Hospital News September 2014 Edition

INSIDEEvidence Matters ................................11

Data Pulse ...........................................15

Nursing Pulse ......................................19

From the CEO's desk ........................... 20

Travel ....................................................28

Careers ................................................ 31

In the air with ORNGE

Enhancing patient safety through new bedside PICC program

6 14

FOCUS IN THIS ISSUEEMERGENCY SERVICES/CRITICAL CARE/TRAUMA/EMERGENCY PREPAREDNESS/RESEARCH:Innovations in emergency and trauma delivery systems. Emergency preparedness issues facing hospitals and how they are addressing them. Advances in critical care medicine. An overview of current research initiatives.SEPT. 2014 | VOLUME 27 ISSUE 9 | www.hospitalnews.com

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the complexities of our health care system. RNs, MSWs, OTs, PTs, RDs and SLPs are invited to apply. For details, locations and staff videos, and to apply for a Care Coordinator, Nursing or other role, visit ccacjobs.ca.Most Community Care Access Centres of Ontario are governed by the requirements of the French Language Services Act. We provide services in French and encourage applications from bilingual candidates.

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opioidcrisis?

Story on page 16

By Geoff Koehler

One in every eight deaths among young adults is related to opioid overdose

An

HOSPITAL NEWS SEPTEMBER 2014 www.hospitalnews.com

2 News

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hrough a partnership between Mackenzie Health and Sunny-brook Health Sciences Centre (Sunnybrook), people of York

Region and beyond will have better access to high quality health care services.

In May 2014, Mackenzie Health and Sunnybrook announced an expanded and formalized collaboration to establish closer and more integrated relationships.

For patients and their families, this means that people in York Region who need highly specialized tertiary and quaternary services in areas such as neuro-surgery, specialized cardiac or cancer care, or treatment for burns, will be referred to Sunnybrook in a more seamless manner than before.

It also means that York Region residents, who have received specialized care at Sunnybrook but no longer need these services, can be easily transferred to Mackenzie Health where they can re-ceive the same level of quality care, closer to home.

“Through our formalized partnership with Sunnybrook Health Sciences Centre, we are now able to create a corridor of care for referral and repatriation for highly spe-cialized services needed by the residents of York Region,” says Altaf Stationwala, President and CEO, Mackenzie Health. “This will mean seamless care for people in our community to further

support our vision to create a world-class health experience.”

Mackenzie Health and Sunnybrook have agreed to explore a number of clinical services under this partnership. A number of collaborations had already been in place

between the two organizations – such as Vascular Surgery, Stroke Services and High Risk Maternal and Newborn care – but the recent formalized partnership allows them to further expand these and introduce new ones. New clinical services to be explored

include, but are not limited to: Cardiac Services; Cancer Services; Chronic Kid-ney Disease; Rehabilitation and Complex Continuing Care; and Seniors’ Care.

By leveraging the strengths of each or-ganization, the new partnership will help reduce duplication of services and improve system capacity, therefore allowing pa-tients and their families to receive the right care, at the right time, in the right place.

It will also allow Mackenzie Health and Sunnybrook to explore opportunities for enhanced research and teaching activities between the two healthcare providers.

“Sunnybrook is proud to be partnering with Mackenzie Health,” says Dr. Barry McLellan, President and CEO, Sunny-brook Health Sciences Centre. “Our or-ganizations share a strong commitment to achieving excellence in patient care and through this agreement both hospitals will be able to improve the coordination of highly specialized and community-based care for people in the York Region. We look forward to our teams working more closely together.”

Both Mackenzie Health and Sunny-brook have many partnerships across the health care system which enable both organizations to better serve our commu-nities. These relationships will continue alongside this new partnership. ■H

Catalina Guran is a Communications and Public Affairs Consultant at Mackenzie Health.

New partnership to create corridor of care By Catalina Guran

T

Board Leaders and Senior Executives from both hospitals at the May 8, 2014 Partnership Announcement Ceremony.

SEPTEMBER 2014 HOSPITAL NEWSwww.hospitalnews.com

3 News

The quality of cardiac rehabilitation programs across Canada is strong, with specifi c criteria areas now identifi ed as re-quiring further enhancement to improve patient outcomes, according to a new study conducted by researchers at the Pe-ter Munk Cardiac Centre, York University and UHN.

Set to be published in the Canadian Journal of Cardiology, the study measured 14 key quality indicators in 10 cardiac re-habilitation programs across Canada, as-sessing over 5,500 cardiac patients. The criteria examined included: accessibility, wait times, referrals, secondary preven-tion, behaviour changes and psychosocial measures.

The study found that cardiac rehabilita-tion programs are successful in: assessing patients’ body composition (85 per cent, measuring blood pressure (90 per cent, increasing exercise capacity (68 per cent) and offering cessation therapy to patients who smoke (61 per cent). Areas requir-ing improvement included: measuring blood sugar in patients with diabetes (23 per cent) and assessment of depression (13 per cent).

Research has shown that heart patients who engage in cardiac rehab are 25 per cent less likely to die, than patients who do not participate in cardiac rehab. At

the same time, only about 30 per cent of heart patients who are hospitalized and who qualify to participate in a cardiac re-hab program actually do so. The United

States and Europe have also developed some quality indicators for cardiac rehab. Canada is the fi rst country to nationally as-sess program quality. ■H

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Canadians have embraced the Ice Bucket Challenge for ALS, raising an unprecedented awareness for the termi-nal disease, amyotrophic lateral sclerosis and opening their wallets donating over $200, 000 to the national non-profi t organization ALS Canada and the ALS Provincial Societies.

As more donations continue to come in across Canada, the organization has raised the fundraising goal to ask Ca-nadians to make their Ice Bucket Chal-lenge count, with a goal to raise 1.5 mil-lion dollars. The potential to increase the goal is imminent as Canadians should be able to raise at least 10 per

cent of the donations raised in the US. To Canadians participating in the Ice

Bucket Challenge, please support Ca-nadian ALS charities. ALS Canada and the Provincial Societies provide services and equipment to the 3, 000 people in Canada living with ALS today and hope for the future through the national ALS Canada Research Program. Canadians can donate to ALS Canada and ALS Provincial Societies at als.ca/icebuck-etchallenge

A viral phenomenon, the Ice Bucket Challenge, started in the USA by the Frates Family, has propelled ALS into the national spotlight. Currently, 1, 000 peo-

ple will be diagnosed with the disease per year. ALS is a neuro-degenerative dis-ease, characterized by rapidly progressive muscle weakness that causes paralysis of the body's most basic functions from mo-bility to communication and eventually to breathing. The average lifespan after diagnosis is two to fi ve years, which means 1, 000 people will die every year because of ALS. Presently, there is no cure or ef-fective treatment for ALS.

The dollars raised from the Ice Bucket Challenge will provide support services for clients and families living with ALS across Canada and fund the national ALS Canada Research Program. ■H

Dr. Chris Simpson is the new president of the Canadian Medical Association (CMA). Dr. Simpson succeeds Dr. Louis Hugo Francescutti, an emergency and preventive medicine physician from Ed-monton. "I strongly believe that Canada's doctors need to recognize and embrace our accountability to the public. We have a social contract with Canadians to serve not only our individual patients, but so-ciety as well, " says Dr. Simpson. "The improvement of Canada's health care system is a professional responsibility. If we are authentic leaders, and sincere in our intentions, we will earn the trust that Canadians place in us."

Currently, he is professor of medi-cine and chief of cardiology at Queen's University, as well as medical direc-tor of the Cardiac Program at Kingston General Hospital / Hotel Dieu Hospital. Dr. Simpson's primary non-clinical pro-fessional interest is health policy – par-ticularly access to care and wait times. He serves as the chair of the Wait Time Alliance (WTA) and served as chair of the Canadian Cardiovascular Society's (CCS) Standing Committee on Health Policy and Advocacy. He is the lead for the Southeast (Ontario) Local Health Integration Network Cardiovascular Roadmap Project, which developed a re-gional model of integrated cardiovascular care for southeastern Ontario. He serves on the executive of the CCS (member-at-large) and on the Cardiac Care Net-work of Ontario board of directors, and is an American College of Cardiology governor. He served as the fi rst president of the Canadian Heart Rhythm Soci-ety – the national association of heart rhythm specialists and allied health professionals.

An active clinician, educator and researcher, Dr. Simpson has authored or co-authored more than 300 peer-re-viewed papers and abstracts. His clini-cal and research interests include access to care, medical fi tness to drive, referral pathway development, atrial fi brillation, sudden death in the young, catheter ablation and cardiac resynchronization therapy.

Dr. Simpson will serve as president of the CMA until August 2015. ■H

A mindfulness-based therapy for de-pression has the added benefi t of reduc-ing health-care visits among patients who often see their family doctors, ac-cording to a new study by the Centre for Addiction and Mental Health (CAMH) and the Institute for Clinical Evaluative Sciences (ICES). The research showed that frequent health service users who received mindfulness-based cognitive therapy showed a signifi cant reduction in non-mental health care visits over a one-year period, compared with those who re-ceived other types of group therapy.

The study was published in the Journal of Psychosomatic Research.

The mindfulness therapy group had one fewer non-mental health visit per year, for every two individuals treated with this therapy – which translates into a reduction of nearly 2,500 visits to pri-mary care physicians, emergency depart-

ments or non-psychiatric specialists in Ontario over eight years.

Mindfulness-based cognitive therapy is a structured form of psychotherapy that combines elements of cognitive-behaviour therapy with mindfulness meditation. It is delivered in a group setting for eight weekly sessions. The therapy was originally developed to prevent relapse of symptoms among people with recurring depression, as an alternative to ongoing medication treat-ment. It has been proven effective in mul-tiple studies, and has been applied to other conditions such as anxiety and chronic pain. "Primary care physicians play a large role in managing patients with distress, and they often report feeling overwhelmed and unable to effectively deal with cases of medically unexplained symptoms," says Dr. Kurdyak. "This study shows the potential of mindfulness-based cognitive therapy to help both patients and their doctors." ■H

Mindfulness-based depression therapy reduces health care visits

New study fi rst to examine quality of cardiac rehabilitation programs

ALS Canada aims to raise 1.5 million dollars with Ice Bucket Challenge

Dr. Chris Simpson new CMA President


4 Editorial

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OCTOBER 2014 ISSUEEDITORIAL SEPT 5ADVERTISING: DISPLAY SEPT 26 CAREER SEPT 30MONTHLY FOCUS: Patient Safety/ Mental Health and Addiction/Health Care Transformation:Developments in patient safety practices. Advances in the measurements of patientoutcomes and program metrics. New treatment approaches to mental health and addiction. Programs and initiatives to provide optimal care within an effective, accountable and sustainable system.+ HEALTH ACHIEVE ANNUAL CONFERENCE GUIDE SUPPLEMENT

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The right to die?ust before noon on a Monday, Gillian Bennett dragged a mattress from in-side her British Columbia

home to her favourite spot outside, on her property. She drank some whiskey and Nembutal with water, and then held her husband’s hand as she took her last breath.

Shortly after her death, Gillian’s last words were made public on deadatnoon.com – a website she cre-ated. Her dying wish was to get people talking about death; she believed ev-ery human has the right to determine how and when they die.

The decision to take her own life was not one Gillian made lightly. Af-ter she was diagnosed with dementia several years ago, she knew there would come a time when her mind would no longer be present in her body. With this notion lingering at the back of her mind, Gillian refused to live out her last days suffering the indignities that inevitably come with dementia.

Dementia is a ruthless and vicious disease. It arrives like a thief at your doorstep and robs you of your most prized possessions – independence, memories and thoughts. It shows no mercy – giving you glimpses of the things it has stolen in rare moments of salience, which become fewer and far-ther between as the disease progresses.

Anyone who has witnessed its ef-fects on a loved one can attest to just how ruthless it is.

Gillian’s open letter reads, “Every day I lose bits of myself, and it’s obvious that I am heading towards the state that all dementia patients eventually get to: not knowing who I am and requiring full-time care. I know as I write these words that within six months or nine months or twelve months, I, Gillian, will no longer be here. What is to be done with my car-cass? It will be physically alive but there will be no one inside. I can live or veg-etate for perhaps ten years in hospital at

Canada’s expense, costing anywhere from $50,000 to $75,000 per year. That is only the beginning of the damage. Nurses, who thought they were embarked on a career that had great meaning, fi nd them-selves perpetually changing my diapers and reporting on the physical changes of an empty husk. It is ludicrous, wasteful and unfair.”

Gillian did her research. She weighed her options and the effects they would have on her family and so-ciety. After careful thought, she made a decision to end her own life, before she no longer had the ability to do so. With no legal option of doctor-assisted suicide, and with it being illegal in Canada to aid a loved one in ending their suffering, what choice did she have? And, isn’t it hers to make?

Having witnessed fi rsthand the in-dignity dementia brings, I don’t blame Gillian. I would not want to live that way, so I respect her decision. On some levels, I even applaud it. Her thought process leading up to Monday is what she wants to share. “There are many ethical issues here: life extension radically alters people’s ideas of what it is to be hu-man – and not for the better. As we, the elderly, undergo manifold operations and become gaga while taking up a hospital bed, our grandchildren’s schooling, their educational, athletic, and cultural oppor-

tunities, will be squeezed dry,” she wrote.Her reasoning was pragmatic – why

should she burden the system to pro-vide care for her, when she doesn’t know who she is and doesn’t want to live in that state? It makes sense. Un-fortunately, death is not pragmatic. It is emotional, painful and messy, and there isn’t always room for reason. But, maybe there should be.

In media interviews following her death, Gillian’s family urged Canadi-ans to rethink assisted suicide, arguing that if Gillian had that option she may have lived another six months, even a year. Her family believes that if Gillian knew her doctor or a loved one could step in once she had fully surrendered to the dementia, she wouldn’t have had to take her own life when she did.

Assisted suicide is a divisive issue – made even more complex when in-terwoven with emotions and religious beliefs. As human beings, however, is it not our right to decide what kind of life we want to live, and what kind of death?

With the passing of Dr. Donald Low last year, and his emotional plea to rethink the law prohibiting assisted suicide – the conversation got started. End-of-life care is gaining awareness, and health professionals and policy-makers are fi nally starting to listen.

Gillian’s legacy was to continue the conversation. While she recognized she didn’t have all the answers, she raised valid questions. It was her hope “that the medical profession will mandate, through sensitive and appropriate proto-cols, the administration of a lethal dose to end the suffering of a terminally ill pa-tient, in accordance with her Living Will.”

By going public with her story, Gil-lian has gotten us to think about death in a different way. She has also empow-ered us to choose our own destiny, and reminded us that we need to fi ght for transformative change in healthcare. I defi nitely applaud her for that. ■H

J

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Assisted suicide is a divisive issue – made even more complex when interwoven with emotions and religious beliefs.


5 EMERGENCY SERVICES/CRITICAL CARE/TRAUMA/EMERGENCY PREPAREDNESS/RESEARCH Focus

he number of emergency room cases where a Windsor/Essex teen or young adult is critically injured or killed in a prevent-

able trauma incident is on a downward trend – and a local hospital program is con-tinuing to educate high school students on how to avoid these tragic situations.

Windsor Regional Hospital’s P.A.R.T.Y. program – which stands for Preventing Al-cohol and Risk-related Trauma in Youth – began its reality-based sessions for students in 1994, focusing on the dangers of drink-ing and driving and other risky activity that can lead to signifi cant injuries. The inter-active program includes demonstrations of fi rst response by paramedics, former police offi cers discussing legal consequences of risky behaviour, a multitude of hospital staff demonstrating trauma care, discus-sions around organ and tissue donation, as well as “role playing” where students play victims and other roles.

According to Windsor Regional Hos-pital Regional Trauma Program statistics, injuries related to motor vehicle collisions, sports, falls and intentional harm – involv-ing youth under age 25 at Windsor Re-gional’s Ouellette Campus totalled 13 in the 2013–14 fi scal year down from 29 the previous year.

Since its inception in Windsor, P.A.R.T.Y. has educated 4,134 students from 239 schools.

Diane Bradford, Manager of the Re-gional Trauma Program/Injury Prevention for Windsor Regional Hospital (WRH), is proud of the overall results and expressed thanks to Windsor Police Service, Emer-gency Medical Services (EMS), physicians, volunteers, injury survivors and parents of fatally injured teens for their support in helping local students understand the po-tential impacts of the decisions they make.

