Hospital News July 2014 Edition by Hospital News

Future directions in cell transplantation for Type I Diabetes

FOCUS IN THIS ISSUE CARDIOVASCULAR CARE/ RESPIROLOGY/DIABETES

Canada's Health Care Newspaper JULY 2014 | VOLUME 27 ISSUE 6 | www.hospitalnews.com

World's smallest heart monitor

INSIDE From the CEO's desk......................... 19

Developments in the prevention and treatment of vascular disease including cardiac surgery, diagnostic and interventional procedures. Advances in treatment for various respiratory disorders including asthma, allergies. Prevention, treatment and long term management of diabetes and other endocrine disorders.

Evidence Matters .............................. 21 Ethics .................................................. 24 Healthcare Technology ...................... 27 Travel ...................................................30 Careers ............................................... 31

Diabetes Epidemic Every hour of every day 20 Canadians are diagnosed with diabetes

By Dr. Jan Hux Story on page 16

Be their link to meeting their unique needs Join our team of proactive Care Coordinators

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In Brief

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Paediatricians call for better diagnosis of urinary tract infections Urinary tract infections (UTIs) are common among Canadian children, yet many are diagnosed when there is no actual infection. The Canadian Paediatric Society is reminding physicians about the importance of accurate diagnosis of UTI to prevent the overuse of antibiotics and unnecessary invasive investigations. "Doctors are worried about missing a UTI, and so they often diagnose with any symptom or laboratory result that could possibly mean that the child has a UTI. This leads to unnecessary antibiotic treatment," says Dr. Joan Robinson, chair of the CPS Infectious Diseases and Immunization Committee. "They worry that missing the diagnosis of UTI for a day or two could lead to long-term health effects including high blood pressure and renal failure, but there is no evidence to support this concern." In a new position statement, authors note that many of the recommendations for the management of UTIs are based on expert opinion because studies are lacking. In the absence of evidence to support the belief that a missed diagnosis will lead to greater health issues, the CPS is urging physicians to take the time to properly diagnose a UTI. "Doctors need to ensure accurate diagnosis with each individual case," says Dr. Robinson, one of the statement's coauthors. "Procedures like rapid urine tests and bag samples often lead to false positive results because samples are easily contaminated. Invasive radiologic tests for most UTIs are not needed. For very young children with a UTI a simple ultrasound is sufficient to rule out any serious abnormality." To properly diagnose a UTI, the CPS recommends: • Babies between two and 36 months of age with a fever of greater than 39°C and no other obvious source for fever should have urine collected and analyzed. Urine should be collected by a catheter or suprapubic aspiration (SPA). • In toilet-trained children, a midstream urine sample rather than a catheter or SPA specimen should be submitted for urinalysis and culture. • Urine collected by bag should never be H used on its own for diagnosis of a UTI. ■

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Memory experts

launch 'thermometer' for the mind If you are in the 50 to 79 age bracket, worried about your memory changes and whether you need to see a doctor, there is a free online brain health test developed by the memory experts at Baycrest Health Sciences that will help you with that decision. The test – co-developed by the brain health solutions company Cogniciti Inc. (owned by Baycrest and partner MaRS Discovery District) – takes about 20 minutes to complete and is available to the public at www.cogniciti.com. The game-like tests tap into functions such as memory and attention, which are affected by aging and brain disease. You can take the test on a desktop or laptop computer at home (with internet access), and receive an overall score of your cognitive health immediately after you finish.

According to the test's creators, the majority of people will score in the normal, healthy range for their age – which will help reassure the "worried well". For the small percentage (approximately two – three per cent) that scores below average for their age and education, those adults will be encouraged to re-test after a week. If their score again falls below the normal threshold for their age, they will be provided with a personalized report to help them start the conversation about their brain health with a doctor. Designed by a team of clinical neuropsychologists and cognitive scientists at Baycrest Health Sciences and its worldrenowned Rotman Research Institute – and lab tested with 300 adults aged 50 to 79 recruited from various sources includ-

ing CARP Canada's subscriber base – the brain health assessment hammers a stake in the ground in an increasingly crowded field of online brain fitness products. "Our aim with the brain health test is to reassure the worried well and nudge that small percentage of people who do have serious memory issues to discuss their concerns with a doctor," says Dr. Angela Troyer, program director of Neuropsychology and Cognitive Health at Baycrest, and a lead member of the research team that developed the test. After completing the test, users will receive a Yes/No report about whether to take their memory concerns to their doctor. If a score is below normal, the individual will be provided with a personalized H report to print and take to the doctor. ■

Canadians want end-of-life care While Canadians have diverse views on end-of-life care issues, there is a strong desire across the country for more palliative care services to help ensure a "good death," the Canadian Medical Association (CMA) says. This is the principal finding in the CMA's final report from its National Dialogue on End-of-Life Care tour between February and late May 2014. "This cross-country effort was not about telling Canadians about CMA's position, it was about listening to Canadians about what their health care system could do to help ensure not only a long, healthy life but also a good death," says CMA President, Dr. Louis Hugo Francescutti. "What we heard in spades was that the public is eager to learn more about end-of-life care and to use that knowledge to inform discussions and decisions with their loved ones about their own wishes." Fewer than 30 per cent of the Canadians who will die in 2014 will have access to palliative care. The report makes a number of conclusions based on the consultation including: • All Canadians should discuss end-of-life wishes with their families or other loved ones. • All Canadians should prepare advance care directives that are appropriate and binding for the jurisdiction in which they live.

• A national palliative care strategy is needed. • All Canadians should have access to appropriate palliative care services. • Medical students, residents and practicing physicians need more education and training about palliative care approaches and greater knowledge about advance care directives. • Should Canada change laws to allow physician-assisted dying, strict protocols

and safeguards are required to protect vulnerable individuals and populations. The national dialogue focused on three main issues: advance care directives, palliative care, and physician-assisted dying. Beyond seeking input from Canadians on their views about the status of end-of-life care in Canada, the National Dialogue also sought to establish a common set of definitions and terminology to inform and frame H discussion on end-of-life care issues. ■

Brain protein may explain depression in pre-menopause Women nearing menopause have higher levels of a brain protein linked to depression than both younger and menopausal women, a new study by the Centre for Addiction and Mental Health (CAMH) shows. This finding may explain the high rates of first-time depression seen among women in this transitional stage of life, known as perimenopause. "This is the first time that a biological change in the brain has been identified in perimenopause which is also associated with clinical depression," says Senior Scientist Dr. Jeffrey Meyer of CAMH's Campbell Family Mental Health Research Institute. Specifically, Dr. Meyer's research

team found elevated levels of the chemical monoamine oxidase-A (MAO-A) among women aged 41-51. During perimenopause, a common symptom is mood changes such as crying. Rates of first-time clinical depression among this group reach 16 to 17 per cent, and a similar number get milder depressive symptoms. On average, levels of MAO-A were 34 per cent higher in women with perimenopause than in the younger women, and 16 per cent higher than those in menopause. The results suggest new opportunities for prevention, says Dr. Meyer, who holds a Canada Research Chair in the NeuroH chemistry of Major Depression. ■

JULY 2014 HOSPITAL NEWS

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UPCOMING DEADLINES AUGUST 2014 ISSUE EDITORIAL JULY 4 ADVERTISING: DISPLAY JULY 25 CAREER JULY 29 MONTHLY FOCUS: Ambulatory Care/Neurology/ Volunteer Programs and Fundraising: Specialized programs offered on an outpatient basis. Developments in the treatment of neurodegenerative disorders, traumatic brain injury and tumours. Innovative approaches to fundraising and the role of volunteers in health care delivery.

SEPTEMBER 2014 ISSUE EDITORIAL AUGUST 8 ADVERTISING: DISPLAY AUGUST 22 CAREER AUGUST 26 MONTHLY FOCUS: Emergency Services/Critical Care/ Trauma/Emergency Preparedness/ Research:

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Thousands of lives could be saved every year by improving our

health care system By Michel Grignon hen a healthcare system cannot make the best use of resources at its disposal, consequences can be dire, and such is the case with the Canadian health system. A recent study from the Canadian Institute for Health Information (CIHI) found that between 12,600 and 24,500 deaths could be prevented each year in Canada if our health system were perfectly efficient. That is, without spending a penny more than what we spend now, without increasing the contributions made by Canadians to their provincial public health care systems, we could be saving thousands of lives. To reach that conclusion, expenditures on various types of health care services were measured, including hospital care, physician and nurse services, prescription drugs, and nursing homes. Also measured were the number of premature deaths across 84 small regions in Canada – deaths taking place before the age of 80 and due to causes that are treatable, such as diabetes, pneumonia and asthma (but not lung cancer). The study then compared how different regions spend their healthcare dollars and found that the average region could improve what it does by between 18 and 35 per cent – and save lives in the process. Who said health policy was boring? The study also detailed the drivers of inefficiency, and they might be a surprise to many. Contrary to what is typically assumed, efficiency is not only based on how hard and how smart the people involved in a system – hospital and institution managers, doctors, nurses and regional health authorities – work. It may also be linked to factors beyond their control.

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Of course, a region that works hard at monitoring stays in hospitals to make sure they are not unduly prolonged, while maintaining quality so that re-admissions after discharge are not too frequent, will be able to prevent more premature deaths for the same level of expenses. Similarly, a region that controls the proportion of specialists among its physician workforce (thus making sure patients can access family doctors) will prevent more deaths. And a region that makes sure individuals at the bottom of the income distribution get access to their family doctors will also save more lives for the same amount of dollars spent. However, regions also operate within constraints they can only partially control. For instance, a higher rate of smokers or physically inactive individuals in the population of a region will eat up more resources with poorer outcomes, including premature deaths. For example, when more individuals smoke, it costs more to prevent deaths due to asthma; similarly, it costs more to prevent deaths due to diabetes when more people are obese. Another significant factor that affects health outcomes, and which health authorities cannot control, is income. Health regions in which the population has higher income on average are less efficient than those in which the population has lower income. This could be because regions with wealthier populations are using their resources in ways that are not reducing premature deaths, but may be achieving other goals, such as faster access to advanced technologies or hip replacement procedures. Similarly, regions with higher proportions of immigrants, non-aboriginal individuals or individuals with higher education manage to save more lives with the same level of expenditures, because these populations

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have lower mortality rates than the rest of Canadians, on average. What can we do with such findings? First, we need to learn from the best health regions across the country how to monitor hospital stays (length and quality), guarantee access to family doctors for the poor, and make sure family physicians make up a reasonable proportion of the physician workforce. Secondly, we need to invest in public health – not necessarily spending more – to find ways to curb smoking rates, obesity rates, and to encourage physical activity. Finally – and perhaps, most importantly – we need to re-think the way we allocate resources to regions in Canada. Not all regions require similar resources for the health of their populations. Regions which attract fewer immigrants, have more aboriginals in their population, and fewer individuals with higher education should receive more funding per capita because it costs more than in other regions to achieve similar levels of health gains. Conversely, regions with more immigrants, fewer aboriginals, and more highly educated individuals don’t need the same healthcare dollars to get the same results. Equality and equity are not the same thing where health is concerned. It’s time we spread the health dollars where they H are needed most. ■ Michel Grignon is an expert advisor with EvidenceNetwork.ca, an associate professor with the departments of Economics and Health, Aging & Society at McMaster University and Director of the Centre for Health Economics and Policy Analysis (CHEPA). He contributed to the research published by CIHI.Reprinted with permission from Troy Media.

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New satellite model for remote monitoring of pacemaker patients By Angela Volpe t. Mary’s General Hospital in Kitchener is the first Ontario hospital to offer a satellite location for pacemaker patients to perform device checkups remotely. This has the potential to significantly reduce patient travel time and expense, while ensuring their pacemakers are operating properly. The hospital operates a tier one Regional Cardiac Care Centre, which offers a full range of cardiac services to residents of Waterloo-Wellington Region and beyond. The first group of patients completed their pacemaker device checkups at the YMCA-YWCA in Guelph, Ontario in late May. This was after months of research, planning and screening of potential St. Mary’s patients. The YMCA-YWCA has been a key partner in bringing this service to patients and allowing St. Mary’s to work within the community at a convenient and accessible location which enhances the patient experience. At the satellite location, a small group of eligible patients had their Medtronic pacemaker devices checked with the support of a representative from St. Mary’s and by holding a Medtronic Carelink Express® monitor antenna over the patient’s implanted cardiac device for two to five minutes. The data from the pacemaker device is instantly and securely transmitted over the telephone lines to secure servers owned and operated by Medtronic Inc. Within minutes the transmission data is viewable by the device clinic staff at St. Mary’s which is 30 kilometers away. Device performance and diagnostic data transmitted from the pacemaker is scheduled to be read within 24 hours by St. Mary’s staff. Any concerns with the information received, is communicated directly to the patient and a follow up appointment at St. Mary’s may be requested.

St. Mary’s is the first hospital in Ontario, and only second in Canada, to use Medtronic’s CareLink Express technology to set up a service model for multi-patient transmission of pacemaker data from a remote monitoring satellite location to a cardiac centre. Some pacemaker patients and their caregivers previously travelled up to 1.5 hours to have their device checked at the hospital. This new service allows those who are deemed eligible to have every second device check performed at a location closer to their homes. The recommended interval between device checks varies from patient to patient. A key aspect of the project is identifying patients who would most benefit from the service because they require more frequent checks. Remote checkups do not take the place of care and health monitoring required by www.hospitalnews.com

Anna Sampson, Project Manager for the Remote Monitoring Pacemaker Project at St. Mary’s General Hospital. a family practitioner and at this point the technology is limited to specific pacemaker devices, manufactured by Medtronic and compatible with Medtronic’s CareLink Express® technology. St. Mary’s has provided Medtronic CareLink home monitors to a small number of pacemaker patients for some time on an in-home and single patient basis for patients who can’t travel even a short distance for health reasons. However, St. Mary’s is the first hospital in Ontario, and only second in Canada, to use Medtronic’s CareLink Express technology to set up a service model for multi-patient transmission of pacemaker data from a remote monitoring satellite location to a cardiac centre. St. Mary’s chose Guelph as the first satellite location for this pilot project because the timing of the availability of this technology combined with the recent transition of Guelph pacemaker patients to St. Mary’s created an appropriate group for this project. For now, remote monitoring in Guelph will be scheduled once a month. If successful, the service could be extended to other outlying areas served by St. Mary’s. “At St. Mary’s we strive to ensure that all patients in the region have convenient access to the most advanced cardiac care,” says Dr. Claus Rinne, a Cardiologist at St. Mary’s. “We hope that this project helps us to learn about a new way to provide seamless care that enhances the overall patient experience.” Health care organizations in the United States, Australia, New Zealand and Europe and a site in Quebec are currently using this technology to offer broad remote pacemaker monitoring. In order to evaluate the success of the project, St. Mary’s collected baseline information which will be used to evaluate key performance indicators during the pilot, such as the patient experience and resource use. “St. Mary’s is proud of its cardiac excellence and we are always looking for new and innovative ways to improve patient

care,” says St. Mary’s President Don Shilton. “After extensive research and discussions with industry and government partners, we determined that remote monitoring technology has evolved in Canada to the point where it can now be a safe, vi-

able and highly beneficial option for many H pacemaker patients in our community.” ■ Angela Volpe is Manager, Communications at St. Mary’s General Hospital.

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Transforming innovation into action By Paulette Roberge he Canadian Foundation for Healthcare Improvement has selected the biggest and most diverse cohort to date of inter-professional senior health care teams for the 11th year of its flagship EXTRA program. During the 14-month program, participants will acquire skills and knowledge to initiate, implement and sustain major quality improvement initiatives of strategic importance in their organizations and regions, with the goal of enhancing patient outcomes, quality of care and costeffectiveness. “On behalf of the federal government, I extend my congratulations to these 42 health leaders who were awarded a unique opportunity to become change agents in health care improvement,” says the Honourable Rona Ambrose, Federal Minister of Health. “Through funding for the Canadian Foundation for Healthcare Improvement, we are helping build leadership capacity to improve patient outcomes and realize health care efficiencies through innovation. I look forward to seeing the results from these strong teams.” The eleven teams will implement improvement projects across Canada in a range of health care areas, including a quality improvement framework to im-

prove patient safety; an integrated ambulatory assessment service for mental health services; and an emergency department dashboard to improve timely patient care.

