In Touch newsletter: October 2016

INTOUCH OCTOBER 2016

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CT O AW BER AR IS EN ME E S NT S AL M O HE N A TH L T

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Bryan Marshall and Anne Borrelly, peer support workers on the Inpatient Mental Health Unit, admire therapeutic plants, such as lavender and sage, which they help their clients grow in the unit’s courtyard. (Photo by Katie Cooper, Medical Media Centre)

Peers encourage wellness as members of mental health unit team

By Evelyne Jhung

A stock broker living the fast life in France and Luxembourg. A sales and marketing associate turned research assistant. Those two lives were traded in long ago and now Anne Borrelly and Bryan Marshall serve coffee and hand out the morning papers as part of their duties as St. Michael’s first two peer support workers on the Inpatient Mental Health Unit.

“It’s been 16 years of my own journey of recovery from addiction and mental health issues and I really wanted to Printed on 100 per cent recycled paper

work with people I could relate to and help, and keep growing along that path,” said Marshall, a former research assistant with St. Michael’s CRICH, now called the Centre for Urban Health Solutions.

Similarly, Borrelly’s goal was to work on an inpatient unit because she felt that a peer support worker – someone with lived experience – could make a real difference as she didn’t have one herself when she was recovering from a bipolar diagnosis.

“In a short time with us, Bryan and

Anne have become valued members of the team, contributing greatly to our positive therapeutic environment,” said Dr. Shelley Brook, a psychiatrist on the unit. “Patients find it comforting to have people with ‘lived experience’ available for support and inspiration.”

As members of the interprofessional team, Marshall and Borrelly participate in rounds and with helping patients heal.

They always start off the day with real (i.e. caffeinated) coffee and the papers with Continued on page 2 OCTOBER 2016 | IN TOUCH | 1

Did you know?

Behind an ordinary door in the basement of St. Michael’s Cardinal Carter wing, a two-level facility houses approximately 30,000 blueprints, plans and other technical drawings. Named “the vault” by the hospital’s Engineering team, the area contains documents, including hand-drawn blueprints, dating as far back as the 1910s.

The contents of the vault map not only the current physical design of the hospital, but its history as well.

As part of St. Michael’s 3.0, the vault must be emptied to create new emergency exiting for the Emergency Department expansion.

All of the documents will be scanned and digitized as part of a building information modelling system, a digital representation of the hospital to assist with continued maintenance and future renovations. The final home for the hard copies is still to be determined.

--Kate Manicom

Peer Support story continued from page 1

their clients. From there, the day could involve taking someone out to help them get a bank card or navigate Ontario Works online, running a mindfulness workshop or going for a tour of Covenant House if that’s where they’re moving next. The goal is to help ease their reintegration back into society.

“We work with a great, compassionate and caring team, but one of the luxuries the peers have is time,” said Borrelly. “We’re able to play chess, paint with them or just talk if that’s what they want. It’s about building trust.”

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The peer support workers self-disclose their experiences when they think it would be helpful.

“Some people want to hear my story and I can say, ‘I’ve been through this too’,” said Marshall.

Borrelly agreed and said that if clients have someone who comes from a place of mutual understanding, they’re not just listening to a medical story but to a humanistic story.

“You have value, you’re not just a diagnosis.”

Follow St. Michael’s on Twitter: @StMikesHospital

BlueDot’s blueprints

Dr. Kamran Khan, an infectious disease specialist and scientist with St. Michael’s, and his team use big data to track disease spread and impact.

They’ve redesigned their space to meet research and business needs. (Photo by Katie Cooper, Medical Media Centre)

By Geoff Koehler

BlueDot draws on big data such as global weather patterns from satellites and worldwide airline ticket sales to create predictive models of where, when and how an outbreak will spread. As BlueDot’s staff move fluidly through their newly designed space, their activity resembles the flight-patterns they use to track pandemics.

Dr. Kamran Khan, an infectious disease specialist and scientist with St. Michael’s Hospital, is the founder of BlueDot. He and his team worked closely with an external consultant to redesign the company’s new space on the third floor of the Keenan Research Centre.

“While planning this space with Research Facilities, we learned that many organizations can’t hire because they have no space for employees to work, yet 10-20 per cent of those spaces are

unoccupied every day,” said Dr. Khan. “We wanted to use the space as efficiently as possible, so moved away from the notion of each team member having a dedicated desk. If I’m not working here, I’m going to pick up my stuff and the space is available for someone else to use.”

