Hospital News March 2020

Page 1

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

Infection Control

March 2020 Edition


Are hospitals ready for

COVID-19? Page 31

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Contents March 2020 Edition


British Columbia surgical services getting upgrade


▲ Cover story: Are hospitals ready for COVID-19?


▲ Hospitals and the climate emergency


▲ First WELL® Certified Healthcare Facility

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


In brief .............................6 Evidence matters ...........30 From the CEO’s desk .....38 Long-term care ..............46

▲ SickKids’ new Patient Support Centre Cover photo credit: Kevin Van Paassen, Sunnybrook Health Sciences Centre


The return of Phage therapy


▲ Special Foc Focus: s Infection Control


How pharmacare can

offset higher drug prices post-CETA

By Joel Lexchin anada recently dodged a bullet when the House Democrats negotiated the removal of extended periods of monopoly protection for biologic drugs, such as treatments for Crohn’s disease and rheumatoid arthritis, from the U.S.-Mexico-Canada Agreement. The Parliamentary Budgetary Officer estimated that these changes, if they’d gone ahead, would have cost Canadians at least $169 million a year. While Canadians can feel good about this, we were not so lucky in the earlier Canada-EU trade deal. Within the coming decade, intellectual property concessions to Big Pharma made in that deal could start hitting Canadians in the pocketbook. Fortunately, swiftly implementing a universal, national pharmacare plan can more than make up for these projected cost increases. As a result of the Comprehensive Economic and Trade Agreement (CETA) between Canada and the European Union, brand name drug


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companies can now obtain up to two additional years of patent protection for their products in Canada. Even before CETA came into effect, new drugs had slightly over 12 years of market exclusivity, i.e., brand name companies had up to a 12-year lead before generic versions would start hitting the shelves. Now, however, that 12 years can turn into 14 under terms protected in the Canada-EU deal. How will those extra two years of brand name patent protection affect the consumer price of prescription medicines in Canada? Out of the 50 best-selling brand name drugs in 2017, 11 qualified for patent extension. From that group, nine got the full two years and the other two got between 1.5 and 1.75 years of additional protection. Collectively these drugs cost Canada $2.2 billion in 2017; assuming sales levels don’t change during the extra patent life of each drug, we can estimate that CETA’s patent term changes will add a maximum of $4.29 billion in costs. Continued on page 7

Joel Lexchin, MSc, MD, is Professor Emeritus at the School of Health Policy and Management, York University, an emergency physician with the University Health Network, and a CCPA research associate. Circulation Inquiries Director of Print Media

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Monthly Focus: Healthcare Transformation/eHealth/Mobile Health/Medical Imaging: Programs and initiatives that are transforming care and contributing to an effective, accountable and sustainable system. Innovations in electronic/digital process in healthcare, including mHealth. A look at medical imaging techniques for diagnosis, treatment and prevention of diseases.

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



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Missed and rushed care

common in Canadian nursing homes as dementia cases rise, study finds Improved work environments could improve quality of care and quality of life for residents and staff bout 80 per cent of nursing home residents in Canada live with some level of cognitive impairment, which means the care needs of this population are increasingly complex. Missed or rushed care is an on-going concern. Researchers from Translating Research in Elder Care (TREC) based at the Faculty of Nursing, University of Alberta interviewed over 4000 care aides from 93 urban nursing homes in Western Canada (BC, Alberta and Manitoba) and published their findings in a recent article in JAMA Network Open. Unregulated care aides provide the bulk of direct care (upwards of 90 per cent) to residents in nursing homes. Researchers asked care aides questions, such as: “On your last shift, did you leave mouth care for residents undone because you did not have enough time?” The study found that 57.4 per cent of care aides reported missing at least one essential care task and 65.4 per cent reported rushing at least one essential care task during their last shift. Essential care tasks include taking residents for a walk; talking with residents; performing mouth care; toileting; preparing residents for sleep; bathing; feeding; and dressing. The most common missed task was taking residents for a walk (37.2 per cent of care aides) and the most frequently rushed task was talking with residents (49.2 per cent). Performing mouth care was missed by 14.1 per cent and rushed by 39.3 per cent. Other essential care tasks were missed


by less than 10 per cent but rushed by more than 30 per cent of care aides. However, the study also found that care aides on units with more favourable work environments were less likely to miss or rush any care tasks. Factors such as better teamwork, stronger perceptions of sufficient resources to deliver quality care (some buffer in the system) and/or social capital (active connections among people to enable knowledge transfer) contribute to better work environments. This finding provides a potentially important pathway for change to reduce missed and rushed care in nursing homes. Dr. Yuting Song, postdoctoral fellow at the University of Alberta says, “We found that rates of missed and rushed essential care in Canadian nursing homes were high and were higher in units with less favourable work environments. The good news is that this means the work environment could be modified to improve nursing home care.” The study also found that care aides are predominately women (89.1

per cent), 40 years or older (68.7 per cent), and spoke English as an additional language (66.3 per cent). “They are a hard working, highly motivated and dedicated part of the care team,” says Dr. Carole Estabrooks,

Professor, University of Alberta. “We need to actively put efforts in place to improve their work environment so that we can enhance both the quality of life and quality of care at Canadian H nursing homes.” ■



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Medical assistance in dying is not driven by socioeconomic vulnerability or poor access to palliative care new study of people who received medical assistance in dying (MAiD) in Ontario found that about three-quarters were cared for by palliative care practitioners at the time of their request for MAiD, and MAiD recipients were younger, wealthier and more likely to be married than the general population at time of death. These findings dispel concerns that MAiD requests are driven by lack of access to palliative care services or by socioeconomic vulnerabilities. MAiD was legalized in Canada in June 2016, and as of October 2018, 6749 Canadians received MAiD. The federal government and the government of Quebec are currently in consultation around drafting new eligibility criteria for MAiD, after a decision of the Quebec Superior Court that one provision of the previ-


ous laws violated the Canadian Charter of Rights and Freedoms. Researchers analyzed clinical and socioeconomic data from 2241 Ontarians who received MAiD, and compared this with data from all 186 814 people in the province who died between June 2016 to October 2018, from databases kept by the Office of the Chief Coroner for Ontario and ICES. Among those who received MAiD, the median age was 75 years and half were women; almost twothirds of patients (64%) had cancer, 12 per cent of patients had neurodegenerative disease, 8.5 per cent had cardiovascular disease and 7.5 per cent had respiratory disease. Patients who received MAiD reported both physical (99.5%) and psychologic (96.4%) suffering. “[W]e found that people who chose MAiD reported physical or

psychologic suffering as the primary reason, despite engagement of palliative care in [77%] of patients, which suggests that for many patients the MAiD requests were not because of poor access to palliative care,” write the authors. Almost half of MAiD recipients were married and the majority (85%) lived in a private home before receiving MAiD. They were younger than people who did not receive MAiD and more likely to live in a higher income neighbourhood, which suggests that MAiD requests are unlikely to be driven by social or economic vulnerability, say the authors. Requests for MAiD can be emotionally difficult for patients and families, and any delays can exacerbate distress. The study found that only 6.6 per cent of families reported challenges with access to MAiD and

Ontario sets new record highs for organ donation and transplantation in 2019 I

n 2019, Ontario set new records for the most organs donated and transplanted in a single year: there were 1,386 organ transplants and 684 deceased and living organ donors, a 13 per cent increase over the previous year. Trillium Gift of Life Network achieved record-breaking results across its internationally-renowned organ and tissue donation and transplant system due to a combination of expanded protocols, innovative treatments and effective leading practices. “More Ontarians than ever before gave and received the gift of life last year thanks to the collaboration among our forward-thinking hospital partners, dedicated stakeholder groups and hard-working staff,” says

Ronnie Gavsie, CEO and President of Trillium Gift of Life Network. “These achievements inspire us to do more. We will continue to work with fervor toward a day when no Ontarian dies on the wait list due to a lack of an organ or tissue.” Higher transplant numbers are partly attributable to technological and medical advancements that allow for the transplantation of organs from donors who historically would have been excluded due to prior medical conditions – these donors accounted for 21 per cent of all organ transplants in 2019. Transplants of healthy and suitable organs from donors with hepatitis C, for example, can now safely occur, expanding the pool of potential donors and decreasing wait times for recipients on the list. There was a

41 per cent increase of donors with hepatitis C in 2019 as compared to 2018, and a 39 per cent increase in transplants from these donors. Ontario’s established leading-practices, such as routine notification, which requires hospitals and referring partners to report all potential organ and tissue donation cases to Trillium Gift of Life Network, led to a record 7,901 organ referrals and 33,585 tissue referrals in 2019. Additionally, Trillium Gift of Life Network’s trained Organ and Tissue Donation Coordinators and referring partners approached 1,341 families to discuss the option of organ and tissue donation after their loved one died and a remarkable 816 families agreed to the gift of life through orH gan donation. ■

these delays were not associated with socioeconomic status. The authors noted, however, that the MAiD data set included only people who actually received MAiD, so these findings would not reflect the experience of patients who requested MAiD but never received it. “The data presented here do not address the moral question of whether any amount of suffering can justify the hastening of death. However, the growing trend toward legalization and use of MAiD in many parts of the world should prompt the health care and research community to improve our understanding and treatment of the type of distress that leads to a MAiD request,” the authors conclude. Early experience with medical assistant in dying in Ontario, Canada: a cohort study” was early-released H February 12, 2020 ■

Real world evidence shows accelerated surgery in patients with hip fracture has substantial benefits

anadian researchers have discovered that accelerated time to surgery – within an average of six hours after a hip fracture diagnosis – resulted in a lower risk of delirium and urinary tract infections, moderate to severe pain, faster mobilization, and a shorter length of hospital stay compared to standard care – when surgery occurred an average of 24 hours after a hip fracture diagnosis. The HIP Fracture Accelerated Surgical TreaTment And Care tracK (HIP ATTACK) Trial, presented at the Orthopaedic Research Society (ORS) 2020 Annual Meeting and published in The Lancet, was led by researchers of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences (HHS) in Hamilton, Canada. HIP ATTACK


Continued on page 7 6 HOSPITAL NEWS MARCH 2020


New report a roadmap for accelerating

virtual health services in Canada he Virtual Care Task Force (VCTF), a collaboration of the Canadian Medical Association (CMA), the Royal College of Physicians and Surgeons of Canada (Royal College) and the College of Family Physicians of Canada (CFPC), released its recommendations for enabling and expanding the implementation of virtual care in Canada. The report, Virtual care: Recommendations for scaling up virtual medical services, outlines 19 recommendations for creating a pan-Canadian approach to the virtualization of health services. To inform its work over the past 11 months, the task force formed four working groups – interoperability and governance, licensure and quality of care, payment models


AS THE WORLD BECOMES MORE AND MORE TECHNOLOGICALLY DRIVEN, HEALTH CARE REMAINS ONE OF THE AREAS WHERE CANADA IS LAGGING BEHIND. and medical education – to explore the current barriers to using virtual care in Canada and to identify possible solutions. “As the world becomes more and more technologically driven, health care remains one of the areas where Canada is lagging behind. We all recognize the potential of new technologies to transform the way we deliver and receive care; it’s time we were able to take more advantage of them. We hope this report will serve as a road-

Hip fractures Continued from page 6 involved 2,970 people at 69 sites in 17 countries. Ten years ago, Dr. Devereaux – principal investigator of the HIP ATTACK trial, as well as senior scientific lead of PHRI’s perioperative and surgery program, professor of medicine at McMaster, and cardiologist with HHS – was consulted to manage a 73-yearold female with a hip fracture who also had an elevated blood test (troponin) demonstrating heart injury. The referring doctor told Dr. Devereaux the patient’s heart issue had to be treated before surgery for her hip fracture could occur. Despite the best of intentions, with the medical treatment Dr. Devereaux provided based on current practice at that time, the patient died before she was able to undergo surgery for her hip fracture. Upon reflecting on this case, Dr. Devereaux wondered if the prevailing dogma regarding the need to medically optimize patients before hip fracture surgery was the wrong approach. He contacted Dr. Mohit Bhandari,

co-principal investigator of HIP ATTACK and an orthopedic surgeon in Hamilton, to get his perspective on the case. Dr. Bhandari told Dr. Devereaux that observational studies suggested that shorter time to surgery may prevent death and major complications in patients with a hip fracture. Based on this evidence, they initiated a large randomized controlled trial to understand the effects of accelerated surgery in patients with a hip fracture. Accelerated surgery did not result in a reduction in death or a collection of major complications; however, patients randomized to accelerated surgery had a lower risk of delirium, urinary tract infection, moderate to severe pain, and were faster to stand, mobilize, and go home compared to patients randomized to standard care. Among patients who had an elevated blood test (troponin) demonstrating heart injury when they presented to the hospital with their hip fracture, accelerated surgery lowered the risk of death compared to H standard care. ■

map to scaling up virtual care in Canada, with the goal of hitting 10 million virtual care visits by 2025,” says Dr. Gigi Osler, Virtual Care Task Force Co-chair for the Canadian Medical Association. Among their key recommendations, the task force calls for: • national standards for patient health information access; • increased support to regulatory bodies to simplify physician registration and licensure processes to

allow physicians to provide virtual care across provincial and territorial boundaries; • a framework to regulate the safety and quality of virtual care services; • provincial and territorial governments, in collaboration with key associations, to develop new fee schedules for in-person and virtual care that are revenue neutral; and • the establishment and incorporation of virtual care education at medical schools and continuing education for health professionals. In addition to the CMA, the Royal College and the CFPC, the task force included representatives from the medical community, the provincial/ territorial medical associations, the medical regulatory bodies, the public H and the patient community. ■

Pharmacare Continued from page 4 Between 2013 and 2018, the first generic on the Canadian market was priced at 75 per cent of the brand name drug. When there were two generics that dropped to 50 per cent and for three generics the price was 2 5per cent of the brand name price. Since 2018, generic prices for many drugs have dropped to just 10per cent of the cost of the brand name product.

IF WE WANT TO AVOID A BLOWOUT IN DRUG SPENDING, THEN PHARMACARE IS A NECESSITY. Using these different scenarios, and assuming that in the absence of the extra patent life that all of the spending was on generic versions of these drugs, we can calculate the savings we are foregoing on the 11 drugs. If there were a single generic

competitor for each of the 11 drugs, the lost savings to Canada from the CETA patent extension would be $1.07 billion. Post-2018, with the even steeper discount in generic prices, lost savings ratchet up to $3.86 billion. The increase in spending due to longer patent life adds to the already overwhelming case for pharmacare. The prospects of undoing the terms of CETA are virtually nonexistent, so in order to keep spending on medicines under control we need to be able to get a better deal for all of the drugs that we need. National pharmacare is the mechanism for doing this because there will be a single national buyer for all of the essential medicines. A single buyer can drive a much better deal with companies than the multitude of public and private payers we currently have. If we want to avoid a blowout in drug spending, then pharmacare is a necessity. This originally H appeared on ■ MARCH 2020 HOSPITAL NEWS 7


Seeing green:

Unity Health Toronto implements various sustainability initiatives By Selma Al-Samarrai

irst the plastic straws went. Then it was Styrofoam and plastic materials such as utensils, take-out containers, soup bowls and lids, coffee cups and lids, stir sticks, and plates. Compost bins and a cooking-oil recycling project were also implemented. St. Joseph’s Health Centre’s cafeteria, named the Lakeside Café, has launched numerous initiatives to significantly reduce the amount of landfill waste produced and become a more sustainable and environmentally friendly place of service. “It was sad to see so much Styrofoam and plastic going in the garbage every day,” explained Dayalan Thevathasan, manager of Hospitality Services for St. Joseph’s.


