In Touch newsletter: Summer 2014

INTOUCH SUMMER 2014

Harvey Stubbert, a nurse from Fred Victor Housing, and Dr. Naheed Dosani, a palliative care physician at St. Michaels, meet with patient Daniel Thibideau during the mobile unit’s first palliative consult. (Photo by Yuri Markarov, Medical Media Centre)

Palliative home care for the homeless

By Geoff Koehler

Homeless and under-housed individuals have specific preferences for where they’d like to die and on July 2, Inner City Health Associates – a group affiliated with St. Michael’s Hospital – began making their preferences a reality.

Palliative Education and Care for the Homeless, or PEACH, is a mobile palliative care program that offers vulnerable individuals the dignity of choosing where to receive end-of-life care.

“Most people want to pass away at Printed on 100 per cent recycled paper

home with family around them,” said Dr. Naheed Dosani, a palliative care physician with St. Michael’s and Inner City Health Associates. “That sentiment is no different from the patients PEACH aims to treat.

The only difference is that our patients’ homes are often a shelter and their families may be shelter clients and staff.”

An interdisciplinary team, comprised of a palliative care physician and nurse, will essentially form a mobile palliative unit.

The team will go out into the community to meet patients with serious illnesses to provide specialized care and work with

the patient’s existing care team.

“Research has shown that when palliative care begins early, it has the potential to improve quality of life and, in some cases, even prolong life,” said Dr. Dosani. “That seems counterintuitive but reveals the importance of palliative care’s integration with the rest of medical treatment. With PEACH, we want to provide upstream, streamlined integration, for this underserviced population.”

Namarig Ahmed, a community nurse Continued on page 7

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OPEN MIKE with Mary Madigan-Lee Vice-President, Human Resources will be rolling out a new corporate priority – one that will see performance appraisals for all employees happen at a minimum of every two years.

St. Michael’s is listening to the development needs of staff When we started talking about improving our hospital’s performance management system for staff, I asked myself “what do our people really want and what do they expect from our organization?”

Do they want better feedback from their managers? Do they want to be more connected to the organization’s larger goals? Do they want clarity in their roles and responsibilities? Do they want more opportunities for their own professional development?

For employees who said they wanted more development opportunities, the new appraisal process will provide just that.

Employees will meet with their managers to discuss their strengths and areas for development. Together, they will build personal learning and development plans.

Mandatory performance appraisals aren’t just good practice – they are a key force in developing our people. Appraisals will give staff an opportunity to carve out goals for themselves and to develop a larger connection to the organization.

Through the engagement survey, we also heard that employees wanted to see more initiative around performance management Our 2013 staff engagement survey saw for all staff. The regular appraisals will high participation rates – 64 per cent of arm the organization with the right tools staff completed the survey. Through the to ensure that equity is maintained – survey, we heard two recurring themes that we’re holding everyone to the same that link back to all of the questions above. standards, accountabilities and behaviours.

The organization listened to feedback and

appraisals were piloted in several areas throughout the hospital. We learned that staff and managers felt that structured appraisals made conversations about staff development easier.

In a living, breathing environment that operates 24 hours a day, seven days a week, it can be a challenge for managers and staff to carve out the time for things like performance appraisals. But it’s important that we find the time to do it.

Good performance management is healthy not just for our people but for our organization – it has the potential to constantly improve organizational performance, productivity and employee loyalty and retention.

To be excellent at performance management will require commitment and involvement from everyone who works at St. Michael’s.

Thank you to everyone who spoke up during the engagement survey – without you this initiative wouldn’t be possible.

The new tools for staff performance

Inexpensive drug has reduced expensive transfusions for hip replacements

By Leslie Shepherd

An inexpensive drug is leading to improved quality of care, fewer blood transfusions and big cost savings at St. Michael’s Hospital Last October, physicians led by Drs. James Baker, Katerina Pavenski and Gregory Hare started giving the drug TXA, or tranexamic acid, a drug used to prevent excessive blood loss during surgery, to all patients undergoing hip or knee replacements.

Within three months the transfusion rate for patients undergoing hip replacements dropped from 13.7 per cent to 6.6 per

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cent. The transfusion rate for knee replacements fell from 7.9 per cent to 5.2 per cent. That rate was already low because of the hospital’s commitment to blood management and the Ontario Transfusion Coordinators (ONTraC) program, which is administered by St. Michael’s.

The drug costs $15 per patient, while the average cost of transfusing one unit of blood is $1,200.

In the past, the drug was given only to patients at high risk of requiring a blood tranfusion, in part because of a province-wide shortage of the drug.

