 ED Average LOS in Hours (All Dispositions) CH LHSC CHEO KGH MCH HHS Mt Sinai Sunnybrook SickKids TOH 42

50 3.1.3 ED ED 90 th Percentile LOS This chart and table present the maximum length of time in which 9 out of 10 patients completed their ED visit. The maximum length of time 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 Date/Time Patient left ED is missing. Hospital 90th % LOS for Admitted Patients LOS Hours 90th % LOS for Non- Admitted High Acuity Patients LOS Hours 90th % LOS for Non- Admitted Low Acuity Patients LOS Hours CH LHSC CHEO KGH MCH HHS Mt Sinai Sunnybrook Sickkids TOH th % LOS for Admitted Patients LOS Hours 90th % LOS for Non-Admitted High Acuity Patients LOS Hours 90th % LOS for Non-Admitted Low Acuity Patients LOS Hours CH LHSC CH LHSC CH LHSC CHEO CHEO CHEO KGH KGH KGH MCH HHS MCH HHS MCH HHS Mt Sinai Mt Sinai Mt Sinai Sunnybrook Sunnybrook Sunnybrook Sickkids Sickkids Sickkids TOH TOH TOH

51 3.1.4 ED ED Visits (Age Profile) This table and chart provide a visual description of the age profile of ED visits according to the following age categories: 0 28 days, days, 1-7 years and 8-17 years. Hospitals 0-28 Days Days 1-7 Years 8-17 Years CH LHSC 668 4,039 17,431 15,396 CHEO 1,534 8,831 32,787 23,080 KGH ,722 3,108 MCH HHS 568 4,349 15,978 11,275 Mt Sinai Sunnybrook ,944 SickKids 1,122 8,491 36,108 17,921 TOH ,835 Total 4,111 26, ,321 75, % ED Visits (Age Profile) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% CH LHSC CHEO KGH MCH HHS Mt Sinai Sunnybrook SickKids TOH 0-28 Days Days 1-7 Years 8-17 Years 44

52 3.1.5 ED ED Visits by Triage Level The following table and chart 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 and Other. Hospitals with less than 6 cases are indicated as <6. Hospital Left Before Triage Level Triage/Other CH LHSC 236 3,589 15,416 17, CHEO < ,776 32,796 25,049 1,971 KGH ,026 3,865 1, MCH HHS < ,808 14,005 9,962 2,100 Mt Sinai Sunnybrook , SickKids ,102 25,454 20,731 1,285 TOH < , % ED Visits by Triage level 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% CH LHSC CHEO KGH MCH HHS Mt Sinai Sunnybrook SickKids TOH Left Before Triage/Other Level 1 Level 2 Level 3 Level 4 Level 5 45

53 CH LHSC CHEO KGH MCH HHS Mt Sinai Sunnybrook Sick Kids TOH TOTAL # of AHSC with this MRDx in Top 15 PCMCH Maternal-Child Benchmarking Report ED ED Visits by Top 15 Main Problems This table displays the Top 15 main problems/most responsible diagnoses for each hospital. The Top 15 are highlighted in RED. Numbers less than 6 are indicated as <6. Main Problem ICD10 J069 Acute URTI unspecified 1,981 4, , , ,659 7 B349 Viral infection unspecified 1,237 3, , , ,510 7 H669 Otitis media unspecified 1,770 2, , ,828 8 R509 Fever unspecified 740 1, , ,986 8 A099 Gastro & colitis of unspec origin 646 2, , , ,894 8 J189 Pneumonia unspecified 1,020 1, , ,548 5 R104 Other and unspecified abdominal pain 880 1, , ,494 8 J050 Acute obstructive laryngitis [croup] 1,133 1, <6 18 1, ,075 6 S099 Unspecified injury of head 748 1, , ,812 8 J4500 Predom allgry asthma wo stat asthma 743 1, <6 1,083 <6 4,368 5 K590 Constipation 537 1, , ,149 6 A084 Viral intestinal infection unspecified 1,023 1, <6 6 1,397 <6 4,131 4 N390 Urinary tract infection site not spec , ,417 6 S0180 Open wounds oth parts head, uncomplicate ,779 6 R112 Vomiting alone <6 17 1,154 <6 2,705 2 J219 Acute bronchiolitis unspecified 300 1, <6 <6 807 <6 2,691 1 J029 Acute pharyngitis unspecified ,143 3 S060 Concussion < ,131 2 J988 Other specified respiratory disorders <6 <6 809 <6 1,835 1 R51 Headache ,592 2 S9349 Sprain and strain of ankle, unspecified < ,218 2 R55 Syncope and collapse ,031 1 T784 Allergy unspecified < ,002 1 R074 Chest pain unspecified S52590 Unspec fx of lower end of radius, closed < Z098 F/U exam after oth Rx for oth cond <6 8 < R458 Oth symptoms signs inv emotional state < S6100 Opn wnd finger w/o damage nail, uncomp < F100 Ment/beh disrd dt alcohol use ac intox S699 Unspecified injury of wrist and hand < S098 Other specified injuries of head <6 <6 < J4590 Asthma, unspec w/o st status asthmaticus <

54 3.1.7 ED ED 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), and 07 (Admit to Facility Inpatient Unit). Hospital FY 09/10 FY 10/11 FY 11/12 CH LHSC 6.1% 6.5% 6.7% CHEO 7.1% 6.9% 6.3% KGH 2.8% 3.0% 12.6% MCH HHS 11.5% 10.5% 10.3% Mt Sinai 2.9% 3.9% 2.4% Sunnybrook 3.9% 5.0% 4.7% SickKids 10.3% 11.2% 10.5% TOH 3.8% 3.7% 3.3% 14% 12% 10% 8% 6% 4% CH LHSC CHEO KGH MCH HHS Mt Sinai Sunnybrook SickKids TOH 2% 0% FY 09/10 FY 10/11 FY 11/12 Notes 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, KGH is no longer reporting together with HDH Kingston. KGH paediatric urgent model has urgent care patient cases requiring admission directed to KGH since HDH is an ambulatory hospital. The joint reporting of the two sites previously may not have highlighted this activity accurately. St. Joseph s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June

55 3.1.8 ED 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), and 05 (registered, triaged, assessed and left against advice). Hospital FY 09/10 FY 10/11 FY 11/12 CH LHSC 2.8% 3.0% 1.9% CHEO 4.0% 2.6% 3.9% KGH 2.3% 1.9% 4.5% MCH HHS 7.2% 4.2% 3.1% Mt Sinai 3.7% 3.4% 1.6% Sunnybrook 7.9% 6.1% 6.9% SickKids 6.1% 4.0% 3.6% TOH 6.1% 7.4% 5.8% 9% 8% 7% 6% 5% 4% 3% 2% CH LHSC CHEO KGH MCH HHS Mt Sinai Sunnybrook SickKids TOH 1% 0% FY 09/10 FY 10/11 FY 11/12 Notes 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, KGH is no longer reporting together with HDH Kingston. St. Joseph s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June

56 CH LHSC CHEO KGH MCH HHS Mt Sinai SickKids Sunnybrook TOH Total # of AHSCs with this CMG in Top 10 PCMCH Maternal-Child Benchmarking Report Clinical Efficiency Indicators 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. The last column provides the number of hospitals with that CMG within their top 10. Numbers less than 6 are indicated as <6. CMG+ Description Newborn/Neonate grams, Other Minor Problem Chemotherapy/Radiotherapy Admission for Neoplasm , <6 1, Newborn/Neonate grams, Jaundice , Upper/Lower Respiratory Infection Viral/Unspecified Pneumonia < Newborn/Neonate grams, Short Gestation Reduction/Fixation/Repair Upper Body/Limb except Fixation/Repair of Shoulder Newborn/Neonate grams, Other Respiratory Problem <6 315 < Symptom/Sign of Digestive System < Simple Appendectomy < Newborn/Neonate grams, Gestational Age 37+ Weeks 85 < Seizure Disorder, except Status Epilepticus Asthma Non-severe Enteritis Newborn/Neonate grams, Gestational Age Weeks 74 < < Oral Cavity/Pharynx Intervention Agranulocytosis Depressive Episode without ECT Newborn/Neonate grams, Other Congenital Anomaly 67 < Major Cardiothoracic Intervention with Pump < Cancelled Intervention 22 <6 <6 <6 <6 186 < Newborn/Neonate grams, Other Moderate Problem Newborn/Neonate grams, Gestational Age <35 Weeks <6 31 <6 25 < Childhood/Adolescence Disorder < Newborn/Neonate grams, Gestational Age Weeks <6 9 < Newborn/Neonate grams, Gestational Age 35+ Weeks 19 <6 11 < Newborn/Neonate grams, Aspiration Syndrome/Fetal Asphyxia

57 CH LHSC CHEO KGH MCH HHS Mt Sinai SickKids Sunnybrook TOH Total # of AHSCs with this CMG in Top 10 PCMCH Maternal-Child Benchmarking Report 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. Numbers less than 6 are indicated as <6. CMG+ Description Newborn/Neonate grams, Other Minor Problem Reduction/Fixation/Repair Upper Body/Limb except Fixation/Repair of Shoulder , < Simple Appendectomy < Oral Cavity/Pharynx Intervention Symptom/Sign of Digestive System < Newborn/Neonate grams, Jaundice Asthma Upper/Lower Respiratory Infection Viral/Unspecified Pneumonia < Newborn/Neonate grams, Short Gestation Seizure Disorder, except Status Epilepticus Non-severe Enteritis Chemotherapy/Radiotherapy Admission for Neoplasm < Convalescence <6 161 <6 < Newborn/Neonate grams, Gestational Age 37+ Weeks 56 < < Newborn/Neonate grams, Other Respiratory Problem 58 < Cancelled Intervention 22 <6 <6 <6 <6 184 < Hard/Soft Palate/Gingiva Intervention < Other Musculoskeletal Intervention on Head < Newborn/Neonate grams, Other Congenital Anomaly 47 <6 < Non-Complex Hernia Repair < Percutaneous Transluminal Cardiothoracic Intervention except Percutaneous Coronary Intervention 776 Open Wound/Other/Unspecified Minor Injury < Newborn/Neonate grams, Gestational Age Weeks 31 <6 <6 44 < Newborn/Neonate grams, Major Respiratory Complication 11 <6 < < Newborn/Neonate grams, Other Moderate Problem 14 < <6 < Newborn/Neonate grams, Aspiration Syndrome/Fetal Asphyxia 7 7 <6 18 < Closed Knee Intervention except Fixation without Infection <6 <6 < <6 < Newborn/Neonate grams, Haemolytic Disease <6 <6 <6 <6 <

58 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. Two areas are examined in this section: QUM 5.1 Appropriateness of Care Note: 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. The following indicators are included: QUM Percent Paediatric Admissions Treated for Asthma QUM Percent Paediatric Admissions Treated for Diabetes QUM 5.2 Effectiveness and Efficacy QUM Percent Medical and Mental Health Admissions with One & Two Days Stay Admission via the Emergency Department QUM Percent Medical, Mental Health and Surgical Admissions via ED 51

59 5.1.1 QUM 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. The most responsible diagnosis codes used are listed below. ICD10-CA code J4500 J4501 J4510 J4511 J4580 J4581 J4590 J4591 Short Description Predom allgry asthma w/o stat asthma Predom allgry asthma w stat asthma Noallgy asthma w/o stat asthma Noallgy asthma w stat asthma Mixed asthma w/o st status asthmaticus Mixed asthma w st status asthmaticus Asthma, unspec w/o st status asthmaticus Asthma, unspec w st status asthmaticus 4% 3% 2% 1% 0% Asthma Cases as Percentage of Total Paediatric Inpatient Cases 2.2% 3.0% 2.4% 2.9% 1.2% CH LHSC CHEO KGH MCH HHS SickKids Inpatient Cases Hospitals Asthma Inpt Cases FY 2009/10 Total Paed Inpt Cases Rate per 1,000 Asthma Inpt Cases FY 2010/11 FY 2011/12 Total Paed Inpt Cases Rate per 1,000 Asthma Inpt Cases Total Paed Inpt Cases CH LHSC 101 3, , , CHEO 220 5, , , KGH 29 1, , , MCH HHS 121 4, , , SickKids , , , Rate per 1,000 Emergency Admissions FY 2009/10 FY 2010/11 FY 2011/12 Hospitals Asthma ED Admissions Total Paed Asthma ED Visits Rate per 1,000 Asthma ED Admissions Total Paed Asthma ED Visits Rate per 1,000 Asthma ED Admissions Total Paed Asthma ED Visits Rate per 1,000 CH LHSC CHEO 246 1, , , KGH MCH HHS SickKids 112 1, , , Notes 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, KGH is no longer reporting together with HDH Kingston. St. Joseph s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June

60 5.1.2 QUM Percent 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. The most responsible diagnosis codes E10 to E14 were used. 1.5% 1.0% 0.7% Diabetes Cases as Percentage of Total Paediatric Inpatient Cases 1.3% 1.2% 0.9% 0.5% 0.4% 0.0% CH LHSC CHEO KGH MCH HHS SickKids Inpatient Cases FY 2009/10 FY 2010/11 FY 2011/12 Hospitals Diabetes Total Paed Rate per Diabetes Total Paed Rate per Diabetes Total Paed Rate per Inpt Cases Inpt Cases 1,000 Inpt Cases Inpt Cases 1,000 Inpt Cases Inpt Cases 1,000 CH LHSC 30 3, , ,007 7 CHEO 64 5, , ,775 9 KGH 10 1, , , MCH HHS 65 4, , , SickKids 75 12, , ,086 4 Emergency Admissions Hospitals Diabetes ED Admissions FY 2009/10 FY 2010/11 FY 2011/12 Total Paed Diabetes ED Visits Rate per 1,000 Diabetes ED Admissions Total Paed Diabetes ED Visits Rate per 1,000 Diabetes ED Admissions Total Paed Diabetes ED Visits CH LHSC CHEO KGH MCH HHS SickKids Rate per 1,000 Notes 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, KGH is no longer reporting together with HDH Kingston. St. Joseph s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June

61 5.2.1 QUM Percent Medical and Mental Health Admissions via ED with One & Two Days Stay The chart and table below display the percentage of medical and mental health inpatients admitted through the Emergency Department for one and two day stays. Hospital Medical % One Day % Two Day % 1 & 2 Day Combined Mental Health % One Day % Two Day % 1 & 2 Day Combined CH LHSC 33% 22% 55% 13% 10% 23% CHEO 16% 19% 35% 10% 7% 18% KGH 42% 20% 62% 16% 9% 26% MCH HHS 40% 21% 61% 19% 7% 26% Mt Sinai 25% 38% 63% SickKids 30% 20% 50% 5% 6% 11% Sunnybrook 41% 3% 44% TOH 33% 15% 48% 70% Percent Medical and MH Admissions via ED (1 and 2 Days Stay Combined) 60% 50% 40% 30% 20% 10% 0% CH LHSC CHEO KGH MCH HHS Mt Sinai SickKids Sunnybrook TOH Medical Mental Health 54

62 5.2.2 QUM Percent Medical, Mental Health and Surgical Admissions via ED This table and graph display the percentage of all Medical, Mental Health (MH) and Surgical inpatients admitted through the Emergency Department (ED). Hospital Percent Medical Admissions via ED Percent Mental Health Admissions via ED Percent Surgical Admissions via ED CH LHSC 67% 76% 37% CHEO 76% 82% 42% KGH 58% 37% 49% MCH HHS 75% 19% 48% Mt Sinai 21% 22% SickKids 59% 64% 25% Sunnybrook 79% 64% TOH 43% 48% 100% Percent Medical, Mental Health and Surgical Admissions via ED 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% CH LHSC CHEO KGH MCH HHS Mt Sinai SickKids Sunnybrook TOH Medical Mental Health Surgical 55

63 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. 56

64 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. MIS Functional Centres FY 11/12 CH LHSC CHEO MCH KGH SickKids Inpatient (7*2) Ambulatory (7*3) Diagnostic & Therapeutic (7*4) Community (7*5) Education (7*8) Admin & Support (7*1) Total 2011/ MIS Functional Centres FY 10/11 CH LHSC CHEO MCH KGH SickKids Inpatient (7*2) Ambulatory (7*3) Diagnostic & Therapeutic (7*4) Community (7*5) Education (7*8) Admin & Support (7*1) Total 2010/ Percentage Change 28.3% 5.7% 2.1% 16.9% 2.2% Note St. Joseph s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June This will result in higher numbers for CH LHSC in FY 2011/12 vs. previous years. 57

65 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 KGH MCH SickKids Inpatient (7*2) 44.7% 23.8% 52.6% 36.5% 33.0% Ambulatory (7*3) 20.8% 12.9% 12.2% 10.9% 12.2% Diagnostic & Therapeutic (7*4) 13.1% 24.1% 10.9% 23.8% 24.0% Community (7*5) 2.7% 11.9% 0.0% 14.5% 0.7% Education (7*8) 0.7% 1.2% 1.3% 0.8% 1.7% Admin & Support (7*1) 18.0% 26.1% 23.0% 13.5% 28.4% Hospital Net Operating Costs - % Distribution CH LHSC CHEO KGH MCH 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) 58

66 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. MIS Functional Centres FY 2011/12 CH LHSC CHEO KGH MCH SickKids Inpatient (7*2) Ambulatory (7*3) Diagnostic & Therapeutic (7*4) Community (7*5) Education (7*8) Admin & Support (7*1) Total 2011/ MIS Functional Centres FY 2010/11 CH LHSC CHEO KGH MCH SickKids Inpatient (7*2) Ambulatory (7*3) Diagnostic & Therapeutic (7*4) Community (7*5) Education (7*8) Admin & Support (7*1) Total 2010/ Percentage Change 28.0% 5.0% 15.6% 9.2% 4.4% Note St. Joseph s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June This will result in higher numbers for CH LHSC in FY 2011/12 vs. previous years. 59

67 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 KGH MCH SickKids Inpatient (7*2) 48.1% 25.9% 55.6% 38.9% 33.2% Ambulatory (7*3) 19.7% 17.3% 11.2% 12.8% 13.8% Diagnostic & Therapeutic (7*4) 15.3% 25.0% 11.8% 26.7% 25.0% Community (7*5) 2.1% 11.4% 0.0% 9.3% 0.9% Education (7*8) 0.9% 1.3% 1.7% 1.0% 2.0% Admin & Support (7*1) 13.9% 19.1% 19.7% 11.4% 25.1% Compensation Costs - Distribution by Functional Centre Category CH LHSC CHEO KGH MCH 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) 60

68 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 2011/12 CH LHSC CHEO KGH MCH Sickkids Inpatient (7*2) ,223.6 Ambulatory (7*3) Diagnostic & Therapeutic (7*4) ,723.3 Community (7*5) Education (7*8) Admin & Support (7*1) ,942.7 TOTAL 1, , , , /12 FTE (using 1950 hours) 803 1, ,231 3,588 MIS Functional Centres FY 2010/11 CH LHSC CHEO KGH MCH Sickkids Inpatient (7*2) ,198.0 Ambulatory (7*3) Diagnostic & Therapeutic (7*4) ,682.4 Community (7*5) Education (7*8) Admin & Support (7*1) ,884.8 TOTAL 1, , , , /11 FTE (using 1950 hours) 633 1, ,156 3,501 Percentage Change (2011/12 FTE vs 2010/11 FTE) 26.9% 4.4% 17.7% 6.5% 2.5% Note St. Joseph s Health Centre, London (SJHC London) moved their maternal-newborn program to CH LHSC in June This will result in higher numbers for CH LHSC in FY 2011/12 vs. previous years. 61

69 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. Functional Centre CH LHSC CHEO KGH MCH SickKids Inpatient (7*2) 45.0% 24.2% 51.2% 35.8% 31.8% Ambulatory (7*3) 19.4% 17.4% 10.5% 13.0% 13.2% Diagnostic & Therapeutic (7*4) 15.2% 24.0% 11.5% 26.5% 24.6% Community (7*5) 2.1% 11.2% 0.0% 12.2% 0.9% Education (7*8) 0.9% 1.3% 1.5% 0.9% 1.8% Admin & Support (7*1) 17.4% 21.9% 25.4% 11.7% 27.8% Hours (MIS 3*) - Distribution by Functional Centre Category CH LHSC CHEO KGH MCH 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) 62

70 6.2 Operational Efficiency Comparisons 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 4,415 CHEO 4,261 KGH 3,409 MCH 3,935 SickKids 4, ,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 5,000 63

71 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 1,211 CHEO 1,048 KGH 905 MCH 1,156 SickKids 1, ,000 1,200 1,400 64

72 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 SickKids Compensation costs (3*) per inpatient weighted case Compensation costs (3*) per inpatient day Hours (3*) per inpatient weighted case 3,658 3,372 2,791 3,244 3,026 1, , Hours (3*) per inpatient days UPP hours (35090*/10*) per inpatient weighted case UPP hours (35090*/10*)per inpatient day Inpatient days (403* Trial Balance) ,675 45,634 13,387 45, ,743 CMG+ Inpatient weighted cases 9,239 11,222 3,552 13,287 34,123 65

73 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 SickKids Net operating costs per inpatient day Compensation costs (3*) per inpatient day UPP worked hours (35090*/10*) per inpatient Inpatient days (403* Trial Balance) ,442 29,819 4,967 24,099 74,823 UPP Worked Hours per Inpatient Day CH LHSC CHEO KGH MCH SickKids

74 CH LHSC CHEO KGH MCH Mt Sinai SickKids Sunnybrook PCMCH Maternal-Child Benchmarking Report Critical Care NICU Department 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. Net operating costs per inpatient day Compensation costs (*3) per inpatient day UPP worked hours (35090*/10*) per inpatient day Inpatient days (403* Trial Balance) 1,099 1, ,389 1,014 1, , , , ,880 5,300 6,395 13,898 12,571 11,728 12,645 NICU/ICU UPP Worked Hours per Inpatient Day CH LHSC CHEO KGH MCH Mt Sinai SickKids Sunnybrook

75 CH LHSC CHEO KGH MCH SickKids PCMCH Maternal-Child Benchmarking Report 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. Net operating costs per inpatient day Compensation costs (*3) per inpatient day UPP worked hours (35090*/10*) per inpatient day Inpatient days (403* Trial Balance) 1,374 1,593 1,046 1,548 1,724 1,210 1, ,162 1, ,304 7,716 1,192 16,369 22,359 PCCU UPP Worked Hours per Inpatient Day CH LHSC CHEO KGH MCH SickKids

76 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. Net operating cost per OR hour Compensation costs (3*) per OR hour UPP worked hours (35090*/10) per OR hour CH LHSC CHEO KGH MCH SickKids , , OR hours 5,675 10,186 1,213 6,578 25,501 OR cases 3,701 8, ,861 11,905 OR Average hours per case Operating Room UPP Worked Hours per OR Hour Operating Room Average Hours per Case CH LHSC CH LHSC CHEO CHEO KGH KGH MCH MCH SickKids SickKids

77 6.4 Ambulatory Costs 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 KGH MCH SickKids Net operating costs 4,658,271 11,604, ,387 10,045,579 28,648,540 Compensation costs 4,280,516 14,089, ,526 7,674,598 24,590,452 Worked UPP & PS (35010*/90*) hours Visits (5*) and/or (45024*/25*/27*/28*) Compensation costs per visit Net operating costs per visit UPP worked hours per visit 42, ,305 6,054 99, ,431 41,956 92,679 1,844 77, , Ambulatory Clinics UPP Worked Hours per Visit CH LHSC CHEO KGH MCH SickKids

78 6.5 Emergency Department 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 KGH MCH SickKids Net operating costs 8,569,509 10,340,532 1,385,622 4,926,590 10,531,414 Compensation costs (3*) 7,356,181 8,123,415 1,124,916 4,023,946 8,096,001 Total Hours (3*) 161, ,957 22,840 72, ,386 Worked UPP & PS (35010*/90*) hours 94, ,941 16,435 72, ,501 Visits (448*/49*/50*/51*) 37,911 66,419 6,645 32,899 63,679 Compensation Costs per Net operating costs per visit Total Hours per visit UPP worked hours per visit Emergency Department UPP Worked Hours per Visit CH LHSC CHEO KGH MCH SickKids

79 COMMUNITY HOSPITALS 72

80 Hospital Profiles Service Profiles Alexandra Marine & General Hospital Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website AMGH Goderich/Huron County Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health ENT Asthma At times youth General Surgery Emergency Medicine between 16 and 17 years of age are admitted to the Adult General Paediatrics Inpatient Psychiatric Schedule 1 Mental Newborn Health Unit. Paediatric Other Early School Age Program Speech Pathology Eating Disorder Ambulatory Clinic (both adolescent and adult populations are served) Paediatric Ambulatory Clinic 73

81 Bluewater Health Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website BWH Sarnia Lambton County Western University St. Joseph s Hospital Sarnia General Hospital Charlotte Eleanor Englehart Hospital Amalgamation to Bluewater Health Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Dental /Oral Surgery Adolescent Medicine Eating Disorders General Surgery Asthma Psychiatry Orthopaedic Surgery Child Protection Substance Abuse Emergency Medicine Endocrinology General Paediatrics Neonatology Nutrition Paediatric Other Brant Community Healthcare System Acronym Main Catchment Area Primary Academic Affiliation BCHS Year Founded 1884 Brant County McMaster University Website Subspecialties / Services Offered Paediatric Surgical Dental / Oral Surgery General Surgery Otolaryngology Paediatric Medical Asthma Child Protection Emergency Medicine General Paediatrics Newborn Paediatric Mental Health Paediatric Other 74

82 Brockville General Hospital Acronym Main Catchment Area Primary Academic Affiliation BGH Year Founded 1881 Website South East Ontario Subspecialties / Services Offered Paediatric Surgical Paediatric Paediatric Mental Medical Health Paediatric Other Circumcision General Paediatrics Early Language Dental / Oral Surgery Newborn Early School Age Program General Surgery Infant & Child Development Program Otolaryngology Outpatient Paediatric Physiotherapy Speech Language Pathology Cambridge Memorial Hospital Acronym Main Catchment Area Primary Academic Affiliation CMH Year Founded 1953 Cambridge, North Dumfries McMaster University Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical General Paediatrics Paediatric Mental Health Paediatric Other 75

83 Collingwood General and Marine Hospital Acronym Main Catchment Area Primary Academic Affiliation CGMH Year Founded 1887 Collingwood, Wasaga Beach, Clearview, Blue Mountain Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental/Oral Surgery Asthma Clinic Paediatric Clinic General Surgery Orthopaedic Surgery Cornwall Community Hospital Acronym Main Catchment Area Primary Academic Affiliation CCH Year Founded 2004 Stormont, Dundas and Glengarry Counties University of Ottawa Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental/Oral Surgery Asthma RSV Clinic Child Protection Emergency Medicine General Paediatrics Newborn 76

84 Credit Valley Hospital Site (Now known as Trillium Health Partners) Acronym Main Catchment Area Primary Academic Affiliation CVH Year Founded 1985 Mississauga-Halton LHIN University of Toronto Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Asthma Psychiatry Clinical Genetics General Surgery Cardiology Psychology Dietetic & Lactation Support Ophthalmology Emergency Medicine Early School Age Program Orthopaedic Surgery Endocrinology Neonatal Follow-Up Otolaryngology General Paediatrics Radiology Plastics Neonatology Retinopathy of Prematurity Urology Nephrology RSV Clinic Nutrition Oncology Palliative Respirology Rheumatology Grand River Hospital Acronym Main Catchment Area Primary Academic Affiliation GRH Year Founded 1995 Waterloo Wellington McMaster University/University of Waterloo Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical CF Clinic General Paediatrics JDEC POGO Satellite Premature Follow up Paediatric Mental Health Paediatric Other Breastfeeding Support Nutrition Counseling Paediatric Physiotherapy RSV Clinic 77

85 Grey Bruce Health Services Acronym Main Catchment Area Primary Academic Affiliation GBHS Grey and Bruce Counties McMaster Year Founded 1998 Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other General Paediatrics Halton Healthcare Services Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website HHS Halton Hills, Milton, Oakville, Clarkson McMaster 1950 August 1,1998 Amalgamation with Milton District Hospital January 2, 2006 Transfer of Georgetown Hospital Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other General Paediatrics Eating Disorders Out Patient Psychiatry 78

86 Headwaters Health Care Centre Acronym Main Catchment Area Primary Academic Affiliation HHCC Year Founded 1912 Dufferin/Caledon Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery General Paediatrics Arthritis Care General Surgery Diabetes Care Otolaryngology Speech Language Pathology Health Sciences North/Horizon Santé-Nord Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website HSN LHIN 13 Northern Ontario School of Medicine (NOSM) 1997 incorporated - prior to this there were 3 separate hospitals (Laurentian Hospital, General Hospital (now St. Joseph Health Centre), Memorial Hospital and one mental health and community service facility, Sudbury Algoma Hospital) Subspecialties / Services Offered Paediatric Paediatric Paediatric Medical Surgical Mental Health Paediatric Other General Surgery Asthma Crisis Autism Child Protection Eating Disorders Dietetic & Lactation Support General Paediatrics Psychiatry Fetal Alcohol Spectrum Diagnostic Newborn Psychology Gait Laboratory Dedicated Obesity Program Substance Abuse RSV Clinic Speech Language Pathology 79

87 Hôpital Montfort Acronym Montfort Main Catchment Area Ottawa Primary Academic Affiliation University of Ottawa and La Cité collégiale Year Founded 1953 Website Subspecialties / Services Offered Paediatric Surgical Humber River Regional Hospital Paediatric Medical Asthma General Paediatrics Haematology Newborn Nutrition Paediatric Mental Health Paediatric Other Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website HRRH North to Steeles Avenue West; South to St. Clair Avenue West; East to Dufferin St; West to Hwy 427 University of Toronto 1997 Amalgamation / Hospital Restructuring Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Allergy & Immunology Psychiatry Dietetic & Lactation Support General Surgery Asthma RSV Clinic Orthopaedic Surgery Emergency Medicine Speech Language Pathology Otolaryngology General Paediatrics Neonatology Newborn 80

88 Joseph Brant Memorial Hospital Acronym Main Catchment Area Primary Academic Affiliation JBMH Year Founded 1961 Burlington McMaster University Website Subspecialties / Services Offered Paediatric Paediatric Mental Paediatric Medical Surgical Health Paediatric Other Otolaryngology Emergency Medicine Dietetic & Lactation Support General Paediatrics Diabetes Program Newborn Regional Centre for Suspected Child Abuse & Neglect Lakeridge Health Acronym Main Catchment Area Primary Academic Affiliation LH Year Founded 1988 Durham Region Queen s University, University of Ontario Institute of Technology (UOIT), and Durham College Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other General Surgery General Paediatrics Crisis Speech Language Pathology ENT Newborn Psychiatry Psychology 81

89 Mackenzie Health (formerly York Central) Acronym Main Catchment Area Primary Academic Affiliation MH Year Founded 1963 York Region University of Toronto Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Asthma Psychiatry Anaesthesiology General Surgery Cardiology Autism Gynecology Developmental Paediatrics Clinical Genetics Orthopaedic Surgery Emergency Medicine Dietetic & Lactation Support Otolaryngology Endocrinology RSV Clinic Urology General Paediatrics Neonatology Nephrology Neurology Newborn Respirology Markham Stouffville Hospital Corporation Acronym Main Catchment Area Primary Academic Affiliation MSH Year Founded 1990 Markham, Stouffville, Unionville and Uxbridge Queen's University and University of Toronto Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Cardiology Autism Developmental Paediatrics Speech Language Pathology Endocrinology General Paediatrics Neonatology Newborn Nutrition 82

90 Middlesex Hospital Alliance Strathroy Middlesex General Hospital Acronym Main Catchment Area Primary Academic Affiliation Year Founded 1914 MHA-SMGH Southwest Middlesex University of Western Ontario Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other General Surgery Emergency Medicine Otolaryngology Niagara Health System Acronym Main Catchment Area Primary Academic Affiliation NHS Year Founded 1909 Niagara Region Welland, St. Catherines, Niagara Falls Support satellite McMaster Medical School Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Emergency Medicine Psychiatry Anaesthesiology General Surgery General Paediatrics Gynecology Neonatology Orthopaedic Surgery Otolaryngology Plastic Surgery Urology 83

91 North Bay Regional Health Centre Acronym Main Catchment Area Primary Academic Affiliation NBRHC Year Founded 1995 Nipissing, Parry Sound, Mattawa, West Nipissing, Temiskaming, Englehart, Kirkland Lake (30,700 sq. km area servicing 129,000 people) Northern Ontario School of Medicine Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Child Protection RSV Clinic 84

92 North York General Hospital Acronym Main Catchment Area Primary Academic Affiliation NYGH Year Founded 1968 North York and South York Region University of Toronto Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental/Oral Surgery Allergy & Immunology Eating Disorders Anaesthesiology General Surgery Adolescent Medicine Psychiatry Autism Asthma Crisis Dietetic & Lactation Support Cardiology Psychology Early School Age Program Dermatology Substance Abuse RSV Clinic Developmental Paediatrics Speech Language Pathology Endocrinology Neonatal Follow-Up Clinic Gastroenterology General Paediatrics Genetics/Metabolics Gynecology Haematology Infectious Diseases Neonatology Nephrology Neurology Newborn Nutrition Dedicated Obesity Program Respirology Rheumatology 85

93 Northumberland Hills Hospital Acronym Main Catchment Area Primary Academic Affiliation NHH Year Founded 1996 West Northumberland County Queen s University; Toronto University Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Adolescent Medicine Dietetic & Lactation Support Emergency Medicine General Paediatrics Neonatology 86

94 Orillia Soldiers Memorial Hospital Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website Subspecialties / Services Offered OSMH LHIN 12, Alliston, Bracebridge, Central Simcoe, Barrie area, Durham County, Haliburton, Huntsville, Kawartha Lakes, North Simcoe, Midland Area, Northeast Simcoe, Orillia Area, Northeast Simcoe, Collingwood Area, Parry Sound District University of Toronto 1908 Hospital Opened 1952 OBS Opened 1953 Paediatrics Opened Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Asthma Eating Disorder Anaesthesiology General Surgery Cardiology Psychiatry Autism Gynecology Child Protection Crisis Dietetic & Lactation Support Ophthalmology Developmental Psychology Early School Age Program Orthopaedic Surgery Paediatrics Social Work Exercise & Nutrition Otolaryngology Emergency Medicine Fetal Alcohol Spectrum Diagnostic Plastic Surgery Endocrinology Radiology Urology General Paediatrics RSV Clinic Genetics / Metabolics Speech Language Pathology Haematology Retinopathy of Prematurity (ROP) Neonatology Regional Centre Suspected Child Neurology Newborn Nutrition Oncology Physical Medicine & Rehabilitation Abuse & Neglect Respirology 87

95 Pembroke Regional Hospital Acronym Main Catchment Area Primary Academic Affiliation PRH Year Founded 1878 Pembroke, Petawawa and surrounding townships Ottawa University Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery General Paediatrics Dietetic & Lactation Support General Surgery Newborn RSV Clinic Ophthalmology Otolaryngology Peterborough Regional Health Centre Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website PRHC Central East LHIN Queen's University, Kingston 1950 (Civic site) Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Asthma Crisis Anaesthesiology General Surgery Child Protection Eating Disorders Clinical Genetics Orthopaedic Surgery Emergency Medicine Psychiatry Dietetic & Lactation Support Otolaryngology General Paediatrics Psychology RSV Clinic Plastic Surgery Newborn Urology Nutrition Pharmacology Notes PRHC: internal records indicate that paediatric subspecialties were under-reported in FY 2010/11. 88

96 Quinte Health Care Acronym Main Catchment Area Primary Academic Affiliation QHC Year Founded 1998 Hastings and Prince Edward County Queens University Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery General Paediatrics Early School Age Program Speech Language Pathology Ross Memorial Hospital Acronym Main Catchment Area Primary Academic Affiliation RMH City of Kawartha Lakes None Year Founded 1902 Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other General Surgery 89

97 Rouge Valley Health System Rouge Valley Ajax Pickering and Rouge Valley Centenary Acronym Main Catchment Area Primary Academic Affiliation RVHS East Scarborough and West Durham University of Toronto Year Founded RVC 1965; RVAP 1954 Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Allergy & Immunology Crisis Anaesthesiology General Surgery Adolescent Medicine Psychiatry Dietetic & Lactation Support Gynecology Asthma Psychology Exercise & Nutrition Ophthalmology Cardiology RSV Clinic Orthopaedic Surgery Child Protection Speech Language Pathology Otolaryngology Emergency Medicine Plastic Surgery Endocrinology Pulsed Dye Laser Gastroenterology General Paediatrics Genetics/Metabolics Haematology Infectious Diseases Neonatology Nephrology Neurology Newborn Nutrition Oncology Pharmacology Respirology Rheumatology 90

98 Royal Victoria Regional Health Centre Acronym Main Catchment Area Primary Academic Affiliation RVH Year Founded 1891 Barrie & PSA (Essa, Innisfil, Oro- Medonte & Springwater) University of Toronto and Georgian College Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Dental / Oral Surgery Asthma Outpatient Mental Developmental Health Assessment Paediatrics Clinic General Paediatrics Neonatology Newborn Nutrition Physical Medicine & Rehabilitation Paediatric Other Autism Dietetic & Lactation Support Early School Age Program Exercise & Nutrition Fetal Alcohol Spectrum Diagnostic RSV Clinic Speech Language Pathology ROP Infant Hearing Assessment/ Treatment Blind Low Vision Feeding/Swallowing Disorders Clinic Paediatric Diabetes Program Neonatal Follow-up Clinic Sault Area Hospital Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website SAH Algoma District Northern Ontario School of Medicine & Sault College Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery General Paediatrics Psychiatry RSV Clinic General Surgery Neonatology Gynecology Newborn Orthopaedic Surgery 91

99 Sioux Lookout Meno Ya Win Health Centre Acronym Main Catchment Area Primary Academic Affiliation SLMHC Year Founded 1951 Sioux Lookout, Pickle Lake, Savant & 28 Northern Communities Northern Ontario School of Medicine Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Adolescent Medicine Anaesthesiology General Surgery Child Protection Dietetic & Lactation Support Otolaryngology Emergency Medicine General Paediatrics Palliative Care Physical Medicine & Rehabilitation South Bruce Grey Health Centre Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website SBGHC Grey and Bruce Counties No formal affiliation Merged Chesley, Durham, Kincardine & Walkerton into one organization Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Newborn Otolaryngology 92

