Hospital News April 2021 by Hospital News

Inside: From the CEO’s Desk | Safe Medication | Long-term Care | e-Health 2021

April 2021 Edition

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Since COVID-19 hit, nurses have been pushed to the limit. In hospitals, long-term care, and public health, in testing centres and local clinics, we’ve seen it all. Every day comes with more risk, and every day we face down the fear. But until this pandemic is over, we’ll be holding the line – because that’s what nurses do. The government often calls us heroes. But what we really need from them is action. Make sure we have the right PPE in our workplaces. When we’re exposed to COVID-19 and have to self-isolate, pay us. Give us a say in our scheduling and working conditions. Don’t override our collective agreements. Ensure that our compensation is determined fairly. To Ontario’s Conservative government we say this: Prove through your actions that you respect our courage and value the vital work we’re doing.

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Contents April 2021 Edition

IN THIS ISSUE:

Mobile Health Unit built at Sunnybrook

▲ Cover story: What to Watch – A look at technologies with high potential to transform health care

▲ e-Health 2021 Virtual Conference and Tradeshow

▲ The pressures of COVID-19 on an already stressful environment for health workers

COLUMNS Editor’s Note ....................4 Safe medication ............28

From the CEO’s desk .....29

▲ Project SEARCH mobilizes community partnerships to transform systems

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▲ Rapid fire: How UHT’s lab team at St. Michael’s works 24/7 to get COVID-19 test results

Patient perspectives on virtual health in B.C. during COVID-19

APRIL 2021 HOSPITAL NEWS 3

A year into the pandemic,

nurses exhausted – and angry A

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By Linda Silas s the anniversary of the World Health Organization declaring COVID-19 a global pandemic has come and gone, nurses across Canada are at their breaking point. We are exhausted, burned out – and angry. Nurses are on the frontlines of the pandemic and our health-care system every day. We see its problems in brutal detail, and we have the experience to know what’s needed to fix them. We have repeatedly called on decision-makers to address critical staffing shortages and provide basic protections to keep workers safe. We continue to be disregarded, and the result has been devastating. According to the Canadian Institute for Health Information, the number of COVID-19 cases among health workers has tripled since July 2020. As of January 15, 65,920 health workers have been infected with the COVID-19 virus, representing 9.5 per cent of all infections in Canada. More than 40 health workers are known to have died from the illness. In our troubled long-term care system, insufficient staffing and safety protocols have contributed to a national tragedy. About 25,000 health-care worker infections are in long-term care. More than 14,000 vulnerable residents have died from COVID-19, representing about 70 per cent of all deaths in Canada.

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It didn’t have to be this way. As early as January of last year, the Canadian Federation of Nurses Unions began urging governments across Canada to heed the lessons of SARS and adopt a precautionary approach. This meant assuming the virus was airborne and protecting health-care workers – potential vectors of transmission – accordingly. Despite similar efforts by unions across the country, health-care workers have been put at unacceptable risk, with implications for their families, patients and communities. Most health-care workers, even those caring for COVID-19 patients, were only provided flimsy surgical masks, and in many jurisdictions, masks were reused until they were soiled and damaged. Faced with supply issues, N95 respirators were often locked away. It took the Public Health Agency of Canada (PHAC) until January 2021 to acknowledge what unions and many experts have said all along. Health-care workers are at risk of airborne transmission when in close proximity to an infected person. Yet PHAC still does not require health-care workers in COVID-19 units and ‘hot zones’ to wear protection from airborne transmission, such as N95 respirators. Similarly, provinces across Canada have failed to update their guidance to adequately reflect what we now know about the virus and how its spreads. Continued on page 6

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NEWS

Photo credit: Kevin van Paassen/Sunnybrook Health Sciences Centre.

Mobile Health Unit built at Sunnybrook n February 2021, Sunnybrook Health Sciences Centre began to make room to accommodate a Mobile Health Unit (MHU), in the event there is increased demand for beds during the COVID-19 pandemic. “The Mobile Health Unit will ensure we’re ready for anything that might come our way,” says Robert Burgess, senior director of emergency preparedness at Sunnybrook. Built in partnership with the federal and provincial governments, the MHU will consist of up to 10 tents and is being configured for 84 beds, though it can be expanded to 100 beds if needed.

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Once completed, the facility will most likely be used to provide space

for patients who are awaiting placement in other facilities and low acuity

recovering patients, which will free up acute and critical care beds in the hospital. “The plan is to moderate the number of beds we have inside the tents based on need,” says Burgess. Each ‘pod’ of 8-10 beds in the MHU is self-contained and is equipped with the necessary medical support system as well as washroom facilities. A number of large generators provide power, and Sunnybrook will be working with the province and partners in the system to staff the facility. Construction of the MHU is expected to be completed by early April, and the facility will be ready for patients H later that month. ■

APRIL 2021 HOSPITAL NEWS 5

IN BRIEF

Global Collaboration to develop new treatments for paediatric diseases F

our leading children’s research institutions on three continents are joining forces to decipher paediatric illnesses, including rare diseases, and find better treatments. The four paediatric hospitals – Boston Children’s Hospital; UCL Great Ormond Street Institute for Child Health and Great Ormond Street Hospital (London); the Murdoch Children’s Research Institute with The Royal Children’s Hospital (Melbourne); and The Hospital for Sick Children (SickKids) (Toronto) – will pool their medical and scientific expertise to analyze medical and genomic data to accelerate discovery and therapeutic development. The partnership, known as the International Precision Child Health Partnership (IPCHiP), is to the founders’ knowledge the first major global collaboration around genomics and child health. The founding partners anticipate that additional institutions will join the collaboration in the future.

