Our Shared Purpose newsletter: September 2018

OUR SHARED PURPOSE September 2018

Uniting the community Working together to improve the health of children in our city (pg. 2)

The doctor will see you now — on video How telemedicine is supporting virtual check-ups (pg. 8)

TRUE DEFINITION OF COLLABORATION A St. Michael’s-Providence initiative is tackling painful wait times (pg. 4)

The first in Ontario An innovative device that will help save lives in the Emergency Department (pg. 3)

Swinging for recovery A golf program that’s helping patients with their rehab (pg.7)

THIS DEVICE WILL SAVE LIVES

BY MARY DICKIE

UNITING THE COMMUNITY FOR CHILD HEALTH

BY ANA GAJIC

Michelle Sullivan (far left) and her son Anthony (middle) are one of the many families served by the Paediatric School Outreach program run through St. Joseph’s and headed up by Dr. Heather Yang (right).

448

PATIENTS SEEN

1000

APPOINTMENTS IN CLINIC

200

FAMILIES SERVED

Clockwise from top left: Dr. Joao Rezende-Neto inserts the ER-REBOA catheter in the manikin; team members discuss the logistics of the test; Dr. Rezende-Neto examines the ER-REBOA catheter before the test; Orlando the manikin in St. Michael’s trauma bay.

The high-tech manikin Orlando lies in St. Michael’s trauma

in Orlando’s groin, advances it up to the aorta, inflates the

bay, surrounded by nurses, respiratory therapists, X-ray

pediatrician at the outreach program and Anthony’s doctor.

balloon, observes, then deflates and removes it. The whole

Michelle Sullivan used to have to travel across the city to visit

techs, physicians, surgeons, clericals, educators, simulation

A demographic study led by Dr. Wormsbecker showed

process takes about 15 minutes, well within the advised

her son’s pediatrician.

centre personnel and observers awaiting the trial of a new

Then she was referred to the Paediatric School Outreach

most families accessing care reported lower incomes and

30-minute limit on restricting blood flow to the legs. Extensive

surgical device, the ER-REBOA catheter. Orlando, the team

Program in the west end, run by St. Joseph’s Health Centre

English as a second language. This research on the first 15

feedback follows, with every detail analyzed for efficiency.

is told, has been in a motorcycle crash and is experiencing

and the Toronto District School Board. Not only was the

months of the program is the start to understanding children’s

pelvic bleeding.

Parkdale Public School clinic closer to home, but it also put

needs, which often extend beyond the clinic appointment.

ER-REBOA catheter, an advanced version of a device developed

11-year-old Anthony, who was diagnosed with attention deficit

Staff are implementing self-regulation training, for themselves,

hyperactivity disorder (ADHD) in Grade 1, at ease.

balloon that stops blood flow from the aorta

patients and families, to strengthen the therapeutic alliance

down, controlling bleeding and saving lives,

and the patient experience.

more relaxed,” Sullivan said. “The doctors at the school know

as pelvic bleeding is a leading cause of death

us and care. My son is more than just a name on a paper.”

following traumatic injury. Previously, the

of these kids,” said Dr. Heather Yang, chief of Paediatrics at

The program’s aim is to provide care for inner-city

surgeon would have opened up the chest

St. Joseph’s. St. Joseph’s is also collaborating with St. Michael’s

elementary students in the school system, breaking down

and clamped the aorta, a much riskier and

Hospital’s school-based clinics on further research that spans

barriers that populations in these communities face when

more invasive procedure.

the whole city.

accessing healthcare. The interprofessional research team

has also been conducting demographic research.

heart and brain going,” explains emergency

approach has made an impact on their family. “He went from

physician Dr. Andrew Petrosoniak, “so we can

having behavioural issues to being completely calm,” she said.

get you to a place for definitive control of bleeding.”

“He’s a different child with their support.”

only be used once a month, the team is excited by its potential.

The in-situ simulation test was designed with the Allan

“It will make a big difference in the way we control bleeding

Waters Family Simulation Centre team, nurse educator Lee

and stabilize hemorrhaging patients,” says Dr. Rezende-Neto.

Barratt and operational readiness champion Candis Kokoski

“And it will save lives.”

“A school environment in a familiar neighbourhood is

“One of the best ways of learning how to improve is

by measuring what you do,” said Dr. Anne Wormsbecker,

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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OUR SHARED PURPOSE

“The whole community is working together for the health

For Sullivan and her son, this community-focused

The ER-REBOA catheter delivers a

“The blood gets diverted to keep the

“

St. Michael’s is the first hospital in Ontario to use the new during the Korean War. This thinner, easier

The blood gets diverted to keep the heart and brain going so we can get you to a place for definitive control of bleeding DR. ANDREW PETROSONIAK EMERGENCY PHYSICIAN

to use version is a step up from the one St. Michael’s surgeons debuted in 2015.