However, Bradford cautions there’s been an increase in drug use related to motor vehicle collisions. Drug use will be a more important focus for the program in the year ahead.

In 2011-12, the use of THC – tetrahy-drocannabinol, the most recognized in-

gredient of marijuana – was found in 21 per cent of youth under age 25 injured in patient cases that showed up at WRH’s trauma centre. In 2012-13, that percent-age rose to 55 per cent and in 2013-14, re-mained much higher than two years earlier at 46 per cent.

“There is a sense that drugs aren’t the same as alcohol when it comes to getting behind the wheel, or attempting other risky behaviour,” says Bradford. “We can see by the statistics we have collected that it is becoming more prevalent and, com-bined with alcohol use is a toxic mix.”

For the 15-20 students who attend each session at WRH throughout the school year, it’s a day packed with interesting in-formation and activities designed to help students become more aware of the impor-tance and consequences of their decisions. They can also directly talk with many knowledgeable people including doctors, nurses, social workers and patients to ask questions, share information, and feel involved.

A student’s day with P.A.R.T.Y. con-sists of a journey that takes them on a tour demonstrating the diffi culties a trau-ma patient who arrives at the hospital’s emergency department will incur. They experience presentations from multiple members of the health care team includ-ing paramedics, Emergency Room Trau-ma Specialists (nurses, physicians, and respiratory Therapists. They also meet and interact with Intensive Care Nurses, Rehabilitation Therapy practitioners and experienced Law Enforcement personnel.

Participants are directed to think about their behaviours and to learn the conse-quences of taking risks. Educational tools are provided to students to take their in-hospital experience from P.A.R.T.Y. and apply it to their daily lives. They are educated to think about how their behav-iours affect those around them as they end their day meeting real injury survi-vors. Friends, family and victims of trauma from risky behaviour share their stories to bring a reality based and powerful end to their day.

P.A.R.T.Y. Program is part of an interna-tional program based out of Sunnybrook Hospital in Toronto. Research has proven the program has long-lasting benefi ts. Ten years after participating in the program, it was shown to effectively reduce the incidence of traumatic injuries.

In sharing real trauma statistics and knowledge about what actually happens to trauma patients and their families, the dedicated medical and allied health volunteers in P.A.R.T.Y. continue to educate youth from Windsor and Essex County secondary schools as they

have over the last 20 years. They hope to further their work to help keep youth trauma declining and provide education that participants can use throughout their lifetime.

The website link is: http://www.party-program.com/. Information can also be found on Facebook: P.A.R.T.Y. Program Windsor or Twitter @PARTY_Windsor. ■H

Steve Erwin is Manager of Corporate Communications, Government and Community Relations at Windsor Regional Hospital.

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Trauma prevention program succeeds in protecting teensBy Steve Erwin

T

Jennie Trkulja, Unit Manager for Windsor Regional Hospital’s Emergency Department, Ouellette Campus, explains trauma services to students of the P.A.R.T.Y. program.

A paramedic demonstrates what happens to injured students during a P.A.R.T.Y. program session at Windsor Regional Hospital.


6 Focus EMERGENCY SERVICES/CRITICAL CARE/TRAUMA/EMERGENCY PREPAREDNESS/RESEARCH

utside the Ornge hangar in Toronto, the sky is clear and the day is tranquil. But in-side, the phones are ringing,

and Ornge’s Operations Control Centre (OCC) has just received a call to attend a three vehicle collision in Caledon, and a Communications Offi cer is calling the hangar to request response. After a check on the weather, pilots deem the conditions safe to fl y, and are soon on their way.

It is roughly 09:30 and Critical Care Flight Paramedics Michael Longeway and Justin Smith receive basic details while get-ting ready to attend Milton District Hospi-tal where the patient was transported by local land paramedic services immediately following the collision. While enroute to the hospital on board Ornge’s AW139 helicopter, they prep their equipment and begin discussing who would carry out each task, and analyzing the possible ‘what ifs’. A classic example of teamwork and prepa-ration by Ornge crews for each call.

“Like any other fi eld of medicine, work-ing in our environment has its unique challenges. In fl ight, we have to rely on a thorough baseline assessment and monitor for changes using a modifi ed assessment,” explains Longeway. “With the noise of the engines, vibration, and constant fl icker-ing light, normal assessments like using a stethoscope are impossible.”

Safely loaded into the helicopter, the pa-

tient is conscious, but crying out loudly in severe pain as fractured bones shift under his own weight.

The Ornge paramedics administer Fentanyl to ease the pain, and manage to calm the patient as the helicopter lifts off the helipad and begins its trek to Hamilton General.

On arrival at Hamilton General, the paramedics transfer patient care to hos-pital staff and soon after, the aircraft lifts off and begins its way back to the Toronto Base at Billy Bishop Airport. Minutes into the fl ight, a new request is received to divert to another crash site for a motor vehicle collision in Milton.

“Scene responses are a challenge,” says Longeway. “You have a lot of information coming at you from different sources and

you usually only have a short time to make sense of it all. Collaboration between our partners, our pilots, OCC dispatchers and local EMS dispatchers is crucial.”

The speed of the helicopter and proxim-ity to the crash site allowed for a quick re-sponse only surpassed by local emergency services personnel, who manage to clear and secure a 500 metre stretch of highway west of the scene. The pilots circle once, and approach the landing site cautiously and safely to avoid power lines towering over the north side of the road.

Once on the ground, Mike and Justin head to the crash site where the patient is being extricated from his vehicle by local emergency services using the Jaws of Life, and human strength. Working together, Ornge, fi re and local paramedics establish

a plan to transfer the patient, who, within minutes is on a stretcher and headed to-wards the helicopter, with Justin going ahead to establish IV lines and lay out an airway solution.

As the helicopter spools up, the patient gets buckled in, and local EMS secures the area for a rapid departure. Within only 35 minutes of receiving the call, the aircraft is in the air and headed back to Hamilton.

Landing at Hamilton General, the pa-tient is transferred to the trauma team for evaluation. Mike and Justin have complet-ed two emergency transports in less than three hours, and they are only halfway through their day. ■H

Joshua McNamara is Corporate Communications Coordinator for Ornge

In the air with ORNGEBy Joshua McNamara

O

Scene responses are a challenge. You have a lot of information coming at you from different sources and you usually only have a short time to make sense of it all.

Ornge Critical Care Flight Paramedics Mike Longeway (left) and Justin Smith.

(Top Left) Working in this environment has its unique challenges. With the noise of the engines, vibration, and constant fl ickering light, normal assessments like using a stethoscope are impossible. (Top Right) Once on the ground, Mike and Justin head to the crash site where the patient is being extricated from his vehicle by local emergency services using the Jaws of Life.



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hen it comes to the challenge of ambulance off-load delays, Trillium Health Partners and Peel Paramedics are partnering

to fi nd a solution. Off-loading patients in a safe and timely

manner is a high priority for all emergency departments so that ambulances can re-turn to the road and be available to pick up the next person in need of emergent care. Unfortunately, ambulance off-load delay is a common problem encountered in emergency departments. The term re-fers to the time between when a patient arrives at hospital by ambulance to when the paramedic crew has transferred patient care to hospital staff, enabling paramedics to begin the process of returning to service. This delay signifi cantly impacts patient care, emergency department congestion and operational costs.

A joint project between Trillium Health Partners and Peel Paramedics was initiated in the summer of 2013 with signifi cant

success. “We wanted to address and reduce off-load hours because we know the impor-tance of getting ambulances back on the road,” says Sonya Pak, Program Director of Emergency Department and Urgent Care Services at Trillium Health Partners. “We knew we absolutely had to do better.”

In order to do better, a new methodol-ogy was developed using a Kaizen – Six Sigma approach. This approach focuses on the fl ow of process, issues and their root causes, and the best way to implement 'solutions.

The fi rst phase was introduced at the Credit Valley Hospital site’s emergency department in the summer of 2013 where the impact of this approach was felt im-mediately. In August 2013, there was a 50 per cent improvement in off-load times compared to the previous month. Prior to this project, Peel Region paramedics were losing 40,000 hours yearly to ambulance off-load delays, with the Credit Valley Hospital site accounting for 30 per cent of those hours. By working together to im-prove processes, the Credit Valley Hospital site decreased off-load times to roughly 33 minutes in early 2014, down from 50 min-utes in 2012. The team is on the way to attaining its goal of 27 minutes by the end of 2014.

The project has sustained itself beyond the pilot phase, with the second phase cur-rently underway at the Mississauga Hos-pital site. Since adopting the Kaizen – Six Sigma approach this past summer, the Mis-sissauga Hospital site’s emergency depart-ment has experienced similar success. The key to the continuation of this project will be to sustain the goal targets, despite grow-ing demand.

Trillium Health Partners and Peel Para-medics are pleased with the results of this project and the positive impact on health care delivery in the hospital and in the community. With growing momentum, the partners hope to see the continuation of strong results for their region, and an opportunity for shared best practices else-where in the province. ■H

Lauren Hayes works in communications at Trillium Health Partners.

Getting ambulances back on the roadBy Lauren Hayes

W

Off-loading patients in a safe and timely manner is a high priority for all emergency departments so that ambulances can return to the road and be available to pick up the next person in need of emergent care.

Continued on page 9

Achieving distinction in trauma services

or some Canadians, a routine commute to work in the morn-ing may end at a designated trauma centre, courtesy of a

moment of inattention or a slippery road. For others, it might be a life threatening medical condition.

The services that trauma centres and networks provide to Canadians are many and varied. Providing a coordinated re-sponse to mass casualty incidents, treating traumatic injury, assessing a patient’s reha-bilitation needs, and providing emotional support and counselling to patients and families are just a few of the critical services they offer. Equally vital is their role in pre-venting or reducing trauma by analyzing information about injury rates to identify risk factors and offering injury prevention programs. These programs help to address issues such as domestic violence awareness and alcohol and substance abuse.

It is paramount that these essential ser-vices are high quality and delivered safely and consistently throughout the country. Accreditation is one way trauma networks can achieve this.

The Trauma Association of Canada (TAC) has been accrediting Canadian trauma centres and systems since the 1990s. In 2012, TAC and Accreditation Canada formed a partnership to move the process to Accreditation Canada to ensure the long-term sustainability of trauma ac-creditation.

This partnership capitalized on the strengths and expertise of each organiza-tion—TAC for trauma services and Ac-creditation Canada for developing and administering accreditation programs—to forge a new and highly specialized Trauma Distinction program. Trauma Distinction marries TAC’s vision to Improve the lives of all those affected by or at risk of trau-matic injury with Accreditation Canada’s vision of Excellence in quality health ser-vices for all. It recognizes organizations that demonstrate clinical excellence and an outstanding commitment to leadership in trauma care.

By Sandra Morrison

The Trauma Association of Canada (TAC) has been accrediting Canadian trauma centres and systems since the 1990s. In 2012, TAC and Accreditation Canada formed a partnership to move the process to Accreditation Canada.

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magine your daughter, mother, wife, husband, father or son is ill enough to be admitted to hospital but the hospital

can only provide a stretcher in a dimly lit hallway in a noisy emergency department. Now imagine them lying there for 26 hours or more. Exceptional care? Perhaps not, but a team eager to make things better for our patients is working to turn that around.

The Patient Flow Improvement Proj-ect currently underway at Georgian Bay General Hospital (GBGH) involves nearly every department, close to 50 people and will impact thousands of patients when successful.

“Our goal is to reduce the time patients wait in the Emergency Department (ED) by 50 per cent by the end of 2014. Right now, patients can wait up to 26 hours to get to their in-patient bed. We aim to re-duce that wait time to 13 hours or less,” says GBGH Transformation Leader Owen Harries.

The push for the project is based on things all health care providers know to be true:1. The ED is not the best place to care for an admitted patient because it is not as quiet or comfortable as an in-patient bed. Patients are more satisfi ed when they are

quickly transferred to their in-patient bed.2. When admitted patients are waiting in the ED, the staff must provide care for them as well as the next trauma patient coming through the door. 3. GBGH receives funding that is partly based on the time admitted patients wait in the ED. The shorter this time is and the more it improves, the more funding re-ceived. This money is used to make further improvements hospital-wide that benefi t both staff and patients.4. Achieving quick transfer of patients to the clinical units requires coordination of all the admission, care, and discharge processes. It requires excellent teamwork along the patient’s journey.

5. The capacity of the in-patient units to accept patients is critical to reducing the wait time. There must be available beds and work must be organized so that pa-tients can be quickly transferred as they are admitted.

“We all agree patients are more satis-fi ed when they are quickly transferred to their in-patient bed once the physician has made the decision to admit them to hospital,” says Dianne Sofarelli, Director of Acute Care. “The care providers in the in-patient units are able to provide patient care in the right place at the right time while the staff in the ED can concentrate on providing emergency care for the pa-tients arriving to the ED.”

GBGH began the journey to transform and improve how we deliver care back in 2010 when the hospital was accepted into a Ministry program aimed at improving emergency department wait times across the province. GBGH has already made big improvements in wait times for non-admit-ted patients, and the Patient Flow project offers a huge opportunity to increase pa-tient safety and satisfaction as well as safe-ty and work life for our staff.

This is one of the largest improvement projects undertaken at GBGH because it crosses all lines of staff. The entire acute

care in-patient team from admission to discharge are members of the team – all clinical and allied health as well as support services such as admitting and registration, housekeeping and information systems and physicians in both the Emergency Depart-ment and the in-patient units.

This project picked up a full head of steam in the fall of 2013 but by its nature is a project that continues in perpetuity – im-provements are identifi ed all the time and need to be applied regularly. ■H

Jackie McLauchlin is Director, Commu-nications, Health Information Services, at Georgian Bay General Hospital.

Improving the patient’s journey takes team workBy Jackie McLauchlin

I The ED is not the best place to care for an admitted patient because it is not as quiet or comfortable as an in-patient bed. Patients are more satisfi ed when they are quickly transferred to their in-patient bed.

TAC’s Trauma System Accredita-tion Guidelines were the foundation of the Trauma Distinction program. Per-formance measures and evidence-based protocols were developed, and the pa-tient-centred focus was expanded and strengthened to create a robust program of excellence. An important part of the program is an on-site visit every two years conducted by expert evaluators with ex-tensive practical experience in trauma care, to provide oversight and guidance.

Key components of the program in-clude:

•Standards – The Trauma System Standards and the Trauma Centre Stan-dards are rigorous and highly specialized standards based on the latest research and evidence related to excellence in trauma care.

•Protocols – Distinction requires the use of evidence-based protocols to pro-mote a consistent approach to care and increase effectiveness and effi ciency.

•Indicators – Indicator data must be submitted on a regular basis and perfor-mance thresholds for a core set of perfor-mance indicators must be met.

•Excellence and Innovation – The program requires trauma centres to im-plement a project or initiative that aligns with best practice guidelines, uses the lat-est knowledge, and integrates evidence to enhance quality of care.

The Trauma System Standards are evaluated at the system level and are focused on how pre-hospital, inter-facil-ity transport and rehabilitation services are integrated within the trauma sys-tem to maximize the recovery of trauma

patients. The standards promote a co-ordinated strategy for rehabilitation ser-vices, with rehabilitation starting in the trauma centre and continuing once the patient is transferred to a rehabilitation centre or unit or discharged home. They address the planning, design and evalua-tion of the trauma system, and collabora-tion with partners.

Evaluated at the site level, the Trauma Centre Standards cover the essential components that Level I to V trauma centres should have in place to ensure the successful functioning of the trauma system as a whole. They address the as-sessment and management of trauma pa-tients from the incident scene until the patient is medically stable and able to be-gin rehabilitation or proceed to an alter-nate level of care. The standards focus on quality of care, planning and design of the centre, care coordination, and support to patients and families coping with trauma.

The program components were evalu-ated by an advisory committee and small working groups of trauma experts from across Canada. Broader feedback on the standards and performance indicators was provided by Accreditation Cana-da client organizations, surveyors, and TAC members via a web-based national consultation. Finally, the program was pi-lot tested with a representative sample of organizations.

Trauma Distinction will be available to trauma centres across the country beginning in September 2014. ■H

Sandra Morrison is a Writer/Editor at Accreditation Canada.



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n hopes of better understand-ing the growing issue of post-traumatic stress disorder (PTSD) and mild traumatic

brain injury (mTBI) among soldiers, the Canadian Armed Forces approached re-searchers at The Hospital for Sick Children (SickKids). Known for their expertise in a type of neuroimaging called MEG, magne-toencephalography, SickKids researchers used MEG to examine brain responses to a variety of cognitive tasks in soldiers with and without PTSD and civilians with and without mTBI.