A large communal table has a sheet of glass over a map of the world—an ideal place to write notes about outbreaks and events happening around the world each day.

The walls marking the divide between BlueDot and the Centre for Urban Health Solutions are wooden topographical maps, built to scale of regions across the globe. All of the wood, including the communal table and desks, were machine-cut from digital files created by the BlueDot design team, which Dr. Khan said significantly reduced the cost.

Lockers where staff can store their personal belongings are named after different

pathogens from the Anaplasma bacterium to Zika virus.

While many elements of the space playfully give nods to the nature of their work, the reimagined space is also outfitted with a Deep Think Room—where phone calls and conversations aren’t allowed—for employees to put their head down and work in a quiet space. All four walls in BlueDot’s War Room are white boards, where the group will be free to work and produce collaborative ideas.

“What we’re doing lies at the crossroads of medicine, engineering, computing, data science, design and business so we needed a space that was going to allow all of those interactions to occur in a fluid way,” said Dr. Khan. “Being in our new space at St. Michael’s fosters real innovation by blending an academic culture of discovery with the pragmatism of industry. In our new space we’re right at home.”

Check out our Facebook page for more photos of BlueDot’s space https://www.facebook.com/stmichaelshospital/ St. Michael’s is an RNAO Best Practice Spotlight Organization

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The Urban Angel: St. Michael’s treats patients no

Biravina Pathmanathan at a followup surgery appointment with Dr. Karen Cross, a plastic surgeon at St. Michael’s.

(Photo by Marcelo Silles, Medical Media Centre)

Toronto’s Urban Angel offers last hope

By Maria Feldman

After being turned away from six hospitals that lacked specialized personnel and resources to solve the mysteriously debilitating pain radiating through the soles of her feet, 19-year-old Biravina Pathmanathan arrived at St. Michael’s Hospital in a final attempt to seek help.

After her visit to St. Michael’s, Dr. Cross’ health-care team ran a series of tests to determine the cause of the pain and wounds. They confirmed that the growths and wounds on Pathmanathan’s feet had turned cancerous and a double leg amputation was the only viable option.

“When Biravina showed up in my practice, she was a delicate young woman who was just barely over 60 pounds,” said Dr. Karen Cross, a plastic surgeon at St. Michael’s. “Hearing her story just tore my heart in pieces. I knew I had to intervene and fight for her, because if I didn’t, no one else would.”

“This was such a hard decision for me,” said Pathmanathan. “No one wants to lose their legs. I knew that Dr. Cross tried everything to save my legs, but this was my very last hope for a pain-free, extended life.”

Diagnosed as a child with a rare immune deficiency, Pathmanathan had a bone marrow transplant from an unrelated donor when she was five. Despite it being a 100-per-cent match, Pathmanathan’s body rejected the transplant and she developed Graft-Versus-Host Disease.

“We had to plan for everything and find creative alternatives,” said Dr. Cross.

As a result of the GVHD, Pathmanathan’s white blood cells attacked her body and caused a myriad of symptoms. Her skin peeled and blistered, she developed joint contractures (shortening and hardening of the muscles) and eventually painful growths known as “cutaneous horns” formed on her feet.

“Dealing with mortality, the potential of losing one’s legs – it’s hard to handle at such a young age,” said Dr. Cross.

Pathmanathan went from being healthy to a sick child in a wheelchair. The pain that would go on for years derailed Pathmanathan’s plans to attend college.

“Thanks to Dr. Cross, I am still here today,” said Pathmanathan.

“I’m deeply touched by the excellent care I received, and extremely grateful to the hospital staff.”

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Pathmanathan’s operation required a highly specialized team and advanced equipment.

For example, routine blood pressure checks could injure her delicate skin. But the challenges extended far beyond the operating table.

Dr. Cross connected Pathmanathan with another patient with a similar experience to help her overcome reservations about life post-amputation.

one else can or will From foot surgery to the football field

By Kaitlyn Patterson

When 17-year-old Riley Manning broke his right foot playing football in 2014, he thought it would be the end of his playing career, not just the season.

The broken sesamoid bone wasn’t the only foot issue that had impacted Manning’s play. At 16, his big toe began to curl up, causing him pain and instability when standing or walking. Running and turning sharply proved difficult.

“While the break itself wasn’t too bad, the shape of my foot and the way it absorbed pressure caused an underlying problem,” said Manning. “After consulting with three surgeons who all had different opinions, I finally met with Dr. [Timothy] Daniels. He prioritized my case because of its severity, which I was amazed by.”

