Mt. Sinai researchers uncover Gumby gene FOCUS IN THIS ISSUE
PATIENT SAFETY/ RESEARCH/INFECTION CONTROL
Canada's Health Care Newspaper SEPT. 2013 | VOLUME 26 ISSUE 9 | www.hospitalnews.com
Developments in patient safety practices. An overview of current research initiatives. Innovations in the prevention and treatment of drug-resistant bacteria and control of infectious diseases, including HIV/AIDS and hepatitis. Advances in the measurement of patient outcomes and program metrics.
Hygiene for little hands
INSIDE Ethics ..................................................13 Caregiver ............................................. 21 From the CEO's Desk .........................22 Patient Safety .....................................34 Careers ...............................................35
PHCRI research study
gives hope to those with chronic non-healing wounds By Melanie Hanson ew research by the Providence Health Care Research Institute (PHCRI) tackles a major problem plaguing long-term care facilities and hospitals. The study, published in the Nature Publication Group journal Cell Death and Differentiation, gives hope to those with chronic non-healing wounds, a problem affecting as many as 20-25 per cent of patients in long-term care facilities. As we age, the skin becomes thinner and weaker reducing its capacity to heal. The elderly and people affected with immobility, diabetes and/or obesity are highly susceptible to developing skin wounds that do not close and heal properly. The article entitled â€œGranzyme B degrades extracellular matrix and contributes to delayed wound closure in apolipoprotein E knockout miceâ€? shows that inhibition of Granzyme B improves the healing of chronic, non-healing wounds. This is the first study to show that inhibiting this protein-degrading enzyme, that builds up with age and chronic inflammation, can restore normal wound healing. The study was funded in part through a Canadian Institutes for Health Research Industry Partnership grant. Continued on page 3
Researchers Dr. Hiebert (left) and Dr. Granville at Providence Health Care Research Institute in BC are working on improving outcomes for chronic non-healing wounds.
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PCHRI resesarch study
Continued from cover
The study was led by Dr. Paul Hiebert, a former PhD candidate in the laboratory of Dr. David Granville, Principal Investigator at the Centre for Heart and Lung Innovation at St. Paul’s Hospital, Professor in the Department of Pathology and Laboratory Medicine at the University of British Columbia and Founder and CSO, viDA Therapeutics, Inc. “It is becoming clear that Granzyme B does a lot more than we once thought,” says Dr. Hiebert. “It is capable of chewing up the structural proteins in skin that are crucial for proper healing, similar to hungry termites eating the wooden frame of a house while it’s being built.”
Chronic, non-healing wounds affect millions of people across North America resulting in $6 billion in estimated costs to the health care system in the US alone. “Chronic ulcers are common in hospitals and long-term care facilities, resulting in enormous costs to the health care system,” noted Dr. Granville. “The present study provides important proofof-concept data to support the notion that drugs targeting Granzyme B could be used as a therapy to improve the lives of so many that are affected by this inability to heal normally.” Chronic, non-healing wounds affect millions of people across North America resulting in $6 billion in estimated costs to the health care system in the US alone. The degree of morbidity and mortality associated with these wounds is similar to that of many types of cancer. Studies are currently under way at viDA Therapeutics, a spin-off company from the University of British Columbia, to further validate Granzyme B as a therapeutic target and to develop and assess new compounds for therapeutic efficacy. However, at present, the inhibitors are still being developed and not available for H clinical applications. ■ Melanie Hanson is Operations Leader, Centre for Heart Lung Innovation, Institute for Heart + Lung Health at St. Paul's Hospital.
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Need for national strategy on health care for seniors The Canadian Home Care Association (CHCA) welcomes the findings from the survey conducted for the Canadian Medical Association (CMA) 2013 National Report Card on Health Care. This report includes the opinion of Canadians on the overall health care system and on key aspects – specifically the Future of Seniors' Health Care. The CMA 2013 National Report Card on Health Care states that nearly all Canadians recognize the need for a national strategy on health care for seniors and be-
lieve this would improve the entire health care system. The CMA 2013 National Report Card on Health Care reveals that six in ten Canadians will need to rely on a public system of home care and long term care if needed later in life. The same proportion said they lack confidence in the current health system's ability when it comes to caring for Canada's aging population. "With increasing demand and limited resources, the onus of care falls on family caregivers; the majority of whom are women, to provide home
care to the frail elderly and those with chronic, long-term conditions," said Donna Dill, Past-President, CHCA. "It is not surprising that the survey shows that those most concerned include women, Canadians between 35 to 54 years old, and Canadians already caring for an elderly person outside their home." Given the finding that 77 per cent of Canadians are worried about their personal access to home care and long-term care, it is imperative that all governments and stakeH holders commit to immediate action. ■
Inequity for people living with HIV and Hepatitis C co-infection in Canada The Canadian Treatment Action Council (CTAC) has produced "Two Standards of Care: toward treatment equity for people living with HIV/HCV co-infection", a report discussing the current inequities in the world of pharmaceutical regulations and clinical trials for people living with both HIV and Hepatitis C. The report, which analyzes the two newest Hepatitis C treatments on the market—boceprevir (Victrelis, Merck) and telaprevir (Incivek, Vertex)—acknowledges the advancements that have been made in medical treatments for people living with Hepatitis C, while focusing on the poor record of large pharmaceutical companies and governmental regulatory bodies in creating and recommending effective and efficient drug treatments for those who are suffering from both HIV and Hepatitis C. The Two Standards of Care policy report outlines several policy recommendations that could aid the efficiency and efficacy of the clinical trial process in Canada. Among them: enforce regulations on Hepatitis C drug development by regulatory agencies; include people who are considered "hard to treat" in clinical trials, and expand focus on equity at the Canadian Agency for Drugs and Technologies in Health. The report highlights the enormous
length of time between clinical trials for mono-infected patients (Hepatitis C alone) and co-infected patients (HIV and Hepatitis C). Due to the high cost for testing drugs (between $500 million and $2 billion for per drug) most treatments are initially tested on those living
with Hepatitis C alone. What's more, time delays for clinical trials are lengthy — with co-infected people waiting up to four years upon clinical trial completion for drugs like, boceprevir. This is only after the drug has been tested on H Hepatitis C mono-infected patients. ■
New President of the Canadian Medical Association Dr. Louis Hugo Francescutti was installed as president of the Canadian Medical Association (CMA) in August during the association's 146th annual meeting in Calgary. Dr. Francescutti succeeds Dr. Anna Reid, an emergency physician at Stanton Territorial Hospital in Yellowknife. Dr. Francescutti currently works as an emergency physician at the Royal Alexandra Hospital and the Northeast Community Health Centre in Edmonton. As a professor in the School of Public Health at the University of Alberta, Dr. Francescutti has taught courses in injury control, public health and advocacy. Over the past two-and-a-half decades, Dr. Francescutti has spearheaded various public safety awareness initia-
tives and campaigns, including an injury prevention program for teenagers called HEROES and an emergency medical response electronic medical record. Dr. Francescutti has also published research on topics that include emergency medicine, health promotion and sport injury. His outstanding research and initiatives have earned him prestigious grants from a variety of funding agencies. He holds five honorary fellowships from colleges around the world. An expert on issues related to injury and wellness, Dr. Francescutti has been invited to speak at prestigious national and worldwide events. He is the first physician to hold the presidencies of the Royal College of Physicians and Surgeons of Canada and the Canadian Medical Association in succession. ■ H
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Ten years after: Infection control after the SARS outbreak It was 10 years ago this past spring that a deadly airborne virus created a health-care tsunami across the world confounding health practitioners and spreading fear and panic in its wake. Ten years later, just mention SARS and survivors and health-care workers alike are still haunted by the memories. Outside of China, Toronto hospitals were the hardest hit by SARS – an acronym for severe acute respiratory syndrome – and until the virus could be contained, devastated the lives of health-care workers and patients alike. The World Health Organization (WHO) issued a travel advisory for Toronto and the city was literally considered a no fly zone for months. Although it never reached pandemic proportions, SARS had a huge impact on Toronto and strained the province’s healthcare system. In May of 2003 Hospital-News took the unprecedented move to focus our entire NEWS section on the SARS outbreak. This was not only because SARS was potentially the deadliest and most infectious disease to surface since the Spanish flu pandemic of 1918, but because we felt that the herculean efforts of our frontline health-care workers, who were dealing relentlessly with the impact of SARS, deserved at least this much attention and probably much more. With SARS, healthcare as we know it changed overnight. With the quarantine and extra precautions necessary for patients, visitors and staff in all Toronto hospitals, practically everyone had a SARS story – most of them heartbreaking – of how this situation impacted their lives. We heard about the palliative patient too disoriented to understand why family members were no longer available to be present at the bedside holding his hand. We heard about the grief-stricken parents of a 13-year-old boy killed in an accident who were unable to donate
their son’s organs as was his wish. My own story focused on my then 76-year-old mother who was scheduled for a CT scan to determine whether a ‘shadow’ on an X-ray was in fact a tumor and if it was malignant or benign. With all diagnostic testing temporarily halted in the province, her anxious wait for clarification turned into a saga of waiting, waiting and more waiting. For many patients that luxury of waiting was something they could not afford. Ten years later and the SARS scars are still visible. According to a recent article in the Globe and Mail: “While many people who were infected did recover, there are others who suffered long-term physical consequences of the disease or of the treatments used,” according to Paula Gardner, a clinical psychologist at St. John’s Rehab (now a division of Sunnybrook Health Sciences Centre). The article cites Gardner, “who has studied the long-term effects of the disease on Toronto SARS cases,” as saying that PTSD is not uncommon among SARS survivors, especially those who were health-care workers. Ten years after SARS and WHO has again declared a new deadly SARSlike virus to be a “threat to the entire world,” according to Margaret Chan, director general of the World Health Organization. The name MERS – Middle East respiratory syndrome – reflects the geographical origins of the virus and is creating grave concerns. “We understand too little about this virus when viewed against the magnitude of its potential threat,” said Dr. Chan, addressing the World Health Assembly in Geneva in June. “Any new disease that is emerging faster than our understanding is never under control. There are alarm bells and we must respond. The novel coronavirus is not a problem that any single country can manage by itself.” The threat of the ‘next big one’ not only refers to earthquakes on the west
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coast, but to the next pandemic that could be globally devastating. There was the H1N1 pandemic in 2009, and the world is still battling HIV/ AIDS. If SARS was a wake-up call for many, it was especially heard in regards to disease planning. In Canada, the federal government created the Public Health Agency of Canada to mount a coordinated effective response to infectious disease outbreaks and appointed our first-ever public health officer. Although worrying about the next pandemic doesn’t really make sense, there are precautionary measures and habits that we can all incorporate into our daily lives, especially in a healthcare setting. Our Ethics column contributor this month, Kevin Reel, puts it succinctly in his column (With MERS and company in our world, infection control must be a habit for us all): “In the end, these sorts of health concerns illustrate our communal responsibility for infection prevention and control. All hospitals are constantly dealing with many potential ‘superbugs’ – such as MRSA, VRE, and C. diff. – and all of us must observe the precautions to help prevent spreading them.” In this issue we have a special fourpage spread on infection control including the results and recommendations of a Sunnybrook-led study, the first national survey of prevalence rates of antibiotic resistant organisms in 176 Canadian acute care hospitals. “The results of this study provide a much-needed baseline for national prevalence rates for MRSA, VRE and C. diff. in Canadian hospitals,” says Dr. Simor, a senior scientist at Sunnybrook Research Institute. “It is our hope the data will inform prioritysetting on resources for the control of resistance, and stewardship of antibiotics, and provide the basis for developing more rigorous national infection prevenH tion and control guidelines.” ■ Julie Abelsohn Acting Editor
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World’s first paedieatric genome clinic at SickKids To start, clinic’s focus is on eye, kidney, heart, autoimmunity By Polly Thompson research platform that will bring the best of individualized genetic medicine to the bedside of children with hardto-treat diseases and rare conditions is underway at The Hospital for Sick Children (SickKids).
SickKids is the first paediatric hospital in the world to offer whole genome sequencing in addition to gene panels for patients who may stand to benefit, says Dr. Ronald Cohn. Dr. Cohn is a Co-director of the Centre for Genetic Medicine at SickKids, which initiated and sponsors the clinic.
As at many hospitals around the world, physicians at SickKids already use clinically available genetic testing to assist in the diagnosis and management of childhood-onset disorders. “In some cases, the genetic result can lead to more effective treatments and better patient outcomes. However, for many patients, the genetic cause of their condition remains unknown. Not all children fit the norm of diseases such as leukemia, while other complex diseases are so rare that there is no actual norm,” Dr. Cohn says. “The whole genome sequence will allow us – in a very few cases – to pinpoint treatment options for specific children. It will also vastly expand our research platform for these rare conditions, contributing to genome research around the world.”
SickKids is the first paediatric hospital in the world to offer whole genome sequencing in addition to gene panels for patients who may stand to benefit, says Dr. Ronald Cohn. Psychosocial implications Dr. Ronald Cohn is a Co-director of the Centre for Genetic Medicine at SickKids, which initiated and sponsors the genome clinic.
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Clinic Co-lead Dr. Sarah Bowdin says, “Just as important as advances in how to apply whole genome sequencing to pre-existing clinical issues, we are learning how to organize and share the data about the individual’s lifetime risk for genetically based conditions with sensitivity and respect for the patient and family’s preferences.Unfolding this picture of lifetime medical risks in a young child is completely new in history and in medical ethics, and opens up new challenges that need to be addressed.” She is a clinical geneticist at SickKids and Assistant Professor of Paediatrics at University of Toronto. Because of this complexity, the consent process for the Genome Clinic takes about 90 minutes for parents to complete. The benefits and risks of whole genome sequencing are fully explained to the family, and questions are encouraged. Trainee geneticists within SickKids are asked to go through the consent process as part of their own learning. Dr. Cohn had his own whole genome sequence performed, “and it was one of the most profound experiences of my life,” he says. “I had to consider the potential implications not only for me, but most importantly for my children and my family. It has triggered fascinating conversations with my children and my wife – an experience that will undoubtedly be beneficial for my future interactions with patients and their families.”
The Genome Clinic is projected as a five-year research project. The patients who may benefit the most in the clinic’s first two years include those with kidney, eye, heart and autoimmune diseases. A major benefit is in bringing together clinicians from different areas to review a child together, says Dr. Cohn. “Sometimes we find that one specific genetic change is associated with two apparently separate conditions and diagnoses. The Genome Clinic can be a catalyst for further diagnostic investigations as well as cross-disciplinary treatment at the bedside and will serve as a future model for clinical care.” Dr. Cohn is a leading researcher of muscle-wasting conditions and is also Chief, Division of Clinical and Metabolic Genetics at SickKids as well as Associate Professor of Paediatrics at University of Toronto. He came to SickKids in 2012 from Johns Hopkins University and Children’s Center specifically for the opportunity to move genetic medicine forward in all of paediatric medicine. The potential to analyze a person’s whole genome has been made possible by the reduced cost of whole genome sequencing, which is coming down from approximately $10,000 to about one thousand dollars. “It’s like the revolution of personal computers that we saw 20 years ago – when the technology becomes affordable, that changes everything,” adds Dr. Stephen Scherer, Co-Director with Dr. Cohn of the Centre for Genetic Medicine, and Professor of Medicine at University of Toronto.
About Peter Gilgan Centre for Research and Learning
The Peter Gilgan Centre for Research and Learning will bring together researchers from different scientific disciplines and a variety of clinical perspectives, to accelerate discoveries, new knowledge and their application to child health — a different concept from traditional research building designs. The facility will physically connect SickKids science, discovery and learning activities to its clinical operations. Designed by award-winning architects Diamond + Schmitt Inc. and HDR Inc. with a goal to achieve LEED® Gold Certification for sustainable design, the Gilgan Centre will create an architectural landmark as the eastern gateway to Toronto’s Discovery District. The Peter Gilgan Centre for Research and Learning is funded by a grant from the Canada Foundation for Innovation, the Government of Ontario, philanthropist Peter Gilgan and community support for the ongoing fundraising campaign. For more information, please visit www. H sickkidsfoundation.com/bepartofit. ■ Polly Thompson is a Senior Communications Specialist at The Hospital for Sick Children in Toronto. www.hospitalnews.com
PATIENT SAFETY/RESEARCH/INFECTION CONTROL
Automated pharmacy compounding essential to patient safety By Niels Erik Hansen
or hospital administrators committed to improving patient safety, the pharmacy should be an area of particular attention. Not only does the pharmacy touch virtually every patient, it is too frequently the source of medication errors, especially with medications that are manually compounded. Despite tremendous advances in pharmacy workflow and aseptic techniques, medication errors continue to present a serious challenge to patient safety.