Of the more than 7,000 rare diseases that affect millions of individuals globally, only a few hundred have approved treatments. Many of these diseases mean children suffer their whole lives, or may die early from complications, sometimes just a day after birth. IPCHiP’s goal is to enable the world’s top experts in pediatrics and genomics to work together to improve diagnosis, implement personalized treatment decisions, and develop new therapeutic targets and treatments that will benefit children around the world. IPCHiP’s first project will involve epilepsy in infants, bringing together efforts already underway at the four centres. Through this project, IPCHiP will establish protected systems to evaluate data across different institutions without any information having to cross international borders. Investigators at each site will prospectively enroll babies under age one with epilepsy in real time, sequence their genomes, change treatment based on the findings as appropriate,

Nurses exhausted Continued from page 4 Only Quebec has followed the scientific evidence to its natural conclusion: As of February 11, 2021, Quebec requires health-care workers in COVID-19 hot zones to wear an N95 respirator or superior level of protection. As new variants circulate in Canada, dramatically increasing the rate of transmission, burned out health-care workers are under even more pressure. Without action, health staffing, which is already in short supply, could become depleted even further. We must not let this happen. We know from experts and evidence that there is a desperate need for more staff, not less. The long-standing cycle of budget cuts, short staffing,

and higher workloads has eroded the health care workforce and quality of patient care. A major investment in the retention and recruitment of nurses is needed now or it is likely we will see an exodus from the profession as burnout takes its toll. It’s time for governments across Canada to take their heads out of the sand and show their respect and appreciation for health care workers. A good first step would be to act on our calls for better workplace safety and safe staffing. Had decision makers heeded the nurses’ warnings prior to the pandemic, perhaps many more lives could have H been saved. ■

Linda Silas is a nurse and president of the Canadian Federation of Nurses Unions. 6 HOSPITAL NEWS APRIL 2021

and follow their development long term. The study will compare infants who receive a genetic diagnosis with those for whom no genetic answer can be found. “Rapid whole genome sequencing can help us find the cause of early onset epilepsy quicker and among a greater number of patients, giving clinicians the critical data they need to choose the most appropriate treatment sooner,” says Dr. Vann Chau, Neurologist and Project Investigator in the Neurosciences & Mental Health Program at SickKids, who is leading the SickKids arm of the epilepsy project. “Our hope is that this collaboration will help create new and tangible changes in

medical practice to cut diagnosis from months to days, and lessen the burden on our patients and families living with epilepsy.” After initial seed funding by each institution, the collaborative anticipates additional funding through national health and medical research grants within each country, industry contracts, and philanthropic efforts. The collaborative as a whole has received support from the International Venture Philanthropy Network. IPCHiP is contributing to Precision Child Health, a movement at SickKids to shift medicine from a one-size-fitsall approach to health care that is inH dividualized to each unique patient. ■

COVID-19 in pregnancy associated with adverse outcomes for mother and baby nfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pregnancy is associated with preeclampsia, stillbirth, preterm birth and other adverse outcomes, found new research published in CMAJ (Canadian Medical Association Journal). “Our findings suggest that pregnant people with COVID-19 have an increased risk of high blood pressure, stillbirth and preterm birth. Their newborns are more likely to need intensive care. Pregnant people with severe COVID-19 symptoms have a particularly high risk of these complications,” says Dr. Nathalie Auger, Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montréal, Quebec, with coauthors. Researchers reviewed 42 studies involving 438,548 pregnant people from around the world to determine the association between SARSCoV-2 infection and adverse pregnancy outcomes. They found double the risk of preterm birth and a 50 per cent increased risk of cesarean delivery in pregnant people with symptomatic COVID-19 than in those

with asymptomatic COVID-19. Those with severe COVID-19 had a 4-fold higher risk of high blood pressure and preterm birth. The reason for the increased risk of adverse outcomes is unclear, but could be because SARS-CoV-2 may lead to vasoconstriction and stimulate an inflammatory response affecting blood vessels. The findings of this systematic review differ from prior findings from case reports and case series. “Our meta-analysis of recent good-quality cohort studies with comparative data does not align with these previous reviews, and provides clear evidence that symptomatic or severe COVID-19 is associated with a considerable risk of preeclampsia, preterm birth and low birth weight,” write the authors. “Clinicians should be aware of these adverse outcomes when managing pregnancies affected by COVID-19 and adopt effective strategies to prevent or reduce risks to patients and fetuses,” they conclude. “The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis” was pubH lished March 19, 2021. ■ www.hospitalnews.com

IN BRIEF

Risk of death for men 60% higher than for women in study of 28 countries A

large study of people in 28 countries found men aged 50 and over had a 60 per cent greater risk of death than women, partly explained by heavier rates of smoking and heart disease in men, although the gap varied across countries, according to new research in CMAJ (Canadian Medical Association Journal). “Many studies have examined the potential impact of social, behavioural and biological factors on sex differences in mortality, but few have been able to investigate potential variation across countries,” writes Dr. Yu-Tzu Wu, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, and Population Health Sciences Institute, Newcastle University, United Kingdom, with coauthors. “Different cultural traditions, historical contexts, and economic and societal development may influence gender experiences in different countries, and thus variably affect the health status of men and women.” The study examined different socioeconomic (education, wealth), lifestyle (smoking, alcohol consumption), health (heart diseases, diabetes, hypertension and depression) and social (spouse, living alone) factors that might contribute to the mortality gap between men and women aged 50 and older. The data included more than 179,000 people across 28 countries and more than half (55%) were women. “[T]he effects of sex on mortality should include not only physiologic

variation between men and women but also the social construct of gender, which differs across societies. In particular, the large variation across countries may imply a greater effect of gender than sex. Although the biology of the sexes is consistent across populations, variation in cultural, societal and historical contexts can lead to different life experiences of men and

women and variation in the mortality gap across countries.” The findings are consistent with the literature on life expectancy and death rates. “The heterogeneity of sex differences in mortality across countries may indicate the substantial impact of gender on healthy aging in addition to biological sex, and the crucial contributions of smoking may also vary across differ-

ent populations,” write the authors. The researchers recommend that public health policies should account for sex- and gender-based differences and the influence of social and cultural factors on health. “Sex differences in mortality: results from a population-based study of 12 longitudinal cohorts” was published H March 15, 2021. ■

