Alberta Health

November 17, 2014

Edmonton Zone 2030 Plan - Phase 1 (Current State Report)

Issue: Edmonton Zone has developed a comprehensive, long-term service and infrastructure plan - Edmonton Zone 2030 Plan - to determine the current and future health care needs for the Zone, now and into the year 2030.

The plan will be completed in two phases. The first phase, now complete, focused on two reports. One report, June 2013 (Phase 1 Current State Report), provides a snapshot of the current condition and inventory of 18 facilities in the Edmonton Zone with the objective of optimizing the location of health services and the use of built space to address operational concerns and capacity needs.

Using data collected, a second report - Phase 1 Final Report - October 2013 - was created. This report looked at short-term strategies to the year 2015-16 to improve service delivery and relieve capacity pressures at the 18 facilities.

The second phase which will complete the Edmonton Zone 2030 Plan, and which is now underway, involves projecting the health needs of the population served by Edmonton Zone and developing a Zone-wide health service plan and supporting infrastructure plan in five-year increments from 2015 to 2030.

The two reports for Phase 1 of the planning are complete and will be shared with public and media on AHS' external website. The Current State report has been the subject of a FOIPP request.

Media will focus on the capital deficiencies and recommended capital investment projects outlined in the report.

The second report for Phase 1 is contained in a separate attached Issues/KM document.

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Key Messages:

High level 2030 plan key messages:

• As providers of health care services, it is our responsibility to plan for the future - to put services, resources and physical structures in place to ensure we meet the current and future health care needs of Edmonton Zone residents and those referred to the Edmonton Zone for health care services.

• The Edmonton Zone has undertaken a precedent setting, comprehensive planning process to look at health care services and infrastructure supports required to meet the current and future health care needs of the Zone. Planning is based on engagement and consultation. It is evidence-based and aligned with AHS' priorities while being responsive to the unique needs of the Edmonton Zone.

• The Current State Report identifies the existing state of our infrastructure. It will be used to develop a detailed database of the current state of Edmonton Zone health care facilities.

• This consultation process will result in the development of the Edmonton Zone 2030 Plan - a dynamic strategy which aligns current and future health care needs with an integrated infrastructure plan to support the Edmonton Zone.

• Other Zones will use the 2030 plan to embark on a similar planning process to ensure healthcare services and infrastructure needs are met across the province.

• The 2030 Plan involved more than 1,000 stakeholders, including frontline staff, physicians and partners.

• The cost for development of the 2030 Plan is approximately $2.8 million.

• The plan will ensure Edmonton Zone is efficiently allocating resources, utilizing existing space and expanding where necessary, while planning for future growth and technology.

• Any decision regarding Edmonton Zone facilities must be made within both the provincial and local context, recognizing the needs of the Zone and all those living and accessing health care in and around Edmonton, including other zones, northern Canada and neighbouring provinces.

High level key messages Phase 1 - June 2013 (Current State Report)

• The health and safety of our patients comes first. Any situation that could impact patient safety, or the operation of programs, is addressed immediately.

• AHS has contingency emergency infrastructure funding to address any immediate infrastructure needs that arise unexpectedly and need immediate attention.

• AHS, Alberta Health and Alberta Infrastructure work together to identify capital needs and priorities

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• Currently there are $585.7 million in active maintenance and renewal projects at AHS facilities across the province.

• AHS's priority lists and recommendations are based on clinical needs and priorities in order to ensure the best quality health services are available in the most appropriate locations.

Specific key messages for facilities outlined in the June 2013 Current State Report:

Aberhart Centre • Deficiencies outlined in report: Fire sprinklers throughout, but not to current code

requirements. Key messages:

• Though the sprinkler system in the Aberhart Centre is older it has passed Fire Department inspections, which are conducted regularly.

Alberta Hospital Edmonton • Deficiencies outlined in report: Acuity of psychiatric illness as well as rates of medical

commodity are increasing and it is very difficult to manage these clinics ; Patients with development disabilities are admitted into the general population, presenting program and safety challenges; size and design adult inpatient units below standards, patient crowding leads to increased safety and security concerns; insufficient infection control measures such as hand sinks, private rooms with private washrooms; Many areas have no coverage for duress alarms or outdated ones for staff and visitors creating higher levels of risk; Non sprinkler buildings creates significant safety issues. Key messages:

• Measures have already taken place to address concerns raised in the Edmonton Zone 2030 Plan .