“The first use of REBOA in Canada

was here,” says Dr. Rezende-Neto. “We have proof: ‘In the Zone: Lessons from the First Canadian Emergency Department Application of REBOA’ has been submitted for publication in The Canadian Journal of Emergency Medicine.”

While the new ER-REBOA catheter might

to make it as realistic as possible. Watched closely by the team, trauma surgeon Dr. Joao Rezende-Neto inserts the catheter OUR SHARED PURPOSE

3

It can be shocking for patients and their family members to see how severe a pressure wound can worsen.

Providence and St. Michael’s team up for better care

BY MICHAEL OLIVEIRA

underlying bone,” Dr. Mahoney says.

“These are very significant and deep and often associated

with complications.”

Kampen was referred to Dr. Mahoney after years of struggles

and setbacks with managing his wound, including misdiagnoses.

He had to go through an extensive assessment process to ensure he was a good candidate for surgery, including input from the nurse practitioner and occupational therapist from the wound care team and experts in infectious disease and imaging.

properly and following a regiment of care after surgery to

In Kampen’s case, hip and lower leg muscle was used. After a few days of recovery at St. Michael’s, Kampen was transferred to

Healthcare to treat his debilitating pressure wound, a

condition caused by his spina bifida.

take on a patient for the typical six-to-eight weeks of post-

operative recovery time, says Dr. James Mahoney, chief of

“There’s a lot of people involved in this,” the 30-year-old

Previously, it was a struggle to find facilities that could

says with a chuckle as he tries to list off the names of all the

Plastic Surgery, who performs the surgeries along with

doctors, nurses, occupational therapists, physiotherapists, his

Dr. Karen Cross. “I had actually stopped doing the surgery

dietician and others who have had a part

for more than a year because I did not

in his care.

have the rehab space to provide patients

“If I forget somebody, I’m sorry, but there’s a lot of names and faces to remember.”

Kampen is the first patient to take

part in the new St. Michael’s-Providence clinical collaboration that could eventually help double the number of pressure wound surgeries performed

This surgery is life-altering for patients, and the new network has been an opportunity to support this underserved population.

CHIARA CAMPITELLI-THOMPSON PATIENT CARE MANAGER

at St. Michael’s each year. Providence

the support I thought they required,” Dr. Mahoney says.

“The surgery is only one little

part,” he adds, stressing how important the collaborative nature of the initiative is. “My surgery can be undone in one episode if something is not done correctly in the rehab process.”

Kampen’s spina bifida – which

staff have enhanced knowledge to provide rehabilitation for

limits the sensation in his lower body – led to his first pressure

patients who undergo the surgery.

wound issue almost a decade ago. “It involves an excessive

“To be a part of this new initiative and be able to provide

load or direct pressure, typically over a bony prominence,

a service in such a meaningful and important surgery is

and it overpowers our normal circulation leading to a wound,”

very exciting,” says Providence patient care manager Chiara

says Dr. Mahoney in explaining how pressure wounds develop.

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OUR SHARED PURPOSE

performs skin flap surgery and patient remains at the hospital for up to a week before being transferred to Providence, with a full discharge plan.

kept in close contact as his treatment progressed, often sharing images and updates electronically so Kampen wouldn’t have to

POST-OPERATIVE CARE

be transferred back to St. Michael’s for follow up assessments

by Dr. Mahoney.

Campitelli-Thompson says the Providence team is relishing

the opportunity to provide care for a group of patients who have suffered through difficult wait times.

“Providence has a strong reputation and history for helping

the more vulnerable and providing access to rehabilitation

6 - 8 WEEKS

has been the true definition of collaboration.”

their surgical appropriateness.

St. Michael’s plastic surgery team

Providence team provides postoperative care and educates patient on best practices once discharged, including ensuring all the essential supports will be in place.

services which may have otherwise been limited or not available.

This surgery is life-altering for patients, and the new network has been an opportunity to support this underserved population,” says Campitelli-Thompson.

“There’s been a lot of excitement around this project and the

incredible progress Trevor has made is a highlight.”

Kampen, who lives in the village of Schomberg northwest of

Toronto, is now looking forward to getting back to the outdoor

3 MONTHS

during his journey from St. Michael’s Hospital to Providence

functional and social history and

He was then booked for so-called skin flap surgery, which

Providence to begin his rehabilitation. Care teams at both sites Campitelli-Thompson. “It may sound a little cheesy but this

assessment of a patient’s medical,

SURGERY

filling the cavity with flaps, or rearrangements of local tissue.