Dr. Daniels, head of Orthopedic Surgery at St. Michael’s Hospital, diagnosed Manning with turf toe, a common sporting injury that is typically treated with rest and time away from the athlete’s sport.

“However, the instability and pain caused by Riley’s toe put him in the category of 20 to 30 per cent of patients requiring surgery for the problem,” Dr. Daniels said.

There are two joints in the big toe. Dr. Daniels took a tendon from one joint in Manning’s big toe to mend torn ligaments on the bottom of Manning’s foot. Dr. Daniels then fused the same toe joint to Manning’s foot. The procedure prevented the toe from curling any further and alleviated Manning’s constant pain. Since the surgery did not involve the second (or main) joint) in his big toe, Manning’s overall balance and ability to move the toe was not affected.

Dr. Daniels, head of Orthopedic Surgery at St. Michael’s Hospital, diagnosed Riley Manning’s football injury as turf toe. Dr. Daniels repaired the toe and a broken foot, allowing Manning to play out his senior season.

(Photo by Katie Cooper, Medical Media Centre)

“It’s important to listen to the doctor’s advice. If you don’t put the work in at home by doing the rehabilitation exercises, you’re not going to heal,” said Manning.

Immediately after the surgery, Manning had a pin in his big toe and a hard cast on the foot. He spent a month recovering on the couch, before the pin was removed. He was able to begin walking with the support of an Aircast afterward and spent a total of three months recovering.

Less than a year after surgery, Manning was able to begin training for his final season of high school football.

In his followup appointments, Dr. Daniels advised Manning that the scar tissue could build up and he should massage it to increase the range of motion.

Manning’s Oakville Trafalgar team had a successful season, winning the Halton senior boys’ Tier 2 football title in November 2015.

Manning’s work ethic, which he’d been honing by playing football since he was eight years old, kicked in.

“After his surgery, Riley recovered even faster than anticipated and was able to return to sports and his normal lifestyle,” said Dr. Daniels.

“Without the surgery, Riley would have had trouble running and participating in high-contact sports for the rest of his life.”

“When I played my final season, there was a 100 per cent difference to the pain in my foot,” said Manning. “The old pain was gone and it felt like I had a new foot.”

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Haytham Sharar, a nurse practitioner in the Heart Failure Clinic, follows up by phone with a discharged patient referred to him after remote monitoring by a Community Care Access Centre nurse. (Photo by Yuri Markarov, Medical Media Centre)

‘Extra eye’ improves patient experience

By James Wysotski

Patients at the Heart Failure Clinic know help is just a phone call away.

If they notice sudden leg swelling or shortness of breath, the clinic’s nurse practitioner, Haytham Sharar, can advise them.

But what if they don’t recognize these symptoms of congestive heart failure?

A recent quality improvement initiative pursued by Ada Andrade, a nurse practitioner in the Heart and Vascular Program, helped people who didn’t realize they needed it.

While on placement at the Ottawa Heart Institute in 2013 during her master’s in quality improvement and patient safety, Andrade was inspired by the hospital’s remote monitoring of discharged patients.

With the goal of reducing readmission rates, she envisioned adapting it for St. Michael’s Hospital.

Sharing the same goal, the Ontario Telemedicine Network and the OCTOBER 2016 | IN TOUCH | 6

Community Care Access Centre partnered with St. Michael’s heart failure team in a sixmonth pilot program that ended in June.

effectiveness at lowering readmission rates, said Andrade. Data won’t be available until later this fall.

Using OTN’s remote-monitoring equipment, a CCAC nurse checked in daily with patients discharged from St. Michael’s and followed in the heart failure clinic. If signs and symptoms of heart failure and deterioration were detected, the nurse contacted Sharar so that he could call the patient to confirm and determine if a visit to the clinic or other steps were required for further tests or a change in medications.

Regardless, both Andrade and Sharar know the program improved the patient experience.

Primarily elderly patients with comorbidities, “some didn’t realize they had developing problems that were worthy of a call or visit, like weight gain or swelling,” said Sharar. Through this increased monitoring, they received help before problems got out of hand.

“This program made a difference in patients’ lives because we kept them out of the hospital."

With fewer than 10 patients recruited to the program, the sample size may be too small to make generalizations about its

“The patients love it, but more importantly, so do the caregivers,” said Sharar. “They have an extra eye looking at their loved ones and they know there is somebody there they can rely on and call any time. This gives them relief.”