The eleven teams will implement improvement projects across Canada in a range of health care areas. “The EXTRA program is a catalyst to transform innovation into action,” says Canadian Nurses Association past-president Barb Mildon. “Health professionals, especially those on the front lines of care delivery, are invaluable sources of insight, knowledge and ideas about better health and better care. CFHI and CNA are committed to harnessing this expertise and giving them a platform through which they can lead real change.” One example of a strong and innovative team is a unique collaboration between two provinces from each end of the country aiming to solve a common chal-

lenge. Fraser Health in British Columbia and Capital Health in Nova Scotia will improve healthy aging in their regions by jointly addressing a disconnect between near frail seniors and community care supports . The interprovincial team will work together to transform the current system to enable seniors to live a higher quality of life within their community longer, reduce unnecessary emergency room visits, avoidable admissions to acute care and premature admission to residential care. “We have been a long-time supporter of the EXTRA program, having many graduates in our midst contributing to evidence-informed practice daily. This year we are extremely excited to participate in a unique partnership with Fraser Health and a private corporation, Shannex, to explore initiatives related to the near frail elderly,” says Chris Power, President and CEO, Capital Health. “This will be the first time that two health care regions have come together within EXTRA to address an issue that we all deal with, sharing and spreading our findings with each other. We are extremely grateful for this opportunity and look forward to contributing to new knowledge for Canadians,” adds Power. “One problem, two provinces, one collaborative solution. This is what makes

the EXTRA program unique in Canada,” says Dr. Jean Rochon, Chair of EXTRA’s Advisory Council which selects the teams on behalf of CFHI and its EXTRA partners – the Canadian College of Health Leaders (CCHL), the Canadian Medical Association (CMA), the Canadian Nurses Association (CNA) and a consortium of 12 Quebec partners represented by the Initiative sur le partage des connaissances et le développement des competences (IPCDC). “The Canadian College of Health Leaders has been privileged to serve as an EXTRA partner since this innovative program was launched 11 years ago. Over that time hundreds of health leaders across Canada have been trained to apply evidence in designing and executing improvement projects that have benefited organizations and health systems. By developing the organizational capacity to apply evidence, the EXTRA program has contributed greatly to improving health leadership in Canada,” says Ray Racette, CHE, President and CEO, Canadian ColH lege of Health Leaders. ■ Paulette Roberge is a senior communications specialist at the Canadian Foundation for Healthcare Improvement.

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Future directions in cell transplantation for Type I Diabetes By Sandra Donaldson ype I Diabetes is a chronic condition caused by a loss of insulin-secreting beta cells. These cells are normally located within the islets of the pancreas but Dr. James Shapiro at the University of Alberta found a second home for them in the liver. In 2000, Shapiro published his landmark Edmonton Protocol in the New England Journal of Medicine when he conducted islet transplantations in seven patients with Type I Diabetes. Shapiro’s team has performed over 400 procedures in more than 200 patients, providing one of the most revolutionary treatments for diabetes since Banting’s discovery of insulin in 1921.

Islet transplantation is recommended for diabetics with frequent or severe episodes of hypoglycemia The team works with donated pancreata, separating the islets from the organ tissue and transplanting them into the patient’s liver. Within a few weeks the beta cells are able to make and secrete insulin, reducing or eliminating the patient’s need for injections. Most patients need two separate transplant procedures, requiring at least two donated organs. Islet transplantation is recommended for diabetics with frequent or severe episodes of hypoglycemia. Most patients remain insulin independent for about twoand-a-half years following transplant with only 15-20 per cent maintaining this status at the five-year mark. The remaining 80 per cent of patients still benefit from lower doses of insulin to maintain stable blood sugars and freedom from hypoglycemia. All patients require immunosuppressive therapy as long as the islet transplant is functioning. Research continues to work on improving long-term islet graft survival and function by further refinement of immunosuppressant therapy, alternative transplantation sites and finding other sources of beta cells. The need for multiple donor pancreata per patient coupled with low rates of organ donation has lead to the search for other sources of the insulin-secreting beta cells. Advances in embryonic and induced pluripotent stem cell biology provide the potential to generate these cells in a petri dish. Embryonic stem cells are sourced from embryos generated by in vitro fertilization and donated to research and are unique in that they can become any cell type in the body and repeatedly self-renew. Induced pluripotent stem cells are adult cells (such as blood or skin cells) altered by genetic technology so they function like embryonic stem cells. No laboratory has been able to generate bona fide human beta cells. However, a recent discovery has shown that a key cell (beta cell progenitor) can be developed from human embryonic stem cells. When www.hospitalnews.com

Dr. James Shapiro and his team provide one of the most revolutionary treatments for diabetes since insulin. these progenitor cells are transplanted start a Phase 1 Clinical Trial to test the into mice, they can create functional beta safety and efficacy of the cells. They will cells, meaning they are sensitive to glu- also evaluate a special device, Encaptra, cose levels and release insulin accordingly. which assists with the delivery of the cells US-based companies are in the process of and protects them from attack by the palaunching clinical trials to test these cells tient’s immune system. in humans. Dr. Shapiro has been working Shapiro indicates there are some chalwith ViaCyte, Inc., a regenerative medi- lenges with this therapy, “Is it safe and efcine company based in San Diego, for the fective? How much will the therapy cost? last ten years. Together they are ready to Will the cells last once they’ve been trans-

planted? These are the questions we are asking right now. This clinical trial is an incredible milestone for diabetes research and it’s exciting that it’s happening right here in Canada.” Dr. M. Cristina Nostro, Scientist at University Health Network, and Harry Rosen Chair in Diabetes Regenerative Medicine Research at the McEwen Centre for Regenerative Medicine, agrees protecting the cells from attack by the immune system is a challenge. “As cell therapy for Type I Diabetes is moving to the clinic, scientists and engineers around the world are working towards the generation of devices that will not only protect the beta cells from the immune system but will also provide the right support for the growth and survival of the transplanted cells,” says Nostro. Nostro is working towards the development of an efficient method to generate the beta cell progenitors from either embryonic or induced pluripotent stem cells. Nostro indicates that, “A method that could be applied to any pluripotent stem cell line will allow for more universal applications.” These are exciting discoveries that give hope to diabetics around the world but continued patience and caution is necessary, “Human embryonic stem cell-derived cells are already in clinical trials for the treatment of macular degeneration. I look forward to seeing the start of the first trial using these cells for the treatment of Type I Diabetes as it will revolutionize the way we treat and think of this disease,” says Nostro, a member of the Ontario Stem Cell H Initiative. ■ Sandra Donaldson is Program Manager, Ontario Stem Cell Initiative (OSCI).

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Helping patients with

chronic disease By Michelle Tadique avigating your way through the health care system can be challenging, especially if you have a chronic illness like Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart Failure (CHF). Thanks to St. Joe’s Patient Navigator and Registered Nurse, Janice Klutt, patients experience a smooth transition from their hospital care and back into the community. Klutt supports patients with COPD and CHF to manage their illness, through education and assessment while they are in hospital and coordinating follow up care when they are discharged back home.

Education, follow up care and ensuring patients are connected with their family doctors and other community resources are ways Klutt is helping them manage their conditions at home The Patient Navigator role has been in place for two years and stems from St. Joe’s work to reduce re-admission rates for patients with COPD and CHF. “Living with any chronic disease is difficult because of the drastic lifestyle changes that patients need to make,” explains Klutt. “The changes are needed to stay healthy, but it’s hard. Not being able to maintain

these changes is often the reason COPD and CHF patients are re-admitted back to hospital,” Klutt adds. Klutt’s first connection with patients is right at the bedside when they are admitted to St. Joe’s. Many patients she sees are elderly and have additional health issues on top of their chronic illness. The socioeconomic status of her patients is another huge factor that affects their overall health. For these reasons, Klutt works closely with them so they are educated about their condition and know what to do if they start feeling unwell and what other resources they can access. “I explain to them what their condition is, what to watch out for and what to do to prevent the exacerbation of either condition,” says Klutt. Both COPD and CHF are chronic illnesses that need to be managed closely once a person is diagnosed, because there is no cure. COPD is a long-term disease caused most often by smoking, and includes chronic bronchitis and emphysema. The damage caused by COPD makes the movement of air in and out of the lungs difficult. CHF is a common condition that develops once the heart is damaged by diseases like heart attacks or other medical illnesses. When patients are ready to go home, Klutt arms them with an educational package including pamphlets that explain their condition in simple, easy-to-understand language. They also get a “stop light” visual, in the form of a fridge magnet, outlining what warning signs should prompt a call to Klutt for advice, a visit to the family doctor or an immediate trip to the Emergency Department (ED).

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Janice Klutt, St. Joe's Patient Navigator, ensures patients experience a smooth transition from hospital care back into the community. A crucial step Klutt oversees for patients they do a full “head to toe” assessment of before they leave the hospital is booking the patient, review their medications with a follow up appointment with their fam- them, and alert Klutt to any concerns ily doctor for a week after discharge. By that come up during the home visit. The the time the patient shows up for their team checks in with patients via phone appointment, their doctor has a full sum- calls or ongoing visits when needed, over a mary of their recent hospital stay, thanks 30-day period. to the information she sends them. Klutt The Rapid Response Team was designed also guides patients in making the neces- on the model Klutt used when her role first sary changes to their lifestyle to improve launched. This collaborative relationship their health and monitors how well they with St. Joe’s and the CCAC means that respond to these changes. high risk patients have support at home, The biggest piece of advice given to her also allowing her to spend more time with COPD patients is to quit smoking. “I con- patients in hospital. nect them with our smoking cessation proUltimately, education, follow up care gram here at St. Joe’s or at the Centre for and ensuring patients are connected with Addiction and Mental Health,” says Klutt. their family doctors and other commu“Many of the patients I see are lower-in- nity resources are ways Klutt is helping come individuals and can’t afford medica- them manage their conditions at home tion so I try to find programs that they are to avoid being re-admitted to hospital. able to manage.” When patients have the right tools and “For CHF patients, they need to restrict support they need, their quality of life can fluid and salt intake – and it really opens improve so they can live well even with a up their eyes to the types of food they are chronic illness. eating, especially pre-packaged food. But Klutt feels a sense of pride in building for many, that’s all they can afford because strong relationships with her patients and they don’t have the resources to buy fresh being an important part of their care to food and cook from scratch,” says Klutt. support them in the hospital and once they Community agencies like Meals on Wheels are at home. are a great resource to access healthier “I help to ensure wrap around care for foods, at least for the first few weeks when patients, so they don’t fall through the patients are home from the hospital and cracks. The key is educating them so they re-gaining their strength, she adds. understand their condition and linking Klutt also makes referrals to the Toronto them to their family doctor and CCAC. Central Community Care Access Centre’s I facilitate those connections and build (CCAC) Rapid Response Team for pa- those partnerships so that our patients tients that are high-risk for re-admission. can get the best care when they need it – Risk factors include a long stay in hospi- whether they are here at St. Joe’s or in the H tal, how many times the patient has been community.” ■ to the ED in the last six months and any other co-morbidities they may have. The Michelle Tadique is a Communications team is deployed to the patient’s home Associate at St. Joseph's Health Centre within 24 hours of their discharge, where Toronto. www.hospitalnews.com

CARDIOVASCULAR CARE/RESPIROLOGY/DIABETES Y/DIABETES

Focus

Six-year-old Heather is one of 20 London-area children taking part in an insulin pump shut-off study, which is looking at ways to prevent dangerous low blood sugars overnight in children with type 1 diabetes. Here, Heather shows off a picture she drew of her experience in the trial.

Diabetes trial testing ways to prevent low blood sugar during the night By Dahlia Reich arents of children in a groundbreaking diabetes trial in London are enjoying peace of mind and a good night’s sleep for the first time in years. The North American trial is looking at ways to prevent dangerous low blood sugars overnight in children with type 1 diabetes, and it’s helping both children and parents go to bed worry free. The study is a partnership between the Centre for Diabetes, Endocrinology and Metabolism of St. Joseph’s Health Care London and the pediatric diabetes group at Children's Hospital, London Health Sciences Centre. Dr. Irene Hramiak, chair/ chief of the Centre for Diabetes, Endocrinology and Metabolism is collaborating with Dr. Cheril Clarson, section head of pediatric endocrinology at Children's Hospital. Both Dr. Hramiak and Dr. Clarson are also Lawson Health Research Institute scientists.

The North American trial is looking at ways to prevent dangerous low blood sugars overnight in children with type 1 diabetes, and it’s helping both children and parents go to bed worry free. Low blood sugar, or hypoglycemia, is a condition that can lead to coma, seizures or death for individuals with diabetes, explains Dr. Hramiak. More than half of these episodes occur during sleep hours. In children, the rate is higher – 75 per cent of hypoglycemic seizures occur during sleep. Dr. Clarson describes the fear of hypoglycemia, particularly at night, as one of the most serious concerns reported by parents of children with type 1 diabetes. The goal of the clinical trial, known as the pump shut-off study, is to test a system that mimics the pancreas to reduce the rate of nocturnal hypoglycemia. The system is a combination of an insulin pump to deliver insulin, a continuous glucose monitoring system to measure blood sugars in the patient every five minutes, and a computer algorithm (software) that predicts for each individual when they are at risk for hypoglycemia (low blood sugar). www.hospitalnews.com

ting, the sysWhen operating, w blood sugar tem avoids low nt is sleeping by while the patient turning off the insulin pump when it predicts low blood sugar could ocurning the pump back cur and then turning i k off llow on when there iis no llonger a risk blood sugar. “It’s a simple solution to a major problem for individuals wearing an insulin pump,” says Dr. Hramiak, principal investigator of the trial in London – the only Canadian centre participating. “We have tested the system in adults and now are testing it in a group of 20 children ages three to 15. This system could potentially prevent overnight hypoglycemia and is a first step to developing a system that functions like a native pancreas.” For Nicole Tracey, mom of 10-year-old Charlise, the study “has absolutely given me the ability to sleep at night. Before using the system, my first thought every time I woke up was “is she okay?” In the past if I had a good sleep I would wake up in a panic because I didn’t check on her during the night. On the other hand, on nights when I do check her three or four times during the night, I am unable to get a proper night’s sleep. With the system, I go to bed worry free and I can sleep the whole night knowing she will be okay.” Anne Crosby, mom of six-year-old Heather, is also going to bed with peace of mind. “My daughter has had a lot of lows during the night and when we are sleeping we don’t realize she is dropping low. It can be very scary. The study has helped to give her better control and I can relax because I know the system will stop her from dropping too low.” Funded in Canada by the JDRF Canadian Clinical Trial Network, the trial is also underway at Stanford University and the University of Colorado in the U.S. A total of 45 adults have been previously studied and now a total of 90 children are being studied. The pediatric trial is expected to be completed in September 2014. Future plans for pump shut off studies will address high blood sugar – or hyperglycemia – in addition to low blood sugar, H first in adults, then in children. ■

Young participants in an insulin pump shut-off study in London proudly display drawings depicting their experience in the novel diabetes trial. From right is Heather with her mom, Anne Crosby, and sister Hannah, along with Nicole Tracey and her daughter Charlise.

