Hospital News December by Hospital News

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December 2020 Edition

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The effects of violence are life-changing.

For Ontario’s nurses and other health-care professionals, the risk of workplace violence is very real. Surveys indicate that 54 per cent of front-line health-care workers have been physically assaulted and 86 per cent have experienced verbal abuse. But those numbers don’t tell the whole story. Although workplace violence often explodes in an instant, the trauma lasts for weeks, months, sometimes years. A single act or even the persistent fear of violence can end a career. As the pandemic brings new levels of stress and tension, the probability of violence will increase. When hospitals and other health-care employers make excuses, they send a message that nurses are expendable. It’s time for change. We need better security, staffing, training, and policies, and we need stronger enforcement of Ontario’s safety laws. That’s the only way we’ll protect nurses, health-care workers, and patients, residents, and clients alike.

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Contents December 2020 Edition

IN THIS ISSUE:

Blood type factor in COVID-19 severity

▲ Cover story: 2020: The year that will reshape healthcare

▲ We will pull through

▲ Aging and brain health solutions making impact in diverse communities

COLUMNS Guest Editorial .................4 In brief .............................6

Safe medication ............36 From the CEO’s desk .....37 Evidence matters ...........40 Data pulse ......................47

▲ Special focus: Canadian Association of Radiologists

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Innovative solution to help protect health care workers

▲ Digital humans combine convenience and compassion

Canada is failing our health care workers Health care workers in Canada represent nearly one in five cases of COVID-19, twice the global average By Linda Silas n November 3, 2020, the Public Health Agency of Canada (PHAC) updated its guidance on the routes of transmission of COVID-19 to recognize potential aerosol spread of the virus. While it elicited little fanfare, this critical move came in response to months of pressure from labour unions and health care advocates who had urged PHAC to recognize recent scientific evidence that pointed to airborne transmission as one of the possible ways COVID-19 is spread. While we welcome PHAC’s recent recognition of the airborne spread of the virus, Canada could have fared much better had it only heeded the lessons learned from its own experience with SARS in 2003. From the moment the virus was detected on Canadian soil, the precautionary principle should have guided our nation’s course of action. The precautionary principle holds that in the absence of scientific certainty about how an illness is spread, we must err on the side of caution and adopt preventive measures to protect health care workers and their patients. Canada’s failure to take a precautionary approach has had profound consequences for health care workers. For months, they have followed the government’s advice in their workplaces, caring for presumed and infected COVID-19 patients, at close range and for long periods of time, and often in wards that lack proper ventilation. We are now at a decisive moment. In light of the airborne spread of COVID-19, we remain deeply concerned by PHAC’s failure to update its guidance on personal protective equipment and other protective measures for health care workers.

UPCOMING DEADLINES

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Following the release of Mario Possamai’s landmark report, A Time of Fear: How Canada failed our health care workers and mismanaged COVID-19, dozens of experts from around the globe – including the Canadian Federation of Nurses Unions – co-signed a consensus statement based on the report’s key recommendations. Among them is that safety guidelines for health care workers should be developed with the precautionary principle acting as a core principle and with the active involvement of health care worker unions. Other signatories to the statement include Dr. Lidia Morawska and Dr. Donald Milton, who co-authored an open letter in July, signed by 239 scientists from 32 countries, urging the World Health Organization to recognize the potential for the airborne transmission of COVID-19 and to adopt preventive measures to mitigate its spread. In Canada, health care workers represent nearly one in five cases of COVID-19, approximately twice the global average. As we battle a second wave, there is little to be gained from pointing fingers. Our collective focus should be on scaling up efforts to protect health care workers now, as well as absorbing the lessons from the first wave and earlier disease outbreaks. Going forward, all guidance impacting the safety of health care workers must be made on a precautionary basis by workplace regulators, health care worker unions and worker safety experts – those decisions should form the basis of health worker safety guidance issued by public health agencies. Continued on page 5

JANUARY 2021 ISSUE

FEBRUARY 2021 ISSUE

EDITORIAL: December 9 ADVERTISING: Display – December 11 | Careers – December 15

EDITORIAL: January 11 ADVERTISING: Display – January 22 | Careers – January 26

Monthly Focus: Professional Development/Continuing Medical Education (CME)/Human Resources: Continuing Medical Education (CME) for healthcare professionals. The use of simulation in training.Human resource programs implemented to manage stress in the workplace and attract and retain healthcare staff. Health and safety issues for healthcare professionals. Quality work environment initiatives and outcomes.

Monthly Focus: Gerontology/Alternate Level of Care/Rehab/ Wound Care/Procurement: Geriatric medicine, aging-related health issues and senior friendly strategies. Best practices in care transitions that improve patient flow through the continuum of care. Rehabilitation techniques for a variety of injuries and diseases. Innovation in the treatment and prevention of wounds.

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NEWS

The blood type factor in COVID-19 severity Patients with A or AB blood groups were more likely to need mechanical ventilation and dialysis, and be hospitalized longer. By Vivian Sum n analysis of COVID-19 cases at six greater Vancouver health centres has revealed a link between A or AB blood group patients and more severe COVID-19 outcomes than O or B patients. The study, led by Vancouver Coastal Health Research Institute researcher Dr. Mypinder Sekhon, points to two main factors that seem to have a protective effect against COVID-19. “These findings open a door to knowledge that could help us understand the reasons underpinning the differences in susceptibility and severity in individual patients with COVID-19,” says Sekhon. “However, they do not change current public health recommendations surrounding how people should take precautions to protect themselves and others around them against infection.” Sekhon’s study was published in Blood Advances, the journal of the

Researcher Dr. Mypinder Sekhon. American Society of Hematology, in October 2020. Sekhon and co-authors’ research findings show that 84 per cent of blood type A or AB patients with respiratory complications due to severe COVID-19 illness – which infects and can damage lung tissues – required mechanical ventilation versus 61 per cent of O or B patients.

Failing our health care workers Continued from page 4 PHAC has yet to offer assurances that its guidance will be updated to recommend airborne protections for health care workers. The federal agency’s continued lack of flexibility in responding to emerging science is troubling and poses serious questions about PHAC’s approach to worker safety. The true cost of these decisions is measured in the infections and deaths of health care workers and the Canadian public who have put their trust in our leaders and public health experts to see us through this pandemic. It’s essential that workers are treated as partners when decisions impacting their safety are made. We mustn’t forget: there is no patient safety without health care worker safety. Throughout the first wave, we heard from health care workers who

felt that they had been treated like their lives were disposable. Without proper protection, they nonetheless ran towards the pandemic and risked their lives to treat the sick and stem the spread of the virus. When Canada needed them most, health care workers were there for us. Our decision-makers can’t let them down a second time. As a second wave grips the nation, immediate action is needed to prevent even more deaths and further trauma. We are running out of time. The Public Health Agency of Canada needs to immediately undertake a review of its guidance on infection prevention and control for health care workers and require airborne precautions for all those caring for patients with suspected and confirmed H COVID-19. ■

Thirty-two per cent of A or AB patients required continuous renal replacement therapy (CRRT) – a type of dialysis used to treat severe kidney failure – compared to nine per cent of O or B patients. Approximately 15-50 per cent of COVID-19 patients admitted to an ICU have experienced some form of acute kidney injury from the infection1. “A or AB patients remained in the intensive care unit 4.5 days longer than O or B patients – a median of 13.5 days versus nine,” notes Sekhon. Study data was collected from a cohort of 125 critically ill COVID-19 patients admitted to an intensive care unit between March 1 and April 28, 2020. Blood type demographics were representative of the general Canadian and British Columbian populations, according to statistics the research team sourced from Canadian Blood Services. “While blood type was not shown to be more or less likely to bring someone into hospital, once there, A or AB patients’ symptoms were on average more severe,” says Sekhon. Protective factors among O or B blood types likely play a role The anti-A antibody flowing through the veins of individuals with

O or B blood types may disrupt the attempts of the COVID-19 virus to attach to the angiotensin converting enzyme 2 (ACE2) receptor and gain entry into cells, says Sekhon. ACE2 provides a doorway for COVID-19 to infect cells, and the ACE2 receptor is like a sign guiding the way in. A connection between blood type and disease outcomes was similarly made during the 2003 Sars-CoV-1 (SARS) outbreak. Individuals with blood group O or B seemed to be less susceptible to this particular coronavirus strain than A or AB patients. The SARS outbreak affected over 24 countries and claimed the lives of more than 700 people before it was contained. O and B patients may have less severe physical implications because of differences in factors related to blood clotting, compared with blood groups A and AB, says Sekhon. However, additional research is needed to identify whether this or other factors are at play. “Our logical next steps are to look at the clotting factors in a patient cohort, further differences by blood group, antibody levels and differences in the immune system responses of both A or H AB and O or B cohorts.” ■

Vivian Sum works in communications at Vancouver Coastal Health Research Institute.

Linda Silas is a nurse and President of the Canadian Federation of Nurses Unions, representing nearly 200,000 nurses and student nurses across the country. www.hospitalnews.com

DECEMBER 2020 HOSPITAL NEWS 5

IN BRIEF

New innovative care model

COVID Care @ Home OVID Care @ Home is a new model of care delivered by St. Joseph’s Home Care (SJHC), in partnership with St. Joseph’s Health System (SJHS), Niagara Health and community partners that connects patients to care wherever they are, whenever they need it. Starting at St. Joseph’s Healthcare Hamilton and Niagara Health, with rapid expansion to Kitchener, this new model of care for COVID patients will provide 24/7 access to high-quality care from one integrated team in the home and in community settings like retirement homes, shelters and hospices. COVID Care @ Home is a uniquely designed program intended for those with a confirmed COVID diagnosis who do not require hospitalization. Complimenting existing local COVID initiatives, the program will support integrated care at home, early discharge from hospitals with supports and help

COVID CARE @ HOME IS A UNIQUELY DESIGNED PROGRAM INTENDED FOR THOSE WITH A CONFIRMED COVID DIAGNOSIS WHO DO NOT REQUIRE HOSPITALIZATION.

to prevent hospitalization. It will also help to prevent outbreaks by providing Infection Prevention and Control (IPAC) and coaching support for community congregate settings. Patients will be assessed to determine what level of service will be provided. Vulnerable patients who are at risk of hospitalization and who require additional supports and services will have access to an integrated clinical care team, remote monitoring and at-home and virtual visits to support a safe recovery at home. This same model of care will be available to patients dis-

charged from hospital so they can safely return home sooner. This innovative, flexible model would provide COVID patients access to services that may not typically be within the scope of traditional home and community care supports. Patients will be cared for by one integrated team representing a variety of providers whose clinical decisions are empowered through the use of a single electronic patient record to support patients in the following ways: • Virtual Care (phone, video and remote patient monitoring)

• One number to call 24/7 • One clinical team • One electronic record • System navigation / connection to social supports • Access to specialists • IPAC Support The program is designed to support older adults who are at greater risk of physical and mental health decline. Patients will be enrolled by the clinical teams at the time of their COVID 19 diagnosis. The new model will also help to protect capacity in hospitals by expanding supports and services in the community through a dedicated team that will facilitate care at home, support safe discharges from hospital and limit unnecessary Emergency Department visits. This will help hospitals to maintain capacity and services during a second wave as well as continuing scheduled surgeries to reduce wait lists and H backlogs. ■

Aggressive public health measures needed to safeguard hospital capacity and protect residents of long-term care he Ontario Hospital Association (OHA) supports the Government of Ontario’s decision to move the Regions of Peel and Toronto into lockdown for the next 28 days to curtail the rise in new COVID-19 cases, safeguard the province’s finite hospital capacity and ensure residents in long-term care are safe. Hospitalizations have been rising steadily across the province in recent weeks and the number of COVID-19 patients admitted to intensive care units reached 150 on November 19th – a threshold that will require some hospitals to postpone some surgeries and procedures.