• Since 2010, approximately $7.6M has been and is currently being spent on critical infrastructure upgrades at the Alberta Hospital Edmonton, including major upgrades to the security system, replacement of the emergency generator transfer switch, fire alarm system replacement, and repairs to the courtyard gates and sewage line.

• Currently new duress alarm systems are being installed in building 10 of the Alberta Hospital. There are plans to update duress alarm systems in other buildings as well .

• In April a significant upgrade was completed to the fire alarm system. Upgrades include a new system which would have the fire department responding to a fire at the Alberta Hospital within 75 seconds.

• Though there are no sprinkler systems in the some of the older buildings there are updated fire alarm systems and fire cabinets in place. The Fire department does regular inspections at the site, as recently as three months ago, and Alberta Hospital has passed all inspections.

• AHS is proactively addressing concerns with patients with developmental disabilities being admitted to the general population. Addiction and Mental Health (A/MH) Edmonton zone has partnered with Persons with Developmental Disabilities (POD) Edmonton and they are working together on plans to better serve these patients by offering supports in their home environment.

• The health and safety of our patients comes first. Any situation that could impact patient safety, or the operation of programs, is addressed immediately.

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Devon General Hospital • Deficiencies outlined in report: The combination of patient care levels (hybrid model)

on the inpatient unit has issues with care standards and efficiencies. Suggestions have been made that the facility should not have any beds or minimal convert to only one level of care; Since 2010 the afterhours has reduced hours of operatoion, is at capacity and ER volumes have been impacted (increasing ratio of CTAS 4 and CTAS 5 patients. Should Devon have a full-service Emergency or is Urgent care more appropriate. Key messages:

• Since 2010, approximately $1.9M has been spent on critical infrastructure upgrade projects at the Devon General hospital, including mechanical, electrical, roofing, fire alarm and nurse call system upgrades and replacements.

• The suggestions identified in this report are recommendations only. There have been no decisions on whether the recommendations will be considered for implementation.

• The recommendations would require further consideration, public consultation and engagement prior to proceeding

• Any decision regarding Edmonton Zone facilities must be made within both the provincial and local context, recognizing the needs of the Zone and all those living and accessing health care in and around Edmonton, including other zones, northern Canada and neighbouring provinces

Kaye Edmonton Clinic • Deficiencies outlined in report (not significant): Very limited nurse call and medical

gases in the building may restrict uses of space; Soiled utility space not consistently designed; reported concerns building systems may limit functions that can locate in building . Key messages:

• The $484M Edmonton Clinic was opened in 2012. Eventually, up to one million ambulatory patients a year will benefit from seamless, outpatient clinical care and streamlined access to specialized services and specialists.

• Northern Alberta Urology Centre including the Men's Health Centre project will consolidate all ambulatory urology services at the Kaye Edmonton Clinic including clinics, diagnostic and biopsy services, cystoscopy, lithotripsy and urodynamic services to streamline access for patients.

• The budget for this project is $39.9M (with $10M from the Men's Health Campaign - a joint initiative of the UAH, RAH and Cancer foundations, 29.9M from Edmonton Kaye Clinic budget)

• This project will include 24 general examination rooms, 8 prostate health clinic exam rooms, a prostate health clinic resource centre, 1 lithotripsy procedure room, 2 urodynamic procedure rooms, 4 general procedure rooms, research and lab simulation rooms as well as offices and academic space for up to 20 urologists including a term of multidisciplinary health care providers.

Edmonton General Continuing Care Centre • Deficiencies outlined in report: The NARP satellite dialysis unit is poorly design and

only have 2 private rooms need 5. Have had flooding in this department; The Sleep Lab has 3 year wait list and many issues are bariatric but unit is not designed to accommodate. Issues with vermin infestation; Elevators are all outdated and function poorly. Key messages:

• Measures have already taken place to address some capital project concerns.

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• In the past two years, $11 million in infrastructure upgrades have been invested to upgrade the fire alarm system, elevators and chillers so that residents are cared for in a safe and comfortable living environment.