SUSTAINABLE PRACTICES AND MITIGATING THE EFFECTS OF CLIMATE CHANGE ALL DIRECTLY RELATE TO PUBLIC AND COMMUNITY HEALTH “With the encouragement and support of the Green Committee, we decided it was time to reduce our impact on the environment. We started by eliminating plastic straws and then felt there was a lot more that we could do, so we followed with all of these recent changes.” Organic waste bins have also been added where staff, patients and visitors can now dispose of food waste and compostable materials. Prior to integrating, each of Unity Health Toronto’s three sites – which also include Providence Healthcare and St. Michael’s Hospital – had its own respective Green Committee.

The Lakeside Café at St. Joseph’s Health Centre. A new group for the network now meets every six weeks to discuss ongoing initiatives and identify new opportunities for sustainability and greening measures. The group is comprised of the network’s Project Engineering, Environmental Services and Hospitality Services teams, along with staff anaesthesiologist Dr. Syed Ali Abbass, whose ongoing work to implement sustainability measures at St. Joseph’s has earned him the additional title of Chief of Environmental Stewardship and Sustainability. “I’m very pleased that this initiative has been implemented in Lakeside Café. We all know we generate a tremendous amount of waste at a hospital and we need to be able to reduce and separate our waste properly, and subsequently, our environmental impact,” says Dr. Abbass.

Photo credit: Kevin Saychareun, Medical Media, Unity Health Toronto

“As a physician, I always tell my trainees that we have to broaden our mandate. We take care of our patients, but we also have to expand that to do right by our communities and our planet. Sustainable practices and mitigating the effects of climate change all directly relate to public and community health.” One knee surgery results in more waste than a family of four will generate in a week, according to Dr. Abbass. He emphasizes that if we compost and recycle at home, we should be doing the same at work where the impact of our sustainability practices is even larger. The Green Committee works on a large variety of initiatives that include recently implementing clinical recycling network-wide, eliminating water bottles in the network’s three cafeterias and catering services, harmonizing waste management across the three

sites, and completing a number of energy efficiency projects such as the installation of LED lighting. Thevathasan is optimistic that the newly implemented changes in the St. Joseph’s cafeteria will be part of an ongoing culture of sustainability at Unity Health Toronto. “I am hoping that this movement will spread throughout the network to different units and areas, and that it will also make all staff and visitors more conscious of sustainability in general, wherever they are. If we all change our habits even a little bit, it can make a big difference for future H generations,” says Thevathasan. ■

Selma Al-Samarrai is a Communications Advisor at Unity Health Toronto 8 HOSPITAL NEWS MARCH 2020


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Building universally-designed operating rooms allows for flexibility for a variety of surgeries.

BC’s major surgical services are getting a massive upgrade By Carrie Stefanson n about a year, Vancouver General Hospital’s Phil and Jennie Gaglardi Surgical Centre will expand for more surgeries to be performed with less wait times and cancellations. The expansion will add 16 new stateof-the-art, universal operating rooms and a 40 bed pre- and post-operative care unit. Building universally-designed operating rooms allows for flexibility for a variety of surgeries – any case, any room. This means less waiting for rooms or moving patients around when emergency cases arise, which is 50 per cent of VGH’s surgical activity. The project includes a new communication system to track patients, equipment and instruments across


two operating floors, and upgraded infrastructure including heating, ventilation, air conditioning, electrical and plumbing. Staff at Vancouver General Hospital were instrumental in the design and construction of the new surgical suite.


The expansion includes a new system to track patients via a wristband. Infrared readers in the ceiling follow patients as they move from admitting to the pre-operative area, the operating room and onto the post-operative/ recovery area. Family members can track their loved one on a monitor in the waiting room. Information is

tions, big screen monitors, and mobile devices. This constant source of upto-date information helps care teams better coordinate their work and provide the best patient care possible.

CAPTURING ANESTHETIC GAS The anesthetic gas lines. anonymized so patient confidentiality is maintained. The Perioperative Patient and Asset Tracking provides “at a glance” tracking for surgical patients and equipment, providing 1,300 staff, clinicians, and physicians with 24/7 real-time information via worksta-

The new surgical suite will also include technology to capture the anesthetic gases used to sedate patients during surgery. A 2018 study in The Lancet by VGH surgeon Dr. Andrea MacNeill found anesthetic gases have a significant effect on the environment. Other hospitals in British Columbia are looking at implementing similar technology as they build for H the future. ■

Carrie Stefanson is Public Affairs Leader at Vancouver Coastal Health. 10 HOSPITAL NEWS MARCH 2020

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Hospitals and the climate emergency By Neil Ritchie o you remember the TV medical drama ‘ER’ that ran for 15 seasons starting in the mid-90s? It was a great show and featured the remarkable skills and intelligence of hospital staff, dealing with the kinds of things that hospitals do best – compassionately handle life-threatening emergencies. Today, hospitals are faced with a different kind of emergency that is perhaps more challenging than anything that has previously come through their doors – the climate emergency; the same climate emergency that was formally declared by the Parliament of Canada in June of 2019 and by over 475 municipalities in Canada since then. While hospitals can point to a number of sustainability initiatives including energy, water and waste management that have made incremental improvements in their environmental


Neil Ritchie performance, it’s simply not enough! Climate action can’t wait. Since 2007, the United Kingdom has reduced its carbon emissions by 18.5 per cent despite a 27 per cent increase in clinical activity and has recently committed to becoming “Net Zero” ahead of the national timeline. Yet in Canada, our health care-relat-

ed emissions continue to rise. Canadian health care’s environmental footprint represents just less than five per cent of total national greenhouse gas emissions, but health care’s impact as a key influencer of business and public perception is enormous. Unfortunately, competing priorities and lack of financial and staff resourc-

es have limited health cares’ environmental progress. But that’s starting to change as climate change takes centre stage nationally and internationally. The health care industry – providers, suppliers and funders – need to step up, show more leadership and set examples for other high carbon emitters. The Canadian Coalition for Green Health Care has developed multiple tools and resources to help health care providers on their journey to climate-smart, resilient health care. Incorporating a climate-lens into what we do every day is a good place to start. Here are a few climate-smart steps that hospitals can take. They can be summarized as the “5 Ps.”


People who are willing to step up, put their shoulders to the wheel and initiate action make all the difference. Although like any major initiative,

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THE CANADIAN COALITION FOR GREEN HEALTH CARE HAS DEVELOPED MULTIPLE TOOLS AND RESOURCES TO HELP HEALTH CARE PROVIDERS ON THEIR JOURNEY TO CLIMATE-SMART, RESILIENT HEALTH CARE. an executive sponsor is essential, informal leaders play a huge part. Just look at the example of youth activist Greta Thunberg. Effective Green Teams can be formed at the corporate, departmental or work unit level - it simply takes people who want to see great things happen to get together and decide to take action. Health care professionals also need to have appropriate training to both recognize climate-related impacts in the work they do and opportunities to adapt.


Development of an overarching climate-smart policy and related departmental policies is also essential

and will no doubt evolve over time as initiatives gain momentum. Showing senior leadership support to develop a climate-smart hospital at the administrative, medical and Board levels will ensure that the hospital ‘ship’ is steered in the right direction.


A plan that builds both resilience to climate change and mitigation of its effects will ensure that everyone is on the same page and will also help promote action. Check out the Climate Change Resiliency Toolkit at -change-resiliency-toolkit/ that can be used to help build resiliency ac-

tions. The plan should have defined priorities, targets and accountabilities and ultimately be linked to the organization’s strategic plan. Don’t wait for the plan to be perfect and think you should have all possible data. Our climate is changing and your plan will have to adapt as new information emerges.


Understanding the key processes that need to change; things like procurement, transportation, food, waste and energy behavior are at the heart of any improvement activity. Quality improvement frameworks and risk management tools can be applied to

analyze processes that need to change while applying a climate-lens.


Measuring progress against established goals throughout the enterprise, comparing performance to past years as well as the performance of peers can help manage improvements. Free tools such as the Green Hospital Scorecard ( ghs/ can help you do this. Hospitals need to build resiliency to climate change and show leadership in reducing their carbon footprint. After all, emergencies are what we H do best! ■

Neil Ritchie is the Executive Director of the Canadian Coalition for Green Health Care. He can be reached at:

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The new Trauma bay at St. Michael’s Hospital. Photo credit: Katie Cooper, Medical Media

New trauma bay at St. Michael’s Hospital shows the impact of simulations on hospital design

By Selma Al-Samarrai brand new trauma bay has opened inside St. Michael’s Hospital’s Slaight Family Emergency Department (ED) after a lengthy and carefully planned testing and design process that ensured trauma patients will get the best possible care when they need it most. “No patient should ever be the first test of a new trauma care space; that’s a key principle behind the design of our new trauma bay,” explains Dr. Andrew Petrosoniak, Emergency Physician and Trauma Team Leader at St. Michael’s Hospital and Unity Health Toronto’s Clinical Integration and Translational Simulation Lead.


“We believe that we should simulate scenarios as a means to test the equipment and the space, ensuring that it works as we imagine it will. We do this so that by the time we open for patient care, we’ll know that all systems are a go.” As a Level 1 adult trauma centre, St. Michael’s cares for an average of 1,100 patients in its trauma bay per year, with the number increasing by 18 per cent between 2015 and 2019. The trauma bay is a specialized care area where patients with traumatic, life-threatening injuries are rushed to upon arriving at the ED. The Operational Readiness, led by Dominic Gascon, Operational Read-

iness Specialist, and Margaret Moy Lum-Kwong, Senior Director of Operational Readiness, and the ED and trauma teams began partnering on the design of the new trauma bay back in 2017. “Two of the key principles in operational readiness are patient safety and staff safety. It’s not ideal to build a space without understanding exactly what happens in the space, and how patients and clinicians flow through it,” explains Moy LumKwong. “So rather than looking back and seeing how we used to do it, we told the trauma team to look forward and ask: how should we do it?”

The teams used various simulation techniques to optimize the design of the space, conducting different exercises in a phased timeline so learnings from one test could be applied to the next. It started with table-top simulations 18 months before the construction of the trauma bay even began. A large group from the ED and trauma teams – including nurses, doctors, respiratory therapists, clerical staff and clinical assistants – all gathered around a massive blueprint of the new space to visualize it and test the flow of staff in the room using cotton balls to represent patients and staff. Continued on page 55

Selma Al-Samarrai is a communications advisor at Unity Health Toronto. 14 HOSPITAL NEWS MARCH 2020


New zero-emission vehicle initiative in Canada’s health sector A

new collaborative zeroemissions vehicle (ZEV) initiative that will see the Canadian Coalition for Green Health Care and Plug’n Drive advance awareness and use of lower-carbon transportation options within Canada’s health services sector. The initiative will help raise awareness of energy-efficient technologies and practices, and lower-carbon vehicles, fuels and infrastructure requirements within the sector. Team members will work with multiple stakeholder groups including senior administrative leaders, medical staff, support staff from facilities and engineering, purchasing and finance, visitors and patients as well as vendors and third-party contractors to enhance understanding and uptake of ZEV technologies. “The Coalition Team is truly excited to be a part of this initiative as we all have a strong personal interest in ZEV technology,” says Coalition Executive Director Neil Ritchie. “Together, with the expertise and talent of our project partner, Plug‘n Drive, we will be bringing new learning and exciting hands-on ZEV driving opportunities to the sector.” Collaborators will advance awareness and knowledge of ZEVs and the infrastructure required to support them, increase the understanding and capacity of the sector with regard to charging and fueling opportunities, and provide collateral and resources to enhance understanding and adoption of ZEV technology. “The biggest barrier to EV adoption is a lack of understanding about the significant environmental and economic benefits of using electricity instead of fossil fuels,” says Cara Clairman, President and CEO of Plug’n Drive. “The health care sector can play an important role in bridging this knowledge gap by engaging hospital staff and making hospital locations EV-friendly environments by offering charging and EV education.”


Visitors to the Electric Vehicle Discovery Centre get ready to take an EV test drive.

HOSPITALS, LONG-TERM CARE HOMES AND OTHER HEALTH CARE DIAGNOSTIC AND TREATMENT ORGANIZATIONS ARE ENCOURAGED TO TAKE PART IN THE INITIATIVE AND MAKE ZEV AWARENESS PART OF YOUR 2020 ENVIRONMENTAL AND CLIMATE CHANGE INITIATIVES. Industry partners include the Canadian Healthcare Engineering Society (CHES) and their Ontario Chapter, the Canadian College of Health Leaders (CCHL), DCL Healthcare Properties, Sunnybrook Health Sciences Centre and University Health Network – all of whom have offered technical, leadership and promotional expertise to the team. Hospitals, long-term care homes and other health care diagnostic and treatment organizations are encouraged to take part in the initiative and make ZEV awareness part of your

2020 environmental and climate change initiatives. In addition to sharing program updates and articles on ZEV technology in the Coalition’s free Green Digest ( and via social media platforms, hosting two ZEV webinars and the development of ZEV fact sheets, we will also be profiling a Canadian health care organization that has adopted ZEV technology and a physician leader who is walking the walk when it comes to ZEV technology. Other resources will also be made available to help facili-

tate a closing of the ZEV knowledge gap in health care. A limited number of hands-on driving experiences will also be hosted in select locations across Canada. The Canadian Coalition for Green Health Care helps health care facilities across Canada address and track their progress on environmental initiatives through our Green Hospital Scorecard benchmarking tool. According to results from the latest Green Hospital Scorecard, of 101 participating facilities, one quarter of facilities already provide charging stations and preferred parking for low emissions vehicles, while only one facility reported low emission vehicles have been incorporated into their fleet. The 2019 version of the Green Hospital Scorecard has introduced a sustainable transportation section which in future years will build off the research that results from the new ZEV project. Please do your part to further health care’s understanding of ZEV adoption and implementation by participating in this year’s Scorecard Survey. Participation deadline is March 30, 2020. Visit The Coalition Team is interested in hearing about Canadian health care organisations that have or want to implement ZEV technologies, and would like to be profiled. You are encouraged to reach out to project manager Kent Waddington at Access complete program details and ZEV knowledge tools at: The Green Hospital Scorecard covers multiple areas of environmental concern including energy and water consumption, waste generation and reduction, leadership, climate change, as well as green purchasing, food and transportation. It is available to all Canadian health care facilities at no cost. To find out more about the program and participation in this year’s data call visit H ■

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Working toward the first WELL® Certified Healthcare Facility in Canada By Mary Jane Johnson iagara Health, a regional healthcare provider in the Niagara region with multiple sites and a growing network of community-based services, is moving forward in planning for a new hospital to be located in Niagara Falls. The South Niagara hospital, targeted to open in 2026, is being planned to embody a campus environment that will foster a community of connected care, have the latest technology advancements and transform Niagara’s experience in healthcare. Niagara Health is taking a bold step in redesigning healthcare by registering the South Niagara hospital with the International WELL® Building Institute to work towards


WELL® CERTIFICATION IS SCIENTIFICALLY DEVELOPED AND AN INDEPENDENTLY VERIFIED TOOL TO HELP DESIGN BUILDINGS AND MEASURE AND MONITOR THEIR IMPACT OF THE HEALTH AND WELL-BEING OF THE OCCUPANTS. becoming WELL® v2 certified. If successful, and once the new hospital is open, the South Niagara hospital will be the first WELL® certified healthcare facility in Canada focused on the health and well-being of staff, physicians, volunteers, patients, families, caregivers and the community it serves.

