FRANCAIS

August 18, 2003

Health Minister Dave Chomiak today released the report of the cardiac care external review led by Dr. Arvind Koshal, director of Edmonton’s Cardiac Sciences Program.

Chomiak committed to act on the report and outlined an implementation plan that includes the following immediate actions:

• Acceptance of the major recommendations in the report--including consolidation of all cardiac surgery at St. Boniface General Hospital--and a commitment to report on implementation progress in one year.
• Appointment of an implementation planning team, chaired by Dr. Brian Postl, CEO of the Winnipeg Regional Health Authority (WRHA).
• An aggressive recruitment process to establish strong physician leadership for the cardiac care program. This leadership will include the establishment of a new position, medical director of the regional cardiac sciences program, as well as the appointment of physician leaders for each of cardiology, cardiac surgery and cardiac anaesthesiology.
• Further expansion of annual cardiac surgery volumes to 1,300 cases this year, and maintenance of the Cardiac Care Network of Ontario recommended surgical volumes thereafter. The WRHA will be directed to utilize the additional surgeries to reduce surgical cancellations.
• Centralization of all cardiac surgery wait lists and wait list management processes in the WRHA. Once this process is completed cardiac surgery wait list statistics will be published on the Manitoba Health Web site.

"Dr. Koshal and his review team have provided Manitobans with a road map to build a first class cardiac care program here in Manitoba," said Chomiak. "I commend them for their excellent work and commit to act aggressively on their advice."

Koshal presented the report after a six-month review process that involved external health care professionals from all aspects of cardiac care. Their investigation involved:

• review of documents, reports and data relating to the cardiac care program;
• site visits;
• interviews with health care professionals who deliver cardiac care in Manitoba;
• interviews with cardiac patients and their families; and
• review of public submissions.

"With the right physician leadership in cardiac care, strong administrative management from the Winnipeg Regional Health Authority, the St. Boniface General Hospital and the Health Sciences Centre, and appropriate support from the province and the faculty of medicine, there is a tremendous opportunity to develop an excellent cardiac care program in Winnipeg," said Koshal.

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Initiated in February 2003, the cardiac care external review was given six months to report back to the minister. The purpose of the review was to provide independent expert advice on improving cardiac care in Manitoba.

The report provides 42 recommendations to build a first-class cardiac care program in Manitoba. Major recommendations include:

• consolidation of all cardiac surgery at St. Boniface General Hospital (SBGH), with strong, high quality cardiology services to be maintained at both SBGH and Health Sciences Centre (HSC);

• the immediate recruitment of strong physician leaders for cardiac surgery, cardiology and cardiac anesthesiology, as well as an overall cardiac sciences program head;

• a regional cardiac sciences program structure with clear accountability and reporting relationships to the Winnipeg Regional Health Authority (WRHA) CEO;

• the appointment of an implementation planning team led by the WRHA CEO;

• establishment of a dedicated envelope of funding (operating and capital) that provides long-term, sustainable support for the cardiac sciences program;

• an immediately increase in the volume of cardiac surgeries to 1,300 cases, and maintenance of the Cardiac Care Network of Ontario recommended surgical volumes thereafter;

• expansion of work done on public reporting to include internal benchmarks for mortality rates on the wait list based on existing experience and that of other cardiac centres; and

• expansion of work on central wait list management to include a formal process to ensure all patients on the cardiac surgery wait list are appropriately monitored.

As the report recommends, the minister of health has committed to report on implementation progress in one year.

In July, 2003, there were an average of 118 patients waiting for elective cardiac surgery--down more than 30 per cent since 1999 when centralized wait list data was first made available.

During the most recent quarter (April-June, 2003), the median wait time for cardiac surgery was 13 days--more than half of cardiac surgery patients received their surgery within two weeks. Elective patients with more stable symptoms wait longer.

For 25 years, there has been debate as to how and when cardiac surgery should be delivered in Manitoba. The combination of this expert report, a well developed regional structure and broad consensus on the need to move forward provides a unique opportunity to finally resolve the long-standing challenges facing cardiac surgery.