6 HOSPITAL NEWS DECEMBER 2020

ONTARIO HOSPITALS COULD FACE POTENTIALLY CATASTROPHIC CONDITIONS WITHIN WEEKS. The OHA has called for and participated in efforts to protect long-term care residents since the early stages of the pandemic and lockdown is vitally needed to limit further spread of COVID-19 in the community. Federal pandemic modelling demonstrates that Ontario hospitals could face potentially catastrophic conditions within weeks. Given this unthinkable risk, other regions with high rates of transmission, such as

York, must be monitored closely and evaluated weekly based on the most current evidence and data. Prudence and vigilance will also be required when considering whether or not to remove public health measures to prevent a resurgence of cases over the winter holiday and into the New Year. For instance, robust test-and-trace capability must be in place locally if measures are to be lifted once infection rates decline.

Implementing a lockdown is a horrifying decision for any government to have to make given the enormous impact on businesses and their employees, and the OHA applauds the Government of Ontario and Government of Canada for providing continued support to businesses affected by the lockdown. Additional investments are also urgently needed to assist Ontario workers who are at disproportionate risk of exposure to COVID-19 and who are not receiving compensation to self-isolate or to recover when sick. We ask the Government of Ontario to make these supports available H at the earliest opportunity.” ■ www.hospitalnews.com

IN BRIEF

Early invasive intervention for atrial fibrillation may improve patient outcomes octors from the Montreal Heart Institute (MHI) presented new data at the American Heart Association Late-Breaking Scientific Sessions. Simultaneously published in the New England Journal of Medicine, the data shows that catheter ablation as first-line treatment may be better than antiarrhythmic drugs in preventing the recurrence of abnormal heart rhythm (atrial tachyarrhythmia, atrial fibrillation), and improve patient well-being. Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting approximately one to two per cent of the overall population. Treatment guidelines recommend a trial of drug therapy to maintain a normal atrial heart rhythm before catheter ablation is considered. However, these medications have only limited ability to maintain a normal heart rhythm and have substantial side effects. Catheter ablation is considered superior to antiarrhythmic drugs in maintaining heart (sinus) rhythm and improving

PATIENTS TREATED WITH INITIAL ABLATION HAD A SIGNIFICANTLY GREATER IMPROVEMENT IN MULTIPLE MEASURES OF QUALITY OF LIFE, WERE MORE LIKELY TO BE ASYMPTOMATIC, AND HAD A LOWER RATE OF HOSPITALIZATION. quality of life in patients in whom drugs have already failed but it was previously unknown whether earlier ablation could improve patient outcomes. Data from The Early Aggressive Invasive Intervention for Atrial Fibrillation (EARLY-AF) trial found that in treatment-naïve patients with symptomatic AF, initial catheter cryoballoon ablation resulted in a significantly lower recurrence of arrhythmia compared to those who received antiarrhythmic drug therapy. “Atrial fibrillation is associated with significant morbidity, and an estimated two-fold increase in premature death. Unfortunately, patient outcomes are

worse when ablation is delayed.,” says Dr Jason Andrade, electrophysiologist affiliated with the MHI, assistant Professor of Medicine, Université de Montréal and lead author of the EARLY-AF study. “These data add to evidence that an early invasive therapy may be a more effective method to improve the lives of our patients with atrial fibrillation. In addition, this study supports the recommendation of pursuing catheter ablation an initial treatment strategy in appropriate patients,” adds Dr Laurent Macle, chief of the electrophysiology service at MHI, and co-chair of the recently published 2020 Canadian Cardiovascular Society Atrial Fibrillation guidelines.

The EARLY-AF study was a multicenter, parallel-group, randomized trial that enrolled participants with treatment-naïve symptomatic AF. A total of 303 patients were randomly assigned either to undergo cryoablation (154 patients) or to receive antiarrhythmic drug therapy (149 patients). At one year, a recurrence of symptomatic episodes of atrial tachyarrhythmia had occurred in 17 of 154 patients (11.0%) assigned to undergo ablation and in 39 of 149 patients (26.2%) assigned to receive antiarrhythmic drugs (hazard ratio, 0.39; 95% confidence interval [CI], 0.22 to 0.68; P<0.001). Patients treated with initial ablation had a significantly greater improvement in multiple measures of quality of life, were more likely to be asymptomatic, and had a lower rate of hospitalization. Serious adverse events occurred in five patients (3.2%) who underwent ablation and in six patients (4.0%) who received antiarrhythmic H drugs. ■

New data released by the Canadian Institute for Health Information (CIHI) ew data released by the Canadian Institute for Health Information (CIHI) examines how Canada’s health care systems were impacted by COVID-19 from March to June 2020, a period widely referred to as Wave 1 of the pandemic.

EMERGENCY DEPARTMENTS (EDS)

• ED volumes dropped an estimated 25,000 visits a day in April 2020 compared with April 2019, representing approximately half the usual number of patients. This trend continued throughout Wave 1, but volumes had rebounded to about 85 per cent of typical visits by June. • There was a six per cent increase in the number of deaths in the ED. Cardiac conditions were the most www.hospitalnews.com

commonly reported among those who died between March and June in both 2019 and 2020. • Those who went to the ED waited less time to see a physician. • In Ontario, the median ED wait time during this period was 46 minutes, down 27 minutes from the median wait time in 2019 (1 hour and 13 minutes).

HOSPITAL CARE

• To accommodate a potential surge of COVID-19 patients, hospitals cancelled less-urgent surgeries. There were more than 320,000 fewer planned inpatient surgeries and day procedures from March to June 2019 compared with 2020 in Canada (excluding Quebec). • Hospitals prioritized life-saving/urgent surgeries and medical care, and

generally operated below capacity from March to June. By June, occupancy levels had returned to 75 per cent of the previous year’s. • While there was an increase in respiratory conditions in intensive care units (ICUs), mainly due to COVID-19, overall occupancy was below previous year’s occupancy.

VIRTUAL CARE

• To facilitate physical distancing, physicians provided in-person care in urgent situations only, and overall patient care dropped across all health care relative to the previous year. • Physicians adapted quickly to the pandemic, with 55 per cent of patient visits, physician-to-physician consults and psychotherapy provided online or by phone in April 2020.

HOME CARE

• Provision of home care also changed during Wave 1, with 41 per cent fewer initial home care screening assessments by April 2020 compared with the previous year. Screening assessments are the first step in setting up regular home care visits for a client. “This data helps us understand how the first wave affected different types of health services. As the pandemic evolves, we will continue to monitor these trends, supporting health system planners in their efforts to provide necessary care to patients, preserve capacity for COVID-19–related surges and minimize the risk for both patients and health care providers,” says Kathleen Morris, Vice President, Research and H Analysis, CIHI. ■ DECEMBER 2020 HOSPITAL NEWS 7

NEWS

We will pull through By Dr. Ann Collins 020 will go down in the books as the Year of Sacrifice. While the COVID-19 pandemic has upended our lives in almost every way, for health care workers in particular, the challenges to how we work and how we live have been unparalleled. Yet somehow, this battle against the virus continues. As I write this, COVID-19 cases across Canada are soaring – averaging 4,000 new cases and 50 deaths per day. Numbers are higher than at the height of the first wave of the pandemic, with governments scrambling to control the spike. We knew for months that a second and potentially more deadly wave was coming. As we head into winter, we’re seeing these predictions play out in real time. Communities like Nunavut that were previously COVID-19 free are now grappling with outbreaks. The Atlantic bubble, which appeared to shield those provinces from the virus, has broken. COVID-19 continues to be a threat in every province and territory. It is distressing. But I strongly believe we can bring cases under control if we have a political leadership that prioritizes health expertise and proper support for front-line workers, and a commitment from Canadians to do their part to prevent infection. As winter takes hold and people spend more time indoors, we need to work twice as hard to contain the spread. Everyone is growing tired of the restrictions affecting all our lives – physical distancing, cancelling normal activities and limiting interactions with loved ones. Yet we can’t let Canadians succumb to this widespread fatigue. This threat is what keeps me up at night – that the public and policy makers will let down their defences when

AS WINTER TAKES HOLD AND PEOPLE SPEND MORE TIME INDOORS, WE NEED TO WORK TWICE AS HARD TO CONTAIN THE SPREAD. front-line health care workers have had so little reprieve. The sacrifices you’ve made to keep others healthy cannot be overlooked or underestimated. What also cannot be overlooked are the weaknesses in our health care system. The pandemic has added thousands more Canadians to wait lists for surgeries, and it will take significant action to reduce these wait times. According to an October report commissioned by the Canadian Medical Association, it will cost at least $1.3 billion to return wait lists for six common procedures – col-

lectively amounting to 80 per cent of diagnostic and surgical care – to pre-pandemic levels. We also know that how we care for seniors must be redesigned. We need to implement pan-Canadian long-term care standards to prevent COVID-19 from continuing to ravage long-term care facilities. At the same time, this pandemic has brought new solutions to light. Virtual care has been quickly adopted and is now playing a much greater role in how we deliver care. And patients are getting onboard. Earlier this year, the CMA commissioned

a survey showing a high satisfaction rate among patients who accessed virtual care. In fact, almost half of the Canadians surveyed said moving forward, they would prefer that the first point of contact with a doctor be virtual. And we’ve only tapped the surface of what can be done in this area. Other positives could eventually emerge. Right now, there’s an incredible burden weighing on our collective shoulders as we consider what our country will look like on the other side of this pandemic. But we will pull through, and we can rebuild a stronger health care system. I take comfort in knowing that one day we will remember this as a time when we made superhuman efforts to take care of each other. We are still in this H together. ■

Dr. Ann Collins is president of the Canadian Medical Association 8 HOSPITAL NEWS DECEMBER 2020

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New challenges of medical and IoT device security By David Jirku, National Healthcare Lead, Solutions Architecture, Cisco Canada atient monitors, ventilators, pulse oximeters and digital imaging workstations are all embedded with sensors, software and other technologies to connect them to a hospital’s network. Globally, the number of these kinds of devices – also known as IoT devices – is growing by approximately 20 per cent every year, and healthcare alone accounts for over 60 per cent of all IoT deployment. The volume of healthcare data being transferred and stored from these devices is immense, and is transforming how healthcare is delivered: improving day-to-day operations, bettering patient treatment and outcomes, and reducing costs. However, IoT devices come with their own security risk. Medical devices are purpose built to serve a specific function and the security of these devices isn’t necessarily top-of-mind for manufacturers. Instead, they often rely on the network to provide a security barrier between devices and bad actors looking to gain access. Of course, with the COVID-19 pandemic, the complexity of maintaining the security of the hospital network – and the medical and IoT devices connected to it – has increased. Here are just a few of the security trends we’ve seen arise, and considerations to defend against them.

moved or plugged into the wrong port, that layer of security is now gone and can provide an opening for an attacker. As hospitals have adapted to provide care during the pandemic, from rethinking physical spaces to providing remote care, more administrative overhead is required to ensure networks are being reconfigured correctly and that devices are not being left exposed.