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10 Focus

Bringing ground-breaking innovations to the bedside Ottawa Heart Institute leads the way with new minimally invasive treatment improving quality of life for patients with mitral valve disease By Vincent Lamontagne hen Health Canada officially approved the revolutionary, catheter-based, MitraClip therapy last April, interventional cardiologists and surgeons at the University of Ottawa Heart Institute knew they had been pioneering an innovative and novel procedure. Now providing physicians in Canada with a breakthrough treatment option that can significantly improve symptoms, disease progression and quality of life for certain patients with a heart condition called mitral regurgitation (MR), the MitraClip device has been approved for people with degenerative MR who are too high risk for mitral valve surgery based on evaluation by a team of cardiologists and surgeons at the Ottawa Heart Institute. “This extraordinary achievement in interventional cardiology would not be possible without the exceptional teamwork our highly specialized experts have demonstrated over the last years. Our ability to continuously develop our innovative approach is truly the product of our team’s unique dedication and limitless ambition,”

HOSPITAL NEWS JULY 2014

says Dr. Marino Labinaz, Cardiologist and the Director of both the Cardiac Catheterization Laboratory and the Cardiac Fellowship Program at the University of Ottawa Heart Institute. Degenerative MR is a type of mitral regurgitation caused by an anatomic defect of the mitral valve of the heart. Treatment with the MitraClip device can be effective in reducing the symptoms associated with severe mitral regurgitation, such as shortness of breath and fatigue, which may help people lead a more active lifestyle. Mitral regurgitation is a common condition, affecting an estimated one in 10 people aged 75 and above. Severe mitral regurgitation can be a debilitating, progressive and life-threatening disease in which a leaky mitral valve causes a backward flow of blood in the heart. The condition can raise the risk of irregular heartbeats, stroke, and heart failure. Open heart mitral valve surgery is the standard-of-care treatment, but many patients are too high risk for an invasive procedure. Medications for the condition are limited to reducing symptoms and do not have the ability

to stop the progression of the disease. “Multiple trials, published reports, and registries of patients treated with the MitraClip device consistently demonstrate a positive safety profile, a reduction in mitral regurgitation, improvements in symptoms, and a reduction in hospitalizations for heart failure,” says Dr. Thierry Mesana, cardiac surgeon and the President and CEO of the University of Ottawa Heart Institute. Developed by Abbott, the MitraClip repairs the mitral valve without the need for an invasive surgical procedure. The device is delivered to the heart through the femoral vein, a blood vessel in the leg, and once the device is implanted, allows the heart to pump blood more efficiently, thereby relieving symptoms and improving quality of life. Patients undergoing MitraClip treatment typically experience short recovery times and short hospital stays of H two to three days. ■ Vincent Lamontagne is Senior Manager, Public Affairs, University of Ottawa Heart Institute.

The MitraClip device has been approved for people with degenerative MR who are too high risk for mitral valve surgery.

www.hospitalnews.com

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Focus 11

Southlake implants world's smallest heart monitor in adult patient

This small wireless monitor provides long-term remote monitoring to help physicians diagnose and monitor patients suffering from irregular heartbeats,

By Kate Poretta r. Atul Verma, cardiologist at Southlake Regional Health Centre in Newmarket, Ontario, recently inserted the world's smallest implantable cardiac monitoring device available – the Medtronic Reveal LINQ Insertable Cardiac Monitor System – in a patient. This was the first time the implant had been inserted in an adult in Canada. The small, wireless device is designed to allow doctors to continuously monitor, and quickly and accurately diagnose patients who suffer from cardiac arrhythmias, or irregular heartbeats, that can lead to severe and unexplained fainting spells or stroke. A made-in-Canada innovation and the smallest of its kind, at approximately onethird the size of a AAA battery, the Reveal LINQ monitor is more than 80 per cent smaller than other implantable cardiac monitors. Placed just beneath the skin through a tiny incision of less than one cm in the upper left side of the chest, the monitor is nearly invisible to the naked eye once inserted. There are several technologies available that can help physicians diagnose patients who suffer from the effects of cardiac arrhythmias. Yet, these devices are only able to track a patient's heart behaviour for a limited period of time, such as days or weeks. For some patients, this isn't a problem because the majority of their symptoms occur within the required test window. For 65-year-old Huntsville, Ontario resident Michael Smith, that window simply wasn't long enough. Smith, a patient of the Heart Rhythm Program at Southlake, has been suffering from dizziness, nausea, and unpredictable and unexplained nearfainting spells for close to eight years. Originally believed to have vertigo – a type of dizziness in which a patient inappropriately experiences the perception of motion – Smith saw a physiotherapist in his hometown to ease his symptoms. When that treatment yielded no results, he went back to the drawing board. “When we ruled out vertigo, my doctor began to suspect I was suffering from a cardiac condition,” says Smith. “I could go months before I experienced symptoms again, and through all of the various tests I took, we were never able to actually capture a time when I was having an episode.” Smith was referred to specialists at Southlake's Regional Cardiac Care Program, an internationally renowned program that – fortunately for Smith – services residents in communities as far north www.hospitalnews.com

as Muskoka. When he met with Dr. Zaev Wullfhart, electrophysiologist and physician leader of the Cardiac Program, Smith was identified as an ideal candidate for the Reveal LINQ monitor implant. On May 12, Smith became the second adult recipient at Southlake to have the implant inserted.

The small, wireless device is designed to allow doctors to continuously monitor, and quickly and accurately diagnose patients who suffer from cardiac arrhythmias, or irregular heartbeats. “Michael's symptoms are so intermittent in nature,” explains Dr. Verma. “Using the new implant, we will be able to accurately and quickly identify the root cause of his condition when he next experiences a near-fainting spell.”

The device is placed using a minimally invasive insertion procedure, in as little as two minutes and on an outpatient basis, simplifying the experience for both physicians and their patients. Through a specialized and remote monitoring network, physicians can also request notifications to alert them if their patients have had cardiac events. “The LINQ device is part of a powerful system that allows us to monitor a patient's heart for up to three years, with 20 per cent more data memory than its larger predecessors,” says Dr. Verma. The implantable cardiac monitor was originally invented by a Canadian physician, Dr. George Klein, as a result of collaboration between Dr. Klein and Medtronic of Canada, the manufacturer of the device. The prototype was developed in London, Ontario, and the first iteration was manufactured by Medtronic in Mississauga, Ontario. The monitor has evolved dramatically over time and the current version received Health Canada license in March 2014. “The Regional Cardiac Care Program at Southlake is no stranger to innova-

tion,” says Dr. Dave Williams, Southlake president and CEO. “Time and again, the talented team of professionals who support our world-class program actively seek out opportunities to do things better, all with the goal to provide our patients with the absolute best the health care system has to offer. I commend Dr. Verma on his perseverance in making this happen for our patients, and I look forward to the possibilities that this new system brings with it.” The introduction of the Reveal LINQ monitor provides physicians with the added ability to diagnose heart rhythm disorders that can be rare in their occurrence, but can still have dramatic and lifethreatening impacts for a given patient. In April 2014, Emily DePaepe, a 13-year-old from southwestern Ontario, became the first person in Canada to receive the Reveal LINQ monitor. This procedure was performed by Dr. Elizabeth Stephenson, a cardiologist at The Hospital for Sick ChilH dren (SickKids). ■ Kate Porretta is a Media and Government Relations Specialist at Southlake Regional Health Centre.

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12 Focus

Cardiac DART provides care closer to the door By Priya Ramsingh visit to the ER is a rarity for 73-year old John Myers*. But when symptoms of a heart attack prompted him to check into the emergency department at Trillium Health Partners, he got his results within hours, thanks to Cardiac DART (Direct Accelerated Response Team).

Cardiac DART is staffed with a nurse practitioner and a cardiologist, who provide specialized care closer to the door so patients can get fast access to testing and quicker results. Launched in November 2013, Cardiac DART provides patients with quicker access to specialists so they are assessed, tested and treated without being admitted to the hospital. “The program was designed to avoid unnecessary admissions to a hospital bed,” says Elena Holt, Director of Cardiac Health at Trillium Health Partners. “It provides patients access to the most appropriate care in a timely manner.”

HOSPITAL NEWS JULY 2014

Ideal candidates for Cardiac DART are patients who are experiencing some type of heart related symptoms, such as chest pains, heart failure or arrhythmia (irregular heartbeat), but who are not having a heart attack. Once assessed by the ER physician, they can be referred to the Cardiac DART for further tests to determine if there’s a risk of heart problems in the future. Cardiac DART is staffed with a nurse practitioner and a cardiologist, who provide specialized care closer to the door so patients can get fast access to testing and quicker results. “We’ve simply eliminated some of the steps to care, so patients can get their answers faster, which reduces their anxiety,” says Holt. It worked well for John Myers who had been experiencing heart-related symptoms. When his symptoms became worse he decided to go to the ER to find out exactly what he was experiencing. He was diagnosed as an ideal candidate for Cardiac DART, where it was determined that his situation was not grave as he’d anticipated. “This is a common situation,” says Elena Holt. “Patients aren’t really sure what they are experiencing, and Cardiac DART allows for early access to highly a skilled cardiac nurse practitioner and cardiologist to determine appropriate testing and treatment, or if they can be discharged with future follow up.”

A patient meets with a nurse practitioner and a cardiologist as part of the DART program which helps patients get faster access to testing. First piloted at Credit Valley Hospital, Cardiac DART delivered results quickly, reducing the wait time from approximately 20 hours to just under five hours. A higher number of patients avoided admissions to a hospital bed, given the ability to access specific cardiac testing without admission. While it’s still in the early phases of implementation across the hospital sites of Trillium Health Partners, the results are positive. “We’ve definitely seen the demand for cardiac beds decrease,” says Holt. “And while it’s still a work in progress, the commitment of our nurse practitioners and cardiologists at all sites have made the success of this program possible.” John Myers and his wife Ann were very pleased with the outcome of their visit to the ER at Trillium Health Partners and said they felt relaxed for the first time in

days because they knew they were in good hands. John has been put on the list for follow up so the hospital can monitor his situation. The Mississauga couple may not be aware of the extensive planning and process that went into developing the groundbreaking program that helped them through a difficult time last December. But when they followed up with a letter to the hospital to express their gratitude, describing the Cardiac DART team as their ‘angels’, it is an indication that the program is on the right track. *Names have been changed to protect H patient privacy. ■ Priya Ramsingh is a Senior Communications Advisor at Trillium Health Partners.

www.hospitalnews.com

CARDIOVASCULAR CARE/RESPIROLOGY/DIABETES

Focus 13

Heart-attack study could lead to longer lives By Gregory Kennedy n summing up his view on the value of research, heartattack survivor Tom Lancaster doesn’t mince words: “If it weren’t for heart research, I wouldn’t be here right now.” When he suffered a major heart attack last June, the 81-year-old Edmontonian soon found himself at the Mazankowski Alberta Heart Institute where he was diagnosed with a blocked artery and several narrowed vessels. As he received treatment, Lancaster helped to reinforce the findings of a study led by the Mazankowski that’s answering one of the biggest questions about heart attack care which could lead to longer, healthier lives for survivors. Typically, patients who suffer a major heart attack with a blocked heart artery are rushed to a catheterization laboratory for an angioplasty. Diagnostic imaging locates the clot, followed by the insertion, via catheter, of a balloon to widen the artery. Then a tiny wire-mesh tube, known as a stent, keeps the artery open. Once blood flow is restored, cardiologists face questions that, at present, have no clear, evidence-based answers. “Do we just leave other narrowed blood vessels and continue with medications? Or do we fix those narrowed vessels with other stents? What’s best for the patient?” says Dr. Kevin Bainey, an Alberta Health Services (AHS) interventional cardiologist who specializes in clearing blocked arteries, as well as an Assistant Professor of Cardiology at the University of Alberta.

Patients who underwent a staged angioplasty procedure plus medication had a 26 per cent reduction in long-term mortality compared to patients who received medication only, according to a study published in the January issue of American Heart Journal. Dr. Bainey and his cross-country research team systematically reviewed the outcomes of 46,234 patients around the world and their findings showed a twostage treatment plan – in which the patient returns at a later date to clear up any other significant blockages – guarantees the best short- and long-term health and recovery for the patient. Patients who underwent a staged angioplasty procedure plus medication had a 26 per cent reduction in long-term mortality compared to patients who received medication only, according to their study published in the January issue of American Heart Journal. Dr. Bainey is the lead author. www.hospitalnews.com

Interventional cardiologist Dr. Kevin Bainey examines heart-attack patient Tom Lancaster Dr. Bainey’s analysis has now set the stage for a comprehensive international trial, which will involve the recruitment of 4,000 patients already underway. The Mazankowski is one of several participating sites in this Canadian-initiated, international trial. Lancaster successfully experienced this two-stage approach to restoring his blood flow – and also chose to be part of the new study, as a way to pay it forward. When the artery that was causing the heart attack was opened, Dr. Bainey determined Lancaster had another coronary artery with significant narrowing. Lancaster returned to the Mazankowski two weeks later, where Dr. Bainey put a stent in the second artery. Lancaster was discharged the following day and will be followed by the study for five years. Adds Lancaster: “If it will help somebody down the road, that’s all that matters. And that’s why I signed up for this new research. It’s a major thing.” “I’ve already changed my practice, in being more aggressive with these other blockages,” says Dr. Bainey, who believes this new approach to restoring blood flow also holds the promise to reduce emergency department visits; free up hospital beds (as patients will be able to go home between procedures); and eliminate future hospital stays as patients live longer. “My study shows patients who are ready to be discharged, but who need to have that other blockage fixed, don’t need to stay two to three days in hospital to wait for that blockage to be fixed. It’s safe to go home, then come back as an outpatient, have the procedure done, and be discharged later that day,” he says. Nowadays, Lancaster hits the treadmill or exercise bike daily as he eagerly awaits

spring thaw – and a new season of golf – so he can get back out on the links. The Faculty of Medicine & Dentistry at the University of Alberta is one of the world’s top 100 medical schools where faculty members are committed to improving patient care through teaching and research. Alberta Health Services is the provincial health authority responsible for plan-

ning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and susH tainable for all Albertans. ■ Gregory Kennedy is a Senior Writer / Communications Advisor at Alberta Health Services.

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14 Focus

Service supports

Muslims with diabetes

Those observing Ramadan, which starts June 28, should plan ahead to fast safely. By Dahlia Reich oping to build on last yearâ&#x20AC;&#x2122;s success and extend its reach, the Primary Care Diabetes Support Program (PCDSP) of St. Josephâ&#x20AC;&#x2122;s Health Care London is once again offering to help Muslims with diabetes fast safely during Ramadan. Beginning June 28, thousands of Muslims in London will start a month of a daily fasting from dawn until sunset in observance of Ramadan. This is an important period of religious devotion and spiritual reflection but for Muslims with diabetes it can pose serious health risks if planning is not done well ahead. For the second year, the PCDSP is offering a special service to people with diabetes who observe Ramadan. Individuals can receive the guidance and support they need through the PCDSP with no referral necessary. â&#x20AC;&#x153;Last year, dozens of Muslims with diabetes took advantage of our service to avoid running into problems with highs and lows in blood sugar levels â&#x20AC;&#x201C; a common problem during this period of fasting,â&#x20AC;? says Dr. Mervat Bakeer, a family physician who specializes in diabetes. â&#x20AC;&#x153;They learned that fasting can be done safely but education and

changes to their diabetes management are needed.â&#x20AC;? Dr. Bakeer is hoping that word spreads further this year so that those with diabetes who fast are doing so with proper guidance. Without it they are taking significant risks with their health, she says.

Research indicates that more than 40 per cent of Muslims with type 1 diabetes and nearly 80 per cent with type 2 diabetes fast during Ramadan Those risks include hyperglycemia or hypoglycemia and diabetic ketoacidosis â&#x20AC;&#x201C; high levels of blood acids called ketones, explains Dr. Bakeer. â&#x20AC;&#x153;Other problems may arise due to dehydration, such as thrombosis and acute kidney injury, especially for people with chronic kidney disease or on blood pressure medication.â&#x20AC;? An estimated 3,000 Muslims in London are living with diabetes and many will fast. Research indicates that more than 40 per

cent of Muslims with type 1 diabetes and nearly 80 per cent with type 2 diabetes fast during Ramadan, says Dr. Bakeer. Most, she adds, donâ&#x20AC;&#x2122;t change how they manage their diabetes while fasting and may be hesitant to ask their doctor for support for fear they will be discouraged from fasting. â&#x20AC;&#x153;So they do it on their own.â&#x20AC;? â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s critical they plan for Ramadan by learning how to adjust their medications for fasting, about insulin use and careful monitoring when fasting, when to break the fast, and proper diet during Ramadan.â&#x20AC;? Dr. Bakeer urges people to see their family doctor before Ramadan or to call the PCDSP to make an appointment. At the PCDSP, located at St. Josephâ&#x20AC;&#x2122;s Family Medical and Dental Centre on Plattâ&#x20AC;&#x2122;s Lane, individuals will be assessed and a plan developed to see them through Ramadan, including weekly visits or monitoring by phone or email. Written information is also provided and is available in Arabic, Farsi, Urdu and English. Those interested can call 519 646-6100 H ext. 67268. â&#x2013; Dahlia Reich works in Communications & Public Affairs at St. Joseph's Health Care, London.

