Our Shared Purpose newsletter - Dec. 2018/Jan. 2019

OUR SHARED PURPOSE December/January 2018

Research at the frontlines How a new appointment is empowering everyone to innovate (pg. 2)

A clinic with a view St. Joseph’s IV clinic is now a calming oasis for treatment (pg. 3)

RESEARCH n o as e s e h t s Ti 101 grateful

to be

What it takes to are thankful rn what people innovateLea(pg.

4) 4) the holidays (pg. for over

Get up and go Studying the impact of movement in the ICU on recovery (pg. 7)

Safety training How simulation helps rehab patients get back to their normal (pg. 8)

Breaking barriers

New space, same great care

Empowering innovative practice-based research

Cecilia Santiago, nursing practice manager, shares her research

Relocated clinic improves patient experience and access

Dr. John Blondal, head of hematology, Jan Boulet, RN, Jean Barber,

findings at the IPBR showcase. (Photo: Yuri Markarov)

Dr. Moishe Davidson, retired physician, Jennifer Spencer, patient care manager

by Emily Dawson

by Ana Gajic

Cecilia Santiago, who started her career at St. Michael’s as a

which are challenging for practicing nurses and health disciplines to

St. Joseph’s Infusion (IV) Clinic is a lifeline in the community for

including two in the hallway, and was open three full days and two half

critical care nurse, has always had the research bug.

meet. With the new appointment clinicians will be able to apply if

people with infusion needs. A commitment to improve the patient

days per week. There are now eight chairs and the clinic will operate

they are the lead on an ongoing study or have recently presented/

experience, meet a growing demand, and reduce length-of-stay

five full days every week.

culture of innovation, there was a gap.

published their research.

and emergency department (ED) visits led to its recent relocation

within the Health Centre.

“I’ve been coming to this clinic every two weeks since 2013. The old

Even though she felt supported by the hospital’s long-standing “For frontline staff, research isn’t our primary role but it is key to

“These new appointments are a tangible way of bridging

Jean Barber says the new area has improved her experience.

evidence based practice”, she said. “Previously, doing and integrating

research and clinical practice across the network and to encourage

The new clinic, made possible through the St. Joseph’s Health

space was over-crowded and noisy – it was right beside an elevator

research into our practice wasn’t always possible or prioritized.”

our nurses and health disciplines to develop their research ideas,” said

Centre Foundation’s oncology fund, is dedicated to Dr. Moishe

in a busy hallway,” said Barber. “The new clinic is beautiful! It’s quieter

Dr. Patricia O’Campo, interim vice-president of Research.

Davidson, in recognition of his exemplary work and commitment

and overlooks Lake Ontario.”

disciplines engaged in research across the network will be eligible

For Rachel Devitt, professional practice leader of Occupational

to our patients. A collaborative effort between the Oncology,

to apply for a research appointment at the Li Ka Shing Knowledge

Therapy and manager of Clinical Research at Providence Healthcare,

Ambulatory Care Centre, and Redevelopment teams brought this

hours each, which underscores the importance of a soothing

Institute (LKSKI).

this is the first step to evolving research across the network.

project to fruition, and patients started using the new space on the first

environment. As a retired social worker, she also noticed how the

“I am always impressed with full-time clinicians who take on

floor of the Morrow wing in August. The clinic is bigger and brighter

new space enables safer care. “The staff are always even-tempered

excellent patient care using the best available evidence,” said Sonya

research,” Devitt said. “It takes a lot of time. This will add a layer of

for our patients, and has more space for the clinical team to deliver

and obliging but I know it was really difficult in the tight quarters with

Canzian, vice president of Clinical Programs at St. Joseph’s (interim)

acknowledgement for them.”

care,” said Jennifer Spencer, patient care manager, Medicine.

all the chairs, IV poles, and equipment they use. It feels much safer

and at St. Michael’s and chief nursing and health disciplines officer

for everyone now.”