ATTACKS ON HEALTHCARE INSTITUTIONS ARE ON THE RISE

Healthcare records are extremely valuable on the black market compared to other personal data, like credit card information or social security numbers. This value means there is a greater demand for that information, which has only increased in the last nine months due to COVID. To complicate matters, 60 per cent of medical devices are at endwww.hospitalnews.com

PROTECTING PATIENTS, STAFF AND INTERNETCONNECTED DEVICES David Jirku

ON AVERAGE, IT TAKES A HEALTHCARE ORGANIZATION 55 DAYS TO DETECT THAT A BREACH HAS OCCURRED. THAT’S 55 DAYS OF DATA BEING EXFILTRATED FROM THE SYSTEM. of-life stage, with no patches or upgrades available. The average age of medical devices is 20+ years. This makes them significant targets for hackers. It may not always be clear when there has been a breach, either. On average, it takes a healthcare organization 55 days to detect that a breach has occurred. That’s 55 days of data being exfiltrated from the system. Healthcare providers must look beyond “normal” and even the “new normal” to embrace the ever-changing reality of the future with new levels of resilience and greater attention to security.

DYNAMICS INSIDE AND OUTSIDE THE HOSPITAL ARE EVOLVING

Managing patient care has shifted from remaining solely inside the four walls of the hospital, to self-managed

care due to the pandemic. Hospital floors are being reorganized to accommodate new needs. Patients may be redirected to a drive-through testing centre. Outpatient care could be delivered virtually. This means network security must become more flexible and agile to safely accommodate these new demands. For example, a patient or visitor may access the wireless network to check email or watch Netflix. Previously, this was all well and good because the hospital has segmented the network for this type of interaction, meaning ports that connect to a ventilator don’t allow for crosstalk between a patient device. However, this approach has typically been done in a very static fashion. Certain ports are dedicated to medical devices, and others are dedicated to wireless access points that provide guest network access. If a device is

Protecting patient data and securing networks, users and devices cannot fall by the wayside. As the number of attacks in healthcare continue to increase and the dynamics inside and outside of the hospital continue to change, healthcare providers must take a second look at their security strategy. Start by asking yourself these questions: Ý 'R \RX KDYH JRRG YLVLELOLW\ LQWR \RXU hospital network? For example, can you identify all endpoints on the network and their security posture? Ý 'R \RX KDYH WKH DELOLW\ WR TXLFNO\ identify, isolate, and remediate cyber attacks? Ý &DQ \RX FRQWURO DFFHVV WR SDWLHQW data at the device, location, and user level to minimize risk? Ý 'RHV \RXU ,7 WHDP KDYH WKH DQDO\Wical insights it needs to minimize security risks and troubleshoot known issues? Being able to answer “yes” to these questions can ensure that IT administrators have the insight, flexibility and agility they need to defend a hospital network – and the devices connected to it – in an constantly changing environment. Not sure if you have the right solutions in place? Learn more about Cisco’s healthcare portfolio and H how it can help here. Q

DECEMBER 2020 HOSPITAL NEWS 15

The future of healthcare is

NEWS

less invasive By Neil Fraser

s Canada heads into winter and closes the door on 2020, hospitals are feeling increasingly snowed in by rising COVID-19 cases and growing wait lists for diagnostic and surgical procedures, estimated by Deloitte to be over 300,000 procedures in Canada. As we open the door to a new year, how can we avoid taking one step forward and two steps back as the pandemic forces hospitals to deal with the conflicting demands of clearing surgical backlogs and creating inpatient bed capacity? The problem is big, but the answer is less invasive. One of the greatest lessons the pandemic has taught us is that we need to prioritize solutions that free up bed capacity and reduce the burden on healthcare professionals, while also reducing the risk of virus and infection exposure to both clinicians and patients. We can do this by leveraging technologies and processes that reduce the time between procedures and discharge, prevent readmissions, and allow for remote monitoring from home. How? By expanding the use of minimally invasive surgeries (MIS).

EXPANDING USE OF MIS

When compared to open surgery, MIS patients can experience lower rates of complications, shorter hospital stays, decreased blood loss and lower readmittance rates – all at lower overall cost . In addition to traditional MIS procedures, MIS can be further leveraged and expanded through minimally invasive implants, robotics and virtual care. Consider how miniaturization innovations in pacemaker technology have enabled some cardiac patients to avoid more invasive surgery through a minimally invasive procedure by replacing a traditional pacemaker with a tiny lead-

less, capsule-shaped device – approximately 2.5 centimetres in length – that is implanted directly into a patient’s heart via a catheter through the femoral artery. Or the transcatheter aortic valve implant that can also be implanted via a catheter, avoiding the higher risk of complications associated with major open heart surgery.

ROBOTS CAN HELP REDUCE RISK

Paired with Robotic Assisted Surgeries (RAS), the benefits of MIS can be further amplified. Robotic surgery allows surgeons to conduct procedures through even smaller incisions which reduce recovery time and risk of infection. For example, a 2019 study in Denmark comparing minimally invasive RAS for endometrial cancer found the use of minimally invasive RAS reduces surgical morbidity and significantly reduced risk of severe complications.

In highly complex surgeries, such as spine surgery, RAS enables increased accuracy and precision resulting in reduced operative time, length of stay and blood loss, as well as providing a less disruptive option to the patient.

LEVERAGING COLLECTIVE WILL

This change to increased use of minimally invasive surgeries, supported by robotics, can be achieved faster than most would think. The example of increased utilization of virtual care in 2020 is proof of what’s possible when there is a collective will to implement solutions with a clear benefit to patients, healthcare providers, and the healthcare system. The use of remote monitoring technologies for people with Type 1 diabetes and cardiac patients with implanted devices has increased significantly during the pandemic for

these reasons. And numerous studies have demonstrated that remote monitoring of cardiac device patients can reduce in-person clinic visits with no change in patient safety while also improving long-term patient survival.

PATIENT PREFERENCE

Patient preference for virtual care during the pandemic made adoption easier. The same can be expected of minimally invasive surgery. We need to begin to see patients as consumers and rethink care from their perspective, offering procedures that minimize not only their exposure risk but also their discomfort and the disruption of their daily life. We are in desperate need for innovative solutions to overcome the destructive impact COVID-19 has had on our healthcare system. There has never been a better time to harness the full power of minimally invasive H surgeries. ■

Neil Fraser is President of Medtronic Canada. 16 HOSPITAL NEWS DECEMBER 2020

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NEWS

How digital humans are

combining convenience and compassion

By Piers Smith t is an understatement to say that 2020 has been a challenging year for those in healthcare. COVID-19 has overwhelmed healthcare workers across the nation and changed the way healthcare is provided and received. The coronavirus has caused many healthcare providers to adopt a form of conversational AI, the most common being chatbots, to assist patients as front-line workers become burdened with other tasks. While they are not meant to diagnose individuals, textbased chatbots provide patients with a contact-free solution where they can ask questions, fill out forms, and symptom screen from the comfort of their own home. However, a study done by the Journal of Consumer Research, indicates that people don’t fully trust text-based AI. While it is human nature to view oneself as unique and one-of-a-kind, the same pertains to the way we view our symptoms. The research showed that individuals do not believe programmed algorithms within these chatbots can accurately detect their symptoms because they think only a human doctor can understand how they feel. Text-based conversational AI is clearly lacking when it comes to making patients feel understood. While these forms of conversational AI can answer questions, fill out forms, and give helpful advice without having patients step foot outside, people can’t seem to get over the fact that at the end of the day, they are talking to a robot. Enter digital humans. Digital humans are a form of conversational AI that look, interact, and act like real humans. Available

DIGITAL HUMANS ARE A FORM OF CONVERSATIONAL AI THAT LOOK, INTERACT, AND ACT LIKE REAL HUMANS. 24-hours a day, seven days a week, and equipped with the ability to speak over 40 languages, digital humans can be used anywhere, by anyone, at any time. By having patients interact with a hyper-realistic digital avatar that has a personality, facial expressions, and voice inflections, patients are put at ease and are more likely to trust a digital human in comparison to a textbased chatbot because they add empathy to the equation.

18 HOSPITAL NEWS DECEMBER 2020

Take a study conducted by the University of Southern California, for example. Researchers wanted to see how returning soldiers’ disclosed information about post-traumatic stress disorder symptoms to AI. In the first phase of the trial, the veterans were given the option of interacting with a faceless AI system or a person. The results showed that the veterans who chose the faceless system were more likely to disclose more details about their symptoms than their

counterparts who talked to a human, since they felt like they weren’t being judged. In the second phase of the study, researchers named the faceless system and added a computer-generated face and body creating Ellie, the digital human. With Ellie, they found veterans were twice as likely to report PTSD symptoms to Ellie than to the faceless system because they established a connection with her, which in turn, allowed them to feel comfortable enough to disclose more. This study indicates adding a face and other human characteristics to existing AI technology can make people more trusting and can even encourage them to be more transparent than they would be with a real www.hospitalnews.com

NEWS human. People need compassion and empathy when it comes to discussing problems with their mental and physical health and digital humans can provide that, while still offering a judgment-free exchange. While these digital humans canâ&#x20AC;&#x2122;t diagnose individuals, they can recommend patients to see a doctor after screening their symptoms. This frees up time for frontline healthcare workers and reduces the risk of illness spread. My colleagues and I developed a digital human named Sophie, that can pre-screen individuals for symptoms of COVID-19. While Sophie did not attempt to diagnose patients with COVID-19, she was programmed to identify a baseline of risk factors and recommend the next steps for the individual. Along with conducting remote triage, digital humans can assist patients with managing major life events, keep track of medication, support the check-out process from hospitals, and

aid rehabilitation and mental health efforts. It is impossible for healthcare professionals to keep track of every patient that has been discharged and continuously check up on them to ensure they are doing their required aftercare. However, digital humans can

engage these patients in their homes and more importantly, keep them engaged in the post-care process through building rapport with them. While traditional, text-based chatbot may get the job done, they are not building meaningful connections with

patients and getting them to follow up. By adding a name, face, and personality to a chatbot, providers will start to see a shift in the number of patients engaging with their conversational AI, as well as an increase in disclosure from H patients. â&#x2013;

Piers Smith is a Healthcare AI Architect at UneeQ.

www.hospitalnews.com

DECEMBER 2020 HOSPITAL NEWS 19

CANADIAN ASSOCIATION OF RADIOLOGISTS

Re-imagining radiology

for the future, through a patient-centered lens OVID-19 has profoundly affected patient access to the healthcare system in Canada. In response to the immense backlog of patients waiting for diagnostic imaging and the threat of burnout of healthcare professionals caused by the pandemic, the Canadian Association of Radiologists (CAR) established a Canadian Radiology Resilience Task Force. The Task Force, led by CAR Board member Dr. Heidi Schmidt, is comprised of radiologists, technologists, and medical physicists from across the country and is supported by the Canadian Agency for Drugs and Technologies in Health (CADTH). Health Canada engaged with the Taskforce as a health system knowledge user. The Taskforce also included international consultation and participation from the United Kingdom, Netherlands, and Germany.

