Hospital News April 2021

Inside: From the CEO’s Desk | Safe Medication | Long-term Care | e-Health 2021

April 2021 Edition

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Since COVID-19 hit, nurses have been pushed to the limit.

In hospitals, long-term care, and public health, in testing centres and local clinics, we’ve seen it all. Every day comes with more risk, and every day we face down the fear.

But until this pandemic is over, we’ll be holding the line – because that’s what nurses do.

The government often calls us heroes. But what we really need from them is action. Make sure we have the right PPE in our workplaces. When we’re exposed to COVID-19 and have to self-isolate, pay us. Give us a say in our scheduling and working conditions. Don’t override our collective agreements.

Ensure that our compensation is determined fairly.

To Ontario’s Conservative government we say this: Prove through your actions that you respect our courage and value the vital work we’re doing.

Courage nursesknow.ona.org

Contents April 2021 Edition

IN THIS ISSUE:

Mobile Health Unit built at Sunnybrook

5

▲ Cover story: What to Watch – A look at technologies with high potential to transform health care

18

▲ e-Health 2021 Virtual Conference and Tradeshow

20

▲ The pressures of COVID-19 on an already stressful environment for health workers

COLUMNS Editor’s Note ....................4 Safe medication ............28

16

From the CEO’s desk .....29

▲ Project SEARCH mobilizes community partnerships to transform systems

www.hospitalnews.com

38

▲ Rapid fire: How UHT’s lab team at St. Michael’s works 24/7 to get COVID-19 test results

30

Patient perspectives on virtual health in B.C. during COVID-19

26

APRIL 2021 HOSPITAL NEWS 3

A year into the pandemic,

nurses exhausted – and angry A

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Kristie Jones

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Denise Hodgson

denise@hospitalnews.com Publisher

By Linda Silas s the anniversary of the World Health Organization declaring COVID-19 a global pandemic has come and gone, nurses across Canada are at their breaking point. We are exhausted, burned out – and angry.

Nurses are on the frontlines of the pandemic and our health-care system every day. We see its problems in brutal detail, and we have the experience to know what’s needed to fix them. We have repeatedly called on decision-makers to address critical staffing shortages and provide basic protections to keep workers safe.

We continue to be disregarded, and the result has been devastating.

According to the Canadian Institute for Health Information, the number of COVID-19 cases among health workers has tripled since July 2020. As of January 15, 65,920 health workers have been infected with the COVID-19 virus, representing 9.5 per cent of all infections in Canada. More than 40 health workers are known to have died from the illness.

In our troubled long-term care system, insufficient staffing and safety protocols have contributed to a national tragedy. About 25,000 health-care worker infections are in long-term care. More than 14,000 vulnerable residents have died from COVID-19, representing about 70 per cent of all deaths in Canada.

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It didn’t have to be this way.

As early as January of last year, the Canadian Federation of Nurses Unions began urging governments across Canada to heed the lessons of SARS and adopt a precautionary approach. This meant assuming the virus was airborne and protecting health-care workers – potential vectors of transmission – accordingly.

Despite similar efforts by unions across the country, health-care workers have been put at unacceptable risk, with implications for their families, patients and communities. Most health-care workers, even those caring for COVID-19 patients, were only provided flimsy surgical masks, and in many jurisdictions, masks were reused until they were soiled and damaged. Faced with supply issues, N95 respirators were often locked away.

It took the Public Health Agency of Canada (PHAC) until January 2021 to acknowledge what unions and many experts have said all along. Health-care workers are at risk of airborne transmission when in close proximity to an infected person. Yet PHAC still does not require health-care workers in COVID-19 units and ‘hot zones’ to wear protection from airborne transmission, such as N95 respirators.

Similarly, provinces across Canada have failed to update their guidance to adequately reflect what we now know about the virus and how its spreads.

Continued on page 6

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NEWS

Photo credit: Kevin van Paassen/Sunnybrook Health Sciences Centre.

Mobile Health Unit built at Sunnybrook n February 2021, Sunnybrook Health Sciences Centre began to make room to accommodate a Mobile Health Unit (MHU), in the event there is increased demand for beds during the COVID-19 pandemic.

“The Mobile Health Unit will ensure we’re ready for anything that might come our way,” says Robert Burgess, senior director of emergency preparedness at Sunnybrook.

Built in partnership with the federal and provincial governments, the MHU will consist of up to 10 tents and is being configured for 84 beds, though it can be expanded to 100 beds if needed.

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Once completed, the facility will most likely be used to provide space

for patients who are awaiting placement in other facilities and low acuity

recovering patients, which will free up acute and critical care beds in the hospital.

“The plan is to moderate the number of beds we have inside the tents based on need,” says Burgess.

Each ‘pod’ of 8-10 beds in the MHU is self-contained and is equipped with the necessary medical support system as well as washroom facilities. A number of large generators provide power, and Sunnybrook will be working with the province and partners in the system to staff the facility.

Construction of the MHU is expected to be completed by early April, and the facility will be ready for patients H later that month. ■

APRIL 2021 HOSPITAL NEWS 5

IN BRIEF

Global Collaboration to develop new treatments for paediatric diseases F

our leading children’s research institutions on three continents are joining forces to decipher paediatric illnesses, including rare diseases, and find better treatments.

The four paediatric hospitals – Boston Children’s Hospital; UCL Great Ormond Street Institute for Child Health and Great Ormond Street Hospital (London); the Murdoch Children’s Research Institute with The Royal Children’s Hospital (Melbourne); and The Hospital for Sick Children (SickKids) (Toronto) – will pool their medical and scientific expertise to analyze medical and genomic data to accelerate discovery and therapeutic development.

The partnership, known as the International Precision Child Health Partnership (IPCHiP), is to the founders’ knowledge the first major global collaboration around genomics and child health. The founding partners anticipate that additional institutions will join the collaboration in the future.

Of the more than 7,000 rare diseases that affect millions of individuals globally, only a few hundred have approved treatments. Many of these diseases mean children suffer their whole lives, or may die early from complications, sometimes just a day after birth.

IPCHiP’s goal is to enable the world’s top experts in pediatrics and genomics to work together to improve diagnosis, implement personalized treatment decisions, and develop new therapeutic targets and treatments that will benefit children around the world.

IPCHiP’s first project will involve epilepsy in infants, bringing together efforts already underway at the four centres. Through this project, IPCHiP will establish protected systems to evaluate data across different institutions without any information having to cross international borders.

Investigators at each site will prospectively enroll babies under age one with epilepsy in real time, sequence their genomes, change treatment based on the findings as appropriate,

Nurses exhausted Continued from page 4 Only Quebec has followed the scientific evidence to its natural conclusion: As of February 11, 2021, Quebec requires health-care workers in COVID-19 hot zones to wear an N95 respirator or superior level of protection.

As new variants circulate in Canada, dramatically increasing the rate of transmission, burned out health-care workers are under even more pressure.

Without action, health staffing, which is already in short supply, could become depleted even further.

We must not let this happen.

We know from experts and evidence that there is a desperate need for more staff, not less. The long-standing cycle of budget cuts, short staffing,

and higher workloads has eroded the health care workforce and quality of patient care. A major investment in the retention and recruitment of nurses is needed now or it is likely we will see an exodus from the profession as burnout takes its toll.

It’s time for governments across Canada to take their heads out of the sand and show their respect and appreciation for health care workers. A good first step would be to act on our calls for better workplace safety and safe staffing.

Had decision makers heeded the nurses’ warnings prior to the pandemic, perhaps many more lives could have H been saved. ■

Linda Silas is a nurse and president of the Canadian Federation of Nurses Unions.

6 HOSPITAL NEWS APRIL 2021

and follow their development long term. The study will compare infants who receive a genetic diagnosis with those for whom no genetic answer can be found.

“Rapid whole genome sequencing can help us find the cause of early onset epilepsy quicker and among a greater number of patients, giving clinicians the critical data they need to choose the most appropriate treatment sooner,” says Dr. Vann Chau, Neurologist and Project Investigator in the Neurosciences & Mental Health Program at SickKids, who is leading the SickKids arm of the epilepsy project. “Our hope is that this collaboration will help create new and tangible changes in

medical practice to cut diagnosis from months to days, and lessen the burden on our patients and families living with epilepsy.”

After initial seed funding by each institution, the collaborative anticipates additional funding through national health and medical research grants within each country, industry contracts, and philanthropic efforts.

The collaborative as a whole has received support from the International Venture Philanthropy Network.

IPCHiP is contributing to Precision Child Health, a movement at SickKids to shift medicine from a one-size-fitsall approach to health care that is inH dividualized to each unique patient. ■

COVID-19 in pregnancy associated with adverse outcomes for mother and baby nfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pregnancy is associated with preeclampsia, stillbirth, preterm birth and other adverse outcomes, found new research published in CMAJ (Canadian Medical Association Journal).

“Our findings suggest that pregnant people with COVID-19 have an increased risk of high blood pressure, stillbirth and preterm birth.

Their newborns are more likely to need intensive care. Pregnant people with severe COVID-19 symptoms have a particularly high risk of these complications,” says Dr. Nathalie Auger, Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montréal, Quebec, with coauthors.

Researchers reviewed 42 studies involving 438,548 pregnant people from around the world to determine the association between SARSCoV-2 infection and adverse pregnancy outcomes. They found double the risk of preterm birth and a 50 per cent increased risk of cesarean delivery in pregnant people with symptomatic COVID-19 than in those

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with asymptomatic COVID-19.

Those with severe COVID-19 had a 4-fold higher risk of high blood pressure and preterm birth.

The reason for the increased risk of adverse outcomes is unclear, but could be because SARS-CoV-2 may lead to vasoconstriction and stimulate an inflammatory response affecting blood vessels.

The findings of this systematic review differ from prior findings from case reports and case series. “Our meta-analysis of recent good-quality cohort studies with comparative data does not align with these previous reviews, and provides clear evidence that symptomatic or severe COVID-19 is associated with a considerable risk of preeclampsia, preterm birth and low birth weight,” write the authors.

“Clinicians should be aware of these adverse outcomes when managing pregnancies affected by COVID-19 and adopt effective strategies to prevent or reduce risks to patients and fetuses,” they conclude.

“The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis” was pubH lished March 19, 2021. ■ www.hospitalnews.com

IN BRIEF

Risk of death for men 60% higher than for women in study of 28 countries A

large study of people in 28 countries found men aged 50 and over had a 60 per cent greater risk of death than women, partly explained by heavier rates of smoking and heart disease in men, although the gap varied across countries, according to new research in CMAJ (Canadian Medical Association Journal).

“Many studies have examined the potential impact of social, behavioural and biological factors on sex differences in mortality, but few have been able to investigate potential variation across countries,” writes Dr. Yu-Tzu Wu, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, and Population Health Sciences Institute, Newcastle University, United Kingdom, with coauthors.

“Different cultural traditions, historical contexts, and economic and societal development may influence gender experiences in different countries, and thus variably affect the health status of men and women.”

The study examined different socioeconomic (education, wealth), lifestyle (smoking, alcohol consumption), health (heart diseases, diabetes, hypertension and depression) and social (spouse, living alone) factors that might contribute to the mortality gap between men and women aged 50 and older. The data included more than 179,000 people across 28 countries and more than half (55%) were women. “[T]he effects of sex on mortality should include not only physiologic

variation between men and women but also the social construct of gender, which differs across societies. In particular, the large variation across countries may imply a greater effect of gender than sex. Although the biology of the sexes is consistent across populations, variation in cultural, societal and historical contexts can lead to different life experiences of men and

women and variation in the mortality gap across countries.”

The findings are consistent with the literature on life expectancy and death rates.

“The heterogeneity of sex differences in mortality across countries may indicate the substantial impact of gender on healthy aging in addition to biological sex, and the crucial contributions of smoking may also vary across differ-

ent populations,” write the authors.

The researchers recommend that public health policies should account for sex- and gender-based differences and the influence of social and cultural factors on health.

“Sex differences in mortality: results from a population-based study of 12 longitudinal cohorts” was published H March 15, 2021. ■

Provinces should prioritize COVID-19 vaccination of cancer patients t is critical that provinces and territories prioritize cancer patients and their caregivers during the second phase of COVID-19 vaccine distribution.