Provinces should prioritize COVID-19 vaccination of cancer patients t is critical that provinces and territories prioritize cancer patients and their caregivers during the second phase of COVID-19 vaccine distribution. The National Advisory Committee on Immunization states that “the goal of Canada’s pandemic response is to minimize serious illness and death while minimizing societal disruption because of the COVID-19 pandemic.” 225,800 Canadians are diagnosed with cancer every year, but this commonly shared statistic does not represent the many more Canadians who were diagnosed in previous years and are still undergoing treatment today. Unfortunately, the pandemic response has inadvertently negatively impacted the lives of cancer patients and survivors. This applies to all cancer patients, and particularly to those with lung cancer, who are uniquely vulnerable to complications if they

contract COVID-19 due to their diminished lung function and immunocompromised systems. The Canadian Cancer Survivor Network commissioned two Leger surveys on COVID-19 disruption of cancer care in Canada, the most recent in December 2020. One of the most startling results identified cancer patient and caregiver hesitancy to access care, with 35 per cent of patients and caregivers choosing to cancel, postpone or avoid a healthcare service during the pandemic. This included: • Cancelling or postponing in person appointments with their doctor. • Avoiding booking an appointment with their doctor even when they need one. • Avoiding going to the ER for symptoms related to cancer. • Choosing to cancel or postpone a lab test or diagnostic procedure for cancer.

• Cancelling visiting a hospital for cancer care. Clearly, the ability of cancer patients to access healthcare and cancer care remains in doubt, and may lead to worse outcomes, including later diagnoses and postponed or missed appointments, tests, or treatments. The anxiety and fear that cancer patients and caregivers are experiencing about contracting COVID-19 can be assuaged by the prioritization of COVID-19 vaccinations of cancer patients and their caregivers so that they feel safe when they go to cancer care appointments. The Canadian Cancer Survivor Network therefore calls on the National Advisory Committee on Immunization as well as the provinces and territories to explicitly include cancer patients and caregivers in Phase 2 imH munization plans. ■

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APRIL 2021 HOSPITAL NEWS 7

NEWS

World-first:

Transplant after MAID at home performed at UHN ore than 14,000 people have received medical assistance in dying (MAID) in Canada, since it was legalized in 2016. Although organ donation is an option for only a fraction of this population, healthcare teams and researchers are working on innovations and new protocols to respect these patients’ final wishes while also allowing for them to help those in need of a transplant. In a coordinated effort with Trillium Gift of Life Network (TGLN), the organization in charge of organ and tissue donation in Ontario, the Toronto Lung Transplant Program at UHN’s Ajmera Transplant Centre has performed the first transplant surgery after MAID at home. “This is ground-breaking as it allows for us to respect the donor’s wishes while also paving an important new avenue to save lives,” says Dr. Marcelo Cypel, Surgical Director at the Ajmera Transplant Centre and corresponding author of the scientific paper reporting this case. The case happened thanks to the great generosity of Sergeant Mike Neill, who received MAID at his home in Burlington, Ont., after a long battle with Huntington’s disease. “In our experience in Ontario, a significant portion of MAID patients who are eligible to donate organs value dying at home more than donating organs and this is critically important to respect,” explains TGLN’s Chief Medical Officer for Donation, Dr. Andrew Healey. “Our combined expertise and most current protocols allow us to respect these patients’ end-of-life plans while also honouring their incredible generosity in giving the gift of life.” This world-first was possible thanks to Sergeant Neill’s generosity and because of an innovative protocol in

“The success of this case is the result of a concerted effort by a number of teams,” says Dr. Jonathan Yeung (R), thoracic surgeon who did the recipient surgery at Toronto General Hospital.

Photo: Courtesy of Dr. Yeung)

Photo: UHN

A landmark advance in lung transplantation pioneered at UHN, the Ex Vivo Lung Perfusion (EVLP) system allows for surgeons to evaluate organ function before transplant.

place for lung transplantation in Toronto – the result of a collaboration between UHN, TGLN, William Osler Health System, and air ambulance and medical transport service, Ornge.

NON-PERFUSED ORGAN DONATION

Since 2016, UHN’s Ajmera Transplant Centre has been able to perform

lung transplants from deceased donors who had not previously been on life support. Known as Non-Perfused Organ Donation (NPOD), this protocol allows for lungs to be preserved for a longer period of time after an unexpected death – such as a heart attack – and still be suitable for transplant. “Lungs are unique organs in that they can stay viable even after a couple of hours without blood circulation in the donors’ body, as long as they are full of air explains,” Dr. Cypel. “So we implemented a strategy to reinflate the organ after death declaration and family authorization.” Because in these cases there is no time to evaluate the organ function in the donor, the NPOD protocol is only possible thanks to Ex Vivo Lung Perfusion (EVLP) system, a landmark advance in lung transplantation pioneered by Drs. Cypel and Shaf Keshavjee, Director of the Toronto Lung Transplant Program and of the Latner Thoracic Research Laboratories.

“We are in a unique position in the world to lead this innovation as we have the technology and the partnerships to implement the necessary protocols,” Dr. Cypel says. UHN’s Ajmera Transplant Centre also had the support from the donor hospital and medical transport teams. Joseph Brant Hospital in Burlington performed the donor surgery and the lungs were transported by Ornge to Toronto General Hospital (TGH). “The success of this case is the result of a concerted effort by a number of teams,” says Dr. Jonathan Yeung, thoracic surgeon who did the recipient surgery at TGH, and Senior Author of the scientific paper. The patient who received the transplanted lungs suffered from end-stage lung disease. By the end of 2019, there were more than 230 patients waiting for a lung transplant in Canada alone, and the estimate is that 20 per cent of patients die while waiting for lungs to become available. Find out how to register to become an H organ or tissue donor at BeADonor.ca ■

This article was submitted by University Health Network. 8 HOSPITAL NEWS APRIL 2021

