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Successfully managing chronic diseases in the elderly FOCUS IN THIS ISSUE

GERONTOLOGY/ALTERNATE LEVEL OF CARE/HOME CARE/REHAB:

www.hospitalnews.com MARCH 2017 EDITION | VOLUME 30 | ISSUE 3

Geriatric medicine, aging-related health issues and senior friendly strategies. Best practices in care transitions that improve patient flow through the continuum of care. Programs and advancements designed to keep patients at home. Care in rural and remote settings: enablers, barriers and approaches. Rehabilitation techniques for a variety of injuries and diseases.

Changing the way we approach concussion care INSIDE Evidence Matters ...............................18 Trends in Transformation...................20 From the CEO’s desk ......................... 21 Nursing Pulse .....................................29 Careers ............................................... 31

Photo courtesy of UHN

World first:

Living without lungs Removing both lungs for six days saves a mom’s life Story on page 6

Dr. Shaf Keshavjee, Surgeon-in-Chief, Sprott Department of Surgery at UHN, Director, Toronto Lung Transplant Program, and one of the three thoracic surgeons who operated together on Melissa to remove both her infected lungs, explains what the medical team did and why.

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HOSPITAL NEWS MARCH 2017

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In Brief

Digital health reduces wait times

by pulling Canadians out of the queue

“Digital health solutions improve access and reduce wait times for Canadians by avoiding certain in-person visits,” says Michael Green, President and CEO, Canada Health Infoway (Infoway). Recently, the Canadian Institute for Health Information (CIHI) released a survey How Canada Compares: Results From The Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries, which shows that Canadians report some of the longest wait times for doctors, specialists and emergency department visits compared to citizens in peer countries. “These findings remind us that Canada can learn from other nations and explore how digital health solutions can be used to address wait times and access barriers,” says Michael Green, President and CEO, Canada Health Infoway. Recent studies indicate the vast majority of Canadians want access to digital health solutions. Federal investments

through Infoway, and collaboration with the provinces, territories, clinicians and other partners has helped double its availability in Canada over the last two years.

“Digital health solutions improve access and reduce wait times for Canadians by avoiding certain in-person visits,” says Michael Green, President and CEO, Canada Health Infoway (Infoway). Patient portals, telehomecare and virtual visits are some of the solutions helping Canadians avoid getting in line for certain GP and emergency department visits, increasing access for those who need or prefer a face-to-face appointment.

Warning stickers and patient information handouts to be mandatory for all opioids dispensed in Canada Reducing the harm associated with problematic use of opioids requires a comprehensive response that involves health professionals, law enforcement, and all levels of government. In addition, we must take steps to better inform Canadians about the potential risks associated with the use of these medications. On February 17th, Canada announced that it will put forward a regulatory proposal to make warning stickers and patient information handouts mandatory with all opioids dispensed in Canada. This commitment to raising awareness is a component of Health Canada’s Opioid Action Plan. The sticker would warn patients about the risks of addiction and overdose with opioid use, and would be applied to the container being dispensed to the patient. The handout would contain broader information on the safe use of opioids and important risks associated with opioid use. By being better informed about their medications, Canadians will be better able to use them appropriately and reduce risks of dependence and overdose. Health Canada’s proposed content for the sticker and handout is currently www.hospitalnews.com

being developed based on the recommendations of the external Scientific Advisory Panel on Opioids, which met in November 2016. The Panel’s full recommendations can be viewed online in the Panel’s Record of Proceedings. The proposed content and format for both the warning sticker and patient handout will also be included with the draft regulations as part of the Canada Gazette, Part I consultation process later this year. Health Canada’s Opioid Action Plan focuses on a broad range of actions to address all parts of the opioid crisis. It includes better informing Canadians about the risks of opioids, supporting better prescribing practices, reducing easy access to unnecessary opioids, supporting better treatment options, reducing the availability and harms of street drugs, and improving the national evidence base. The Joint Statement of Action to Address the Opioid Crisis further builds on commitments to take action on this crisis. By working together, we can protect ourselves and our families from the harms associated with the problematic H use of opioid medications. ■

Infoway’s consumer health strategy aims to provide more Canadians with secure access to their health information, telehomecare solutions that reduce hospitalization and reliance on Emergency Departments, and other digital health services. “With support from the Government of Canada, Infoway is working with its partners to connect Canadians to their health information, their care teams and digital tools in order to maintain the momentum that is already driving increased access to care and reducing wait times,” added Green. Below are some examples of digital health solutions that are increasing access and reducing wait times:

Patient portals

• In Nova Scotia, 91 per cent of individuals who used MyHealthNS, a province-wide patient portal, to send a message seeking medical advice said they might have otherwise made an in-person appointment to see their doctor. • British Columbians who received their lab results online were significantly less likely to need an in-person visit to receive or discuss their most recent lab results (59 vs. 83 per cent).

Virtual visits

• 57 per cent of BC residents who had a virtual visit with a primary care provider said they avoided an in-person visit with their doctor/regular place of care.

Telehomecare

• 86 per cent of telehomecare patients indicated less need to visit an emergency department while receiving reH mote care in their own homes. ■

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Pioneering home care safety improvement Striving for safe patient care when delivering home care services poses many challenges. Inconsistencies in care planning and delivery, potential medication errors, and home safety risks are examples of possible risks. Eight leading home care organizations, part of the Home Care Safety Improvement Collaborative, are working to improve safety and quality as they collaborate to apply proven improvement techniques to introduce and support sustainable change that will keep patients safe in their homes. This initiative is led by the Canadian Home Care Association (CHCA) and Canadian Patient Safety Institute (CPSI), who will work with these frontline home care providers and government home care programs to develop effective strategies to engage patients and carers in improvement initiatives; build effective communication strategies and high functioning teams; and engage senior leadership to reinforce safety as a strategic priority. “Falls, infection and medication incidents are the major safety issues facing people receiving home care, and half of them are preventable,” says Chris Power, CEO, CPSI. “Through the engagement of home care recipients and their families and home care providers in safety improvement work, we can ensure safety and effective home care delivery.” “Providing care in the home setting poses unique safety challenges,” says Nadine Henningsen, CEO, CHCA. “The safety improvement collaborative will provide teams with the necessary tools and knowledge to prevent falls, safety manage medication and improve overall quality of care.” The eight home care organizations involved in the collaborative are: Beacon Community Services, Care at Home Services, CBI Health Group, Central West Community Care Access Centre, Nova Scotia Health Authority, Spectrum Health, Vancouver Island Health Authority and VHA Home Healthcare. Team results from the collaborative will be available in early 2018 and shared broadly with stakeholders across the H country. ■

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Editorial

UPCOMING DEADLINES

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Frailty and the

new ageism By Kenneth Rockwood

hould medicine be ageist? A young trainee doctor recently proposed to me that it should. Healthcare is overstretched, she argued. “We can’t do everything for everyone, so why spend money on old people, who have little chance of benefit?” For her, ageism is not all that bad – in fact, it’s a practical response to limited resources. I’m unpersuaded. Ageism is not benign. We fail older people when we treat them, as typically we do, in ways that are at odds with how ageing works. Ageism masks our need to do better. The challenge is the complexity of ageing. With age, almost all diseases become more common. Healthcare has gotten pretty good at treatment, assembling teams that specialize in specific problems. Kudos and full-page ads celebrate this focused, subspecialized care. Here’s the trick though: patients do best when their single illness, no matter how complicated, and no matter what their age, is their main problem. Subspecialized care may work very well for them. The complexity of ageing arises because, as we age, we are more likely to have more than one illness and to take more than one medication. And as we age, the illnesses that we have are more likely to restrict how we live – not just outright disability, but in our moving more slowly, or taking care in where we walk, or what we wear or where we go. Not everyone of the same age has the same number of health problems. Those with the most health problems are frail. And when they are frail, they do worse. Often, those with frailty do worse because healthcare remains focused on single system illness. Our success with a single illness approach has

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ADVISORY BOARD Cindy Woods,

Senior Communications Officer The Scarborough Hospital,

Barb Mildon,

RN, PHD, CHE , CCHN(C) VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences

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EDITOR

KRISTIE JONES

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For healthcare, such a notion would be self-defeating. If frail patients are unsuited to the care doctors provide, we must provide more suitable care. People get sick the only way they know how. Frail older adults consume a lot of care. Far better that those of us in the health system treat them as our very best “customers.” That would improve care for everyone. No one admitted to hospital benefits from poor sleep, but (mostly) we get away with it in our fitter patients. Not so in the frail, in whom it leads to worse outcomes: longer stays, more confusion, more medications, more falls and a higher death rate. No one benefits from being immobilized too long. No one benefits from not having medications reviewed, or from poor nutrition, or inadequate pain control, or getting admitted when care at home would be better, or in not clearly

Helen Reilly,

Publicist Health-Care Communications

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President Brainstorm Communications & Creations Director, Public Affairs, Community Relations and Telecommunications Rouge Valley Health System

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discussing goals of care. Just because the health system mostly gets away with it in fitter patients is no reason to forego change. Changing routines to improve care will benefit everyone. But it won’t happen if we see frailty as an acceptable form of ageism. We need to invest in better care and in better understanding how to design, test and implement it. As important as subspecialties are, by definition, each subspecialty group benefits a small fraction of people. The skills required to provide expert generalism, particularly for frail older adults, have been less celebrated. Compared to disease research, ageing and frailty are barely on the funding radar screen. In any guise, ageism can be insidious. We don’t have to go far to find it. I find it in myself when I’m in a long line. It’s not the science of how movement becomes slow that saves me then – it’s realizing that slowness is not a moral failing, much less one directed at my busyness. What we do in our health system now fails older people who might benefit if we provided better care. In that way, it fails us all. Attitudes must change. Medicine should not be ageist. It shouldn’t even be frailest. As a society, we all should take up this marvelous challenge, one that we are privileged to face. We must work to provide better care for frail oldH er adults, especially when they are ill. ■ Kenneth Rockwood is a geriatrician in Halifax, Nova Scotia and a researcher with Canadian Frailty Network (CFN), a not-for-profit organization dedicated to improving care for older Canadians living with frailty.

Bobbi Greenberg,

Health care communications

Sarah Quadri Magnotta, Health care communications

Dr. Cory Ross,

B.A., MS.C., DC, CSM (OXON), MBA, CHE Dean, Health Sciences and Community Services, George Brown College, Toronto, ON

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Ontario Hospital Association

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HOSPITAL NEWS MARCH 2017

Compared to disease research, ageing and frailty are barely on the funding radar screen.

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biased us to think that this is the approach we should always take. When frail people show up with all their health and social problems we see them as illegitimate – as unsuited for what we do. So, would the young doctor be right if instead of restricting care in old people, she simply opted for restricting care for frail people? Should “frail-ism” be the new ageism?

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Helping discharged patients

manage chronic conditions at home By Melissa Raftis ean Brown says Niagara Health’s Integrated Comprehensive Care (ICC) program has changed her life. In December 2016, the 73-year-old grandmother was recovering from a heart attack when she started having trouble breathing.

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The program directly integrates hospital and community care services

Ms. Brown received care in the emergency department at Niagara Health’s Welland Site, where she was then connected with an Integrated Care Co-ordinator after it was determined she met the criteria for the ICC program. Launched last April, the program directly integrates hospital and community care services for patients who are admit-

ted with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) and require home care after discharge. Ms. Brown no longer drives and has limited ability to travel. “So when they said the healthcare workers would come to the house, I said this is wonderful.” Ms. Brown was discharged from Niagara Health’s Welland Site on a Friday. By 9 a.m. Saturday, a nurse was knocking at her front door to deliver care. “I was so happy to see her the next day because I was scared,” says Ms. Brown. “She took my blood pressure and she explained a lot of things and explained what happened to me.” Heather Paterson, Niagara Health Director of Patient Care and Integrated Comprehensive Care project lead, says as of the end of 2016, 311 patients have come through the ICC program. Integrated Care co-ordinators act as a link between hospital specialists and connect COPD and CHF patients with necessary service providers in the community, including home care provided by St. Joseph’s Home Care.

Integrated Care Co-ordinator Barb Berketo with Heather Paterson, Niagara Health Director of Patient Care and Integrated Comprehensive Care project lead. “The feedback from our patient satisfaction surveys has been very positive,” says Ms. Paterson. “So far the data is indicating that we’ve created significant positive change.” Patients and their family members have access to support on a 24/7 basis for 60 days after discharge. For Ms. Brown, that means she receives home visits from nurses, physiotherapists and a dietitian. “I learned a lot from this program. The dietitian came to my house and showed me how to read labels,” says Ms. Brown. “I honestly believe if I would have had this program after my first heart attack, I don’t think I would have had the heart attack in December because I think I would have understood what was happening.

The nurses really explained it to me and explained what I have to do.” For those patients who are readmitted, Ms. Paterson says they are staying in hospital for shorter periods of time because they are learning to manage their chronic conditions. “It’s making the transition from hospital to home a more seamless one,” says Ms. Paterson. The ICC program builds on the success of St. Joseph’s Health System’s early work in launching an innovative approach to integrated care and currently includes all acute care hospitals in the Hamilton NiH agara Haldimand Brant LHIN. ■ Melissa Raftis is a communications specialist at Niagara Health Services.

