Hospital News April 2020

Inside: From the CEO’s Desk | Ethics | Evidence Matters | Long-term care | Careers

April 2020 Edition

www.hospitalnews.com

FEATURED

Battling COVID-19

Page 12

BENEFITS THAT WORK FULL-TIME FOR THOSE WHO DON’T • Part-Time • Casual • Contract • Retirees Reach out to us today to learn more about our guaranteed coverage options for hospital employees!

1-866-768-1477 | www.healthcareproviders.ca

NOW AVAILABLE FROM COAST TO COAST!

nursesknow.ona.org

On the front line.

In this time of COVID-19, daily life has been profoundly disrupted. Every hour brings new information, new challenges, and new concerns. In the midst of this turbulence, Ontario’s nurses and health-care professionals are stepping up, fully aware of the personal risks.

They are offering their knowledge, their skills, and their dedication to the public good.

We’re all going to learn from this moment. But today, the public can count on the commitment and courage of nurses, and everyone else on the front line, to pull us through.

Representing more than 68,000 nurses and health-care professionals across Ontario.

Contents April 2020 Edition

IN THIS ISSUE:

Virtual interpreting service breaks down barriers

6

▲ Cover story: Battling COVID-19

12

▲ Inside Sunnybrook’s response to COVID-19

20

▲ Simulation app helps long-term care staff

COLUMNS Guest editorial .................4

26

In brief .............................7 From the CEO’s desk .....10 COVID-19 coverage ........12 Ethics ..............................18 Long-term care ...............24 Evidence matters ...........29

▲ Free COVID-19 simulation training

22

www.hospitalnews.com

Revolutionizing kidney transplantation

8

▲ Technology helps alleviate the COVID-19 crisis

16

Leaving no one behind

with COVID-19

By Katherine Lippel n the heels of the COVID-19 crisis, the federal government has now improved access to Employment Insurance, and some provinces, but not all, have discouraged employers from requiring sick notes. Banks have offered a six month payment deferral for mortgages and organizations responsible for workers’ compensation and occupational health and safety in some provinces have produced timely guidance material.

Much more needs to be done.

Little if any action has been taken to relieve the needs of tenants who can’t meet their rental payments. No one in Canada, including the precariously employed, should be left homeless or destitute because of COVID-19 and the consequences it will have for both the health of our people and our economy. We must ensure that workers have the ability to stop working if they are ill, in their own interest, and in the interest of public health.

Statistics Canada estimates that between 27 per cent and 45 per cent of all Canadian workers do not have full-time stable jobs. This does not include low wage earners with full time stable jobs who still live from paycheck to paycheck. The precariously employed include: the solo self-employed including those working in the gig economy; those on temporary contracts, working on call or for temporary employment agencies; and part-time workers, including the involuntary part-time.

O

In many provinces, full time low-wage earners are also in situations of employment precarity where employers may lay them off at will or where non-unionized workers can be fired for being absent for more than three days, even if they are absent because of illness. Labour legislation does not discourage employers from requiring sicknotes to justify absences.

Bill 148 in Ontario had curtailed employers’ right to require sicknotes, but that provision was repealed by the Ford Government’s Making Ontario Open for Business Bill 47. Now we’ve heard promises that legislation is in the works that will ensure employers no longer require sickness notes in Ontario for those in quarantine, although the legislation has yet to be tabled.

Anyone can be at risk of contracting COVID-19 at work, but workers in certain sectors, such as health care, and also those working with the public, are particularly at risk. Occupational Health and Safety legislation requires that employers protect workers from hazards, and workers have the right to refuse work that endangers their health.

Health and safety regulators and public health officials are mandated to proactively provide guidance to workers on the front lines to protect their health and safety and that of others.

If workers do become ill out of and in the course of their employment, workers’ compensation should normally be provided. Compensation boards need to adapt their requirements of all injured workers in light of current challenges to the health care system.

Continued on page 8

610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 TEL. 905.532.2600|FAX 1.888.546.6189

www.hospitalnews.com Editor

Kristie Jones

editor@hospitalnews.com Advertising Representatives

Denise Hodgson

denise@hospitalnews.com Publisher

Stefan Dreesen

stefan@hospitalnews.com Accounting Inquiries

accountingteam@mediaclassified.ca Circulation Inquiries

info@hospitalnews.com Director of Print Media

Lauren Reid-Sachs

Senior Graphic Designer

Johannah Lorenzo

ADVISORY BOARD Barb Mildon,

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

Helen Reilly,

Publicist Health-Care Communications

Jane Adams,

President Brainstorm Communications & Creations

Bobbi Greenberg,

Health care communications

Sarah Quadri Magnotta, Health care communications

Dr. Cory Ross,

B.A., MS.C., DC, CSM (OXON), MBA, CHE Vice President, Academic George Brown College, Toronto, ON ASSOCIATE PARTNERS:

UPCOMING DEADLINES MAY 2020 ISSUE

JUNE 2020 ISSUE

EDITORIAL: April 13 ADVERTISING: Display – April 24 | Careers – April 28

EDITORIAL: May 11 ADVERTISING: Display – May 22 | Careers – May 26

Monthly Focus: Surgical Procedures/Pain Management/ Palliative Care/Oncology: Non-invasive surgery, plastic surgery, orthopedic surgery and new surgical techniques including organ donation and transplantation procedures. New approaches to pain management and palliative care delivery.

Approaches to cancer diagnosis and treatment.

Monthly Focus: Personalized Medicine/Volunteers and Fundraising/Pharmacy: Developments in the field of personalized medicine. Innovative approaches to fundraising and the role of volunteers in healthcare. An examination of safe and effective use of medications in hospitals.

+ National Nursing Week

+ Annual Hospital Pharmacists’ Association Supplement + Special Focus: Cannabis

THANKS TO OUR ADVERTISERS Hospital News is provided at no cost in hospitals.

When you visit our advertisers, please mention you saw their ads in Hospital News.

4 HOSPITAL NEWS APRIL 2020

Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario.

The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers.

Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised.

Changes of address, notices, subscriptions orders and undeliverable address notifications.

Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: subscriptions@ hospitalnews.com Canadian Publications mail sales product agreement number 42578518.

www.hospitalnews.com

NEWS

Navigator app puts patients at the centre of their care

By Steven Gallagher

ime Pavlovic doesn’t hesitate to respond when asked where the launch of the Niagara Health Navigator app ranks over his nearly 20-year career in healthcare innovation.

“For me it’s one of the most exciting things I’ve been part of,” says Pavlovic, Niagara Health’s Chief Information Officer. “The philosophy of this app is really changing the way the ecosystem of technology and healthcare has been developed over the last two decades.”

S

“WE WANT TO KNOW WHAT OUR PATIENTS AND COMMUNITY ARE LOOKING FOR FROM A TECHNOLOGY PERSPECTIVE”

Niagara Health, a multi-site hospital organization with a growing number of community-based services in Ontario’s Niagara region, released the Navigator last fall. The made-in-Niagara digital solution makes it easier for patients and families to access health information, navigate the healthcare system and connect with their care team.

The app’s launch was a proud moment for Pavlovic and his team at Niagara Health. But it’s what the future holds for the app – which is available as a free download on a smartphone or tablet – that has Pavlovic even more excited.

The first release included features that allow users to see Niagara Health’s Emergency Department and Urgent Care Centre wait times in real time, provide feedback on the app, learn about the organization’s programs and services and how they can thank a Niagara Health team member or express a concern. www.hospitalnews.com

In February 2020, Niagara Health released version 1.1 of the Navigator, providing users more healthcare content to support their well-being.

New features include information on healthcare options in Niagara and how to seek mental health and addictions support, a direct link to the Ontario Caregiver Organization website and updates on the planning for the new hospital in South Niagara.

The plan is to gradually roll out features on the Navigator in what Pavlovic calls a “commonsense approach.”

Getting feedback is critical to the app’s development. Niagara Health, which has had more than 3,000 downloads of the app, is encouraging users to provide their input to ensure the Navigator meets the needs of its patients, their families and members of the Niagara community.

“We want to know what our patients and community are looking for from a technology perspective,” says Pavlovic. “They’ve provided us a lot of great feedback so far that has helped us to create a roadmap, working with our teams at Niagara Health and our community partners, on how we prioritize what we are going to release in the future.”

As Niagara Health Navigator grows and evolves, it will increasingly put patients at the centre of their care.

Future releases will provide users with real-time access to their health information, including booking appointments and checking test results, using a private and secure single sign-on identity management system, which would be a first in Ontario.

Mark Rajack, Project Director, Partnerships and Innovation at Niagara Health, says being part of the Navigator development team has been a rewarding experience.

“A lot of the changes happening in healthcare and the vision that the Ontario Ministry of Health has, it so closely aligns with the vision that we have for the Navigator and the ben-

Niagara Health Chief Information Officer Sime Pavlovic and Mark Rajack, Project Director, Partnerships and Innovation.

efits that can come out of it for the community,” Rajack says.

“There is a potential that we are setting a model that can be used across the province. So to me to be part of that experience and work with like-minded individuals on something that can be so impactful, it’s just amazing.”

Pavlovic, who thanked technology partners IDENTOS Inc. and nCipher for helping to bring the Navigator to life, echoes Rajack’s comments.

“This really shifts the paradigm of how we want to provide care,” he says.

“The conversation to me is not about the technology; it’s around the patient experience. How can we remove anxiety? How can we make sure we are providing better care and how can we streamline care? That’s where our clinical community will really guide us to focus on the app releases in the future. We’re creating an ecosystem that will allow our community different H pathways to different services.” ■

Steven Gallagher is a Communications Specialist at Niagara Health.

EMERGENCY LOANS

FOR HOMEOWNERS!

DOES YOUR BANK OFFER PAYMENTS THIS LOW? Mortgage Amount

$200,000 $250,000 $300,000 $350,000 $400,000 $450,000 $500,000

Monthly Payment

$830 $1,038 $1,245 $1,453 $1,661 $1,868 $2,076

Bi-weekly Payment

$383 $479 $575 $670 $766 $862 $958

Rates from

2.9% Amortization up to 30 years

O.A.C. Payments based on 5 year Term & 30 Year AM. Rates subject to change without notice.

MANNY JOHAR, Mortgage Agent

My husband lost his job. We fell behind on our mortgage. The bank was seizing our home. I still can’t believe that you gave us an emergency mortgage with no proof of income. You saved our home & gave us L_[YH JHZO [V NL[ I` \U[PS OL Ä UKZ HUV[OLY QVI ;OHURZ Expert Mortgage! C.S.

Licence # 12079

MANNY JOHAR REPRESENTS OVER 400 LENDERS MANY PROVIDE 1st, 2nd & 3rd MORTGAGES EVEN WITH:

Horrible Credit Bankruptcy Unemployed Power of Sale

Mortgage Arrears Property Tax Arrears Self-Employed Pension & Disability

ASK ABOUT LOANS FOR COMMERCIAL, FARM, CONSTRUCTION

CALL

MANNY JOHAR 7 DAYS A WEEK

1.888.646.7596

www.MannyJohar.ca Your Mortgage, Your Expert!

MANNY JOHAR is Ontario’s Mortgage SUPERSTAR!

APRIL 2020 HOSPITAL NEWS 5

NEWS

Virtual interpreting service

helps break down language barriers across three health authorities

By Kris Olsen s Canada’s third largest and third-most populous province, British Columbia (B.C.) is home to people of many different ethnic origins.

According to the Canada 2016 Census, 28 per cent of people in B.C. spoke only one language that wasn’t English or French. Language barriers can cause a number of challenges during a medical appointment, and can lead to frustration for patients and providers, as well as confusion with care plans.

The Provincial Language Service (PLS), a program of Provincial Health Services Authority, provides interpreting and translation services to BC health authorities and private physician offices. In 2019 it received 164,914 requests for interpreting services. In one year, that works out to roughly 451 requests a day! 93 per cent of those requests came from entities in the Lower Mainland.

LOOK FOR VRI AT THE FOLLOWING LOCATIONS

A

A PROJECT TO TEST VIRTUAL INTERPRETING TECHNOLOGY

With a goal to ease frustration and ensure patients have a good understanding of their care plans, PLS collaborated with the Office of Virtual Health (OVH) to launch a Video Remote Interpreting (VRI) project at BC Cancer-Vancouver in December.

A tablet mounted on an adjustable rolling stand enables clinicians and patients to speak with an interpreter on a live video call during a medical appointment. The service provides access to 40 languages using the video feature and 240 languages through audio.