“We did more than 650 hip replacements last year so that’s 45 or so transfusions saved,” said Dr. Hare, an anesthesiologist and one of the founders of the hospital’s Centre of Excellence for Patient Blood Management. “Patients go home with higher hemoglobin levels, less anemia and fewer transfusions for just $15.”

Follow St. Michael’s on Twitter: @StMikesHospital

By rustling clothes and shoes, patients on 17 Cardinal Carter North create their own soundtrack to a silent film as part of TIFF’s Reel Comfort workshop. (Photo by Yuri Markarov, Medical Media Centre)

TIFF program provides creative outlet for mental health inpatients

By Bao Xiong

The Toronto International Film Festival and St. Michael’s Hospital are bringing the outside world into an inpatient unit one film at a time.

Since 2009, TIFF has led an outreach program aimed at engaging mental health patients at St. Michael’s and Toronto General Hospital. The program, Reel Comfort, brings films and filmmaking workshops to the inpatient mental health unit on 17 Cardinal Carter North.

Reel Comfort provides not just entertainment to patients but education and a way of engaging with one another. Barbara Campbell, a registered nurse on 17CC, said she has seen a tremendous impact since the program’s inception.

“Patients need a creative outlet like Reel Comfort and they love the program,” said Campbell. “We offer many different

patient-centred programming on the unit, but some patients will only come out for Reel Comfort workshops and that’s a testament to its ability to engage patients.”

Monthly screenings at St. Michael’s include feature-length films such as Coraline or The Sound of Music, short films and documentaries. Many of the movies focus on themes of personal development or coming of age.

For the monthly workshops, TIFF brings an array of directors, producers, writers and others to lead sessions on different aspects of filmmaking. During a recent session, participants used props to make the soundtrack for a 1920s movie, Neighbours. They tapped their shoes on top of the table to mimic walking, rustled clothing near the microphone to generate

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

the sound of motion and clapped their hands for other sounds throughout the movie. Other workshops have focused on stop-motion animation, screenwriting and improvisation.

“We want to bring the film festival experience to patients who may not otherwise have access to it, to utilize film’s capacity to encourage creative expression and to cultivate relationships between health care providers, patients, and the wider community,” said Elysse Leonard, coordinator for Reel Comfort.

The lounge area used for workshops on 17 Cardinal Carter North is bright and airy, adorned with artwork on the walls. TIFF donated a television to the unit in 2010.

“The films are uplifting and inspiring and represent a relatable story,” said Campbell. “By using creative arts as a way to reach out, patients don’t feel limited by their diagnosis and they feel they can accomplish anything.”

Did You Know?

Since 2012, more than patients have participated in TIFF’s Reel Comfort Program

600

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GIVING BL

D

the journey from one arm to another

Every year, 980,000 units of blood are used in hospitals across the country. Have you ever wondered what happens to your blood after you donate it? How is it tested? Where does it go? And who gets it?

Barbara Russell, a supervisor for Canadian Blood Services and manager of a clinic that collects blood for GTA hospitals, has the answers.

How much blood does Canada need?

Every year, 980,000 units of blood are used in hospitals across the country. That’s more than 2,300 units every day.

St. Michael’s Hospital alone uses between 8,000 and 10,000 units of red blood cells every year – in addition to other blood products such as plasma and platelets. The biggest users are the trauma service and cardiovascular surgery, said Dr. Katerina Pavenski, head of division of transfusion medicine.

Photo of Canadian Blood Services’ massive Brampton processing facility where blood goes for processing and distribution to hospitals across central Ontario. (Photo: Canadian Blood Services)

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On any given day, CBS knows exactly how many units of blood it has on hand, and how much it needs to collect.

Usually, there is about a four-day supply of all blood types on hand, but the summer is difficult because fewer people donate on long weekends. Red blood cells can be stored for a month, but platelets, needed during many cardiac surgeries, can be kept for only five days.

Work at the blood bank begins after the needle comes out and the donor leaves. Russell said most people don’t know how complicated it is to get blood from donors to patients quickly and safely.

Blood travel - from start to finish There are two steps involved in getting blood from donors to recipients. First, blood clinics screen donors and collect the blood. Then, the blood is sent for testing, processing and distribution to hospitals.

STEP 1 Donation Once the needle is placed in a donor’s arm, it connects to a bag resting on a scale. The scale automatically stops the blood transfer as soon as the bag reaches 485 ml, which usually takes six to eight minutes. While the bag fills, the scale rocks it back and forth continuously, mixing it with an anticoagulant to keep the blood from clotting.

When the bag is full, a small vial is removed for testing, and both the bag and vial are given a barcode to identify which donor the blood came from.

“The barcode can be used to track every unit of blood from the time it leaves a donor’s arm, to the time it enters the recipient’s,” said Russell. “This way, if there was ever an issue with the blood, we can quickly locate and remove it.”