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Cart full of fun helps seniors ACE their hospital stay By James Wysotski

or patients on St. Michael’s Acute Care of the Elderly (ACE) Unit, the new activity cart helps pass time more enjoyably. For their caregivers, it contributes to getting the seniors home sooner. Full of newspapers and magazines, colouring books, radios, large-print novels and games like bingo, cards and dominos, the cart features activities to stimulate the mind and keep patients engaged, explains Joanna Stanley, a physiotherapist from the Regional Geriatric Program (RGP) who works on the unit. In keeping with the unit’s philosophy of designing care around seniors’ needs, the cart also offers specific activities tailored to each patient, such as embroidery or knitting, if they’ve been requested. “Some of the activities on the cart help keep the patients oriented, and that’s important because it can help prevent delirium,” adds Stanley. Along with RGP occupational therapist Lisa Vandewater and PT/OT assistant Edma Apostol, Stanley helped create the cart in November 2016, a month after the ACE Unit opened. Created for the Volunteers Involving Seniors in Activities – or VISA – Program, which has been running at St. Michael’s for several years, the cart allows volunteers to engage patients in activities and conversation during friendly visits. Each day, the trio sets up the cart for the volunteers and provides a list of patients for them to visit. Equipped with fresh newspapers and sometimes an iPad, the volun-

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“Keeping patients engaged in activities helps to keep them oriented and reduce the incidence of delirium, which can contribute to a shorter length of stay.” – Joanna Stanley, a physiotherapist from the Regional Geriatric Program

Photo courtesy of Yuri Markarov, St. Michael’s Hospital

Volunteer Pauline Aarons hands items from the seniors’ activity cart to Maria Raso, a patient in the Acute Care of the Elderly Unit. teers discuss current events or search for images such as places where the patients grew up. Since many of the patients have short-term memory impairments, these activities help to provide mental stimulation through reminiscence. “It’s a good launching point for further conversations,” says Stanley. While the VISA visits help with orientation, they also improve the patients’ hospital experience.

Passing time more enjoyably is another benefit. “Interactions with the volunteers help reduce the stress and anxiety related to being in the hospital environment,” says Vandewater. “There’s also the added benefit of more time spent sitting up or out of bed, both of which further therapy goals,” adds Stanley.

While many of the items on the cart were on the unit before its inception, Volunteer Services has also been a huge support by offering funds to make rooms more senior-friendly, as well as providing new cart items to improve the patient H experience. ■ James Wysotski works in communications at St. Michael’s Hospital.

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Unique exercise program for seniors By Ania Basiukiewicz esearch suggests that falls are the leading cause of injuries among older adults, such that 20 to 30 per cent of older adults living independently experience one fall each year. Canadian physical activity guidelines recommend that older adults get at least 150 minutes of moderate physical activity weekly, participate in activities to help strengthen muscle and bone at least twice weekly, and engage in physical activities that will help enhance balance and prevent falls. To help improve the health of seniors in the community, Trillium Health Partners created the Strong and Steady Falls Prevention Program (Strong and Steady) for adults 65 years and over who are at risk of falls. The program aims to improve their strength, balance, endurance and gait. To deliver Strong and Steady, THP partnered with the City of Mississauga to design a program that allows hospital staff to work out of a bright, attractive and well-equipped community location easily accessible to seniors. The city also operates its own Stronger and Steadier recreation program at the same location, and seniors can choose to enrol in it after graduating from the hospital program. “The strong relationship between Trillium Health Partners and the City of Mississauga has allowed a unique hospital-municipal health integration model

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Trillium Health Partners’ Strong and Steady exercise and education class in progress. to emerge. Such a partnership between the hospital and city is pioneering – no one else has ever provided an exercise program in this format. Delivering hospital-level rehabilitation in the commu-

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nity setting is powerful because it helps people truly focus on wellness, and not illness, and offers other opportunities for older adults as well, including increased ways to remain social,” says Brenda Callaghan, Community Development Coordinator, Therapeutic Programs, City of Mississauga. Strong and Steady is offered twice a week in six week sessions, and combines two hours of exercise and two hours of education weekly, tailored to each individual participant. The class size is capped at 12 participants to ensure individual attention is given, and patients attend twice per week.

Canadian physical activity guidelines recommend that older adults get at least 150 minutes of moderate physical activity weekly.

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Participants are either hospital patients or are referred by physicians in the community. The program begins with a comprehensive falls prevention assessment by a geriatrician or nurse practitioner as well as a physiotherapist to better understand the reasons for falls, then, if able to do so, participants can continue with the group exercise and education component. “Many older adults have a challenge finding and adjusting to a regular exercise routine, especially after they’ve been in the hospital or have had a fall. The Strong and Steady program offers a valuable opportunity for peer to peer support, helping older adults connect and share experiences, such as coping after a fall,

Photo courtesy of Paul van den Ende

building the hope, motivation and confidence to continue participating in an exercise program,” says Sabina Sobota, PTA/OTA at Trillium Health Partners’ Falls Prevention Program. Because of its co-location in the community centres with the city-operated Stronger and Steadier Program, Strong and Steady makes it a lot easier for older adults to continue an exercise program in the community: graduates of Strong and Steady are already familiar with the facilities, have often made friends and are thus more willing to join the more advanced community exercise program to maintain their physical activity gains. “Without Strong and Steady, I would not have learned as much as I know now about preventing a fall. A big thing for me to be aware of now when I’m out and about or even at home, is to always keep both my hands free so that I can quickly regain balance if I need to. I wouldn’t have known to think of this before. I also feel I really benefitted from learning different exercises, nutrition and helpful tips about how to set my home up to be safer,” says Phyllis McKibbin, Trillium Health Partners patient and Strong and Steady participant. Trillium Health Partners has been operating Strong and Steady since 2011. The program is now offered at two community centres in Mississauga, which are easily accessible to the hospital’s patients. Trillium Health Partners’ Strong and Steady program currently has an average class attendance of 2,000 people annually. The unique partnership between the city and hospital reflects Trillium Health Partners’ mission of building a new kind of health care for a new community, where an interconnected system of care is organized around patients inH side and outside the hospital. ■ Ania Basiukiewicz is a Communications Advisor at Trillium Health Partners. www.hospitalnews.com


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Successfully managing

chronic diseases in the elderly

Focusing on health promotion, disease prevention and early detection is the best strategy for successful chronic disease management.

By Dr. Pamela Eisener-Parsche anaging chronic diseases is a growing part of medical care in Canada. Advances in science, technology and pharmaceuticals mean that many diseases considered fatal just a few decades ago have now become chronic treatable conditions. The elderly, in particular, are now living with one or more chronic diseases for extended periods of time. This new reality requires that many physicians shift the focus of the care they provide towards the management of chronic, incurable illnesses such as heart and kidney disease, diabetes, osteoporosis and Chronic Obstructive Pulmonary Disease (COPD), among others. The World Health Organization (WHO) reports that 63 per cent of all deaths globally are due to cardiovascular diseases, diabetes, cancers and chronic respiratory illnesses – making chronic disease the leading cause of death worldwide. Patients who are afflicted with chronic diseases often have to manoeuver a complex healthcare system for years at a time. Their care can involve multiple healthcare professionals in different locations, as well as a variety of medications and treatments. In this labyrinthine environment, good communication and a proactive approach to diagnosis and treatment are important.

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Positive communication

Focusing on health promotion, disease prevention and early detection is the best strategy for successful chronic disease management. Identification and early treatment of intercurrent illness is particularly important in frail seniors. Equally important is open communication. Transitions in care, particularly in complex chronic cases, are widely viewed as vulnerable points when breakdowns in communication can lead to patient safety incidents. The Canadian Medical Protective Association (CMPA) advises physicians who are managing a chronic disease to listen actively, show compassion and partner with patients to achieve care goals. After all, patients can play a big part in effectively managing their own chronic disease – whether through

medication adherence, physiotherapy or adjusting their lifestyle. Physicians should work with patients to make shared decisions that strike a balance between meeting healthcare goals and providing optimal quality of life. Documenting discussions with patients, treatment plans and other clinical issues in the medical record is good practice as it can improve continuity of care by communicating to other physicians, nurses and health professionals what took place during a patient meeting and the rationale for a treatment plan. Using structured communication processes and tools, such as handover mnemonics, can help to overcome barriers to effective handovers. Patient care coordination is enhanced by sharing information appropriately, collaborating with other healthcare professionals, and preparing effective referrals and consultations. Physicians should also have measures in place to help members of their practice know their responsibilities in a chronic disease case. These can include assisting with care coordination, proper information transfer, test result management, and followup procedures. An internal analysis of medical-legal cases that were managed by the CMPA involving chronic diseases showed that communication breakdowns most often occurred during transitions in care. Incomplete verbal or written communications during handovers with other providers were associated with deficiencies in the diagnostic process. For example, in some handovers, poor communication led to delaying or failing to arrange appropriate testing, or failure to communicate the need to follow-up on tests that were ordered. Among the reviewed CMPA cases involving ineffective communication with patients, more than a third involved people aged 70 and older. This is problematic and highlights the need for clear communication with seniors, who are a growing demographic in Canada, as well as the family members and other caregivers who may be involved in their care. Documented communication problems often involve a lack of informed consent

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HOSPITAL NEWS MARCH 2017

by a patient for treatment; failure to communicate important and timely information; failure to communicate information clearly in a way that the patient understands; and failure to communicate difficult news about a diagnosis or prognosis. Two-way communication between a physician and patient is key. It is important that patients feel heard by their physicians and other members of their care team. Poor communication can lead to misunderstandings in the doctorpatient relationship.

A patient-centred approach

Taking a patient-centred approach that is respectful of, and responsive to, individual patient preferences, needs and values is advisable. Physicians should inform patients of the prognosis of their illness, how the illness can impact their lifestyle, and suggest solutions for coping with changes to their routine. Patient adherence to treatment plans can sometimes be difficult. Physicians should take steps to educate their patients about the disease they are afflicted with, encourage proper self-care, reinforce key information about the condition, and explore reasons why a patient may be having difficulties with adherence. It is also important for physicians to recognize the complexity inherent in managing multiple chronic conditions – particularly in seniors. Several different chronic diseases can be present in elderly patients, and balancing these often competing illnesses can be difficult. Certain heart disease medications, for example, can cause blood pressure to drop and lead to falls and fractures that send people into long-term care facilities. Knowing the risks and potential impacts of different treatment regimes, and discussing them with elderly patients and their caregivers, is the right approach. Adult patients, no matter how old, should be involved in the decision making process when it comes to treating multiple chronic diseases. Physicians should never make assumptions about what treatment plan a patient will choose, but rather should discuss available options. As always, getting the patient to consent to a particular course of treatment is of paramount importance. Doctors should also recognize when a patient, such as a senior, needs help managing a chronic illness. Because patients may be suffering from multiple chronic conditions, careful attention may be required when caring for patients who have chronic illnesses. Again, it may be necessary to watch for interactions among different medications used to treat different conditions. Chronic disease sufferers also need to know when they should access healthcare services and whom to contact. Physicians

and patients should create an action plan and keep it up to date – including symptoms that merit a doctor’s visit, follow-up protocols, a list of required tests, how to manage medications, and information patients should track to assist healthcare providers in monitoring their condition; i.e. blood sugar and blood pressure levels.

Mitigating risks

Caring for patients with chronic diseases can be challenging. However, physicians can take steps to mitigate the risks. These include: • Educate patients so they can make informed decisions and be engaged in their care. • Familiarize yourself with relevant clinical practice guidelines provided by specialty societies, recognizing that strict adherence may be difficult to achieve with patients who have multiple chronic conditions. • Work with patients and other healthcare providers to develop patient-centred care plans. • Make use of reminders and alerts in electronic medical records to assist in managing follow-up care. • Implement a process to facilitate timely follow-up. (In addition to a good discussion, written follow-up and discharge instructions are helpful). • Communicate consistently with patients and other healthcare providers. • Document patient discussions, treatment decisions and courses of action. • Have an effective system in place to manage test results and coordinate care. In a collaborative care setting, roles and responsibilities should be clearly defined. • Evaluate patient outcomes with the patient and their family. Managing chronic diseases is likely to be the norm for many physicians going forward. As people live longer, physicians will inevitably have to manage more chronic but treatable conditions. Successful management of chronic diseases can be enhanced by taking a proactive approach to diagnosis and treatment; educating patients about their condition and involving them in their own care; and ensuring good communication with patients, family members and healthcare providers. Seniors especially require open and proactive communication, and physicians need to recognize when the elderly need asH sistance adhering to a treatment plan. ■ Dr. Eisener-Parsche is a family physician with a certificate of Added Competence in Care of the Elderly and the Director of Physician Consulting Services at the Canadian Medical Protective Association. www.hospitalnews.com


GERONTOLOGY/ALTERNATE LEVEL OF CARE/HOME CARE/REHAB

Focus 11

Adam goes the distance.

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Improving care for seniors By Roxanne Torbiak espite having Chronic Obstructive Pulmonary Disorder (COPD) and Congestive Heart Failure (CHF), 89 year old Frederick Kendall enjoys a very active life. Regular activities include riding his bicycle around town, lawn or carpet bowling three times a week, gardening and tending to his tomatoes, volunteering in his community and travelling.