The National Advisory Committee on Immunization states that “the goal of Canada’s pandemic response is to minimize serious illness and death while minimizing societal disruption because of the COVID-19 pandemic.”

225,800 Canadians are diagnosed with cancer every year, but this commonly shared statistic does not represent the many more Canadians who were diagnosed in previous years and are still undergoing treatment today.

Unfortunately, the pandemic response has inadvertently negatively impacted the lives of cancer patients and survivors. This applies to all cancer patients, and particularly to those with lung cancer, who are uniquely vulnerable to complications if they

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contract COVID-19 due to their diminished lung function and immunocompromised systems.

The Canadian Cancer Survivor Network commissioned two Leger surveys on COVID-19 disruption of cancer care in Canada, the most recent in December 2020. One of the most startling results identified cancer patient and caregiver hesitancy to access care, with 35 per cent of patients and caregivers choosing to cancel, postpone or avoid a healthcare service during the pandemic. This included: • Cancelling or postponing in person appointments with their doctor.

• Avoiding booking an appointment with their doctor even when they need one.

• Avoiding going to the ER for symptoms related to cancer.

• Choosing to cancel or postpone a lab test or diagnostic procedure for cancer.

• Cancelling visiting a hospital for cancer care.

Clearly, the ability of cancer patients to access healthcare and cancer care remains in doubt, and may lead to worse outcomes, including later diagnoses and postponed or missed appointments, tests, or treatments. The anxiety and fear that cancer patients and caregivers are experiencing about contracting COVID-19 can be assuaged by the prioritization of COVID-19 vaccinations of cancer patients and their caregivers so that they feel safe when they go to cancer care appointments.

The Canadian Cancer Survivor Network therefore calls on the National Advisory Committee on Immunization as well as the provinces and territories to explicitly include cancer patients and caregivers in Phase 2 imH munization plans. ■

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NEWS

World-first:

Transplant after MAID at home performed at UHN ore than 14,000 people have received medical assistance in dying (MAID) in Canada, since it was legalized in 2016. Although organ donation is an option for only a fraction of this population, healthcare teams and researchers are working on innovations and new protocols to respect these patients’ final wishes while also allowing for them to help those in need of a transplant.

In a coordinated effort with Trillium Gift of Life Network (TGLN), the organization in charge of organ and tissue donation in Ontario, the Toronto Lung Transplant Program at UHN’s Ajmera Transplant Centre has performed the first transplant surgery after MAID at home.

“This is ground-breaking as it allows for us to respect the donor’s wishes while also paving an important new avenue to save lives,” says Dr. Marcelo Cypel, Surgical Director at the Ajmera Transplant Centre and corresponding author of the scientific paper reporting this case.

The case happened thanks to the great generosity of Sergeant Mike Neill, who received MAID at his home in Burlington, Ont., after a long battle with Huntington’s disease.

“In our experience in Ontario, a significant portion of MAID patients who are eligible to donate organs value dying at home more than donating organs and this is critically important to respect,” explains TGLN’s Chief Medical Officer for Donation, Dr. Andrew Healey.

“Our combined expertise and most current protocols allow us to respect these patients’ end-of-life plans while also honouring their incredible generosity in giving the gift of life.”

This world-first was possible thanks to Sergeant Neill’s generosity and because of an innovative protocol in

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“The success of this case is the result of a concerted effort by a number of teams,” says Dr. Jonathan Yeung (R), thoracic surgeon who did the recipient surgery at Toronto General Hospital.

Photo: Courtesy of Dr. Yeung)

Photo: UHN

A landmark advance in lung transplantation pioneered at UHN, the Ex Vivo Lung Perfusion (EVLP) system allows for surgeons to evaluate organ function before transplant.

place for lung transplantation in Toronto – the result of a collaboration between UHN, TGLN, William Osler Health System, and air ambulance and medical transport service, Ornge.

NON-PERFUSED ORGAN DONATION

Since 2016, UHN’s Ajmera Transplant Centre has been able to perform

lung transplants from deceased donors who had not previously been on life support. Known as Non-Perfused Organ Donation (NPOD), this protocol allows for lungs to be preserved for a longer period of time after an unexpected death – such as a heart attack – and still be suitable for transplant.

“Lungs are unique organs in that they can stay viable even after a couple of hours without blood circulation in the donors’ body, as long as they are full of air explains,” Dr. Cypel.

“So we implemented a strategy to reinflate the organ after death declaration and family authorization.”

Because in these cases there is no time to evaluate the organ function in the donor, the NPOD protocol is only possible thanks to Ex Vivo Lung Perfusion (EVLP) system, a landmark advance in lung transplantation pioneered by Drs. Cypel and Shaf Keshavjee, Director of the Toronto Lung Transplant Program and of the Latner Thoracic Research Laboratories.

“We are in a unique position in the world to lead this innovation as we have the technology and the partnerships to implement the necessary protocols,” Dr. Cypel says.

UHN’s Ajmera Transplant Centre also had the support from the donor hospital and medical transport teams.

Joseph Brant Hospital in Burlington performed the donor surgery and the lungs were transported by Ornge to Toronto General Hospital (TGH).

“The success of this case is the result of a concerted effort by a number of teams,” says Dr. Jonathan Yeung, thoracic surgeon who did the recipient surgery at TGH, and Senior Author of the scientific paper.

The patient who received the transplanted lungs suffered from end-stage lung disease.

By the end of 2019, there were more than 230 patients waiting for a lung transplant in Canada alone, and the estimate is that 20 per cent of patients die while waiting for lungs to become available.

Find out how to register to become an H organ or tissue donor at BeADonor.ca ■

This article was submitted by University Health Network.

8 HOSPITAL NEWS APRIL 2021

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CELEBRATING 25 YEARS 1997 - 2022

NEWS

Transforming health care amidst a crisis

By Jim Schembri n any given day, Lindsay Hogeboom can pull up William Osler Health System’s (Osler) Operational Command Centre (OCC) on her mobile phone or computer screen and see in real time what’s going on across Osler’s five sites, including two busy acute care hospitals. That wasn’t the case a year ago, when Osler found itself among the hardest hit regions in Ontario for COVID-19.

“When the global pandemic hit Ontario, and we started seeing a rapid influx of patients with COVID-19 arriving at our hospitals, it was clear to our Incident Management Team (IMT) that we needed more timely access to decision-making tools throughout the organization, many of which were still being informed using a mix of manual and electronic processes,” says Hogeboom, Osler’s Director, Access and Flow.

“We needed to know where all our patients were at any given time including how many patients were in our emergency departments awaiting admission to an inpatient bed, where we could place admitted patients who needed isolation, how many patients were ready for discharge, and how we could quickly mobilize our clinical and support teams to safely prepare for new patients being admitted to their units.”

While newer hospitals have the added benefit of access to the latest in health information technology, many hospitals, like Osler, have continued to update existing systems over the years to meet their needs. Modernizing Osler’s decision-making tools was an initiative already underway as part of the organization’s 2019-24 Strategic Plan, but the urgency to implement an efficient, user-friendly digital solution escalated with the onset of the pandemic.

“While sitting at the IMT meetings, our team heard first-hand what the needs were, and recognized that we had the in-house expertise to build a secure, customized, cloud-based solution without having to go through a lengthy Request for Proposal (RFP) process

O

The Operational Command Centre at William Osler Health System.

WITH MORE THAN 500 DATA POINTS FEEDING INTO THE OCC, THE APPS AND DASHBOARDS OFFER CUSTOMIZED SOLUTIONS FOR TRACKING PATIENT FLOW, TRANSFER OF ACCOUNTABILITY, BED CENSUS, PATIENT ACTIVITY IN THE EMERGENCY DEPARTMENTS, ALTERNATE LEVEL OF CARE PATIENTS, COVID-19 PATIENTS, AND COVID-19 ACUITY. for an external vendor’s product,” says James Moolecherry, CIO and Interim Vice President, Digital Transformation and Information Management.

Pre-pandemic, Muhammad Khan, Manager, Information, Intelligence and Technical Innovation (IITI), and his team had already built some proof of concept Apps based on end users’ needs, which laid the groundwork for getting components of a digital OCC up and running within three months.

“Fifty-five inch touch screen monitors had already been installed across

the organization to support the evolving OCC,” says Khan. “This made it possible for us to transform some existing manual processes into a set of user-friendly, customized Apps that our leaders and staff use to input information into the OCC at the unit level, which then feeds into centralized real-time dashboards, such as Patient Flow and iOccupancy.”

With more than 500 data points feeding into the OCC, the Apps and dashboards offer customized solutions for tracking patient flow, transfer of

accountability, bed census, patient activity in the emergency departments, alternate level of care patients, COVID-19 patients, and COVID-19 acuity.

Each dashboard and App appears as an icon on the OCC, similar to what people see on a mobile phone or computer. The OCC is used by Osler’s Patient Flow Centres, as well as senior leaders, directors, managers, and staff and physicians, with access to the most appropriate Apps and dashboards as determined by role.

Khan and his team are continuously working together with leaders and their teams to further customize existing solutions and develop new ones.

Shailesh Nadkarni, Osler’s Clinical Services Manager, Mental Health & Addictions at Brampton Civic Hospital, looked to his Information Systems Analyst and Khan’s team to make changes to the Bullet Rounds App by colour-coding time-sensitive mental health forms that would show his team at a glance when each patient’s form is due.

“They made it happen,” says Nadkarni. “I’m a big believer in using visual management tools with my team, because people tend to retain 80 per cent of what they can both see and do, and the interactive nature of the App really promotes team engagement.”

The innovation behind the OCC has not only transformed what Osler does as an organization internally, it’s also helped it at a systems level, by forecasting capacity pressures that may require transferring patients to other GTA or Ontario hospitals that have the ability to take on additional patients, ensuring safe, quality care for all patients.

“Having 24/7 access to real-time data has been nothing short of a game-changer for Osler’s decision-makers,” says Kiki Ferrari, Chief Operating Officer. “In addition to supporting safe, high quality and seamless care for patients, the OCC has been a catalyst for further strengthening accountability, resource efficiencies, employee engagement, capacity planning and organizational effectiveness H during a time of crisis.” ■

Jim Schembri works in communication at William Osler Health System.

10 HOSPITAL NEWS APRIL 2021

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NEWS

Protecting time

to reflect and learn from COVID experiences

By Ashleigh Townley, Joanna Wincentak and Shauna Kingsnorth he COVID-19 pandemic has brought a whirlwind of change to the Canadian healthcare context and daily practice of healthcare staff. Rapid shifts to telehealth and virtual care, routine adoption of enhanced personal protective equipment (PPE), mandatory symptom screening for staff and patients, as well as increased workfrom-home arrangements are but a few examples.

For many healthcare workers, the speed of these changes has left little time to consider broader impacts beyond immediate goals, to them as individuals and as teams in their workplace setting.

Protecting time for teams to reflect and learn from their collective COVID experiences can offer a beneficial pause; generate discussions that are helpful to staff, organizations and systems; provide an opportunity to catalogue events during periods of rapid decision-making; and make recommendations for changes to current practices and future reactions to healthcare crises.

One tool to help structure this reflective process is called an After Action Review (AAR). Adopted by the World Health Organization (WHO) for healthcare crises, AARs “... are structured, qualitative reviews of the actions taken during the response to identify best practices, gaps and lessons learned”and are “...not intended to assess individual performances or competences, but rather to identify functional challenges that must be addressed, and best practices to be maintained”.

At Holland Bloorview Kids Rehabilitation Hospital, the Knowledge Translation team, Evidence to Care, is using the AAR format to support clinical, management and senior leadership teams to understand rapid adoption of virtual care,

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organizational communication, and leadership’s decision-making process during COVID-19. Externally, Evidence to Care has supported the Toronto Academic Health Sciences Network (TAHSN) Learner Engagement Advisory Group to understand the removal and reinstatement of students to hospital learning environments during the pandemic.