Dr. Mervat Bakeer is a family physican who specialized in diabetes, reminds Muslims with diabetes to make changes to their diabetes management while fasting for Ramadan.

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Focus 15

Centre performs 1,000th transcatheter

heart valve procedure By Dave Lefebvre heart valve procedure is enough to make any patient nervous, but Gisela Wegner didn’t show any nerves as doctors at St. Paul’s Hospital performed a transcatheter heart valve (THV) implantation on her while she lay awake without sedation. Wegner’s calm was even more impressive because the procedure was being broadcast around the world and to a conference of doctors in downtown Vancouver.

Dr. Webb is recognized internationally as a leader in these procedures, having the broadest experience in the world and having taught these techniques to health care professionals in more than 25 countries. “If no valve replacement was becoming available or if Dr. (John) Webb had not considered me a candidate, if I went just by medication…the deterioration is frightening, it’s coming so fast,” Wegner said prior to the procedure. The THV implantation, on June 5, was the 1,000th procedure for the Centre for Heart Valve Innovation at St. Paul’s Hospital. THV procedures involve inserting a thin tube with a replacement valve into the body through a small incision, then directing it to the heart through an artery. It can be done by making a small hole in the leg or the chest wall. Dr. John Webb, director of interventional cardiology at St. Paul’s, was the first to successfully perform a transcatheter aortic valve implantation (TAVI) through an artery in 2005, which involves inserting a new valve from a small puncture in the leg. “The Centre for Heart Valve Innovation at St. Paul’s is recognized internationally as a pioneer of innovative, minimally invasive heart valve replacement procedures that provide an alternative for patients who are at higher risk for open-heart surgery. By performing this surgery on patients that are awake, we can reduce the stress and risks of surgery, improve results and avoid complications, and allow patients to return home sooner,” says Dr. Webb. Only patients who are at high risk for surgery are considered for THV procedures. The Centre for Heart Valve Innovation is now performing half of its THV procedures on patients that are awake. In addition to TAVI, the Centre for Heart Valve Innovation also performs other transcatheter procedures for people with valve disease, including percutaneous www.hospitalnews.com

m i t r a l v a l v e r e p a i r ( “ M i t r a C l i p” ) . Dr. Webb is recognized internationally as a leader in these procedures, having the broadest experience in the world and having taught these techniques to health care professionals in more than 25 countries. He is not only breaking new ground with medical procedures, but also in the way he teaches others how to conduct this procedure. From offering three-day courses locally, to traveling to all corners of the world to assist with initial cases, Dr. Webb and his team are dedicated to sharing their knowledge so that the TAVI procedure is accessible to all of those who qualify for it. In 2011, St. Paul’s launched the Virtual Teaching Laboratory which provides live feeds of the TAVI procedures at St. Paul’s to medical professionals around the world. “We bring together cardiologists, cardiac surgeons, nurses, geriatric medicine specialists, the patient and also the family doctor to discuss whether this is something that we can do but also whether it is something that we should do,” says Sandra Lauck, clinical nurse specialist at St. Paul’s. Wegner’s procedure was broadcast to the Transcatheter Valve Therapies conference held in Vancouver. The conference was designed for interventional cardiologists, cardiovascular surgeons, cardiac imaging specialists, clinical cardiologists, cardiac nurses, cardiovascular technologists, and other health care professionals with a

The 1000th transcatheter heart valve procedure was broadcast to the Transcatheter Valve Therapies conference held in Vancouver. special interest in the field of transcatheter valve therapy. “In just nine years, St. Paul’s Hospital has grown from a trailblazer in TAVI procedures to the home of the Centre for Heart Valve Innovation. This milestone is evidence of the deep commitment of our caregivers and researchers, who have put the needs of patients first and dared to push the boundaries and find new solutions,” says Dianne Doyle, President and CEO of Providence Health Care, which operates St. Paul’s. Wegner used to exercise regularly but her condition deteriorated dramatically. Without this procedure, doctors expected her lifespan to be shortened considerably. “Things were quite alright. I exercised, I was in the (St. Paul’s Hospital) Healthy

Heart Program. Then I felt my strength was going down, I was having more and more problems and had to give up exercise altogether,” she explains. The Vancouver program is a partnership between St. Paul’s Hospital and Vancouver General Hospital. Sites of the provincial THV program also include Royal Columbian and Royal Jubilee Hospitals. From her hospital bed just four hours after the procedure, Wegner gave some advice to others who might be in her situation. “If you have the chance to be chosen, be grateful and grab it…I feel blessed. I feel H fine, certainly better than before.” ■ Dave Lefebvre is a Senior Communications Specialist at Providence Health Care in BC.

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JULY 2014 HOSPITAL NEWS

16 Focus

Diabetes Epidemic Cover Story

By Dr. Jan Hux ore than nine million Canadians are living with diabetes or prediabetes. With more than 20 people being newly diagnosed every hour of every day, chances are the disease affects someone you know. That could be a relative, friend, neighbour, co-worker or someone who’s part of your personal or professional community. In Ontario alone, there has been a 68 per cent increase between 1995 and 2005. The majority of cases are of type 2 diabetes and that is where most of the growth is seen. The need to ensure optimal care and outcomes for people living with diabetes has always been great, but is now being brought into sharper focus by the magnitude of the situation.

“Each person experiences the diagnosis of a chronic disease, like diabetes, in a different way. But one of the themes common to people with diabetes is the loss of flexibility in their lives.” A chronic disease, diabetes is often debilitating and sometimes fatal. The body either cannot produce the hormone insulin (type 1 diabetes), or it cannot properly use the insulin it produces (type 2 diabetes). This leads to high levels of glucose (sugar) in the blood, which can damage organs, blood vessels and nerves and result in a variety of complications. To use sugar as an energy source, the body needs insulin. People with prediabetes have higher-thannormal blood sugar levels that aren’t high enough to be diagnosed with type 2 diabetes. Without intervention, 50 per cent of those people will develop type 2 diabetes.

What accounts for the dramatic rise in the number of people with diabetes? There are four reasons for the rise in the numbers. LONGEVITY People are living longer with diabetes, and we are successfully treating them. That’s a good news story, and we want that trend to continue even though it is a major contributor to the growing prevalence of diabetes.

GENES Genetic factors can put a person at greater risk of developing type 2 diabetes. We also know that the risk varies for people of different ethnicities. These factors cannot be modified. On the Canadian Diabetes Association’s (CDA’s) website at www.diabetes.ca, we have a risk assessment that provides people with more information about factors that could put them at risk for diabetes. LIFESTYLE We are becoming a more sedentary society, consuming more calories, and more calories of an unhealthy variety. This can lead to obesity, which is of concern not only to people with diabetes, but to everyone. In Canada, obesity is a public health crisis. And like smoking, it needs a multi-pronged public health response. ENVIRONMENT We are seeing that more recently designed neighbourhoods

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Kathryn Kozell, CNS/Manager ZĂĐŚĞů &ůŽŽĚ ĚƵĐĂƟ ŽŶ WƌŽŐƌĂŵ ŵĂŝů͗ ŬŬŽǌĞůůΛŵƚƐŝŶĂŝ͘ŽŶ͘ĐĂ dĞů͗ ϰϭϲͲϱϴϲͲϰϴϬϬ yd͘ ϴϯϱϵ

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are unwalkable. Research, such as the CDA-funded study by Dr. Gillian Booth and her team, found that neighbourhood walkability was a strong predictor of a person’s risk of developing diabetes, independent of his or her age and income, particularly among recent immigrants. Poverty accentuated these effects. Linked to that is the idea that some neighbourhoods represent “food deserts,” where people have tremendous difficulty obtaining foods that are nutritious, such as fresh fruits and vegetables, that provide healthful calories. This can be due to unaffordability or unavailability, or both. For instance, if you live on First Nations reserve in northern Manitoba, it’s very difficult to get enough calories without eating a lot of added sugar.

What can health care professionals do to help people living with diabetes?

CREATE A CONNECTION. As part of the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada (www.guidelines.diabetes.ca), we emphasize the importance of a person with diabetes connecting with a healthcare team. A person’s diabetes care team can include a family doctor, nurse, pharmacist, dietitian, endocrinologist, certified diabetes educator, and more. It’s a proven approach that can improve treatment and a person’s quality of life. Whether an individual is treated by many health care professionals or just a few, it’s important for each team member to have a clear role that the patient understands, and for the team to talk to each other and share information. CDA volunteer Christina Vaillancourt, a registered dietitian and patient care specialist at Lakeridge Health Durham Region Diabetes Network in Whitby, Ont., believes that everything health care

professionals do should start with the person living with diabetes. In other words, the system should fit the patient, not the other way around. SUPPORT EDUCATION. People living with diabetes need information about how to manage the disease and live healthily. Health care professionals can play an important role in educating people and helping them put the information to practical use in their everyday lives. Encouraging a healthier lifestyle is an important goal for everyone, especially those with prediabetes. As the Diabetes Prevention Program (DPP) study showed, modest weight loss achieved through dietary changes and physical activity can delay or even prevent the onset of type 2 diabetes. At the CDA, we suggest small, simple steps that are realistic and achievable. Creating targets and goals is another way for people to stay on track with their diabetes management. We have tools on our website to help people prepare for diabetes visits, create action plans and track their progress – these can be used in conjunction with their health care team. Other valuable resources, which the CDA has worked with volunteers to develop, include local support, whether it’s a peer-based support group; one-on-one support, in person and online; and webinars. STAY INFORMED. The 2013 Guidelines provide health care professionals with the best and most current evidence-based clinical practice data. They were developed over a five-year period by a CDA volunteer committee of diabetes experts who assessed and reviewed the latest scientific evidence about diabetes prevention and management. Rated among the best in the world, the 2013 Guidelines support the CDA’s commitment to being a global leader in diabetes care, management and prevention. We have just released the www.hospitalnews.com

Cover Story 17

3.3 million living with diabetes (type 1, type 2) 5.7 million have prediabetes (abnormal blood sugar, or glucose, levels); without intervention, almost 50 per cent of people with prediabetes will develop type 2 diabetes

Cost of diabetes:

$13.5 billion in 2014 (TBC) Expected to rise to $17 billion by 2024

Growth of diabetes:

Prevalence (those living with the disease) – 2000: 4.2%; 2010: 7.6%; 2014: 9%; 2024: 11.8% Number of Canadians affected – 2000: 1 million; 2010: 2.7 million; 2014: 3.3 million; 2024: 4.8 million

Clinical Practice Guidelines app (CDA CPG) for health-care providers – an interactive, searchable and mobile-friendly resource with interactive tools. It’s available from the App Store and Google Play.

What’s new with diabetes?

TYPE 2 Twenty-five years ago in medicine, we had a rule of thumb that said anyone under the age of 30 with diabetes must have type 1 diabetes. That is no longer the case. Today, children are being diagnosed with type 2 diabetes. For instance, Dr. Jill Hamilton of the Hospital for Sick Children in Toronto says she sees children who are developing type 2 diabetes at an increasingly younger age in her practice. With funds from the CDA, Dr. Hamilton and her team are studying the link between mothers who develop gestational diabetes (which occurs during pregnancy) and their babies who may be at greater risk for obesity and diabetes later in life. The face of diabetes is also changing among gender lines. Traditionally, the prevalence of diabetes (those living with the disease) has been higher in men, but the greatest increase in rates is among young women aged 20 to 49 years old. TYPE 1 Unlike type 2, which can be prevented, the cause of type 1 is unknown and there is currently no cure. However, there are two good news research stories on the horizon. Islet Transplants Canada’s first successful islet cell (the pancreatic cells that produce insulin) transplant was conducted in 1991 by Dr. Garth Warnock. Building on his work, a University of Alberta research team – whose investigative work is funded by the CDA – announced a breakthrough technique for islet cell transplantation for patients with severe type 1 diabetes. This became known as the Edmonton Protocol. As of June 2012, more than 300 islet cell www.hospitalnews.com

transplant procedures have been successfully performed across Canada. Today, there are a host of researchers working in the area of islet cell transplantation. One of them is CDA-funded researcher, Dr. Pere Santamaria, a University of Calgary professor and director of the Julia McFarlane Diabetes Research Centre (which supports research focused on finding a cure for diabetes), who has developed a vaccine that could increase the success of transplants. Artificial Pancreas Whether it’s wearable or implanted, an artificial pancreas is an automated system that mimics a functioning pancreas by delivering insulin in response to the body’s changing glucose levels. De Montfort University in Leicester, England, recently announced that the first human trials of an implanted artificial pancreas created by one of its professors could be just two years away. On this side of the pond, CDA-funded research by Dr. Rémi Rabasa-Lhoret and his team has evaluated conventional insulin pump therapy versus an insulin pump that uses a continuous glucose monitor (CGM) to calculate insulin dosages without any input from the wearer. Dr. RabasaLhoret is currently comparing a two-hormone – insulin and glucagon (a hormone that responds to correct low blood sugar levels) – system that would function as a wearable artificial pancreas. It wouldn’t require any input from the wearer and would normalize blood sugar levels.

What’s ahead for people living with diabetes? This spring, the CDA released the Diabetes Charter for Canada, which outlines the rights and responsibilities of people living diabetes, their caregivers, healthcare providers, governments and others who may provide care and support. This all-hands-on-deck approach underscores how important it is for everyone to work together to fight this disease. Our hope is that this document will foster positive change that will lead to equal access to diabetes care and support for all Canadians living with diabetes or at risk for the H disease, no matter where they live. ■ Dr. Jan Hux is chief science officer for the Canadian Diabetes Association (CDA). For more information about the CDA, visit diabetes.ca.

Patient-centred care is your specialty.

Making it easier for you is ours.

The Canadian Diabetes Association is pleased to introduce even MORE interactive tools and resources to help you apply the Clinical Practice Guidelines in your daily practice. Look for the NEW tools on guidelines.diabetes.ca or in your favourite app store.

JULY 2014 HOSPITAL NEWS

CARDIOVASCULAR CARE/RESPIROLOGY/DIABETES

18 Focus

Remote control treatment for

irregular heart beats By Marie Sanderson unnybrook is the first centre in Canada to use a new remote control system for treating arrhythmia that is more effective and safer for patients than other options. "Adding this technology to our minimally invasive arrhythmia lab, which is already cutting-edge with its use of robotic imaging-guided technology, is further enhancing the precision and safety of heart procedures," says Dr. Eugene Crystal, cardiologist and Director of Arrhythmia Servies at Sunnybrook’s Schulich Heart Centre. "We can now access really challenging areas of the heart chambers, which results in greater accuracy during ablation and a reduced risk of complications for patients." The VdriveTM system from Stereotaxis is the latest addition to Sunnybrook's arrhythmia suite that treats about 300 patients a year for irregular heartbeats that occur when the electricity that flows through the heart to trigger the pumping action "short circuits", or gets blocked, and disturbs the heart's normal rhythm. Heart palpitations, fatigue, dizziness, chest pain and shortness of breath are all symptoms, which if left untreated can lead to heart attack and stroke. The sophisticated GPS-like technology controls powerful magnets near the patient to map a pathway through a patient's blood

Dr. Eugene Crystal, Director of Arrhythmia Services at Sunnybrook, is pictured in the control room of the hospital's Arrhythmia Suite. vessels and heart to the diseased heart tissue. The magnets lead a soft catheter gently along this pathway by guiding its magnetic tip, precisely identifying the location of the faulty electrical site in each patient. Clinicians from the Schulich Heart Centre then ablate, or destroy, damaged heart tis-

sue that causes the electrical malfunction to restore a regular heart rhythm. "This is win-win technology that greatly benefits both patients and the health care teams looking after them. Patients receive the best care for irregular heart rhythms in the safest possible environment, and they

can often go home the same day with such minimally invasive treatment," adds Dr. Crystal, Associate Professor, Department H of Medicine, University of Toronto. ■ Marie Sanderson works in Communications at Sunnybrook Health Sciences Centre.