This state-of-the-art technology prepares chemotherapy drugs safely and improves accuracy in a clean and contained environment.” Two other Canadian hospitals have installed RIVA for general use and many others are interested in acquiring the technology. Earlier this year, several Ontario hospitals were appalled to learn that some cancer patients received diluted chemotherapy preparations made by an outsourced compounding pharmacy. An investigation found the pharmacy’s technicians failed to account for overfill in standard IV bags – so the drugs the hospitals and their patients received may have contained lessthan-therapeutic concentrations. While that case may be an egregious example, medication errors are all too common. A survey of three Canadian hospitals published in the Journal of Pediatric Nursing reported 372 medication errors over the three-month study period, four of which resulted in patient deaths. In January, the National Post reported on a 2012 Canadian study which found nearly 10 percent of pediatric patients at 22 hospitals suffered an adverse event, with medication-related incidents being the second most common cause. Manual medication compounding must be done with meticulous care and attention to detail. But despite the best efforts of pharmacy workers to mix medications perfectly, humans are not perfect and even the most experienced technicians make mistakes. Some studies have documented observed manual error rates of up to 10 per cent in hospital pharmacies. As a result, ensuring the safety of compounded medications has been a priority for hospitals. Many have instituted procedures involving dozens of steps with multiple checks and re-checks. Such protocols are important but also timeconsuming and inefficient for hospital pharmacies that produce hundreds of IV doses a day. That’s why automated compounding systems are increasingly seen as an essential component of safe and efficient pharmacy operation. www.hospitalnews.com
Pharmacy automation technology has existed for more than a decade and is being adopted by a growing number of hospitals for its ability to ensure accuracy, repeatability and patient safety. One of the biggest advantages automated compounding technology provides is removing the primary source of contamination and error – humans – from the compounding process. Automated compounders have an aseptic chamber where medications are mixed and some even can be operated outside a clean room environment. The automated compounding system our company developed, RIVA, provides other safeguards as well. Vials are photographed and their barcodes are scanned; both are then matched to a product database to ensure the right product is being used in each step. As compounding progresses, pulsed UV light provides extra disinfection to critical puncture sites, needles are automatically capped (reducing the risk of needle sticks), and the finished product is dispensed in a syringe or IV bag with an electronic barcode label for documentation. The result is a sterile and accurate medication compound that is verifiably safe for the patient. Importantly, because of the multiple safety technologies and aseptic environment in which medications are compounded, the technology provides USP<797>-compliant beyond use dating, helping pharmacies maximize production efficiency. RIVA also can be configured with negative air pressure to protect pharmacy workers during chemotherapy compounding.
Safety and accuracy are the leading reasons CancerCare Manitoba is installing RIVA to prepare chemo compounds for patients. Its CEO Dr. Dhali Dhaliwal put it simply: “This state-of-the-art technology prepares chemotherapy drugs safely and improves accuracy in a clean and contained environment.” Two other Canadian hospitals have installed RIVA for general use and many others are interested in acquiring the technology. By increasing safety, the technology also saves money. Automation lowers the costper-dose of medication and reduces the need for outsourcing. Equally important, automated compounding minimizes the risk of medication errors that can result in patient injury, emergency intervention, extended hospitalizations and liability. For those who might look to output quality as evidence of production efficacy, pharmacy automation has proven a resounding success. Since RIVA technology was commercialized in 2008, systems have been installed at more than 30 sites worldwide and have cumulatively produced some 2 million IV doses safely and accurately. Further, installed units have performed more than 100,000 routine contamination tests with zero failures. Throughout the healthcare system, technology has been implemented to enhance the safety and efficiency of countless procedures and systems. For hospitals working to ensure the highest standards of patient care, automated pharmacy compounding technology is an essential means of enhancing medication and H patient safety. ■ Dr. Niels Erik Hansen is president and CEO of Intelligent Hospital Systems in Winnipeg.
Photo courtesy of Intelligent Hospital Systems
RIVA automatically draws the correct amount of fluid from a vial. The system can process individual or batch doses.
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New fertility discoveries made at Mount Sinai Hospital By Leslie O’Leary nfertility affects 15 per cent of North American couples and is a tremendous strain on partners from an emotional, physical and financial perspective. Patients are looking for new treatments that will increase their chances of getting pregnant and researchers at Mount Sinai Hospital’s Centre for Fertility and Reproductive Health have a similar goal in mind – to improve patient success rates and patient satisfaction. Supported by Mount Sinai Hospital’s internationally acclaimed LunenfeldTanenbaum Research Institute, the Centre for Fertility and Reproductive Health is on the leading-edge of investigative research in the field of female and male fertility. Mount Sinai clinician-scientists have been at the forefront of some significant research breakthroughs including most recently, studying the relationship between vitamin D sufficiency/insufficiency as well as what genes are involved when a woman’s uterus will be most receptive to an embryo to achieve pregnancy. In a study recently published in CMAJ Open, Dr. Kimberly Liu looked at 173 patients who were all undergoing fertility treatments at the Centre and found that 54.9 per cent of patients were consid-
ered vitamin D insufficient/deficient and 45.1 per cent were considered vitamin D sufficient. The researchers then looked at the pregnancy success rates following embryo transfer and found that patients who were considered vitamin D sufficient had significantly higher pregnancy rates (52.5 per cent) than those women who were considered vitamin D insufficient/deficient (34.7 per cent). “We know that Canadians are prone to vitamin D insufficiency, especially during the winter months and this study shows that vitamin D supplementation could provide an easy and cost-effective means for improving pregnancy rates,” said Dr. Kimberly Liu, fertility specialist at Mount Sinai Hospital’s Centre for Fertility and Reproductive Health. “At Mount Sinai Hospital’s Centre for Fertility and Reproductive Health, we are always looking at ways to improve a patient’s success with fertility treatments and this study gives us an opportunity for further research so we can continue to help our patients.” In a new discovery published recently in the journal Fertility Sterility, Drs. Ellen Greenblatt, Ted Brown and Chrystal Chan have pinpointed which key genes are involved when a wom-
Led by Dr. Ellen Greenblatt (right), Mount Sinai Hospital’s Centre for Fertility and Reproductive Health is on the leading-edge of investigative research in the field of female and male fertility. an's uterus will be most receptive to an embryo to achieve pregnancy. Current methods to assess uterine receptivity—or the ability of a woman’s uterus to ‘accept’ a viable embryo—involve uterine biopsy, which is invasive and unable to accurately predict pregnancy. However, a new method developed by researchers at Mount Sinai assesses the uterus non-inva-
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sively by gently suctioning fluid from the uterine cavity, called fluid aspiration. This method has allowed researchers to uncover which genes are involved in uterine receptiveness and based on these new findings, researchers hope that the new biomarkers will potentially guide the development of clinical tests that can improve the success of IVF outcomes for patients. “The real strength of this approach is that it can be used in a cycle when a woman is trying to conceive, which, for the first time, will enable us to directly correlate candidate molecular markers with successful conception,” says Dr. Ellen Greenblatt, Medical Director, Mount Sinai Hospital’s Centre for Fertility and Reproductive Health. “It is our hope that this work will ultimately lead to improved success rates in IVF and in diagnosing underlying issues in infertility.” The Centre for Fertility and Reproductive Health offers the most advanced infrastructure in Canada in genetics, maternal fetal medicine, surgical and medical support disciplines. Patients of the Centre are supported by Mount Sinai's world renowned Women’s and Infants’ Health program, a Hospital-wide team specializing in the areas of genetics, maternal-fetal medicine, social work, nutrition and psychological counselling. The Centre is also known for its innovations in treating patients including being one of the first fertility clinics in Canada to offer fertility preservation options for cancer patients. To learn more about the Centre, please visit http://www. H mountsinai.on.ca/care/fertility. ■ Leslie O’Leary is the Senior Specialist, Media Relations and Public Affairs at Mount Sinai Hospital. www.hospitalnews.com
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Dr. Evan Wood receives 2013 Providence Health Care Research and Mission Award By Jennifer Lee r. Evan Wood, director of the Urban Health Research Initiative at the BC Centre for Excellence in HIV/AIDS based at St. Paul’s Hospital and professor of Medicine, Division of AIDS at the University of British Columbia, has been awarded the 2013 Providence Health Care Research and Mission Award. This award is presented annually by the Providence Health Care Research Institute (PHCRI) to a research scientist at Providence Health Care (PHC) who has made significant contributions to advancing research in our community and addressing current issues afflicting today’s society. This award also highlights PHC’s mission and values by seeking a candidate who demonstrates quality service to our patient population through compassionate care, teaching and research. Dr. Evan Wood leads an outstanding research program in addictions medicine research. In 2009, he founded the International Centre for Science in Drug Policy (ICSDP), which brings together scientists, academics and health practitioners from around the world to improve the health of communities and individuals affected by drug use. He was also one of the principal investigators of Insite, Canada’s first supervised injection facility. Dr. Wood created and co-directs the Urban Health Research
Dr. Evan Wood Initiative at the BC Centre for Excellence in HIV/AIDS that comprises a network of studies looking into the many factors affecting the health of urban populations. More recently, Dr. Wood was named Canada Research Chair in Inner City Medicine by the Government of Canada for his efforts in improving the treatment of addiction-related diseases and bringing awareness to the harm that drug and alcohol addiction has on public health.
This prestigious appointment is an opportunity to transform addiction treatment in British Columbia. Dr. Wood’s commitment to addictions medicine research and to the treatment of individuals with drug and alcohol addiction has been recognized beyond the life sciences and research community, having recently been selected as one of Business in Vancouver’s Top 40 under 40. Additionally, in 2011, Dr. Wood helped St. Paul’s
Hospital acquire a $3 million donation from Goldcorp Inc. towards a fellowship program to train physicians in addiction medicine. Dr. Wood’s colleagues described him as an outstanding teacher and mentor, who always shows genuine interest in his interactions with others. He has helped many young investigators find their place in the research community and has shed light on the importance of care for a population that is troubled by drug and alcohol addiction. The Research and Mission Awards have recognized leading scientists at Providence for the past eight years. Dr. Wood has led an outstanding career in his field of research, contributing to a diverse research landscape here at Providence and he is a strong role model of the high-standard of research that Providence is committed to. Congratulations to Dr. Wood on his achievements. The Research and Mission Award was presented at the annual PHCRI Research Day, an event that welcomed researchers, staff and coordinators at PHC to connect and learn about the latest research activity around our organization. For more information about PHCRI and our research scientists, please visit www. H providenceresearch.ca. ■ Jennifer Lee is a communications coordinator with the Providence Health Care Research Institute.
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Photo credit: Kevin Holm
The ultraviolet light in use disinfecting a patient room.
Toronto East General Hospital striving to combat hospital acquired infections By Lauren Ramsay n innovator in Ontario healthcare, Toronto East General Hospital (TEGH) is dedicated to developing effective health and safety procedures. Currently TEGH is at the forefront of
implementing leading practices to combat rising cases of hospital acquired Clostridium difficile (C. difficile) by introducing Clorox® Healthcare BleachBased Wipes to clean and disinfect the hospital environment and equipment. As part of the same initiative, TEGH is also conducting an ultraviolet (UV)
light trial to determine best practices in a hospital setting. In an effort to reduce the number of health care associated infections (HAIs), TEGH began a patient safety initiative in 2012 to bring a Sodium Hypochlorite product into the hospital. Recommended by the Public Health Agency of Canada for daily disinfection, Sodium Hypochlorite disinfectants contribute to successful management of common HAIs including Norovirus, VRE and C. difficile. Clorox® Wipes are effective against 47 pathogens and can kill C. difficile spores in three minutes.
“The cost to the hospital for a single patient contracting hospital acquired C. difficile is staggering; costs include medications, care provided, supplies, and room cleaning,” Cleaning products typically used in hospitals have been found to have a negative effect on equipment; corroding materials over time. Clorox® products have an anticorrosive agent that helps to ensure common hospital surfaces like plastic, stainless steel, porcelain and glass are not destroyed, giving them a longer life. Reduction in replacement costs over time free hospital resources to be directed towards valuable programs and services. “The cost to the hospital for a single patient contracting hospital acquired C. difficile is staggering; costs include medications, care provided, supplies, and room cleaning,” says Amanda Stagg, Infection Control Specialist at Toronto East General Hospital. “By shifting from a reactive to a proactive system we have created fewer opportunities for these bacteria to remain in the hospital, which helps to reduce strain on hospital resources.” Since introducing Clorox® Wipes, TEGH has reported a drop in cases HOSPITAL NEWS SEPTEMBER 2013
of hospital acquired C. difficile and in November of 2012, TEGH proudly reported zero cases in their facility. With increasing incidences of C. difficile in the community and other health care facilities, this marks an important moment in Canadian health care and a great success for TEGH. Using a two-phased plan, Clorox® Wipes were introduced into the hospital over a period of sixteen months. Strategic deployment through Environmental Services, education and flexibility were key factors in the success of the first stage. In the second stage, Clorox® Wipes were launched into care areas for equipment cleaning; using the familiarity developed during the initial phase coupled with continued education. As of summer 2013, Clorox® Wipes are used in all areas of the hospital, making TEGH one of very few hospitals to be using bleachbased products hospital-wide. Throughout the process TEGH provided learning materials, education sessions, information pamphlets and videos to all physicians, staff and volunteers to educate all on the benefits of using this product. The hospital accommodated individual concerns, and while this process presented with some challenges, the end result was seen as positive. To further reduce HAIs, TEGH is conducting a trial on UV light as an extra layer of disinfecting. The light, which takes approximately 15 minutes per room, kills 99.9 per cent of bacteria. Placed in the center of the room, UV light is cast onto walls, hard to reach places and surfaces that cannot be traditionally disinfected, providing a broader clean. Looking to the future, TEGH hopes to combine Clorox® Wipes and UV light to proactively disinfect all areas of the Hospital, helping to drastically reduce health care associated infections and continuing their commitment to excellent and safe H care for their patients. ■ Lauren Ramsay is a Corporate Communications Student at Toronto East General Hospital. www.hospitalnews.com
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Dr. Julio Montaner is the director of the British Columbia Centre for Excellence in HIV/AIDS at St. Pauls’ Hospital.
Province steps up measures to address Viral Hepatitis By Sarah Rapplinger model for HIV treatment and prevention developed by the British Columbia Centre for Excellence (BC-CfE) in HIV/AIDS at St. Paul’s Hospital may also be the key to changing the course of the
province’s hepatitis epidemics. In March, the government of British Columbia announced the creation of a $1.5-million fund through St. Paul’s Hospital Foundation, which will enable theBC-CfE to explore ways to better address hepatitis B and C.
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“With the support of the government of BC, we have led the way in the fight against HIV/AIDS. Now we hope to do the same with viral hepatitis,” said Dr. JulioMontaner, director, BC-CfE. “What we have done for HIV can and should be donefor other high burden diseases like hepatitis. We can take the infrastructurewe have developed under STOP HIV/ AIDS and apply that so we can deliver ahepatitis-free generation to our province.” Following the model pioneered by the BC-CfE, this project will focus on determining vulnerable individuals, identifying the best ways to prevent new infections and engage those at-risk or living with the diseases, and assessing the reach and effectiveness of new antiviral treatments. Viral hepatitis affects thousands of British Columbians, many of whom are unaware they even have the disease. The BC Centre for Disease Control estimates that approximately 80, 000 British Columbians are living with hepatitis C and 60, 000 are living with hepatitis B.
Both viruses infect the liver and can lead to permanent damage, including liver cancer and failure. In many cases, liver is severely damaged.