“While the two disorders can be con-fused because of similar behavioural symptoms, the data show that they are very distinct,” says Dr. Margot Taylor, co-investigator of the research and Di-rector of Functional Neuroimaging and Senior Scientist at SickKids. “This research could lead to faster diagnosis based on objective measures rather than having a soldier self-identify, which according to Canadian Forces Health Services is an ongoing challenge.”

Currently PTSD and mTBI are diag-nosed clinically based on emotional and psychological symptoms. The symptoms of these two conditions show considerable

overlap, and particularly in the military setting, are often both present and diffi cult to distinguish.

While the use of MEG to study PTSD is relatively novel, clinicians at SickKids have been using MEG as a diagnostic tool for children with epilepsy for many years. In fact, the SickKids Epilepsy Program is a world leader in developing and imple-menting use of MEG as a non-invasive di-agnostic tool to select children for epilepsy surgery. “MEG has excellent resolution for locating areas in the brain that generate seizures. This is particularly important for children with intractable focal epilepsy as it provides crucial pre-surgical information that we previously would not have had without implanting electrodes on the pa-tient’s brain,” says Dr. Elizabeth Pang, who is Neurophysiologist and Associate Scien-tist at SickKids, and co-investigator of the PTSD research.

MEG is the only brain imaging tech-nique that provides millisecond timing res-olution with millimeter spatial resolution, meaning it is the most precise tool avail-able to determine when events take place in the brain and in which part of the brain.

Drs. Pang and Taylor also use MEG to investigate cognitive functions such

as memory, emotional processing, men-tal fl exibility, inhibition and language in children with Autism Spectrum Disorder (ASD) and children born very preterm (<32 weeks gestational age). The tasks used in this recent PTSD/mTBI research were based on these other clinical MEG studies and address the cognitive diffi cul-ties commonly associated with PTSD and mTBI which included tests of memory, in-hibition, attention, mental fl exibility and emotional processing.

The team studied not only soldiers with PTSD and civilians with mTBI, but also had a control group of soldiers with similar military experience who did not have PTSD or mTBI. The difference in brain activity between the clinical group and their respective control group was remarkable. For example, while all groups demonstrated significant brain respons-es to the cognitive tests, the soldiers without PTSD could return to a resting state while those with PTSD remained

highly activated even in a rested state. “The ultimate goal of providing objec-

tive diagnostic testing for PTSD and mTBI is to not only better understand the con-ditions and make fast, accurate diagnoses, but also to be able to test the individual to determine if he or she can safely return to service,” says Taylor.

Taylor adds that this work also helps advance our understanding of PTSD and traumatic brain injury in children and the general population.

The PTSD/mTBI research was conduct-ed in partnership with Defense Research and Development Canada and by Cana-dian Forces Health Services. The research of Drs. Pang and Taylor with children with autism or very preterm-born children is funded by the Canadian Institutes of Health Research. ■H

Caitlin McNamee-Lamb is a Communications Specialist at The Hospital for Sick Children.

By Caitlin McNamee-Lamb

IDr. Elizabeth Pang (left) and Dr. Margot Taylor with the MEG machine.

SickKids research may lead tofaster diagnosis of PTSD in Canadian soldiers


11

n healthcare, there are many kinds of emergencies – but not all are medical in nature. The emergency may be the urgent

need for evidence to help guide important decisions. For a medical emergency, you head to the ER or call 911. But whom do you turn to for an urgent search and assess-ment of the medical evidence on a drug or other health technology?

CADTH – an independent, evidence-based agency that assesses health technol-ogies – fi nds and summarizes the research on drugs, medical devices, and procedures so health care decision-makers can make informed choices. In some cases, this is a lengthy, in-depth assessment taking a year or more. But for others, the need is more urgent. The CADTH Rapid Review service balances scientifi c rigour with rel-evance and real-world timelines and pro-vides summaries and critical appraisal of the evidence to decision-makers in as little as 30 days.

Knowing what the evidence is on a health technology is helpful to decision-makers faced with tough decisions. How-ever, in some cases, there is no evidence available or it is limited and of low-quality. But knowing this is helpful to decision-makers as well. Faced with a lack of evi-dence, decisions may be based on other factors, such as cost or convenience. De-cisions might be deferred until more evi-dence is available. Or, a lack of evidence can lead to discontinuing the use of a drug, device, or procedure if its use is not sup-ported by research.

Many of the rapid assessments that are requested of CADTH focus on trauma, emergency services, and critical care to de-termine whether there is evidence to sup-port the use of a particular drug, device, or procedure in this care setting. Here is a round-up of recent Rapid Response reports from CADTH in this area.

Treat and release (T&R) protocols al-low patients to be treated by emergency medical services (EMS) personnel without being transported to a hospital or referred to a health care facility. Their purpose is to increase the number of emergencies that EMS personnel can respond to without compromising the quality of medical care and to reduce emergency room overcrowd-ing. In the US, T&R protocols have been found to reduce emergency department and inpatient admissions; however, in Can-ada they are not common. When CADTH reviewed the evidence on T&R protocols,

not a lot was found. No evidence-based clinical practice guidelines were identifi ed and only one retrospective study abstract was found that met the criteria for inclu-sion in the review. Based on the limited evidence found, it appears that T&R EMS protocols are safe and effective – but the study involved only patients with supra-ventricular tachycardia. No evidence was found on T&R protocols for other condi-tions. T&R protocols may be a promising practice for EMS personnel but evidence is lacking and their implementation in our complex health care system may be diffi cult.

When a patient has sustained a trau-matic brain injury, one of the primary goals of pre-hospital care is to prevent a lack of oxygen to the brain – a major cause of secondary injury to the brain following the initial trauma. A review of the optimal ox-ygen saturation for traumatic brain injury was requested of CADTH to help guide decisions about oxygen saturation goals for these patients to ensure the best pos-sible outcomes. Evidence was found from two retrospective observational studies and one evidence-based clinical practice guideline. An assessment of the evidence found that higher than normal pre-hos-pital oxygen levels appear to decrease the chances of surviving in hospital compared with normal oxygen saturations. Oxy-gen saturation levels of less than 90 per cent are not recommended; however, the maximum safe oxygen saturation level is not known.

The use of a spine board – a board placed underneath a person’s back to im-mobilize the spine – for suspected spinal cord injuries is a practice that is widely ac-cepted in Canada and around the world. Spine boards for pre-hospital stabilization of trauma patients are intended to reduce the chance of any secondary injury occur-ring to the spinal cord due to movement during transportation. But despite their widespread use, the way in which they are

used varies greatly. Although there are systematic reviews of the evidence involv-ing healthy volunteers, CADTH found a lack of high-quality medical evidence fo-cusing on actual trauma patients to guide how and when spine boards should be used and whether their use is associated with any harms.

Rapid reviews of the medical evidence such as CADTH’s Rapid Response reports can’t answer all the questions that arise in emergency and trauma care. But CADTH Rapid Response reports can go a long way in providing the evidence pieces to the emergency and trauma care puzzle – and

can indicate where more research may be needed. Clinicians, policy-makers, pa-tients, and others involved in making im-portant decisions in healthcare in Canada can access our Rapid Response reports free of charge on our website anytime at www.cadth.ca/RapidResponse.

To learn more about CADTH, visit www.cadth.ca, follow us on Twitter: @CADTH_ACMTS, or talk to our Liaison Offi cer in your region: http://www.cadth.ca/en/services/liaison-offi cer. ■H

Janice Mann MD is a Knowledge Mobilization Offi cer at CADTH.

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illiam Osler Health System has made significant gains in organ and tissue dona-tion, according to year-end

data from Trillium Gift of Life Network (TGLN), the Ontario agency respon-sible for organ and tissue donation and transplant. TGLN reports that Osler’s conversion rate (the number of potential donors who become actual organ donors) increased dramatically at its two hospitals,

Brampton Civic and Etobicoke General.In the first three quarters of the last

fiscal-year (April 2013 – December 2013), Osler’s conversation rate was 33 per cent, but during the last quar-ter, the rate jumped to 80 per cent at its hospitals. This means that the or-gans of four out of five potential do-nors at Osler hospitals during that quarter went on to save lives through organ donation.

Improving organ donation numbersBy Cara Francis

esearch at St. Joseph’s Health-care Hamilton strives to engage patients, clinicians, employees and academics in

re-inventing the way in which we deliver healthcare. Our vision is to deliver an in-tegrated, high quality care experience to those we are privileged to serve. Pursuing knowledge is a key driver in our ability to deliver on this vision – but equally impor-tant is our ability to share and translate that knowledge to others so that we are advancing health and well-being beyond the walls of our hospital – and beyond the borders of our city and province.

Research at St. Joseph’s begins and ends with the patient in mind. Due to a long-standing partnership with McMaster Uni-versity, dedicated clinicians have launched research studies that have aimed to di-rectly improve the care patients receive on a daily basis. Home to more than 4,000 staff, 700 physicians and 600 volunteers, our institution houses multiple campuses, departments and centres of care to treat a range of patient needs.

Since the new Margaret and Charles Ju-ravinski Centre for Integrated Healthcare opened its doors to patients in 2014, St. Joseph’s Healthcare Hamilton has shared with the world how its new integrated model of medical and mental health care will positively transform the way patients with mental illness and addiction are di-agnosed and treated. The facility also pro-vides dedicated research areas where men-tal health researchers can explore ways to improve treatments and therapies for those diagnosed with mental illness.

Respiratory medicine and thoracic sur-gery build upon a rich legacy of explora-tion into treatment and prevention of lung

and chest-related ailments. The Firestone Institute for Respiratory Health, founded in 1978, has played an instrumental role in changing the practice of respiratory healthcare on a global level by developing the AeroChamber® inhaler as well as the fi rst Canadian guidelines for the treatment of asthma.

Nephrology research at St. Joseph’s Healthcare Hamilton developed as a result of clinical and basic science researchers coming together to engage in cutting-edge kidney and urinary research. The Hamil-ton Centre for Kidney Research located at St. Joseph’s Healthcare Hamilton receives over$2.3 million annually in peer-reviewed

funding from sponsors such as the Cana-dian Diabetes Association, the Kidney Foundation of Canada, and the Canadian Institutes of Health Research.

In the emergency department, physi-cians have developed a new, effi cient as-sessment process which drastically cuts emergency room wait times. By including a triage physician located inside the wait-ing room, patients receive an immediate initial assessment which includes giving out medication and scheduling medical ex-aminations. Re-inventing the emergency department process has led to decreased mortality rates as well as improved patient satisfaction.

This year, our respirology researchers have successfully tested an antibody that can improve the quality of life for individu-als with asthma by relieving infl ammation in the lungs. It concluded that blocking a specifi c protein in the lungs with an an-tibody both alleviates baseline infl amma-tion and provides resistance to allergens for those with mild allergic asthma. These fi ndings can lead to a potentially new anti-body-based treatment for allergic asthma,

especially useful for those individuals that have issues with inhalers or steroid-based medications.

Our basic science nephrology research-ers are studying the mechanisms involved in kidney failures caused by diabetes and hypertension – the two most common causes of kidney failure in North America. Clinically, St. Joseph’s is the top recruiting centre in the world for PEVIXAS – the world’s largest study of autoimmune renal disease.

The PEVIXAS study strives to answer questions that will help clinicians to pro-vide the best possible care for those with patients with kidney disease caused by ANCA (anti-neutrophil cytoplasmic anti-bodies).

From developing treatments for hoard-ing disorder, to uncovering biomarkers for bipolar disorder, mental health research at St. Joseph’s serves a wide-range of patient needs. Currently, mental health research-ers at St. Joseph’s Healthcare Hamilton are conducting a study that hopes to measure the effectiveness of the evidence-based design principles used in constructing the new West 5th facility. Patients as well as their families, learners and volunteers are participating in the study to help research-ers understand how design principles can be used in improving care, safety and staff satisfaction.

Research at St. Joseph’s Healthcare Hamilton is inclusive and collaborative; continuously striving to improve the qual-ity of life for patients. Our researchers act as an academic community that strives to use scientifi c inquiry and exploration in order to change the way that healthcare is practiced around the world. ■H

Sebastian Dobosz is Research Communications Coordinator at St. Joseph’s Healthcare Hamilton.

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Research focused on

By Sebastian Dobosz

R

Research at St. Joseph’s Healthcare Hamilton is inclusive and collaborative; continuously striving to improve the quality of life for patients.

Dr. Margaret McKinnon (right) reviews notes with a student in the Margaret & Charles Juravinski Centre for Integrated Healthcare.

improving quality of life

W

Continued on page 13



“As part of our commitment to on-going quality improvement, Osler has undertaken a number of efforts to improve our organ and tissue donation perfor-mance,” says Joanne Flewwelling, Execu-tive Vice President, Clinical Services and Chief Nursing Executive, William Osler Health System.

Osler’s gains have come after months of dedicated team efforts. Last October, Os-ler designated its own internal physician champion for organ and tissue donation to help lead efforts – a fi rst in Ontario hos-pitals. Since her appointment, Dr. Alex-andra Mcmillan, an Intensive Care Unit (ICU) physician, has focused her efforts and those of her team on educating staff and physicians about organ and tissue do-nation and following up on all potential organ donors at Osler’s hospitals.

“We have done a tremendous amount of work as a team, focusing on educa-tion as well as implementing communi-cation strategies with our staff regarding early recognition of potential donors,” says Mcmillan.

Osler’s success is encouraging, especial-ly because Osler hospitals serve areas with below-average donor registration rates. Brampton’s and Etobicoke’s organ donor registration rate is 14 and 16 per cent respectively, while the provincial average is 25 per cent.

In addition to improving its conversion rate, Osler also improved upon its rou-tine notifi cation rate – how often TGLN is notifi ed of all patient deaths or immi-nent deaths. Osler has seen an increase from 75 to 94 per cent in this rate in re-cent months. This improvement came after TGLN implemented hospital-wide notifi cation at Osler in April 2013, which made it mandatory for every patient death to be reported. Previously, only deaths in the emergency department (ED), Critical Care Units and Palliative Care Units were required to be reported for tissue donation potential.

“Educational outreach to all staff mem-bers helped Osler achieve a baseline noti-fi cation rate of 75 per cent. More notably, records show that when Osler mandated electronic notifi cation in December 2013, we saw a 15 per cent improvement within one month,” says Dr. McMillan. “I'm hap-py to report that our internal monthly au-dit and performance feedback has resulted in a 99 per cent compliance rate at the six month mark.”

To further boost Osler’s performance, a dedicated team comprised of a social worker, dietician, nurse educator, respi-ratory therapist, charge nurse and some-times a doctor, assess ICU patients daily based on four clinical triggers established by TGLN to prompt routine notifi cation of a potential donor. These triggers, imple-mented for patients who are at high risk of imminent death, include a grave prog-nosis, an injured brain or non-recoverable injury/illness, a family-initiated discussion of donation or a discussion of the with-drawal of life support.

To support front-line efforts, Osler also updated its corporate policy on organ and tissue donation so that it refl ected the or-ganization’s renewed efforts. “We have a

multi-disciplinary approach, and our com-munity and hospital staff have been very receptive and engaged, ” says McMillan.

Osler has also made electronic record-keeping of notifi cations to TGLN manda-tory and monthly internal audits are con-ducted to ensure opportunities for organ and tissue donation have not been missed. Through the audit, the fi les of every ven-tilated patient who dies in the ICU and Emergency Department are reviewed by an Osler Organ Donation Coordinator and Clinical Quality Coordinator.

“Osler staff and physicians remain dedi-cated to this important work and will con-tinue to build on these positive changes to help save more lives, ” says Flewwelling.

With more than 1, 500 Ontarians await-

ing life-saving transplants, Osler’s goal is to achieve a 100 per cent notifi cation rate. Osler plans to focus its efforts on strategies that will ensure the gains made over the past months are sustainable.

Donation performance data, includ-ing routine notifi cation and conver-sion rates, by hospital is available at http://www.giftoflife.on.ca/en/publicre-porting.htm. One donor can save up to 8 lives and enhance up to 75 others through tissue donation. You can register consent for organ and tissue donation at www.beadonor.ca. ■H

Cara Francis is Manager, Public Relations and Digital Communications at William Osler Health System.

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month mark.”

To support front-line efforts, Osler also updated its corporate policy on organ and tissue donation so that it refl ected the organization’s renewed efforts.