This means that if a donor feels fine when they give blood but gets sick the next day, they can inform CBS and have the donation flagged.

After the blood is labelled, CBS volunteers transfer the bag to a small cooler about the size of a case of pop. The cooler also contains a thermometer that monitors the temperature from when the blood goes in until it comes out. Once the blood arrives at CBS’s production facility, the temperature in the cooler must have dropped for the blood to be usable.

When the clinic closes for the day, FedEx picks up the coolers and transports them to the Brampton production facility which services Toronto, Hamilton and London.

STEP 2 Processing

In Toronto, all donations are sent to CBS’s new Brampton production facility. Opened in 2011, the 127,000 sq. ft. facility is 20 per cent larger than an average Walmart supercentre, and replaces production and distribution facilities in Toronto, Hamilton and London.

On an average day, the facility’s 400 staff members supply 1,600 units of blood to more than 100 hospitals across the GTA. Its location near the airport makes it possible to quickly ship rare blood products all across the country to wherever they are needed.

After it arrives, the blood is placed into a centrifuge, which spins the blood at high-speed to separate it into its three components: one bag of blood yields one unit of red blood cells, one unit of plasma and one-quarter unit of platelet concentrate.

While the blood is being processed, a small sample gets tested for common diseases transmitted through the blood like AIDS, hepatitis and West Nile Virus to make sure it is safe.

Natalia Soczka (left) and Amanda Pape (right), medical laboratory technologists for Transfusion Medicine, pack blood in a cooler for use by the Trauma Service. (Photo by Katie Cooper, Medical Media Centre)

The processed red blood cells are then sorted by blood group (A, AB, B and O) and ready to ship to hospitals.

units. The hospital also keeps about four units of platelets, roughly enough for two cardiac surgeries using cardiopulmonary bypass.

Once the blood is ready, hospital customers place orders for it by fax or by phone. The appropriate components are then retrieved, checked, packed, and shipped to hospital where internal blood banks take over and deliver it to patients.

St. Michael’s is also one of only two adult plasmapheresis centres in the GTA, where patients come to have their blood cleaned to treat disease. A patient with the otherwise fatal disease thrombotic thrombocytopenic purpura needs to have his or her blood cleansed every day for about two weeks. At 10 units of plasma a day, that’s a total of 140 units per patient.

Dr. Pavenski stressed the need for people to donate blood, especially during the summer. St. Michael’s keeps about 200 units of red blood cells on hand, she said, but that can disappear quickly, given that one bad car accident victim could need 50

This story has been adapted from one written by the University Health Network.

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“Patients who actively use their binders have told us they find them extremely informative. Many of these patients had little to no knowledge of what a stroke was and what the recovery process would involve. So this book provides them with that extra support.”

The two-year-old passport is one component of a bigger project known as the Transition Improvement for Continuity of Care initiative led by the Toronto Stroke Network. St. Michael’s is one of six sites in Toronto to offer the My Stroke Passport.

The patient or his or her caregiver is encouraged to keep the passport up to date. Patients can use it to:

Donna Cheung, a rehab and community re-engagement co-ordinator for the Toronto Stroke Network, and Sandy Gill, a clinical nurse specialist at St. Michael’s Hospital, discuss My Stroke Passport before giving it to a patient. (Photo by Yuri Markarov, Medical Media Centre)

St. Michael’s stroke patients benefitting from My Stroke Passport resource guide

By Heather Brown

Passports are a gateway to the world.

They are used to document where people have been and are a key item to have on hand when people leave home to travel.

The Toronto Stroke Network’s My Stroke Passport binder is much larger than a traditional passport but it provides patients living with stroke a convenient place to document their medical history and experiences as they recover and learn to adapt to their life post-stroke.

My Stroke Passport allows patients to record information about themselves

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such as the language they speak, where they work, the cause of their stroke, how it has affected them and the people they would like to be informed about their progress. They can also use it to keep track of the medication they are taking and keep printouts of their test results.

“The biggest benefit of the passport is that it contains all the important information in one spot and reduces the need for a patient or his or her caregiver to repeat medical history or recovery goals at each new visit,” said Donna Cheung, a rehab and community re-engagement co-ordinator for the Toronto Stroke Network.

Did You Know?

It is estimated that there are That’s one stroke every 10 minutes.

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•

Record information about their health and care

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Identify their strengths, needs and questions

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Help set goals to recover, live well and prevent another stroke

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Understand and monitor the risk factors related to their stroke

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Keep track of their progress

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Communicate with their health care team and caregivers

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Find resources and support services to meet their needs

“It also enables health care providers to interact with their patients in a more meaningful way and encourages collaboration with other providers from across the system,” said Cheung. “The health care provider can assist in filling out any missing information by speaking with their patient or connecting with previous health care providers to discuss strategies to use or what ongoing therapy may be required.”