The project is testing virtual interpreting technology with the potential of adoption on a permanent basis. A collaboration with PHSA’s PLS, the Office of Virtual Health, Vancouver Coastal Health and Fraser Health, the project aims to provide better access to care by improving the timeliness of interpreting services and enhance communication between cli-

PHSA • BC Cancer – Vancouver – Dentistry • BC Cancer – Surrey – Radiation Therapy Clinic • BC Cancer – Surrey – Pharmacy Consult • BC Cancer – Surrey – Patient Review Fraser Health • Surrey Memorial Hospital – Family Birthing Unit • Surrey Memorial Hospital – High Acuity Unit and Intensive Care Unit Vancouver Coastal Health • VGH Geriatric Inpatient Unit • VGH Cardiac Cath lab • VGH Emergency Department

(above) Pulkit Mahajan, James Sidney and Samuel See, radiation therapists at the BC Cancer – Surrey radiation therapy clinic with the VRI device. (right) Jorawur Singh, radiation therapist educator at BC Cancer – Surrey radiation therapy clinic poses with the VRI device.

nicians and their patients who have a language barrier.

Spurred by positive feedback from patients and clinicians, the VRI project is now being expanded to additional locations across the Lower Mainland. “We are committed to ensuring language isn’t a barrier to receiving access to care, and in that spirit we are thrilled to provide this service at more clinics in Fraser Health, Vancouver Coastal Health and PHSA,” says Kiran Malli, director of PLS. One of the recent clinics to introduce VRI is the Radiation Therapy Clinic at BC Cancer-Surrey. As chief radiation therapist at BC Cancer-Surrey, Craig Elith works directly with patients who have challenges with English. “I think it’s great to see a simple

PROJECT IS A COLLABORATION ACROSS HEALTH AUTHORITIES

to use, everyday communication tool be adapted in the health care setting,” says Craig. “I expect the interpreting device to have a positive impact on the patient care experience of non-English speaking patients. All staff had a positive response to the device during the introduction and education sessions.

The Radiation Therapy staff are genuinely excited to start using it.”

The VRI service is provided through a project that is testing virtual interpreting technology with the potential of adoption on a permanent basis. A collaboration with PHSA’s Provincial Language Service, the Office of Virtual Health, Vancouver Coastal Health and Fraser Health, the project aims to provide the patient with better access to care by improving the timeliness of interpreting services and enhance communication between clinicians and their patients who have a language barrier.

The Office of Virtual Health leads and provides strategic direction for the overall Virtual Health initiative across PHSA. The Provincial Language Service provides interpreting and translation services to BC health authorities and private physician offices. The video remote interpreter augments PLS’ other interpreter offerings, which include in-person and H over-the-phone interpreting. ■

Kris Olsen is a Communications Officer at the Office of Virtual Health.

6 HOSPITAL NEWS APRIL 2020

www.hospitalnews.com

IN BRIEF

No scientific evidence that ibuprofen worsens

COVID-19 symptoms ealth Canada is aware of reports, including on social media, that reference safety issues with the use of ibuprofen in COVID-19 cases. There is no scientific evidence that establishes a link between ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), and the worsening of COVID 19 symptoms. The Government of Canada is monitoring the situation closely, including reviewing new information and reports as they become available, and will take the appropriate action to help protect the health and safety of Canadians.

Some reports have suggested that there are risks of using ibuprofen to

H

treat symptoms of infection. In August 2019, Health Canada initiated a safety review of ibuprofen and the risk of certain serious bacterial infections in children with chicken pox, and has recently concluded there was no link. A summary of this review is expected to be published shortly.

When choosing a fever or pain relief medication for COVID-19, patients and healthcare professionals should consider all available treatment options, including acetaminophen and other NSAIDs. Each product has its own benefits and risks, listed in the product labelling.

Ibuprofen is an NSAID used for pain and fever relief, and to reduce in-

flammation. The majority of ibuprofen products in Canada are available overthe-counter (e.g., Advil and Motrin).

NSAIDs, as with acetaminophen, may mask the usual signs and symptoms of an infection. Patients should consult with their healthcare professional if symptoms persist.

It is important to note that Canadians who currently use any NSAIDs (such as ibuprofen and naproxen) to treat their chronic diseases should not stop their treatment and should speak to their healthcare professional if they have any questions about changing medications. Report any health product adverse events or complaints to H Health Canada. ■

ASA no longer recommended to prevent first stroke new Heart & Stroke guideline published in the Canadian Medical Association Journal does not recommend taking ASA (Acetylsalicylic acid) as a preventive measure for those who do not have a history of stroke or heart or vascular disease, a change to a decades-old common practice.

The recommendations are based on strong new research that indicates taking ASA (brand names include Aspirin, Entrophen, Novasen) daily could potentially do more harm than good for those at low risk for stroke, heart or vascular disease, by causing serious side effects such as internal bleeding.

A

“The new recommendations only apply to those who have not had a stroke, heart condition or peripheral artery disease. It is still strongly recommended that anyone with a history of stroke, or heart or vascular disease continue to take low-dose, daily ASA to prevent another event from occurring if they have been advised to do so by a health professional,” says Dr Theodore Wein, neurologist at McGill University and the chair of the Heart & Stroke writing group that developed the new guideline.

The recommendations could have far-reaching effects. Based on the results of a new poll commissioned by Heart & Stroke, 5.3 million Canadi-

an adults are taking ASA to prevent heart disease or stroke, of whom 2.4 million do so without being directed to by their doctor.

“We are urging Canadians to talk to their doctor or health care professional to weigh the risks and benefits before deciding to start, continue or stop taking ASA daily to prevent stroke, heart disease or vascular disease,” says Dr. Patrice Lindsay, Director, Systems Change and Stroke Program, Heart & Stroke.

“It is an important personal health decision that should be informed by the recent research and made in consultation with health care H professionals.” ■

Cumulative doses of oral steroids linked to increased blood pressure umulative doses of oral steroids in patients with chronic inflammatory diseases are associated with increased hypertension (blood pressure) for those who take them regularly, found new research in CMAJ (Canadian Medical Association Journal).

“The cumulative effect of oral steroid doses on hypertension is substantial, and given that these are commonly prescribed medications, the related health burden could be high,” says Dr. Mar Pujades-Rodriguez, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.

Hypertension, or high blood pressure, affects one in five adults around the world and can have significant negative health effects. Previous studies have reported a dose-related response between oral steroids and hypertension, although evidence has been inconclusive.

This study of more than 71,000 patients from 389 general practices in England looked at the relationship between oral glucocorticoid doses and hypertension in patients with chronic inflammatory diseases between 1998 and 2017. The most common underlying diseases included inflammatory bowel disease (35%) and rheumatoid arthritis (28%). Researchers found that in the cohort studied, there were 24,896 (35%) new cases of hypertension. When patients reached cumulative doses, rates of hypertension increased accordingly in a dose–reH sponse pattern. ■

C

RNs AND NPs JOIN NOW RNAO has earned your trust once again.

Tell us you appreciate what we do for you by becoming a member.

RNAO.ca/join 1-800-268-7199 www.hospitalnews.com

$256 $100 for only

with PLP included

APRIL 2020 HOSPITAL NEWS 7

NEWS

Revolutionizing kidney transplantation

By Anna Wassermann n Ontario alone, more than 1,000 people are waiting for a kidney transplant. Kidney failure is a growing problem in Canada and with few kidneys available for transplantation, many patients spend years waiting – and some never have an opportunity to receive one.

With this in mind, doctors have begun accepting kidneys from sicker donors. While some of them perform well, others are in poor condition before they’re transplanted and tend to fail quickly.

To help doctors make informed decisions about which kidneys to accept for transplantation and who should receive them, a research team at St. Michael’s Hospital is embarking on a first-of-its-kind study. In collaboration with Ryerson University through the Institute for Biomedical Engineering, Science and Technology (iBEST), the team is aiming to develop ultrasound-based techniques that measure damage in transplant kidneys.

“We currently have no way of reliably assessing the quality of a donor kidney,” said Dr. Darren Yuen, a nephrologist at St. Michael’s and a scientist in the Keenan Research Centre for Biomedical Science. “This was the impetus behind our project. Scarring is a major type of kidney damage that can occur in donor kidneys. If we could measure scarring in a kidney before it’s transplanted, we could make

kidneys. The laser moves through the kidneys and gets absorbed by different chromophores – the part of a molecule responsible for colour. Each chromophore produces a different colour, depending on the substance in the kidney it belongs to.

“The collagen, which is the major component of scarring, has a unique spectrum compared to blood,” said Dr. Kolios. “So we can distinguish between the signal from the scarring and the signal from the blood. We’ve been able to get very good results in determining the amount of collagen, and therefore scarring, in the kidneys.”

The results have been so good, in fact, that Drs. Yuen and Kolios were recently named finalists at Angels Den – a health care competition hosted annually by the St. Michael’s Hospital Foundation. In addition to

being one of the top four teams at Angels Den, the duo received two prestigious grants from the Canadian Institutes of Health Research and the Natural Sciences and Engineering Research Council of Canada to continue their work.

With this funding, the doctors hope to begin a clinical trial later this year, in collaboration with the transplant surgeons at St. Michael’s, taking their machine over to an operating room in the hospital to scan kidneys as they arrive for transplantation. The trial will be led by Hysi.

If successful, the clinical trial – the first in the world to use photoacoustic imaging and ultrasound to evaluate kidney damage – could help doctors around the world make better use of donor kidneys.

The end goal, said Dr. Yuen, is to have a machine that surgeons could travel with, to make immediate decisions about whether kidneys should be transplanted.

And he’s feeling pretty good about their chances, thanks to the extent of their collaborations.

“This is only possible because of iBEST, our other collaborators, VisualSonics, and buy-in from St. Michael’s surgeons and anesthetists who are really on board to do this,” said Dr. Yuen. “I think it’s all going to pay off.

I think this has the potential to revolutionize how we allocate kidneys H for transplantation.” ■

they are away, regardless of their contractual status. They should not be required to produce sick notes by their employers and they should be protected from reprisals if they are absent for health reasons.

New measures should be introduced to protect the jobs of workers who are unable to work because of COVID-19.

Provinces should enact temporary prohibition of evictions for non-payment of rent.

It sometimes takes a crisis to reveal all the fault lines in our flawed social safety nets. We can weather the difficulties arising from COVID-19, but only if we face it together, and make sure to leave H no one in Canada behind. ■

I

sure that somebody who’s been on a waitlist for a long time doesn’t get a kidney that’s only going to last a year or two.”

The study began back in 2017, after an informal conversation between Dr. Yuen and Dr. Michael Kolios, co-director of iBEST. Dr. Yuen mentioned his inability to assess donor kidneys and Dr. Kolios jumped at the opportunity to help.

A medical physicist, Dr. Kolios has spent much of his career studying ultrasound imaging in medicine. Recently, however, he’s been doing work with photoacoustic imaging – a form of laser-generated ultrasound that produces greater specificity than conventional ultrasound imaging.

Working with PhD student Eno Hysi, Dr. Kolios developed an ultrasound machine that uses laser to scan

Anna Wassermann is a communications advisor at Unity Health Toronto.

No one left behind Lots of workers will be falling through the cracks of a very uneven social safety net in Canada, primarily provincially regulated with regard to labour legislation, and federally regulated, with regard to Employment Insurance.

In other words, it is highly likely that some workers will not be able to pay their rent or feed their families if the

Continued from page 4

current crisis is to go on for weeks or even months. Our governments need to take more action.

Legislation improving Labour Standards and Workers’ Compensation coverage is required to ensure that all workers who are absent because of illness or in quarantine should be guaranteed economic support while

Katherine Lippel is the Distinguished Research Chair in Occupational Health and Safety Law and a member of the Centre for Health Law, Policy and Ethics at the University of Ottawa.

8 HOSPITAL NEWS APRIL 2020

www.hospitalnews.com

Hygiene and Health Solutions for Improved Care Outcomes Essity partners with your Care Home in providing cost effective incontinence, wound care and vascular therapy solutions that lead to proven positive care outcomes, with trusted brands like TENA®, Cutimed® and JOBST®, and our expert support.

JOBST® FarrowWrap® Incontinence and Skincare Solutions

Advanced Wound Care Management

A wide range of innovative products, programs and care routines to help develop and implement individualized care plans

Therapy solutions that ultimately raise the therapeutic index

Solutions to help you assess and evaluate your budget based on incontinence related productivity and satisfaction

of Chronic Edema and Lymphedema

High quality, reliable and advanced products for individual care

Designed to reduce and control edema while providing ease of donning and adaptability

An innovative wound management range which covers all wound healing phases for the successful treatment

Helps prevent limb swelling during the day supporting individual's independence

On-going education and support tools to help Health Care Professionals select the right product based on the individual care needZ

For more information, contact us: 1-800-510-8023 | www.essity.com Medical Care 1-877-978-5526

FROM THE CEO’S DESK

Transforming health care through innovation

By David Diamond s President and CEO of Eastern Health, I am thrilled that we have embarked on an exciting innovation journey to transform health care in our province and throughout Canada. This year, we released “Innovating Together: An Innovation Strategy to Guide Creative Thought and Action in Eastern Health: A Living Lab”. This strategy will help us further develop our identity as a Living Lab – or user-centred innovation space.