Trevor Kampen marvels at the number of people he’s met

An extensive interdisciplinary

prevent complications and to improve wound healing. involves removing compromised tissue related to the wound and

Trevor Kampen is a patient at St. Michael’s Hospital and Providence Healthcare (Photo: Katie Cooper)

PRE-OPERATIVE ASSESSMENT

Kampen also had to commit to giving up smoking, eating

1 WEEK

PRESSURE WOUND REHAB

“These go all the way through your skin down to the

6 - 12 MONTHS

FROM ST. MICHAEL’S TO PROVIDENCE

FOLLOW-UP Patient is seen by St. Michael’s team every three months for one year.

activities he loves, like hiking and biking.

But his takeaway has been that he needs to remember the

Kampen. “So don’t be stubborn,” Kampen says he is still

education he has received from his teams at St. Michael’s and

reminding himself. “Know your body and what your

Providence so he can engage in a healthy active lifestyle and

limitations are.”

ensure his wound doesn’t return. “The biggest thing I had to overcome was my stubbornness, the ‘I can do it myself,’” says OUR SHARED PURPOSE

5

RESEARCHING PRIMARY CARE NEEDS Researchers from St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences have found considerable variations in primary health- care needs and delivery across Ontario — and the areas with the highest needs, including northern Ontario and large cities like Toronto, tend to receive the lowest level of care.

The new report “Geographic Variation in Primary Care Need, Service Use and Providers in Ontario 2015/16” outlines how seniors, recent immigrants and people with low incomes have the most unmet needs for primary care.

“We hope that the patterns, variations and gaps in care found in this report help to inform policy and planning,” says Dr. Rick Glazier, lead author of the report, a scientist at the Centre for Urban Health Solutions and Institute for Clinical Evaluative Sciences, and a family physician at St. Michael’s Hospital.

BACK IN THE SWING OF THINGS

See the full report at www.ices.on.ca Map credit : Institute for Clinical Evaluative Sciences

BY RAMON SYYAP

CLINIC SUPPORTS COMPLEX NEEDS OF OLDER ADULTS The Geriatric Psychiatry Clinic is part of a multidisciplinary program, The Regional Geriatric Program of Toronto, that’s been housed at Providence since 1988. The program is a collaboration of geriatric medicine and geriatric psychiatry with the understanding that chronic medical or psychiatric illnesses contribute to frailty in the elderly. A critical component of the program is the outreach service, which involves various health-care professionals visiting patients’ homes to identify psychosocial and functional stressors that contribute to frailty.

The mandate of the program is the assessment and treatment of frail older adults who may have a mental health issue, dementia syndrome, behaviour disorder, or a psychosocial problem. Education for families and caregivers about their symptoms is part of the treatment offered by the geriatric psychiatrists.

Geriatric psychiatrist Dr. Ian Ferguson is among the physicians to visit patients in the community (Photo: Ramon Syyap)

Patients Gilbert (left) and Bill spent their final golf session at The Docks Driving Range in August. (Photo: Ramon Syyap)

“FORE!” exclaimed Bill as his club struck a bright orange

The program’s holistic approach to care has helped several

dimpled ball. With a subtle grin, fellow patient, Gilbert,

individuals build their confidence and self-assurance as well as

tracked the trajectory of their latest hit.

realize independence through sport. Not easily measured, but

The two men were part of a larger group enrolled in

vital to recovery, is the added social benefit that participants

Providence Healthcare’s golf transition program in August –

gained by working through challenges and accomplishing

a three-day program that combines golf with rehabilitation

goals in a group setting.

during the summer months. In its nine-plus years, the program has been serving both

a club. With this in mind, therapeutic

MARY SCARBOROUGH THERAPEUTIC RECREATIONIST

outpatients and inpatients alike who were recovering from a stroke or amputation, transition from hospital to community.

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Health-care teams are constantly searching for new and effective Patients might patient expectcare radiation doses for CTcare scans be ways to improve – especially to make safer.toWith comparable from hospital to the next, but a team at positive the introduction ofone a new system at St. Michael’s called St. Michael’s Hospital says the technicians dose variance be startling. patient ID, medical laboratory are can carrying mobile The team is collecting and analyzing eight devices and portable printers to makedata thefrom process ofhospitals drawing for theeasier Medical Imaging MetadataThe Repository of Ontario blood and more efficient. device can scan a (MIMRO) patient’s to help reduce the province’s average radiation dose wristband to confirm the technician is drawing blood fromper thescan. right Using artificial intelligence sort the hospitals’ data,what the test team person for the right test. Withtothe device, they can see is generated comparative by facility, scanner and exam toto help required, what tubes are data needed and what time blood needs be determine practices. is funded primarily byspot and drawn.

