Printed on 100 per cent recycled paper NOVEMBER 2014 | IN TOUCH | 1

New heart and lung machine reduces need for blood transfusions during open heart surgery By Heather Brown

Perfusionist Jennifer Bezaire prepares to initiate the cardiopulmonary bypass. She will then stop the patient’s heart to enable surgery. (Photo by Yuri Markarov, Medical Media Centre)

Open heart surgery is not for the faint of heart. Not only is a patient’s heart exposed, but for a period of time it stops beating altogether.The blood that once flowed freely through its chambers is redirected, leaving a motionless and fluid-free organ, ready to be repaired by a cardiovascular surgeon.

A heart-lung bypass machine, also known as a pump, keeps the patient alive by draining blood from the body into a reservoir, where it is stored, then cooled, oxygenated and pumped back into the body. The amount of

blood pumped and the speed at which it flows into and out of the machine are regulated either by a series of rollers or a centrifugal device.

Most hospitals use the roller head technology, which draws blood from the body through tubes connected to the machine. Blood is compressed in the tubes as it passes by the rollers, exposing it to trauma it doesn’t usually encounter when flowing freely in a person’s body.

The centrifugal device maintains blood flow in and out of the body through centrifugal force, a more natural way that causes little or no damage to the

INTOUCHNOVEMBER 2014

blood because it is not being squeezed through rollers.

St. Michael’s began using the centrifugal device in February. It is the only teaching hospital and one of only two in Ontario to use this device exclusively during open-heart surgeries.

Between February and September the centrifugal device has contributed to reducing the hospital’s blood transfusion rate during open-heart surgery. In the month of August the rate of transfusion decreased by 70 per cent compared to last year, further positioning St.

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Navigating our way to be a world leader in urban health

The world around us is constantly evolving and the provincial health system is undergoing a period of transformative change. As a leading downtown hospital, we’ve not only got to stay ahead of the game, but take charge in spearheading positive change for our organization and community.

I’m pleased to let you know that all your hard work this past year in developing the hospital’s 2015-18 Strategic Plan has paid off. The result will be a comprehensive plan that will guide and measure our activities over the next three years as we work to transform care with and for our patients. Our

Bob Howard President and CEO

strategy is guided by our commitment to the hospital’s mission, values and culture, and we will strive to achieve our vision of world leadership in urban health. And because we are an academic health sciences centre, everything we do falls under the canopy of care, research and education.

The strategic plan will steer us toward achieving our priorities – comprehensive care for our entire urban community; advance systems of care for disadvantaged patients; and excel in the care of critically ill patients – which are supported by quality, integration and innovation, principles that permeate across the organization and activities.

Of course, none of this has been or will be possible without you. Our people, along with infrastructure, information management and fundraising, make up what we are calling our “enablers.” Thank you for your input these past few months. We heard from staff in droves

OPEN MIKE with

via our online survey, lunch sessions and open houses. We also solicited feedback from other VIPs, including patients and families, community partners and colleagues at other hospitals. In a nutshell, this plan has been well informed by the people who matter most to us and care about us.

Melanie Kohn, director of Corporate and Strategic Planning, and her team have done a tremendous job of driving this complex process to develop our strategic plan. Now that the plan is nearly complete (it will go to the St. Michael’s Hospital Board of Directors for approval next month), it will be up to all of us to implement it. I want to thank you in advance for your help in making the plan a reality and invite you to join me as we embark on this transformational journey over the next three years.

For more information, visit the strategic plan section of the intranet, under “corporate initiatives.”

Follow St. Michael’s on Twitter: @StMikesHospital

St. Michael’s social media statistics

Nancy Sinatra loved Sophia Wong’s hand hygiene spin of her classic hit These Boots Are Made for Walking

18,000 viewson #SavingCyla Facebook gallery

105 combined clicks for last month’s hand hygiene story, making it the second most “clicked” story, behind the

117 combined clicks for the Peter Gilgan announcement

CELEBRITY FOLLOWING

NOVEMBER 2014 | IN TOUCH | 3St. Michael’s is an RNAO Best Practice Spotlight Organization

More than 5,000 people in Toronto are homeless on any given night. An anonymous gift of $10 million to the Urban Angel Fund for Homeless People has allowed St. Michael’s to develop a think-tank for homeless solutions with its sights set on reducing that figure.

St. Michael’s has established a “health-solutions incubator” focused on testing new approaches to help homeless and vulnerably housed people regain their independence.

The incubator’s first project is a recovery and learning centre called Supporting Transitions and Recovery, or STAR. The centre, which officially launched in September, has partnered with community organizations to offer a range of free classes from skills training to arts-based recreation. The classes are designed to support people as they make

the transition to housing and work to recover their mental health.

