In Touch newsletter: September 2014

INTOUCH SEPTEMBER 2014

The Titanium Club differs from previous recognition programs by honoring hours of service as opposed to years at St. Michael’s. It also honors all volunteers who have reached the 2,500-hour milestone, including those who are retired from volunteering. “It’s become a bit of an alumni club,” said Kidd.

The volunteers appreciate the sense of community at St. Michael’s.

Dan Har Li, a volunteer in the Medical Daycare Unit, said she enjoys the dayto-day contact with patients.

“It’s like family, especially when you get to know them,” said Li. She often experiences the highs and lows along with her patients. “I celebrate when patients tell me they won’t be back for another year,” she said.

Li was encouraged to volunteer by her goddaughter, who was a nurse at St. Michael’s. She has been a volunteer for 12 years, and joined the Titanium Club last year.

Dan Har Li makes her rounds on the Medical Daycare Unit. (Photo by Liam Sharp)

St. Michael’s Titanium Club – membership has its privileges

By Greg Winson

Organizations from hotel chains to Starbucks have a gold or platinum level membership. When volunteers at St. Michael’s reach 2,500 hours of service, they automatically become members of the Titanium Club.

Printed on 100 per cent recycled paper

“These people have been significant contributors to St. Michael’s for some time,” said Michael Kidd, director of Volunteer Services. With most volunteer shifts averaging three to four hours, it takes more than 600 shifts to make the 2,500-hour milestone.

John Metcalfe has been a regular volunteer in the gift shop, racking up the 2,500 hours to become a Titanium Club member just five years. After working at Sears Canada for 35 years, the retail environment was a natural fit for him. “I work with a great bunch of people, and it gives me a bit of exercise.”

Like Li, Metcalfe understands the important role volunteers can play in overall patient experience. “Volunteers are a main contact with the patients quite often, and (the support) means a lot to them,” he said.

Metcalfe recalled one statutory holiday when he helped a woman find a friend in the hospital who had been in a serious car accident.

“She was sitting in a chair just outside the gift shop,” said Metcalfe. “Her Continued on page 6 SEPTEMBER 2014 | IN TOUCH | 1

OPEN MIKE with Patricia Houston Vice President of Education and professional development opportunities and creating a new model for patient and family education. We have much to be proud of and so much more to look forward to.

Opportunities, outreach and outcomes key principles of new education strategic plan

Our new strategy outlines our priorities for the next three years. It is the result of months of hard work and input from many leaders within the education September is always an exciting time of portfolio, the hospital and external year. As sad as it is to say good-bye to partners. Our vision is to be leaders in summer, I always look forward to the feeling of starting over in the fall. For me health professional education. We will accomplish this by providing health it is the unofficial start to a new year. education programs and services with Although some of our students started the goal of enabling excellence in patient in the summer I am pleased to welcome outcomes. We have chosen to focus on our new ones starting this month. I patient outcomes because it is a key part hope you enjoy your experience at of a patient’s experience at St. Michael’s.

St. Michael’s. You are joining us at Outreach and opportunities are also key the start of an exciting time for the principles to helping us achieve our goals. education portfolio. Next week we Embedded in our plan are five strategic will introduce our new education strategy, which builds on the great work directions: learning collaboratively, engaging the patient, advancing we’ve accomplished to date, including academic practice, developing enhancing our student experience, our people and driving quality increasing our continuing education

through education. Technology and infrastructure are also key components of our plan and we will continue to leverage our cutting edge tools and resources to enable groundbreaking impact across all our strategic directions.

Whether you’re a medical, nursing or health discipline student, or a staff member, your learning opportunities are important to us. We believe this plan sets us on a course to achieve great momentum around enhancing our educational interactions with our patients and families, supporting collaboration amongst our peers and advancing our academic practice.

I encourage you to familiarize yourself with our plan, which can be found on the Teaching and Learning section of our website. I’ve said in the past that we are all students and all teachers. While this is still true, I also believe that by learning you will teach, by teaching you will learn.