Both viruses infect the liver and can lead to permanent damage, including liver cancer and failure. In many cases, no symptoms appear until the person’s liver is severely damaged. “This funding will increase awareness and help us set up a province-wide strategy to combat these epidemics,” said Dr. Mel Krajden, medical director, hepatitis services, at BC Centre for Disease Control and professor of pathology and H laboratory medicine, UBC. ■ Sarah Rapplinger is a communications coordinator with the St. Paul’s Hospital Foundation in BC. www.hospitalnews.com
With MERS and company in our world, infection control must be a habit for us all By Kevin Reel ave you heard of MERS yet? If not, you likely will soon. The Middle East Respiratory Syndrome Novel Coronavirus (MERS-nCoV) was in the news over the last year as the number of people across the globe affected by it slowly grows. At the time of writing, there have been fewer than 100 cases worldwide, with about half of those causing death. It is a virus that has some similarities to SARS. The World Health Organization (WHO) stated in mid-July that while MERS was a great concern, it is not an international public health emergency. Not yet, and perhaps not ever. The CBC recently reported on a study that found there are important differences between MERS and SARS that mean it is, presently, unlikely to spread as easily as SARS did. Things may change; mutations happen. There is also another virus lurking in the world, the H7N9 influenza virus, presenting the possibility of becoming a much bigger problem than it has been so far. And new viruses can become a worry at any time, as did H1N1 a few years ago. In the end, these sorts of health concerns illustrate our communal responsibility for infection prevention and control. All hospitals are constantly dealing with many potential â€˜superbugsâ€™ â€“ such as MRSA, VRE, and C. diff. â€“ and all of us
must observe the precautions to help prevent spreading them. It is not always easy to keep vigilant about something that we canâ€™t see or hear â€“ these little bugs that bring particularly dangerous consequences to patients in hospital who are not otherwise healthy. But donning those annoying gowns, the awkward gloves and even uncomfortable masks is a mustâ€Śethically and clinically.
The habits we form now will help protect us during the next inevitable winter flu season, due in the next few months. These habits do save livesâ€Ś The nurturing of good habits around more common bugs will only serve us well if others like MERS or H7N9 become bigger problems. When we are automatically observing good infection prevention habits we are poised well to respond to those truly scary viruses. This always seems somewhat akin to safe driving practices. Keeping a â€˜two secondâ€™ distance from the car in front of you, limiting even (hands-free!) cell phone use and, of course, not drinking and driving â€“ these are as simple and straightforward as washing your hands and donning a gown
and/or a mask. The trouble is, if you take a risk and decide everything ended up just fine, you develop a false sense of security that your shortcut â€“ your shortcoming â€“ is acceptable. You experience a bit of luck â€“ there may have been no accident when you drove after you took liberties. Until, of course, your luck runs out and there is an accident of your doing. Or there is an outbreak of MRSA or C. difficile because of the risks you chose to take. The reasons why it is â€˜goodâ€™ and â€˜rightâ€™ to wash your hands regularly apply at all times and in all places â€“ just like the reasons to refrain from texting while driving or from drinking and driving hold true always and everywhere. In all these cases, we might make a judgement for ourselves that the risk is acceptableâ€Śbut we have not asked the others we are also putting at risk. Managing risk is much easier with good information, and keeping informed of global health concerns is really too simple to overlook. Whether you are planning international travel or just wanting to be aware of what is happening, it takes little time to check the WHO website for the latest information. For Ethicists, the prospect of a serious pandemic raises highly controversial issues of deciding who gets scarce healthcare resources like ventilators or ICU beds or vaccines, if they end up being in short supply. The film â€˜Contagionâ€™ explores these possi-
bilities in a very engaging drama based on the SARS experience. Happily, there is rarely a shortage of hand soap or sanitizer or other essentials of infection prevention and control, including winter flu vaccinesâ€Śbut there is a shortage of the habits around using them. Again, the ethical issue revolves around the risks you take when your actions or inactions put others are at risk, too. There are usually only very minimal risks associated with the flu vaccine; but the same cannot be said for the risks posed by the flu we might pass on to many of those for whom we care. Vaccination ought to be a habit for most of us, just like routinely washing our hands. (For more on the ethics of vaccination at work, see Jonathan Breslinâ€™s November 2012 column at http:// www.hospitalnews.com/.) The habits we form now will help protect us during the next inevitable winter flu season, due in the next few months. These habits do save livesâ€Śnow â€Śand will save even more when some more deadly infecH tious threat fully develops in the future. â– Kevin Reel is the clinical and organizational ethicist at Mackenzie Health and Southlake Regional Health Centre, a registered occupational therapist and a member of the Joint Centre for Bioethics where he codirects a course on the MHSc bioethics program.
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with the Association of Canadian Academic Healthcare Organizations (ACAHO) and the Health Charities Coalition of Canada (HCCC). By Tina Saryeddine rom the discovery of genes that cause disease to the development of new treatments and new policies and practices that improve our health, Canada's Health Charities and Academic Healthcare Organizations partner for success in health research to the benefit of the health and health systems of Canadians. In a first-of-its kind joint publication, the Association of Canadian Academic Healthcare Organizations (ACAHO) and the Health Charities Coalition of Canada (HCCC), examine a selection of partnerships between their member organizations and how these partnerships contribute to our collective health and well-being. The full report can be found on their respective websites. We sat down for a Q&A with the two organizations about how health charities
and academic healthcare organizations partner for success in health research: Why did ACAHO and HCCC partner on this celebrations report? Members of ACAHO and HCCC have a well-kept but unintended secret – thousands of successful partnerships in health research and applied innovation. Our goal is to help share this secret so that a growing number of Canadians, have a clear sense of how academic healthcare organizations and health charities work together to improve the health of Canadians and the health care they receive. What is a Health Charity? Health Charities are charitable organizations that often focus on a particular illness or organ system. They envision: (1) the complete eradication of a disease; (2)
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finding a cure for a disease; (3) improving quality of life for individuals with a particular disease or condition and/or (4) supporting families, friends and caregivers of individuals with acute and/or chronic diseases. They fund research and applied health innovation, provide education and influence policy development, implementation and evaluation. What is an Academic Healthcare Organization? Academic Healthcare Organizations are research hospitals and academic regional health authorities that do three things: (1) they provide complex and advanced care; (2) they engage in leading edge research for new treatments and practices that directly benefit patients and all Canadians; and (3) they educate and train tomorrow’s health care professionals. Why do ACAHO and HCCC members partner in Research? Members of ACAHO & HCCC bring funds, focus, patients, clinicians and researchers together to support people and families at risk of, or coping with, disease or disability. This improves care, treatment, quality of life, and enables access to leading-edge treatments and world-class equipment and facilities. How do Canada's Health Charities & Academic Healthcare Organizations contribute to advancing knowledge and treating disease? In the case studies that we looked at in this celebrations project, we noted that the research projects are (1) helping to discover genes that cause disease; (2) understanding the way disease works; (3) developing and testing potential therapies; (4) applying research and innovation in patient care; (5) changing operating policies and clinical practices; and (6) building expertise by training clinician scientists who blend research and care. However, it should be noted that the focus here is only on the case studies in this report. Other important types of research are also conducted by both health charities and academic healthcare organizations.
How many lives can be impacted by specific research partnerships? The report identifies research undertaken in 12 disease specific areas, where the health of over 17 million Canadians is affected, and over 121, 000 die each year. What factors do researchers say are needed to achieve success? Many factors affect research success, but common ones in the partnerships examined consistently included: (1) Proximity of research to patients and families and its integration in patient care (2) The ability to work in networks, with mentors, and inter disciplinary teams (3) Funding to cover salaries, operations and access to latest equipment and facilities. What are a few examples of what we have collectively achieved? There are many examples that we could give, but here are a few from the case studies examined in this initiative, •We improved survival rates after heart attacks by demonstrating the impact of CPR •We tested a potential drug for ALS and developed a process to test others •We found a way to slow liver cancer so that treatment can have a chance to work •We found a gene that when replaced helps some individuals to regain their sight. •We enabled advanced training of a clinician researcher for Parkinson’s disease •We provided evidence resulting in adding exercise to the guideline for diabetes care •We showed how engaging Lupus patients in the care process can reduce side effects •We identified factors that would affect, treat, or help prevent Irritable Bowel H Syndrome. ■ Tina Saryeddine is Assistant Vice President Research & Policy Analysis, Association of Canadian Academic Healthcare Organizations. www.hospitalnews.com
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Why do we wait for health care? Our health care system may be set up to make us wait, but innovative practices and solutions are making a difference in reducing wait times and improving patient safety and care. By Ari Grief ait times create a heavy burden on Canadian patients, caregivers, employers and the economy through worsening of medical conditions, lost productivity and revenues, and other effects. In fact, Canadian physicians say that only 47 per cent of their patients can get a same-day or next-day appointment when requested. However, in recent years positive steps have been taken in different parts of our country to reduce wait times, some of which are excellent examples of innovative practices that the Health Council features on our Health Innovation Portal to promote adoption as similar challenges exist across the country.
With the pan-Canadian video series â€œInnovations in Reducing Wait Timesâ€? our goal is to make a positive impact in reducing wait times for patients, by promoting the spread and adoption of these and additional innovative practices in other health care settings. We launched the first two videos
in the series in June. Our first video showcases the Burntwood Community Health Resource Centre (BCHRC) in Thompson, Manitoba and looks at their success story in Advanced Access for the primary health setting. Serving a regional population of approximately 45, 000 in the Northern Health Region
of Manitoba, the Burntwood Community Health Resource Centre opened in 2000 but was immediately plagued by an overwhelming number of complaints from community members due to extremely long waits for appointments. Continued on page 34
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Using social media to empower people with arthritis By Rachael Ogorek
nline social networking sites such as Facebook are used for individuals and organizations to connect with others, share photos and videos, as well as provide status updates by posting to a profile page. Can they also be used as a tool to implement a health care education program? A group of researchers, including Dr. Lucie Brosseau, School of Rehabilitation Sciences, University of Ottawa, and Dr. Sydney Brooks, Director of Research, The Arthritis Society, Ontario Division, completed a study to answer this very question. The study, entitled: People getting a grip on arthritis II: An innovative strategy to
implement clinical practice guidelines for rheumatoid arthritis and osteoarthritis patients through Facebook, set out to determine if an updated online evidence-based educational program delivered through Facebook was effective in improving the knowledge, skills, and self-efficacy of patients with arthritis (osteoarthritis OA - and rheumatoid arthritis - RA) in relation to evidence-based self-management rehabilitation strategies. The study included 110 participants over 18 with self-reported OA or RA. Eleven participants were part of a focus group that would choose effective selfmanagement strategies for OA and RA for posting on Facebook. The other 99 were part of the online Facebook study, which featured case-based video clips on the
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self-management strategies and how to apply them. “Since this was a new approach to patient education, I wasn’t sure what to expect, but I was hopeful we might reach a new group of people who were comfortable using technology to participate in arthritis research and education,” says Dr. Brooks.
Our positive results support the use of social media as a knowledge transfer and education tool, even among an older population It turns out many arthritis sufferers were interested in participating in the study. “Our biggest surprise was the ease in recruitment,” adds Dr. Brooks. “Once the study was advertised on The Arthritis Society website, we reached our required sample size quickly.” Over a three-month period, all participants were asked to complete three online questionnaires regarding their previous knowledge, intention to actually use the self-management strategies and confidence level in the self-management of their arthritis. Ultimately, a goal of the research team was to discover after the study that using Facebook would be an effective, low-cost solution to providing people with arthritis across the country with information about self-management strategies. The first focus groups watched a two-hour presentation describing the self-management strategies. The group then engaged in discussions and ranked each strategy according to the relevance and practicality. The online study participants received a brief tutorial on how to use the Face-
book page to complete the online questionnaires.They logged in to the Facebook group pages to view the uploaded YouTube videos describing the arthritis self-management strategies. The videos were only posted after participants had completed the first questionnaire regarding previous knowledge. Once the videos were viewed, participants could communicate with one another via the ‘wall’ and ‘comment’ tools available and complete the other two online questionnaires (intention to use strategies and confidence level). In the end, the research team was happy with the results. Immediately after the online study, 41 participants with OA had improved knowledge on the topic of arthritis self-management strategies, while 22 participants with RA had improved knowledge. Eighty-three per cent of participants with OA and 74 per cent of participants with RA intended to use at least one of the arthritis self-management strategies following the study. Some of these strategies included aquatic therapy, strengthening exercises of the hand and weight management. “Our positive results support the use of social media as a knowledge transfer and education tool, even among an older population,” says Dr. Brooks. “Facebook was a successful tool for recruiting research participants and disseminating evidencebased self-management strategies to people living with arthritis. This low-cost intervention allowed people with arthritis from across Canada to learn about evidence-based self-management strategies in the privacy and comfort of their own home,” she adds. Not only can the participants continue to use the videos on Facebook as a learning tool, they can share this information with others who suffer from arthritis. For more information about The Arthritis Society’s research activities, visit H www.arthritis.ca/research. ■ Rachael Ogorek is a Specialist in Marketing and Communications at The Arthritis Society in Ontario. www.hospitalnews.com
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Trillium Health Partners sees reduction in C.difficile rates with simple step for patients By Catherine Pringle
ash your hands before you eat. The simple, sage advice your mother taught you as a child is having a significant impact on hand hygiene at Trillium Health Partners in an effort to combat the spread of infectious diseases such as Clostridium difficile (C.difficile) among patients. C.difficile, bacteria that causes mild to severe diarrhea and intestinal conditions is the most frequent cause of infectious diarrhea in Canadian hospitals. In the interest of improving patient care and safety, hospitals are constantly looking for ways to prevent the spread of the bacteria. The Corporate Services team at Trillium Health Partners worked closely with the Infection Prevention and Control (IPAC) staff to come up with the idea to promote patient hand washing before each meal. The idea came to them while brainstorming ways to curb the spread of hospital infections like C. difficile within the hospital. Despite the cleanliness of the facilities and the diligence of the staff when it came to good hand hygiene, patients were still coming into contact with the bacteria. The answer lay in the patients’ hands.
“We are committed to providing our patients with the best possible care and we believe that this program is part of achieving that goal.” The hand washing program has not only had an impact on patient care and C. difficile
rates, it has also had an effect on Environmental Service and Food Service staff. “Our staff understand the importance of this initiative, not only in helping to reduce C. difficile rates but also in improving health outcomes and the
overall patient experience,” said Carol Steffler, H Resource and Nutrition Service Manager. ■ Catherine Pringle is Senior Communications Advisor at Trillium Health Partners.
“No doubt about it. A permanent spinal cord injury will depress you... but you have to work through it and realize that life goes on and still has a lot of wonderful surprises for you.” – Frank Nunnaro
This simple solution is helping to ensure the increased safety of Trillium Health Partners' patients “The C.difficile bacteria have to be ingested,” said Pam Siddall, IPAC Manager. “It just made sense to us that if we work in partnership with the Environmental and Food Services teams to promote good hand hygiene before every meal that it could really make a difference for our patients.” Every day staff offer patients the use of a Wet Ones towelette or a packaged wipe prior to giving them their meal. The use of this towelette or wipe helps rid patients’ hands of bacteria before they eat. Corporate Services was pleasantly surprised with the compliance of the hand washing program amongst patients. “Patients appreciate it,” said Ingrid McKee, Manager, Environmental Services. “Some of our patients are unable to get out of bed and clean their hands before a meal. This program is adding to their quality of care by enabling them to do that simple but important task before they eat.” Trillium Health Partners has seen some incredibly positive results since first implementing the program. There has been a significant decrease in the hospital’s C.difficile Infection (CDI) rate, as well as a dramatic increase in patient hand hygiene compliance as a result of adding this hand washing step. This simple solution is helping to ensure the increased safety of Trillium Health Partners’ patients. “This is an extremely important program,” said Marianita Lampitoc, Manager, IPAC. www.hospitalnews.com
Frank Nunnaro is a regular guy with a real talent for barbecue cooking. He was a produce manager at an Orillia IGA when he had a terrible car accident that damaged his spinal cord and left him a paraplegic. After intensive rehabilitation at Lyndhurst Hospital, and with the loving help from his wife Vicky, Frank has gone on to become one of the great BBQ hosts of the century. Every year in the middle of the summer, Frank and Vicky host an amazing barbeque party at their Wasaga Beach home. Frank likes to think of it as a real celebration of life. We like to think of it as a testimony to the human spirit. We are honoured to have represented Frank Nunnaro in his lawsuit and to count Frank as a friend and one of the many everyday heroes we have been able to help.