There are a range of ways to facilitate an AAR, from multi-day organizational retreats, to short interviews with select individuals. An AAR consists of key questions that should be tailored to context. Here are some examples: • What was expected to happen?

• What was expected to happen with learners in TAHSN hospitals in the event we experienced a pandemic?

• What actually occurred?

• What actually occurred with senior management decision-making and communication between March – May 2020 as the hospital reacted to the COVID-19 pandemic?

• What went well and why?

• From March – May 2020, what went well with virtual care at the hospital and why?

• What can be improved and how?

• How will your learnings about communication systems, structures, tools, and strategies impact how the team does things in the future? What are specific recommendations?

In Evidence to Care’s experience, to generate the most useful results for pandemic learnings, AARs should be conducted with: • A defined group of staff or volunteers that work together or have similar roles (e.g. operations managers, a single clinical unit, or a committee dedicated to pandemic efforts). Consider power dynamics in groups that are participating. Will the presence of management change the answers from other group members? Consider holding a sep-

arate AAR with management and leadership.

• A topic that focuses on one area of the group’s pandemic response over a specific period of time. For example, an AAR could be conducted with an organization’s physiotherapists to understand their transition to virtual care delivery during the first six months of the pandemic (a period of time with rapid change).

• A minimum of one, two-hour meeting, with the potential for a second follow-up meeting to review, clarify and confirm AAR results.

• Facilitators from outside of the group participating in the AAR. At least two facilitators are recommended, one to lead the group and one to take notes and observe group dynamics. If a team is large, using smaller subgroups is helpful. We recommend having one facilitator per subgroup.

• A lens to interactivity. If in-person group activities are prohibited or

pose other challenges (i.e. masks hinder hearing), consider a video call platform. For example, Zoom has many features like breakout groups, polling and chat functions, that make running an AAR more interactive than can be achieved in-person during the pandemic.

• An actionable report that catalogues the synthesized themes and recommendations. Recommendations should have accountability to implement changes attached to them, and be reviewed and updated on a predetermined schedule (i.e. biennially) When the AAR is completed, the results should be reviewed with the contributing group. If possible, provide support to groups to prioritize and select recommendations to implement.

AARs are a relatively easy to use, resource-conscious, quick and powerful reflective tool that can enable teams and organizations to capture key learnings during this transformaH tive period of health care practice. ■

Ashleigh Townley, is the knowledge translation specialist; Joanna Wincentak, the knowledge broker; and Shauna Kingsnorth is manager, Evidence to Care at Holland Bloorview Kids Rehabilitation Hospital.

12 HOSPITAL NEWS APRIL 2021

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NEWS

Pandemic shines a light on

SickKids’ Peer Support Program A

t a time that many hospitals are considering peer support programs in response to the pandemic, The Hospital for Sick Children (SickKids) recognized the benefits such a program could have for staff long before COVID-19 became part of our vernacular.

When SickKids launched its Peer Support and Trauma Response Program three years ago, there was no global pandemic in sight, but there was this sinister statistic: health-care workers are 1.5 times more likely to be off work due to illness or disability than workers from other sectors, according to a 2015 report from the Canadian Healthcare Association (now HealthCareCAN).

This longstanding issue in the health-care field was magnified by the onset of COVID-19. For those on the front line, the constant donning/doffing of personal protective equipment, compliance with physical distancing/ masking, and fears of contracting/ transmitting the virus, take their toll.

“From April to December 2020, we had about 12,000 contacts for Peer Support, which is an astounding number considering we would normally have a couple of thousand at most in that period of time,” says Kelly McNaughton, Program Manager, Peer Support and Trauma Response Program, SickKids. “This tells me the program’s visibility has increased and that the challenges staff face at work and at home are heightened due to COVID.” Peer Support, which is made up of staff from diverse backgrounds and roles ranging from research, to Corporate Services (e.g., Security, Facilities, Patient Support Services), to nurses and physicians, responded quickly to the pandemic. The team established a temporary “de-stress” space in the hospital for staff to take a quick break and enjoy a snack; a roaming tea cart to offer staff a drink and wellness check-ins; on-site and virtual counselling sessions; and a dedicated “Mental

From left: Genna Villella, MSW Student, Peer Support and Trauma Response, and Nafilia Sachedina, Program Coordinator, Peer Support and Trauma Response, routinely provide wellness check-ins for SickKids staff members stationed at hospital entrances, including Stephanie Lappan Gracon, Sr. Clinical Manager, Safe Access Management, and Anna Worley, Entry Screener.

Health & Wellness” resource webpage for staff.

A more recent initiative involves scheduled daily visits by two dedicated members of the Peer Support program to our screening teams, a group of front-line workers who are charged with ensuring compliance with pandemic protocols upon entering SickKids. These two peers are on hand twice-daily for an hour to offer triage and direct “in-the-moment support.”

Perhaps the most important resource is how to connect with the dedicated and compassionate group of 76 trained Peers within the program itself, supporting staff across the SickKids campus whether they work in clinical/ non-clinical areas, research or learning.

“Without Peer Support during COVID, there’s a good possibility many staff who needed help may not have received it,” Kelly says. “Some may have had to take a leave of absence, others may have tried hard to continue on, but eventually ended up on leave anyway.”

How Peer Support makes a difference is acting as a friendly and trusted gateway to support. Instead of having

to figure out which way to turn on their own, people are much more likely to turn to a Peer because of the common ground they share at SickKids – an understanding of the culture, environment, potential stressors and psychological demands.

SickKids’ Peer Support program is not only attracting attention inside SickKids but outside too. In recent weeks, Kelly has been contacted by hospitals in Ontario, the U.S. and the Bahamas to learn more about what’s involved in setting up a program. Here are her top three tips: • Dedicate someone to manage the program – it’s not something that can be run from the side of one’s desk.

• Secure adequate funding and ensure the right infrastructure is in place.

• Recruit and train Peers who are in this for their colleagues and not themselves – not everyone is equipped to handle the heavy topics staff open up about.

Dr. Gino Somers is the Division Head of Pathology at SickKids and a physician Peer. During a difficult time in his career, he engaged the support of

his colleagues before there was a formal peer program. He credits them and their ability to understand the challenges of an academic hospital environment for lifting him back up again.

“After this episode, I was drawn to ‘peer support’ as a way of helping those who have suffered psychological trauma, disappointment or who just need to talk, and I love the idea of listening to people and helping them through a difficult period,” Gino says. “My involvement with the Peer Support program has really put me back in touch with why I became a doctor in the first place.”

Kelly notes that many volunteer to be a Peer, but like any job, it’s not for everyone. Some are interviewed and not invited to training; some are recruited and discover it’s not a fit for them. “The Peers themselves are the critical factor and we’re fortunate to have an exceptional group at SickKids,” Kelly says. “Even more important than training is the recruitment of a genuine and authentic complement of Peers. They are responsible for the program’s credibility and, ultimately, H its success.” ■

This article was submitted by the Hospital for Sick Children.

14 HOSPITAL NEWS APRIL 2021

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16th Annual Hospital News

NURSING HERO AWARDS

NOMINATE G N I S R U N A

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• Full name of the nurse • Facility where he/she worked at the time <RXU FRQWDFW LQIRUPDWLRQ 6SHFLÀF H[DPSOHV RI \RXU QRPLQHH JRLQJ DERYH DQG EH\RQG Along with having their story published, the winner also will take home:

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NEWS

The pressures of COVID-19 on an already stressful environment for health workers

By Dr. Ann Collins ired and anxious.

As we enter the second year of the COVID-19 pandemic in Canada these two words go a long way to describing how Canada’s physicians are feeling.

And I know we are not alone. Hospitals have been ground zero in managing the pandemic and everyone working in these hospitals – from cleaners and food services staff to therapists and nurses are feeling the impact. A recent poll of U.S. hospital executives identified provider burnout as one of the most potentially disruptive forces facing hospitals in the next three years and I am sure many Canadian hospital CEOs would echo this sentiment.

A recent survey of doctors conducted by the Canadian Medical Association (CMA) shows what a toll the pandemic is taking on the mental health of physicians both in hospitals and in community settings. The poll of more than 1600 physicians found that respondents’ fatigue has increased by 69 per cent over the last year, with 64 per cent experiencing anxiety around the pandemic.

A year ago, we and other health care providers were dealing with the stress of procuring adequate (or any) personal protective equipment (PPE) for ourselves, and the unknowns involved in caring for seriously ill-patients sickened by the new virus. Now we must deal with the uncertainties of just when and how COVID-19 vaccines will be distributed, while dealing with a growing number of patients with COVID-19 being admitted to intensive care units (ICUs).

The recent CMA poll showed that concerns about the rollout of COVID-19 vaccines was present among 62 per cent of physicians responding to the survey, with uncertainty about the future impacting 63 per cent.

Our poll shows that in late February, many doctors were disappointed with how governments were handling the one measure that holds the pros-

T

Dr. Ann Collines pect of relieving the situation – the supply and distribution of COVID-19 vaccines. There has been good progress made but we can’t let go of our collective determination to vaccinate our population.

What needs to be emphasized is that the stressful situation caused by the pandemic came at a time when the system was already overburdened. As a colleague, Alberta anesthesiologist Dr. Alika Lafontaine said in a recent interview “the burnout and moral injury that physicians have been experiencing across the country has always been there. We’ve been overworked and under resourced for many years.”

The CMA National Physician Health Survey conducted in 2017

documented some of these concerns and showed nearly one-third of doctors, residents and medical students report burnout and depression at some point in their career. Physicians whose main practice setting was a hospital had increased odds of lower emotional well-being, lower social well-being, and lower psychological well-being, compared with those working in other settings.

It should be noted that those managing our health care system are starting to pay attention. The framework seen as essential for maintaining a high-quality health care system, the so-called Quadruple Aim, now includes the health and well-being of those providing care.

While too many physicians continue to deal with mental health issues in silence and fail to receive the necessary care, the pandemic has seen a willingness by many of my colleagues to share their personal circumstances with their peers and on social media.

Winnipeg internist and author Dr. Jillian Horton who has just published a highly praised personal memoir “We Are All Perfectly Fine” said she has noted a new “esprit de corps” among physicians in the face of the pandemic. Her perspective is echoed by Dr. Micheal Myers, a psychiatrist who has specialized in treating mental health issues of physicians. “Doctors are reaching out to each other in both directions, asking for help and offering help. More and more physicians are talking about their mental health struggles in significant ways, some in private, others publicly,” he writes.

What will it take to significantly improve the well-being and outlook of Canadian physicians?

The recent poll found that the most likely contributing factors to positive mental health are directly related to the pandemic. They include getting accustomed to the “new normal”, more time dedicated to self-care, an improved outlook regarding COVID-19, improved work-life integration, and improved availability of PPE. Moving forward, physicians and all hospital workers must have the mental health supports they need to face new challenges. If vaccines succeed in vanquishing the immediate threat of COVID-19, doctors and the hospital sector still face the huge challenge of bridging the care gap for the many patients who have seen postponement of elective procedures due to the pandemic.

The COVID-19 pandemic has placed huge pressures on physicians and all front-line workers, not to mention the isolation felt by so many Canadians. We’re all feeling the pressure of a global pandemic that has upend our lives and all that we cherish. Compassion remains the best prescription H now and into the future. ■

Dr. Collins is a family physician in Fredericton, New Brunswick and president of the Canadian Medical Association 16 HOSPITAL NEWS APRIL 2021

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Infection Control Risk Assessment

ICRA

SMARTER TRAINING SAVES LIVES

The United Brotherhood of Carpenters’ Infection Control Risk Assessment (ICRA) training teaches healthcare construction protocols that save lives.

Our training educates Healthcare Personnel, Construction Professionals and Architects in ICRA best practices that protect patients by working safely during all phases of healthcare facility renovations.

Contaminants released during renovation projects can lead to deadly healthcare associated infections.

This is why it’s critical for anyone working in a healthcare facility during renovation to have participated in ICRA Training.

TRAINED PROFESSIONALS PREVENT THE SPREAD OF DEADLY INFECTIONS

1 in 25

With the UBC ICRA training, you’ll learn necessary safeguards to protect your patients from health hazards during construction.

healthcare associated infection at

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Safety is priceless. ICRA training is free.