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These customized programs link the patient and family with providers including primary care, specialists, hospitals, long-term care, home care and community supports services such as Meals on Wheels. In Spring of 2016, the Beamsville resident was eagerly awaiting a special ‘bucket list’ trip he had planned to Iceland with his son and grandchildren. Unfortunately, Mr. Kendall suffered a setback when his heart failure worsened and his trip was at risk of being cancelled. As a result of long standing health issues, Mr. Kendall has had hospital stays at two sites of Hamilton Health Sciences – West Lincoln Memorial Hospital (WLMH) and Hamilton General Hospital sites. He credits the great healthcare teams at both hospitals for helping him return to health every time. In the past, he would return home and resume his regular lifestyle when he was ready. But this time was different; after a two-week stay in WLMH hospital, the previously vivacious senior felt fearful and lacked confidence.

Eighty-nine year old Frederick Kendall recently traded in his bicycle for an electric bike. Mr. Kendall was identified as a candidate for two programs offered out of WLMH which aim to improve care for seniors and others with complex conditions – Integrated Comprehensive Care (ICC) and Health Links, which are initiatives of the Ontario Ministry

of Health and Long-Term Care and the Hamilton Niagara Haldimand Brant Local Health Integration Network. Hamilton Health Sciences is the designated lead hospital for the Hamilton West Health Link and the Niagara North West Health Link.

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These customized programs link the patient and family with providers including primary care, specialists, hospitals, longterm care, home care and community supports services such as Meals on Wheels. Together, they a develop care plan that is focused on what is important to the patient. “For people living with complex healthcare needs, transitioning out of hospital can be complicated because there are many providers involved,” says Tara Bloomfield, a registered nurse and care coordinator for ICC and Hamilton Health Sciences’ Health Link. “Effective communication and information sharing among the entire team is key to providing our patients with the care they need, when and where they need it.” Upon making the move home from WLMH, the teams focused on teaching Mr. Kendall self-management skills including how to recognize worsening symptoms to help him manage his chronic illnesses at home. Mr. Kendall received visits from a physiotherapist, an occupational therapist, a dietitian, a personal support worker and his family doctor, with Tara Bloomfield acting as his nurse and care coordinator. Working collaboratively, the team helped to ensure that Mr. Kendall could follow his care plan safely in his home to achieve his goals. If concerns arise, the appropriate team member works to support Mr. Kendall to avoid an unnecessary trip to the emergency department (ED). However, should there be need for a visit to the ED, Mr. Kendall’s care plan is available so that staff and physicians have the information they require. “The ICC and Health Links teams boosted my morale and my ambitions,’ says Mr. Kendall. “They made it possible to love life again.” As a result of this comprehensive support, Mr. Kendall soon resumed almost all of the activities he loved prior to his health event, except he recently needed to give up his cycling. “The hill on the way to my house became too hard for me. So, I donated my bike to a farm for a migrant worker, and got an electric bike instead.” This inspiring 89-year-old man didn’t stop there… he also set his sights on fulfilling his bucket list trip to Iceland. “I’m a firm believer that if you want to do something, you’ve just got to do it.” Dr. Santino DePetrillo, Mr. Kendall’s family physician and Bloomfield worked together to prepare him for a safe journey. They created a care plan that included bringing a blister pack of pre-sorted medications and educating him on their use if he experiences symptoms of a flare up while away. Mr. Kendall had a wonderful trip and enjoyed Iceland’s clean fresh air, ‘never coughing once.’ Since visiting Iceland, Mr. Kendall has already crossed another trip off his bucket list. In November, he visited the polar bear capital of the world, Churchill, Manitoba. “Without this coordination, travel would be impossible for me. This team has saved my life. ” What’s next on Frederick Kendall’s bucket list? A trip to the Arctic Circle for H his 90th birthday. ■ Roxanne Torbiak is a freelance writer, specializing in healthcare communications.

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Focus 13

MARCH 2017 HOSPITAL NEWS


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Cover story

World first:

Living without lungs for six days saves a mom’s life By Alex Radkewycz n a bold and very challenging move, thoracic surgeons at Toronto General Hospital, University Health Network removed severely infected lungs from a dying mom, keeping her alive without lungs for six days, so that she could recover enough to receive a life-saving lung transplant.

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It was bold, but scientifically sound. Removing both her lungs – the source of bacterial infection – could save her life. This is believed to be the first such procedure in the world, made possible by advanced life support technology, a dedicated and diverse surgical, respirology, intensive care and perfusion team, as well as the grit and gumption of the patient and her close-knit family. “This was bold and very challenging, but Melissa was dying before our eyes,” says Dr. Shaf Keshavjee, Surgeon-in-Chief, Sprott Department of Surgery at University Health Network (UHN), one of three thoracic surgeons who operated together on Melissa to remove both her lungs. “We had to make a decision because Melissa was going to die that night. Melissa gave us the courage to go ahead.”

Photo courtesy of UHN

Melissa Benoit, then 32, was brought into Toronto General Hospital’s (TGH) Medical Surgical Intensive Care Unit (MSICU) in early April 2016, sedated and on a ventilator to help her laboured breathing. For the past three years, Melissa, who has cystic fibrosis, had been pre-

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scribed antibiotics to fight off increasingly frequent chest infections. A recent bout of influenza just before her hospital admission had left Melissa gasping for air, with coughing fits so harsh that she fractured her ribs. Her inflamed lungs began to fill with blood, pus and mucous, decreasing the amount of air entering her lungs, similar to a person drowning. As Dr. Niall Ferguson, Head of Critical Care Medicine at the University Health Network (UHN) and Mount Sinai, describes it, the influenza “tipped her over the edge into respiratory failure. She got into a spiral from which her lungs were not going to recover. Her only hope of recovery was a lung transplant.” Melissa’s oxygen levels dipped so low, conventional ventilation was no longer enough. To help her breathe, and to gain more time until donor lungs became available, physicians placed her on ExtraCorporeal Lung Support (ECLS), a temporary life-support medical device that supports the work of the lungs and heart. Despite this, Melissa’s condition worsened. The bacteria in her lungs developed resistance to most antibiotics, and spread throughout her body. Her blood pressure dropped. She slid into septic shock, triggering inflammation, leaky blood vessels and reduced blood flow. One by one, her organs began to shut down. She had to have kidney dialysis. Melissa was now on maximum doses of three medications to maintain her blood pressure, along with the most advanced respiratory support, and on lastline powerful antibiotics, the last option

for patients resistant to other available antibiotics. The team was still waiting for donor lungs but, by this time, Melissa was too sick to have a lung transplant. Dr. Marcelo Cypel, the thoracic surgeon on call that late April weekend, kept a careful watch on Melissa. On a Sunday afternoon, with the clock ticking, he kept weighing her risk of death versus the risk of trying something which had never been done before. It was bold, but scientifically sound. Removing both her lungs – the source of bacterial infection – could save her life. Dr. Cypel gathered his colleagues, calling in Dr. Shaf Keshavjee, Dr. Tom Waddell, Head of Thoracic Surgery at UHN, Dr. Niall Ferguson, and respirologist Dr. Mathew Binnie – all seasoned and well-known for their skills in navigating complex cases, along with Melissa’s husband, mom and dad. The surgical team had been discussing the concept of this procedure for several years. They had observed patients with cystic fibrosis, waiting for a lung transplant, who developed severe lung infections. These infections spread through the bloodstream into their bodies, resulting in septic shock and death, despite maximum support on the ECLS device. While the team faced many unknowns – risk of bleeding into an empty chest cavity, whether her blood pressure and oxygen levels could be supported afterwards, and if she would even survive the operation – they agreed that Melissa was a possible candidate, and that it was her only chance, although a slim one. www.hospitalnews.com


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GERONTOLOGY/ALTERNATE LEVEL OF CARE/HOME CARE/REHAB

As Dr. Keshavjee explained, she likely still had enough strength to withstand the procedure and get better afterwards, the source of the infection was clear-cut and difficult to control in current circumstances, the family understood the risks and explained that Melissa had often told them she would want to try everything possible to live for her husband Christopher and two-year-old daughter, Olivia. “Things were so bad for so long, we needed something to go right,” remembers, Chris, “and this new procedure was the first piece of good news in a long time. We needed this chance.” As Melissa tells it, Chris was the one who “held my life in his hands...He had to trust in himself, knowing me, relying on past conversations, and he chose exactly what I would have told him to.” Melissa’s mom, Sue, was so eager to save her daughter’s life, she urged the team to go ahead: “Melissa always volunteers for any study or clinical trial. She would want to do this. Let’s not waste any more time and get her into the OR.” At 9:00 pm that Sunday evening in midApril, a team of 13 operating room staff, including three thoracic surgeons – Drs. Cypel, Keshavjee and Waddell – removed Melissa’s lungs, one at a time, in a ninehour procedure. Her lungs had become so engorged with mucous and pus that they were as hard as footballs, recalls Dr. Keshavjee. “Technically, it was difficult to get them out of her chest.”

Photo courtesy of UHN

Melissa Benoit, who was kept alive without lungs for six days before a successful transplant, plays with daughter Olivia, 2, before news conference detailing what’s believed to be the world’s first such procedure. But within hours of removing her lungs, Melissa improved dramatically. She did not need blood pressure medication, and most of her organs began to improve. To keep Melissa alive, she was placed on the most sophisticated support possible for her heart and lungs. Two external life support circuits were connected to her heart via tubes placed through her chest. A Novalung device, a small portable artificial lung, was connected by arteries and veins to her heart to function as the missing lungs. Working with the pumping heart, the device added oxygen to her blood, removed carbon dioxide, while helping to maintain continuous blood flow. At the same time, another external

device, extracorporeal membrane oxygenation (ECMO), which has an external pump, circuit and oxygenator for the gas exchange of oxygen and carbon dioxide, also helped to circulate oxygen-rich blood throughout her body. TGH is a leader in using these technologies, with the largest such program in Canada, performing up to 100 ECLS cases per year. ECLS specialists or perfusionists and MSICU nurses are specially trained in caring for patients on various ECLS devices. Six days later, a pair of donor lungs became available and Melissa was stable enough to receive a lung transplant in late April 2016.

“The transplant procedure was not complicated because half of it was done already,” noted Dr. Cypel, “Her new lungs functioned beautifully and inflated easily. Perfect.” For the past several months, Melissa has been steadily improving. Her previously thick hair is growing back, she can play with her daughter for whole days without getting tired, and she has not needed a walker or cane for the past month. She is still on kidney dialysis. “It’s the simple things I missed the most,” she says, “I want to be there for Chris and Olivia, even through her temper tantrums! I want to hear Olivia’s voice, play with her and read her stories.” The medical team is developing criteria for the select types of patients who could be candidates for this novel procedure while waiting for a lung transplantation. The report of this case by Drs. Marcelo Cypel, Shaf Keshavjee, Tom Waddell, Lianne Singer, Lorenzo del Sorbo, Eddy Fan, Mathew Binnie and Niall Ferguson on Melissa Benoit entitled, “Bilateral pneumonectomy to treat uncontrolled sepsis in a patient awaiting lung transplantation” was published online in The Journal of Thoracic CardiovasH cular Surgery, November, 2016. ■ Alex Radkewycz is a Senior Public Affairs Advisor, Toronto General Hospital, University Health Network.

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Helping frail seniors

extend their ability to live at home By Patti Enright

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ighty-nine years young, Lenore lives alone in a seniors’ apartment in Don Mills. Her goal is to remain there for as long

as possible. Like many people well into their late eighties, Lenore has experienced some health challenges. She had become prone to falls, and her back and hips often feel painful. In 2015, the situation was taking a toll. “I felt down,” she says. “I didn’t feel like doing anything.” Lenore was at risk of admission to hospital or having to move to a long-term ‘care home. Many other frail seniors are in a similar position. Identifying and helping them avoid admission to hospital and further decline in their health or their independence is a strategic priority for the Ministry of Health and Long-Term Care and the Local Health Integration Networks (LHINs). However, in spite of providence-wide initiatives to address this issue there is a lack of referral options available to staff in emergency departments to support frail seniors and provide them with innovative and timely programs focused on restoration. Primary care providers continue to search for solutions and resources for frail seniors who present in their offices. Care coordinators and nurse practitioners at Community Care Access Centres (CCACs) are limited by the narrow range of options available to them when they have a client who requires more care than can be provided in the client’s home yet is not appropriate for admission to an acute care facility. To bridge this gap, a partnership led by Providence Healthcare is helping frail and vulnerable seniors at risk of hospitalization

Lenore works with Physiotherapist Nicola Bell in Providence’s Falls Prevention Clinic. or admission into a long-term care home to remain at home for an extended time. The Community Referral Pathway brings together four health sectors in Providence’s catchment area – hospitals, CCACs, primary care providers and community services – to create a solution for complex, frail seniors living in the community who have restorative potential that will delay the need for institutional care. The new standardized expedited care pathway provides referral options for direct admission to inpatient or outpatient programs. The initiative leverages Providence’s existing Frailty Intervention Team, an interprofessional assessment team providing patients with a one-stop comprehensive assessment.

The program has been up and running since funding was obtained from the Toronto Central LHIN in the fall of 2015. From April 2015 to December 2016, 196 patients received assessments from the Frailty Intervention Team. “The team working on this initiative feels extreme satisfaction knowing that we have helped a vulnerable population at risk of falling through the cracks get access to the health services they need, and in a timely manner,” says Kelly Tough, Patient Flow Manager at Providence Healthcare. Lenore understands firsthand what a difference the program can make. In 2015, her daughter Hazel was working at Providence and heard about the newly launched standardized care path.