Thebest portable printerMIMRO then spits out a label on the St. of Michael’s and was createdisbydigitally two of submitted its radiologists, all the relevant information in real time to Drs.laboratory.

Timothy Dowdell and Bruce Gray. the

“Using positive patient IDdata adds an extra to reduce the Radiologist Dr. Bruce Gray and analyst Liannecheck Concepcion review data submitted said to MIMRO. (Photo: technology Katie Cooper) potential for mixing up patient samples,” information coordinator Drake Yip, “which helps keep our patients as safe as OUR SHARED PURPOSE possible.”

“

to individuals who have never touched

The ability to apply what they’ve learned from therapy in a real-world setting using a fun activity is a significant goal

with an overall goal of easing their

IMPROVING SAFETY QUALITY IN ACTION SHARING MEDICAL IMAGING DATA WHEN DRAWING BLOOD TO CUT RADIATION DOSES

Participants range from avid golfers

recreationists at Providence use a

“It stimulates my body and my mind,” explained Bill, who enlists the use of a walker to aid his mobility since his stroke.

Balance and movement are common

concerns for those recovering from brain injuries or amputations. Equally daunting is the process of reintegrating into the community without purposeful activities and meaningful relationships to lean on.

progressive schedule to accommodate its newest players.

Although the treatment for each patient is different, the golf

The first session allow them to assess a patient’s ability and

transition program brings much-needed elements of pleasure

introduce them to the fundamentals of the game, with the

and socialization to therapy. It is also creating new fans of the

program culminating in a trip to The Docks Driving Range in

game.

downtown Toronto.

I’ll have to come back here again with Bill when we’re done

“The ability to apply what they’ve learned from therapy

in a real-world setting using a fun activity is a significant

“I’ve never played golf before today,” said Gilbert. “But

therapy. I’m very competitive,” he laughed.

goal,” says therapeutic recreationist Mary Scarborough.

OUR SHARED PURPOSE

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HOME IS WHERE THE CARE IS

Telemedicine opens up St. Michael’s renowned care to people outside the city

BY EMILY DAWSON TPN team simulates a telemedicine appointment within their clinic at St. Michael’s. Patients can attend the clinic in-person or remotely via telemedicine. (Photo credit: Yuri Markarov)

For Trudy Porretta, who lives with Short Bowel Syndrome

interprofessional team for appointments without having to

(SBS) and several other complex conditions, St. Michael’s

travel to the city. Porretta lives in Barrie, and although she

Home Total Parenteral Nutrition (TPN) clinic is a

has a car, she relies on public transportation to get to medical

“godsend.”

appointments in Toronto.

A well-balanced diet contains all the nutrients we need

“It would be very hard to get to the clinic, especially in the

to function properly. The food we eat breaks down in our

winter,” she said. “I have only one lung, and that really affects

stomach and travels into our bowels. For most people, the

my breathing on cold days. This technology is a godsend.

bowels absorb the nutrients, and carry them to the rest of

our body.

and well cared for using telemedicine as I do in the clinic.”

Porretta’s SBS prevents the proper

absorption of nutrients. Thankfully, there’s an alternative for her and others with digestive conditions: parenteral nutrition, a special liquid diet given through an intravenous (IV) catheter.

One of the greatest benefits of

parenteral nutrition is that people can self-manage their IV from the comfort of home, but patients require frequent monitoring to ensure everything stays

“

“Everyone on the team is wonderful. I feel just as welcomed

Telemedicine improves the efficiency of health-care delivery and makes sure patients have easy access to a team of specialists, despite geographic barriers DR. KHURSHEED JEEJEEBHOY TELEMEDICINE PROGRAM PHYSICIAN

Dr. Jeejeebhoy is a proponent of

leveraging this technology as much as possible.

“Telemedicine improves the

efficiency of health-care delivery and makes sure patients have easy access to a team of specialists, despite geographic barriers,” said Dr. Jeejeebhoy. “We can do almost everything virtually that we can do physically in the clinic.”

While the patient must go to a local

on track.

telemedicine site to access the technology, it’s far simpler than

the long trip to Toronto for Porretta. “What used to take me a

St. Michael’s TPN clinic has the capacity to extend care to

people living outside Toronto via telemedicine. Facilitated by the St. Michael’s Telemedicine Program, patients can remotely connect with the clinic’s physician,

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Dr. Khursheed Jeejeebhoy, and the rest of the

OUR SHARED PURPOSE

full day can now be done in a few hours.”

As a member of the Ontario Telemedicine Network (OTN), St. Michael’s physicians and staff can deliver services over a secure network infrastructure that links to telemedicine/videoconferencing sites across Ontario.