St. Michael’s adds another world first By Geoff Koehler hen Cook Medical chose to debut the newest model of its endovascular stent graft to the world, it chose an experienced team at St. Michael’s Hospital. Dr. Tony Moloney, an endovascular surgeon with the Heart and Vascular

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Program, was the first to use Cook’s new Alpha graft to repair a patient’s aorta and treat an abdominal aortic aneurysm. An abdominal aortic aneurysm, often called a “Triple-A,” is when part of the aorta –the largest artery in the body– is weakened and may rupture. One way to repair the aorta is with an endovascular stent graft – a tube containing a mesh stent that will expand and support the artery’s weak spot. Surgeons insert stent grafts through the femoral artery and deftly lead it up to the damaged area. When they’ve reached the correct spot, surgeons pull on a cord and release the compressed mesh. That mesh expands to fit the exact framework of the patient’s injured arterial wall and provide structural support. “Rather than pulling on a cord, the Alpha graft is released with a twisting motion,” says Dr. Moloney. “A twisting release gives us more control and stability which should be safer for patients and make placement more precise.” Placement is crucial when it comes to repairing an aneurysm. If you’re off by a few millimeters, the aorta may not get

Photo courtesy of Cook Medical

Dr. Tony Moloney was the world’s first to use Cook’s new Alpha graft. He’s shown here performing a different vascular procedure. the structural support it needs. Having a stent graft that is small enough to maneuver through tight spots can be the difference between having a minimally invasive procedure, such as a stent graft, and undergoing surgery. The Alpha graft is slimmer than Cook Medical’s other endovascular grafts so access is easier.

"Other medical device companies have grafts that are similarly slimmer or released with the twisting motion,” says Dr. Moloney. “But because each aorta is different, we need many different kinds of grafts. With this world-first, we’ve H added a new arrow to our quiver.” ■ Geoff Koehler is a Media Relations Adviser at St. Michael’s Hospital. www.hospitalnews.com

From the CEO's Desk 19

Providence Care’s new hospital in Kingston will change the perception of mental healthcare By Cathy Szabo arlier this year, I stood on the front of a large piece of heavy construction machinery with the Providence Care Board Chair as we marked the groundbreaking of our new hospital redevelopment project. It was an exciting moment – we are now building a facility that will benefit patients and their families from across southeastern Ontario. When it opens in 2017, Providence Care Hospital will be one of the first in North America to combine long- term, specialized mental health services in the same building as complex care and rehabilitation. Right now, we provide these services at two different hospital sites. Historically, psychiatric hospitals in Ontario have been built and operated separate from other hospital programs. However, more and more, we are seeing commonalities between patients seeking these services, particularly as care is delivered through an interprofessional team approach. Seniors diagnosed with dementia also rely on physical rehabilitation services, and just as individuals who have experienced a significant injury may also require mental health care. Psychiatric hospitals have also been stereotyped as very institutional and disconnected from the rest of the community. The new Providence Care Hospital will help change the perceptions around mental health and how care is provided. Providence Care Hospital will bring to life the concept of patient-centred care, where services are not siloed in separate facilities but instead are working in collaboration to meet the physical, emotional, social and spiritual needs of each person. In our new building, patients, clients and families will use the same entrance, there are spaces for informal and formal gatherings, and inpatient rooms and units are designed to be consistent – no matter what services are being provided. We’re committed to welcoming all people – creating a homelike and person-centred care environment at Providence Care Hospital. One way we hope to do this is by designating spaces within the building to showcase artwork by people with lived experience of mental illness, and by rehabilitation or complex care patients. I came to Providence Care this year, with a background of many years working in community care. There is a real shift in health care today toward ensuring that hospital stays are “transitions” and not a place for individuals to spend indefinite periods of time. With this in mind, the Providence Care Hospital will support patients as they prepare to leave the hospital to return home to the community or alternate care setting. We have two trial discharge apartments (one located with a mental health inpatient unit, and another with a rehab unit) to support clients as they complete their hospital stay. These elements reflect a shift in how mental health care is delivered in Canada:

www.hospitalnews.com

it is one part of the broader continuum of health services. Integrating mental health with complex medical care and physical rehabilitation is one way Providence Care is demonstrating its holistic, person-centred approach. We meet the ‘physical, social,

emotional and spiritual needs’ of each person – and in the process, we’re working to destigmatize mental healthcare in our H community. ■ Cathy Szabo is President & CEO, Providence Care, Kingston.

Cathy Szabo

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CARDIOVASCULAR CARE/RESPIROLOGY/DIABETES

20 Focus

Off the transplant list By Caroline Bourque Wiley fter months of exercise and dedication, Niagara Health System (NHS) cardiac patient Garwin Cockhead has accomplished a remarkable feat – improving his heart health enough that he’s been taken off Ontario’s heart transplant list. A severe heart attack in August 2012 and related cardiovascular complications left the 52-year-old Niagara Falls man with a failing heart that doctors initially said needed to be replaced. He was placed on the cardiac transplant list at Toronto General Hospital in early 2013. He was given a pager so he could be notified immediately if a health compatible heart became available. But Garwin didn’t sit idly waiting for the pager to buzz. He got busy trying to repair the damaged heart he already had. He was referred to the NHS’s Cardiovascular Health and Rehabilitation Program and committed himself to exercise and improving his cardiac health.

The Trillium Gift of Life Network reports that between four and nine cardiac patients have been removed from transplant lists in Ontario each of the past five years because of improved health. This regional program offers a variety of cardiovascular rehabilitation and risk reduction services, such as supervised exercise programs, nutrition counseling, stress management, smoking cessation and health teaching in both group and individual forums.

By Dahlia Reich diabetes trial starting at St. Joseph’s Hospital is testing a potential magic bullet to combat both diabetes and the oftendeadly complications of heart disease. St. Joseph’s is one of 29 Canadian sites – and about 1,200 sites around the world – taking part in the DECLARE study to test a novel agent called Dapagliflozin, which experts hope will become a much-needed new tool in the diabetes care “toolbox”. The purpose of the trial is to lower blood sugar in people with type 2 diabetes and prove it to be safe in heart disease. About 80 per cent of people with diabetes will die as a result of a heart attack or stroke. St. Joseph’s endocrinologist Dr. Irene Hramiak has recruited 25 patients with type 2 diabetes who are over age 40 and at high risk of heart disease or who have had a heart event, such as a heart attack. “Currently, there is only one drug available, Metformin, for those with type 2 diabetes that has been found to be good for both diabetes and heart disease,” explains Dr. Hramiak, chair/chief of the Centre for Diabetes, Endocrinology and Metabolism and a scientist with Lawson Health Research Institute. “But you can’t just use one drug forever. Diabetes is a progressive disease so we have to keep adding treatment. It’s not like other conditions where you can stay on the same pill for 20 years. With diabetes the loss of pancreatic function is ongoing. We always need more tools in the toolbox.” Dapagliflozin works to block an enzyme in the kidney that pulls sugar back into the blood from the urine. By blocking the enzyme the sugar leaves the body by way of the urine and improves blood sugar levels. Ironically, if the drug works effectively, sugar in the urine will be good news while many years ago it was considered bad news, says Dr. Hramiak. Before blood glucose monitors became readily available, diabetes patients tested their urine as an indication of how they were managing their disease. If sugar in their urine was high, it meant that sugar in the blood was likely high. In the DECLARE study, sugar in the urine will mean the new drug is doing its job. “We’re changing how we think about diabetes treatment,” explains Dr. Hramiak.”We’re changing the dynamics in the kidney. Here’s an agent that in fact puts sugar in the urine as a form of treatment. The kidney is causing more sugar to leak out and the sugar in the blood is dropping.” The hope, she adds, is that the drug is proven safe in diabetics with, or at higher risk of, heart disease. About 17,150 patients worldwide will be taking part in the five-year study, which is being coordinated by the Timi Study H Group in Boston, MA. ■

Garwin Cockhead improved his heart health enough to be taken off the heart transplant list. Almost 800 new patients participated in the program last year, logging almost 14,000 exercise visits. The YMCA of Niagara is a partner in the program. Garwin completed the 16-week program at the YMCA’s Niagara Falls location, focusing on cardiovascular exercises, such as walking, spinning on stationary bikes and using the treadmill, as well as some light weights to improve his strength. He continues to exercise at the Y at least five times per week, even though he completed the rehab program. All of Garwin’s sweat and hard work have paid off. He recently received the good news that his cardiac health has improved to the point that he no longer needs a new heart. “The exercise rehab program was a lifesaver,” says Garwin. “When I began I could barely walk from one side of the room to the next. Now I can do 25 minutes of cardio and some strength training in a session. The program is also a place to be with people who are experiencing the same challenges you are; it’s a great support.”

At some point, everyone can use a hand.

It’s rare for patients with failing hearts to get well enough that they no longer require a transplant. The Trillium Gift of Life Network reports that between four and nine cardiac patients have been removed from transplant lists in Ontario each of the past five years because of improved health. On average, there are typically up to 165 people on the transplant list each year. Garwin is among the fortunate ones – he was recently able to return the pager he wore for nearly a year, anxiously waiting for a change of heart. Garwin’s medical team credits his involvement in the NHS cardiac rehab program in part for his remarkable progress. “We see benefits with most of our patients, and everybody progresses differently,” says Steve Walker, NHS Exercise Specialist with the program. “Garwin has worked very hard, and we are really pleased H with his progress.” ■ Caroline Bourque Wiley is Manager, Communications at Niagara Health System.

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Dahlia Reich works in Communications & Public Affairs at St. Joseph's Health Care, London. www.hospitalnews.com

Evidence Matters 21

Cutting through the noise: What we know about the safe use of wireless devices in hospitals By Barbara Greenwood Dufour s wireless device use becomes an integral part of our daily lives, we are asking for fewer restrictions on their use in hospitals. Devices such as smart phones and tablets provide many potential benefits in this environment. Patients can use wireless devices to connect with friends and family or pass time in the waiting room, making their hospital visit a more positive experience. Clinicians can use wireless technology to do their work more efficiently — quickly consulting with other care providers, easily accessing information resources and electronic health records, and viewing and recording patient data on the spot. But, the potential for electromagnetic radiation generated by wireless devices to interfere with medical equipment remains a concern to patient safety. In 2011, CADTH conducted an environmental scan of hospital policies on wireless device use. At that time most of the Canadian hospitals surveyed were either in the process of revising their policies or had revised them within the last three years. The newly implemented policies attempted to strike a balance between convenience and safety — limiting wireless device usage within a specific distance from medical equipment and prohibiting their use in patient care areas where medical equipment is heavily used, while allowing their use in hospital waiting areas, lounges, private offices, and cafeterias. But are such restrictions actually required? What do we know about the interference to medical equipment caused by wireless devices and the extent to which this interference compromises patient safety?

Given that the popularity of wireless devices among patients, visitors, and health care providers is here to stay and likely to continue increasing, there are measures that need to be taken to limit harm to patients. Hospitals are, and will continue todevelop policies to regulate wireless device use in highly instrumented areas to protect sensitive equipment from exposure to hazardous electromagnetic interference. And experts in these technologies can help hospitals select equipment that is less susceptible to interference from commonly used wireless devices. Such measures will protect patient safety while allowing for the continued use of wireless devices to benefit medical practice and improve convenience. For more information about CADTH visit www.cadth.ca and follow us on TwitH ter @CADTH_ACMTS. ■

The technology used to design both wireless devices and medical equipment is constantly changing — in the near future it may create more interference or be more susceptible to interference than was the case at the time. To answer these questions, CADTH’s Rapid Response service undertook a review of the available evidence on the use of wireless devices in health care environments. The studies looked at several types of wireless devices — ultra-high frequency radios, various mobile phones, and a variety of Bluetooth-enabled devices — using a broad range of transmission technologies such as code division multiple access (CDMA), general packet radio service (GPRS), global system for mobile communication (GSM), Terrestrial Trunked Radio www.hospitalnews.com

(TETRA), universal mobile telecommunications system (UMTS), wireless local area network (WLAN) and analog. The effect of these devices on the performance of several types of medical equipment was investigated in the studies, including defibrillators, ventilators, brain stimulators, pumps, and ophthalmic equipment. The CADTH review found that electromagnetic emissions from wireless devices do frequently cause interference with medical equipment. This interference manifests itself in several ways — noises, screen distortions, false alarms, complete stoppages, and malfunctions in output parameters. Equipment is more likely to be affected if the wireless device is using the same radio frequency, transmitting a strong signal, or in close proximity to the equipment. Incidences of the interference affecting medical equipment to such an extent that it compromised patient safety were, however, found to be uncommon. When it did occur, the equipment and the wireless device were in very close proximity to one another — less than three feet apart. However, the available evidence on this issue has limitations. Not all types of medical equipment were assessed, and there may be some equipment that is more susceptible to interference than those that were included in the studies. The technology used to design both wireless devices and medical equipment is constantly changing — in the near future it may create more interference or be more susceptible to interference than was the case at the time. Some of the studies were conducted with a single piece of equipment in the room, which may not be the case in every health care setting. Even without these limitations, any risk of electromagnetic interference resulting in a malfunction in medical equipment exposing patients to risk of harm, misdiagnosis, or incorrect treatment is cause for concern. The unrestricted use of wireless

devices in health care settings, therefore, cannot generally be considered to be a safe practice.

Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH.