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Hospitals must protect health personal information through encryption Raising the bar on patient safety and security measures By Dr. Ann Cavoukian s portable storage devices become more prevalent in the health care sector, so do concerns regarding the privacy and security of personal health information. Though convenient, these devices are at great risk of being misplaced or stolen. The loss or theft of unencrypted mobile computing devices or storage media remains one of the main causes of privacy breaches in the health care sector. As Ontario’s Information and Privacy Commissioner, I have had to investigate a number of unfortunate cases of lost information in the health care sector which could have been avoided by implementing proactive and preventive measures. Hospitals need to ensure strong data security and protection of health information, as the potential for privacy breaches can be both costly and cause lasting damage to an organization’s reputation. Most important, this represents a major violation of a patient’s privacy. Every health care facility must take as much responsibility for the care of their patient’s health information as they do for the patient themselves. Toronto’s Sunnybrook Health Sciences Centre, with 1.2 million patient visits each year, has established itself as the largest single-site hospital in Canada. Sunnybrook’s information assets are vulnerable to loss or theft, like all health-care institutions, including risks to the confidentiality of personal health information patients. The solution to this challenge, which Sunnybrook has adopted, is based on the Privacy by Design (PbD) principle of “End-
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to-End Security.” By applying this principle proactively and systematically, Sunnybrook created an “encryption by default” policy for all of its portable storage devices. The long term benefits cannot be overestimated – we know from the academic literature that the default rules! Taking these steps provides a doubly-enabling, positive-sum outcome, which benefits both patients and caregivers. The task of encrypting numerous portable devices is not always easy to ensure, in such a large and dynamic operating environment. However, Sunnybrook has shown its leadership in privacy and security practices by understanding the message that health care can benefit directly from improvements in security technologies and access to information, without significant user or institutional burden. “Electronic health information improves the quality of health care by enabling informed decision-making wherever the information is needed, but mobile devices have to be kept safe,” commented Sam Marafioti, Vice President Development and Corporate Strategy and Chief Information Officer, Sunnybrook Health Sciences Centre. “At Sunnybrook, encryption technology is mandatory for all portable storage devices to ensure that personal health information is kept safe and secure wherever these devices go, allowing our health care teams to do what they do best: care for patients.”
While the encryption of end-point devices may not be a new idea, the need for seamless access in high-availability environments is growing and means that deployment and support considerations are now major factors when evaluating solutions. Regardless of how these technologies are deployed in operation, taking a Privacy by Design approach and mandating encryption by default will go a long way towards meeting the challenges of securing an organization’s expanding perimeters, as well as achieving compliance and trust objectives. To provide an example of how personal health information can be protected, I recently released a paper introducing the “Circles of Trust” concept in partnership with Toronto’s Sunnybrook Health Sciences Centre and CryptoMill Technologies. The concept refers to the mobile encryption deployment scenarios and role-based access that enables the free flow of personal health information among authorized health-care providers, while at the same time, ensuring that the information remains encrypted and inaccessible to everyone else. To find out more about this concept and its adoption, I invite you to download, Encryption by Default and Circles of Trust: Strategies to Secure Personal Information in High-Availability Environments, from www.ipc.on.ca. Hospitals are now benefitting, and can benefit further, from
Dr. Ann Cavoukian is Ontario’s Information and Privacy Commissioner. improvements in security technologies which enable the delivery of privacy for patients, while granting appropriate access to information where and when it is needed, without significant user or institutional burden. No matter what the size of your hospital, the message is the same: secure your perimeter and end-points against unauthorized access – encrypt by H default! ■ Dr. Ann Cavoukian is Ontario’s Information and Privacy Commissioner.
Performance rounds boost quality improvement and communication at Sunnybrook By Marie Sanderson unnybrook’s Schulich Heart Centre is continuously looking for ways to improve quality of care and patient safety. A recent initiative involves instituting performance rounds every two weeks for cardiac surgery cases. The performance rounds are open forums attended by heart team staff from all clinical and administrative areas, and also draw on expertise from other areas such as patient flow, critical care, and infection prevention and control as needed. “Staff are really engaged, it’s a safe environment for addressing ongoing and new issues,” says Pam Meyer, Patient Care Manager of Sunnybrook’s Cardiovascular Intensive Care Unit. “Everyone is welcome to speak up, the meetings are perceived as an opportunity to highlight problems, find solutions and celebrate successes.”
Every heart surgery case is reviewed using a simple visual template that follows each patient’s progress from the time the decision to operate is made through to discharge from the hospital to either home or rehabilitation care. Close monitoring of every case is essential in identifying whether quality indicators have been met. “The template is designed to be very visual, with green conveying that we’re meeting our benchmark, and red meaning we’re not,” explains Pam Meyer. “It’s a snapshot of the patient’s timeline and a great starting point for discussing both quality of care and efficiency.” “Some staff were initially surprised that we were reviewing every surgical case, not just the difficult ones,” says Dr. LaFlamme, Medical Director of Cardiac Anaesthesia. “The attention to each case has allowed us to touch on so many different aspects of care.
For example, a recent discussion around VRE and MRSA prompted us to contact Infection Prevention and Control, who were able to respond with a solution. Communication within the heart team, and also with other hospital groups, has improved as a result.” The performance rounds have provided a collaborative opportunity for continuous quality improvement for cardiac surgery at the Schulich Heart Centre. “This is such a collaborative effort, it’s not one or two people giving information, everyone is sharing information and participating in questions and answers. And if we don’t know the answer, we’ll find out and close the loop,” adds H Dr. LaFlamme. ■
Marie Sanderson is a Senior Communications Advisor at Sunnybrook Health Sciences Centre.
www.algonquinacademy.com HOSPITAL NEWS SEPTEMBER 2013
PATIENT SAFETY/RESEARCH/INFECTION CONTROL
Recent study shows most men with
prostate cancer die with the disease rather than from it By Sandeep Dhaliwal new international study led by researchers at Mount Sinai Hospital, published recently in the Journal of the National Cancer Institute, shows that close to 50 per cent of the men studied posthumously harboured prostate cancer over the age of 60, but had died of other causes. The study provides further evidence that a large proportion of prostate cancer tumours are not destined to become life-threatening. Led by Dr. Alexandre Zlotta, Director of Uro-Oncology at Mount Sinai Hospital’s Murray Koffler Urologic Wellness Centre, a scientist with Mount Sinai’s Lunenfeld-Tanenbaum Research Institute and Professor of Surgery at the University of Toronto, the new study advocates for an improved screening method that can detect cancers based on their clinical significance and level of aggressiveness, rather than screening for all forms of this disease. The current widespread use of prostate-specific antigen (PSA) testing in North America for the disease increases the likelihood of the over-detection of low-risk prostate cancers, which can potentially lead to unnecessary treatment that may result in major lifestyle and emotional side effects for patients. “The study emphasizes the importance of understanding how many men in North America over a certain age harbour the latent form of prostate cancer, as this population is often over-diagnosed and over-treated,” says Dr. Alexandre Zlotta. “But our study shows that in Japan, despite completely different lifestyles, despite a much lower incidence of clinically detected prostate cancer, and a much lower mortality rate due to prostate cancer compared to men in North America, Asian men have similar prevalence of the disease – but they aren’t dying from it.” In the study, researchers studied autopsied Caucasian men in Russia, who share environmental characteristics with North American men, such as reduced sun exposure and a high-fat diet, both of which have been implicated in increased risk for prostate cancer. At the same time, the study also looked at autopsied Asian men in Japan, because the incidence of prostate cancer is much lower in Japan than in North America. Japanese Asian men typically have a lower death rate from prostate cancer as well as a very different diet from North American men. And contrary to North America, there is no widespread PSA screening in either Russia or Japan. By studying these two distinct populations, the research team showed that despite the differences in incidence and mortality rates, and in genetics and life-
style factors, the prevalence of prostate cancer was similar in both Caucasian and Asian men. In fact, the disease was even more aggressive in Asians. A subset of the autopsied prostates presented with tumor characteristics physicians would usually recommend treatment for, such as surgery or radiation, but these men had actually died of causes other than prostate cancer.
The study emphasizes the importance of understanding how many men in North America over a certain age harbour the latent form of prostate cancer as this population is often over-diagnosed and over-treated In light of this data, the study suggests that the progression of early prostate cancer, including more aggressive forms of the disease, is far from inevitable within a man's lifetime. The study concludes that it is worth re-examining our current definitions of clinically unimportant and clinically significant prostate cancer. The study’s findings also support efforts toward a better understanding of the biology of prostate cancer.
Dr. Alexandre Zlotta was lead researcher in a study on prostate cancer that showed that a large proportion of tumours will not become life-threatening. Dr. Zlotta, who is also on staff at the University Health Network, collaborated on the study with Dr. Theodorus Van der Kwast, a pathologist at the University Health Network, along with researchers at Sunnybrook Health Sciences Centre, and scientists in Tokyo and
At some point, everyone can use a hand.
Moscow. The study was supported by grants from Prostate Cancer Canada and H GlaxoSmithKline. ■ Sandeep Dhaliwal is the Communications Specialist for the Lunenfeld-Tanenbaum Research Institute.
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SEPTEMBER 2013 HOSPITAL NEWS
PATIENT SAFETY/RESEARCH/INFECTION CONTROL
Bridging the gap between research and practice By Jeff Latimer, PhD
anada has rightfully earned a reputation around the world for excellence in health research. But is health research evidence making its way to the bedside? Currently, 50 per cent of patients do not get treatments of proven effectiveness and up to 25 per cent get care that is not
needed â€“ or potentially harmful. This care is also expensive. Between 2000 and 2010, public spending on health care increased by seven per cent per year. Canadian health providers want to ensure they are using the best possible evidence to make informed choices about care for patients. At the same time, Canadian patients want to participate in the management of their own health, contributing to discussions involving
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HOSPITAL NEWS SEPTEMBER 2013
care decisions, and providing input into research priorities. Canadaâ€™s Strategy for Patient-Oriented Research (SPOR) was created to respond to this need to better integrate research into care. SPOR is a national coalition of federal, provincial and territorial partners (patient advocates, provincial health authorities, academic health centres, charities, philanthropic organizations, pharmaceutical sector, etc.) dedicated to ensuring that the right patient receives the right treatment at the right time. Patient-oriented research focuses on patient-identified priorities. It produces information for decision makers and health care providers that will improve health care practices, therapies, and policies. It ensures that new and innovative diagnostic and therapeutic approaches are applied when and where needed. For Canadaâ€™s health providers, this means they are able to easily access timely and relevant evidence and integrate this evidence into care decisions. For Canadaâ€™s patients, it means they are active, informed, and motivated participants in their own care and have opportunities to define research priorities. How does patient-oriented research work in practical terms? A great example comes from a recent study of neonatal intensive care units. The study was called the EPIQ (Evidence-based Practice for Improving Quality) Project. It began as a pilot project in 12 sites, outlining new practices for care. This was followed by a national scale-up of the new practices, implemented in 30 hospitals and 17 universities across Canada. Doctors and nurses know that babies born prematurely face many risks as they begin life. Great care must be taken by hospital staff when treating these most fragile patients. However, researchers found that there were large variations in the care provided by Canadaâ€™s hospitals â€“ and large discrepancies in the resulting health and wellbeing of the babies. Using the principles of patient-oriented research, a national network was created that allowed hospitals to work together and learn the best practices for caring for premature babies.
For example, hospitals that had low infection rates would demonstrate to other hospitals the best techniques for reducing infections. Emphasis was also placed on directly involving parents in the patient care, as research has shown that premature babies thrive when they are held and nurtured by their parents. In the end, this patient-oriented approach resulted in saved lives, healthier babies, and cost savings: â€˘Decreased infection rates (by 32%) â€˘Decreased chronic lung disease (by 15%); â€˘Average reduction in length of NICU stay: 2 days; â€˘Cost savings to Canadian NICUs: $7 million annually. This is just one example of how patientoriented research is bridging the gap between research evidence and health care practice. It provides health professionals with the very best policies, practices, and therapies. Most importantly, it enhances the health care experience for patients and improves health outcomes for Canadians. Patient-oriented research also provides economic benefits by optimizing spending on health care systems, reinvesting resources where the evidence shows that these can have greatest impact, and attracting private investments in evaluative research. In addition, it drives innovation in patient-centred care, in such areas as ehealth, implementation science, and clinical practice. Canadaâ€™s Strategy for Patient-Oriented Research (SPOR) is an exciting new approach to health research. It is a new way of doing business that shifts the focus from a researcher-driven agenda to a patientdriven agenda. Through SPOR, the Government of Canada and the provinces and territories are working in collaboration with partners and stakeholders. Together, they are learning from one another and translating best practices into patient-centred care across Canada â€“ for the benefit of H all Canadians. â–
Dr. Jeff Latimer is the Director of Platforms and Major Initiatives, at the Canadian Institutes of Health Research. To learn more about SPOR, visit www.cihr-irsc.gc.ca/spor.html. www.hospitalnews.com
Care Giving 21
on aging and eldercare in the family here this month By Bart Mindszenthy
leven years ago, Dr. Michael Gordon, Canada’s leading geriatrician and then head of geriatrics and internal medicine at Toronto’s world-renowned Baycrest Centre for Geriatric Care and I had the first of our Parenting Your Parents book series published in Canada. We were way ahead of the curve with the book; the issues around aging and eldercare in the family just weren’t on people’s agenda, or even in most cases on their radar. Our second co-authored edition of the book appeared in 2004, which pushed it into the best-sellers category, and then an American version followed in 2005. In bookstores across Canada and the United States on September 21st is what’s officially called the third edition of the Parenting Your Parents book series, titled Parenting Your Parents: Straight Talk about Aging in the Family published again by Dundurn Press.
So what’s so important or pressing about aging in the family? For one thing, it’s a familial and societal reality. Demographics are demonstrating that beyond a doubt, an ever-larger percentage of our population is nearing and exceeding the age of 65. And an amazing number of them still have at least one parent and often two living parents who are in their 80s or even their 90s. At the same time, the actual cases of Alzheimer’s and other forms of dementia are soaring across North America and globally among those aging parents, meaning that we’re facing potentially more difficult challenges on the near horizon. And those in the 45-65 age range are most vulnerable to the consequences of aging parents while aging themselves. Few make plans. Various research shows that more than three-quarters of those with aging parents have ever sat down with them to understand their latter life wishes and build plans to achieve those wishes. And as a rule, they haven’t created an inventory of critical information regarding bank accounts, insurance policies, retirement funds, and the like. So not if, but when, something goes wrong with either parent’s health, there’s more often than not nothing in place to www.hospitalnews.com
help things move ahead as smoothly and flawlessly as possible.
What we need to know
Our new book offers 24 case histories that range from early elder issues, like hip replacement, to later issues like dementia, nursing home conflicts and eventually death in the family. Each case history has its own geriatrician’s viewpoint of what the family might want to consider doing in the specific situation being presented, with options and implications. What Michael and I have observed over the years is that families with aging parents and other loved ones in fact need to know more about what kind of issues and challenges they’ll probably have to face and then, what to consider and what to do. However, that’s something most families opt not to do. As I like to remind people, our aging parents are in denial and their boomer kids are in avoidance. Every family and its dynamic is different and so likely will be the outcomes. But the core issues are usually similar enough that readers can learn from the case studies offered in the new Parenting Your Parents.
Facing the facts
Aging in families is real; it’s happening across Canada, the United States, and around the world. Our aging parents and other loved ones seek our support, actively or often passively. We know it, feel it, and truth be told, often just don’t know what to do or how to do it best. Visit us at www.parentingyourparents.ca It’s never easy, but it’s always possible if H we plan ahead and put our minds to it. ■
Bart Mindszenthy, APR, FCPRS, LM, is co-author of the Parenting Your Parents series of books; to read more, visit www. parentingyourparents.ca. He is a best-selling author on the issues and challenges of caregiving in the family as well as other topics; see www.famliyeldercareworkbook.ca. His column on caregiving appears quarterly in Hospital News.
Vulnerability index resources
Unique to this edition of the book is a Vulnerability Index that asks the reader to score a series of specific statements about the current state of either parent. The total scores lead to a guide as to where one’s parents may be at the moment in terms of their vulnerabilities and what actions might be considered. The goal of the Vulnerability Index is to help readers determine what they should be doing with and for their parents right now. As well, there is a financial planning section that addresses both Canadian and American financial planning issues and challenges for aging parents. It explores everything from the status of banking accounts and insurance policies to RRSPs to RIFs and beyond. There also is a fulsome Resources Directory that covers both Canada and the United States in terms of helpful major organizations providing services across the spectrum of needs of aging loved ones.