“STAR works by helping people discover or rediscover activities that are meaningful to them and support their reintegration to the community,” said Dr. Vicky Stergiopoulos, psychiatrist-in-chief at St. Michael’s Hospital.

Howard Freedman, 68, was living in Seaton House when STAR came to the shelter this summer to talk about the programming. He saw it as an opportunity to expand knowledge and meet people.

“It was a chance to get outside and interact,” said Freedman. “A chance to feel like a human being for a few hours.”

Freedman has taken several of the courses and even established his own course: “Walk and Talk.” Participants take a two-hour walk around the city, visiting historical or major sites in Toronto.

“It helps participants learn to build a

A STAR is born

Howard Freeman is one of the first people to benefit from the Urban Angel Fund for Homeless People, which will test new ideas and approaches to help homeless people regain their lives through stable housing, professional and peer support, job assistance and other kinds of help. (Photo by Yuri Markarov, Medical Media Centre)

By Geoff Koehler

rapport with people and re-introduces the concept of engaging with others,” said Freedman. “Plus it’s good exercise.”

Some of the courses he’s taken include budgeting, exercise and an entrepreneurial course. “I like the choice of the courses. It feels good to expand horizons and try new things.”

At the beginning of September, Freedman left Seaton House and is now living independently.

He has taken fewer classes since moving out on his own but expects to pick them up again soon.

“Any approach to homelessness must recognize the complex health issues and understand the loss of identity and positive social networks that go along with it,” said Dr. Stergiopoulos. “I’m thrilled that we now have an ongoing stream of funding to support a series of innovative ways to promote well-being, recovery and community integration for homeless people.”

NOVEMBER 2014 | IN TOUCH | 4

Volunteer Services recently completed a satisfaction survey of high school teachers who have sent their co-op students to St. Michael’s. The results were overwhelmingly positive, with all of the scores well into in the 90th percentile, complemented by highly favourable comments. Teachers reported their overall satisfaction with the co-op program at 98 per cent.

“The co-op program offered by St. Michael’s Hospital is the best hospital co-op experience a student can receive,” said Christine Sabetti, a teacher from Runnymede Collegiate Institute. “The training, assignments, tours and other learning opportunities are outstanding.”

Indeed, respondents gave the program’s modules, assignments and tours a rating of 98 per cent. Other areas where St. Michael’s program scored

highly include: the orientation of new students (98 per cent); opportunities for career exploration or job shadowing (98 per cent); and providing assignments and feedback (97 per cent).

Co-op students are high school students who are placed at St. Michael’s through Volunteer Services as part of an experiential learning program. Each year, 50 co-op students come to the hospital for a four-month assignment to earn high school credits. The co-op program helps students develop workplace skills, explore health-care careers and better understand the science behind patient care.

Students spend the majority of their co-op time in their assigned hospital unit and they are overseen by a hospital staff member. “The staff are critical to the success of co-op,”said Sandy Gobin, the co-op program co-ordinator. “They make sure our students have a great experience here.”

By Michael Kidd Students follow a unique curriculum designed by St. Michael’s and have an opportunity to practice a variety of workplace skills, such as interpersonal communications. As the semester goes on, they are given more and more duties.

In addition, students participate in a series of tours, job shadowing and educational lunch-and-learn sessions. “When my students come to me asking for a medical co-op, St. Mike’s is my first choice!” said Kathryn Stearns-Brown, a teacher from Oakville Trafalgar High School. “The extra modules are the best! No other hospital offers this.”

For more information: www.stmichaelshospital.com/volunteer/coop.php.

High school co-op students, (l to r) Jessica Cordeiro Isidoro, Michaela Finn, and Ruby Jane DeVera, take part in a tour of the hospital’s Allan Family Waters Simulation Centre as part of their placement with St. Michael’s. Teachers rated the modules, assignments and tours component of the hospital’s co-op program a favourable 98 per cent on a recent satisfaction survey. (Photo by Yuri Markarov, Medical Media Centre)

Survey shows that high school teachers are impressed with St. Michael’s co-op program

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Doing things better without adding hours to the dayBy Emily Holton

Change is all around us! Thousands of passionate people at St. Michael’s Hospital are working right now on countless projects and initiatives to improve the way they do what they do, while at the same time actually doing their work.

“I see great enthusiasm for quality improvement in every corner of the hospital, and together we’ve achieved so much,” said Dr. Chris Hayes, medical director of quality and performance. “But I also see that this work can add extra time and effort, on top of the already busy work that we do to care for patients. It can lead to overburdening of providers and contribute to quality improvement – and other change initiatives – not being successful.”

