Our Shared Purpose newsletter - February 2019

OUR SHARED PURPOSE February 2019

“I knew I could lose my dad” A family’s story about experiencing the dangers of the flu (pg. 3)

Learning about gender dysphoria A new review on how to support at-risk youth (pg. 7)

GOING HOME WITHOUT RESEARCH CANCER 101

What takes to A newit clinic that’s treating innovate (pg.cancers 4) some skin in a

single day (pg. 4)

Getting the word out A new system for outbreak notifications that’s consistent, accurate and timely (pg. 2)

Elephant in the Room New program signals the need to talk about mental health issues at work (pg. 8)

Automated mass calling project team members gather in the Houses of Providence. Clockwise from top left: Pat Colucci, Aurora Wilson, Shiva Nadarajan, Jube Walker, and Maggie Bruneau

Getting the word out

The impact of the flu

New technology to improve outbreak notifications

A patient’s story about the very real dangers of influenza

by Emily Dawson

by Amber Daugherty

Keeping people safe is at the heart of everything we do at Unity

non-clinical staff - and sometimes volunteers - making these calls.

Umberto Leone knows all too well the dangers of the flu. When his

respiratory failure. It can cause severe issues for high-risk groups

Health Toronto, including efforts to minimize the impact and

The call process added to stress and frustration amidst an outbreak.”

father was diagnosed at the beginning of 2017, it set off a devastating

including babies, pregnant women and the elderly. Every year, it

spread of outbreaks. This is important across all programs, including

Wilson knew there was a better way. Providence had recently

chain of events leading to nine months in hospital – including almost

causes more than 12,200 hospitalizations and 3,500 deaths across

Providence Healthcare’s Cardinal Ambrozic Houses of Providence long-term care home, where 288 residents live in a close-knit, active community.

Historically, once Infection Prevention and

Control (IPAC) declared an outbreak on a unit in the Houses, staff and volunteers would manually call families to inform them of the outbreak details.

During an outbreak, Providence notifies

contracted a vendor to provide automated

two in the Intensive Care Unit.

“...We noted a few barriers to providing consistent, accurate and timely notifications”

post-discharge calling to all patients leaving its

Hospital, and Wilson jumped on the opportunity

daily and drove himself around,” Leone said. “Now

to harness the same technology for outbreak

he’s on first floor living, has heart failure, has to be

notifications.

careful what he eats – his whole life has changed.”

AURORA WILSON MANAGER OF IPAC PROVIDENCE

families for several reasons: to keep other

Now, when an outbreak is declared,

“My father was a healthy guy who walked

Leone’s father – Michele – was diagnosed

IPAC staff uploads the contacts to an external

with influenza at 81 years old. After trying to ride

carrier’s portal, selects the affected unit, and

it out at home with fluids and rest, he started to

initiates the automated calling. If the call is

get worse, which prompted an emergency visit

answered or goes to voicemail, families hear a

to the hospital where he was admitted to the ICU.

standardized script with the outbreak details. The

He was there for 48 days.

Canada. “Unfortunately, many people don’t take

“It isn’t 100 per cent effective but it will help protect you, which is better than no protection at all.”

DR. MARK DOWNING

INFECTION CONTROL OFFICER ST. JOSEPH’S

Downing, infection control officer at St. Joseph’s.

“The risks are so high, especially when there’s a free option available that can help keep people healthy – the flu shot. It isn’t 100 per cent effective but it will help protect you, which is better than no protection at all.”

Leone’s father is now back home and planned to get the flu shot this year. “The flu isn’t just a bad cold – it’s a virus that can lead to a complete

residents and visitors healthy by minimizing the spread of infection;

system is programmed to repeat the call when there is no answer.

to maintain organizational transparency; and to help people make

After a respiratory outbreak in December 2018 affecting two units

said. “He also entered a state of a comatose-like catatonic stupor,

changes to your quality of life,” Leone said.

informed decisions for visiting.

in the home, the system generated 64 calls, of which 78 per cent were

suffered two bacterial pneumonias, sepsis and more. Everything

answered (live or voicemail), 15 per cent went unanswered or reached

came to a grinding halt – I knew I could lose my dad.”

it out of the hospital at all. I’m grateful to St. Joseph’s and all of the staff

barriers to providing consistent, accurate and timely notifications,” said

a busy line, and seven per cent had invalid numbers.

there who took such good care of my dad – we’re happy to have him

Aurora Wilson, Providence’s manager of IPAC.

to other infections and complications, including pneumonia and

“When evaluating the efficacy of manual calls, we noted a few

“A robust report is immediately available after the automated

“The process was time-consuming and took clinicians away

call,” added Wilson. “It tracks the number of people reached, whether

from care during critical moments in an outbreak. We also found the

it was live or voicemail, out-of-service numbers, no answer or busy

communications were inconsistent, as we would have clinical and

lines – all at the click of a button.”