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SEPTEMBER 2013 HOSPITAL NEWS
22 From the CEO's Desk
Introducing Bridgepoint Active Healthcare By Marian Walsh
t Bridgepoint, our focus is on transforming the lives of people with the most complex health conditions. This year we achieved a tremendous milestone in achieving that goal, with the completion of our brand new state-of-the-art hospital, and the introduction of our active healthcare model. Our approach is called active healthcare, because patients themselves – and their families – play the central role in defining and achieving their own care goals. Patients don’t live their lives in hospitals, and most of the events that lead to complex conditions don’t happen in hospitals, so active healthcare takes a sustained and lifelong view, that doesn’t begin and end with treatment. And active healthcare is based on an integrated and customized solution for each patient, drawing on an inter-disciplinary team that extends beyond our own walls, and addressing all the factors that contribute to the patient’s overall health. The opening of our new hospital represents a critical step in delivering on our active healthcare approach. And strange as it may sound, it is a milestone in helping us to become more than a hospital. In designing and developing the new Bridgepoint, we challenged the most basic assumptions about what a hospital should be and what role it should play in healthcare. It doesn’t look or feel like a hospital because we don’t think like a hospital. The highest compliment we’ve received was from a patient who told us “this is the hospital I would have designed.” Nothing in our new building is ornamental or accidental. From the floor to ceiling windows, which connect patients to the community and inspire health and healing, to the rehabilitation spaces on every floor that accelerate each person’s HOSPITAL NEWS SEPTEMBER 2013
functional improvement, it is designed to enable restorative care for real life in real time, and to support our patients’ return to the community. The design of the new Bridgepoint Hospital, and its cutting-edge innovations, motivate and inspire our patients to be as active as possible even during an inpatient stay. We sometimes say that our new hospital has 404 beds, and a thousand ways to make sure patients spend as little time in them as possible.
We sometimes say that our new hospital has 404 beds, and a thousand ways to make sure patients spend as little time in them as possible Whether it’s our therapeutic pool; our calming labyrinth; our internet café; our community gathering spaces, our patient auditorium and roof-top garden, we have destinations everywhere. They call people out of bed and get them back to active living, through engagement in real life at Bridgepoint. At the same time, we have re-focused our hospital to be a centre of innovation in clinical care and knowledge development for complex patients and their caregivers. As the foundation for this, we established the first Research Collaboratory in the field of complexity. We started by building a deep understanding of who these complex patients are, why they are complex, and what we need to do to improve the health care value proposition for these patients. These findings underpin our new approach to care delivery. Because we know that the most com-
plex patients are those most likely to be let down by poor transitions, the care we provide for patients who need a stay in our unique, state-of-the-art hospital, will be seamlessly integrated with the care they receive when they go home. Within the hospital we are about to offer new community resources, like a day hospital and complexity clinics, to give complex patients care that was never before available without a hospital stay, while enabling them to live at home. Our hospital of the future is becoming a community resource and hub for complex patients. For most patients, a family doctor is the gateway to the health system, and the best way to ensure integrated care. But for the most complex patients, no family doctor can do that job alone. The core of our new model of care recognizes that accountability and integration must be provided by a primary care provider, but in partnership with a larger, more capable organization like Bridgepoint. Our own Bridgepoint Family Health Team serves as a model of the role that primary care can play in treating and preventing complexity; we are working with our community partners and with the new Health Links initiative to put our new model into practice more broadly. Bridgepoint’s mission is rooted in the recognition that we are at the beginning of a new era in healthcare. When we look at our patients, we see that many of their lives were saved by the phenomenal success of our acute healthcare system. That is terrific news! And our system is getting so good that the number of these patients is growing exponentially. But we also know that these patients – people living with complex conditions after their lives have been saved – have not historically gotten the care they need: To regain their mobility; To return to the community; To live life well. This next generation of patients need
Marion Walsh something different. Not just because one per cent of the patients in the system use a third of the resources, and five per cent of the patients use two thirds. But because the complex patients we see every day are the face of “the 1%”, for too long our system quite frankly did not know how to care for them. After 15 years of developing solutions for complex patients, 2013 is a milestone year for everyone at Bridgepoint, from staff and patients to our community and neighbours. On Sunday April 14th we moved out of our old hospital. With military-like precision we executed a plan that was in the works for over a year, and in just under eight hours we moved over 350 patients and thousands of pieces of furniture and medical equipment into our new hospital. The distance between the two buildings was less than forty metres, but for the patients, it’s a world apart. For more information about Bridgepoint, visit our website at http://www. H bridgepointhealth.ca/. ■ Marian Walsh is President and CEO of Bridgepoint Active Healthcare in Toronto. www.hospitalnews.com
PATIENT SAFETY/RESEARCH/INFECTION CONTROL
Mt. Sinai Researcher Dr. Sabine Cordes and her team are studying a connection between a gene named Gumby and blood vessel growth.
Mount Sinai researchers uncover new gene linked to blood vessel growth By Sandeep Dhaliwal
ecently published in the prestigious journal Nature, Dr. Sabine Cordes and her team of researchers at Mount Sinai’s Lunenfeld-Tanenbaum Research Institute have established a connection between a gene named Gumby and blood vessel growth. The new discovery provides hope that, in addition to other treatments for cancer, the Gumby gene can become an attractive target for drug therapies against certain cancers by potentially restricting blood flow to tumours that are inoperable, such as in the brain. The Gumby gene affects blood vessels that form the blood brain barrier, which regulates the supply of essential nutrients into the brain and keeps unwanted molecules out. If the Gumby gene is defective, it can impair the development and function of blood vessels, causing a blockage in blood flow to the brain, which can also lead to mental health disorders. “This new finding is exciting for us because it means that the Gumby gene can be modified to enhance or limit blood vessel growth in a number of illnesses,” explains Dr. Sabine Cordes, Senior Investigator at the Lunenfeld-Tanenbaum Research Institute and Associate Professor, Department of Molecular Genetics and the Institute of Medical Sciences at University of Toronto. In their study, Mount Sinai researchers found that Gumby plays a significant role in cellular communication systems by acting as a local “mailman”. Once cells receive an external signal, such as one required for blood vessel growth, cells rapidly send proteins to specific locations within them and thereby change their shape and behavior in order to fulfill the message. www.hospitalnews.com
Gumby contributes to this shape and behaviour change by selectively removing a tag called ubiquitin, a protein which cells use as a “zipcode” to direct other proteins to places where they are needed. A defective, form of Gumby disrupts this communication system, ultimately leading to impaired blood vessel growth. For the first time, Dr. Cordes and her team may have also discovered potential therapeutic targets for Cri du chat syndrome, a disorder that affects approximately 1 in 20,000 children due to the loss of multiple genes on chromosome 5. Infants with this condition often have a highpitched cry that sounds similar to that of a cat, and is characterized by intellectual disability, delayed development, and facial anomalies. Gumby is found on a region of chromosome 5 associated with mental retardation and craniofacial anomalies in Cri du chat patients. To better understand how the Gumby gene works and to ultimately help improve diagnoses and treatments for patients affected by mutations in this gene, Dr. Cordes’ team collaborated with researchers in Dr. Frank Sicheri’s and Dr. AnneClaude Gingras’ labs at the LunenfeldTanenbaum Research Institute, as well as with Dr. Yoichi Gondo and Dr. Ryutaro Fukumura from RIKEN, a large natural sciences research institute in Japan. The work published in this Nature paper was also made possible through generous funding by the EJLB Foundation and a generous gift from Henry and Esther BerH nick, donors to Mount Sinai Hospital. ■
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Sandeep Dhaliwal is the Communications Specialist for the Lunenfeld-Tanenbaum Research Institute. SEPTEMBER 2013 HOSPITAL NEWS
PATIENT SAFETY/RESEARCH/INFECTION CONTROL
Exploring with purpose: cancer research at CHEO By Isabelle Mailloux and Adrienne Vienneau
espite the numerous advances made in the fight against cancer, despite the fact that today more children survive cancer than ever before, it is still far too prevalent and it affects far too many people. Researchers, staff and trainees alike at the Children’s Hospital of Eastern Ontario (CHEO) Research Institute share a common goal: to make cancer a thing of the past. It’s what fuels us as we look for ways to not only cure cancer but to also make treatments easier on patients. Because cancer is a nemesis that has one name but many faces - there are in fact well over 100 different types of cancer - CHEO researchers are looking at it from different angles. For example, some consider biology by analyzing tumor biopsies, while others address treatment options by looking at what timing is optimal for administering chemotherapy, and others look at supportive care to see if acupuncture helps to alleviate nausea, in the hope this will eliminate some of the side effects of existing treatments. CHEO is also a member of the Children’s Oncology Group (COG) which aims to understand the causes of cancer and find more effective treatments for children. As part of this international research network, our clinical cancer researchers have access to funding, treatments, research support and services specifically aimed at better outcomes for pediatric cancer patients. Dr. Jacqueline Halton is the Canadian Senior Medical Officer for COG, making her responsible for securing approval to use novel cancer treatments in Canada and at CHEO.
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CHEO’s team of oncology doctors and scientists. Back left to right: Dr. Karen Mandel, Dr. David Stojdl, Dr. Robert Klaassen, Dr. Martin Holcik, Dr. Robert Korneluk, Dr. Donna Johnston, Dr. Ewurabena Simpson. Front: Dr. Raveena Ramphal, Dr. Mylene Bassal, Dr. Jacqueline Halton This allows physicians to offer each oncology patient in their care the opportunity to take part in a clinical trial, if one is available for their particular type of cancer and seems like a promising course of treatment. Many other CHEO oncologists are pursuing research interests, independent of the COG network. Dr. Donna Johnston, Chief, Division of Hematology/Oncology at CHEO, Dr. Jacqueline Halton, Dr. Robert Klaassen, Dr. Karen Mandel, Dr. Raveena Ramphal, Dr. Mylène Bassal, and Dr. Ewurabena Simpson, are individually collaborating on 36 multi-centre studies ranging in topics from evaluating the cardiac late effects in childhood cancer survivors; to looking at central line dysfunction in children with cancer; to applying biomarkers to long term effects of childhood/adolescent cancer treatment; and to equipping patients with iPhones to record their pain scale.
“We are extremely proud that our researchers are leading projects that have the potential to change cancer treatments on an international scale,” says Dr. Martin Osmond, CEO and Scientific Director, CHEO Research Institute. Another instance is Dr. Johnston’s phase one clinical trial to determine what dose of melatonin, a natural health product, is tolerable by pediatric cancer patients when it is used as an appetite stimulant. Dr. Klaassen, for his part, has recently launched a trial to validate a new myelodysplasia-specific measure of quality of life. This scale was developed thanks to input from patients, caregivers, healthcare providers and quality of life experts and aims to assess the impact of myelodysplastic syndromes, a blood disorder with low blood counts and a high risk of cancer, on a patient’s quality of life.
We are extremely proud that our researchers are leading projects that have the potential to change cancer treatments on an international scale Meanwhile, Dr. Leanne Ward is focusing her research on the bone health of our children, since children with leukemia have the potential to develop osteoporosis, a serious bone disorder causing fractures of the spine as well as other parts of the skeleton (such as the arms and legs). She is presently leading a study to define how often osteoporosis occurs in children with leukemia, to look at what is the profile of the child most likely to develop osteoporosis, and to assess the potential for recovery. Ultimately, her goal is to identify osteoporosis as early as possible, and to develop best treatment and prevention strategies for this complication of childhood leukemia. Concurrently, recent developments in CHEO’s laboratories have provided us with better insight into the biology of cancer cells. Indeed, our esteemed scientists are looking at cancer research from an altogether different standpoint: Dr. David Stojdl has found a way to trick resistant cancer cells into committing suicide following oncolytic virus therapy. Oncolytics are cancer-killing vi-
ruses, so oncolytic virology uses live viruses to sense the genetic difference between a normal tumor and a normal cell. This means that once the virus finds a tumor cell, it replicates inside that cell, kills it and spreads to adjacent tumor cells to seed a therapeutic ‘chain reaction.’ His success in mouse models is the beginning of a laborious journey that should see this discovery tested in clinical trials in a couple of years. This type of therapy is far less toxic for children than the traditional oncology treatments of radiation and chemotherapy, meaning there would be fewer toxic side effects, and more importantly, fewer chances of cancer reoccurring in adulthood. Dr. Robert Korneluk and his team are studying targeted anti-cancer therapies that will complement existing treatments by providing a safer, more effective way to kill tumor cells. Dr. Korneluk is currently exploring ways to combine new tumor-killing virus therapy with experimental 'anti-IAP' drugs. IAP is short for ‘inhibitor of apoptosis’ and represent a family of genes that are central to the survival of cancer cells. They are also essential to immunity, making them ideal drug targets. These anti-IAP drugs induce the specific death of cancer cells and further sensitize them to killing by the immune system, which is often triggered by anti-cancer viruses. The drug effect is further enhanced when the tumors are infected with the virus. This combination approach, Dr. Korneluk believes, will eventually become an effective and safe treatment for a variety of cancers, including those that affect children. Importantly, both of these new experimental anti-cancer therapies are not "genotoxic," meaning they do not damage DNA or kill normal dividing cells, as current cancer therapies do. Therefore, the overall quality of life of children with cancer undergoing treatment, or childhood cancer survivors, should improve with the use of these new agents. Another exciting project is that of Dr. Martin Holcik and his team. They have identified new ways to control expression of several key regulators of cell death and survival. His work is focused on the investigation of the regulation of protein synthesis (translation), with specific emphasis on selective translation of specific factors during pathophysiological cellular states such as cellular stress, apoptosis (cell death) and cancer. Specifically, his team is investigating why and how cancer cells turn on genes that allow cancer cells to survive and thrive despite radiation or chemotherapy. It takes energy, passion and commitment to investigate better treatment options and new cures for cancer. At the CHEO Research Institute we aim to make discoveries today for healthier kids tomorrow. Because kids should be kids… not patients. For more information about the CHEO Research Institute, please visit H www.cheori.org ■
Adrienne Vienneau is Director of Communications at the CHEO Research Institute and Isabelle Mailloux is a Communications Specialist at the CHEO Foundation. www.hospitalnews.com
PATIENT SAFETY/RESEARCH/INFECTION CONTROL
Principal investigator Dr. Darcy Fehlings examines Paige Zaldin, a client in a Bloorview Research Institute study on children with cerebral palsy and pain.
New study finds 25 per cent of children with cerebral palsy suffer from moderate to severe pain By Claire Florentin ven Dr. Darcy Fehlings, the principal investigator on a study examining pain in children with cerebral palsy (CP) was surprised by her team’s findings; over 25 per cent of children with CP have moderate to severe chronic pain that limits their daily activity. “This study clearly showed us the extent to which children with cerebral palsy experience chronic pain,” says Dr. Fehlings. She says healthcare providers have long been concerned that they were missing pain in children with CP, but lacked data showing pain prevalence. Dr. Fehlings, Physician Director of the Child Development Program at Holland Bloorview Kids Rehabilitation Hospital and Clinician Senior Scientist at the Bloorview Research Institute, published the findings of her study in the health journal Pediatrics. CP is the most common neurodevelopmental physical disability, occurring in 2–2.5 out of every 1000 live births in developed countries. Dr. Fehlings, who leads the Cerebral Palsy Discovery Lab at the Bloorview Research Institute, aimed to better understand the prevalence and impact of pain on children and youth with CP. Her study tracked the physician-diagnosed cause of pain, and found that hip pain and increased muscle tone were the most common causes. Dr. Fehlings is optimistic about how her findings can be applied. “This knowledge will allow pediatricians to focus on accurately assessing and managing the root cause of this pain.” Cameron Purdy is a 13 year old boy with cerebral palsy. He and his mom Corinna have been long-time Holland Bloorview clients working with Dr. Fehlings; Corinna even lived at Holland Bloorview for three months in 2009 while Cameron recovered from a surgery. Corinna Purdy is glad to see the Bloorview Research Institute looking at chronic pain in kids with CP. “It can be hard for www.hospitalnews.com
kids to explain where the pain is, especially if they’ve lived with pain their whole life. Maybe they think it’s normal, or maybe they are too shy to tell you – either way, you may not know they’re in pain. Dr. Fehlings used cartoon faces instead of a one-10 pain scale, which helped Cameron communicate his pain levels.” Dr. Melanie Penner, a Fellow in Developmental Pediatrics at Holland Bloorview working with Dr. Fehlings, says Cameron and Corinna’s experience is typical. “This study has underlined the importance of asking every child with CP about their pain levels. This can sometimes pose a challenge for children with communication limitations, which makes a systematic
pain assessment plan crucial.” Dr. Fehlings is hoping to share her findings with as many physicians and parents of children with CP as possible. “Developing a strategy to prevent, assess, and manage chronic pain for kids with CP is key to improving their health and quality of life.”