(interim). “The new ‘Practice Based Researcher (Status-Only)’

“Currently practice-based research is carried out in pockets,” Dr.

transfusions for patients referred primarily from the Oncology and

appointment will recognize and empower the innovative research

Topolovec-Vranic said. “These new appointments will help to

Haematology programs, features an open concept layout and large

We’ve created capacity to offer more timely access to our patients.

being carried out by our nurses and health disciplines.”

develop a community of like-minded clinicians who seek to generate

windows to bring natural light into the treatment areas. The larger

We can now minimize how often we redirect outpatients to the ED

evidence that changes practice across the network. We want to

space accommodates more patients and promotes a safer work

for urgent IV needs, explore ways to expand services, and improve

motivate our clinicians to participate in research.”

environment. Before its relocation, the clinic had six treatment chairs,

the patient experience.”

Now, that will change. For the first time, nurses and health

“We take great pride in the fact that our clinicians seek to deliver

Historically, certain barriers may have impeded our clinicians

from leading research projects, said Dr. Jane Topolovec-Vranic,

Applications for the appointment will open in January 2019.

The clinic, which conducts both infusion therapies and

Barber’s bi-weekly appointments run between two and four

Spencer is proud of the new space. “It’s been a real team effort.

director of Interprofessional Practice Based Research at St. Michael’s.

Traditionally, a scientist appointment at LKSKI required affiliation with a university, and a commitment of time dedicated to research; criteria

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OUR SHARED PURPOSE

Our Shared Purpose is a monthly newsletter highlighting our people and the ways they are improving care, patient experience and the health of our communities.

Learn more: www.oursharedpurpose.com

OUR SHARED PURPOSE

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What are you grateful for this holiday season?

This time of year provides the perfect opportunity to reflect on wha t makes us smile. Perhaps it’s family or friends. Maybe it’s the decorations on you r unit or a special tradition. To mark the holidays, we asked people from across our network to tell us what it is that elevat es the season for them. Here’s what we hea rd…

I am grateful to work for an organization with an incredible network of people who empower me to be the best that I can be.

- Crystal, St. Joseph's

ho are deeplIy w le op pe h it w g in ct a Inter re is one thing ca g n vi gi ut bo a te a n io pass for. will always be grateful - Steve, St. Joseph's

I'm grateful for my friends and family. We have a big family dinner, exchange gifts and play board games.

- Michelle, St. Michael's

s y a d s i l y o a H d i l y o p H p H appy Ha I'm thankful to share a spec lunch with our residents. I get ial Christmas wear a hat that makes them smto ile.

- Henr

o yours t y il m a f r from ou

y, Providence

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see my family Every year I put out a 'money I'm going home to Nova ScotIia to see chocolate coins for our visitors tree' filled with to t ge ly on o wh , ids dk an gr to wish them good and nine fo . rt ar une and joy. twice a ye OUR SHARED PURPOSE La To s ' l ya, Providence ae - Donald, St. Mich

welcoming e 'r e w e us ca e b l a ci spe This holiday is extrainto the world. I'm also grateful our first daughter pport from my Providence family. for the love and suennifer, Providence -J

During the holidays I am grat eful r the extra time spent with my famifo ly - Robert, St. Joseph's .

I'm heading to Mexico to see family some I haven't seen in over 10 years! I'm grateful to get to spend time with them.

- Jocelyn, St. Michael's OUR SHARED PURPOSE

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SHARING LIFE STORIES The Cardinal Ambrozic Houses of Providence is a community of 288 people of different backgrounds and life experiences, and this sense of community is at the heart of its new “Life Stories” initiative.

“We wanted to find a creative, meaningful way to build stronger relationships between residents, staff and volunteers,” said Cindy Martin, manager of activation and programs. “The a-ha moment came during a Residents Council meeting when a few residents themselves said that it was sometimes hard to get to know each other.”

Volunteers meet with willing residents and ask them a series of questions ranging from children’s names and careers to favourite foods and things they love. Staff then create a visual “Life Story” board that gets posted on the resident’s door.

“Everyone has a fascinating story that deserves to be shared.