WELL® Certification is scientifically developed and an independently verified tool to help design buildings and measure and monitor their impact of the health and well-being of the occupants. WELL® certification is recognized worldwide throughout the architectural and building communities. Certification aligns with LEED®

using a similar certification system of Silver, Gold and Platinum levels and based on a points system. WELL® Certification is based on ten concepts: Air, Water, Nourishment, Light, Movement, Thermal Comfort, Sound, Materials, Mind and Community. Each concept aims to improve building design, operations and the overall impact on the occupant’s specific body systems such as Cardiovascular, Digestive, Endocrine, Immune, Muscular, and Respiratory. Using a unified standard and a dynamic scorecard, the WELL digital platform will guide the project team through the development of the South Niagara hospital and will set out project-specific parameters.

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NEWS The parameters will be built too include multiple opportunities for staff, physician and community engagement. ment. Building from the ground up allows lows organizations to look at health in every very aspect. The spaces we live and work rk in everyday have a significant impactt on people. By examining the amount nt of exposure to light, air quality, thermal rmal comfort and mental health strategies, gies, the new hospitals will be able to better etter align the relationship between its sursur urounding environment and health. Niagara Health has prioritized d rreecruiting and retaining top talentt by creating a culture that is committed ed d ttoo fostering a productive, safe and comfortable work environment where staff sttaf af and physicians can learn and grow. Too w. T maintain high employee satisfaction, tio ion, n, it is important to create a healthy, lth thy, y y, vibrant environment where people ople op l can perform at their best. Working king ki n ng toward WELL® certification will pr pproovide yet another benchmark to ensure nsu sure ree Niagara Health is building a healthier thier H Niagara. ■

Future site of Niagara Health’s new South Niagara Hospital located in Niagara Falls.

Mary Jane Johnson is Project Director, rector, Communications att N Niagara iaga ia gara ga r H ra Health. e lt ea lth. h h.

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Partnership optimizes

care for diabetes patients By Morteza Zohrabi ver the past three decades, The Charles H. Best Diabetes Centre in Whitby has established a national reputation for excellence, providing care and education to a growing number of people living with type 1 diabetes. The Best Centre’s leadership, staff and volunteers approach their work helping patients of all ages stay healthy as a mission, not just as a job. Unfortunately, a couple of years ago, the community-based centre was having a difficult time keeping up with patient demand. Operational challenges began to slow program delivery. Mountains of paperwork were stacking up. Wait times for care increased. Frustrations grew among staff who wanted to help more people but couldn’t create more capacity. The Best Centre engaged the Medtronic Integrated Health Solutions (IHS) team, which was launched five years ago to help hospitals and healthcare organizations cut through complex problems that bog down efficiency, waste already strained resources and create roadblocks to patients accessing care in a timely manner. “At the time, the centre was struggling to do everything that needed to be done but had no lived experience with process improvement methodologies,” says Executive Director Lorrie Hagen, who joined the centre in 2017 shortly after Medtronic’s IHS team began its work. “Having an outside set of eyes was very important. It’s a great benefit to take advantage of that expertise, if you don’t have it in your organization or even the capacity to do the work with internal resources.” The IHS team carried out an initial baseline assessment to gauge the centre’s operations and conducted interviews with key stakeholders to highlight areas of focus. After identi-


The Charles H. Best Diabetes Centre in Whitby

“HAVING AN OUTSIDE SET OF EYES WAS VERY IMPORTANT. IT’S A GREAT BENEFIT TO TAKE ADVANTAGE OF THAT EXPERTISE, IF YOU DON’T HAVE IT IN YOUR ORGANIZATION OR EVEN THE CAPACITY TO DO THE WORK WITH INTERNAL RESOURCES.” fying areas for improvement, the team worked with members of the centre’s working group to develop a two-year work plan. Key elements of the plan aimed to: • Increase operational capacity by creating a remotely accessible “float” educator role • Improve access and quality of care by standardizing referral processes and optimizing staff workflow • Improve operational efficiency through enhanced data tracking and analysis

The changes have paid off with significant improvements, allowing the Best Centre to reach more patients and improve their overall experience. “The results have been remarkable,” says Dr. Morteza Zohrabi, lead consultant with the Medtronic IHS team. “The patient experience has improved, wait times have gone down, return times on callback to patients have decreased and the centre is able to see more patients.” Among the improvements:

• Clinical interactions with active patients have increased by 12 per cent • Wait times for initial appointments have improved by nearly 50 per cent • The time for patients to reach A1C target levels has been reduced by 65 • Variability in time to reach A1C targets was reduced by 68 per cent The IHS team and the Best Centre were particularly pleased to see such significant improvement in patients reaching A1C targets sooner since type 1 diabetes patients face fewer risks for health complications when they are able to maintain blood glucose levels within an optimal range “The patient experience and clinical outcomes as a whole improved,” says Farbod Abolhassani, a project manager with the IHS team. “Patients were receiving a good level of care previously, but they’re getting it faster now, and they’re getting it in a more standard way.” Leadership and staff at the Best Centre are encouraged by the results and pleased to have overcome some operational obstacles. “With any healthcare team, the magic comes with working together, so I’m hugely proud of the team,” Hagen says. “I think that they really adapted to making it work. They were committed and that’s something to be commended.” The centre expects the process improvements it put in place will continue to serve it well as demand for its services increases every year. The centre currently has a caseload of approximately 1,700 people living with Type 1 diabetes and is projecting a need to double its services over the coming decade. “We’re still growing at a rapid rate,” Hagen adds. “There’s always a need for process improvement, whether it’s on the clinical side or administrative side or fundraising side. It’s part of our H workplan now.” ■

Morteza Zohrabi MD is an Integrated Health Solutions Consultant, Medtronic Canada. 20 HOSPITAL NEWS MARCH 2020





Infection Prevention and Control (IPAC) By Madeleine Ashcroft


ince late December 2019, a new coronavirus has been spreading exponentially in China. The World Health Organization notes over 75,700 confirmed cases and 2,100 deaths (20 February 2020). While most are in mainland China, additional cases continue to spring up around the world. What can we do to protect ourselves, our patients/ residents/clients, and our families? COVID-19 is an enveloped virus able to be removed and killed with cleaning and low level disinfection. It is spread by large droplets deposited on another person’s mucous membranes (nose, mouth, and eyes) when the infected person coughs or sneezes in that direction, within two metres. Droplets also fall on surfaces and objects, which others may touch, transferring virus to their own mucous membranes, or to other people or items. The infected individual may cough or sneeze into his/her hands and then touch others’ hands or surfaces. Certain medical procedures such as resuscitation may cause droplets to aerosolize, breaking into microdroplets and travelling further. In infection prevention and control (IPAC), we have long-established evidence-based best practices to deal with any infectious organism. Routine prac-


Madeleine Ashcroft tices are the actions that all healthcare workers (HCWs) should undertake with every patient encounter, to assess the risk of contact with body fluids,

and to protect ourselves and prevent transmission to others. Hand hygiene is the single most effective way to prevent the spread of infections. Respira-

tory etiquette (coughing or sneezing into one’s sleeve, or covering one’s mouth and nose with a tissue which is then discarded and hands cleaned), keeping hands away from one’s face, staying home when ill, and being immunized are other key IPAC practices. Spatial separation (e.g., a separate room or area for someone with symptoms), and cleaning and disinfection of surfaces and equipment also help to prevent spread. Appropriate personal protective equipment (PPE) such as gloves, gowns, masks, and eye protection, protects HCWs when there is risk of contact with or splashes or sprays of body fluids. When we know or suspect that someone has a communicable disease, we also use additional precautions, based on the mode of transmission. This includes applying PPE before contact with the affected patient or environment, while remembering that gloves are not a substitute for hand hygiene. For COVID-19, droplet-contact precautions are recommended, with airborne precautions for aerosol-generating medical procedures. In Canada, we learned from the 2003 SARS outbreak, and developed new resources to enhance preparedness for any novel infection. While the numbers from China are definitely cause for concern, many infected people appear to have minimal symptoms. In Canada, influenza with pneumonia is among the top 10 leading causes of death with an estimated 12,200 influenza-related hospitalizations and 3,500 deaths annually. We have a vaccine for influenza, yet uptake remains suboptimal (e.g., 42% in adults in the 2018-19 season). Let’s remain vigilant as we move beyond fear, and adhere to routine practices to protect ourselves H and those for whom we care. ■

Madeleine Ashcroft RN BScN MHS CIC is a Director of Infection Prevention and Control. 22 HOSPITAL NEWS MARCH 2020



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Leveraging infrastructure

design and innovative technology to deliver quality care By Arielle Zomer hen the new Humber River Hospital (HRH) building was being planned back in 2007 at its now current Wilson site location, it began as a desire to ensure our patients and our community were able to access the kind of exceptional care they deserve – putting patient safety, quality and clin-


ical expertise at the forefront of the hospital’s innovative design. This desire to build a hospital that nurtures patient and family-centred care was pivotal in creating the infrastructure that would be relevant for years to come – recognizing that technology, care pathways, and acute care delivery continues to evolve. Construction began in 2010 and five years

Shown here is a negative pressure room at Humber River Hospital. Joan Collado, a Registered Nurse, is seen here wearing the personal protective equipment for droplet contact precaution. later, the hospital opened its doors. “The hospital was designed to maximize the benefits of digital technology, lean design and green health care principles – all with the goal to support our vision of high reliability care leading to a healthier community,� says Barbara Collins, President & CEO. “From the inception of the new building, the Hospital was envisaged with a lens to being responsive to the ever-changing needs of the community and the health care landscape.�



Recognizing that health, health care and the environment are inextricably linked, the design and construction of the HRH building at its Wilson site adhered to the guidelines and sustainability principles of the Leadership in Energy and Environmental Design (LEEDŽ) rating system since its beginning. In 2017, HRH received confirmation from the Canada Green Building Council that our building is certified as LEED gold. Achieving our targets has helped us improve air and water quality, reduce greenhouse gas emissions and contribute to the enhancement of the natural environment. Green highlights include: • 100% fresh air circulation, well above CSA-Z317 standards • 20% of materials used to construct the facility contained recycled content and 46% were sourced regionally • 96% of construction waste was diverted from landfill

• 38% of the project’s total site area includes vegetated open space • 33% water use reduction and water efficient landscaping using captured rainwater • Vegetated roof and reflective roofing materials to reduce heat island effect • Planned and commissioned building systems which demonstrate unprecedented energy efficiency targets: • Design energy use intensity (EUI) of 348 ekWh/m2 • 47% lower than the Energy Star Portfolio Manager Canada target for hospitals • HRH features almost 26,000 square feet of dynamic glass. Patients are able to control the window tint in their rooms using Integrated Bedside Terminals. This feature helps the hospital achieve its sustainability goal of 40% less energy usage.


Well-designed health care facilities are a key component in improving work patterns and preventing health care associated infections. In health care settings, hand hygiene is the single most important way to prevent infections. The use of sinks at all treatment spaces and staff zones in patient rooms, in addition to hand sanitizer stations outside each room and at the head of each bed or treatment stretcher makes handwashing compliance easy. Continued on page 26




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Design and innovative technology Continued from page 24 The facility was designed and built with 80 per cent single patient rooms, each with its own three piece patient washroom. Room sign monitors are located outside the entrance to patient rooms – these monitors are integrated with the patient chart and continuously update in digital pictures the contact precautions that are in place and the Personal Protective Equipment (PPE) that should be worn by staff and visitors. PPE is available in a purpose-built wall unit easily accessible at the room entrance. In total, HRH has 83 negative pressure rooms with ante rooms, throughout the facility in both inpatient and ambulatory procedure areas. These rooms are centrally monitored and digitally alarmed for accuracy and maintenance of proper negative pressure levels. In addition, the facility was built with a forward view to the likely presence of increased pandemics, ensuring an HVAC system that allows for the

THE DESIGN OF THE NEW HOSPITAL BUILDING CAME ON THE HEELS OF THE SARS OUTBREAK OF 2003, URGING DESIGNERS TO TAKE INTO ACCOUNT THE MANY LESSONS LEARNED FROM THAT EXPERIENCE. immediate reprogramming of a significant number of additional negative pressure spaces including: • 36 rooms in the Emergency Department’s Acute and Sub-Acute zones • 2 ER trauma rooms that are full surgical suites • A 48 bed critical care unit in pods of 12 rooms • One 32 bed inpatient respiratory unit “The hospital’s ventilation system supports entirely fresh air– there is no-recirculated air in this building,” adds Collins. “We designed the facility such that we can isolate inpatient treatment ar-

Arielle Zomer is the manager of public affairs at Humber River Hospital.

eas from the emergency department and outpatient treatment areas, while still enabling patients to be assessed and treated in designated areas,” says Collins. “Outpatient clinics have negative pressure rooms should a patient visiting the hospital need to be treated, and most treatment spaces in these areas are single rooms.” The design of the new hospital building came on the heels of the SARS (Severe Acute Respiratory Syndrome) outbreak of 2003, urging designers to take into account the many lessons learned from that experience. Through this knowledge, the designers were able

to create infrastructure that is wellequipped to help prevent against the spread of infectious diseases and handle potential future viral outbreaks. In addition to considering pandemic needs, the facility design also took into consideration Chemical, Biological, Radiological, Nuclear (CBRN) practices. If a major CBRN event occurred, the HRH ambulance garage that today accommodates up to eight vehicles, can be quickly be converted to a mass pandemic intake ready area complete with showers. Wastewater from these shower systems are kept separate from the water system that sustains the rest of the hospital. In minor contamination cases, a separate Hazmat Room accommodates a patient shower station, and assessment is available from the ambulance garage. “We built the hospital with containment in mind to provide the best resources and tools to prevent the spread of infections for patients and visitors,” H adds Collins. ■


Revolutionizing human waste management and infection control in hospitals n today’s hospital environment, the patient experience, their health outcomes and the support of their professional care-givers has never been more important. One of the key areas within the hospital and health care setting that has, and remains a challenge, is the safe and efficient method of dealing with human waste. With mounting pressure on cost reduction, demands for increased efficiency and the need for improved infection control, the process of effectively dealing with human waste can put additional stress on nursing and care staff. Within the last century, a simple, yet effective way to combat these pressures, while delivering optimum care results has been achieved through the development of environmentally friendly, moulded pulp products and maceration disposal units. The pioneer and current leader in this field is Vernacare, who first introduced moulded pulp products and maceration units to the healthcare system. Vernacare brought the new biodegradable pulp product line made from 100% recycled post-consumer newsprint to the market in 1959 to replace the traditional method of human waste disposal via plastic or metal reusable bedpans, urinals, bowls and basins.