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NEWS

Transforming health care amidst a crisis By Jim Schembri n any given day, Lindsay Hogeboom can pull up William Osler Health System’s (Osler) Operational Command Centre (OCC) on her mobile phone or computer screen and see in real time what’s going on across Osler’s five sites, including two busy acute care hospitals. That wasn’t the case a year ago, when Osler found itself among the hardest hit regions in Ontario for COVID-19. “When the global pandemic hit Ontario, and we started seeing a rapid influx of patients with COVID-19 arriving at our hospitals, it was clear to our Incident Management Team (IMT) that we needed more timely access to decision-making tools throughout the organization, many of which were still being informed using a mix of manual and electronic processes,” says Hogeboom, Osler’s Director, Access and Flow. “We needed to know where all our patients were at any given time including how many patients were in our emergency departments awaiting admission to an inpatient bed, where we could place admitted patients who needed isolation, how many patients were ready for discharge, and how we could quickly mobilize our clinical and support teams to safely prepare for new patients being admitted to their units.” While newer hospitals have the added benefit of access to the latest in health information technology, many hospitals, like Osler, have continued to update existing systems over the years to meet their needs. Modernizing Osler’s decision-making tools was an initiative already underway as part of the organization’s 2019-24 Strategic Plan, but the urgency to implement an efficient, user-friendly digital solution escalated with the onset of the pandemic. “While sitting at the IMT meetings, our team heard first-hand what the needs were, and recognized that we had the in-house expertise to build a secure, customized, cloud-based solution without having to go through a lengthy Request for Proposal (RFP) process

The Operational Command Centre at William Osler Health System.

WITH MORE THAN 500 DATA POINTS FEEDING INTO THE OCC, THE APPS AND DASHBOARDS OFFER CUSTOMIZED SOLUTIONS FOR TRACKING PATIENT FLOW, TRANSFER OF ACCOUNTABILITY, BED CENSUS, PATIENT ACTIVITY IN THE EMERGENCY DEPARTMENTS, ALTERNATE LEVEL OF CARE PATIENTS, COVID-19 PATIENTS, AND COVID-19 ACUITY. for an external vendor’s product,” says James Moolecherry, CIO and Interim Vice President, Digital Transformation and Information Management. Pre-pandemic, Muhammad Khan, Manager, Information, Intelligence and Technical Innovation (IITI), and his team had already built some proof of concept Apps based on end users’ needs, which laid the groundwork for getting components of a digital OCC up and running within three months. “Fifty-five inch touch screen monitors had already been installed across

the organization to support the evolving OCC,” says Khan. “This made it possible for us to transform some existing manual processes into a set of user-friendly, customized Apps that our leaders and staff use to input information into the OCC at the unit level, which then feeds into centralized real-time dashboards, such as Patient Flow and iOccupancy.” With more than 500 data points feeding into the OCC, the Apps and dashboards offer customized solutions for tracking patient flow, transfer of

accountability, bed census, patient activity in the emergency departments, alternate level of care patients, COVID-19 patients, and COVID-19 acuity. Each dashboard and App appears as an icon on the OCC, similar to what people see on a mobile phone or computer. The OCC is used by Osler’s Patient Flow Centres, as well as senior leaders, directors, managers, and staff and physicians, with access to the most appropriate Apps and dashboards as determined by role. Khan and his team are continuously working together with leaders and their teams to further customize existing solutions and develop new ones. Shailesh Nadkarni, Osler’s Clinical Services Manager, Mental Health & Addictions at Brampton Civic Hospital, looked to his Information Systems Analyst and Khan’s team to make changes to the Bullet Rounds App by colour-coding time-sensitive mental health forms that would show his team at a glance when each patient’s form is due. “They made it happen,” says Nadkarni. “I’m a big believer in using visual management tools with my team, because people tend to retain 80 per cent of what they can both see and do, and the interactive nature of the App really promotes team engagement.” The innovation behind the OCC has not only transformed what Osler does as an organization internally, it’s also helped it at a systems level, by forecasting capacity pressures that may require transferring patients to other GTA or Ontario hospitals that have the ability to take on additional patients, ensuring safe, quality care for all patients. “Having 24/7 access to real-time data has been nothing short of a game-changer for Osler’s decision-makers,” says Kiki Ferrari, Chief Operating Officer. “In addition to supporting safe, high quality and seamless care for patients, the OCC has been a catalyst for further strengthening accountability, resource efficiencies, employee engagement, capacity planning and organizational effectiveness H during a time of crisis.” ■

Jim Schembri works in communication at William Osler Health System. 10 HOSPITAL NEWS APRIL 2021

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NEWS

Protecting time

to reflect and learn from COVID experiences By Ashleigh Townley, Joanna Wincentak and Shauna Kingsnorth he COVID-19 pandemic has brought a whirlwind of change to the Canadian healthcare context and daily practice of healthcare staff. Rapid shifts to telehealth and virtual care, routine adoption of enhanced personal protective equipment (PPE), mandatory symptom screening for staff and patients, as well as increased workfrom-home arrangements are but a few examples. For many healthcare workers, the speed of these changes has left little time to consider broader impacts beyond immediate goals, to them as individuals and as teams in their workplace setting. Protecting time for teams to reflect and learn from their collective COVID experiences can offer a beneficial pause; generate discussions that are helpful to staff, organizations and systems; provide an opportunity to catalogue events during periods of rapid decision-making; and make recommendations for changes to current practices and future reactions to healthcare crises. One tool to help structure this reflective process is called an After Action Review (AAR). Adopted by the World Health Organization (WHO) for healthcare crises, AARs “... are structured, qualitative reviews of the actions taken during the response to identify best practices, gaps and lessons learned”and are “...not intended to assess individual performances or competences, but rather to identify functional challenges that must be addressed, and best practices to be maintained”. At Holland Bloorview Kids Rehabilitation Hospital, the Knowledge Translation team, Evidence to Care, is using the AAR format to support clinical, management and senior leadership teams to understand rapid adoption of virtual care,