As a Living Lab, we will harness innovative solutions to improve life for our patients, our health system and our province. Since we started this journey at Eastern Health, we have developed an innovation ecosystem comprised of the other regional health authorities, the Newfoundland and Labrador Centre for Health Information, Memorial University, College of the North Atlantic, Marine Institute, provincial and federal government and government agencies and our private sector strategic innovation partners.

We, along with our partners, are on a mission to improve the health status of Canadians through innovation. To help us achieve our goal, we recognize that we must start looking at ourselves as a Living Lab where opportunities to come up with innovative ideas and have access to innovative health-care solutions are accessible to all our employees throughout the organization.

A

OUR STRATEGY HAS FOUR PILLARS:

• We will apply a value-based lens to all activities including decision-making and procurement. Value means benefits realized by patients, clients, family members, care providers and the health system compared to the cost. We aim to provide outcomes including better health and increased quality of life to those who receive our services.

• We will develop and implement a Health Innovation Acceleration Centre. This will be a collaborative environment where ideas are generated, and solutions tested and refined. These innovative solutions are anticipated to have meaningful impact on patient care and quality of life with the potential to impact the broader health-care system and to generate economic or commercial value and benefit.

• We will cultivate a culture of innovation. We believe that our staff are key to helping us grow a culture of innovation from within. We will encourage all employees to be creative in their daily work and will provide them with the opportunities to do so.

• We will build partnerships to support economic growth. Meaningful partnerships are essential to the successful functioning of an ecosystem and we are excited to work with a variety of partners including our 10 vendors of record, members of the local innovation system, the provincial government, post-secondary education institutions, Atlantic Canada Opportunities Agency (ACOA), Newfoundland and Labrador Association of Technology and Innovation (NATI), the start-up community and many others. Through partnerships, we can find innovative solutions to health-care challenges for the benefit of our patients, clients and long-term care residents.

The support of our partners in our innovation ecosystem has been integral to our success to date. Partnerships have resulted in signed agreements with several partners for the development of health-care technologies in the areas of cancer care, diabetes management, cybersecurity, emergency management and many others. We are also active in the clinical trials space in pharmaceuticals and we would like to expand our footprint further

David Diamond into device and software research and development.

At Eastern Health, we are excited to continue generating ideas and to create products with our partners that can be sold into the broader market where there is revenue potential and job opportunities in research and development. For example, we have had tremendous success with MyCCath, a secured, web-based IT solution for clinicians which has improved workflow and scheduling at the cardiac catheterization laboratory (cath lab) at the Health Sciences Centre in St. John’s, NL. Working in partnership with MOBIA Technology Innovations, MyCCath has resulted in reduced overtime expenses within the cath lab as well as cost savings and greater bed capacity at hospitals across the province. As a result, within six months inpatient wait times for cath lab procedures were reduced by 56 per cent across the province. In addition, our partnership with Medtronic Integrated Health Solutions, will help us commercialize this technology so that other jurisdictions can use it to improve cardiac care for their patients.

The primary goal of our innovation strategy is to improve outcomes for our patients. They are at the centre of everything we do, whether it is purchasing a specific outcome for patients or working directly with patients to determine what technologies will work best for them and the care they require. Innovation is about having a meaningful impact on our patients, clients and their families’ lives, quality of care and quality of life.

With support from our Board of Trustees and involvement of the executive team, innovation is underpinning everything we do at Eastern Health - whether that is improving access to services or improving quality and safety or improving sustainability. I am looking forward to working closely with all our partners to transform health care and to improve health outcomes for our patients, clients and residents. Together, we are making Eastern Health a centre of excellence for innovation.

I encourage you to review our strategy and our new web site at H ri.easternhealth.ca. ■

David Diamond is President and CEO, Eastern Health.

10 HOSPITAL NEWS APRIL 2020

www.hospitalnews.com

BETTER OUTCOMES MADE POSSIBLE THROUGH PARTNERSHIP Collaboration is key.

To get to more sustainable, patient-centered models of care, it takes a willingness to go beyond business as usual.

For us, this means working in partnership to innovate how care is delivered. It includes: Delivering services that ERRVW FOLQLFDO HƯFLHQFLHV Using real-time patient data to create more targeted care Entering into outcomesbased agreements to deliver better outcomes for patients And more

LET’S THINK OUTSIDE 7+( %2; ǭ 72*(7+(5. medtronic.ca/IHS

© 2020 Medtronic All Rights Reserved.

COVID-19

Populism and pandemics

By Kumanan Wilson t wasn’t supposed to play out this way. The world had entered into a grand bargain in 2005 with the approval of the revised International Health Regulations (IHR). Countries had essentially ceded some sovereignty to the World Health Organization (WHO) in order to best protect each other from global public health emergencies, and to preserve international travel and trade when these emergencies occurred.

Countries also agreed to implement measures to detect, report and respond to potential international threats that emerge within their borders. The WHO would decide when an event had met the level of a public health emergency of international concern. If it did, the WHO would decide what measures were necessary to prevent the spread of the threat, while at the same time, avoiding unnecessary interference with international travel and trade.

I

HOW DID THIS UNFOLD WITH COVID-19?

On Jan. 20, 2020, using its authority under the International Health Regulations, the WHO declared COVID-19 a public health emergency of international concern. Currently the WHO has stated there is no role for travel bans to prevent the spread of the disease, except at the earliest stages of the disease entering a country to give the country time to develop preparedness measures.

However, from the beginning of this crisis, countries and non-state actors, such as airlines, have exceeded the WHO recommendations. The United States announced a ban of all non-essential travel to mainland Europe.

Canada has asked all non-essential travel to be cancelled and has closed its borders to non-Canadian travelers.

European nations are rapidly closing borders. The WHO’s statement on travel restrictions remains unchanged.

WHAT WENT WRONG?

The international agreement was always a bit of a long shot. While unanimously approved by World Health Assembly (WHA) member states, there was no enforcement mechanism for the IHR. It was largely based on trust in the WHO, and a trust in global governance.

And that is what has changed. The International Health Regulations were approved in a world which believed in global approaches to combating these and other threats. We don’t live in that world anymore.

We live in a world which is increasingly distrustful of global elites, one characterized by increasing populist sentiment.

In this world, it’s not surprising that countries would disregard WHO guidance. Did President Trump even know (or care) what this guidance was? Is Boris Johnson going to “take orders” from Geneva? Is Modi? Putin? Bolsonaro?

No. In the current world, increasingly, countries are acting solely in their own best interest. But it’s not just the populist nations that are taking this action as the pandemics toll increases. Now we are all looking to protect our own citizens first.

Diseases are harder to control when countries act independently.

Travel and trade are unnecessarily impacted. The loss of global wealth attributed to COVID-19 is in the trillions. And when we eventually come out of this crisis, we are all going to have to agree on rules to reopen our borders – it is apparent the WHO is not currently a trusted source to make this decision.

SO, WHAT NEEDS TO HAPPEN?

Countries need to trust the WHO – and the WHO needs to earn this trust.

Trust was dissipating after a series of questions in recent years surrounding WHO leadership in addressing emergencies, most notably its response to the 2014 Ebola outbreak.

It is incumbent upon the WHO to ensure that it acts in a way that is transparent and accountable to rebuild this trust. It is very concerning that there is such a discordance between WHO advice and nation’s actions. Either the WHO advice was incorrect and contributed to the spread of the virus, or countries are over-reacting and causing unnecessary harm to international trade and travel.

The WHO also needs to be financially supported and, in turn, needs to financially support low- and middle-in-

come countries so that they can invest in surveillance and response capacity.

A comparatively small investment in local public health could lead to the early detection and containment of future COVID-19-type outbreaks. A compensation program also needs to be created to offset the economic consequences of early reporting of potential threats – particularly by low- and middle-income countries.

Importantly, the views of local populations affected by outbreaks and travel advisories – which can be devastating to local industries – need to be considered, and these local populations need to be supported. It is the perception that their needs are secondary to global goals that has, perhaps more than any other factor, fueled populist sentiment.

The world needs the International Health Regulations, even in spite of the fact that nations are not following all of their guidance, as we’re currently seeing with COVID-19. The good news is if we can learn from this outbreak and make this system work, local populations will be better supported.

Investments in local public health by the global community will have tangible results. And this will increase confidence in global efforts to prevent disease spread as well as other efforts H to work as a global community. ■

Kumanan Wilson, MD, MSc, FRCPC, is a physician at The Ottawa Hospital and a member of the University of Ottawa Centre for Health Law, Policy and Ethics. He has been a consultant to the World Health Organization on the IHR (2005).

12 HOSPITAL NEWS APRIL 2020

www.hospitalnews.com

Adam goes the distance.

Meet Adam. This type A personality gets up before dawn every morning to run and competes in marathons and road races at every opportunity. Whether running outdoors or running to a courtroom, Adam is in a constant competition. A runner’s focus and a well-defined plan ensure that even the smallest aspects of a complex personal injury case are done exactly right.

Before he joined Oatley Vigmond, Adam practiced with a prominent Toronto litigation firm, defending physicians in malpractice claims. With this valuable experience and insight into the way Canadian doctors are defended, Adam now uses that understanding on behalf of clients injured at the hands of the health care profession.

Successfully settling a case and seeing the smiles on his clients’ faces while he helps them to move on with their lives is gratifying for Adam. To him, it’s the same feeling as crossing the finish line in a race, knowing he has given it his all.

To learn more about Adam visit www.oatleyvigmond.com/adam Proud Member

1.888.662.2481 oatleyvigmond.com

SPONSORED CONTENT

What’s your outbreak protocol?

Communicable diseases cause a significant burden on society in terms of healthcare expenditure and health impact on individuals.1 A Canadian analysis suggests that hospital outbreaks of influenza occur on a regular basis and contribute to overall morbidity and mortality. 2 Additionally, healthcare-associated infections (HAIs) affect 4% to 10% of patients and can result in significant harm to patients and healthcare workers. 3,4 Healthcare facilities are complex environments where the provision of care to large numbers of patients can result in the contamination of surfaces and equipment with harmful microorganisms. 5

Outbreaks are costly.

The costs associated with outbreaks can be considerable and often include: 6 • Costs associated with utilizing additional staff (such as nurses, healthcare workers, environmental services staff, etc.);

• Loss of revenue from private room accommodation;

• Microbiological testing;

• Increased use of supplies (including personal protective equipment);

• Ward and bed closures;

• Increased use of medications, including preventative vaccinations.

Outbreaks happen.

The ongoing novel coronavirus disease (COVID-19; formerly known as 2019-nCoV) outbreak originating in China, but now spreading worldwide, including Canada, serves as a timely reminder of the importance of adhering to strict infection prevention protocols for outbreak situations, especially at healthcare facilities.

Plan to prevent.

Be healthcare clean.

According to the 2020 report Best Practices for Prevention, Surveillance and Infection Control Management of Novel Respiratory Infections in All Health Care Settings, by the Provincial Disease Advisory Committee (PIDAC), there are a number of factors that can influence outbreaks, including:7

“Healthcare clean” is an approach to cleaning that aims to reduce or eliminate microbial contamination of all surfaces and equipment within the healthcare environment. 8

• Adherence to infection prevention and control (IPAC) protocols; • Hand hygiene, including the use of alcohol-based hand rub and hand washing; • Assessment of the risk of infection transmission and the appropriate use of personal protective equipment, including correct selection, safe application, removal and disposal; • Healthcare providers should be apprehensive when screening anyone with a new onset of antimicrobial-resistant infection symptoms or other symptoms characteristic of a novel infection; • Anyone accompanying a patient who is entering a healthcare setting should also be screened; • Appropriate cleaning and/or disinfection of healthcare equipment, supplies and surfaces or items in the healthcare environment; • The use of Health Canada-approved disinfectants; • Individual staff are responsible for keeping patients, healthcare workers and themselves and coworkers safe. This is in addition to employer and supervisor responsibilities for worker safety.