SINGLE USE PULP PRODUCTS DRAMATICALLY REDUCE THE SPREAD OF INFECTION AND SAVE PRECIOUS NURSING TIME PREVIOUSLY SPENT ON UNPRODUCTIVE AND OFTEN UNSAFE MANUAL WASHING AND DISINFECTING OF REUSABLE BEDPANS, URINALS AND BASINS. This new product line revolutionized human waste methods by introducing single use, maceratable waste containers to the bedside. Single use pulp products dramatically reduce the spread of infection and save precious nursing time previously spent on unproductive and often unsafe manual washing and disinfecting of reusable bedpans, urinals and basins. To complement the advent of moulded pulp products and further enhance the human waste disposal system, environmentally friendly, compact and hands-free maceration units were added to complete the system. The maceration unit allows for the ultra-hygienic and efficient disposal of single use pulp products through the existing sewer system with minimal and in some cases no disruption to the existing plumbing configuration within the health care facility or hospital. Not

all maceration units can provide the assurance of minimization of particle size to ensure no dry or bulky material can pass into the pipework and causing disruptive clogs. Only Vernacare’s SmartFlow Technology can deliver this type of efficiency. Single-use containers and maceration units are now common place in hospitals around the world, thanks to the dedicated product development innovation focus of Vernacare. Other critical factors to consider and ensure successful implementation of this type of human waste disposal system are the ongoing training, support and supply chain effectiveness of your supplier. Selecting a supplier who has singular control from product manufacturing through to distribution and servicing of the products and system ensures the highest quality and reliability of this critical function. Again, Vernacare has the

only moulded pulp factory in the world that is exclusively dedicated to the manufacture of medical grade products and their comprehensive training and service support is unparalleled. Downtime in human waste management is simply unacceptable. By working with the only end to end supplier in human waste systems, health care facilities can enjoy the benefits of improved infection control, assured excellence in material quality, better use of nursing resources, and improved efficiencies all resulting in enhanced patient experiences and cost control. The industry has been well served by Vernacare in their dedication to this vision, as the originator and leader in the field of human waste systems. The healthcare and patient care sectors are experiencing rapid evolution and change. Vernacare is an organization that is a trust partner known for delivering uncompromised quality and service support. Excellence in patient outcomes and staff morale depend on the quality of care often contingent on products that facilitate wellbeing and positive, reliable results. This objective is well served and understood by Vernacare, the global leader and innovator in human waste management H systems. ■ MARCH 2020 HOSPITAL NEWS 27


The threat of emerging pathogens. Emerging infectious diseases are infections that have recently appeared within a population and can be caused by previously undetected or unknown infectious agents, or the emergence of new pathogens.1

In the news. As of February 20, 2020, there have been eight confirmed cases of COVID-19 (formerly known as 2019-nCoV) in Canada (three in Ontario and five in British Columbia). 2 The Public Health Agency of Canada (PHAC) is working with Ontario and international partners, including the World Health Organization (WHO), to actively monitor the situation. Currently PHAC has assessed the public health risk associated with COVID-19 as low for Canada. Public health risk is continually reassessed as new information becomes available. 2 On January 30, 2020 WHO declared that the outbreak now meets the criteria for a Public Health Emergency of International Concern. 3 Coronaviruses (CoV) are a family of enveloped viruses that were first discovered in the 1960s. Coronaviruses are most commonly found in animals, including camels and bats, and are not typically transmitted between animals and humans; however, six strains of coronavirus were previously known to be capable of transmission from animals to humans, the most well-known being Severe Acute Respiratory Syndrome (SARS) CoV, responsible for a large outbreak in 2003, and Middle Eastern Respiratory Syndrome (MERS) CoV, responsible for an outbreak in 2012. 4 According to Dr. Alison McGeer, infectious disease specialist at Mount Sinai Hospital, Toronto, cases being found in other countries suggests that screening systems are working, which is good news about the work underway to prevent a wider SARS-like outbreak. 5 There have also been cases of person-to-person transmission outside of China. 3

How does it spread? Coronaviruses typically spread through the air via coughing or sneezing, via contact with an infected person or contaminated surfaces, and sometimes, but rarely, via fecal contamination.6 SARS-CoV-2,7 the virus that causes COVID-19, is thought to have originally spread from animals to humans, but there is growing evidence of person-to-person transmission. This pattern of transmission was also reported with SARS CoV and MERS CoV. 8 PHAC has also issued an information sheet on COVID-19. 9,10

Protection is paramount.

Plan to protect.

WHO has declared COVID-19 as a public health emergency of international concern. 3

Under conditions of a public health emergency of international concern declared by PHAC or the WHO, Health Canada permits disinfectants to make non-label efficacy claims against the emerging viral pathogen if they have a broad-spectrum virucidal claim or for emerging viral pathogens or for which the taxonomic genus of the virus has been identified, efficacy data against other viruses within that genus may be considered acceptable (e.g., any coronavirus for a claim against the novel coronavirus, SARS-CoV-2).11

When the PHAC issues a public notice that an emerging viral pathogen poses a significant risk to Canadians or has been declared by the WHO as a public health emergency of international concern, manufacturers can communicate to the public about non-label efficacy of some currently available disinfectants against emerging pathogens, such as SARS-CoV-2.11 PHAC recommends the following infection control and prevention strategies to prevent or limit transmission of SARS-CoV-2 in healthcare facilities: prompt identification, appropriate risk assessment, management (including promotion of adherence to hand hygiene, use of personal protective equipment, etc.), placement of probable and confirmed cases, and investigation and follow-up of close contacts.12 PHAC also has additional information on prevention and risk from COVID-19 and an information line (1-833-784-4397). 2

The following Clorox® products all have a broad-spectrum virucidal claim and demonstrated effectiveness against coronaviruses. These products are expected to be effective against SARS-CoV-2 when used as directed:13 • Clorox Total 360® Disinfectant Cleaner • Clorox Healthcare® Spore Defense™ • Clorox Healthcare® Bleach Germicidal Wipes • Clorox Healthcare® Fuzion™ Cleaner Disinfectant • Clorox Healthcare® Germicidal Disinfecting Cleaner • Clorox® Germicidal Bleach

References: 1. Emerging infectious disease. Baylor College of Medicine. Accessed January 19, 2020. 2. Coronavirus disease (COVID-19): Outbreak update. Government of Canada. Accessed February 21, 2020. 3. WHO declares coronavirus outbreak an international emergency. CBC News. Accessed January 30, 2020. 4. About human coronaviruses. Centers for Disease Control and Prevention. Accessed January 31, 2020. 5. Key things to watch for in the coronavirus outbreak. CBC News. Accessed January 22, 2020. 6. Transmission. Centers for Disease Control and Prevention. about/transmission.html. Accessed February 4, 2020. 7. CDC grows SARS-CoV-2, the virus that causes COVID-19, in cell culture. Centers for Disease Control and Prevention. about/grows-virus-cell-culture.html. Accessed February 21, 2020. 8. 2019 novel coronavirus (2019-nCoV) situation summary. Centers for Disease Control and Prevention. summary.html. Accessed February 4, 2020. 9. 2019 novel coronavirus. Public Health Agency of Canada. Accessed January 30, 2020. 10. Novel coronavirus infection: Frequently asked questions (FAQ). Public Health Agency of Canada. https://www. Accessed February 4, 2020. 11. Health Canada Guidance Document: Safety and efficacy requirements for hard surface disinfectant drugs. Government of Canada. safety-efficacy-requirements-hard-surface-disinfectant-drugs.html#b5. Accessed January 27, 2020. 12. 2019 Novel coronavirus: For health professionals. Government of Canada. Accessed February 5, 2020. 13. Data on file. The Clorox Company.

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The alcohol swab before the needle:

A point of debate By Barbara Greenwood Dufour or many of us, getting a vaccine or other routine injection is not a pleasant experience. But there’s something comforting about the injection site being wiped with an alcohol swab. Other than signaling to us that it’s time to brace ourselves for the needle, it reassures us that good care is being taken to reduce the risk of infection. We know that without it we’d be inviting bacteria into the puncture wound. Or do we? Alcohol swabbing before an injection is a long-standing, widely used infection control practice. It’s thought that prepping the skin using alcohol swabs removes bacteria that could be pushed into the puncture and might cause an infection. To clean the skin before a vaccination or other injection, suggested standard practice according to the World Health Organisation (WHO) is to swab the injection site with a saturated 60 per cent to 70 per cent alcohol swab for 30 seconds, then


let the area dry for another 30 seconds so that the alcohol doesn’t enter the puncture and sting. But, for many years there has been debate around whether this practice is effective for reducing infection. Not many patients arrive for their shot with dirty skin. And various health organizations – including the WHO and the Public Health Agency of Canada – say that if the skin is visibly clean, there’s no need to swab it with alcohol. Still, alcohol swabbing remains a common and routine practice in hospitals and other health care facilities across Canada and around the world, and those in the health care community continue to wonder if there’s any evidence that it’s preventing infection. Decision-makers within the Canadian health care system recently turned to CADTH to find out. CADTH is an independent, evidence-based agency that finds, assesses, and summarizes the research on drugs, medical devices, and procedures. In response, CADTH searched for and critically appraised the available evidence on the clinical effectiveness of skin preparation prior to injections and produced a report on what was found.

When CADTH searched for published studies on this topic, it found that only one, the results of which were published in 2019, met the inclusion criteria for the review. The study was conducted in a Canadian outpatient clinic where children were receiving standard childhood vaccinations. Although all the children in this study had their arms swabbed with alcohol, half of them then received their injection in an area of skin that hadn’t been swabbed. Afterward, their parents were asked to report on whether their child experienced any skin reactions, pain, redness, swelling, or feelings of heat at the injection site. The researchers who conducted this study reported that swabbing the injection site didn’t make any difference in patient outcomes in terms of local skin reactions, pain afterward, redness, swelling, or heat sensations. When the data related to pain was analyzed further, it turned out that the children who had received their injection into swabbed skin felt the pain from the needle for a longer time than those who received injections into unswabbed skin. But, wait – what did the study say about the effect of alcohol swabbing

on the incidence of skin infection? Unfortunately, the study wasn’t able to answer this specific question. Pediatricians who later examined the children found that none of them had developed a skin infection, whether or not they were swabbed; and, even if there had been any cases of infection, the researchers hadn’t been able to recruit enough children for the study to come to a meaningful conclusion on whether swabbing prevents infection. Although the swabs themselves are inexpensive, the cost of using them is not insignificant when you consider how many of them are used during public vaccination programs. So, if the practice isn’t effective, it could be a waste of money. But, given that we’re not sure, maybe it represents a bit of precaution that’s worth the peace of mind. Until further research can inject some certainty about its effectiveness, some will continue to wonder if we should still be swabbing prior to routine injections and vaccinations. Most are probably just thinking about the needle. To view CADTH’s full report, go to If you would like to learn more about CADTH, visit, follow us on Twitter @CADTH_ACMTS, or speak to our Liaison Officer in your H region: ■ Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH.


INFECTION CONTROL 2020 Sunnybrook researchers like Lily Yip are among the many scientists worldwide working towards better understanding the virus, how it evolves, and what we can do to combat it.

Photo credit: Kevin Van Paassen/Sunnybrook Health Sciences Centre

Are hospitals ready for


The past, present and future of hospital preparedness for high-consequence pathogens By Dr. Jerome Leis he discovery of the novel coronavirus COVID-19 has reopened the wounds of severe acute respiratory syndrome (SARS) – the outbreak of 2003 that resulted in a reported 8,098


cases and 774 deaths in 26 countries. In Canada, and particularly Toronto, many cases of human-to-human transmission occurred in hospitals and circulated heavily among frontline health-care workers.

With the introduction of now another novel coronavirus, the memories of yesteryear have triggered fear that not only lurks within our communities, but also within our hospitals – and understandably so.

But if there is one good thing that has come out of the epidemics of the past it is that Canadian hospitals are more prepared than ever. We have come a long way in the 17 years since SARS hit. Continued on page 32 MARCH 2020 HOSPITAL NEWS 31


COVID-19? Continued from page 31 Take, for example, the discovery and identification of COVID-19. On December 31, 2019, Canadian hospitals were alerted to a new virus that was clustering in Wuhan, China. The alert gave hospitals the opportunity to flag the virus as a potential high-consequence pathogen and prepare for any imported cases, particularly if they presented to our emergency departments. Within the next 10 days, scientists in China had decoded the genome of the virus and shared the genetic blueprint online. The timely release gave laboratories around the world a head start in understanding the virus and developing diagnostic testing. This global co-operation in the identification of the infection occurred in fewer than two weeks – a process that took five months with SARS, according to timelines released by the U.S. Centres for Disease Control and Prevention (CDC).