100 Southlake Regional Health Centre Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website Southlake Northern York Region and South Simcoe, and north-west Durham Region None 1920s Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Allergy & Immunology Crisis Autism General Surgery Adolescent Medicine Eating Disorder Dietetic & Lactation Support Ophthalmology Asthma Psychiatry Exercise & Nutrition Orthopaedic Surgery Child Protection Psychology Radiology Otolaryngology Developmental Paediatrics RSV Clinic Plastic Surgery Emergency Medicine Speech Language Pathology Urology Endocrinology Gastroenterology General Paediatrics Haematology Neonatology Nephrology Newborn Nutrition Oncology Palliative Care Respirology 93

101 St. Joseph s Healthcare, Hamilton Acronym Main Catchment Area Primary Academic Affiliation Year Founded 1890 SJHC Hamilton Hamilton, Niagara, Haldimand, Brant (LHIN 4) McMaster University Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental/Oral Surgery General Paediatrics Otolaryngology Newborn St. Joseph s Health Centre, Toronto Acronym Main Catchment Area Primary Academic Affiliation Year Founded 1921 SJHC Toronto South West Toronto University of Toronto (Community Hospital Affiliation) Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other General Surgery Allergy Psychiatry Developmental Paediatrics Asthma Neonatal Follow-Up Clinic Emergency Medicine Occupational Therapy Endocrine Paediatric Walk-In Clinic General Paediatrics RSV Clinic Neonatology Speech Language Pathology Newborn Nutrition Pharmacology 94

102 St. Michael s Hospital Acronym Main Catchment Area Primary Academic Affiliation SMH Year Founded 1892 The main catchment for our Obstetrical, Neonatal and Paediatric population is focused on Southeast Toronto and includes the rest of GTA. University of Toronto Website Subspecialties / Services Offered Paediatric Surgical St. Thomas Elgin General Hospital Paediatric Medical Paediatric Mental Health Paediatric Other Adolescent Medicine Eating Disorders Autism Allergy & Immunology Psychiatry Dietetic & Lactation Support Cardiology Fetal Alcohol Spectrum Diagnostic Dermatology Immigrant Health/Refugee Developmental Paediatrics RSV Clinic General Paediatrics Haematology Infectious Diseases Neonatology Newborn Nutrition Acronym Main Catchment Area Primary Academic Affiliation STEGH Elgin County Western Year Founded 1954 Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery General Paediatrics Maxillofacial Neonatology Otolaryngology Newborn 95

103 Stevenson Memorial Hospital Acronym Main Catchment Area Primary Academic Affiliation Stevenson The hospital s primary service area includes the Township of Adjala- Tosorontio, Canadian Forces Base Borden (CFBB), Essa, Innisfil and New Tecumseth None Year Founded 1928 Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Stratford General Hospital Site of Huron Perth Healthcare Alliance Acronym Main Catchment Area Primary Academic Affiliation Year Founded 1891 SGH HPHA Huron and Perth, parts of Middlesex and Oxford University of Western Ontario Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental/Oral Surgery Allergy & Immunology Crisis Anaesthesiology General Surgery Adolescent Medicine Eating Disorders Dietetic & Lactation Support Gynecology Asthma Psychiatry Early School Age Program Ophthalmology Development Paediatrics Psychology Radiology Orthopaedic Surgery Emergency Medicine Speech Language Pathology Otolaryngology General Paediatrics Plastic Surgery Newborn Urology Nutrition 96

104 The Scarborough Hospital Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website TSH North and South Scarborough University of Toronto 1999 through Restructuring and Amalgamation Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental/Oral Surgery Allergy & Immunology Crisis Anaesthesiology Ophthalmology Asthma Psychiatry Autism Orthopaedic Surgery Cardiology Psychology Burns Otolaryngology Child Protection Dietetic & Lactation Support Plastic Surgery Developmental Paediatrics Immigrant Health/Refugee Emergency Medicine Radiology General Paediatrics RSV Clinic Genetics / Metabolics Speech Language Pathology Infectious Diseases Neonatology Neurology Newborn Nutrition Palliative Care Pharmacology Respirology 97

105 Thunder Bay Regional Health Sciences Centre Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website TBRHSC Thunder Bay and Northwestern Ontario Area Northern Ontario School of Medicine, Lakehead University Founded in 1995, amalgamated to new facility Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Dental / Oral Surgery Cardiology (Paed Outpatient clinic) Crisis General Surgery General Paediatrics Psychology Orthopaedic Surgery Neonatology Otolaryngology Oncology Urology Paediatric Other 98

106 Toronto East General Hospital Acronym Main Catchment Area Primary Academic Affiliation TEGH Year Founded 1929 West: Etobicoke/High Park North West: Davenport/Bloor South West: West Downtown/Parkdale North Central: Midtown/Leaside/North Riverdale/Forest Hill South East: East Downtown/South Riverdale East: Old East York/East End/The Beach North East: Flemingdon/Thorncliffe/ Crescent Town/Oakridge University of Toronto Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Allergy/Immunology Crisis Dietetic & Lactation Support Gynecology Asthma Psychiatry RSV Clinic Ophthalmology Cardiology Psychology Speech Language Pathology Otolaryngology Developmental Paediatrics General Paediatrics Neonatology Neurology Newborn Nutrition Dedicated Obesity Program Respirology 99

107 Trillium Health Centre (prior known as Mississauga Hospital; now known as Trillium Health Partners) Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website THC Halton-Peel University of Toronto, Mississauga 1998 (prior Mississauga Hospital) Subspecialties / Services Offered Paediatric Surgical West Lincoln Memorial Hospital Paediatric Medical Paediatric Mental Health Paediatric Other Asthma Psychiatry Autism Cardiology Dietetic & Lactation Support Child Protection Fetal Alcohol Spectrum Diagnostic Developmental Paediatrics RSV Clinic Endocrinology Speech Language Pathology General Paediatrics Neonatology Neurology Newborn Nutrition Acronym Main Catchment Area Primary Academic Affiliation WLMH Year Founded 1946 Grimsby, West Lincoln, Lincoln McMaster University Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Otolaryngology 100

108 West Parry Sound Health Centre Acronym Main Catchment Area Primary Academic Affiliation WPSHC Year Founded 1995 District of Parry Sound Northern Ontario School of Medicine and Canadore College Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other General Paediatrics 101

109 William Osler Health System Acronym Main Catchment Area Primary Academic Affiliation Year Founded Website WOHS Located in the Central West LHIN. Our catchment area includes Brampton, Etobicoke and surrounding area. Affiliated with McMaster University, University of Toronto, Ryerson, Humber College and students from many other academic facilities. Brampton Civic Hospital: October 28, 2007 Etobicoke General Hospital: 1972 Peel Memorial Hospital: Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Adolescent Medicine Crisis Anaesthesiology General Surgery Allergy & Immunology Psychiatry Exercise & Nutrition Ophthalmology Asthma Psychology RSV Clinic Otolaryngology Cardiology Substance Abuse Speech Language Pathology Plastic Surgery Child Protection Urology Emergency Medicine Endocrinology Gastroenterology General Paediatrics Haematology Infectious Diseases Neonatology Nephrology Newborn Nutrition Palliative Care Pharmacology Respirology 102

110 Windsor Regional Hospital Acronym Main Catchment Area Primary Academic Affiliation WRH Year Founded 1928 Windsor and Essex County University of Windsor, St. Clair College, Schulich School of Medicine Website Subspecialties / Services Offered Paediatric Surgical Paediatric Medical Paediatric Mental Health Paediatric Other Dental / Oral Surgery Allergy & Immunology Crisis Anaesthesiology General Surgery Adolescent Medicine Eating Disorders Autism Gynecology Asthma Psychiatry Burns Maxillofacial Cardiology Psychology Dietetic & Lactation Support Ophthalmology Child Protection Substance Abuse Exercise & Nutrition Orthopaedic Surgery Dedicated Obesity Fetal Alcohol Spectrum Diagnostic Otolaryngology Program Immigrant Health/Refugee Plastic Surgery Dermatology Radiology Urology Development Paediatrics RSV Clinic Emergency Medicine Speech Language Pathology Endocrinology Gastroenterology General Paediatrics Genetics / Metabolics Infectious Diseases Neonatology Neurology Newborn Nutrition Oncology Palliative Care Pharmacology Physical Medicine & Rehabilitation Respirology 103

111 Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical PCMCH Maternal-Child Benchmarking Report 2012 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 300. 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. AMGH BCHS BGH BWH CCH CGMH CMH CVH Beds Level I a b a Perinatal Level II b c Level III a b SUBTOTAL PERINATAL Level I a b a Neonatal Level II b c Level III a b SUBTOTAL NEONATAL Med/Surg Mental Health Other TOTAL Notes AMGH: AMGH has no dedicated paediatric inpatient acute care beds. Youth between 16 and 17 years are at times admitted to Adult Inpatient Mental Health Schedule 1 Unit (20 beds). BGH: The whole 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, 1 semi-private room, and one 3-bed ward. BWH: Two designated beds for paediatric outpatient surgery/observation. BWH operates 10 inpatient paediatric beds and 10 post-partum inpatient beds. CCH: The whole unit takes 17 patients 10 funded obstetrical beds (sometimes used for medical or surgical patients) and 7 funded paediatrics 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 paediatrics 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 patients occupy the 10 funded beds. 104

112 Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical PCMCH Maternal-Child Benchmarking Report 2012 Bed Profiles (cont) GBHS GRH HHCC HHS HRRH HSN JBMH LH Beds Level I a b a Perinatal Level II b c Level III a b SUBTOTAL PERINATAL Level I a b a Neonatal Level II b c Level III a b SUBTOTAL NEONATAL Med/Surg Mental Health Other TOTAL Notes JBMH: Perinatal Beds: B - includes Labour and Delivery beds in the L&D Suite (6). Neonatal Beds: Includes 5 bassinets in the Level 2A Special Care Nursery (SCN). Renovations to the SCN during the Fall of 2012 may impact available beds. LH: Mental Health Child and Youth beds officially opened August Therefore, staffed and in operation beds only reflects the actual numbers since this unit has been opened. 105

113 Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical PCMCH Maternal-Child Benchmarking Report 2012 Bed Profiles (cont) MH MHA - SMGH Montfort MSH NBRHC NHS NYGH OSMH Beds Level I a b a Perinatal Level II b c Level III a b SUBTOTAL PERINATAL Level I a b a Neonatal Level II b c Level III a b SUBTOTAL NEONATAL Med/Surg Mental Health Other TOTAL Notes MSH: Perinatal beds listed above include Labour, Birth and Postpartum beds. MSH has a shared floor with post partum and L&D for paediatrics and is able to surge to meet capacity demands on a case by case basis above 5 paediatric beds listed above. 106

114 Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical PCMCH Maternal-Child Benchmarking Report 2012 Bed Profiles (cont) PRH PRHC QHC RMH RVH RVHS SAH SBGHC Beds Level I a b a Perinatal Level II b c Level III a b SUBTOTAL PERINATAL Level I a b a Neonatal Level II b c Level III a b SUBTOTAL NEONATAL Med/Surg Mental Health Other TOTAL Notes PRHC: In the med/surg area, the bed count varies with demand. PRHC has 6 paediatric beds for part of the year, and 10 paediatric beds for the rest of the year. Therefore, 8 beds have been reported. 107

115 Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical PCMCH Maternal-Child Benchmarking Report 2012 Bed Profiles (cont) SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH TEGH Beds Level I a b a Perinatal Level II b c Level III a b SUBTOTAL PERINATAL Level I a b a Neonatal Level II b c Level III a b SUBTOTAL NEONATAL Med/Surg Mental Health Other TOTAL Notes TEGH: Total number of maternal beds has been reduced by 1 to create a recovery room for maternal patients. 108

116 Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical Staffed / In Operation Physical PCMCH Maternal-Child Benchmarking Report 2012 Bed Profiles (cont) THC TSH WOHS WPSHC WRH Total Beds Level I a b a Perinatal Level II b c Level III a b SUBTOTAL PERINATAL ,098 Level I a b a Neonatal Level II b c Level III a b SUBTOTAL NEONATAL Med/Surg Mental Health Other TOTAL ,943 2,195 Notes WRH: Level of care is self designated and subject to confirmation. 109

117 Emergency Department Profiles Alexandra Marine & General Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes Assessment vital signs, cap refill, weight, subjective and objective assessment triage based on presentation and vital signs according to the CTAS guidelines. No Fast Track System. Nurse Practitioner is utilized to move large volumes of IV & V. Paediatric medical directives in place, i.e. Tylenol/Advil for fever; Oral Rehydration, for use by RNs. Bluewater Health Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic The Short Stay Unit for the paediatric population would be for the 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. Combined No Yes CTAS guidelines, separate Paediatric assessment tool. Currently developing a See and Treat Pathway through EDPIP for levels 4 & 5. Brant Community Healthcare System Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes All paediatric patients are weighed and have a full set of vitals taken. Nurses are certified in both adult and paediatric triage. The hospital has a RADAR unit rapid assessment and discharge area. 110

118 Brockville General Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes 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 is used if possible when the 2nd physician comes in 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 Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes 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. CMH has a sub-acute/fast Track area with 5 stretchers and 6 chairs. The Nurse Practitioners work in this area from 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 Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No No Paediatric Patients are triaged based on the CTAS guidelines See and Treat Area. 111

119 Cornwall Community Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic Yes Combined No Yes Paediatric patients presenting to adult/paediatric combined ED are triaged as per the pediatric CTAS guidelines. The ED have implemented a See and Treat model of care where CTAS 3, 4, 5 ambulatory patients not requiring cardiac monitoring are directed. Credit Valley Hospital (now known as Trillium Health Partners) Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes Paediatric CTAS guidelines are followed from presentation at the triage desk upon arrival to the ED 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. Paediatric patients triaged at levels 4 and 5 are less urgent and 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. CVH had short term support from the LHIN to pilot a paeds ED team of nurse, respiratory therapy and child life specialist which has proven very positive with families/patients and staff. 112

120 Grand River Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process: Fast Track / Quick Care / Medical Walk-in Clinic: No Combined No Yes Minor Treatment area for all patients (levels 3, 4 & 5) which is staffed with nurse practitioners, with support from physicians. These patients are initially triaged with general group of patients and then brought into MT area, have initial assessment by nurse, wait, and then are seen by NP or MD. Levels 3, 4 & 5 newborns are expedited into MT area to prevent exposure. See Triage Process. Grey Bruce Health Services Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes All patients are triaged electronically using CTAS guidelines. Fast Track area operational hours Monday-Friday. Note: Will expand to 7 days per week in early

121 Halton Healthcare Services Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No - however PENC and/or PALS supported. Yes All patients are triaged first by a RN trained in Triage/Paediatric CTAS. Triage process includes utilizing P-CTAS and includes a full set of vital signs. There is a RPN and MD dedicated to fast track at the OTMH site. Fast Track is open from 1200h 2400h. They also stream CTAS 3 and some CTAS 2 patients from triage to RAZ (Rapid Assessment Zone), which is operational h Sunday to Thursday and h Friday and Saturday. 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 hours at the MDH site and during peak evening 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 Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes Meditech system for electronic documentation - special triage screen for pediatric patients. "See and Treat Zone" in the Emergency Department for stable, 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. 114

122 Health Sciences North/Horizon Santé-Nord Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes 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. Green Zone, 2 RN s, 1 Ward Clerk, with MD coverage, which operates daily for appropriate CTAS 3, 4 and 5. Hôpital Montfort Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic Yes Combined No Yes Triage is completed as usual; VS, weight are taken into consideration. Fast Track area. Humber River Regional Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes Paediatric patients are triaged based on CTAS guidelines. There is a Rapid Assessment area and an ED Fast Track where 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. 115

123 Joseph Brant Memorial Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic Yes Clinical Decision Unit - Patients who meet the unit's protocols are admitted to the unit for observation. Max LOS < 24 hours. Combined No Yes Paediatric triage is completed in area used for all presenting patients. EMAaT (Emergency Minor Assessment and Treatment Area) open from 10:00 to 22:00 daily. Lakeridge Health Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes Use the OHA PCTAS Guidelines LH has a Paediatric Fast Track Program Mackenzie Health (formerly York Central) Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes 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. There is a triaging process that separates patients based on zones 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. 116

124 Markham Stouffville Hospital Corporation Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes 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. Fast Track clinic open early morning until 23:00 hrs daily to accommodate appropriate Level IV & V patients. Middlesex Hospital Alliance Strathroy Middlesex General Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process: Fast Track / Quick Care / Medical Walk-in Clinic: No Combined No Yes Triaged using paediatric guidelines through same process as adults. Green zone area to Fast Track Level IV and V, dedicated nurse and geographical area. Niagara Health System Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes 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. All paediatric patients are triaged and seen by a RN and then cared for by the ERP. Based upon this initial assessment, the ERP will determine if a paediatric consult is required. 117

125 North Bay Regional Health Centre Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes Present to triage nurse and complaints follow the CTAS guidelines. Go through the See and Treat area. Physician starts at noon until North York General Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes Every Patient is triaged according to the Canadian Triage Acuity Scale. This includes Paediatric modifiers. Yes. At Triage, patients are highlighted for our Ambulatory Care 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 Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic Yes. CDU. Held in CDU (Clinical Decision Unit) up to 24 hours. In order to qualify for the CDU the patient must have one of the following conditions: Head Injury; Blood Transfusion; Chest Pain; Allergic Reaction; Asthma/COPD; Paediatric Asthma, Abdominal Pain; Adult vomiting and Dehydration. The patient is then either admitted as in inpatient to our facility, discharged home, or transferred out to another facility. Combined No No Triaged by an RN and seen by a physician based on presenting acuity. Rapid Assessment area for low acuity visits and ambulatory CTAS 3 patients. 118

126 Orillia Soldiers Memorial Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic Yes. <12 hour LOS on Paeds unit (Paediatric Day Care Clinic). Combined No Yes Levels 1, 2 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. Community walk in clinics, rapid access family physicians, direct admission to acute care paediatrics (bypassing the emergency department). Pembroke Regional Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic Yes. The paediatric patients are observed for 24 hours then reassessed for need for admission. Combined No Yes CTAS guidelines, paediatric patients are seen before adults if arrival time is the same. Implemented a See and Treat Zone for mobile patients which would expedite children visits in the ED. Peterborough Regional Health Centre Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes/No CTAS guidelines with adult and paediatric modifiers and paediatric assessment triangle are used. Ambulatory Care Area (Fast Track Area). 119

127 Quinte Health Care Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes CTAS Guidelines No specific paediatric triage forms Fast Track areas during certain times of day in both the Belleville and Trenton emergency departments of Quinte Health Care. Ross Memorial Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic Yes. 24 hour observation unit 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 PRHC peads in the ED for admission if child has not improved Combined No Yes All children present to RN who perform complete set of vitals and child s weight on arrival to the ED then triage score is assigned RMH flows CTAS 4 & 5 children to a different area; RMH opens "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 Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined Yes Yes All patients are triaged according to Paediatric CTAS Guidelines on a priority basis. There is an Ambulatory Care Area adjacent to the Emergency Department, whereby 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

128 Royal Victoria Regional Health Centre Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic Yes. Results pending area staffed 24 hours by RPN's. PTs with predictable outcomes, pending DI, bw etc. Combined No Yes Same as adult but following OHA Ped CTAS guidelines and modifiers. All paeds pts weighed at triage. Minor exam area staffed 16 hours per day with RPN staff. Subacute area used for less predictable but ambulatory pts are staffed 24 hours per day with RN's. Sault Area Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic Yes. 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. Combined No Yes 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 and See and Treat unit. 121

129 Sioux Lookout Meno Ya Win Health Centre Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes Triage in ER department is the same for both paediatrics and adult patients. No South Bruce Grey Health Centre Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes CTAS guidelines No Southlake Regional Health Centre Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic Yes Combined No Yes 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 area is open 7 days a week from

130 St. Joseph s Healthcare, Hamilton Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined Yes Yes All paediatric patients (direct referrals or not) are triaged using the CTAS guidelines. CTAS IV &V are mostly seen in ambulatory area at both (King 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. Joseph s Health Centre, Toronto Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process: Fast Track / Quick Care / Medical Walk-in Clinic Yes. 36 hours admitting physician is Emergency Physician Combined No Yes Electronic triage system with paeds CTAS incorporated into it. Fast Track and Medical Directives St. Michael s Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No No Consult the paediatric CTAS scale and use clinical judgment to increase the acuity and reduce time to assessment by an MD when appropriate. St. Michael s Hospital is not a Paediatric ED but available to Paediatric Patients. Nurse Practitioner Fast Track area is open from 10am-10pm weekdays. 123

131 St. Thomas Elgin General Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes Follow Paediatric CTAS guidelines. Integrated triage with adult population. Rapid Assessment Zone open 7 days per week from h. From h Monday to Friday and on some weekends we have a 3rd physician that runs this unit. Stevenson Memorial Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process: Fast Track / Quick Care / Medical Walk-in Clinic Yes. Paediatric patients are admitted for observation depending on CTAS level and acuity. Patient may be transferred to level 2 or 3 facility. Combined No Yes The following guidelines are used: Paediatric Pain Scale, Paediatric Coma Scale, and Paediatric Vital Sign guidelines. Fast Track and use a See and Treat Program. Stratford General Hospital Site of Huron Perth Healthcare Alliance Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes Paediatric Triage Process is taught with adult triage process with specific Paediatric assessment/ratings based on national guidelines. Do not have a Fast Track area and only one ED MD on-call. Do have a 2 nd on call MD and adjust rooms that are available with an available ER RN. 124

132 The Scarborough Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes Assessed by triage RN, taken to the appropriate patient care area based on triage score, care provided, transferred or discharged. Rapid Assessment Zone (RAZ) and PaedLink Clinic where children can be transferred. Thunder Bay Regional Health Sciences Centre Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes 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 area where all uncomplicated patients are seen for quick assessment and treatment. Do not triage to walk-in clinics. Toronto East General Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes 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. CTAS 4 & 5 patients are seen in our ambulatory Green Zone. Here 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

133 Trillium Health Care (formerly known as Mississauga Hospital; now known as Trillium Health Partners) Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic Yes. The model of care has changed in ED with a virtual CDU and a redesigned Rapid Access Zone to facilitate the flow of CTAS 3 patients and stable triage 2 patients. Paediatric No Yes Children are triaged by a CTAS trained RN using CTAS guidelines and placed in the appropriate treatment waiting areas until a bed is ready. We have separate Paediatric Triage Assessment Forms and use the PAT, Paediatric Assessment Triangle based on P-CTAS guidelines. Children with CTAS>3 ( and CTAS 4/5 as indicated) have a full set of vital signs with weight obtained at Triage. In our ED we have a dedicated paeds waiting room with access to exam rooms for CTAS 3 and access to the Treatment Hall for CTAS 4/5. Paeds CTAS 3 are processed through the RAZ based on criteria to facilitate flow. THC has an after hours Kidz Klinic that is mostly run by paediatricians to reduce the pressure on the ED. We do not Triage away from Emergency, although THC does have an Urgent Care Centre at our ambulatory care centre for minor illness/injury. There are several Medical Walk-In clinics in our immediate vicinity. West Lincoln Memorial Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No No 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. Currently working on medical directives. There is a second physician on call with parameters for calling in due to large volumes. 126

134 West Parry Sound Health Centre Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes CTAS guidelines & paediatric 1st & 2nd order modifiers and enhanced based tools (e.g. CIAMPEDS) During high volume time periods, Fast Track is used for peak times. Standardized back up MD is utilized for other high volume times. William Osler Health System Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process Fast Track / Quick Care / Medical Walk-in Clinic No Combined No Yes Triage both adults and paeds together but use the P-CTAS guidelines. There is Ambulatory care treatment centre in both EDs. Lower acuity CTAS 4, 5 patients and rapid turnaround CTAS 3 patients go to these areas. Windsor Regional Hospital Observation / Short Stay Unit / Assessment Unit Paediatric or Combined Adult/Paediatric ED Paediatric ED Nurses Paediatric CTAS Guidelines Triage Process: Fast Track / Quick Care / Medical Walk-in Clinic Yes. Only operating Mon-Fri hours. Combined No Yes All Paediatric patients that come to the ED are triaged using CTAS levels. Paediatric patients are given priority when able to be triaged faster Mon-Fri Paediatric CTAS level 3 patient with respiratory or GI symptoms come directly up to paediatrics to be seen by Paediatrician. All CTAS 4 and 5 are assessed and treated in our ambulatory hall by NPs and Emergency Room doctors. This runs 24/7. 127

135 Respiratory Therapy Profiles The table below summarizes Respiratory Therapy profile information for community hospitals. 1. Data Collection Method AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH Paper-based method 0% 100% 100% 2% n/a 100% 0% 10% 100% 0% Workload collection software 100% 0% 0% 98% n/a 0% 100% 90% 0% 100% 2. Staffing Model Dedicated Paediatric RTs NO NO NO NO NO NO NO YES NO NO 3. Paediatric RT Clinical Care Intubations Assisted/Performed n/a Bronchoscopies Assisted/Attended n/a High Frequency Oscillation Initiations n/a BiPAP/CPAP Initiations (in ICU or outside ICUs) n/a Nitric Oxide Initiations n/a Number of ventilation hours / year n/a n/a Number of ventilated patients / year n/a Ventilation hours per patient n/a 5.0 n/a n/a % of time spent by paediatric RTs on supporting transport activities for neonatal/paediatric patients* n/a 0.2% 0% 0% 0% 0% 0% 20% 2% <1% Notes BCHS: Excel-based workload measurement system. On a monthly basis, the spreadsheet is sent to Decision Support team for analysis. BGH: All stats are collected and written on paper and then put into an electronic document with the proper codes. BGH has a very small inpatient paediatric population; all critically ill children are transferred to CHEO. Regular RTs are paged when needed for a paediatric case. When a paediatric patient needs to be intubated, anesthesia or the ER physician perform the procedure. CCH: RTs work from 7am - 12midnight. After midnight they are on call and there is no specific RT assigned to pediatrics. CGMH: Excel-based workload measurement system. CVH: The RT staff enters workload electronically in a Meditech program at the end of every shift. Reports are being run via a Crystal reporting structure that was built specific to the RTs by internal IT department (monthly or when needed). There is some manual / paper collection of ancillary data that is used to justify budgets and / or requests for additional staff. This is a combined report that reflects all RT involvement for NICU / L&D and Paediatric populations. CVH has dedicated RTs for NICU / L&D, but coverage for paediatric calls is provided from the pool of RTs working any shift. The majority of the intubations and ventilation hours refer to the neonatal population. GBHS: Manual paper-based documentation of monthly statistics/workload. Intubations Assisted/Performed: 2 paeds, 6 Neonatal, subsequent invasive ventilation. BiPAP/CPAP initiations: 0 paediatric and 24 neonatal. Critical Care RT on duty is also responsible to respond to Intensive Care Nursery as needed. There are very small volumes of vented paediatric patient care for in the Adult ICU. GRH: RTs collect workload electronically in the HED documentation system by manually entering patient specific data each shift. There are no RTs dedicated to paediatric or neonatal care at GRH. There are 4 RTs on shift on days and 3 on shift on nights. Any of these RTs may provide paediatric/neonatal care. The majority of intubations, BIPAP/CPAP initiations, ventilator hours, and ventilated patients are in the neonatal population. 128

136 Respiratory Therapy Profiles (cont) 1. Data Collection Method HHCC HHS HRRH HSN JBMH LH MH Montfort MSH NHS Paper-based method 0% 0% 0% 100% 0% 0% 100% 25% 0% 0% Workload collection software 100% 100% 100% 0% 100% 100% 0% 75% 100% 100% 2. Staffing Model Dedicated Paediatric RTs NO NO NO YES NO NO NO NO NO NO 3. Paediatric RT Clinical Care Intubations Assisted/Performed Bronchoscopies Assisted/Attended 0 0 n/a High Frequency Oscillation Initiations 0 0 n/a BiPAP/CPAP Initiations (in ICU or outside ICUs) Nitric Oxide Initiations 0 0 n/a Number of ventilation hours / year , n/a Number of ventilated patients / year n/a Ventilation hours per patient n/a n/a n/a 3.3 n/a 4.0 n/a n/a % of time spent by paediatric RTs on supporting transport activities for neonatal/paediatric patients* 0% 0% 50% 5% 0% 65% 0% 0% 1% 2% Notes HHCC: RT workload is captured electronically from documentation of interventions. HHCC Included NCPAP in ventilated numbers listed above. HHS: Meditech and InfoMed are used to collect RT workload. All RRT FTEs (21.6) across all 3 sites respond to pediatric calls with the only exception being 1.8 FTE assigned to home care and outpatient Asthma Clinic. All RRT staff have CPR and NRP training. Total of 476 ventilation hours per year includes 445 CPAP hours. HRRH: No Paediatric ICU. HRRH provides intubations and then transfers to outside hospital. HSN: Statistics captured on paper by RTs and entered into an Access database on a daily basis. JBMH: RRTs enter workload electronically. This is consolidated monthly in an electronic report using InfoMed. LH: Electronic via MEDITECH, Interventions are patient specific with MIS workload assigned in the background. Information includes NICU - intubation for ventilation (occasional intubation for surfactant admin only). Bipap/CPAP includes Sipap. MH: Each RT submits at end of each shift the number of intubations, high risk births and CPAP they supported. Collated by RT coordinator and submitted monthly. Looking at expanded skill set for RTs to have PALS certification and umbilical vein insertion. Montfort: All the data is electronic except ED which is paper-based. MSH: MSH does patient specific workload and uses CIHI data. Workload is documented after all patient care and submitted monthly. NHS: Billable workload is captured through our Meditech ITS system. All non-billable procedures and non-patient care workload is captured through GRASP. 129

137 Respiratory Therapy Profile (cont) 1. Data Collection Method NBRHC NYGH OSMH PRH PRHC QHC RVH RVHS SAH SGH HPHA Paper-based method 100% n/a 0% 0% 95% 0% 0% 5% 0% 0% Workload collection software 0% n/a 100% 100% 5% 100% 100% 95% 100% 100% 2. Staffing Model Dedicated Paediatric RTs NO NO NO NO NO NO NO NO NO NO 3. Paediatric RT Clinical Care Intubations Assisted/Performed 11 n/a Bronchoscopies Assisted/Attended (rare) High Frequency Oscillation Initiations BiPAP/CPAP Initiations (in ICU or outside ICUs) 18 n/a Nitric Oxide Initiations Number of ventilation hours / year n/a Number of ventilated patients / year 11 n/a n/a Ventilation hours per patient 43.6 n/a 25.4 n/a n/a n/a % of time spent by paediatric RTs on supporting transport activities for neonatal/paediatric patients* 1% 0% 1% 0% 0% 5% 0% <1 5% 5-10% Notes NBRHC: RT complete stats based on MIS guidelines for all work completed on shift. Paper copy is given to clerks who enter information electronically. NYGH: Workload data is not currently collected at the clinical level. Finance department provides a proxy to the Ministry of Health. Question 3.2 (A) Number of ventilation hours / year (paediatric patients only) - this number may not be accurate as NYGH does not have a reliable method of collecting this data. OSMH: Emerld Workload Operating System is used to capture RT workload. Data for paediatric patient care activities / interventions includes total numbers for ages 0-17 yrs. QHC: Meditech is used for data collection of procedures and workload. QHC has increased the scope to respond to all high risk deliveries while continuing its role with intubated patients. An RT is available 24 hours per day and 7 days per week for assistance of neonatal and paediatric patients. Paediatricians and Anaesthesia staff continue to provide a majority of the intubation support. RVH: Meditech is used to capture RT workload data. RVHS: Workload is collected and entered using Meditech. It is patient-specific, with amount of time entered per procedure on a specific patient. It is further categorized into Therapeutic, Diagnostic, and non-service Recipient. Visits to L&D are tracked using Excel. No dedicated RTs for pediatrics. Their role is shared amongst multiple areas. On any given shift there are at least 2 RTs on, any RT can service paediatrics. SAH: RT staff fills in workload stats after each shift. Data is manually entered using InfoMed. RTs attend high risk deliveries and C-sections at the hospital. 130

138 Respiratory Therapy Profiles (cont) 1. Data Collection Method Southlake SJHC Hamilton SJHC Toronto STEGH TBRHSC TEGH THC TSH WOHS WRH Paper-based method 0% 0% 100% 5% 100% 0% 0% 100% 0% 100% Workload collection software 100% 100% 0% 95% 0% 100% 100% 0% 100% 0% 2. Staffing Model Dedicated Paediatric RTs YES NO Yes NO NO NO NO NO NO Yes 3. Paediatric RT Clinical Care Intubations Assisted/Performed Bronchoscopies Assisted/Attended 0 n/a High Frequency Oscillation Initiations 0 n/a BiPAP/CPAP Initiations (in ICU or outside ICUs) > Nitric Oxide Initiations 0 NA Number of ventilation hours / year 0 n/a 3,076 n/a n/a ,864 n/a Number of ventilated patients / year 20 n/a 133 n/a > Ventilation hours per patient n/a n/a 23.1 n/a n/a 1.4 n/a n/a 15.5 n/a % of time spent by paediatric RTs on supporting transport activities for neonatal/paediatric patients* 0% 0% 1% 0% 0% 2% 0% 0% 0% 0% Notes Southlake: RT Ware electronic tool is used to capture RT workload. We currently have approximately 2 FTE to cover all wards (adult med/surg, cardiac wards, cardiac clinics, L &D, paediatrics and the NICU). 1 RT covers all of these areas. It is difficult to estimate the % of time devoted to pediatrics. SJHC Hamilton: Workload entered into STAR. The RTs responsible for paediatrics cover the entire hospital with the exception of the adult ICU. 5 RTs on days and 4 on nights. All RTs rotate to paediatrics/neonatology. SJHC Hamilton provides short term (<24 hours) ventilation and provides CPAP regularly. SJHC Toronto: Workload measurements are based on the CIHI tool for RT workload data collection. Ventilated patients and ventilation hours include both invasive and non-invasive forms of ventilation. Attend on an annual basis a minimum of 1,400 deliveries plus they attend all meconium deliveries. Ventilated patients and ventilation hours include both invasive and non-invasive forms of ventilation. The RT's also obtain biannually NRP certification as well as attend Mock Code Pink Neonatal and Paediatrics on an annual basis. STEGH: RTs are not area dedicated, only available organization wide. RT workload is entered electronically through InfoMed. TBRHSC: Excel is used to manually capture RT data. The data is submitted to the Finance department, which later uploads it to MIS database. TBRHSC has 4 RTs on days and 3 on nights. TBRHSC sees pediatric patients in ED. RNs on perform the aerosol treatments on paediatric patients. TEGH: RTs enter data themselves on shift by shift basis. TEGH does not have dedicated paediatric RTs and the education provided to staff and physicians is supported by the supervisor in IPP who is an RT but not part of the FTE allotment. The RT responsible for paediatrics covers the entire hospital with the exception of the adult ICU. All RTs rotate to paediatrics. The number of paediatric RT FTEs provided above relates to time with paediatric patients in any location in hospital. THC: Each RT is responsible for inputting aggregate data on a shift by shift basis. Data is then downloaded and calculated at month end. TSH: Adult Ventilator Days are collected from CCIS data. Workload is benchmarked to other hospital sites using the Ministry HIT Tool. No dedicated RT for paediatric patients, the wards/hospital RT covers all areas. The majority of patients are adult. However, TSH does ventilate and provides temporary ventilatory support (in the ED and Paediatric units) until the transport team arrives. WOHS: RT workload is entered electronically through MediTech. A workload (by user) summary is reported monthly by clinical informatics. Please note that the data cited is a cumulative total between both sites. The ventilation hours are reflective of both invasive and noninvasive ventilation. WRH: Excel is used for RT data collection. It is generalized reporting of therapeutic and procedural hours. WRH has a dedicated Code Pink and Pediatric Emergency Response Team, and a dedicated RT for the NICU and Labour and Delivery. Paediatric coverage is assigned on a daily basis rotating all RT staff through this position in order to maintain competencies. 131

139 RT Data Collection Method The following table shows the percentage of Respiratory Therapy data which each community hospital collects using workload collection software, and the percentage it collects using paper-based methods. AMGH BCHS BGH BWH CGMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH Montfort MSH NHS NBRHC OSMH PRH PRHC QHC RVH RVHS SAH SGH HPHA Southlake SJHC Hamilton SJHC Toronto STEGH TBRHSC TEGH THC TSH WOHS WRH 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Paper-based method Workload collection software 132

140 Clinical Indicators 2.0 Hospital Descriptors DES Inpatient and Same Day Surgery Volumes The following chart displays the distribution between inpatient and same day surgery volumes in each facility. AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH % of Inpatient and Same Day Surgery Volumes FY 11/12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Inpatient Cases FY 11/12 SDS Cases FY 11/12 133

141 The following table displays inpatient and same day surgery volumes. Hospitals that joined the Benchmarking project in 2012 do not have data for FY 10/11. Hospital Inpatient Cases FY 10/11 FY 11/12 % Change vs Previous Year SDS Cases FY 10/11 FY 11/12 % Change vs Previous Year AMGH BCHS 1,196 1,298 9% % BGH BWH 852 1,034 21% % CCH % % CGMH CMH 1,463 1,476 1% % CVH 3,157 3,315 5% 1,644 1,788 9% GBHS % % GRH 2,871 3,013 5% 1,250 1,299 4% HHCC % % HHS 2,227 2,348 5% 950 1,140 20% HRRH 1,891 1,902 1% 1,337 1,229-8% HSN 1,452 1,520 5% % JBMH 1,155 1,082-6% % LH 2,244 2,670 19% 1,605 1,502-6% MH 1,635 1,800 10% % MHA-SMGH % % Montfort 1, % % MSH 1,587 1,569-1% % NBRHC 989 1,012 2% % NHH % % NHS 3,402 3,149-7% 1,506 1,523 1% NYGH 3,971 4,184 5% 3,161 3,179 1% OSMH 1,051 1,111 6% % PRH % % PRHC 1,712 1,578-8% 1,306 1,413 8% QHC 1,203 1,186-1% % RMH % % RVH 1,226 1,237 1% 1,363 1,431 5% RVHS 2,800 3,006 7% 1,785 1,965 10% SAH % % SBGHC SGH HPHA % % SJHC 1,082 1,109 2% % SJHC Toronto 2,113 2,064-2% % SLMHC % % SMH 1,236 1,480 20% % Southlake 2,282 2,224-3% % STEGH % % Stevenson % % TBRHSC 2,214 2,293 4% 975 1,002 3% TEGH 1,932 1,843-5% % THC 2,390 2,584 8% 1,093 1,132 4% TSH 3,337 3,216-4% 1,472 1,417-4% WLMH % % WOHS 5,913 7,373 25% 2,000 2,049 2% WPSHC WRH 2,874 2,674-7% 2,264 2,329 3% 134

