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Holland Musculoskeletal prograM teaM
Welcome to the tenth edition of the Holland Musculoskeletal Team News.
Every few months, you’ ll find updates on clinical services, education
and staff activities.
We welcome your suggestions for content and your articles for future issues.
Please send any ideas and/or submissions to [email protected]
or call 416.967.8554
newsTenth Edition, Winter 2010
partnering for patientsSunnybrook and Providence work together to ensure best post-operative rehabilitation for hip fracture patients
Providence Healthcare is one of several rehabilitation
organizations that Sunnybrook is exploring partnerships
with to ensure patients receive the best possible care
after they’re discharged. Led by a team of staff from
the Orthopaedic and Neurosurgical Unit (D5) at the
Bayview Campus, the relationship began with the goal
of dev eloping a new care pathway for patients who have
experienced a hip fracture while living in the community.
The goal of this new model of care is to ensure that
Sunnybrook’s patients have a successful return to
their pre-fracture living situation. Staff first met with
Providence representatives in September 2009 during
a site visit and tour of D5. Now the Clinical Leader
of Providence’s Patient Flow Department has been
attending D5’s weekly rounds and reviewing patients
who are ready, or close to being ready, for transfer to a
rehabilitation facility.
This “pull strategy” helps to identify patients who
are good candidates for Providence’s rehabilitation
program for hip fracture patients which includes medical
management, strengthening, mobility, activities of
daily living and assistive device training. Patients were
consulted through the process as active players in their
care and were impressed by the coordination of post-
operative rehabilitation services between Sunnybrook
and Providence.
“This new partnership is a good fit for everyone,
especially our patients who receive top-notch geriatric
rehabilitation services in a timely manner at Providence,”
says Gerry Hubble, Patient Care Manager for D5. “By
pre-identifying the patients, we assist in helping to get
them transferred quickly and efficiently so that they can
begin their rehabilitation journey. We’re in the process
of exploring closer partnerships with other rehabilitation
organizations, including St. John’s Rehabilitation
Hospital and Bridgepoint Health Centre.”
This new strategy will be assessed after three months
to see if there has been a decrease in length of stay for
Sunnybrook’s hip fracture population and an increase
in transfers to Providence.
Winter 2010 Holland Musculoskeletal Program Team News2
A patient survey, compiled from February to
June 2009 in the post-operative follow-up
clinics shows that patients at the Holland Centre
are very satisfied with both the surgeon-led
and the Advanced Practice Physiotherapist-led
clinics. Among the 750 patient surveys that were
analyzed, 88 per cent indicated that they had
no further suggestions for improving the care
and services in the outpatient clinics. Qualitative
feedback on the survey reflected positively
on the reduced wait times for appointments,
pleasant and professional care and attention
to answering patients’ questions. Patient
satisfaction is an integral component of ongoing
evaluation of Sunnybrook’s Hip and Knee
Arthritis Program model of care.
ontario Hip Fracture care: removing access Barriers to return people Home
On January 22, 2010, Holland Musculoskeletal
Program leaders participated in a forum hosted
by the Ministry of Health and Long Term Care’s
Orthopaedic Expert Panel and Bone & Joint
Health Network. The invitation-only event was
developed in conjunction with the Canadian
Orthopaedic Care Strategy Group, the Canadian
Orthopaedic Association and the Canadian
Orthopaedic Foundation’s ‘Because You Can
Program’. Healthcare leaders from across
Ontario were invited to address barriers and
develop solutions to improve care for patients
following a hip fracture.
Two of the key benchmarks for the project are
reducing the time to surgery for hip fracture
patients and reducing length of stay in an acute
care setting. Sunnybrook recently implemented
a new practice of escalating the urgency of
these patients if they have been waiting for
surgery for more than 24 hours, and has been
working closely with rehabilitation partners,
like Providence Healthcare, to promote early
transfer of these patients to an appropriate
rehabilitation setting. In the third quarter of
2009/10, 92 per cent of patients had surgery
within 48 hours (previously 74 per cent in 08/09)
and the average acute care length of stay was
14.80 days (previously 19.3 days in 08/09).
working condition program presents at Best practices day 2010A group from the Working Condition Program
presented a poster titled “The Relationship
Between Fear Avoidance Beliefs and Disability
in Work-Related Injuries” at the GTA Rehab
Network’s annual Best Practices Day. Held
on March 1, 2010, the event brought together
clinicians, researchers and administrators from
across the rehabilitation sector to hear the latest
developments in research and practice.