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OUR SHARED PURPOSE

“He was intubated three times and put on life support,” Leone

the flu as seriously as they should,” said Dr. Mark

Flu can often weaken the body and make it more susceptible

shutdown and if you’re lucky you’ll make it out with hopefully minimal “The problem is that a lot of elderly people who get it don’t make

back home.”

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.

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Changing how skin cancer is treated A new clinic that’s offering patients sameday treatments with impressive cure rates

by Mary Dickie

A clinic that treats some skin cancers in a single day has opened

slides,” says Dr. Dahlke. “It’s great for the patient, and it’s really satisfying

at St. Joseph’s Health Centre. Using the Mohs micrographic surgery

for me to be able to provide this.”

procedure — which is named after Dr. Frederic Mohs, who pioneered

the procedure — the physician removes cancerous growths and tests

as little surrounding healthy tissue as possible to minimize disfigurement.

the tissue on the spot, repeating the process if necessary until the

The tissue is then flash frozen and examined under a microscope while

tumour is removed entirely.

the patient waits.

“Basal cell and squamous cell are the most common forms of skin

“The tissue is processed in a way wherein the entire periphery can

be examined,” Dr. Dahlke explains. “That’s why our cure rates are higher

dermatologist who leads the new Mohs clinic, in partnership with the

than other techniques.”

hospital’s Medical Education Teaching Clinic.

“Left untreated, they can lead to metastasis, disfigurement and

“The patient might go back to the waiting room once or twice more,

death — and the incidence is on the rise for several reasons, including a

because we keep taking the smallest amount possible and checking

depleted ozone layer and an aging population,” Dr. Dahlke adds. “So it’s

the margins,” she says. “It’s extremely precise. By the end of the day,

great to be able to offer this treatment. My patients come in with cancer,

we’ve confirmed there’s no tumour left and taken the least amount of

and go home without it.”

normal tissue possible.”

If she sees any tumour cells, Dr. Dahlke will take a bit more tissue.

William Hanley, one of the first patients treated at the clinic,

— 99 per cent for primary tumours, 94 to 95 per cent for ones that have

came in because of a growth on his face that had not responded to

been previously irradiated or treated — but it’s also relatively fast and

conventional treatment. “They can give a biopsy result in 45 minutes,

cost effective. The procedure is done in an outpatient setting, and the

which is fantastic,” Hanley says. ”You’re not waiting for a week or more,

physician also acts as the pathologist. “I do the surgery and also read the

as you would if something had to be sent out to be tested.

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DR. ERIN DAHLKE

The Mohs procedure involves Dr. Dahlke removing the tumour and

cancer, and that’s what we treat,” says Dr. Erin Dahlke, the St. Joseph’s

Mohs micrographic surgery not only delivers impressive cure rates

“My patients come in with cancer and leave without it.”

MOHS CLINIC LEAD ST. JOSEPH’S

“For me, it took three sessions before it was clear,” he adds. “It can

(clockwise from opposite page) Dr. Erin Dahlke and nurse Josipa Marinovic operate on a patient in the Mohs micrographic surgery clinic at St. Joseph’s; previous patient William Hanley with Dr. Dahlke; Dr. Dahlke examines the tissue while the patient waits.

members dealing with tenuous housing or homelessness can get the

be a long process, but you know it’s going to get done that day, which

care they need.

is great.” Dr. Dahlke sees her patients a week later to make sure they’re

healing well.

marginalized populations,” Dr. Dahlke says. “There’s a need for outpatient

treatments in our local community, and to be able to treat everyone with

“Removing the tumour in its entirety is the top priority, and Mohs

“There is evidence that skin disease tends to go untreated longer in

surgery is best as it provides the highest cure rates,” she says.

skin cancer in the best possible way is something I’m excited about.”