142 2.1.2 DES Neonatal and Paediatric Inpatient Case Distribution This chart displays the distribution between neonatal (0-28 days) and paediatric (29 days-17 years) inpatient cases. AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH Neonatal and Paediatric Inpatient Case Distribution FY 11/12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Neonatal FY 11/12 Paediatric FY 11/12 135

143 This table displays the distribution between neonatal (0-28 days) and paediatric (29 days-17 years) inpatient cases. Hospitals that joined the Benchmarking project in 2012 do not have data for FY 10/11. Hospital Neonatal Cases FY 10/11 FY 11/12 % Change vs Previous Year Paediatric Cases FY 10/11 FY 11/12 % Change vs Previous Year AMGH BCHS % % BGH BWH % % CCH % % CGMH CMH % % CVH 1,428 1,588 11% 1,729 1,727 0% GBHS % % GRH 1,509 1,501-1% 1,362 1,512 11% HHCC % % HHS 1,156 1,115-4% 1,071 1,233 15% HRRH 1, % % HSN % 1,003 1,005 0% JBMH % % LH 1,128 1,306 16% 1,116 1,364 22% MH % % MHA-SMGH % % Montfort 1, % % MSH % % NBRHC % % NHH % % NHS 1,079 1,140 6% 2,323 2,009-14% NYGH 2,521 2,774 10% 1,450 1,410-3% OSMH % % PRH % % PRHC % 1, % QHC % % RMH % % RVH % % RVHS 1,397 1,472 5% 1,403 1,534 9% SAH % % SBGHC SGH HPHA % % SJHC Hamilton 1,019 1,038 2% % SJHC Toronto 1,278 1,212-5% % SLMHC % % SMH 1,141 1,383 21% % Southlake % 1,363 1,420 4% STEGH % % Stevenson % % TBRHSC % 1,397 1,478 6% TEGH 1,169 1,051-10% % THC 1,191 1,355 14% 1,199 1,229 3% TSH 2,029 1,937-5% 1,308 1,279-2% WLMH % % WOHS 2,714 3,950 46% 3,199 3,423 7% WPSHC WRH 1,044 1,058 1% 1,830 1,616-12% 136

144 2.1.3 DES Patient Volume Breakdown This chart summarizes the distribution of inpatient cases between medical, mental health (MH), neonatal and surgical. The data is from the DAD and does not include Ontario MH Reporting System (OMRHS) data. AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH Patient Volume Breakdown FY 11/12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Medical Mental Health Neonatal Surgical 137

145 This table summarizes the volume of inpatient cases according to medical, mental health (MH), neonatal and surgical as well as same day surgery cases. The data is from the DAD and does not include Ontario MH Reporting System (OMRHS) data. A zero volume or hospitals reporting MH cases through OMHRS will appear blank. Hospitals whose volume is less than 6 are indicated in the table as <6. Hospital Inpatient Cases Medical Mental Health Neonatal Surgical Inpatient Cases: Total SDS Cases: Total AMGH 14 <6 21 < BCHS , BGH BWH , CCH CGMH CMH , CVH 1, , ,315 1,788 GBHS GRH , ,013 1,299 HHCC HHS , ,348 1,140 HRRH ,902 1,229 HSN , JBMH , LH , ,670 1,502 MH 651 < , MHA-SMGH 15 < Montfort < MSH 322 < , NBRHC , NHH 41 < NHS 1, , ,149 1,523 NYGH , ,184 3,179 OSMH , PRH 164 < PRHC ,578 1,413 QHC , RMH RVH ,237 1,431 RVHS 1, , ,006 1,965 SAH SBGHC 31 <6 61 < SGH HPHA SJHC Hamilton 44 1, , SJHC Toronto , , SLMHC SMH 46 <6 1, , Southlake , STEGH 273 < Stevenson 58 < TBRHSC ,293 1,002 TEGH , , THC 1,022 <6 1, ,584 1,132 TSH 1,071 <6 1, ,216 1,417 WLMH < WOHS 2, , ,373 2,049 WPSHC 46 < WRH 1, , ,674 2,

146 2.1.4 DES Inpatient Case Age Profile The following chart provides the age profile of the inpatient population of each hospital. The age categories are according to the CMG+ age categories: 0-28 days, days, 1-7 years and 8-17 years. AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH Inpatient Case Age Profile FY 11/12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-28 Days Days 1-7 Years 8-17 Years 139

147 The following table provides the age profile of the inpatient population of each hospital. The age categories are according to the CMG+ age categories: 0-28 days, 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 Days 1-7 Years 8-17 Years Total AMGH 21 <6 < BCHS ,298 BGH BWH ,034 CCH CGMH 85 < CMH ,476 CVH 1, ,315 GBHS GRH 1, ,013 HHCC HHS 1, ,348 HRRH ,902 HSN ,520 JBMH ,082 LH 1, ,670 MH ,800 MHA-SMGH Montfort 932 < MSH ,569 NBRHC ,012 NHH 137 < NHS 1, ,149 NYGH 2, ,184 OSMH ,111 PRH PRHC ,578 QHC ,186 RMH 135 < RVH ,237 RVHS 1, ,006 SAH SBGHC 61 < SGH HPHA SJHC Hamilton 1, ,109 SJHC Toronto 1, ,064 SLMHC SMH 1, ,480 Southlake ,224 STEGH Stevenson 62 < TBRHSC ,293 TEGH 1, ,843 THC 1, ,584 TSH 1, ,216 WLMH WOHS 3, ,605 1,226 7,373 WPSHC WRH 1, ,

148 2.1.5 DES Same Day Surgery Age Profile This chart provides a description of the age profile of the same day surgery (SDS) population of each hospital. AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH Same Day Surgery Age Profile FY 11/12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-28 days days 1-7 years 8-17 years Notes SJHC Hamilton: Due to CIHI submission errors, the data reported in the 0-28 days age category is inaccurate. SJHC Hamilton has zero volume in this age category for FY 2011/

149 This table provides a numerical breakdown 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 days 1-7 years 8-17 years Total AMGH BCHS BGH < BWH < CCH < CGMH < CMH < CVH <6 45 1, ,788 GBHS GRH < ,299 HHCC < HHS ,140 HRRH < ,229 HSN JBMH < LH ,502 MH MHA-SMGH Montfort MSH < NBRHC < NHH < NHS ,523 NYGH 116 2, ,179 OSMH PRH PRHC ,413 QHC < RMH RVH < ,431 RVHS ,965 SAH <6 < SBGHC SGH HPHA SJHC Hamilton < SJHC Toronto SLMHC SMH Southlake < STEGH < Stevenson < TBRHSC ,002 TEGH THC ,132 TSH < ,417 WLMH WOHS 7 1, ,049 WPSHC < WRH 12 1, ,329 Notes SJHC Hamilton: Due to CIHI submission errors, the data reported in the 0-28 days age category is inaccurate. SJHC Hamilton has zero volume in this age category for FY 2011/

150 2.1.6 DES ALOS The following chart provides 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. A provincial comparator of all Ontario hospitals (excluding paediatric Academic Health Sciences Centres) has been added. AMGH MHA-SMGH Stevenson HHCC CGMH WLMH BGH SBGHC PRH WPSHC RMH NHH CCH SLMHC CMH JBMH SGH HPHA MSH STEGH NHS MH BWH QHC THC BCHS Montfort TSH PRHC HHS LH NYGH ON Community Hospitals WOHS NBRHC SAH HRRH GBHS SJHC Toronto RVHS Southlake HSN RVH TEGH GRH OSMH WRH CVH TBRHSC SMH SJHC Hamilton Total ALOS FY 11/

151 The following table provides 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 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. Hospital ALOS 10/11 ALOS 11/12 % Change vs Previous Year AMGH 1.6 BCHS % BGH 2.0 BWH % CCH % CGMH 2.0 CMH % CVH % GBHS % GRH % HHCC % HHS % HRRH % HSN % JBMH % LH % MH % MHA-SMGH % Montfort % MSH % NBRHC % NHH % NHS % NYGH % OSMH % PRH % PRHC % QHC % RMH % RVH % RVHS % SAH % SBGHC 2.0 SGH HPHA % SJHC Hamilton % SJHC Toronto % SLMHC % SMH % Southlake % STEGH % Stevenson % TBRHSC % TEGH % THC % TSH % WLMH % WOHS % WPSHC 2.2 WRH % Ontario Community Hospitals % 144

152 2.1.7 DES Neonatal and Paediatric ALOS The following charts 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 provincial comparator of all Ontario hospitals (excluding paediatric Academic Health Sciences Centres) has been added. Neonatal ALOS FY 11/12 AMGH CGMH SBGHC SLMHC WLMH Stevenson NHH PRH RMH HHCC CCH MHA-SMGH WPSHC BGH CMH Montfort MSH HHS QHC NYGH MH THC JBMH SGH HPHA WOHS SJHC Toronto TSH LH STEGH HRRH ON CHs NHS TEGH RVHS GRH BWH PRHC GBHS Southlake BCHS SAH NBRHC SMH HSN WRH SJHC Hamilton CVH RVH OSMH TBRHSC Paediatric ALOS FY 11/12 MHA-SMGH WLMH Stevenson AMGH BGH PRH JBMH HHCC WPSHC SGH HPHA MSH BCHS RMH STEGH NHH CCH NHS MH BWH CGMH SBGHC CMH TSH QHC PRHC RVH NBRHC THC Montfort OSMH SLMHC CVH LH ON CHs SAH HSN GBHS NYGH HRRH WOHS RVHS Southlake HHS WRH TBRHSC SJHC Toronto GRH TEGH SMH 9.2 SJHC Hamilton Notes ON CHs = Ontario Community Hospitals PRHC: FY 2011/12 ALOS includes eating disorder patients. PRHC is monitoring these results with a target of reducing ALOS in their funded eating disorder program. 145

153 The following table provides 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. Hospitals that joined the Benchmarking project in 2012 do not have data for 10/11. A provincial comparator of all Ontario hospitals (excluding paediatric Academic Health Sciences Centres) has been added. Hospital 10/11 11/12 Neonatal ALOS % Change vs Previous Year 10/11 11/12 Paediatric ALOS % Change vs Previous Year AMGH BCHS % % BGH BWH % % CCH % % CGMH CMH % % CVH % % GBHS % % GRH % % HHCC % % HHS % % HRRH % % HSN % % JBMH % % LH % % MH % % MHA-SMGH % % Montfort % % MSH % % NBRHC % % NHH % % NHS % % NYGH % % OSMH % % PRH % % PRHC % % QHC % % RMH % % RVH % % RVHS % % SAH % % SBGHC SGH HPHA % % SJHC Hamilton % % SJHC Toronto % % SLMHC % % SMH % % Southlake % % STEGH % % Stevenson % % TBRHSC % % TEGH % % THC % % TSH % % WLMH % % WOHS % % WPSHC WRH % % ON CHs % % Notes ON CHs = Ontario Community Hospitals PRHC: FY 2011/12 ALOS includes eating disorder patients. PRHC is monitoring these results with a target of reducing ALOS in their funded eating disorder program. 146

154 2.1.8 DES 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 11/12 ARIW is shown. AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH Total Average Inpatient Weight per Case FY 11/

155 The following table provides the average inpatient weight per case for neonatal and paediatric populations as well as the total average inpatient weight per case. The value of 1.0 represents a "typical" inpatient case. Due to a change in CMG & Grouper methodology only 11/12 ARIW is shown. Hospital FY 11/12 ARIW Neonatal Paediatric Total AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH

156 2.1.9 DES Percent Typical, Outlier & Other Inpatient Cases and Patient Days These charts display the percentage of inpatient cases and associated days 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 Distribution FY 11/12 Patient Days Distribution FY 11/12 AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH 0% 20% 40% 60% 80% 100% Typical Other Outlier 0% 20% 40% 60% 80% 100% Typical Other Outlier 149

157 This table displays the percentage of inpatient cases and associated patient days classified as Typical, Outlier or Other. Hospital Cases Typical Other Outlier Typical Other Outlier AMGH 74.4% 25.6% 79.0% 21.0% BCHS 88.4% 8.4% 3.2% 69.7% 16.0% 14.3% BGH 93.0% 7.0% 95.2% 4.8% BWH 94.5% 3.0% 2.5% 79.6% 5.5% 14.9% CCH 93.9% 5.6% 0.5% 93.8% 4.6% 1.6% CGMH 71.1% 28.9% 80.3% 19.7% CMH 93.1% 6.4% 0.5% 90.0% 8.2% 1.8% CVH 89.2% 7.2% 3.6% 73.5% 16.0% 10.5% GBHS 90.3% 7.6% 2.1% 80.0% 12.6% 7.4% GRH 91.3% 6.7% 2.0% 75.7% 17.3% 7.0% HHCC 87.4% 11.3% 1.3% 82.9% 12.7% 4.4% HHS 92.2% 6.2% 1.6% 82.4% 9.0% 8.5% HRRH 88.0% 9.4% 2.6% 78.4% 13.0% 8.6% HSN 87.3% 9.7% 3.0% 77.4% 12.3% 10.3% JBMH 92.6% 5.1% 2.3% 79.5% 7.8% 12.8% LH 90.3% 8.8% 0.9% 76.4% 18.2% 5.4% MH 94.0% 4.9% 1.1% 82.6% 11.2% 6.2% MHA-SMGH 89.7% 8.8% 1.5% 87.4% 7.2% 5.4% Montfort 89.3% 9.9% 0.8% 89.2% 8.5% 2.2% MSH 92.7% 6.4% 0.9% 82.1% 13.6% 4.3% NBRHC 88.1% 9.1% 2.8% 72.1% 13.2% 14.7% NHH 85.9% 13.2% 1.0% 84.9% 9.0% 6.1% NHS 91.7% 6.4% 1.9% 81.1% 11.4% 7.6% NYGH 93.0% 5.6% 1.4% 77.5% 16.2% 6.3% OSMH 83.7% 12.9% 3.4% 71.8% 15.4% 12.8% PRH 92.8% 7.0% 0.2% 94.5% 5.0% 0.5% PRHC 91.5% 6.5% 2.0% 81.4% 12.0% 6.6% QHC 90.2% 7.2% 2.6% 78.3% 11.0% 10.7% RMH 89.7% 9.8% 0.5% 91.6% 7.2% 1.2% RVH 92.1% 5.7% 75.4% 13.6% RVHS 91.8% 5.7% 2.5% 70.6% 14.5% 14.8% SAH 89.7% 8.1% 2.2% 86.5% 6.6% 7.0% SBGHC 91.9% 8.1% 93.4% 6.6% SGH HPHA 88.0% 10.8% 1.2% 71.1% 22.6% 6.3% SJHC Hamilton 79.3% 16.0% 4.8% 50.1% 33.9% 16.0% SJHC Toronto 90.9% 7.5% 1.6% 74.0% 15.7% 10.3% SLMHC 90.9% 8.1% 1.0% 92.2% 5.5% 2.2% SMH 87.4% 11.2% 1.4% 61.8% 32.5% 5.7% Southlake 90.8% 7.2% 1.9% 81.5% 11.7% 6.8% STEGH 91.0% 6.7% 2.2% 73.4% 14.0% 12.7% Stevenson 82.8% 17.2% 88.7% 11.3% TBRHSC 91.3% 5.2% 3.5% 81.9% 8.1% 10.0% TEGH 90.7% 7.8% 1.5% 75.2% 19.3% 5.6% THC 93.3% 4.5% 2.1% 78.1% 13.4% 8.6% TSH 93.9% 4.6% 1.5% 79.3% 14.6% 6.1% WLMH 81.4% 18.6% 88.3% 11.7% WOHS 92.2% 5.6% 2.2% 79.4% 10.5% 10.2% WPSHC 87.5% 12.5% 91.4% 8.6% WRH 91.1% 7.3% 1.6% 83.5% 11.6% 4.9% Days 150

158 This table displays the number of inpatient cases and associated patient days classified as Typical, Outlier or Other. Hospital Cases Days Typical Other Outlier Typical Other Outlier AMGH BCHS 1, , BGH BWH , CCH <6 1, CGMH CMH 1, , CVH 2, ,967 2,386 1,569 GBHS , GRH 2, ,961 2, HHCC HHS 2, , HRRH 1, , HSN 1, , JBMH 1, , LH 2, ,155 1, MH 1, , MHA-SMGH 61 6 < Montfort , MSH 1, , NBRHC , NHH < NHS 2, ,417 1, NYGH 3, ,403 2, OSMH , PRH < <6 PRHC 1, , QHC 1, , RMH < <6 RVH 1, , RVHS 2, ,625 1,776 1,813 SAH , SBGHC SGH HPHA , SJHC Hamilton ,627 2,458 1,157 SJHC Toronto 1, ,035 1, SLMHC < SMH 1, ,324 2, Southlake 2, ,393 1, STEGH , Stevenson TBRHSC 2, , ,068 TEGH 1, ,005 1, THC 2, ,237 1, TSH 3, ,578 1, WLMH WOHS 6, ,408 2,822 2,741 WPSHC WRH 2, ,002 1,

159 DES Percent "Transfer From" Inpatient Cases and Patient Days This chart presents the percentage of cases and associated days that were recorded as transferred from another acute care institution within CIHI coding. AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH Montfort MSH NBRHC NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH TBRHSC TEGH THC TSH WOHS WPSHC WRH % "Transfer From" Inpatient Cases and Patient Days FY 11/12 0% 5% 10% 15% 20% 25% 30% 35% 40% % Cases % Days 152

160 This table presents percentage of cases and associated days that were recorded as transferred from another acute care institution within CIHI coding. Zero volumes are blank. Hospital All Cases Neonatal Cases Paediatric Cases % Cases % Days % Cases % Days % Cases % Days AMGH 12.8% 12.9% 23.8% 22.9% BCHS 4.8% 20.6% 10.4% 29.4% 1.0% 4.9% BGH 0.5% 1.3% 1.4% 2.6% BWH 0.9% 4.6% 2.2% 7.5% 0.3% 1.8% CCH 0.3% 0.8% 1.0% 2.0% CGMH 2.0% 4.1% 2.4% 6.0% 1.6% 2.1% CMH 2.0% 6.3% 3.1% 9.2% 0.6% 1.7% CVH 4.1% 15.6% 6.0% 17.0% 2.3% 12.6% GBHS 4.2% 11.9% 5.8% 12.7% 3.4% 11.2% GRH 4.3% 15.9% 4.8% 19.5% 3.8% 11.8% HHCC 1.5% 3.1% 5.6% 8.6% 0.7% 1.6% HHS 2.5% 8.6% 4.3% 15.9% 0.9% 2.3% HRRH 3.8% 11.8% 4.8% 11.9% 2.7% 11.8% HSN 4.5% 10.8% 4.5% 10.3% 4.5% 11.3% JBMH 2.4% 9.7% 3.6% 10.8% 0.8% 6.9% LH 6.0% 18.5% 5.4% 21.9% 6.5% 13.9% MH 2.1% 11.0% 2.7% 12.5% 1.4% 7.9% Montfort 2.4% 5.5% 2.3% 5.0% 16.7% 54.8% MSH 2.5% 11.4% 3.3% 14.6% 1.2% 1.5% NBRHC 5.8% 11.4% 4.1% 8.5% 7.1% 15.7% NHS 2.8% 10.9% 6.8% 18.8% 0.4% 1.9% NYGH 3.9% 18.7% 3.7% 18.4% 4.2% 19.3% OSMH 9.1% 16.2% 16.2% 19.0% 3.9% 11.2% PRH 0.2% 0.2% 0.6% 0.7% PRHC 4.2% 10.1% 6.2% 13.0% 2.8% 5.8% QHC 2.1% 9.6% 3.0% 12.5% 0.8% 3.2% RMH 0.5% 0.5% 1.7% 1.8% RVH 2.9% 11.2% 3.6% 11.1% 2.4% 11.3% RVHS 3.8% 17.1% 4.3% 20.1% 3.3% 13.1% SAH 3.4% 5.0% 2.2% 5.6% 3.9% 4.5% SBGHC 1.0% 0.5% 1.6% 0.9% SGH HPHA 5.6% 20.7% 9.8% 29.6% 2.2% 6.5% SJHC Hamilton 14.5% 36.6% 12.1% 30.6% 49.3% 90.4% SJHC Toronto 5.2% 15.0% 5.9% 21.4% 4.1% 5.5% SLMHC 0.7% 0.4% 0.7% 1.1% 0.6% 0.0% SMH 9.3% 32.6% 8.0% 29.4% 27.8% 60.4% Southlake 4.5% 10.8% 5.7% 15.2% 3.9% 7.4% STEGH 3.2% 15.6% 7.2% 27.8% 0.9% 1.3% TBRHSC 2.6% 6.0% 2.6% 7.4% 2.6% 4.5% TEGH 5.2% 18.7% 5.4% 19.1% 4.9% 18.1% THC 2.0% 11.9% 2.7% 13.0% 1.2% 10.3% TSH 2.5% 14.6% 3.0% 14.0% 1.7% 16.2% WOHS 2.4% 9.8% 2.4% 10.0% 2.4% 9.5% WPSHC 1.0% 1.0% 2.8% 2.1% WRH 2.4% 6.6% 1.5% 4.4% 3.0% 8.8% Notes OSMH: 50% of infants and children in OSMH pediatrics ward and NICU are transferred from Level 1 partners. These transfers occur from the Level 1 emergency department, OBS Unit or in utero. OSMH Level 1 centres do not admit children and have Level 1 NICUs (well newborns). This indicator is reflective of acute care to acute care transfers only, not showing the majority of OSMH transfers. SAH: Internal results indicate: Paediatric Transfers From cases = 2.6% (15 cases); All Transfers From cases = 2.4% (21 cases); Paediatric Transfers From days = 3.6% (67 days); All Transfers From days = 4.5% (148 days). 153

161 DES Percent "Transfer To" Inpatient Cases and Patient Days This chart presents the percentage of patient cases and associated days that were recorded as transfers to another acute care institution within CIHI coding. AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH % "Transfer To" Inpatient Cases and Patient Days FY 11/12 0% 5% 10% 15% 20% 25% 30% % Cases % Days 154

162 This table presents the percentage of patient cases and associated days that were recorded as transfers to another acute care institution within CIHI coding. Zero volumes are blank and a volume less than 6 is indicated as <6. Hospital All Cases Neonatal Cases Paediatric Cases All Cases Neonatal Cases Paediatric Cases Cases Days Cases Days Cases Days % Cases % Days % Cases % Days % Cases % Days AMGH <6 <6 <6 <6 <6 <6 10.3% 6.5% 9.5% 5.7% 11.1% 7.4% BCHS % 3.4% 6.2% 3.1% 4.0% 3.9% BGH <6 <6 6.4% 3.5% 12.7% 5.3% 2.6% 1.6% BWH < % 1.6% 1.6% 0.5% 1.7% 2.7% CCH % 3.3% 8.7% 5.3% 1.8% 2.2% CGMH <6 <6 25.5% 15.0% 43.5% 26.2% 1.6% 3.4% CMH % 2.8% 4.0% 2.0% 5.3% 4.0% CVH % 5.0% 4.6% 4.5% 2.8% 6.0% GBHS % 3.6% 3.4% 2.3% 3.6% 4.8% GRH % 3.4% 3.1% 3.4% 2.5% 3.4% HHCC % 8.5% 10.1% 4.1% 8.2% 9.8% HHS % 2.7% 5.0% 3.4% 2.2% 2.1% HRRH % 4.1% 9.0% 5.3% 1.6% 2.6% HSN % 5.2% 5.6% 5.0% 6.5% 5.3% JBMH % 2.4% 4.0% 2.0% 2.3% 3.6% LH % 1.9% 2.8% 1.9% 2.3% 1.9% MH % 2.4% 2.6% 1.8% 2.4% 3.7% MHA-SMGH 6 8 <6 <6 <6 <6 8.8% 7.2% 23.8% 9.1% 2.1% 5.4% Montfort % 4.1% 7.0% 4.2% MSH % 4.0% 4.5% 3.7% 2.9% 4.7% NBRHC % 5.4% 5.3% 6.7% 3.4% 3.3% NHH % 10.0% 13.9% 7.3% 11.8% 16.1% NHS % 3.5% 4.1% 3.5% 3.4% 3.5% NYGH % 2.2% 1.8% 1.6% 3.1% 3.5% OSMH % 4.4% 6.4% 4.2% 5.5% 5.0% PRH % 3.4% 4.2% 2.5% 4.5% 5.2% PRHC % 3.4% 3.2% 1.1% 2.4% 6.8% QHC % 3.4% 5.5% 2.9% 5.3% 4.5% RMH < % 6.3% 10.4% 5.1% 3.4% 9.6% RVH % 2.3% 1.7% 1.5% 3.2% 4.0% RVHS % 2.6% 2.6% 3.5% 2.0% 1.6% SAH % 3.1% 3.2% 1.0% 5.1% 4.8% SBGHC 7 12 <6 <6 < % 6.1% 4.9% 2.7% 10.5% 10.3% SGH HPHA % 5.6% 10.1% 5.7% 3.3% 5.4% SJHC Hamilton < % 6.4% 3.8% 5.0% 7.0% 18.4% SJHC Toronto % 2.1% 2.6% 2.8% 1.9% 1.1% SLMHC % 4.7% 4.5% 3.4% 9.2% 5.4% SMH % 3.4% 2.4% 2.8% 9.3% 8.6% Southlake % 2.6% 4.6% 4.5% 1.5% 1.1% STEGH % 2.7% 6.2% 3.6% 2.9% 1.7% Stevenson % 10.9% 21.0% 10.3% 12.5% 11.5% TBRHSC % 3.2% 2.0% 2.1% 2.9% 4.3% TEGH % 2.3% 3.1% 2.3% 2.4% 2.2% THC % 2.9% 3.1% 2.6% 1.6% 3.4% TSH % 2.5% 2.6% 2.2% 1.6% 3.1% WLMH <6 <6 18.6% 11.7% 19.2% 11.9% 10.0% 7.1% WOHS % 3.0% 2.8% 2.6% 2.7% 3.5% WPSHC 9 13 <6 < % 6.3% 2.8% 1.1% 13.3% 10.7% WRH % 6.7% 3.6% 4.6% 5.4% 8.8% 155

163 DES Percent of Cases and Days with LOS > 30 Days The percentage of all inpatient cases and associated days with a total length of stay greater than 30 days is displayed in this chart. % of Cases and Days with LOS > 30 Days FY 11/12 BCHS BWH CMH CVH GBHS GRH HHS HRRH HSN JBMH LH MH MSH NBRHC NHS NYGH OSMH PRHC QHC RVH RVHS SAH SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH TBRHSC TEGH THC TSH WOHS WRH 0% 5% 10% 15% 20% 25% 30% % Cases % Days 156

164 The percentage of all inpatient cases and associated days with a total length of stay greater than 30 days is displayed in this chart. A zero volume is blank and hospitals with less than 6 cases are indicated as <6. Hospital All Cases Neonatal Cases Paediatric Cases All Cases Neonatal Cases Paediatric Cases Cases Days Cases Days Cases Days % Cases % Days % Cases % Days % Cases % Days BCHS < % 7.8% 1.3% 9.7% 0.3% 4.5% BWH <6 180 <6 131 < % 5.8% 1.3% 8.5% 0.1% 3.2% CMH <6 70 <6 38 < % 1.7% 0.1% 1.5% 0.1% 2.0% CVH 68 2, , % 19.0% 3.7% 24.6% 0.5% 7.6% GBHS % 10.1% 1.4% 18.7% GRH 39 1, , % 11.4% 2.2% 18.6% 0.4% 3.4% HHS % 10.9% 0.5% 5.4% 1.1% 15.6% HRRH < % 8.3% 1.4% 12.8% 0.2% 2.4% HSN < % 10.3% 1.4% 10.1% 0.4% 10.5% JBMH <6 106 <6 71 < % 3.6% 0.3% 3.2% 0.2% 4.4% LH 25 1, < % 11.1% 1.5% 14.8% 0.4% 6.0% MH < % 11.5% 1.3% 16.0% 0.1% 2.9% MSH <6 74 < % 1.7% 0.2% 2.2% NBRHC < % 15.8% 3.1% 21.6% 0.5% 7.3% NHS <6 148 < % 1.6% 0.4% 3.0% NYGH 54 2, , % 16.9% 1.3% 16.7% 1.3% 17.1% OSMH < % 11.7% 2.8% 15.6% 0.3% 4.6% PRHC <6 195 < % 5.1% 0.7% 5.9% 0.2% 3.9% QHC <6 62 < % 1.7% 0.3% 2.5% RVH < % 18.1% 3.6% 23.6% 0.4% 7.3% RVHS 45 2, , , % 20.5% 1.8% 18.3% 1.2% 23.3% SAH <6 220 <6 139 < % 6.7% 1.1% 9.6% 0.3% 4.4% SGH HPHA <6 36 < % 2.0% 0.3% 3.3% SJHC Hamilton 40 1, , % 22.8% 3.3% 21.6% 8.5% 33.4% SJHC Toronto 27 1, % 14.3% 1.5% 13.8% 1.1% 15.1% SLMHC <6 36 < % 4.9% 0.6% 7.5% SMH 58 2, , % 29.6% 3.8% 29.7% 6.2% 28.9% Southlake % 9.9% 1.5% 11.1% 0.4% 8.9% STEGH <6 79 < % 5.2% 1.0% 9.7% TBRHSC 28 1, % 11.0% 2.0% 11.6% 0.8% 10.4% TEGH 31 1, % 16.5% 1.8% 16.0% 1.5% 17.3% THC < % 8.1% 1.0% 10.7% 0.2% 4.0% TSH 38 1, , % 14.2% 1.5% 14.6% 0.7% 13.3% WOHS 69 2, , , % 10.7% 1.0% 10.7% 0.8% 10.7% WRH 55 2, , % 21.6% 4.0% 32.3% 0.8% 10.6% 157

165 3.0 Emergency Department Indicators ED ED Patient Volumes The table and chart below present the volume of ED visits by hospital. Hospitals that joined the Benchmarking project in 2012 do not have data for 10/11. Hospital Visits % Change vs 10/11 11/12 Previous Year AMGH 3,589 BCHS 12,193 13,936 14% BGH 4,568 BWH 18,014 19,083 6% CCH 9,520 10,158 7% CGMH 7,029 CMH 11,631 11,841 2% CVH 19,738 20,709 5% GBHS 19,532 20,566 5% GRH 12,925 13,087 1% HHCC 8,652 9,412 9% HHS 29,367 30,157 3% HRRH 16,273 16,879 4% HSN 8,550 8,915 4% JBMH 8,301 7,803-6% LH 26,260 27,617 5% MH 18,078 MHA-SMGH 4,967 5,319 7% Montfort 1,723 1,898 10% MSH 18,058 18,959 5% NBRHC 8,698 10,331 19% NHH 5,567 5,592 0% NHS 16,723 16,402-2% NYGH 21,914 21,461-2% OSMH 10,656 11,059 4% PRH 5,909 5,845-1% PRHC 12,935 14,263 10% QHC 19,765 20,155 2% RMH 8,621 8,904 3% RVH 13,226 13,803 4% RVHS 23,600 25,932 10% SAH 10,951 11,608 6% SGBHC 11,186 SGH HPHA 5,475 5,588 2% SJHC Hamilton 18,136 14,858-18% SJHC Toronto 17,670 18,849 7% SLMHC 3,415 3,545 4% SMH 1,243 1,480 19% Southlake 16,607 18,550 12% STEGH 8,260 9,382 14% Stevenson 6,650 6,879 3% TBRHSC 18,883 20,060 6% TEGH 11,407 12,190 7% THC 26,015 27,122 4% TSH 18,768 19,971 6% WLMH 4,994 4,910-2% WOHS 36,664 38,623 5% WPSHC 4,099 WRH 14,197 13,584-4% AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SGBHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH ED Visits FY 11/ ,000 20,000 30,000 40,

166 3.1.2 ED 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 AMGH 1.40 BCHS 2.81 BGH 2.54 BWH 1.65 CCH 2.62 CGMH 2.20 CMH 2.96 CVH 2.95 GBHS 1.68 GRH 4.66 HHCC 2.01 HHS 2.75 HRRH 3.26 HSN 4.28 JBMH 2.85 LH 2.50 MH 2.95 MHA-SMGH 2.19 Montfort 3.04 MSH 2.44 NBRHC 2.20 NHH 2.81 NHS 2.92 NYGH 2.67 OSMH 1.96 PRH 2.58 PRHC 2.81 QHC 2.15 RMH 2.46 RVH 3.37 RVHS 2.39 SAH 2.24 SBGHC 1.25 SGH HPHA 2.82 SJHC Hamilton 2.01 SJHC Toronto 2.63 SLMHC 1.83 SMH 3.26 Southlake 2.45 STEGH 1.88 Stevenson 2.50 TBRHSC 2.41 TEGH 3.15 THC 2.88 TSH 2.92 WLMH 2.39 WOHS 3.49 WPSHC 2.30 WRH 3.57 AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH ED Average LOS in Hours FY 11/ Notes TEGH: ED Average LOS calculated by TEGH is

167 3.1.3 ED ED 90th Percentile LOS This chart and table presents the maximum length of time in which 9 out of 10 patients completed their ED visit. The maximum length of time 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 Date/Time Patient left ED is missing. Hospital Admitted Patients 90th Percentile LOS in Hours Non-Admitted High Acuity Patients Non-Admitted Low Acuity Patients AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SGBHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH Notes SJHC Hamilton: The higher 90 th percentile patients related to a transfer to McMaster Children s Hospital Child and Youth Mental Health Program. TEGH: 90 th % LOS for admitted patients calculated by TEGH is 10.0 hours. 160

168 3.1.4 ED 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, days, 1-7 years and 8-17 years. Hospital 0-28 days days 1-7 years 8-17 years AMGH ,511 1,775 BCHS 184 1,263 6,109 6,380 BGH ,936 2,224 BWH 131 1,498 8,114 9,340 CCH ,590 4,650 CGMH ,704 3,820 CMH ,504 5,305 CVH 390 1,796 9,440 9,083 GBHS 199 1,682 9,025 9,660 GRH 352 1,547 5,945 5,243 HHCC ,697 4,748 HHS 390 2,136 13,797 13,834 HRRH 312 1,709 7,840 7,018 HSN ,374 4,639 JBMH ,363 3,640 LH 319 2,016 11,492 13,790 MH 239 1,215 7,876 8,748 MHA-SMGH ,132 2,778 Montfort ,163 MSH 411 1,347 8,752 8,449 NBRHC ,431 4,931 NHH ,411 2,764 NHS 201 1,504 6,857 7,840 NYGH 474 1,824 9,794 9,369 OSMH ,691 5,418 PRH ,548 2,703 PRHC 135 1,098 6,046 6,984 QHC 220 1,639 8,514 9,782 RMH ,542 4,681 RVH 245 1,205 5,676 6,677 RVHS 411 2,178 11,739 11,604 SAH ,179 5,368 SBGHC ,125 5,071 SGH HPHA ,414 2,605 SJHC Hamilton ,854 8,213 SJHC Toronto 345 1,855 9,891 6,758 SLMHC ,312 1,757 SMH Southlake 269 1,388 7,134 9,759 STEGH ,185 4,321 Stevenson ,940 3,452 TBRHSC 162 1,775 7,957 10,166 TEGH 291 1,187 5,730 4,982 THC 409 2,041 12,298 12,374 TSH 367 1,904 9,883 7,817 WLMH ,295 2,208 WOHS 762 3,539 17,645 16,677 WPSHC ,622 2,219 WRH 244 1,460 6,421 5,459 AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH ED Visits Age Profile FY 11/12 0% 20% 40% 60% 80% 100% 0-28 days days 1-7 years 8-17 years 161

169 3.1.5 ED ED 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. 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. AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH ED Visits by Triage Level FY 11/12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Left Before Triage/Other Level 1 Level 2 Level 3 Level 4 Level 5 162

170 3.1.5 ED ED Visits by Triage Level (cont) Hospital Left Before Triage Level Triage/Other AMGH 61 < ,265 2, BCHS 28 2,116 6,394 5, BGH 13 < ,959 1, BWH ,063 9,971 1,989 CCH ,531 3, CGMH ,204 2, CMH 31 1,192 5,608 4, CVH ,099 10,345 5, GBHS ,672 8,798 9, GRH 66 2,627 7,399 2, HHCC < ,314 4, HHS ,603 14,062 10,234 1,095 HRRH <6 73 3,376 9,420 3, HSN 88 2,510 3,800 2, JBMH ,258 3,596 2, LH <6 88 2,777 12,942 10,681 1,128 MH 326 4,405 8,026 5, MHA-SMGH ,769 3, Montfort , MSH ,233 8,450 7, NBRHC ,054 5, NHH < ,410 2, NHS 126 4,373 8,840 2, NYGH 163 4,874 8,796 7, OSMH ,968 6, PRH ,481 3, PRHC 29 2,449 5,635 5, QHC <6 45 2,337 9,042 8, RMH <6 < ,566 4, RVH 63 2,648 5,487 5, RVHS <6 40 3,006 13,628 8, SAH ,951 6,040 3, SBGHC 198 < ,895 6,271 2,599 SGH HPHA ,342 2, SJHC Hamilton ,012 5,459 7, SJHC Toronto ,966 11,561 3, SLMHC ,137 1, SMH < Southlake 124 2,126 8,004 7, STEGH ,144 3,267 4, Stevenson ,475 3, TBRHSC 178 2,799 10,085 6, TEGH ,797 6,876 3, THC 104 2,860 10,514 13, TSH <6 80 3,455 10,436 5, WLMH 17 < ,390 3, WOHS ,540 22,950 8,853 1,030 WPSHC 59 < ,166 2, WRH ,485 6,882 2,