Hazel suggested the pathway to her mother; Lenore agreed it was worth trying and obtained a referral. Through the care path, Lenore received an assessment from the Frailty Intervention Team that concluded she should come to Providence for two weeks as an inpatient for a “wellness stay.” Lenore noted her spirits began to lift when she was admitted. Since completing her two-week stay, she has started the next phase of her recommended treatment plan – weekly sessions at Providence’s Falls Prevention Clinic as an outpatient. At the clinic, physiotherapist Nicola Bell is working with Lenore to improve her strength, endurance and posture. Through a combination of using a seated stepper machine that simulates walking and performing specific exercises in the Clinic and at home between appointments, Nicola notes Lenore now has more energy and is stronger since she first came to the clinic. Her spirits are up, too. Lenore says she looks forward to her time at the clinic and that she cannot say enough about the friendliness of the staff. “It is a wonderful place,” she beams. For Lenore’s daughter the experience has been a relief. “I had a feeling of ‘whew’,” she says. Hazel particularly found seeing one interprofessional team instead of requiring numerous appointments with different health professionals to be very helpful. “I appreciated not feeling like you have to jump through 1,500 hoops to get results.” To access the Community Referral Pathway a Community Referral Checklist must be completed and signed by a physician or nurse practitioner; the document is available at www.providence.on.ca/ referrals. For more information contact the Admissions Hotline at 416-285-3744, email admitting@providence.on.ca or H visit www.providence.on.ca ■ Patti Enright is a Corporate Communications Manager at Providence Healthcare.

HOSPITAL NEWS MARCH 2017

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Focus 17

“Thanks to TENA Solutions, it is possible to have a positive impact on the quality of life of people who rely on our care” Giorgio Lupazzi Nursing Home Director, Italy

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MARCH 2017 HOSPITAL NEWS


18 Evidence Matters

If not opioids, then what? By Dr. Janice Mann

hronic pain. It’s one of the most common reasons we visit a doctor or other health care professional. And, until recently, it wasn’t uncommon to leave their office with a prescription for an opioid painkiller in hand. Opioids are a class of drugs that are prescribed to treat pain, and include codeine, fentanyl, oxycodone, and morphine. However, the drawbacks and risks of these commonly prescribed medications are becoming increasingly recognized. Opioids, in addition to treating pain, can also result in a feeling of euphoria or a “high.” And stopping the medication can cause unpleasant withdrawal symptoms. As a result, some people who have been prescribed opioids for pain can become addicted to the medication. Prescription opioids can also be misused in a variety of ways; they may be taken by someone else, taken at a higher dose than intended, taken in a different way than prescribed (i.e., injected rather than taken by mouth), or combined with other drugs or alcohol.

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The interdisciplinary team from Trillium Health Partners and the Mississauga Halton CCAC collaborated to develop a safer approach for patients transitioning from hospital to home. Learnings from the Seamless Transitions: Hospital to Home approach prompted the Mississauga Halton CCAC to develop ‘My Story’ – a personalized information package that helps each patient understand and manage their care at home.

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helps patients move safely from hospital to home By Avori Cheyne fter slipping on ice and fracturing his hip, Gordon spent five days in hospital. There, he met many members of his care team, but was unsure who to ask about his care instructions. As Gordon packed to leave hospital, his care team members asked him the same questions he had answered many times. Having to repeat his story was frustrating. When he left hospital, he didn’t know how he was going to heal at home or who would help him. Recognizing stories like Gordon’s were all too common, the Mississauga Halton Community Care Access Centre (CCAC) partnered with Trillium Health Partners (THP) to develop a safer way for patients to leave hospital and return home

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with less repeated steps or unanswered questions. The goal was to eliminate process duplications and reduce gaps in care and communication that can put patients at risk. To develop this approach, THP and the Mississauga Halton CCAC formed an interdisciplinary team. They gathered feedback from their staff, physicians, community providers, a leading practice review, patients and families. Informed by these insights, they developed Seamless Transitions: Hospital to Home, a consistent, integrated approach to improve patients’ experiences as they transition from hospital back to home and their community. For patients like Gordon, this approach would mean meeting his care team mem-

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bers early in his hospital stay and learning how each contributes to his care. This team would meet daily to discuss his care and eventual discharge. And his care team would be consistent throughout his hospitalization, with one person, a Transition Coordinator, liaising between him and the other team members. All members of Gordon’s care team would also update and have access to his Story – a written, plain language summary of his care needs and plan. Gordon would know who to ask for help and didn’t need to repeat information. Before leaving hospital, Gordon’s My Story information would be sent to his family physician and local pharmacist. His Transition Coordinator would book his follow-up doctor’s appointments, and connect with his CCAC community care coordinator to ensure his care plan was in place. Following 500 patients like Gordon from admission through to discharge and recovery at home, the Seamless Transitions team tested the approach for nine months in the THP-Credit Valley Hospital Medicine program. Significant results occurred. On average, patients were discharged almost one day sooner, their satisfaction increased and their hospital readmissions 30 days after discharge dropped by 52 per cent. Patients and families, who experienced Seamless Transitions said, “I did not feel like I was left out… There was a team approach – everyone was talking to one another. The discharge booklet was great. I left knowing what I was doing – everything was explained… I can just bring the booklet to appointments. You really put the ‘care’ back in healthcare.” Physicians, who were members of the interdisciplinary test teams, remarked: “Our patients are discharged sooner, the process is much smoother, and I feel like part of the team. There are less handovers and duplications because we are always connected.” Continued on page 21

But what treatments – other than opioids – are available for chronic pain? And more importantly, how do we know if they work? The potential for addiction or misuse combined with a long list of possible side effects – including coma and death in the case of overdose – have led the health care community and patients in Canada to seek alternatives to opioids for safely and effectively treating chronic pain. In fact, the 2017 Draft Recommendations for Use of Opioids in Chronic Non-Cancer Pain from the National Pain Centre at McMaster University recommend optimization of non-opioid pharmacotherapy (medications other than opioids) and non-pharmacological therapy (treatments that aren’t medications), rather than opioids for patients with chronic pain. But what treatments – other than opioids – are available for chronic pain? And more importantly, how do we know if they work? That’s where CADTH – an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures – can help. Recently CADTH was asked to look at the evidence on a treatment for chronic pain that doesn’t involve any medication and that patients can use in their own home, called transcutaneous electrical nerve stimulation or TENS. With TENS, electrodes are placed on the skin around the area of pain. The area is then stimulated with low-voltage electricity usually for 30 minutes up to an hour, twice each day. Traditionally TENS has been provided by a healthcare provider in a clinic setting. Continued on page 24 www.hospitalnews.com


GERONTOLOGY/ALTERNATE LEVEL OF CARE/HOME CARE/REHAB

Focus 19

Improving home and community care by

putting patients first By Tina Novotny

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n 2015, the Ontario Ministry of Health and Long-Term Care released a three-year roadmap to strengthen home and community healthcare in the province. The plan includes goals to expand capacity which will also include more nursing hours, and to modernize delivery, putting more choice in the hands of patients, their families, and professional healthcare workers themselves. In Ontario, the homecareassigning Community Care Access Centres (CCACs) are under review and may be significantly reorganized, with coordination of home care said to be moving to Local Health Integration Networks (LHINs). In this new environment of more self-directed care, internationally educated nurses (IENs) are integral to addressing the needs of Canada’s increasingly multicultural and aging population. “IENs are very committed and loyal nurses, they bring an international perspective to the care they deliver,” says Dr. Ruth Lee, Interim Executive Director of CARE Centre for IENs, a bridge-training program funded by the Government of Ontario. “With their multilingual skills they are very well positioned to meet the needs of our increasingly diverse patient population.” In large Canadian cities like Vancouver and Toronto, newcomers make up about 40 and 50 per cent of the populations

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respectively, percentages that will only increase. Currently, one in four nurses in the Greater Toronto Area is internationally educated, and they form about 12 per cent of the nursing workforce across Ontario. Recent figures from British Columbia put the IEN workforce at 18 per cent. There are fewer IENs working in Eastern Canada, but more concerted recruitment efforts across the Atlantic Provinces will undoubtedly increase percentages. Older generations of immigrant Canadians often revert back to their native languages, and can have cultural preferences for home care. Grace Gatti is selfemployed in the finance sector and cares for her elderly parents with the help of PSWs and IENs. “We’ve had Ukrainian, Chinese, Somalian, Filipino and Jamaican caregivers, but with my parents both being Italian, the Italian caregiver was the best at calming them in the evenings, speaking in their shared language,” says Gatti. “There aren’t that many Italian caregivers available, however, so you work with who they send.” Many IENs pursuing registration in Canada will work as PSWs to earn income and gain Canadian healthcare experience. For some, it’s a huge switch from registered nurse (RN) duties they performed in their home countries, often in hospital settings and sometimes in supervisory or teaching roles. The 2016 CARE Centre Joan Les-

mond IEN of the Year Award-winner in the registered practical nurse (RPN) category, Viral Pandya, illustrates the calibre of IENs who have found a calling in community nursing. “In India I worked as an RN in the ER, ICU and in the OR. When I came to Ontario I obtained my RPN license and was hired by ParaMed. Although my previous experience was in acute care, community nursing makes such a difference in people’s lives. Nurses are the main communication link between the patient and the interdisciplinary team. Personally, having the opportunity to impact someone every day is very powerful. The words I use, my actions and my attitude can help another human being to heal.”

CARE Centre’s Dr. Lee knows it’s not an easy path for IENs to gain registration and establish their careers in Canada, but the cross-over between hospital and community care can help IENs to reinvent themselves and re-discover their passion for nursing. “The biggest challenges right now for IENs is the lack of full-time positions due to cut backs and skill-mix or scope-of-practice changes, but I believe there is always work for those who are prepared,” says Lee. “I would recommend that IENs be adaptable, and the right job will be there for them when the right time H comes.” ■ Tina Novotny is a Communications Specialist at the CARE Centre for Internationally Educated Nurses.

MARCH 2017 HOSPITAL NEWS


20 Trends in Transformation

Paper and electronic hybrid

is the next evolution in quality boards By Jennifer Quaglietta and Talha Hussain orth York General Hospital (NYGH) has placed a strong emphasis on continuous quality improvement for well over a decade. This culture has made NYGH a leader in adopting healthcare information technology that has significantly improved patient safety and the quality of care we provide. One of the building blocks to successful quality improvement is measurement and reporting back. Several years ago paper-based Quality Boards were launched on every patient unit along with support services program to provide frontline staff (clinical team managers, unit coordinators, nurses, nurse educators and allied health staff) with recent hospital data related to patient safety and quality. In discussions with management, North York General’s Quality Improvement Office became aware the Quality Boards were not being used regularly because of limited real-estate, low visual appeal and infrequent data updates.

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Electronic quality boards (eBoards) give NYGH the capability to share the most current patient safety and quality data that is specific to each unit or program. The Quality Improvement (QI) team decided to apply their own techniques to the Quality Boards and conducted a PlanDo-Study-Act (PDSA) cycle to evaluate and improve the interactivity of the boards. During the planning phase of the PDSA it was made very clear that the biggest gap with the existing quality boards was the lack of real-time data. Working with staff, and knowing how successful the adoption of healthcare technology has been in the hospital, the recommendation was made to evolve the Qual-

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NYGH’s Quality Boards combine paper and electronic-based solutions and can be customized to any unit. ity Boards from a paper-based board to an electronic one. Electronic quality boards (eBoards) give NYGH the capability to share the most current patient safety and quality data that is specific to each unit or program. The first pilot of the eBoards took place in 2015 on a respiratory medicine unit. The pilot unit’s operating framework considered the following: • Impactful and value-added metrics • Length of quality circle time • Appropriate location • Day and time for conducting quality circles • Desired support structure Leadership and staff welcomed the new approach, and within months, nineteen eBoards were launched across the hospital, in both clinical and non-clinical departments. Following the launch, members of the QI team were assigned to support every department and local unit on a weekly basis to help with refreshing the data, organizing the quality circles, and ensuring that both technical and QI expertise was available. One year later, a rapid cycle evaluation (part of the Study phase of the PDSA cycle) of the nineteen eBoards was held to judge the effectiveness of the new boards. The QI team evaluated how effectively the eBoards facilitated interdisciplinary discussion among frontline staff, and how well they drove evidence-based action plans to improve unit-specific patient safety and quality indicators. The QI office conducted organizationwide rounds to collect and share feedback from the units. This included best practice examples, as well as areas for improvement

or opportunities for further investigation. Some gains were realized from going to a fully electronic system, yet there were still gaps in the new model, including: • “Data provided on a monthly basis is reported with a one-two month delay” • “Quality circles take too long and keep us away from patient care” • “The video slide lags when running a quality circle” • “The slides change too quickly, making it difficult to read the content” Based on this feedback all slides were set to 15 second pauses, and the QI team decided to conduct an external scan of other hospitals using eBoards. The learnings from our focus groups and external scans led to the development of a new hybrid model where paper and electronic platforms are merged to maximize benefits. It was clear staff wanted more ownership in the QI efforts which were part of the paper platform, but they also enjoyed the electronic platform’s user friendliness for patients and families. Using Roger Martin’s Integrative Thinking approach, the QI team was able to design a solution without compromise – giving back customization to the units. The hybrid approach included switching from outcome based metrics to process metrics. The units first received a demonstration from the QI team using a physical prototype. The prototype included the option to incorporate a visual management system using Kamishibai cards. Kamishibai cards are a form of storytelling that uses visual cards to perform audits for a particular process. A series of cards are placed near the QI boards and one is randomly select-

ed for an audit to ensure safety and quality checks are performed. This allows staff to visually see what processes or metrics where unsatisfied and provide an opportunity in real time to make a change to the design of a system or process. Additionally, the prototype allows staff to run a 10 minute quality circle, or huddle, daily instead of weekly to discuss or monitor a single safety or quality metric such as the number of falls per day, number of cribs with fresh linens or completed Braden scale for patients at risk for developing pressure injuries. Finally, the prototype also provided space for an optional white board and cork board so teams can document and share action plans which all staff, regardless of their shift, can contribute to. Once staff were satisfied with their customization selection, the QI team supported units through the transition to the eBoard and continues to support all nineteen eBoards and quality circles on a weekly basis. Currently, five units have gone live with the hybrid model, with another seven planned over the next two months. Initial feedback has been positive in terms of being able to catch safety concerns earlier and developing mitigating strategies durH ing the quality huddle. ■ Jennifer Quaglietta is the Director of Patient Experience, Quality Transformation and Patient- and FamilyCentred Care at North York General Hospital and Talha Hussain is a Quality Improvement Specialist with North York General Hospital. www.hospitalnews.com