organizational communication, and leadership’s decision-making process during COVID-19. Externally, Evidence to Care has supported the Toronto Academic Health Sciences Network (TAHSN) Learner Engagement Advisory Group to understand the removal and reinstatement of students to hospital learning environments during the pandemic. There are a range of ways to facilitate an AAR, from multi-day organizational retreats, to short interviews with select individuals. An AAR consists of key questions that should be tailored to context. Here are some examples: • What was expected to happen? • What was expected to happen with learners in TAHSN hospitals in the event we experienced a pandemic? • What actually occurred? • What actually occurred with senior management decision-making and communication between March – May 2020 as the hospital reacted to the COVID-19 pandemic? • What went well and why? • From March – May 2020, what went well with virtual care at the hospital and why? • What can be improved and how? • How will your learnings about communication systems, structures, tools, and strategies impact how the team does things in the future? What are specific recommendations? In Evidence to Care’s experience, to generate the most useful results for pandemic learnings, AARs should be conducted with: • A defined group of staff or volunteers that work together or have similar roles (e.g. operations managers, a single clinical unit, or a committee dedicated to pandemic efforts). Consider power dynamics in groups that are participating. Will the presence of management change the answers from other group members? Consider holding a sep-

arate AAR with management and leadership. • A topic that focuses on one area of the group’s pandemic response over a specific period of time. For example, an AAR could be conducted with an organization’s physiotherapists to understand their transition to virtual care delivery during the first six months of the pandemic (a period of time with rapid change). • A minimum of one, two-hour meeting, with the potential for a second follow-up meeting to review, clarify and confirm AAR results. • Facilitators from outside of the group participating in the AAR. At least two facilitators are recommended, one to lead the group and one to take notes and observe group dynamics. If a team is large, using smaller subgroups is helpful. We recommend having one facilitator per subgroup. • A lens to interactivity. If in-person group activities are prohibited or

pose other challenges (i.e. masks hinder hearing), consider a video call platform. For example, Zoom has many features like breakout groups, polling and chat functions, that make running an AAR more interactive than can be achieved in-person during the pandemic. • An actionable report that catalogues the synthesized themes and recommendations. Recommendations should have accountability to implement changes attached to them, and be reviewed and updated on a predetermined schedule (i.e. biennially) When the AAR is completed, the results should be reviewed with the contributing group. If possible, provide support to groups to prioritize and select recommendations to implement. AARs are a relatively easy to use, resource-conscious, quick and powerful reflective tool that can enable teams and organizations to capture key learnings during this transformaH tive period of health care practice. ■

Ashleigh Townley, is the knowledge translation specialist; Joanna Wincentak, the knowledge broker; and Shauna Kingsnorth is manager, Evidence to Care at Holland Bloorview Kids Rehabilitation Hospital. 12 HOSPITAL NEWS APRIL 2021

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NEWS

Pandemic shines a light on

SickKids’ Peer Support Program A

t a time that many hospitals are considering peer support programs in response to the pandemic, The Hospital for Sick Children (SickKids) recognized the benefits such a program could have for staff long before COVID-19 became part of our vernacular. When SickKids launched its Peer Support and Trauma Response Program three years ago, there was no global pandemic in sight, but there was this sinister statistic: health-care workers are 1.5 times more likely to be off work due to illness or disability than workers from other sectors, according to a 2015 report from the Canadian Healthcare Association (now HealthCareCAN). This longstanding issue in the health-care field was magnified by the onset of COVID-19. For those on the front line, the constant donning/doffing of personal protective equipment, compliance with physical distancing/ masking, and fears of contracting/ transmitting the virus, take their toll. “From April to December 2020, we had about 12,000 contacts for Peer Support, which is an astounding number considering we would normally have a couple of thousand at most in that period of time,” says Kelly McNaughton, Program Manager, Peer Support and Trauma Response Program, SickKids. “This tells me the program’s visibility has increased and that the challenges staff face at work and at home are heightened due to COVID.” Peer Support, which is made up of staff from diverse backgrounds and roles ranging from research, to Corporate Services (e.g., Security, Facilities, Patient Support Services), to nurses and physicians, responded quickly to the pandemic. The team established a temporary “de-stress” space in the hospital for staff to take a quick break and enjoy a snack; a roaming tea cart to offer staff a drink and wellness check-ins; on-site and virtual counselling sessions; and a dedicated “Mental

From left: Genna Villella, MSW Student, Peer Support and Trauma Response, and Nafilia Sachedina, Program Coordinator, Peer Support and Trauma Response, routinely provide wellness check-ins for SickKids staff members stationed at hospital entrances, including Stephanie Lappan Gracon, Sr. Clinical Manager, Safe Access Management, and Anna Worley, Entry Screener. Health & Wellness” resource webpage for staff. A more recent initiative involves scheduled daily visits by two dedicated members of the Peer Support program to our screening teams, a group of front-line workers who are charged with ensuring compliance with pandemic protocols upon entering SickKids. These two peers are on hand twice-daily for an hour to offer triage and direct “in-the-moment support.” Perhaps the most important resource is how to connect with the dedicated and compassionate group of 76 trained Peers within the program itself, supporting staff across the SickKids campus whether they work in clinical/ non-clinical areas, research or learning. “Without Peer Support during COVID, there’s a good possibility many staff who needed help may not have received it,” Kelly says. “Some may have had to take a leave of absence, others may have tried hard to continue on, but eventually ended up on leave anyway.” How Peer Support makes a difference is acting as a friendly and trusted gateway to support. Instead of having

to figure out which way to turn on their own, people are much more likely to turn to a Peer because of the common ground they share at SickKids – an understanding of the culture, environment, potential stressors and psychological demands. SickKids’ Peer Support program is not only attracting attention inside SickKids but outside too. In recent weeks, Kelly has been contacted by hospitals in Ontario, the U.S. and the Bahamas to learn more about what’s involved in setting up a program. Here are her top three tips: • Dedicate someone to manage the program – it’s not something that can be run from the side of one’s desk. • Secure adequate funding and ensure the right infrastructure is in place. • Recruit and train Peers who are in this for their colleagues and not themselves – not everyone is equipped to handle the heavy topics staff open up about. Dr. Gino Somers is the Division Head of Pathology at SickKids and a physician Peer. During a difficult time in his career, he engaged the support of