171 AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH PCMCH Maternal-Child Benchmarking Report ED ED Visits by Top 10 Main Problems This chart displays the Top 10 most responsible diagnoses for each of the participants (highlighted in RED). Organizations will have more than 10 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 J069 Acute URTI unspecified , ,027 1, ,224 1, , H669 Otitis media unspecified , , , , R509 Fever unspecified , , S099 Unspecified injury of head , R104 Other and unspecified abdominal pain A099 Gastroe & colitis of unspec origin B349 Viral infection unspecified J189 Pneumonia unspecified J029 Acute pharyngitis unspecified J050 Acute obstructive laryngitis [croup] S0180 Open wounds oth parts head, uncomplicate N390 Urinary tract infection site not spec J4500 Predom allgry asthma wo stat asthma R112 Vomiting alone J020 Streptococcal pharyngitis S9349 Sprain and strain of ankle, unspecified R05 Cough J209 Acute bronchitis unspecified A084 Viral intestinal infection unspecified < J039 Acute tonsillitis unspecified H109 Conjunctivitis unspecified S699 Unspecified injury of wrist and hand < S609 Unspec superficial injury wrist & hand < S909 Superficial injury of ankle & foot NOS < Z480 Attention to surg dressings & sutures R458 Oth symptoms signs inv emotional state < S0110 Open wound eyelid & periocular area unco < L010 Impetigo [any organism] [any site] S608 Oth superficial injuries of wrist & hand J111 Influenza w oth resp manif virus not id < M7960 Pain in upper limb < <6 < Z769 Pers encounter hlth service circumst NOS <6 <6 726 H659 Nonsuppurative otitis media unspecified 11 <6 6 <6 10 <6 61 <6 <6 <6 <6 14 J068 Other acute URTI of multiple sites <6 <6 224 <6 7 < <6 <6 H608 Other otitis externa 6 <6 <6 <6 164

172 MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA PCMCH Maternal-Child Benchmarking Report ED Visits by Top 10 Main problems (cont) Main Problem ICD10 J069 Acute URTI unspecified , ,535 1, , ,807 1,002 1, H669 Otitis media unspecified ,118 1, , , R509 Fever unspecified S099 Unspecified injury of head , R104 Other and unspecified abdominal pain A099 Gastroe & colitis of unspec origin , B349 Viral infection unspecified J189 Pneumonia unspecified J029 Acute pharyngitis unspecified J050 Acute obstructive laryngitis [croup] S0180 Open wounds oth parts head, uncomplicate N390 Urinary tract infection site not spec J4500 Predom allgry asthma wo stat asthma 51 < R112 Vomiting alone J020 Streptococcal pharyngitis S9349 Sprain and strain of ankle, unspecified R05 Cough J209 Acute bronchitis unspecified 14 < A084 Viral intestinal infection unspecified J039 Acute tonsillitis unspecified H109 Conjunctivitis unspecified S699 Unspecified injury of wrist and hand S609 Unspec superficial injury wrist & hand < S909 Superficial injury of ankle & foot NOS 27 < <6 39 <6 Z480 Attention to surg dressings & sutures R458 Oth symptoms signs inv emotional state S0110 Open wound eyelid & periocular area unco L010 Impetigo [any organism] [any site] S608 Oth superficial injuries of wrist & hand 38 < < J111 Influenza w oth resp manif virus not id 7 < < <6 M7960 Pain in upper limb 9 < < <6 Z769 Pers encounter hlth service circumst NOS <6 <6 H659 Nonsuppurative otitis media unspecified <6 <6 <6 17 <6 < < < J068 Other acute URTI of multiple sites <6 <6 <6 <6 <6 <6 <6 <6 H608 Other otitis externa <6 <6 <6 <6 <6 6 <6 <6 <6 <6 165

173 SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH Total Visits # of Hospitals with this CMG in top 10 PCMCH Maternal-Child Benchmarking Report ED Visits by Top 10 Main problems (cont) Main Problem ICD10 J069 Acute URTI unspecified 1,232 1, , ,097 1, , , H669 Otitis media unspecified , , , R509 Fever unspecified , , , S099 Unspecified injury of head , , R104 Other and unspecified abdominal pain , , A099 Gastroe & colitis of unspec origin , B349 Viral infection unspecified , , J189 Pneumonia unspecified , J029 Acute pharyngitis unspecified , J050 Acute obstructive laryngitis [croup] , S0180 Open wounds oth parts head, uncomplicate , N390 Urinary tract infection site not spec , J4500 Predom allgry asthma wo stat asthma < , R112 Vomiting alone ,901 8 J020 Streptococcal pharyngitis < , S9349 Sprain and strain of ankle, unspecified ,734 5 R05 Cough ,457 3 J209 Acute bronchitis unspecified < ,844 2 A084 Viral intestinal infection unspecified , ,648 1 J039 Acute tonsillitis unspecified < ,638 3 H109 Conjunctivitis unspecified ,476 3 S699 Unspecified injury of wrist and hand ,118 1 S609 Unspec superficial injury wrist & hand < ,698 1 S909 Superficial injury of ankle & foot NOS < ,632 1 Z480 Attention to surg dressings & sutures < ,701 1 R458 Oth symptoms signs inv emotional state < < < <6 72 2,501 1 S0110 Open wound eyelid & periocular area unco < ,469 1 L010 Impetigo [any organism] [any site] < <6 2,153 1 S608 Oth superficial injuries of wrist & hand 9 13 <6 < ,678 1 J111 Influenza w oth resp manif virus not id < <6 <6 1,015 1 M7960 Pain in upper limb 9 10 < < < Z769 Pers encounter hlth service circumst NOS <6 < H659 Nonsuppurative otitis media unspecified <6 <6 <6 <6 9 <6 18 <6 10 <6 <6 < J068 Other acute URTI of multiple sites 21 <6 < H608 Other otitis externa <6 <6 <6 <6 <6 <6 87 < Notes TSH: Total volume of H669 cases calculated by TSH is

174 3.1.7 ED 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 2012 do not have data for FY 09/10 and FY 10/11. Hospital FY 2009/10 FY 2010/11 FY 2011/12 AMGH 0.6% BCHS 5.6% 5.6% 5.2% BGH 2.0% BWH 2.0% 2.7% 3.0% CCH 3.2% 3.3% CGMH 0.8% CMH 4.3% 4.4% CVH 7.6% 7.5% 7.1% GBHS 2.3% 2.2% 2.2% GRH 8.3% 8.4% 9.8% HHCC 3.3% 3.5% HHS 3.0% 3.0% 3.1% HRRH 3.7% 3.2% 3.4% HSN 6.1% 8.1% 7.7% JBMH 5.4% 5.8% 5.4% LH 2.4% 2.5% 3.1% MH 3.7% MHA-SMGH 0.2% 0.3% Montfort 0.7% 0.9% 0.4% MSH 2.5% 3.0% 2.2% NBRHC 5.0% 4.8% 4.2% NHH 1.1% 0.9% NHS 9.9% 10.7% 10.3% NYGH 4.0% 4.2% 4.4% OSMH 2.9% 3.3% 2.7% PRH 3.7% 3.7% PRHC 6.7% 5.9% 5.0% QHC 2.7% 2.1% 2.1% RMH 0.8% 0.8% 1.0% RVH 5.0% 4.9% 5.1% RVHS 4.5% 4.2% 4.3% SAH 4.2% 4.2% 4.5% SGBHC 0.4% SGH HPHA 6.3% 5.2% SJHC Hamilton 0.4% 0.4% 0.3% SJHC Toronto 3.3% 3.6% 3.3% SLMHC 3.6% 3.9% 4.2% SMH 3.8% 3.4% 3.3% Southlake 6.7% 6.6% 6.1% STEGH 2.9% 2.6% Stevenson 0.8% 1.1% 1.0% TBRHSC 5.4% 5.5% 5.6% TEGH 5.0% 5.1% 4.8% THC 4.0% 3.8% 3.8% TSH 4.1% 3.8% 3.1% WLMH 0.2% 0.2% WOHS 6.9% 7.2% 7.4% WPSHC 1.4% WRH 6.8% 7.0% 6.0% AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SGBHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH ED Visits Admitted FY 2011/12 0% 2% 4% 6% 8% 10% 12% 167

175 3.1.8 ED ED Visits Left Without Being Seen or Against Medical Advice This chart and table present 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 2012 do not have data for FY 09/10 and FY 10/11. Hospital FY 2009/10 FY 2010/11 FY 2011/12 AMGH 1.6% BCHS 9.0% 9.7% 7.8% BGH 9.0% BWH 2.3% 3.4% 2.9% CCH 11.3% 5.5% CGMH 2.6% CMH 4.9% 5.7% CVH 3.8% 3.9% 3.2% GBHS 3.0% 2.4% 2.2% GRH 11.7% 11.9% 11.2% HHCC 3.8% 2.3% HHS 6.0% 4.9% 4.7% HRRH 6.4% 5.4% 4.8% HSN 9.8% 8.4% 9.2% JBMH 5.7% 5.5% 6.8% LH 6.3% 6.0% 6.1% MH 4.9% MHA-SMGH 4.7% 5.6% Montfort 11.3% 8.3% 6.6% MSH 5.4% 5.0% 3.0% NBRHC 5.8% 4.9% 3.2% NHH 7.4% 8.2% NHS 10.3% 9.7% 7.6% NYGH 6.1% 4.9% 4.5% OSMH 4.0% 2.7% 1.9% PRH 6.4% 6.8% PRHC 7.9% 4.7% 5.8% QHC 4.9% 4.7% 3.8% RMH 4.8% 4.5% 4.7% RVH 7.5% 8.1% 7.5% RVHS 5.3% 3.0% 2.5% SAH 3.1% 5.5% 4.7% SGBHC 1.8% SGH HPHA 3.7% 4.3% SJHC Hamilton 3.5% 2.8% 2.5% SJHC Toronto 1.8% 1.5% 1.6% SLMHC 1.8% 2.1% 3.6% SMH 6.5% 4.3% 6.2% Southlake 6.9% 5.4% 2.5% STEGH 3.5% 3.4% Stevenson 7.0% 5.2% 4.7% TBRHSC 1.9% 1.9% 1.9% TEGH 7.6% 4.2% 4.9% THC 6.0% 4.5% 4.0% TSH 7.4% 5.6% 4.3% WLMH 6.0% 6.5% WOHS 7.0% 5.3% 4.7% WPSHC 5.5% WRH 8.5% 8.7% 9.3% AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SGBHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH ED Visits Left Without Being Seen or Against Medical Advice FY 2011/12 0% 2% 4% 6% 8% 10% 12% 168

176 AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH PCMCH Maternal-Child Benchmarking Report 2012 CE 4.0 Clinical Efficiency CE 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+ 601 Newborn/Neonate grams, Other Minor Problem Newborn/Neonate grams, Jaundice < < Newborn/Neonate grams, Other Respiratory Problem < < < Newborn/Neonate grams, Short Gestation < Viral/Unspecified Pneumonia < < Upper/Lower Respiratory Infection Newborn/Neonate grams, Gestational Age 37+ Weeks < Non-severe Enteritis < Asthma < Simple Appendectomy < < < Oral Cavity/Pharynx Intervention < Newborn/Neonate grams, Gestational Age Weeks < <6 13 <6 < Symptom/Sign of Digestive System <6 14 < Newborn/Neonate grams, Major Respiratory Complication <6 9 8 <6 13 < < Depressive Episode without ECT <6 <6 <6 <6 194 <6 97 < Stress Reaction/Adjustment Disorder <6 10 <6 < < Newborn/Neonate grams, Other Moderate Problem <6 17 < < < Newborn/Neonate grams, Other Congenital Anomaly 7 17 <6 29 < < Poisoning/Toxic Effect of Drug 8 14 <6 11 <6 < <6 13 < Complicated Appendectomy <6 <6 8 <6 <6 < < <6 <6 < Other/Unspecified Viral Illness < <6 25 < Reduction/Fixation/Repair Upper Body/Limb except Fixation/Repair of Shoulder < < < Convalescence 26 9 <6 <6 < <6 < Seizure Disorder, except Status Epilepticus < Newborn/Neonate grams, Haemolytic Disease <6 < < < Newborn/Neonate grams, Aspiration Syndrome/Fetal Asphyxia 13 <6 <6 10 <6 < <6 < Diabetes <6 23 <6 < Childhood/Adolescence Disorder <6 <6 <6 < Open Wound/Other/Unspecified Minor Injury < <6 7 <6 6 <6 6 <6 586 Newborn/Neonate grams, Gestational Age <35 Weeks < < < Newborn/Neonate grams, Septicemia/Other Neonatal Infection < < <6 < Replacement/Fixation/Repair of Tibia/Fibula/Knee <6 <6 <6 <6 7 <6 6 <6 <6 <6 <6 < Other Ear Intervention <6 <6 <6 <6 <6 <6 662 Fever <6 < < Croup <6 15 < < Newborn/Neonate grams, Gestational Age Weeks <6 <6 < <6 23 < Other Respiratory Disorder <6 7 <6 < < Influenza/Acute Upper Respiratory Infection <6 <6 7 8 < Cellulitis <6 7 <6 7 < <6 13 <6 6 7 < Upper Urinary Tract Infection < <6 <6 8 <6 < < Other Gastrointestinal Disorder <6 <6 <6 <6 <6 6 <6 <6 <6 <6 11 < General Symptom/Sign <6 8 <6 13 <6 <6 9 <6 15 <6 <6 <6 433 Disorder related to Nutrition <6 <6 <6 <6 <6 6 8 <6 <6 6 <6 <6 <6 597 Newborn/Neonate grams, Cardiovascular Anomaly < <6 <6 7 <6 <6 < Other Musculoskeletal Intervention on Head <6 25 <6 <6 < Concussion <6 7 <6 <6 <6 6 <6 <6 <6 <6 6 < Reduction/Fixation/Repair of Ankle/Foot <6 <6 <6 <6 <6 <6 7 <6 <6 <6 767 Other Fracture Dislocation of Leg <6 8 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 727 Fixation/Repair Hip/Femur <6 <6 <6 8 <6 <6 <6 <6 <6 <6 699 Psychoactive Substance Use, Harmful Use <6 <6 13 <6 <6 <6 408 Trauma of Skin/Subcutaneous Tissue/Breast <6 <6 <6 <6 <6 <6 <6 <6 <6 766 Fracture of Femur <6 <6 <6 <6 <6 <6 815 Cancelled Intervention <6 6 <6 698 Psychoactive Substance Use, Acute Intoxication <6 <6 <6 <6 288 Disorder of Biliary Tract <6 <6 <6 <6 <6 <6 345 Soft Tissue Intervention of Lower Limb <6 <6 <6 <6 737 Skin/Soft Tissue Intervention with Trauma without Flap/Graft <6 <6 <6 <6 <6 <6 745 Nerve Intervention with Trauma <6 <6 <6 <6 334 Major Foot Intervention except Soft Tissue without Infection <6 082 Mastoid Intervention 813 Follow-Up Treatment/Examination <6 <6 <6 169

177 MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA PCMCH Maternal-Child Benchmarking Report CE Top 10 CMGs Typical Inpatient Cases (cont) CMG+ 601 Newborn/Neonate grams, Other Minor Problem , Newborn/Neonate grams, Jaundice Newborn/Neonate grams, Other Respiratory Problem < <6 < Newborn/Neonate grams, Short Gestation < < Viral/Unspecified Pneumonia Upper/Lower Respiratory Infection < < Newborn/Neonate grams, Gestational Age 37+ Weeks < < Non-severe Enteritis < < <6 < Asthma < < Simple Appendectomy < Oral Cavity/Pharynx Intervention < < Newborn/Neonate grams, Gestational Age Weeks < < <6 < Symptom/Sign of Digestive System < <6 < Newborn/Neonate grams, Major Respiratory Complication <6 15 < < Depressive Episode without ECT < < Stress Reaction/Adjustment Disorder 28 <6 66 <6 < < Newborn/Neonate grams, Other Moderate Problem < Newborn/Neonate grams, Other Congenital Anomaly < <6 < Poisoning/Toxic Effect of Drug 14 < <6 15 < < < Complicated Appendectomy <6 6 <6 < <6 < Other/Unspecified Viral Illness < < Reduction/Fixation/Repair Upper Body/Limb except Fixation/Repair of Shoulder <6 13 <6 <6 < Convalescence 15 < <6 15 <6 <6 42 <6 13 <6 040 Seizure Disorder, except Status Epilepticus < Newborn/Neonate grams, Haemolytic Disease <6 < <6 <6 <6 < Newborn/Neonate grams, Aspiration Syndrome/Fetal Asphyxia < < < Diabetes < < <6 24 <6 696 Childhood/Adolescence Disorder < < Open Wound/Other/Unspecified Minor Injury 6 < <6 6 <6 9 9 <6 <6 6 <6 586 Newborn/Neonate grams, Gestational Age <35 Weeks <6 16 < Newborn/Neonate grams, Septicemia/Other Neonatal Infection 10 <6 19 <6 16 <6 10 <6 31 <6 30 <6 < Replacement/Fixation/Repair of Tibia/Fibula/Knee <6 <6 <6 <6 <6 <6 <6 < Other Ear Intervention <6 <6 < Fever 6 <6 29 < < < Croup 24 < Newborn/Neonate grams, Gestational Age Weeks 9 14 < <6 8 <6 18 < Other Respiratory Disorder 8 <6 18 < < <6 <6 < Influenza/Acute Upper Respiratory Infection <6 < <6 8 <6 10 < <6 12 <6 405 Cellulitis 9 <6 10 < < < Upper Urinary Tract Infection < <6 10 <6 <6 10 <6 <6 12 <6 <6 <6 9 <6 258 Other Gastrointestinal Disorder < <6 <6 <6 <6 7 8 <6 18 <6 811 General Symptom/Sign <6 < <6 <6 9 <6 <6 9 6 <6 7 <6 433 Disorder related to Nutrition <6 <6 <6 7 <6 8 7 <6 597 Newborn/Neonate grams, Cardiovascular Anomaly <6 <6 <6 <6 8 <6 <6 <6 21 <6 6 <6 078 Other Musculoskeletal Intervention on Head <6 25 <6 12 <6 779 Concussion <6 <6 9 <6 <6 <6 <6 8 <6 <6 <6 <6 <6 747 Reduction/Fixation/Repair of Ankle/Foot <6 <6 <6 <6 <6 <6 <6 767 Other Fracture Dislocation of Leg <6 <6 <6 <6 <6 <6 <6 <6 727 Fixation/Repair Hip/Femur <6 <6 <6 <6 <6 <6 <6 <6 <6 699 Psychoactive Substance Use, Harmful Use <6 <6 <6 7 <6 408 Trauma of Skin/Subcutaneous Tissue/Breast <6 <6 <6 <6 <6 <6 <6 <6 <6 766 Fracture of Femur <6 <6 <6 <6 <6 <6 <6 815 Cancelled Intervention <6 <6 <6 <6 <6 698 Psychoactive Substance Use, Acute Intoxication <6 <6 <6 <6 <6 <6 <6 288 Disorder of Biliary Tract <6 <6 <6 <6 <6 <6 <6 <6 <6 345 Soft Tissue Intervention of Lower Limb <6 <6 <6 9 <6 737 Skin/Soft Tissue Intervention with Trauma without Flap/Graft <6 <6 <6 <6 745 Nerve Intervention with Trauma <6 <6 <6 <6 <6 334 Major Foot Intervention except Soft Tissue without Infection <6 <6 <6 <6 082 Mastoid Intervention <6 <6 813 Follow-Up Treatment/Examination <6 170

178 SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH Total # with this CMG in Top 10 PCMCH Maternal-Child Benchmarking Report CE Top 10 CMGs Typical Inpatient Cases (cont) CMG+ 601 Newborn/Neonate grams, Other Minor Problem < , , Newborn/Neonate grams, Jaundice < < , Newborn/Neonate grams, Other Respiratory Problem < , Newborn/Neonate grams, Short Gestation < < , Viral/Unspecified Pneumonia <6 24 < , Upper/Lower Respiratory Infection < , Newborn/Neonate grams, Gestational Age 37+ Weeks <6 22 < < , Non-severe Enteritis 17 < < , Asthma 26 < < , Simple Appendectomy <6 < <6 < <6 < , Oral Cavity/Pharynx Intervention 19 < , Newborn/Neonate grams, Gestational Age Weeks < , Symptom/Sign of Digestive System 23 <6 10 < < , Newborn/Neonate grams, Major Respiratory Complication < < Depressive Episode without ECT <6 < , Stress Reaction/Adjustment Disorder <6 < Newborn/Neonate grams, Other Moderate Problem 31 9 < < Newborn/Neonate grams, Other Congenital Anomaly <6 < < Poisoning/Toxic Effect of Drug <6 6 <6 < <6 <6 59 < Complicated Appendectomy <6 < <6 < Other/Unspecified Viral Illness 6 < <6 36 < Reduction/Fixation/Repair Upper Body/Limb except Fixation/Repair of Shoulder 7 <6 <6 <6 < < Convalescence <6 <6 12 < < Seizure Disorder, except Status Epilepticus 15 <6 < Newborn/Neonate grams, Haemolytic Disease 13 <6 <6 < < Newborn/Neonate grams, Aspiration Syndrome/Fetal Asphyxia 8 38 <6 <6 < < < Diabetes <6 <6 <6 < <6 13 < Childhood/Adolescence Disorder Open Wound/Other/Unspecified Minor Injury <6 6 <6 <6 <6 < <6 <6 < Newborn/Neonate grams, Gestational Age <35 Weeks <6 < Newborn/Neonate grams, Septicemia/Other Neonatal Infection 10 <6 <6 < < Replacement/Fixation/Repair of Tibia/Fibula/Knee <6 <6 <6 <6 9 6 <6 < Other Ear Intervention <6 <6 <6 <6 <6 < Fever 7 11 < Croup < < Newborn/Neonate grams, Gestational Age Weeks < Other Respiratory Disorder 7 <6 < Influenza/Acute Upper Respiratory Infection < < Cellulitis 6 < Upper Urinary Tract Infection <6 <6 <6 <6 < < Other Gastrointestinal Disorder <6 <6 9 < General Symptom/Sign 7 <6 <6 <6 20 <6 <6 < Disorder related to Nutrition <6 <6 <6 <6 6 <6 < Newborn/Neonate grams, Cardiovascular Anomaly 9 <6 <6 <6 <6 7 <6 <6 15 < Other Musculoskeletal Intervention on Head <6 < Concussion <6 <6 <6 <6 <6 <6 <6 <6 17 < Reduction/Fixation/Repair of Ankle/Foot <6 < <6 <6 <6 < Other Fracture Dislocation of Leg <6 <6 <6 8 <6 <6 <6 < Fixation/Repair Hip/Femur <6 <6 <6 <6 <6 <6 < Psychoactive Substance Use, Harmful Use <6 8 6 < Trauma of Skin/Subcutaneous Tissue/Breast <6 <6 <6 <6 <6 <6 10 < Fracture of Femur <6 <6 <6 <6 < Cancelled Intervention <6 <6 <6 6 <6 < Psychoactive Substance Use, Acute Intoxication <6 <6 <6 < Disorder of Biliary Tract <6 <6 <6 <6 <6 < Soft Tissue Intervention of Lower Limb <6 <6 <6 <6 < Skin/Soft Tissue Intervention with Trauma without Flap/Graft <6 <6 <6 <6 <6 < Nerve Intervention with Trauma <6 <6 < Major Foot Intervention except Soft Tissue without Infection <6 <6 <6 <6 < Mastoid Intervention <6 < Follow-Up Treatment/Examination

179 AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH PCMCH Maternal-Child Benchmarking Report CE 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+ 601 Newborn/Neonate grams, Other Minor Problem < Newborn/Neonate grams, Jaundice < < Newborn/Neonate grams, Other Respiratory Problem < < < Non-severe Enteritis Asthma < Upper/Lower Respiratory Infection Oral Cavity/Pharynx Intervention <6 138 Viral/Unspecified Pneumonia < < Simple Appendectomy <6 24 < Newborn/Neonate grams, Gestational Age 37+ Weeks <6 12 <6 < <6 37 < Newborn/Neonate grams, Short Gestation 11 <6 7 < Symptom/Sign of Digestive System 32 < < Seizure Disorder, except Status Epilepticus 19 < Newborn/Neonate grams, Other Congenital Anomaly 11 <6 7 < < Other/Unspecified Viral Illness 12 < < <6 14 < Convalescence 9 26 <6 <6 < <6 < Croup 21 <6 14 < < Reduction/Fixation/Repair Upper Body/Limb except Fixation/Repair of Shoulder 6 9 < <6 < < Poisoning/Toxic Effect of Drug 13 <6 6 <6 < < Newborn/Neonate grams, Major Respiratory Complication <6 <6 <6 < <6 <6 < Newborn/Neonate grams, Gestational Age <6 <6 <6 <6 22 < < Diabetes 8 <6 7 <6 < < <6 662 Fever 12 < < <6 < <6 148 Other Respiratory Disorder 7 <6 <6 <6 13 < < Newborn/Neonate grams, Aspiration Syndrome/Fetal Asphyxia <6 <6 <6 <6 <6 8 <6 <6 < <6 < Influenza/Acute Upper Respiratory Infection <6 21 <6 12 <6 <6 6 6 <6 17 <6 602 Newborn/Neonate grams, Haemolytic Disease <6 <6 <6 9 <6 <6 < <6 6 < Tonsillitis/Pharyngitis 10 <6 14 < <6 <6 <6 < Stress Reaction/Adjustment Disorder 9 <6 < < Open Wound/Other/Unspecified Minor Injury <6 8 < <6 8 <6 7 <6 6 6 < Complicated Appendectomy <6 <6 <6 <6 <6 <6 6 < <6 <6 <6 9 <6 693 Depressive Episode without ECT <6 <6 <6 <6 <6 22 < Newborn/Neonate grams, Other Moderate Problem <6 <6 <6 <6 <6 <6 6 < < General Symptom/Sign 7 <6 <6 10 <6 <6 <6 9 <6 9 <6 <6 <6 258 Other Gastrointestinal Disorder <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 < Other Fracture/Dislocation of Arm/Shoulder <6 <6 <6 <6 <6 <6 <6 <6 9 <6 <6 <6 <6 078 Other Musculoskeletal Intervention on Head <6 22 < Concussion <6 <6 7 <6 <6 6 <6 <6 <6 <6 <6 6 6 <6 729 Replacement/Fixation/Repair of Tibia/Fibula/Knee <6 <6 <6 6 <6 <6 <6 <6 <6 <6 <6 8 <6 597 Newborn/Neonate grams, Cardiovascular Anomaly <6 <6 <6 <6 <6 7 <6 <6 9 <6 747 Reduction/Fixation/Repair of Ankle/Foot <6 <6 <6 <6 <6 <6 6 <6 <6 < Disorder related to Nutrition <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 101 Disease of Oral Cavity/Salivary Gland/Jaw <6 <6 <6 <6 <6 <6 <6 <6 <6 767 Other Fracture Dislocation of Leg <6 <6 <6 7 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 080 Other Ear Intervention <6 <6 <6 <6 <6 <6 408 Trauma of Skin/Subcutaneous Tissue/Breast <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 815 Cancelled Intervention 6 <6 <6 718 Non-Extensive Burn <6 <6 <6 <6 <6 <6 766 Fracture of Femur <6 <6 <6 <6 698 Psychoactive Substance Use, Acute Intoxication <6 <6 <6 345 Soft Tissue Intervention of Lower Limb <6 <6 <6 678 Schizotypal/Delusional Disorder <6 <6 <6 <6 <6 699 Psychoactive Substance Use, Harmful Use <6 <6 <6 <6 <6 288 Disorder of Biliary Tract <6 <6 <6 <6 <6 <6 737 Skin/Soft Tissue Intervention with Trauma without Flap/Graft <6 <6 <6 <6 745 Nerve Intervention with Trauma <6 <6 <6 <6 334 Major Foot Intervention except Soft Tissue without Infection <6 <6 768 Fracture of Patella/Upper Tibia/Fibula 434 Disease/Disorder of Adrenal/Pituitary Gland <6 <6 813 Follow-Up Treatment/Examination <6 <6 <6 751 Removal Foreign Body Skin/Soft Tissue <6 <6 082 Mastoid Intervention 172

180 MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton PCMCH Maternal-Child Benchmarking Report CE Top 10 CMGs Typical Inpatient Cases One and Two Day Stay (cont.) CMG+ 601 Newborn/Neonate grams, Other Minor Problem < Newborn/Neonate grams, Jaundice < < Newborn/Neonate grams, Other Respiratory Problem < < < < Non-severe Enteritis < < < Asthma < Upper/Lower Respiratory Infection < < Oral Cavity/Pharynx Intervention 20 < < Viral/Unspecified Pneumonia < <6 22 <6 234 Simple Appendectomy <6 < <6 <6 <6 588 Newborn/Neonate grams, Gestational Age 37+ Weeks < <6 < < <6 < Newborn/Neonate grams, Short Gestation < < < Symptom/Sign of Digestive System < < < Seizure Disorder, except Status Epilepticus <6 598 Newborn/Neonate grams, Other Congenital Anomaly < <6 <6 < <6 <6 < Other/Unspecified Viral Illness < <6 < < Convalescence 6 < <6 15 <6 < <6 12 <6 104 Croup < Reduction/Fixation/Repair Upper Body/Limb except Fixation/Repair of Shoulder <6 35 < <6 <6 < < Poisoning/Toxic Effect of Drug <6 10 < < < <6 <6 589 Newborn/Neonate grams, Major Respiratory Complication 34 7 < <6 < <6 < Newborn/Neonate grams, Gestational Age <6 21 <6 35 <6 <6 <6 < <6 15 <6 437 Diabetes <6 <6 < < <6 662 Fever <6 < <6 <6 23 < Other Respiratory Disorder <6 < <6 <6 12 <6 16 <6 <6 <6 590 Newborn/Neonate grams, Aspiration Syndrome/Fetal Asphyxia <6 9 < <6 <6 <6 <6 <6 <6 <6 097 Influenza/Acute Upper Respiratory Infection <6 12 < <6 8 < Newborn/Neonate grams, Haemolytic Disease < <6 36 <6 <6 <6 17 <6 <6 103 Tonsillitis/Pharyngitis <6 < <6 <6 18 < <6 <6 687 Stress Reaction/Adjustment Disorder < <6 < Open Wound/Other/Unspecified Minor Injury <6 <6 7 < <6 8 9 <6 <6 <6 <6 233 Complicated Appendectomy <6 7 9 <6 <6 9 <6 <6 <6 <6 <6 12 <6 <6 693 Depressive Episode without ECT <6 <6 6 <6 <6 28 <6 600 Newborn/Neonate grams, Other Moderate Problem 8 6 <6 7 <6 <6 <6 <6 7 <6 <6 <6 <6 811 General Symptom/Sign < <6 <6 9 <6 <6 <6 8 <6 <6 258 Other Gastrointestinal Disorder <6 < <6 <6 <6 <6 <6 <6 <6 770 Other Fracture/Dislocation of Arm/Shoulder <6 <6 23 <6 <6 <6 < Other Musculoskeletal Intervention on Head <6 <6 23 < Concussion <6 <6 9 <6 <6 <6 8 <6 <6 <6 <6 <6 <6 729 Replacement/Fixation/Repair of Tibia/Fibula/Knee 11 <6 10 <6 <6 <6 <6 <6 <6 <6 <6 597 Newborn/Neonate grams, Cardiovascular Anomaly <6 <6 <6 7 <6 <6 <6 15 <6 <6 <6 747 Reduction/Fixation/Repair of Ankle/Foot <6 10 <6 <6 <6 <6 <6 <6 433 Disorder related to Nutrition <6 <6 8 <6 <6 <6 <6 <6 <6 <6 101 Disease of Oral Cavity/Salivary Gland/Jaw <6 <6 <6 <6 <6 <6 <6 <6 767 Other Fracture Dislocation of Leg <6 <6 <6 <6 <6 <6 <6 080 Other Ear Intervention <6 <6 6 <6 < Trauma of Skin/Subcutaneous Tissue/Breast <6 <6 <6 <6 <6 <6 <6 <6 815 Cancelled Intervention <6 <6 <6 <6 <6 718 Non-Extensive Burn <6 <6 <6 <6 <6 <6 <6 <6 766 Fracture of Femur <6 <6 <6 <6 <6 <6 <6 698 Psychoactive Substance Use, Acute Intoxication <6 <6 <6 <6 <6 <6 <6 345 Soft Tissue Intervention of Lower Limb <6 <6 <6 < Schizotypal/Delusional Disorder <6 <6 <6 699 Psychoactive Substance Use, Harmful Use <6 <6 <6 288 Disorder of Biliary Tract <6 <6 <6 <6 <6 737 Skin/Soft Tissue Intervention with Trauma without Flap/Graft <6 <6 <6 <6 <6 <6 745 Nerve Intervention with Trauma <6 <6 <6 <6 <6 334 Major Foot Intervention except Soft Tissue without Infection <6 <6 <6 <6 768 Fracture of Patella/Upper Tibia/Fibula <6 <6 434 Disease/Disorder of Adrenal/Pituitary Gland <6 813 Follow-Up Treatment/Examination <6 751 Removal Foreign Body Skin/Soft Tissue <6 <6 082 Mastoid Intervention <6 <6 173

181 SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH Total # with this CMG in Top 10 PCMCH Maternal-Child Benchmarking Report CE Top 10 CMGs Typical Inpatient Cases One and Two Day Stay (cont) CMG+ 601 Newborn/Neonate grams, Other Minor Problem < , , Newborn/Neonate grams, Jaundice <6 61 2, Newborn/Neonate grams, Other Respiratory Problem 72 < , Non-severe Enteritis 31 < < , Asthma 80 < < <6 46 1, Upper/Lower Respiratory Infection 37 < <6 70 1, Oral Cavity/Pharynx Intervention < , Viral/Unspecified Pneumonia < , Simple Appendectomy 29 8 < <6 95 <6 40 1, Newborn/Neonate grams, Gestational Age 37+ Weeks 64 < <6 <6 < , Newborn/Neonate grams, Short Gestation 47 < < <6 73 1, Symptom/Sign of Digestive System 25 < < < Seizure Disorder, except Status Epilepticus 16 < < Newborn/Neonate grams, Other Congenital Anomaly 13 < < < Other/Unspecified Viral Illness 8 15 <6 <6 6 < < Convalescence <6 < < < Croup < < Reduction/Fixation/Repair Upper Body/Limb except Fixation/Repair of Shoulder 6 <6 12 < < Poisoning/Toxic Effect of Drug <6 < <6 51 <6 < Newborn/Neonate grams, Major Respiratory Complication 7 12 <6 6 <6 7 < < Newborn/Neonate grams, Gestational Age <6 16 <6 <6 < < Diabetes <6 <6 8 <6 <6 7 < < Fever <6 <6 15 < Other Respiratory Disorder 10 <6 <6 < Newborn/Neonate grams, Aspiration Syndrome/Fetal Asphyxia <6 <6 <6 < <6 12 < Influenza/Acute Upper Respiratory Infection <6 8 < < Newborn/Neonate grams, Haemolytic Disease 10 <6 < <6 21 < Tonsillitis/Pharyngitis 15 8 < Stress Reaction/Adjustment Disorder 6 < <6 22 <6 < Open Wound/Other/Unspecified Minor Injury <6 <6 6 6 <6 18 <6 < < Complicated Appendectomy 7 <6 <6 < <6 8 < Depressive Episode without ECT <6 37 <6 7 <6 <6 < Newborn/Neonate grams, Other Moderate Problem 8 <6 <6 <6 <6 <6 < General Symptom/Sign <6 <6 <6 6 <6 <6 <6 <6 12 <6 < Other Gastrointestinal Disorder <6 <6 11 <6 <6 < Other Fracture/Dislocation of Arm/Shoulder <6 <6 8 <6 < <6 < Other Musculoskeletal Intervention on Head <6 29 <6 <6 < Concussion <6 <6 <6 <6 <6 <6 17 <6 < Replacement/Fixation/Repair of Tibia/Fibula/Knee <6 <6 8 <6 <6 < Newborn/Neonate grams, Cardiovascular Anomaly <6 <6 <6 <6 <6 <6 <6 12 < Reduction/Fixation/Repair of Ankle/Foot <6 <6 9 <6 <6 <6 <6 < Disorder related to Nutrition <6 <6 <6 <6 <6 <6 <6 9 < Disease of Oral Cavity/Salivary Gland/Jaw <6 <6 <6 <6 <6 10 <6 < Other Fracture Dislocation of Leg <6 <6 <6 <6 <6 <6 <6 < Other Ear Intervention <6 <6 <6 <6 < Trauma of Skin/Subcutaneous Tissue/Breast <6 <6 <6 <6 <6 <6 9 < Cancelled Intervention <6 <6 <6 6 <6 < Non-Extensive Burn <6 <6 <6 <6 <6 < Fracture of Femur <6 <6 <6 < Psychoactive Substance Use, Acute Intoxication <6 <6 <6 < Soft Tissue Intervention of Lower Limb <6 <6 <6 < Schizotypal/Delusional Disorder <6 <6 <6 <6 <6 <6 < Psychoactive Substance Use, Harmful Use <6 <6 < Disorder of Biliary Tract <6 <6 <6 < Skin/Soft Tissue Intervention with Trauma without Flap/Graft <6 <6 < Nerve Intervention with Trauma < Major Foot Intervention except Soft Tissue without Infection <6 <6 <6 < Fracture of Patella/Upper Tibia/Fibula <6 <6 <6 < Disease/Disorder of Adrenal/Pituitary Gland <6 <6 < Follow-Up Treatment/Examination Removal Foreign Body Skin/Soft Tissue < Mastoid Intervention