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As of June 1, 2014, OAC

he Intensive Care Unit (ICU) at St. Joseph’s Health Cen-tre is a safe haven for quality care. Machines beep faintly as

clinicians closely monitor the conditions of patients who are coping with serious ill-nesses or injuries. Those patients are being cared for around-the-clock by a dedicated team striving to improve their condition and, eventually, get them well enough to go back home.

The last thing you want to do with a fragile patient is take them out of that acute care setting.

With this in mind, St. Joseph’s Health Centre has launched a bedside program in our ICU for the insertion of a special type of intravenous access.

“We have had the support of the hospi-tal to implement a new bedside peripher-ally inserted central catheter (PICC) pro-gram, where instead of having sick patients that are in the hospital come to (Diagnos-tic Imaging) to have this special intrave-nous inserted, we actually take our equip-ment to the patient,” explains Dr. Wendy Thurston, Chief of Diagnostic Imaging at St. Joe’s.

PICC lines are a type of intravenous ac-cess meant for long-term use. Each PICC line is a long, thin tube that is inserted by interventional radiology specialists

through a vein in the upper arm. The tip of the tube is advanced through the vein until it ends in a large blood vessel near the heart. The lines are typically inserted using ultrasound and fl uoroscopy. Fluoroscopy is an imaging technique that uses x-rays to obtain real-time moving images of the pa-tient’s internal body.

Patients in areas such as the ICU have PICC lines inserted for various reasons, such as long-term intravenous access, nu-trition, antibiotic usage or chemotherapy.

“If you’re going for chemotherapy with a regular intravenous, the chemotherapy burns your veins,” explains Lori Debono, a Registered Nurse at St. Joe’s who spear-headed our bedside PICC program along-side Dr. Thurston. “The PICC lines pro-tect your veins.”

The PICC lines can also provide nutri-ents when people have surgery and can’t eat, she adds. “It acts as a substitute.”

When it comes to patient safety, those

are some obvious benefi ts to using PICC lines – and our new beside program takes that safety focus one step further.

Debono has been the fi rst staff member inserting PICCs at the bedside – a process she says cuts down on delays in treatment and the waiting times that crop up when you’re bringing patients down to the inter-ventional radiology room.

Having the entire procedure done in a patients’ room decreases their level of dis-comfort. And, with the bedside program, it’s just one nurse inserting the PICC – speeding things up for the patient and re-ducing the amount of staff and time pre-viously required to bring an ICU patient down several fl oors to Diagnostic Imaging

(DI). In other words, a win-win situation.“Staff say loud and clear that (the new

bedside program) is safer for patients and provides better patient care and lower wait times,” says Julie Ann Ninnis, Patient Care Manager for the ICU.

Previously, when ICU patients would be shuttled down to DI, they’d often need a respiratory therapist on hand for the short trip to keep them breathing prop-erly – since they wouldn’t be hooked up to an ICU ventilator. Staff would also be lugging the patient’s intravenous pole and other necessary equipment into an eleva-tor. Overall, the medically necessary trip for a PICC line insertion was disruptive for the patient.

“When patients are sick and they have to be moved within the hospital, there’s an increase in adverse events that happen,” says Dr. Thurston. “And now the PICC lines are being done at the bedside, so it’s just been a positive thing for everybody – the patients, the interventional suite, and our hospital.”

Eventually, Dr. Thurston and Debono would love to see the bedside program spread to other units in the health centre. But in the meantime, for some of our sick-est patients in the ICU, it’s already making a difference.

“I just can’t explain how great it is that we no longer have to move patients out of (the ICU), an area with all the necessary services and safety nets,” says Ninnis. “It’s much better to have the (PICC line) ser-vice come to the patient.” ■HLauren Pelley is a Junior Associate at St. Joseph’s Health Centre, Toronto.

Enhancing patient safetyBy Lauren Pelley

T

Patients in areas such as the ICU have PICC lines inserted for various reasons, such as long-term intravenous access, nutrition, antibiotic usage or chemotherapy.

St. Joe’s has implemented a new bedside peripherally inserted central catheter (PICC) program, where instead of having sick patients that are in the hospital go to Diagnostic Imaging, the equipment comes to the patient.

through new bedside PICC program

uring a cold afternoon in mid-December 2013, a young patient walked in the emer-gency department at Hôpital

Montfort in Ottawa. She had nausea, vertigo, and was feeling disorientated.

The team handling the patient, which included emergency nurses Yan Landry-Bruneau RN, Geneviève Falardeau RN and Marjolaine Eckert RN, as well as Dr. Charles-Antoine Breau, was puzzled.

“We regularly see patients with nau-sea at the emergency, but to see a young patient with signs of confusion, now that was odd,” says Dr. Breau, emergency physician at Montfort, a Francophone academic health care institution that provides quality care in both offi cial languages.

While talking with the patient, mem-bers of the team learnt that she had

recently moved into a new apartment building, which was equipped with gas heating. “That’s when the light bulb went on,” adds Dr. Breau.

The patient was showing signs of car-bon monoxide (CO) poisoning.

By Geneviève Picard

At Montfort, rapid refl exes saved lives outside the hospital

D


Three of the four team members who called 911 from the emergency department.

The day the emergency ward called 911


15 Data Pulse

“It’s my pleasure to say ‘thank you.’ Your knowledge

-

– A.W.

atients admitted to acute care hospitals on the weekend have slightly higher odds of dying than those admitted on week-

days, according to a recent report by the Canadian Institute for Health Informa-tion (CIHI).

Weekend Admissions and In-Hospital Mortality takes an in-depth look at the so-called “weekend effect,” examining four million urgent acute care admissions to Canadian hospitals, in all provinces and territories, between 2010 and 2013.

The report concludes that the odds of dying for Canadians admitted on the weekend for urgent medical or surgical care were four per cent higher than for pa-tients admitted on weekdays.

CIHI’s report breaks down the numbers for patient groups.

•Those who underwent urgent surgery had seven per cent higher odds of dying if admitted on the weekend.

•Urgent medical care patients had three per cent higher odds.

•There was no weekend effect for all other acute care patient groups – children and patients admitted for childbirth or mental health services.

Staffi ng, access potential factors

One possible reason for the weekend effect is staffi ng levels. CIHI’s report includes a case study of one hospital’s staffi ng level changes over the weekend. Front-line nursing staff numbers remained similar to those on weekdays, while phy-sician and clinical staff coverage – which includes therapists, pharmacists and tech-nicians for specialized diagnostic services – was reduced.

Delays in access to diagnostic testing may also be a factor. Heart attack and stroke patients waited longer for diagnos-

tics on the weekend, yet there was a week-end effect for only heart attack patients (eight per cent higher odds of dying).

Another reason, the study suggests, is that patients with less severe conditions may delay getting treatment until week-days. Daily admissions go down by 11 per cent on the weekend on average.

While the report provides much food for thought, experts stress the value of keeping the data in perspective.

“It is important to keep in mind that the study was able to analyze only the most serious outcome: death,” says Kathleen Morris, CIHI’s Director, Health System Analysis and Emerging Issues. “Individual hospitals are in the best position to moni-tor key contributors to successful patient outcomes: appropriate treatments, patient experience, and diagnostic and treatment wait times. Though Canada’s weekend ef-fect is very small, hospitals could ensure that staffi ng on weekends is suffi cient to meet best practice guidelines for the high-risk conditions seen in acute care.”

How Canada stacks upAlthough small, the numbers related to

Canada’s weekend effect are nevertheless

signifi cant. But how does Canada compare to other countries?

“There has been much discussion con-cerning a possible ‘weekend effect’ in Canadian acute care hospitals,” says Jer-emy Veillard, Vice President, Research and Analysis at CIHI. He notes that the study’s fi ndings – compared to all similar studies (national scope, looking into ur-gent cases across all diagnoses), including those conducted in the U.S., U.K., and Australia – reveal that Canada seems to have the lowest weekend effect in urgent care. “Our study’s fi ndings are very reas-suring to Canadians and should increase public confi dence that weekend admis-sions are safe.” ■H

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. CIHI's data and reports inform health policies, support the effective delivery of health services, and raise awareness among Canadians of the factors that contribute to good health.

Examining the “weekend effect” at

P The report concludes that the odds of dying for Canadians admitted on the weekend for urgent medical or surgical care were four per cent higher than for patients admitted on weekdays.

Canadian hospitals



he misuse and abuse of opioids – strong painkillers such as morphine, codeine and oxy-codone – is an issue that has

grown considerably across North America over the past two decades. An American study estimated that early deaths due to opioid abuse has resulted in more than $18 billion in lost future earnings in the United States alone.

Globally, Canada is second only to the United States when it comes to the total amount of opioids dispensed per capita.

This rise in opioid use has been attribut-ed to a variety of factors – including their wide availability, lack of tools and training for physicians for the treatment of pain, and the belief that they are safe to use be-cause they are prescribed by doctors.

The misconception around the safety of opioids has also likely driven increased recreational use of these opioids and the sharing of these medications with friends and family.

“Opioids are over-prescribed in North America,” says Tara Gomes, a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital. “They have the same active chemical in them as heroin and should not be prescribed lightly. Although there is evidence that these drugs are effec-tive for short-term treatment of moderate to severe pain, they are increasingly being used for long periods of time at doses that have proven to be potentially dangerous."

The “inappropriate” use of opioids is itself a diffi cult concept to pin down. Re-searchers don’t have data on how people use these drugs (e.g. if they crush/inhale/inject). They also don’t know to what extent people receiving prescriptions for these drugs are misusing or abusing them. However there is evidence clearly showing that high-dose prescribing – which can be dangerous regardless of whether or not the

person is using the drugs ‘as prescribed’ - is very prevalent.

Clinical practice guidelines recommend dosages not exceed the equivalent of 200 mg of morphine. By looking at high dose prescribing, Gomes found that more than one-quarter of the patients eligible for Ontario Drug Benefi t Program who were treated with long-acting opioids received doses that exceed the recommended guidelines. More than one-third of those getting long-acting oxycodone, such as OxyContin, also received higher-than-recommended doses.

It's hard to know exactly how often opi-oids are prescribed because data is limited,

but research shows that six years ago nearly 1.5 million opioid prescriptions were given to the 180,000 Ontarians between the ages of 18 and 64 who were eligible for the On-tario Drug Benefi t Program.

Today that number likely exceeds 1.5 million prescriptions.

Gomes recently showed the impact of Ontario’s high prevalence of opioid use on overdose deaths. Her study showed that rates of overdose deaths increased nearly 250 per cent over the past two decades. This research, published in the journal July, also revealed that these deaths are increasingly impacting Ontario’s young adults. One in every 170 deaths among

Ontarians is related to opioid overdose; that number climbs to one in every eight deaths among young adults.

Opioid overdoses can occur when someone accidentally misuses a prescribed opioid or when opioids are intentionally tampered with to achieve a ‘high’. This tampering may include chewing, crushing and inhaling, or dissolving and injecting opioids.

Pharmaceutical companies have worked to develop safer formulations of opioids since concerns were raised about the safety of opioids – particularly when used inap-propriately. One such example is the re-placement of OxyContin in 2012 with a new tamper-deterrent formulation of long-acting oxycodone called OxyNeo.

Despite such advances, there is con-cern that pharma’s approach may not ad-equately address the issue of opioid abuse in North America.

“Although the intent of tamper-deter-rent formulations of opioids is to make them more diffi cult to crush, inhale or inject, the effectiveness of these changes have not been proven in the real-world,” says Gomes. “Drug abusers have proven themselves very creative at fi nding ways to get high.” Furthermore, tamper-deterrent forms of opioids haven’t done much to curb overall rates of opioid abuse because a large number of original, non-tamper-deterrent opioids are still available on the market.

“To combat this epidemic, we need to make sure that opioids are being used in a safe and effective manner and this starts with prescribers,” says Gomes. “Unfortunately, our health care system is not designed to provide them with suf-fi cient information upon which to base these decisions.

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Therapy & RehabBetter care for a better life

By Geoff Koehler

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An opioid crisis?Cover story

35

30

25

20

15

10

5

02003 2004 2005 2006 2007 2008

Year

% p

opul

atio

n

Long-acting oxycodone

Transdermal fentanyl (no long-acting oxycodone)

Other long-acting opioids (no long-oxycodone or fentanyl)

Immediate-release single-agent therapy

Percentage of participants with a prescription for high or very high doses of oral morphine for equivalent by year and opioid group.



If a prescriber can’t confi rm whether a patient is receiving prescriptions for opi-oids from multiple sources, they are often unable to determine whether a patient needs these drugs for legitimate pain, or if they are sourcing large quantities of opi-oids because they are addicted to opioids or are selling them illegally for profi t.”

This is particularly diffi cult for physi-cians treating patients in an emergency department. Unlike a family practice, where the doctors and nurses have a his-tory with their patients and can more readily identify indicators of opioid addiction, emergency department clini-cians are often seeing patients for the fi rst time and without the hindsight of recent visits.

It can be diffi cult for them to discern the difference between someone with legitimate severe pain who may ben-efi t from an opioid and someone with an opioid addiction.

“In an emergency department, clini-cians often have limited time and infor-mation to determine whether a patient’s pain is legitimate and how it should best be treated,” says Gomes. “Electronic health records that are accessible to prescribers throughout the health care system would provide clinicians with enough information to determine a pa-tient’s medication history, and whether they may be exhibiting drug-seeking be-havior. Identifying patients who might be addicted to, or diverting these potentially dangerous medications would help re-duce the prevalence of opioid overdoses and related deaths in Ontario.” ■H

Geoff Koehler works in communications at St. Michael’s Hospital in Toronto.

Tara Gomes is a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital


T G i i i h Li

From 2005-2006 to 2010-2011, there was an almost 250% increase in the number of emergency room (ER) visits in Ontario related to narcotics withdrawal, overdose, intoxication, psychosis, harmful use and other related diagnoses. (Expert Working Group on Narcotic Addiction 2012)

In a study of opioid-dependent patients admitted to the Centre for Addiction and Mental Health in Toronto, 37% reported receiving opioids solely from physician prescriptions, 26% from both a prescription and “the street,” and 21% from the street. (Changing patterns in opioid addiction – Canadian Family Physician 2009)



he Association of Ontario Midwives (AOM) recently recognized two health care organizations for successfully

integrating midwives into their maternity care teams. Markham Stouffville Hospi-tal and Trillium Health Partners received the AOM’s inaugural Hospital Integration Awards.

Midwives have been well-integrated at Markham Stouffville since 1994 when Carol Cameron became the fi rst midwife to provide primary care at a hospital birth un-der regulation. Cameron was head midwife at the hospital for 18 years, before becom-ing the clinical manager of the hospital’s childbirth centre (and the fi rst midwife in Ontario to run a birth unit), a position she held for more than two years.

Cameron says she and a number of other midwives formed an interdisciplinary hos-pital integration committee at Markham Stouffville two years before midwifery was regulated in Ontario. To this day, she says she’s grateful for the support of Dr. Jim Ma-cLean (who was the hospital’s chief of staff 22 years ago and later served as President and CEO), who was very supportive of midwives and midwifery.

Midwives at Markham Stouffville Hos-pital work to their full scope of practice including managing oxytocin and moni-toring epidurals. Midwives have also infl u-enced the way physicians and nurses at the hospital practice.

“We’ve got other care providers using birthing stools and there are policies on water birth, delayed cord clamping and skin-to-skin. All these things were mid-wifery-led and now everybody’s doing it,” says Cameron.

Elaine Gouldbourne, the Patient Care Director of Surgical and Maternal Child Services at Markham Stouffville, says em-bracing the midwifery program enables the hospital to offer more birth options, enhance the patient experience, meet the needs of a diverse population and contrib-ute to a healthier community.

“We recognize that there’s a percentage of our population that has low-risk births and our midwifery partners are very ca-pable of providing that service to our pa-tients. And they have a vital role to play as we continue to expand our program,” says Gouldbourne.

Trillium Health Partners has supported midwives to work to their full scope of practice since its Mississauga Hospital site fi rst privileged midwives in 1994. Trillium has also created midwifery-specifi c pro-tocols and a Division of Midwifery, and their Head Midwife receives a stipend for her work. In addition, the administration involves midwives in planning, policy de-velopment and maternity-care decision making.

Head Midwife Aderemi Ejiwunmi (Mid-wifery Care of Peel and Halton Hills) says the positive work environment that mid-

wives have always enjoyed at Trillium is built on a foundation of mutual respect between the administrators, midwives and other health care providers.