From the CEO's Desk 21

Integration key to success By Dr. Verna Yiu

askatchewan recently became the third province in Canada to move towards a single Provincial Health Authority, a move that has naturally put focus on what we do in Alberta. We wish our friends to the east well, and are happy to share our experiences with them. Alberta was the first province in Canada to implement a single, provincewide, fully integrated health system, a move which has benefited patient care to all Albertans. AHS officially came into being in April 2009, and immediately became the largest healthcare system in the country. The organization is responsible for delivering healthcare services to more than four million Albertans, as well as to some residents of Saskatchewan, B.C., and the Northwest Territories. AHS has more than 108,000 employees and almost 10,000 physicians, working in 106 acute care hospitals, five stand-alone psychiatric facilities, and more than 500 other healthcare facilities including cancer centres, clinics and continuing care. We also provide home care services for more than 115,000 Albertans. We have partnership in 42 Primary Care Networks that provide access to multidisciplinary teams, including family doctors. And, we partner with private business and academic institutions to drive research and innovation. AHS is the largest employer in Alberta, and the fifth largest employer in Canada. But, our greatest accomplishments are not the result of our size. They are the result of our integration - where we integrate, we succeed. And most important of all, our accomplishments are the result of our people. A great example of the benefits of a single health system was our response to last year’s Fort McMurray wildfire. Because we are integrated and function as one, we

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were able to quickly and effectively mobilize resources from across the province. Our physicians, staff and volunteers at Northern Lights Regional Health Centre safely evacuated more than 100 patients and clients from the facility in less than two hours. They transported these patients and clients to safety, and provided them the care they needed. Our people also set up a mobile hospital and the first mobile operating room in Fort Mac to support first responders, emergency crews and others still working in the area.

It is imperative that, in creating one system, the ability to include everyone is not lost or ignored.

Our people in facilities across the province made sure those displaced Albertans who needed immediate care – such as expectant moms and dialysis patients – got that care without delay or interruption. And our people – our caring and compassionate people – also welcomed displaced Albertans into their homes, and were generous with their time and money in order to ease the burden of others. One month after this biggest medical evacuation in Alberta history, the Northern Lights Regional Health Centre was once again fully operational and serving residents of the Wood Buffalo area. Our people work with utmost compassion, with Albertans at the centre of all that they do. Seeing our people overcome these challenges, I know nothing is beyond our grasp when our people pull together. Over our eight-year history, we have integrated acute care, cancer care, surgical

Award-winning program Continued from page 18

Other care team members, such as social workers, nurses, therapists and CCAC care coordinators, also supported the approach, noting My Story as “one source of truth” for patient information and daily discharge rounds to facilitate team building and timely solutions for barriers to discharge. With these results, the Ontario Association of Community Care Access Centres (OACCAC) recognized Seamless Transitions with the 2016 Sector Innovation Award for Partnering with Quality at the provincial association’s Awards of Excellence this past June. The award acknowledged the efforts of a sector team that has demonstrated outstanding, innovative leadership in developing and implementing initiatives driven from sector-shared purpose and priorities. Locally, this approach has since been tested at Halton Healthcare, to serve as a regional standard. And learnings from it have informed the Mississauga www.hospitalnews.com

Halton CCAC’s ‘My Story’ patient information package, which includes plain language, patient-centred care planning tools focused on achieving goals set by the patient and their family. Its patients receive this package before leaving hospital to help them understand and manage their care at home. It also includes information for carers who help support loved ones, who have complex medical needs but want to remain at home. You can learn more about Seamless Transitions in the project’s Guidebook, which outlines the partnership and design process. It also serves as a blueprint to help other hospital and community organizations implement new models of transition planning and effectively integrate care for their patients. The guidebook and other info can be found H at www.healthcareathome.ca ■

care, continuing care, home care, primary care, addiction and mental health services, public and population health, and Emergency Medical Services. This was done with the intent of providing seamless care for Albertans during every phase of their lives, by spreading and implementing best practices across the province. The move towards a single healthcare system was a massive task, and not without challenges. In retrospect, the amalgamation could have been planned more deliberately. It required hard work, ingenuity, dedication, and patience from all of our staff, physicians and volunteers. But, we also know that it was the right thing to do, for our patients. We have heard the concerns that we are too urban-centric, that much of our focus is on Calgary and Edmonton, and that decisions were being made without input from communities. We agree that we swung too far towards centralization. We forgot to really listen to all of our communities and stakeholders. These challenges highlight the need to be flexible and fluid. We are now working hard to support decision-making in the hands of local decision makers, and to ensure we hear all voices and listen to all residents from across the province. We have a new Board in place, with deep roots in communities and not just in our cities. We are rebuilding these connections through our Health and Provincial Advisory Councils and our Wisdom Council, made up of Albertans from across the province who have a direct line to our executive and our Board. We realize the importance of these grassroots connections, and value their feedback. It is imperative that, in creating one system, the ability to include everyone is not lost or ignored.

Dr. Verna Yiu It is estimated the move to one organization saved taxpayers approximately $600 million in administrative costs upon amalgamation, and these efficiencies continue to this day. Before AHS, Alberta taxpayers footed the bill for 12 separate health entities with 12 separate administrative functions. By consolidating business functions, AHS is able to redirect hundreds of millions of dollars back into patient care while bending the cost curve downwards. We have the lowest healthcare administrative costs in the country, approximately 27 per cent lower than the national average. And that’s where the most important advantage of a single, provincewide, fully integrated health system begins and ends – with our patients. That is also where our greatest asset is – the people who provide our patients and resident with excellent and timely care, every hour of every day. We know our challenges continue. But we are confident Alberta Health Services is in a strong position now more than ever to improve patient care, outcomes and experiences. And, now more than ever, we are certain that a single provincial healthcare sysH tem is the best way to do that. ■ Dr. Verna Yiu, is President and CEO of Alberta Health Services.

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Avori Cheyne is a Communications Strategist at the Mississauga Halton CCAC. MARCH 2017 HOSPITAL NEWS


22 Focus

GERONTOLOGY/ALTERNATE LEVEL OF CARE/HOME CARE/REHAB

Is fall prevention

part of your job? By Marguerite Oberle Thomas s fall prevention an issue in your workplace? Help is readily available and accessible and comes at no cost from the Fall Prevention Community of Practice (CoP). Falls are a predictable and often preventable problem that seriously affect older adults’ health and quality of life. Fall prevention requires multiple strategies and methods of information sharing, such as offered via the Loop communication platform www.fallsloop.com created in September 2015. Effective fall prevention practice also requires workers from many sectors, older adults themselves and the general community. A Community of Practice is simply a group of people who come together to share a common interest. The Fall Prevention CoP began in 2010 with the goal to connect members so that they can better meet the needs of their clients and their caregivers, while improving their own practice based on the latest evidence. CoP members make a commitment to support and learn from one another, particularly across the continuum of care, from the healthy older adult to the frail elderly across disciplines and perspectives for improved practice and research.

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A nurse in Southlake’s Regional Cardiac Care Program speaks with a former cardiac patient.

Simple, innovative idea puts cardiac surgery patients first By Kaylyn Ward

hysiotherapy is an essential part of post-operative care for all cardiac surgery patients. From helping prevent respiratory complications to increasing patient mobility to preparing for discharge, physiotherapists play a key role in patient care. However, unlike their physician and nurse colleagues, physiotherapists are not typically fully staffed seven days a week in a hospital setting. Instead, they generally work Monday to Friday, with a small patient population who receive care on weekends. This used to be the case here at Southlake Regional Health Centre’s Regional Cardiac Care Program. This schedule meant that Mondays always brought a weekend backlog of patients waiting to be assessed and prepped for discharge. Patients who had cardiac surgery late in the week did not receive the same level of post-operative care, since our physiotherapists did not work over the weekends. Our nursing team did their best to provide some physiotherapy supports, on top of all their regular patient care duties. We knew there had to be a better way to serve our patients. Our Clinical Services Team, which includes surgeons, anaesthesiologists, pharmacists, physiotherapists, educators, nurse practitioners, and administrators, worked collaboratively to address this challenge. The solution was very simple. We needed our physiotherapists to work on Saturdays.

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HOSPITAL NEWS MARCH 2017

In September 2012, we started providing physiotherapy on Saturday for patients who had surgery on Wednesday, Thursday, or Friday. The goal was to keep all patients on their care pathway regardless of which day of the week they had surgery. “The impact was immediate and obvious,” says Dr. Charles Peniston, cardiac surgeon at Southlake. “It allowed us to evolve our model of care so that we could enhance and expedite the recovery of our cardiac patients.”

Southlake’s cardiac surgery program offers the shortest length of stay and most efficient cost per case in Ontario.

Patients who received expanded access to physiotherapy achieved functional milestones more quickly. These results were validated through a research project I completed as part of my Masters of Science in Physical Therapy at the University of Toronto. This study demonstrated that the addition of Saturday physiotherapy decreased hospital length of stay for patients who had cardiac bypass surgery on a Wednes-

day, Thursday or Friday by an average of 0.78 days. Not only was this a positive outcome for patients, reducing length of stay by nearly one full day also led to a significant cost savings of $270,000 annually, which has been reinvested into our cardiac program. Six-day a week physiotherapy has essentially given us more hands on deck to better serve the needs of our patients. This innovative model helped pave the way for us to introduce a new standard fourday pathway of care for cardiac surgery patients. This means that we aim to discharge patients – who meet specific health criteria – four days after their surgery. In fact, recent data from the Canadian Institution for Health Information demonstrates that Southlake’s cardiac surgery program offers the shortest length of stay and most efficient cost per case in Ontario. This accomplishment is very much a credit to our interprofessional model of care, where all team members practice to their full scope. We believe that our spirit of collaboration, innovation and relentless commitment to putting patients first will continue to set us apart as a leader in the H delivery of cardiac care. ■ Kaylyn Ward, MScPT, is Manager of the cardiac surgery units (CVICU and CVS) and Cardiovascular Prevention and Rehabilitation at Southlake Regional Health Centre’s Regional Cardiac Care Program.

Falls are a predictable and often preventable problem that seriously affect older adults’ health and quality of life.