10 million and counting

By Evelyne Jhung

Dr. Michael Evans, a staff physician in the Department of Family and Community Medicine, is changing the way we interact with patients. He does this by working with filmmakers, illustrators, patients, and experts to make content that people like to both use and share.

“Every day we get thanked for not being preachy, for being evidence-based, for being funny, and for telling it like it is. It’s very rewarding,” said Dr. Evans.

Incredibly, his YouTube Channel, www.youtube.com/ docmikeevans, has garnered more than 10 million views. The channel has 19 videos, some of which are being translated into multiple languages. Topics covered in some of the videos include: how to reduce your stress, concussions, low back pain,

SEPTEMBER 2014 | IN TOUCH | 2

how to quit smoking and how to treat acne. Many more are on the way, with topics including medication management, the early childhood brain, low risk drinking and quality improvement.

Follow St. Michael’s on Twitter: @StMikesHospital

Illustration by Marcelo Silles, Medical Media Centre

“Greener” paycheques part of hospital’s My Business system launch

By Karen Orme

Every two weeks, Yordanos Kiros is one of 5,741 hospital employees receiving a paper paystub record of their earnings.

“That’s a lot of paper when the hospital is trying to reduce its paper consumption,” said Kiros, a St. Michael’s environmental services employee who empties the hospital’s recycling bins as part of her daily rounds.

One tree, once processed, produces about 8,330 sheets of paper. That means it takes approximately 18 trees a year to produce paper paystubs at St. Michael’s. The environmental footprint is even larger when the toner ink, printer energy and manual labour to produce the paystubs are factored in.

This fall, the hospital is launching an eco-friendly system that will deliver electronic paystubs.

Instead of picking up their paper

paystubs, all staff will be able to electronically view their wages two days prior to a payday by logging into St. Michael’s intranet or at one of five new touch-screen kiosks stationed around the hospital. Staff will also be able to electronically access their 2014 earnings to date and check vacation balances.

The transition from paper to e-paystubs is part of My Business, a new business system that replaces all the different information operating processes that finance, human resources, payroll and procurement currently use and integrates them into one centralized system.

The new suite of task-related online applications is accessible from the intranet’s main tool bar. My Business will simplify everything, from how payroll is entered to how the hospital places orders for supplies to how managers run financial reports.

“My Business equips our staff, physicians and our organization with the information

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

and tools they need to better collaborate with greater accuracy and efficiency on many different levels,” said Vas Georgiou, executive vice-president and chief administrative officer. “It also further enhances our ability to successfully achieve the corporate goals we have set out, from quality improvement of how we manage our financial resources to our greening strategy.”

Also set to go live is a new intranetbased finance report and an e-requisition process.

Staff who have previewed the new paystub and vacation balance system gave two thumbs up for the convenient 24-7 online access from work or home to their pay records and to the fact they can now view their pay two days prior to its deposit.

“The system looks quite simple to use and is definitely a progressive move in helping us reduce paper wastage,” said Kiros.

SEPTEMBER 2014 | IN TOUCH | 3

Patient-centred care focus of new Longitudinal Integrated Clerkship Pilot

By Kaylea Forde

St. Michael’s is piloting a new curriculum for third-year medical students allowing them to follow patients from admission to discharge.

The program, known as the Longitudinal Integrated Clerkship Pilot (LInC), is the first of its kind at a Toronto teaching hospital.

Seven students from the University of Toronto’s FitzGerald Academy were accepted to study under this pilot, which focuses on patient-centred care on a longitudinal basis.

These students will follow patients through all phases of their diagnosis and treatment, across clinical services including family medicine, internal medicine, surgery, obstetrics and gynecology, pediatrics, psychiatry, anesthesia, dermatology, emergency medicine, ophthalmology and otolaryngology. They will accompany their patients to follow-up appointments during their year of training.