Ejiwunmi also attributes the integration success to the fact that the hospital has always believed that the midwives should speak for themselves.

“If there was a confl ict or challenge or misunderstanding, people were encour-aged to speak directly to the midwives and the midwives were supported to explain their own scope of practice, their own approach to care and their own rationale for whatever it was that was being ques-tioned,” says Ejiwunmi.

In the late 1990s, Trillium was one of the pilot sites for MOREOB (Managing Obstetrical Risk Effi ciently), a perfor-mance improvement program that creates a culture of patient safety in obstetrical units. According to Ejiwunmi, participat-ing in this program helped strengthen the

interprofessional relationships and col-laboration among colleagues at Trillium by making members of the maternity care team more aware of each profession’s clini-cal knowledge and giving the midwives, obstetricians and other participants an op-portunity to develop social relationships that fostered teamwork.

Dr. Peter Scheufl er, the Program Chief and Medical Director of Women’s Health at Trillium Health Partners, says the mid-wives have infl uenced the practice of their interprofessional colleagues and helped the organization meet the needs of women and families.

“I think midwifery has opened up our minds in many ways to augmenting the way that we provide health care to women having babies,” says Scheufl er. ■H

Jill-Marie Burke is a Communications Offi cer at the Association of Ontario Midwives.

Hospitals successfullyintegrate midwivesBy Jill-Marie Burke

Midwife Carol Cameron (left) and Elaine Goulbourne (right), Patient Care Director, Surgical and Maternal Child Services at MSH, received the award from AOM president Lisa M. Weston.

T


19 Nursing Pulse

ne of the fi rst things patients notice about Lisa McKay is the set of white, DJ-calibre headphones she sports around

her neck or over her ears at Pembroke Re-gional Hospital’s ER intensive care unit. The RN uses them because she has severe hearing loss: 70 per cent in one ear; up to 60 per cent in the other. McKay wears hearing aids, but they don’t pick up the low range sound of a heartbeat or a patient’s breathing. So she pops them out and uses an electronic stethoscope (or, e-scope) that amplifi es sound, connecting it to her trendy headphones.

At least once a day, curious patients or staffers ask: “Why do you wear those?” Teenagers say the headphones are “really cool.” But for McKay, they’re not a style statement. They’re one of the reasons she is able to practise as an RN. “I thought there would be no way I could work in an emergency department,” she says. “And (here) I am.”

McKay was born with hearing loss. When she was three-years-old, her mother realized something was wrong when her daughter hadn’t started talking. Diag-nosed shortly after this discovery, McKay has worn hearing aids ever since. Now 38, she relies on closed captioning on televi-sion and cranks the volume on telephones and IV pump machines. If the latter starts beeping, she’ll ask the patient to use the call bell. She also reads lips, a task that can prove troublesome if the speaker is wear-ing a mask. Colleagues sometimes forget to face her when they’re talking, and McKay is forced to dash ahead of them to watch their mouths move. She’ll remind them to look at her and speak slowly, and says they have been receptive, supportive and help-ful. Her manager is investigating ways to add to McKay’s arsenal of support, and is looking into the possibility of a device that vibrates when a patient presses a call bell. “Little things like that help,” she says.

Nursing isn’t McKay’s fi rst career. In fact, she worked as a massage therapist for a year-and-a-half, until 2000, when she learned she had melanoma. Currently clear of cancer, McKay refl ects on the eye-opening experience that made her think “this (job) is not something I want to do for the rest of my life.” The diagnosis may have triggered her decision to leave her job as a massage therapist, but McKay says she’s always been fascinated by the human body. While pregnant with her two sons, she turned to the Internet, following their evolution from fetus to newborn. But even when she was in massage therapy school, McKay admits she enjoyed anatomy, physi-ology and pathology courses.

When the family moved to Petawawa in

2006, she had already been looking to en-roll in a nursing program. She heard about the University of Ottawa and Algonquin College’s collaborative BScN program – classes were 20 minutes away in Pembroke – on the radio. “I always wanted my de-gree, and it just seemed like an interesting fi t,” she explains. “It never occurred to me in high school or elementary school to pur-sue (nursing).”

Almost immediately after learning of her acceptance into the program, McKay ran into a roadblock. Her hearing aid special-ist encouraged her to “fi nd a new career” following one unsuccessful attempt to fi nd an e-scope before classes began. “I cried for

a day-and-a-half after that, ” she recalls. It was her husband who said “we’ll fi nd some-thing that works.”

The couple researched e-scopes, and shortly before she began her studies, he found the headphones she still uses today. In anticipation of the challenges she might face in the classroom, McKay went to stu-dent services, asking: “What can you do to help me?” They drew up an individual learning plan, offering note takers and pre-ferred seating.

In April 2013, McKay graduated with the University of Ottawa Silver Medal for re-ceiving the second highest grade point av-erage in the nursing program. Ten months later, she completed her fi rst permanent shift at Pembroke Regional Hospital. She says she’s lucky to have support from fam-ily and friends, and encourages those with hearing loss who might be considering a ca-reer in nursing to just keep trying to fi nd a way to work around the condition. “Hope-

fully, (those who are hard of hearing) will realize that (nursing) is an option.”

*** At fi rst, Lorrie Reynolds wasn’t com-

pletely troubled by what seemed like be-nign lower back pain two summers ago. The then-43-year-old avid runner – she used to clock 10 kilometres on a run – had just returned to her BondHead home af-ter spending two weeks at the family cot-tage waterskiing and playing ball hockey. She assumed the pain was related to her sciatic nerve.

Then, her left knee began to repeatedly give out. In the early hours of July 16, 2012,

when she woke up to go to the bathroom, Reynolds was alarmed to discover her left leg had lost all sensation from the knee down. She gingerly made her way back into the bedroom to wake her husband. “I know I’m being silly, ” she said, “but can we go to the hospital?”

Doctors discovered a mass of blood ves-sels clumped around the seventh thoracic vertebra in her spinal cord, right below her breasts: a cavernoma that had hemor-rhaged. The pressure on the spinal cord resulted in Reynolds being paralyzed from her toes to her upper rib cage. Sixteen days later, the RN of 23 years, who was, and still is, director of maternal child/professional practice and deputy chief of nursing at Newmarket’s Southlake Regional Health Centre, woke up from surgery. The paraly-sis was permanent.

According to Spinal Cord Injury On-tario, there are more than 33, 000 people living with a spinal cord injury. Never in

her wildest dreams did Reynolds think she would be one of those statistics. “I was just stunned, just shocked, ” she says.

Less than a month after her operation, she was transferred to rehab, where she pushed herself to boost her upper body strength as well as learn the techniques re-quired to transfer from her wheelchair to a shower chair every day. She attributes her determination to the competitive streak that runs in her family. But her journey hasn’t been without obstacles. She fell once at rehab. “I felt like a child. I had to call to get someone to help pick me up, ” she remembers, adding that the experience was empowering, especially after her phys-iotherapist praised her for her resolve.

At another point, while discussing her commitment to physiotherapy, a physi-cian told her she was wasting her time and money. “I’m around people in wheelchairs, and (this is important for) my emotional and spiritual healing, ” she told him. “I might not be cured, but I’m healing.” The following visit, he changed his tune, en-couraging her to keep up the good work. After two months at a rehabilitation facil-ity, Reynolds was discharged and ready to adjust to a new normal.

She sits at the edge of the bed and rolls onto her stomach to slip on pants. She drives using hand-held controls. Nothing is as it once was, but she’s grateful she has the support of her family. Her husband renovated the home and cottage to accom-modate a wheelchair by widening doorways and adding lifts and roll-in shower stalls.

Reynolds’ next objective was to get back to work. She returned to an acces-sible offi ce and accompanying bathroom on a modifi ed schedule in April 2013, and went full-time three months later. “They really embraced me, ” she says of her col-leagues, who refer to her as “hot wheels, ” as she races down the hospital hallways. In an effort to motivate health-care pro-fessionals to refl ect on their own practice and leadership style – and on the patient’s perspective – Reynolds shares the details of her journey in presentations to col-leagues. She’s spoken to Southlake’s nurse practitioners, fourth-year York Univer-sity nursing students, and members of the Registered Practical Nurses Association of Ontario.

She talks about the nurse who offered to wash her hair. “I can’t tell you how good it felt. She wasn’t curing my illness, but she was really helping me to heal.” She re-members the nurses who, after coming in to run tests, allowed Reynolds’ daughters and husband to stay in bed with her. Or the staff who allowed her mother to show up every morning at 8:30 with breakfast and a back rub, well before visiting hours.

“I always used to say everything happens for a reason and I (spent) time trying to fi nd a reason for this (paralysis), ” she says of her struggle to make sense of things. “If I can bring that patient perspective and try to infl uence the care we deliver, then that’s my silver lining.” ■H

Melissa Di Costanzo is communications offi cer/writer for the Registered Nurses’ Association of Ontario (RNAO).

Overcoming adversityBy Melissa Di Costanzo

O

She encourages those with hearing loss who might be considering a career in nursing to just keep trying to fi nd a way to work around the condition

Meet two registered nurses who don’t let obstacles stand in their way

Lorrie


20 From the CEO's Desk

hen blood donors roll up their sleeves to give, they do so with trust in our commitment to put their donation to the best

use to save lives. Canadian Blood Services manages the

supply of blood and blood products in Can-ada (except Quebec). In addition to en-suring a safe and secure blood system, we work with our partners – hospitals, medi-cal associations, physicians, patient groups and governments – to improve how we use and monitor the supply of blood products in Canada to reduce waste and lower costs.

In May 2014, Canadian Blood Services’ hospital Blood Component and Product Disposition System moved to the web and became accessible to hospitals through a secure login. This system is the foundation for how we share information and interact electronically with our hospital customers. Using this system, hospitals can input dis-position data on all blood products, includ-ing blood groups, discards, and the number and type of patients receiving transfusions for each blood component. They can also track the number of O-negative units

transfused into patients whose blood type is not O-negative.

We strongly encourage hospitals to share their daily inventories through this system. Reliable data, combined with a comprehensive understanding of hospital services, will give Canadian Blood Services better insight into the shifts in demand for blood products so we can better plan for patient needs now and in the future.

Starting in September, we will use sub-mitted data to create reports for participat-ing hospitals twice a month. These reports enable hospitals to compare their use of blood products against previous months and years to identify trends, such as in-creased use of O-negative blood. Hospitals are also able to compare their utilization rates against similar institutions. While the reports are anonymous, we encourage hos-pitals to work with our hospital liaison spe-cialists to connect with other participating hospitals and share best practices.

The system has over 600 active users, and more users are scheduled to join when a new version is launched in September.

The challenge of optimal blood utiliza-

tion is not unique to Canada. The AABB, formerly known as the American Associa-tion of Blood Banks, of which I serve as president, is an international association committed to advancing transfusion medi-cine and cellular therapies. The AABB partnered with the American Board of Internal Medicine on Choosing Wisely, a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures.

The campaign offers recommendations that physicians and patients should con-sider when determining treatment. These recommendations are excerpted below (slightly revised for length; see the original list at choosingwisely.org): 1. Don’t transfuse more units of blood than absolutely necessary.

Each unit of blood carries risks. A re-strictive threshold should be used for the vast majority of hospitalized, stable pa-tients without evidence of inadequate tissue oxygenation. Transfusion decisions should be infl uenced by symptoms and hemoglobin concentration. Single unit red cell transfusions should be the standard for non-bleeding, hospitalized patients. Addi-tional units should only be prescribed after patients and their hemoglobin values have been re-assessed. 2. Don’t transfuse red blood cells for iron defi ciency without hemodynamic instability.

Blood transfusion has become a routine medical response despite cheaper and safer alternatives in some settings. Pre-opera-tive patients with iron defi ciency and pa-tients with chronic iron defi ciency without hemodynamic instability (even with low hemoglobin levels) should be given oral or intravenous iron, or both.

3. Don’t routinely use blood products to reverse warfarin.

Warfarin can often be reversed with vitamin K alone. Prothromobin complex concentrates or plasma should only be used for patients with serious bleeding or who require emergency surgery. 4. Don’t perform serial blood counts on clinically stable patients.

Transfusion of red blood cells or plate-lets should be based on the first labora-tory value of the day unless the patient is bleeding or otherwise unstable. Mul-tiple blood draws to recheck whether a patient’s parameter has fallen below the transfusion threshold (or unnecessary blood draws for other laboratory tests) can lead to excessive phlebotomy and unnecessary transfusions.5.Don’t transfuse O-negative blood except to patients with O-negative blood and in emergencies for women of child-bearing potential with an un-known blood group.

O-negative blood units are in chronic short supply due in part to overutilization for patients who do not have O-negative blood. O-negative red blood cells should be restricted to patients with O-negative blood and women of child-bearing poten-tial with an unknown blood group who require emergency transfusion before blood group testing can be performed.

Similar conversations are also happen-ing in Canada. As part of the Choosing Wisely Canada campaign, the Canadian Society for Transfusion Medicine has created a list that reflects Canada’s tests, treatments and procedures. This list is under review and is anticipated shortly.

These are just some of the ways we can improve blood utilization. New ideas are always on the horizon and many of these, like developing less invasive procedures and redistributing blood products be-tween hospitals, will come from our part-ners. We are relying on you to share your ideas and developments with us for the betterment of Canada’s blood system.

To Canadians, we are one very large team, and we must manage the use of this precious, life-saving resource together. ■HDr. Graham D. Sher, MB, BCh, PhD is CEO, Canadian Blood Services.

Making the most of every drop: By Dr. Graham Sher

W

In May 2014, Canadian Blood Services’ hospital Blood Component and Product Disposition System moved to the web and became accessible to hospitals through a secure login.

Dr. Graham Sher

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n the past few years, Health Sciences North/Horizon San-té-Nord (HSN) in Greater Sudbury has struggled with

some of the longest emergency department wait times (ED) in Ontario. Now, HSN is being commended for the performance of its ED.

The Ontario Ministry of Health and Long-Term Care has congratulated HSN for achieving the best improvement in ED wait times among teaching hospitals in Ontario. In 2013/14, HSN’s overall 90th percentille ED Length of Stay (LOS) was 9.8 hours, a two-hour improvement from the year before.

The MOHLTC also says HSN’s over-all 90th percentile LOS last year was 1.4 hours shorter than the average of 11.2 hours for all teaching hospitals in Ontario.

These improvements were achieved at a time when ED visits actually jumped by 6000 to approximately 66,000 patients.

“It’s great news that the ED team is be-ing recognized for all the hard work and efforts put into improving wait times,” says Dr. Rob Lepage, an ED physician and Medical Director of HSN’s Emergency De-partment.

Dr. Lepage points to a number of initia-tives that have been launched to improve the ED LOS. They include a “See and Treat” area for patients with less serious conditions, an Acute Observation area for patients with more urgent health con-cerns, and daily huddles where ED staff discuss the patient load and how best to meet any challenges that arise.

One of the most dramatic improve-ments in LOS has occurred in the wait for a hospital bed for patients admitted from the ED. Last year that time was 21.7 hours, compared to 38.7 hours the year before.

This is an achievement not only for the ED, but for HSN’s entire clinical program and the hospital’s community-based health care partners.

“ED wait times are affected by how safe-ly and smoothly we can transition patients from the ED to an inpatient fl oor and then back into the community, and how well we can then avoid readmissions to the ED or a hospital bed,” says David McNeil, HSN’s Vice President of Clinical Programs and

Chief Nursing Offi cer. “Our clinical pro-grams and community partners have done a wonderful job of transitioning patients back home safely. There is always room for improvement, but we do feel we’re heading in the right direction.”

In the past two years, HSN has imple-mented a number of measures across its clinical programs to improve care and pa-tient fl ow.

The ED Outreach program has been expanded, whereby an ED clinician vis-its participating long-term care homes to treat minor conditions so patients do not have to visit the ED. There are nurses in the ED to deal specifi cally with patients ar-riving by ambulance or who have mental health care needs. HSN has relocated its mental health Crisis Intervention Service to downtown Sudbury and expanded the hours of operation, to provide appropriate care at a time and place more convenient for clients, resulting in much fewer visits to the ED.