Sponsored by the Ontario Neurotrauma Foundation (ONF), www.onf.org, Loop has over 1300 members who connect electronically to work together, share mininewsletters, webinars and library services. Loop brings together a variety of hospital, long term care and community healthcare workers to provide updates on research, hands-on practices and resources, to identify learning needs, to share success stories and to plan educational events and initiatives. Via Loop, the CoP can provide settingspecific knowledge as well as sharing falls prevention knowledge from a variety of geographic settings. We strive to provide evidence informed and promising practices to all our members. Although most of our members are from Ontario, we are pleased to connect electronically all across Canada and internationally. Members choose own level of involvement. A good example of a synergetic collaborative effort during the past two years has been ONF and the CoP bringing together various partners to promote November as Fall Prevention month. www.hospitalnews.com


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Thousands of toolkit resources were downloaded by organizations participating in Fall Prevention Month. The most popular resources were: • Six Warning Signs of Falls http://fallpreventionmonth.ca/toolkit/resources/ six-warning-signs • Infographic of Ontario Fall Statistics http://fallpreventionmonth.ca/toolkit/ resources/infographic-ontario-fall-statistics • How to Lower Your Fall Risk http://fallpreventionmonth.ca/toolkit/ resources/how-to-lower-your-fall-risk • Activity Guide: Guerilla Marketing http://fallpreventionmonth.ca/toolkit/ resources/guerilla-marketing • Fact Sheet with 3 Key Messages http://fallpreventionmonth.ca/toolkit/ resources/fact-sheet-with-3-key-messages

The ongoing theme is “It takes a community to prevent a fall – we all have a role to play”. In November 2015, 109 organizations were involved in Fall Prevention Month initiatives which included conferences, presentations, health fairs, webinars, and fitness activities, which targeted older adults and healthcare practitioners. A number of fall prevention resources, were available in the November 2016 toolkit including information for older adults and caregivers; promotion and media; sample activities for November; practitioner resources; ongoing programs and interventions; statistics and infographics; and evaluation tools. This toolkit remains available on the recently designed Fall Prevention

www.hospitalnews.com

Month website – http://fallpreventionmonth.ca/. The partners who provided leadership and planning for Fall Prevention Month are: • Canadian Patient Safety Institute • Finding Balance Alberta • Finding Balance Ontario • Fall Prevention Community of Practice • Saskatoon Health Region •National Institute on Ageing – Ryerson University • Ontario Injury Prevention Resource Centre • Ontario Neurotrauma Foundation • Osteoporosis Canada • Parachute • Public Health Agency of Canada • Registered Nurses’ Association of Ontario

• Toronto Rehabilitation Institute – UHN For November 2016, the partners encouraged organizations to coordinate their efforts for a larger impact. An evaluation of the efforts and impact is underway, but we are already noticing a highly positive trend. New this year was a campaign website (fallpreventionmonth.ca), featuring an events calendar, information on fall prevention for older adults, and a toolkit of resources to assist participation. Since launching the bilingual website in the late summer, there have been over 38,000 pageviews by approximately 4300 unique users! It is the place to go! Another new piece of the Fall Prevention Month was a Twitter account @fallpreventON. Each week of the campaign,

a different partner organization “took over” the Twitter account and tweeted out fall prevention messaging. By the end of the campaign, we posted 171 tweets and garnered 188 followers. Many groups participating in Fall Prevention Month retweeted us and used our #PreventFalls2016 hashtag on their own tweets. We are now planning and growing the campaign for 2017. There is a lot to gain in your work setting! For further information please visit Loop, www.fallsloop. com or contact the coordinator margueH rite@thomas.name ■ Marguerite Oberle Thomas, RN., BScN., is the Ontario CoP Program Coordinator, Consultant, Ontario Neurotrauma Foundation.

MARCH 2017 HOSPITAL NEWS


24 Focus

GERONTOLOGY/ALTERNATE LEVEL OF CARE/HOME CARE/REHAB

Changing the way we approach

concussion care By Catherine Varner

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s an Emergency Medicine physician and researcher, I encounter patients with head injury very frequently. While we see a significant amount of serious and complex cases in the emergency department at Mount Sinai Hospital, for the majority of head injuries that come through our doors, most will have symptoms of concussion, also referred to as mild traumatic brain injury, rather than intra-cranial damage. How we prevent, diagnose and treat concussions is changing, as we broaden our scope of research. Historically, the majority of published concussion studies have been focused on head injury as a result of sports, resulting in somewhat of a knowledge gap because the majority of adult concussions diagnosed in the emergency department are from injuries sustained in motor vehicle collisions, falls, bicycle accidents and workrelated accidents. Filling knowledge gaps in emergency medicine is one of the mandates of the Schwartz/Reisman Emergency Medicine Institute (SREMI) and a study that we published earlier this year, challenges the standard protocol in treatment. The study, published in Academic Emergency Medicine, demonstrates there is no difference in symptoms or recovery times between patients who received standard post-concussion discharge instructions developed by the Centre for Disease Control and those who did not. In the study, 118 patients entering Mount Sinai Hospital’s Schwartz/Reisman Emergency Centre with a concussion were divided into two groups. Only one group received the standard medical recommendation to refrain from physical and cognitive activities (such as reading, talking on the phone, watching TV and exercise) with a gradual return to regular activity. Follow ups were completed at twoand four-week intervals, and appropriate measures were taken to ensure the safety of all patients. This is an interesting study for us because it challenges current guidelines. While there is still ample evidence for rest for 2448 hours following injury, and if symptomatic, to not operate heavy machinery or drive for 24 hours, beyond that, there seems to be indication that normal activity could and should resume. In fact, strict bed rest should be avoided as it has been shown to worsen

symptoms and prolong recovery. Contact sports should be avoided until the treating physician says its ok to resume – to avoid risk of a repeat head injury. Another departure from the current treatment guidelines is a recent interest in exercise as a treatment for acute concussion. Published in the Journal of the American Medical Association in December 2016, a study led by Dr. Roger Zemek, a pediatric emergency physician and concussion researcher at the Children’s Hospital of Eastern Ontario, indicates that physical activity within a week of a youth’s head injury may hasten recovery. Children and teens with concussion were less likely to have persistent symptoms four weeks after their injury if they engaged in light aerobic exercise within the first week. The results from this study and other human and animal studies suggest physical activity may, in fact, prevent persistent concussion symptoms. The good news is that for between 80-90 per cent of patients diagnosed with concussion, typical symptoms such as headache, nausea, vision changes, sleep disturbances, disorders of balance, fatigue, irritability, memory and concentration problems will abate between seven to 10 days. Patients with acute concussion don’t typically require medical interventions, treatments or subspecialty management. In fact, education about these symptoms and reassurance may help decrease the likelihood of persistent symptoms. Although early and spontaneous resolution occurs in most patients, a small proportion of adults with concussion will have a protracted course. Between 15-30 per cent of patients with concussion develop persistent symptoms such as headache, nausea, emesis, memory loss, dizziness, diplopia, blurred vision, emotional lability, or sleep disturbances. This is known as post-concussion syndrome (PCS) and it usually lasts 2-4 months, with symptoms typically peaking 4-6 weeks following the injury. However, about 20 per cent of patients with PCS can have symptoms for a year or longer, and will end up being off from full-time work for a year after the initial injury, and some are disabled permanently. Interestingly, psychological counseling is one of the few interventions shown to effectively treat protracted courses of PCS. This very patient-

centred approach involves education, reassurance, and reattribution of symptoms to benign causes, and considers the complex neurobiological and psychological factors impacting the patient’s recovery. It also reestablishes a new and effective sense of self by focusing on gaining control over symptoms through compensatory strategies and modifying emotional responses. For patients who experience persistent symptoms four weeks following the injury, a referral for a more comprehensive evaluation with a specialist may be required. Risk factors that may indicate the need for a specialist include: • Post-traumatic amnesia • History of previous traumatic brain injury • History of previous physical limitations • History of previous neurological or psychiatric problems • High number of symptoms reported early after injury • Reduced balance or dizziness during acute stage • Confounding effects of other health related issues, e.g., pain medications, disabling effects of associated injuries, emotional distress • Presence of memory problems after injury • Personal, psychosocial, or environmental factors that may negatively influence recovery post-concussion • Not returning to work or significant delays in returning to work following the injury • Presence of life stressors at the time of the injury • Older age • Lack of social supports • Less education/lower social economic status (Adapted from the Ontario Neurotrauma Foundation Guidelines for Mild Traumatic Brain Injury and Persistent Symptoms) It is indeed encouraging that there is an increase in knowledge and clinicians providing concussion care in Canada. But there remains a wide variability in practice and a dearth of multi-disciplinary concussion programs in Ontario. To address the issue, the Ontario Neurotrauma Foundation convened the Summit on Concussion Care last year, which brought together patient advocates, healthcare professionals, and concussion experts to begin the process of develop-

How is concussion diagnosed? A diagnosis is based on the following definition of a concussion: the result of a direct blow to the head, face, neck or elsewhere on the body with a force transmitted to the head which may or may not involve loss of consciousness and results in brain injury with one or more symptoms with one or more of the following symptoms: headache, nausea, vision changes, sleep disturbance, disorders of balance, fatigue, irritability, memory, and concentration problems. Because concussion isn’t a structural injury, abnormalities aren’t detected by standard neuroimaging such as MRI. Medical imaging is only used in cases where there is a suspected skull fracture or intracranial bleed. Using the Canadian CT Head Rule as a guide to determine the need for imaging, helps to minimize radiation exposure without jeopardizing patient safety. ing standards of concussion care in Ontario. New standards will indeed strengthen our ability to provide individuals with ongoing concussion symptoms evidence-based care from qualified providers. While the best way to approach concussion care is to prevent it – for example, using helmets in sports and recreational activities, we also need to ensure that we are using the very best practices for this patient population. The evolution of those practices require an investment in research to better understand how to prevent persistent symptoms and a robust system to ensure that all clinicians are knowledgeable about H the new advances of this dynamic field. ■ Catherine Varner is an emergency medicine physician at Mount Sinai Hospital, part of Sinai Health System, working in the Schwartz/Reismen Emergency Department.

If not opioids, then what? Continued from page 18

However, TENS is now commonly available for home use. While using TENS at home can be more convenient for patients, whether it is effective in this setting hasn’t been clear and purchasing the devices can be expensive for patients and their families. That’s why CADTH was asked to assess the evidence and shed some light on the usefulness of home-based TENS for chronic pain. After a careful search for evidence, CADTH found four clinical studies and five evidence-based guidelines that were best suited to help answer questions about how well TENS in the home may work to treat chronic pain. UnHOSPITAL NEWS MARCH 2017

fortunately, it wasn’t a lot of evidence to go on, and questions about TENS in the home still remain. For example, the studies showed mixed results about whether home-based TENS improved chronic pain. And no studies compared home-based TENS with drug treatment options such as opioids. Guidelines did not recommend TENS for osteoarthritis of the knee, chronic neck pain, or chronic low back pain (although these weren’t specific to home-based TENS). Two guidelines did recommend that home-based TENS be purchased to treat chronic pain only if TENS in a clinic setting had already been tried and proved to be effective for that patient.

So what does this tell us? It means that we aren’t really sure how effective TENS in the home may be for chronic pain. The available evidence doesn’t prove that it works, but it also doesn’t prove that TENS in the home does not work. And that means we need more evidence. TENS in the home is just one example of a health technology that may be considered for the treatment of chronic pain. And it’s a good example to remind us that we need to look at the evidence before jumping to alternatives to opioids to treat pain. As the push to find effective and safe alternatives to opioids to treat chronic pain continues to grow, the need for high-quality evidence on these

alternatives will also increase. With the evidence in hand, healthcare decisionmakers – including healthcare providers and their patients – can make informed decisions about the safe and effective treatment of chronic pain. CADTH is committed to ensuring that all decision-makers have the evidence they need on alternatives to opioids for the treatment of chronic pain. To learn more, visit www.cadth.ca/opioids or speak to a CADTH liaison officer in your H region. ■ Dr. Janice Mann, Bsc, MD is a Knowledge Mobilization Officer at CADTH. www.hospitalnews.com


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Hospital News’ 12th Annual Nursing Hero Awards

NOMINATE A

NURSING HERO!

Have you been inspired, encouraged or empowered by an employee or a colleague? Have you or your loved one been touched by the care and compassion of an outstanding nurse? Do you know a nurse who has gone above and beyond the call of duty? Hospital News will once again salute nursing heroes through our annual National Nursing Week (May 8th to 14th) contest. Nominations can be submitted by patients or patients family members, colleagues or managers. Please submit by April ril il 7th and make sure that your entry contains the following information:

Along with having their story published, the winner will also take home:

1ST PRIZE:

$1,000 Cash Prize

2ND PRIZE:

$500 Cash Prize

3RD PRIZE:

$300 Cash Prize

• Full name of the nurse • Facility where he/she worked at the time • Your contact information • Your nursing hero story

Please email submissions to editor@hospitalnews.com or mail to: Hospital News, 610 Applewood Crescent, Suite 401, Vaughan, ON, L4K 0E3 vޜÕ`œ˜œÌÀiViˆÛiVœ˜wÀ“>̈œ˜܈̅ˆ˜Ó{…œÕÀÃœvi“>ˆˆ˜}ޜÕÀ˜œ“ˆ˜>̈œ˜] «i>ÃivœœÜÕ«>Ìeditor@hospitalnews.com œÀLÞÌii«…œ˜i905.532.2600 x2234.

www.HospitalNews.com www.hospitalnews.com

MARCH 2017 HOSPITAL NEWS


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Longterm care: Where innovation can bloom By Amy Porteous ruyère Continuing Care’s goal is to be a leader in care of the elderly and to provide the exceptional care and services residents need to reach their physical, social, psychological and spiritual potential. This philosophy extends far beyond the four walls of our hospitals and long-term care (LTC) homes. Our patient and resident-centered philosophy guides us as we make strategic decisions and build partnerships. Our academic hospitals have worked with researchers from the Bruyère Research Institute (BRI) and hosted students in numerous disciplines for many years. Building on this strong foundation, in 2011, we welcomed the Bruyère Centre for Learning, Research and Innovation (CLRI) in LTC* to the Bruyère family.

B

Raquel Meyer, manager of the Baycrest Centre for Learning, Research & Innovation in Long Term Care (right) demonstrates the SOS app to Jane Philpott, the Federal Health Minister (left).