So, on January 23, 2020 when an adult male presented to the emergency department at Sunnybrook Health Sciences Centre in Toronto with fever, respiratory symptoms, and a recent travel history to Wuhan, China, the health-care team immediately isolated the patient and took the necessary precautions to ensure the safety of all patients and staff. Diagnostic testing was conducted and specimens were sent to the Public Health Lab in Ontario which then confirmed the diagnosis two days later. Our preparedness for this patient began well before COVID-19 – with lessons applied from our prior experience with SARS and other epidemics since. Like other acute care hospitals across the country, Sunnybrook has adapted to a world where any person with a novel or high-consequence pathogen can end up on the doorstep



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COVID-19 NUMBERS as of February 26, 2020

Coronavirus Cases:

81,288 Deaths:

2,770 Recovered:

30,358 Canada:


Source: of our Emergency Department. We always keep an updated list of countries of concern for screening patients in triage. We have dedicated isolation space in the emergency department for patients that screen positive so we can minimize exposure to others waiting. And, we use personal protective equipment that is familiar to our health-care workers when we assess those who need our care. Furthermore, new clinical protocols help reduce the risk of transmission from treatment, particularly those that cause aerosol generation – a process that suspends infected droplets in the air, potentially infecting others nearby. But the advances we have seen within our hospitals have not only been clinical. During an epidemic, hospitals have a responsibility to not only care and protect their patients and staff, but also be a transparent and expert source of information and instruction both internally and to the broader community. The age of social media has brought greater transparency to situations like COVID-19, but also enabled misleading information that can create more anxiety than necessary. This is likely the biggest challenge facing hospitals and public health agencies today: providing people with real-time updates that inform the ac-

tual level of risk to their wellbeing and what they should be doing to protect themselves and those around them. Collaboration between the infection control and hospital communications teams is crucial for ensuring that health-care workers are well equipped with the knowledge they need to care for patients with COVID-19 – whether through e-mails, intranets, or town halls. The same collaboration requirements are true for ensuring responsible communication with the public. COVID-19 is an emerging pathogen and how far it will reach remains to be seen. Our hospitals need to remain nimble in our response based on the level of risk that is constantly changing. Imported cases of COVID-19 can be identified and contained, but we will face even greater challenges if this virus begins to transmit locally within Canada as part of a pandemic. Preparedness for this more complex scenario is already underway and will require a co-ordinated response across all health-care sectors. But what we do know is this: In the years since SARS, we have become faster at identifying novel infections, better at protecting our patients and staff, and pro-active at communicating the risks. By the time COVID-19 is behind us H we will have learned from it, too. ■

Dr. Jerome Leis is the Medical Director for Infection Prevention and Control at Sunnybrook Health Sciences Centre.

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The return of phage therapy to combat the global superbug crisis By Steffanie Strathdee never imagined that bacteria I used to streak on my petri plates back in the 1980’s at the University of Toronto would evolve to become ‘superbugs’ that have become increasingly resistant to antibiotics. As an infectious disease epidemiologist and a professor with academic appointments in both the US and Canada, I am ashamed to say that I was blindsided by the gravity of the global antimicrobial resistance (AMR) crisis until November 2015, when a family illness made this issue very personal. During a holiday to Egypt, my husband Tom suffered a gallstone attack and a superbug moved into the giant abscess that had formed inside his abdomen. It wasn’t a garden variety bacterium, but Acinetobacter baumannii, the World Health Organization’s #1 most dangerous superbug. Since I’d last met A.baumannii as an undergraduate in my virology class, it had evolved into a bacterial kleptomaniac that collected a treasure trove of antibiotic-resistance genes from other bacteria. By the time Tom was medevacked back to our home in San Diego, his bacterial isolate had become resistant to all antibiotics, even colistin and meropenem. Despite receiving top medical care, my husband was dying. When I realized that Tom was about to become one of the estimated 1.5 million people who die from superbug infections every year I took matters into my own hands. Although I was not an MD, I knew how to conduct a literature review. I turned to PubMed, a publicly available database made available by the National Library of Medicine. Buried in the scientific literature was something that rang a bell from my U of T days: phage therapy. Bacteriophages (phages for short) are the natural predators of bacteria. They were discovered in 1917 by Felix d’Herelle, a self-taught French-Canadian microbiologist. After dosing himself, his family and staff with a purified suspension of bacteriophages with no



Steffanie Strathdee and Thomas Patterson. ill effects, d’Herelle used phages to treat a boy suffering from dysentery during an outbreak in Paris in 1919; the child was miraculously cured within 24 hours and subsequently, so were many others. Phage therapy had a heyday in the 1920’s and 30’s, especially in the former Soviet Union, where d’Herelle helped a bacteriologist named Giorgi Eliava launch the first phage therapy centre in what is now Tbilisi, Georgia. Meanwhile, in the West, phage therapy came under fire after several attempts at commercialization because some companies over-promised and under-delivered. No one knew at the time that phages needed to be matched to the specific bacteria they infected, and if they aren’t kept refrigerated they can be rendered useless. After penicillin was introduced in 1942, phage therapy was largely forgotten in the West. Since d’Herelle was considered an egotist with a tendency to infuriate his peers and anything resembling Russian was shunned during WWII, phage therapy was essentially

abandoned for decades outside of the Republic of Georgia and Poland. Antibiotics were one of the most important medical advances of the 20th Century but their use and mis-use, especially in livestock, meant that by the turn of the century, AMR was spreading faster than anyone imagined. In November 2015, the same month Tom fell ill, the mcr-1 gene that confers resistance to colistin, considered an antibiotic of last resort, was discovered in China, where it had been routinely given to pigs as a growth promotor. By the time the report was published in The Lancet, mcr-1 had spread to 30 countries. Tom’s bacterial isolate had it, along with 50 other AMR genes. When I proposed treating Tom with phage therapy in early 2016, most of his physicians had never heard of it and almost all were skeptical. It was considered experimental by the Food and Drug Administration. But faced with a dying man who had no antibiotic options left, I am grateful that they were willing to give it a chance, provided I could

find phages that matched his bacterial isolate. With the help of PubMed, I managed to find phage researchers – a global village of total strangers – from the US, Belgium, Switzerland, India and even the US Navy Medical Research Center – who offered to undergo a phage hunt to see if they could find some to match Tom’s bacterial strain. Phage researchers from Texas A&M University (TAMU) turned their lab into the command centre. They tested not only characterized phages from established libraries but environmental samples from sewage, the ship bilges, barnyard waste and garbage dumps, since phage are best sourced from locations where there are vast quantities of bacteria. Within three weeks, TAMU and the Navy team had each prepared a phage cocktail active against Tom’s bacterial strain that was purified to remove as much endotoxin as possible, enabling us to administer the phages intravenously. This was a highly risky move, since no one knew if the endotoxin level was low enough to avoid

INFECTION CONTROL 2020 septic shock. After obtaining emergency approval from the FDA, we injected a billion phages per dose into Tom’s bloodstream every two hours. Three days later, he woke from a deep coma and began his long recovery. Our experience prompted us to write our book, The Perfect Predator, to raise global awareness of AMR and phage therapy. Right after Tom’s case was presented at the Pasteur Institute’s 100th Anniversary of the discovery of bacteriophages in Paris in April, 2017 and again following publication of his case report, his doctors and I began receiving requests from all over the world from family members asking for phage therapy to save their loved ones from superbug infections. We were able to help some. Others sought treatment from Georgia, Poland or a new phage therapy center in Belgium. Some died before phages could reach them. In response to the growing number of

BEYOND MOVING PHAGE THERAPY INTO CLINICAL TRIALS, WE ARE ALSO FUNDRAISING TO DEVELOP A PHAGE LIBRARY TO ALLOW US TO MORE QUICKLY MATCH PHAGE TO CLINICAL ISOLATES. requests, my colleagues and I founded the non-profit Center for Innovative Phage Applications and Therapeutics (IPATH) at UC San Diego (UCSD) in 2018. In 2019, the US National Institute of Health funded its first phage therapy trial in conjunction with the Antibiotic Resistance Leadership Group, and we will enroll our first patients in San Diego in 2020. Beyond moving phage therapy into clinical trials, we are also fundraising to develop a phage library to allow us to more quickly match phage to clinical isolates. In the meantime, we continue to assist with emergency requests for

patients with superbug infections that are no longer responding to antibiotics. To date, IPATH has treated nine patients at UCSD, and dozens others in the US and internationally. We receive frequent requests from Canada and are working with a number of Canadian infectious disease physicians to develop protocols so that Health Canada can consider approval of compassionate use cases. The pharmaceutical industry has been circumspect about phage therapy until relatively recently. However, the first successful use of genetically modified phage to treat a case of dissem-

inated Mycobacterium abscessus in a teenager with cystic fibrosis in the UK has piqued their interest, since genetically altered phage are easier to patent. Further, since phage-antibiotic combinations can be synergistic, phage can also be used indirectly to re-sensitize bacteria to antibiotics they were resistant to. More research is needed to enable clinicians to rapidly identify and exploit these relationships. Looking ahead, the advent of synthetic phage cocktails is likely to expand treatment options even further. While it is unlikely that phage therapy will ever replace antibiotics, it is a promising alternative and/or adjunct therapy that deserves to be rigorously evaluated in clinical trials. Given that the global AMR crisis is worsening and is considered to be a more immediate threat to human health than climate change, we cannot afford to allow a promising alternative to be forgotten H for another hundred years. ■

Steffanie Strathdee, PhD is the Associate Dean of Global Health Sciences, Harold Simon Professor, University of California San Diego Department of Medicine Co-Director, Center for Innovative Phage Applications and Therapeutics and author of The Perfect Predator: A Scientist’s Race to Save her Husband from a Deadly Superbug. For more information visit:

NEWS Joaquin Esperanza.


a parking lot

attendant By James Scarfone ho are the mystery people in the orange vests in the underground garage at McMaster University Medical Centre (MUMC)? No, they are not here to upsell you on prime parking spaces at our hospitals. They are, in many ways, the first part of the patient and family experience. And they’re here to help. Joaquin Esperanza has been with Hamilton Health Sciences (HHS) for one year. His goal at work is to bring smiles to visitors’ faces. “We know coming to the hospital is probably not the best part of their day,” Joaquin says. “What we want to do is make the experience easier by helping them get through a stressful situation like parking their car in a strange, new place.”



Joaquin had to get used to a new way of life when he fled the Salvador-


an Civil War in the early 1980s. He was only 15 at the time. After landing in Los Angeles, he met his wife and had a baby girl. But they knew they couldn’t live there long-term. Though U.S. immigration laws allowed people into the country who escaped the war in El Salvador, Joaquin didn’t qualify because he crossed the border after a certain date. Only his daughter, Nora, who was born there, was a legal citizen. Living with the fear of being sent back to a war-torn country with a young family, they made their way to Canada via Buffalo to claim refugee status. His love for baseball after following the Los Angeles Dodgers was the reason he wanted to live here.

“I learned Canada had two teams, one in Toronto and one in Montreal. I couldn’t speak French so I chose Toronto,” he says. Once he got to Buffalo, though, he needed to persuade three judges to let him and his family stay in Canada because they were afraid to return to El Salvador. He still has the paper the government gave him that prevented the chance of being deported while he waited for his hearing in the U.S. After the hearing, the judges allowed Joaquin and his family to stay in Canada and eventually become citizens. His dream came true. He now has three daughters, two of whom are nurses in nearby London and another who works at Humber College. They

are also regulars at their church, which helped them get settled in the community when they first arrived. “Working at HHS has given me more time to spend with family,” he says. On top of that, he can make a person’s day by helping them park their car during a stressful time. Parking lot attendants at MUMC take care of a garage that can fit over 1,000 cars a day. Visitors come down the ramp and can park themselves, but on a busy day, spaces may be limited. During those times, drivers can hand an attendant their keys, who take care of the rest while they rush to make an appointment or visit a loved one. “I once had someone call me an angel and another who said ‘God bless you guys’,” he recalls proudly. “When people tell us we’re doing a good job, it makes me feel great.” Many car owners are quite protective of their cars, particularly large trucks. Joaquin and his colleagues do a great job moving cars to where they need to go. His favourite car he’s driven? “A H Tesla. It’s beautiful!” ■

James Scarfone works in communications at Hamilton Health Sciences Centre. 36 HOSPITAL NEWS MARCH 2020


Putting evidence into practice

to elevate patient care By Michael Oreskovich ollaboration among healthcare providers is key for spreading best practices and elevating the quality of patient care. Runnymede Healthcare Centre is joining a global network of healthcare providers that’s known for outstanding care and exceptional patient outcomes through a new partnership with the Registered Nurses Association of Ontario (RNAO). The RNAO is a professional association representing registered nurses, nurse practitioners and nursing students in Ontario. For nearly a century it’s promoted clinical excellence and has been an influential advocate for quality improvement in healthcare. One of their hallmark accomplishments is the Best Practice Guidelines (BPG) program. Launched in 1999 with support from the Government of Ontario, the program develops standards for best practices that are informed by the most current scientific research.


tinue to reflect the most up-to-date evidence to promote the very best patient outcomes. The Best Practice Spotlight Organization (BPSO) initiative was created by the RNAO to provide support for healthcare organizations that are implementing the guidelines. Runnymede is currently working with the RNAO to integrate multiple guidelines into its policies and procedures. After successfully sustaining the new evidence-based practices for three years, the hospital will receive the BPSO designation. Recognized worldwide, it’s a distinction that will reinforce Runnymede’s reputation for clinical excellence and patient-centred care. “Quality improvement is woven throughout Runnymede’s culture from the top-down and bottom-up and participation in the BPSO program demonstrates our hospital’s capacity to build on our strengths and raise the bar for patient care and safety,” said Run-

EVERY FIVE YEARS THE GUIDELINES UNDERGO A THOROUGH REVIEW TO ENSURE THAT THEY CONTINUE TO REFLECT THE MOST UP-TODATE EVIDENCE TO PROMOTE THE VERY BEST PATIENT OUTCOMES. BPGs are developed through a collaborative process that involves consultation and feedback from a diverse group of healthcare leaders, patients and the public. Every five years the guidelines undergo a thorough review to ensure that they con-

nymede’s Executive Vice President, Clinical, Chief Operating Officer and Chief Nursing Executive, Raj Sewda. Runnymede has chosen to implement best practices related to person- and family-centred care, care transitions, falls prevention and injury

Through partnership with the Registered Nurses Association of Ontario (RNAO), Runnymede Healthcare Centre is joining a network of healthcare providers known for outstanding care and exceptional patient outcomes. reduction and pressure injury assessment and management. Staff champions have been identified to support the rigorous implementation process and they will be provided with continuous mentorship and education throughout the process. “Empowering staff on the front lines is essential as it provides them with an opportunity to own the process and ensure that these practices are sustained in the long-term,” says Runnymede’s Director of Flow, Quality Pharmacy and Privacy, Catherine Fitzpatrick. Runnymede is wasting no time in moving forward and the person- and

family-centred care guideline will be rolled-out hospital-wide in early 2020. Enhancing person- and family-centred care is at the heart of a new model of care delivery being introduced by the Government of Ontario. Runnymede and its partners in the newly formed North Western Toronto Ontario Health Team (NWT OHT) are the first to sign up to undergo the BPSO process as a team. Together with its NWT OHT partners, Runnymede is positioned to leverage this process to create a more patient-centred healthcare system that aligns with the govH ernment’s vision. ■

Michael Oreskovich is a communications specialist at Runnymede Healthcare Centre.