“The next step is providing the best esthetic results, which means

Dr. Dahlke also looks forward to building St. Joseph’s dermatology

reconstructive surgery, flaps and grafts to minimize scarring,” she adds.

division, and working within the new Unity Health Toronto network to

“I like to see my patients back at one week and again at two months to

offer Mohs procedures to St. Michael’s kidney transplant recipients, who

ensure everything is healing as it should be.”

are at high risk for skin cancer.

Once a patient has had one basal cell carcinoma, they have about

“I want to build the education component and the dermatology

a 50 per cent chance of getting another one in the next five years, says

division,” she says. ”And through our partnership with St. Michael’s, I’m

Dr. Dahlke. “So patients do need followup monitoring — if not with their

looking forward to how we integrate and build our division together.”

dermatologist, then with their family doctor.”

Another benefit of the Mohs clinic is that St. Joseph’s community OUR SHARED PURPOSE

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CO-DESIGNING THE FUTURE OF TEACHING AND LEARNING Over the past few months, staff across the organization have been engaging teams, patients, learners, and academic partners to start developing a road map for the future of teaching and learning at Unity Health Toronto. We launched an Organizational Learning Scan (OLS) survey in September, followed by a Teaching and Learning retreat in October, and an Education Summit in December. Thank you to the 1,600 people who completed the survey – your input is invaluable.

Our sites have strong legacies of excellence in education, and people continue to see teaching and learning as a catalyst for positive change, and an essential ingredient to both personal and organizational success. Results of this work will be shared in the future.

View from the Summit: Almost 100 participants attended Unity Health Toronto’s Education Summit on December 4.

Helping families with complex decisions Review explores best practices for supporting youth with gender dysphoria

by Michael Oliveira

RESEARCHING RARE DISEASES AND THEIR CAUSES A rare disease gene is responsible for muscle and heart diseases, suggests recent research led by St. Michael’s and international collaborators.

Dr. Xiao-Yan Wen, director of the Zebrafish Centre for Advanced Drug Discovery, replicated the genetic make-up of two siblings with heart disease, neuromuscular symptoms and increased levels of sialic acid sugar in zebrafish. He confirmed that an NPL (N-acetylneuraminate pyruvate lyase) gene deficiency in zebrafish resulted in muscle and heart problems and identified potential treatment options for this disorder.

“No one had linked this gene to muscle myopathy before,” said Dr. Wen, who is also a scientist in Keenan Research Centre for Biomedical Science. “It might mean better treatment options for NPL-deficient patients one day.”

Dr. Xiao-Yan Wen (centre) and his team at the Zebrafish Centre for Advanced Drug Discovery of St. Michael’s. (Photo: Xiao-Yan Wen Lab)

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St. Michael’s Dr. Joey Bonifacio says there are practice gaps that need to be examined when it comes to treating young people with gender dysphoria.

(Photo: Katie Cooper)

With a growing number of young people seeking care for gender

dysphoria, primary care providers should be preparing for how

around collaborative decision-making among the youth, family or

to help support this vulnerable population, says St. Michael’s

guardians, and care providers,” writes Dr. Bonifacio. “The youth’s voice

Hospital’s Dr. Joey Bonifacio.

is always paramount.”

A review co-authored by Dr. Bonifacio in CMAJ (Canadian Medical

Dr. Bonifacio advises that other primary care providers can help

Association Journal) calls for a “thoughtful,

their young patients by asking questions about

affirming, well-reasoned individualized approach

“Transgender

that attempts to maximize support … as youth

care has benefited

and their caregivers make complex and difficult

HALF A CENTURY OF SUCCESS FOR THE KIDNEY TRANSPLANT PROGRAM SHARING MEDICAL IMAGING DATA TO CUT RADIATION DOSES When Registered Nurse Maureen Connelly started to work with

decisions.”

transplant patients in the 1970s, getting a transplant was considered Patients might expect radiation doses for CT scans to be a risky choice. comparable from one hospital to the next, but a team at

Now celebrating its 50th anniversary, the Kidney Transplant St. Michael’s Hospital says the dose variance can be startling.