Dr. Hayes took these concerns to the Institute for Healthcare Improvement in Boston where he spent a one-year Harkness Fellowship researching the best way to design and implement quality improvement projects.

“To succeed, the people who are implementing the changes need to be able to reliably do the new tasks and see value in what they are being asked to do,” said Dr. Hayes. “There needs to be the right balance between how valuable the outcome will be, and how much cognitive and physical work it will take to get there.”

It’s not a complicated recipe, but Dr. Hayes said people tend to go through a lot of trial and error – and exhaustion – trying to get it right.

Dr. Hayes conducted a literature review, site visits, expert interviews and focus groups. He distilled what he learned into six main questions to ask, including one about extra workload, before planning and implementing a change. He developed the Highly Adoptable Improvement model and tool to help determine exactly how likely a change initiative is to succeed, or if further thought is needed.

“I piloted the assessment tool with 16 improvement advisers from the Institute for Healthcare Improvement,” said Dr. Hayes. “They all took it back to their institutions, and tried it out on their quality projects. They said the model was intuitive, clear and useful, and it opened their eyes to why some projects just weren’t getting anywhere. They all said they’d keep using the tool.”

Learn more and download the tool at www.highlyadoptableqi.com.

Dr. Chris Hayes is a staff physician in the MSICU as well as medical director of quality and performance. (Photo by Yuri Markarov, Medical Media Centre)SIX QUESTIONS TO ASK BEFORE PLANNING

AND IMPLEMENTING A CHANGE

• Are the end users involved in designing, testing, revising and implementing the change?

• Does the change initiative align with the organization’s and/or team’s values and goals and has the rollout been planned effectively?

• Are the required resources (training, equipment, time, personnel) for making the change known and will they be made available?

• How much workload (cognitive, physical, time) is associated with the initiative?

• How complex is the initiative?

• What degree of evidence and belief is there that this initiative will lead to the intended outcome?

NOVEMBER 2014 | IN TOUCH | 6

An apple a day may keep the doctor away, but the Family Health Team at St. Michael’s Hospital hopes that a lawyer may have the same effect.

Legal Aid Ontario is funding a partnership between the Family Health Team at 80 Bond and several community legal clinics. ARCH Disability Law Centre will be the lead partner. While not the first medical-legal partnership in Canada, this is Canada’s first partnership between a hospital, community legal clinics and legal aid clinics. Clinicians will be able to refer patients to a lawyer who works for a community legal clinic partner but is housed within the Family Health Team at 80 Bond.

“A mould infestation that isn’t being looked after by a landlord or difficulty accessing disability benefits are social issues that greatly affect our patients’ health,” said Laurie Malone, executive director of the Family Health Team. “With this, patients could be referred for legal support for any needs that play

The power of an attorney

Michelle Moldofsky, general counsel for Sr. Michael’s, and Dr. Nav Persaud, a family physician, agree that sometimes social interventions are needed to help resolve health problems. (Photo by Yuri Markarov, Medical Media Centre)

By Geoff Koehler a role in health outcomes.”

This is not the first instance of St. Michael’s Family Health Team bringing in non-medical expertise to improve social factors for their patients. A financial expert is already available to help patients address needs such as inadequate income for proper food or housing.

“We can already write a prescription for income support,” said Dr. Nav Persaud, a

family physician with St. Michael’s Family Health Team. “Adding legal services to the clinic gives us one more way we can improve the quality of life for our patients.”

The in-clinic lawyer has yet to be chosen but would begin working at 80 Bond before the end of the year. He or she will provide legal assistance or referrals in areas of the law that often impact low income

people, such as family law, employment, tenant rights and social benefits.

“This partnership creates a network of several specialized legal clinics which the in-clinic lawyer can refer patients to when they require specific expertise,” said Michelle Moldofsky, general counsel for St. Michael’s Hospital. “We’re only bringing one lawyer into 80 Bond but we’re also bringing the medical, legal and

local community together to increase access to legal services and improve health for our patients.”

During the first year pilot phase of this partnership, legal services will be available at 80 Bond only. The service would be extended to the other Family Health Team sites once it has been tested and adapted as needed.

“We can already write a prescription for income support,” said Dr. Nav Persaud, a family physician with St. Michael’s Family Health Team. “Adding legal services to the clinic gives us one more way we can improve the quality of life for our patients.”

NOVEMBER 2014 | IN TOUCH | 7

Valter Silva, a facility housekeeper, cleans the floor of the Environmental Services training and simulation room during a training exercise. (Photo by Katie Cooper, Medical Media Centre)

Improving training and efficiency key for new training and simulation room

Health care professionals use patient simulators to get hands-on experience to respond to critical situations in a controlled environment. Now, Environmental Services has its own training and simulation patient room to ensure best practices in cleaning are being practiced every day.