Resilience Now and Beyond Report. The report was informed by member surveys, as well as the best publicly-available data. From the moment the first SARS-CoV-2 cases were recorded in Canada, radiologists stepped up to lead through uncertain and challenging times. The report aims to share lessons learned from the radiology communityâ&#x20AC;&#x2122;s experiences, while celebrating the success stories that have emerged in the face of this difficult process. The report includes four main foci: 1. The impact COVID-19 has had on wait times for medical imaging. 2. Lessons learned during the pandemic, and how radiology can adapt while moving forward. 3. Recommendations for enhancing the resilience of radiology, including investment in human resources, technology, and infrastructure.

THE RADIOLOGY RESILIENCE REPORT PROVIDES GUIDANCE TO THE RADIOLOGY COMMUNITY AND HEALTHCARE TEAMS FOR SUSTAINABILITY OF MEDICAL IMAGING IN CANADA. The Task Force embarked on a Radiology Resilience Now and Beyond initiative to better understand how to prevent gaps in care delivery, and to determine where and how those gaps had been exacerbated by the shutdown. At the center of this enterprise is the desire to maintain continuity of care for patients. Radiology can take a leadership role in the COVID-19 recovery by optimizing service delivery while focusing on the patient experience. After months of work connecting with the community across the country, the CAR published the Radiology

4. The future of radiology and where we see medical imaging in five-10 years. The Task Force examined wait time data for medical imaging and surveyed the current challenges facing radiology departments, with the intent to make recommendations about how to build resilience in the face of disruption. For radiology, developing resilience will enable departments and clinics to recover quickly from difficulties and disruptions with minimal effect on patient care. Resilience also requires capacity and flexibility within the health system to adapt to shifting demands

20 HOSPITAL NEWS DECEMBER 2020

and pressures created by COVID-19 now, and in the future. The Report includes 10 key recommendations: 1. Invest in infrastructure to collect standardized data 2. Adopt standardized imaging prioritization categories and benchmarks across all provinces and territories 3. Invest in human resources 4. Let data drive procurement and investment in capital equipment 5. Institute clinical decision support tools 6. Create centralized intake systems for CT and MRI 7. Reorganize clinical space 8. Reassess the metrics being used to measure radiology performance 9. Harness AI applications 10. Develop a disaster preparedness plan The radiology community in Canada responded to the disruption caused by COVID-19 with a strong, agile response as it endeavoured to adapt to uncertain, complex, and evolving circumstances, while ensuring the continuity of high-quality patient care to the

greatest extent possible. Through this experience, radiology departments and clinics worked to build resilience while fostering their ability to recover from challenges and emerge stronger on the other side. As the pandemic continues, the radiology community has collectively accumulated many lessons learned in responding to the pandemic while continuing to care for patients. This will support the full resumption of services following the pandemic. Some of the new protocols made to patient scheduling, examination workflow, and communication necessitated by these circumstances can be harnessed and retooled to incite lasting, positive change to medical imaging care in Canada. The Radiology Resilience Now and Beyond Report is one of the many initiatives that the CAR, working with healthcare partners, has undertaken during the pandemic to provide radiologists with guidance and to advocate for federal investment in medical imaging equipment, infrastructure, and H health human resources. n www.hospitalnews.com

CANADIAN ASSOCIATION OF RADIOLOGISTS

Robust data collection essential for health system resilience By Dr. Gilles Soulez

tients across modalities. Modalities with high throughput (ultrasound and CT) are more problematic, as there is a greater gap to overcome. Obtaining a complete picture of exactly how many Canadians have been affected by the shutdown and postponement of necessary imaging services remains challenging, given the limitations of the available data.

OVID-19 led to a significant drop in medical imaging examinations from March to June 2020. Patients have been adversely affected by the deferral of imaging procedures and lengthening wait lists. Solutions are needed to ensure a sustainable system so that Canadians can access quality, safe, appropriate care during and after the pandemic.

PATCHY DATA UNDERMINES EFFORTS TO IMPROVE PATIENT ACCESS TO CARE

We cannot improve what we do not measure. There is a shortage of timely and comprehensive data to understand and track imaging volume and demand in Canada, within and across jurisdictions. The Canadian Institute for Health Information (CIHI) reports on this information, but not all provinces and territories contribute and there is no established benchmark for medical imaging wait times. Not all provinces and territories have a centralized inventory of wait lists and there is no universal imaging priority classification system in place in Canada. Imaging wait times are not systematically reported according to a standardized national framework. Furthermore, not all provinces are using the standardized medical imaging wait time benchmarks recommended

WHEN WILL WE CLOSE THE GAP? by the CAR. Pan-Canadian medical imaging wait time benchmarks are necessary to create a national dashboard and methodology which can be used to support and promote equitable access to imaging based on medical need, regardless of geographic challenges. The lack of data is a major hurdle to examining the true impact of the shutdown of services for the health of Canadians. Our attempts to analyze wait time data are limited because data are not available for every province or jurisdiction and the provinces that do have wait time data utilize different benchmarks. Demand for imaging has consistently outpaced supply even with demand being relatively predictable. Prior to COVID-19, wait times for CT and MRI exceeded recognized standards in most provinces, particularly

for patients assigned to non-urgent, non-critical priority levels.

THE COVID-19 EFFECT

Imaging volumes were significantly hindered by curtailing of care deemed non-urgent in the spring and early summer. We observed a late resurgence of imaging throughput in June, but the overall level remained below 80 per cent of pre-COVID activities. The important drop in requisitions during the same period helped to maintain the gap between requisitions and examinations performed at a similar level to pre-COVID-19. However, we can observe a widening of this gap and anticipate an increasingly difficult situation when general referral patterns resume to pre-pandemic levels. We have new volume data indicating growing wait lists for non-urgent pa-

“WE HAD TO SIGNIFICANTLY INCREASE THE TIME SLOTS IN ORDER TO SUCCESSFULLY COMPLETE THE SAME NUMBER OF EXAMS AS DURING THE PRE-COVID PERIOD. THE MAIN ISSUE REMAINS THE RECRUITMENT OF STAFF (TECHNOLOGISTS AND SUPPORT STAFF) WHICH CONTINUES TO BE A CHALLENGE, MAKING IT DIFFICULT TO MEET ALL NEEDS AND THE EXTENDED WORKING HOURS” – NATIONAL AND INTERNATIONAL RADIOLOGY DIRECTORS SURVEY RESPONDENT, JULY 2020

Despite a decreased demand for imaging services between March and June 2020, the number of Canadians with a health condition that necessitates getting a scan has not changed. This means demand will likely return to pre-COVID levels over time, and likely surpass pre-COVID demand to make up for the current decrease. Putting our most optimistic assumption forward as to how quickly CT and MRI services can recover, the total difference between the expected provision of CT and MRI and what is missing accounts for approximately 1,440,000 CT and 612,000 MRI scans between March 2020 and December 2022. We do not know the full extent of the backlog for ultrasound services, but our data suggest a dire lack of ultrasound capacity. These findings will not come as a surprise to most health professionals, however, the pandemic has certainly brought the deficiencies in the healthcare system into the spotlight. Consistently centering around the needs of the patient will naturally lead to the development of data-driven applications and platforms to streamline care pathways and the reasonable exchange of patient data in a jurisdiction-agnostic way. The silver lining of the pandemic may be the recognition of pinch points, barriers, and unnecessary hurdles in the system, and the subsequent building of political will to enact sysH tem-wide change. n

Dr. Gilles Soulez, MD, MSc, FRCPC, FSIR is Professor of Radiology, Université de Montréal and Director of the Laboratory of Clinical Imaging Processing, CHUM Research Center. www.hospitalnews.com

DECEMBER 2020 HOSPITAL NEWS 21

CANADIAN ASSOCIATION OF RADIOLOGISTS

Reproduced with permission from CAR

Artificial intelligence and digitization to enhance the patient experience By Dr. An Tang

he disruption created by COVID-19 has created an opportunity to consider modernization of the patient journey through the healthcare system. Technology “appification” and the improvement of the patient experience through the integration of technology could turn our current structure into a streamlined, paperless, patient-oriented system designed for the 21st century. Appification refers to the use of programs running on mobile devices to provide a user-friendly interface to enter and consult data available on the web or from medical databas-

es. Apps can facilitate patient access and integration with radiology departments but will require overcoming communication, technical, and security barriers encountered in medical imaging. Achieving seamless integration of databases within and between radiology departments will require adoption of open architectures and communication standards by providers of medical databases. Dynamic scheduling apps with real-time notifications can reduce idle time in radiology departments and eliminate the need for crowded waiting rooms. Patients, in consultation with referring physicians, may be able to:

22 HOSPITAL NEWS DECEMBER 2020

• Access necessary imaging services through the web or an app • Note special needs (e.g. allergies, claustrophobia, restricted mobility, scheduling conflicts) • Allow referring to match level of examination priority with the scheduling availability of the department based on wait times • View the impact of special requests on availability • Inform radiology departments of arrival delays • Receive notifications and status updates by phone, in the event of a schedule change • Access information on parking or how to reach the radiology department

• Receive real-time updates on the progress and reporting status of their imaging study Ultimately, appification will allow patients to remain informed and empowered. The implementation of tools that provide more updated information and demystify a needlessly complex patchwork of services, providers, and protocols will greatly improve the patient experience. In the future, patients need not be subject to overbooking, lack of granularity in scheduling, or the disempowerment and anxiety that may result from a lack of information regarding their tests and appointments. The patient journey through a radiology department is a process that www.hospitalnews.com

