A hospital without walls
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Transforming how we provide care
A hospital without walls What if we could send patients home a day after surgery? What if patients could check-in with their specialist from the comfort of their home? What if our emergency teams could help resuscitate a child in Niagara, from Hamilton? At Hamilton Health Sciences, we’re replacing “What if” with “We are”. Our teams are using digital and technological innovations to transform care, beyond our hospital walls. In doing so we have the potential to:
Create a more connected system by maintaining a consistent care team
Empower patients to be more involved in their health care Prevent hospital stays by predicting complications before they happen
Reduce costs by avoiding unnecessary hospital visits Improving access to virtual care so patients can stay in the comfort of their home
Read on to learn more about how our teams are making this a reality
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Wearable medical devices
Preventing ER visits after heart surgery
Eighty-two year old Beverly Herridge was preparing for knee replacement surgery when she learned she needed heart surgery, too. Beverly needed a transcatheter aortic valve implantation (TAVI), a minimally invasive procedure to replace a damaged aortic valve. TAVI is a highly effective alternative to openheart surgery, which can be taxing and even dangerous for older people. Three-quarters of TAVI patients are able to go home within 24 hours of the procedure, versus up to 10 days after open-heart surgery. However, about 20 per cent of TAVI patients also have abnormal heart rhythms that send them back to the emergency room for care. Dr. Madhu Natarajan, a cardiologist at Hamilton Health Sciences (HHS), is leading a study that’s using remote heart monitoring technology to detect and flag any abnormalities before they become serious. “This is an early warning system that allows us to see episodes of abnormal heart rhythms before complications occur,” says Dr. Natarajan. “If needed, the patient comes directly back to our centre rather than their local hospital or the emergency department, which prevents ER visits and creates a more seamless patient experience.”
We’re sending portable technology home with patients to help them recover better from surgery.
After Beverly’s surgery, she returned home with her portable monitoring device, developed in partnership with m-Health Solutions. It picked up an irregular heartbeat and alerted her medical team. She returned to HHS for a pacemaker without any complications. The study team is optimistic about the positive impact that remote monitoring technology is already having on their patients and the broader system. The Redirect TAVI project is supported by the Ministry of Health and Long-Term Care’s Health Innovation and Strategies Branch through Ontario Centres of Excellence.
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Making surgery safer with remote monitoring
It’s easy to think that a patient having surgery is most vulnerable in the operating room, but patients are actually most at risk in the days and weeks after surgery. “Surgery itself has become safer due to monitoring technology used within the operating room (OR),” says Dr. PJ Devereaux, cardiologist at Hamilton Health Sciences (HHS), and co-principal investigator for the SMArTVIEW project. “But outside of the OR, patients aren’t monitored as closely, leaving room for complications to develop.” SMArTVIEW is a clinical trial currently underway at HHS that’s exploring the use of unique monitoring technology to help patients have a safer recovery from surgery. By utilizing Phillips Healthcare technology, SMArTVIEW is designed for early intervention to prevent complications and subsequent emergency room visits or hospital re-admissions. In hospital, SMArTVIEW constantly tracks a patient’s respiratory rate, blood pressure, pulse and blood oxygen through a wireless wearable device and makes that data available to the nurse in real-time. Any subtle change prompts an alert for the nurse to return to the bedside to check the patient.
Each year, 2 million adults worldwide die within 30 days of having surgery.
Once home, patients are given Phillips Bluetooth-enabled equipment. They input their vitals into the system several times a day for the nurse to review virtually. Patients also have daily video conferences with their nurses to discuss their recovery progress. “There’s intelligence built in to the system,” says Dr. Michael McGillion, co-principal investigator for SMArTVIEW. “So, if there’s a change in weight for example, the system asks the patient if their ankles are swollen or if they’re short of breath. If answered yes, the nurse receives this information to help guide the video conference with the patient.” SMArTVIEW aims to engage patients and their healthcare teams in a connected care strategy throughout the entire recovery process. 6
Reducing post-surgical complications
Our researchers are exploring whether a futuristic, horseshoe-shaped device can help make sure that patients recover smoothly after surgery. While our teams seek to prevent common complications that affects patients after they have heart surgery through the SMArTVIEW project (pg. 6), they’ve also turned their attention to other types of surgeries that come with their own risks. Researchers at the Population Health Research Institute (PHRI) of Hamilton Health Sciences and McMaster University are trialing a new wearable device to see whether it can detect and help prevent post-surgical complications. It applies the same amount of vital signs monitoring that happens during surgery, to patients after surgery in intensive care units and once they’re home. Vitaliti™ is a horseshoe-shaped device developed by Kitchener-based Cloud DX that’s worn around the patient’s neck with an in-ear sensor and two electrodes to continuously monitor multiple vital signs, including heart rate, blood oxygen, temperature, blood pressure, respiration and body movements.