JULY 2014 HOSPITAL NEWS

CARDIOVASCULAR CARE/RESPIROLOGY/DIABETES

22 Focus

The healing hands of time: Transformation of health and safety practices in the nursing profession he nursing world of work continues to evolve. In light of changes in the health care system, the patient population characteristics and the society in general, nurses are faced with unique challenges despite which they continue to strive for better healthcare for all. Nurses are situated in close proximity to the patients and hence directly experience any patient-related changes in practice, be it new legislation that urges to reduce wait-times and improve wound care, or a new regulation that affects the general public, such as the smoking ban. The environment in which nurses work has been recognized as an important place to not only prevent disease and promote health in nurses, but also as instrumental in sustaining quality patient care. A Healthy Work Environment is a practice setting that maximizes the health and well-being of nurses, quality patient/client outcomes, organizational performance and societal outcomes” (RNAO HWE Best Practice Guidelines). Creating a healthy work environment is not merely an ideological construct; rather, it has firm and evidential underpinnings. A culture of safety is one component of the evidence that leads to a healthy work environment and nurses have a pivotal role in keeping themselves and patients safe. One need only to reflect over the past 15 years at such sobering events as Acquired Immunodeficiency Syndrome (AIDS), severe acute respiratory syndrome (SARS), aggressive nosocomial infections, and increased violence to distinguish the permanent changes nurses and organizations were obligated to make in the last decade to protect themselves and, equally important the patients or

HOSPITAL NEWS JULY 2014

Through Toronto’s SARS experience, the employers’ legislated responsibility to maintain a safe work environment was greatly challenged. clients they care for. Many aspects of the response to AIDS and SARS are worth remembering as they led to innovations such as needleless systems, personal protective gear, and improved isolation products, to protect nurses and other health care workers. The work of nurses is sometimes portrayed as a fragile balancing act between caring for oneself and others. The hazards of nursing work can impair health both physically and mentally. The resulting health impacts include musculoskeletal injuries, frequent infections, changes

in mental health, and cardiovascular and metabolic disorders. Musculoskeletal injuries among nurses and health care workers continue to be the major source of disabilities and time loss at work (Health Canada, 2012). Nurses had a rate of absence due to illness or disability nearly twice the rate for all other occupations and higher than all other health care occupations in 2010. Ontario reported approximately 147,000 nurses for 2012, of these 96 per cent of Ontario’s nurses, or 108,500 were women, and four per cent, or 4,500, were men (College of Nurses Ontario). In Ontario, nearly

one-third (33 per cent) of nurses reported experiencing high job strain. Job strain results when the psychological demands of a job exceed the worker’s discretion in deciding how to do the job (Health Canada, 2012). Approximately two-thirds of nurses in Ontario (65 per cent) reported that their jobs were highly physically demanding. The figure for all of Canada’s nurses was 62 per cent (Health Canada, 2012). Along with the physical strain nurses are under, the last decade has also revealed persistent levels of workplace violence. Workplace violence includes physical aggression, sexual violence, verbal or physical, and psychological violence including bullying (RNAO, BPG Preventing and Managing Violence in the Workplace, 2009). Governments have responded favourably with legislation to protect nurses and other workers against violence through the introduction of Bill 168 which requires employers to develop, implement and maintain a workplace violence policy and program. A key driver to the transformation of health and safety practices in the nursing profession has been federal and provincial legislation. For example, a number of regulations across Canada followed the Tobacco Act that impacted the manufacture, sale, labelling and promotion of tobacco products. Provincial legislation prohibiting smoking in enclosed workplaces later evolved in order to protect workers from exposure to second hand smoke. It is hard to imagine that at one point in time you could be working on a Cardiac floor, providing health teaching on the impact of smoking and effect it has on the heart, and then documenting on the patient in a smoke-filled nursing station. In addition to federal and provincial legislation, the global epidemic of Severe Acute Respiratory Syndrome (SARS) in 2003 pushed medical infrastructure to the limit. SARS outbreaks greatly impacted Canada’s largest city, Toronto. SARS placed heavy pressures on Toronto's public health and health care system. The region's health care professionals, as frontline workers vital to controlling the disease, were at heightened risk for contracting the disease, and under considerable physical and psychological stress. Many patients required intensive care, hospitals had to close, elective procedures were cancelled, and procuring adequate types and quantities of supplies to combat the disease was difficult. SARS also placed unprecedented demands on the public health system, challenging regional capacity for outbreak containment, surveillance, information management, and infection control. Through the SARS experience, the employers’ legislated responsibility to maintain a safe work environment was greatly challenged. Many issues involving occupational health and safety surfaced from N95 respirator availability and applicability, to proper mask-fit testing and use. Workers rights such as the right to refuse unsafe work and right to know about health and safety hazards in their workplace were debated and tested. Continued on page 23 www.hospitalnews.com

CARDIOVASCULAR CARE/RESPIROLOGY/DIABETES

Focus 23

healing hands Continued from page 22

To better understand how nurses feel about the changes in nursing health and safety practices throughout the last decade, a group of nurses from Public Services Health & Safety Association and the Registered Nurses’ Association of Ontario, put together a survey asking nurses to share their experiences and perspectives on the changes in nursing practice. Participants were asked about the changes observed related to health and safety practices in the nursing profession and what are some of the influential events and system developments that led to these changes. The respondents provided an insightful look at the evolution of health and safety practices in nursing in the last decade. Seven experienced nurses who lived through the changes shared their thoughts on the strengths and areas for improvement related to workplace health and safety in the nursing profession. Respondents’ years of nursing experience in Canada ranged from 13–34 years. Most of the nurses reported diverse nursing experience and had worked in a variety of setting, including Pediatrics, Intensive Care, Emergency, Obstetrics, Gerontology, Occupational Health, Medical Surgical, Urgent Care Clinics, Administration, Public Health, Community and Long-term Care, and specialized care clinics. Their responses fall into six broad themes, including infection prevention and control; workplace violence and bullying; smoke-free workplace; technology; general workplace safety; and looking forward.

Infection prevention and control SARS certainly came out as the most significant event, “a turning point to increasing nurse’s safety,” according to one participant, among all related events and changes. Participants have reported an increase in awareness and emphasis on hand hygiene; increased and appropriate use of personal protective equipment (PPE); regular mask-fit testing for health care staff; screening of respiratory symptoms; and stronger partnerships with the local health units, Ministry of Health and Long-Term Care, as well as the World Health Organization. Some participants noted that the downside of introducing these practices is the time it takes to get it done right! Handwashing between patients is critical, as is additional screening of patients for infectious diseases but the nurses are required to complete these tasks within their already busy days. The tragic events associated with the global SARS pandemic made most employers realized that they have responsibilities when it comes to staff safety. Completing a screening for patients, particularly in the time with emerging antibiotic resistant organisms and acute respiratory illnesses, nurses are not only concerned about their patients, but also their own health and wellbeing.

Workplace violence and bullying There were times when nurses accepted physical and verbal abuse as part of their job. The place of work has evolved for nurses with more nursing care being provided in patients’ homes. This heightens nurses’ awareness about safety because of the increased risks associated with working away from a controlled health care facility www.hospitalnews.com

During the SARS crisis many issues involving occupational health and safety surfaced from N95 respirator availability and applicability, to proper mask-fit testing and use. environment. Today, the nurses felt that in most workplaces, workplace violence and bullying is not being tolerated. This is a result of continued education and awareness raising in workplaces.

Smoke-free workplace Smoke-Free Ontario Act went into effect in 2006, and aims to protect Ontarians from exposure to second-hand smoke by banning smoking in workplaces, enclosed public spaces and also in motor vehicles where a child under the age of 16 years is present. Although the survey participants acknowledged the benefit of creating smokefree workplaces for all involved, some felt it is important to note that nurses, as a result of this ban, have been given more responsibilities with screening patients and asking if they would like smoking cessation aids.

Technology – cannot live with it, cannot live without it For the most part, advances in technology, in the form of electronic charting and online learning have certainly improved the overall working lives of nurses. A common concern is that introducing rapid technological changes has led to nurses spending much of their time learning how to operate the technology, then operating the technology which can sometimes become a barrier to spending more one-oneone time with the patient. An insufficient number of charting stations and malfunctioning computers are some of the troubles nurses experience with technology.

General workplace safety Overall, workplace safety is much more of a priority now in places where nurses work and care for patients. One nurse recalls how back in the day, no PPE was worn while caring for a patient who was hemorrhaging; and nurses mixed chemo drugs themselves without hoods. In some workplaces, nurses lacked a clear definition of where their duties ended and did everything from bathing a patient to plunging the toilet.

Looking forward The nurses felt that overall, there has been great progress and a general consensus around creating healthy and safe workplaces. Employers recognize that when nurses have the opportunity to provide care in a safe and healthy work environment, everyone involved benefits, including the nurse, patient and their family. Some of the challenges and barriers to sustaining healthy and safe environments for nurses is the fact that nurses themselves need to actively participate to upkeep the new and innovative practices. This places more time pressures on the nurses who find it difficult to cut back on patient-nurse time. The nurses called for appropriate and adequate education on safety measures being implemented. At times, a new practice is introduced and nurses find themselves struggling trying to understand the rationale behind the intervention. Good examples of successful program implementation are the RNAO best practice guidelines on Professionalism, Fatigue Management and Conflict Management. It was recommended to continue to break the silos between healthcare subsectors to work together on developing and successfully implementing standardized tools that address healthcare system challenges. Communication is still fragmented and information sharing, particularly around resources, tools and databases, is difficult. It is still common to see great ideas and innovative solutions remain within one organization while many others are seeking answers and left trying to reinvent the wheel. Although a number of valuable interventions and practice changes have been introduced in healthcare workplaces, some are done without a proper evaluation. This is important when we want to understand the effectiveness and areas for improvement. Every professional in the health care system plays an important role in caring for the patient and assisting them in achieving better health. However, nurses are in a very special place when consid-

ering their proximity to the patient and ability to connect everyone in the circle of care.

Recommendations Keeping nurses safe and healthy is a natural extension of providing quality care. Every worker has the right to be free from harm. Commitment to high standards of professional practice doesn’t mean bearing the burden of risk, but rather managing risk for better outcomes. Nurses and employers need to work together to eliminate occupational injuries, illnesses, and fatalities. Bringing about further change requires strong collaboration. Efforts need to heighten awareness, promote knowledge mobilization, and support ongoing engagement. Nurses have the responsibility to raise health and safety concerns and the right to be part of the solution. Employers have the duty to invest in their workH force. ■ Authors - Liz Sisolak, Althea StewartPyne, Tina Dunlop, Olena Chapovalov Reviewers – Connie Limnidis, Janice Gallant.

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24 Ethics

What makes ‘informed consent’ moral and meaningful? By Kevin Reel xtraordinary developments in treatments for various conditions have meant a new lease on life for many individuals. Some of these treatments are clearly not a cure – they are management approaches that minimize the effects of the condition and often slow its progress significantly. The idea of a time limited lease is particularly apropos in the example of the Implantable cardioverter defibrillator (ICD) – without which the individual’s demise could be sudden. Other interventions might be a clearer ‘fix’ to avoid death, but come with higher risks – such as cardiac surgery that presents the only real prospect for survival. This is increasingly being offered to patients whose age or general state of health makes the typical risk shift to an even higher level. A great thing – if it works in the end. These examples illustrate two distinct challenges to the process of informing – whether or not to make it clear at the outset that ‘the fix’ is temporary (for the ICD) and being explicit about the risks of failure and/ or post-operative complications in the high-risk surgery. So what does ‘informed consent’ mean when there is likely no other option? There are two significant factors at play – impending tragedy (i.e. death), and the trust placed in the practitioners who can offer these interventions. On the latter point, McKneally and Martin (2000) explored what they called ‘an entrustment model of consent’ – identifying some of the elements at play in patients’ consenting to surgery (in their study it was esophagectomy for cancer). Among these were the general ‘belief’ in surgical interventions and the multiple dimensions of being referred to and receiving a recommendation from a ‘specialist’. Should it bother us that these factors play such a central role in the consent of the patient? My own feeling is that these are less of a concern when they are acknowledged by the practitioner, and efforts are made to avoid them carrying undue influence in the informed consent process. Schwarze et al (2010) examined another dimension of the consent process – a sort of agreement in advance about the possibly complex after care post-surgery – they called it ‘buy-in’. This involves acknowledging that the post-surgery recovery may take a while, and may involve a high level of intensive support. They found this part of an exceptionally complex, quasi-contractual relationship between surgeon and patient. This quite likely creates an immense internalized pressure on the practitioner to continue aggressive interventions post operatively. But then what if a substitute decision maker then says ‘no more’ at some point in that post-op period, insisting this was not what the patient was expecting? The age old tension in the informed consent process comes to the fore here: the question of how much information?

Photo courtesy of Doug Nicholson, Sunnybrook Media Source.

The TAVI procedure involves implanting a new heart valve without opening the patient's chest. Benefits to patients include reduced pain, smaller scars and a faster recovery.

Guidelines needed for Transcather Aortic Valve Implementation By Marie Sanderson new study suggests that modest delays in receiving transcatheter aortic valve implementation (TAVI) for severe aortic stenosis could have a substantial impact on the effectiveness of treatment. Aortic stenosis is a narrowing of the aortic valve opening that restricts normal blood flow to the body. Patients are typically older and often have other health issues, making them high risk for conventional surgery. TAVI has emerged as the preferred treatment for these patients as the replacement valve is implanted through a small incision in the groin or between the ribs, eliminating the need for a large chest incision. There is, however, a lack of data about what is an acceptable wait time for patients deemed as good candidates for TAVI. A team of investigators from the University of Toronto and the Institute for Clinical Evaluative Sciences in Toronto have used mathematical modeling with the results from a landmark randomized trial, Placement of Aortic Transcatheter Valves (PARTNER), to look what happens when TAVI wait times are increased. Even modest increases in wait times were found to have a substantial impact on how effective TAVI is in otherwise inoperable patients and high-risk surgical candidates. “To our knowledge, our study is the first to evaluate the effect of delayed access to TAVI, and provides insight into the importance of wait time and outcomes,” says lead investigator Dr. Harindra Wijeysun-

HOSPITAL NEWS JULY 2014

dera, interventional cardiologist at Sunnybrook’s Schulich Heart Centre and assistant professor at the University of Toronto. “Creating benchmarks for appropriate wait times should be a priority.” Published in the Canadian Journal of Cardiology, the study suggests that although TAVI would result in fewer deaths in patients deemed inoperable regardless of wait time, the magnitude of benefit decreased dramatically. In the high-risk surgical candidates, at TAVI wait times beyond 60 days, TAVI was less effective on average compared with conventional surgery. “Our findings have implications on care delivery for severe aortic stenosis patients who are TAVI candidates. Because of the importance of wait-time monitoring, ideally, detailed information should be collected on the time of referral for TAVI workup, the time at which diagnostic work-up is complete, and the time at which a patient is accepted for the procedure,” says Dr. Wijeysundera. “Data on delays in any of these intervals should be made available to programs in a timely fashion, such that cases can be triaged. This is especially important for the patients deemed as good candidates for surgery. The clinical decision of when high-risk surgery is preferable over TAVI should incorporate the program’s current TAVI wait time, and the associated potenH tial wait-time mortality.” ■ Marie Sanderson works in Communications at Sunnybrook Health Sciences Centre.

Does one acknowledge that the fix is effectively temporary, and you’ll have to discuss other options later to manage the nearly inevitable decline? Does one concede that the risks of a procedure are real and high…despite one’s expertise… and there should be a frank exploration of potential preferences for withdrawing care, while still focusing on the hope of the grand surgical solution? Looking at it ethically, the issue is about the value of truth telling and honesty. One can offer truth that is not entirely honest and open. So the ICD can be a clear and reliable improvement – its medium term nature can be a conversation saved for later, if one chooses to leave it. The high risk surgery is undoubtedly an option preferable to imminent death…even discussions about the risks pale in comparison to the dying soon. But how far should informed consent go to prepare for the honest possibility of a poorer outcome than hoped for?

Is there a possibility for a principled decision making approach to making informing and consenting as moral and as meaningful as possible? Clinically, the story is usually made even more complex by the time (not) available for these discussions, the urgency, the concern about diluting hope, the lengthy list of potential complications, the understandable hesitancy around facing one’s own professional limitations as a healer…all of these make the moral muck of consent a deep one. Complexity does not absolve us from trudging through that muck in pursuit of best practice, especially if we’re part of a team that is wading into it regularly. The worst thing is to become inured to that moral muck…to stop pursuing better practice. If some of that moral muck can be avoided by taking time to create a high quality process for approaching high risk consent – is there not a degree of obligation to make it happen, somehow? Could there be a team process, in part – standardized as far as possible? Is there a possibility for a principled decision making approach to making informing and consenting as moral and as meaningful as possible? Have any teams developed such approaches already? Let us know – tell the Ethicist at Hospital News….we’ll aim to share the responses. Email editor@hospitalnews. H com ■ Kevin Reel is Ethicist, The Centre for Addiction and Mental Health and Assistant Professor, Department of Occupational Science and Occupational Therapy, University of Toronto. www.hospitalnews.com

CARDIOVASCULAR CARE/RESPIROLOGY/DIABETES

Focus 25

Telehomecare is a self-management program that engages patients as partners in their own care plan, in their own home.