Program at St. Michael’s cares for more than 2,000 patients whose The team is collecting and analyzing data from eight hospitals prognoses after transplant continue to improve. “It was really those for the Medical Imaging Metadata Repository of Ontario (MIMRO) early pioneers of transplant who were brave enough to consider it to help reduce the province’s average radiation dose per scan. an option that paved the way for us to learn from those experiences Using artificial intelligence to sort the hospitals’ data, the team and be able to improve outcomes,” Connelly said. generated comparative data by facility, scanner and exam to help

Connelly and her colleagues are marking this anniversary with determine best practices. MIMRO is funded primarily by the launch of a campaign, #MyTXAnniversary, which encourages St. Michael’s and was created by two of its radiologists, patients to share their own transplant anniversary stories. Stay tuned Drs. Timothy Dowdell and Bruce Gray. for stories throughout the year and register to be an organ donor Radiologist Dr. Bruce Gray and data analyst Lianne Concepcion review data today.

by knowledge gaps,” says Dr. Bonifacio, who

submitted to MIMRO. (Photo: Katie Cooper) The internal St. Michael’s newsletter, Capsule News, celebrates the hospital’s 100th transplant in 1977. (Photo: St. Michael’s Hospital Archives) OUR SHARED PURPOSE

“Ideally, the approach to youth with gender dysphoria revolves

“Transgender care has benefited greatly

from detailed guidelines but practice is hampered works in the St. Michael’s pediatrics department.

The article defines gender dysphoria as “the

distress experienced by an individual when their

greatly from detailed guidelines but practice is hampered by knowledge gaps” DR. JOEY BONIFACIO PEDIATRICIAN ST. MICHAEL’S

gender identity and their gender assigned at birth

gender in an inclusive way that treats them with respect.

“Know your adolescents by spending

time with them and understanding their lived experience and how such experiences have affected the way they understand their gender and what is going on now,” he says.

“Adolescents with gender dysphoria

present in different ways. Some may overtly state they are transgender. Others may present to their primary care provider with a mental health issue

are (at odds with each other).”

such as anxiety or depression. Others may have difficulty in school.

Studies from other countries have estimated that between 1.2 per

“So the only real way we can understand what the youth is going

cent to 4.1 per cent of adolescents may identify as a different gender

through is to make sure that we ask these questions and connect

identify from their birth gender.

them with providers that can give them appropriate care.”

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Doors that are always open A program that’s encouraging everyone to open up about mental health

by Selma Al-Samarrai

Virona Ibrahim, wellness co-ordinator at St. Joseph’s, is holding the blue elephant that specially trained managers have in their offices as identifiers of the Elephant In The Room campaign

If you walk through St. Joseph’s, you’ll find images of blue elephants on certain office doors. To visitors, this probably means nothing. But to staff members, each elephant means there’s a leader inside that office specially trained to discuss mental health and ready to direct them to the right supports and resources when needed.

This is part of the national Elephant in the Room campaign,

“The first thing that came to mind when I heard of this campaign was

developed by the Mood Disorders Society of Canada, which St.

the World Health Organization’s recent finding that listed depression

Joseph’s recently joined. Using the blue elephant as an identifier, the

as the number one cause for years lived with disability across the

campaign creates a safe space for staff to literally and figuratively

globe,” said Dr. Jose Silveira, chief and medical director of the Mental

discuss the elephant in the room.

Health and Addictions Program at St. Joseph’s.

“Unfortunately, we find that mental health isn’t very easily

“Early identification of mental health issues while somebody is

addressed,” explained Virona Ibrahim, wellness co-ordinator at St.

at work is very important, especially in a health-care setting given the

Joseph’s.

psychological strain associated with providing care. It’s particularly

“It’s always easy for us to do programs around physical wellness

important that health-care providers are healthy emotionally and

and healthy eating, but it’s hard to get people to talk about mental

psychologically in order to be able to provide the right support to

health. This was our way of making the conversation approachable.”

our patients.”

So far, 60 St. Joseph’s leaders have been trained on mental

The Elephant in the Room Campaign is expected to expand to

health in the workplace and are now equipped to be able to recognize

Providence and St. Michael’s.

when a staff member may need support. They’ve also learned how

to positively and supportively engage their staff on this topic, and

just get people to talk about it, I think more people will start seeking

generally promote mental health at work.

help,” said Ibrahim.

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OUR SHARED PURPOSE

“Mental health affects everyone in their own way, so if we can