his colleagues before there was a formal peer program. He credits them and their ability to understand the challenges of an academic hospital environment for lifting him back up again. “After this episode, I was drawn to ‘peer support’ as a way of helping those who have suffered psychological trauma, disappointment or who just need to talk, and I love the idea of listening to people and helping them through a difficult period,” Gino says. “My involvement with the Peer Support program has really put me back in touch with why I became a doctor in the first place.” Kelly notes that many volunteer to be a Peer, but like any job, it’s not for everyone. Some are interviewed and not invited to training; some are recruited and discover it’s not a fit for them. “The Peers themselves are the critical factor and we’re fortunate to have an exceptional group at SickKids,” Kelly says. “Even more important than training is the recruitment of a genuine and authentic complement of Peers. They are responsible for the program’s credibility and, ultimately, H its success.” ■

This article was submitted by the Hospital for Sick Children. 14 HOSPITAL NEWS APRIL 2021

www.hospitalnews.com

16th Annual Hospital News

NURSING HERO AWARDS

NOMINATE G N I S R U N A

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NEWS

The pressures of COVID-19 on an already stressful environment for health workers By Dr. Ann Collins ired and anxious. As we enter the second year of the COVID-19 pandemic in Canada these two words go a long way to describing how Canada’s physicians are feeling. And I know we are not alone. Hospitals have been ground zero in managing the pandemic and everyone working in these hospitals – from cleaners and food services staff to therapists and nurses are feeling the impact. A recent poll of U.S. hospital executives identified provider burnout as one of the most potentially disruptive forces facing hospitals in the next three years and I am sure many Canadian hospital CEOs would echo this sentiment. A recent survey of doctors conducted by the Canadian Medical Association (CMA) shows what a toll the pandemic is taking on the mental health of physicians both in hospitals and in community settings. The poll of more than 1600 physicians found that respondents’ fatigue has increased by 69 per cent over the last year, with 64 per cent experiencing anxiety around the pandemic. A year ago, we and other health care providers were dealing with the stress of procuring adequate (or any) personal protective equipment (PPE) for ourselves, and the unknowns involved in caring for seriously ill-patients sickened by the new virus. Now we must deal with the uncertainties of just when and how COVID-19 vaccines will be distributed, while dealing with a growing number of patients with COVID-19 being admitted to intensive care units (ICUs). The recent CMA poll showed that concerns about the rollout of COVID-19 vaccines was present among 62 per cent of physicians responding to the survey, with uncertainty about the future impacting 63 per cent. Our poll shows that in late February, many doctors were disappointed with how governments were handling the one measure that holds the pros-

Dr. Ann Collines pect of relieving the situation – the supply and distribution of COVID-19 vaccines. There has been good progress made but we can’t let go of our collective determination to vaccinate our population. What needs to be emphasized is that the stressful situation caused by the pandemic came at a time when the system was already overburdened. As a colleague, Alberta anesthesiologist Dr. Alika Lafontaine said in a recent interview “the burnout and moral injury that physicians have been experiencing across the country has always been there. We’ve been overworked and under resourced for many years.” The CMA National Physician Health Survey conducted in 2017

documented some of these concerns and showed nearly one-third of doctors, residents and medical students report burnout and depression at some point in their career. Physicians whose main practice setting was a hospital had increased odds of lower emotional well-being, lower social well-being, and lower psychological well-being, compared with those working in other settings. It should be noted that those managing our health care system are starting to pay attention. The framework seen as essential for maintaining a high-quality health care system, the so-called Quadruple Aim, now includes the health and well-being of those providing care.

While too many physicians continue to deal with mental health issues in silence and fail to receive the necessary care, the pandemic has seen a willingness by many of my colleagues to share their personal circumstances with their peers and on social media. Winnipeg internist and author Dr. Jillian Horton who has just published a highly praised personal memoir “We Are All Perfectly Fine” said she has noted a new “esprit de corps” among physicians in the face of the pandemic. Her perspective is echoed by Dr. Micheal Myers, a psychiatrist who has specialized in treating mental health issues of physicians. “Doctors are reaching out to each other in both directions, asking for help and offering help. More and more physicians are talking about their mental health struggles in significant ways, some in private, others publicly,” he writes. What will it take to significantly improve the well-being and outlook of Canadian physicians? The recent poll found that the most likely contributing factors to positive mental health are directly related to the pandemic. They include getting accustomed to the “new normal”, more time dedicated to self-care, an improved outlook regarding COVID-19, improved work-life integration, and improved availability of PPE. Moving forward, physicians and all hospital workers must have the mental health supports they need to face new challenges. If vaccines succeed in vanquishing the immediate threat of COVID-19, doctors and the hospital sector still face the huge challenge of bridging the care gap for the many patients who have seen postponement of elective procedures due to the pandemic. The COVID-19 pandemic has placed huge pressures on physicians and all front-line workers, not to mention the isolation felt by so many Canadians. We’re all feeling the pressure of a global pandemic that has upend our lives and all that we cherish. Compassion remains the best prescription H now and into the future. ■

Dr. Collins is a family physician in Fredericton, New Brunswick and president of the Canadian Medical Association 16 HOSPITAL NEWS APRIL 2021

www.hospitalnews.com

Infection Control Risk Assessment

ICRA

SMARTER TRAINING SAVES LIVES

The United Brotherhood of Carpenters’ Infection Control Risk Assessment (ICRA) training teaches healthcare construction protocols that save lives. Our training educates Healthcare Personnel, Construction Professionals and Architects in ICRA best practices that protect patients by working safely during all phases of healthcare facility renovations. Contaminants released during renovation projects can lead to deadly healthcare associated infections. This is why it’s critical for anyone working in a healthcare facility during renovation to have participated in ICRA Training.