Telehomecare for COPD and Heart Failure: Using technology in the home to tap the power within the patient By Sharon Rose Airhart program that uses technology to link people in their own homes with specially-trained medical staff is aiming to address one of the biggest challenges of today’s health care system – chronic disease. Telehomecare is a self-management program that engages patients as partners in their own care plan, in their own home. It is expanding across Ontario to reach people living with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). It is also running a pilot project for people with diabetes. Telehomecare is a program of the Ontario Telemedicine Network (OTN). Patients receive a tablet monitor and standard medical devices to measure blood pressure, oxygen levels and weight and answer simple questions about how they are feeling. A dedicated, specially-trained nurse or respiratory therapist monitors results and provides health and lifestyle coaching. Doctors say the technology delivers objective data that enables direct and immediate feedback which patients grow to trust. That, in turn, helps medical staff teach participants how to manage their disease. “[Telehomecare] has been very powerful and I think it has really allowed us to treat patents and avoid some of the hospital emergency room visits that otherwise would have happened,” says Thuy-Nga Pham, director of the South East Toronto Family Health Team and deputy chief of the Department of Family Medicine at Toronto East General Hospital. In one recent case, a man in his late 60s had been identified by Toronto East General Hospital as a COPD patient at high risk for re-admission. The individual was enrolled in Telehomecare and, within a few weeks, Dr. Pham’s office noticed a drop in his oxygen levels. A physician assistant immediately contacted him and learned he was not taking his medication. He came to the office the next day for further training on how to take his medication and avoided the need to return to hospital. The anecdote is reflective of early results from the OTN Telehomecare, which is funded by the Ontario Ministry of Health and Long-Term Care and Canada Health Infoway. The William Osler Health System reported a 71 per cent reduction in in-patient hospital stays among COPD and www.hospitalnews.com

heart failure patients in the Telehomecare program between April and September in 2013. The program also saw a 43 per cent decrease in emergency room visits in the same period, when compared with the preTelehomecare rate. “OTN offers many opportunities that I think we could be utilizing much more,” Pham says. “I think the uptake in our province could go much faster and more broadly. We need to incorporate it into our daily practices more. It shouldn’t be innovation anymore. It should just be something we do.” The number one reason that CHF patients are re-admitted to hospital is that they stop following their medical and/ or dietary schedules. “Telehomecare addresses this shortfall by building trusting relationships with patients on which they can be coached and taught to behave differently,” says Sacha Bhatia, a cardiologist and the director of the Institute for Health System Solutions & Virtual Care at Women’s College Hospital.

“The most important notion is, can we prevent hospital admissions by acting early,” he says. “The Telehomecare program represents a fundamental shift to proactive care from reactive care. But for medical staff to be able to step in and help in a timely fashion, projects should be set up so that the information gathered from patients’ homes goes directly to their primary care physicians,” Pham says. While Pham has dedicated a physician assistant in her office to monitor the stream of data coming out of the homes of the 10 to 15 Telehomecare patients on her roster, most Telehomecare patients are monitored on behalf of their primary care providers by dedicated clinicians in Community Care Access Centres or hospitals like William Osler or Southlake Regional Health Centre. When there is a significant change for any individual, the clinician immediately informs the primary care provider who decides what steps to take.

“Most specialists monitoring cases of chronic disease don’t see their patients for months at a time. These large gaps can be reduced in some degree with home-based programs such as Telehomecare,” says Deborah Casey, a respirologist at Toronto Western Hospital who has referred several patients to Telehomecare. “The technology is useful to reach a greater number of people with chronic disease and to capitalize on “teachable moments,” when patients are most open to change,” she adds. “The power of this is in the patient, who you can teach to better manage their disease,” Casey says. The goal for technology-based, home-centred care should be to improve patients’ knowledge of their own conditions, increase their self-efficacy and introduce behavioral H changes. ■ Sharon Rose Airhart is Telehomecare Communications Lead, OTN.

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26 Focus

Enhancing the standards of

care in seating By Olivia McVey

hen Martina Tierney worked as an Occupational Therapist (OT) in hospitals, the community and long-term care with adults and children both, she was continually frustrated by the chairs she had to use with her patients. Standards of care in many other areas had moved on in leaps and bounds, but seating seemed to be stuck in the past. “As OTs, we were always being told to use evidence-based practice,” says Martina. “But when it came to seating, we were having to use chairs that had no clinical evidence to support their use, and in a lot of cases that is still happening today. In addition, there were lots of good choices for people who needed transport chairs for going down the street to the shops. For those who had pressure ulcers, there were little or no choices backed by solid, impartial clinical evidence.” With her engineer-husband and her family, Martina set out to design the Seating Matters range of chairs that would help to reduce pressure ulcers, improve posture and comfort and be backed by strong clinical evidence to prove their effectiveness. With their range of chairs being used extensively throughout the world, Martina partnered with a prestigious university in the UK, the University of Ulster, to develop a research project and clinical trial that would examine the use of the chairs and their effects on a range of clinical outcomes, including pressure ulcer reduction, quality of life and functional ability. “Independence and objectivity is important when doing research. We wanted the results to reflect what would happen in a real-life environment, with real caregivers, real patients and real variables in a typical hospital or care facility. For these reasons, the University of Ulster carried out the study and gained ethical approval for the clinical trial. This ensured that the results were true to life and not subject to any bias,”explains Martina. The research project was carried out over 12 weeks in three different facilities. Each participant was assessed before the study started to gain a full picture of the amount of pressure ulcers they had, their blood oxygen levels and functional ability together with interviews with caregivers, families and the participants themselves. This allowed the researchers to examine the effects on the entire person by using the Seating Matters chairs. The group was then split in two at random, the control group using their existing chairs, typical to hospital and care facilities, the intervention group using the Seating Matters chairs. Over the next 12 weeks the participants were monitored and the assessments were repeated at the end of the study. Those results enthused the researchers that what they were doing could make a big impact on patient care. “In the control group using their existing chairs, there were five per cent more pressure ulcers at the end when compared with the beginning. In the intervention group using the Seating Matters chairs, there was 88 per cent less pressure ulcers

HOSPITAL NEWS JULY 2014

in the exact same period of time. This is a really significant reduction,” says Martina. “When you look at the cost of pressure ulcers to our health care systems and the fact that around 23 per cent of people in hospitals and care homes have a pressure ulcer right now, knowing that we have a method to reduce the incidence of these costly and painful sores by 88 per cent marks a huge leap forward.” Martina and the therapists in her clinical team travel the world to share these results and to help their fellow clinicians raise the standard of care. Martina has also written 'The Clinician's Seating Handbook' as a reference guide to clinical seating provision, explaining the fundamentals of seating and how these can be implemented in real-life situations. Her family have also set up a network of home health care providers across Canada

and around the world to provide the Seating Matters chairs to patients. They are used extensively in hospitals, long term care homes and in the community. “It’s fantastic to see that the Seating Matters chairs, designed by therapists and backed by quality clinical evidence are being used so widely across Canada. It makes me proud that we are able to positively impact patient care, reduce pressure ulcers and make people more comfortable through something that my family pours our heart and soul into.” To learn more about the clinical trial, or to request a free copy of Martina’s seating handbook, visit www.seatingmatters.com To contact Martina directly email marH tina@seatingmatters.com. ■ Olivia McVey OT is a member of the Seating Matters Clinical Team.

Martina Tierney OT and ‘The Phoenix’. Named after the symbol for OT in Ireland, the Phoenix is shown to help reduce pressure ulcers by 88 per cent.

Two heads better than one when it comes to eHealth By Leah Hanna

hile efficiency and better patient care are the ultimate goals of eHealth initiatives and integrated electronic health records, the actual implementation of electronic health records has proven to be a challenging project for some hospitals. North York General Hospital has been steadily implementing advanced clinical systems throughout the hospital and is now almost entirely electronic – having been one of only three large hospitals in Canada to earn a Stage 6 designation from the Healthcare Information Management Systems Society in 2011. Because of the success the hospital has seen through eCare, the name NYGH has given its electronic health records strategy, other hospitals nation-wide have been looking to NYGH to help apply this success to their own organizations. Sonia Pagliaroli is the Manager of Clinical Informatics at NYGH and has been working on eCare since its inception in 2006. Pagliaroli says that it’s a common occurrence for other hospitals to call NYGH asking for assistance with one of their own eHealth projects – and inversely, it’s easy for NYGH to reach out to other hospitals for assistance as well. “I think we’ve established a strong collaborative environment amongst hospitals implementing similar clinical systems. Just as we feel comfortable reaching out to others for their advice and experience, we try to be as generous as possible with our time in supporting our colleagues with their eHealth projects,” says Pagliaroli. Pagliaroli says this kind of inter-hospital collaboration is beneficial not only to the hospital seeking assistance, but for all hospitals involved. While launching Phase 4 of eCare at NYGH, which involved

A patient being scanned with one of the hand-held devices that scans the patients ID bracelet and the patients medication before administering the medicine to ensure the right medication is going to the right patient. bringing eCare to surgery and maternalnewborn units, NYGH brought in trainers from Toronto East General Hospital and Mount Sinai to help with the process.

North York General Hospital has been steadily implementing advanced clinical systems throughout the hospital and is now almost entirely electronic “With Phase 4, having Toronto East’s assistance was hugely beneficial for us, since they had already implemented the same electronic surgery application, and

their experience and knowledge was invaluable. Mount Sinai also benefitted greatly from observing our implementation, as they will be embarking soon on their own maternal-newborn project,” says Pagliaroli NYGH has also been collaborating with hospitals from coast to coast, including Vancouver Island Health Authority in B.C. and Health PEI. “Collaboration provides a tremendous opportunity to learn from the experiences of others,” says Angela Doucette, a pharmacist and clinical analyst for Health PEI. “Often times the "lessons learned" from another hospital on what worked, and more importantly what didn't, are invaluable in moving a project forward.” Continued on page 27 www.hospitalnews.com

Healthcare Technology 27

New diabetes-specific electronic medical record Canadian first By Dahlia Reich he new system, a Canadian first, gives care providers access to patient information anytime, anyplace, improving care coordination, efficiency and effectiveness. The Centre for Diabetes, Endocrinology and Metabolism of St. Joseph’s Health Care London has long been a leader in innovation and diabetes care, and now another ground-breaking milestone has been reached. The team has successfully combined clinical and research work with technology to implement an innovative electronic medical record (EMR), the first of its kind in Canada. Web DR (Web-based Diabetes Records) is a fully functional diabetes-specific EMR. With no existing EMRs available to meet the needs of the outpatient diabetes clinic, the team, over the past two years, built this new system from the ground up under the leadership of Dr. Stewart Harris and Dr. Irene Hramiak, and project leads Dr. Tamara Spaic and Selam Mequanint. “Web DR is a diabetes-specific, webbased, researchable, electronic medical record and database,” explains Dr. Spaic. It is simultaneously used by the primary and tertiary diabetes specialists, medical trainees, diabetes educators, allied health professionals and administrative staff at three locations: the Diabetes, Endocrinology and Metabolism Clinic at St. Joseph’s Hospital, Diabetes Education Centre also at St. Joseph’s Hospital, and the Primary Care Diabetes Support Program at St. Joseph’s Family Medical and Dental Centre. (All are part of St. Joseph’s Centre for Diabetes, Endocrinology and Metabolism.) “Each patient has a unique Web DR medical record that can be used by all diabetes team members,” says Dr. Stewart Harris. “This allows coordination of care across disciplines and helps improve the efficiency and effectiveness of care delivery.” Web DR was built by an external vendor and is now fully supported by Information Technology Services at St. Joseph’s, providing maintenance and sustainability. It has a bidirectional link with the hospital electronic medical record system (Cerner), providing multiple interfaces with Cerner

Web DR Benefits

Improved documentation and efficiency: • From paper-based to electronicbased practice • From a desktop-based computer system to a web-based system that is enhanced to meet the needs of care providers anywhere, anytime, and improve care delivery • From dictation to electronic documentation • From manual faxing of consult notes to electronic distribution to referring physicians

Heather Reid, left, health information administrator, and endocrinologist Dr. Tamara Spaic were part of the team at the Centre for Diabetes, Endocrinology and Metabolism of St. Joseph's Health Care London that developed Canada's first electronic medical record specifically for diabetes - a web-based system that is enhancing care coordination and efficiency as well as diabetes research. to receive patient information and also send completed assessments and clinic notes back to Powerchart in Cerner. The clinic note, previously requiring transcription, is now created automatically using a unique combination of dropdown menus, checkboxes, and free text fields. This promotes ease of use and speed, while still preserving the narrative nature of the note. Web DR currently houses more than 15,000 patient records from the diabetes care programs at St. Joseph’s. At present, 14 physicians and more than 40 aligned health care professionals use Web DR for more than 90 per cent of patient visits. “There has been a great interest in Web DR across the region,” says Dr. Hramiak. “The next expansion will include the Paediatric Diabetes Clinic at the Children’s Hospital, London Health Sciences Centre. Future plans are to continue to expand to other care providers in the region.” Through the creation of Web DR, “we have learned that accepting new and let-

Two heads better than one Continued from page 26 Doucette says that Health PEI has been collaborating with hospitals across the country through the Cerner Regional User Group, comprised of all Cerner client hospitals in Canada. “It has been invaluable to have other analysts share with us what did or didn't work for them as far as design and workflow,” says Doucette. “NYGH and (Toronto East General Hospital) in particular were very generous with time and resources – hosting site visits for our team as well as answering questions over e-mail and sharing documentation.” Pagliaroli says that it`s crucial to success for hospitals to watch each other and learn from each other’s experiences. “After a hospital completes a project, there’s always a ‘lessons learned’ event www.hospitalnews.com

that everybody can benefit from,” says Pagliaroli. “Hospitals face similar challenges when implementing systems, so if they can learn from others implementations, it can ensure a smoother transition.” Doucette says that inter-hospital collaboration has not only been a major asset for Health PEI’s own initiatives, but has also helped them grow to the point where they can offer their assistance as well. “As we mature as an eHealth jurisdiction we are evolving into a position where we are able to give some advice and guidance,” says Doucette, “where traditionally H we have been the ones seeking it out.” ■ Leah Hanna is an intern, Corporate Communications and Public Affairs at North York General Hospital.

ting go of old requires time, support and strong leadership,” adds Dr. Spaic. “But once Web DR was fully adopted in the clinical practice, it was difficult to imagine not being connected and having information at your fingertips – anytime, anyplace. Today, we can say we are at the forefront of diabetes patient care. It is wonderful to see so much involvement from everyone, and the support from the hospital has been H great.” ■ Dahlia Reich works in Communications & Public Affairs at St. Joseph's Health Care, London.

Improved coordination of care: • Interface with the Cerner system for demographic information and real time laboratory results • One-patient, one-chart approach for optimization of care and enhanced patient safety • A dynamic link between providers to enhance information sharing and delivery of best practice in care of diabetes patients Quality Improvement and research • Facilitates access to researchable data for researchers, as well as medical students, research fellows and residents as part of their training • Allows care providers to measure workload, quantify their patient population demographic as well as a clinical profile for strategic planning and budgeting purposes. • Allows for the creation of reports for practice audits and influencing changes in care process

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28 Health Technology

FallsLab aims to keep Canadians upright By: Michael Ronchka espite researchers’ best efforts, no one has ever fallen in FallsLab. The newest lab in Toronto Rehab’s iDAPT Centre safely simulates falls so scientists can determine how to prevent them. A sophisticated robotic safety harness protects people from hitting the ground when they lose their balance. The FallsLab research may help prevent some of the 180,000 fall-related injuries Canadians aged 65 and over suffer every year.

Falls cause more than a third of all injury-related hospital admissions. Researchers at Toronto Rehabilitation Institute want to fix that. A Public Health Agency of Canada report documents that falls account for 85 per cent of seniors’ injury-related hospitalizations. Forty per cent of these falls result in hip fractures that lead to death for one in five seniors a year. These injuries are costly – Canadians spend approximately $2 billion annually on direct health care costs alone. Preventing a small percentage of falls could help seniors maintain their independence, enjoy a better quality of life and also ease the strain on the health care system. “Toronto Rehab is attacking this problem from two directions,” says Dr. Geoff Fernie, institute director, Toronto Rehab. “We’re helping train people who’ve recovered from a brain trauma and other injuries to regain their ability to resist falling. We’re also making changes to the environment to reduce the risk of falling. These changes include safer building code standards for stairs and better non-slip footwear for winter.”