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A

P R O G R A M

O F

T H E

COVER

What to Watch:

A look at technologies with high potential to transform health care

By Barbara Greenwood Dufour he fast pace of medical technology development is already transforming the Canadian health care system. But what game-changers are waiting around the corner? To help health care decision-makers prepare for the adoption of technologies that are not yet widely used, CADTH is continuously scanning the horizon to identify the ones that are the most promising.

CADTH is an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures. CADTH recently released its List of 2021 Health Technology Trends to Watch – a list of emerging health technology trends that have potential to significantly influence the future of health care in Canada.

To develop its Watch List, CADTH looked for technologies with an FDA Breakthrough Devices Designation and for any other technologies that could change how health care is delivered. Then, CADTH consulted with its Device Advisory Committee for more context and to help determine which technologies had the highest likelihood of having an impact.

This article describes just a few of the technologies featured in the Watch List.

T

WEARABLES

The market for wearable devices – or “wearables” – developed for use in health care continues to grow. Two new wearables have been designed to learn the wearer’s normal vital signs and detect changes in them. One has recently been developed for people with nightmare disorder or who have nightmares associated with post-traumatic stress syndrome. Worn on the wrist (like a smartwatch) while sleeping, the device detects and learns an individual’s normal sleeping heart rate

and body movements. When it senses a change that suggests a nightmare is beginning, the device vibrates gently enough to stop the nightmare without waking up the wearer.

Another new wearable has been developed for users of opioids who are at risk of opioid-induced respiratory depression. This device is worn on the chest to detect and learn the normal breathing patterns of the wearer.

When it detects abnormal breathing, which could mean the wearer is experiencing respiratory depression, the device sends an alert to first responders.

AUGMENTED AND VIRTUAL REALITY

Augmented reality and virtual reality (VR) technologies are also providing new treatment options for people with various conditions. A new contact lens has been developed that uses augmented reality to help people with low or impaired vision see better – by increasing contrast or brightness, for example. And a VR headset has recently been designed to provide cognitive behavioural therapy, mindfulness, and relaxation programs for people with conditions such as fibromyalgia or chronic low back pain.

ARTIFICIAL INTELLIGENCE

Other innovations included in the Watch List involve the use of artificial intelligence (AI) to create systems for performing health care-related tasks that typically require human intelligence. Two of these are AI-based systems for analyzing diagnostic images – one analyzes CT scans of the brain to detect critical abnormalities that could lead to stroke (such as intracranial hemorrhage and large vessel occlusion), and another analyzes MRI scans of the breast to detect abnormalities that could suggest the presence of breast cancer.

AI-based imaging systems are already being used in all Canadian provinces and some territories. Data on where AI imaging technology is being used in Canada is captured in CADTH’s Canadian Medical Imaging Inventory, available at cadth.ca/cmii.

COVID-19

CADTH also identified new technologies that directly address issues related to COVID-19. As testing for the virus remains an important part of managing the pandemic, new COVID-19 tests are being approved rapidly. A number of home sampling kits have been developed – one that has been approved by Health Canada could soon be available at your local pharmacy. There are also new tests being developed that can detect and differentiate between COVID-19 and influenza from a single sample – some are for use in the lab, while others are for use at the point of care.

In addition, 3-D printer designs are emerging that address ventilator shortages resulting from the COVID-19 pandemic. Examples include a new low-cost ventilator design as well as a

design for a plastic adaptor that converts BiPAP (bilevel positive airway pressure) machines into mechanical ventilators – both of which can be quickly 3-D printed on location in a hospital.

As is the case with new and emerging technologies, there’s only limited evidence so far on how effective these devices are or how they compare with existing treatments. But CADTH’s Watch List provides an early look at the technologies that could change and impact Canadian health care in the coming years – which can help health care decision-makers see around the next corner.

You can access the entire CADTH Watch List at cadth.ca/health-technology-trends-watch. To learn more about our Horizon Scanning program, visit cadth.ca/horizon-scanning, or to suggest a new or emerging health technology for CADTH to review, email us at HorizonScanning@cadth. ca. If you’d like to learn more about CADTH, visit cadth.ca, follow us on Twitter @CADTH_ACMTS, or speak to a Liaison Officer in your reH gion: cadth.ca/Liaison-Officers. ■

Barbara Greenwood Dufour is a knowledge mobilization officer at CADTH. 18 HOSPITAL NEWS APRIL 2021

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HEALTHCARE HEROES MAKING A DIFFERENCE IN EVERY WAY POSSIBLE

It’s been a long year and the COVID-19 pandemic has hit Canada hard.

With stories of hospital bed shortages, delayed medical care, RYHUZRUNHG IURQWOLQH VWDƪ DQG ULVLQJ GHDWK FRXQWV &DQDGLDQV KDYH EHHQ LQ JUHDW QHHG RI VXSSRUW t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p// *(7 7+528*+ 7+,6 Ǭ 72*(7+(5

medtronic.ca

© 2021 Medtronic. All rights reserved.

E-HEALTH

Join us for two days of online learning, digital networking, and cyber-celebration – with three weeks of pre-conference events!

e-Health 2021

Virtual Conference and Tradeshow ince 1970, the annual e-Health Conference and Tradeshow has brought Canadian digital health professionals together to network, connect, and learn from one another.

With in-demand keynote presenters, expert panelists, and leading-edge exhibitors, e-Health always delivers memorable education and networking opportunities. This May, delegates will connect, learn, and engage virtually

S

with digital health leaders from across Canada and the world at three unique Pre-Conference Events and two days of stimulating virtual Conference and Tradeshow activities in an all-new interactive environment.

After 21 years, e-Health continues to thrive and adapt along with the digital health ecosystem and the people who live in it. Let’s gather virtually to share updates and insights on improving the health of H Canadians through technology. ■

PRE-CONFERENCE EVENTS

• Wednesday, May 5, 2021 from 1:00-3:00pm ET • Wednesday, May 12, 2021 from1:00-3:00pm ET • Wednesday, May 19, 2021 from1:00-3:00pm ET

MAIN CONFERENCE

• Wednesday, May 26, 2021 from 10am-5pm ET • Thursday, May 27, 2021 from 10am-5pm ET

Patients at e-Health We are pleased to announce that the e-Health Conference & Tradeshow is applying for the Patients Included status, continuing with our long-term commitment to incorporate patient expertise into the conference.

For more information on Patients Included, please visit the Patients Included website.

We strongly believe that e-Health satisfies all five criteria as identified in the Patients Included charter: • Patients or caregivers with experience relevant to the conference’s central theme actively participate in the design and planning of the event, including the selection of themes, topics and speakers.

• Patients or caregivers with experience of the issues addressed by the event participate in its delivery and appear in its physical audience. Our

patient advisors will be invited to participate as session moderators during the conference. Patient advisors and scholarship recipients are invited to stay for the duration of the conference and attend any session they choose.

• Scholarships are provided to allow patients or caregivers affected by the relevant issues to attend as delegates. All patients and caregivers are eligible to apply for a patient scholarship.

• All applicable sessions, breakouts, ancillary meetings, and other program elements are open to patient delegates.

• Recorded audio and video of all sessions will also be available via the Virtual Library, to which all registered delegates have complimentary H access. ■

#eHealth2021 is hosted by:

20 HOSPITAL NEWS APRIL 2021

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E-HEALTH

What’s new this year THREE DAYS OF PRECONFERENCE EVENTS

Conference registration includes attendance at the two-day e-Health 2021 Virtual Conference and Tradeshow on Wednesday, May 26 and Thursday, May 27, 2021 as well as three Pre-Conference Virtual Events (May 5, May 12, and May 19), plus access to the e-Health Virtual Library.

• Wednesday, May 5, 2021 from 1:003:00pm ET • Wednesday, May 12, 2021 from1:003:00pm ET • Wednesday, May 19, 2021 from1:003:00pm ET

VIRTUAL NETWORKING WITH HOT TOPIC ROUNDTABLES

Half-hour roundtable networking breaks are scheduled throughout the conference to break up the day and give everyone a chance to pause and refresh or network and connect with other attendees. Enter the Remo virtual networking platform for real-time, face-to-face engagement with optional

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Hot Topic Roundtables featuring moderated pre-selected discussion topics to keep the e-Health conversation going between sessions.

VIRTUAL TRADESHOW AND EXHIBIT HALL

The e-Health 2021 virtual conference platform includes a 2D Welcome Area, Help Desk, Exhibit Hall and more, elevating the online exhibit experience and introducing more options for interaction and easy navigation.

VISIT THE E-HEALTH VIRTUAL LIBRARY

All the great presentations from the e-Health 2020 Virtual PopUp have been brought together in one place so that you can watch and re-watch any of the sessions. e-Health 2020 Virtual PopUp Attendees enjoy complimentary access to the 2020 e-Health Virtual Library. Login with the unique Access Code emailed to all attendees (Contact info@e-healthconference. com if you didn’t receive your access H code). ■

e-Health 2021 Patient Partners “The passion for eHealth across this nation is inspiring! Collaborating with other experienced health, industry, and patient leaders across Canada to steer programming has been insightful and a wonderful opportunity. You can expect a virtual conference equally as inspiring and insightful!”

– Alissa MacMullin “As a patient partner on the Program Committee at e-Health 2021, I am consulted and empowered to participate as a full committee member. Patient engagement is ever-present at e- Health 2021!”

– Christine MacKinnon “It has been an insightful opportunity to see what is happening across Canada when it comes to the adaptation and progression of the digital health landscape. It is encouraging to see how industry and care has adapted to the COVID Pandemic and used the opportunity to not only enhance care in our communities, but to progress the adoption of digital solutions in the future of health care.”

– Sarah Hissett

APRIL 2021 HOSPITAL NEWS 21

Same compelling content.

We can’t meet in person, but Canadian digital health professionals can still count on the annual e-Health Conference and Tradeshow to deliver valuable networking, quality content, great speakers, and multiple learning opportunities.

This year, let’s meet online at three unique Pre-Conference virtual events and over two days of virtual Conference and Tradeshow activities—in an all-new interactive online environment!

These days, making connections can be hard. e-Health makes it easy.

Early Bird Savings until March 30, 2021 Register at e-healthconference.com

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Supporting diagnostic and therapeutic decision-making From test ordering to imaging processing – our products provide clinical decision support to aid you in personalized diagnostic and treatment decisions. t "* 3BE $PNQBOJPO automatically performs measurements and prepares results in the form of clinical images and reports t .FEJDBMJT $MJOJDBM %FDJTJPO 4VQQPSU imaging clinical decision support platform that helps evaluate the appropriateness of imaging orders by delivering up-to-date, evidence-based clinical best practice guidelines at the point of order entry

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Connecting care teams and patients Optimize your decision-making with cooperative care to save costs and speed up the processes. t F)FBMUI 4PMVUJPOT get service and applications for cross-institutional communication and collaboration for efficient patient care t UFBNQMBZ NZ$BSF $PNQBOJPO – remote care management: a telehealth solution for care providers, teamplay myCare Companion helps to manage large numbers of patients smartly thanks to powerful workflow support

E-HEALTH

Pre-Conference events

May is e-Health month with three pre-conference events on May 5, May 12, and May 19. Each day features a Public-Private Showcase (May 5: Consulate General of the Kingdom of the Netherlands in Toronto; May 12: Cisco; May 19: Empower Health/iamsick. ca) and four virtual e-Poster Presentations. e-Poster presentation topics include: • Data Quality Improvement from AI-Powered Auditing • Comparing Wearable Devices for Use in Public Health Surveillance • Developing an Informatics Competency Self-Assessment Tool for Nurse Leaders • Business Intelligence Dashboards for Patient Safety and Quality • Virtual Family-Centered Rounds: A Collaborative Necessity During COVID-19 and Beyond • Delivering Home Care Virtually: Lessons Learned through a Rapid Expansion • Kids Uncomplicated: Effective Virtual Intervention for Children and Families Using Teleroo World • Population-level Behavioural Changes Due to Covid-19 Using IoT data • Optimizing Major Trauma Patient Care Journey to Definitive Care • A Provincial Approach to Immunization Scheduling and Documentation Utilizing EMR • Using Computer Assisted Physician Documentation (CAPD) to Improve Documentation Quality • Competency-based Education Programs Prepare Health Care Leaders H for the Future ■

Right patient

Right care

Find out more at orionhealth.com

24 HOSPITAL NEWS APRIL 2021

Program highlights: THURSDAY, MAY 27 (DAY TWO) Time

Session

Details

10:45

Plenary Session

Patient and Professional Perspectives on Engagement and Access in a Digital World

11:30

Virtual Tradeshow

12:00

Concurrent Sessions

12:30

Networking

1:00

Host Session A presentation from e-Health Conference host Canadian Institute for Health Information

1:30

Symposium

2:15

Virtual Tradeshow

2:45

Concurrent Sessions

3:15

Networking

3:45

Host Session A presentation from e-Health Conference host Digital Health Canada

4:15– 4:50 PM

Closing Closing keynote Mark Black is a Heart and Keynote Double-Lung Transplant Recipient turned 4-Time Presentation Marathon Runner. A resilience expert, coach, and author, Mark helps people “Break Through” their limitations and his coaching programs provide clients the tools to transform your adversity into your competitive advantage. Mark doesn’t just teach resilience, he embodies it.