50,000 strokes in Canada each year.

Elizabeth Hanna takes a break during her visit to St. Michael’s Hospital at the Cardinal Carter elevators.

(Photo by Katie Cooper, Medical Media Centre)

Please, have a seat

By Leslie Shepherd

There’s good news for seniors and others who may have difficulty standing for a long time while waiting for elevators in the hospital.

Thanks to a $25,000 donation from the Gift Shop, the hospital has bought 25, two-seat chairs and installed them near many of the Cardinal Carter elevators so patients and visitors can have a comfortable place to sit while waiting.

The chairs were purchased as part of

Palliative home care story continued from page 1

with Inner City Health Associates and the PEACH program coordinator, heads the education arm of PEACH. Inner City Health Associates works in more than 40 shelters, drop-ins and community sites in Toronto and will use their network to recruit patients who can benefit from PEACH. Ahmed and Dr. Dosani developed additional

the senior-friendly hospital strategy.

They were selected using Code Plus Senior Friendly Design Standards, evidence-based guidelines that take into consideration how well the physical environment is equipped to address the developmental needs of older adults.

“These standards provide excellent ideas about how to enhance all of our inpatient units and public spaces for seniors beyond accessibility,” said Susan Blacker, co-chair of the Senior Friendly Hospital Steering Committee. “Changes

like the addition of seating will make a difference for, and enhance the comfort and experience, of all patients and visitors to the hospital.”

The standards help with the selection of furniture and in identifying where rest stations could be placed to help those with mobility challenges. The colour of the upholstery on the new seating contrasts with both the wall and floor colour to ensure that the seats are easy to see. The arms of the chair are a different colour than the upholstery to make them easier to identify. Both sides of the chair have arms to help people lower themselves into the chairs and stand up from them.

partnerships with palliative care centres such as St. Michael’s Palliative Care Unit, Toronto Central CCAC, The Toronto Grace Health Centre, Kensington Hospice, and the Temmy Latner Center for Palliative Care, prior to the launch of PEACH.

are thrilled to be able to provide this important service to their clients.”

“Many are surprised that we’re able to offer this care to people who are living in shelters and on the street,” said Ahmed.

“But all of the community partners

To learn more about PEACH, please write to peach@smh.ca .

PEACH will have a research component as well, evaluating the needs of this vulnerable population and exploring issues related to palliative care delivery for this unique group.

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Q&A

VASUKI PARAMALINGAM,

ORGAN AND TISSUE DONATION CO-ORDINATOR

By Heather Brown (Photo by Yuri Markarov, Medical Media Centre)

Although she works for the Trillium Gift of Life Network, Vasuki Paramalingam is St. Michael’s in-hospital organ and tissue donation co-ordinator. Paramalingam, along with the critical care clinicians and operating room staff, has been instrumental in raising St. Michael’s organ donor rates. For 2013-14 the hospital’s conversion rate -- the number of potential donors who actually donate an organ -- was 82 per cent, which means that of the 34 potential donors, 28 went on to become donors. She began her career at St. Michael’s in 2009 a registered nurse in the Trauma Neurosurgery Intensive Care Unit and has been in her current role for the past two years.

Q. Can you describe your role?

My interaction with a family begins when a patient has been legally declared brain dead or there has been a decision to withdraw life-sustaining therapies. I discuss the option of organ donation and help support them through the decision process.

Once a decision has been made, I facilitate medical tests required for the donation process and liaise with the physicians, nurses, multidisciplinary teams, anesthetist and operating room staff until the organs have been allocated and the surgical recovery has taken place. Post recovery I support the families

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SUMMER 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

and staff involved in the care. The other part of my role involves educating our clinicians about the organ donation process at St. Michael’s, working with them to implement best practices.

Q. Are there themes or major questions that every family has?

Yes, I often get asked: • Can my loved one have an autopsy and still be a donor?

• Can they still have an open casket following organ recovery?

• Will my religion or culture let me be a donor?

The answer is yes to these questions

Q. What is most rewarding about your job?

Being part of something that makes a difference in other people’s lives. Whether it’s supporting them in their time of tragedy or thinking about the person that gets a second chance at life, I feel fortunate to hold the role I do. I also feel supported by the leadership team at the hospital, especially Sonya Canzian, Dr. Andrew Baker and Dr. Jeff Zaltzman who are an integral part of this program.

Q. What do you do to unwind at the end of the day?

If I am not on call, I turn my Blackberry off and relax at home.