CANADIAN ASSOCIATION OF RADIOLOGISTS can be greatly improved with enhanced use of technology and apps. For historical reasons, some of the steps – such as requisitions for outpatients and printed preparation instructions – are still paper-based or reliant on faxed copies even when the information is available in digital formats. The Simplified Patient Journey figure illustrates existing processes (in gray) and areas for targeted improvement (in blue) from scheduling and image acquisition through to reporting and subsequent integration with multi-disciplinary care. While all documents are already available in digital format, there is still a propensity to print and mail screening questionnaires and preparation forms. Even for steps that are entirely digital, there is room for improvement with respect to how we link existing systems and information. Complete digitization of the patient workflow has the potential to shorten delays between each step, facilitate automation of repetitive tasks, reduce clerical errors, and enable the use of optimization algorithms and artificial

APPS CAN FACILITATE PATIENT ACCESS AND INTEGRATION WITH RADIOLOGY DEPARTMENTS BUT WILL REQUIRE OVERCOMING COMMUNICATION, TECHNICAL, AND SECURITY BARRIERS ENCOUNTERED IN MEDICAL IMAGING. intelligence for image analysis. From the patient’s perspective, thoughtful integration of technology into the process can improve the overall experience. For example, patients will be able to share their needs and requests, complete screening questionnaires, and read preparation instructions remotely and ahead of their examinations. These steps are important to prevent the late discovery of a contraindication to an imaging examination that may further delay appropriate imaging. With cell phone applications, patients may receive geolocated information (such as guidance on waiting location to reduce patient density according to social distancing require-

ments) and real-time updates (such as potential delays due to medical emergencies). Imaging will be combined with other specialist appointments and nextstep referrals to streamline the patient experience. Doing so will also expedite imaging for screening and follow-up. This would lead to seamless sharing of reports and actionable items by radiologists to referring physicians and other professionals involved in multi-disciplinary patient care. For patients who are eligible for screening according to practice guidelines, reminders to book imaging appointments can be made. These reminders may be sent by email, text messaging, notifications

via the phone application, or by access through a patient results portal. In the future, we envision patients at the center of the feedback loop. Patients should be able to access all results, including their medical images and reports, from a unified portal that can be accessed from any clinic or hospital, and across provincial jurisdictions. Communication will be two-way, so that patients can upload their own data such as photographs of how a scar is healing. Establishing appropriate data protection and safety nets will be essential to this evolution, so that parents/guardians can access results on behalf of their dependents where necessary, and to ensure patients receive their results in an environment where they have the opportunity to ask follow-up questions and receive guidance from their physician. It is our vision that artificial intelligence and digital applications will be harnessed to improve the patient experience and prepare for a better H future. n

Dr. An Tang, MD, MSc, FRCPC is Full Clinical Professor, Radiology Department at the Université de Montréal

Transforming Breast & Skeletal Care AT HOLOGIC, we are committed to positively impacting the lives of Canadian women and to promoting access to best-inclass women’s health solutions. Ultimately, we aim to set a new and much higher benchmark specifically in the fields of breast cancer diagnosis and treatment. To facilitate this, we are now offering our Breast and Skeletal Health Solutions directly to our customers in Canada. With an estimated 1 in 8 Canadian women likely to develop breast cancer during their lifetime1, the need for effective breast screening solutions is vital. As a company with a global presence as the leader in mammography technology, we have heavily invested in ongoing research and development. We are dedicated to transforming breast cancer screening and diagnosis to ensure radiologists can find 1

www.hospitalnews.com

even the most invasive cancers at the earliest stage possible. The development of our imaging solutions is driven by insight-driven innovation with the aim of enhancing early detection, improving diagnostic accuracy and delivering compassionate technologies. Every day we strive to make advances toward greater certainty for our customers by providing them with cutting-edge technology that makes a real difference. We call it the Science of Sure, and we are passionate and resolute in our commitment every step of the way. We have always been at the forefront of breast cancer screening, from fullfield digital mammography systems first introduced more than a decade ago to the first commercial offering of the groundbreaking 3D Mammography™ technology. Our product portfolio addresses the entire clinical continuum of breast

cancer diagnosis and care from digital specimen radiography and stereotactic breast biopsy systems, to breast biopsy markers and surgical guidance systems. In bone health, we set the gold standard for bone densitometry in 1987 with the first dual-energy X-ray absorptiometry (DXA) system. Today, we continue to take bone health to new heights, with the Horizon® DXA platform, which assesses osteoporosis, cardiovascular disease, and obesity. Hologic is raising the bar for fluoroscopy imaging as well, with our CMOS flat detector and its exclusive rotating capabilities. We have a Breast and Skeletal Health Team in place, who are ready to support our Canadian customers. For more information or if you have any questions, please visit our website, www.Hologic.ca, email us at Canada2@Hologic.com or call us on 1-877-209-7192. Your local representative will reach out to you directly.

Canadian Cancer Society. Last accessed https://www.cancer.ca/en/cancer-information/cancer-type/breast/statistics/?region=on

DECEMBER 2020 HOSPITAL NEWS 23

Don’t Compromise Your Breast Care. Use the Hologic Advantage. When you partner with Hologic, you are opting for the advantage of integrated solutions across the Breast Health Continuum of Care. From screening to monitoring, our clinically proven breast and skeletal health innovations support you in delivering excellence in disease management along the patient pathway. RADIOLOGY

SCREENING

BREAST SURGERY

ANALYTICS, DETECTION & DIAGNOSIS

ARTIFICIAL INTELLIGENCE

BIOPSY

LOCALIZE**

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PATHOLOGY

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We continually strive to advance the early detection and treatment of breast cancer. This is our speciality. As pioneers of breast tomosynthesis with the largest body of clinical evidence, we have built our Breast Health portfolio on a foundation of proven solutions. Our expanding portfolio ensures access to the latest innovations to support patients seamlessly – from screening to treatment. As an innovative medical technology company primarily focused on women’s health, we are dedicated to delivering a pipeline that responds to the needs of medical professionals. We are passionate about making mammography more accurate, more comfortable and easier to use. This is evident with the 3Dimensions™ Mammography System including the SmartCurve™ Breast Stabilization System and our pipeline of A.I. powered technologies. We lead the way in R&D investment to advance women’s imaging and interventional solutions. When you invest with Hologic, you future-proof your investment. We bring The Science of Sure® to life by helping healthcare professionals minimise doubt and maximise confidence in decisions and diagnoses. Achieving robust science-based certainty keeps us at the forefront of breast health and patient care. This clinical superiority creates high expectations, which we fulfil by constantly challenging ourselves to improve outcomes. At Hologic, dedicated teams of breast scientists and deep learning experts have unparalleled access to data to develop next generation solutions. Contact us for more information at Canada2@Hologic.com or call 1-877-209-7192. Learn more about our product portfolio at 3dimensionsmammography.eu/screening-portfolio ADS-03102-CAN-EN REV.001 Hologic Inc. ©2020 All rights reserved. Hologic, The Science of Sure, 3D Mammography, 3Dimensions, Selenia, Dimensions, SmartCurve, 3DQuorum, Quantra, I-View, C-View, Clarity HD, Intelligent 2D, Unifi Workspace, Genius AI, SecurView, SecurXchange, Affirm Prone, Brevera, Eviva, Atec, Tumark, SecurMark, TriMark, LOCalizer, TruNode, BioZorb, Trident HD, Faxitron, Faxitron Path+, Horizon, Viera and associated logos are trademarks and/or registered trademarks of Hologic, Inc., and/or its subsidiaries in the United States and/or other countries. All other trademarks, registered trademarks, and product names are the property of their respective owners. This information is intended for medical professionals and is not intended as a product solicitation or promotion where such activities are prohibited. Because Hologic materials are distributed through websites, eBroadcasts and tradeshows, it is not always possible to control where such materials appear.

3Dimensions™ Mammography System

The fastest, highest resolution breast tomosynthesis system ever. The 3Dimensions™ Mammography System matches the unrivaled performance of our 3D Mammography™ exam, which is more accurate than conventional 2D mammograms, detecting up to 65% more invasive breast cancers.§ Breakthrough improvements transform the patient experience without compromising speed or accuracy.

Designed to improve visibility of fine details for greater diagnostic confidence.* Providing the same clinical performance faster by accelerating reading time to streamline workflow.**

Improve the patient experience with curved compression surface that mirror the shape of the breast, for a more even compression.

* Data on file (MAN-03608 Rev 006; DHM-05051_002; DHM-06039 Rev 002; MAN-02290 Rev 007)\ ** When Clarity HD™ high-resolution 3D imaging is used in combination with the optional Intelligent 2D™ imaging technology license on SecurView® workstations. § Results from Friedewald, SM, et al. “Breast cancer screening using tomosynthesis in combination with digital mammography.” JAMA 311.24 (2014): 2499-2507; a multi-site (13), non-randomized, historical control study of 454,000 screening mammograms investigating the initial impact the introduction of the Hologic Selenia Dimensions on screening outcomes. Individual results may vary. The study found an average 41% increase and that 1.2 (95% CI: 0.8-1.6) additional invasive breast cancers per 1,000 screening exams were found in women receiving combined 2D. FFDM and 3D™ mammograms acquired with the Hologic 3D Mammography™ System versus women receiving 2D FFDM mammograms only.

CANADIAN ASSOCIATION OF RADIOLOGISTS

Supporting human resources to promote health system resilience By Dr. Ania Kielar

OPTIMIZATION OF OUR CURRENT IMAGING CAPACITY WILL MEAN SCANNING MORE PATIENTS PER YEAR WITHOUT INCREASING THE AMOUNT OF AVAILABLE EQUIPMENT.

OVID-19 has made it evident that our nation’s health system has incredibly little built-in redundancy. Both human resources and equipment are operating to their maximum capacity. Even at maximum output, wait lists for imaging are growing. In a time of crisis, this can result in personnel burnout and system failure. To meet a growing demand for medical imaging, we know that capacity in radiology needs to increase, and that additional equipment will help to build a more resilient health system for patients. Equipment procurement and renewal are a medium/ long-term solution to an immediate problem and other solutions need to be considered concurrently.

OPTIMIZING OUR IMAGING CAPACITY

Optimization of our current imaging capacity will mean scanning more patients per year without increasing the amount of available equipment. Completing more scans will require additional human resources (administrative staff, technologists, nursing, cleaning, radiologists), and will necessitate appropriate investment in those resources. Improving and optimizing patient throughput can decrease wait times and drive capacity improvements in the near term. Taking a careful look

BRACCO IMAGING CANADA

at the current patient journey through radiology and ensuring metrics align with throughput as well as quality can help. Barring significant increases in CT, MRI, and ultrasound capacity, the only way to increase throughput is to decrease the length of time that it takes to scan a single patient. Given our existing equipment capacity, staffing is a factor limiting overall increases in the amount of imaging that we can perform on an institutional or regional basis. As CT and MRI examinations are in high demand, most of these scanners are being operated at maximum capacity, limited by staffing constraints. In some jurisdictions, the only way to increase capacity is not only increase staffing but also increase the number of units. Adding to technologists’ and sonographers’ current workloads will have significant physical and psychological effects on a workforce that was already being challenged before the onset of the pandemic. In theory, it is possible to optimize our existing capacity through improved scheduling. Scheduling and exam time are the most easily adjusted variables in the equation. However, increased scheduling density and intensity can rapidly lead to burnout of imaging staff, including schedulers, nurses, technologists, and radiologists. Radiology is already a specialty at a high-risk of burnout, due to heavy workloads and the ceaseless demand for round-the-clock medical imaging.