Right place

Rapid Fire: This is ME: Capturing the patient’s story within the HER; Utilizing Technology to Improve Adherence to Quality Standards for Schizophrenia; A Multimodal E-Learning Module Alternative to Facilitating Cadaveric Labs; Impact of ‘Digital Empathy’ in Improving Outcomes Among Youth. Oral: Impact of COVID-19 on Telemedicine Services in First Nations Communities; Virtual Tools for Supporting Outpatients, Parents and Caregivers during COVID-19. Panel: Ethical AI Framework: evaluating ethics maturity in pandemic modeling. Oral: Robots: enabling proactive care during the pandemic and beyond; Provider Perspectives of a Pediatric Patient Portal

Oral: Virtual Care During COVID-19: Long-Term Care and Retirement Homes; Delivering access to Specialist care in long-term care homes; Emergency Room (ER) Diversion During a Pandemic; Health system management data for new inpatient and ED settings. Panel: Leveraging Remote Patient Monitoring to Build Clinical Capacity during COVID-19. Rapid Fire: Virtual Health Connections in Critical Care at Vancouver General Hospital; Remote patient monitoring is a foundation for rapid pandemic response; Client-centred virtual approach to Community Behavioural Support in the Western Region of Newfoundland; The impact of virtual health during COVID-19 pandemic

www.hospitalnews.com

Digital health’s next big transformation:

SPONSORED CONTENT

The shift to healthcare, anywhere rguably, one of the biggest challenges facing healthcare is the increasing frustrations from consumers around the way they access and interact with the health system. Consumers’ expectations are rising around their desire to access healthcare in a way that suits them, based on the way they interact with other digital services such as online shopping or banking. To address this, healthcare needs an equivalent.

Typically, to access healthcare services, citizens must make an appointment with their doctor, wait some time for that appointment, then wait again for any referrals to other healthcare providers. Alternatively, they can spend hours waiting in an emergency room that can be located a great distance away and is difficult to access.

The process is fragmented, slow, opaque, and fraught with risk of errors.

What if technology could solve all of this and ensure that individuals consistently receive the right care for them, at the right place and at the right time?

INTEGRATING EXISTING TECHNOLOGY

A

ADDRESSING THE CHALLENGING

This challenge has become more urgent as health systems are struggling with increased patient demand and more complex clinical needs in a budget-constrained reality. Healthcare providers and systems face simultaneous pressures with the global COVID-19 pandemic, an opioid crisis, rising mental health issues, an aging demographic, and rise in the incidence and burden on systems from multiple chronic diseases. To tackle these issues effectively, healthcare needs to consider and address challenges including social determinants of health and health system inequity.

As the ability of healthcare organizations to offer the services their patients need and want is stretched to beyond breaking point, now is the time to put a strategy and tools in place to support better access to healthcare services and meaningful ways for patients and their families to www.hospitalnews.com

participate in their own healthcare.

Fortunately, technology can have a significant positive impact on these issues.

THE FUTURE OF HEALTHCARE AND THE DIGITAL FRONT DOOR

A digital front door solution integrates a suite of tools which allows organizations to use systems already in place and adopted. It provides people with access to all of the tools needed to manage their own, as well as their dependents’ health and wellbeing, from a secure, central web application.

By putting consumers at the center of healthcare delivery and empowering them to navigate disjointed, complex health systems, a digital front door promises to address the challenges facing today’s healthcare organizations.

PROVIDING HIGH-QUALITY HEALTHCARE, DIGITALLY

The components of a digital front door are extensive; a chatbot with automated and digital human communication functions to assist with access, a symptom checker that triages patients to the right advice or care, natural language processing (NLP) powered search, and telehealth capability so that people can choose how they

would like to interact with services and providers.

The potential of a digital front door also includes online prescription ordering and payment options, healthcare resources and support services that use machine learning to personalize information based on the user’s preferences and search history, and user-recognition tools that can pre-fill forms and learn the most effective way to engage with users.

A STRATEGY WITH A VISION TO SUPPORT CONSUMERS

When considering implementing a digital front door, organizations should envision a complete ecosystem that supports consumers across all their healthcare interactions. As the solution can span such a wide variety of functions, it is best regarded as a strategic project with several individual initiatives. Each initiative should provide value to the organization, be aligned with strategic priorities and, most importantly, provide better access to the health system to empower consumers.

The true value of a healthcare digital front door will be realized when implemented at a population level, leveraging all the data, resources, and tools from across the entire health system.

Many patients have already adopted the use of patient portals, telehealth technology and other digital health solutions to help manage their healthcare, and the COVID-19 pandemic has accelerated the need for organizations to adopt virtual healthcare services to keep people out of hospitals, reserving valuable resources for those who need them most.

A digital front door strategy should allow for integration with these existing technologies such as e-referral, virtual care and appointment booking systems and take a best-of-breed approach that does not demand replacement of the tools that already exist.

Taking an incremental approach to implementation, leveraging existing successes, and extending and adding services will provide a holistic digital front door that is adopted and used more quickly.

DIGITAL HEALTH’S NEXT BIG TRANSFORMATION – THE TIME TO ACT IS NOW

The recent rapid adoption of virtual and online care tools presents health and service providers with an opportunity to fundamentally transform the way people across cities, regions and even entire nations experience and interact with healthcare. Something that has been a long time coming for an industry that has historically lagged in terms of patient engagement and experience, particularly in the digital space.

Now is the best time to plan a digital front door strategy. Integrating existing technologies and leading with a cohesive strategy will put healthcare organizations firmly in tune with engaging and empowering consumers now and in the future, and finally deliver the healthcare we H all desire. Q

APRIL 2021 HOSPITAL NEWS 25

E-HEALTH

Patient perspectives

on virtual health in B.C. during COVID-19

By Kris Olsen

n the wake of the COVID-19 pandemic, virtual health has become an essential means of delivering care safely to citizens across British Columbia. Numbers show that health care providers and patients quickly adapted to a new normal – since March, the number of virtual health visits

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across B.C. rose from 1,800 a week to 21,000 a week in December. The ability to receive care without having to leave home has become a great option for many, especially those in more remote areas or with specific needs.

Airlie Pinkerton, a Vancouver Island resident who had been in the process of immunotherapy for years

preceding COVID-19, was able to convert what would have been in-person appointments to virtual check ins – saving her the nearly three-hour drive to her Victoria-based physician’s office. Based on what she needed clinically, and her previous relationship with her care team, this was an ideal solution.

Jim Lyster, another patient on Vancouver Island, had a similar experience to Pinkerton; his self-monitoring pacemaker electronically transfers reports on his heart activity directly to his specialist at Royal Jubilee Hospital in Victoria. Because Jim’s physicians and care team are able to see this data remotely, his physical presence in the

Virtual care and the future of digital health

By Michael Green ithin weeks of the start of the COVID-19 pandemic, the use of virtual care exploded in Canada. About 60 per cent of all primary care visits were being done virtually, via phone, video or secure messaging. That was a dramatic increase from 2019, where about 10 to 20 per cent of primary care visits were done virtually. Surveys conducted by Canada Health Infoway in early 2021 show that virtual visits now make up about 40 per cent of primary care visits, more than double the pre-pandemic numbers.

What does this tell us?

Prior to the pandemic, we had been making a gradual migration to virtual care. The pandemic provided the spark that really accelerated use, mainly out of necessity – we needed to keep patients and health care providers safe.

Now that patients and providers are getting used to virtual care, they like it and they want to keep it, at least as an option for routine visits.

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HOW DO WE KEEP THE MOMENTUM GOING?

It will take a concerted effort by all health system stakeholders – including governments, clinicians, patients and industry. Over the past few months, Infoway hosted a series of online discussions to talk about the future of

virtual care and the related topics of patient empowerment, mental health, and privacy and cybersecurity. Participants included patient and family advocates and representatives from Accenture, Cerner Canada, Orion Health, Roche Canada, Teladoc Health and TELUS Health. These companies are members of the Infoway Alliance, a collaboration between Infoway and industry partners.

IMPROVING ACCESS

With the increased demand for virtual services brought on by the pandemic, we need to ensure that all Canadians have access to digital health tools and services and to their heir personal health information. Equity is essential.

“There are still a lot of dead ead zones in Canada that don’t have basic asic internet access,” says Sarah Hissett, an Infoway patient advisor. “So when you’re pushing to a system that’s more digitized, you could be potentially cutting people off.”

While access is growing, g, there are still some who feel that patients atients may be overwhelmed or confused ed by lab results and other personal health information. Bhavanita Patel, patient experience manager for Roche he Canada, says we need to debunk that at notion.

“There are a lot of assumptions made about what people are comfortable with,” she says. “Generally erally speaking, I think they want as much information as they can get.”

GIVING PATIENTS A VOICE

Patients and providers benefit when patients have access to more information, and when they have a greater say in the health system. “[Patients] have more at stake than anyone on the health care team to ensure effective, efficient and quality care,” says patient advisor Anne O’Riordan. “And our contribution is unique, as we have a different perspective to offer: our lived experience, perhaps better described as lived expertise.”

This is critically important when it comes to mental health care.

“We need to go where the patient is, and the patient really should be driving their care,” says Dr. Diane McIntosh, psychiatrist and chief neuroscience officer at TELUS Health. “[When I treat a client] I am the navigator – they are the captain of their ship.”

WHAT’S NEXT?

I’m optimistic about the future, and the increased benefits we will see from digital health. I’m especially optimistic about the continued use of virtual care. If technology provides a benefit, people will use it, and that’s clearly what we are seeing with virtual care.

Our surveys show that about 90 per cent of patients are satisfied with their virtual care experience, so I expect use to continue to grow beyond the pandemic.

I also think the language that we use to talk about this model of care will change sooner than we think. I’ll leave the last word to Timothy Foggin, vice president with Teladoc Health.

“With digital photography, we no longer say ‘digital’ – we just say ‘photography,’” Foggin says. “If we need to talk about film photography, we say ‘film photography.’

Right now, we’re saying ‘virtual care.’ Soon enough, we’ll just be H talking about care.” ■

Michael Green is President and CEO of Canada Health Infoway.

26 HOSPITAL NEWS APRIL 2021

www.hospitalnews.com

E-HEALTH hospital isn’t required for standard check-ins. Given the present circumstances, having the ability to check in virtually with his physician to discuss how he is feeling and review any changes needed to his care, lowers his risk of acquiring COVID-19.

There can be concerns around the logistics of arriving at a health care practitioner’s office; some patients who don’t have their own vehicles may have other challenges to accessing in-person health care. Taxis or public transit can be out of the question, especially for those considered high-risk for COVID-19. Some people can feel considerable stress around vehicles in general; Diana Campbell, who has suffered the consequences of several car accidents, noted that when she is in the car, she “takes all the oxygen out when there’s a near miss … it’s very stressful.” These stressors highlight the advantages to attending appointments virtually when appropriate.