182 5.0 Quality and Utilization Management Indicators Introduction 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. Two areas are examined in this section: QUM 5.1 Appropriateness of Care 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. The following indicators are included: QUM - Percent Paediatric Admissions Treated for Asthma QUM - Percent Paediatric Admissions Treated for Diabetes QUM 5.2 Effectiveness and Efficacy QUM - Percent Medical and Mental Health Admissions with One & Two Days Stay Admission via the Emergency Department QUM - Percent Medical, Mental Health and Surgical Admissions via ED 175

183 5.1.1 QUM Paediatric Admissions Treated for Asthma The following chart presents the proportion of acute care paediatric (29 days-17 years) inpatient cases that received care for the treatment of Asthma. The most responsible diagnosis codes used are listed are listed on page 302. AMGH BWH BCHS BGH CMH CCH CVH GRH GBHS HHS HHCC HSN HRRH JBMH LH MH MSH NHS NBRHC NYGH NHH OSMH PRH PRHC QHC RVHS SAH SLMHC Southlake SJHC Toronto STEGH Stevenson SGH HPHA RVH TSH TBRHSC TEGH THC WPSHC WOHS WRH Asthma Cases Per 1000 Paediatric Inpatient Cases (FY 11/12)

184 The following tables present the number of acute care paediatric (29 days-17 years) inpatient and Emergency Department patients that received care for the treatment of Asthma. The most responsible diagnosis codes used are listed are listed on page 302 of the Report. A zero volume is blank and a volume less than 6 is indicated as <6. Inpatient Cases Hospital Asthma Inpatient Cases Total Paediatric Inpatient Cases Rate Per 1,000 AMGH < BWH BCHS BGH CMH CGMH 64 CCH CVH GRH GBHS HHS HHCC HSN Montfort 12 HRRH JBMH LH MH MSH NHS NBRHC NYGH NHH < OSMH PRH PRHC QHC RMH 59 RVHS SAH SLMHC < SGBHC 38 Southlake SJHC Toronto SJHC Hamilton 71 SMH 97 STEGH Stevenson < SGH HPHA MHA-SMGH 47 RVH TSH TBRHSC TEGH THC WLMH 10 WPSHC < WOHS WRH Emergency Admissions Hospital Asthma ED Admissions Total Paediatric Asthma ED Visits Rate Per 1,000 AMGH < BWH BCHS BGH CMH CGMH 47 CCH CVH GRH GBHS HHS HHCC HSN Montfort 21 HRRH JBMH LH MH MSH NHS NBRHC NYGH NHH < OSMH PRH PRHC QHC RMH 123 RVHS SAH SLMHC < SGBHC < Southlake SJHC Toronto SJHC Hamilton 98 SMH 10 STEGH Stevenson < SGH HPHA MHA-SMGH 61 RVH TSH TBRHSC TEGH THC WLMH 70 WPSHC < WOHS WRH

185 5.1.2 QUM Paediatric Admissions Treated for Diabetes The following chart presents the percentage of acute care paediatric (29 days-17 years) inpatients that received care for the treatment of Diabetes. The most responsible diagnosis codes E10 to E14 were used. BWH BCHS BGH CMH CGMH CCH CVH GRH GBHS HHS HHCC HSN HRRH JBMH LH MH MSH NHS NBRHC NYGH OSMH PRH PRHC QHC RVHS SAH SBGHC Southlake SJHC Toronto SMH STEGH Stevenson MHA-SMGH RVH TSH TBRHSC TEGH THC WPSHC WOHS WRH Diabetes Cases Per 1000 Paediatric Inpatient Cases (FY 11/12)

186 The following 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. The most responsible diagnosis codes E10 to E14 were used. A zero volume is blank and a volume less than 6 is indicated as <6. Inpatient Cases Hospital Diabetes Inpatient Cases Total Paediatric Inpatient Cases Rate Per 1,000 AMGH 18 BWH BCHS BGH < CMH CGMH < CCH < CVH GRH GBHS HHS HHCC HSN Montfort 12 HRRH JBMH LH MH MSH NHS NBRHC NYGH NHH 68 OSMH PRH < PRHC QHC RMH 59 RVHS SAH SLMHC 173 SGBHC < Southlake SJHC Toronto < SJHC Hamilton 71 SMH < STEGH < Stevenson < SGH HPHA 362 MHA-SMGH < RVH TSH TBRHSC TEGH < THC WLMH 10 WPSHC < WOHS WRH Emergency Admissions Hospital Diabetes ED Admissions Total Paediatric ED Visits Rate Per 1,000 AMGH <6 BWH BCHS BGH <6 <6 333 CMH CGMH < CCH < CVH GRH GBHS HHS < HHCC HSN Montfort HRRH JBMH LH MH < MSH NHS NBRHC NYGH NHH 10 OSMH PRH <6 <6 500 PRHC QHC RMH 7 RVHS SAH SLMHC <6 SGBHC Southlake SJHC Toronto < SJHC Hamilton <6 SMH <6 <6 333 STEGH < Stevenson < SGH HPHA 10 MHA-SMGH <6 < RVH TSH TBRHSC TEGH < THC WLMH 6 WPSHC <6 <6 250 WOHS WRH

187 5.2.1 QUM Medical and Mental Health Admissions via ED with One & Two Days Stay These chart display the percentage of medical and mental health inpatients admitted through the Emergency Department for one and two day stays. AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH % of Medical Admissions with 1-2 Days Stay 40% 50% 60% 70% 80% 90% AMGH BCHS BWH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN LH MH MHA-SMGH NBRHC NHS NYGH OSMH PRH PRHC RVH RVHS SAH SJHC Toronto % of Mental Health Admissions with 1-2 Days Stay SLMHC Southlake Stevenson TBRHSC TEGH THC TSH WOHS WPSHC WRH 0% 20% 40% 60% 80% 100% 180

188 This table displays the percentage of medical and mental health inpatients admitted through the Emergency Department for one and two day stays. A zero volume is blank. Hospital Medical % One Day % Two Day % 1 & 2 Day Combined Mental Health % One Day % Two Day % 1 & 2 Day Combined AMGH 41.7% 41.7% 83.3% 100.0% 100.0% BCHS 56.1% 24.8% 80.9% 51.9% 25.9% 77.8% BGH 58.0% 28.4% 86.4% BWH 47.9% 24.9% 72.8% 23.1% 30.8% 53.8% CCH 41.2% 32.5% 73.7% CGMH 56.5% 21.7% 78.3% 91.7% 8.3% 100.0% CMH 43.0% 26.9% 69.9% 76.9% 7.7% 84.6% CVH 37.3% 28.7% 66.0% 42.9% 0.0% 42.9% GBHS 40.9% 26.5% 67.4% 37.5% 25.0% 62.5% GRH 36.8% 25.3% 62.1% 13.3% 9.9% 23.2% HHCC 48.1% 28.3% 76.4% 58.3% 8.3% 66.7% HHS 47.0% 27.7% 74.7% 25.5% 6.4% 31.9% HRRH 44.6% 29.9% 74.6% 9.5% 4.8% 14.3% HSN 53.4% 19.9% 73.3% 28.7% 12.8% 41.5% JBMH 61.3% 24.5% 85.8% LH 54.5% 25.1% 79.6% 21.2% 7.9% 29.1% MH 58.3% 22.3% 80.6% 100.0% 100.0% MHA-SMGH 57.1% 14.3% 71.4% 100.0% 100.0% Montfort 50.0% 50.0% MSH 39.0% 33.3% 72.3% NBRHC 49.8% 26.9% 76.7% 33.3% 11.1% 44.4% NHH 50.0% 27.8% 77.8% NHS 46.3% 26.5% 72.8% 49.5% 20.6% 70.1% NYGH 53.6% 22.4% 76.0% 14.7% 17.5% 32.2% OSMH 37.2% 30.2% 67.4% 25.0% 25.0% 50.0% PRH 58.5% 25.0% 83.5% 100.0% 100.0% PRHC 42.1% 28.2% 70.3% 33.3% 16.7% 50.0% QHC 49.0% 19.9% 68.9% RMH 50.0% 25.0% 75.0% RVH 50.7% 23.8% 74.5% 31.8% 25.9% 57.6% RVHS 36.9% 28.7% 65.6% 30.7% 18.0% 48.7% SAH 52.6% 20.9% 73.5% 14.3% 14.3% 28.6% SBGHC 44.8% 24.1% 69.0% SGH HPHA 49.4% 32.4% 81.9% SJHC Hamilton 57.1% 57.1% SJHC Toronto 48.5% 25.3% 73.8% 22.3% 10.7% 33.0% SLMHC 25.6% 28.6% 54.1% 36.4% 9.1% 45.5% SMH 41.2% 17.6% 58.8% Southlake 40.2% 27.0% 67.2% 13.0% 10.8% 23.8% STEGH 46.6% 26.0% 72.6% Stevenson 71.4% 14.3% 85.7% 100.0% 100.0% TBRHSC 38.6% 23.9% 62.5% 17.3% 10.1% 27.4% TEGH 59.8% 22.4% 82.2% 6.6% 8.4% 15.0% THC 38.7% 24.9% 63.7% 50.0% 50.0% 100.0% TSH 50.4% 24.1% 74.5% 66.7% 33.3% 100.0% WLMH 66.7% 66.7% WOHS 46.5% 26.6% 73.1% 16.9% 8.2% 25.1% WPSHC 65.1% 20.9% 86.0% 100.0% 100.0% WRH 42.2% 31.7% 73.9% 40.0% 16.0% 56.0% 181

189 5.2.2 QUM Medical, Mental Health and Surgical Admissions via ED These charts display the percentage of all medical, mental health and surgical inpatients admitted through the Emergency Department. % Medical Admissions via ED % Mental Health Admissions via ED % Surgical Admissions via ED AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH 0% 20% 40% 60% 80% 100% AMGH BCHS BWH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN LH MH MHA-SMGH MSH NBRHC NHH NHS NYGH OSMH PRH PRHC RVH RVHS SAH SBGHC SJHC Toronto SLMHC SMH Southlake Stevenson TBRHSC TEGH THC TSH WOHS WPSHC WRH 0% 20% 40% 60% 80% 100% AMGH BCHS BGH BWH CCH CGMH CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH LH MH MHA-SMGH Montfort MSH NBRHC NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson TBRHSC TEGH THC TSH WLMH WOHS WPSHC WRH 0% 20% 40% 60% 80% 100% 182

190 This table displays the percentage of all medical, mental health and surgical inpatients admitted through the Emergency Department. A zero volume is blank. Hospital % Medical % Mental Health % Surgical AMGH 85.7% 100.0% 66.7% BCHS 81.4% 100.0% 79.4% BGH 75.7% 88.9% BWH 65.5% 86.7% 50.4% CCH 75.1% 91.2% CGMH 92.0% 100.0% 81.5% CMH 66.1% 81.3% 93.6% CVH 83.3% 63.6% 63.2% GBHS 87.0% 47.1% 54.9% GRH 79.5% 72.1% 77.8% HHCC 94.2% 100.0% 24.0% HHS 71.3% 87.2% 63.1% HRRH 71.6% 21.2% 33.5% HSN 62.4% 77.7% 56.0% JBMH 90.0% 46.1% LH 62.4% 82.2% 44.6% MH 72.2% 100.0% 80.6% MHA-SMGH 46.7% 100.0% 16.1% Montfort 66.7% 22.2% MSH 82.0% 100.0% 38.4% NBRHC 74.2% 50.0% 51.3% NHH 87.8% 100.0% 46.2% NHS 71.1% 97.0% 56.3% NYGH 65.6% 67.5% 36.0% OSMH 48.8% 57.1% 31.7% PRH 100.0% 100.0% 100.0% PRHC 78.1% 75.0% 47.3% QHC 77.2% 77.5% RMH 66.7% 82.9% RVH 90.8% 94.4% 60.1% RVHS 74.9% 61.0% 37.4% SAH 82.9% 86.7% 75.9% SBGHC 93.5% 50.0% 100.0% SGH HPHA 78.5% 31.3% SJHC Hamilton 15.9% 70.4% SJHC Toronto 71.2% 79.4% 71.3% SLMHC 93.7% 100.0% 66.7% SMH 37.0% 50.0% 46.9% Southlake 76.9% 84.8% 57.9% STEGH 76.2% 26.9% Stevenson 96.6% 100.0% 91.7% TBRHSC 74.4% 71.9% 43.2% TEGH 72.6% 75.9% 44.7% THC 78.1% 66.7% 74.1% TSH 47.2% 75.0% 41.2% WLMH 100.0% 100.0% WOHS 84.9% 52.0% 59.9% WPSHC 93.5% 100.0% 100.0% WRH 59.0% 9.7% 53.8% 183

191 Operational Efficiency Indicators Introduction Trial Balances from Community Hospital members follow MIS guidelines in 3 MIS functional areas: inpatient acute pediatric wards, paediatric intensive care (PICU), and 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 and Sunnybrook Health Sciences Centre are included in the community OE indicators because they are not stand alone paediatric centres. 184

192 6.1 Operational Efficiency Descriptors OE Paediatric Inpatient Unit Only (7*270*) Net Operating Costs per Inpatient Day (403* Trial Balance) BCHS BWH CCH CMH GRH HSN JBMH LH MH MSH NBRHC NHS NYGH OSMH QHC RVH RVHS SAH SGH HPHA SJHC Toronto Southlake STEGH TBRHSC TEGH THC TSH WOHS WRH Paediatric Inpatient Net Operating Costs per Inpatient Day Hospital Cost BCHS 756 BWH 900 CCH 1,009 CMH 935 GRH 806 HSN 665 JBMH 433 LH 667 MH 583 MSH 786 NBRHC 670 NHS 827 NYGH 634 OSMH 797 QHC 792 RVH 576 RVHS 783 SAH 803 SGH HPHA 1,032 SJHC Toronto 826 Southlake 545 STEGH 1,472 TBRHSC 622 TEGH 802 THC 812 TSH 912 WOHS 701 WRH

193 6.1.2 OE Paediatric Inpatient Unit Only (7*270*) Compensation Costs (3*) per Inpatient Day (403* Trial Balance) BCHS BWH CCH CMH GRH HSN JBMH LH MH MSH NBRHC NHS NYGH OSMH QHC RVH RVHS SAH SGH HPHA SJHC Toronto Southlake STEGH TBRHSC TEGH THC TSH WOHS WRH Paediatric Inpatient Compensation Costs per Inpatient Day Hospital Cost BCHS 675 BWH 834 CCH 878 CMH 860 GRH 745 HSN 561 JBMH 373 LH 596 MH 543 MSH 743 NBRHC 600 NHS 753 NYGH 564 OSMH 720 QHC 702 RVH 544 RVHS 673 SAH 724 SGH HPHA 942 SJHC Toronto 730 Southlake 478 STEGH 1,302 TBRHSC 567 TEGH 739 THC 700 TSH 849 WOHS 602 WRH

194 6.1.3 OE Paediatric Inpatient Unit Only (7*270*) UPP Worked Hours (35090*/10*) per Inpatient Day (403* Trial Balance) BCHS BWH CCH CMH GRH HSN JBMH LH MH MSH NBRHC NHS NYGH OSMH QHC RVH RVHS SAH SGH HPHA SJHC Toronto Southlake STEGH TBRHSC TEGH THC TSH WOHS WRH Paediatric Inpatient UPP Worked Hours per Inpatient Day UPP Worked Hospital Hours BCHS 10.0 BWH 12.2 CCH 13.0 CMH 11.3 GRH 10.0 HSN 7.8 JBMH 5.3 LH 15.7 MH 12.5 MSH 13.9 NBRHC 8.5 NHS 11.1 NYGH 8.8 OSMH 11.1 QHC 9.7 RVH 9.0 RVHS 8.8 SAH 10.9 SGH HPHA 15.0 SJHC Toronto 10.1 Southlake 8.1 STEGH 19.3 TBRHSC 7.7 TEGH 10.7 THC 9.5 TSH 11.9 WOHS 9.0 WRH

195 6.2 NICU 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). LOC Hospital Net Operating Costs Per Inpatient Day IIc NBRHC 708 IIc TBRHC 773 IIc HSN 1,010 IIc SAH 1,252 IIc NYGH 866 IIc LH 813 IIc RVHS 805 IIIa WRH 945 IIIa Mt Sinai 1,014 IIIa Sunnybrook 1,228 Net Operating Costs Per Inpatient Day NBRHC - IIc TBRHC - IIc HSN - IIc SAH - IIc NYGH - IIc LH - IIc RVHS - IIc WRH - IIIa Mt Sinai - IIIa Sunnybrook - IIIa ,000 1,500 Notes WRH: Level is self-designated and subject to confirmation. 188

196 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). LOC Hospital NICU Compensation Costs per Inpatient Day IIc HSN 854 IIc LH 722 IIc NBRHC 606 IIc NYGH 776 IIc RVHS 756 IIc SAH 1081 IIc TBRHC 684 IIIa Mt Sinai 824 IIIa Sunnybrook 1082 IIIa WRH 851 NICU Compensation Costs per Inpatient Day HSN - IIc LH - IIc NBRHC - IIc NYG - IIc RVHS - IIc SAH - IIc TBRHC - IIc Mt Sinai - IIIa Sunnybrook - IIIa WRH - IIIa Notes WRH: Level is self-designated and subject to confirmation. 189

197 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). LOC Hospital NICU UPP Worked Hours Per Inpatient Day IIc HSN 13.3 IIc LH 9.9 IIc NBRHC 9.1 IIc NYGH 11.3 IIc RVHS 10.5 IIc SAH 16.0 IIc TBRHC 10.4 IIIa Mt Sinai 11.9 IIIa Sunnybrook 14.7 IIIa WRH 10.9 NICU UPP Worked Hours Per Inpatient Day HSN - IIc LH - IIc NBRHC - IIc NYGH - IIc RVHS - IIc SAH - IIc TBRHC - IIc Mt Sinai - IIIa Sunnybrook - IIIa WRH - IIIa Notes: WRH: Level is self-designated and subject to confirmation. 190

198 6.3 Obstetrics, Labour and Delivery (LDRP) 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* ) net operating costs per inpatient day (403* Trial Balance). BCHS BGH BWH CCH CMH GRH HHCC HHS HSN JBMH KGH LH MH MSH Mt Sinai NBRHC NSH NYGH OSMH PRHC QHC RMH RVH RVHS SAH SJHC Hamilton SJHC Toronto SLMHC Southlake STEGH Sunnybrook TBRHC TEGH THC TSH WLMH WOHS WPSHC WRH Obstetrics, LDRP Net Operating Costs per Inpatient Day FY 11/ LOC Hospital Net Operating Costs per Inpatient I BGH 545 I RMH 984 I WLMH 516 I WPSHC 1,602 Ib HHCC 705 Ib SLMHC 500 IIa BWH 732 IIa CCH 837 IIa CMH 698 IIa NSH 805 IIa QHC 823 IIa STEGH 712 IIb BCHS 763 IIb GRH 688 IIb JBMH 839 IIb PRHC 602 IIb SJHC Hamilton 634 IIb SJHC Toronto 694 IIb TSH 641 IIb WOHS 723 IIc HSN 749 IIc LH 687 IIc MH 763 IIc MSH 644 IIc NBRHC 429 IIc NYGH 546 IIc OSMH 748 IIc RVH 721 IIc RVHS 778 IIc SAH 709 IIc Southlake 704 IIc TBRHC 324 IIc TEGH 652 IIc THC 696 III HHS 797 III KGH 762 III Mt Sinai 734 III Sunnybrook 756 III WRH 756 Notes WRH: Level is self-designated and subject to confirmation. 191

199 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* ) UPP worked hours per inpatient day (403* Trial Balance). Obstetrics, LDRP UPP Worked Hours per Inpatient Day (FY 11/12) LOC Hospital UPP Worked Hours per Inpatient Day BCHS BGH BWH CCH CMH GRH HHCC HHS HSN JBMH KGH LH MH MSH Mt Sinai NBRHC NSH NYGH OSMH PRHC QHC RMH RVH RVHS SAH SJHC Hamilton SJHC Toronto SLMHC Southlake STEGH Sunnybrook TBRHC TEGH THC TSH WLMH WOHS WPSH WRH I BGH 8.2 I RMH 12.4 I WLMH 8.2 I WPSH 26.9 Ib HHCC 9.2 Ib SLMHC 8.0 IIa BWH 9.6 IIa CCH 11.8 IIa CMH 8.9 IIa NSH 10.8 IIa QHC 10.6 IIa STEGH 9.5 IIb BCHS 8.9 IIb GRH 8.8 IIb JBMH 10.4 IIb PRHC 8.2 IIb SJHC Hamilton 7.4 IIb SJHC Toronto 8.4 IIb TSH 8.1 IIb WOHS 8.5 IIc HSN 9.2 IIc LH 16.6 IIc MH 8.1 IIc MSH 8.7 IIc NBRHC 7.9 IIc NYGH 7.0 IIc OSMH 9.9 IIc RVH 9.1 IIc RVHS 9.4 IIc SAH 8.8 IIc Southlake 8.7 IIc TBRHC 4.5 IIc TEGH 8.8 IIc THC 8.8 III HHS 12.2 III KGH 9.4 III Mt Sinai 8.7 III Sunnybrook 8.7 III WRH Notes WRH: Level is self-designated and subject to confirmation. 192

200 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* ) compensation costs per inpatient (403* Trial Balance). BCHS BGH BWH CCH CMH GRH HHCC HHS HSN JBMH KGH LH MH MSH Mt Sinai NBRHC NSH NYGH OSMH PRHC QHC RMH RVH RVHS SAH SJHC Hamilton SJHC Toronto SLMHC Southlake STEGH Sunnybrook TBRHC TEGH THC TSH WLMH WOHS WPSH WRH Obstetrics, LDRP Compensation Costs per Inpatient FY 11/12 LOC Hospital Notes: WRH: Level is self-designated and subject to confirmation. Compensation Costs per Inpatient I BGH 495 I RMH 905 I WLMH 456 I WPSH 1,535 Ib HHCC 618 Ib SLMHC 401 IIa BWH 652 IIa CCH 760 IIa CMH 431 IIa NSH 727 IIa QHC 690 IIa STEGH 639 IIb BCHS 646 IIb GRH 606 IIb JBMH 719 IIb PRHC 540 IIb SJHC Hamilton 535 IIb SJHC Toronto 576 IIb TSH 563 IIb WOHS 594 IIc HSN 609 IIc LH 601 IIc MH 641 IIc MSH 560 IIc NBRHC 320 IIc NYGH 461 IIc OSMH 664 IIc RVH 625 IIc RVHS 667 IIc SAH 610 IIc Southlake 613 IIc TBRHC 303 IIc TEGH 571 IIc THC 625 III HHS 706 III KGH 633 III Mt Sinai 634 III Sunnybrook 624 III WRH

201 6.4 Obstetrics Intermediate Nursery Level II 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). BCHS GRH HHS JBMH MH MSH Mt Sinai NHS OSMH PRHC QHC RVH RVHS SGH HPHA SJHC Hamilton Obstetrics Intermediate Nursery Level II Net Operating Costs per Inpatient Day LOC Hospital Net Operating Costs per Inpatient Day II HHS 538 II Mt Sinai 614 IIa BCHS 674 IIa JBMH 426 IIa NHS 692 IIa QHC 660 IIa SGH HPHA 914 IIb GRH 689 IIb PRHC 913 IIb SJHC Hamilton 618 IIb SJHC Toronto 740 IIb Southlake 823 IIb TSH 714 IIc MH 808 IIc MSH 709 IIc OSMH 661 IIc RVH 806 IIc RVHS 897 IIc TEGH 736 IIc THC 825 IIc WOHS 762 SJHC Toronto Southlake TEGH THC TSH WOHS

202 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* ) UPP worked hours per inpatient day (403* Trial Balance). BCHS GRH HHS JBMH MH MSH Mt Sinai NHS OSMH PRHC QHC RVH RVHS SGH HPHA SJHC Hamilton SJHC Toronto Southlake TEGH THC TSH WOHS Obstetrics Intermediate Nursery Level II UPP Worked Hours per Inpatient Day LOC Hospital UPP Worked Hours per Inpatient Day II HHS 9.1 II Mt Sinai 8.0 IIa BCHS 8.7 IIa JBMH 5.4 IIa NHS 9.9 IIa QHC 8.4 IIa SGH HPHA 13.2 IIb GRH 8.9 IIb PRHC 10.6 IIb SJHC Hamilton 7.9 IIb SJHC Toronto 9.2 IIb Southlake 11.0 IIb TSH 9.6 IIc MH 10.5 IIc MSH 10.4 IIc OSMH 9.3 IIc RVH 10.7 IIc RVHS 15.6 IIc TEGH 9.4 IIc THC 9.8 IIc WOHS

203 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* ) compensation costs per inpatient day (403* Trial Balance). BCHS GRH HHS JBMH MH MSH Mt Sinai NHS OSMH PRHC QHC RVH RVHS SGH HPHA SJHC Hamilton Obstetrics Intermediate Nursery Level II Compensation Costs per Inpatient Day LOC Hospital Compensation Costs per Inpatient Day II HHS 503 II Mt Sinai 550 IIa BCHS 583 IIa JBMH 382 IIa NHS 639 IIa QHC 581 IIa SGH HPHA 846 IIb GRH 612 IIb PRHC 670 IIb SJHC Hamilton 572 IIb SJHC Toronto 637 IIb Southlake 748 IIb TSH 640 IIc MH 687 IIc MSH 613 IIc OSMH 588 IIc RVH 717 IIc RVHS 894 IIc TEGH 685 IIc THC 745 IIc WOHS 655 SJHC Toronto Southlake TEGH THC TSH WOHS

204 POPULATION-SPECIFIC INDICATORS 197

205 Neonatal Indicators Introduction Included in the 2012 Report are the updated standardized PCMCH Neonatal Levels of Care as identified by each hospital. All neonatal data has been organized according to these levels to help organizations identify peers in order to benchmark their data. The following multisite organizations are grouped at their 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. 198

206 Section Framework Section One Indicators through utilize BORN Ontario data to provide an overview of births within the province. This data is very specific to the perinatal period and focuses 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 and utilize CIHI data to provide an overview of Neonatal Abstinence Syndrome (NAS) trends in Ontario for FY 2003/04 FY 2011/12. Section Two Section Two 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. Section Three Section Three 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. Section Four Section Four 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. 199

207 1.0 Provincial Overview 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. Mother's LHIN of Residence Volume (#) Volume (%) Erie St. Clair 6, % South West 9, % Waterloo Wellington 8, % Hamilton Niagara Haldimand Brant 13, % Central West 11, % Mississauga Halton 12, % Toronto Central 13, % Central 19, % Central East 15, % South East 4, % Champlain 13, % North Simcoe Muskoka 4, % North East 5, % North West 2, % Unknown LHIN % TOTAL 138, % South East 3.1% Central East 11.4% North Simcoe Muskoka 3.0% Champlain 9.6% Central 13.8% North East 3.8% North West 1.8% Toronto Central 9.7% Erie St. Clair 4.6% South West 7.0% Waterloo Wellington 6.0% Hamilton Niagara Haldimand Brant 9.4% Central West 8.1% Mississauga Halton 8.8% Notes Data Source: BORN Ontario, Fiscal year This analysis includes birth weight 300 grams with all hospital live births for Ontario residents only. 200

208 Erie St. Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West PCMCH Maternal-Child Benchmarking Report SCN Percent Distribution by Mother s LHIN of Residence and LHIN of Birth Hospital This table presents the percent distribution of 138,547 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 South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West Unknown LHIN TOTAL 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Notes Data Source: BORN Ontario, Fiscal year This analysis includes birth weight 300 grams with all hospital live births for Ontario residents only. 201

209 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 Level Level 3 1, Total 1, % Level % Level 1 2.6% Note Data Source: BORN Ontario, Fiscal year This analysis includes birth of infants less than 32 weeks gestation and/or 1500 grams This data is not based on the new neonatal Levels of Care. Level II includes Level II and Level II+. Level III includes Level III and modified Level III. Level % 202

210 Number of Infants with NAS as MRDX NAS Beds Per Day PCMCH Maternal-Child Benchmarking Report 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. FY Number of infants with NAS as MRDx LOS (AVG) Beds per day utilized across the province Top 3 LHINs by Case Volume HNHB = 25 TC = 14 CE = 12 TC = 19 HNHB = 18 NSM = 13 HNHB = 29 NW = 24 TC = 21 NW = 29 HNHB = 27 NSM = 16 HNHB = 46 NW = 41 TC = 27 NW = 60 HNHB = 42 SW = 22 NW = 71 HNHB = 51 ESC = 34 NW = 132 HNHB = 86 ESC = 38 NW = 151 HNHB = 94 NE = 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)/

211 Number of Infants with NAS as Any Dx NAS Beds Per Day PCMCH Maternal-Child Benchmarking Report 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. FY Number of infants with NAS as any Dx LOS (AVG) Beds per day utilized across the province Top 3 LHINs by Case Volume HNHB = 40 TC = 27 CE = 18 HNHB = 41 TC = 36 CE = 17 HNHB = 51 TC = 40 NW = 34 HNHB = 40 NW = 35 TC = 29 HNHB = 71 NW = 57 TC = 54 NW = 80 HNHB = 58 SW = 47 NW = 87 HNHB = 77 SW = 51 NW = 156 HNHB = 112 SW = 59 NW = 175 HNHB = 128 NE = Beds per day utilized across the province Number of infants With NAS as Any Diagnosis 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)/

212 2.0 Neonatal Distribution SCN 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. LOC Hospital Neonatal Cases Neonatal Cases as % of Total Inpatient Cases Typical Neonatal Cases as % of Total Neonatal Cases Non-Typical Neonatal Cases as % of Total Neonatal Cases I AMGH 21 54% 67% 33% I BGH 71 38% 86% 14% I CGMH 85 57% 54% 46% I CCH % 90% 10% I HHCC 89 16% 80% 20% I NHH % 86% 14% I PRH % 93% 7% I QHC % 89% 11% I RMH % 88% 12% I SLMHC % 94% 6% I SBGHC 61 62% 93% 7% I Stevenson 62 46% 77% 23% I MHA-SMGH 21 31% 71% 29% I WLMH % 81% 19% I WPSHC 36 38% 94% 6% IIa BWH % 90% 10% IIa BCHS % 80% 20% IIa CMH % 92% 8% IIa Montfort % 89% 11% IIa JBMH % 90% 10% IIa NHS 1,140 36% 87% 13% IIa STEGH % 85% 15% IIa SGH HPHA % 80% 20% 205

213 2.1.1 SCN Neonatal Inpatient Cases (cont) LOC Hospital Neonatal Cases Neonatal Cases as % of Total Inpatient Cases Typical Neonatal Cases as % of Total Neonatal Cases Non-Typical Neonatal Cases as % of Total Neonatal Cases IIb GRH 1,501 50% 91% 9% IIb GBHS % 88% 12% IIb HHS 1,115 47% 90% 10% IIb HRRH % 83% 17% IIb PRHC % 89% 11% IIb Southlake % 88% 12% IIb SJHC Toronto 1,212 59% 90% 10% IIb SJHC Hamilton 1,038 94% 81% 19% IIb TSH 1,937 60% 93% 7% IIb THC 1,355 52% 91% 9% IIc CVH 1,588 48% 86% 14% IIc HSN % 88% 12% IIc LH 1,306 49% 91% 9% IIc MH % 94% 6% IIc MSH % 91% 9% IIc NBRHC % 87% 13% IIc NYGH 2,774 66% 94% 6% IIc OSMH % 75% 25% IIc RVHS 1,472 49% 91% 9% IIc SAH % 89% 11% IIc SMH 1,383 93% 89% 11% IIc RVH % 90% 10% IIc TBRHSC % 91% 9% IIc TEGH 1,051 57% 90% 10% IIc WOHS 3,950 54% 92% 8% IIIa Mt Sinai 2,971 97% 70% 30% IIIa Sunnybrook 1,355 92% 65% 35% IIIa TOH 2,388 94% 82% 18% IIIa WRH 1,058 40% 94% 6% IIIb CH LHSC 1,545 28% 81% 19% IIIb CHEO % 46% 54% IIIb KGH % 83% 17% IIIb MCH HHS 1,725 25% 56% 44% IIIb SickKids 1,149 8% 25% 75% Notes WRH: Level is self-designated and subject to confirmation. 206

214 2.1.2 SCN 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. LOC Hospital Neonatal ALOS FY 2010/11 FY 2011/12 I AMGH 1.7 I BGH 2.7 % Change vs Previous Year I CGMH 1.8 I CCH % I HHCC % I NHH % I PRH % I QHC % I RMH % I SLMHC % I SBGHC 1.8 I Stevenson % I MHA-SMGH % I WLMH % I WPSHC 2.6 IIa BWH % IIa BCHS % IIa CMH % IIa Montfort 3.3 IIa JBMH % IIa NHS % IIa STEGH % IIa SGH HPHA % IIb GRH % IIb GBHS % IIb HHS 3.4 IIb HRRH 4.3 IIb PRHC % IIb Southlake % IIb SJHC Toronto % IIb SJHC Hamilton % IIb TSH % IIb THC % LOC Hospital Neonatal ALOS FY 2010/11 FY 2011/12 % Change vs Previous Year IIc CVH % IIc HSN % IIc LH 4.1 IIc MH 3.6 IIc MSH % IIc NBRHC % IIc NYGH % IIc OSMH % IIc RVHS % IIc SAH % IIc SMH % IIc RVH % IIc TBRHSC % IIc TEGH % IIc WOHS % IIIa Mt Sinai % IIIa Sunnybrook % IIIa TOH 6.5 IIIa WRH % IIIb CH LHSC 8.4 IIIb CHEO % IIIb KGH 10.0 IIIb MCH HHS % IIIb SickKids 17.3 Notes HHS: The grouping of different levels may impact data that may be different based on level of care. HHS is grouped with level IIB sites however the ALOS may be lower than the other Level IIB that are single site organizations due to the averaging of the data across 3 sites with different levels of care. HHS Oakville and HHS Milton and Georgetown site data was reported separately last year. Therefore, no value is shown for FY 20010/11 in this version of the report. KGH: data for FY 09/10 and FY 10/11 included records from Hotel Dieu Hospital, Kingston (HDH Kingston). In FY 2011/12, KGH is no longer reporting together with HDH Kingston. TOH: Level 3 Neonatal Intensive Care unit includes a newborn observation area and includes level 1 babies. This may dilute some of the indicator values for NICU reported by TOH, including ALOS. TOH General campus and TOH Civic campus data was reported separately last year. Therefore, no value is shown for FY 20010/11 in this version of the report. SJHC London: moved their maternal-newborn program to CH LHSC in June WRH: Level is self-designated and subject to confirmation. 207

215 2.1.3 SCN Total Average Inpatient Weight per Case These tables present 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 I AMGH 0.37 I BGH 0.52 I CGMH 0.32 I CCH 0.48 I HHCC 0.45 I NHH 0.31 I PRH 0.40 I QHC 0.64 I RMH 0.29 I SLMHC 0.38 I SBGHC 0.33 I Stevenson 0.33 I MHA-SMGH 0.30 I WLMH 0.34 I WPSHC 0.29 IIa BWH 0.76 IIa BCHS 0.90 IIa CMH 0.56 IIa Montfort 0.57 IIa JBMH 0.62 IIa NHS 0.76 IIa STEGH 0.82 IIa SGH HPHA 0.75 IIb GRH 0.88 IIb GBHS 1.05 IIb HHS 0.60 IIb HRRH 0.78 IIb PRHC 0.83 IIb Southlake 0.95 IIb SJHC Toronto 0.83 IIb SJHC Hamilton 1.14 IIb TSH 0.72 IIb THC 0.64 LOC Hospital Neonatal ARIW IIc CVH 1.13 IIc HSN 1.19 IIc LH 0.82 IIc MH 0.92 IIc MSH 0.71 IIc NBRHC 0.87 IIc NYGH 0.67 IIc OSMH 1.28 IIc RVHS 0.89 IIc SAH 0.86 IIc SMH 1.01 IIc RVH 1.10 IIc TBRHSC 1.05 IIc TEGH 0.86 IIc WOHS 0.76 IIIa Mt Sinai 1.87 IIIa Sunnybrook 2.76 IIIa TOH 1.43 IIIa WRH 1.41 IIIb CH LHSC 2.13 IIIb CHEO 3.48 IIIb KGH 2.25 IIIb MCH HHS 3.22 IIIb Sickkids 6.32 Notes HHS: The grouping of different levels may impact data that may be different based on level of care. HHS is grouped with level IIB sites however ARIW may be lower than the other Level IIB that are single site organizations due to the averaging of the data across 3 sites with different levels of care. TOH: Level 3 Neonatal Intensive Care unit includes a newborn observation area and includes level 1 babies. This may dilute some of the indicator values for NICU reported by TOH, including Average RIW. WRH: Level is self-designated and subject to confirmation. 208