The authors of the research study, Taucha
Inrig, Bev Amey, Dorcus Beaton and Cheryl
Borthwick, administered the “Fear Avoidance
Beliefs Questionnaire” to a group of injured
workers in the Workplace Safety and Insurance
Board (WSIB) Shoulder and Elbow Specialty
Clinics. Their goal was to see if specific fear
avoidance beliefs about physical activity and
work could be identified. As experienced
clinicians, the group had seen these beliefs
demonstrated among workers in the past. If
a questionnaire could be validated for use in
the clinics, these workers could possibly be
referred to other treatment, such as cognitive
behaviour therapy, so that the cycle of chronic
pain might be avoided.
The group learned that there was a so-called
“high ceiling effect” in the statistical analysis as
most of the questions, centered around work
causing pain, compelled the workers to answer
with “completely agree.” The group concluded
that the questionnaire was perhaps more of a
measure of WSIB claim status versus true pain
behaviours.
patient satisfaction High with post-operative Holland centre clinics
Advanced Practice Physiotherapy role receives high scores from patients
Advanced Practice Physiotherapist Shahiroz
Juma explains the results of an x-ray with
Holland Centre patient Jeannette Mercer.
Photo by Geoff George.
Holland Musculoskeletal Program Team News Winter 2010 3
Sunnybrook’s Night of Stars, to be held on May 17, 2010 at the Princess
of Wales Theatre, will be showcasing a stellar lineup of Canadian talent.
Tickets are available, starting at just $49 for staff, and all proceeds go
to Sunnybrook’s Holland Centre.
Canada’s best in music, comedy and dance are donating their time
to the event, including pianist and artistic director of the Art of Time
Ensemble Andrew Burashko; Cirque de Soleil choreographer Debra
Brown; stars of the upcoming production Rock of Ages Yvan Pedneault
and Elicia Mackenzie, known for her role as Maria in The Sound of
Music; Canadian Idol Eva Avila; comedians Jessica Holmes and Ron
James; Glass Tiger front man Alan Frew; The National Ballet of Canada’s
Sonia Rodriguez, Aleksander Antonijevic and Karen Kain and classical
violinist James Ehnes.
Ross Petty will produce the show which will raise money for
redevelopment of the Holland Centre and will allow Sunnybrook to
continue to provide the exceptional hip and knee care for which the
hospital is renowned.
“We are thrilled that such amazing Canadian talent have thrown their
support behind Sunnybrook’s Holland Centre,” says Marilyn Wright,
co-chair, Night of Stars and member of the Holland Musculoskeletal
Program Campaign Cabinet. “The Holland Centre is Canada’s largest
centre for joint replacement surgery, where the most severe cases are
treated using techniques developed by our own specialists.”
Ticket prices start at $49 and can be purchased online at
nightofstars.ca or by calling 416.967.8628.
Fast-tracking patients after surgery could lead to Improved efficiency
Pilot study develops new criteria for discharge from the post anesthesia care unit
A pilot study at the Holland Centre has
developed new criteria to help safely fast-track
patients through the post anesthesia care unit
(PACU) to a step-down unit or the ward.
The Holland Centre’s PACU provides care for
patients recovering from general and regional
anesthesia. Staff in the unit monitor patients’
vital signs, manage post-operative pain, treat
symptoms of postoperative nausea and vomiting
and monitor surgical sites for excessive bleeding,
discharge, swelling and redness.
The new study, led by Dr. Imad Awad, a staff
anesthesiologist at Sunnybrook, modifies the
commonly used Aldrete scoring system, which
helps determine when patients can be safely
discharged from the PACU. The Aldrete scoring
system looks at consciousness, respiration,
motor function, as well as pain, nausea and
vomiting to determine when a patient is ready
to be moved. Dr. Awad noted that there
were no well-defined criteria to discharge
patients having intrathecal anesthesia from the
PACU. Intrathecal anesthesia is a local spinal
anesthetic that is commonly paired with regional
anesthesia for the 2200 total joint replacements
at the Holland Centre last year.