Avoiding a commute and reducing exposure to the virus are a few of the benefits to virtual interactions be-

tween patients and health care providers. For example, patients who suffer from migraines, chronic pain, or have experienced traumatic brain injuries may find it very draining to sit in a waiting room. The process of getting to the office can affect the entire visit and ultimately detract from the patient’s care.

Campbell explains that when she has to travel to see her physician, “by the time I see him, I have trouble holding a conversation because … I am overstimulated and cannot process information.” When attending appointments from home, “I can get health concerns addressed, I know I have an appointment with the doctor and I can rest beforehand so I don’t get to that place where I don’t remember what he said … but I don’t have that option in a facility.” In the right circumstances, a virtual health visit is just as effective and safe as one done in person, if not more so.

Virtual health is helping to create real change in how we access and give care. For someone like Campbell,

who has had multiple concussions and brain injuries, “sitting in an office makes the sensory overload almost unbearable. Having a virtual health visit from home is more comfortable and allows me to focus on the issue I need to discuss with my GP.” The Office of Virtual Health is a service of Provincial Health Services Authority (PHSA). It leads and provides strategic direction and inno-

vation for the overall virtual health initiative across PHSA. It works collaboratively with clinical, operational and corporate partners, and leads organization-wide planning, and facilitates transformation, including process redesign, change management, project management, education and reporting. For more information, please visit the OVH webpage or send an email to H officeofvirtualhealth@phsa.ca. ■

Kris Olsen is a Communications Officer, Provincial Health Services Authority.

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APRIL 2021 HOSPITAL NEWS 27

SAFE MEDICATION

The 5W’s of adverse event reporting following immunization in Canada

By Yifan Zhou, Crystal Zhang, and Certina Ho veryone has a role in reporting adverse reactions to drugs and other health products. With the recent approval and mass distribution of COVID-19 vaccines, it is important to learn about the 5 W’s (Why, Who, What, When, and Where) of reporting adverse events following immunization (AEFI).

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WHY REPORT?

Results of clinical trials provide us with a list of potential side effects associated with the drug product under development. However, the listed side effects may not be comprehensive or reflective in what may actually happen when the drug (e.g. the COVID-19 vaccine) is being administered to the general population.

Post-market adverse event reporting allows greater data collection from the general population for further safety profile analysis of the drug project that has been approved for use. This may help: (1) identify previously unknown adverse events; (2) understand an increase in adverse event frequency or severity; and (3) target areas requiring further investigation.

The findings may then be used for updating the drug’s safety profile, product information, regulatory actions, and policy changes associated with provincial and/or federal initiatives.

WHO CAN REPORT?

Anyone can report a side effect to a vaccine at https://www.canada. ca/en/health-canada/services/drugshealth-products/medeffect-canada/ adverse-reaction-reporting/vaccine. html. Reporters can be patients, health care providers, and drug manufacturers (Table 1).

POST-MARKET ADVERSE EVENT REPORTING ALLOWS GREATER DATA COLLECTION FROM THE GENERAL POPULATION FOR FURTHER SAFETY PROFILE ANALYSIS OF THE DRUG PROJECT THAT HAS BEEN APPROVED FOR USE. WHAT TYPE OF AEFI SHOULD BE REPORTED?

Any adverse event that is associated with vaccination should be reported even if the causal relationship has not been established. Adverse events that are serious, unexpected (regardless of seriousness), have a temporal association with vaccine administration, or have no other clear cause(s) at the time of reporting should be reported. Mild events, such as, transient injection site reactions, do not need to be reported.

For further information, refer to the Reporting Adverse Events Following

Immunization (AEFI) in Canada: User guide to completion and submission of the AEFI reports (https://www.canada. ca/en/public-health/services/immunization/reporting-adverse-events-following-immunization/user-guide-completion-submission-aefi-reports.html).

WHEN/WHERE TO REPORT?

If a patient experiences an AEFI, healthcare providers (HCPs) who provide immunizations should complete the AEFI form. Similarly, if patients experience adverse event(s) following immunization, they should ask their

HCPs to complete the AEFI form accordingly. Note that the AEFI forms may differ between hospitals and provinces. The completed AEFI forms will be sent to local public health units, followed by federal/provincial/territorial immunization authorities, and ultimately to the Public Health Agency of Canada (PHAC), which, together with Health Canada, monitors vaccine safety in Canada (Table 1).

CONCLUSION

In the time of rapid and widespread immunization of COVID-19 vaccines, AEFI reporting is crucial to better understanding their safety profiles. Patients receiving vaccinations should be encouraged to reach out to their healthcare providers if they experience any adverse events. As COVID-19 vaccination providers, healthcare professionals play an important role in educating patients and contributing to H ongoing vaccine safety monitoring. ■

Table 1: Everyone Has a Role in Reporting Adverse Events Following Immunization Patients

Health Care Providers (HCPs)

• For the general public, the decision of reporting AEFI is voluntary. Patients can ask their HCPs to complete the AEFI form.

• AEFI should be reported by HCPs as soon as possible, which will then be submitted to local public health units, federal/provincial/territorial immunization authorities, and PHAC, respectively.

• Mandatory reporting of serious adverse drug reactions and medical device incidents by hospitals to Health Canada has been effective since December 16, 2019.

Reporting is mandatory within 30 days.

Drug Manufacturers

Impact

• They are required to report to Health Canada's Canada Vigilance Program (https://www.canada. ca/en/health-canada/services/drugs-healthproducts/medeffect-canada/canada-vigilanceprogram.html) within 15 days of becoming aware of the adverse event.

• This is an alliance of 12 pediatric centres across Canada. It actively screens for hospital admissions for neurologic events. If IMPACT identifies any unexplained adverse event temporally associated with an immunization, it will report to PHAC, federal/provincial/ territorial immunization authorities, and local public health units for follow up.

Yifan Zhou and Crystal Zhang are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto.

28 HOSPITAL NEWS APRIL 2021

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FROM THE CEO’S DESK

COVID-19: Year two By: Dr. Catherine Zahn n the summer of 2020, I wrote about the capacity of the COVID-19 pandemic to power change.

One year after the WHO declared the COVID-19 pandemic, there are reasons to be optimistic. And building on the past year’s experience, I think we all agree that we can do better. In July 2020, I proposed opportunities to optimize our new reliance on virtual care, including barriers we needed to overcome. At that time, many identified the shortage of affordable and supportive housing as a crisis during the pandemic, but we underestimated the risks to infection prevention and control in congregate living settings, shelters and for people experiencing homelessness. I expressed sincere optimism about opportunities unfolding as the entire mental health sector created meaningful alliances and spoke in a unified voice on behalf of the people we serve. There is no denying the positive change. Now we need to ensure it’s operationalized and embedded.

Virtual care has exploded across all of healthcare. But do we see care via phone or video continuing to be a substitute for in-person care, or is it an opportunity to increase access to specialty care? In addition to studying safe and effective ways to deliver virtual care, we need to understand when, how and for whom it’s appropriate.

There are decades of experience in virtual, long-distance care in psychiatry and now, expertise in its delivery needs to be considered a core competency. A bright side bar to the virtual care story is that the technology is being used to not only deliver direct care, but also to build individual and team expertise. The creation of this new capacity will serve remote and rural areas of the province in the long run.

This past year, our focus on the gaps in mental healthcare has sharpened, but a disciplined effort to address wait times and access to supportive hous-

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DESPITE ARTICULATIONS OF DISMAY, RIGHT NOW THERE ARE 28,000 YOUNG PEOPLE IN ONTARIO ON WAITLISTS FOR MENTAL HEALTHCARE. ing, psychotherapy, psychosis care or complex addictions has yet to be seen. I acknowledge with hopefulness the small dent in the housing arena, but encampments continue to spring up in parks and ravines. For people with complex mental illness, housing, income support and food security are healthcare rights. A solution to homelessness, a suboptimal shelter system and congregate living settings will require a substantial capital and operating investment, not to mention the political will. This sector cannot be last on a long list of competing societal needs.

I’m encouraged by the strong collaboration and problem-solving of the mental health sector, but we’re keen to extend that partnership to government to help build rational and effective investments in the mental health system. It’s hard to hear public pronouncements about the importance of mental health when the words carry no investment.

Despite articulations of dismay, right now there are 28,000 young people in Ontario on waitlists for mental healthcare. Filling the mental healthcare gaps that have been exposed by a global pandemic will take more than we’re giving right now. Mental health leaders have redoubled our advocacy efforts through a collaborative campaign, ‘Everything is not OK,’ bringing hospitals and community agencies together in a call for investment in the mental health system that matches

the burden of illness – and investment that will have real impact and measurable results. We’ve been waiting for a decade-long commitment to be fulfilled. Change comes slowly for those who live with mental disorders.

During COVID-19, the pace of change slowed further, as the healthcare system’s focus narrowed to ad-

dressing the crisis and critical care needs of patients and the workforce impacted by COVID-19. I can’t help but wonder where we would be now if there had been a parallel task force charged with delivering upstream measures to mitigate the impact of the virus on people most vulnerable to infection and poor outcomes, such as those in congregate settings and those with complex mental illness.

What if there had been an early focus to test, trace and isolate people known to be at high risk? This year has exposed longstanding inequities in our society. For example, data shows that rates of COVID-19 infection, hospitalization and death are higher in communities with greater numbers of people who identify as non-white – the same communities who have less access to vaccines.

Improvements in health equity can’t come fast enough.

There is more good news. Last summer, I wrote ‘COVID-19 has presented an opportunity to position mental health at the centre of our healthcare system – to establish the fact that mental health is health.’ Slowly but surely, this message is being absorbed.

Canada’s vaccination campaign is underway and with each injection there is a sigh of relief. I’m confident that our Year One COVID-19 learnings will not be squandered. For one, you can count on my mental health system colleagues and me to demand funding equity for mental healthH care. It’s time. ■

Dr. Catherine Zahn is the President and CEO, Centre for Addiction and Mental Health. www.hospitalnews.com

APRIL 2021 HOSPITAL NEWS 29

NEWS

Rapid fire:

How Unity Health Toronto’s lab team at St. Michael’s works 24/7 to get COVID-19 test results

WHAT HAPPENS TO A NASAL SWAB AFTER A PATIENT IS TESTED? PHOTOGRAPHER KATIE COOPER OF UNITY HEALTH TORONTO FOLLOWS THE PROCESS. To begin, samples are sorted and registered into the lab’s computer system. Attention to detail is crucial. “If there is a mismatch, it will affect the result,” explains Adineke Oguntimehin, a Lab Technician at St. Michael’s.

“For example, if a person who is positive comes out as negative, that could cause more harm to the public. So, the role of the technician is very important. I feel great to be part of that team.”

The samples are put in an incubator at 66 degrees to deactivate the virus, and then are separated into smaller vials so they can be inserted into a special machine for testing. The hard-working team of 45 staff spread their shifts over a 24 hour period to expedite test results for the public. They’re always looking for ways to be faster. Operations Lead in the Molecular Lab, Kim Chrisztopulosz, says: “Currently our test capacity is approximately 1,000 per day, but our goal is to get to 2,000 in the very near future.”

30 HOSPITAL NEWS APRIL 2021

Hundreds of nasal samples arrive daily at the lab from points around Toronto, including the assessment centres at St. Michael’s Hospital, St. Joseph’s Health Centre, long-term care homes and Toronto Public Health. It’s a massive undertaking, and since the onset of the pandemic, the lab has operated 24 hours per day, seven days a week.

Mikki Lim, Lab Technician, inserts the samples into a liquid handling instrument where the Viral RNA is removed from the virus, purified, and reagents are added.

This process takes 2.5-3 hours. “You have to be mentally prepared to work in the COVID Lab,” Lim says. “You will get many samples, and of course you will expect many that will be positive...The health of our patients come first. Doing COVID work, we feel more valued because it’s a global problem.” www.hospitalnews.com

NEWS

Supporting frail seniors

across the continuum and back to the community

By Kim Cook hroughout the pandemic, West Park’s focus on providing seniors with the opportunity to get their lives back has not wavered, and the introduction of our Frail Seniors to Home program in March 2020 has proven to be an effective strategy to offer support on the journey from acute care to the community.