216 2.1.4 SCN Percent Neonatal Transfer From Inpatient Cases and Patient Days The chart 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. LOC Hospital Neonatal "Transfers From" Cases Neonatal "Transfers From" Cases as % of Total Neonatal Cases Neonatal "Transfers From" Days Neonatal "Transfers From" Days as % of Total Neonatal Days I AMGH <6 24% 8 23% I BGH <6 1% <6 3% I CGMH <6 2% 9 6% I CCH <6 1% 10 2% I HHCC <6 6% 19 9% I QHC 21 3% % I SLMHC <6 1% <6 1% I SBGHC <6 2% <6 1% I WPSHC <6 3% <6 2% IIa BWH 7 2% 115 7% IIa BCHS 54 10% % IIa CMH 25 3% 228 9% IIa Montfort 21 2% 154 5% IIa JBMH 22 4% % IIa NHS 78 7% % IIa STEGH 14 7% % IIa SGH HPHA 28 10% % IIb GRH 72 5% 1,368 20% IIb GBHS 17 6% % IIb HHS 48 4% % IIb HRRH 47 5% % IIb PRHC 42 6% % IIb Southlake 46 6% % IIb SJHC Toronto 72 6% 1,045 21% IIb SJHC Hamilton % 1,995 31% IIb TSH 58 3% 1,101 14% IIb THC 37 3% % IIc CVH 96 6% 1,703 17% IIc HSN 23 4% % IIc LH 71 5% 1,182 22% IIc MH 26 3% % IIc MSH 33 3% % IIc NBRHC 17 4% 192 9% IIc NYGH 103 4% 1,827 18% IIc OSMH 76 16% % IIc RVHS 63 4% 1,379 20% IIc SAH 6 2% 81 6% IIc SMH 110 8% 2,278 29% IIc RVH 19 4% % IIc TBRHSC 21 3% 429 8% IIc TEGH 57 5% % IIc WOHS 93 2% 1,524 10% IIIa Mt Sinai 35 1% 1,092 5% IIIa Sunnybrook 54 4% 1,950 14% IIIa TOH 115 5% 1,952 13% IIIa WRH 16 2% 269 4% IIIb CH LHSC % 2,677 21% IIIb CHEO % 6,540 74% IIIb KGH 47 6% 1,181 15% IIIb MCH HHS % 4,688 23% IIIb Sickkids % 18,064 91% Notes OSMH: OSMH also accepts High Risk patients 'in Utero' from our Level 1 partners although not an acute care transfer. There are very high volumes of patients whose care is transferred to us as a regional centre, and these numbers are not captured in the Benchmarking Report methodology. WRH: Level is self-designated and subject to confirmation. 209

217 2.1.5 SCN 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. LOC Hospital Neonatal "Transfers To" Cases Neonatal "Transfers To" Cases as % of Total Neonatal Cases Neonatal "Transfers To" Days Neonatal "Transfers To" Days as % of Total Neonatal Days I AMGH <6 10% <6 6% I BGH 9 13% 10 5% I CGMH 37 44% 39 26% I CCH 17 9% 26 5% I HHCC 9 10% 9 4% I NHH 19 14% 23 7% I PRH 10 4% 14 3% I QHC 39 5% 73 3% I RMH 14 10% 16 5% I SLMHC 6 4% 9 3% I SBGHC <6 5% <6 3% I Stevenson 13 21% 13 10% I MHA-SMGH <6 24% <6 9% I WLMH 32 19% 40 12% I WPSHC <6 3% <6 1% IIa BWH <6 2% 7 0% IIa BCHS 32 6% 83 3% IIa CMH 32 4% 49 2% IIa Montfort 65 7% 127 4% IIa JBMH 24 4% 44 2% IIa NHS 47 4% 170 3% IIa STEGH 12 6% 29 4% IIa SGH HPHA 29 10% 63 6% IIb GRH 46 3% 239 3% IIb GBHS 10 3% 34 2% IIb HHS 56 5% 129 3% IIb HRRH 88 9% 220 5% IIb PRHC 22 3% 37 1% IIb Southlake 37 5% 179 4% IIb SJHC Toronto 31 3% 136 3% IIb SJHC Hamilton 39 4% 328 5% IIb TSH 50 3% 174 2% IIb THC 42 3% 126 3% IIc CVH 73 5% 451 5% IIc HSN 29 6% 147 5% IIc LH 36 3% 104 2% IIc MH 25 3% 62 2% IIc MSH 44 4% 123 4% IIc NBRHC 22 5% 152 7% IIc NYGH 50 2% 160 2% IIc OSMH 30 6% 133 4% IIc RVHS 39 3% 237 3% IIc SAH 9 3% 14 1% IIc SMH 33 2% 219 3% IIc RVH 9 2% 49 1% IIc TBRHSC 16 2% 124 2% IIc TEGH 33 3% 110 2% IIc WOHS 110 3% 396 3% IIIa Mt Sinai % 10,734 48% IIIa Sunnybrook % 7,790 56% IIIa TOH % 3,795 24% IIIa WRH 38 4% 281 5% IIIb CH LHSC 127 8% 2,505 19% IIIb CHEO 95 13% 1,243 14% IIIb KGH 37 5% 567 7% IIIb MCH HHS % 7,937 39% IIIb SickKids % 5,435 27% Notes WRH: Level is self-designated and subject to confirmation. 210

218 2.1.6 SCN 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. LOC Hospital Neonatal Cases with LOS > 30 Days Neonatal Cases with LOS > 30 Days as % of Total Neonatal Cases Neonatal Days from LOS > 30 Days Neonatal Days from LOS > 30 Days as % of Total Neonatal Days I QHC <6 0.3% % IIa BWH <6 1.3% % IIa BCHS 7 1.3% % IIa CMH <6 0.1% % IIa JBMH <6 0.3% % IIa NHS <6 0.4% % IIa STEGH <6 1.0% % IIa SGH HPHA <6 0.3% % IIb GRH % 1, % IIb HHS <6 0.5% % IIb HRRH % % IIb PRHC <6 0.7% % IIb Southlake % % IIb SJHC Toronto % % IIb SJHC Hamilton % 1, % IIb TSH % 1, % IIb THC % % IIc CVH % 2, % IIc HSN 7 1.4% % IIc LH % % IIc MH % % IIc MSH <6 0.2% % IIc NBRHC % % IIc NYGH % 1, % IIc OSMH % % IIc RVHS % 1, % IIc SAH <6 1.1% % IIc SMH % 2, % IIc RVH % % IIc TBRHSC % % IIc TEGH % % IIc WOHS % 1, % IIIa Mt Sinai % 11, % IIIa Sunnybrook % 7, % IIIa TOH % 3, % IIIa WRH % 1, % IIIb CH LHSC % 6, % IIIb CHEO % 4, % IIIb KGH % 3, % IIIb MCH HHS % 10, % IIIb Sickkids % 11, % Notes WRH: Level is self-designated and subject to confirmation. 211

219 3.0 NICU/SCN Distribution SCN 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. LOC Hospital Total NICU/SCN Inpatient Cases Typical NICU/SCN Cases Typical NICU/SCN Cases as % of Total NICU/SCN Inpatient Cases Non-typical NICU/SCN Cases Non-typical NICU/SCN Cases as % of Total NICU/SCN Inpatient Cases IIa BCHS % % IIa Montfort % % IIa JBMH % % IIa NHS % % IIa SGH HPHA % % IIb GRH % % IIb GBHS % % IIb HHS % % IIb HRRH % % IIb PRHC % % IIb Southlake % % IIb SJHC Toronto % % IIb SJHC Hamilton % % IIb TSH % % IIb THC % % IIc CVH % % IIc HSN % % IIc LH % % IIc MH % % IIc MSH % % IIc NBRHC % % IIc NYGH % % IIc OSMH % % IIc RVHS % % IIc SAH % % IIc SMH % % IIc RVH % % IIc TBRHSC % % IIc TEGH % % IIc WOHS 1,390 1, % % IIIa Mt Sinai 1, % % IIIa Sunnybrook % % IIIa TOH 1,583 1, % % IIIa WRH % % IIIb CH LHSC % % IIIb CHEO % % IIIb KGH % % IIIb MCH HHS 1, % % IIIb Sickkids % % Notes STEGH: St Thomas Elgin General Hospital currently functions as a level IIa SCN. The designation has not been formally recognized. SCN activity is not reported under the CIHI NICU location and thus has been excluded from this section of the report. WRH: Level is self-designated and subject to confirmation. 212

220 3.1.2 SCN 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. LOC Hospital 0-28 Days 29 Days and Over IIa BCHS 313 <6 IIa Montfort 438 <6 IIa JBMH 288 <6 IIa NHS IIa SGH HPHA 168 <6 IIb GRH IIb GBHS IIb HHS 200 <6 IIb HRRH IIb PRHC 359 <6 IIb Southlake IIb SJHC Toronto IIb SJHC Hamilton IIb TSH IIb THC IIc CVH IIc HSN IIc LH IIc MH IIc MSH 253 <6 IIc NBRHC 167 <6 IIc NYGH IIc OSMH IIc RVHS IIc SAH 124 <6 IIc SMH IIc RVH IIc TBRHSC IIc TEGH IIc WOHS 1, IIIa Mt Sinai 1,232 6 IIIa Sunnybrook IIIa TOH 1, IIIa WRH IIIb CH LHSC IIIb CHEO IIIb KGH 396 <6 IIIb MCH HHS 1, IIIb SickKids BCHS Montfort JBMH NHS SGH HPHA GRH GBHS HHS HRRH PRHC Southlake SJHC Toronto SJHC Hamilton TSH THC CVH HSN LH MH MSH NBRHC NYGH OSMH RVHS SAH SMH RVH TBRHSC TEGH WOHS Mt Sinai Sunnybrook TOH WRH CH LHSC CHEO KGH MCH HHS SickKids 80% 85% 90% 95% 100% 0-28 Days 29 Days and Over Notes WRH: Level is self-designated and subject to confirmation. 213

221 3.1.3 SCN 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 NICU Average LOS in Days FY 10/11 FY 11/12 IIa BCHS IIa Montfort IIa JBMH IIa NHS IIa SGH HPHA IIb GRH IIb GBHS IIb HHS 8.4 IIb HRRH IIb PRHC IIb Southlake IIb SJHC Toronto IIb SJHC Hamilton IIb TSH IIb THC IIc CVH IIc HSN IIc LH IIc MH IIc MSH IIc NBRHC IIc NYGH IIc OSMH IIc RVHS IIc SAH IIc SMH IIc RVH IIc TBRHSC IIc TEGH IIc WOHS IIIa Mt Sinai IIIa Sunnybrook IIIa TOH 8.2 IIIa WRH IIIb CH LHSC 16.3 IIIb CHEO IIIb KGH IIIb MCH HHS IIIb SickKids NICU Average LOS in Days (FY 11/12) BCHS Montfort JBMH NHS SGH HPHA GRH GBHS HHS HRRH PRHC Southlake SJHC Toronto SJHC Hamilton TSH THC CVH HSN LH MH MSH NBRHC NYGH OSMH RVHS SAH SMH RVH TBRHSC TEGH WOHS Mt Sinai Sunnybrook TOH WRH CH LHSC CHEO KGH MCH HHS SickKids Notes KGH: data for FY 09/10 and FY 10/11 included records from Hotel Dieu Hospital, Kingston (HDH Kingston). In FY 2011/12, KGH is no longer reporting together with HDH Kingston. TOH: TOH General campus and TOH Civic campus data was reported separately last year. Therefore, no value is shown for FY 2010/11 in this version of the report. WRH: Level is self-designated and subject to confirmation. 214

222 3.1.4 SCN Percent NICU/SCN Transfer From Inpatient Cases and Days This table and chart present 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. LOC Hospital Inpatient Cases: "Transfers From" other Institutions to NICU / SCN As % Of All Total Number NICU/SCN Cases IIa BCHS 53 17% IIa Montfort 24 5% IIa JBMH 24 8% IIa NHS 78 18% IIa SGH HPHA 31 18% IIb GRH 98 17% IIb GBHS 25 13% IIb HHS 48 24% IIb HRRH 49 11% IIb PRHC 40 11% IIb Southlake 54 12% IIb SJHC Toronto 68 19% IIb SJHC Hamilton % IIb TSH 65 9% IIb THC 48 9% IIc CVH % IIc HSN 33 12% IIc LH 87 22% IIc MH 31 8% IIc MSH 35 14% IIc NBRHC 14 8% IIc NYGH % IIc OSMH 82 24% IIc RVHS 76 13% IIc SAH <6 3% IIc SMH % IIc RVH 27 9% IIc TBRHSC 28 7% IIc TEGH 66 19% IIc WOHS 125 9% IIIa Mt Sinai 49 4% IIIa Sunnybrook 61 9% IIIa TOH 143 9% IIIa WRH 25 6% IIIb CH LHSC 83 15% IIIb CHEO % IIIb KGH 45 11% IIIb MCH HHS % IIIb SickKids % BCHS Montfort JBMH NHS SGH HPHA GRH GBHS HHS HRRH PRHC Southlake SJHC Toronto SJHC Hamilton Inpatient Cases: "Transfers From" other Institutions to NICU / SCN (As % Of All NICU/SCN Cases) TSH THC CVH HSN LH MH MSH NBRHC NYGH OSMH RVHS SAH SMH RVH TBRHSC TEGH WOHS Mt Sinai Sunnybrook TOH WRH CH LHSC CHEO KGH MCH HHS SickKids 0% 20% 40% 60% 80% 100% 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. WRH: Level is self-designated and subject to confirmation. 215

223 3.1.5 SCN 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 NICU/SCN LOC Hospital As % Of All Total Number NICU/SCN Cases IIa BCHS 46 15% IIa Montfort 58 13% IIa JBMH 21 7% IIa NHS 52 12% IIa SGH HPHA 30 17% IIb GRH 46 8% IIb GBHS 19 10% IIb HHS 18 9% IIb HRRH 37 8% IIb PRHC 30 8% IIb Southlake 42 10% IIb SJHC Toronto 33 9% IIb SJHC Hamilton 73 15% IIb TSH 50 7% IIb THC 33 6% IIc CVH 70 9% IIc HSN 45 16% IIc LH 40 10% IIc MH 28 8% IIc MSH 40 16% IIc NBRHC 25 15% IIc NYGH 57 12% IIc OSMH 44 13% IIc RVHS 29 5% IIc SAH 8 6% IIc SMH 39 8% IIc RVH 16 5% IIc TBRHSC 24 6% IIc TEGH 37 10% IIc WOHS 118 8% IIIa Mt Sinai % IIIa Sunnybrook % IIIa TOH % IIIa WRH 39 9% IIIb CH LHSC % IIIb CHEO % IIIb KGH 47 12% IIIb MCH HHS % IIIb SickKids % Inpatient Cases: "Transfers To" other Institution NICU/SCN (As % Of All NICU/SCN Cases) BCHS Montfort JBMH NHS SGH HPHA GRH GBHS HHS HRRH PRHC Southlake SJHC Toronto SJHC Hamilton TSH THC CVH HSN LH MH MSH NBRHC NYGH OSMH RVHS SAH SMH RVH TBRHSC TEGH WOHS Mt Sinai Sunnybrook TOH WRH CH LHSC CHEO KGH MCH HHS SickKids 0% 10% 20% 30% 40% 50% 60% 70% 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. WRH: Level is self-designated and subject to confirmation. 216

224 4.0 SCN NICU/SCN Jaundice SCN 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. LOC Hospital NICU/SCN Jaundice Inpatient Cases Total Inpatient Jaundice Cases % of NICU/SCN Jaundice Inpatients Cases IIa BCHS % IIa Montfort % IIa JBMH % IIa NHS % IIa SGH HPHA % IIb GRH < % IIb GBHS % IIb HHS % IIb HRRH % IIb PRHC % IIb Southlake % IIb SJHC Toronto <6 93 3% IIb SJHC Hamilton < % IIb TSH % IIb THC % IIc CVH % IIc HSN % IIc LH < % IIc MH < % IIc MSH % IIc NBRHC <6 88 5% IIc NYGH % IIc OSMH % IIc RVHS % IIc SAH % IIc SMH % IIc RVH <6 24 4% IIc TBRHSC % IIc TEGH <6 75 1% IIc WOHS % IIIa Mt Sinai % IIIa Sunnybrook % IIIa TOH % IIIa WRH % IIIb CH LHSC <6 80 6% IIIb CHEO % IIIb KGH <6 44 7% IIIb MCH HHS % IIIb SickKids % % of NICU/SCN Jaundice Inpatient Cases BCHS Montfort JBMH NHS SGH HPHA GRH GBHS HHS HRRH PRHC Southlake SJHC Toronto SJHC Hamilton TSH THC CVH HSN LH MH MSH NBRHC NYGH OSMH RVHS SAH SMH RVH TBRHSC TEGH WOHS Mt Sinai Sunnybrook TOH WRH CH LHSC CHEO KGH MCH HHS SickKids 0% 20% 40% 60% 80% 100% Notes WRH: Level is self-designated and subject to confirmation. 217

225 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 their 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 London Health Sciences Centre (LHSC) Obstetrical data is noted under Children's Hospital (CH LHSC). Data Sources CIHI data is the traditional data source used for the PCMCH Benchmarking Report through the DAD database. Obstetrical discharge data is 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. 218

226 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 536 Caesarean Section With Previous Uterine Scar 537 Primary Caesarean Section 538 Vaginal Birth With Previous Uterine Scar, Forceps/Vacuum Delivery, With Other Non-Major Intervention 539 Vaginal Birth With Previous Uterine Scar, Forceps/Vacuum Delivery, With Other Non-Major Intervention 540 Vaginal Birth With Previous Uterine Scar, Without Instrumentation, With Other Non-Major Intervention 541 Vaginal Birth With Previous Uterine Scar, Without Instrumentation, No Other Intervention 542 Forceps/Vacuum Delivery with Non-Major Intervention 543 Forceps/Vacuum Delivery, No Other Intervention 544 Vaginal Delivery with Non-Major Intervention 545 Vaginal Delivery, No Other Intervention 556 Antepartum Disorder Treated Surgically/Non-Major Intervention 557 Antepartum Disorder treated Medically 999 Ungroupable - Includes the following CMGs that are masked in the CIHI Portal: 546 Ectopic Pregnancy Treated Surgically/Non-Major Intervention 547 Ectopic Pregnancy treated Medically 548 Abortion for Fetal Anomaly Treated Surgically/Non-Major Intervention 549 Abortion for Fetal Anomaly Treated Medically 550 Abortion Diagnosis Treated Surgically/Non-Major Intervention 551 Abortion Diagnosis Treated Medically 552 Postpartum Disorder Treated Surgically/Non-Major Intervention 553 Postpartum Disorder Treated Medically 554 Post Abortion Disorder Treated Surgically/Non-Major Intervention 555 Post Abortion Disorder Treated Medically 219

227 1.0 Hospital Descriptors OBS 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 LOC Hospital Total OBS Total % of Cases Deliveries Deliveries Ia AMGH % Ia MHA-SMGH % Ib BGH % Ib CGMH % Ib CCH % Ib HHCC % Ib NGH % Ib NHH % Ib PRH % Ib QHC 1,553 1,406 91% Ib RMH % Ib SLMHC % Ib SBGHC % Ib Stevenson % Ib WLMH % Ib WPSHC % IIa BWH 1,108 1,017 92% IIa CMH 1,559 1,408 90% IIa Montfort 3,390 3,024 89% IIa NHS 3,050 2,684 88% IIa STEGH % IIa SGH HPHA 1,229 1,151 94% IIb BCHS 1,539 1,437 93% IIb GRH 4,729 4,241 90% IIb GBHS % IIb HHS 3,799 3,532 93% IIb HRRH 3,933 3,545 90% IIb JBMH 1,707 1,598 94% IIb PRHC 1,700 1,491 88% IIb Southlake 2,825 2,600 92% IIb SJHC Toronto 3,306 3,007 91% IIb SJHC Hamilton 3,825 3,439 90% IIb TSH 5,260 4,767 91% IIb THC 4,294 4,048 94% IIb WOHS 8,396 7,482 89% IIc CVH 5,383 5,014 93% IIc HSN 2,025 1,882 93% IIc LH 3,094 2,851 92% IIc MH 2,722 2,411 89% IIc MSH 3,241 3,067 95% IIc NBRHC 1, % IIc NYGH 6,201 5,785 93% IIc OSMH 1, % IIc RVHS 4,067 3,617 89% IIc SAH 1, % IIc RVH 2,269 2,097 92% IIc TBRHSC 1,672 1,488 89% IIc TEGH 3,763 3,360 89% III CH LHSC 5,698 4,995 88% III KGH 2,230 1,992 89% III MCH HHS 3,167 2,689 85% III Mt Sinai 8,406 6,564 78% III SMH 3,487 3,156 91% III Sunnybrook 4,365 3,747 86% III TOH 7,490 6,430 86% III WRH 4,132 3,700 90% AMGH MHA-SMGH BGH CGMH CCH HHCC NGH NHH PRH QHC RMH SLMHC SBGHC Stevenson WLMH WPSHC BWH CMH Montfort NHS STEGH SGH HPHA BCHS GRH GBHS HHS HRRH JBMH PRHC Southlake SJHC Toronto SJHC Hamilton TSH THC WOHS CVH HSN LH MH MSH NBRHC NYGH OSMH RVHS SAH RVH TBRHSC TEGH CH LHSC KGH MCH HHS Mt Sinai SMH Sunnybrook TOH WRH Percent of Admissions with a Delivery 50% 60% 70% 80% 90% 100% Notes GBHS: GBHS had one additional delivery obstetrical case identified by patient service 51 that didn t group to one of the obstetrical CMGs used in the Benchmarking Report methodology. WRH: Level is self-designated and subject to confirmation. 220

228 1.1.2 OBS 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. LOC Hospital <20 Years Notes WRH: Level is self-designated and subject to confirmation Years Years Years Years Years 45+ Years Ia AMGH < <6 Ia MHA-SMGH <6 Ib BGH <6 Ib CGMH Ib CCH Ib HHCC <6 Ib NGH Ib NHH Ib PRH Ib QHC <6 Ib RMH <6 Ib SLMHC Ib SBGHC <6 Ib Stevenson Ib WLMH <6 Ib WPSHC <6 IIa BWH <6 IIa CMH <6 IIa Montfort <6 IIa NHS <6 IIa STEGH <6 IIa SGH HPHA <6 IIb BCHS IIb GRH IIb GBHS IIb HHS IIb HRRH IIb JBMH <6 IIb PRHC <6 IIb Southlake <6 IIb SJHC Toronto IIb SJHC Hamilton IIb TSH IIb THC IIb WOHS IIc CVH IIc HSN IIc LH IIc MH IIc MSH IIc NBRHC <6 IIc NYGH IIc OSMH IIc RVHS IIc SAH IIc RVH <6 IIc TBRHSC <6 IIc TEGH III CH LHSC III KGH <6 III MCH HHS III Mt Sinai III SMH III Sunnybrook III TOH III WRH

229 This graph provides the distribution of cases by age category of the inpatient obstetrical cases of each hospital. AMGH MHA-SMGH BGH CGMH CCH HHCC NGH NHH PRH QHC RMH SLMHC SBGHC Stevenson WLMH WPSHC BWH CMH Montfort NHS STEGH SGH HPHA BCHS GRH GBHS HHS HRRH JBMH PRHC Southlake SJHC Toronto SJHC Hamilton TSH THC WOHS CVH HSN LH MH MSH NBRHC NYGH OSMH RVHS SAH RVH TBRHSC TEGH CH LHSC KGH MCH HHS Mt Sinai SMH Sunnybrook TOH WRH Obstetrical Age Profile 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% <20 Years Years Years Years Years Years 45+ Years 222

230 1.1.3 OBS Total Average LOS This table and chart illustrate 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 Total Average LOS 11/12 Ia AMGH 2.1 Ia MHA-SMGH 2.0 Ib BGH 2.4 Ib CGMH 1.9 Ib CCH 2.0 Ib HHCC 2.2 Ib NGH 2.0 Ib NHH 2.3 Ib PRH 2.3 Ib QHC 2.1 Ib RMH 2.2 Ib SLMHC 1.8 Ib SBGHC 2.0 Ib Stevenson 2.0 Ib WLMH 2.1 Ib WPSHC 2.5 IIa BWH 2.3 IIa CMH 2.0 IIa Montfort 2.4 IIa NHS 2.1 IIa STEGH 1.7 IIa SGH HPHA 1.8 IIb BCHS 2.1 IIb GRH 1.9 IIb GBHS 2.1 IIb HHS 2.0 IIb HRRH 2.0 IIb JBMH 2.0 IIb PRHC 2.3 IIb Southlake 2.3 IIb SJHC Toronto 1.7 IIb SJHC Hamilton 2.4 IIb TSH 1.9 IIb THC 1.8 IIb WOHS 2.0 IIc CVH 2.1 IIc HSN 2.0 IIc LH 2.3 IIc MH 1.9 IIc MSH 1.9 IIc NBRHC 2.3 IIc NYGH 2.0 IIc OSMH 2.6 IIc RVHS 2.3 IIc SAH 2.3 IIc RVH 2.1 IIc TBRHSC 2.8 IIc TEGH 1.9 III CH LHSC 2.6 III KGH 2.5 III MCH HHS 3.6 III Mt Sinai 2.9 III SMH 2.3 III Sunnybrook 3.3 III TOH 2.8 III WRH 2.4 AMGH MHA-SMGH BGH CGMH CCH HHCC NGH NHH PRH QHC RMH SLMHC SBGHC Stevenson WLMH WPSHC BWH CMH Montfort NHS STEGH SGH HPHA BCHS GRH GBHS HHS HRRH JBMH PRHC Southlake SJHC Toronto SJHC Hamilton TSH THC WOHS CVH HSN LH MH MSH NBRHC NYGH OSMH RVHS SAH RVH TBRHSC TEGH CH LHSC KGH MCH HHS Mt Sinai SMH Sunnybrook TOH WRH Total Average LOS Notes HHS: The grouping of different levels may impact data that may be different based on level of care. HHS is grouped with level IIB sites however the ALOS may be lower than the other Level IIB that are single site organizations due to the averaging of the data across 3 sites with different levels of care. WRH: Level is self-designated and subject to confirmation. 223

231 1.1.4 OBS 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 AMGH 0.52 Ia MHA-SMGH 0.50 Ib BGH 0.57 Ib CGMH 0.50 Ib CCH 0.57 Ib HHCC 0.54 Ib NGH 0.50 Ib NHH 0.55 Ib PRH 0.54 Ib QHC 0.55 Ib RMH 0.54 Ib SLMHC 0.49 Ib SBGHC 0.49 Ib Stevenson 0.52 Ib WLMH 0.51 Ib WPSHC 0.50 IIa BWH 0.53 IIa CMH 0.52 IIa Montfort 0.52 IIa NHS 0.52 IIa STEGH 0.50 IIa SGH HPHA 0.52 IIb BCHS 0.53 IIb GRH 0.52 IIb GBHS 0.53 IIb HHS 0.53 IIb HRRH 0.54 IIb JBMH 0.54 IIb PRHC 0.54 IIb Southlake 0.53 IIb SJHC Toronto 0.54 IIb SJHC Hamilton 0.53 IIb TSH 0.53 IIb THC 0.52 IIb WOHS 0.55 IIc CVH 0.53 IIc HSN 0.55 IIc LH 0.54 IIc MH 0.52 IIc MSH 0.54 IIc NBRHC 0.56 IIc NYGH 0.54 IIc OSMH 0.60 IIc RVHS 0.56 IIc SAH 0.56 IIc RVH 0.54 IIc TBRHSC 0.56 IIc TEGH 0.53 III CH LHSC 0.59 III KGH 0.58 III MCH HHS 0.69 III Mt Sinai 0.63 III SMH 0.54 III Sunnybrook 0.71 III TOH 0.59 III WRH 0.59 AMGH MHA-SMGH BGH CGMH CCH HHCC NGH NHH PRH QHC RMH SLMHC SBGHC Stevenson WLMH WPSHC BWH CMH Montfort NHS STEGH SGH HPHA BCHS GRH GBHS HHS HRRH JBMH PRHC Southlake SJHC Toronto SJHC Hamilton TSH THC WOHS CVH HSN LH MH MSH NBRHC NYGH OSMH RVHS SAH RVH TBRHSC TEGH CH LHSC KGH MCH HHS Mt Sinai SMH Sunnybrook TOH WRH Total Average Inpatient Weight per Case Notes HHS: The grouping of different levels may impact data that may be different based on level of care. HHS is grouped with level IIB sites however ARIW may be lower than the other Level IIB that are single site organizations due to the averaging of the data across 3 sites with different levels of care. WRH: Level is self-designated and subject to confirmation. 224

232 1.1.5 OBS Percent Typical, Outlier & Other Inpatient Cases and Patient Days These charts display the percentage of inpatient obstetrical cases and patient days 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. AMGH MHA-SMGH BGH CGMH CCH HHCC NGH NHH PRH QHC RMH SLMHC SBGHC Stevenson WLMH WPSHC BWH CMH Montfort NHS STEGH SGH HPHA BCHS GRH GBHS HHS HRRH JBMH PRHC Southlake SJHC Toronto SJHC Hamilton TSH THC WOHS CVH HSN LH MH MSH NBRHC NYGH OSMH RVHS SAH RVH TBRHSC TEGH CH LHSC KGH MCH HHS Mt Sinai SMH Sunnybrook TOH WRH % Typical, Outlier and Other Patient Cases 80% 82% 84% 86% 88% 90% 92% 94% 96% 98% 100% Typical Outlier Other AMGH MHA-SMGH BGH CGMH CCH HHCC NGH NHH PRH QHC RMH SLMHC SBGHC Stevenson WLMH WPSHC BWH CMH Montfort NHS STEGH SGH HPHA BCHS GRH GBHS HHS HRRH JBMH PRHC Southlake SJHC Toronto SJHC Hamilton TSH THC WOHS CVH HSN LH MH MSH NBRHC NYGH OSMH RVHS SAH RVH TBRHSC TEGH CH LHSC KGH MCH HHS Mt Sinai SMH Sunnybrook TOH WRH % Typical, Outlier and Other Patient Days 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Typical Outlier Other 225

233 This table displays the percentage of inpatient obstetrical cases classified as Typical, Outlier or Other. LOC Hospitals % Cases % Days Typical Outlier Other Typical Outlier Other Ia AMGH 93.3% 2.2% 4.5% 87.8% 7.9% 4.2% Ia MHA-SMGH 97.4% 0.0% 2.6% 98.7% 0.0% 1.3% Ib BGH 97.0% 2.7% 0.3% 93.8% 6.1% 0.1% Ib CGMH 96.4% 0.5% 3.1% 96.2% 1.4% 2.4% Ib CCH 96.6% 0.6% 2.7% 96.1% 2.5% 1.4% Ib HHCC 97.5% 0.8% 1.7% 94.3% 4.7% 1.0% Ib NGH 97.6% 0.6% 1.8% 97.5% 1.5% 1.0% Ib NHH 98.4% 0.0% 1.6% 99.1% 0.0% 0.9% Ib PRH 98.8% 0.9% 0.3% 96.7% 3.0% 0.2% Ib QHC 97.2% 1.5% 1.3% 95.2% 3.8% 1.0% Ib RMH 98.2% 0.3% 1.5% 98.7% 0.6% 0.7% Ib SLMHC 96.1% 2.1% 1.7% 87.4% 11.1% 1.5% Ib SBGHC 97.6% 0.0% 2.4% 98.6% 0.0% 1.4% Ib Stevenson 95.9% 1.8% 2.4% 92.8% 5.7% 1.5% Ib WLMH 98.2% 0.3% 1.5% 98.2% 0.9% 0.9% Ib WPSHC 89.7% 5.8% 4.5% 84.1% 13.9% 2.0% IIa BWH 98.2% 1.3% 0.5% 93.4% 6.2% 0.4% IIa CMH 98.4% 0.3% 1.3% 98.2% 0.9% 1.0% IIa Montfort 98.0% 1.2% 0.8% 95.7% 3.6% 0.6% IIa NHS 97.3% 0.7% 2.0% 96.1% 2.3% 1.6% IIa STEGH 98.6% 0.4% 1.1% 97.7% 1.6% 0.7% IIa SGH HPHA 95.4% 0.6% 4.1% 93.6% 3.0% 3.5% IIb BCHS 98.1% 0.8% 1.2% 95.6% 3.4% 1.0% IIb GRH 98.0% 1.4% 0.6% 91.9% 7.6% 0.6% IIb GBHS 97.9% 1.0% 1.1% 92.5% 6.3% 1.2% IIb HHS 98.1% 0.8% 1.1% 95.8% 3.2% 1.0% IIb HRRH 98.2% 0.7% 1.1% 95.6% 3.6% 0.8% IIb JBMH 99.0% 0.3% 0.7% 98.5% 1.1% 0.5% IIb PRHC 96.6% 1.5% 1.9% 90.5% 7.8% 1.7% IIb Southlake 97.8% 1.6% 0.7% 92.4% 7.1% 0.5% IIb SJHC Toronto 98.8% 0.5% 0.8% 96.2% 2.6% 1.3% IIb SJHC Hamilton 96.7% 2.1% 1.2% 92.0% 6.9% 1.1% IIb TSH 98.3% 0.8% 0.9% 95.0% 4.2% 0.8% IIb THC 98.7% 0.9% 0.3% 95.3% 4.4% 0.3% IIb WOHS 97.5% 1.5% 0.9% 90.8% 8.4% 0.8% IIc CVH 98.5% 0.9% 0.6% 95.8% 3.8% 0.4% IIc HSN 96.1% 1.5% 2.4% 86.9% 10.9% 2.2% IIc LH 97.9% 0.6% 1.5% 96.8% 2.0% 1.2% IIc MH 97.5% 1.3% 1.2% 90.4% 8.5% 1.0% IIc MSH 98.5% 1.0% 0.4% 94.7% 5.0% 0.4% IIc NBRHC 95.2% 2.0% 2.8% 83.7% 13.6% 2.7% IIc NYGH 98.7% 0.9% 0.4% 95.2% 4.4% 0.4% IIc OSMH 91.8% 2.5% 5.7% 85.3% 8.7% 6.1% IIc RVHS 97.7% 1.8% 0.5% 87.1% 12.5% 0.4% IIc SAH 96.5% 2.0% 1.5% 88.3% 10.4% 1.3% IIc RVH 98.6% 0.7% 0.7% 95.4% 3.8% 0.8% IIc TBRHSC 92.5% 4.7% 2.9% 84.6% 13.1% 2.4% IIc TEGH 98.2% 0.9% 0.9% 93.9% 4.8% 1.3% III CH LHSC 95.4% 3.2% 1.5% 76.7% 21.4% 1.9% III KGH 94.0% 2.8% 3.2% 84.0% 12.6% 3.4% III MCH HHS 86.7% 6.2% 7.1% 66.6% 26.2% 7.2% III Mt Sinai 93.1% 4.9% 2.0% 73.5% 24.2% 2.3% III SMH 97.4% 1.4% 1.2% 94.5% 4.3% 1.1% III Sunnybrook 89.4% 5.8% 4.7% 60.7% 33.6% 5.7% III TOH 94.7% 3.1% 2.2% 86.1% 11.7% 2.2% III WRH 95.6% 3.7% 0.7% 76.1% 23.3% 0.6% Notes WRH: Level is self-designated and subject to confirmation. 226

234 1.1.6 OBS 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. LOC Hospitals "Transfers From" Inpatient OBS cases % "Transfers From" Inpatient OBS cases "Transfers From" Inpatient OBS Days % "Transfers From" of Total Inpatient OBS Days Ia AMGH <6 3.4% <6 2.6% Ib CCH <6 0.2% <6 0.1% Ib HHCC <6 0.1% <6 0.1% Ib QHC 9 0.6% % Ib SLMHC <6 0.6% <6 0.4% Ib WPSHC <6 0.6% <6 0.5% IIa BWH <6 0.1% % IIa CMH <6 0.1% 8 0.3% IIa Montfort <6 0.1% % IIa NHS % % IIa STEGH <6 0.4% <6 0.3% IIa SGH HPHA % % IIb BCHS <6 0.3% 9 0.3% IIb GRH <6 0.1% % IIb GBHS 7 0.9% % IIb HHS % % IIb HRRH 7 0.2% % IIb JBMH <6 0.2% 8 0.2% IIb PRHC % % IIb Southlake 9 0.3% % IIb SJHC Toronto 8 0.2% % IIb SJHC Hamilton % % IIb TSH 9 0.2% % IIb THC <6 0.0% 7 0.1% IIb WOHS % % IIc CVH <6 0.1% % IIc HSN % % IIc LH % % IIc MH <6 0.1% % IIc MSH <6 0.1% 9 0.1% IIc NBRHC % % IIc NYGH 9 0.1% % IIc OSMH % % IIc RVHS 8 0.2% % IIc SAH 9 0.9% % IIc RVH 7 0.3% % IIc TBRHSC % % IIc TEGH % % III CH LHSC % % III KGH % % III MCH HHS % % III Mt Sinai % % III SMH % % III Sunnybrook % % III TOH % % III WRH % % Notes QHC: QHC has a small program at one site which has been excluded from the reported volumes. This program yields fewer than fifty cases annually. The majority of reported transfer from cases are from this program. WRH: Level is self-designated and subject to confirmation. 227

235 1.1.7 OBS 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. LOC Hospitals "Transfers To" Inpatient OBS Cases Notes WRH: Level is self-designated and subject to confirmation. % "Transfers To" Inpatient OBS Cases "Transfers To" Inpatient OBS Days % "Transfers To" of Total Inpatient OBS Days Ia AMGH <6 2.2% % Ia MHA-SMGH <6 1.3% <6 0.6% Ib BGH <6 0.6% % Ib CGMH % % Ib CCH 6 1.0% % Ib HHCC <6 0.7% 7 0.4% Ib NGH 6 1.8% 7 1.0% Ib NHH 9 1.6% % Ib QHC 9 0.6% % Ib RMH <6 1.0% <6 0.5% Ib SLMHC 6 1.2% % Ib Stevenson <6 1.2% <6 0.6% Ib WLMH % % Ib WPSHC <6 3.2% <6 1.3% IIa CMH % % IIa Montfort % % IIa NHS % % IIa STEGH <6 0.5% 6 0.4% IIa SGH HPHA % % IIb BCHS % % IIb GRH % % IIb GBHS <6 0.5% 7 0.4% IIb HHS % % IIb HRRH % % IIb JBMH 7 0.4% 7 0.2% IIb PRHC % % IIb Southlake % % IIb SJHC Toronto 8 0.2% 8 0.1% IIb SJHC Hamilton % % IIb TSH % % IIb THC % % IIb WOHS % % IIc CVH % % IIc HSN % % IIc LH % % IIc MH % % IIc MSH % % IIc NBRHC % % IIc NYGH % % IIc OSMH 6 0.6% 8 0.3% IIc RVHS % % IIc SAH 6 0.6% % IIc RVH 9 0.4% % IIc TBRHSC 9 0.5% % IIc TEGH % % III CH LHSC % % III KGH <6 0.2% % III MCH HHS % % III Mt Sinai % % III SMH % % III Sunnybrook % % III TOH % % III WRH % % 228