• 6 elevators are currently being repaired and work is expected to be complete by end of 2014.

• Edmonton General has sought the advice and guidance of AHS Environmental Public Health, related to the reported presence of bats in the facility. Environmental Public Health recommended that a licensed pest control operator be employed to provide expert assessment and risk mitigation services. Edmonton General has done this. At this time, there is no further evidence of bat presence in the facility.

• The health and safety of our patients come first. Any situation that could impact patient safety, or the operation of programs, is addressed immediately.

Fort Saskatchewan Community Hospital • Deficiencies outlined in report (not significant): There is unused space in the ED;

large rehabilitation, OR and public health spaces underutilized. Key messages:

• The $87M Fort Saskatchewan Hospital began treating patients in March 2012. With more than triple the space of the previous facility, the new Fort Saskatchewan Community Hospital is serving the community well by offering 32 acute-care beds, with capacity for expansion to 38, and 24-hour emergency services.

• Local residents are now benefiting from a wider range of health services with the opening of this hospital, including the community's first CT scanner, and many other services like IV therapy clinics, obstetrics, general surgery, radiology, rehabilitation, Pharmacy and Laboratory Services.

Glenrose Rehabilitation Hospital • Deficiencies outlined in report: GlenEast is past its expected life and should be

replaced; Child and adolescent mental health is housed in small, very poor quality space with safety risks and no access to secure doors. Key messages:

• Measures have already taken place to address some capital project concerns. • Since 2010, approximately $5.9M has been and is currently being spent on critical

infrastructure renovation upgrades at the Glenrose Rehabilitation Centre including energy centre boiler expansion, boiler economizers' upgrade, completion of design for fire alarm and smoke detector upgrade, chiller piping upgrade, and upgrades to diagnostic imaging services.

• AHS recognizes the GlenEast trailer, while not ideal, it is currently serving patient needs. • AHS, Al and AH are currently reviewing the spaces used by children and adolescent

mental health and psychiatry programs at both the Glenrose Rehabilitation and the Royal Alexandra Hospital. A needs assessment has been completed and is being reviewed.

• The health and safety of our patients come first. Any situation that could impact patient safety, or the operation of programs, is addressed immediately.

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Grey Nuns Community Hospital • Deficiencies outlined in report: Major capacity issues in psychiatric unit (unit 92) may

put 3 patients with serious psychiatric problems in the same room. There is only one room that can be secured on Units 91/93 for 24 hours. Key messages:

• Measures have already taken place to address some capital project concerns. • Since 2010, approximately $1.85M has been spent on critical infrastructure upgrade

projects at the Grey Nuns Community Hospital, including mechanical, electrical and medical gas system upgrades and replacements.

• Admission protocol for psychiatric patients being admitted at the Grey Nuns Emergency Department is to transport them to another Edmonton Zone facility if there are no secure room onsite available.

• Patients are only placed in units 91/93 as a last resort when there are capacity issues throughout the Edmonton Zone.

• Dealing with these capacity issues is exactly what the Edmonton 2030 plan will address.

Leduc Community Hospital • Deficiencies outlined in report (not significant): There is capacity pressure on in­

patient beds. ED requires reconfiguration at entrance; there are no CT/MRI on site but shelled space for CT scanner and recovery area for DI.

• Key messages: • Since 2010, approximately $900,000 has been spent on critical infrastructure upgrade

projects at the Leduc Community Hospital, including structural repairs and central sterilization area upgrades.

Mazankowski Alberta Heart Institute • Deficiencies outlined in report (not significant): Short stay unit is vacant; Concerns

with workloads with vascular assist device (VAD) and lung transplant; top three floors are not developed. Key messages:

• Since 2010, approximately $4.6M has been spent on critical infrastructure upgrade projects at the Mazankowski Alberta Heart Institute, including cardiac MRI and Cardiac Rehabilitation area fit-ups.