In a 2018 report, PIDAC recommended that enhanced cleaning and disinfection are often required during outbreaks when environmental contamination and subsequent transmission is known to be related to the organism suspected of causing the outbreak (e.g., norovirus, Clostridium difficile). 5 There are multiple studies demonstrating how outbreaks caused by antibioticresistant organisms were controlled or stopped following the adoption of enhanced cleaning and disinfection approaches.9,10 In an effort to keep up, the technology used to perform environmental cleaning continues to evolve. No-touch disinfection systems use chemical disinfectants or physical agents to disinfect surfaces and can supplement, but not replace, manual cleaning and disinfection. 5

CloroxPro™ can help.

Our infection control specialists are equipped to review your current outbreak protocols, recommend products based on clinical evidence and customize your protocols to the needs of your facility.

References: 1. Diener A & Dugas J. Inequality-related economic burden of communicable diseases in Canada. Can Commun Dis Rep Suppl 2016;42:S1-S7.

2. Murti M, et al. Influenza outbreaks in Ontario hospitals, 2012-2016. Can Commun Dis Rep Suppl 2018;44(9):201-5. 3. Magill SS, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370(13):1198-208. 4. Taylor G, et al. Assessing the magnitude and trends in hospital acquired infections in Canadian hospitals through sequential point prevalence surveys. Antimicrob Resist Infect Control 2016;5(19). 5. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Best practices for environmental cleaning for prevention and control of infections in all health care settings. 3rd ed. Toronto, ON: Queen’s Printer for Ontario; 2018. 6. Dik J-H H, et al. (2016) Cost-analysis of seven nosocomial outbreaks in an academic hospital. PLoS ONE 11(2):e0149226. https://doi.org/10.1371/journal.pone.0149226. 7. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Best practices for prevention, surveillance and infection control management of novel respiratory infections in all health care settings. 1st revision. Toronto, ON: Queen’s Printer for Ontario; 2020. 8. Gauthier J. “Hospital clean” versus “construction clean” – is there a difference? Can J Infect Control 2004;19(3):150-2. 9. Delgado Naranjo J, et al. Control of a clonal outbreak of multidrug-resistant Acinetobacter baumannii in a hospital of the Basque country after the introduction of environmental cleaning led by the systematic sampling from environmental objects. Interdiscip Perspect Infect Dis 2013;2013:582831. 10. de Lassence A, et al. Control and outcome of a large outbreak of colonization and infection with glycopeptide-intermediate Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2006;42(2):170-8.

Learn more, or request a product demo at CloroxHealthcare.ca | healthcare@clorox.com

© 2020 The Clorox Company

Protect her. She has aqua aerobics classes to get to.

CloroxPro™ offers 3 formulations for triple protection from hospital-acquired infections.

Your patients trust you to create a safe healing environment, so trust CloroxPro™ to stand behind you to help protect them. With multiple Health Canada-registered disinfectants, based on 3 chemistries in a variety of ready-to-use formats, you have more choices to meet your unique cleaning and disinfection needs. Because we believe that supporting you every step of the way means protecting them.

CloroxHealthcare.ca | healthcare@clorox.com © 2020 The Clorox Company

COVID-19

How technology can help alleviate the COVID-19 crisis

By Dr. Chris Hobson he rapid emergence of COVID-19 and its far-reaching effects have been a startling wake-up call for patients and healthcare providers across the globe. Amidst travel bans, political disputes and economic crises, countries are confronted with questions around how to maintain a sustainable healthcare system.

The Angus Reid Institute released a study that shows “five per cent of Canadians are worried that they may face the deadly consequence if they contract COVID-19, while 12 per cent say they fear hospitalization.” Overall, nearly one-in-five feel they are at high risk if infected. The number of Canadians who felt that the country was at serious risk rose from “just 31 per cent in early February to 68 per cent in mid-March.”

These concerns are well founded. It is clear from events that have unfolded in China, Italy, Iran and other countries that health systems need to prepare for a massively increased load – especially on their hospitals. Demand for essential items such as Intensive Care Unit beds, respirators, ventilators and personal protective equipment is expected to greatly exceed supply.

With minimal knowledge on the biology of the disease, interventions need to be agile to meet a rapidly evolving threat. Now is the time for healthcare officials to turn their attention to digital health to support the sustainability of healthcare systems during a pandemic relies on technology.

The ability to screen large volumes of patients is the first major response needed. A self-assessment platform gathers information on each patient, such as their age, chronic conditions and contact with coronavirus. It works to establish a complete picture of an individual’s health, determining those in need of medical attention either immediately, or in the near future.

Using advanced electronic health records, a clinician can then access a

T

combined view of all the traditional clinical data as well as the new data types, perform analytics on that data, and act on those insights. The ability to predict and identify those patients most at risk, limits the strain on the system while ensuring correct patients are treated in the right place, at the right time.

To alleviate pressure within hospitals, it is critical that patients who can safely be managed at home are discharged early. There are several categories of patients where this applies. Most obviously are COVID – 19 patients in recovery and those with other conditions that can be managed at home, such as chronic diseases (COPD and CHF) and patients currently in hospital waiting for alternative levels of care.

For hospitals these are an extra set of tools to manage non-emergent patients in a way that reduces the risk to employees and other patients. Technology has the ability to capture data and help us better understand the disease – as currently there is a real shortage of reliable information.

For successful remote monitoring at home, the technology must offer clear, two-way trigger points. Patients can call for help or transfer to hospital, meanwhile alerts need to be sent to providers when patients deteriorate at home. The data is fed into hospitals, ensuring care can be allocated without overloading individual clinicians or departments.

Progress in remote patient monitoring will see critical data lead to a deeper understanding of the resources available in hospitals. A study in the Lancet identified multi-system organ failure, sepsis and delayed hospital transfers were significant hurdles for healthcare providers in Wuhan, China. In the case of a pandemic such as COVID-19, the death toll increases rapidly when Intensive Care Units are overwhelmed.

One of the greatest challenges in developing technology during a pandemic crisis is the rapid emergence of new requirements, as the disease impacts an increasing number of patients. The technology implemented must be easy to learn, configure and adapt.

What’s more, with a lack of reliable best practices and scientifically validated information on the disease, confident decision-making is difficult.

The COVID-19 pandemic is an opportunity to demonstrate to health care officials and decision-makers that technology can facilitate sustainable healthcare systems. It can support the care of individual patients across the community, while also managing the needs and resources of the wider population. There is plenty more to come from machine learning-based predictive tools as healthcare providers leverage more data and experience from the disease.

Appropriate technology targeted at the key issues health systems face will help drive a multi-pronged strategy. The knowledge and experience Canada already has acquired in digital health, community care and remote patient monitoring can act as a steppingstone through this pandemic. If we seize the moment, there is an opportunity to significantly impact a rapH idly evolving crisis. ■

Dr. Chris Hobson is a former family physician with 16 years of experience and two decades as the chief medical officer at Orion Health, a global provider of health information technology.

16 HOSPITAL NEWS APRIL 2020

www.hospitalnews.com

COVID-19 NUMBERS

COVID-19

Areas in Canada with cases of COVID-19 as of March 23, 2020, 6:00 pm EDT Province, territory or other

British Columbia Alberta Saskatchewan Manitoba Ontario Quebec New Brunswick Nova Scotia Prince Edward Island Newfoundland and Labrador Yukon Northwest Territories Nunavut Repatriated travellers Total

Number of confirmed cases

Number of probable cases

472 301 65 11 503 221 9 41 3 4 2 1 0 13 1,646

0 0 1 9 0 407 8 0 0 20 0 0 0 0 445

Number of deaths

13 1 0 0 6 4 0 0 0 0 0 0 0 0 24 Source: Public Health Agency of Canada

National Microbiology Laboratory’s summary of people tested in Canada as of March 23, 2020 at 6:00 pm EDT Total number of patients tested in Canada 107,147 Total positive 1,584 Total negative 95,500

COMM

UNIC

ATION People w diseas ith Parkinso e shou ld be en n to part ic co their ow ipate in choi uraged ces ab n care out .

Co mmun ic atio in verb al and n should be writte D iscuss n form. io achiev ns should aim e provid a balance be to in tw and pr g realistic in een omotin format ion g optim Fa milies ism. should and caregive be info rs the co ndition rmed about suppor an t servic d available es.

Best practice information to guide you to diagnose, treat and manage Parkinson’s

Now Available!

The Canadian Guideline for Parkinson Disease

PARKINS DISEASE ON

VISUA L FROM SUMMARY O T PARKIN HE CANADIA F RECOMME ND N SON D ISEAS GUIDELINE ATIONS E, 2ND FOR ED

DIAGN O PROGR SIS AND ESSIO N Park

inso suspec n disease sh te ou tremor d in anyone ld be , st w balanc iffness, slow ith e disord problems or ness, ers. gait CT or MRI brain should scanni no to diag t be routin ng ely us nose Pa ed diseas rkinso e. n Pa tients, who re especially yo qu should est genetic ung, be testing movem assessed by ent di sorder a specia s list.

N o ther apies are eff slowin ec g degene or stopping tive for br ration diseas in Park ain e. inson

This 2nd Edition includes 97 recommendations based on the best published evidence to guide you in clinical practice.

Visit ParkinsonClinicalGuidelines.ca to download: Full Guideline

Executive Summary Infographic

Resources for you & your patients Aussi disponible en fran̋ais : Visitez le site Web ParkinsonGuideClinique.ca For print copies, contact: Education@parkinson.ca | 1 (800) 565-3000 | parkinson.ca Charitable Registration Number 10809 1786 RR0001

TREATM

PALLIA TIVE C

A

RE The pa lli of peop ative care ne eds le with diseas e shou Parkinson ld throug hout al be consider ed the di sease. l phases of If the pa of med tient asks, th ical as e optio si dying n should stance in be disc ussed.

ENT

Levodo pa is th effectiv e mos t e may be medication and used ea A rly. regula begun r exercise re gi ea benefit rly has prov men . en Pa tients diagno with possib le sis of Pa diseas rk in so e n a trial may benefit of from replac dopamine em help w ent therap y to ith diag nosis.

Im pulse can de control diso ve rd nergic lop on dopa ers therap y at an mistage in y are mor the disease but e com m on do pamin on in patient e agon s D ists. eep br and ge ain stimulat io l routin infusion are n el now motor y used to m anage sympt oms.

Re habilit experie ation therap nced w ists diseas ith Pa e rk diagno can help ne inson wly se others d patients, and throug h all st ages.

NONM

OTOR

FEATU Botulin RES um to xin A he Drug th lps co erapy ntrol dr midod fo ooling. rine, flu r low bloo d pr dr M oc or anagem tisone essure incl ud and do en t to the of mperid es individu depression one. al and sh D emen their cu ould be ta tia shou ilored rrent th Parkin ld no erapy. son di sease, t exclude a Ra diagno even if pid ey sis presen disord e movemen t early of er t .

Parkin can pre-da sleep behavi te the son di sease. diagno our sis of

COVID-19

Ethics in an outbreak

By Andria Bianchi t the time of writing this column, most Canadians will likely be familiar with Coronavirus disease 19 (COVID-19). As defined by the World Health Organization (WHO), “[c]oronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as…Severe Acute Respiratory Syndrome (SARSCoV).” These viruses are zoonotic, which means that they spread from animals to humans (WHO 2020).

COVID-19 is a new coronavirus strain that emerged in China and has never been identified in humans before. The WHO labelled the COVID-19 outbreak a global health emergency in January 2020, and more recently classified it as a pandemic. As of March 11, over 118,000 cases have been identified across 114 countries.

In an attempt to contain the virus, individuals are being encouraged to maintain social distancing, avoid unnecessary international travel, etc.

In a public health crisis such as that of COVID-19, many questions need to be answered in order to help society deal with its implications. For instance, what exactly is COVID-19? (How) can we contain it? Can we cure it? Who is most vulnerable? Do travel bans actually work to stop it from spreading?

A

questions that need to be responded to in a timely, thoughtful, and well-reasoned manner during these situations.

I will highlight some of these questions below. It is impossible to adequately respond to the questions in this short column since a response would also require providing information about thorough decision-making frameworks developed by ethicists.

Some of the most cited and difficult dilemmas that occur in a pandemic are those regarding the prioritization and dissemination of scarce resources. For

SOME OF THE MOST CITED AND DIFFICULT DILEMMAS THAT OCCUR IN A PANDEMIC ARE THOSE REGARDING THE PRIORITIZATION AND DISSEMINATION OF SCARCE RESOURCES. In addition to consulting with experts to help us answer important descriptive and clinical questions such as those noted above, it is also the case that ethicists are often consulted in public health crises.

