Providenciales, Turks and Caicos Islands (Tuesday, September 20th, 2016): Multiple change enquiries submitted by Interhealth Canada (TCI) Ltd were recently approved in principle by Cabinet, pending confirmation that funds are available in the Ministry of Health budget. Each enquiry was supported by detailed clinical data and research to justify a sustainable service model.

Under the Project Agreement between InterHealth Canada (TCI) Ltd and Turks and Caicos Islands Government, changes made to existing healthcare services must undergo a Change Request Procedure seeking pre-approval from government. This process allows for services to be reviewed and representation made to the Government for any additional resources that can facilitate patient care. Requests made for additional resources are largely based on increases in patient volume over time and changes in medical technology. Below is a synopsis of five proposals recently submitted by InterHealth Canada (TCI) Ltd.

Change Enquiry No.30 (Management and Development of Blood Banking Services):

A request has been made for the National Blood bank to be managed by TCI Hospital for a period of two years. The National Blood Service is currently managed by the Government in accordance with the Project Agreement. TCI Hospital draws blood units from the bank in order to comply with requirements for onsite blood bank storage for the delivery of care. The hospital operates a full service accredited laboratory.

The transfer of the National Blood Bank to TCI Hospital will maximize the operational efficiency of the Blood Bank and allow the hospital to commence the foundational work required to advance TCIG blood donation services to accreditation status. TCI Hospital already provides an accredited transfusion blood service under the management of its Clinical Laboratory Manager. The hospital service works closely with the Ministry of Health and the transfer would be relatively straight forward.

Change Enquiry No. 31 (Implementation of Tele-radiology Services):

A proposal has been made to introduce cost-effective technology such as Tele-radiology services to cater to the increasing demand for diagnostic imaging, which is presently covered by a single Consultant Radiologist at TCI Hospital.

Tele-radiology improves patient care by allowing radiologists to provide services without actually having to be at the location of the patient. Tele-radiology also allows for trained specialists to be available 24/7. Patient images such as radiographs (X-rays), CT’s, and MRI’s will be transferred via a secure system to a remote company of radiologists and physicians for professional analysis. This is particularly important when a sub-specialist such as a MRI Radiologist, Neuro- Radiologist, Pediatric Radiologist, or Musculoskeletal Radiologist is needed, since these professionals are generally only located in large metropolitan areas during daytime hours.

The Turks and Caicos Islands Hospital performs an average of 14,000 diagnostic imaging tests every year. Tele-radiology is becoming increasingly popular since imaging procedures are growing approximately 15% annually against an increase of only 2% in the radiologist population. This service also costs far less than hiring another full-time radiologist.

Change Enquiry No.32 (Procurement of Hysteroscopy Equipment to improve Obstetrics and Gynecology Services)

Hysteroscopy is the inspection of the uterine cavity by endoscopy with access via the cervix. The implementation of hysteroscope technology at the Turks and Caicos Islands Hospital will allow specialists to evaluate the cavity of the uterus in female patients using a thin tube-like telescope with a built-in video camera giving doctors a more direct visual of the uterus prior to removing any tissue, as opposed to D&C where the tissue is removed without direct visualization.

The technology not only enhances the diagnosis and management process, but also supports service delivery that aligns with advancements in technology and minimally invasive approaches to care. Both D&C and hysteroscope are out-patient procedures where the patient usually does not require admission to hospital upon completion.

Change Enquiry No.33 (Expansion and Improvement of Dialysis Services):

A proposal has been made for additional equipment in the Dialysis Unit along with a full-time Nephrologist due to an increase in Dialysis patients at both TCI Hospital sites. TCI Hospital presently employs a General Internist who is a cross-trained Nephrologist. A Consultant Nephrologist also visits the hospital every three months.

While the number of machines have remained the same since commencement of clinical operations (CTMC – 3 machines, CHMC – 6 machines), the number of patients on dialysis machines for Grand Turk has increased by 50% and Providenciales by 65% since 2010. The inclusion of a full-time Nephrologist will enable care to be managed more proactively with an emphasis on preventing the progression into kidney failure.

The majority of patients within the TCI develop kidney disease due to complications of diabetes and hypertension. Additional measures and programs will be implemented to reduce the number of patients developing chronic kidney disease and to strengthen the primary health care management of our patients with chronic non-communicable disease such as diabetes and hypertension.

Change Enquiry No.38 (Procurement of Polymerase Chain Reactor Machine and Associated Equipment for Human Pathogen Detection)

A proposal has been made for the procurement of special blood screening equipment which will reduce the cost of oversees screening and allow for swifter results.

In accordance with recommendations issued by the Food and Drug Administration (FDA), TCI Hospital screens donated blood for Zika virus using an overseas reference laboratory. TCI Hospital will continue to ensure the safe delivery of appropriately screened blood to patients in light of confirmed local transmission of the virus with the procurement of the equipment cited above.

TCI Hospital Chief of Medical Services, Dr. Denise Braithwaite-Tennant said the government was very receptive to the recent proposals as patient volumes and needs have changed over the years. Tennant said:

“InterHealth Canada is very appreciative of the investment on behalf of the Turks and Caicos Islands Government in the services delivered at the Turks and Caicos Islands Hospital. It is important that the services keep pace with increases in patient volume as well as technology. It is our mandate to ensure high quality patient care and value for money. Patient Safety is our priority.”