It’s bringing a whole new energy to our community,” said Martin.

Move to improve Early rehabilitation in critical care the focus of pilot project

by Greg Winson

Resident Helen McAllister was an early participant in the Life Stories project.

Photo credit: Ramon Syyap

ST. MICHAEL’S JOINS CHIRPP St. Michael’s recently became the first adult hospital in a downtown urban setting to participate in the national Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP).

St. Michael’s joins 11 pediatric hospitals and seven general hospitals across Canada that survey patients who come in to the Emergency Department with an injury or poisoning. The purpose is to understand the how, why, what and when behind the incident, for the purpose of building knowledge for better prevention strategies. The definitions for injury and poisoning in CHIRPP range widely to include everything from a drug overdose to a car accident to a workplace injury.

“St. Michael’s serves such a diverse population that it really represents a microcosm of Canada. Our participation in this program will provide unique perspectives that have been lacking until now at the federal level,” explained Dr. Michael Cusimano, neurosurgeon and co-director of CHIRPP at St. Michael’s.

The CHIRPP team at St. Michael’s is, from L to R: Stanley Zhang, research coordinator, Injury Prevention Research; Dr. Michael Cusimano; Nancy Agbaje, research assistant, Injury Prevention Research; Dr. Alun Ackery.

HONEY, I SHRUNK THE RESEARCH A new facility at St. Michael’s will allow researchersDATA to build miniscule SHARING MEDICAL IMAGING projects thatRADIATION will drive faster, lower cost and more accessible TO CUT DOSES innovation.

Patients might expect radiation doses for CT to be

The Microfabrication Core facility will allow for scans the in-house comparable from one hospital to the next, but a team at development of experiments using elements such as microbubbles St. Michael’s Hospital says the dosethat variance can be startling. for ultrasounds; lab-on-a-chip devices shrink experiments; and The team is collecting and analyzing data from hospitals single-cell droplets that show responses of one celleight at a time. for Imaging Metadata Repository ofDelivery Ontario (MIMRO) the Dr.Medical Scott Tsai, the theme lead for Biomedical Systems to help reduce the province’s average radiation dose per scan. at the Institute for Biomedical Engineering, Science and Technology Using intelligence sort theUniversity, hospitals’ data, the team (iBEST)artificial of St. Michael’s andtoRyerson will be able to generated comparative data by facility, scanner and exam to help fabricate bubbles that are smaller than a hair follicle on-site. These determine bestinto practices.

MIMRO isfor funded primarily byimaging. can be injected the bloodstream cancer and heart St. Michael’s and was created by two of its radiologists, “Until now, we’ve had to outsource tools,” Dr. Tsai said. “Researchers Drs. Timothy Dowdell and Bruce Gray. at iBEST and the Keenan Research Centre for Biomedical Science nowRadiologist have access to these tools can imagine Dr. Bruce Gray and datahere. analyst“People Lianne Concepcion reviewnew data submitted to MIMRO. (Photo: Katie Cooper) experiments they couldn’t before. ”

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The OUR Microfabrication Room allows for the area to remain clear of dust SHARED Clean PURPOSE particles as small experiments are being built. (Photo: Yuri Markarov)

Ken Slak (centre) walks around the ICU with assistance from physiotherapist Danny Slack and physiotherapy assistant Kelly Hyduk.

For patients admitted to the Intensive Care Unit, early mobility

actually good for patients to get up and mobilize.”

can be a key factor to a successful recovery. Now a pilot project

underway at St. Michael’s and St. Joseph’s will study how to

practice prior to the PERCC pilot project.

implement early mobility in the ICU environment and provide a

standardized toolkit of best practices to critical care units across

clinical nurse educator in the MSICU at St. Michael’s. “We had previous

the province.

guidelines in place, so this project involved formalizing and continuing

to improve, creating a 2.0 version.”

