In Touch newsletter: May 2014

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MAY 2014

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Nurse practitioner Kari Fulton tends to a patient in her home.

(Photo by Yuri Markarov, Medical Media Centre)

The patient will see you now

By Patricia Favre

Medical house calls are thought to have gone the way of rotary phones.

But at a time when home phones are being replaced by smartphones, the St. Michael’s Family Health Team is delivering the time-tested service to patients who need it most.

Nurse practitioners Lorna McDougall and Kari Fulton are part of an interprofessional team that visits frail, home-bound seniors in downtown Toronto.

“Our patients have complex health care issues, but for many of them isolation is what looms large in their

day-to-day lives,” said McDougall. “Our goal is to provide them with access to acute and chronic care in the home.

Our visits also give patients a sense of socialization and remind them that they have access to support.”

Since the program’s inception about a year and a half ago, 400 nurse practitioner home visits were completed with the 29 patients who are enrolled in the program.

In addition to the two nurse practitioners, the team also consists of two family physicians, a geriatrician, a palliative care physician, a pharmacist Continued on page 5

Printed on 100 per cent recycled paper

St. Michael’s and Ryerson hit the road to drive neuroscience research

By Evelyne Jhung

Dr. Tom Schweizer really wants to get into your car. And your mind.

Preferably at the same time.

Dr. Schweizer, director of the Neuroscience Research Program, maps drivers’ brains to see which areas activate or shut down when they perform complicated maneuvers, such as making left turns at busy intersections, or are distracted by talking on a cell phone.

He puts healthy young drivers into a high-powered functional MRI and Continued on page 7 MAY 2014 | IN TOUCH | 1

OPEN MIKE with Ella Ferris

Executive Vice-President, Programs, Chief Nursing Executive, Chief Health Disciplines Executive keeps patients safer and gives them opportunities to engage with us at important transition points in their care, and our partnership with our health Nursing: A Leading Force for Change discipline colleagues in designing and executing year one of our three-year The theme of National Nursing Week is Nursing: A Leading Force for Change. Professional Practice Strategic Plan, When I reflect on the past year, I am very Living Interprofessional Excellence. proud of the changes that nurses at St. Another example of how nurses stay Michael’s Hospital have designed and led engaged with changes that impact and the many corporate initiatives that nursing practice is through our Nursing nurses support in their daily work.

Advisory Council, or NAC. Under the Our nurses continue to position themselves as knowledge professionals equipped with evidence-based practice that supports patients and their families through the changes they experience when they enter our hospital.

Examples of this are numerous: our continued work to support our RNAO Best Practice Spotlight Organization designation, our externally recognized transfer of accountability initiative that

co-leadership of Rachel Craig, a staff nurse in the MSICU, and Heather Campbell, director of Nursing Practice and Education, NAC has been an active knowledge broker for nursing in many areas such as legislative changes, practice standards and policy development. One of the highly successful initiatives arising out of NAC is its monthly Professional Practice Scenario of the Month--an interactive

forum that discusses a case that often challenges our assumptions, urges us to be reflective and puts the patient at the centre of the discussion. The learning is then applied in the practice setting to enhance quality patient care.

To our patients, how we prepare ourselves to give the best possible care is invisible.

However, what they do experience is how we deliver our care. This year in the hospital Quality Improvement Plan, you will read about upcoming work aimed at improving the patients’ experience. I am excited about this work and I believe that nurses are in ideal positions to ensure that our patients’ voices are heard and integrated into the plan of care.

I personally thank every nurse at St. Michael’s for your commitment to the nursing profession and the hospital, and most importantly, to our patients.

Happy Nursing Week!

St. Michael’s has great taste St. Michael’s Hospital and George Brown College have partnered to bring more healthy meals made from local ingredients to patients, staff and visitors.

With support from the Greenbelt Fund, George Brown College developed a certification course for hospital food service staff. In return, St. Michael’s is offering internship placements where George Brown students work alongside hospital staff to assist with menu creation featuring local food.

Student chef Cory Martin serves his dishes at a taste testing event.

(Photo by Yuri Markarov, Medical Media Centre)

MAY 2014 | IN TOUCH | 2

So far St. Michael’s has hosted four students.