MITIGATING BURNOUT

A 2018 mental health study conducted for technologists and sonographers found high levels of emotional exhaustion, in additional to other in-

dicators of burnout. Associations and colleges have started to recognize the mental health needs of their memberships and are working towards national initiatives to support their professionals in the workplace. The pandemic has added layers of psychological effects on the workforce which are not well understood to date, but evidence is emerging demonstrating increased mental health burden on health professionals. Increasing the pool of available technologists will have several benefits including reducing wait times, reducing burden on existing staff, and increasing staffing flexibility. Additional infection prevention and control (cleaning) staff were also identified as priorities, as were additional administrative staff. In cases where technologists are pulled into infection control or administrative roles and away from patient care, staffing challenges become magnified. It is essential that departments and institutions become aware of how assigned responsibilities align with the goal of effective patient care. Metrics and data should be collected to capture time spent on patient care vs. administrative vs. other duties, so that improvements can be data driven. It should be noted that initiatives aimed at quality assurance and quality improvement should be considered “patient care” rather than administrative work – within reason. Collectively, we need to recognize the true threat of overworking staff for the sake of improving productivity metrics. As valued medical professionals, the collective wellbeing of an imaging care team will directly translate into patient wellbeing. In some cases, adding additional capacity (e.g. more scanners) is preferable over maximizing the utilization of existing systems in the interest of preventing burnout. Radiology professionals put patients first; this obligates our health care systems to recognize that these professionals are an extremely important H asset worth investing in. n

Dr. Ania Kielar, MD, FRCPC is Associate Professor, University of Toronto and Deputy Chief Joint Department of Medical Imaging (JDMI), Quality and Practice Improvement. 26 HOSPITAL NEWS DECEMBER 2020

www.hospitalnews.com

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NEWS

Canadians are ready to embrace “Virtual First” in health care By Shelagh Maloney recently participated in a podcast where we were discussing the rapid uptake of virtual care as a result of the COVID-19 pandemic. When one of my colleagues turned the phrase “necessity is the mother of invention” into “necessity is the mother of adoption,” I thought it was very applicable to today’s situation. From the evidence we’ve been collecting for years, we know virtual care is a viable care delivery option that can improve access to care, give patients agency so they can better manage their care, and can save them time and money. The pandemic has necessitated the adoption of virtual care, and Canadians are mostly embracing this change – they are ready to include virtual care in their health management. Well before the pandemic began, Canada Health Infoway (Infoway) engaged Environics Research to consult with Canadians about their needs, expectations and concerns about the future of their health system, and the role of technology in the delivery of better health care. We called this consultation A Healthy Dialogue, and it reached more than 58,000 Canadians through a national survey (including a representative sample of Indigenous people), online focus groups, an online engagement forum, interviews with people who are underserved by the health system (e.g., new immigrants, members of the LGBTQ community), and focus groups with Indigenous people in their communities. After the dramatic shift to virtual care in March and April, we felt it was important to see whether the attitudes of Canadians had changed, so a second survey was undertaken in June with a representative sample of those who had participated in the first survey. The second survey found that seven in 10 Canadians who sought medical care during the pandemic used virtual care, 91 per cent were satisfied

Shelagh Maloney with the experience, and 86 per cent agreed that virtual care tools can be important alternatives to seeing doctors in-person. Regardless of whether they had used virtual care during the pandemic, 76 per cent are willing to use it in the future. That’s up from 64 per cent in the first survey. This growing appetite for “virtual first” is very encouraging. Our research also found that the appetite for digital health in general is growing. Ninety-two per cent of Canadians want technology that makes health care as convenient as other aspects of their lives, and 84 per cent say they would use technology tools to help manage their health. They have seen how

technology has transformed banking, commerce and many other areas of their lives, and they have a strong desire for health care to catch up. Canadians also recognize the benefits of digital health tools and services. Of those who have used health technology in the past year, nine in 10 said it saved them time, eight in 10 said they were better able to manage their health, and 53 per cent said it helped them avoid an in-person visit. Eightysix per cent also agree that technology can solve many of the issues with our health care system and 80 per cent believe investing in health care technology should be a top priority for government.

The findings were not all positive, however, and the message is clear that there is still work to do. For example, nearly four in 10 Canadians say their level of understanding of their health information and/or their comfort with technology is a barrier to their use of digital health, while nearly six in 10 feel they don’t know enough about digital health apps and services. Canadians also want assurances that privacy and security of personal health information will be a top priority and they say this is the main barrier that prevents them from fully embracing health care technology. Some Canadians face additional barriers. Twenty-six per cent say they don’t have access to the reliable internet service needed to use health technology. Those who typically face discrimination in the health system are also more concerned about privacy, and they need greater assurance that their personal health information will be protected and not used to marginalize them further. Governments, health care organizations, health care providers, industry and other partners can choose to view these barriers as opportunities. Opportunities to improve digital health literacy and Canadians’ access to their personal health information, and to alleviate concerns about privacy and security of that information. Opportunities to bridge the digital divide. And opportunities to address the very real concerns of underserved groups, especially related to equity in our health system. One of the lessons learned about the pandemic is that, through collaboration and determination, we can make a difference. The pandemic can be an opportunity for us to make lasting changes to our health system. Canadians want digital to be an option for certain aspects of their care journey, and we can work together to ensure that this option is available to all H Canadians for the long term. ■

Shelagh Maloney is Executive Vice President, Engagement and Marketing at Canada Health Infoway. www.hospitalnews.com

DECEMBER 2020 HOSPITAL NEWS 29

NEWS

Shifting the power imbalance in healthcare through mental health outreach

Photo: Yuri Markarov

By Natalie Leung hen Dr. Saadia Sediqzadah started her residency, she saw herself practicing psychiatry in a big room with a Persian rug, her patients lying on a couch while they discussed how they felt. Now a Psychiatrist at St. Michael’s Hospital in

Toronto, her workday looks a little different. A few days a month, Dr. Sediqzadah changes into jeans and bikes around Toronto as part of the FOCUS program, a mental health outreach program. Instead of seeing patients in a traditional clinic, she meets them in

Dr. Saadia Sediqzadah (left) and Shinkay Karimi are two members of the FOCUS team. their homes, at shelters and in coffee shops. The program is a partnership between St. Michael’s Hospital Mental Health and Addictions and Cota, a

community-based mental health organization. Operating 24 hours a day, seven days a week, the interdisciplinary team supports people experiencing serious mental health problems. Many

Safety strategies for women experiencing domestic violence during the COVID-19 Pandemic By Maria Sarrouh s a veteran researcher who has studied intimate partner violence for 25 years, Dr. Patricia O’ Campo knows that women experience higher rates of increased violence during epidemics – a troubling and well documented pattern. However, Dr. O’Campo discovered a puzzling gap in academic literature when the COVID-19 pandemic hit: there are no verified strategies women can utilize to promote safety and protect themselves during public health emergencies. “There’s a lot of opinions about what women might do, but nobody has verified those strategies,” says Dr. O’Campo, Interim Executive Director of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital of Unity Health Toronto, and Scientist at MAP Centre for Urban Health Solutions. Once the COVID-19 pandemic was declared, Dr. O’Campo and her co-principal investigator, Dr. Nicholas Metheny, a Post-Doctoral Research Fellow at St. Michael’s, began exploring how to redesign the Pathways

Dr. Patricia O’ Campo. app–an earlier project which provides women in abusive partnerships with a personalized safety plan. In a pandemic, women and children living with violence may be forced to shelter with violent partners, unable to access resources outside of the home, while dealing with a reduction in services available to them. Due to public health measures to prevent the spread

of COVID-19, Service agencies aren’t always able to support women face-toface, so women experiencing violence may need to consider additional safety strategies. To fill this gap in research, Dr. O’Campo and her team put together a list of around 35 suggested strategies and asked over 100 service providers and women with lived experience of domestic violence to rate whether the suggestions are “recommended” or “not recommended.” Some of the suggestions were rated by survey responders as having the potential to make violence worse. “For example, we know that alcohol and substances can make an episode of violence more likely, and one of the recommendations was to hide alcohol or other substances that may make abuse worse,” she says. “That one was rated by many women with lived experience as being something that would make violence worse.” Other strategies that were rated as “not recommended” include trying to “keep the peace” and switching to texting or emailing instead of phone calls. Based on the results of the rapid

survey, Dr. O’ Campo and her team created factsheets listing verified recommendations for women living in situations of intimate partner violence. The factsheets include tips for online and physical safety planning during public health emergencies. They are being disseminated to women and service providers to help them navigate issues that COVID-19 has exacerbated. “There are risk factors for violence that are increasing as a result of the pandemic, and the economic pandemic that’s accompanying the infectious pandemic,” Dr. O’ Campo says. “For example, an episode of unemployment highly increases household stress and therefore the risk of violence.” The takeaway from this work, she says, is that there are strategies women can implement – that are recommended by women with lived experience and experienced service providers – to promote safety when they’re sheltering at home. These strategies, however, are not a “one-size fits all.” “Everything should be tailored to the context in which you’re residing, but you can continue to promote safeH ty even in this very difficult time.” ■

Maria Sarrouh works in communications at Unity Health. 30 HOSPITAL NEWS DECEMBER 2020

www.hospitalnews.com

NEWS are also facing socioeconomic challenges, such as inadequate housing and shortage of food. “Going into the community helps with the power imbalance that’s inherent in health care. It’s no longer – I’m the doctor in a clinic and you are the patient coming into my space. This flips it to – I’m the doctor and I’m coming to meet you in your space,” explains Dr. Sediqzadah, “I’m often wearing casual attire, so we all kind of look the same.” Shinkay Karimi, Peer Support Specialist at St. Michael’s, says the program works well because the team looks at a combination of biological, psychological and social factors that affect mental health. She focuses on providing emotional support for her clients. “Being in their homes and in their spaces, I get to see what the majority of society doesn’t see. I have a better understanding of how factors, like living in a boarding home and systemic discrimination, affect mental health.” The interdisciplinary team consists of psychiatrists, nurses, social workers, occupational therapists and other allied healthcare professionals. They provide supports that are individualized to each person such as psychotherapy, medication management and assistance with accessing financial support programs. Karimi has seen many individuals secure housing, adhere to treatment and live a much more meaningful life thanks to the program. She also noticed benefits to her personal mental well-being. “Sometimes my clients will express some thoughts and I will recall being in that situation myself and how I can really relate. I feel inspired to take the knowledge, skills and lived experiences I have to help them accomplish their goals.” Dr. Sediqzadah was not aware of outreach when she started her career in psychiatry, but now biking through the city to see patients is one of her favourite parts of her job. She hopes medical students and residents will consider this an option when choosing their career paths. “It was a beautiful fall day and I stopped and I thought – this is awesome. How many health care jobs are there where you can be out and about in the city? I definitely had a moment H of gratitude.” ■ Natalie Leung is a communications advisor at Unity Health Toronto www.hospitalnews.com

Lisa watches her daughter, Marlena, wed her partner, Brandon, in a ceremony at Niagara Health’s Walker Family Cancer Centre.