The goal of the new model of care is to transition frail seniors in acute care who have been classified (or are at risk of becoming) ‘alternative level of care’ (ALC) patients to the community. This is achieved by restoring their functional abilities, improving their health and wellness and therefore prolonging their opportunity to live independently.

And it works – 89 per cent of those who have entered the program since inception have transitioned to a community setting within 40 days.

The program admits seniors who are at least 65 years old and are planning to return to the community but may be suffering from disabling function with a recent acute decline or deconditioning, often with comorbidities such as musculoskeletal, neurological or vascular conditions.

Individuals must be medically stable, have sufficient cognitive ability, and be motivated to participate in setting goals for themselves. These characteristics and attributes are crucial to the success of each individual in the program.

Once at West Park our interprofessional team will conduct a comprehensive assessment to begin dialogue with the patient and family, and start developing a person and family centred, customized care plan to ensure their success. The plan

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For the last stage of testing, the samples go into an analyser to amplify and detect any present virus using fluorescence. This pandemic has raised the profile of Medical Laboratory Technologists and Medical Lab Assistants/Technicians who often fly under the radar, says Chrisztopulosz.

“People don’t know who is behind the scenes doing your testing, and that has really been brought to light by COVID,” she says. “People are coming up to me saying thank you for your service like I’m in the military. That was unheard of before.”

Phoenix Smith, a Lab Technologist, analyzes the test results where a peak in the graph indicates that a patient is positive. The entire laboratory process from receiving the sample to finding the result typically takes 8-12 hours for members of the public, unless expedited in special cases. “The lab staff works extremely hard to keep up with the constant changes, train new staff and process the high volume of specimens to get results out in a timely fashion,” Mark Bignell, Operations Lead in Microbiology, says. “It is incredible to see what has been achieved in such a short period of time.”

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includes treatment and education components to restore function and enhance residual functional capacity to meet the goals that will allow the patient to safely return to the specified community destination.

During the patient’s stay at West Park, the strong emphasis on therapy will become obvious quickly. Most participants can expect between 30 minutes and two hours of therapy daily, tailored to their needs that will address any deficiencies in functional abilities and help improve overall health and wellness.

In order to build the confidence and knowledge to be successful at home, caregivers and patients will access support and education designed for frail seniors by knowledgeable multi-disciplinary clinicians that will include self-management skills for chronic disease management and health promotion.

When the time comes for discharge from West Park, we collaborate with our community partners to ensure a smooth transition to the community with services wrapped around the patient to support as needed.

The outcomes of the program are undeniable. The patient gains the opportunity to leave acute care; develop goals aligned with their preferred discharge destination; access care and services to support the transition; and education and support to prolonged independent living in the community.

West Park is proud to have initiated the Frail Seniors to Home program during the COVID-19 pandemic as a part of our multi-faceted Geriatric Strategy, ultimately to help H seniors remain in the community. ■

Kim Cook, RN, MSHSA is Vice President Programs & Chief Nursing Executive at West Park Healthcare Centre.

APRIL 2021 HOSPITAL NEWS 31

NEWS

A simple solution to avoid empty hand sanitizer dispensers

By Sybil Millar he COVID-19 pandemic has shone a spotlight on the importance of cleaning our hands repeatedly.

And while hand hygiene rates have improved considerably over the past year, hospitals have been presented with a new challenge as they continue using more hand sanitizer than ever: how do we make sure hand sanitizer dispensers are refilled as soon as they’re empty?

Together with his colleagues, Dr. Donald Redelmeier, a staff physician in the division of general internal medicine at Sunnybrook Health Sciences Centre, has found a simple yet effective solution to keep the dispensers functioning that was recently published in BMJ Innovations.

“We placed a label on the hand sanitizer dispensers to encourage people to report an empty dispenser. It’s a simple behavioural nudge that encourages people to do the right thing, which means picking up a phone and requesting a refill,” says Dr. Redelmeier.

The label placed on the dispensers says, ‘If empty call 4555’, which is the internal telephone number for the hospital’s Environmental Services office. On average, the office receives over a dozen such calls during an 8-hour shift from individuals reporting an empty dispenser including outpatients, families, visitors, staff, students and volunteers.

“We believe the label is a practical way for a hospital to use crowdsourcing to increase the reliability of hand hygiene,” says Dr. Redelmeier, who is also a senior scientist at the Sunnybrook Research Institute and a professor of medicine at the University of Toronto.

Improving and maintaining the reliability of hand hygiene is vitally important at Sunnybrook, which has over 800 hand sanitizer dispensers.

Busy locations may need to be refilled two to three times per day, whereas other locations might need a refill only two to three times per month.

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32 HOSPITAL NEWS APRIL 2021

After the labels were added to dispensers around the hospital, the research team sent a medical student to check 100 dispensers at Sunnybrook and found only 2 were empty. The student called, and both were refilled within the hour. In comparison, a similar check of 100 dispensers at a different hospital close to Sunnybrook found 11 empty, with no readily apparent way to contact anyone for refilling.

Dr. Redelmeier says this approach differs from past strategies to improve hand hygiene through posters or other reminders to promote behaviour.

“More exhortation may not always lead to more hand hygiene since people already have plenty of awareness,” he says.

“This nudge is designed to target sludge, defined as elements of a process that discourage people from doing the right thing. A classic non-medical

example of sludge is an awkward system hindering people from cancelling a magazine subscription they no longer need. Reducing sludge can be a distinctly effective, acceptable and lasting way to advance positive behaviour,” he adds.

“Other hospitals could immediately adopt this nudge of adding a label to hand sanitizer dispensers as a way to strengthen the connection between intentions and H actions for hand hygiene.” ■

Written by Sybil Millar, Communications Advisor at Sunnybrook Health Sciences Centre

Innovation enhances infant care in Niagara

By Steven Gallagher iagara Health’s tiniest patients are receiving enhanced care thanks to new technology in our Neonatal Intensive Care Unit (NICU).

When NICU team members at Niagara Health’s St. Catharines Site need to consult specialists on the Neonatal Intensive Care Unit at McMaster Children’s Hospital (MCH) in Hamilton, they can now connect through video.

The video connection, through the Ontario Telemedicine Network, gives Members of Niagara Health’s Neonatal Intensive Care Unit with the video the MCH team a bird’s-eye view of technology. Photo credit: Will Foran, Niagara Health the patient, their vital signs and othHealth. “This collaborative approach team is very reassuring for our physier important information. The MCH ensures we are being comprehensive cians and multi-disciplinary staff.” team can control the view, as well as and providing the best quality of care.”

The NICU partnership is another listen and speak to the team at NiagThe video technology, a mobile example of Niagara Health and Mcara Health about a baby’s condition. unit that can be used anywhere in the Master Children’s Hospital collabPreviously, these consultations NICU, may also reduce the need for orating on an innovative project to happened over the phone. Now that patients to be transferred from Niagaenhance patient care. In 2019, the the McMaster team can see the baby, ra to Hamilton for follow-up care.

Pediatric Tele-resuscitation system, a more detailed plan of care can be put “Having a sick baby is stressful the first-of-its-kind system in Ontario, into place. enough, so anytime we can provide was launched. The system uses video “The ability for the Niagara Health care closer to home is important for conferencing-like technology to aland MCH teams to work together as if our patients and their families,” says low Emergency Department teams they were in the same room is anothCarol Munro, Clinical Manager of the from Niagara Health and McMaster er significant advancement in infant NICU and Children’s Health Unit at Children’s Hospital to remotely work care in Niagara,” says Dr. Madan Roy, Niagara Health. “Being able to contogether to care for pediatric patients Deputy Chief of Pediatrics at MCH H nect through video with the MCH who are critically ill. ■ and Chief of Pediatrics at Niagara

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Steven Gallagher works in communications at Niagara Health. www.hospitalnews.com

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LONG-TERM CARE NEWS

Event to celebrate

and provide support for unpaid caregivers

By Tracey Turriff npaid caregivers, the family and friends caring for people at home, are the backbone of the health care system. They provide ongoing care for those with chronic illnesses at home, often with limited supports.

The COVID-19 pandemic has been a particularly challenging and isolating time for many caregivers, as a number of the programs and services they rely on are not available. Frontline workers at home care organizations see the hard work and the challenges of these amazing caregivers first-hand.

For over 15 years, VHA Home HealthCare (VHA) has been trying to provide a little support for unpaid caregivers by celebrating their efforts with the Heart of Home Care Awards.

“When I found out Anwara won the award, I was just so thrilled, because she really deserves it,” says Alison Byworth, VHA nurse speaking about 2020 Heart of Home Care award winner Anwara Siddique. “I don’t know how she does half of what she does.

She really puts her mom first all of the time.”

On Tuesday, April 6, 2021, National Caregiver Day in Canada, the Heart of Home Care event will once again celebrate unpaid caregivers with the announcement of this year’s award winners. This year’s event will be held virtually and will feature programming specifically designed for unpaid caregivers trying to cope during the pan-

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demic with tools to support themselves and their loved ones and to manage caregiver burnout.

The programming includes: A workshop from the Regional Geriatric Program of Toronto on the Stretch, Lift, Tap program developed for older adults living with mobility restrictions to provide practical ways to add more movement to the activities of daily life.

A mindfulness session to address burnout and help caregivers let go of the many roles they play and connect with their own inner well-being, delivered by Gillian Forsyth, yoga and iRest teacher who works with schools, hospitals, treatment centres and corporate offices to support healing and well-being.

THE WINNERS OF THIS YEAR’S HEART OF HOME CARE AWARDS IN THREE CATEGORIES WILL BE ANNOUNCED WITH SPECIAL HEARTWARMING TRIBUTE VIDEOS THAT SHARE THEIR STORIES.

THE HEART OF HOME CARE AWARDS AND THIS EVENT ARE ONE SMALL WAY WE CAN SHOW OUR SUPPORT FOR UNPAID CAREGIVERS AND RECOGNIZE THEIR INCREDIBLE RESILIENCE AND CARE. A guided presentation of the Heart in Mind activation therapy toolkit, a free guide to engaging loved ones with dementia with feelings-based activities, presented by VHA physiotherapist and Heart in Mind co-creator Brandi D’Souza.

The winners of this year’s Heart of Home Care Awards in three categories will be announced with special heartwarming tribute videos that share their stories. This year winners are being recognized in three categories: Caring and Giving Back – recognizing a caregiver who isn’t just an amazing support for their loved one, they are also sharing their knowledge of their journey to help inform and guide others who may face similar challenges; Young Caregiver – celebrating the extraordinary efforts of a friend or

family member who is under 25 years of age; and Caring with Compassion – recognizing the extraordinary efforts of a friend or family member who has gone above and beyond in providing support needed to live at home with more independence.

“The Heart of Home Care awards and this event are one small way we can show our support for unpaid caregivers and recognize their incredible resilience and care,” says Kathryn Nichol, President and CEO at VHA Home HealthCare. “Their role in our health care system is critical and we can never take it for granted.”

The Heart of Home Care event is free but registration is required. To learn more and register for the event, please visit https://www.vha.ca/news/ H national-caregiver-day-event/. ■

Tracey Turriff is the Senior Communications & PR Manager at VHA Home HealthCare.

34 HOSPITAL NEWS APRIL 2021

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LONG-TERM CARE NEWS

Seniors are not the problem – they are part of the solution

By John Muscedere and John Puxty OVID-19 has framed older Canadians as frail and vulnerable during the pandemic – for good reason. The pandemic has hit older adults particularly hard, accounting for the majority of those suffering from serious illness and death. Fear of COVID-19 contagion continues to impact seniors far more than most other Canadians, forcing them into stricter lockdown measures for their own health and safety.

What’s forgotten in the focus on keeping seniors safe is that older adults aren’t solely vulnerable and reliant but contribute greatly to our economy and to our society. Canada’s older adults should not only be seen as victims of COVID-19, but also as a resource to help society recover from it.