The Provincial Early Rehabilitation in Critical Care (PERCC)

The shift has been embraced at both sites and had been put into “Our culture has been very mobility-driven,” said Shannon Swift,

initiative is a partnership between St. Michael’s and Critical Care

Services Ontario.

achieved in their mobility session, ranging from passive bed exercises

to walking independently. The chart, posted at the bedside, shows

“Maintaining strength is very important,” said Dr. Andrew Baker,

Each patient receives a chart with a number based on what they

chief of the Critical Care department at St. Michael’s. “It allows one to

patients their progress.

maintain activities of daily living, everything from getting out of a chair,

taking care of one’s own personal needs, eating meals independently,

said Danny Slack, a physiotherapist in the Intensive Care Unit at St.

and of course being able to enjoy activities with one’s family like

Joseph’s. “Now patients and their family members can see the target

walking and shopping.”

goals for the day.”

Maintaining strength has the potential to reduce the length

“Before, patients wouldn’t know what their rehab goals were,”

Both St. Michael’s and St. Joseph’s have additional physiotherapy

of stay in hospital, and reduce or eliminate the need to go to a

coverage as part of the pilot, which is making a difference.

rehabilitation hospital as part of recovery.

Slack. “This speeds up recovery times, especially for more complex

Early mobility represents a shift from the traditional concept

“We’re able to see more patients, see patients twice a day,” said

of a patient resting and recovering before undergoing any sort of

patients.”

rehabilitation.

eventually be rolled out to Critical Care units throughout Ontario.

“It doesn’t always seem intuitive, because you think, if someone’s

The early rehabilitation concepts learned during the pilot will

really sick they need to rest,” said Deanna Feltracco, a physiotherapist

“The primary objective is to help patients,” said Dr. Baker. “The

in the Medical Surgical Intensive Care Unit at St. Michael’s. “But it’s

goal is to get patients better sooner.”

OUR SHARED PURPOSE

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The indoor Toyota Canada Motor Skills Clinic at Providence Healthcare, offers patients a safe and controlled area to practice navigating in and out of a car, as well as walking on various surfaces. (Photo: Ramon Syyap)

Practicing safely Providence patients work on outdoor mobility indoors

The room offers various walking surfaces and walking equipment

by Selma Al-Samarrai

to offer patients a range of mobility options to practice on.

Inside the walls of Providence Healthcare is a parked SUV, patches

from their wheelchair or walker into the car, and vice versa. Caregivers

of artificial grass and gravel, concrete sidewalks, ramps and curbs.

are shown how to help patients with this and are taught safe body

The Toyota Canada Motor Skills Clinic is a specially designed

mechanics when lifting mobility devices in and out of a vehicle,” said

room where rehabilitation professionals can help their patients practice

Poon. “We also practice on the different surfaces so patients can

and regain their strength and mobility. Patients can get comfortable

become more confident in outdoor mobility or getting around in the

navigating on different outdoor surfaces, getting in and out of a real car

community.”

—a Toyota Venza — and folding and storing walking equipment such

as wheelchairs and gait aids in a vehicle.

re-familiarize themselves with the feeling of the gas and brake pedals,

added Dellene Sakaguchi, a physiotherapist and practice consultant

“This room provides our patients with a realistic and safe

Patients who want to return to driving sometimes need to also

environment where they feel supported and secure while trying new

for the Orthopedic and Amputee Clinic.

things after a stroke, orthopaedic surgery, or an injury, such as a lower

limb amputation,” explained Shawn Brady, director of Interprofessional

a car so we can problem solve with the patient,” said Sakaguchi.

Practice at Providence.

The room is used for multiple purposes, said Sarane Poon, an

regarding how their walker is best stored and what types of adaptive

occupational therapist and practice consultant in the Orthopedic and

equipment they need. Then the client can decide for themselves what

Amputee Clinic at Providence.

works best for them.”

“We often use the room to practice car transfers with patients.

Before the patients go home, they need to practice safely getting 8

OUR SHARED PURPOSE

“The room allows us to simulate what it’s like to get in and out of “We try different methods and provide recommendations

This room was donated by Toyota in 2006 and is often used

multiple times a day by patients and health-care practitioners.