Holland Bloorview Kids Rehabilitation Hospital
Holland Bloorview is Canada’s largest children’s rehabilitation hospital, fully affiliated with the University of Toronto. We pioneer treatments, technologies, therapies and real-world programs that give children with disabilities the tools to participate fully in life. Every year, we see about 7,000
children with about 600 inpatient admissions and 58,000 outpatient visits.
The Bloorview Research Institute
The Bloorview Research Institute is the only hospital-embedded pediatric rehabilitation institute in Canada. Established in 2004, the internationally recognized Bloorview Research Institute is dedicated to improving the lives of children with disabilities through client and family-centred H rehabilitation research. ■ Claire Florentin is a Communications Associate at Holland Bloorview Kids Rehabilitation Hospital.
NOTICE To Nurses: Minister of Health and Long-Term Care directive: nurses to have professional liability protection In the summer issue of the College of Nurses of Ontario’s Standard magazine, the Minister of Health and Long-Term Care issued a directive requiring all nurses to have and maintain professional liability protection (PLP). The good news is, membership in RNAO satisﬁes the PLP requirement. Not an RNAO member? Sign up now under our Two Months Free offer to ensure you comply with the PLP requirement.
For details and to sign up online: www.RNAO.ca/join or call Toll-free: 1-800-268-7199
SEPTEMBER 2013 HOSPITAL NEWS
PATIENT SAFETY/RESEARCH/INFECTION CONTROL
Showcasing leadership through patient safety at Humber River Hospital By Sarah Quadri Magnotta
Humber River Hospital developed a specialized program for HRH leaders, ensuring patient safety has a uniform and standardized approach across the Hospital. The program achieved a 100 per cent completion rate by the 75 HRH leaders who participated. Front row (l-r): Deborah Dennie, HRH Director of Education, Quality Support and Risk Management and Jill Green, HRH Patient Safety Specialist. Back row (l-r): Beverley Philp, Director of Humber River’s Women’s and Children’s Health Program; Phillip Laundry, HRH Surgical Program Clinical Practice Leader and Paula Villafana, HRH Program Director – Mental Health and Addictions.
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JEREMY D. DIAMOND
Practice areas: Car accidents, Motorcycle accidents, Slip/Falls, Disability claims
BARRISTER & SOLICITOR
HOSPITAL NEWS SEPTEMBER 2013
t Toronto’s Humber River Hospital (HRH), patient safety is at the forefront of delivering quality care to the Hospital’s patients and community. It’s so important that the hospital developed a specialized program – using the leading patient safety program from the world renowned Institute for Healthcare Improvement – to create a customized course, for HRH leaders, ensuring patient safety has a uniform and standardized approach across the organization. “Standardizing our approach to patient safety is an important focus in our department and throughout our hospital,” said Deborah Mercer Dennie, Humber River’s Director of Education, Quality Support and Risk Management. “In putting together a certificate program we wanted to ensure a sound understanding by HRH leaders of the fundamentals of patient safety; improve patient safety through the use of consistent approaches and further develop a culture of safety at Humber River Hospital.” But that’s not all. Dennie and Jill Green, HRH Patient Safety Specialist created a one-of-a kind program containing an array of modules and projects suitable for the versatile and diverse leadership at Humber River – addressing a wide variety of possible patient safety incidents that occur in a larger acute care hospital setting. The leadership group included Directors, Managers, Clinical Practice Leaders Infection Prevention and Control Coordinators and Professional Practice Leaders. “It is a multimedia learning approach that is effective in conveying theoretical information about patient safety as well as providing real life incidents that may occur at any hospital, including possible medication errors and problems with equipment due to technology automation,” noted Paula Villafana, HRH Program Director for Mental Health and Addictions. “The program emphasized that patient safety is a way of thinking and I came away from the course feeling as though I have the tools to deal with any patient-safety related situation – from individual and system issues to effective teamwork and communication.” The certificate program – which takes four months to complete and is comprised of case studies, modules, videos, facilitative workshops, group work and an exciting online learning platform – was a mandatory course introduced last November and had been in the planning stages for several months before its launch. “This is a very comprehensive program that helps to convey the importance of patient safety initiatives and training, including James Reason’s unsafe acts; human factors design principles; incident analysis; critical incidents; disclosure process and strategies to develop a culture of safety,” added Green. Compiling these learning elements into a unique ‘hands-on’ structure proved to
be rewarding and successful for Dennie and Green. When the course finished in March, they were excited to have achieved a 100 per cent completion rate by the 75 leaders who participated. They also received excellent feedback on the program and its varying modes of delivery. “Nothing less than the best is going to do at Humber River,” said Phillip Laundry, Clinical Practice Leader in the HRH Surgical Program. “We can sit here and say we post all of our results on many clinical indicators but it’s also a matter of what we do going forward with these results. Using a program like this enhances what the leaders already know and is certainly adds to our knowledge and skill set, especially with its solid focus on patient and family -centered care,” he added. “It is simple: we are further educating our own people in a culture of patient safety and that says a lot about our hospital and the dedication that’s here.”
The certificate program – which takes four months to complete and is comprised of case studies, modules, videos, facilitative workshops, group work and an exciting online learning platform – was a mandatory course introduced last November “The enthusiasm from our teams and the results we achieved indicates a huge commitment to ensuring we do the best possible to keep our patients safe at all times,” added Villafana. “We acknowledge that invariably there are times that something may go amiss but we are using those opportunities to learn, problem solve and work together effectively,” she added. “Those learning experiences are real and to be able to take this information and apply it to something you are experiencing in your everyday work environment is very impactful and important.” With the success of standardizing an approach to patient safety well in hand Dennie and Green aren’t stopping now. They have already begun planning part two of the course. “We are excited to be focusing on quality improvement and standardizing this approach to quality care at our hospital,” said Dennie. “We began with our leadership team but eventually we would like to open the course up to all staff in many roles throughout our hospital,” she added. Patient safety is everyone’s business and H it’s our first priority at Humber River. ■ Sarah Quadri Magnotta is Senior Writer/Communications Specialist at Humber River Hospital. www.hospitalnews.com
PATIENT SAFETY/RESEARCH/INFECTION CONTROL
Down and Out Preventing outbreaks of pests and their diseases By Alice Sinia
ests in your hospital can do more than harm your reputation. Different pests can actually pose health threats to your staff and patients. And some of the most dangerous pests can be the hardest to control. In the last four annual Association for the Healthcare Environment (AHE) member surveys on pest management, ants have been both the most common pest in healthcare facilities and the toughest to control. Cockroaches, flies and rodents also pose significant threats, and all of these pests can harm your patients. Ants and cockroaches can pick up and transfer harmful bacteria. Cockroach droppings and cast skins can aggravate allergies and even cause asthma attacks, especially in sensitive individuals. Flies spread microorganisms and disease-causing organisms everywhere they land. Then there are rodents, which can also cause serious health problems. According to Health Canada, rats and mice are known to spread diseases including Hantavirus. Fortunately, you can control many of these pests with Integrated Pest Management (IPM). Instead of being reactive, to pest problems, IPM focuses on preventing and managing pest activity through sanitation, facility maintenance and exclusion techniques. As the saying goes, “an ounce of prevention is worth a pound of cure.” Try these techniques around your facility to clean up, clear up, lock down and lock out any pest pressures:
Clean up, clear up
Pests are always on the lookout for a free meal. Don’t offer one, and they’ll be less attracted to your facility. • In food preparation areas, keep food stored away in airtight containers. Make sure that employee break rooms are free of any crumbs or food sitting in the open, and clean up any spills immediately. Don’t forget about spilled food or drinks in recycling bins – a favorite target for ants and flies. • Ask your staff to report any ant sightings to your pest management professional. Create a written sanitation program and educate your staff on the role they play in it. From the break room to patient rooms, have your staff follow these steps to ensure www.hospitalnews.com
pests don’t have reason to venture in or hang around. • Apply the same strategies to receiving and storage areas. Loading docks can be a little more accessible than other entrances. Not only can pests squeeze under receiving doors, but they can also sneak in on shipments. Inspect shipments right away and make sure that exterior doors form a tight seal when closed. • Keep storage and receiving areas clean, well-lit and uncluttered – pests love clutter as it gives them places to hide. Close all containers with airtight lids and store them at least six inches off the floor and 18 inches away from walls. Also, throw away or recycle cardboard boxes whenever you can as cockroaches can hide in their corrugation.
Lock down, lock out
While guests and residents can unknowingly bring pests into your facility, many threats that you will face will come from outside – and near – your building. Pay
close attention to your landscaping, your parking lot and your facility’s exterior. • Trim back vegetation and tree branches, creating a two-foot buffer around your perimeter. Ants and other insects can use those bushes that brush up against your building as a vehicle to gain access. The buffer will also deter rodents, which don’t like to be crawling out in the open. Work with your pest management professional to identify any gaps around your building’s perimeter and close them. Install weather stripping and window screens and seal holes with a metal mesh that rodents can’t chew through and weather-resistant sealant. • At entrances, install automatic doors, which give pests fewer opportunities to pass through. To help keep flying pests out, work with an HVAC professional to make sure you have positive airflow; test this by holding a piece of paper in a doorway and make sure the air blows out of – not into – your building. You can also create an air curtain that pests can’t fly through
by vertically mounting fans on either side of a doorway. • Inspect your grounds and parking lots regularly to make sure that they are free from trash that can attract pests. If pests find a little appetizer outside, they may want to get inside for the entree. You can further deter flying insects by swapping out mercury vapor lamps outside next to entryways with sodium-vapor lights. • The goal of any IPM program is to take preventative action to reduce the presences of pests. However, just like patients, each hospital is different. So talk with a pest management professional about creating a customized IPM plan for your facility. A proper IPM plan will ensure that your hosH pital is only serving patients, not pests. ■ Alice Sinia, Ph.D. is Quality Assurance Manager – Regulatory/Lab Services for Orkin Canada focusing on government regulations pertaining to the pest control industry. asinia@orkincanada. com or visit www.orkincanada.com.
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Therapy & Rehab SEPTEMBER 2013 HOSPITAL NEWS
PATIENT SAFETY/RESEARCH/INFECTION CONTROL
Championing infection prevention and control at Runnymede By Debbie Kwan ccording to Public Health Ontario, over 1.4 million people worldwide suffer from infections acquired in hospital at any time. In Canada, it is estimated that 220,000 incidents of healthcare associated infections (HAIs) occur each year, resulting in more than 8,000 deaths. Cleaning hands, although a simple action plays a significant role in preventing the spread of these infections. In fact, according to Public Health Ontario, hand hygiene is the single most effective measure to reduce HAIs. For that reason, it is championed as a priority at Runnymede Healthcare Centre in various ways, including awareness, education and monitoring.
The interprofessional team at Runnymede work together to identify and reduce the risk of hospital acquired infections (HAI) by implementing educatinal initiatives, audits and immunization campaigns “Hand hygiene is integral to enhancing patient safety and is a vital part of our infection control strategy,” says Chief Nursing Executive Raj Sewda. “Runnymede’s cumulative hand hygiene compliance rate for 2012-2013 before patient contact was 87.14 per cent, which is above the provincial average. This speaks to our staff’s on-
going commitment to achieving the highest standards in the quality of care that we provide to our patients.” As healthcare workers move from patient to patient and room to room to provide care, their hands touch many surfaces and encounter many opportunities for transmitting organisms that may cause infections. Accordingly, the most common way for the transfer of germs is through the hands. Runnymede’s staff and volunteers rarely forget this. They see firsthand how easily germs stay on the hands through the Ultraviolet (UV) Glo Germ test conducted during general orientation for new staff and volunteers. In this test, the infection control practitioner first passes around a bottle of what appears to be alcohol based hand rub during the education session. Believing the substance is hand sanitizer, employees rub the gel all over their hands. They don’t realize the substance is actually Glo Germ— a gel that mimics the effect of bacteria on the hands and is only visible under UV light—until after they are asked to wash off the substance and place their hands under a UV lamp for inspection. Since UV light reveals any residue that is not washed off properly, employees see clearly for themselves the areas they may easily miss while cleaning their hands. They also learn techniques for washing their hands more effectively going forward. Rigorous audits are important in order to support infection control protocols, identify and address barriers to compliance and subsequently improve standards for infection control practices across the hospital. Each month, Runnymede’s infection control practitioner and manager
A demonstration of the Glo Germ test where UV light is used to highlight areas (often around the nails) that may be missed while cleaning hands. of environmental services perform a UV audit in which gel pens containing Glo Germ are placed on critical touch points of the patient environment. After a standard cleaning, a UV light can be used to identify locations that may need extra attention. This allows Runnymede’s infection control and environmental services staff to work in collaboration to identify possible areas for quality improvement and continue to maintain the cleanest and safest environment for patients. Protecting patients, staff and volunteers through immunization is another integral component of infection control. In addition to an institution wide influenza (commonly known as “the flu”) vaccination program for high-risk patients, Runnymede conducts an influenza vaccination campaign for staff and volunteers. This ensures that everyone recognizes the importance of the flu shot in order to strengthen their body’s natural immune response against the flu and in turn prevent spreading it to others. As of December 2012, Runnymede’s influenza immunization rate for healthcare workers was 80 per cent, which is
significantly higher than 58.5 per cent, the average healthcare worker immunization rate for Toronto’s complex continuing care facilities. This is extremely important based on Runnymede’s patient population: adults with chronic diseases and underlying medical conditions such as heart or kidney disease, chronic respiratory disease and diabetes. These patients are at a greater risk of developing flu related complications which can have serious healthcare related outcomes. The interprofessional team at Runnymede work together to identify and reduce the risk of hospital acquired infections (HAI) by implementing educational initiatives, audits and immunization campaigns. These diligent practices keep patients safe and support the success of the hospital in reaching and surpassing targets and benchmarks for key clinical indicators, all evidence of ongoing leadership in safety and H quality improvement. ■ Debbie Kwan is a Communications Associate at Runnymede Healthcare Centre in Toronto.
Day in the life of superbugs study prompts critical dialogue on national infection control guidelines By Natalie Chung-Sayers n any given day superbugs like MRSA and C. difficile affect 1 in 12 Canadian adult patients with most cases being healthcare-acquired, reveals a Sunnybrook-led study, the first national survey of prevalence rates of antibiotic resistant organisms in 176 Canadian acute care hospitals recently published in Infection Control and Hospital Epidemiology. “Superbugs” or antibiotic resistant organisms such as MRSA (methicillin resistant Staphylococcus aureus), VRE (vancomycin-resistant Enterococci) and CDI (Clostridium difficile infection) result in a substantial burden of disease in hospitals, and costs to the healthcare system. “This disconcerting finding signals the need for more investigation to manage a major public health concern,” says Dr. Andrew Simor, lead author and chief of Microbiology, and Infectious Diseases at Sunnybrook.