A special multidisciplinary COACH (Care of Older Adults with Compromised Health) team has been created for seniors admitted to hospital. Led by leading Ca-nadian geriatrician Dr. Janet McElhaney, the COACH team uses best practices to prevent further frailty, reduce the length of hospital stay, and reduce or avoid hos-pital readmissions. HSN has also launched a new outpatient service, the Short Term Assessment and Treatment (STAT) pro-gram, which provides frail seniors with a number of services in one location.

HSN is also working with the North East Community Care Access Centre to implement a system of in-home, follow-up visits within 48 hours of frail seniors being discharged from hospital.

HSN’s Heart Failure Infusion Clinic has dramatically reduced ED visits and hospi-tal admissions for patients with Congestive Heart Failure. HSN’s Diabetes Care Ser-vice is also serving as a one-stop location for all outpatient diabetes care, to prevent or reduce ED visits and hospital admissions due to complications from diabetes. HSN’s surgical program has expanded its number of minimally invasive procedures, leading to quicker recovery times and fewer days spent in hospital.

It is this process of constant evaluation and improvement that Dr. Rob Lepage says will continue. The ED is planning to ex-pand the Acute Observation area, and is also looking at scheduling a back-up physi-cian on days when the ED is particularly busy, for example after long weekends. “We won’t be satisfi ed until the ED LOS is re-duced further,” adds Dr. Lepage. “We want to keep working to give our patients a bet-ter experience in the ED.” ■H

Dan Lessard is a Media and Public Relations Offi cer at Health Sciences North/Horizon Santé-Nord.

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ED wait times are affected by how safely and smoothly we can transition patients from the ED to an inpatient fl oor and then back into the community, and how well we can then avoid readmissions to the ED or a hospital bed.

Dr. Rob Lepage is Medical Director of HSN’s emergency department.

Sudbury hospital shows most improvement in

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emergency wait times



ow do factors such as diet, physical activity and genet-ics impact human health and disease? The Ontario Health

Study (OHS) has been working to answer this and other questions since it began four years ago. The OHS is a not-for-profi t, population-based study that collects health and lifestyle information from vol-unteers through an online survey, as well as physical measures such as blood pres-sure and grip strength. This information is being used to help researchers better understand chronic diseases such as can-cer, Alzheimer’s and diabetes and develop improved strategies for prevention and treatment.

To date, more than 225, 000 participants have signed up for the OHS questionnaire and over 20, 000 have provided blood sam-ples. Recently, the Study opened its fi rst Local Study Centres to further engage par-ticipants across the province. These tem-porary centres allow participants to par-ticipate in the Study conveniently within their own communities.

The Study will be visiting towns and cities across Ontario. So far it has visited Mississauga, Markham, and most recently Peterborough. Completing the OHS on-line questionnaire is an easy way to help improve the health of future generations in Ontario and worldwide. By attending a Local Study Centre, participants aged 35-69 are able to enhance the impact of their questionnaire data for researchers and learn more about their own health in the process.

“We understand that between work, family and other commitments people don’t have as much time as they used to. That’s why we wanted to make providing a blood sample and physical measures as easy and as enjoyable as possible, ” says Nina Chan, OHS Senior Manager, Clini-cal Operations and Quality Assurance. “It has been great to be able to bring this op-portunity to more people.”

The Study encourages individuals in-terested in visiting a Local Study Centre in their area to contact the Study by call-ing 1-866-606-0686 or sending an email to

[email protected]. The Ontario Health Study recently

had additional exciting news – the ap-pointment of Dr. Mark Purdue as OHS’s new Principal Investigator and Executive Scientifi c Director.

Dr. Purdue most recently worked as an Investigator in the Occupational and Environmental Epidemiology Branch of the Division of Cancer Epidemiology and Genetics at the National Cancer Institute

in the U.S. He also gained valuable expe-rience working for Cancer Care Ontario and Health Information Partnership of Eastern Ontario. Dr. Purdue attended the University of Toronto where he earned a PhD from the Department of Public Health Sciences.

With new leadership in place and the Local Study Centre program up and run-ning, the Study is looking forward to en-gaging more Ontarians across the prov-

ince. “Looking back over the last four years it is impressive how far we have come. It is inspiring to see so many On-tarians volunteering to help us answer im-portant questions about our health, ” says Dr. Karen Menard, OHS Chief Planning and Administrative Offi cer. “I encour-age anyone over the age of 18 to take a small amount of time out of their day and contribute. Together we will have a real impact.”

The Ontario Health Study is one of the largest long-term health studies in Canada. Since 2010 almost 225, 000 On-tarians have taken a short online survey to help researchers better understand the causes of chronic diseases like cancer, heart disease and diabetes, and to develop new ways to prevent and treat them. The 158, 000 OHS participants that were 35 to 69 years of age at the time of enrollment are also part of the Canadian Partnership for Tomorrow Project, a harmonized, fi ve-province, pan-Canadian cohort health study with 300, 000 participants.

If you live in Ontario and you’re 18 years or older, you’re eligible to partici-pate. A small investment of your time to-day will help to improve public health for generations to come.

For more information or to participate please visit www.ontariohealthstudy.ca. ■HHal Costie is a senior communications offi cer at the Ontario Institute for Cancer Research.

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Ontario Health Study still looking for participantsBy Hal Costie

H

A volunteer has his hand grip strength measured at an Ontario Health Study assessment centre.

he rate of type 1 diabetes is on the rise worldwide, with the greatest increase happen-ing in children younger than

fi ve. There’s no established way to slow down or prevent type 1 diabetes. In an effort to fi nd a way, the National Insti-tutes of Health has created a network of the world’s leading diabetes researchers, called Type 1 Diabetes TrialNet.

The TrialNet research team at The Hospital for Sick Children (SickKids Hospital) is part of the international Tri-alNet network. The team is running The Pathway to Prevention study which aims to learn more about what causes type 1 diabetes and identify how to prevent and or delay the onset of the disease in at-risk individuals. Individuals who have a rela-tive with type 1 diabetes have a 15 times greater chance of being diagnosed with diabetes than a person with no family his-tory of the disease. The Pathway to Pre-vention study screens relatives to iden-tify their risk. Research has found that the potential risk can be detected years before symptoms appear. This advanced knowledge provides a window of opportu-nity when steps can be taken to attempt to delay or prevent the disease. TrialNet is currently conducting type 1 diabetes

prevention trials at SickKids Hospital and eligibility for these trials is partially deter-mined during screening.

Screening involves a simple blood test to check for diabetes-related autoanti-bodies that may appear up to 10 years be-fore type 1 diabetes develops.

First-degree blood relatives – siblings, children and parents – who are 1 to 45 years of age as well as second-degree blood relatives – cousins, uncles, aunts, nieces, nephews, grandchildren or half-siblings – who are 1 to 20 years of age may be screened to determine their risk of de-veloping type 1 diabetes.

Those who test positive for autoanti-bodies are offered the option to move into the monitoring phase of the study where

they are closely monitored for the earliest signs of the disease. Early diagnosis makes it possible to avoid dangerous complica-tions that can occur when diabetes goes undetected and may also help the body make insulin for a longer period of time. They may also be able to join research studies testing ways to delay and prevent the disease.

The TrialNet research team at Sick-Kids Hospital has teamed up with Diabe-tes Education Centres across Ontario to host local type 1 diabetes screening events throughout the year. There are a number of ways to get screened and screening is available across Canada, the United States, Australia and parts of Europe.

Participants in TrialNet screenings or studies are an important part of type 1 diabetes research and contribute greatly to the discovery of prevention strategies and a cure.

To get screened of for more informa-tion call: 416-813-7654 x 201798 or toll free at 1-866-699-1899. More informa-tion is also available on the TrialNet web-site: www.trialnet.org. ■H

Farah Sultan is a Clinical Research Coordinator at The Hospital for Sick Children.

Study aims to learn more about type 1 diabetes

The TrialNet research team at SickKids Hospital has teamed up with Diabetes Education Centres across Ontario to host local type 1 diabetes screening events throughout the year

By Farah Sultan

T



major 16-centre Canadian study, published June 26 in the prestigious New England Journal of Medicine, shows the

benefi t of prolonged heart monitoring to diagnose silent, but dangerous, irregular heart rhythms in people who have unex-plained strokes.

Findings of the three-year EMBRACE trial represent “an important advance” in determining the cause of up to a third of ischemic strokes, which result from blood clots to the brain, writes Cornell University neurologist Dr. Hooman Kamel in an edito-rial accompanying the study.

“The results... indicate that prolonged monitoring of heart rhythm should now be-come part of the standard care of patients with cryptogenic (unexplained) stroke,” Dr. Kamel writes.

Led by Dr. David Gladstone, an associate professor in the Department of Medicine at the University of Toronto and clinician-scientist at Sunnybrook Research Institute, the EMBRACE trial followed 572 patients ages 55 and older with a recent stroke or TIA and in whom standard diagnostic tests (including conventional heart monitor-ing for at least 24 hours) failed to detect the cause.

The study found that, by monitoring pa-tients at home with a new chest electrode belt for 30 consecutive days, atrial fi brilla-

tion (irregular heart rhythm) was detected in 16 per cent of patients, as compared with the standard 24-hour monitoring which found the arrhythmia in only three per cent of patients.

Prevention of stroke due to atrial fi bril-lation is “a global public health issue,” ac-cording to the Canadian Stroke Network-funded study, the largest clinical trial of heart monitoring in stroke patients. Atrial fi brillation is known to cause some of the most disabling, deadliest, and most costly types of strokes.

However, the challenge has been that atrial fi brillation is often hard to diagnose because the irregular heartbeat may last for just a few minutes at a time, after which the heart reverts back to its normal rhythm.

Unless an individual is wearing a heart monitor at the time it occurs, the diagnosis is usually missed.

In practice, stroke patients have tradi-tionally received only short-duration heart monitoring (e.g. for 24 hours) to screen for atrial fi brillation – a strategy that now ap-pears inadequate according to the study’s fi ndings. “The harder we look with more intensive heart monitoring, the greater the chance of fi nding this hidden risk factor – it’s like medical detective work,” says Dr. Gladstone, whose research was supported by the Heart and Stroke Foundation (HSF) and the HSF Canadian Partnership for Stroke Recovery.

In the study, enhanced detection of atrial fi brillation led to signifi cantly

more patients being prescribed stron-ger anti-clotting medications to prevent recurrent strokes.

Atrial fi brillation is a risk factor for stroke because it can promote the formation of blood clots in the heart that can travel to the brain. It is important to detect because it can be effectively treated with certain an-ti-clotting medications, which cut the risk of clots and strokes by two-thirds or more.

Dr. Gladstone has already begun imple-menting the study’s fi ndings in practice by offering prolonged heart monitoring to pa-tients at Sunnybrook Health Sciences Cen-tre, where he directs the Regional Stroke Prevention Clinic.

“With improved detection and treat-ment of atrial fi brillation, the hope is that many more strokes and deaths will be prevented,” Dr. Gladstone says. The New England Journal of Medicine published a second U.S-based study on prolonged monitoring last month, called CRYSTAL AF, which further supported the practice change.

The EMBRACE trial was conducted by investigators of the Canadian Stroke Con-sortium and coordinated at the Li Ka Shing Knowledge Institute of St. Michael’s Hos-pital in Toronto. ■H

Cathy Campbell is Director of Communications at the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery.

Canadian study demonstrates benefi t of

By Cathy Campbell

A

Dr. David Gladstone is leading the EMBRACE trial.

prolonged heart monitoringThe results indicate that prolonged monitoring of heart rhythm should now become part of the standard care of patients with cryptogenic (unexplained) stroke.



n healthcare – and particularly a hospital setting – innovation and evolution can be a long and diffi cult process. From

concept to approval, the most signifi cant change happens as the result of a good idea that becomes a pilot project, which then is evaluated and assessed – and then some-times further refi ned before taking fl ight. But when a crisis hits, immediate and innovative action can result in transfor-mation that results in even better, more effi cient and effective care.

On January 8, 2014 a fi re hose stand-pipe burst at the Charlton Campus of St. Joseph’s Healthcare Hamilton (SJHH), fl ooding 12 state-of-the art operating suites, the sterile core, and medical device reprocessing department. Within min-utes, water was fl ooding the fl oor below – including the Emergency Department (ED) and Diagnostic Imaging department. All told, more than 60,000 square feet of clinical and support space was affected – requiring immediate cancellations of scheduled and emergency surgery, the closure of the emergency department and delay in providing some diagnostic care.

“The fl ood happened right at shift change and it was unlike anything I’ve ex-perienced before,” says Michelle Burrows, RN, who has worked at St. Joseph’s for 11 years. Staff mobilized immediately, calling a hospital-wide Code Aqua (fl ood) and Code Green (evacuation) for the emer-gency department, and launching into action to save millions of dollars worth of diagnostic and surgical equipment. Cory Fraser, RN, was also present at the time of the fl ood, “Everyone just knew what to do to keep patients safe; there was no time to overthink decisions – there was only time to act.”

As water poured into the operating rooms, Chief of Surgery, Dr. Anthony Adili worked with staff to begin calling and no-tifying patients of the cancellations – in many cases, meeting patients at the de-partment door as they arrived for care.

“In the emergency department, our pri-ority was to evacuate patients to safe areas, and to establish an area where we could continue to provide acute care for those unable to move,” explains Dr. Ian Preyra, Chief of Emergency Medicine.

St. Joseph’s made the diffi cult decision of closing its ER, resulting in ambulance redirection to Hamilton Health Sciences’ (HHS) Juravinski and General Hospitals. The redirect forced HHS into a Code Or-ange Standby – a situation that was both challenging for the team at HHS, and un-sustainable for more than a short period of time. This is where the innovative trans-formation at St. Joe’s began.

“The doors to the emergency room never really close so continuing to turn pa-tients away was not an option, even in the midst of a crisis,” says Dr. Preyra. SJHH is the city’s busiest emergency department, seeing more than 50,000 patients a year. “We were down by about 60 per cent of our physical capacity, but we couldn’t redirect for long. We needed a solution to maximize the beds and space we had left.” Within 72 hours, the hospital launched a Medi-cal Surgical Assessment Unit (MSAU) in surge space within Day Surgery on the 2nd fl oor, directly above the ED.

Despite staffi ng and communication challenges resulting from running an ED on two separate fl oors, the MSAU exposed a new level of effi ciency. “It presented a signifi cant shift in the way we process and manage patients. Consulting doctors were challenged to see their patients quickly and to prioritize differently,” says Preyra. The fl exibility of specialists and other care providers enabled St. Joseph’s to resume normal patient volumes despite the crisis, and even reduce emergency room wait times.

“When you give people opportunities to provide better care they will,” says Dr. Preyra.

Similar innovation was happening in the surgical progam, as leaders there brain-stormed how to bring surgical capacity back on line in the absence of a surgical

centre. “Patients facing surgery – no mat-ter how major or ‘minor’ face a lot of anxi-ety and stress,” says Dr. Adili. “Resuming surgery as soon as possible was our top priority.”

To do so, the hospital leveraged its role as an academic centre by equipping four OR’s used for teaching and overfl ow to the same standard as damaged by the fl ood. Then, staff worked to equip the hos-pital’s King Steet Campus (an outpatient surgical and urgent care centre) with the equipment needed to perform additional, more complex surgical cases in ORs at that campus. “Our ability to quickly mobilize new solutions was possible because of the innovative thinking of our team, and the fl exibility of our specialists who were open to new ways of doing things – all in the best interests of patient care,” says Dr. Adili.

The MSAU and interim surgical plan were creative and necessary transforma-tions that quickly enabled St. Joseph’s Healthcare Hamilton to restore care, de-spite the dramatic physical damage that occurred as a result of the fl ood. “In a hos-pital, we don’t have the luxury of closing while we return to ‘normal’ facilities and operations,” says President Dr. David Hig-gins. “It is amazing to see how a crisis like this one brings our visionary ideas, innova-tive thinking, and a true sense of collabo-ration and system-based care.”

System-based collaboration was a key element to St. Joseph’s ability to innovate and resume care so quickly, continues Dr. Higgins. “Our relationships with Hamil-ton Health Science, the Community Care Access Centre and the City of Hamilton’s Emergency Medical Services were critical during this crisis. Their people mobilized to support us and took on the extra bur-den of patients we couldn’t care for in the initial days after the fl ood. Our ability to continue operations would not have been possible without them.”

Discussions are underway at St. Joseph’s Healthcare Hamilton to determine if the new processes will be sustained even after repairs are complete, as staff, physicians and leaders see the benefi t of innovative thinking in more effi cient, patient-centred care. ■H

Helena Foulds is a Public Affairs Assistant at St. Joseph's Healthcare Hamilton.