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CANADA’S OLDER ADULTS SHOULD NOT ONLY BE SEEN AS VICTIMS OF COVID-19, BUT ALSO AS A RESOURCE TO HELP SOCIETY RECOVER FROM IT. Canada’s older adults are living longer now than ever before. The oldest Baby Boomers are turning 75 this year and are more committed than any other generation in the past to aging well, aging in-place and keeping healthy and active as long as they can. This is shown in the statistics of seniors who are still actively working.

The employment rate of seniors in the Canadian labour force has more than doubled since 2000. In 2015, one

in five Canadians aged 65 and older, or nearly 1.1 million seniors, reported working during the year. In 2018, Stats Canada reported that 28.4 per cent of Canadians 60 and older who reported working as their major activity were self-employed.

More seniors now hold post-secondary degrees than in the past and this seems to keep them working longer.

Older Canadians with at least a bachelor’s degree were almost two times more likely to continue working after

the age of 65 than those with a high school diploma.

It’s important to note, however, that sometimes seniors are still in the workforce because they cannot afford to retire and not because they choose to continue to work. Employment income was the main source of income for 43.8 per cent of seniors who worked in 2015. Those without private pensions – which have declined over the past 30 years – are 1.5 times more likely to continue working than those seniors with private pensions.

It’s not just through employment – and the taxes they continue to pay while they work – that seniors help grow the economy. Seniors are also committed to giving back and building their communities.

Join us virtually on April 6 for the annual Heart of Home Care Awards On National Caregiver Day, VHA is hosting a special event to recognize and support the true heart and soul of home care: unpaid caregivers. We will be announcing our winners, sharing their heartwarming stories, and providing helpful workshops for caregivers and their loved ones.

Visit www.vha.ca/hohc2021 to learn more and register!

36 HOSPITAL NEWS APRIL 2021

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LONG-TERM CARE NEWS Older Canadians are committed volunteers. They provide a wealth of knowledge, experience and skills that can be of great benefit to their communities. Seniors are responsible for one in five volunteer hours given to non-profits and charities. Volunteer Canada values a volunteer hour at $27, which means seniors are providing upwards of $10.9 billion of unpaid work into our economy annually.

Seniors are not only generous with their time but also with their money.

In 2017, Canadian seniors provided 42 per cent of all donations to charities, totaling over $4 billion. This is close to half of all charitable donations in Canada.

Almost one-quarter of Canadian seniors aged 65 years and older are also caregivers. In 2018, 1.5 million of the 7.8 million Canadian caregivers were aged 65 years and older.

During the pandemic, seniors have stepped up to support communities through food bank drives, delivering groceries, driving others to ap-

pointments, making sure neighbours aren’t isolated, and volunteering for charities to support Canada’s most vulnerable, regardless of their age.

Also, some seniors, such as doctors and nurses, have come out retirement to help out.

All of this generosity and employment activity doesn’t just have

benefits for our economy and society. By keeping active and engaged through paid or charitable work, research shows seniors receive benefits to their own health and well-being.

A one-sided view of older Canadians as frail and vulnerable does not describe the vast majority of Canada’s

6.8 million seniors. They have a lifetime of experience to contribute and many are simply not done yet.

Canada needs to tap into their energy and expertise as we face some of the greatest challenges in many generations due to COVID-19 and the resulting economic damage it has H caused. ■

John Muscedere is CEO of the Canadian Frailty Network and a Professor in the School of Medicine at Queen’s University. John Puxty is the Director of the Centre for Studies in Aging and Health at Providence Care and an Associate Professor in the School of Medicine at Queen’s University.

Care after hospitalization

about where to turn, how to cope and where to get help. can be an overwhelming process. Our goal is to ensure that feel most comfortable – home.

Support is just a phone call away.

1.877.289.3997 clientservice@bayshore.ca

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APRIL 2021 HOSPITAL NEWS 37

NEWS

Project SEARCH

mobilizes community partnerships to transform systems

By Tracey Millar ith the uncertainties of the pandemic aside, Andrew Kinapen, 19, eagerly seeks a full-time job and the chance to start earning a living. Yet, with an intellectual disability, Andrew could face some barriers.

According to a 2017 Canadian survey on disability, only 59 per cent of working-age adults with disabilities are employed – compared to 80 per cent of those without disabilities. A key enabler for youth is work-based training so that they gain the skills needed for entry-level employment opportunities in today’s workforce.

Enter Project SEARCH: a global school-to-work transition program for youth with intellectual disabilities. On the premise that employment is central to well-being, Project SEARCH prepares high school students for the working world both in the classroom and through hands-on training for 10 months. The program has been immensely successful: about 75 per cent of students find gainful employment within a year of graduation.

Andrew was one of nine Toronto District School Board (TDSB) students selected to participate in the first-ever Project SEARCH program in Toronto, which launched in September 2019. Students are immersed in a host business – the Toronto hosts are Holland Bloorview Kids Rehabilitation Hospital and Toronto Rehab-UHN. In the on-site classroom, the TDSB teacher focuses on life skills such as time management and professional communication. Students engage in a series of co-op placements, supported by their teacher and by jobs and skills developers from Community Living Toronto. Over the months, they collectively build a personalized employment plan and, after graduation, Community Living Toronto provides

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follow-up support to help students secure quality jobs.

Andrew’s first co-op began at the Holland Bloorview Foundation, where he counted cash donations, updated the donor database, prepared information packages and helped with tours.

Andrew also worked with the hospital’s client registration team recording visits and collating health equity data.

“I loved working in the Foundation offices and learning about fundraising,” Andrew said. “Everyone at Holland Bloorview has been supportive and helpful as we learn new skills.”

Last summer Andrew joined the hospital’s Foundation team as the first recruit from this new talent pool.

PARTNERSHIPS BREED SUCCESS

Project SEARCH is one of the most successful school-to-work transition programs, beginning first at the prestigious Cincinnati Children’s Hospital Medical Center in 1996 and spreading to more than 600 sites around the world. It landed in Manitoba in 2011, and the program arrived in Toronto and Ontario’s Halton region in 2019 thanks to efforts by ODEN, the Ontario Disability Employment Network.

The program’s inter-organizational partnerships are key to driving meaningful outcomes. In Toronto, that collaboration includes Holland Bloorview, ODEN, Toronto Rehab-UHN, the Toronto District School Board, and Community Living Toronto – with support from the United Way Greater Toronto’s Career Navigator program.

All six partners provide leadership for Project SEARCH in the city.

The organizations work together to provide streamlined, personalized support on a skills pathway – and all during the critical, sensitive period when youth with disabilities leave the

Andrew Kinapen was one of nine Toronto District School Board (TDSB) students selected to participate in the first-ever Project SEARCH program in Toronto. education system and enter the working world. In disconnected systems young people with complex needs risk falling through the cracks.

BREAKING DOWN BARRIERS TO IMPROVE HEALTH OUTCOMES

Despite the global success of Project SEARCH, it has had slow adoption in Canada. If the pandemic is teaching organizations anything, it’s that COVID-19 is a wakeup call for accessible and inclusive workplaces. Fortunately, many organizations in Canada are now starting to understand why inclusion is a business imperative – and the timing couldn’t be better for Project SEARCH to be embraced nationwide.

And what a difference this could make. The transformative program helps young adults with intellectual disabilities live full, healthy, meaningful lives – because that is the power of employment. Though the program has only just begun in Ontario, the benefits are exceeding expectations and the partners are exploring other opportunities for program development, research, workforce planning, and much more.

Meenu Sikand, executive lead, equity, diversity and inclusion at Holland Bloorview, calls Project SEARCH “truly energizing.”

“Not only will Project SEARCH lead to great employment outcomes for our young people, but these students are also an important part of our own diverse organization,” said Sikand. “Modeling inclusive practices benefits our clients, families, staff, volunteers and other students, and the outcomes we are seeing far outpace what we could have imagined.”

Any program that seeks to mobilize community partnerships is challenging, but in the case of Project SEARCH, it is already a proven model that is ready to go. Holland Bloorview and Toronto Rehab-UHN are continuing their role as host sites for the second cohort of students that began this past September.

For hospitals and organizations interested in taking the leap to help transform wellness in this country, please reach out to contactus@projectsearchtoronto.ca to learn more H about our experience. ■

Tracey Millar is the chief people and culture officer at Holland Bloorview Kids Rehabilitation Hospital 38 HOSPITAL NEWS APRIL 2021

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CAREERS

Ventilators contributing to infection control

By Carmela Reyes educing the risk of infection has always been a key priority for hospitals, with the major focus on the importance of handwashing to decrease hospital acquired infections.

Over the past year, the COVID-19 pandemic has changed the way we connect, the way we work, and the way we live. Handwashing is still crucial in the prevention of infections in hospital settings and beyond; however, the pandemic has placed renewed focus and value on processes and devices that lower the risk of propagating the virus.

Early in the pandemic, a key focus area for provincial and federal governments was securing as many ventilators as possible to help patients whose respiratory systems required mechanically assisted ventilation, while manufacturers focused on ramping up production to meet the exponential increase in demand for ventilators of any kind.

Ventilators have always played an indispensable role in clinical settings. For example, they help patients breathe while under anesthesia and are essential in the management of conditions and injuries that adversely affect the lungs’ ability to function properly.

Acting as bellows to move air in and out of a patient’s lungs, ventilators can help patients breathe or can fully breathe for them – in many cases, keeping patients alive – with the expert programming and management of healthcare providers, such as respiratory therapists and doctors.

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HELPING PATIENTS AND HEALTHCARE PROVIDERS

While all ventilators perform the basic function of helping patients breathe, few offer the elevated level of protection from respiratory infection to the clinicians providing care, and even fewer are equipped with the expiratory filtering capabilities integrated in Medtronic’s Puritan Bennett™ 980 (PB980) ventilator system.

Just as a surgical or cloth mask does not provide the same protection as the www.hospitalnews.com

coveted N-95, infection control protocols are increasingly citing the use of respirators with N100 filtration.

“N95 masks are highly sought after for their high level of protection from respiratory transmission of COVID,” says Medtronic Ventilation Product Specialist and RRT, Richard Kauc.

“However, N99 and N100 are the highest levels of filtration efficiency – not only for masks, but also for ventilators. The PB980 incorporates N100 filtration for optimal staff protection.”

The risk of infection among healthcare providers may increase with new variants of COVID in Canada. The highest efficiency filter available in Canada, the integrated and heated N100 filter is incorporated in the PB980 system to create a barrier between healthcare providers and infectious airborne pathogens exhaled by patients.

Sunnybrook Health Sciences Centre (Sunnybrook) in Toronto uses the PB980 for its innovative integrated filter design that allows the ventilator to check the filter for defects before using it on patients. Additionally, the re-usable filter option grants the hospital self-sufficiency in case of manufacturing interruptions or delays.

Julie Nardi, Clinical Practice Leader for Adult Respiratory Therapy explains, “at Sunnybrook, our teams use the most advanced technology to provide optimal patient care while ensuring the safety of our front-line clinicians.”

The ventilator’s infection control capabilities made it a non-negotiable asset at the hospital, especially during the pandemic.

“Respiratory therapists are involved in the vast majority of aerosol-generating medical procedures across the hospital, presenting a significant exposure risk,” says Nardi. “The PB980’s superior high-efficiency expiratory filter helps to protect our RTs so they can use their highly specialized skills to care for the most critically-ill COVID-19 patients.”

The recently opened Cortellucci Vaughan Hospital – currently dedicated to providing relief for hospital capacity challenges resulting from the COVID-19 pandemic – has also exclusively equipped all of its adult critical care with PB980 ventilators.

With the threat of an impending third wave, hospitals are looking to protect their staff during the pandemic by factoring in infection protection in their procurement process.

“Our people are our most valuable resource when it comes to providing the ultimate in care to our community, especially during the pandemic,” says Erik Nordgren, Director of Equipment at Mackenzie Health, “some people can stay home to protect themselves, but hospital staff put themselves at risk every day – we want to do our best to H take care of them.” ■

A COVID-19 ward.

Carmela Reyes is the Sr. Public Relations & Communications Specialist at Medtronic Canada.

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