Photo credit: Stephanie Iannacchino

Wedding wish:

Mom sees daughter marry in hospital ceremony By Steven Gallagher t was a mother’s wish fulfilled. Inside a meeting room at Niagara Health’s St. Catharines Site, Lisa watched her daughter, Marlena, wed her partner, Brandon. Just a few days earlier, Lisa and her family were told she had only a short time to live. Lisa, a patient in the Oncology Unit, was suffering from an aggressive form of cancer. Together for seven years, Marlena and Brandon knew one day they would get married, with Lisa looking on. The sad news prompted them to quickly arrange a wedding so Lisa could be part of their special day. “My mom was very traditional, so she wanted my husband to ask her for my hand in marriage,” says Marlena. Brandon headed to the St. Catharines hospital and did just that. Then he proposed to Marlena in the hospital elevator. “He got down on one knee and asked if I would marry him, and, of course, my answer was yes.”

Marlena reached out to her mom’s Oncologist, Dr. Mithula Tharmabala, who said the Oncology team would be honoured to help plan her wedding. The team chose a conference room for the ceremony in the Walker Family Cancer Centre and decorated it beautifully. A member of the Niagara Health Foundation team, who is also a photographer, offered to capture images of the special day. Marlena’s friend, who is a minister, agreed to officiate the wedding, which was limited to 10 people because of pandemic safety restrictions. Marlena shopped for a dress at a local bridal shop, and her mother was able to see them all through video chat from her hospital room. “When I walked out with one dress, she started crying, so we knew that was the dress,” she says. Marlena was grateful her mother was able to see her marry Brandon. “She was such a big part of both of our lives. For me to be able to get married with her being there was such a bitter-sweet thing. Being able to have her with us during the ceremony meant everything to us. I couldn’t

have imagined having a wedding without her.” Marlena said she was touched by the compassion of the Niagara Health team to help plan the wedding. “I wouldn’t be able to have a wedding with my mom there if it wasn’t for them. Being able to have that memory and the fact we have the pictures is amazing. We didn’t even think of having a photographer. They handled everything for us. Every step of the way, whatever we needed, they were there for us. And they were there for my mom because they knew that, not only was this important to me and my husband, it was important for my mom to be there. People keep telling me how happy my mom was to have that opportunity.” Sadly, Lisa passed away two weeks after the wedding. Marlena says her mom was an incredibly kind and caring person. “My mom was kind and generous. She was very modest. She taught me to be very generous. She was a single mom who raised us by herself. She was my role model. She was a very strong H and independent woman.” ■

Steven Gallagher works in communications at Niagara Health. DECEMBER 2020 HOSPITAL NEWS 31

COVER

2020: The year that will

reshape healthcare By Natasha Salt and Dr. Jerome Leis ew Year’s Eve 2019 was an ominous time for us. We were busy tracking the movements of a novel coronavirus in China that at the time appeared concerning but it was difficult then to foretell what kind of global impact this illness would unleash on the rest of the world. On January 23, 2021, it will have been exactly one year since we admitted the first patient in Canada with COVID-19 to Sunnybrook. In looking back over the past year, it is worth asking ourselves, what have we learned and what has changed? To no one’s surprise, the short answer is, plenty. The pandemic has been stressful and has placed enormous pressure on our hospital, our staff, and the healthcare system at large. At the same time, it has been a tremendous catalyst for learning and for rapid cycle change. A number of key advances have improved quality within our institution and collectively across the system. Chief among the most significant changes has been the necessity for hospitals to be better integrated with their community partners. Prior to the pandemic, our hospital like many others recognized the importance of supporting health outcomes beyond the walls of our facility – but COVID-19 has strengthened this integration at many levels. For example, we have seen accelerated adoption of virtual care platforms that have enabled our clinical teams to manage patients remotely. Our Infectious Diseases specialists created a virtual consulting service called COVIDEO, that has managed over 1500 patients with COVID-19 from their homes, while providing ongoing clinical support and home oxygen monitoring. This system of care has given these patients clinical and social supports in the community and resulted in fewer unplanned visits to the Emergency Department. Similarly, a cross-Toronto initiative called “Long-Term Care” Plus has pro-

Photo credit: Kevin van Paassen/Sunnybrook Health Sciences Centre

vided virtual consultative care to longterm care physicians as needed to help support the management of residents of long-term care. The partnership between primary care physicians in both long-term care and the community has been strengthened in the process while striving to care for the most vulnerable patients in their home, rather than in hospital, whenever possible. Hospital infection prevention and control (IPAC) programs have repeat-

32 HOSPITAL NEWS DECEMBER 2020

edly demonstrated that they are essential and a pillar in effective response to local infectious disease transmission, epidemics or pandemics. After SARS in 2003, hospital IPAC teams were strengthened in Ontario. Significant iterative improvements were made over nearly two decades prior to COVID-19. Strong surveillance and containment strategies have successfully minimized transmission of COVID-19 in hospital settings and

the demand for this expertise has risen exponentially well beyond these walls. Our hospital as well as many others have formally been supporting longterm care, retirement homes and the broader community, throughout the pandemic in attempts to build IPAC capacity across the continuum of care. Investment of resources in IPAC will be crucial to making further advances in IPAC across these institutions over years to come. www.hospitalnews.com

COVER From planning to practice, we have also learned a significant amount about the allocation and resourcing of personal protective equipment and specifically, the use of masks. In the nascent days of the pandemic last spring, our conversations and decision-making were dominated by the scarcity of personal protective equipment. Our supply chain has responded to these pressures and there has been relatively broad acceptance of the use of masks both inside our organizations and publicly. Enhanced awareness and education about proper mask use and other preventive measures such as hand washing and social distancing have become normalized in our routines and their broad use has helped in managing the pressure on our facilities. In addition to the day-today management of the virus, the academic curiosity of our teams has also been in full flight during the pandemic. Early in the pandemic, researchers were designing innovative devices to support

CHIEF AMONG THE MOST SIGNIFICANT CHANGES HAS BEEN THE NECESSITY FOR HOSPITALS TO BE BETTER INTEGRATED WITH THEIR COMMUNITY PARTNERS.

infection prevention and personal protection when supply chains were threatened. Our Sunnybrook Research Institute has in excess of 100 different studies taking place to examine every aspect of the pandemic and ensure we are learning from it. We have been a lead hospital in a number of global trials and have conducted research that has isolated the virus and has set the groundwork for what we hope will be the introduction of a vaccine in 2021. It has been inspiring to see how our teams across the hospital and others throughout the system have responded to the pandemic. The resiliency of our front-line staff has been nothing short of heroic and they continue to set new

expectations for high performance. The support we have received from our community including everything from donations to advance research, to thank you cards and letters, have helped buoy our teams and motivate them to continue moving forward. Looking back on this year, it has clearly been unparalleled and has challenged every aspect of our work and our lives as a whole. It has had pitfalls and occasional triumphs but as we look forward we can say confidently we have learned a substantial amount, and have gained further confidence that we are on the right path and will emerge from this stronger and better informed.

Looking ahead to 2021, like many, we are eagerly anticipating the arrival of a vaccine. But we must remain extremely cautious to avoid declaring a premature victory. Among the many lessons we have learned is that as soon as you think you are on top of this situation, your perspective changes without much notice and you find yourself slipping underneath it again. COVID-19 is a crafty virus and the biggest mistake we can make is underestimating it. No one knows exactly when this will end but we do know the pathway to get there is best travelled with the lessons of the past in mind and a vision for the future that is well-informed and rooted in evidence. New Year’s Eve 2020 will certainly be a different time for all of us but let’s take the opportunity to look back, reflect on what we have experienced, and look forward to the year ahead, when we take what we have learned and use it to our advantage against this H virus in 2021. ■

Natasha Salt is the director of infection prevention and control at Sunnybrook Health Sciences Centre, and Dr. Jerome Leis is the medical director of infection prevention and control at Sunnybrook Health Sciences Centre.

www.hospitalnews.com

DECEMBER 2020 HOSPITAL NEWS 33

NEWS

Most predictive symptoms of COVID-19 in children ore than one-third of children who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were asymptomatic, and the symptoms most strongly associated with a positive test were loss of taste/smell, nausea/vomiting, headache and fever, according to new research published in CMAJ (Canadian Medical Association Journal). “Administrators of screening questionnaires for schools or daycares may wish to consider reassessing the symptoms they screen for to include only those that are most strongly associated with positive results for swabs for SARS-CoV-2 infection,” writes Dr. Finlay McAlister, University of Alberta, Edmonton, Alberta, with

THE SYMPTOMS MOST STRONGLY ASSOCIATED WITH A POSITIVE TEST WERE LOSS OF TASTE/SMELL, NAUSEA/VOMITING, HEADACHE AND FEVER

coauthors. They note that “many other influenza-like symptoms (such as cough, rhinorrhea [runny nose], and sore throat) were as common, or more common, in children testing negative for SARS-CoV-2,” and thus had limited predictive value for detecting COVID-19 in children. To understand what symptoms are associated with coronavirus disease 2019 (COVID-19) in children, re-

searchers looked at symptom patterns in children followed by Alberta Public Health who had swabs done for SARSCoV-2 between April 13 and September 30, 2020. They compared children who were positive with those who were negative for infection. In children who tested positive for SARS-CoV-2, 25.5 per cent had fever or chills, 24.5 per cent had cough and 19.3 per cent had a runny nose.

Of note, 714 (35.9%) who tested positive showed no symptoms. The most common symptoms in children who tested negative for SARS-CoV-2 were the same as for those testing positive: cough (25.4%), runny nose (22.1%), and fever or chills (15.1%). Children aged four and younger were more likely to test negative, and teenagers (ages 13 to 17) were more likely to test positive. “Because more than one-third of pediatric patients who test positive for SARS-CoV-2 infection exhibit no symptoms, identifying children who are likely to be infected is challenging. Indeed, the proportion of asymptomatic SARS-CoV-2 infections in children is likely much higher than we have reported, given the likelihood that many

Did you know about 20% of health care workers have had dermatitis? As a health care worker there are many potential hazards that can affect your skin and cause skin disease. Irritant contact dermatitis is common, leading to four out of every ﬁve cases of occupational contact dermatitis. It is caused by physical agents or chemical substances that are irritating and damaging to the skin, typically because of repeated and prolonged contact. Common irritants are: • Cleaning agents • Wet work like wearing gloves for more than a total of 2 hours per day, having your hands in water or liquid for more than 2 hours per day or washing your hands more than 20 times a day Occupational contact dermatitis can also be caused by allergies to substances in the workplace such as • ingredients in protective gloves, • preservatives, or • fragrances

Participate in our Research Study. If you are a health care worker, we want you to participate in an online research study. The study will require the evaluation of an education module for occupational hand dermatitis. To participate, visit: https://www.vha.ca/skindiseasemodule/story_html5.html Participants will receive up to $40 in gift cards for participating.