Dr. Andrew Simor in Sunnybrook's Microbiology lab. Dr. Simor led the first national baseline study of common antibiotic resistant organisms in Canadian acute-care hospitals. HOSPITAL NEWS SEPTEMBER 2013
“The results of this study provide a much-needed baseline for national prevalence rates for MRSA, VRE and C. diff. in Canadian hospitals,” says Dr. Simor, a senior scientist at Sunnybrook Research Institute. “It is our hope the data will inform priority-setting on resources for the control of resistance, and stewardship of antibiotics, and provide the basis for developing more rigorous national infection prevention and control guidelines.” Sunnybrook researchers reported a total of 2,895 patients who were colonized or infected with MRSA, VRE or CDI. The researchers also uniquely correlated prevalence rates with certain hospital characteristics and infection prevention and control policies to report: •significantly lower rates of MRSA and VRE were found in hospitals that routinely used private rooms to accommodate patients either colonized or infected with these organisms •periods of higher occupancy of beds in
a hospital were associated with higher prevalence of CDI •enhanced environmental cleaning of rooms used for patients with VRE was associated with lower VRE rates. Participating hospitals were from all ten Canadian provinces and the Northwest Territories representing 65 percent of eligible hospitals with at least 50 inpatient beds. The study was done in November 2010. On the survey date, all adult patients were identified by hospital census. Patients colonized (with the organism but without signs or symptoms of infection), and patients infected or symptomatic with the organism were identified. Data from a similar, follow-up survey conducted in 2012 are currently being H analyzed. ■ Natalie Chung-Sayers is a Communications Advisor at Sunnybrook Health Sciences Centre. www.hospitalnews.com
PATIENT SAFETY/RESEARCH/INFECTION CONTROL
Setting a new standard in infection control By Caroline Bourque Wiley
hey’re the bane of hospitals and long-term care facilities across the country. These microscopic bacteria — so-called superbugs like C. difficile and MRSA — cast massive shadows as they spread their damage. Controlling the spread of these germs and the infections they cause takes a multipronged approach, combining greater education, state-of-the-art equipment and high-level professional standards of care. The newly opened St. Catharines Site of the Niagara Health System is making the most of all of these tactics. The comprehensive acute-care hospital, which opened its doors at the end of March, is one of the most advanced hospital designs in Canada when it comes to infection prevention and control. The building — nearly one million square feet in size — incorporates all of the latest infection prevention and control standards in its design. “The new St. Catharines Site was designed to support a healing environment that is equipped to protect patients, staff and visitors from infections,” says NHS Infection Prevention and Control Manager Shelley Schmidt. “Everything from air flow to floor layout, to materials to the number of sinks in the facility was purposely designed and utilized to reduce the risk of infection.” Eighty per cent of the rooms in the hospital are single-patient occupancy — the highest average of single-patient rooms in Ontario — which helps curb the spread of infections. Each single-patient room has a private washroom and shower. The fourbed wards have two washrooms per room and every patient room features a separate sink exclusively for staff hand washing use.
hering to the highest possible standards for infection prevention and control at all of our sites,” says Ms. Schmidt. “Ensuring the safety and comfort of our patients, their visitors and our staff is our top priority.”
Infection prevention and control at the St. Catharines Site of the NHS
The Niagara Health System's new hospital in St. Catharines was designed with numerous features aimed at controlling the flow of germs and infections, including 1,400 low-flow hand-washing sinks. pitals. Corian is a special material that is solid, non-porous and seamless, making it easier to clean and control the spread of harmful bacteria. The ORs are also serviced by a clean restricted corridor that includes a private elevator that connects the operating suites with a state-of-the-art cleaning, disinfection and sterilization facility in the basement of the hospital. This design is intended to keep sterile
Caroline Bourque Wiley is Manager of Communications for the Niagara Health System.
Hands up! Patients speak up about what they need for effective hand hygiene By Ann McFeeters he Infection Control Team at Providence Care always talks about hand hygiene with patients. It is their job to increase awareness and prevention of drug-resistant bacteria and infectious diseases in the hospital. But while they have these conversations on a regular basis, for some patients – washing their hands is not as easy as it is for others. “I was talking to a new patient who was being admitted with Vancomycin Resistant Enterococci (VRE), and who used a wheelchair,” said Jim Gauthier, ICP. “Patients who use wheelchairs are touching the wheels or other parts of the chair frequently throughout the day, and their hands are often visibly soiled and need regular washing.” Jim said he talked to the patient about how important it would be for him to clean his hands before meals, after touching his face and when entering or exiting his room. “He was shocked that this was the first time anyone had talked to him about hand hygiene. He’d been using a wheelchair for a long time before coming to Providence Care, and the importance of clean hands had never come up before.” Shortly afterwards, the Providence Care ICP team received a letter from a different patient who had recently left the hospital. This patient, who also had VRE when she came to Providence Care, offered advice on how health care staff can strengthen
Each patient floor has isolation rooms with negative air pressure, which pulls air into the room and prevents cross-contamination. Each isolation room also has an ante-room to be used by staff entering and exiting the room that ensures the negative air pressure is maintained at all times. Throughout the facility are an unprecedented 1,400 hand-washing sinks, with a similar number of alcohol hand-rub dispensers. “Fighting superbugs is a reality for all hospitals and will always present a challenge, but the innovative design features of the new facility will help us control these infections,” says NHS Interim Chief of Staff Dr. Joanna Hope. “Our staff, physicians and volunteers are committed to ensuring patients receive safe, quality care.” The hospital design also allows for the segregation of patient zones, enabling the hospital to be split into two distinct airhandling zones to allow for a complete isolation in the event of a pandemic or other significant event. The ventilation system is designed to keep contaminated air from flowing into other parts of the hospital. The walls in the operating rooms are lined with corian, a first for Canadian hos-
items separated, and contain any contaminants within the soiled items area. Articulating arms from the walls and ceilings in key areas such as ORs and ICU bring equipment off the floor and promote better cleaning. In addition, solid movable partitions have been used in place of curtains and bedside curtains have been minimized wherever possible to ensure easier cleaning. “Our organization is committed to ad-
• 80% single patient rooms • 1,400 hand-washing sinks, and nearly as many alcohol hand-rub dispensers • Corian walls in the operating rooms and procedure rooms • Cabinets for personal protective equipment outside of patient rooms • Isolation capabilities in event of an outbreak • Articulating arms from ceilings in key areas to keep equipment off the floor and promote better cleaning • Solid moveable partitions used in place of curtains where possible • Public elevators separate from those for H patients, staff and service ■
Jim Gauthier and Ann McFeeters, infection control practitioners at Providence Care in Kingston, have found ways to collaborate with patients to promote regular handwashing, particularly patients with specific needs because they use a wheelchair or have just had surgery.
their efforts to promote hand hygiene by engaging patients in the campaign. “She suggested putting hand cleaner within reach of meal trays, and hand wipes on the meal tray for easy access,” said Ann McFeeters, ICP. “Because some patients arrive at Providence Care from another hospital after surgery or stays in the ICU and are in pain, she said ICPs should connect with them again and discuss hand hygiene when the ‘brain fog’ has cleared. She was telling us ways we can help patients be more involved in infection control – which is our goal.” Inspired by these patient interactions, the ICP team implemented new strategies to make sure patients are as empowered to support hand hygiene as hospital staff. ICPs and nursing staff speak with each newly admitted inpatient about the importance of hand hygiene, and to understand the patient’s specific needs and physical and cognitive ability to wash his or her own hands. The team put together a brochure for patients and visitors on hand hygiene and a second pamphlet for those patients using wheelchairs. For those patients who need help with hand hygiene – a “hand hygiene logo” is place above their bed, to remind staff to provide assistance. “Sometimes we forget it is not easy for a patient to keep their hands clean in our environment,” said Kathleen Poole, ICP. “We need to make sure their hands H are clean too!” ■ Ann McFeeters is an Infection Control Practitioner at Providence Care. SEPTEMBER 2013 HOSPITAL NEWS
PATIENT SAFETY/RESEARCH/INFECTION CONTROL
‘Bath in a Bag’
helps keep patients safe at Rouge Valley Better staff and patient satisfaction
By Akilah Dressekie product introduced at Rouge Valley Health System’s (RVHS) two hospital campuses – Rouge Valley Centenary in east Toronto, and Rouge Valley Ajax and Pickering in west Durham Region – is helping to drastically reduce the number of hospital-acquired bacteria. The RVHS infection control team began looking for ways to combat VancomycinResistant Enterococci (VRE); MethicillinResistant Staphylococcus Aureus (MRSA); and Extended Spectrum Beta-Lactamase (ESBL) in units that were more prone to these organisms. Staff were already using a liquid form of two per cent Chlorhexidine Gluconate (CHG), a skin antiseptic that’s highly effective in preventing the spread of these organisms, while reducing secondary transmission to health care workers. Staff would use a basin to mix the CHG with water, however, it wasn’t working as effectively as they had hoped. “We found that CHG in liquid form mixed with the patient’s bath water did not allow for a consistent application of two percent CHG,” explains Paula Raggiunti, director of infection prevention and control, RVHS. “We thought that there had to be a more effective way to apply it to the patient’s skin.”
Not only have the wipes helped to improve infection control and drastically reduce the number nosocomial colonizations, both patients and staff are pleased with the product. A survey collected at the end of the trial showed that the majority of the staff liked the CHG wipes, found them easy and effective to use, and that the majority of their patients were also satisfied. “It’s become such a part of our routine now,” explains Marie Loughnane, clinical practice leader on 9West, one of the medicine units now using the CHG wipes. “It’s really helped to improve things, not just from an infection control perspective, but it has also enhanced the patient experience.” “I like them. They’re fast, and you can get the job done in just one action. It’s also easy to teach a patient how to use them. They’re always warm when we use them, and our patients appreciate that,” explains registered practical nurse Joyce Cameron, who frequently uses the wipes on her unit at Rouge Valley Centenary.
“Bath in a Bag”
The team learned of an alternative: wet cloths that contained two per cent CHG. Sometimes called a “bath in a bag”, the packaged wipes are stored in a warmer on the unit, making them warm to the touch when applied on the patient’s skin. Each pack contains six individual wipes soaked in CHG. One pack per day is used for each patient for bathing. One wipe is used for
Flavia Vales, a registered nurse in Rouge Valley Centenary's 9West unit, takes a pack of CHG 2 per cent wipes from a warmer on the unit. The wipes are now being used in certain areas at the hospital to help reduce the spread of hospital-acquired bacteria, especially VRE, MRSA and ESBL. the neck and torso; one for the arms; one for the legs; one for underneath the belly; one for the back; and one for the patient’s buttocks. “The wipes allow for the consistent application of CHG, from an infection control perspective. It also eliminated the use of basins, which can harbor bacteria. This was a win-win for us,” says Raggiunti. The cloths were trialed on five different units at both hospital campuses from
February to April 2012. This included intensive care, medicine and telemetry units. Staff were trained on how to properly use the wipes, and daily reinforcement on the units helped to ensure proper use. On average, there were about 24 cases per quarter of VRE, MRSA, EBSL, combined, on the trialed units. By the end of three-month trial, there was an astounding 74.5 per cent drop, down to just 6 cases in total across those units.
Maintaining improved results
After the trial, usage of the wipes was expanded to include two additional medicine units at Rouge Valley. Eighteen months after they were introduced in those first five units, there has been a combined 52 per cent reduction in nosocomial colonizations of MRSA, VRE and ESBL. Some individual units have seen a drop by as much as 79 per cent. Infection control continues to meet quarterly with the units, helping to H maintain these successful results. ■ Akilah Dressekie is a Senior Communications Specialist at Rouge Valley Health System.
Hygiene for little hands By Scot Magnish
t was standing room only June 27th in the Family Waiting Room on B6 when Children’s Hospital launched a customized hand washing campaign intended to help paediatric patients and their families stay healthy inside and outside of London Health Sciences Centre. Continued on page 31
Deacon, 7, tries out a Glitterbug at the launch of Children’s Hospital’s paediatric hand hygiene campaign HOSPITAL NEWS SEPTEMBER 2013
PATIENT SAFETY/RESEARCH/INFECTION CONTROL
Continued from page 30 Thanks to funding from the Children’s Health Foundation, paediatric inpatient and day unit patients aged four to nine are now learning about hand hygiene, checking their handwashing skills with Glitterbug’s ultraviolet light technology, and taking home the Canadian Institute of Child Health’s colouring book “William: Won’t You Wash Your Hands?”.
By educating this population and their families, we are giving them the tools they need to help keep themselves healthy "The introduction of “William: Won’t You Wash Your Hands?” offers parents the opportunity to educate their little ones, imprinting good hand hygiene techniques for home and hospital, as well as providing a good review of hand hygiene techniques for parents, the child’s siblings, family, and friends,” said Val Rousom, Director of Children’s Care, Children’s Hospital, before joining Children’s Health Foundation President and CEO Susan Crowley in demonstrating the Glitterbugs. “This campaign provides an enjoyable learning experience for families where Children’s Hospital staff are working with patients and families. This inclusive approach to hand hygiene is expected to improve the patient experience as well as increase quality and safety for our wee patients and their families." According to Health Canada, "Washing your hands correctly (or using an alcohol-based hand rub) is the most effective thing you can do to protect yourself against a number of infectious diseases. Not only will it help keep you healthy, it will help prevent the spread of infectious diseases to others." The new paediatric hand hygiene program was developed by Lisa Kroesbergen, an Infection Control Practitioner who said young children, those with chronic illnesses and those who are immunocompromised are all at heightened risk of becoming ritically ill from infections that may be preventable through good hand hygiene. “By educating this population and their families, we are giving them the tools they need to help keep themselves healthy,” Kroesbergen told the crowd. “We are also influencing a generation to practice proper hand washing as a standard behavior." “Children’s Health Foundation is very proud to support the paediatric hand washing initiative in collaboration with Children’s Hospital,” said Crowley. “While it seems simple, this initiative is vitally important in demonstrating proper hand hygiene to our H young patients.” ■ Scot Magnish is a Communications Consultant at London Health Sciences Centre. www.hospitalnews.com
Sandra Callery and Dr. Mary Vearncombe of Sunnybrook’s Infection Prevention and Control team, review Hand Hygiene data.
Hand Hygiene Matters: Key internal supports and strategies help Sunnybrook achieve high compliance. By Natalie Chung-Sayers
eeing is believing. Germs can’t readily be seen on hands and surfaces but when Hand Hygiene is not top-ofmind, hospitals have undoubtedly seen related outbreaks. “Our goal is to help make the seemingly invisible, proactively ‘visible’ for staff and physicians so that performing proper Hand Hygiene remains a central and consistent part of everyday practice,” says Dr. Mary Vearncombe, Medical Director, Infection Prevention and Control (IP&C), Sunnybrook Health Sciences Centre. Sunnybrook is one of the early adopters of the “Four Moments of Hand Hygiene” based on Ontario’s Just Clean Your Hands (JCYH) initiative that began in late 2007. The hospital is now 91 per cent Hand Hygiene compliant, or more than double its rate at the start of this provincial initiative. Says President and CEO, Dr. Barry McLellan, “Hand Hygiene is a priority at Sunnybrook. Our Infection Prevention and Control team has done a tremendous job in propelling this priority across the organization. Our high rates of good practice are testament to staff and physicians across all disciplines who have literally had a hand in our achievement thus far.” Hand Hygiene compliance is part of Sunnybrook’s Quality Improvement Plan for 2013/2014, and a Ministry Publicly Reported Safety Indicator for all hospitals. To facilitate success, Infection Prevention and Control together with Quality and Patient Safety, employ strategies Dr. Vearncombe refers to as “a multi-modal, multidisciplinary approach” in line with the Ontario Just Clean Your Hands toolkit. JCYH recommended strategies include senior management support and program leadership, environmental changes, moni-
toring and observation, engaging champion and opinion leaders, and education for health care providers. “Our Hand Hygiene education activities are targeted across all groups and are a frequent and integrated component within, for example, orientation, in-service sessions, on-line modules, and training for students including nurses and physicians,” says Sandra Callery, Director, Infection Prevention and Control, Sunnybrook.