Unlike the traditional block clerkship program, which has students changing services and preceptors every two to eight weeks, LInC students will be paired with the same preceptor for the year and will weave in and out of services.

“This model provides a new approach to hands on learning,” said Dr. Molly Zirkle, the director of the FitzGerald Academy at St. Michael’s Hospital. “Our students are able to follow a patient over the course of their medical journey directly seeing how the integration of care affects a patient’s experience.”

If a patient arrived in the Emergency Department with abdominal pain and needed surgery, the LInC student could follow the patient from the ED to the operating room and then continue to be involved during the post-op care “I was drawn to the LInC curriculum because of the variety of care environments I could be in over the course of a day,” said Matt Speckert, a LInC student. “It excites me to think that my

day could start in the family medicine clinic and end in the operating room instead of having to wait until my surgical rotation to experience what it’s like to be in that setting.”

Another aspect that sets the LInC curriculum apart from the block clerkship model is the allocation of white space time, which students can use toward flexible self-directed clinical time, to attend appointments with patients or academic development.

Both programs have their advantages and provide the same quality of education,” said Dr. Zirkle. “They have the same objectives, exams, curriculum content, preceptors, clinic time, patient encounters and procedures. Our students will be just as prepared for their fourth year no matter which route they chose. We do, however, feel the LInC will give a window to the patient experience that will be very meaningful for students”

Dr. Karen Weyman, a staff physician and the Longitudinal Integrated Clerkship faculty lead at St. Michael’s, and Matt Speckert, a third-year medical student, review a patient's medical history. (Photo by Yuri Markarov, Medical Media Centre) SEPTEMBER 2014 | IN TOUCH | 4

Terry Tang Poy sets up the DRX Revolution digital mobile X-ray. (Photo by Katie Cooper, Medical Media Centre)

From minutes to seconds: new mobile X-ray units are 120x faster

By James Wysotski

Since January, Trauma Unit doctors requesting immediate X-rays have received unprecedented turnaround times. With the acquisition of two DRX Revolution digital mobile units, wait times for images dropped from about eight minutes to four seconds.

“It's phenomenal how fast we can deliver that service,” said Terry Tang Poy, the quality control technologist for Medical Imaging. “Physicians can act on what they see right away.”

Tang Poy likens the new machines to digital cameras because their images are virtually instantaneous. Unlike the system they replace, there’s no transportation time after the X-rays are taken. No one has to run cassettes back to Medical Imaging for processing while patients wait back on the unit.

So, if doctors require multiple retakes, it’s just another four seconds per request. That’s precious time saved.

The impact is most evident in situations such as line and tube placements where doctors can see right away if everything is in place. Less waiting time means less discomfort for patients.

Originally, the mobile units were meant to replace the Trauma Unit’s dedicated, stationary device. The second machine was to ensure the unit didn’t have any down time, but the increased efficiency freed it up to be used on the floor and in operating rooms. And it is outside of the Trauma Unit where the greatest change occurred.

“The DRX is revolutionary because it actually changes the workflow quite a bit,” said Tang Poy, who was instrumental in selecting the units and putting them into service. “It eliminates a couple of [delivery and processing] steps. Since January, it’s taken over the workload of 80 per cent of our [older] floor portables.”

said overall costs decrease since there isn’t as much time “wasted.” He recounted waiting 25 minutes recently to get an X-ray while using an older unit. If using the DRX, the time saved “means that another case can get done during the day.”

Dr. Ahn likes the DRX’s bigger field of view, improved clarity and that it reduces dose radiation by 50 per cent.

Since the images are localized, patients get fewer X-rays.

Dr. Ahn isn’t the only surgeon who’s a DRX enthusiast. Tang Poy said there’s a huge demand for the mobile floor unit in operating rooms.

“They’re demanding it,” said Tang Poy. “They’re basically saying ‘don’t come in here without that unit,’ and it’s very hard to provide that service at this point.”

But who can blame surgeons for asking? Using them, surgeons can make decisions faster and that means earlier interventions in critical moments.