YOU

FallsLab is the largest of its kind in the world. Force plates that measure the weight of the person moving or standing on them are attached together to form a moving platform. Researchers use infrared cameras and reflective sensors to watch how subjects move and react as the platform shifts. The measurements make it possible to analyze falls and test the effectiveness of interventions such as training or safety equipment. Other research at FallsLab is looking at how to best treat injuries affecting mobility. Dr. Adam Katchky, an orthopaedic surgery resident at the University of Toronto, was first in line when the lab opened. He is researching two types of knee replacement devices to see which one provides patients with the best balance after surgery. “Older platforms were too slow to make people fall, and too small to allow subjects to walk naturally. This platform creates motions jarring enough to simulate the types of falls that cause serious injuries. My research wouldn’t be possible without it,” says Katchky. “It feels like being on the subway when it stops suddenly,” says research participant Patrick Keenan. “Only the direction and the intensity changes each time, making the movement impossible to anticipate. Sometimes it’s really startling.” “FallsLab fits perfectly with iDAPT’s mission: keeping people safe and independent in their home as they age,” says Fernie. “People experience more slips and trips as they get older. Recovering becomes harder, and injuries worse. This research will advance falls prevention and treatment strategies that help people maintain their independence, a primary factor in H quality of life.” ■ Michael Ronchka is a member of the University of Health Network's Public Affairs and Communications team.

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HOSPITAL NEWS JULY 2014

A researcher demonstrates FallsLab’s moving platform and robotic safety harness.

Improving the adoption of innovative health technologies L

ast Fall, the Ontario government announced the creation of the Ontario Health Innovation Council (OHIC) – an exciting initiative that has the capacity to transform the way that the medical technology sector operates in the province. The Council, which is led by the Ontario Ministry of Health and Long-Term Care, and Ministry of Research and Innovation, seeks to “accelerate the adoption of new technologies in our health care system and support the growth and competitiveness of Ontario’s health technology sector.” The OHIC Terms of Reference state that the “council’s specific focus is to consider how Ontario can: 1) Facilitate technological innovations that promote health and well-being, improve access to health and health services, and deliver effective, efficient, quality care; 2) Strategically find ways to use the purchasing power of the province and broader public sector to accelerate the growth of the health technology sector; and 3) Expand the adoption of innovative new technologies more broadly across the health care sector (e.g., including hospitals, but also in-home and longterm care settings). With the recent re-election of the governing Ontario Liberal Party, the council is ensured an opportunity to continue their work. The government has directed the council to deliver a final report by late 2014 containing evidence-based strategic advice on how the objectives in the terms of reference can be achieved. As the association that represents Canada’s medical technology industry, MEDEC enthusiastically supports this initiative. Brian Lewis, President and CEO of MEDEC, says “With the announcement of this council, the Wynne Government has recognized that medical

technology companies are key partners in delivering better patient care, while creating new jobs and contributing to a more sustainable health care system.” Since the council officially convened, MEDEC staff, as well as many other sector leaders, have already taken the opportunity to present to its advisory board, highlighting opportunities that exist to better leverage the province’s innovative medical technology industry in order to improve patient outcomes, make the health care system more sustainable and improve the economy. One of the key messages delivered to the council by MEDEC was that in order to capitalize on these opportunities, we need to better adopt new medical technologies that have been created in Ontario and we need to make these adoption processes faster and easier to navigate. The council is chaired by Dr. Dave Williams, President and CEO of Southlake Regional Health Centre and its advisory board consists of individuals from various sectors that impact health care. They include leaders from hospitals, the medical technology industry, home care, academia, and more – all bringing a variety of different perspectives to the table. “When we embrace innovation as collaborative partners, we increase the likelihood that Ontarians can gain more timely access to the best medical technologies available” says Neil Fraser, one of the council’s advisory board members and President of Medtronic Canada. He adds, “The true promise of innovation lies in simultaneously increasing the quality of patient care, while lowering the total cost of each patient’s journey through the health care system.” The council is seeking ideas about how to accelerate the adoption of innovative new technologies into Ontario’s health care system and grow the province’s health technology sector. Join the conversation at: http://www.ohic.ca/en/ H join-conversation ■ www.hospitalnews.com

CARDIOVASCULAR CARE/RESPIROLOGY/DIABETES

Focus 29

Educational & Industry Events To list your event, send information to “events@hospitalnews.com”.

We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to “advertising@hospitalnews.com”

Q July 14–16, 2014 Health technology Assessment for Decision Makers Dalhousie University, Halifax Website: www.theta.utoronto.ca Q July 15–17, 2014 Virtual health Informatics Bootcamp Online Series, Canada Website: www.nihi.ca

Mobile app helps people reduce or quit drinking Kate Richards new mobile app developed by the Centre for Addiction and Mental Health (CAMH) offers those who want to reduce or quit drinking alcohol the ability to track and manage their drinking habits. Excessive alcohol consumption is a major public health concern, leading to over 200 diseases and injuries. In May 2014, the World Health Organization released a report that showed Canadians drink more than the global average, with 23 per cent of drinkers engaging in binge drinking.

Saying When App The new app, called Saying When, is a mobile version of a self-monitoring program pioneered by Dr. Martha SanchezCraig while a Senior Scientist at the former Addiction Research Foundation (now CAMH). Previously a paper-based manual, the program is clinically sound and has helped people cut back or quit drinking successfully for over 25 years. “We’ve been waiting for the technology to catch up to this program,” says Wayne Skinner, Deputy Clinical Director at CAMH. “The ability to discreetly track and monitor urges and consumption in real time will help people who are concerned about their drinking be successful with their goal to reduce or abstain.” Saying When is designed for people who are concerned about their drinking, but who do not have a severe alcohol use disorder. On launch, Saying When app users are presented with a tour of the app’s features, including an introduction to Canada’s Low Risk Drinking Guidelines developed by the National Alcohol Strategy Advisory Committee. Before moving on to track urges and consumption, app uswww.hospitalnews.com

ers will complete a section called “Taking Stock” to help determine current drinking patterns and set a baseline for future success. “Recent studies have shown that entertainment-based apps including drinking recipes or drinking games are the most common type of alcohol-related app,” says Tim Tripp, Director, Library Services & Knowledge Mobilization at CAMH. “To our knowledge, Saying When is the only mobile tool based on an established clinical program that helps people monitor their drinking and efforts to cut back or quit.” To make personal tracking easy and precise, the Saying When app describes and defines standard drinks through infographics. Each drink entered is measured when the app user fills the interactive glass and determines how many standard drinks they have consumed. Throughout the tracking process, the app is programmed to offer tips for success as the user makes progress. The coping section of the app also provides users with the opportunity to learn what strategies work best for them as they rank the success of each one over time. “Many people are motivated to change their drinking behaviour,” says Skinner. “Saying When gives them a way to do so on their own or, if they are getting help, to set goals and keep track of how they are doing, day by day. Having a mobile version of this resource will allow us to reach and help more people.” The Saying When app is now available H for purchase in the iTunes store. ■ Kate Richards works in Media Relations at The Centre for Addiction and Mental Health.

Q August 6–8, 2014 The 6th International Conference on Patient and Family Centered Care: Partnerships for Quality and Safety Westin Bayshore, Vancouver Website: www.cfhi-fcass.ca Q September 20–21, 2014 Minimally Invasive Gynaecologic Surgery University of Toronto Conference Centre, Toronto Website: www.cpd.utoronto.ca/migs/ Q September 26, 2014 CPAS – APAGBI Joint Meeting Montreal, Quebec Website: www.pediatricanesthesia.ca Q September 29–30, 2014 National Interprofessional Healthcare Conference Metro Toronto Convention Centre, Toronto Website: www.healthcareconferences.ca Q October 19–21, 2014 CAPHC Annual Conference Calgary, Alberta Website: www.caphc.org Q October 22–23, 2014 2nd Annual Reducing Hospital Readmissions & Discharge Planning Conference Marriott renaissance Harbourside, Vancouver Website: www.healthcareconferences.ca Q October 28–29, 2014 National Healthcare Practitioners Mental Health Conference Double Tree by Hilton, Toronto Website: www.healthcareconferences.ca Q November, 2014 2nd Annual National Correctional Services Healthcare Conference Ottawa Website: www.healthcareconferences.ca Q November 3–5, 2014 HealthAchieve 2014 Metro Toronto Convention Centre, Toronto Website: www.healthachieve.com Q November 30–December 5, 2014 RSNA 2014 McCormick Place, Chicago Website: www.rsna.org Q December 4–5, 2014 2nd Annual National Operating Room Management Conference Vancouver Website: www.healthcareconferences.ca

To see even more healthcare industry events, please visit our website www.hospitalnews.com/events JULY 2014 HOSPITAL NEWS

30 Travel

Luxury in the wilderness:

Canada’s lodges By Craig Burkinshaw anada is a country that evokes a sense of untouched landscapes and pristine wilderness teeming with wildlife, where pure mountain air blows across crystal clear glacial lakes. There is no better way to experience this tranquillity than with a stay in a luxury lodge, and Canada has some indulgent options for those looking to do exactly this. Here are my top 5 luxury lodges in Canada.

with antique furniture and boasting some impressive touches such as down duvets and cotton bathrobes. For those wanting to take advantage of their remote surroundings, activities include clay pigeon shooting, kayaking, mountain biking and horse riding, while those simply wanting to relax will welcome a visit to the property’s spa, where guests can take in their remarkable surroundings from the comfort of an outdoor hot tub.

Clayoquot Wildnerness Lodge

Nimmo Bay Wilderness Resort

It’s a 55 minute sea plan across the Strathcona Provinicial Park to reach the Clayoquot Wilderness Resort, and this property well and truly lives up to its name. 23 luxurious, safari style tents make up the accommodation, each lavishly decorated

Ever heard of British Columbia’s Great Bear Rainforest? If so you’ll know it’s is one of the largest tracts of unspoiled temperate rainforest left in the world, and one of my favourite places to stay in this area is Nimmo Bay Wilderness Resort. This property is

a family-owned resort offering an intimate experience in a fantastic location. You will stay in one of just nine luxury cabins at Nimmo Bay, feast on fresh coastal cuisine and take part in some of the many activities on offer. Bear viewing is a given here, but don’t miss out on the opportunity to heli-hike, fish, go beachcombing or on a glacier tour.

The Wickaninnish The Wickaninnish is a Relais and Chateaux property, a name synonymous with luxury. “Rustic elegance on Canada’s west coast” is how the hotel is described and rightly so; it sits on the shoreline looking out across the Pacific ocean. This is a great hotel for those who care about travelling responsibly as it has attained Five Green Keys (out of a possible five) in the Green

A single source for your clients’ home care and rehab needs People with serious injuries often need a variety of health care services – attendant care and nursing for their daily needs and physiotherapy and other rehabilitative services to make the best possible recovery. Bayshore Home Health and Bayshore Therapy & Rehab, the newest addition to the trusted Bayshore brand of health care offerings, can provide professional services in both areas. Our caregivers and rehab professionals are supported by internal clinical experts and our National Care Team – a convenient central contact point for workers’ compensation boards, insurers and government care programs, providing standardized reporting and timely service with a personal touch.

1.877.289.3997 www.bayshore.ca

Better care for a better life HOSPITAL NEWS JULY 2014

Therapy & Rehab

Key certification scheme which awards accommodation facilities for exemplary environmental stewardship. Only 50 hotels in the world have achieved this so it is a great reflection of the hotel’s commitment to reducing its carbon footprint. All of the rooms at ‘The Wick’ have waterfront views and the Pointe restaurant is the only 4 Diamond restaurant north of Victoria – make sure you book well in advance if you want to dine here!

Arctic Watch The Arctic Watch Wilderness Lodge itself is not the most luxurious of properties, but there is no denying the location certainly is. Located 500 miles north of the Arctic circle, Arctic Watch is the most northerly and remote lodge in the world, presenting a unique opportunity to explore the magical Arctic environment in relative comfort. The lodge claims to serve the best food in Nunavut and I think it’s got a strong case! Sample musk ox tenderloin or fish caught fresh that day as you catch a waft of freshly baked bread from the property’s kitchen. Wildlife thrives on Somerset Island and is one of the best places for beluga whale sightings. You can also expect to see musk oxen, caribou, arctic foxes and even polar bears.

Fogo Island Inn A contemporary hotel off the northern coast of Newfoundland, Fogo Island Inn is a fantastic place in which to unwind and enjoy your isolation. There are 29 suites at the property as well as a library, art gallery, lounge, cinema, gym and hot tubs, not to mention an enticing restaurant serving tasty local dishes, all created by a renowned local chef. Take in your wild surroundings through the floor to ceiling windows in your room, where the sea views seemingly go on forever. Wireless internet is available for those who don’t want to feel completely cut off H from the outside world. ■ Craig Burkinshaw is a Founding Director of Audley Travel. www.hospitalnews.com

CARDIOVASCULAR CARE/RESPIROLOGY/DIABETES

Focus 31

First in Canada: Innovation Unit helps deliver patient-centred care By Catalina Guran ackenzie Health is transforming care through the creation of an Innovation Unit, a firstin-Canada project which features a unique integration of advanced technology that transforms the delivery of care. A first in Mackenzie Health’s Innovation Journey, the Innovation Unit is an acute care medical unit that has been transformed into a living and breathing laboratory for innovations to be developed, evaluated and adopted by other patient care units at Mackenzie Richmond Hill Hospital, as well as the new Mackenzie Vaughan Hospital and at the health system level. The Innovation Unit includes 17 Smart Patient Rooms (34 beds) which feature “smart” badges, “smart” stations, “smart” therapeutic beds, patient call lights and hand hygiene support systems as part of a multi-phase implementation designed to enhance the quality of care. Enabled by an interactive environment, the beds have a number of features that communicate information directly to the clinical staff who are caring for patients, including patient and bed rail positioning, and if patients are entering or exiting their bed. “Smart” stations with an enhanced user interface are installed in every room and at the Nursing Station to provide staff with

access to patients’ information and status. Each staff member wears a badge which identifies their location on the unit, alerts them of any patient calls, enables staff communication and records patient call response times. Dome light indicators outside each room alert the staff to whether patients are at risk for falls, track the nurses’ location and communicate real-time information to the status boards. The hand hygiene support solution utilizes a system that reviews hand hygiene and proactively alerts staff of potential “missed” hand-hygiene opportunities

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through proximity sensors. “The Innovation Unit is about using innovation to drive change and become more patientcentred,” says Tiziana Rivera, Chief Nursing Executive and Chief Practice Officer, Mackenzie Health. “By implementing technologies that are designed and integrated to improve the patient experience and clinical outcomes, doctors and nurses are better able to perform their roles and deliver safer, more efficient care to patients.” The concept, design and implementation of the Innovation Unit have been developed by Mackenzie Health in collaboration with Hill-Rom, a leading provider of medical technologies for the healthcare industry. Mackenzie Health has also partnered with the Ivey School of Business to evaluate the impact of the integration of technology on quality, safety and patient care. Once the evaluation of the Innovation Unit has been completed, the findings will inform plans for the future expansion of this new and innovative approach to care across the hospital and beyond. On June 19, 2014, Mackenzie Health celebrated the official launch of the unit alongside technology, academic and community partners, local government representatives, hospital leaders, as well as staff H and physicians. ■ Catalina Guran is a Communications and Public Affairs Consultant at Mackenzie Health.

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• Promote your booth to key decision makers PRIOR to the show in November. • Research show 75% of delegates have planned their visits prior to the show. • Reach over 50,000 healthcare professionals and decision makers. • Delivered to the desks of over 2,500 CEO’s and Senior Management ŽĨ ,ŽƐƉŝƚĂůƐ Θ >ŽŶŐ dĞƌŵ ,ĞĂůƚŚĐĂƌĞ &ĂĐŝůŝƟ ĞƐ ĂĐƌŽƐƐ ĂŶĂĚĂ͘

Call T oda Please contact y ! Denise Hodgson

at 905-532-2600 x2237 or denise@hospitalnews.com HOSPITAL NEWS JULY 2014