236 1.1.8 OBS 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. LOC Hospital Inpatient OBS Cases with Duration >30 Days Notes WRH: Level is self-designated and subject to confirmation. Inpatient OBS Cases with Duration >30 Days as % of Total OBS Cases Inpatient OBS Days for Cases with Duration >30 Days Inpatient OBS Days (for Cases with Duration >30 Days) as % of Total OBS Cases Ib HHCC <6 0.14% % IIb GRH <6 0.04% % IIb GBHS <6 0.12% % IIb HHS <6 0.03% % IIb PRHC <6 0.12% % IIb Southlake <6 0.04% % IIb SJHC Hamilton <6 0.03% % IIb TSH <6 0.02% % IIb THC <6 0.02% % IIb WOHS <6 0.06% % IIc CVH <6 0.02% % IIc HSN <6 0.10% % IIc LH <6 0.03% % IIc MH <6 0.04% % IIc MSH <6 0.03% % IIc NBRHC <6 0.27% % IIc RVHS % % IIc SAH <6 0.10% % IIc RVH <6 0.04% % IIc TBRHSC <6 0.18% % IIc TEGH <6 0.05% % III CH LHSC % 1, % III KGH <6 0.09% % III MCH HHS % 1, % III Mt Sinai % 1, % III Sunnybrook % 2, % III TOH % % III WRH % % 229

237 WLMH WPSHC BWH CMH Monfort NHS STEGH SGH HPHA BCHS GRH GBHS HHS HRRH JBMH AMGH MHA-SMGH BGH CGMH CCH HHCC NGH NHH PRH QHC RMH SLMHC SBGHC Stevenson PCMCH Maternal-Child Benchmarking Report OBS 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+ Ia Ia Ib Ib Ib Ib Ib Ib Ib Ib Ib Ib Ib Ib 545 Vaginal Delivery, No Other Intervention Primary Caesarean Section Caesarean Section With Previous Uterine Scar Forceps/Vacuum Delivery, No Other Intervention < Antepartum Disorder treated Medically < Ungroupable 6 < < Vaginal Delivery with Non-Major Intervention <6 <6 < <6 <6 7 <6 541 Vaginal Birth With Previous Uterine Scar, Without Instrumentation, No Other Intervention <6 <6 13 <6 <6 < < Forceps/Vacuum Delivery with Non-Major Intervention <6 <6 < < <6 <6 <6 556 Antepartum Disorder Treated Surgically/Non-Major Intervention 539 Vaginal Birth With Previous Uterine Scar, Forceps/Vacuum Delivery, No Other Intervention 540 Vaginal Birth With Previous Uterine Scar, w/o Instrumentation, w/other Non-Major Intervention 532 Fetal Intervention 538 Vaginal Birth w/ Prev.Uterine Scar, Forceps/Vacuum Delivery, w/ Other Non-Major Intervention 531 Major Intervention not related to Obstetric Diagnosis <6 <6 <6 <6 <6 <6 <6 <6 <6 6 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 530 Major Intervention related to Obstetric Diagnosis <6 CMG+ Ib Ib IIa IIa IIa IIa IIa IIa IIb IIb IIb IIb IIb IIb 545 Vaginal Delivery, No Other Intervention ,863 1, , ,069 1, Primary Caesarean Section Caesarean Section With Previous Uterine Scar Forceps/Vacuum Delivery, No Other Intervention 74 < Antepartum Disorder treated Medically Ungroupable Vaginal Delivery with Non-Major Intervention 6 < Vaginal Birth With Previous Uterine Scar, Without Instrumentation, No Other Intervention Forceps/Vacuum Delivery with Non-Major Intervention < Antepartum Disorder Treated Surgically/Non-Major Intervention 539 Vaginal Birth With Previous Uterine Scar, Forceps/Vacuum Delivery, No Other Intervention 540 Vaginal Birth With Previous Uterine Scar, w/o Instrumentation, w/other Non-Major Intervention 532 Fetal Intervention 538 Vaginal Birth w/ Prev.Uterine Scar, Forceps/Vacuum Delivery, w/ Other Non-Major Intervention <6 <6 <6 <6 6 <6 <6 11 <6 <6 18 <6 <6 <6 9 8 <6 <6 <6 12 <6 <6 <6 11 <6 <6 <6 <6 <6 6 <6 <6 <6 <6 <6 <6 531 Major Intervention not related to Obstetric Diagnosis <6 <6 <6 <6 <6 <6 530 Major Intervention related to Obstetric Diagnosis <6 <6 <6 <6 <6 <6 230

238 OSMH RVHS SAH RVH TBRHSC TEGH CH LHSC KGH MCH HHS Mt Sinai SMH Sunnybrook TOH WRH TOTAL PRHC Southlake SJHC Toronto SJHC Hamilton TSH THC WOHS CVH HSN LH MH MSH NBRHC NYGH PCMCH Maternal-Child Benchmarking Report OBS Obstetrical Top 5 CMGs (cont) CMG+ IIb IIb IIb IIb IIb IIb IIb IIc IIc IIc IIc IIc IIc IIc 545 Vaginal Delivery, No Other Intervention 873 1,699 1,559 2,166 2,665 2,530 4,313 2,897 1,193 1,728 1,465 1, , Primary Caesarean Section , Caesarean Section With Previous Uterine Scar , Forceps/Vacuum Delivery, No Other Intervention Antepartum Disorder treated Medically Ungroupable Vaginal Delivery with Non-Major Intervention Vaginal Birth With Previous Uterine Scar, Without Instrumentation, No Other Intervention Forceps/Vacuum Delivery with Non-Major Intervention < Antepartum Disorder Treated Surgically/Non-Major Intervention 539 Vaginal Birth With Previous Uterine Scar, Forceps/Vacuum Delivery, No Other Intervention 540 Vaginal Birth With Previous Uterine Scar, w/o Instrumentation, w/other Non-Major Intervention 532 Fetal Intervention 538 Vaginal Birth w/ Prev.Uterine Scar, Forceps/Vacuum Delivery, w/ Other Non-Major Intervention <6 <6 11 < <6 8 <6 <6 <6 7 < <6 < <6 14 <6 <6 6 8 <6 7 <6 <6 10 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 531 Major Intervention not related to Obstetric Diagnosis <6 <6 <6 <6 <6 <6 530 Major Intervention related to Obstetric Diagnosis <6 <6 <6 <6 <6 7 CMG+ IIc IIc IIc IIc IIc IIc III III III III III III III III 545 Vaginal Delivery, No Other Intervention 424 1, , ,925 3,130 1,204 1,385 3,375 1,897 1,904 3,511 2,127 73, Primary Caesarean Section , , , Caesarean Section With Previous Uterine Scar , Forceps/Vacuum Delivery, No Other Intervention , Antepartum Disorder treated Medically , , Ungroupable , Vaginal Delivery with Non-Major Intervention , Vaginal Birth With Previous Uterine Scar, Without Instrumentation, No Other Intervention , Forceps/Vacuum Delivery with Non-Major Intervention < , Antepartum Disorder Treated Surgically/Non-Major Intervention 539 Vaginal Birth With Previous Uterine Scar, Forceps/Vacuum Delivery, No Other Intervention 540 Vaginal Birth With Previous Uterine Scar, w/o Instrumentation, w/other Non-Major Intervention 6 11 <6 <6 < <6 10 <6 <6 < < <6 <6 <6 7 8 <6 6 7 < < Fetal Intervention 67 < Vaginal Birth w/ Prev.Uterine Scar, Forceps/Vacuum Delivery, w/ Other Non-Major Intervention <6 <6 <6 <6 <6 <6 <6 <6 <6 6 < Major Intervention not related to Obstetric Diagnosis <6 <6 <6 <6 <6 <6 6 <6 < Major Intervention related to Obstetric Diagnosis <6 <6 <6 <6 <6 <6 <6 <6 <6 <6 40 Notes WRH: Level is self-designated and subject to confirmation. 231

239 Mental Health Indicators Introduction A Mental Health Work Group (MHWG) was convened by the Benchmarking Steering Committee in 2012 to identify opportunities for improvement and refinement of the Mental Health section of the Benchmarking Report. A number of updates were recommended and approved by the Steering Committee for inclusion in the Report. The Mental Health Profile has been revised to include new information regarding telepsychiatry services and dedicated psychiatric emergency services for children/youth. "Eating Disorders" and "Psychiatry" age sub-groups have been updated to foster useful comparisons between similar populations and different institutions. In addition, the Mental Health Profile questionnaire has been revised to simplify the data submission process. A new indicator measuring Mental Health Emergency Department Average Length of Stay has been included on page 269. Mental Health indicators will continue to be updated to reflect the changing needs of our stakeholders and in collaboration with the MHWG. 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 2012 year, the OMHRS data continues to be submitted by self report to PCMCH for indicators comparable to the current DAD indicators. 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 has been revised in Data Sources CIHI data is the traditional data source used for the PCMCH Benchmarking Report through the DAD and NACRS databases. Mental Health discharge data is available to be used for both an assessment of hospital stay characteristics and resource utilization. Self-report OMHRS data was provided for selected indicators by the participating hospitals. 232

240 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 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 B055 B170 CACS Description Mental Health Intervention and Other Counselling Mental Health & Psychosocial Condition 233

241 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 Age Groups Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other 0-7 years No YES YES YES N/A YES 8-12 years YES YES YES YES N/A YES years YES YES YES YES N/A YES Cases Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other # of Inpatient Cases # of Inpatient Weighted Cases ,675 Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Offers dedicated psychiatric emergency service for children / youth No 0 YES 1529 YES 199 (e.g.: Crisis Team)? Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Psychiatry Clinic Funds 1 and 2 5,152 Funds 1 and 3 17,928 N/A 0 Psychiatric Urgent Care Clinic N/A 0 Funds 1 and N/A 0 Psychiatric Day Treatment Funds 1 and 2 1,075 N/A 0 N/A 0 Eating Disorder Clinic Funds 1 and 2 1,575 Funds 1 and 2 2,047 N/A 0 Eating Disorder Day Hospital Funds 1 and Funds 1 and 2 2,461 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 Telepsychiatry Program? N/A 0 YES 131 No 0 Has capacity/equipment to provide MH consultations via Ontario Telehealth Network (OTN)? YES YES YES Schedule 1 Facility YES YES YES Regional Mandate YES Huron Perth, Oxford, Elgin, Chatham Kent, Sarnia, Lambton, Grey Bruce YES Champlain LHIN No Patients from inside and outside the LHIN are admitted Notes CH LHSC: Regional mandate is for eating disorders only. KGH: While inpatient services were at Hotel Dieu Hospital (until June 21, 2011), the services were provided as a Schedule 1 facility. When the inpatient services moved to Kingston General Hospital on June 21, 2011 notification to the LHIN to continue Schedule 1 services did not occur and now, although the Schedule 1 designation has lapsed, the inpatient units continue to provide Schedule 1 services. This is being rectified with the LHIN/Ministry. All ambulatory care services remain at Hotel Dieu Hospital; only inpatient services (Child and Adolescent, and Adult) moved to Kingston General Hospital. 234

242 Mental Health Profiles: Academic Health Sciences Centres (cont) MCH HHS SickKids Sunnybrook Inpatient Beds Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Number of Inpatient Beds 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 years YES YES YES YES No YES Cases Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other # of Inpatient Cases # of Inpatient Weighted Cases Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Offers dedicated psychiatric emergency service for children / youth No 0 Yes 177 No 0 (e.g.: Crisis Team)? Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Psychiatry Clinic Funds 1 and 3 11,493 Fund 1 8,093 Fund 2 0 Psychiatric Urgent Care Clinic Fund 1 1,025 Fund Fund 2 0 Psychiatric Day Treatment Fund 1 1,081 Fund N/A 0 Eating Disorder Clinic Fund 2 2,962 Fund 1 1,212 N/A 0 Eating Disorder Day Hospital N/A 0 Fund 2 1,502 N/A 0 Substance Abuse N/A 0 Fund 2 1,493 N/A 0 Telepsychiatry Services Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYS-funded Ontario Child and Youth Telepsychiatry Program? YES 1 YES 1064 No 0 Has capacity/equipment to provide MH consultations via Ontario Telehealth Network (OTN)? YES YES N/A Schedule 1 Facility YES No YES Regional Mandate YES Hamilton Niagara Haldimand Brant & Waterloo Wellington YES Toronto Central LHIN and GTA No 0 The graph below shows the number of paediatric inpatient psychiatry beds at each AHSC facility separated into eating disorder beds and other psychiatry beds. Paediatric inpatient psychiatry beds CH LHSC CHEO KGH MCH HHS SickKids Sunnybrook Number of Eating Disorder Beds Number of Other Inpatient Psychiatry Beds 235

243 Mental Health Profiles: Community Hospitals The tables below summarize Mental Health profile information for Community Hospitals. AMGH BWH CCH CMH Inpatient Beds Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Number of Inpatient Beds Age Groups Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other 0-7 years No No YES YES No No No YES 8-12 years No No YES YES No No No YES years No YES YES YES No YES No YES Cases Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other # of Inpatient Cases # of Inpatient Weighted Cases Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Availability # of Visits Dedicated psychiatric emergency service for children/youth (e.g.: Crisis Team)? No 0 No 0 No 0 No 0 Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Funding # of Visits Psychiatry Clinic n/a 0 Funds 1 and 2 0 n/a 0 Funds 1 and 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 N/A 0 Eating Disorder Clinic Fund 2 21 Funds 1 and 2 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 N/A 0 Funds 1 and 2 0 n/a 0 N/A 0 Telepsychiatry Services Availability Volume Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYSfunded Ontario Child and Youth Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth Network (OTN)? Schedule 1 Facility No 0 No 0 n/a 0 No 0 YES YES YES YES YES YES YES No Regional Mandate YES Huron Perth YES ESC LHIN n/a 0 No 0 Notes BWH: Outpatient Eating Disorders Clinic - 21 unique clients served in FY 2011/12. CCH: CCH has an adult inpatient psychiatric unit where at times youth between 16 and 17 years of age are admitted. 236

244 Mental Health Profiles: Community Hospitals (cont) GBHS GRH HHS HRRH Inpatient Beds Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Number of Inpatient Beds Age Groups Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other 0-7 years N/A N/A No YES No YES No YES 8-12 years N/A N/A No YES No YES No YES years N/A N/A No YES No YES No YES Cases Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other # of Inpatient Cases # of Inpatient Weighted Cases Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Availability # of Visits Dedicated psychiatric emergency service for children/youth (e.g.: Crisis Team)? No 0 No 0 No 0 No 0 Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Funding # of Visits Psychiatry Clinic N/A 0 Funds 1 and Funds 1 and Funds 1 and Psychiatric Urgent Care Clinic N/A 0 N/A 0 Funds 1 and N/A N/A Psychiatric Day Treatment N/A 0 N/A 1312 N/A 0 Funds 1 and Eating Disorder Clinic N/A 0 N/A 0 Funds 1 and N/A N/A Eating Disorder Day Hospital N/A 0 N/A 0 N/A 0 N/A N/A Substance Abuse N/A 0 N/A 34 N/A 0 N/A N/A Telepsychiatry Services Availability Volume Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYSfunded Ontario Child and Youth Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth Network (OTN)? Schedule 1 Facility N/A 0 N/A 0 No 0 No 0 YES YES N/A YES YES YES YES YES Regional Mandate N/A 0 YES Waterloo- Wellington YES Halton YES GTA 237

245 Mental Health Profiles: Community Hospitals (cont) HSN JBMH LH MH Inpatient Beds Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Number of Inpatient Beds N/A n/a Age Groups Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other 0-7 years N/A YES N/A N/A No YES N/A N/A 8-12 years N/A YES N/A N/A No YES N/A N/A years YES YES N/A N/A YES YES N/A N/A Cases Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other # of Inpatient Cases # of Inpatient Weighted Cases Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Availability # of Visits Dedicated psychiatric emergency service for children/youth (e.g.: Crisis Team)? YES 355 No 0 YES 467 No 0 Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Funding # of Visits Psychiatry Clinic Funds 1 and Funds 1 and Funds 2 and Fund Psychiatric Urgent Care Clinic N/A 0 N/A 0 Fund Fund Psychiatric Day Treatment N/A 0 N/A 0 Fund N/A 0 Eating Disorder Clinic Fund N/A 0 Fund N/A 0 Eating Disorder Day Hospital N/A 0 N/A 0 N/A 0 N/A 0 Substance Abuse Fund N/A 0 Fund N/A 0 Telepsychiatry Services Availability Volume Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYSfunded Ontario Child and Youth Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth Network (OTN)? Schedule 1 Facility No 0 No 0 No 0 No 0 YES YES No YES YES YES YES YES Regional Mandate No 0 N/A 0 YES Durham Region No 0 Notes JBMH: JBMH has a Specialty Child/Adolescent Consultation Clinic, with the physician compensation coming from both direct Ministry Specialty Clinic funds and a sessional from Fund 2. The Social Workers and Clerical staff are funded from the hospital's global budget. 238

246 Mental Health Profiles: Community Hospitals (cont) MSH NBRHC NHS NYGH Inpatient Beds Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Number of Inpatient Beds N/A N/A Age Groups Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other 0-7 years N/A N/A N/A No YES YES yes yes 8-12 years N/A N/A N/A YES YES YES yes yes years N/A N/A N/A YES YES YES yes yes Cases Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other # of Inpatient Cases N/A N/A # of Inpatient Weighted Cases N/A N/A Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Availability # of Visits Dedicated psychiatric emergency service for children/youth (e.g.: Crisis Team)? YES 148 No 0 No 0 no 0 Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Funding # of Visits Psychiatry Clinic Fund N/A 0 Funds 1 and Funds 2 and Psychiatric Urgent Care Clinic N/A 0 N/A 0 N/A 0 Fund Type 2 60 Psychiatric Day Treatment N/A 0 N/A 0 N/A 0 Fund Type Eating Disorder Clinic N/A 0 N/A 0 Fund Fund Type Eating Disorder Day Hospital N/A 0 N/A 0 N/A 0 Fund Type Substance Abuse N/A 0 N/A 0 Fund Fund Type 2 664** Telepsychiatry Services Availability Volume Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYSfunded Ontario Child and Youth Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth Network (OTN)? Schedule 1 Facility No 0 YES 0 No 0 No 0 YES YES YES YES YES YES Yes YES Regional Mandate No 0 No 0 No 0 No 0 Notes NYGH: Volumes for substance abuse are a total of patients ages from 16 to 24. Please be aware that 664 visits is not a true reflection of just the child and adolescent population. 239

247 Mental Health Profiles: Community Hospitals (cont) OSMH PRHC RMH RVH Inpatient Beds Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Number of Inpatient Beds Age Groups Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other 0-7 years YES YES YES YES No YES N/A YES 8-12 years YES YES YES YES No YES N/A YES years YES YES YES YES No YES YES YES Cases Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other # of Inpatient Cases # of Inpatient Weighted Cases Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Availability # of Visits Dedicated psychiatric emergency service for children/youth (e.g.: Crisis Team)? No 0 Yes 178 YES 0 No 0 Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Funding # of Visits Psychiatry Clinic Fund 3 39 Funds 1, 2, and N/A 0 N/A 0 Psychiatric Urgent Care Clinic 0 0 N/A 0 Funds 1 and N/A 0 Psychiatric Day Treatment Fund 1 26 N/A 0 N/A 0 N/A 0 Eating Disorder Clinic Fund Funds 1, 2, and N/A 0 N/A 0 Eating Disorder Day Hospital 0 0 N/A 0 N/A 0 N/A 0 Substance Abuse 0 0 N/A 0 N/A 0 N/A 0 Telepsychiatry Services Availability Volume Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYSfunded Ontario Child and Youth Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth Network (OTN)? Schedule 1 Facility YES 540 Yes 2 No 0 N/A 0 YES No YES YES YES YES N/A N/A Regional Mandate N/A 0 YES North East Cluster of the Central East LHIN (HKPR) YES CE LHIN N/A 0 Notes OSMH: Designated Schedule 1 for adult population only. PRHC: HKPR = Haliburton Kawartha Pine Ridge. PRHC internal records indicate that a) psychiatry and eating disorder visits were underreported in FY 2010/11 and b) 0 (zero) paediatric mental health beds should have been reported for FY 2010/

248 Mental Health Profiles: Community Hospitals (cont) RVHS SAH SBGHC SGH - HPHA Inpatient Beds Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Number of Inpatient Beds Age Groups Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other 0-7 years No YES Yes No No No No No 8-12 years No YES YES N/A No No No No years No YES YES N/A No No YES YES Cases Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other # of Inpatient Cases # of Inpatient Weighted Cases Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Availability # of Visits Dedicated psychiatric emergency service for children/youth (e.g.: Crisis Team)? YES 876 YES 1511 No 0 No 0 Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Funding # of Visits Psychiatry Clinic Funds 1 and N/A N/A N/A 0 Fund Psychiatric Urgent Care Clinic Funds 1 and Fund N/A 0 Fund Psychiatric Day Treatment Funds 1 and N/A 0 N/A 0 N/A 0 Eating Disorder Clinic N/A 0 Fund N/A 0 Fund 2 28 Eating Disorder Day Hospital N/A 0 N/A 0 N/A 0 N/A 0 Substance Abuse N/A 0 Fund 2 48 N/A 0 N/A 0 Telepsychiatry Services Availability Volume Availability Volume Availability Volume Availability Volume Offers telepsychiatry services via MCYSfunded Ontario Child and Youth Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth Network (OTN)? Schedule 1 Facility No 0 YES 20 No 0 No 0 YES YES No YES YES No YES YES Regional Mandate No 0 YES Algoma No 0 YES Huron and Perth Notes SAH: Regarding Question 4.1 (Emergency Services - Availability), our Crisis Services Team serves both Paediatric and Adult patients. Regarding Question 4.2 (Emergency Services - Volume), the number provided above excludes Adult visits. Regarding Question 5.2 (Ambulatory Services, Psychiatric Urgent Care Clinic) the number of visits for this clinic are based on visits to our Mobile Paediatric Crisis Unit. Regarding Question 8 (regional mandate), we have a Regional Mandate for our Eating Disorder Clinic and STEP Early Intervention Programs. We are currently working on a plan with NBRHC to expand and provide 2 "tertiary" mental health beds for this district. The parameters of admission criteria have not yet been established and it is only in the planning stages. SGH-HPHA: Crisis Team is not paediatric-specific. ACTT = Assertive Community Treatment Team. Outpatient team serves paediatrics as well as adults. 241

249 Mental Health Profiles: Community Hospitals (cont) SJHC Hamilton SJHC Toronto SMH Southlake Inpatient Beds Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Number of Inpatient Beds Age Groups Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other 0-7 years No YES N/A YES No YES N/A YES 8-12 years No YES N/A YES No YES N/A YES years No YES N/A YES YES YES N/A YES Cases Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other # of Inpatient Cases # of Inpatient Weighted Cases Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Availability # of Visits Dedicated psychiatric emergency service for children/youth (e.g.: Crisis Team)? No 0 No 0 No 0 YES 680 Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Funding # of Visits Psychiatry Clinic Fund N/A 1518 Fund 1 0 Funds 1 and Psychiatric Urgent Care Clinic N/A 0 N/A 400 N/A 0 Fund Psychiatric Day Treatment N/A 0 N/A 0 N/A 0 Fund Eating Disorder Clinic N/A 0 N/A 0 N/A 0 Funds 1 and Eating Disorder Day Hospital N/A 0 N/A 0 N/A 0 Fund 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 MCYSfunded Ontario Child and Youth Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth Network (OTN)? Schedule 1 Facility No 0 No 0 No 0 No 0 YES YES No YES N/A No YES YES Regional Mandate YES LHIN 4 No 0 No 0 YES York Region Notes SJHC Hamilton: Regarding Question 4 (Emergency Services), SJHC Hamilton has a dedicated psychiatric emergency service but it is not dedicated for children & youth. Its primary purpose is to serve the adult population. However, SJHC Hamilton currently serves children and youth as well. In FY there were 445 visits of patients 17 years and under to Psychiatry Emergency Services, and 292 Mental Health Paediatric visits to the General Emergency Department. Effective January 2013, all pediatric PES visits will move to the McMaster Children's Hospital. 242

250 Mental Health Profiles: Community Hospitals (cont) TEGH THC WOHS WRH Inpatient Beds Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Number of Inpatient Beds Paediatric 0 6 Age Groups Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other 0-7 years No YES No N/A YES YES No No 8-12 years YES YES No N/A YES YES No YES years YES YES No N/A YES YES No YES Cases Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other Eating Disorders Psychiatry Other # of Inpatient Cases # of Inpatient Weighted Cases Emergency Services Availability # of Visits Availability # of Visits Availability # of Visits Availability # of Visits Dedicated psychiatric emergency service for children/youth (e.g.: Crisis Team)? YES 151 No 0 No 0 YES 444 Ambulatory Services Funding # of Visits Funding # of Visits Funding # of Visits Funding # of Visits Psychiatry Clinic Funds 1 and Fund Funds 1 and N/A 407 Psychiatric Urgent Care Clinic Funds 1 and N/A 0 N/A 0 N/A 0 Psychiatric Day Treatment Funds 1 and N/A 0 Funds 1 and N/A 0 Eating Disorder Clinic N/A 0 N/A 0 Funds 1 and 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 MCYSfunded Ontario Child and Youth Telepsychiatry Program? Has capacity/equipment to provide MH consultations via Ontario Telehealth Network (OTN)? Schedule 1 Facility No 0 No 0 N/A 0 No 0 YES YES YES YES N/A YES YES YES Regional Mandate YES East Metro Toronto No 0 N/A 0 No 0 Notes TEGH: Eating Disorder cases are admitted for medical stabilization only and then discharged to an outpatient service for follow up. 243

251 1.0 Mental Health Indicators MH Inpatient Mental Health Volumes This table and chart depict inpatient mental health volumes. A zero volume is blank and a volume less than 6 is indicated as <6. Hospital DAD Inpatient Cases OMHRS Inpatient Cases AMGH <6 9 BCHS 27 BWH 15 CCH <6 CGMH 12 CH LHSC 322 CHEO 473 CMH 16 CVH 11 7 GBHS 17 <6 GRH HHCC 12 HHS HRRH HSN 121 JBMH 10 KGH LH 247 <6 MCH HHS 435 MH <6 8 MHA-SMGH <6 MSH <6 12 NHH <6 NHS NYGH 212 OSMH 42 PRH <6 21 PRHC 8 15 RVH RVHS 246 SAH SBGHC <6 SGH HPHA 12 SickKids 180 SJHC Hamilton 10 SJHC Toronto 141 SLMHC 11 SMH <6 Southlake 382 STEGH <6 Stevenson <6 Sunnybrook <6 83 TBRHSC TEGH 220 THC <6 11 TSH <6 WOHS 375 WPSHC <6 WRH 258 GRH CHEO MCH HHS Southlake WOHS CH LHSC HHS WRH TBRHSC LH RVHS TEGH NYGH KGH SickKids SJHC Toronto HSN SAH NHS HRRH RVH OSMH BCHS GBHS CMH BWH CGMH HHCC CVH SLMHC PRHC TSH THC WPSHC PRH MH SBGHC SMH Stevenson Sunnybrook MSH AMGH MHA-SMGH NHH STEGH SGH HPHA JBMH SJHC Hamilton CCH DAD and OMHRS Inpatient Mental Health Cases DAD Inpatient Cases OMHRS Inpatient Cases Notes RMH: RMH does not admit paediatric mental health patients. Schedule 1 mandate is age 16 and over. 244

252 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 years. A zero volume is blank and a volume less than 6 is indicated as <6. DAD Inpatient Mental Health Age Profile Hospital 0-7 years years years Total AMGH <6 <6 BCHS < BWH < CGMH CH LHSC CHEO CMH <6 < CVH <6 < GBHS < GRH HHCC < HHS < HRRH < HSN < KGH LH MCH HHS < MH <6 <6 MHA-SMGH <6 <6 MSH <6 <6 NHH <6 <6 NHS < NYGH < OSMH < PRH <6 <6 PRHC <6 <6 8 RVH < RVHS < SAH SBGHC <6 <6 SickKids SJHC Toronto < SLMHC <6 < SMH <6 <6 Southlake < STEGH <6 <6 Stevenson <6 <6 Sunnybrook <6 <6 TBRHSC < TEGH < THC <6 <6 TSH <6 <6 <6 <6 WOHS < WPSHC <6 <6 <6 WRH < AMGH BCHS BWH CGMH CH LHSC CHEO CMH CVH GBHS GRH HHCC HHS HRRH HSN KGH LH MCH HHS MH MHA-SMGH MSH NHH NHS NYGH OSMH PRH PRHC RVH RVHS SAH SBGHC SickKids SJHC Toronto SLMHC SMH Southlake STEGH Stevenson Sunnybrook TBRHSC TEGH THC TSH WOHS WPSHC WRH Inpatient Mental Health Age Distribution (DAD) 0% 20% 40% 60% 80% 100% 0-7 years 8-12 years years 245

253 This table and graph 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 years. A zero volume is blank and a volume less than 6 is indicated as <6. OMHRS Inpatient Mental Health Age Profile Hospital 0-7 years years years Total AMGH 9 9 CCH <6 <6 CVH 7 7 GBHS <6 <6 GRH 6 6 HHS < HRRH < JBMH < KGH < LH 3 <6 MH 8 8 MSH NHS PRH PRHC RVH SAH SGH HPHA SJHC Hamilton Sunnybrook TBRHSC < THC AMGH CCH CVH GBHS GRH HHS HRRH JBMH KGH LH MH MSH NHS PRH PRHC RVH SAH SGH HPHA SJHC Hamilton Sunnybrook TBRHSC THC Inpatient Mental Health Age Distribution (OMHRS) 0% 20% 40% 60% 80% 100% 0-7 years 8-12 years years 246

254 1.1.3 MH Inpatient Mental Health Average LOS 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. Hospital ALOS ALOS DAD OMHRS AMGH 1.0 BCHS 1.7 BWH 6.6 CCH 2.3 CGMH 1.1 CH LHSC 11.3 CHEO 17.4 CMH 3.4 CVH GBHS GRH HHCC 1.8 HHS HRRH HSN 7.4 JBMH 1.7 KGH LH MCH HHS 12.4 MH MHA-SMGH 1.0 MSH NHH 8.0 NHS NYGH 6.8 OSMH 5.2 PRH PRHC RVH RVHS 6.7 SAH SBGHC 3.5 SGH HPHA 6.7 SickKids 29.1 SJHC Hamilton 6.1 SJHC Toronto 11.8 SLMHC 5.5 SMH 13.5 Southlake 6.4 STEGH 1.0 Stevenson 1.0 Sunnybrook TBRHSC TEGH 8.5 THC TSH 6.5 WOHS 10.4 WPSHC 1.0 WRH 7.6 AMGH BCHS BWH CCH CGMH CH LHSC CHEO CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH KGH LH MCH HHS MH MHA-SMGH MSH NHH NHS NYGH OSMH PRH PRHC RVH RVHS SAH SBGHC SGH HPHA SickKids SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson Sunnybrook TBRHSC TEGH THC TSH WOHS WPSHC WRH Inpatient Mental Health Average Length of Stay ALOS DAD ALOS OMHRS 247

255 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 AMGH 0.74 BCHS 1.34 BWH 1.58 CGMH 1.35 CH LHSC 2.00 CHEO 2.37 CMH 1.62 CVH 3.29 GBHS 2.61 GRH 1.67 HHCC 0.59 HHS 1.67 HRRH 1.84 HSN 1.38 KGH 2.01 LH 1.45 MCH HHS 2.17 MH 0.60 MHA-SMGH 0.40 MSH 0.90 NHH 0.89 NHS 1.23 NYGH 1.70 OSMH 2.07 PRH 0.82 PRHC 1.92 RVH 1.70 RVHS 1.86 SAH 1.75 SBGHC 1.34 SickKids 3.48 SJHC Toronto 1.78 SLMHC 2.43 SMH 1.73 Southlake 1.50 STEGH 1.34 Stevenson 0.33 Sunnybrook 2.27 TBRHSC 1.63 TEGH 1.65 THC 1.44 TSH 1.48 WOHS 1.74 WPSHC 1.24 WRH 1.78 SickKids CVH GBHS SLMHC CHEO Sunnybrook MCH HHS OSMH KGH CH LHSC PRHC RVHS HRRH WRH SJHC Toronto SAH WOHS SMH RVH NYGH HHS GRH TEGH TBRHSC CMH BWH Southlake TSH LH THC HSN CGMH BCHS SBGHC STEGH WPSHC NHS MSH NHH PRH AMGH MH HHCC MHA-SMGH Stevenson Inpatient Mental Health Average Weight per Case

256 AMGH BCHS BWH CGMH CH LHSC CHEO CMH CVH GBHS GRH HHCC HHS HRRH HSN KGH LH PCMCH Maternal-Child Benchmarking Report 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 693 Depressive Episode without ECT 7 <6 < <6 < Stress Reaction/Adjustment Disorder 11 <6 < < Childhood/Adolescence Disorder 6 < <6 79 < Eating Disorder <6 < <6 <6 9 <6 <6 <6 <6 <6 686 Anxiety Disorder < <6 < Schizotypal/Delusional Disorder <6 < <6 <6 16 < < Mental Retardation/Disorder of Development 8 18 < <6 17 <6 694 Mood [Affective] Disorder < <6 < Bipolar Disorder without ECT <6 <6 <6 <6 <6 697 Mixed Disorder of Conduct/Emotion <6 27 <6 < Somatoform/Dissociative Disorder <6 < <6 <6 <6 <6 8 <6 699 Psychoactive Substance Use, Harmful Use <6 <6 <6 <6 13 <6 <6 <6 <6 683 Disorder of Adult Personality Behaviour <6 <6 14 <6 <6 <6 <6 7 <6 684 Obsessive Compulsive Disorder <6 <6 <6 9 <6 <6 703 Psychoactive Substance Use, Residual/Late-onset/Psychotic Disorder <6 <6 <6 <6 <6 <6 698 Psychoactive Substance Use, Acute Intoxication <6 <6 <6 <6 <6 <6 <6 <6 700 Psychoactive Substance Use, Dependence Syndrome <6 <6 <6 <6 <6 <6 677 Schizophrenia without ECT <6 <6 <6 <6 <6 680 Schizoaffective Disorder without ECT <6 <6 <6 <6 <6 704 Psychoactive Substance Use, Amnesic/Other/Unspecified <6 <6 <6 <6 672 Miscellaneous Mental Disorder <6 <6 <6 <6 <6 <6 682 Habit/Impulse Disorder 9 <6 <6 675 Other Behavioural Syndrome <6 <6 <6 691 Bipolar Disorder, Severe Depression without ECT <6 681 Gender Identity/Sexual Preference Disorder <6 249

257 MCH HHS MH MHA-SMGH MSH NHH NHS NYGH OSMH PRH PRHC RVH RVHS SAH SBGHC SickKids SJHC Toronto PCMCH Maternal-Child Benchmarking Report MH Top 10 CMGs (cont.) CMG 693 Depressive Episode without ECT < < Stress Reaction/Adjustment Disorder <6 < Childhood/Adolescence Disorder < < Eating Disorder 58 <6 <6 <6 25 <6 < <6 686 Anxiety Disorder <6 <6 <6 6 6 < Schizotypal/Delusional Disorder 17 <6 <6 19 < Mental Retardation/Disorder of Development 11 <6 <6 <6 <6 10 <6 <6 <6 694 Mood [Affective] Disorder 15 <6 <6 <6 689 Bipolar Disorder without ECT 10 <6 <6 <6 11 <6 13 <6 697 Mixed Disorder of Conduct/Emotion <6 < Somatoform/Dissociative Disorder 16 <6 <6 <6 <6 < Psychoactive Substance Use, Harmful Use <6 <6 < Disorder of Adult Personality Behaviour 12 <6 <6 <6 <6 10 <6 684 Obsessive Compulsive Disorder <6 <6 <6 <6 <6 703 Psychoactive Substance Use, Residual/Late-onset/Psychotic Disorder <6 <6 <6 <6 <6 <6 <6 698 Psychoactive Substance Use, Acute Intoxication 9 <6 <6 <6 <6 <6 <6 <6 700 Psychoactive Substance Use, Dependence Syndrome <6 6 <6 <6 <6 <6 <6 677 Schizophrenia without ECT <6 <6 <6 <6 <6 680 Schizoaffective Disorder without ECT <6 <6 <6 704 Psychoactive Substance Use, Amnesic/Other/Unspecified < Miscellaneous Mental Disorder <6 <6 682 Habit/Impulse Disorder <6 675 Other Behavioural Syndrome <6 691 Bipolar Disorder, Severe Depression without ECT <6 <6 681 Gender Identity/Sexual Preference Disorder 250

258 SLMHC SMH Southlake STEGH Stevenson Sunnybrook TBRHSC TEGH THC TSH WOHS WPSHC WRH Total visits # Hospitals with this CMG in Top 10 PCMCH Maternal-Child Benchmarking Report MH Top 10 CMGs (cont.) CMG 693 Depressive Episode without ECT <6 <6 246 <6 < < , Stress Reaction/Adjustment Disorder < <6 114 <6 49 1, Childhood/Adolescence Disorder < Eating Disorder 9 < Anxiety Disorder < Schizotypal/Delusional Disorder <6 9 9 <6 <6 16 < Mental Retardation/Disorder of Development <6 < Mood [Affective] Disorder <6 <6 < Bipolar Disorder without ECT < Mixed Disorder of Conduct/Emotion Somatoform/Dissociative Disorder <6 <6 <6 <6 <6 < Psychoactive Substance Use, Harmful Use <6 <6 9 9 < Disorder of Adult Personality Behaviour <6 <6 < Obsessive Compulsive Disorder 6 <6 < Psychoactive Substance Use, Residual/Late-onset/Psychotic Disorder <6 <6 <6 < Psychoactive Substance Use, Acute Intoxication <6 <6 <6 < Psychoactive Substance Use, Dependence Syndrome <6 <6 < Schizophrenia without ECT <6 <6 <6 <6 < Schizoaffective Disorder without ECT <6 < Psychoactive Substance Use, Amnesic/Other/Unspecified < Miscellaneous Mental Disorder <6 <6 <6 <6 < Habit/Impulse Disorder < Other Behavioural Syndrome < Bipolar Disorder, Severe Depression without ECT < Gender Identity/Sexual Preference Disorder <6 <