Our high rates of good practice are a testament to staff and physicians across all disciplines who literally had a hand in our achievement thus far Internal awareness campaigns are another education component. Staff mentors are highlighted, discussing the importance of Hand Hygiene in their specific roles. Another campaign directed to staff physicians, residents, fellows and medical students, features physician champions with their quotes and published evidence related to the efficacy of Hand Hygiene compliance. All activities are supported with infrastructure and resources to ensure point-ofcare placement of alcohol-based hand rub product, and individualized assessments of patient care units and work areas in collaboration with staff. Human factors analysis is also used to better understand workflow, patient type, and types of healthcare professionals within each area. Another part of the proactively visible strategy, says Dr. Vearncombe, involves recognizing good Hand Hygiene ‘in the moment’. This reinforces what she calls ‘positive deviance’. While on the units,
staff and physicians are routinely audited by Hand Hygiene nurse observers (originally funded through late-career or modified work programs). “The approach is educational, nonpunitive,” Dr. Vearncombe notes. Observers give immediate and personalized feedback using a report card that highlights areas of good technique and suggested improvements. For demonstrating excellent Hand Hygiene compliance, staff and physicians at Sunnybrook get uniquely ‘Caught Clean-Handed’ with special recognition stickers. To gather data consistently, observers use a validated JCYH tool formatted as an input program for laptops. This allows IP&C to provide timely analysis and feedback to units, programs and Sunnybrook senior leadership. IP&C also generates quarterly reports for leadership and the Sunnybrook Board’s Quality Committee. The IP&C team also conducts Hand Hygiene compliance research and regular literature reviews for the latest strategies. In a 2009 study of an outbreak at Sunnbrook, the team found Hand Hygiene compliance inversely related to infection attack rates, reporting units with higher Hand Hygiene compliance had lower numbers of cases. “Hand Hygiene matters,” says Dr. Vearncombe, extending Sunnybrook’s tagline of ‘When It Matters Most’. “At Sunnybrook, Hand Hygiene compliance has become more tangible, achievable and acknowledged, as critically supported by our senior leaders and with the resources and infrastructure to make H it all work.” ■ Natalie Chung-Sayers is a Communications Advisor at Sunnybrook Health Sciences Centre. SEPTEMBER 2013 HOSPITAL NEWS
PATIENT SAFETY/RESEARCH/INFECTION CONTROL
Cultivating a culture of safety at Runnymede Healthcare Centre By Sabrina Jeria o achieve the best possible clinical outcomes for patients, Runnymede Healthcare Centre cultivates a culture of safety that focuses on continuous quality improvement. The hospital is dedicated to implementing a number of practical initiatives that are based on leading practices to not only enhance patient safety and overall satisfaction, but contribute to the quality improvement of patient care and services, and allow the organization to sustain a just culture of safety that promises better patient care.
Enhancing patient safety is about creating an open environment that is committed to change and continuous improvement. To support these efforts and promote transparency and accountability, Runnymede publicly reports on a number of core
patient safety indicators recommended by the Ontario Hospital Association (OHA). These include avoiding falls, hand hygiene compliance and the rate of healthcare associated infections (HAIs), such as C. difficile. A leader in safety—as evidenced by the hospital’s recent achievement of a four-year Accreditation with Exemplary Standing rating from Accreditation Canada—Runnymede recently incorporated four additional patient safety indicators for complex continuing care (CCC) and rehabilitation facilities into its Quality Improvement Plan (QIP): pain, worsening pain, the rate of urinary tract infections (UTIs) and the use of physical restraints.
According to the Registered Nurses Association of Ontario (RNAO), one in three seniors experiences a fall each year, with over 50 per cent of them developing serious injuries as a result. In the last quarter, individuals over the age of 65 made up 89 per cent of Runnymede’s patient
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As part of Runnymede’s Falls Prevention Program, clinical staff ensure patients at high-risk for falling wear proper fitting, non-slip footwear. population. To reduce the risk of patient falls and fall-related injuries among this at-risk demographic, a Falls Prevention Program was effected at the hospital. The program utilizes a Falls Risk Assessment Tool to evaluate patients that are at risk of falling and develop an individualized care plan that focuses on prevention strategies to increase safety and build awareness about falls prevention. Specific falls prevention interventions include placing regularly used items within reach, clearing rooms and hallways of hazards, and ensuring patients are equipped with proper fitting, non-slip footwear. On average in the past year, only 6.5 per cent of the hospital’s patients fell during a 30-day period. This is significantly lower than the 11 per cent average reported by peer hospitals in the Toronto Central Local Health Integration Network (TC LHIN), demonstrating the success of Runnymede’s falls prevention efforts.
Executive Patient Safety Walkabouts (EPS-Ws)
On a monthly basis, Executive Patient Safety Walkabouts (EPS-Ws) are conducted by a member of the senior leadership team. The EPS-W involves touring an area where patient care is provided— for instance, on the units or in the physiotherapy gym—and engaging frontline staff members in a discussion about how safe they feel their work environment is. In addition to encouraging staff to share concerns and/or offer suggestions for improvement, the dialogue aims to identify any obstacles that exist that may prevent the delivery of reliable, high quality care.
Quality Improvement Forums
At Runnymede, excellence is the driving force behind decision-making, clinical HOSPITAL NEWS SEPTEMBER 2013
practices and quality of care. The hospital’s relentless focus on excellence and going above and beyond the call of duty ensures patients continue to receive the best possible care at the bedside. To identify additional ways to improve safety on the patient care units, staff members from various clinical disciplines come together to hold Quality Improvement Forums every month. Fostering a dialogue about patient safety among frontline staff not only reinforces the interprofessional team dynamic that exists among the clinical disciplines, it also ensures the team is directly involved in the decision-making process and transformation of care at the hospital.
Before performing a medical procedure or providing any treatment, such as administering medication, it is essential to confirm a patient’s identity. Every healthcare professional at the hospital is responsible for checking a minimum of two patient identifiers to verify identity and ensure the appropriate treatment is being provided to the right patient. Acceptable patient identifiers include the name on a patient’s identification bracelet, the photograph in a patient’s chart and the patient’s date of birth. The hospital’s commitment to putting safety and quality first, and adopting leading practices to improve patient outcomes, speaks to the exemplary care that is provided to patients on a daily basis. By continuing to build on the hospital’s existing organizational culture of safety, Runnymede ensures that every patient experiH ence is a safe one. ■ Sabrina Jeria is a Communications Associate at Runnymede Healthcare Centre. www.hospitalnews.com
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34 Patient Safety
What you need to know about the Patient Safety Institute By Hugh MacLeod atient safety doesn’t always get the kind of attention it deserves. The public is more often concerned with wait times and access to care than they are quality and safety but it’s hard to fault them for this. After all, there is an expectation that our healthcare system is a safe place to be. Every now and then a major patient safety incident will make the front-page of the local paper or will be the lead story on your evening newscasts but before long, people’s attention has shifted to something else. However, just because we aren’t always conscious of patient safety and the potential for harm, doesn’t mean it goes away. Healthcare providers don’t go to work in the morning to make mistakes, yet there are thousands of harmful incidents that occur every year across the continuum. With that said, I’d like to introduce you to the Canadian Patient Safety Institute. Established in 2003 by Health Canada, we are a not-for-profit organization that exists to raise awareness and facilitate implementation of ideas and best practices to achieve transformation in patient safety.
Canadian Patient Safety Week has become the marquee event on our calendar every year. It's our chance to reflect on the progress we've achieved and ready ourselves for the uphill climb ahead We are a small organization with big aspirations. We believe that every patient experience should be safe and that preventing harm is worth the effort. We’re working behind the scenes with healthcare providers and organizations across the country to develop evidenced-based tools and resources to improve the quality of healthcare in Canada. For the heroes on the front-line, we offer programs such as Safer Healthcare Now!, a collection of 11 interventions aimed at improve care at the bedside. From medication reconciliation and surgical site infections, to preventing venous thromboembolism and reducing injury from falls, we’ve got everything you need free of charge to implement these lifesaving interventions. You can also find us in the class room where we’re working to educate not only the healthcare providers of today, but medical students and the doctors and nurses of tomorrow through the Patient Safety Education Program (PSEP – CanHOSPITAL NEWS SEPTEMBER 2013
ada), the Canadian Patient Safety Officer Course, and the Advancing Safety for Patients In Residency Education (ASPIRE) program. We also offer the Effective Governance for Quality and Patient Safety course, designed to support the boards of healthcare organizations in their efforts to improve safety and quality through effective governance. While preventing an incident from happening is one half of the equation, what happens afterwards is just as important. It is imperative that we disclose when harm has occurred without fear of blame. It is equally important to report incidents in order to learn from them and share those findings with others so that they never happen again. To support these efforts, we offer tools such as the Canadian Disclosure Guidelines, the Canadian Incident Analysis Framework and Global Patient Safety Alerts. Every year, we take one week to shine a spotlight on patient safety. Canadian Patient Safety Week has become the marquee event on our calendar every year. It’s our chance to reflect on the progress we’ve achieved and ready ourselves for the uphill climb ahead. It’s also an opportunity to celebrate the tremendous efforts and accomplishments that every one of our partners and stakeholders has made. In conjunction with Canadian Patient Safety Week, we are also proud to present Canada’s Virtual Forum on Patient Safety and Quality. Where fiscal restraint and travel bans have made attending inperson events next to impossible, we’ve gone virtual and are excited to bring 40 hours of live content to you over the Internet delivered by more than 40 patient safety experts. Both of these exciting events are taking place from October 28 to November 1, 2013 and registrations are open. Visit www.asklistentalk.ca to sign up today! Despite all of our efforts, we can never forget that the patients and their families are always at the core of everything we do. Their stories of harm and suffering humble us everyday and remind us of what’s at stake. At CPSI, we are honoured to work with a group called Patients for Patient Safety Canada whose mission is to ensure that healthcare organizations and systems include the perspective of patients and their families when making decisions and planning safety and quality improvement initiatives. Their courage to work with us to improve a system that has failed them in their time of need is inspirational and is a great motivator for everyone at CPSI. As you can see, we have a lot to offer, and there is much more to discover on our website. I encourage you to visit us at www.patientsafetyinstitute.ca to learn more about what we do and how we can help you improve safety and quality for H your patients, residents and clients. ■ Hugh MacLeod is CEO of the Canadian Patient Safety Institute.
Why do we wait for healthcare? Continued from page 15
More than just a scheduling system, Advanced Access is a continuous quality improvement initiative which resulted in a paradigm shift for Burntwood. Physicians and practitioners no longer push work off to tomorrow but rather, they accomplish today’s work today. Advanced Access strengthened the concept of the health care team to sup-
Patients are now provided with pre and post-op services to better prepare them for not only their surgeries, but also their recuperation, which also improves the efficiency of hospital services. port them working at their highest level; and as a result, patient complaints have essentially gone down to zero, primary care appointment wait times have decreased, and 93 per cent of Burntwood’s patients are now able to get an appointment with their primary care provider when they want. Our second video shines a light on Eastern Health’s Orthopedic Central Intake (OCI) based in St. John’s, Newfoundland and Labrador. Before 2011, the residents of Newfoundland and Labrador had difficulties accessing orthopedic surgical consultations, due to a referral system that created extremely long waits. At that time, the median time for a patient referral from doctor to specialist was more than 300 days. The new system refers orthopedic patients to the next available surgeon while keeping track of the referral status and involving all health care providers throughout the process. OCI reduced orthopedic surgery wait times through a system change which redesigned the orthopedic service along the entire continuum of care. Patients are now provided with pre- and post-op services to better prepare them for not only their surgeries, but also their recuperation, which also improves the efficiency of hospital services. The third video in our series launching on September 9th, highlights the Payfor-Performance emergency department model in Vancouver, British Columbia. Emergency department congestion has been a long-standing issue for quite some time. With an ever-increasing demand, emergency departments, like the one at Vancouver General Hospital, struggle to provide patients with more timely care and access to diagnostics, while also creating capacity for admitted patients – something referred to as “access block.”
But the name Pay-for-Performance can be misleading. The model does not pay nurses or doctors to work faster and harder. Rather, the Pay-for-Performance model rewards the hospital with additional funding, if it meets predetermined targets for moving patients through the emergency department, either to a hospital bed or back to the community. This additional funding provides hospitals like Vancouver General with more options in regards to staffing, patient flow tools and other access initiatives. This relieves congestion in the emergency department and ensures patients receive the care they need in a timely manner. “What the financial incentive does is it gives you a little bit of comfort in taking risks that you might not otherwise have taken,” says Michelle de Moor, Operations Director, Emergency Access and Flow at Vancouver General Hospital. “So if you’re working within a system that has a fixed funding envelope, you tend to stick with what you know you can safely fund and safely do to deliver service. If you have a little bit of an incentive to try different things, in order to create more access, financially you’ll take risks and try different things.” Early in the fall, we will release the fourth and fifth videos in our series which will look at the Saskatchewan Surgical Initiative and the Champlain Building Access to Specialists through E-consultation (BASE) in Ottawa, ON. The sixth and final video in the series will focus on an innovative practice in the long-term care setting. With this video series, our goal is to promote some of the solutions that are available to help solve the problem of wait times in the Canadian health care system. To view the first two installments and learn about innovative approaches to reducing wait times, visit our website at healthcouncilcanada.ca/waittimes. Also, please consult our Health Innovation Portal: healthcouncilcanada. ca/innovation which houses hundreds of innovative health care practices, policies, programs and services from across Canada. For more information about the video series please contact email@example.com Health Council of Canada. (2013). How do Canadian primary care physicians rate the health system? Results from the 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. Canadian Health Care Matters. Bulletin 7. Toronto: Health Council of Canada, p. 20. HealthH councilcanada.ca ■ Ari Grief is Project Lead/Bilingual Communications Specialist at the Health Council of Canada. www.hospitalnews.com
PATIENT SAFETY/RESEARCH/INFECTION CONTROL
Innovative Study Helps debunk common myths and improve patient care By Catalina Guran otivated by a deep desire to better understand its most complex patients, Mackenzie Health undertook an in-depth study of its patient population in early 2013. The resulting information is now being used to make informed decisions for the future and help Mackenzie Health move toward its vision of creating a worldclass health experience for patients. The study focused on the top 10 per cent of Mackenzie Health’s high-acuity patients, with a deep-dive analysis on the top one per cent. The study was intended to help the organization improve transitions between care providers, access to services, quality and coordination of care, all in the pursuit of improving the patients’ experience and health outcomes. The results of the study were not only surprising, but also counter- intuitive, and the resulting information has helped staff and physicians develop new strategies to better meet the needs of these patients.
Debunking myths and creating evidence-based care
Prior to the study, some of the common assumptions among clinicians were that high-acuity patients were almost always older seniors who had three or more chronic conditions. It was also as-
sumed that most of these patients visited the Emergency Department six or more times each year. These assumptions indirectly influenced the hospital’s efforts to care for the patients who require the most assistance.
What the study revealed
Imagine the surprise among staff and physicians when the results of the study showed that less than half of the highacuity patients are over 75 and that less than a third have three or more chronic illnesses. And while cancer was not initially considered a prevalent factor in the top 10 per cent patients, finding out that this patient population is three times more likely to have cancer than the average patients prompted another “Aha!” moment. An additional surprise came with respect to Emergency Department visits. The study found no significant difference between high-acuity and regular Emergency patients, with an average of only two visits a year. “Specific to the Emergency Department, the information revealed by the study is extremely valuable to Mackenzie Health as it helps us understand that, despite the general pre-study assumptions, most high-acuity patients are not frequent Emergency Department patients. The findings offer a fresh perspective and allow us to make informed decisions going forward,” says Julie Simard, Interim Op-
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erations Director, Emergency, Medicine, Intensive Care Unit, District Stroke and Flow, Mackenzie Health.
How the study will make a difference
While at times counter-intuitive, the study results provided valuable, timely information which challenges Mackenzie Health staff and physicians to think differently in order to respond to the needs of its patient population. Mackenzie Health’s immediate focus will be on creating and implementing additional strategies to improve the outcomes of high-acuity patients through new nurse navigator roles, clinics and enhanced care processes, and advancing broader system collaboration. The enhanced understanding and management of high-acuity patients may also help reduce the costs to the healthcare system, as the top 10 per cent of high-acuity patients account for most of the organization’s direct acute care costs. In the 2011/12 fiscal year, Mackenzie Health’s top 10 per cent most complex patients (approximately 1380 patients) accounted for 62 per cent of the organization’s resources and the top one per cent of these (138 patients) accounted for 49 per cent of the costs. Kristine Jarvi, Executive Director, Transformation, Mackenzie Health, says,
“There will always be people who need a significantly higher amount of care in terms of lengths of stay in the hospital, the number and type of interventions and treatments, and the need for critical care than the average population. For this reason, it is essential to better understand these patients with complex needs and develop targeted strategies to help improve their care outcomes and, in turn, help reduce the costs to the system.” The information gathered will not only inform the planning and design of the organization as a whole, but will also have a significant impact on the development of the new Mackenzie Vaughan Hospital, scheduled for completion in 2018/19. Mackenzie Health will be looking at sharing its innovative approach with other hospitals in the province and across the country through publications, conferences and other channels. “Mackenzie Health’s evaluation is a step in the right direction as it will allow us to make better use of our resources, plan according to our patients’ needs and ultimately improve care to create healthier communities,” says David Stolte, Vice President, Strategy and Redevelopment, H Mackenzie Health. ■ Catalina Guran is a Communications and Public Affairs Consultant at Mackenzie Health.
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