The DRX units “definitely exceeded expectations,” said Tang Poy. “I’d love to see another one.”

Dr. Henry Ahn, an orthopedic surgeon, SEPTEMBER 2014 | IN TOUCH | 5

Titanium club story continued from page 1

English wasn’t very good, so I brought her into the gift shop and she wrote her friend’s name down on a piece of paper, and I called the patient inquiry line for her.”

As a former patient of St. Michael’s, he also sees volunteering as a way to give back to the nurses who cared for him in the

VOLUNTEER STATISTICS Age of Volunteers

10%

OVER 75 YEARS

25%

UNDER 25 YEARS

45%

55-75 YEARS

past. “If one nurse needs a can of pop on a stat holiday, I’ll be there to open the [gift shop] door for them.”

The fourth annual Titanium club luncheon will be held on Sept. 23. This year’s luncheon will include a tour of the Allan Waters Family Simulation Centre.

Number of Members of the Titanium Club

25 ACTIVE

Percentage of Volunteers by Type of Volunteer Role

16%

23%

8%

11%

18%

24%

FAMILIES & INFO DESKS

20%

25-55 YEARS

21 ALUMNI

PROJECTS & SERVICES

PROGRAMMING

INPATIENT

GIFT SHOP

OUTPATIENT

A new innovative home for coronary care

By Kendra Stephenson

In Canada, every seven minutes someone has a heart attack.

As a large hospital serving the heavily populated downtown core, St. Michael’s Hospital cares for many cardiac patients every day. When those patients are in critical condition, they go to the Coronary Care Unit, or CCU. With St. Michael’s 3.0, the CCU will get a new home on the seventh floor of the future patient care tower. Its new home has been designed to provide adequate space for health teams, patients and families, and proximity to frequently used services, especially the CATH lab, which will cut down on patient movement and stream-line the health team’s delivery of care.

“In the past, critical care spaces focused on the technology and clinical needs of the health team to care for the patient,” said Dr. Michael Freeman, medical SEPTEMBER 2014 | IN TOUCH | 6

director of the Heart and Vascular Program and administrative physician involved with planning the new CCU. “We’ve designed the facility to be more in-tune with the patient’s needs and experience, while also allowing families to interact with their care alongside the health team.”

The CCU manages patients with a variety of cardiac conditions such as congestive heart failure, lethal heart arrhythmia or out-of-hospital cardiac arrest (85 per cent of cardiac arrests occur in homes or public places).

Care for cardiac patients has changed drastically over the past 20 years with advances in technology and research,

requiring a completely different patient environment than the CCU’s current home – which is small, not ideally located and in one of the oldest facilities in Canada.

“The rooms are intended to manage the most critically ill patients, as well as transition into a recovery environment as a patient’s health status potentially improves,” said Jana Jeffrey, the former CLM in the CCU who was also involved in planning the future unit.

“This means patients recover in the same quiet, familiar and restful healing space without having to move through different environments.”

New generation of St. Michael’s physicians launches hospital’s first podcast

By Bao Xiong

generated through social media.”

Whether it’s anti-influenza medications or obesity rates, Drs. Fahad Razak and Amol Verma have much to say over a spectrum of medical topics. The Rounds Table, a free weekly podcast hosted by Healthy Debate, is their new way of sharing noteworthy research and material in an informal and educational way.

The 20-minute long podcast is moderated by Dr. Verma and generally consists of one or two other speakers who present their chosen piece of recent medical research. Each person is given five minutes to discuss his or her material with time for the others to weigh in. The podcasts end with a “good stuff” section, in which the hosts offer quick recommendations about interesting topics in medicine.

One of a few medical podcasts in Canada, the Rounds Table is also accredited Continuing Medical Education, for which internists can receive 0.5 hours of credit for each podcast they listen to via the Canadian Society of Internal Medicine or the American Medical Association. This may help doctors who practice in remote areas to stay on top of major new studies.