“We have more than 280 staff members that need training,” said Justin Carrozza, a supervisor of inpatient and critical care units in Environmental Services. “Before we created this room, staff were trained in patient rooms if they could find a vacant one.”

As many as 150 hours a year were lost finding an appropriate room to use for training.

The mock patient room, located in B1 Shuter Wing, has a patient bed, windows, lockers, toilet and sink. The room also features the three types of flooring – terrazzo, vinyl and linoleum – found throughout the hospital. The same cleaning solution is used on all flooring,

By Greg Winson but the time required to properly clean each type of floor varies.

And just like the Allan Waters Simulation Centre, the EVS simulation and training room isn’t just for new staff.

“We will use this room to retrain existing staff as well,” said Douglas Johnson, a supervisor in outpatient, core areas and off-sites in Environmental Services.

Studies have shown that improved training of Environmental Services staff can have a significant impact on hospital-acquired infection rates, patient safety and patient satisfaction.

In addition to the training and simulation room, a new training video is being produced to complement a series of in class and online training modules. These initiatives are being led by Carrozza, Johnson, Tony Nguyen and Michael Camara of Environmental Services.

Michael’s as a centre for excellence in blood management.

“This device enhances patient safety during open heart surgery,” said Constantine Dalamagas, the chief perfusionist at St. Michael’s. “Not only does it handle the blood more gently, but it also reduces air pockets by pushing the air back into the heart lung machine’s reservoir, preventing it from going into the body and causing

Heart and lung machine story continued from page 1 complications such as an embolism or air pocket within a vein.”

The centrifugal device spins at roughly 2000 rpm, moving four to six litres of blood per minute through the machine and back into the body -- 20 to 25 times faster than the roller head device.

Maintaining more natural flow rates at greater velocities during open heart surgery, with fewer transfusions often results in patients being able to go home sooner with fewer complications.

A heart beats about 1,000 times in one day and about 35 million times in a year. Over a lifetime, a person’s heart will beat 2.5 billion times.

The centrifugal pump in action pulling blood from a patient’s body and circulating it back during open heart surgery. (Photo by Yuri Markarov, Medical Media Centre)

INTOUCH NOVEMBER 2014

In Touch is an employee newsletter published by Communications and Public Affairs. Please send story ideas to In Touch editor Leslie Shepherd at shepherdl@smh.ca.

Design by Dermot Covel, Medical Media Centre

Q & AMany patients never meet their pathologists, but these doctors are critical to patient diagnosis, care and recovery. Pathologists are often referred to as the “detectives” of a health care team. Dr. Cathy Streutker is a pathologist at St. Michael’s Hospital – here’s what she has to say about her role.

Q. Can you tell us about your role as a pathologist?In simple words, I analyze test results and biopsy specimens to make diagnoses that determine how patients are treated. As a pathologist, I often feel like I’m trying to solve a mystery by analyzing clues such as a patient’s test results and personal medical history. While I do a variety of work, I specialize in gastrointestinal pathology.

Q. What made you want to specialize in pathology?I didn’t enter medical school thinking I would become a pathologist. I quickly learned that it’s one of the few areas of medicine where can still be more of a generalist and think about how the organs all affect each other. Also, pathology isn’t just a science – it’s an art, too. We often say you need the eye in order to pattern match and make a diagnosis. It’s an ever-changing environment and I get to see new cases every day.

DR. CATHY STREUTKER, PATHOLOGIST, DIAGNOSTIC LABORATORIES

Q. What is the biggest misconception about pathologists?

I often don’t like talking about what I do because many people don’t understand pathology and think that we only perform autopsies. Most of our medical practice involves making critical diagnoses of the living. However, some of us do perform autopsies to determine a cause of death, but it is a small percentage of our work. This is with the exception of forensic pathologists of course.

Q. What do you find most rewarding about pathology?Every once in a while, pathologists have the chance to make that miracle diagnosis that really affects someone’s life. It’s generally something that no one else was expecting. It’s only happened a few times in my career – but to me this is extremely exciting and rewarding.

Q. If you could be any character from a mystery show, who would you be?

I’ll stay away from shows such as CSI because I think that perpetuates the misconceptions we discussed. I was always a big fan of the X-Files. As far as I can tell from the early years of the show, Scully seemed to be a pathologist. So if I could be anyone – it would be her.

By Patricia Favre

(Photo by Yuri Markarov, Medical Media Centre)