Although one may not immediately think of ethicists as important contributors to consult with during a pandemic, there are many complex ethical

instance, if multiple people test positive for COVID-19 and require a ventilator/an isolated room/a treatment in order to survive, yet there are only a few ventilators/rooms/treatments available, then who ought to be prioritized? Should we prioritize the person who is most likely to make a full recovery? The taxpaying citizen? The person who is the youngest? The philanthro-

pist? Etc. Ultimately, who ought to die and who ought to survive? Making decisions about how to prioritize scarce resources during a pandemic requires the careful consideration of multiple competing values, which is precisely what ethicists are trained to do.

Alongside questions of resource allocation, there are also often questions asked about whether and under what conditions healthcare workers are obliged to care for patients in an outbreak. Are there certain conditions under which it may be ethically defensible for healthcare workers to not attend work (even if they offer an essential service to patients)? If so, what might those conditions look like?

Other questions that exist extend beyond hospital walls. For instance, at what point might it be defensible to place restrictions on individual citizens’ freedoms (e.g. via travel bans, city lockdowns, etc.)? Given the importance placed on autonomy (particularly in Western liberal societies), the decision to limit an individual’s right to engage/not engage in certain activities ought to be taken seriously.

Finally, what are our obligations to society’s most vulnerable, such as those who depend on our shelter sys-

tem? As a result of COVID-19, many shelters will be closed for the foreseeable future. And while a decision to close shelters would not have been made lightly, it is worth highlighting the cost that this decision will have on some of society’s most vulnerable and unsupported people. From the perspective of justice, it seems reasonable to suggest that we owe these individuals a great deal of resources and support in response to the COVID-19 outbreak (which may lead us to also ask: where should these resources be taken from? And to whom ought they be given if they are scarce in number?).

Ultimately, there are many ethical dilemmas that arise during an outbreak that require thoughtful attention. Ethicists working at hospitals, within community settings, and in partnership with organizations such as Toronto’s Joint Centre for Bioethics (JCB) are trained to respond to these complex questions. They are an essential part of a pandemic planning and response team.

At the link below you will find resources developed by the Joint Centre of Bioethics in response to the novel coronavirus pandemic: http://jcb.utoH ronto.ca/news/covid-19.shtml. ■

Andria Bianchi, PhD, is a Bioethicist and Clinician-Scientist at the University Health Network and an Assistant Professor at the Dalla Lana School of Public Health- University of Toronto.

18 HOSPITAL NEWS APRIL 2020

www.hospitalnews.com

15th Annual Hospital News!

NURSING HERO AWARDS Postponed Until Further Notice.

Awards Due to the current Covid-19 pandemic, we will postpone the Annual Nursing Hero until further notice. Our healthcare heroes have their hands full at this time helping Canada get through this crucial period. Stay tuned for updates. ers during this challenging time!

Hospital News and its Advertising Supporters salute all of Canada’s healthcare provid

Celebrating Canada’s Nurses and Their Contributions Along with having their story published, the winner also will take home: CASH PRIZES: 1st PRIZE $1,500 2nd PRIZE $1000 3rd PRIZE $500

+DYH \RX EHHQ LQVSLUHG HQFRXUDJHG RU HPSRZHUHG E\ DQ HPSOR\HH RU D FROOHDJXH" +DYH \RX RU \RXU ORYHG RQH EHHQ WRXFKHG E\ WKH FDUH DQG FRPSDVVLRQ RI DQ RXWVWDQGLQJ QXUVH" 'R \RX NQRZ D QXUVH ZKR KDV JRQH DERYH DQG EH\RQG WKH FDOO RI GXW\" +RVSLWDO 1HZV ZLOO RQFH DJDLQ VDOXWH QXUVLQJ KHURHV WKURXJK RXU DQQXDO 1DWLRQDO 1XUVLQJ :HHN 0D\ WK WR WK FRQWHVW 1RPLQDWLRQV FDQ EH VXEPLWWHG E\ SDWLHQWV RU SDWLHQWV IDPLO\ PHPEHUV FROOHDJXHV RU PDQDJHUV

Please submit by April 8 and make sure that your entry contains the following information: Â&#x2021; )XOO QDPH RI WKH QXUVH Â&#x2021; )DFLOLW\ ZKHUH KH VKH ZRUNHG DW D WLPH Â&#x2021; <RXU FRQWDFW LQIRUPDWLRQ Â&#x2021; <RXU QXUVLQJ KHUR VWRU\ 3OHDVH HPDLO VXEPLVVLRQV WR HGLWRU#KRVSLWDOQHZV FRP RU PDLO WR +RVSLWDO 1HZV $SSOHZRRG &UHVFHQW 6XLWH 9DXJKDQ 21 / . (

,I \RX GR QRW UHFHLYH FRQÃ&#x20AC;UPDWLRQ ZLWKLQ KRXUV RI HPDLOLQJ \RXU QRPLQDWLRQ SOHDVH IROORZ XS DW HGLWRU#KRVSLWDOQHZV FRP RU E\ WHOHSKRQH [

COVID-19

A look

inside

Sunnybrook’s response to COVID-19 unnybrook staff photographer Kevin Van Paassen captured moments at the hospital’s Bayview Campus during the week of March 17, as the Ontario government declared a state of emergency due to the COVID-19 pandemic. ■H

S

TOP: Sunnybrook staff screen patients entering hospital.

ABOVE: A Sunnybrook staff member wheels equipment past a row of chairs.

Every other chair is taped off to encourage social distancing — a strategy that aims to limit the spread of COVID-19.

ABOVE: Sunnybrook staff wear personal protective equipment inside the hospital’s COVID-19 Assessment Centre.

RIGHT: A Sunnybrook staff member cleans chairs in a seating area.

FAR RIGHT: A Sunnybrook staff member cleans equipment in a patient room.

20 HOSPITAL NEWS APRIL 2020

www.hospitalnews.com

Protecting the

PATIENT, CAREGIVER, AND THE HEALTHCARE ENVIRONMENT The SC Johnson Professional range unites the DebMed Hand Hygiene Monitoring System with hand hygiene products formulated to meet the strict standards of healthcare facilities and help to:

REDUCE INFECTIONS DECREASE COSTS INCREASE PATIENT SAFETY PROVIDE ACTIONABLE COMPLIANCE REPORTS TO LEARN MORE VISIT https://info.scjp.com/healthcare

COVID-19

Free COVID-19

simulation training hen CAE Healthcare announced the availability of its COVID-19 simulation training scenario for healthcare providers this month, the response was immediate, and eye-opening.

“The novel coronavirus response is going to completely reshape the education system globally. It’s going to force us to reevaluate how we always did training,” says CAE Healthcare Chief Learning Offer Amar Patel.

With just a few days’ notice, nearly 1,000 nurses, physicians and clinical educators from 30 countries logged into CAE Healthcare’s one-hour webinars about COVID-19 preparedness. When asked in a survey if their hospital was prepared to manage the coronavirus, only 39 per cent of clinicians agreed. Simulation can help close the gap on preparation to manage the pandemic.

“The clinical workforce is being utilized in unique places, in areas they were not trained. A classic example

W

may be an obstetrician working in the adult ICU,” Patel says. “How do we get them up to speed, refresh their memories and give them new foundational knowledge?”

CAE Healthcare, a division of global aviation training leader CAE, has been known for highly realistic medical simulators, and most recently, its augmented reality applications for HoloLens 2. Today, the fastest growing segment of the company is its custom training services for hospitals.

Over the past year, Patel has doubled the size of the CAE Healthcare Academy, a global team of clinical educators and adjunct faculty who have worked in the field and specialize in simulation-based training.

Within a few short weeks of the coronavirus outbreak, the CAE Healthcare Academy released a COVID-19 Simulated Clinical Experience (SCE) to train front-line nurses, emergency room physicians, respiratory therapists, and more. Patel, who developed similar training for hospitals during the

THE NOVEL CORONAVIRUS RESPONSE IS GOING TO COMPLETELY RESHAPE THE EDUCATION SYSTEM GLOBALLY. IT’S GOING TO FORCE US TO REEVALUATE HOW WE ALWAYS DID TRAINING. Ebola outbreak, wanted to ensure that healthcare providers protected themselves before caring for patients.

“The failure to properly don and doff Personal Protective Equipment (PPE) properly is one of the primary reasons why healthcare providers contract infectious diseases,” says Patel.

“We’ve created a COVID-19 training scenario that includes the World Health Organization (WHO) PPE checklists, infection control practices, triage, containment and managing patient complications.”

Already, many hospitals have cancelled clinical rotations for nursing students and even medical residents to preserve PPE for caregivers and safe-

guard students and patients. Nursing students have expressed fear that they will not complete their required clinical hours in time to graduate this year, and the pipeline of new medical professionals could be reduced when they are most needed.

“Educators are seeking ways to provide clinical education, what was previously considered hands-on training, within a virtual format,” says Patel.

“With the shortage of PPE, for example, they are asking, ‘How do I teach donning and doffing to the actively engaged workforce and find a way for people to learn without the equipment?’ We are turning to video-based learning.”

Self-contamination rates among healthcare workers during simulated doffing and donning PPE*

Contamination of Skin and/or Clothing

Contamination Related to Improper Gown Removal

Contamination Related to Improper Glove Removal

*Tomas ME, Kundrapu S, Thota P, et al. Contamination of health care personnel during removal of personal protective Equipment.

JAMA Intern Med. 2015;175(12): 1904-1910.

22 HOSPITAL NEWS APRIL 2020

www.hospitalnews.com

COVID-19

For the duration of the pandemic, the CAE Healthcare Academy has summoned all of its forces in the field to provide just-in-time training to front-line clinicians before they begin to see patients. When the day arrives that systems can begin to look beyond the crisis, Patel envisions a transformed educational landscape for healthcare.

“We will reevaluate how we conduct training in a digital realm and how we distribute education. It’s unprecedented, and it’s an opportunity for the medical community to learn and become better prepared.”

The CAE Healthcare Academy is delivering ongoing, one-hour training webinars for healthcare providers and a complimentary training scenario, titled Suspected COVID-19, all of which is available online at https://caehealthcare.com/covid19/. A four-scenario training course, Pathogens of High Consequence, will be offered to healthcare providers and systems in the comH ing weeks. ■

LONG-TERM CARE NEWS

Operation pollination How one home care agency is sowing the seeds of innovation s the new Ontario Health Team (OHT) integrated model begins to take shape, it’s clear that home care is stepping into the spotlight as the future of health care. With these activities rapidly moving forward, VHA Home HealthCare (VHA), a large Ontario not-for-profit agency that has served the community for nearly a century, began looking at new ways to empower its workers to deliver positive change and grow its already blossoming culture of innovation.

“Innovation is part of our DNA,” notes Dr. Kathryn Nichol, Vice President of Innovation, Quality, Best Practice, Research and Education (iQBPRE) and Chief Nursing Executive at VHA. “We are known to respond to system gaps with great collaborations and unique programming,” she adds.

“But we saw a need to formalize some of these efforts so that everyone at VHA is using the same language and has access to the same tools.”

A

INNOVATION IN ACTION

VHA started by defining the actions of an innovative culture which included: • Asking questions and embracing curiosity to better understand information, others’ opinions and processes.

• Investigating before acting to fully get to the root of the pain point/ opportunity.

• Testing ideas and assumptions in small but meaningful ways to validate or refute them and, in so doing, save time, energy and resources.

• Dissecting mistakes so they are not replicated.

• Dissecting successes to try and understand the “secret sauce” so it can be replicated.

• Evolving – change or iterate based on what is learned from all the previous activities and apply this knowledge to do better.

“I think spelling out these activities helps to make innovation more tangible for people to understand, get behind and incorporate them into their daily work,” says Pam Stoikopoulos, 24 HOSPITAL NEWS APRIL 2020

Head Solutions Strategist who leads innovation capacity building initiatives at VHA. “It’s not just some complex abstract theory.”

HIGH-SPEED DESIGN THINKING

VHA began looking at formally incorporating Design Thinking into its problem-solving and opportunity mining activities. Design Thinking is a user-experience-centred approach championed by California-based company IDEO. Google’s Design Sprint, meanwhile, is a kind of Design Thinking “recipe” which concentrates the steps of researching, developing ideas, prototyping and testing in an intense four or five days.

In the not-for-profit world though, carving out a week for already timestrapped teams can be challenging.

“The biggest obstacle I faced in running a Design Sprint was finding four days where the core team was all available,” notes Stoikopoulos.

INNOVATION SAFARIS ARE TOURS OF PROGRESSIVE COMPANIES IN COMPLETELY DIFFERENT INDUSTRIES TO LEARN AND INSPIRE. Inspired by York Region’s accelerated problem-solving sessions (completed in 90-minutes to two hours) Stoikopoulos got to work on developing a similar “innovation pollination” program for VHA, educating a core group of people to become facilitators of what eventually became known as Fast Labs. “What’s so refreshing about the innovation space is that it’s completely open. York Region was so excited to share their knowledge, insights and lessons,” she says.