“The Rounds Table is a project we’ve wanted to start for a year,” said Dr. Verma. “The idea stemmed from our love of podcasts, and it’s been great to receive feedback and to see all the activity it’s

Dr. Verma, a Rhodes Scholar, is starting a two-year general internal medicine fellowship at St. Michael’s Hospital. Co-host Dr. Razak is a staff internist and research scientist at St. Michael’s, and a David E. Bell fellow at

the Harvard Centre for Population and Developmental Studies. Like the co-hosts, the Rounds Table is conversational, fun, engaging and easy to follow. The internet audio files are categorized by episodes and available through iTunes.

“As physicians, there’s always a certain pressure for us to keep up with the current literature,” said Dr. Razak.

“There aren’t very many Canadian medical podcasts, so we thought the Rounds Table could show that listening to clinicians and learning about new things in medicine can be enjoyable.”

To listen to the Rounds Table or to learn more about the hosts, visit healthydebate.ca/theroundstable

“Rounds Table = wonderful! You are such a genial, well-spoken and thoughtful bunch. This is great. I love that you guys take the podcast seriously, but don’t take yourselves too seriously in the podcast.”

– Dr. Lauren Lapointe-Shaw, general internist, University Health Network

Dr. Amol Verma Skypes with Dr. Fahad Razak in Boston to record a podcast session. (Photo by Yuri Markarov, Medical Media Centre)

SEPTEMBER 2014 | IN TOUCH | 7

Q&A

DR. PHILIP BERGER,

MEDICAL DIRECTOR OF THE INNER CITY HEALTH PROGRAM

By Evelyne Jhung (Photo by Yuri Markarov, Medical Media Centre)

The Federal Court of Canada ruled in July against Ottawa’s 2012 cuts to health care coverage for refugee claimants, saying that the "intentional targeting of those seeking protection of Canada — an admittedly poor, vulnerable and disadvantaged group" amounts to "cruel and unusual treatment." Dr. Philip Berger, medical director of the Inner City Health Program, and a founding member of Canadian Doctors for Refugee Care, was a co-litigant in the court case.

Q. When did you get involved with health care for refugees?

I’ve been seeing refugees since 1977 when I was a family practice resident here. A refugee lawyer friend asked me to document cases of torture to be used in refugee determination hearings.

After 90 physicians occupied (then-Natural Resource Minister) Joe Oliver’s Toronto office in May 2012, we realized we needed to form a group because the protest against the cuts would continue until the next federal election. That’s when Canadian Doctors for Refugee Care was born.

Q. How did you find out about the decision and what was your reaction?

We knew on July 3 that the ruling was coming out at 8:30 a.m. the next day. At 8:40 a.m., I received an email from Lorne

INTOUCH

SEPTEMBER 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

Waldman, legal counsel for the court challenge, simply stating: “Have not read the decision yet but we won!!” The mood was more serious than celebratory, a day of thankfulness that refugees would be receiving care, particularly pregnant women and children. We felt vindicated because the judge agreed with what we had been saying for the past two years. Most importantly, it was a day of victory for patients more so than for doctors.

Q. What was your strategy?

We took a multi-pronged approach: we did media; wrote op-eds and peer-reviewed journal articles analyzing the effects of the cuts; and mobilized about 50 prominent Canadian artists, like Vincent Lam and Margaret Atwood. We continued protests in the streets against the cuts and joined in the federal court challenge.

We are fiercely non-partisan. Political parties and unions are not allowed to be part of CDRC activities because alignment with any group would undermine our credibility. We received support from more than 20 national health associations and editorial support from the Canadian Medical Association Journal.

Q. What does the ruling mean for everyone?

In January, the provincial government introduced the Ontario Temporary Health Program to fill in gaps in health care coverage for refugee claimants and rejected refugee claimants created by the federal cuts. Even though the federal government is still making the coverage process highly bureaucratic, with this ruling, St. Michael’s Hospital and Ontario will no longer be responsible for absorbing those costs.