Annual Report 2016-17: Dalhousie University Department of Critical Care

Dalhousie University Department of Critical Care Annual Report

2016-2017

Mission Accountability and excellence in medicine In the Department of Critical Care, we provide exemplary, compassionate and supportive care to critically ill patients, using a multidisciplinary approach that is based on evidence and updated regularly to reflect new research discoveries and improved best practices.

Goals Accountability

Compassion

We strive to improve communication within the department, and raise the profile of the Department of Critical Care.

Respect & Trust

Excellence

We’re fostering an environment of open communications, respect and trust with the program.

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D E P A R T M E N T

O F

C R I T I C A L

We aim to support our patients and their families at all times, but especially during health crises that require intensive levels of medical care. We are always respectful of the sanctity of life and take care to provide comfort and dignity in death.

C A R E

We’re focused on providing exemplary care at all times.

Introduction

Farewell

A MESSAGE FROM INTERIM D E PA RT M E N T H E A D

D R . W A R D P AT R I C K L E A D E R S H I P HONOURED

It’s been a pleasure to serve as the Department’s Interim Department Head. It is a role I have been privileged to slip into with relative ease, due to the strength and leadership from my predecessor, Dr. Ward Patrick.

Over the past year our team h a s c o n t i n u e d t o g ro w stronger and more united, grounded on our desire to provide the best possible critical care services. We have introduced new internal processes where we have greater clarity on our unique roles and contributions. By having this clear view to our individual roles, we better understand the collective impact we have on patient care, teaching and research. It also allows us to make better decisions to ensure we are working in a positive and productive environment.

Since stepping into this role, I have gained a new appreciation for the impact our small but highly productive, efficient and influential team can accomplish in just one year.

I am proud of the role we play in caring for Nova Scotians who turn to us when their life depends on it the most.

Over the past year, our small team of 25 highly-skilled and specialized clinicians handled just under 2,300 ICU admissions, on a 24/7-hour basis. In addition to our impressive clinical productivity, we are making significant contributions in medical education.

The Department’s commitment to growing, shaping and influencing the future of health care is staggering and impressive. Our Department members are strong leaders.

From provincial health services planning to serving on national bodies, our expertise and knowledge is shaping how care will be provided tomorrow.

I look forward to being part of the Department’s continued success.

Dr. Tobias Witter Interim Department Head Department of Critical Care, Dalhousie University

After 12 years serving as its leader, in 2017 Dr. Ward Patrick (left) stepped down as Critical Care Department Head.

Dr. Patrick led the Department through a great deal of change, including the transition from the Division of Critical Care to a strong, vibrant and highly productive Department of Critical Care. He has held various leadership roles in provincial health services planning, helping to shape how services are delivered across the province.

While he has very much blazed the trail for how critical care services are provided, his greatest legacy may be the impact he has had on those who consider themselves privileged to have learned from or worked alongside him.

His colleagues describe him as a strong, compassionate and effective leader, who always puts the needs of patients first. He does this with a balance of humour and tenacity.

His successful leadership style was recognized this year with the 2017 Faculty of Medicine’s Excellence in Leadership Award.

An avid life-long learner himself, Dr. Patrick is also lauded by his students and has received dozens of teaching awards.

Knowing he has much more to give and Nova Scotians have a great deal to gain, Dr. Patrick is now the NSHA’s Senior Medical Director for the Provincial Program of Critical Care. He will also continue to provide patient care and teach.

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Who We Are and What We Do W H AT W E D O

WHERE WE DO IT

H Critical Care Adult

Halifax Infirmary, QEII

Critical Care Pediatric

Victoria General, QEII

Provincial Critical Care Program Organ and Tissue Donation

Dartmouth General Hospital

Education

IWK Health Care Centre

Research

P R E PA R E D F O R D I V E R S E C A R E N E E D S Patients seen on the Critical Care units come from various places and have diverse care needs, yet they share one thing – they are extremely ill and require intensive care. Skilled clinicians must be prepared to support patients from a broad spectrum of care needs:

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Multi-Organ Transplant Program

In-Patient Dialysis Unit

Trauma

General Surgery

Bone Marrow Transplant Unit

Acute General Surgery

Thoracic Surgery

Hematology/Oncology

Ear-Nose-Throat Surgery

Gastrointestinal Medicine

Plastic Surgery (including severely injured burn patients)

Urological Surgery

General Medicine

General Internal Medicine

Gynecological Oncology

Neurosurgery

Respirology

Oral Maxillofacial Surgeries

Orthopedics

Neurology

D E P A R T M E N T

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C R I T I C A L

C A R E

Who We Are and What We Do WHO WE ARE

25 100+ Physicians

Allied health care professionals from nursing, respiratory therapy, physiotherapy, pharmacy, nutrition, social work and spiritual care