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Transforming patient careBy Helena Foulds

I

Dr. Ian Preyra, Chief of Emergency Medicine in the ED after the fl ood.

Dr. Anthony Adili, Chief of Surgery stands in what was once a fl ooded area of the hospital.

in the midst of a crisisWhen you give people opportunities to provide better care they will.



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ver the past few years, many smaller community hospitals have struggled to keep their vital emergency departments

(ED) adequately staffed. Across Ontario, rural communities have experienced a shortage of physicians which impacts 24-hour coverage of EDs.

Quinte Health Care (QHC) is a four hospital system in south-eastern Ontario with emergency departments in Belleville, Trenton, Picton and Bancroft. They have experienced these staffi ng pressures before, particularly during vacation months. This past spring the organization was looking at a larger number of uncovered emergency physician shifts into the summer and early fall, particularly at Trenton Memorial Hos-pital and North Hastings Hospital.

As with other smaller centres, QHC often relies on HealthForceOntario, an Ontario government program that links physicians working full-time in other On-tario hospitals with hospitals who need help covering shifts, to avoid temporarily closing emergency departments.

“The last thing anyone wants to see is an emergency department temporarily close their doors, but with increasing pres-sures on physician resources we realized that this was a real risk for QHC,” says Jeff Hohenkerk, Vice President at Quinte Health Care. “We operate more than one emergency department in smaller commu-nities and are more acutely aware of this potential than most.”

Past experience with staffi ng shortages had shown that QHC was able to fi ll vacant shifts, through outreach to other hospitals and the resources of HealthForceOntario, although sometimes at the eleventh hour. In response, QHC chose to set-up an Inci-dent Management System (IMS) structure to help deal with this reoccurring potential

risk. The IMS team began by looking at the existing emergency preparedness poli-cy and realized that it did not have enough detail to safely manage the complexity and impact of a temporary suspension of emer-gency services. The QHC IMS team set about changing this.

“In the world of emergency prepared-ness we know that most of the time people think it will never happen to them and therefore do not prepare, but QHC began working to be prepared in case we ever actually had to suspend services for one of our emergency departments for what-ever reason, not just from potential physi-cian shortage,” explains Melanie Maracle, QHC’s Manager of Corporate Risk.

By working through the process within an Incident Management System struc-ture, QHC was quickly able to see a formal contingency plan taking shape. They con-tinued their work by looking at the exist-ing code orange and surge planning and realized that neighbouring emergency de-partments would be impacted with larger volumes of patients.

“QHC needed to make sure that vol-ume increases at our other hospitals could be accommodated while maintaining re-sponsive quality care for these higher acu-ity patients,” says Kim Fletcher, Interim Emergency Department /Primary Director.

Meetings were also held with local part-ners including Emergency Medical Ser-vices offi cials to plan how they would sup-port and manage the potential suspension of emergency hospital services. Discussion with community and health care partners underscored the need for a formalized communication process as part of the con-tingency plan.

The complexity of communicating si-multaneously to staff, the community, both municipal and provincial govern-ments, stakeholders and health care part-ners within very specifi c time frames was a challenge. The solution was to create a comprehensive communications matrix that identifi ed key contacts that needed to receive information, at what times during the service disruption and through what methods.

“It was important to have all of the inter-nal and external partners identifi ed along with the method and timing of the com-munication to effectively relay messages in a timely and effi cient way – the com-munications matrix is now an important tool in our overall emergency preparedness processes,” says Susan Rowe, Senior Direc-tor of Communications at QHC.

With a substantive contingency plan developed and now in place, QHC con-tinues to explore permanent options to solve emergency physician shortages and is excited to welcome several new ER phy-sicians to their team this fall. Thankfully with the support of QHC physicians and HealthForceOntario, they have not had to put their new plan into action. However the process of planning before a service disruption allows hospitals adequate time to ensure that patients are safely cared for should an emergency closer actually occur.

“Interestingly, when we looked to other hospitals for assistance as we began plan-ning there were so few resources available. Given our own experience we are very open to sharing any of the learning we have encapsulated during this process with other organizations facing a similar situa-tion,” encourages Melanie Maracle. ■H

Lisa Callahan is a Communications Consultant at Quinte Health Care.

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Contingency planning for potential emergency service disruptionBy Lisa Callahan

O

Physician shortages and uncovered emergency physician shifts have been a challenge for small rural hospitals like North Hastings Hospital.

Across Ontario, rural communities have experienced a shortage of physicians which impacts 24-hour coverage of EDs

Carbon monoxide is an odorless, col-orless and tasteless gas which reduces the body’s ability to transport oxygen through the blood. Exposure can cause headaches, fatigue, dizziness, chest pain, and at high levels, coma or death.

The emergency staff immediately thought of the other tenants of the build-ing: their lives may be in danger, too. Unsure of what to do next, nurse Eckert contacted her husband, a fi reman. He suggested they call 911 immediately.

The 911 operator may have been sur-prised to receive a call from the hospital emergency room, as things usually go the other way around. Dr. Breau certainly recognized it was the fi rst time he had to take such a measure. But it moved swiftly from there.

Firefi ghters rushed to the eight-apart-ment building to check on people resid-ing at the address and test the air quality. Indeed, levels of CO were very high and could have caused the deaths of some of the tenants within a few hours. Tenants were immediately evacuated and some were sent for further CO testing.

In the meantime, technicians were called in to check on the heating system – they suspect that a chimney blockage

caused the CO leak – and new CO de-tectors were installed. The Ottawa Fire authorities later recognized that Hôpital Montfort staff likely prevented a tragedy.

“Emergency department practitioners see a wide range of patients with an even wider range of presenting complaints in a single day. This case illustrates just how these skilled professionals need to always use their well-honed assessment and critical thinking skills at all times,” says Carl Balcom, Clinical director of emer-gency and critical care services at Hôpital Montfort. “We are very happy that the quick-thinking refl exes of our team saved lives that day.”

In February 2014, the four members of the emergency team were honoured by Eve Adams, Parliamentary Secretary to the Minister of Health, as part of an awareness campaign on the dangers of carbon monoxide.

“Health teams are always on the look-out for symptoms of carbon monoxide poisoning, but the best defense remains prevention,’’ says Dr. Breau. “Carbon monoxide detectors are precious allies in protecting your family.” ■HGeneviève Picard is Communications Director at Hôpital Montfort.

Continued from page 14Emergency ward called 911



his fall, the Montreal Neuro-logical Institute and Hospital (The Neuro, at McGill Uni-versity and the McGill Univer-

sity Health Centre) expects to introduce a previously unavailable form of treatment for Parkinson’s disease patients. Although the treatment will be limited to patients who fulfi ll specifi c criteria, the treatment has been shown to be effective in Europe, where it has been available for more than a decade.

The treatment involves administering the drug Duodopa (a combination of le-vodopa and carbidopa) directly into the patient’s small intestine via the stomach through a tube. The drug’s dosage is con-trolled by a mini-pump weighing about half a kilogram that the patient wears at the waist. The body transforms levodopa to dopamine to increase the amount of dopa-mine in the brain. Parkinson’s disease symp-toms are linked to dopamine levels. Carbi-dopa helps to guide levodopa to the brain and also helps to avoid stomach upset and other undesirable side effects of levodopa.

“The benefi t of the Duodopa treatment is that the patient gets the drug continu-ously and so avoids the kinds of fl uctuations that can come when drugs are taken orally at intervals during the day. Some patients have diffi culty swallowing, and with this treatment, there’s no need to swallow,” says Dr. Anne-Louise Lafontaine, a neurologist and Director at The Neuro’s Movement Disorder Clinic.

Not all Parkinson’s disease patients will qualify for the treatment.

“Candidates must still respond to levodo-pa but show that the effect of the drug does not last long, which leads to fl uctuations in their symptoms. Some people take a dose and a couple of hours later, they need an-other dose. Taking a dose six or seven times a day or even more often is not practical or feasible.”

Candidates will usually be under 70 years of age, be in good general health, and have had no major surgery on the stom-ach. Patients who think that they qualify should ask their doctor for a referral to a neurologist specially trained to administer Duodopa. Quebec’s health ministry will reimburse patients for the treatment only in cases where a neurologist specializing in Duodopa has recommended it.

Patient candidates will begin their regi-men initially as in-house patients.

“They will have a three-day tryout to see how they react to a continuous infu-sion of Duodopa,” says Dr. Lafontaine. “At fi rst, they will not get the dose through the stomach but through a tube in the nose. If it works out, then the dose can be ad-ministered through the stomach. The pa-tient will probably stay in the hospital for another two or three days while a neurolo-gist and a nurse check to fi nd the proper dosage. Once the rate is set, there’s not much fi ddling with it. The examples in Eu-rope show that the set rate seems to remain quite stable.”

Patients will use the mini-pump to ad-minister the drug into the body for 16 hours a day. At night, the treatment is stopped, but the hope is that the brain can store enough dopamine during the day to last overnight.

Dr. Lafontaine sees Duodopa as an al-ternative or complementary treatment to Deep Brain Stimulation (DBS). DBS in-volves surgically implanting a pacemaker in the brain. The pacemaker sends electric impulses to parts of the brain, which act to control Parkinson’s disease symptoms such as dyskinesia, tremors and dystonia.

“Duodopa could be used to treat an older group of patients who are not fi t for DBS, and also some younger patients who just might not be ready for surgery, ” says Dr. Lafontaine. “Some patients might

want to try Duodopa for several years and then undergo DBS.”

Dr. Lafontaine acknowledges that Du-odopa does not make all Parkinson’s dis-ease symptoms disappear.

“Duodopa doesn’t necessarily address tremor, but “off” time and dyskinesia is signifi cantly reduced.”

The Neuro treats about one thousand Parkinson’s disease out-patients. As the percentage of Quebec’s elderly popula-tion increases, the number of patients with Parkinson’s disease is expected to increase proportionately. Unfortunately, because Duodopa treatment is labour in-tensive, only a relatively small number of patients will be able to receive it.

“We hope to have our fi rst Duodopa patient in the fall, and then expect to

have about ten patients a year. That com-pares to about 15 or so cases of patients at The Neuro who undergo DBS.”

Dr. Lafontaine foresees a time when the criteria for qualifying for Duodopa treatment might be broadened. “We used to offer DBS only to the most severely affected patients, but now the literature shows that there might be advantages to doing it earlier before there are advanced fl uctuations. So DBS might stabilize them earlier on. It’s possible that with Du-odopa, you might not have to wait until a patient is taking medication every few hours. I don’t know the future, but the bar might move one day to include more patients.” ■H

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Dr. Anne-Louise Lafontaine, neurologist and Director of the Movement Disorders Clinic at The Neuro.



patient at The Hospital for Sick Children (SickKids) is the fi rst child in North America to have undergone a specialized

procedure that uses ultrasound and mag-netic resonance imaging (MRI) to destroy a tumour in his leg without piercing the skin. Doctors used an MRI to guide high-intensity ultrasound waves to destroy a be-nign bone tumour called osteoid osteoma. The lesion had caused 16-year-old Jack Campanile excruciating pain for a year prior to the July 17 procedure. By the time he went to bed that night, the athletic teen experienced complete pain relief.

In previous decades, osteoid osteoma was treated with orthopaedic surgery that involved scraping the tumour from the bone or removing the affected part of the bone. The procedure was very painful and the recovery could take many weeks. Since the mid-1990s, minimally-invasive treat-ments have been used to burn the tumour; in these treatments, radiofrequency or la-ser energy is delivered through a needle placed in the tumour using computerized tomography (CT) guidance. These thera-pies are effective and less risky than inva-sive surgery, and are currently widely used. However, these procedures still carry risks, including radiation exposure, infection, burning of the surrounding tissue, and bone fractures resulting from the hole that remains following treatment of the tumour.

High-intensity focused ultrasound ther-apy uses sound waves to heat an area the size of a grain of rice, under MRI guidance, to destroy the tumour. The treatment is completely non-invasive, so the skin and surrounding bone remain intact, greatly reducing the risk of complications like in-fections. The use of MRI rather than CT scan to guide the sound waves means the patient avoids exposure to radiation. The risk of bone fracture is also likely lower than in other treatments, and recovery is quick. An added benefi t is rapid pain relief.

“With high-intensity focused ultrasound, we are moving from minimally-invasive to non-invasive therapy, signifi cantly reduc-ing risk to the patient and fast-tracking recovery,” says SickKids interventional radiologist Dr. Michael Temple, who led the team that performed the surgery. “The osteoid osteoma tumour was chosen as our

pilot study because the lesion is easily ac-cessible and while the procedure is sophis-ticated, it is relatively straightforward. The success of this fi rst case is great news for Jack, and exciting for our team as we look at developing more complex incisionless treatments in the future.”

The July 17 procedure was performed by SickKids staff using a specialized MRI table at Sunnybrook Health Sciences Cen-tre, with support from Sunnybrook’s MRI and Radiation Oncology staff. While the surgery itself took 30 minutes, it required about three hours of preparation, which involved general anaesthesia and precise placement of the patient on the table, which is equipped with a built-in, high-intensity focused ultrasound transducer. The team used the MRI to determine the exact location of the tumour and to help target the ultrasound waves to burn the

whole tumour, one focal spot at a time at a high energy. The MRI also enabled them to monitor the temperature induced by the ultrasound to ensure that there was no un-expected increase in heat in surrounding tissues. Accurate positioning and monitor-ing are critical, as the ultrasound waves could damage surrounding tissues, nerves or skin.

A few hours after the procedure, Jack was discharged home, where his recov-ery has been smooth and quick, with no complications to date. After dealing with a few hours of severe pain following the procedure, he was suddenly pain free. That night, he had uninterrupted sleep for the fi rst time in months. Two days following the procedure, Jack was able to resume most daily activities, including a day trip to Niagara Falls on Day 4.

Before the surgery, Jack’s pain was so de-

bilitating that he needed to take pain med-ication up to four times daily. “If I didn’t treat the pain attack early enough, it would be so strong that it felt like someone was trying to bend my femur into the shape of a hockey stick,” says the 16-year-old hock-ey player, snowboarder and wakeboarder, who took his last painkiller following the procedure.

The idea of being the fi rst to undergo this new treatment was intriguing, Jack ex-plains. “I wanted to see what it would be like. If it did work, it would be a whole new world for medical procedures and treating osteoid osteoma.”

This breakthrough is the latest from SickKids’ Centre for Image-Guided In-novation and Therapeutic Intervention (CIGITI), a research program that brings together surgeons, radiologists, software developers and engineers to develop in-novative technologies in robotic and mini-mally-invasive surgery.

High-intensity focused ultrasound ther-apy is available in paediatric and adult cen-tres in Europe. The procedure was fi rst per-formed on patients with osteoid osteoma in Italy in 2010 and is currently used in North America to treat uterine fi broids and bone metastases in adult patients.

Osteoid osteoma occurs most commonly in males 10 to 35 years of age. The condi-tion has been reported in patients as young as seven months. Despite its small size – about 1 cm – the tumour is known to cause extreme pain. SickKids sees as many as 18 patients per year with this condition. ■H

Suzanne Gold works in communications at The Hospital for Sick Children.

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Jack Campanile and Dr. Drake.

sk people to draw up a buck-et list of islands they would most like to visit and Zan-zibar, Barbados,, Tahiti and

Sri Lanka are the likeliest candidates to top the polls. Here, we look at a quartet of smaller, lesser know islands that of-fer an intriguing alternative to the A list and might well be the answer to those in search of something a little different.

For beauty: Vamizi, Mozambique

Often referred to as the ‘new Mal-dives’, the Quirimbas is an archipelago of sparkling islands in the Indian Ocean off the coast of northern Mozambique. Aside from some of the most jaw-drop-ping beaches on the planet, the islands are home to a huge amount of protected wildlife, including turtles, whale sharks, dolphins and Manta rays.

Vamizi Island, slender and crescent-shaped, was home to the fi rst lodge in the Quirimbas. The island now boasts a collection of luxurious private villas, each with a chef, housekeeping and hospital-ity manager; there are also ten smaller, beachfront villas. Daily life revolved around beach barbeques, remote picnics, diving, big game fi shing, pampering and sunset dhow cruises.