TRAINED PROFESSIONALS PREVENT THE SPREAD OF DEADLY INFECTIONS

1 in 25

With the UBC ICRA training, you’ll learn necessary safeguards to protect your patients from health hazards during construction.

healthcare associated infection at

hospital patients has at least one

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Safety is priceless. ICRA training is free.

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P R O G R A M

O F

T H E

COVER

What to Watch:

A look at technologies with high potential to transform health care By Barbara Greenwood Dufour he fast pace of medical technology development is already transforming the Canadian health care system. But what game-changers are waiting around the corner? To help health care decision-makers prepare for the adoption of technologies that are not yet widely used, CADTH is continuously scanning the horizon to identify the ones that are the most promising. CADTH is an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures. CADTH recently released its List of 2021 Health Technology Trends to Watch – a list of emerging health technology trends that have potential to significantly influence the future of health care in Canada. To develop its Watch List, CADTH looked for technologies with an FDA Breakthrough Devices Designation and for any other technologies that could change how health care is delivered. Then, CADTH consulted with its Device Advisory Committee for more context and to help determine which technologies had the highest likelihood of having an impact. This article describes just a few of the technologies featured in the Watch List.

WEARABLES

The market for wearable devices – or “wearables” – developed for use in health care continues to grow. Two new wearables have been designed to learn the wearer’s normal vital signs and detect changes in them. One has recently been developed for people with nightmare disorder or who have nightmares associated with post-traumatic stress syndrome. Worn on the wrist (like a smartwatch) while sleeping, the device detects and learns an individual’s normal sleeping heart rate

and body movements. When it senses a change that suggests a nightmare is beginning, the device vibrates gently enough to stop the nightmare without waking up the wearer. Another new wearable has been developed for users of opioids who are at risk of opioid-induced respiratory depression. This device is worn on the chest to detect and learn the normal breathing patterns of the wearer. When it detects abnormal breathing, which could mean the wearer is experiencing respiratory depression, the device sends an alert to first responders.

AUGMENTED AND VIRTUAL REALITY

Augmented reality and virtual reality (VR) technologies are also providing new treatment options for people with various conditions. A new contact lens has been developed that uses augmented reality to help people with low or impaired vision see better – by increasing contrast or brightness, for example. And a VR headset has recently been designed to provide cognitive behavioural therapy, mindfulness, and relaxation programs for people with conditions such as fibromyalgia or chronic low back pain.

ARTIFICIAL INTELLIGENCE

Other innovations included in the Watch List involve the use of artificial intelligence (AI) to create systems for performing health care-related tasks that typically require human intelligence. Two of these are AI-based systems for analyzing diagnostic images – one analyzes CT scans of the brain to detect critical abnormalities that could lead to stroke (such as intracranial hemorrhage and large vessel occlusion), and another analyzes MRI scans of the breast to detect abnormalities that could suggest the presence of breast cancer.

AI-based imaging systems are already being used in all Canadian provinces and some territories. Data on where AI imaging technology is being used in Canada is captured in CADTH’s Canadian Medical Imaging Inventory, available at cadth.ca/cmii.

COVID-19

CADTH also identified new technologies that directly address issues related to COVID-19. As testing for the virus remains an important part of managing the pandemic, new COVID-19 tests are being approved rapidly. A number of home sampling kits have been developed – one that has been approved by Health Canada could soon be available at your local pharmacy. There are also new tests being developed that can detect and differentiate between COVID-19 and influenza from a single sample – some are for use in the lab, while others are for use at the point of care. In addition, 3-D printer designs are emerging that address ventilator shortages resulting from the COVID-19 pandemic. Examples include a new low-cost ventilator design as well as a

design for a plastic adaptor that converts BiPAP (bilevel positive airway pressure) machines into mechanical ventilators – both of which can be quickly 3-D printed on location in a hospital. As is the case with new and emerging technologies, there’s only limited evidence so far on how effective these devices are or how they compare with existing treatments. But CADTH’s Watch List provides an early look at the technologies that could change and impact Canadian health care in the coming years – which can help health care decision-makers see around the next corner. You can access the entire CADTH Watch List at cadth.ca/health-technology-trends-watch. To learn more about our Horizon Scanning program, visit cadth.ca/horizon-scanning, or to suggest a new or emerging health technology for CADTH to review, email us at HorizonScanning@cadth. ca. If you’d like to learn more about CADTH, visit cadth.ca, follow us on Twitter @CADTH_ACMTS, or speak to a Liaison Officer in your reH gion: cadth.ca/Liaison-Officers. ■

Barbara Greenwood Dufour is a knowledge mobilization officer at CADTH. 18 HOSPITAL NEWS APRIL 2021

www.hospitalnews.com

HEALTHCARE HEROES MAKING A DIFFERENCE IN EVERY WAY POSSIBLE

It’s been a long year and the COVID-19 pandemic has hit Canada hard. With stories of hospital bed shortages, delayed medical care, RYHUZRUNHG IURQWOLQH VWDƪ DQG ULVLQJ GHDWK FRXQWV &DQDGLDQV KDYH EHHQ LQ JUHDW QHHG RI VXSSRUW t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p// *(7 7+528*+ 7+,6 Ǭ 72*(7+(5

medtronic.ca

E-HEALTH

Join us for two days of online learning, digital networking, and cyber-celebration – with three weeks of pre-conference events!

e-Health 2021

Virtual Conference and Tradeshow ince 1970, the annual e-Health Conference and Tradeshow has brought Canadian digital health professionals together to network, connect, and learn from one another. With in-demand keynote presenters, expert panelists, and leading-edge exhibitors, e-Health always delivers memorable education and networking opportunities. This May, delegates will connect, learn, and engage virtually

with digital health leaders from across Canada and the world at three unique Pre-Conference Events and two days of stimulating virtual Conference and Tradeshow activities in an all-new interactive environment. After 21 years, e-Health continues to thrive and adapt along with the digital health ecosystem and the people who live in it. Let’s gather virtually to share updates and insights on improving the health of H Canadians through technology. ■