Misericordia Community Hospital • Deficiencies outlined in report: There are major facility issues that interfere with patient

care and lead to daily crisis management. List includes sewage leaks in OR, leaking building envelope, mould, failing elevators, obsolete medical gas system, outdated nurse call system, plumbing failures, hot water issues, and insufficient security system; Emergency generators do not meet minimum backup needs; Outdated in patient wards; Lack of intermediate care beds; Outpatient clinic busy with gowned patienrts wait in public areas and soiled utility does not have waste disposal system; Psychiatric unit not configured to meet population needs; Undersized and poorly configured ORs. The Sterile Core has been through mould remediation after the flood. Key messages:

• AHS and the Government of Alberta have committed to begin extensive planning, including master planning, of the Misericordia Hospital site. Results of the planning will help guide decisions on the future of the facility. The Master Plan is expected to be complete by December, 2015.

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• $6.2 million has been spent on the Misericordia Hospital over the last three years on repairs to the central sterilizing room, replacing chillers, elevator upgrades and renovations to the laboratory.

• AHS plans to spend another $25 million in repairs, renovations and upkeep to Misericordia over the next 5 years. $9.4 million will be spent on water damage remediation and renovation projects associated with flooding issues. Close to $10 million will be spent on upgrades to the electrical systems, emergency generators, elevator upgrades, nurse call systems, sanitary sewage and portable water systems.

Northeast Community Health Centre • Deficiencies outlined in report (not significant): Emergency was built for 25,000 and

is now seeing 53,000 people per annum. ED is undersized; lab area is small; parking is poorly designed. Key messages:

• Since 2010, approximately $270,000 has been spent on critical infrastructure upgrade projects at the Northeast Community Health Centre, including loading dock and ambulance bay upgrades and electrical and mechanical system upgrades.

Royal Alexandra Hospital • Deficiencies outlined in report: There is a shortage of Observation Beds throughout

the facility that affects all programs; Psychiatry for children, adolescents and adults are all substandard spaces that present risks to patients and staff; Elevators and lifts are often not working; There is unused capacity in the form of closed beds; The Bridging and Trabsition units are in very poor quality spaces that do not meet the needs of vulnerable and frail elderly patients; "The Pit" (Health records space in the sub-basement) present fire safety concerns. Key messages:

• AHS and the Government of Alberta have committed to begin extensive planning, including master planning, of the Royal Alexandra Hospital site. Results of the planning will help guide decisions on the future of the facility. The Master Plan is expected to be complete by December, 2015.

• Measures have already taken place to address some capital project concerns. • Since 2010, approximately $18.6M has been and is currently being spent on critical

infrastructure upgrades at the Royal Alexandra Hospital including major upgrades to cooling and gas systems, security upgrades, heliport upgrades, renovations to switchboard area, and new data centre.

• Repairs have also been done to 6 of the elevators in the older part of the building and repairs of remaining elevators have been identified as high priority project.

• $15.3 million has been approved for renovations to existing space at the Royal Alexandra Hospital to create 18 beds for adult mental health and detox patients.

• Future replacement plans for the ATC inpatient tower are part of the discussions and planning process of the Edmonton Zone 2030 plan. Any decision regarding the Royal Alexandra Hospital must be made within a larger context and must be made recognizing the needs of the entire zone and all those living and accessing care in and around Edmonton.

• AHS, Al and AH are currently reviewing the spaces used by children and adolescent mental health and psychiatry programs at both the Glenrose Rehabilitation and the Royal Alexandra Hospital. A needs assessment has been completed and is being reviewed.

• AHS is currently looking into options to move elderly patients from the current Bridging unit to other locations.

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• The health records space while out dated does meet fire safety standards. The Royal Alex has passed all recent Fire Marshall inspections.

• The health and safety of our patients come first. Any situation that could impact patient safety, or the operation of programs, is addressed immediately.

• In the AHS' 2013 Capital Submission, the RAH redevelopment was listed in the top 10 priority projects for AHS.

University of Alberta Hospital (includes Stollery Children's Hospital) • Deficiencies outlined in report: Capacity pressures in all critical care units, observation

beds, EEG telemetry, trauma and inpatient beds; The inpatient units (medical, surgical, mental health) are considerably out-of-date and creates safety and IPC risks. Storage is major problem on all units; the scope cleaning areas in the ENT clinic does not meet standards. Key Messages:

• AHS and the Government of Alberta have committed to begin extensive planning, including master planning, of the the University of Alberta Hospital site. Results of the planning will help guide decisions on the future of the facility. The Master Plan is expected to be complete by December, 2015.