Recently, student chef Cory Martin was onsite developing menu options for patients. Staff from across the hospital sampled Martin’s Asian salad, cider chicken, vegetarian chili and spiced lentils in a taste testing event.

Follow St. Michael’s on Twitter: @StMikesHospital

Dr. Alex Ho, an anesthesiologist, prepares the anesthesia machine for a patient prior to surgery (Photo by Katie Cooper, Medical Media Centre)

New anesthesia machines placing patients at the centre of their care

By Heather Brown

St. Michael’s is the first teaching hospital in Canada to have acquired a new anesthesiology workstation that contains all the critical components on one platform, allowing anesthesiologists to maintain complete focus on their patients.

All the vital information needed at various points of a patient’s surgical journey can now be accessed by the touch of a screen on the 35 new workstations, before the patient even arrives in the operating room.

“These state-of-the-art workstations have been designed to improve patient care and advance the way anesthesiologists perform their responsibilities during a procedure,” said Dr. Alex Ho, the anesthesiologist who spearheaded the acquisition of these machines.

“The new devices incorporate an ICUgrade ventilator, which enables us to better manage our most critically ill patients and eliminates the need for additional intensive care equipment to be brought

into the operating room. The workstations also include a computer with access to the hospital’s IT network and Sorian, which provides all the relevant patient information we require at the point of care.”

The anesthesiologist can continue to view his or her patient’s vital signs in the recovery room by logging onto the

monitors can be plugged directly into the anesthesia workstation when the patient arrives in the operating room.

Previously, patients had to be hooked up to a vital sign monitor every time they changed locations; now they are hooked up to only one monitoring system, which travels with them through all points of their pre- and post-operative care.

Thanks to the improved ICU-grade ventilator, patients can be better weaned from the breathing tube in the operating room. For critically ill

“Not only are these machines improving patient care but they are also helping to reduce our greenhouse gas emissions,” said Dr. Ho. computer on a workstation. This can be particularly valuable if the physician is unable to leave the operating room.

Similarly, this technology can enhance resident training because it fosters progressive independence, while allowing the supervising physician to follow a patient’s progress from other operating suites in the hospital.

Another significant difference with the new machine is that portable vital sign

St. Michael’s is an RNAO Best Practice Spotlight Organization

patients, this helps minimize the time they spend in the intensive care unit.

“Not only are these machines improving patient care but they are also helping to reduce our greenhouse gas emissions,” said Dr. Ho. “Through the use of the target controlled anesthesia we are able reduce the amount of waste emitted from the machine and operate them in a more efficient manner.”

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Nursing Week 2014 - “Nursing:

Cecilia Santiago (right) reviews a patient care plan with nurse colleague Rachel Craig (left) in the MSICU. (Photo by Katie Cooper, Medical Media Centre)

St. Michael’s nurse helps patients through transitions in care

By Patricia Favre

Cecilia Santiago has a plan. Whether patients are waiting to get into the Medical Surgical ICU or transition out of it, her plan will help get them there.

Santiago, the clinical nurse specialist at St. Michael’s MSICU, works with Toronto Central LHIN co-ordinators to develop and execute care plans for patients who require ongoing invasive ventilator support.

Thanks to these care plans, Santiago has helped 28 ventilator-dependent patients transition out of the MSICU and into an environment that is better suited for their long-term care needs.

“Patients who are dependent on mechanical ventilators have often MAY 2014 | IN TOUCH | 4

gone through some kind of life-altering incident – such as a spinal infarction causing quadriplegia,” said Santiago.

“Patients have to be stable for 21 days before transitioning to another care facility, but often families are anxious about leaving the ICU where patients receive one-on-one care.”

Santiago collaborates with the MSICU interprofessional team to develop and implement care plans that address such things as optimizing ventilation through consultation with a respiratory therapist, improving communication by working with a speech language pathologist and enhancing mobility by involving nurses, physiotherapists and occupational therapists.

“The goal is to get patients to a point

where they can safely transition to a better environment for them,” said Santiago. “But care plans also aim to put families at ease by preparing them for a setting that isn’t constantly monitored.”

Patients’ families are educated about leaving the ICU setting and Santiago helps with the preparation of patient medical history and applications for long-term care facilities.