Excellent patient care meets environmental stewardship By Anne-Marie Malek s noted in The Lancet Countdown on Health and Climate Change’s annual report (2019), Canada’s health care sector produces the third-highest per capita greenhouse gas emissions in the world, with 900 kilograms per capita of C02. As President and CEO of West Park, I feel responsible to ensure our facility leads by example in fostering sustainable health care by not only reducing greenhouse gas emissions, but on several factors that contribute to climate change. We have demonstrated our commitment for decades and as we build our new campus of care we are doing so with the environment in mind. West Park is a proud founding member of Greening Health Care and has continued its active participation since 2004. The Centre’s leadership team compares its energy and water usage to similar facilities on an ongoing basis, and is committed to reaching for the top of the benchmark charts in environmental sustainability while constantly learning from and sharing with other hospitals. This work has resulted in very positive outcomes and we take pride in having decreased electricity usage by 18.5 per cent between 2005 and 2018; reduced overall gas usage by 16.6 per cent between 2009 and 2018; and lowered our greenhouse gas emissions by 67 tonnes C02e between 2013 and 2018. The strong commitment at every level of leadership and the board of directors as well as a culture of environmental stewardship has resulted in these outcomes. With the engagement of staff in our Environmental Committee, we anticipate this trend will continue. West Park is not only making sustainable strides on campus, but in the community as well. In an effort to help advance the dialogue on climate change and sustainable health systems, I am honored to be a member of


the Stewardship Group for the recently established Centre for Sustainable Health Systems in the Institute for Health Policy, Management and Evaluation at the University of Toronto. For over a year, West Park has been preparing its grounds for the construction of a new rehabilitative hospital and the creation of a campus of care that will completely transform West Park Healthcare Centre. The facility, originally opened as a sanatorium for tuberculosis patients in 1904, has traditionally looked and felt much more like a park than a hospital. This longstanding appreciation for the natural environment reflects our belief in the connection between nature and heal-

ing and provides a blueprint for the new campus. West Park’s campus spans 27 acres in the Mount Dennis community of Toronto. As mentioned in David Nickle’s 2019 Toronto Star article, Planners envision an eco-friendly future for Toronto’s Mount Dennis Area, this is an area of the city that has a collective desire to lead eco-friendly development. As one of the area’s largest employers, we have always felt a responsibility to demonstrate environmental stewardship when planning our new campus development. Alongside our goal of providing exemplary care, and in partnership with EllisDon, we aspire to the high-

est standards of energy and environmental performance. We plan to do this through the incorporation of heat recovery chillers, high efficiency lighting and controls, oversized air heating units, operable windows, and automated roller shades. We intend on following the ongoing performance of the top-performing P3 hospitals to incorporate lessons learned and continuously update and implement operational best practices from the outset and sustain that high level of commitment going forward. The results we have achieved in the last several years as well as our commitment to continuous improvement helped earn West Park the 2018 Green Hospital of the Year Award (nonacute) from the Coalition for Green Health Care. The Coalition cited our 21.1 per cent year-over-year decrease in waste generation, 4.1 per cent yearover-year decrease in water usage and a third consecutive year of below average energy use intensity as contributing to our selection for the award. West Park was also recognized for its progress in all six policy and planning areas; environmentally preferable purchasing, toxins management, sustainable construction/renovation, energy, waste, and water. It is our strong belief that while our health system’s primary focus should always be on working together to ensure the best health outcomes for our patients, we should also be dedicating time, resources, and leadership to reducing our carbon footprint. Given the urgency of the climate crisis, it is every organization’s responsibility to take a look at the impact that we are having on the environment and human health. For West Park’s part, we will continue to learn from other facilities implementing new and exciting technology, programs, and systems, while sharing the work we are doing to proH mote environmental sustainability. ■

Anne-Marie Malek is President and CEO, West Park Healthcare Centre. 38 HOSPITAL NEWS MARCH 2020

15th Annual Hospital News!



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






The greening of a By Donna Harris ver the years, studies have shown an undeniable link between the environment and human health. That understanding was a critical factor in William Osler Health System’s (Osler) decision-making when designing the Peel Memorial Centre for Integrated Health and Wellness in Brampton. Today, the outpatient facility, which opened in 2016, is among the most energy efficient and sustainable health care facilities in Canada. “From concept to completion our goal was to minimize our carbon footprint and contribute to the health and wellness of our workforce and community,” says John Marshman, Executive Director of Facilities Operations, William Osler Health System. “We’ve been highly successful, thanks to the early discussions we had with our partners during the planning and design phases, and our own relentless focus on sustainability.” Peel Memorial’s approach to health care is indicative of a growing shift in thinking from sickness to health, wellness and prevention of illness and chronic disease. Its outpatient health care services prioritize the unique needs of seniors, women and children, and people living with mental health issues and chronic conditions, and empower them to take a proactive role in managing their own health. With that as its mandate, Osler was adamant that the building reflect its comprehensive commitment to wellness and make the most efficient use of natural resources. Today, at the heart of that commitment are highly efficient systems to manage heating and cooling, lighting, water use and air flow and a highly-skilled facilities team.




Peel Memorial’s large double-glazed windows allow the sun’s natural light to filter into high traffic areas and automated sun shades raise and lower during daylight hours to minimize heat gain.


Peel Memorial added 600,000 square feet to Osler’s physical footprint (which includes Brampton Civic Hospital and Etobicoke General Hospital) while reducing its energy intensity by an impressive 30 per cent. “We integrated sustainable design principles into all facets of the building’s infrastructure including HVAC systems, domestic water systems, lighting,

the building envelope and materials,” says Marshman. “Our goal from the outset was to be significantly more efficient than the international standard.” The prime focus of its energy efficient operations is Peel Memorial’s central plant, which has been instrumental in supporting Osler to reduce both energy consumption and the facility’s carbon footprint. It features three heat recovery chillers and a geothermal field that taps into the natural heating and cooling properties of the earth via 100 wells that reach about

600 feet below the building. Any heat rejected by the building throughout the summer is stored in the ground through a geo-thermal loop and used to heat the facility in the winter. More traditional condensing boilers are only used on excessively cold days. Domestic hot water for the building is generated by the heat recovery chillers that draw heat from the building, and then from the geothermal field. The primary source of cooling for the facility is drawn from the free chilled water in the heat recovery chillers, with the

NEWS remainder sourced from high efficiency magnetic bearing chillers. “Another key success factor in our energy efficiency efforts has been our air handling systems which use energy recovery ventilation (ERV) and are oversized to minimize air velocity and fan energy,” says Marshman. Peel Memorial also uses a dedicated outdoor air system with zone level control and CO2 sensors that only ventilate rooms when they are occupied. With a focus on reducing costs and conserving energy, the facility has been fitted throughout with energy-efficient LED light fixtures, using occupancy sensors to ensure rooms are only lit when being used. Double-glazed windows allow the sun’s natural light to filter into high traffic areas like the lobby and hallway corridors, while automated sun shades raise and lower during daylight hours, to minimize heat gain. Among the facility’s great successes has been in its ability to minimize water consumption. Peel Memorial features

“FROM CONCEPT TO COMPLETION OUR GOAL WAS TO MINIMIZE OUR CARBON FOOTPRINT AND CONTRIBUTE TO THE HEALTH AND WELLNESS OF OUR WORKFORCE AND COMMUNITY.” energy-efficient low-flow plumbing fixtures that reduce water consumption by as much as 41 per cent. Osler has also been able to reduce water usage for landscape care and maintenance by 50 percent through using drought-tolerant and native species plants in its outdoor spaces, including the open air courtyards located within the building. An integrated energy metering system helps Marshman’s team manage the building’s performance. “A lot of thought went into planning the systems that would support an energy efficient and sustainable outpatient facility,” says Marshman. “But, education is also key, both for our operators to ensure these complex

systems operate in an energy efficient manner, and for our staff, physicians, volunteers, visitors and patients to ensure they are conscious of efficiency and sustainability as they utilize the facility in an energy efficient manner.”


Osler has created a facility that contributes to community and workplace wellness, not only through the services Peel Memorial provides, but also through its efforts to minimize its carbon footprint on the environment. Evidence of this can be seen from the expansive outdoor green spaces, walk-

ways and cycling paths that connect the facility with the surrounding community to the warm and welcoming physical spaces within the building. Peel Memorial was awarded LEED Gold certification by the Canada Green Building Council reflecting its status as a high performing ‘green’ building. It’s anticipated that any further development of the surrounding community will be positively influenced by Peel Memorial’s focus on sustainability. Peel Memorial was also recently awarded the 2020 American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Technology Award for Healthcare Facilities worldwide. “We’re proud of our efforts to date to positively impact the health and well-being of the community through sustainable practices and respect for the environment,” says Marshman. “And we will continue to progressively advance those efforts at all Osler facilH ities in the coming years.” ■

Donna Harris is Manager, Public Relations and Digital Media at William Osler Health System.



Creating an AI-powered solution to address scheduling challenges By Jennifer Stranges t was less than a year ago that Ray Howald, the clinical leader manager of the Emergency Department (ED) at St. Michael’s Hospital in Toronto, thought out loud, “Would it be possible to create a system that does this for us?” The “this” was the daily assignment of nurses in the ED and mitigating the frustration that came with it. It’s a frustration shared by health care teams in EDs across the country – team leaders were spending an hour and a half each day assigning nurses and administrators spent four hours manually recording the information. Meanwhile, the duplication rate of assignments was high, at about 20 per cent. Aside from being time-consuming, Howald had concerns that his staff were not receiving a variety of assignments in their shifts. His goal was to ensure that nurses had exposure to working in different zones, with different colleagues, and that there was objectivity in their assignments. And so Howald’s simple question led to a journey of collaboration and an AI-powered solution that addresses scheduling and assignment challenges. Howald, along with two ED nurses who championed the project, worked closely with Dr. Muhammad Mamdani, director of the Li Ka Shing Centre for Healthcare Analytics Research & Training (LKS-CHART), and his team to develop a system that automates the assignments for nurses. “We needed the system to take into account multiple considerations,” says Howald. “It had to remember previous assignments so that nurses weren’t duplicating the zones they worked in; we needed a mix of experience and skillset so that each zone has the appropriate pairing of senior and junior nurses; and we needed the flexibility to make manual entries in the event there was a change in the schedule like someone calling in sick.”


Ray Howald, clinical leader manager of the Emergency Department (ED) at St. Michael’s Hospital in Toronto, with ED Administrator Pamela Lovell and ED Registered Nurse Kerri Lynn Penney. Photo credit: Yuri Markarov, Unity Health Toronto Over the course of eight months and multiple iterations, Dr. Mamdani and the LKS-CHART team worked with Howald and ED nursing staff to develop and design a system that met their requirements and was user-friendly. The system was tested by “super-users” in the ED, so it could be evaluated and tweaked. It was initially designed to remember the previous three days of assignments, which created a blind spot in the scheduling of part-time staff who worked less frequently. The LKS-CHART team adjusted the algorithm to remember the past 10 days of shifts, creating more accuracy in the assignments and fewer duplications. The end product is one that Dr. Mamdani says has radically changed the RN ED assignments. “What previously consumed four hours of admin staffs’ day, now takes 15 minutes,” he says. “The assigning that took team leaders an hour and a half is now generated by the system in 15 to 20 seconds. And the duplication

rate has decreased from 20 per cent to about five per cent. “This has been an exciting optimization problem, and it’s exciting from an engineering perspective. The magic of it all is that it’s helping people do their jobs more efficiently and effectively,” says Dr. Mamdani. He notes that a meaningful benefit of the system – affectionately dubbed “The Robot” by ED staff – is that it’s created opportunities for better patient care. Dr. Mamdani and his team have adapted the concept to be used for assigning resident physicians to their shifts at St. Michael’s. “Historically, residents were assigned very structurally. It was very rigid, and the assignments weren’t reactive to volumes,” he says. Dr. Mamdani worked with Dr. Ophyr Mourad, a general internist at St. Michael’s, to review patterns that should be considered in scheduling residents – including flow of patients on weekdays versus weekends, pat-

terns in emergency codes within the hospital, and the intensity levels of cases. The collection of these patterns served as data points for the resident assignment tool, and the LKS-CHART team created a data-driven solution that has fundamentally changed the way residents are assigned to shifts. “There were times where residents were underutilized because they were over-staffed, and there were times where residents would feel pressure because there wasn’t enough support and there were too many patients,” says Dr. Mamdani. AI-powered tools such as the RN and residents assignment systems are optimizing hospital resources – a challenge that hospitals aim to address globally. For Dr. Mamdani, creating cost efficiencies and better experiences for hospital staff and patients through AI is largely about monitoring patterns. “A lot of the solutions are about H learning what happens when.” ■

Jennifer Stranges is a communications advisor at Unity Health Toronto 42 HOSPITAL NEWS MARCH 2020


Conference on

Aging+ Brain Health highlights what’s next in senior care innovation he reality of a rapidly growing population of seniors is upon us. Do we have the capacity and resources to address the unique needs of older adults and their caregivers? How can we build a sustainable healthcare ecosystem that allows older adults to age and thrive in their setting of choice? On March 11th, prominent thought leaders, entrepreneurs, venture capitalists, healthcare providers, and companies from around the world will come together to discuss these very questions at What’s Next Canada – the Centre for Aging + Brain Health Innovation’s (CABHI) conference on aging and brain health.


fessionals who are passionate about elevating the quality of innovation in the longevity sector in Canada and around the world. This year’s conference, co-produced with Mary Furlong and Associates, will focus on Aging, Medtech & Mental Health. The conference will feature engaging panel sessions that draw attention to critical issues such as: • Innovating with seniors for seniors • Designing for dementia • Developing innovative healthcare solutions in a real-world setting, and • Healthcare access for rural and indigenous communities Keynote speaker Dr. Jean Accius, Senior Vice President of Global

LAST YEAR, WHAT’S NEXT CANADA SAW OVER 35 WORLD-CLASS SPEAKERS AND AN AUDIENCE OF OVER 300 COME TOGETHER TO DISCUSS THE FUTURE OF SENIOR CARE. What’s Next Canada was born out of CABHI’s vision of a world where people can age in their setting of choice, maintaining their cognitive, emotional and physical well-being, as well as their independence, for as long as possible. Now in its second year, What’s Next Canada is a growing opportunity for innovators to form transformative collaborations with renowned researchers, clinicians, healthcare providers and corporate executives in the seniors’ sector. Last year, What’s Next Canada saw over 35 world-class speakers and an audience of over 300 come together to discuss the future of senior care. Once again, the conference will connect industry and healthcare

Thought Leadership at AARP, will headline the conference with a discussion on the economic impact of age discrimination. The conference will also focus on addressing the mental health of caregivers for people living with dementia and other cognitive impairments. Our Lived Experience Panel, which features members of CABHI’s Seniors Advisory Panel, will allow attendees to learn more about the first-hand experiences of people impacted by dementia and how good mental health plays a critical role in maintaining and improving cognitive health. Audience members will get the opportunity to vote for their favou-

(from left) CABHI Managing Director Dr. Allison Sekuler, CEO and Founder of Mary Furlong and Associates, Darmiyan Chief Medical and Technology Office Dr. Kaveh Vejdani, CABHI Director of Business Development Mel Barsky. rite up-and-coming brain health and aging solution at the Pitch Competition, where nine startups will vie for the 2020 CABHI Innovation and People’s Choice Awards. SOMPO Digital Labs based out of Japan will be bringing 50,000 YEN in prize money!