We are CARE PROVIDERS

24/7 care 365 days per year 2279 admissions to the ICU 38 ICU beds 4.6 days - Average stay in Adult ICU 3.3 days – Average stay in Pediatric ICU

We are EDUCATORS

We are RESEARCHERS

20% full professorship status

37 publications

156 learners

$105,767 (includes grants & industry funding)

5 weeks on average in ICU (residents) 3.4 weeks in ICU on average (medical students)

1801 teaching Hours

+ $2.2 Million Partnership in trauma research

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Who We Are and What We Do W H O W E A R E (Cont’d.)

We are AWARD WINNERS

✓ 4.6 / 5

Family Members Share their Experience

Dr. Janice Chisholm Dalhousie Faculty of Medicine Excellence in Education Award

Dr. Rick Hall

Families rate the ICU experience

Canadian Anesthesiologist’s Society, Research Recognition Award

Dr. Babar Haroon

Dr. Ward Patrick

“Everything the doctors and nurses did was excellent. Kind, compassionate, taking time to talk to you and always asking how you were doing.”

Dalhousie Faculty of Medicine Teaching Award

“Professionalism and sense of quality training was wonderful. Medical care was exceptional!”

2017 Dalhousie Faculty of Medicine Excellence in Leadership Award

“You did everything well: your compassion for my sister, your confidence in your skills and knowledge, your patience with me, your kindness towards my sister and me, your thoughtfulness, your thorough explanation of care and procedures, your sense of humor when needed, your professionalism, your humanity.”

We are LEADERS Dr. Steve Beed

Clinical Advisor to Legacy of Life, Nova Scotia Organ and Tissue Donation Program

Dr. Rob Green

Provincial Director Trauma NS

Dr. Jennifer Hancock National donation education program development Dr. Osama Loubani

Co-Chair of the NSHA Research Ethics Board

Dr. Ward Patrick

Senior Medical Director for Provincial Critical Care program

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C A R E

“You saved my Dad’s life.”

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We create extraordinary patient outcomes that historically were never heard of; the care delivered by our teams has demonstrated a high-quality and person-centred approach which has translated into positive patient care outcomes.

Dr. Janice Chisholm

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QEII Site Chief, Critical Care Deputy Head, Department of Critical Care

2016-2017 Accomplishments & Milestones A YEAR OF TRANSITION

I M P R O V E A N D I N N O V AT E

The past year the Department of Critical Care has experienced, initiated and led a great deal of change; change that propels the Department along its path of continued delivery of high quality care.

The Department is consistently growing and evolving to keep up with best patient-care practices and ensure the most critically ill patients in Nova Scotia, and beyond, receive quality care when needed.

New Department Leadership Dr. Tobias Witter, intensivist and anesthesiologist, assumed the role as Interim Department Head after Dr. Ward Patrick stepped down. The search for a permanent Head is underway.

Pediatrics ICU joins Department In 2016, the IWK Pediatric ICU joined the Department. This highly specialized care team of four clinicians offers tertiary and quaternary intensive care support to four provinces.

The small program, with big responsibilities, provides a robust and intensive clinical load not replicated elsewhere in the country.

Research readies for rejuvenation The Research portfolio is embracing rejuvenation and renewal. The research office said goodbye to two key people who shaped the Department’s research success: Research Chair Dr. Rick Hall and Research Coordinator Lisa Julien. The portfolio, initially taken over by Dr. Robert Green, now led by Chair Dr. Osama Loobani and Coordinator Tamara Mitterer, are creating new protocols to ensure the Department has the greatest impact in participating in cutting edge critical care research.

Organ and Tissue Donation Program aims to expand The Department of Critical Care’s Organ and Tissue Donation Program plans to expand its reach provincewide. This expansion is on hold as the Nova Scotia Health Authority becomes more established. Meanwhile, the program continues to hold its national standing as one of the highest donor per million rates in Canada. The program welcomed Janet Gallant as its new manager.

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New Pediatric Critical Care Outreach Team Through its new Pediatric Critical Care Outreach Team, important strides have been made in improving patient care while predicting and potentially preventing admissions to the PICU. This physician-led team consists of staff, residents, critical care nurses and respiratory therapists who provide bedside support and advice in all areas of the hospital. The team can be activated by any health care provider concerned for a patient’s deteriorating health, yet not requiring admission to the PICU. The team physically assesses the patient, advises on therapy and recommends appropriate disposition.