“By helping patients transition to a longterm care facility we can help them attain a better quality of life,” said Santiago.

“These facilities offer a home-like setting where patients have private rooms and often access to gardens. In turn, beds in our MSICU are opened up for other patients who need the ICU setting.”

A Leading Force for Change” This year marks...

120 YEARS since the first graduating class of the former St. Michael’s Hospital School of Nursing.

100 YEARS since the first contingent of nurses from St. Michael’s Hospital left to serve overseas during the First World War.

House calls story continued from page 1

and a social worker. Most team members participate in the program in addition to their work with one of the St. Michael’s FHT sites.

A home visit could include anything from a routine checkup to immunizations and safety and frailty assessments. McDougall explained

that while some visits are scheduled – a lot of her work consists of drop-ins.

often find a solution over the phone and avoid a trip to the ED.”

Patients can also call McDougall and Fulton in an emergency.

The St. Michael’s FHT home visit program is part of a larger study called the Bridges Integrated Home-Based Primary Care project. The project is partnered with a number of family health teams across the city.

“Instead of going to the Emergency Department when the situation escalates, patients can call us if they’re worried about a health issue such as blood sugar levels,” said Fulton. “We can

MAY 2014 | IN TOUCH | 5

Decanting… just breathe

By Geoff Koehler

It turned out better than we could have hoped. Environmental Services rapidly cleaned our new spaces on 1 Bond and 6 Donnelly. IT set up our computers, telephones, printers and fax machine quite quickly. Engineering staff dropped in on us every couple of hours to make sure everything was going well.

Planning’s Josh O’Neil was the quarterback of our move. He tirelessly made sure that we had what we needed.

While not permanent, the change in scenery and set up was invigorating.

Bruno Freire from Engineering, Josh O’Neil of the Planning department and Orlando Silveira with Environmental Services transported materials from Communications’ temporary locations back to our flood-renovated office. Each group played a pivotal role in our smooth decanting.

(Photo by Yuri Markarov, Medical Media Centre)

The first time I heard Bob Howard mention decanting was at a Town Hall in October 2013.

It was my first week at St. Michael’s and I excitedly turned to my neighbour and exclaimed: “They serve wine at Town Halls here?!”

While saddened to learn that Bob was talking about a different kind of decanting, I was impressed by the amount of thought, planning and preparedness that had gone into the decanting rollout for St. Michael’s 3.0.

That said, I didn’t envy the groups that would be moving to temporary spaces while construction and renovation projects took shape.

There were no animals walking two-bytwo, but a burst pipe on 2 Donnelly made a mess of our offices on 1 Donnelly and forced 10 members of our team into new spaces throughout St. Michael’s.

We packed our belongings into bins, labeled our larger items and hoped for the best.

The number of desks available in each space shook up our team’s seating arrangements and broke up our routines.

Teammates expressed appreciation for their colleagues’ quality of work – simple things that can’t be noticed until regularly sharing the same office space.

The flood cleanup is complete and Communications has returned to 1 Donnelly after our exodus– until our slated decanting for 3.0. This experience made me less anxious about the future move and I’ve learned that even when wine isn’t involved, decanting doesn’t have to be a bad thing.

Patient care tower model

It was clear from the questions people were asking Bob that many other staff were concerned about their own work spaces but, more importantly, were considering the impact on patient care areas.

I knew I’d be affected eventually; my department, Communications and Public Affairs, was slated for decanting down the road but that seemed like a long ways off so I wasn’t worried.

A flood made decanting a reality much sooner than I’d been prepared for…

MAY 2014 | IN TOUCH | 6

The hospital and foundation commissioned an intricate scale model of the entire city block of the St. Michael’s Hospital campus with addition of the new patient care tower. It took JS Models 160 hours to complete, using basswood and acrylic pieces laser cut from computer drawings by Diamond Schmitt Architects. Diamond Schmitt, the design-compliance architect for St. Michael’s 3.0, also designed the Li Ka Shing Knowledge Institute.. (Photo by Yuri Markarov, Medical Media Centre)

St. Michael’s student Kristin Vesely monitors Ryerson student Reyhaneh Nosrati’s performance on a driving simulator using functional near-infrared spectroscopy. (Photo by Yuri Markarov, Medical Media Centre) Road to drive story continued from page 1

has them operate a driving simulator equipped with a steering wheel, brake pedal and accelerator. St. Michael’s is one of only two centres in the world with a fully immersive and MRIcompatible driving simulator.