Together with innovation consultancy Adaptive X, who also led the

Left: Led by Adaptive X innovation consultancy, Fast Labs provide staff with hands-on tools and facilitation skills to drive innovation throughout VHA. sessions, elements from various methods were borrowed, tweaked and refined evolving into VHA Fast Labs.

Since beginning in 2019, approximately 40 facilitators from all departments of VHA have graduated from the Fast Labs program and are now part of VHA’s ever-growing innovation community of practice. Members are encouraged to run sessions with their own teams or support others cross-departmentally to help solve problems, generate ideas and create a plan of action rapidly.

EDUCATION, INSPIRATION AND HARD CURRENCY

The multi-pronged approach to building a culture of innovation includes other activities and support across the organization. This includes Innovation Safaris – or tours of progressive companies in completely different industries to learn and inspire. To date VHA leadership members have visited the super chic workplace design company of Steelcase and the data-rich call centre of Rogers Communications.

Though Leader lunch and learn sessions meanwhile, provide opportunities for staff and service providers to soak up the latest information on a range of hot topics from industry leaders including: diversity and inclusion, growth mindset, failing “forward” and creative leadership.

The Ideas to Innovation Fund further supports staff and service providers in fleshing out a great idea by offering up to $55,000 in financing to anyone in the organization to define, develop, test and potentially pilot a solution. “Collectively we hope these activities and support continue to build on a test and learn culture that is part of our legacy and our future,” notes Stoikopoulos.

“This is the beginning of an exciting new chapter of innovation at VHA,” says Dr. Nichol. “Uncovering creative and better ways of doing things is really everyone’s job here. The tools and education provide people with a new approach and practical, invaluable tools to achieve this so that we’re not just talking about it, but engaging people at every level of the organization in a way that is H both powerful and empowering.” ■ www.hospitalnews.com

Your Wi-Fi connection is their human connection.

TELUS Business understands the difference great Wi-Fi can make to your residents â&#x20AC;&#x201C; and your business. telus.com/seniorsliving

LONG-TERM CARE NEWS

Simulation app

helps long-term care staff recognize changes in

By Noel Gruber nvestment in education and training is one says an LTC Educator the most important decisions your long-term care (LTC) team can make and the Ontario Centres for Learning, Research and Innovation in Long-Term Care (CLRI) wants to make that education accessible. The SOS Game for Seniors Care is a serious simulation and gaming app created at the Ontario CLRI at Baycrest to help healthcare providers and students to recognize, reflect and respond to subtle and acute changes in the health of elderly residents.

Given the significant risk of client morbidity and mortality in

I

THE APP TAKES PLAYERS THROUGH A SERIES OF REAL-LIFE, GERIATRIC MEDICAL CASES ASSOCIATED WITH PREVENTABLE HOSPITALIZATIONS. healthcare, clinical reasoning and timely communication are essential to reduce error rates and adverse events. The app uses a Sensory Observation System, an SBAR communication framework and the latest evidence to equip nurses, personal support workers and allied health professions with gerontological specialty knowledge and skills in the early identification and care

of the frail elderly at risk of acute deterioration.

“In developing the app, we wanted a way to increase learning retention and application – with instant feedback – for staff and students taking workshops and eLearning,” says Raquel Meyer, PhD, manager at the Ontario CLRI at Baycrest.

“We wanted to re-engage teams in cultures of learning based on lead-

ing educational practices and to enhance the profile of long-term care, because aging care is where innovation is happening!”

It is no secret that those working LTC need flexible learning options.

Education innovations like the SOS Game App for Seniors Care provide immersive learning that fits within the demanding schedule of LTC team members. The app offers microlearning – learning activities that range from 30 seconds to 10 minutes to maximize uptake of new information. It takes about 90 seconds to play a case in the app. Evaluation of the app has shown significant improvements in players’ learning curves. The more learners play, the more cases they solve!

Finding home care for yourself or a loved one often begins with one simple question – “Where do I start?”

Start with Bayshore HealthCare! By answering Care Planner tool will create a customized care plan, recommend home care services and provide you with resources for further now and in the future.

Take the first step in starting a care plan. bayshore.ca/care-planner

26 HOSPITAL NEWS APRIL 2020

www.hospitalnews.com

LONG-TERM CARE NEWS

s in health of residents WHAT DO LEARNERS DO?

The app takes players through a series of real-life, geriatric medical cases associated with preventable hospitalizations. SOS App players have to recognize and prioritize symptoms, identify patterns or critical symptoms, make efficient clinical decisions and, in so doing, rehearse team communication.

“SOS is a fun and different way of learning, which makes you think differently about resident care. It is an immediate application of knowledge, which is more engaging and I feel it relates well to the residents I care for.

Also, it has helped me to work on my communication skills and to really seek out and value input from all members of the nursing team when I provide care,” says an LTC Educator Day participant.

The App’s game mechanics improve efficiency and application of best practices. For example, action point starvation limits the number of actions a player can make before the game ends.

This forces players to focus assessment and intervention choices based on the patient situation and history, which fosters reflection and efficiency in clinical decision-making. Rather than applying knowledge to a known medical condition, learners must consider

real-world patient presentations and integrate evidence to solve a variety of cases.

The app was the recipient of the 2018 International Ted Freedman Award for Innovation in Education.

Learn more and access the SOS Game App for Seniors Care on the Ontario CLRI website (clri-ltc.ca/resource/sos-app/).

The Ontario CLRI is mandated to be a resource for the sector by providing education and sharing innovations to strengthen quality of life and care for people who live and work in long-term care.

The Program is funded by the Government of Ontario and hosted at Baycrest Health Sciences, Bruyère, and the Schlegel-UW Research InstiH tute for Aging. ■

Noel Gruber is the Communications Manager, Ontario Centres for Learning, Research and Innovation in Long-Term Care.

Are you a Torontobased unpaid dementia caregiver? You could win 50 free respite hours!

In celebration of National Caregiver Day, VHA Home HealthCare has partnered with The Caregivers’ Club Family Relief Fund to provide two awards of 50 free respite care hours to Toronto-based unpaid caregivers who are caring for those with dementia.

To apply for the award, please visit bit.ly/TCCAward *This web address is case sensitive

For more information and to donate to The Caregivers’ Club Family Relief Fund, please visit ʥʥʥӝɽȃljƺƃɨljǼȈʤljɨɰƺȢʍƹˎȢȴӝƺɁȴӣɰʍɥɥɁɨɽ

www.hospitalnews.com

APRIL 2020 HOSPITAL NEWS 27

LONG-TERM CARE NEWS

Additional protections announced for long-term care residents n response to the COVID-19 pandemic, Vancouver Coastal Health (VCH) is working closely with the Ministry of Health and BC’s other health authorities to protect the health of all British Columbians, particularly the most vulnerable, including seniors living in long-term care homes.

To protect this population and address anticipated pressures on the acute care system, VCH is adopting the advice of Ministry of Health for health authorities to: • Temporarily suspend inter-facility transfers, except in circumstances of intolerable risk, until further notice and ensure clients’ place on the wait list for transfer is maintained during the suspension of transfers; • Prioritize admissions to long-term care from acute care over those from community where possible; • Temporarily suspend all health au-

I

thority operated/funded home & community Care (HCC) adult day programs and; • Temporarily suspend the provision of in-facility respite, except in circumstances of intolerable risk.

CURRENTLY, THREE LONG-TERM CARE FACILITIES IN THE VCH REGION HAVE CONFIRMED OUTBREAKS OF COVID-19.

In addition to these measures, Medical Health Officer Dr. Althea Hayden today issued a Public Health Order to all licensed long-term care facilities in the Vancouver Coastal Health Authority region. The Order aims to help prevent the further spread of COVID-19

in long-term care homes and protect the health of vulnerable seniors.

Under the Public Health Act, Medical Health Officers are given powers to enact and enforce such Orders.

Currently, three long-term care facilities in the VCH region have confirmed outbreaks of COVID-19.

The Public Health Order issued by Vancouver Coastal Health today: • Prohibits long-term care staff and volunteers (with the exception of physicians, paramedics and laboratory technicians) from working at more than one health care facility; • Requires facilities to deny access to all visitors to the facility, with the limited exception of the immediate family members and spiritual advisor of residents who are clinically assessed to be at the end of their lives; • Prohibits resident transfers between health care facilities unless approved by a Medical Health Officer;

• Requires facilities to carry out enhanced cleaning of facilities and enhanced screening of staff, contractors and visitors, and to adhere to higher standards for notification of cold and flu-like illnesses; • Cancels or postpones indefinitely all group social activities.

The Order comes into force within three days and remains in effect until further notice.

VCH is taking every precaution necessary to protect the health and safety of its most vulnerable, which includes residents and staff at long-term care homes. We ask the public to also do their part, which includes staying home when you are sick and social distancing – such as staying home and at least two metres away from others – to help reduce virus transmission.

For more information on COVID-19 and steps being taken to reduce its imH pact, visit VCH.ca/COVID19■

>OLU `V\ 5LLK 8\HSPÄ LK *HYL

WE WILL BE THERE! Nurses PSWs - Alzheimers HCA - Sick Kids Massage Therapy Homemakers Companions

Sitters Foot Care Nurses Drivers Live in Caregivers Denture Services at home Palliative Care

>HP[PUN MVY `V\Y UL_[ JHSS Royal Canadian Health Care Services Inc.

Serving all of Ontario including HAMILTON • TORONTO • OTTAWA

24 HOURS 7 DAYS A WEEK 28 HOSPITAL NEWS APRIL 2020

905.669.5453 info@rchcs.com www.rchcs.com

www.hospitalnews.com

EVIDENCE MATTERS

Using technology to link more patients with mental health services:

Internet-based cognitive behavioural therapy

By Barbara Greenwood Dufour f you or a loved one has ever needed access to mental health support, how quickly were you able to connect with a mental health professional? What services and treatment options were available to you? If you are a health care professional, how easy is it to get mental health support for your patients?

According to a report produced for the Mental Health Commission of Canada, by the time Canadians reach 40 years of age, half will have or have had a mental illness. Depression and anxiety are among the most common mental health disorders in Canada, and both can be treated effectively. Cognitive behavioural therapy (CBT) is the most commonly used psychological treatment for these conditions. This treatment provides patients with coping strategies and skills to change dysfunctional thoughts, behaviours, beliefs, and attitudes; and it is an effective treatment if provided in a timely manner.

However, accessing psychological care is not always easy. Depending on where you live and how “urgent” your issue is, you could be on a wait list for more than a year for certain mental health services (e.g., seeing a psychiatrist), just wait a few weeks, or not wait at all. Variances in health system capacity and availability of trained staff may be among the reasons for these differences. Affordability is also an issue – psychological services are out of reach for many people as most provincial and territorial health insurance plans will not pay for services provided outside of the public system.

CBT is usually delivered as a series of face-to-face sessions with a therapist; however, technology has made it possible for treatment to be provided over the internet with no need for client and therapist to meet in person. Internet-delivered (iCBT) can be accessed anywhere on a computer, smartphone, or tablet as long as there is an internet connection. iCBT programs typically

I

THE REVIEW FOUND THAT ICBT IS EFFECTIVE FOR REDUCING SYMPTOMS OF MILD-TOMODERATE MAJOR DEPRESSION AND SELECT ANXIETY DISORDERS, AND FOR IMPROVING QUALITY OF LIFE. include a series of structured, goal-focused modules and readings, activities, and may include text, audio, or video messaging. As it is delivered remotely, iCBT may be a good option for individuals who are unable to access faceto-face treatment because of long wait times, poor access to treatment (e.g., in rural or remote areas), cost, and perceived stigma or privacy concerns.

Several iCBT programs are available in Canada either via private vendors (where patients pay for treatment) or, in some provinces, as a publicly funded service. As the demand for innovative approaches to mental health care grows, understanding whether and how iCBT works, and for whom and in what circumstances, is important

for clinicians and health care facilities considering iCBT, for decision makers who need to determine policies on the appropriate use of iCBT in this context, as well as for patients.

CADTH, in collaboration with Ontario Health (Quality), reviewed the available evidence on iCBT for mild and moderate major depression and anxiety disorders. The review found that iCBT is effective for reducing symptoms of mild-to-moderate major depression and select anxiety disorders, and for improving quality of life.