– Haytham Sharar, nurse practitioner in the Heart Failure Clinic

3D printing makes rapid prototyping a reality

By Greg Winson

St. Michael’s Hospital’s first 3D printer promises many advancements, including more cost-effective surgical tools, safer surgeries and improved patient communication.

The ProJet 3510 HDPlus 3D printer was donated to the Research Core Facility for the use of all hospital staff by Dr. Michael Cusimano, a researcher and neurosurgeon who acquired it as part of a Cummings Foundation grant.

“Physicians can perform a simulation using an accurate model before performing surgery on the patient, and they can better communicate ideas to patients and colleagues,” said Dario Bogojevic, a research core facilities specialist with Research Facilities. “We’ve printed an entire human skull based on CT imaging.”

The 3D printer is also proving valuable for rapid prototyping of items such as surgical tools. Bogojevic is working with Dr. Joao Rezende-Neto, a trauma-acute care general surgeon at St. Michael’s and an associate scientist in the Keenan Research Centre for Biomedical Science, to develop a surgical tool to perform a tracheostomy.

The device currently used is made of metal. The cost of producing this device is much higher than it would be from plastic. It is also more difficult to make design changes to metal devices.

“Creating the device from plastic is much more versatile,” said Dr. Rezende-Neto. Making changes to the prototype is as easy as clicking a mouse on a computer. “The 3D printer is an important tool to translate metal into plastic and vice versa.”

Dr. Rezende-Neto’s surgical tool prototype is scheduled to be tested within the next year.

The printer has one of the best resolutions for commercially available printers. The “printing,” or the creation of an acrylic plastic model, can take anywhere from a couple of hours to a couple of days, depending on the complexity of the model.

The first step is to create a 3D model using computer-aided design software. Data from medical imaging such as MRI and CT scans can also be used to create 3D models of bones and organs for 3D printing. The models are saved in a file format suitable for the 3D printer. 3D printing technology uses a layer-based method where an object is made by adding successive layers of material to form the physical part. The printer can produce a model up to 298 X 185 X 203 millimetres and its highest resolution is 16 microns in vertical direction.

Left: A model of a human hand produced by the ProJet 3510 HDPlus 3D printer. Right: Flowers produced by the 3D printer show the great level of detail possible with 3D printing. (Photos Courtesy of St. Michael’s Research Facilities) OCTOBER 2016 | IN TOUCH | 7

Q&A

INES DE CAMPOS CLINICAL NURSE EDUCATOR IN THE MEDICAL-SURGICAL INTENSIVE CARE UNIT

By Kaitlyn Patterson (Photo by Katie Cooper, Medical Media Centre)

Ines De Campos is the clinical leader manager for the Outpatient Mobility Program. Two of the clinics she manages, Multiple Sclerosis and Neurophysiology (EMG/EEG), moved to 9 Donnelly in May and June as part of St. Michael’s 3.0.

Q: How did you prepare to move two clinics into one integrated area?

We started meeting with Planning and Redevelopment two years ago to discuss the floor plans and layouts, and operational readiness meetings began in January to ensure we were prepared for both moves. The operational readiness team ensured we had the support and tools we needed to provide care in our new location. Before moving, we also transitioned to paperless records to limit the number of physical files we were bringing with us.

Q: What are the benefits of the new space?

From a physical perspective, it’s a more modern, open space with natural light, which patients and staff both enjoy. The combined space provides more administrative support, as the clerical staff are cross-trained. Change can be hard, but by incorporating positive changes into something we already had to do, it made the transition smoother.

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OCTOBER 2016

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 Lauren Gatti

Q: What challenges did your team face in moving?

Adapting to a different space, a new way of working and new people was a challenge, but it’s one we anticipated. We learned that it’s inconceivable to think we could adjust immediately. But we also learned that our staff are resilient, as they continued to provide quality care while organizing the new clinics.

Q: What advice do you have for other units and departments preparing for a move?

Plan for anything you can anticipate. If it doesn’t happen, it’s a win. Make sure other teams you will continue to work with, such as housekeeping, are part of the transition. And share as much information with your team and colleagues as possible. The less confusion around the move, the less anxiety staff will have.

Q: What is your favourite part of the new space?

I love that the openness and brightness make everything feel positive. Similar to when you clean your closet out and bring new things in, the new clinic gives us the opportunity to improve the care we provide. I find it really energizes me to be in a new space and to be able to encourage my team to embrace the new perspective it brings.