Sharma Sunjay, Bohn Des, Mikroyiannakis Iphigenia, Trowbridge Joslyn, Thompson Donna, Bell Robert, Rutka James
Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Critical Care Secretariat, Ministry of Health and Long Term Care, Toronto, Ontario, Canada; CritiCall Ontario, Hamilton, Ontario, Canada.
Health Policy. 2017 Feb;121(2):207-214. doi: 10.1016/j.healthpol.2016.11.012. Epub 2016 Nov 22.
Neurosurgical emergencies require expedient access to definitive care at neurosurgical centers. Neurosurgical resources in province of Ontario are highly centralized, and subsequently, most patients with neurosurgical emergencies will present to non-neurosurgical centers. From 2000-2010, metrics demonstrated the organization of neurosurgical resources might not be optimal. In response to this a program entitled Provincial Neurosurgery Ontario (PNO)- was formed to address these issues in cooperation with neurosurgeons, hospitals and the provincial government. PNO worked with multiple stakeholders to implement interventions to not only prevent out of country transfer, but to also improve the flow of neurosurgical patients in the province and potentially improve outcome. The main interventions undertaken by PNO were: 1) implementation and development of a province-wide tele-radiology system; 2) development of neurosurgery as a provincially-funded program; 3) significant outreach to non-neurosurgical centers; and 4) specialized funding packages for highly specialized level care. This report provides background on the challenges faced by neurosurgery in the province of Ontario and the process developed to address these challenges. Finally, we describe the impact provincial strategies have had on improving access to emergency neurosurgical care in the Ontario.
神经外科急症需要迅速在神经外科中心获得确定性治疗。安大略省的神经外科资源高度集中，因此，大多数患有神经外科急症的患者会前往非神经外科中心就诊。2000年至2010年期间，各项指标表明神经外科资源的配置可能并非最优。对此，一个名为安大略省省级神经外科（PNO）的项目应运而生，该项目与神经外科医生、医院及省政府合作以解决这些问题。PNO与多个利益相关方合作实施干预措施，不仅要防止患者被转至国外治疗，还要改善该省神经外科患者的就医流程，并有可能改善治疗结果。PNO采取的主要干预措施包括：1）实施并开发全省范围的远程放射学系统；2）将神经外科发展成为省级资助项目；3）大力向非神经外科中心拓展；4）为高度专业化护理提供专门的资金套餐。本报告介绍了安大略省神经外科所面临的挑战以及为应对这些挑战而制定的流程。最后,我们描述了省级策略对改善安大略省急诊神经外科护理可及性所产生的影响。