Accelerating aging and brain health innovation By David Stoller

t is an undeniable reality that as the global population ages, all countries must improve their involvement and oversight in helping manage and care for older adults. To put this into context, the World Health Organization’s (WHO) “World Report on Ageing and Health” predicts that the number of people over the age of 60 will double to 2 billion by 2050. Tied to the aging population is the rise in the number of seniors with dementia. The WHO notes there are approximately 47.5 million people worldwide who currently have dementia, and that 7.7 million new cases are diagnosed every year. The increase in the number of older adults, and specifically those who suffer from dementia, calls for organizations and professionals within the healthcare community to work together to provide better longterm outcomes for these patients and their families. Enter the Canadian Centre for Aging and Brain Health Innovation (CC-ABHI), a solution accelerator focused on driving innovation in the aging and brain health sector. Established in 2015 with $124 million in funding from the Government of Canada, the Government of Ontario, the Baycrest Foundation, and other health system partners, CC-ABHI represents the largest investment in brain health and aging in Canadian history, and one of the largest investments of its kind in the world. To accelerate the pace of innovation, CCABHI collaborates with researchers, clinicians, point-of-care workers, and industry partners to develop, test, and disseminate solutions that improve brain health and quality of life for older adults.

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HOSPITAL NEWS MARCH 2017

In the fall of 2016, CC-ABHI launched several funding programs that have the potential to directly improve the future wellbeing of our aging population. One such program was SPARK, which offers up to $50,000 per project to support small-scale, grass-roots proof-of-concept activities for innovations developed by point-of-care staff. Launched in September 2016, the SPARK call attracted 124 expressions of interest, of which 31 were selected by independent reviewers to receive funding. In total, $1.4 million in total allocations will be distributed amongst the 31 recipients. One of this year’s SPARK recipients is Kensington Health, located in Toronto. Working with UHN’s OpenLab and the Toronto Rehabilitation Institute, they are testing the potential benefits of virtual reality (VR) on seniors with dementia who are otherwise restricted to their homes or long-term care residences. The aim of their project is to assess the use of VR to improve patients’ mental health and quality of life, and to reduce their propensity to wander. Vepeson Wijeyakulasingam, another SPARK recipient, is working with his team at the Assistive Technology Clinic to design a product that will reduce falls in older adults with mobility issues or cognitive impairments. “The Laser Walk” is a laser module that can be mounted to a senior’s existing mobility aid in order to project a line that facilitates safe and independent mobility. With SPARK support, this project will refine and test an existing prototype on a wide variety of assistive devices (i.e. walkers and canes) to ensure that it is durable and can be easily transferred to different clients’ mobility devices.

While the application window for the 2016 SPARK program funding has since closed, other funding programs are open to the public. For instance, on February 16th, CC-ABHI launched the Researcher-Clinician Partnership Program (RCP2), which provides up to $600,000 per project to teams of clinicians and researchers with an innovative aging and brain health product or service that is at an advanced stage of development. By participating in RCP2, teams will be able to test and validate their technology so as to obtain the evidence needed to successfully market their product in the seniors’ care and brain health marketplace. Through this initiative, CC-ABHI will support up to eight new projects, with a total funding allocation of $2.4 million. The deadline for submitting Expressions of Interest is March 30, 2017. The need for innovation is critical. Patients, families, and members of the healthcare community are facing evermounting challenges from an aging population. Of particular note is the struggle people face in caring for someone with an illness that affects their cognitive abilities. However, thanks to funding programs made available through organizations such as CC-ABHI, the future of innovation in Canada is bright, and the prospects for our aging population continue to improve. For more information on how you can participate in CC-ABHI innovation programs visit www.ccabhi.com or email H info@ccabhi.com ■ David Stoller is a Sr. Marketing Specialist at The Canadian Centre for Aging and Brain Health Innovation.

Supporting innovative care practices is also part of the CLRI program. Our team has been looking at a unique service arrangement: designated specialized units in LTC homes. LTC homes are very special places. Over 250 seniors live in Élisabeth Bruyère and Saint-Louis Residences, where they visit with their loved ones and build their lives. Our CLRI’s goal is to enhance the quality of care for all Ontario LTC residents by supporting innovation and collaboration between researchers, health planners, educators, LTC staff, other health practitioners, residents and families. The team creates and shares new knowledge and relevant and practical tools, in both official languages. As it comes to the end of its 6th year of operation, it is worth taking a moment to reflect on some of the Bruyère CLRI’s greatest achievements. The CLRI has hosted many exciting learning initiatives. I have watched as fourth year nursing students’ eyes were opened to the rich professional and personal opportunities this sector offers. These students were benefitting from a new gerontology-intensive placement in partner LTC homes, an innovative program designed by Algonquin College in collaboration with the CLRI. www.hospitalnews.com


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I’ve read the enthusiasm in the testimonials of professionals who attended a CLRI interactive Educators’ Day. At these sessions, educators pick up practical tools, such as e-learning modules, and make connections they can build on as they strive to create varied teaching opportunities for staff. “Sold-out” webinars on tools for de-prescribing and on communication at the end-of-life further attest to the sector’s thirst for learning. Research is close to our heart at Bruyère. In a relatively short time, we designed and conducted over 20 research projects. By their nature, research projects are connected and intertwined. As an example, researchers from the CLRI and La Cité, along with Saint-Louis Residence (SLR) staff validated the standardized Oral Health Assessment Tool in French and developed an animated short video Mouth Matters on the importance of good oral health. This eased the way for the implementation of the RNAO’s Oral Care Best Practice Guidelines at SLR, the first francophone Best Practice Spotlight Organization in Ontario. Gathering momentum, SLR’s first group of La Cité dental hygiene students successfully completed their placements last Fall. These placements help our home with ongoing knowledge exchange and also ensure future dental hygienists have the skills required to serve LTC residents.

CLRIs. The three CLRIs have already laid strong foundations from which to expand the impacts of each project for sustained behavioural changes across the LTC sector. We jointly developed the proposal for CLRI 2.0 through extensive stakeholder consultation. A continuation of Ontario’s CLRIs would strengthen this integrated program that responds to challenges seen in LTC. Together, we are striving to ensure that Ontario’s most vulnerable seniors receive quality, evidence-informed care in Ontario’s long-term care homes grounded H in leading practices. ■

Supporting innovative care practices is also part of the CLRI program. Our team has been looking at a unique service arrangement: designated specialized units in LTC homes. These units expand the role a LTC home plays in the continuum of care as they serve residents who do not require

the full range of care provided in hospitals but whose needs go beyond what a regular LTC home can offer. As we look towards the future, together with our partner CLRIs at Baycrest and Schlegel, we are looking forward to hearing positive news about the renewal of the

*Ontario’s CLRI Program at Bruyère, Baycrest and Schlegel works to enhance the quality of care provided to LTC residents by supporting research, new innovations, learning and knowledge exchange on evidencebased initiatives. The examples above highlight some of the Bruyère CLRI’s work. Ontario’s CLRI Program was made possible through funding provided by the Ministry of Health and Long Term Care. For more information, to access tools, learning materials and research findings, please visit www.clri-ltc.ca. Amy Porteous is VP, Public Affairs, Planning and Family Medicine at Bruyère Continuing Care.

NATIONAL

NURSING WEEK 12th Annual Supplement

The May 2017 issue of Hospital News will be celebrating National Nursing Week in Canada (May 8th – 14th) with a special section showcasing our “Nursing Heroes” contest winners as well as highlighting outstanding leadership and stories from the nursing frontlines!

ADVERTISERS: Don’t miss this opportunity to celebrate and acknowledge the outstanding contributions of your hard working nurses with your own THANK YOU ad!

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GERONTOLOGY/ALTERNATE LEVEL OF CARE/HOME CARE/REHAB

New care model to better support vulnerable seniors By Alica Hall

A

s Ontario prepares for a growing seniors population, healthcare providers are increasingly focused on developing new strategies to better support them. Seniors often have complex conditions that require frequent care and monitoring. One condition that has received considerable attention for this reason is dementia.

“When we’re working with seniors who have more than one illness, we really have to look at the whole person to understand how they will respond to treatment.” While dementia is commonly believed to be a natural part of aging, it is actually a degenerative neurological disease that affects a person’s memory, behaviour and ability to perform everyday activities – it’s also one of the major causes of disability and dependency among older people. A 2016 report by the Ministry of Health and Long-term Care found that one in 10 seniors in Ontario lives with some form of dementia. Seniors who have a chronic disease, such as heart failure or diabetes, in addition to dementia, are considered to be at greater risk for poor health outcomes.

“The traditional model of medicine looks at each part of the body separately,” says Dr. Fiona Menzies, Chief of Geriatric Medicine at St. Joseph’s Health Centre in Toronto. “When we’re working with seniors who have more than one illness, we really have to look at the whole person to understand how they will respond to treatment.” This holistic approach is particularly important for seniors who are frail and may not be able to tolerate medical and surgical treatments that tend to benefit healthier people. Geriatricians must work closely with other specialists, as well as patients and their caregivers to help patients consider all of their options. Historically, collaboration across medical disciplines has been challenging. “How I define frail may not be how a cardiologist would define frail,” explains Dr. Menzies. “We need a common understanding of a patient’s condition in order to determine their treatment options.” The Palliative Care and Therapy Harmonization Model (PATH) is a new model of care, originally developed by physicians in Nova Scotia, that tackles the challenge of coordinating care for seniors with serious illnesses. PATH creates a standardized method to assess how frail or vulnerable a senior is which gives physicians a shared understanding of a patient’s condition and the impact different treatment options can have on their quality of life. In January, St. Joe’s launched the PATH program in the cardiology department, with plans to expand to the nephrology and oncology department in the coming months.

Dr. Fiona Menzies is Chief of Geriatric Medicine at St. Joseph’s Health Centre in Toronto. “For patients to make decisions that are right for them, they need to understand their condition and the risks and possible benefits of each treatment, and how they are likely to respond,” says Dr. Menzies. “PATH enhances our ability to collaborate, not only as doctors, but with patients and families as well.” Family members and caregivers play a critical role in caring for patients with dementia because as a person’s cognitive function declines they may not fully understand their medical condition. Families often have questions about how to get the most out of life, how to make healthcare decisions and how to manage symptoms and plan for what lies ahead. It is a challenging conversation, but our

interprofessional team works closely with caregivers at every stage of the process. “Dementia used to be like cancer – it was a word people avoided,” says Dr. Menzies. “Now I find families really appreciate the frank conversations we have about a patient’s condition – it empowers them to make decisions that reflect the patient’s needs and life goals.” St. Joe’s sees 28,000 seniors annually across our programs and this new model promises to enhance the way we care for H the most vulnerable among them. ■ Alica Hall is a Communications Associate at St. Joseph’s Health Centre in Toronto.

Medical ageism: No longer limited to seniors? By Karen Henderson

could not believe a true story I heard the other day: A 40ish woman I know who is extremely physically fit fell on the ice while walking her dog, and broke her wrist. The break needed surgery. The (young) surgeon at one of Toronto’s leading teaching hospitals told her: “Since you are not 65, and reasonably active, we will operate to set your wrist.” At first I was appalled at such an ageist attitude, but then the shock set in – at what age will our healthcare system now cut off reasonably needed care? I have written about other forms of ageism in the past, but only as it applied to those well advanced in years, which was my personal experience as a family caregiver 20 years ago. My story written in the 1990s goes as follows. My father was almost 94 when he died. Being a caregiver for him opened my eyes to a world I don’t want to move into – the world of the old.

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If you are lucky, you will live long enough to become old. None of us should be surprised or angry; it’s a fact of life. But what’s also a fact of life is this: In my opinion we don’t treat older people as people.

Less than half of all Canadian medical schools have implemented required clerkships in geriatric medicine of at least one week in duration. We treat them as a commodity to be used, abused and disposed of as we see fit. We somehow learn to raise our children well; we try hard to give our pets a good life. Why can’t we extend the same efforts to our older people? I have been as guilty as the next person. On the highways, I become impatient

with older, slower drivers. In lineups at the grocery store, I want to hurry an older person fumbling with her change so I can get home. How did our world get like this? There are too many reasons to discuss here. However, I think one of the biggest is that the young and old have never really learned to communicate with each other. We, the younger, have not figured out how to respect our older people. Thus, we don’t know how to talk to them or learn from them. Too often we ignore older people or treat them like children, particularly if they are cognitively impaired. I remember a wise friend telling me one day when I was going through a very tough time with my Dad: “Remember what your father has lived through – a financial depression and economic collapse, two world wars and the fathering of five children. Your dad is a survivor and should be honoured as such.” Years ago my aunt (Dad’s sister) was telling me stories about life during the war,

things I never knew about my father and his family. I so wanted to ask my Dad about this. But it was too late; his dementia was so far along that he could not communicate any more. He did not speak up and I did not ask. What a waste for him and for me. As Alex Haley wrote, “The death of an old person is like the burning of a library.” I didn’t spend enough time with Dad in his library. On the other hand, many older people have not learned to speak up for themselves. According to author Joan Cleveland of New York, too often older people buy into the myth that they are useless. They allow younger people to tell them what they are or are not capable of. In Another Country: Navigating the Emotional Terrain of Our Elders, Mary Pipher reveals no deep, dark secrets about how our society treats the old. What she does is show us how the patterns were formed. She writes: “We make it almost impossible (for old people) to be dependent yet dignified, respected, and in control. Continued on page 29 www.hospitalnews.com


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NURSES TO THE RESCUE: PART 2 OF 3

Nurses to the rescue

Emergencies can strike at any time. Jarring, chaotic and often life-threatening, they startle the senses and send adrenaline soaring. In this three-part series, you will meet three registered nurses and one nurse practitioner whose peaceful off-hours were catapulted into frenzied encounters on planes, in quiet living rooms, and even in a community bar. These nurses jumped into action without hesitation. By Kimberley Kearsey

I

t was a Thursday afternoon in June 2015, and Natalie Speirs, an RN in the emergency department at Toronto’s Mount Sinai Hospital, had just finished teaching a course to undergraduate nursing students at University of Toronto. She was tired, and although her bus was waiting at the TTC station when she arrived, she decided not to get on. Instead, Speirs began walking home, enjoying the fresh air on a pleasant afternoon.

