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2. 2 July 26 th, 2012 - News Release As part of the province 's commitment to strengthen health care in rural Saskatchewan, Minister responsible for Rural and Remote Health Randy Weekes today announced that the province is exploring the implementation of Collaborative Emergency Centers (CECs) in the province as an innovative approach to provide emergency and primary health care. “Collaborative Emergency Centers are designed to enhance access to high quality, comprehensive primary care that is capable of dealing with unexpected illness or injury in a timely fashion. Nova Scotia has been implementing this model in communities where 24-7 emergency service is difficult. CECs are open twenty four hours a day, seven days a week, and are staffed by a primary health care team during the day and a team that includes a nurse and a paramedic, with physician oversight through the emergency health system, during the night. The benefits of the CEC model include: improved access, shorter wait lists, same day appointments, reducing number of visits to emergency rooms and increased patient satisfaction.”

3. 3 September 18 th, 2012 - Knowledge exchange between Nova Scotia and Saskatchewan Nova Scotia Collaborative Emergency Centre’s – Strategic Overview- Panel Discussion – Q&A – Exploring CECs from various perspectives World Café – Key Success Factors for SK CECs-

4. 4 Better Care Sooner Model Collaborative Emergency Center (CEC) A CEC proposes to make emergency care a seamless part of primary health care. A CEC enhances access to high quality comprehensive primary health care (provided by a team or mix of professionals for extended hours with same day or next day appointments) and is capable of dealing with unexpected illness or injury. A CEC has three essential components that are formally linked: primary health care team, urgent care capacity, and a plan/protocol for emergency care in collaboration with EHS. Source: Letter of Understanding

5. 5 Commitment to rapid clear disposition: o Treat and Release o Treat and Follow up ( same day next day) o Transfer There is no ‘hand off’ to the on coming staff; all patients coming into the center are dealt with. When functioning as a CEC there are no observation beds, no admitting. Better Care Sooner Model

6. 6 NPs are utilized in the primary health care team and not in the CEC. Their skills are better utilized to manage the presentations in the clinic office. RNs do not require transfer of medical function or additional advanced practice skills to function in the CEC. The advanced skills such as airway management, defibrillation etc are managed by the PCP under their training and protocol. The RN manages the assessment, medication and patient education required. Better Care Sooner Model

7. 7 Considerations for SK: Day Time Model – 12 hours a day/7 days a week – team based care Night Time Model- 12 hours/7 days a week – 2 RN’s or 1 RN & 1 Paramedic PHC physicians are on alternate payment with additional income for call for their own patients after hours. PCPs will require additional training to meet the same competency as the PCP in Nova Scotia. The sites visited had well developed PHC team support with no less than 3 physicians and 1-2 NPs.

8. 8 Considerations for SK: RNs require additional training in ACLS, PALS, CTAS, TNCC and an upgrade in health assessment. Advanced practice is not required in the CEC. Primary care physicians do not provide after hours call to the CEC. This allows the physician to see more patients during the day- suggests that the public is accessing PHC sooner. They do provide after hours call for their patients admitted to LTC or acute. Physician on phone support is provided by a provincially funded and directed ER physician team. No ambulance fee is charged for between facility transfers in the rural areas

9. 9 What is Required: Established Primary Health Care Services Collaboration between the Physicians, Paramedics, Nurses E-Communication Tool Some additional training Providers utilizing full compliment of competencies Community awareness and understanding of services Contract between Emergency Medical Care, Ministry and The Health District (MOU)

10. 10 What are the next steps? Provincial o Provincial Advisory Group o Toolkit – guiding documents o Funding Model Regional o Map out potential plan for this model o AIM/Charters o Approach Primary Care Clinics