PRE-CONFERENCE EVENTS

• Wednesday, May 5, 2021 from 1:00-3:00pm ET • Wednesday, May 12, 2021 from1:00-3:00pm ET • Wednesday, May 19, 2021 from1:00-3:00pm ET

MAIN CONFERENCE

• Wednesday, May 26, 2021 from 10am-5pm ET • Thursday, May 27, 2021 from 10am-5pm ET

Patients at e-Health We are pleased to announce that the e-Health Conference & Tradeshow is applying for the Patients Included status, continuing with our long-term commitment to incorporate patient expertise into the conference. For more information on Patients Included, please visit the Patients Included website. We strongly believe that e-Health satisfies all five criteria as identified in the Patients Included charter: • Patients or caregivers with experience relevant to the conference’s central theme actively participate in the design and planning of the event, including the selection of themes, topics and speakers. • Patients or caregivers with experience of the issues addressed by the event participate in its delivery and appear in its physical audience. Our

patient advisors will be invited to participate as session moderators during the conference. Patient advisors and scholarship recipients are invited to stay for the duration of the conference and attend any session they choose. • Scholarships are provided to allow patients or caregivers affected by the relevant issues to attend as delegates. All patients and caregivers are eligible to apply for a patient scholarship. • All applicable sessions, breakouts, ancillary meetings, and other program elements are open to patient delegates. • Recorded audio and video of all sessions will also be available via the Virtual Library, to which all registered delegates have complimentary H access. ■

#eHealth2021 is hosted by:

20 HOSPITAL NEWS APRIL 2021

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E-HEALTH

What’s new this year THREE DAYS OF PRECONFERENCE EVENTS

Conference registration includes attendance at the two-day e-Health 2021 Virtual Conference and Tradeshow on Wednesday, May 26 and Thursday, May 27, 2021 as well as three Pre-Conference Virtual Events (May 5, May 12, and May 19), plus access to the e-Health Virtual Library. • Wednesday, May 5, 2021 from 1:003:00pm ET • Wednesday, May 12, 2021 from1:003:00pm ET • Wednesday, May 19, 2021 from1:003:00pm ET

VIRTUAL NETWORKING WITH HOT TOPIC ROUNDTABLES

Half-hour roundtable networking breaks are scheduled throughout the conference to break up the day and give everyone a chance to pause and refresh or network and connect with other attendees. Enter the Remo virtual networking platform for real-time, face-to-face engagement with optional

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Hot Topic Roundtables featuring moderated pre-selected discussion topics to keep the e-Health conversation going between sessions.

VIRTUAL TRADESHOW AND EXHIBIT HALL

The e-Health 2021 virtual conference platform includes a 2D Welcome Area, Help Desk, Exhibit Hall and more, elevating the online exhibit experience and introducing more options for interaction and easy navigation.

VISIT THE E-HEALTH VIRTUAL LIBRARY

All the great presentations from the e-Health 2020 Virtual PopUp have been brought together in one place so that you can watch and re-watch any of the sessions. e-Health 2020 Virtual PopUp Attendees enjoy complimentary access to the 2020 e-Health Virtual Library. Login with the unique Access Code emailed to all attendees (Contact info@e-healthconference. com if you didn’t receive your access H code). ■

e-Health 2021 Patient Partners “The passion for eHealth across this nation is inspiring! Collaborating with other experienced health, industry, and patient leaders across Canada to steer programming has been insightful and a wonderful opportunity. You can expect a virtual conference equally as inspiring and insightful!” – Alissa MacMullin “As a patient partner on the Program Committee at e-Health 2021, I am consulted and empowered to participate as a full committee member. Patient engagement is ever-present at e- Health 2021!” – Christine MacKinnon “It has been an insightful opportunity to see what is happening across Canada when it comes to the adaptation and progression of the digital health landscape. It is encouraging to see how industry and care has adapted to the COVID Pandemic and used the opportunity to not only enhance care in our communities, but to progress the adoption of digital solutions in the future of health care.” – Sarah Hissett

APRIL 2021 HOSPITAL NEWS 21

Same compelling content. We can’t meet in person, but Canadian digital health professionals can still count on the annual e-Health Conference and Tradeshow to deliver valuable networking, quality content, great speakers, and multiple learning opportunities. This year, let’s meet online at three unique Pre-Conference virtual events and over two days of virtual Conference and Tradeshow activities—in an all-new interactive online environment! These days, making connections can be hard. e-Health makes it easy.

Early Bird Savings until March 30, 2021 Register at e-healthconference.com

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E-HEALTH

Pre-Conference events

May is e-Health month with three pre-conference events on May 5, May 12, and May 19. Each day features a Public-Private Showcase (May 5: Consulate General of the Kingdom of the Netherlands in Toronto; May 12: Cisco; May 19: Empower Health/iamsick. ca) and four virtual e-Poster Presentations. e-Poster presentation topics include: • Data Quality Improvement from AI-Powered Auditing • Comparing Wearable Devices for Use in Public Health Surveillance • Developing an Informatics Competency Self-Assessment Tool for Nurse Leaders • Business Intelligence Dashboards for Patient Safety and Quality • Virtual Family-Centered Rounds: A Collaborative Necessity During COVID-19 and Beyond • Delivering Home Care Virtually: Lessons Learned through a Rapid Expansion • Kids Uncomplicated: Effective Virtual Intervention for Children and Families Using Teleroo World • Population-level Behavioural Changes Due to Covid-19 Using IoT data • Optimizing Major Trauma Patient Care Journey to Definitive Care • A Provincial Approach to Immunization Scheduling and Documentation Utilizing EMR • Using Computer Assisted Physician Documentation (CAPD) to Improve Documentation Quality • Competency-based Education Programs Prepare Health Care Leaders H for the Future ■

Right patient

Right care

Find out more at orionhealth.com

24 HOSPITAL NEWS APRIL 2021

Program highlights: THURSDAY, MAY 27 (DAY TWO) Time

Session

Details