This program helps with early detection of patients requiring a higher level of care and offers new and increased support outside the PICU setting. In addition to reducing the number of unplanned admissions from the floor, it offers education to staff. The program promotes inter-service communication, which has resulted in improved patient flow and continuity of care. In addition, the team also follows all patients discharged from the PICU for at least 48 hours.

2016-2017 Accomplishments & Milestones Launched Unit-Based Nursing Simulation

Provincial Program of Critical Care

This year saw the launch of the province’s first critical care inpatient unit that has an in-unit simulation bay for on-going learning. This provides in-unit, low and high fidelity simulation based training for nursing staff in a safe environment.

It helps maintain and build competencies in skills that staff are exposed to on a limited basis. The new learning model increases nurses’ confidence, by providing handson engagement in demonstrating their knowledge, skills, and abilities with low-volume, high-impact patient care treatments. The program has been a success, largely due to the commitment from the nursing leadership group.

The Department of Critical Care is leading the development of the Provincial Critical Care Program. Great progress was seen this past year in building and securing the needed skill, expertise and information to move the vision forward for a Provincial Critical Care Program. Dr. Ward Patrick has been named as the program’s Senior Medical Director and Sharon A. Stevens, Senior Director. The skilled duo has put the program in an excellent position for progress and success in the years ahead. The past year focused on working with partners from across the province to ensure the program reflects and serves province-wide needs.

Developing a program to collect and analyze data has been a major priority. Access to credible data is crucial to ensuring future decisions support the best delivery of care possible. The Department of Critical Care is expected to have an ongoing leadership role as the program is rolled out, from continuing to provide care to the sickest patients in the province, teaching and supporting regional sites in developing their own local skills and being called on for specialized expertise.

Education portfolio grows This past year the education portfolio continued to provide core training to residents from across four disciplines. Its excellence in education was acknowledge this year when Dr. Janice Chisholm received the 2017 Faculty of Medicine Excellence in Education Award from Dalhousie’s Faculty of Medicine. Pushing beyond the status quo, this year the Department added an additional trainee to its roster and successfully retained its first international trainee (on site elective).

Mobility Program delivers results The Mobility Program – designed to promote and support early mobilization to improve patient outcomes and longterm survival – continues to deliver positive results. Data is demonstrating that the program is contributing to the progressive year-over-year decline in the incidence of delirium. The program was also the subject of a national presentation at the Canadian Association of Critical Care Nurses conference in September 2016. The program is built on a culture of making mobility a priority and recognizes it as a key treatment for patients, helping in both preventing and treating ICU delirium. It incorporates such strategies as having dedicated physiotherapy support, and attentiveness to minimizing sedation with spontaneous awakening and spontaneous breathing trials.

Dartmouth General ICU space modernization

Dr. Babar Haroon, and the trainees from 2016-17 L-R, Emily Rowsell, Babar Haroon, Kevin Klassen, Jack Rasmussen, Edmund Tan and Laurel Murphy.

The Dartmouth General ICU is in the final stages of preparing for its much-needed modernization and relocation of its eight-bed ICU/CCU unit and the creation of a new six-bed Intermediate Medical Care Unit.

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Accomplishments cont’d.

B E I N G R E S O U R C E F U L H E L P S S U S TA I N Q U A L I T Y C A R E Providing high-quality, extremely complex and intensive care with often limited, and sometimes outdated resources and infrastructure is a core strength and skill of the Department of Critical Care.

While a challenging work environment is no cause for celebration, the Department’s demonstrated resourcefulness and tenacity to continue to deliver high-quality care, despite not always having access to needed resources cannot be ignored.

Increasing demands, aging populations, growing retirement rates and outdated infrastructure had been the backdrop of the 2016-17 year. The Department maintains a positive, productive and solution-oriented approach, by: •

Stepping into various leadership roles to proactively plan for a strong and sustainable system;

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Encouraging the collaboration of all health care providers to pool skills and resources and supporting the growth and professional development for all allied health care providers;

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Stretching existing resources to add new services, as demonstrated with the New Paediatric Critical Care Outreach Team;

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Maintaining a highly collegial, productive and positive work environment to support retention and recruitment;

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Collecting and analyzing data to make smart decisions that extend the resources as wisely as possible; and

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Being nimble and responsive for both patients and the system.

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“We are a team of nurses, physicians and allied health care providers who provide an efficient, effective service in an environment of professional trust and respect. Our direct patient care involves a heavy clinical load for the attending staff, of a pattern not replicated anywhere in Canada.�

Dr. Gavin Morrison Chief of Pediatric Critical Care IWK Health Centre