“I think about nursing as a profession for sure, but it takes a certain type of person to be a nurse,” As she rounded a corner close to her condo, she saw a frantic woman in her PJs and without shoes darting out into the road on her cell phone. She was looking up and down the street, screaming about an ambulance. “I immediately thought she must be on a call with 911,” Speirs recalls. “I was across the street, so I ran over to her and said: ‘I’m a nurse. What’s going on? Can I help you?’” The woman’s one-year-old daughter was inside with her grandmother, choking on what turned out to be a hair clip. Speirs ran with the woman into the house and saw the grandmother on her knees with the little girl upside-down. “I literally took the baby from

her and I crouched down on one knee. I put her over the other knee and started doing back blows.” Speirs did two or three blows and heard the baby cry, but nothing fell from her mouth. “I sat her up on my knee and she started to drool again and not make a noise (indicating she still had something blocking her airway). At this point the paramedics showed up and they took her from me and ran to the truck to suction and do what they needed to do. It was all very quick,” Speirs says. With seven years of emergency nursing under her belt, Speirs looks back at the sudden and very chaotic situation and knows she was able to manage her adrenaline and remain calm thanks to her experience in the ER. She admits, however, that her expertise is with adult patients. “When (the mother) said to me that her one-year-old was choking, I will always remember my first thought being: ‘Oh God, I wish it was an adult,’” she says with a laugh. It was a “dazed” walk home after that, Speirs adds. With the baby’s drool dried up on her arm, she arrived at her condo and told her partner what happened. She was exhausted and took a nap. “I don’t know that it resonated how important it was that I stopped because I was able to sleep and then, when I woke up and started talking about it more, I realized: ‘Wow… that was kind of crazy.’ Thank God I ran over to help this woman because the other outcome… you can’t even imagine.” It’s not the first time this Toronto RN has found herself running towards an emergency

Medical ageism Continued from page 30

The old must learn to say, ‘I am grateful for your help and I am still a person worthy of respect.” Have we done anything for the old we can be proud of? Certainly not in the area of healthcare – medical ageism still happens – and now to an even younger population. You would be shocked at the inadequate number of hours allotted to the study of aging in Canadian medical schools. One graduate thesis research indicated a “lack of consistency in the content and hours dedicated to geriatric material, and the realization that less than half of all Canadian medical schools have implemented required clerkships in geriatric medicine of at least one week in duration (Diachun et al., 2010; Frank, 2010). To make matters worse, we don’t have enough geriatricians now to properly meet the demands of our aging society, let alone 20 years from now when 10 million boomers will be expecting excellent care from an already overburdened care system. I could go on. Instead I want to focus on two easy but very effective solutions www.hospitalnews.com

each of us can implement to help alleviate ageism. My father used to keep telling me: “Slow down, you’re always in a hurry.” Starting today I ask everyone (from family caregivers to physicians) to honour our older people by spending more time with those you know, treat or love – uninterrupted, quality time. The other thing we can do is to listen to what older people have to say. Help give them the opportunity to be proud of having lived 80, 90 or even 100 plus years. Our older people don’t ask for much. It’s precious little for us to give. That was then, but it now appears the playbook has changed. My friend’s experience is a wakup call regarding the attitude the healthcare system seems required to take, due to what appears to be inadequate funding and inability to cope with the inevitable growing care requirements of (agH ing) Canadians. ■

Natalie Speirs is an RN in the emergency department at Toronto’s Mount Sinai Hospital. during off hours. She heard screaming in a parking garage once, and ran to find a woman whose car was stolen by a man who tried to stab her with a pair of scissors. In that case, Speirs was called to testify as a witness. She says she has “…this compulsion that if someone is (frantic), they obviously need help. Why not see if there’s some way I can help them? “I think about nursing as a profession for sure, but it takes a certain type of person to be a nurse,” Speirs continues. “There are going to be experiences that come up when you’re not in a hospital setting. You could be….out in public like I was, and if people

need help, for me, I don’t turn a blind eye. There’s a reason I went into nursing. It’s part H of who I am.” ■ Kimberley Kearsey is managing editor/ communications project manager for RNAO, the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. This article was originally published in the November/December 2016 issue of Registered Nurse Journal, the bi-monthly publication of the Registered Nurses’ Association of Ontario (RNAO).

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Karen Henderson is an Independent Aging/Long Term Care Planning Specialist. MARCH 2017 HOSPITAL NEWS


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Educational Empowering & 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 March 1-5, 2017 Canadian Critical Care Conference Whistler, British Columbia Website: www.canadiancriticalcare.ca Q March 6, 2017 UpOnDigital – The Update on Ontario Digital Health Courtyard Marriott Toronto Downtown Website: www.coachorgnew.ca Q March 8-9, 2017 Mobile Healthcare Holiday Inn Toronto Airport, Toronto Website: www.mobilehealthsummit.ca Q March 20-22, 2017 Neural Dynamics and Brain Health Conference and Workshop Toronto, Ontario Website: www.research.baycrest.org/conference Q March 21-22, 2017 Industrial Autonomous Vehicles Summit Calgary, Alberta www.iotevents.ca Q April 3-5, 2017 Together We Care Toronto Congress Centre, Toronto Website: www.together-we-care.com Q April 7-8, 2017 Innovative Approaches to Optimal Cancer Care in Canada Toronto, Ontario Website: www.partnershipagainstcancer.ca Q April 23-25, 2017 Hospice Palliative Care Ontario Conference Richmond Hill, Ontario Website: www.hpco.ca/conference Q April 26-27, 2017 Healthy Canada Conference 2017: Access to Affordable Medicines Old Mill, Toronto Website: www.cchl-ccls.ca Q April 26-27, 2017 Canadian Healthcare Infrastructure West Metropolitan Hotel, Vancouver Website: www.Canadianinstitute.com Q June 4-7, 2017 eHealth Conference & Tradeshow Toronto, Ontario Website: www.ehealthconference.com Q June  12-13, 2017 National Health Leadership Conference Ottawa Conference & Event Centre, Ottawa Website: www.nhlc-cnls.ca Q June  22, 2017 EMR: Every Step Conference Westin Bayshore, Vancouver BC Website: www.ontariomd.ca To see even more healthcare industry events, please visit our website www.hospitalnews.com/events HOSPITAL NEWS MARCH 2017

providers and patients

through a “one patient, one record, one connected system” approach By Justin Faiola

V

isiting a healthcare provider for an initial consultation can be a lengthy, cumbersome process. You have paperwork to fill out, you bring a list of medications you’re taking, and you have to tell them about your health history, which is often followed up with a number of questions. But after that initial visit, you don’t have to go through that entire process again – you simply update any new information or validate existing information to ensure safe care. However, for Lisa Richardson and her husband Chris McHardy, whose seven-year-old daughter Kathleen is globally developmentally delayed, it often feels like every visit to one of Kathleen’s many providers is a “start-from-the-beginning” initial visit.

“We need to work towards creating a more coordinated system to improve care across the province; a system where a child’s entire care team, including their family, can contribute their expertise and access their health information.” Kathleen has been a patient at The Hospital for Sick Children (SickKids) for six of the seven years of her life. “She sees many different specialists for various appointments when she visits the hospital, and also works with different providers such as physiotherapists and occupational therapists in the community,” explains Lisa. Lisa says that working with multiple providers is challenging because the burden of keeping each of these individuals informed about what care Kathleen is receiving is often their family’s responsibility. “Each time we visit one of Kathleen’s specialists we receive a piece of paper that contains some information about her visit – a test result, comments from her specialist – which we keep record of and bring to her next appointment to ensure our daughter’s care is accurately represented.

We’ve been doing this for six years so we’ve become good at keeping everyone in the loop, but it’s still easy to miss something or overlook small details.” Having an incomplete picture of the patient story can also be frustrating for clinicians who are fully aware of the impact this can have on clinical decisions and patient outcomes. “The evolution of patient care, not only at SickKids, but throughout the entire healthcare system, has become incredibly complex and fragmented,” says Dr. Michael Apkon, President and CEO of SickKids. “We need to work towards creating a more coordinated system to improve care across the province; a system where a child’s entire care team, including their family, can contribute their expertise and access their health information.” To move in this direction, SickKids has begun a multi-year project to implement a fully integrated health information system using software from the company Epic, an industry leader in electronic health record software. In addition, SickKids and the Children’s Hospital of Eastern Ontario (CHEO) have partnered to develop and implement the first integrated Canadian paediatric instance of Epic. The project will fundamentally change the way SickKids provides care and will improve research by bringing all patient information and charting into one integrated electronic system. The Epic system also provides patients and their families with anytime access to their health information through an online portal called MyChart, a radical departure from the limited access many patients and families currently have. To tackle this complex, transformative process, SickKids has assembled more than 100 project staff who will be dedicated to working on the project. In addition, hundreds of staff from across the hospital will work closely with the project team to shape the system into one that reflects the care delivered at SickKids. “This investment we are making is not just an IT project,” explains Dr. Sarah Muttitt, Vice-President and Chief Information Officer at SickKids. “There will be a mass amount of change that will also transform the way we do business and the way we operate clinically. Continued on page 31 www.hospitalnews.com


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Careers Continued from page 30 It’s exciting, but it’s going to be a challenging process; one that will force us to re-imagine the way we do our work and deliver care to children and their families.� In addition, the SickKids-CHEO partnership will inspire and facilitate innovations that will result in better, more consistent and more coordinated care, especially for patients with complex needs. It will also help set the provincial standard for paediatric care, scale up a mutual vision for clinical research, benchmark and report on quality improvement practices across a broad range of paediatric service providers, and ensure a more efficient and sustainable future. For Lisa and her family, the start of this project and partnership is a glimpse into what the future holds for their care journey. “Consolidating all of Kathleen’s health information in one system will not only improve her care and ease the communications burden on our family, but will empower us to be more involved in managing H her health.� ■Justin Faiola is a Communications Specialist at The Hospital for Sick Children (SickKids).

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Submit your application now to: human_resources@giftoflife.on.ca Or visit our website to learn more: https://www.giftoflife.on.ca/en/careers.htm

www.hospitalnews.com

To advertise please contact

Denise Hodgson denise@hospitalnews.com 905-532-2600 ext. 2232

Saint Elizabeth is a national health care provider that has been opening the door to new possibilities and care experiences for more than a century. 5HFRJQL]HG DV &DQDGD¡V ODUJHVW VRFLDO HQWHUSULVH ZH HPSOR\  SHRSOH DQG YLVLW  FOLHQWV HYHU\ GD\ 7KURXJK WKH 6DLQW (OL]DEHWK 5HVHDUFK&HQWUHRXU+HDOWK&DUHHU&ROOHJHVRXUFRPPLWPHQWWRSHUVRQ DQG IDPLO\ FHQWHUHG FDUH DQG WKH 6DLQW (OL]DEHWK )RXQGDWLRQ ZH DUH helping to make the future of health care brighter and stronger. Learn more at www.saintelizabeth.comRUĂ&#x20AC;QGXVRQ7ZLWWHUDW@StElizabethSEHC.

LOOKING FOR

Registered Nurses (RN) Registered Practical Nurses (RPN) Wound/Enterostomal Therapy Nurses (ET) ACROSS CANADA FOR OUR HOME AND COMMUNITY CARE PROGRAM

If you join our team you will become a part RI D GLVWLQJXLVKHG &DQDGLDQ QRWIRUSURĂ&#x20AC;W organization with a century of experience. â&#x20AC;˘ You will have access to a total rewards SURJUDP ZKLFK LQFOXGHV JURXS EHQHĂ&#x20AC;WV and pension plan â&#x20AC;˘ You may be eligible for our education bursaries and tuition assistance program Â&#x2021;<RXPD\KDYHĂ H[LEOHZRUNLQJKRXUV â&#x20AC;˘ You will be provided with an extensive paid orientation and preceptorship program â&#x20AC;˘ You will be eligible for subsidized RNAO/ RPNAO memberships $OO DSSOLFDQWV PXVW KDYH D YDOLG GULYHU¡V license and access to a car and current CNO registration

Join our health Care team today! PLEASE APPLY ONLINE

www.saintelizabeth.com

MARCH 2017 HOSPITAL NEWS


32 Focus

GERONTOLOGY/ALTERNATE LEVEL OF CARE/HOME CARE/REHAB

EXTEND YOUR REACH WITH MEDTRONIC CARE MANAGEMENT SERVICES

4 Million 95,000

15 Years

TELEHEALTH PATIENTS PATIENT ON SERVICE MONTHS

DEVELOPING TELEHEALTH MARKET

Through a combination of remote patient monitoring platforms, proprietary software, patient engagement, and care coordination, Medtronic Care Management Services serves as an extension of patient care teams – amplifying HƪRUWV WR PDQDJH FRPSOH[ SDWLHQW SRSXODWLRQV at home.

HOSPITAL NEWS MARCH 2017

www.hospitalnews.com

Hospital News 2017 March Edition  

Focus: Gerontology, Alternate Level of Care, Home Care and Rehab.

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