• Measures have already taken place to address some capital project concerns. • Since 2010, approximately $19M has been and is currently being spent on critical

infrastructure upgrades at the University of Alberta Hospital and the Stollery Children's Hospital including upgrades to elevators, fire alarm system, medical gas, domestic water distribution system, food services redevelopment, MRI renovations, pediatric emergency area renovations, and roof replacement.

• The $14.SM Endoscopy Suite Expansion of the former health records space were completed in the summer of 2013. The renovations have allowed increased capacity of five additional procedure rooms while also replacing the existing procedure rooms with new, state-of-the-art facilities.

• The $64.1 million critical care expansion project at the Stollery Children's hospital will create 48 neonatal, pediatric and pediatric cardiovascular intensive care beds, with each of the three units having 16 individual patient rooms

• Construction is to start in 2015, with the project being completed in two phases. • Pre-construction on the $33. 7 million Stollery Pediatric Surgical suite renovation project is

underway. • The completed surgical suite will occur in 2 phases. The approved plan includes 5 pre­

procedure rooms, 1 emergency holding bay, 10 ORs, 18 primary recovery beds, 18 secondary recovery beds, 10 day ward surgery beds and 2 isolation rooms.

Strathcona Community Hospital • Deficiencies outlined in report (not significant): Both Emergency and Urgent care

are planned for this site is this optimal?; Recruitment for ED expected to be challenge; Is the large allied/rehab space underutilized, how should it be used?. Key messages:

• The $130 million Strathcona Community Hospital opened to patients on May 21, 2014. • Work continues on the Consolidation of Addiction and Mental Health portion of this

project. Design work is complete and construction has started. • Strathcona Community Hospital is very much a hospital, with a dedicated team of

physicians and staff who deliver 24-hour emergency care, supported by pharmacy and diagnostic imaging services, as well as providing primary care and increasing access to community-based health care services.

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• The new hospital has been doing well since it opened in May, averaging 115 to 120 patients per day in the Emergency Department with peaks of 135 to 140 on some days. Median time from arrival to seeing a physician is 1.3 hours, and 73 per cent of Emergency patients are discharged home within four hours.

• More than 5000 patients have been seen by the hospital's Diagnostic Imaging Department. That's 5000 patients who did not have to travel out of their community for DI services.

• The need for acute care services can be effectively and efficiently provided at existing acute care hospitals within the Edmonton Zone, four of which are within a 30-minute drive for most residents.

Sturgeon Community Hospital • Deficiencies outlined in report (not significant): Capacity/operating pressures in

Women's Health/NICU, ICU, Medicine, Observation Beds, Home Care office space; Poorly designed dissimilar inpatient units require greater capacity, lifts, support spaces for staff; Need more mental health services. Key messages:

• Since 2010, approximately $530,000 has been spent on critical infrastructure upgrade projects at the Sturgeon Community Hospital, including mechanical and electrical system upgrades and reconstructing an exterior driveway

Walter Mackenzie Health Sciences Centre • Deficiencies outlined In report (not significant): Walter Mackenzie Centre is large

and complex. Distances from main entrances to programs and services can be lengthy. Key messages:

• The $13.8 million redevelopment of Stollery Ambulatory clinics within the Walter Mackenzie Centre is complete.

• The clinics include24 general exam rooms, 4 consultation rooms, 6 ENT rooms, specialized rooms for Home Nutrition, a pediatric pulmonary function lab (which will also serve adult inpatients), a challenge chamber and a small clinical investigation unit, as well as staff workspace, where required.

WestView Health Centre • Deficiencies outlined in report: Emergency requires major renovations to deal with

capacity issues, patient flow, security, lack of clean and spoiled supply areas, small trauma room. Key messages:

• Since 2010, approximately $200,000 has been spent on critical infrastructure upgrade projects at the WestView Health Centre in Stony Plain, including mechanical, electrical and roofing system upgrades and replacements.

Contact for Follow-up:

Deb Gordon, Vice President and Chief Health Operations Officer, Edmonton Zone (780) 342-2025

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