What’s Next Canada follows Baycrest’s 30th annual Rotman Research Institute Conference taking place March 9-10, 2020. To learn more about What’s Next Canada activities and speakers, or to register, please visit the event page at: H ■

HSCN National Healthcare Supply Chain Conference Delta Marriott Toronto Airport May 11–13, 2020

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A new phase begins:

Patient Support Centre


NEWS By Tara MacPherson new SickKids is starting to rise. After eight months of demolition, we recently marked a milestone moment for our campus redevelopment (known as Project Horizon) as we broke ground on the Patient Support Centre: a new 22-storey education, training and administrative hub, expected to open in late 2022. Staff, donors and onlookers were feeling the buzz (and clang!) as performers clad in construction gear challenged traditional ideas of musical instruments with a lively performance featuring hammers, wrenches and more. Ted Garrard, Chief Executive Officer, SickKids Foundation, opened the groundbreaking ceremony with a land acknowledgement. He then introduced a moving video featuring the new SickKids vs. This is Why campaign. Mayor Tory was also in attendance, representing the City, and offered his congratulations on this exciting new phase, “I’ve had the chance to meet many kids at SickKids, past and present. Thank you to the doctors, nurses and staff and all those who provide care to those who need it. The new development has taken a lot of hard work, but the goal is on its way to being met!” Dr. Ronald Cohn, SickKids President and CEO, brought the significance of this milestone home, “beginning to build a new hospital for precision child health significantly impacts the way we manage, treat and care for our people at SickKids. The new building will really represent our identity – who we are”, says Dr. Ronald Cohn. The Patient Support Centre will house the SickKids Learning Institute, which will support over 1000 world-class trainees, students and learners annually. It will also include a Simulation Centre for hands-on teaching, allowing our healthcare practitioners to continue to provide leading-edge paediatric care to patients. The aesthetic of the PSC will be inviting, with a modern and wellness-focused workspace for over 3000 professionals, management and support staff. The space will include a variety of collaboration and activity spaces that will be accessible for all staff from across


The new Patient Support Centre, the first critical phase on our way to build a new SickKids. 44 HOSPITAL NEWS MARCH 2020

NEWS Transparent glass at the main level creates an open feel, while a playful art piece dangles above (specific art not confirmed).

THE PATIENT SUPPORT CENTRE WILL HOUSE THE SICKKIDS LEARNING INSTITUTE, WHICH WILL SUPPORT OVER 1000 WORLD-CLASS TRAINEES, STUDENTS AND LEARNERS ANNUALLY. the SickKids campus. Being housed under one roof will provide convenience and ease for professionals from different departments at SickKids – creating an inclusive environment for all staff. The Patient Support Centre is the first of three phases in SickKids master redevelopment plan, situating staff in a shared location as the Hill and Black Wings are demolished to make room for the new hospital tower, the Peter Gilgan Family Patient Care Tower. The benefits of the new space include saving on costs for leasing purposes, compliance with new building standards and advanced work spaces to keep staff on the forefront of paediatric medicine.

Another key phase – The Peter Gilgan Family Patient Care Tower – will house critical care and inpatient units. It will reflect the very latest in medical design: a renewed focus on privacy for patients and families, dedicated mental-health beds, a state-of-the-art blood and marrow transplant/cellular therapy unit, specialized operating theatres, advanced diagnostic imaging facilities, and a vastly expanded emergency department. The project is the first step to improving the efficiency and effectiveness of our operations with a SickKids’ plan to build a hospital of the future, transform how we deliver care in a world-class setting and empower patients and families to be H partners in their care. ■

Tara MacPherson is a Communications and Public Affairs Intern at The Hospital for Sick Children (SickKids).

16th Annual Conference



Conversation: A critical but overlooked piece in LTC dining By Maria Biasutti was temporarily working at a long-term care (LTC) home where I went to assess a female resident, we’ll call ‘Pearl’ , for a follow-up on her trial for thin fluids because I had noticed it had been a longstanding temporary order since she fell ill the previous weeks. She was sitting in the dining room in her wheelchair, silent and isolated in her thoughts. I quickly wondered if anyone was going to offer her something to drink, since she didn’t seem to notice the three beverages sitting in front of her. In the dining room during meals, it is a seriously crowded, hustle and bustle environment where everyone comes together to ensure that all residents receive every part of their


meal and medications, and somewhere thrown in there – bathroom visits - in a thirty to forty five minute time span. Attempting not to get side swiped by a cart full of coffee, I sat down and said ‘Hi Pearl’. I introduced myself and asked how she was doing today. “Oh, I’m not feeling too good today”, she responded. I asked her why. She has dementia and her response was not entirely clear or audible, but I felt it was important to continue listening to her. I offered her a sip of her juice and watched carefully as she swallowed without hesitation. “Mmhmm… that was so good”, said Pearl while licking her lips. Pearl eagerly accepted several more sips, clearly expressing her thirst, and loving every bit of it. As I stood up

after observing how adequately Pearl was swallowing, a staff member walked over and dropped down a beige plastic lipped plate holding two heaping piles of green and orange mush. An unconscious sigh escaped my lips. Not one word about the food was said by the staff member to Pearl. I looked at the plate and then at Pearl, who didn’t even flinch when the loud drop of the plate sounded. The thick milky cataracts in her eyes explained to me that she would have difficulty seeing what was placed in front of her. I realized that for a while since her illness, she had been receiving pureed texture meals to reduce her risk for choking. As a dietitian experiencing this moment, I realized that I had the

opportunity to potentially make her day better. I approached the servery and requested a change in her meal from the staff member behind the steam cart. “Thank goodness you’re changing her diet because Pearl’s really not been eating very well on the puree food”, commented the staff member to me which confirmed exactly what I thought. A quick double check of Pearl’s mouth showed me she had properly fitting dentures in place and she was swallowing without observable concerns, so I assessed that she was ready to try something more challenging than pureed food. I brought minced sandwiches back to Pearl. They were crustless sandwiches made with a soft, diced filling. I sat

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LONG-TERM CARE NEWS down and helped her with her first bite. A brief surprised look crossed Pearl’s face and then she said “Mmhmm, I like that!”. In between bites, I had a chance to start a conversation, asking her about her life. Pearl’s grandson apparently was a well-known local blues singer! During our conversation, Pearl consumed her entire sandwich and even helped herself to her own soup. She ate, drank, happily conversed and told me pieces of stories of what she can remember of her family. “Oh my, I haven’t had that in a while…”, Pearl would say about her food. What captured me most during this experience was realizing how powerful and valuable a simple conversation with a resident during a meal can be. Pearl’s solemn and quiet mood earlier had become a bright and lively one. Conversation created an opportunity for me to learn about Pearl, but also to be a better health professional by ensuring that she received food that was

WHAT CAPTURED ME MOST DURING THIS EXPERIENCE WAS REALIZING HOW POWERFUL AND VALUABLE A SIMPLE CONVERSATION WITH A RESIDENT DURING A MEAL CAN BE. nutritionally appropriate and accepted by her. In this case, dialogue had sparked appetite and interest in the food and engaged Pearl in the present. This experience also made me wonder how long it could have taken from the time Pearl’s plate of food was placed in front of her to her first bite if I had not been there with her? How long would it have taken before anyone noticed that she could not clearly tell you that she no longer wants to eat orange and green mush? How long has it been since anyone showed interest in listening to the stories that Pearl could share?

The recent release of the 2019 Auditor General’s Report on the provincial review of Food and Nutrition in Long Term Care Homes “found that long-term-care homes were not consistently providing residents with sufficient and high-quality food and nutrition care.” It is also true that residents admitted to LTC are more cognitively impaired and require more assistance with day to day living. This alone urges us to pay special attention specifically to what happens to residents during meals and how it affects their experience and nutritional status. Conversations can be short but crucial to de-

termining how we should proceed with a resident’s care, and it could possibly be the only conversation they had that day. Taking the opportunity to sit with residents during meal service and having a conversation with them can truly help reduce the feeling of meal service rush for everyone, including staff. As well, it promotes quality of life for residents because food and mealtimes are often the most anticipated part of their day. Allowing more flexibility in meeting timelines and work schedules can alleviate pressure and encourage a more home-like experience for residents. When organization leaders acknowledge the significance of this and develop mealtime policies and processes that support the human aspect of resident meal service, everyone benefits. So, I encourage you to learn from my experience with Pearl and take a seat at the dinner table, because H a little conversation goes a long way. ■

Maria Biasutti is a Registered Dietitians with extensive experience in long-term care. She participates on the Ontario Long Term Care Action Group, an advocacy group of the Dietitians of Canada.


Battling social isolation with the power of intergenerational storytelling By Arielle Townsend lder adults living in longterm care facilities are at risk of experiencing social isolation and loneliness. These challenges are often associated with anxiety, depression and cognitive decline. The Zeitgeist project, a social innovation bringing seniors and students together, is using the power of intergenerational storytelling to help change this narrative. The project is the result of a collaboration between Vancouver Coastal Health Authority (VCH) and Emily Carr University (ECU). Through support from the Centre of Aging + Brain Health Innovation (CABHI), powered by Baycrest, research on the project’s effectiveness was conducted at Purdy Pavilion, a long-term care facility in Vancouver. The objective of the project was twofold: to provide meaningful engagement for seniors at risk of social isolation, and to create a unique learning opportunity for communication and design students at ECU. The first phase of the project allowed residents and students to get to know each other better. It was during this phase that the residents shared their stories about growing up, raising families, and transitioning into long-term care. Donna Levi, project lead and recreational therapist at Purdy Pavilion, says this moment – the exchange of stories – was powerful enough on its own. “The project helped boost the self-esteem of a lot of our residents,” she shares. “They were very proud to tell their stories, and proud that the students responded with such attentiveness.” At the end of the sessions, the students worked with the resident to compile the stories into booklets residents could share with their family and friends. Some residents expressed


The Zeitgeist project helps bridge generational divide and combat social isolation in seniors.

“THE PROJECT HELPED BOOST THE SELF-ESTEEM OF A LOT OF OUR RESIDENTS” a desire to leave their books as legacy gifts for their grandchildren. Levi notes that the booklets also helped staff provide more personalized care, especially when meeting residents for the first time. When asked how the project directly impacted them, many of the residents reported feeling relieved they had someone to talk to. “It made me feel less lonely,” says Reg, an 85-year old resident at Purdy. Another resident says the experience helped connect them with more people. While the project helped residents engage with others and express them-

selves through storytelling, ECU students received the gift of perspective. Zeitgeist created a space for the residents to be seen – not for their needs, but for their unique experiences. “It is always an enjoyable experience to exchange stories,” explains one of the student participants. “But to take it to the next level and create a publication, validates that these stories are important, valuable, and remembered.” CABHI’s SPARK program, designed to foster innovations from point-of-care health care workers, helped the Zeitgeist project fulfill its objectives to become an activity both the residents and students enjoyed doing together. SPARK equips innovators with the tools they need to test and validate their ideas, so they can be transformed into real-life solutions. In addition to funding, innovators in the SPARK program also receive access to CABHI services and expertise.

“CABHI gave us tremendous project support,” Levi says. “If we had any questions along the way, they were there to support.” The Zeitgeist project continues to run at Purdy Pavilion under a new name: Perspectives. Plans to expand to other long-term care facilities are also underway. With additional CABHI funding, a How-to Zeitgeist Guide is being created, which Levi hopes will help other care homes adopt the program. “Other recreational therapists can’t wait for the guide to be completed so they can contact local universities and create their own programs on site,” she says. With CABHI’s support, the Zeitgeist project is well on its way to helping older adults live more connected and socially active lives. Learn more about how we support innovations in aging and brain health, like the Zeitgeist project, through our H Spark Program. ■

Arielle Townsend is the Marketing & Communications Content Specialist at the Centre for Aging + Brain Health Innovation (CABHI). 48 HOSPITAL NEWS MARCH 2020


The power of music By Annie Webb

usic unites and uplifts people of all ages and cultures. “There’s overwhelming evidence that music is very powerful across our lives. Older people are no different from people of other ages,” says Dr. Andrea Creech, a former international orchestral musician who is a Canada Research Chair, psychologist and professor of music at Université Laval. Making music has been shown to produce a range of social, cognitive, physiological and emotional benefits, irrespective of whether people have had musical training or not. But how can older adults create music collaboratively when they are in late life, have physical and cognitive challenges or


may never have played a note before? The answer is technology. “It’s a way into a wonderful world of making music that may not have been accessible through other means,” explains Dr. Creech. “Making music is also a very cost-effective way to address many challenges facing older people.” With support from AGE-WELL, Canada’s technology and aging network, Dr. Creech is leading a project with four other co-investigators from four Canadian universities to study how assistive music technology can help older adults overcome barriers to making music, and enhance wellbeing and quality of life. The project focuses on a technology called Soundbeam, which emits an ul-

sic to change the culture of care. “The community partners are absolutely integral because our first step is a needs analysis and what we can do to have an impact within each community,” says Dr. Creech. The research team will be helping participants make music with Soundbeam in groups, and empowering them to use the technology with minimal facilitation. Using personally meaningful sounds, participants will create soundscapes together, which will be recorded. “In a way, it’s a bit like creating a life-story or narrative with music,” says Dr. Creech. “My dream is to one day have a music room in long-term care facilities or retirement communities with H resources like Soundbeam.” ■

trasound beam that can be manipulated by motion and movement, and translated into sound. For example, sweeping an arm overhead can create a sequence of sounds. “What you’re playing are recorded samples, which are stored in the control centre. There are infinite possibilities for the music you can play,” notes Dr. Creech. The beams can also be adjusted for someone who is in a wheelchair or has limited mobility. Dr. Creech and her team are working with community partners, including a retirement community in Quebec City, the Schlegel-UW Research Institute for Aging in Waterloo and the Room 217 Foundation, a Canadian health arts organization that uses mu-

Annie Webb is a freelance writer. AGE-WELL is a federally-funded Network of Centres of Excellence. The pan-Canadian network brings together researchers, older adults, caregivers, partner organizations and future leaders to accelerate the delivery of technology-based solutions for healthy aging. For more information, visit


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Using ‘serious games’ to monitor memory and cognitive health By Annie Atkinson nyone who has accompanied a friend or relative to a memory test, or had one themselves, knows how stressful it can be. Research teams supported by AGE-WELL, Canada’s technology and aging network, are hard at work on new ways to monitor cognitive health and detect changes – by using tests that could actually be enjoyable. A team led by Dr. Frank Knoefel, a physician at the Bruyère Memory Clinic in Ottawa, is testing a tablet-based version of the well-known game whack-a-mole to measure brain abilities such as reaction time and accuracy levels. By monitoring a player over time, researchers can track the individual’s speed of processing and inhibition. The “serious” tablet game was designed by AGE-WELL researchers at the University of Alberta. Dr. Knoefel usually conducts standard paper-and-pencil memory testing with his patients every six months or annually. He is hoping that games like whack-a-mole can help him to monitor his patients more frequently and accurately. “If I can have other data of how they are functioning, that would be a huge addition to my diagnostic skills,” he says, adding that the current paper-and-pencil tests become increasingly unreliable as a person’s cognition declines. In Edmonton, Dr. Eleni Stroulia is also exploring the potential of “serious games” as a clinical tool. A professor of computing science at the University of Alberta, Dr. Stroulia is testing a suite of computer games as assessment and intervention tools for people with cognitive impairment. The tablet-based games include favourites like word search, bejeweled and mahjong for older adults. They were developed by Dr. Stroulia with AGE-WELL project co-lead Dr. Lili Liu and other colleagues.