“We’re using machine learning to help predict and prevent complications, rather than reacting after they happen” Dr. P.J. Devereaux co-principal investigator and cardiologist at HHS.
“Obtaining a continuous blood pressure reading through a wearable sensor is a key next step in remote patient monitoring after surgery,” says Dr. Michael McGillion, co-principal investigator on Vitaliti and assistant dean of research in the School of Nursing at McMaster University. The current gold standard for continuous vital signs monitoring in the operating room and intensive care unit is a catheter inserted in to a major artery – an invasive and uncomfortable procedure. The goal of the Vitaliti project is to prove that wearable devices combined with intelligent software systems can be just as effective.
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Virtual care
Saving kids’ lives from kilometres away
What if doctors at McMaster Children’s Hospital (MCH) could help save a child’s life, from kilometres away? Thanks to a new pilot project with Niagara Health, they already have. Together, our teams are using live-streaming technology to bring MCH expertise in to the emergency room in Niagara to help stabilize kids who arrive in life-threatening condition. The technology allows our doctors to virtually be in two places at once. Although MCH is the regional hub for children’s health care, in emergency cases kids are sometimes taken to their nearest community hospital to get immediate medical care. Since community hospitals aren’t fully equipped for complicated cases, these patients are often transferred to MCH once stabilized. The Tele-Resuscitation project at MCH allows our emergency teams to remotely coach their colleagues at Niagara Health through advanced techniques to stabilize patients as quickly as possible. Using video conferencing-like technology from our partners at Ontario Telemedicine Network, emergency doctors at MCH are given a bird’s-eye view of the patient and the resuscitation room at the partner hospital using high-definition cameras. The MCH team can control the camera views and speak and listen to the doctors and nurses on the other end. It’s like FaceTime, except the stakes are much higher.
We’re collaborating with system partners to improve outcomes for kids in critical condition.
“We’re focused on reaching beyond our walls to provide the best care possible to our most critical patients. This includes drownings, car accidents, poisonings, and acute asthma attacks,” says Dr. Chris Sulowski, deputy chief of pediatric emergency medicine at MCH and tele-resuscitation lead. “The system provides a view as if we’re standing there ourselves, allowing us to give advice and act as an extra set of eyes.” It’s the first such system in Ontario and part of MCH’s vision to improve emergency care for kids throughout our region.
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Improving access to specialist care, from home
Anna lives part time in Toronto and part time in London, England. She has ulcerative colitis and needs to see her gastroenterologist regularly, who’s located at Hamilton Health Sciences (HHS). For Anna, scheduling appointments is challenging. Her condition can make the commute from Toronto to Hamilton uncomfortable. Our teams are trialing virtual care technology that allows patients like Anna to check in with her healthcare team from home. “E-visits make the appointment only about the patient’s health, not about the stress of getting there,” says Nate VandenDool, clinical manager at HHS and project lead. “We’re trying to demonstrate that e-visits reduce cancellations and no-shows because they’re more convenient for our patients and they make better use of doctors’ time.” E-visits support reduced reliance on hospitals for non-urgent care, eliminate the risk of patients being exposed to illness while they’re there, and save time and money associated with travel. For clinic staff, shifting routine appointments from in-person to the virtual space allows more time for teams to support patients with more complicated needs, which may in turn reduce emergency room visits.
93% of patients surveyed said e-visits improved their patient experience at HHS.
The HHS e-visits pilot project, in partnership with the Ontario Telemedicine Network, will measure the impact of an e-visit model among outpatients across HHS. This is just one example of how HHS teams are using virtual care technology to improve patient care and bring greater efficiency in to our system. Before the project, Anna’s plans were made around her clinic appointments. Now, her doctor is only a click away.
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Utilizing technology to create healthier communities outside our walls
We’re proud to be partnering with the following companies on these projects.
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