For topography: Lord Howe, Australia

Few Australians have ever been, but Lord Howe is a true gem. A two-hour fl ight from Sydney or Brisbane, this World Heritage Listed island is Australia’s very own South Sea island. Dominated by volcanic highlands and fringed by a la-goon that is protected by the most south-erly reef on the planet. There are many endemic species of wildlife, including a fl ightless woodhen, so it is no wonder Sir David Attenborough described the island as “so extraordinary it is almost unbelievable”.

For the real Caribbean: Bequia

Other than to yachties island-hopping the string of Grenadines, Bequia (only seven square miles) is one of the least known of the Caribbean islands, but has all the usual assets of warm seas and sunshine.

Those wanting to get involved in local life and hang out with local fi shermen and boat builders – the Frangipani on the har-bour is its heartbeat – will fall in love with Bequia. The island has excellent beaches, Princess Margaret and Lower Bay, are both walkable or a short water taxi from Port Elizabeth, the village-size capital.

For history: Nantucket, USA

Nantucket, the so-called ‘Faraway Island’, lies as far from US mainland as France does from Folkestone. Fourteen miles long and four miles wide, the island has become one of the most affl uent vaca-tion spots in the USA. As well as fantastic beaches, Nantucket also boats an incred-ible history. In the 1800s it was the whal-ing capital of the world until, with the demise of whaling, the population shrank. Today, however, the whole island is classi-fi ed as a National Historic Monument, an America without shopping malls, traffi c lights and McDonald’s.

The lack of development lies at the root of its charm. Nantucket is about old money, its ‘cottages’ owned by people whose names mean less than the corpora-tions they skipper. ■H

Nick Van Gruisen is Managing Director of The Ultimate Travel Company.

By Nick Van GruisenLesser-known luxury island escapes

SickKids doctors destroy bone tumour using incisionless surgery

A



Educational & Industry Events

September 20–21, 2014 Minimally Invasive Gynaecologic Surgery University of Toronto Conference Centre, Toronto Website: www.cpd.utoronto.ca/migs/

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September 29–30, 2014 National Interprofessional Healthcare Conference Metro Toronto Convention Centre, Toronto Website: www.healthcareconferences.ca

October 19–21, 2014 CAPHC Annual Conference Calgary, Alberta Website: www.caphc.org

October 22–23, 2014 2nd Annual Reducing Hospital Readmissions & Discharge Planning Conference Marriott renaissance Harbourside, Vancouver Website: www.healthcareconferences.ca

October 28–29, 2014 National Healthcare Practitioners Mental Health Conference Double Tree by Hilton, Toronto Website: www.healthcareconferences.ca

October 29–November 1, 2014 Critical Care Canada Forum Sheraton Centre, Toronto Website: www.criticalcarecanada.com

November 27–28, 2014 2nd Annual National Correctional Services Healthcare Conference Ottawa Website: www.healthcareconferences.ca

November 3–5, 2014 HealthAchieve 2014 Metro Toronto Convention Centre, Toronto Website: www.healthachieve.com

November 24–25, 2014 Leveraging Accreditation for Transformational Change Vancouver Sheraton Wall Centre Website: www.accreditation.ca/accreditation-forum-2014

November 30–December 5, 2014 RSNA 2014 McCormick Place, Chicago Website: www.rsna.org

December 2–3, 2014 3rd Annual Data Analytics for Healthcare Summit Toronto Website: www.healthdatasummit.com

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January 27–28, 2015 11th Annual Mobile Healthcare Summit Toronto Website:www.mobilehealthsummit.ca

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esigning and building a 1.8 million square foot acute care hospital facility presents many operational challenges.

Workfl ows, supply delivery routing and environmental effi ciency are just a few – as is emergency preparedness. For the planning team at Toronto’s new Hum-ber River Hospital (HRH), scheduled to open in October of 2015, adapting the hospital’s existing emergency codes and procedures for the new building has been a critical project.

According to Mike Orrico, Humber’s Director of Emergency Preparedness, “Taking current safety and emergency policies and procedures that were devel-oped for our old buildings, and ensuring they are revised to be relevant in our new facility is a huge challenge. Moving day is a hard deadline for us – by that day these must all be complete, comprehensive and thoroughly tested to ensure 100 per cent reliability.”

To ensure moving day goes smoothly, Orrico and his team have been hard at work on emergency preparedness, but they’ve had help. “We’ve had a great partnership with Toronto Fire, Toronto Police Services and Toronto EMS, as well as other experts,” he explains. “Develop-ing policies and procedures to help en-sure the safety and security of everyone in the new hospital.”

Given the size and complexity of what will be North America’s fi rst fully digi-tal hospital, Orrico’s team is building a new Code Manual for staff, physicians and volunteers. “This manual is their guide on how to react in different code and emergency situations,” says Orrico. “There will be extensive on-site training starting in May of 2015, once we have possession of the building, so that when doors open on October 18, 2015, every-one is prepared to respond to an emer-

gency situation in a seamless and coordi-nated effort.”

The new building will leverage state-of-the-art technology to minimize the risks in emergency situations, to ensure that affected units, staff and physicians, security and EMS personnel are connect-ed and notifi ed immediately of emergen-cy location and details, as well as up-to-the-minute updates. Staff and physicians, security and code response teams will be alerted through PDA and computer alarms, while the public will be informed though electronic monitors throughout the hospital when appropriate.

Code Response teams will provide the support necessary to effectively respond to medical emergencies within the hos-pital. A Real Time Locating System (RTLS) with a ‘Nurse Call’ system will be implemented to further enhance safety in the hospital, including newborn foot monitors, and wrist monitors for at-risk adult and paediatric patients.

For community disasters – explosions, derailments etc. – HRH will be better equipped to respond thanks to its large decontamination capability. There will be a designated decontamination unit, as well as the ability to use the enclosed am-bulance bay to decontaminate over 100 people at one time. In addition, if a local incident impacts the external air qual-ity, the supply control system will switch from using external air to purifi ed recir-culated air.

“Ensuring life safety within the new hospital – for patients, for staff and phy-sicians, for volunteers and visitors – is an absolute priority for my team,” says Or-rico. “We all hope it never happens, but if that day does come, we will be ready. We will keep everyone safe and informed.” ■H

Gerard Power is Director, Public and Corporate Communications.

at the new Humber River HospitalBy Gerard Power

D

A Real Time Locating System (RTLS) with a ‘Nurse Call’ system will be implemented to further enhance safety in the hospital, including newborn foot monitors, and wrist monitors for at-risk adult and paediatric patients.

Emergency preparedness



mpowering patients, improving care and support, and enhanc-ing quality of life; that’s what the newly launched iCHIP ap-

plication will deliver to patients across the province of BC.

The BC Provincial Blood Coordinat-ing Offi ce (PBCO) launched the Inherited Coagulopathy and Hemoglobinopathy In-formation Portal (iCHIP) on July 23, 2014 in Vancouver. iCHIP is the fi rst web-based, secure application of its kind in North America. It helps track patients with rare, chronic and life-threatening conditions like hemophilia and sickle cell disease electronically through two components – a Patient Home Module and a Clinical Module.

“The development and launch of iCH-IP will have a tremendous impact on pa-tient care. From a system-wide perspective, with patient care being provided in a more timely manner, it will reduce the acute episodes or crises that patients may run into if some of their signs and symptoms are not captured earlier on,” says Dr. John Wu, Pediatric Medical Director, Inherited Bleeding & Red Cell Disorders Program, BC Children’s Hospital.

Hemophilia patient Eagan and his mother Carmen, also spoke about the im-pact iCHIP has had on their lives.

“With iCHIP, Eagan can manage his own care and it empowers him to look after himself and his condition,” says Carmen. She adds the application also sends her a notifi cation when her son’s blood products have arrived at the local hospital, saving time once lost for back and forth trips.

Patients with conditions like Eagan’s are usually treated with products from donated blood and may need frequent blood product transfusions. In the past, a

patient’s at-home product use would be assessed by their clinician at their regular bi-annual or annual visit.

With iCHIP, patients with inherited bleeding disorders record their infusion activities in their own home via the Pa-tient Home Module. A real-time inter-face allows clinicians to monitor care in a more timely manner and helps prevent the onset of possible acute episodes which may require emergency visits or inpatient admissions.

iCHIP also enables clinicians to moni-tor how patients are managing their indi-vidual treatment protocols and their con-ditions as well as their home blood product inventory. By monitoring the information entered by the patient, clinicians can con-tact the patient and make changes to the treatment plan or provide additional edu-cation and follow-up.

Understanding how blood products are used at home will lead to better use of these life-saving products. In addition, specifi cally for inherited bleeding disorder patients, iCHIP can track a number of other items including orders placed with Canadian Blood Services and the mea-surement, use and waste of blood products

relative to a patient’s actual dosage. It also provides medical staff across BC with the ability to access basic patient information including the patient’s product prescrip-tion. The program will allow for the abil-ity to identify facilities with nearly expired products in order to facilitate timely redis-tribution, ultimately avoiding wastage.

Uniquely, it also enables care providers to upload existing patient documentation fi les as attachments to patient records and displays a synopsis page for each patient summarizing demographics, diagnosis, treatment protocol and recent product in-fusion dose totals so the health care team has the most recent patient status.

iCHIP contains highly sensitive patient information, and as such, strong security controls are in place to protect against inappropriate and unauthorized internal and external access. Access to the system is authenticated by the user’s ID and pass-word. Additionally, access to information is granted on a need-to-know basis using defi ned role viewing privileges.

iCHIP was developed in collaboration with the two BC Inherited Bleeding and Red Cell Disorders (IBRCD) program sites, Pediatric at BC Children’s Hospital and Adult at St. Paul’s Hospital, to support the unique clinical care needs of patients with blood disorders.

For more information on iCHIP, visit www.pbco.ca. ■HAlyshia Higgins is a Communications Offi cer at the Provincial Health Services Authority in BC.

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iCHIP Application a North American fi rst for

By Alyshia Higgins

E

Empowering patients, improving care and support, and enhancing quality of life; that’s what the newly launched iCHIP application will deliver to patients across the province of BC.

Hemophilia patient Eagan and his mom, Carmen, demonstrate how easy the iCHIP application is to use.

New social and health partnerships integrate care and deliver better outcomesBy Barry Burk

hile we may not know who said it, we all know we’ve heard it: “It takes a village to raise a child.” In the context

of today’s health care system, I would argue it takes a village to keep one healthy, too.

After all, healthcare is not the only fac-tor that plays a role in one’s health status. Genetics, health-related behaviors and social and environmental factors all con-tribute to the health of individuals.

But if we are to combat and conquer the challenges our health care system faces – increasing costs, an aging popula-tion, an upsurge in chronic disease – we must embrace the notion that improving the health and vitality of our children and citizens requires a much broader, coordi-nated effort by many systems and stake-holders, beyond our front-line and sup-porting health care practitioners.

We need care that emphasizes collabo-ration and interaction across the bound-aries of government, social programs, life sciences, health plans and providers. We need a system where data – existing and new, from many sources – is shared and analyzed to reveal insights that can lead to improved wellness, for individuals and for communities.

Advanced analytics and cognitive com-puting today provide the tools needed to mine data and uncover valuable insights into lifestyle choices, social determinants and clinical factors. Taking a holistic view of the individual and entire populations, sharing knowledge and better under-standing individuals’ risks, can lead to better care delivery.

This is more than an abstract idea, as evidenced by a number of projects hap-pening globally where health care provid-ers, governments and cities are working together to create communities of care.

Catalan Institute of Health, a major health provider in, Spain, is piloting a new care coordination program designed to make it easier for multiple providers – doctors, nurses, social workers – to coor-dinate care. The pilot serves more than 150 patients, many of who have complex health conditions and engages treat-ment centers, labs, primary care centres and hospitals. The end goal is to provide caregivers with the ability to address level of needs across different factors such as daily living, nutritional and social care needs.

Closer to home, in Alberta, a research initiative called The Child and Youth Data Laboratory (CYDL) provided a number of government agencies and ministries with insights into which services and programs the province’s children and youth access. Among those agencies working collabora-tively were not just Health but also Ab-original Relations, Education, Justice and Solicitor General and others. The CYDL Web site lists the research benefi ts as bet-ter insight into the extent programs and services are being accessed by youth in Alberta, the characteristics of the youth accessing them– information that is being used to make improvements in programs to better serve children’s health and well-being.

The city of Surrey, British Columbia undertook a similar approach recently, with a project that focused on children

ages 0-5. City leaders examined child care, health and nutrition, safety, commu-nity and culture, socialization, and physi-cal activity in an effort to understand how to sustain a healthy community through specifi c projects aimed at youth and early childhood development.

What Surrey learned was that this ap-proach requires better sharing of informa-tion across service providers, funders and supporters and other stakeholders, but that by introducing data-driven analy-sis and decision-making into their early childhood services, they could deliver better programs and reduce the need for future spending in remediation.

Here’s something else we may not know who said, but we’ve all certainly heard: “An ounce of prevention is worth a pound of cure.” Surrey’s city leaders dis-covered, information insights – coupled with cross collaboration – can dramati-cally improve quality of care, while also improving its cost-effectiveness. Catalan Institute of Health discovered a 10 to 15 per cent reduction in costs for caring for chronically ill patients.

“Smarter care” centers around the construct that sharing and use of data from new and diverse sources can help pinpoint opportunities in a population to transform care for the individuals with the greatest needs. Being able to capture, manage and use all forms of data from all relevant sources is what enables the types of personalized insights. And that can lead to care that can make a difference. ■H

Barry Burk is Vice-President Healthcare Industry, IBM.

W

blood disorder patients



At the Toronto Central Community Care Access Centre (CCAC), we are committed to the relentless pursuit of every option to deliver what is most important to each of our clients, and to supporting them to live the fullest and healthiest lives possible. In the same way, we work tirelessly to unleash the potential of our people.

We are looking for Client Services Managers with a passion for health care, expert communication skills and a commitment to quality improvement and employee engagement,

and their families get the health care services and support they need. With 3 to 5 years of experience managing in a multidisciplinary, culturally diverse health care environment, you have the operational and people management skills needed to oversee the management, planning and evaluation of community health care coordination in your area. A graduate

English/French bilingualism is an asset.

Full position details are available online at www.ccacjobs.ca. If you are seeking a chance to truly make a difference in the lives of others as well as your own, please apply online or send your résumé directly to [email protected] Community Care Access Centres of Ontario are governed by the requirements of the French Language Services Act. We provide services in French and encourage applications from bilingual candidates.

Toronto Central CCAC is committed to accommodating people with disabilities as part of our hiring process. If you have special requirements, please advise Human Resources during the recruitment process.

ccacjobs.ca

Toronto Central CCAC services are made possible through the funding support of the Toronto Central LHIN

in ensuring quality careLead by example

Join our team of Client Services Managers

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Looking for more?At VHA Home HealthCare, more is not just our commitment to our clients, but to our incredible team of health care professionals.

Please apply online at www.vha.ca

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Celebrating 90 Years of Inspiration and InnovationThe largest and most prestigious health care event in North America turns 90 this year, and we’re celebrating by hosting some of the most unique and inspiring thought leaders of our time who will be sharing their groundbreaking research and innovative ideas. Don’t miss your chance to learn, share and celebrate with the best and brightest!

Confirm your spot at the health care industry’s must-attend event by registering now at healthachieve.com/registration.

2014 Keynote Speakers

Register today to be inspired by these revolutionary

minds and their innovative ideas at our 90th anniversary!

Visit healthachieve.com to see our full roster.

Our Satellite Locations

If you can’t make it to the Toronto event, you can still hear from these incredible speakers by attending one of our satellite locations: HealthAchieve North in Thunder Bay and HealthAchieve East in Halifax!

Michael E. Porter, Harvard Business School Professor Transforming health care delivery.

Tom Rand, Environmental Sustainability Expert Bringing clean technology to life.

Preet Banerjee, Personal Finance Expert Inspiring financial empowerment.

Jennifer Gardy, Scientist and guest host on The Nature of Things Uncovering the truth behind medical folklore.

Jessica Green, Director of the Biology and Built Environment and TED Senior Fellow Visualizing the invisible world of microbes.

Nina Tandon, CEO and Co-Founder of EpiBone and TED Senior Fellow Exploring biology’s new industrial revolution.

Robert Gupta, Founder of Street Symphony and TED Senior Fellow Demonstrating the healing power of music.

Dr. Wendy Sue Swanson, Executive Director of Digital Health at Seattle Children’s Hospital Using new technology to improve care

and communication.

November 3, 4 & 5, 2014

Metro Toronto Convention Centre healthachieve.com

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Documents

Hospital News September 2014 Edition