A customized version of whack-a-mole is being tested as a new way to spot those at risk of delirium.

Senior Ken Yu is helping an Alberta team to develop “serious games.” The team is analyzing findings from a trial comparing outcomes of game play among healthy older adults and older adults with cognitive impairment. Meanwhile, testing of their word search game is underway in Greece and Italy. Gaming is also being applied to a challenge that confronts hospital emergency departments: identifying whether older people are at risk for

onset of delirium, an acute state of confusion or brain failure associated with increased risk of death, medical and surgical complications, confusion and memory loss. Delirium can come and go, and the “hypoactive” form is easy for clinicians to miss as patients are inactive or drowsy. AGE-WELL investigators have been using a customized version of whack-a-mole as a new way to spot

those at risk of delirium. Emergency department trials of the tablet game showed that measuring changes in patient response times and error rates are useful as a screening tool to predict delirium, according to Dr. Jacques Lee, an emergency physician and scientist at Sunnybrook Health Sciences Centre. Dr. Lee is collaborating on the project with Dr. Mark Chignell, a psychologist in the Department of Mechanical and Industrial Engineering at the University of Toronto, and Dr. Tiffany Tong, an AGE-WELL trainee alumna. “This project is something Mark, Tiffany or myself could not have done alone,” says Dr. Lee, commenting on the transdisciplinary nature of the AGE-WELL-supported project team. “Complex problems have complex solutions, and we need the collaboration of different disciplines to address these complex problems.” Dr. Lee is now conducting a national randomized clinical trial of the tablet game with more than 1,300 older adults in emergency departments, with support from the Centre for Aging and H Brain Health Innovation. ■

Annie Atkinson is a freelance writer. AGE-WELL is a federally-funded Network of Centres of Excellence. The pan-Canadian network brings together researchers, older adults, caregivers, partner organizations and future leaders to accelerate the delivery of technology-based solutions for healthy aging. For more information, visit 50 HOSPITAL NEWS MARCH 2020

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Providence Care Hospital achieves LEED Silver certification ®

By Elaina Raponi hen Providence Care set out to build its new hospital along the shores of Lake Ontario, incorporating environmentally friendly features to reduce its impact on the planet was top of mind. The state-of-the-art hospital was recently awarded LEED® Silver certification. The LEED® (Leadership in Energy and Environmental Design) system rewards points for innovations that minimize the impact of new construction on humans and the environment. Green buildings are built to protect occupant health, use resources such as energy and water more efficiently, and reduce the overall impact of the building on the environment. “Achieving LEED® Silver certification demonstrates our commitment to being environmentally responsible and energy efficient,” says Krista Wells Pearce, Vice President, Planning & Corporate Support Services. The 622,000 square foot hospital boasts the following innovations: • Automated building control systems such as lights and window blinds • Low-flow toilets and faucets to reduce water consumption • Large amounts of natural light throughout the hospital to offset


(top) The welcome desk at Providence Care Hospital. (left) The main entrance at Providence Care Hospital. (right) The cafeteria at Providence Care Hospital the need for artificial light during the day This isn’t the first time Providence Care Hospital has been recognized for being ‘green’. In September 2019, the hospital was awarded a cheque for $514,000 as part of the High Performance New Construction Incentive. The incentive was offered as one of the province’s electricity conservation programs and encouraged a higher level of efficiency when constructing new facilities. According to Utilities Kingston, the hospital’s numerous energy efficient initiatives saved approximately 423,000 kWh of electricity and

1,760,000 kg of carbon dioxide equivalent emissions. That’s enough electricity to power 45 homes, and the emissions saved are equal to 374 passenger cars, driven for a year! And while the ‘green’ design of the building was a top priority during planning, Providence Care was also interested in evaluating what impact the new hospital had on its patients, clients and staff. With this in mind, Providence Care engaged Methologica, a Toronto-based research and evaluation consulting firm, to conduct pre and post-occupancy studies. Providence Care recently received a final copy of Methologica’s User

Experience and Design Evaluation Summary. The report highlights how Providence Care Hospital was able to reduce stigma, promote recovery and transition, and enhance its connection to nature with its design. “This report affirms the work we did to improve the outcomes for the people we serve,” says Cathy Szabo, President & CEO. “By achieving LEED® Silver certification, being recognized by Utilities Kingston, and receiving the findings of Methologica’s report, it is clear that Providence Care Hospital is leading the way in more ways than one. We H are very proud of the results.” ■

Elaina Raponi is a Communications Officer at Providence Care. 52 HOSPITAL NEWS MARCH 2020


Equipment we no longer use

can make a difference elsewhere n the eve of a medical volunteer trip to the southeast African country of Malawi, Dr. Karim Taha wasn’t sure if the few dozen blood pressure machines flying with him would have an impact on patient care. But when he arrived at the country’s biggest government-run hospital in Blantyre – Malawi’s second-largest city – serving a population larger than the Greater Toronto Area, it was clear the equipment would be of great use. “What seemed like a small donation ended up making a huge difference,” says Dr. Taha. Dr. Taha, a cardiology fellow at the University of Toronto, has always had an interest in global health and international health promotion. Since graduating medical school, he’s been training at Toronto General Hospital and the Peter Munk Cardiac Centre (PMCC), working closely with Dr. Heather Ross on PMCC’s Digital Cardiovascular Health Platform. With years of medical training under his belt, Dr. Taha felt the time was right for him to go and contribute what he had learned. Visiting with another cardiologist who frequently volunteers in Malawi, they flew over with blood pressure machines, sugar testing kits, stethoscopes and other equipment. The team set up a cardiology provision service at the hospital, performing echocardiography and electrocardiograms (ECGs) when possible on patients who were referred from around the city. They also taught internal medicine and cardiology to medical students, nurses, residents, and medical trainees. But the resources brought by Dr. Taha would make a lasting difference, continuing long after the doctors came back to Canada. When the team distributed the equipment to hospital staff, Dr. Taha describes their reaction as amazing – staff were incredibly grateful and thankful for the donation. Dr. Taha helped teach the healthcare professionals how to operate


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Q March 9-13, 2020 2020 HIMSS Global Conference & Exhibition Orange County Convention Center, Orlando Florida Website: Q March 24-25, 2020 CTO 2020: Clinical Trials Conference Hilton Toronto, Toronto, ON Website:

the equipment and bought reusable batteries to ensure machinery was always charged. He also distributed the blood pressure machines and other equipment in small increments, ensuring staff felt comfortable using the new tools and to safeguard them from being stolen. The equipment, which was donated by Dr. Ross, her research teams, and other individuals at both the UHN and St. Michael’s Hospital, was put to great use. “These resources were no longer used here,” says Dr. Taha. “Now, it is part of patient care in Malawi. “Equipment we no longer use can make a huge difference elsewhere in the world.” Back home in Canada, Dr. Taha is hoping to raise awareness about the need for equipment in underdeveloped countries, the impact donations can have and how clinicians can help by volunteering. “We are fortunate to have as many resources as we do, and we should consider donating what we no longer use instead – if no one is using it, no one can benefit from it,” says Dr. Taha. “There is also ample opportunity for doctors, nurses and health professionals to make a difference abroad with their expertise.” If you’re interested in donating medical equipment or volunteering on a medical trip to Malawi, please contact Dr. Karim Taha at karim.taha@mail. H ■

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The first academic Division of Hospital Medicine in Canada

By Nikki Jhutti

hree years ago, Providence Care Hospital’s Complex Medical Management program was facing a physician staffing crisis. Two of the three part time physicians in the unit were retiring. Recruitment had been a challenge for the hospital in the past, so filling those roles was easier said than done. But that wasn’t the only concern. “The model we had in place was not able to keep up with the growing needs of our organization or our patient population,” says Kathleen Fitzpatrick, outgoing Medical Administration Director at Providence Care. “We needed to revolutionize our physician staffing model.” Fitzpatrick knew a change of this magnitude required help. That’s why the hospital partnered with Queen’s University Department of Family Medicine and the Southeastern Ontario Academic Medical Organization (SEAMO) for the transformation. The makeover included replacing the old specialist-based physician staffing model with a new one focusing on hospital medicine. One of the fastest growing medical specialties in North America, hospital medicine features hospitalists who are dedicated inpatient physicians who work exclusively in a hospital setting. “What we’ve seen over the years is the medical complexity of patients has increased and specialists aren’t necessarily able to focus on all the clinical needs of a patient,” Fitzpatrick explains. “People are living longer with more complex, chronic conditions and so we need a more holistic approach in terms of treatment. A hospitalist is able to look at all the needs of a patient and work with the team to create a care plan to meet those needs.” The group spent years researching, planning and recruiting. Fast forward to October 2019, and the trio has established the first academic Division of Hospital Medicine in

Not only will the hospitalists be able to create care plans that focus on addressing all the clinical needs of patients, but Fitzpatrick adds the division will also help decrease wait times.



The Division of Hospital Medicine brings together many of the services Providence Care Hospital offers into one group for better continuity of care.

HOSPITAL MEDICINE FEATURES HOSPITALISTS WHO ARE DEDICATED INPATIENT PHYSICIANS WHO WORK EXCLUSIVELY IN A HOSPITAL SETTING. Canada. Dr. Ammar Rashid is the chair of the division. “Patient safety and evidence based medicine is our highest priority,” he says. “I’m excited to be in this position because we are making history by establishing this division and this is the largest care providing division at Providence Care Hospital.” The division features 11 hospitalists who help support care across 230 hospital beds. The Department of Family Medicine oversees the entire operation. Queen’s is the first Canadian university to have a division like this and acknowledge hospital medicine as its own specialty. “While many family medicine departments offer inpatient hospital based care as part of their training program, family physicians in this division will focus a significant portion, and in some cases all of their time, on hospital medicine,” explains Dr. Michael Green, Department of Family Medicine Head.

SEAMO manages an alternative funding plan agreement with the Ministries of Health and Long-Term Care, as well as the Ontario Medical Association. “Our role included pulling together the three disparate services into a single, unified program under the leadership of the Department of Family Medicine,” says Danielle Claus, SEAMO Executive Director. “By working together I think we create a stronger unit of service because people are providing consistent care under common leadership.” There are four main goals for the division: enhancing patient care, improving physician wellness, training future hospitalists, and raising the awareness of hospital medicine.


Providence Care is Southeastern Ontario’s leading provider of specialized care in aging, mental health and rehabilitation. The division brings together many of the services the hospital offers into one group. “It allows for better continuity of care, cross coverage and the opportunity to collaborate when certain services need more assistance. That’s something we haven’t had in the past,” says Fitzpatrick. “Now we have a consistent group of people who are able to learn from each other and work together which is a huge benefit to our patients.”

The division is not only looking out for patients, but also physicians. Rashid says creating a team atmosphere for hospitalists helps combat issues such as physician fatigue or burnout. “Everyone is striving to have that healthy work/life balance. Physicians are no different,” says Rashid. “Being in a team not only increases morale but you also have back up to cover when people are on vacation for example.” And the more people in the division, the less time physicians spend on call. “When the Complex Medical Management program was run by three part time physicians, they were providing on call services once every three weeks. Now with this division, each physician is on call for one week out of every nine weeks. That’s a big difference,” says Fitzpatrick.


The division may be up and running but the group is now working on the next phase; developing a fellowship program for third year family medicine residents, specifically dedicated to hospital medicine. “With the aging population there will be more and more complex patients with significant sub-acute care or rehabilitation needs. This division provides a great opportunity for medical learners to improve their skills in those areas,” says Green. “The program is new and unique because physicians will also have a mandate to innovate in developing hospital medicine learning opportunities and conduct academic work related to hospital medicine from a family medicine perspective.” Continued on page 55

Nikki Jhutti is a Communications Officer at Providence Care. 54 HOSPITAL NEWS MARCH 2020


St. Michael’s Hospital Continued from page 14

New modular carts with supplies, charting stands and a work surface that can be brought directly to the patient’s bedside.

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Next came the mock-up simulation: the Operational Readiness team built a replica trauma bay and asked the trauma team to run a full-scale simulation in it. “The blueprints provided in the table-top simulations are valuable at an early stage but the difference between them and the mock-up simulation is the latter really allows you to figure out the details that can only be determined when you’re inside the space, such as the best position for the vital signs monitor where it can be seen by the entire team,” explains Dr. Petrosoniak. Finally, they conducted in-situ simulations inside the almost completed trauma bay. The team ran six completely different medical scenarios over the course of two days so that they could finalize key details such as floor markings to guide where individual team members should stand and planned locations of life-saving equipment so that they can be quickly accessed. “In situ simulation is the last stop – it confirms that our designs and early simulation work resulted in the most streamlined way of delivering care to critically injured patients. When we need immediate, life-saving


Hospital medicine

Continued from page 54

help advocate for more hospital medicine divisions across the country,” Rashid says. “My long term goal is to develop a collaborative network of hospital medicine divisions amongst all Canadian universities. Through that network we could work together to develop a hospital medicine curriculum and eventually advocate for it to be added as a certified competence through the College of Family Physicians of Canada.” And while it may take some time before that happens, the fully staffed division is already making a difference by providing the best possible care for patients and clients at H Providence Care Hospital. ■

“We wanted to put some time and energy into helping the province and the entire country solve the issue around the lack of physicians available for hospitalist positions,” adds Fitzpatrick. “It’s actually one of the things I’m most proud of. Not only are we solving our own problem, but we also want to train people to help solve problems beyond the walls of Providence Care Hospital.”


While already a staple in a number of healthcare facilities south of the border, Rashid says hospital medicine continues to grow in Canada. “We want to be that voice to


Careers tions, we expect that the equipment will be at our fingertips and that we’ll have the necessary space to make that easy. A well-designed workspace is absolutely critical when seconds matter, and we’re excited that we’ve achieved that,” says Dr. Petrosoniak. A key resource used in the design of the trauma bay was the findings of the 2016 TRUST study, conducted by Dr. Petrosoniak and Dr. Chris Hicks, fellow St. Michael’s Emergency Physician and Trauma Team leader. The year-long study, supported by the Allan Waters Family Simulation Centre, both observed and inquired about how trauma team members interact with one another and with the space to see what changes they could implement to make the trauma bay more conducive to efficient and collaborative patient care. “St. Michael’s is really ahead of the curve for integrating the clinical team in the design of the space the way they did. We’re grateful for the Operational Readiness team’s safety-minded approach and that we have a simulation program that can support this type of work,” says H Dr. Petrosoniak. ■


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