259 AMGH BWH BCHS CMH CH LHSC CHEO CGMH CVH GRH GBHS HHS HHCC HSN HRRH KGH LH PCMCH Maternal-Child Benchmarking Report MH Top 10 CMGs Average LOS This chart illustrates the total average length of stay for all inpatient cases within the Top 10 CMGs. The length of stay is calculated from the date of admission to the date of discharge. CMG 693 Depressive Episode without ECT Stress Reaction/Adjustment Disorder Childhood/Adolescence Disorder Eating Disorder Anxiety Disorder Schizotypal/Delusional Disorder Mental Retardation/Disorder of Development Mood [Affective] Disorder Bipolar Disorder without ECT Mixed Disorder of Conduct/Emotion Somatoform/Dissociative Disorder Psychoactive Substance Use, Harmful Use Disorder of Adult Personality Behaviour Obsessive Compulsive Disorder Psychoactive Substance Use, Residual/Lateonset/Psychotic Disorder 698 Psychoactive Substance Use, Acute Intoxication Psychoactive Substance Use, Dependence Syndrome Schizophrenia without ECT Schizoaffective Disorder without ECT Psychoactive Substance Use, Amnesic/Other/Unspecified Miscellaneous Mental Disorder Habit/Impulse Disorder Other Behavioural Syndrome Bipolar Disorder, Severe Depression without ECT Gender Identity/Sexual Preference Disorder

260 MH MSH MCH HHS NHS NYGH NHH OSMH PRH PRHC RVHS SAH SLMHC SBGHC Southlake SJHC Toronto PCMCH Maternal-Child Benchmarking Report MH Top 10 CMGs Average LOS (cont.) CMG 693 Depressive Episode without ECT Stress Reaction/Adjustment Disorder Childhood/Adolescence Disorder Eating Disorder Anxiety Disorder Schizotypal/Delusional Disorder Mental Retardation/Disorder of Development Mood [Affective] Disorder Bipolar Disorder without ECT Mixed Disorder of Conduct/Emotion Somatoform/Dissociative Disorder Psychoactive Substance Use, Harmful Use Disorder of Adult Personality Behaviour Obsessive Compulsive Disorder Psychoactive Substance Use, Residual/Lateonset/Psychotic Disorder Psychoactive Substance Use, Acute Intoxication Psychoactive Substance Use, Dependence Syndrome Schizophrenia without ECT Schizoaffective Disorder without ECT Psychoactive Substance Use, Amnesic/Other/Unspecified Miscellaneous Mental Disorder Habit/Impulse Disorder Other Behavioural Syndrome Bipolar Disorder, Severe Depression without ECT Gender Identity/Sexual Preference Disorder 253

261 SMH STEGH Stevenson MHA-SMGH Sunnybrook SickKids RVH TSH TBRHSC TEGH THC WPSHC WOHS WRH # Hospitals with this CMG in Top 10 PCMCH Maternal-Child Benchmarking Report MH Top 10 CMGs Average Length of Stay (cont.) CMG 693 Depressive Episode without ECT Stress Reaction/Adjustment Disorder Childhood/Adolescence Disorder Eating Disorder Anxiety Disorder Schizotypal/Delusional Disorder Mental Retardation/Disorder of Development Mood [Affective] Disorder Bipolar Disorder without ECT Mixed Disorder of Conduct/Emotion Somatoform/Dissociative Disorder Psychoactive Substance Use, Harmful Use Disorder of Adult Personality Behaviour Obsessive Compulsive Disorder Psychoactive Substance Use, Residual/Lateonset/Psychotic Disorder Psychoactive Substance Use, Acute Intoxication Psychoactive Substance Use, Dependence Syndrome Schizophrenia without ECT Schizoaffective Disorder without ECT Psychoactive Substance Use, Amnesic/Other/Unspecified Miscellaneous Mental Disorder Habit/Impulse Disorder Other Behavioural Syndrome Bipolar Disorder, Severe Depression without ECT Gender Identity/Sexual Preference Disorder

262 AMGH BCHS BWH CGMH CH LHSC CHEO CMH CVH GBHS GRH HHCC HHS HRRH HSN KGH LH MCH HHS MH MHA-SMGH MSH NHH NHS NYGH PCMCH Maternal-Child Benchmarking Report MH Top 10 CMGs Average Weight per Case This table presents the ARIW for all inpatient mental health cases within the Top 10 CMGs. 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 Description 693 Depressive Episode without ECT Stress Reaction/Adjustment Disorder Childhood/Adolescence Disorder Eating Disorder Anxiety Disorder Schizotypal/Delusional Disorder Mental Retardation/Disorder of Development 694 Mood [Affective] Disorder Bipolar Disorder without ECT Mixed Disorder of Conduct/Emotion Somatoform/Dissociative Disorder Psychoactive Substance Use, Harmful Use Disorder of Adult Personality Behaviour Obsessive Compulsive Disorder Psychoactive Substance Use, Residual/Lateonset/Psychotic Disorder Psychoactive Substance Use, Acute Intoxication Psychoactive Substance Use, Dependence Syndrome Schizophrenia without ECT Schizoaffective Disorder without ECT Psychoactive Substance Use, Amnesic/Other/Unspecified 672 Miscellaneous Mental Disorder Habit/Impulse Disorder Other Behavioural Syndrome Bipolar Disorder, Severe Depression without ECT 681 Gender Identity/Sexual Preference Disorder

263 OSMH PRH PRHC RVH RVHS SAH SBGHC SickKids SJHC Toronto SLMHC SMH Southlake STEGH Stevenson Sunnybrook TBRHSC TEGH THC TSH WOHS WPSHC WRH # Hospitals with this CMG in Top 10 PCMCH Maternal-Child Benchmarking Report MH Top 10 CMGs Average Weight per Case (cont.) CMG Description 693 Depressive Episode without ECT Stress Reaction/Adjustment Disorder Childhood/Adolescence Disorder Eating Disorder Anxiety Disorder Schizotypal/Delusional Disorder Mental Retardation/Disorder of Development Mood [Affective] Disorder Bipolar Disorder without ECT Mixed Disorder of Conduct/Emotion Somatoform/Dissociative Disorder Psychoactive Substance Use, Harmful Use Disorder of Adult Personality Behaviour Obsessive Compulsive Disorder Psychoactive Substance Use, Residual/Lateonset/Psychotic Disorder Psychoactive Substance Use, Acute Intoxication Psychoactive Substance Use, Dependence Syndrome 677 Schizophrenia without ECT Schizoaffective Disorder without ECT Psychoactive Substance Use, Amnesic/Other/Unspecified 672 Miscellaneous Mental Disorder Habit/Impulse Disorder Other Behavioural Syndrome Bipolar Disorder, Severe Depression without ECT 681 Gender Identity/Sexual Preference Disorder

264 1.1.8 MH Average Length of Stay by Age Category This table illustrates the total average 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 years. A zero volume is blank. DAD Inpatient Length of Stay by Age Category Hospital 0-7 years 8-12 years years AMGH 1.0 BCHS BWH CGMH 1.1 CH LHSC CHEO CMH CVH GBHS GRH HHCC HHS HRRH HSN KGH LH MCH HHS MH 1.0 MHA-SMGH 1.0 MSH 3.0 NHH 8.0 NHS NYGH OSMH PRH 1.0 PRHC RVH RVHS SAH SBGHC 3.5 SickKids SJHC Toronto SLMHC SMH 13.5 Southlake STEGH 1.0 Stevenson 1.0 Sunnybrook 2.0 TBRHSC TEGH THC 1.3 TSH WOHS WPSHC WRH

265 SickKids CVH GBHS CHEO SMH HRRH MCH HHS CH LHSC PRHC SJHC Toronto WOHS KGH HHS BWH NHH WRH TEGH TBRHSC HSN RVHS NYGH Southlake SAH LH GRH OSMH RVH SBGHC MSH SLMHC NHS Sunnybrook BCHS HHCC CMH TSH THC CGMH AMGH MH MHA-SMGH PRH STEGH Stevenson WPSHC PCMCH Maternal-Child Benchmarking Report 2012 These charts illustrate the total average length of stay for all inpatient DAD mental health cases by age category DAD Average Length of Inpatient Stay years 35 DAD Average Length of Inpatient Stay years DAD Average Length of Inpatient Stay years

266 This table and chart illustrate the total average 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 years CCH 2.3 CVH 2.1 GBHS 4.0 GRH 1.7 HHS HRRH JBMH KGH LH 4.0 MH 1.0 MSH 7.3 NHS PRH 4.8 PRHC 5.5 RVH 2.3 SAH 7.3 SGH HPHA 6.7 SJHC Hamilton 6.1 Sunnybrook 15.9 TBRHSC THC OMHRS Average Inpatient Length of Stay by Age Category years 8-12 years years 259

267 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. Hospitals 0-7 Years Total Years Years ARIW AMGH BCHS BWH CGMH CH LHSC CHEO CMH CVH GBHS GRH HHCC HHS HRRH HSN KGH LH MCH HHS MH MHA-SMGH MSH NHH NHS NYGH OSMH PRH PRHC RVH RVHS SAH SBGHC SickKids SJHC Toronto SLMHC SMH Southlake STEGH Stevenson Sunnybrook TBRHSC TEGH THC TSH WOHS WPSHC WRH SickKids CVH GBHS SLMHC CHEO Sunnybrook MCH HHS OSMH KGH CH LHSC PRHC RVHS HRRH WRH SJHC Toronto SAH WOHS SMH RVH NYGH HHS GRH TEGH TBRHSC CMH BWH Southlake TSH LH THC HSN CGMH BCHS SBGHC STEGH WPSHC NHS MSH NHH PRH AMGH MH HHCC MHA-SMGH Stevenson ARIW - All Inpatient DAD Mental Health Cases

268 MH Percent Transfer From Mental Health Inpatient Cases and Days This table and chart present 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. Hospital Mental Health "Transfer From" CASES Mental Health "Transfer From" DAYS # % # % CH LHSC % % CHEO 9 1.9% % GRH % % HHS <6 1.0% % HRRH % % HSN 7 5.8% % KGH 6 3.0% % LH 8 3.2% % MCH HHS % 1, % NYGH % % OSMH <6 2.4% 6 2.7% RVH <6 1.1% <6 0.3% RVHS % % SAH <6 2.7% % SickKids % % SJHC Toronto <6 1.4% % SMH <6 50.0% <6 7.4% Southlake % % TBRHSC % % TEGH % % WOHS % % WRH % % % "Transfer From" MH Inpatient Cases and Days CH LHSC CHEO GRH HHS HRRH HSN KGH LH MCH HHS NYGH OSMH RVH RVHS SAH SickKids SJHC Toronto SMH Southlake TBRHSC TEGH WOHS WRH 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% % Cases % Days 261

269 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. Hospital Mental Health "Transfer To" CASES Mental Health "Transfer To" DAYS # % # % BCHS % % CH LHSC % % CHEO % % CMH <6 25.0% % CVH <6 9.1% 6 3.4% GBHS <6 11.8% % GRH 9 1.8% % HHCC % % HHS <6 0.7% % HSN % % LH <6 2.0% <6 0.3% MCH HHS <6 1.1% % MH <6 50.0% <6 50.0% NHS % % NYGH <6 0.5% % OSMH <6 4.8% <6 2.3% PRHC <6 12.5% % RVH 6 6.7% % RVHS <6 1.2% <6 0.2% SAH <6 1.8% % SickKids <6 2.8% % SJHC Toronto <6 3.5% <6 0.4% SLMHC <6 18.2% <6 6.6% SMH <6 50.0% <6 7.4% Stevenson < % < % TBRHSC <6 0.4% <6 0.1% TEGH <6 2.3% % TSH <6 25.0% <6 3.8% WOHS % % WRH % % % "Transfer To" MH Inpatient Cases and Days BCHS CH LHSC CHEO CMH CVH GBHS GRH HHCC HHS HSN LH MCH HHS MH NHS NYGH OSMH PRHC RVH RVHS SAH SickKids SJHC Toronto SLMHC SMH Stevenson TBRHSC TEGH TSH WOHS WRH 0% 20% 40% 60% 80% 100% % Cases % Days 262

270 MH Percent of Cases and Days with Length of Stay >30 Days This table and chart present the percentage of all inpatient cases and associated days for all inpatient DAD mental health cases with a total length of stay greater than 30 days. Hospitals whose volumes are less than 6 are indicated as <6. Hospital DAD % of Cases & Days with Length of Stay >30 Days Inpatient Cases Inpatient Days % Cases LOS >30 Days % Days LOS >30 Days BWH < % 49.5% CH LHSC 25 1, % 42.6% CHEO 65 3, % 43.2% CMH < % 59.3% CVH < % 48.6% GBHS < % 53.7% GRH < % 1.1% HHS % 26.4% HRRH < % 11.2% HSN < % 33.1% KGH % 15.3% LH < % 13.4% MCH HHS 26 1, % 27.2% NYGH < % 13.3% PRHC < % 79.4% RVH < % 35.6% RVHS % 43.1% SAH < % 11.1% SickKids 62 3, % 76.0% SJHC Toronto % 29.5% SLMHC < % 59.0% Southlake % 18.3% TBRHSC % 25.9% TEGH % 19.2% WOHS % 17.6% WRH % 15.6% BWH CH LHSC CHEO CMH CVH GBHS GRH HHS HRRH HSN KGH LH MCH HHS NYGH PRHC RVH RVHS SAH SickKids SJHC Toronto SLMHC Southlake TBRHSC TEGH WOHS WRH % of Cases and Days with LOS >30 Days: DAD 0% 20% 40% 60% 80% 100% % DAD Cases % DAD Days 263

271 This table and chart present the percentage of all inpatient cases and associated days for all inpatient OMHRS 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 Stay >30 Days Hospital Inpatient Cases Inpatient Days % Cases LOS >30 Days % Days LOS >30 Days HHS % 26.2% HRRH < % KGH < % 10.4% MSH < % 59.8% PRH < % 31.0% Sunnybrook % 28.6% TBRHSC % 20.0% HHS HRRH KGH MSH PRH Sunnybrook TBRHSC % of Cases and Days with LOS >30 Days: OMHRS 0% 10% 20% 30% 40% 50% 60% % OMHRS Cases % OMHRS Days 264

272 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. Hospital DAD % Cases 1-2 Days Stay OMHRS % Cases 1-2 Days Stay AMGH 100.0% BCHS 77.8% BGH BWH 53.3% CCH 4.0% CGMH 100.0% CH LHSC 19.9% CHEO 16.1% CMH 81.3% CVH 36.4% 14.3% GBHS 29.4% GRH 20.3% 83.3% HHCC 66.7% HHS 28.8% 19.6% HRRH 7.1% 6.0% HSN 34.7% JBMH 80.0% KGH 17.5% 13.3% LH 26.7% 33.0% MCH HHS 11.5% MH 100.0% MHA-SMGH 100.0% MSH 50.0% NHS 69.0% 61.0% NYGH 26.9% OSMH 40.5% PRH 100.0% 62.0% PRHC 37.5% 46.7% QHC RMH RVH 56.7% 52.0% RVHS 47.2% SAH 29.2% 20.0% SickKids 9.4% SJHC Hamilton 50.0% SJHC Toronto 27.7% SLMHC 45.5% SMH 50.0% Southlake 22.3% STEGH 100.0% Stevenson 100.0% Sunnybrook 100.0% 12.0% TBRHSC 22.1% 19.9% TEGH 15.0% THC 100.0% 82.0% TSH 75.0% WOHS 18.7% WPSHC 100.0% WRH 13.6% AMGH BCHS BGH BWH CCH CGMH CH LHSC CHEO CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH KGH LH MCH HHS MH MHA-SMGH MSH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SickKids SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson Sunnybrook TBRHSC TEGH THC TSH WOHS WPSHC WRH % of Cases with 1-2 Days Length of Stay 0% 20% 40% 60% 80% 100% DAD % 1-2 Days OMHRS % 1-2 Days 265

273 2.0 Mental Health ED Indicators MH-ED Mental Health ED Patient Volumes This table and chart depict mental health ED patient volumes. Hospital ED Visits AMGH 29 BCHS 155 BGH 73 BWH 323 CCH 148 CGMH 101 CH LHSC 867 CHEO 1,842 CMH 285 CVH 350 GBHS 265 GRH 400 HHCC 128 HHS 473 HRRH 272 HSN 307 JBMH 183 KGH 264 LH 839 MCH HHS 375 MH 235 MHA-SMGH 50 Montfort 27 MSH 161 Mt Sinai 59 NBRHC 186 NGH 71 NHH 69 NHS 477 NYGH 239 OSMH 174 PRH 80 PRHC 260 QHC 307 RMH 156 RVH 275 RVHS 612 SAH 163 SBGHC 77 SGH HPHA 85 Sickkids 757 SJHC Hamilton 617 SJHC Toronto 343 SLMHC 175 SMH 66 Southlake 452 STEGH 86 Stevenson 40 Sunnybrook 98 TBRHSC 390 TEGH 235 THC 330 TOH 92 TSH 123 WLMH 35 WOHS 612 WPSHC 39 WRH 396 CHEO CH LHSC LH Sickkids SJHC Hamilton RVHS WOHS NHS HHS Southlake GRH WRH TBRHSC MCH HHS CVH SJHC Toronto THC BWH HSN QHC CMH RVH HRRH GBHS KGH PRHC NYGH MH TEGH NBRHC JBMH SLMHC OSMH SAH MSH RMH BCHS CCH HHCC TSH CGMH Sunnybrook TOH STEGH SGH HPHA PRH SBGHC BGH NGH NHH SMH Mt Sinai MHA-SMGH Stevenson WPSHC WLMH AMGH Montfort ,000 1,200 1,400 1,600 1,800 2,

274 2.1.2 MH-ED Emergency Department Psychiatric 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 years. AMGH BCHS BGH BWH CCH CGMH CH LHSC CHEO CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH KGH LH MCH HHS MH MHA-SMGH Montfort MSH Mt Sinai NBRHC NGH NHH NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA SickKids SJHC Hamilton SJHC Toronto SLMHC SMH Southlake STEGH Stevenson Sunnybrook TBRHSC TEGH THC TOH TSH WLMH WOHS WPSHC WRH 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-7 years 8-12 years years 267

275 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 years. Hospitals whose volume is less than 6 are indicated as <6. Hospital 0-7 years 8-12 years years Total AMGH < BCHS < BGH < BWH CCH CGMH < CH LHSC CHEO ,425 1,842 CMH CVH GBHS GRH HHCC HHS HRRH HSN JBMH KGH LH MCH HHS MH MHA-SMGH <6 < Montfort <6 < MSH Mt Sinai < NBRHC NGH 8 < NHH 6 < NHS NYGH OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC 7 < SGH HPHA < SickKids SJHC Hamilton SJHC Toronto SLMHC < SMH < Southlake STEGH < Stevenson < Sunnybrook <6 < TBRHSC TEGH THC TOH < TSH WLMH <6 < WOHS WPSHC <6 < WRH

276 2.1.3 MH-ED Emergency Department 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 AMGH 2.2 BWH 2.2 BCHS 3.1 BGH 3.5 CMH 4.1 CH LHSC 3.5 CHEO 4.1 CGMH 3.2 CCH 3.1 CVH 3.5 GRH 5.5 GBHS 2.9 HHS 3.6 HHCC 3.3 HSN 3.7 Monfort 5.7 HRRH 4.7 JBMH 5.2 KGH 3.9 LH 3.9 MH 4.9 MSH 3.9 MCH HHS 3.8 Mt Sinai 4.5 NHS 3.4 NGH 3.6 NBRHC 2.9 NYGH 4.6 NHH 3.4 OSMH 2.8 PRH 2.9 PRHC 4.6 QHC 3.5 RMH 3.5 RVHS 2.5 SAH 3.5 SLMHC 2.5 SGBHC 2.5 Southlake 3.9 SJHC Toronto 6.5 SJHC Hamilton 4.7 SMH 5.8 STEGH 2.7 Stevenson 3.2 SGH HPHA 3.5 MHA-SMGH 3.1 Sunnybrook 5.1 Sickkids 5.3 TOH 4.3 RVH 4.3 TSH 4.4 TBRHSC 4.2 TEGH 4.9 THC 6.5 WLMH 2.5 WPSHC 3.5 WOHS 5.6 WRH 4.4 AMGH BWH BCHS BGH CMH CH LHSC CHEO CGMH CCH CVH GRH GBHS HHS HHCC HSN Monfort HRRH JBMH KGH LH MH MSH MCH HHS Mt Sinai NHS NGH NBRHC NYGH NHH OSMH PRH PRHC QHC RMH RVHS SAH SLMHC SGBHC Southlake SJHC Toronto SJHC Hamilton SMH STEGH Stevenson SGH HPHA MHA-SMGH Sunnybrook Sickkids TOH RVH TSH TBRHSC TEGH THC WLMH WPSHC WOHS WRH

277 BCHS BGH BWH CCH CGMH CH LHSC CHEO CMH CVH GBHS GRH HHCC HHS HRRH 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 F100 Ment/beh disrd dt alcohol use ac intox F419 Anxiety disorder unspecified F329 Depressive episode unspecified R458 Oth symptoms signs inv emotional state F430 Acute stress reaction F432 Adjustment disorders R4688 Oth sym signs inv appearance behaviour F410 Panic disrd [ep paroxysmal anxiety] F101 Ment/beh disrd dt harmful alcohol use F919 Conduct disorder unspecified F439 Reaction to severe stress unspecified R454 Irritability and anger F322 Sev depressive episode wo psych symptoms F900 Disturbance of activity and attention F191 Ment/beh dis harmf use mult dr & psyact F509 Eating disorder unspecified 15 6 R452 Unhappiness R462 Strange and inexplicable behaviour F121 Ment/beh disrd dt cannab use harmf use F913 Oppositional defiant disorder 7 20 F938 Other childhood emotional disorders F959 Tic disorder unspecified F111 Ment/beh disrd dt harmful opioid use F321 Moderate depressive episode 7 F412 Mixed anxiety and depressive disorder F429 Obsessive-compulsive disorder NOS 8 F438 Other reactions to severe stress F445 Dissociative convulsions 6 F489 Neurotic disorder unspecified 10 F609 Personality disorder unspecified F840 Childhood autism 12 F911 Unsocialized conduct disorder 6 F99 Mental disorder not otherwise specified R451 Restlessness and agitation 6 Z638 Oth spec probs rel to prim support grp 37

278 HSN JBMH KGH LH MCH HHS MH MHA-SMGH MSH Mt Sinai NBRHC NGH NHH NHS NYGH PCMCH Maternal-Child Benchmarking Report MH-ED ED Mental Health Visits by Top 10 Main Problems (cont) Main Problem ICD10 F100 Ment/beh disrd dt alcohol use ac intox F419 Anxiety disorder unspecified F329 Depressive episode unspecified R458 Oth symptoms signs inv emotional state F430 Acute stress reaction F432 Adjustment disorders R4688 Oth sym signs inv appearance behaviour F410 Panic disrd [ep paroxysmal anxiety] F101 Ment/beh disrd dt harmful alcohol use F919 Conduct disorder unspecified F439 Reaction to severe stress unspecified 6 R454 Irritability and anger F322 Sev depressive episode wo psych symptoms 6 16 F900 Disturbance of activity and attention F191 Ment/beh dis harmf use mult dr & psyact F509 Eating disorder unspecified R452 Unhappiness 7 9 R462 Strange and inexplicable behaviour F121 Ment/beh disrd dt cannab use harmf use F913 Oppositional defiant disorder 7 6 F938 Other childhood emotional disorders F959 Tic disorder unspecified 9 F111 Ment/beh disrd dt harmful opioid use F321 Moderate depressive episode F412 Mixed anxiety and depressive disorder F429 Obsessive-compulsive disorder NOS F438 Other reactions to severe stress F445 Dissociative convulsions F489 Neurotic disorder unspecified F609 Personality disorder unspecified F840 Childhood autism 6 8 F911 Unsocialized conduct disorder F99 Mental disorder not otherwise specified 97 R451 Restlessness and agitation Z638 Oth spec probs rel to prim support grp Notes NYGH: The above case count does not include the Branson UCC. Internal calculations including the Branson site UCC are as follows: F329 = 29 cases, F419 = 20 cases, F410 = 12 cases and F840 = 9 cases. 271

279 OSMH PRH PRHC QHC RMH RVH RVHS SAH SBGHC SGH HPHA Sickkids SJHC Hamilton SJHC Toronto SLMHC PCMCH Maternal-Child Benchmarking Report MH-ED ED Mental Health Visits by Top 10 Main Problems (cont) Main Problem ICD10 F100 Ment/beh disrd dt alcohol use ac intox F419 Anxiety disorder unspecified F329 Depressive episode unspecified R458 Oth symptoms signs inv emotional state F430 Acute stress reaction F432 Adjustment disorders R4688 Oth sym signs inv appearance behaviour F410 Panic disrd [ep paroxysmal anxiety] F101 Ment/beh disrd dt harmful alcohol use F919 Conduct disorder unspecified F439 Reaction to severe stress unspecified 9 21 R454 Irritability and anger F322 Sev depressive episode wo psych symptoms F900 Disturbance of activity and attention F191 Ment/beh dis harmf use mult dr & psyact 9 F509 Eating disorder unspecified 15 R452 Unhappiness R462 Strange and inexplicable behaviour F121 Ment/beh disrd dt cannab use harmf use 9 6 F913 Oppositional defiant disorder 24 6 F938 Other childhood emotional disorders 24 F959 Tic disorder unspecified 36 F111 Ment/beh disrd dt harmful opioid use F321 Moderate depressive episode F412 Mixed anxiety and depressive disorder F429 Obsessive-compulsive disorder NOS 6 12 F438 Other reactions to severe stress F445 Dissociative convulsions 6 6 F489 Neurotic disorder unspecified F609 Personality disorder unspecified 12 F840 Childhood autism 6 9 F911 Unsocialized conduct disorder 6 F99 Mental disorder not otherwise specified R451 Restlessness and agitation 6 7 Z638 Oth spec probs rel to prim support grp 272

280 SMH Southlake STEGH Stevenson Sunnybrook TBRHSC TEGH THC TOH TSH WLMH WOHS WPSHC WRH # Hospitals with this Diagnosis in Top 10 PCMCH Maternal-Child Benchmarking Report MH-ED ED Mental Health Visits by Top 10 Main Problems (cont) Main Problem ICD10 F100 Ment/beh disrd dt alcohol use ac intox F419 Anxiety disorder unspecified F329 Depressive episode unspecified R458 Oth symptoms signs inv emotional state F430 Acute stress reaction F432 Adjustment disorders R4688 Oth sym signs inv appearance behaviour F410 Panic disrd [ep paroxysmal anxiety] F101 Ment/beh disrd dt harmful alcohol use F919 Conduct disorder unspecified F439 Reaction to severe stress unspecified R454 Irritability and anger 7 10 F322 Sev depressive episode wo psych symptoms F900 Disturbance of activity and attention F191 Ment/beh dis harmf use mult dr & psyact F509 Eating disorder unspecified R452 Unhappiness 3 R462 Strange and inexplicable behaviour 7 3 F121 Ment/beh disrd dt cannab use harmf use 13 2 F913 Oppositional defiant disorder 2 F938 Other childhood emotional disorders 62 2 F959 Tic disorder unspecified 2 F111 Ment/beh disrd dt harmful opioid use 7 1 F321 Moderate depressive episode 1 F412 Mixed anxiety and depressive disorder 1 F429 Obsessive-compulsive disorder NOS 1 F438 Other reactions to severe stress 1 F445 Dissociative convulsions 1 F489 Neurotic disorder unspecified 1 F609 Personality disorder unspecified 1 F840 Childhood autism 1 F911 Unsocialized conduct disorder 17 1 F99 Mental disorder not otherwise specified 1 R451 Restlessness and agitation 1 Z638 Oth spec probs rel to prim support grp 1 Notes THC: F419, F329 and F410 values calculated internally by THC are as follows: F419 = 45, F329 = 36, F410 =

281 Holland Bloorview Kids Rehabilitation Hospital Paediatric Rehabilitation Analysis Data for Fiscal Year 2011/12 Hospital Profile Acronym HBKRH Main Catchment Area Toronto, GTA, Ontario Primary Academic Affiliation University of Toronto Year Founded 1899 Website Subspecialties / Services Offered Child Development Rehabilitation & Complex Continuing Care Participation and Inclusion Communications & Writing Autism Acquired Brain Injury Aids Cleft Lip & Palate Amputee Community Based Services Dental/Oral Surgery / Chronic Pain Life Skills Maxillofacial Orthopaedics Nursery Schools Developmental Paediatrics Respite Student Support Services Feeding Sleep Studies Hypertonia Spinal Cord Lifespan Clinic Neuromotor Neuromuscular Psychopharmacology Specialized Seating Services Spina Bifida Interventional Diagnostic Services Radiology Beds Staffed and in Operation as of April 2004 Rehab CCC Respite TOTAL 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

282 How We Measure Up 275

283 Number of Days PCMCH Maternal-Child Benchmarking Report 2012 Access and Wait Times for Child Development Program Services What s Important? Neuromotor Wait Times - 80th Percentile (Fiscal 2011/12) Demonstrated sustainability for 8 months in Neuromotor Service Autism during fiscal 2011/12 did not attain target, however recent improvements are producing results Wait lists continue to decrease in both Neuromotor and Autism services Compared to other national programs Neuromotor has demonstrated one of the shortest wait times for complex children Target Days Process Improvement initiatives using Lean methodology have resulted in the improved performance ACCESS Autism Wait Times - 80th Percentile (fiscal 2011/12) 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 Target Days 276

284 Holland Bloorview Kids Rehabilitation Hospital Indicators 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 twothirds from 3 LHIN areas (highlighted in red). Summary of Discharges by LHIN by percentage for Fiscal Years & Inpatients Outpatients FY FY FY FY Erie St. Clair 1% 0.7% 0.3% 0.3% 2 South West 2% 1.2% 0.8% 0.6% 3 Waterloo Wellington 1% 2.1% 1.6% 1.5% 4 Hamilton Niagara Haldimand Brant 1% 3.0% 1.3% 1.4% 5 Central West 8% 7.2% 6.3% 5.9% 6 Mississauga Halton 13% 6.0% 6.1% 5.6% 7 Toronto Central 15% 13.9% 25.5% 24.9% 8 Central 29% 29.0% 24.4% 24.8% 9 Central East 21% 26.2% 19.7% 20.7% 10 South East 2% 0.7% 0.6% 0.6% 11 Champlain 0% 0.0% 0.2% 0.2% 12 North Simcoe Muskoka 2% 3.0% 3.6% 3.0% 13 North East 2% 3.5% 5.9% 6.4% 14 North West 1% 0.5% 2.0% 2.1% Unknown 3% 3.0% 1.6% 2.1% Total 100% 100% 100% 100% 277

285 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 2010 through The chart depicts the percentage of families who utilized translation services to assist in their understanding or execution of care in fiscal year 2011/12. While families have identified language, not all families utilized translation services. Summary of top ten self identified primary languages of clients Rank Fiscal Year 2010/11 Fiscal Year 2011/12 1. Urdu Spanish 2. Tamil Tamil 3. Cantonese Urdu 4. Spanish Cantonese 5. French Mandarin 6. Mandarin French 7. Tagalog Somali 8. Portuguese Tagalog 9. Arabic Arabic 10. Punjabi Portuguese 278

286 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 Continuing Care Rehabilitation Respite Service* Total Inpatient Day Patient Grand Total BIRT SODR FY 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 multisystem 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 2011/12 a total of 6,763 clients were served, through more than 52,646 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. 279

287 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. Inpatient Distribution for Fiscal year 2011/12 3% 24% 53% 21% CCC BIRT SODR Respite 280

288 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 2011/12 Rehabilitation (SODR and BIRT) 11,800 Complex Continuing Care 6,835 Respite 1,307 Total 19,942 Distribution of Inpatient Days - Fiscal Years from 2010 to % 32% 33% 34% 30% 30% 31% 30% 29% 29% 29% 25% 20% 15% 10% 8% 7% 7% 5% 0% CCC SODR BIRT Respite Fiscal Year 2009/10 Fiscal Year 2010/11 Fiscal Year 2011/12 281

289 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 20 years of age. While Holland Bloorview serves the paediatric population, we continue to provide services until transitions 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. Inpatient Age Profile - Fiscal year 2011/ Age and older 282

290 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 20 years of age. Illustrated is the later age of children requiring respite services versus the continuous distribution of rehabilitation services. 60 Inpatient Age Profile by Service - Fiscal Year 2011/ and older CCC Rehab Respite 283

291 Number of Days PCMCH Maternal-Child Benchmarking Report 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 two fiscal years 2010/11 and 2011/12 in SODR and BIRT. Average Length of Stay - Fiscal Years 2010/11 and 2011/ Rehab - BIRT Fiscal Year 2010/11 Fiscal Year 2011/12 Rehab - SODR 284

292 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. An outlier 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. Average Length of Stay - Outliers for Fiscal Years 2010 to 2012 Brain Injury Rehabilitation Team Specialized Orthopedic Developmental Rehabilitation Complex Continuing Care Respite Services 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Average Length of Stay Outliers - Length of Stay 285

293 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 2012, demonstrating an increase in the number of clients accessing outpatient services. The increase is a reflection for the need that as client s transition across the continuum of care, specialized services can and should be delivered on an outpatient basis to maximize functional recovery. Percentage of Inpatient Clients Receiving Outpatient Services - Fiscal Years 2009 to % 90.0% 75.8% 73.8% 76.8% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% FY FY FY

294 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 destination 2 (or when the patient s needs or condition changes and the designation of ALC no longer applies). Note 1: The patient s care goals have been met or progress has reached a plateau or the patient has reached her/his potential in that program/level of care or an admission occurs for supportive care because the services are not accessible in the community (e.g. social admission ). Note 2: Discharge/transfer destinations may include, but are not limited to: home (with/without services/programs), rehabilitation (facility/bed, internal or external), complex continuing care (facility/bed, internal or external), transitional care bed (internal or external), long term care home, group home, 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 1 st, 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. 287

295 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. Percentage of ALC Days - Fiscal Year 2011/ % 10.7% ALC Days Non-ALC Days 288

296 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 20 years and older. Outpatient Age Distribution Fiscal Year 2011/12 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1, and older Age - Number of Years 289

297 Number of Referrals Accepted PCMCH Maternal-Child Benchmarking Report HBV Referral Pattern for Outpatient Services The chart below displays the referral pattern for all of Outpatient Services for fiscal year 2011/12 (highest volume services). Of note is the significant volume of Autism referrals when compared to other services, which has increased over twofold since Outpatient Referrals for Fiscal Year 2011/ Neuromotor Communication and Writing Aid Services Augmentative Communication Autism (main site and satellites) 290

298 Volume PCMCH Maternal-Child Benchmarking Report HBV Referral Pattern for Child Development Services The chart below displays the referral pattern for Child Development Services over the past two 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. Child Development Program - Referrals/Attendances/Wait Lists for Fiscal Years 2010 to Referrals Appointments Attended Wait List Fiscal Year 2010/11 Fiscal Year 2011/12 291

299 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. Child Development Program (Autism) - Referrals/Attendances/Wait List for Fiscal Years 2010 to Referrals Appointments Attended Wait List Referrals Appointments Attended Wait List Fiscal Year 2010/11 Fiscal Year 2011/12 Child Development Program (Neuromotor) - Referrals/Attendances/Wait List for Fiscal Years 2010 to Referrals Appointments Attended Wait List Referrals Appointments Attended Wait List Fiscal Year 2010/11 Fiscal Year 2011/12 292

300 Number of Referrals PCMCH Maternal-Child Benchmarking Report HBV Referral Pattern for Neuromotor Services The chart below displays the referral pattern for Neuromotor services over the past three 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 continued increase in referrals and demand for the service. Neuromotor Referrals - Fiscal Years 2009 to Fiscal Year 2009/10 Fisca Year 2010/11 Fiscal Year 2011/12 293

301 Number of Referrals Number of Referrals PCMCH Maternal-Child Benchmarking Report 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 increased number of referrals received for assessment and diagnosis of ASD. Consolidated Referral Pattern for Autism Assessment Services for Fiscal Years 2009 to Fiscal Year 2009/10 Fiscal Year 2010/11 Fiscal Year 2011/12 Fiscal Year 2009/10 Fiscal Year 2010/11 Fiscal Year 2011/12 Consolidated Referral Pattern for Autism Assessment Services (including all sites) - Fiscal Year 2011/ Autism - Main Site Autism Satellite - Branson Autism Satellite - St. Joseph Autism Satellite - TEGH Psychopharmacology - Autism 294

302 Volume PCMCH Maternal-Child Benchmarking Report HBV Referral Pattern for Communication and Writing Aids Services The charts below display the referral pattern over the past two 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. Communication and Writing Aids - Referrals/Attendances/Wait Lists from 2010 to Referrals Appointments Attended Wait List - Fiscal Year End Fiscal Year Fiscal Year Communication and Writing Aids - Referrals/Attendances/Wait List for Fiscal Years 2010 to Referrals Appointments Attended Waitlist - FY end Referrals Appointments Attended Waitlist - FY end Augmentative Communications Writing Aids Fiscal Year Fiscal Year

303 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. Percentage Summary of Operating Costs Fiscal Year 2011/ % 2.20% 22.50% 5.70% 1.50% 39.30% Inpatients Ambulatory Diagnostic & Therapeutics Community Administration & Support Education 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

304 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 share 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. Better organized services 5. Evaluation to support benchmarking (timeline TBD) More consistency in care across Canada Improved access to services An assurance that time and energy is being spent on the right therapies and intervention that will make a meaningful difference Fiscal stewardship Pan-National strategic planning 3. Pilot the NDS at three sites across Canada (target timeline Dec 2012) 4. Implement Across Canada (timeline TBD) 2. Complete feasibility study (complete September 2012) 1. National Agreement on framework + indicators for National Data 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. 297