Life or Limb Implementation Update
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Dear Colleagues,

Welcome to Critical Care Services Ontario’s 7th edition of the Life or Limb Policy Implementation Update. The Provincial Life or Limb Policy has completed 3 years since implementation in 2014. CCSO would like to thank you for your efforts in improving access to care for the sickest, most vulnerable, critically ill patients in the province. The Life or Limb Policy established improvements in facilitating physician consultation for critically ill patients, as illustrated in the chart below.


These results are complemented by the qualitative component of the Life or Limb policy evaluation.  Interview participants reported strong familiarity with the policy and appreciation for the existence of a defined policy that helps ensure that patients with life or limb threatening conditions could have access to care within target time frames.  In the words of one clinical director:

“It's an excellent way to ensure we're looking after Ontario patients in the right environment at the right time for their illness.”

In September and October 2016, CCSO was pleased to once again host a series of Town Hall Meetings for all fourteen Local Health Integration Networks. The 2016 Town Hall Meeting focused on “Leadership and Accountability for Quality and Safety in Critical Care” which included discussions of the Life or Limb Policy, Repatriation, and the Critical Care Quality Framework. 

The Town Hall Meetings provide a venue for CCSO to share information with health care system partners. CCSO was pleased to note there were over 400 attendees across the province at the 2016 Town Hall Meetings that received information and provided a broad range of perspectives on the discussion topics. Please note the dates for the 2017 Town Hall Meetings at the bottom of this newsletter.

CCSO was invited to conduct a workshop at the 2016 Institute for Healthcare Improvement (IHI) Forum in Orlando, Florida entitled “Improving Patient Safety for the Sickest of the Sick”, about the journey of developing and implementing the Provincial Life or Limb Policy. It was attended by international participants and CCSO received positive feedback on this work. The presentation can be viewed via this link.

New at CCSO

CCSO has launched the Provincial Life or Limb Advisory Committee (PLLAC). PLLAC acts as an advisory committee to CCSO regarding issues related to Life or Limb including Repatriation and Evaluation and Performance Management of One-Number-to-Call Phase 1. PLLAC and its Performance Management Working Group will provide advice regarding performance management and system improvement initiatives to ensure that the objectives of the Life or Limb Policy are met. Membership is comprised of Ministry of Health and Long-Term Care (MOHLTC), physicians, hospitals, EMS, Ornge, CritiCall Ontario and CCSO.

Coming Your Way: 
Repatriation Performance Reports

In 2017 CCSO will be sending letters on hospitals’ repatriation performance to hospital CEOs. CCSO hopes that this information will enable hospital system partners to review their performance and identify opportunities for improvements with respect to Repatriation and Patient Flow.   

Repatriation is a vital component of the Provincial Life or Limb Policy. Returning patients to the referring hospital within 48 hours ensures that larger, specialty hospitals continue to have the capacity to accept and care for patients with Life or Limb threatening conditions.  Over the last 3 years, the Repatriation Guide, performance management framework and tools were introduced and progressively implemented in Ontario.  The main objectives of these resources are to provide education and increase uptake of key Repatriation principles and to strengthen the successful implementation of the Life or Limb Policy.

Supporting Repatriation of Neurosurgical Patients

The Neurosurgery Education and Outreach Network (NEON) was established in May 2013 to work in collaboration with the Provincial Neurosurgery Advisory Committee to support better integration and access to neurosurgical services in the province. NEON has also been instrumental in some neurosurgical centres in assisting with repatriation of neurosurgical patients back to their home hospitals.  NEON is composed of Neuro-Nurse Educators and Clinical Outreach Specialists, who support patient management, develop repatriation strategies for neurosurgical patients, provide neurosurgical nursing education and improve quality of care. If you require support with any of these topics please contact the Clinical Outreach Specialist for your LHIN:

LHIN Organization Clinical Outreach Specialist 
 LHIN 1  Windsor Regional Hospital  Sean Hopkins
 LHIN 2  London Health Sciences Centre  Kimberly Salway
 LHIN 3/4  Hamilton Health Sciences  Klaudia Gogishvili
 Sera Nicosia
 Tina Petrelli (Paeds)
 LHIN 5/6  Trillium Health Partners  Beverly Espedido
 LHIN 7/8/9W/12  University Health Network  Dawn Tymianski
 LHIN 7/8/9W/12  St. Michael’s Hospital  Wen-Ya (Lory) Lee
 LHIN 7/8/9W/12  Sunnybrook Health Sciences Centre  Catherine Morash
 LHIN 7  The Hospital for Sick Children  Elisabeth White
 LHIN 9E/10  Kingston General Hospital  Nicole Chenier-Hogan
 LHIN 11  The Ottawa Hospital  Dianna Hughes
 LHIN 13  Health Sciences North Sudbury  Lindsay Roach
 LHIN 14  Thunder Bay Regional Health Sciences Centre  Kim Belluz

2017 CCSO Town Hall Dates
Save the date! CCSO will be back in your LHIN in the fall with our annual Town Hall Meeting.
Date LHIN(s)
 Wednesday, September 6, 2017  South East LHIN
 Thursday, September 7, 2017  North Simcoe Muskoka LHIN
 Friday, September 8, 2017  Waterloo Wellington LHIN
 Tuesday, September 19, 2017  North West LHIN
 Thursday, September 21, 2017  North East LHIN
 Tuesday, October 3, 2017  Erie St. Clair LHIN
 Wednesday, October 4, 2017  South West LHIN
 Thursday, October 5, 2017  Central West & Mississauga Halton LHINs
 Tuesday, October 17, 2017  Champlain LHIN
 Wednesday, October 18, 2017  Toronto Central, Central & Central East LHINs
 Thursday, October 19, 2017   Hamilton Niagara Haldimand Brant LHIN


Bernard Lawless, MD, MHSc, CHE, FRCSC 
Provincial Lead
Critical Care Services Ontario (CCSO)
T: (416) 340-4800 Ext. 5566
Linda Kostrzewa, RN, BAS Hons., MHSc
Senior Director Strategy and System Transformation  
Critical Care Services Ontario (CCSO)
T: (416) 340-4800 Ext. 6627   
Copyright © 2017 Critical Care Services Ontario, All rights reserved.

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