Because the evidence was stronger for guided iCBT (where the user receives support from a therapist) than for unguided iCBT (self-directed programs), it is recommended that guided iCBT be

offered. As patient needs vary, the guidance of a therapist during iCBT may allow treatment to be tailored according to a patient’s individual priorities and needs, which may also help patients adhere to, and succeed with, treatment.

Still, iCBT may not be right for all patients. Some may feel uncomfortable interacting with a therapist remotely or may be unable to if they do not have a computer, internet access, or adequate computer literacy. iCBT might also be unsuitable for those with a visual impairment or other special needs. There are also concerns about data security, privacy, and confidentiality when receiving treatment online.

And, despite of the lower cost of iCBT compared with that for face-to-face sessions, many people do not have access to coverage for the treatment. iCBT is also being considered for other mental health conditions, including post-traumatic stress disorder (PTSD). CADTH recently reviewed the evidence on iCBT for PTSD but found only limited and low quality evidence. So, although there may be a role for iCBT in the treatment of PTSD, more research is needed.

With increasingly more iCBT platforms becoming available, a variety of options exist for patients and health care professionals. However, iCBT may be not be a solution that suits the needs and comfort level of all patients and health care providers or be appropriate for every mental health condition. On the other hand, incorporating iCBT into existing clinical pathways – either with a stepped care approach, as a short-term option, or in combination with face-to-face therapy – could help more Canadians access effective mental health care when they need it.

The reviews mentioned in this article, and many other reviews of health technologies, are freely available at www.cadth.ca. To learn more about CADTH, visit our website, follow us on Twitter @CADTH_ACMTS, or speak H to a Liaison Officer in your region. ■

Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH. www.hospitalnews.com

APRIL 2020 HOSPITAL NEWS 29

NEWS

(Left) 2D mammogram image of left breast, where no lesion was visible. (Right) 3D tomographic image of the same breast showing a lesion, indicated by arrows.

3D imaging technology

could improve outcomes for patients with breast cancer

By Emilly Dubeau study at Lawson Health Research Institute (Lawson) is looking to determine if digital breast tomosynthesis, a type of 3D imaging, is better at detecting breast tissue abnormalities than the 2D mammography regularly used today.

During a conventional digital 2D mammogram, two x-ray images are taken of the breast, one from top-tobottom and another from side-to-side at an angle. This technology is limited by the overlapping breast tissue that occurs from the required compression of the breast, and breast abnormalities may be hidden.

A tomosynthesis exam is relatively new technology in which the x-ray tube moves in an arc over the compressed breast and captures multiple images from different angles. The images are then reconstructed into a

A

A TOMOSYNTHESIS EXAM IS RELATIVELY NEW TECHNOLOGY IN WHICH THE X-RAY TUBE MOVES IN AN ARC OVER THE COMPRESSED BREAST AND CAPTURES MULTIPLE IMAGES FROM DIFFERENT ANGLES. set of 3D images by a computer. By being able to examine the breast at multiple layers of depth, the radiologist is better able to distinguish normal breast tissue from potential abnormalities. It is therefore assumed that tomosynthesis may solve some challenges associated with standard mammography, and could be especially useful for women with dense breast tissue.

In the Tomosynthesis Mammographic Imaging Screening Trial (TMIST), women are randomized to receive screening with standard digital 2D mammography, or digital 2D mam-

mography plus tomosynthesis. Participants will undergo either an annual or biennial screening frequency, depending on their risk factors for breast cancer, for approximately four years.

Then participants will undergo longterm follow-up for at least three morte years. Researchers hope this study will help radiologists evaluate whether the newer technology of tomosynthesis is indeed a more effective tool for detecting aggressive tumours.

Through the Ontario Breast Screening Program (OBSP), women between the ages of 50 and 75 receive regular notices through the mail, encourag-

ing them to schedule a mammogram for breast cancer screening. Women scheduled for a regular OBSP breast exam at St. Joseph’s Hospital London (St. Joseph’s) receive a letter with the study’s contact information. Eligible participants are enrolled at the time of their scheduled appointment. Participating in the study does not significantly change the overall experience of the breast exam.

“Our goal is to contribute to the body of evidence around tomosynthesis technology, and ultimately, we hope to improve the outcomes for women diagnosed with breast cancer, meaning, earlier detection,” says Dr. Anat Kornecki, Lawson Scientist and Radiologist at St. Joseph’s.

The TMIST study is being conducted in over 100 centres across Canada, the United States, and Argentina. Approximately 165,000 participants will H be recruited. ■

Emilly Dubeau works in communications at Lawson Health Research Institute.

30 HOSPITAL NEWS APRIL 2020

www.hospitalnews.com

NEWS

New pilot project helps post-surgical patients learn to manage their pain medication

By Amber Daugherty ecovering from surgery can be painful. And that pain can lead to significant stress and anxiety once someone is discharged from the hospital and has to manage pain on their own. A new pilot project at St. Joseph’s Health Centre is helping patients gain confidence to effectively manage their pain while they’re in the hospital so they have a better recovery once they leave.

“The oral PCA (patient-controlled analgesia) project is a way for patients to self-administer medications that the care team would normally give to them,” says Carlie Lewis, a registered nurse on the first unit to trial this initiative. “It puts the control in patients’ hands – letting them take the pain medication when they believe they need it, instead of having to ring their call bell, ask the nurse for medication and then wait while they go dispense it.”

R

Patients document their level of pain each time, both before taking the pill and two hours after.

“There’s a maximum dose they can have within 24 hours so we keep track of how much they’re taking,” says Lewis. “Sometimes a pill sits on their bedside for a whole day.”

This initiative is part of a bigger program called “My Road to Recovery” at St. Joseph’s, which helps to educate and prepare surgical patients and families for their surgical journey.

It explains everything from what they need to bring to the hospital, to what to expect as they’re preparing for surgery, to managing their pain afterwards and recovering at home.

“It’s really about setting realistic expectations so they know what’s coming up and they can prepare,” says Jill Campbell, a nurse practitioner for the Acute Pain Service. “It also makes them more comfortable with assessing

THE ORAL PCA (PATIENT-CONTROLLED ANALGESIA) PROJECT IS A WAY FOR PATIENTS TO SELF-ADMINISTER MEDICATIONS THAT THE CARE TEAM WOULD NORMALLY GIVE TO THEM. Care teams can be busy and with multiple steps involved in understanding what medication is needed and then retrieving it, patients can sometimes wait up to 30 minutes for that pain medication – adding to their stress. The oral PCA project was launched by the Acute Pain Service for patients recovering from hepatobiliary surgery (involving the liver, gallbladder, bile ducts, or bile). This initiative involves nurses placing a pain pill in a medication bottle at the patient’s bedside which they can then take when they feel they need it. Once the pill has been taken, the nurse will replace it. Patients receive education about the pain medication and how frequently they can take the pills.

what’s a normal part of the recovery process and when they should contact their surgeon or return to the Emergency Department for care – we’re helping empower them to actively participate in their recovery.”

For nurses like Lewis, the oral PCA project is all positive because she’s seeing patients report lower levels of pain while they’re getting ready to go home from the hospital.

“The last thing you want is for someone to be at home and in pain and not know what to do or how to manage it,” she says. “Because of this project, patients are already independently managing that pain so by the time they do go home, they know exactly what H to do.” ■

Amber Daugherty is a senior communications advisor at Unity Health Toronto. www.hospitalnews.com

Left: Normal scaphoid fracture. Centre: Scaphoid fracture that is struggling to heal. Right: Scaphoid non-union where the bone has failed to heal.

Detecting the undetectable

New study aims to find undetectable infections that impair healing of the scaphoid

By Cynthia Yi simple fall can lead to long-term hand problems such as arthritis due to fracturing the scaphoid bone in the wrist. Scaphoid fractures are known to have the highest rate of healing failures. While this bone’s fragile blood supply is commonly thought to be the main reason for why it is difficult to heal, Dr. Ruby Grewal is looking into a different reason – infection.

Infections are known to cause difficulty in healing bones, but traditional tests for infections in the scaphoid have come up negative. With new advancements in detecting microbial DNA, scientists can now test for ‘clinically undetectable’ infections.

In a new study, Dr. Grewal will use microbial DNA test whether or not there are infections in the scaphoid fracture which causes improper healing of the bone.

“The goal of this study is to use advanced DNA sequencing technology to test whether or not we can detect evidence of microorganisms in non-healing scaphoids,” explains Dr. Grewal, Lawson Scientist and Orthopaedic Surgeon at the Roth McFar-

A

lane Hand and Upper Limb Centre (HULC) at St. Joseph’s Health Care London.

Finding new causes of improper healing of the scaphoid bone could improve treatments for individuals with these injuries and prevent long-term problems with hand function. These insights into the causes of improper healing could also prevent young patients from developing wrist arthritis.

Dr. Grewal’s study is being funded through the Lawson Internal Research Fund (IRF).

“The financial support provided by Lawson’s IRF is of utmost importance to researchers. These funds will allow our team to embark on a new area of research and test a novel hypothesis,” says Dr. Grewal, “While traditional granting agencies are reluctant to fund completely novel areas of research without pilot data to prove feasibility, the Lawson IRF allows researchers to investigate new theories in a sound scientific manner. Without the ability to test new ideas we cannot innovate and make advancements in health care. Support for this project H allows for that.” ■

Cynthia Yi works in communications at Lawson Health Research Institute.

APRIL 2020 HOSPITAL NEWS 31

NEWS Photo credit: Unity Health Toronto

The new online tool lists numerous organizations across the Greater Toronto Area that provide various social services, along with contact information.

New online tool directs patients and visitors to support services in the community

By Selma Al-Samarrai ften, discharged patients, community members or visitors come to Unity Health Toronto staff asking for help to find social care such as crisis services, financial support, abuse resources, housing options or support for newcomers.

In response, the Patient and Family Education and Social Work teams at St. Michael’s Hospital created the new Community Resources for Patients and Families online tool, which lists numerous organizations across the Greater Toronto Area that prtovide these services, along with contact information.

We spoke to Lauren Massey, manager of Collaborative Practice and Education, and Tedi Brash, patient education specialist, who explained why this tool was developed and how they hope it will quickly and effectively help those in need.

O

WHY DID YOU DECIDE TO CREATE THIS TOOL?

Massey: Very often, community members call to speak to a social worker when they are struggling with their mental health or are in crisis and feel

THIS TOOL HOUSES THE WEALTH OF KNOWLEDGE THAT OUR SOCIAL WORK TEAM CARRIES AND MAKES IT ACCESSIBLE TO ALL STAFF AND TO THE PUBLIC. they have nowhere else to turn. While our focus is our registered patients and families, we know that system navigation is a challenge for most people, so we do try to provide some recommendations whenever we are asked. We needed to create a place with appropriate resources to share with our patients and families as well as community members.

Brash: We built the tool because we wanted to be small part of the solution, helping to ease the load in times of need.

WHAT WAS THE IDEA BEHIND THE STRUCTURE OF THIS TOOL?

Brash: The idea was to enhance health literacy. We wanted to create an easy-to-understand, mobile friendly, clean and immediately useful tool for patients and families who are looking to access resources in the community.

This tool houses the wealth of knowledge that our social work team

carries and makes it accessible to all staff and to the public.

We designed it to be a “one-stop shop” experience, meaning there is no need to leave the tool to contact the various resources listed. All the information is there, the phone numbers are designed to dial if touched from a mobile device, and all the menus are drop-down so the tool can be navigated without opening multiple pages.

WHO CREATED THIS TOOL?

Brash: This was a truly collaborative effort. Our small but dynamic team consisted of Patient and Family Education and social workers from diverse health care areas at St. Michael’s Hospital. We started with an extensive list of community resources and refined it to reflect a core set of quality resources in six key areas, which address key as-

pects of the Social Determinants of Health.

WHAT’S A COMMON CONCERN HEARD FROM STAFF ABOUT THE NEED FOR A TOOL LIKE THIS?

Massey: When you receive a call from community members who are in crisis or desperate for help, you do not want to abandon a person at this critical time.

People who do not know how they will pay for their next meal or who are trying to get mental health support can be under extreme psychological stress, and navigating a complex system of resources can exacerbate their distress. This tool was designed to make this process easier, faster and more reliable.

As experts in system navigation, social workers can support the patients we see within our programs, but we know that there are many underserved people in our community that would benefit from having access to this tool. We hope it will positively impact the lives of both our patients and our community with the availabilH ity of this tool. ■

Selma Al-Samarrai is a communications adviser at Unity Health Toronto.

32 HOSPITAL NEWS APRIL 2020

www.hospitalnews.com

NEWS

Creating a seamless mental health and addiction patient experience

By Paula Reaume-Zimmer any sectors are working hard to improve timely access to mental health and addictions care for Ontarians, which is a stated priority of the Ministry of Health. Integration is a key to avoiding delays, closing gaps in care, and improving patient outcomes. A major barrier to integration is the use of separate assessment tools by every sector.