But operating the equipment is expensive, about $600 an hour. So Dr. Schweizer was excited to meet Dr. Vlad Toronov, a physicist at Ryerson University, while organizing the neuroscience component of last June’s second annual Institute of Biomedical Engineering and Sciences Technology, or iBEST, Research Symposium. The event showcases the work of St. Michael’s and Ryerson scientists and students.

Dr. Toronov has a portable imaging

device called a functional near-infrared spectroscopy, or fNIRS, that is strapped onto a study participant’s head and can map the brain while the participant performs tasks in real-world conditions.

It’s also quieter and much less expensive than an MRI. Dr. Schweizer recently used the fNIRS to test 16 undergraduate students to see whether the results are as accurate as the studies conducted in the MRIs. “We’re working with them to test out a more cost effective way of visualizing the brain while driving and investigating the effects of distracted driving,” said Dr. Schweizer. “This brings us one step closer to our ultimate goal of developing a practical, evidence-based and affordable test for evaluating fitness to drive. The purpose of using fNIRS is

to make brain imaging more affordable not only for researchers but as a potential diagnostic tool as well.”

Dr. Schweizer said he can see one day being able to take the fNIRS into a car and map a driver’s brain activity in real time on a real road rather than in a simulator.

His joint study with Ryerson is part of iBEST. Announced in November 2013, iBEST is a 20-year partnership between Ryerson and St. Michael’s.

It is a collaboration enabling Ryerson faculty to have access to resources at the hospital’s Li Ka Shing Knowledge Institute (including core lab facilities, researchers, clinicians and patients) and St. Michael’s staff and researchers access to Ryerson’s bioengineering expertise.

Volunteer Week: May 5 - 11 St. Michael’s volunteers donate their time, expertise and energy to the hospital every day. Help us say a special thank you to them during Volunteer Week, from May 5 to 11.

500+ Number of volunteers at St. Michael’s (annually)

60,000 95% said YES Number of hours volunteered

Recent exit survey of volunteers asked: “Did you have a positive volunteer experience?”

MAY 2014 | IN TOUCH | 7

Q&A

DANIEL VAILLANCOURT,

TRIAGE NURSE, EMERGENCY DEPARTMENT

By Patricia Favre (Photo by Katie Cooper, Medical Media Centre)

In St. Michael’s Emergency Department, a group of nurses has the responsibility of determining the priority of patients’ treatments. Daniel Vaillancourt has been a nurse at St. Michael’s Hospital for more than six years and has been working as a triage nurse for 15 years. .

Q. Tell us about your role. What do you do as a triage nurse?

The triage nurse is often the first person patients see when they come into the Emergency Department. The role includes prioritizing patients based on what they’re here for. We assess symptoms and complaints and decide where patients should go in the ED. We also decide how quickly they need to be seen.

Q. What is the biggest challenge you face in your role?

The biggest challenge is never knowing who’s coming in.

Sometimes 10 patients will come in at once and we have to decide what’s wrong with them and how quickly they need to be seen. Our ED is quite hectic, so space and time constraints are top of mind.

INTOUCH

MAY 2014

In Touch is an employee newsletter published by Communications and Public Affairs.

Please send story ideas to In Touch editor Leslie Shepherd at shepherdl@smh.ca.

Design by Dermot Covel, Medical Media Centre

Q. How do you cope with the hectic nature of the Emergency Department?

To be a triage nurse, you have to have a certain amount of experience on the ED floor. So when things get hectic, I tap into my knowledge and experience to get me through it. I’m also very motivated by trying to do the best for my patients.

Q. What has been the most rewarding aspect of your job?

The best part of the job is when I get to see patients walk out of the hospital after receiving the right kind of care – or knowing that patients have been directed to the right place for the kind of care they need. I also work with a great team of people. Having colleagues that I can relate to and share experiences with is important.

Q. What book would we find on your nightstand?

Right now I’m reading David and Goliath by Malcolm Gladwell. I generally prefer non-fiction and Gladwell’s stories are always well researched and enlightening!