Dr. Awad and his colleagues modified the
scoring system to include measures related
to spinal anesthesia that PACU nurses can
use to monitor before a patient’s discharge
to the ward. The results showed that the
new modifications work very well, improving
efficiency by expediting patients’ discharge
from PACU while at the same time ensuring
patient safety.
As this was a pilot study, next steps include
testing and validating the modified scoring
system in other centres and clinical settings to
ensure it can be applied outside the Holland
Centre clinical environment.
canada’s Best in Music, dance and comedy support sunnybrook’s night of stars
Great tickets for May 17 event available at nightofstars.ca
Members of The National Ballet of Canada
dazzle at the 2007 Night of Stars event.
Winter 2010 Holland Musculoskeletal Program Team News4
Sunnybrook is pleased to be lending a hand to
‘Caring Crutches’, a program that is donating
new and used crutches and canes to Haitian
amputees. With a goal of rounding up 500
crutches and/or canes, Sunnybrook is one of
several GTA hospitals participating. If you have
walking aids that you would like to donate, there
are two drop-off locations, both at the Holland
Centre, one in the main lobby and another in
the Rehabilitation Department in the basement.
For more information on the project,
please contact Lindsay D’Andrade
or Val Jenner at [email protected].
remembering dr. robert Jackson
Dr. Robert Jackson, pictured
at the 50th anniversary celebration of the
Orthopaedic and Arthritic Hospital in 2007.
Photo by Doug Nicholson.
M e m b e r s o f S u n n y b r o o k ’ s H o l l a n d
Musculoskeletal Program were saddened to
learn of the passing of Dr. Robert Jackson on
January 6, 2010. As Chief of Staff and Surgery
at the Orthopaedic and Arthritic Hospital from
1985 to 1991, Dr. Jackson touched many of the
staff working at the site. “He was so influential
and such a caring man,” says Dr. Veronica
Wadey, orthopaedic surgeon at the Holland
Centre, who first met Dr. Jackson in 1976 when
she was a 15-year-old volunteer at the Toronto
Paralympics.
Dr. Jackson is known for his role in bringing
arthroscopy for knee surgery and other joints
to Canada after a study trip to Japan. The
technique greatly reduced the time needed for
a patient to heal. Dr. Jackson began teaching
the procedure to both Canadian physicians
and to those from abroad. In 1994, Sports
Illustrated recognized the “particular genius”
of Dr. Jackson by honouring him as one of the
40 individuals who have dramatically changed
the games we play, as a result of bringing the
“miracle of arthroscopy” to sports medicine.
Dr. Jackson a lso founded the Canadian
Wheelchair Sports Association of Canada in 1967,
the precursor for the creation of the Canadian
Paralymic Committee. Over his lifetime, awards
received included the Order of Canada, the
Olympic Order, the Paralymic Order and induction
into the Hall of Fame of the American Orthopaedic
Society for Sports Medicine.
caring crutches: sunnybrook Helps Haiti Move Forward, one step at a time
pharmacy kiosk provides convenient option for picking up post-surgery
Medication Sunnybrook’s commitment to innovation was
recently showcased by the launch of a new
PharmaTrust MedCentre kiosk in the main lobby
of the Holland Centre on February 23, 2010. The
Holland Centre performs 2200 hip and knee
replacements each year and pain management
is a key factor in helping to restore quality of
life and mobility. The convenient location of the
kiosk, centrally located in the hospital’s main
lobby, will make it easier for patients to pick up
their medication before they leave the hospital.
The kiosk offers a live two-way video link with
a pharmacist who guides patients through the
dispensing process, counsels on the medication
and answers any questions. Each step of the
medication dispense is completely controlled
by the pharmacist to ensure patient safety and
personal information is secure and protected.
Only the patient can hear the pharmacist
over the phone and the technology enables
patients to speak quietly and privately with the
pharmacist.
Since the summer of 2008, Sunnybrook has
taken the lead role in assessing this medication
dispensing system, with a similar kiosk for
patients at the Bayview Avenue campus.
Holland Centre patients now have access
to a PharmaTrust MedCentre kiosk,
a telepharmacy that dispenses prescription
drugs, in the main lobby of the hospital.
PharmaTrust pharmacist Sunny Lalli
speaks with Sabina Dizdar, pharmacist
at the company’s call-centre.
Photo by Doug Nicholson.