Bluewater Health and Canadian Mental Health Association (CMHA) Lambton-Kent have been working together for over three years to improve integration in order to create an improved patient experience. Their leaders first embarked on an integrated structure, establishing the role of Integrated Vice-President, Mental Health and Addiction Services, who sits on the executive of both organizations.

They were now better positioned to fix frustrating processes that require patients to be reassessed every time they moved across sectors. This redundancy delays care, wastes health system resources in the form of staff time, and distresses patients and family members who must repeat their story many times. The problem was so pronounced, that front line staff and managers challenged the senior teams of both organizations to create a more streamlined system to benefit patients and staff alike.

To streamline the process, Bluewater Health and CMHA Lambton-Kent joined with Dr. John Hirdes and his team at the University of Waterloo to develop a true mental health and addictions system in Sarnia-Lambton. They identified a suite of assessment tools that share a core framework, but also have the versatility to respond to unique patient populations such as individuals with addictions, intellectual impairments, and children and adolescents.

In a recent publication in the journal Frontiers in Psychiatry, Dr Hirdes noted:

M

(left to right) – Paula Reaume-Zimmer and Dr. John Hirdes at the recent World interRAI conference in Leuven, Belgium.

“Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations.”

Today in Sarnia-Lambton, partners in the community child and youth sector, the adult mental health sector, as well as the Emergency Department (ED) and addiction services are already utilizing, or preparing to launch, the interRAI suite of mental health tools. The common assessments can follow the patient wherever they ac-

cess care and services, and treatment planning becomes the focus of the next stop in their recovery journey.

According to Dr. Hirdes and colleagues, “The [interRAI] instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols.” (Hirdes, 2020, Frontiers) Over the past two years, Bluewater Health and CMHA Lambton-Kent have celebrated many successes and benefits as a result of their work: • The partners have established a common language between sectors

(addiction and mental health, community to hospital and from child and youth, to adult and older adult).

• interRAI synoptic reports are being utilized and valued amongst stakeholders including ED physicians, Department of Psychiatry and Primary Care Providers.

• Community partners are now able to report directly to hospital physicians, the ED and Psychiatrist on Call without handing over to a hospital nurse to repeat and liaise (i.e. CMHA Lambton-Kent Mental Health Engagement and Response (MHEART) team RN arrives in the ED with police and apprehended patient and reports directly to the ED physician for a treatment recommendation), speeding up time to treatment and increasing health system efficiency.

• More partners are adopting the interRAI assessment system: Sarnia Police Service will go live with the Brief Mental Health Screener in June 2020, which aligns with the May 2019 policy document, Tools for Developing Police-Hospital Transitions Protocol in Ontario.

In the first three months of operation and with the interRAI Emergency Screener having been completed prior to arrival at the ED, the MHEART team was able to provide the attending ED physician with a direct report, resulting in 31 per cent of individuals receiving immediate care and 61 per cent of individuals receiving care within two hours.

Bluewater Health and CMHA Lambton-Kent were inspired to redesign their structures and processes by their shared vision for a seamless patient experience. Their positive experience, improved trust and understanding, and the success of the shared interRAI tool now aligns with the emergence of the Ontario Health Team planning and sets up the two organizations for further success and H leadership in their region. ■

Paula Reaume-Zimmer is Integrated Vice-President, Mental Health and Addiction Services, Bluewater Health and CMHA Lambton-Kent. She holds a Doctorate in Health Administration (DHA) with her focus on Youth Mental Health Services. www.hospitalnews.com

APRIL 2020 HOSPITAL NEWS 33

NEWS

Student-led program supports

young people with disabilities transitioning to adulthood

By Dr. Kathryn Parker olland Bloorview Kids Rehabilitation Hospital is helping young people with disabilities and their families navigate the complexities of adulthood under the leadership of students.

The program, called OnTrack: Transition to Adulthood, showcases the leadership of students while filling a major system gap: how to navigate myriad life transitions that young people with disabilities face when shifting to adult life, within and beyond the context of healthcare.

In a recent seven-week pilot that ended in February 2020, two second-year occupational therapy students co-designed and facilitated twice weekly 45-minute sessions with Holland Bloorview youth leaders to develop tools to assist in the transition process. Tools included a welcome poster, solution-focused interview questions and tip sheets. The students, under the guidance and with the support of their preceptors, then piloted the tools during six clinic days.

In the pilot, five outpatient clients and their families were offered to participate based on interest and their soon-to-be-adult status. Topics covered included: navigating the adult health system, finding volunteer opportunities and navigating funding for support services.

“Moving from pediatric to adult services and adult life is often described by clients and families as ‘falling off a cliff,’” says C.J. Curran, director of Holland Bloorview’s transition strategy. “OnTrack: Transition to Adulthood offers a structured environment that brings together students, clinicians, clients and families under one umbrella with the goal of creating a path that supports young people living with disabilities to have a softer landing into adulthood.”

In the clinic, students gradually gained confidence and skill in

H

Holland Bloorview’s student-led pilot to support young people transitioning to adulthood was brought to life by (pictured L-R): Griffin Fitzhenry and Alissia McGlashan, second year occupational therapy students from the University of Western Ontario and McMaster University; Laura Thompson and Laura Hartman, transition strategy team leads, and Darlene Hubley, student-led environment lead. leading conversations with clients and their families asking generative questions like: • How will you know our time together has been helpful?

• After our conversation today, what will be the first small sign that you’re on track and making even more progress with your transition?

• What accomplishments have you already achieved that we can celebrate?

In one clinic session, a parent visited the students to ask about respite care resources. The students guided the parent through a step-by-step conversation about their goals and together, on a large computer screen, they searched for respite resources available in the community. By doing it this way, the parent was left with more than answers; they had a model to tackle questions on any transi-

tion-related topic they may face in the future.

To paraphrase a well-known maxim: give a person the answers and they are okay for a day; teach them how to find the answers to guide them for a lifetime.

The “Track” in OnTrack stands for: Teaching, Research, Assessment, Care and Knowledge, an important acknowledgement of the multi-disciplinary approach taken to support clients and their families while simultaneously fostering an environment of teaching and learning among students and their preceptors.

“Although challenging, the student-led experience at Holland Bloorview gave me an opportunity to practice traditional clinical skills, as well as develop my leadership abilities,” says Griffin Fitzhenry, a second year occupational therapy student from the

University of Western Ontario and one of the student co-leads for the pilot. “We used structured, human-centered, innovative design processes to create the clinic from inception through to execution.”

The student-led model was originally developed four years ago at Holland Bloorview’s Concussion Clinic.

In the OnTrack: Concussion program, students studying occupational therapy, physical therapy, and kinesiology filled a major service gap by providing education on best practices in early concussion management for children and youth with concussion and their families during their fieldwork placements at Holland Bloorview.

Students advanced their own learning while supporting families that were often desperate for reliable, evidence-based advice on how to help a child with concussion.

The opportunity to acquire leadership skills is making Holland Bloorview an attractive destination for up-and-coming clinicians. Student placements for both the concussion and transition clinics are booked into 2020.

“Every aspect of the clinic, from client appointments to new student training has been designed by or with OnTrack students, in partnership with youth, families, and staff,” says Darlene Hubley, student-led environment program lead. “With an emphasis on student leadership and critical thinking, we are addressing client needs while simultaneously instilling a client- and family-centred approach in the next generation of healthcare professionals.”

To learn more about the OnTrack model, reach out to Dr. Kathryn Parker, at kparker@hollandbloorview.ca To learn more about Holland Bloorview’s transition strategy for youth, reach out to C.J. Curran at cjcurran@ H hollandbloorview.ca. ■

Dr. Kathryn Parker is the senior director of the Teaching and Learning Institute at Holland Bloorview Kids Rehabilitation Hospital.

34 HOSPITAL NEWS APRIL 2020

www.hospitalnews.com

NEWS

Point-of-care ultrasound enhances emergency care

By Danae Theakston anielle Lucky is passionate about helping people. It’s why she loves working in the Emergency department (ED) – where people come when they need help the most. When a patient walks into the ED, providing them with the care they need, as fast as possible, is crucial.

This year, Danielle became the first physician assistant (PA) in Canada to undergo formal training in advanced point-of-care ultrasound (POCUS). At Scarborough Health Network (SHN) an innovative new program geared towards expanding the use of POCUS, is training highly skilled PAs, like Danielle, to do just that.

Danielle and her fellow PAs work within multi-disciplinary teams to provide a broad range of medical services including patient histories, physical examinations, and ordering and performing appropriate diagnostic tests and procedures. The PAs work with SHN physicians with a high degree of autonomy and their role continues to grow as their training and knowledge expand.

When an opportunity to expand her skills to include using POCUS to help diagnose Emergency patients came around, Danielle couldn’t wait to be involved.

Introduced in 2016, SHN’s Emergency Ultrasound Fellowship program trains emergency physicians and PAs in advanced POCUS and improves care for patients.

Using POCUS machines helps health care professionals make quick diagnoses right at the patient’s bedside, ensuring rapid diagnoses and course of treatment.

POCUS allows PAs to conduct an ultrasound wherever the patient needs it.

“Expanding the fellowship program helps grow the PA profession in Canada,” explained Danielle. “Being able to support patients at the bedside, resulting in less wait times and better patient centred care, is important to me.”

D

Spearheaded by one of SHN’s emergency physicians, the program is helping shape the future of emergency care.

Dr. Jeffrey Shih, the Emergency Ultrasound Fellowship program director at SHN, has trained emergency physicians in advanced POCUS skills since 2016. He immediately saw the benefits of expanding the program to include PAs. “PAs bring an immense value to physicians in our Emergency department, by supporting our clinical work and providing high quality patient-centred care – something I see first-hand.”

“Our goal for the physician assistants who complete the program is to generate high quality ultrasound images for the physicians they work with, allowing for more productive, efficient, and patient-centered care,” explained Dr. Shih.

The program has been a success and is expanding.

Last June, Danielle and Dr. Shih introduced PA students at the University of Toronto to the fellowship program and the basic principles of ultrasound.

In addition, the program has sparked interest internationally. In late 2019, Dr. Shih and Danielle presented this unique PA Ultrasound Program at the 10th Annual Mediterranean Emergency Medicine Congress in Dubrovnik, Croatia hosted by the American Academy of Emergency Medicine.

“We had a lot of interest and discussion among emergency physicians from around the world, some who had never heard of PAs and some who work with PAs and see the utility that would come with advanced point-of-care ultrasound skills,” explained Dr. Shih.

“By adapting the Emergency Ultrasound Fellowship program at SHN to train physician assistants, we will continue our reputation of being trailblazers in the fields of emergency ultrasound, teaching, and physician assisH tant education.” ■

Danae Theakston is a Communications Specialist at the Scarborough Health Network. www.hospitalnews.com

Using POCUS machines helps health care professionals make quick diagnoses right at the patient’s bedside, ensuring rapid diagnoses and course of treatment.

Careers

VIEW CAREER ADS AT:

www.hospitalnews.com

We’re Hiring!

Join SE Health today and create amazing care experiences tomorrow.

SE Health

110+ Years

9,000

21,000

Providing Quality Expert Care

Staff Across Canada and Growing

Visits per Day

97%

Of Our Clients Would Recommend SE Health to Family and Friends

•

Registered Nurses

•

Personal Support Workers

•

Registered Practical Nurses

•

Therapists

Apply now for a full-time, part-time, virtual, hospital or community role at SE Health.

You will: •

•

Have access to a total rewards program ZKLFK LQFOXGHV JURXS EHQHʃWV DQG pension plan Be eligible for our education bursaries and tuition assistance program

•

+DYH ʄH[LEOH ZRUNLQJ KRXUV

•

%H SURYLGHG ZLWK DQ H[WHQVLYH SDLG orientation and preceptorship program

•

Be eligible for subsidized RNAO/RPNAO memberships

Apply now at jobs.sehc.com

APRIL 2020 HOSPITAL NEWS 35

Best practice for your practice Separate your personal and business expenses with a business credit card offer just for medical professionals†: • Annual fee rebate ($120 annual fee rebated every year) • Earn up to $800 towards a flight

CIBC Business Plus Aventura Visa Card Talk to an advisor or visit cibc.com/medical †

Conditions Apply. Applications for new eligible card accounts must be submitted and approved by October 31st, 2020. Visit cibc.com/medical for details. * Trademark of Visa Intl., used under license. All other trademarks are owned by CIBC.

Every customer deserves to be in the driver’s seat.