NEWS

would not present for testing,” says Dr. McAlister. Symptoms of fever or chills, cough and runny nose in this study (19% to 26%) were less frequent than in studies conducted in hospital settings. The authors suggest that because this was a community-based cohort, the cases of disease were most likely milder than those seen in hospitals. “The refrain that ‘children are not small adults’ certainly seems to apply in the context of COVID-19,” write the authors. In a related commentary, Dr. Nisha Thampi, an infectious diseases pediatrician at CHEO and coauthors write, “Given the high proportion of children with SARS-CoV-2 who remain asymptomatic, it is unlikely that any

symptom screening strategy will prevent every child with SARS-CoV-2 infection from entering school. Therefore, school-based health and safety measures beyond screening – includ-

ing physical distancing, hand hygiene, masking, improved ventilation and outdoor learning opportunities – play an essential role in preventing the spread of infection in this setting.”

“Symptoms associated with a positive result for a swab for SARSCoV-2 infection among children in Alberta” was published November H 24, 2020. ■

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ͻ ŝĞƟƟĂŶ • Nurse ͻ KĐĐƵƉĂƟŽŶĂů dŚĞƌĂƉŝƐƚ • Physiotherapist • Social Worker

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SAFE MEDICATION

The 5W’s of medication incident reporting By Yi Zhou Situ, Bita Janzadeh and Certina Ho ccording to the Institute for Safe Medication Practices Canada (ISMP Canada) “Definition of Terms” (https://www.ismp-canada. org/definitions.htm), a medication incident is “a mistake with medication, or a problem that could cause a mistake with medication.” Medication incidents can, and on occasion, do occur. Unfortunately, such incidents or events can sometimes have serious consequences for a patient’s well-being (and long-lasting psychological impact on the healthcare providers involved).

MEDICATION INCIDENT (OR MEDICATION ERROR) REPORTING

Reporting and sharing the learning of medication incidents (including near misses and medication errors) are vital to error prevention and patient/ medication safety, as this will provide us with the opportunity not only to identify potential underlying or contributing factors of the incidents, but also to learn from mistakes and reduce the chance of error recurrence through implementation of prevention strategies.

ADVANCING PATIENT/ MEDICATION SAFETY

In Canada, the Canadian Medication Incident Reporting and Prevention System (CMIRPS) (https:// www.cmirps-scdpim.ca/) is a collaborative pan-Canadian program of Health Canada, the Canadian Institute for Health Information (CIHI), the ISMP Canada, and the Canadian Patient Safety Institute (CPSI). The goal of CMIRPS is to reduce and prevent harmful medication incidents in Canada. Reporting of medication incidents is the first step. In order to learn from our mistakes, analysis of medication incidents, which typically involve a comprehensive review and dis-

cussion with stakeholders involved in the incident (including the patient) of “what happened”, “why happened”, and “what we can do to prevent the same incident from happening again”. Interventions or prevention strategies will then be implemented by applying a plando-study-act quality improvement approach. It is through ongoing and iterative finetuning of prevention

strategies, with support from leadership and management, as well as frontline healthcare providers that our reporting efforts will help create a safer healthcare system. It is important to note that adverse drug reactions (or commonly known as side effects) are undesirable effects, which may occur under normal use conditions of medications. They, typically, cannot be prevent-

ed, and should be reported to the Health Canada’s Canada Vigilance Program (https://www.canada.ca/ en/health-canada/services/drugshealth-products/medeffect-canada/ canada-vigilance-program.html). As a reminder, mandatory reporting of serious adverse drug reactions and medical device incidents by hospitals to Health Canada is effective as of H December 16, 2019. ■

Yi Zhou Situ and Bita Janzadeh are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto. 36 HOSPITAL NEWS DECEMBER 2020

www.hospitalnews.com

FROM THE CEO’S DESK

Strategic planning during a pandemic By Dr. Naveed Mohammad As hospital administrators, we’re constantly evolving our services and models of care in response to changing health care needs and to further enhance quality and patient safety. But how does this strategic planning come into play when facing a global pandemic that hits close to home? William Osler Health System’s (Osler) hospitals have been operating within two of the province’s biggest hot spots for COVID-19 – Brampton and North Etobicoke – placing unprecedented pressures on our emergency departments, critical care and inpatient units. During Wave 1, we treated more patients for COVID-19 than any other hospital system in Ontario. At the time I’m writing this, our testing centres have seen tremendous volumes, leading the province with more than 275,000 tests to date. Since the resurgence of COVID-19 over the past weeks, our current test positivity rate has risen and with high numbers of COVID-19 patient admissions, hospital capacity challenges have emerged. Like all hospitals, we faced many unknowns when COVID-19 landed on our doorstep, challenging us to think differently about how we sustain access to services, while addressing the resource-intensive needs of patients requiring specialized care. Rather than taking a step back, we streamlined select action plans aligned with our strategic priorities – quality excellence, organizational effectiveness, health system leadership, and people and culture – accelerating those plans that would best support our teams at the point of care, with a particular focus on technology, partnerships and innovation.

unteers who have been working tirelessly to deliver safe, quality care under often difficult circumstances. Faced with significant capacity pressures, we’re also grateful to the many Greater Toronto Area hospitals who accepted patient transfers so that we could continue to provide safe, quality care to patients arriving in our emergency departments and admit them onto our units. Pre-pandemic and beyond, members of the Brampton Etobicoke Ontario Health Team (OHT) solidified a strong partnership that has been instrumental to our region’s pandemic response. From working together to support care and safety in longterm care facilities, to working with the Region of Peel on availability and distribution of PPE, to addressing the needs of vulnerable populations and helping expand options for COVID-19 testing, our joint efforts have proven invaluable.

LEVERAGING TECHNOLOGY

Every day, our teams face the difficult task of finding appropriate beds for patients with, and under investigation for COVID-19. The logistics of placing the right patient in the right

Dr. Naveed Mohammad bed often calls for a herculean effort on the part of several teams. With the onset of COVID-19, we accelerated planning for our Operational Command Centres to facilitate this process. These physical and virtual ‘hubs’ at each hospital offer teams a 24/7 birdseye view of where every inpatient is from admission at the Emergency Department to an inpatient bed. They were designed to help reduce patient gridlock, enhance quality and patient safety, and support an improved patient and staff experience. As we move through this second wave of COVID-19 and cold and flu season, we’re fully utilizing our Operational Command Centres to help us manage demand. At the outset of the pandemic we also advanced our existing virtual care technologies to connect with older patients and those with complex health conditions who are most vulnerable to contracting infections and/or who are isolated, or who face barriers due to distance, transportation and travel/ parking costs. To date, we have successfully grown our virtual care pro-

gram to include more than 30 outpatient clinics.

STRENGTHENING PARTNERSHIPS

While Osler has enjoyed a long history of working closely with government, health care and community partners, these partnerships have never been more crucial than they are today. Given ours is a voice among many, we have stepped up our relationships with elected officials and public servants. Locally, this includes regular meetings with municipal leaders, Public Health, the Ministry of Health, and provincial and federal representatives. These efforts helped to increase awareness of our needs and we were pleased to receive support through the province’s recent decision to invest in 87 additional beds at Osler to help manage COVID-19, the flu season and anticipated winter surge. This capacity investment not only helps improve access to care for our patients and communities, but also boosts the morale of our leaders, staff, physicians and vol-

ADVANCING INNOVATION

Last, but certainly not least, we have adopted some innovative strategies to help further improve access to care. Among them is the creation of one of Ontario’s first COVID-19, Cold and Flu Clinics. In a bid to keep mild and moderate cases of influenza and COVID-19 out of our emergency departments, we opened the clinic at Osler’s Peel Memorial Centre for Integrated Health and Wellness so residents can get timely access to a COVID-19 test and undergo a medical assessment. While we’re optimistic these strategies will help address some of the ongoing pressures created by the pandemic, we will continue to encourage our communities to adopt the basic public health measures designed to minimize spread. It’s only in working together as individuals, communities, health systems and a province, that we will truly minimize the impacts of COVID-19 on our hospitals, our patients, and our dedicated health care H workers.■

Dr. Naveed Mohammad is President & CEO, William Osler Health System. www.hospitalnews.com

DECEMBER 2020 HOSPITAL NEWS 37

NEWS

Building the mental health facility of the future By Hilary Caton his November, CAMH reached an incredible milestone that will help redefine mental health as Canadians know it, with the official opening of the McCain Complex Care & Recovery Building and the Crisis & Critical Care Building. These two state-of-the-art buildings located in the vibrant West Queen West community in Toronto include 235 patient beds between them and are designed to provide the best possible mental health care experience in an environment that is spacious, respectful and dignified.

The buildings also co-locate CAMH’s educational programming for learners and clinical services, creating opportunities for knowledge exchange between CAMH patients, learners and its community.

A SYMBOL FOR RECOVERY

While CAMH continues to work to end the prejudice and discrimination towards people with mental illness, it’s made great strides – the redevelopment vision is a symbol of this progress. “In this phase of our redevelopment, we reintroduce ourselves to Queen Street. The iconic corner of Queen and Ossington invites our community

38 HOSPITAL NEWS DECEMBER 2020

to continue our work together to confront the prejudice and discrimination experienced by people who live with mental illness,” says Catherine Zahn, CEO and President of CAMH. With these two buildings CAMH is redefining healthcare, while also showing the community that mental health is health and recovery is possible for all patients who step through our doors.

CRISIS & CRITICAL CARE BUILDING

The Crisis & Critical Care Building will house the Gerald Sheff and Shanitha Kachan Emergency Department – the only 24/7 Emergency De-

partment in the province devoted to mental health care. The new space is double the size of the current Emergency Department and features three assessment rooms, more treatment rooms, space for families who are supporting loved ones, private waiting areas and entrances for emergency transport services. With its increased capacity enabling improved intake, assessment and triage procedures, the space will offer people in crisis safe, dignified and private spaces to receive care. CAMH Emergency Department Psychiatrist Dr. Juveria Zaheer says these environmental changes will have a positive impact on how people apwww.hospitalnews.com

NEWS ing that you feel at peace in and welcomed in is really key and will help prevent relapse.â&#x20AC;? Along with learning new skills, patients will also have access to spaces that support them on their road to recovery. This will include tranquil outdoor settings that feature gardening programs, exercise and music rooms, and media and art spaces. Here, patients can explore additional non-traditional forms of healing that will support them on their journeys toward mental wellness.

proach and receive emergency mental health care. â&#x20AC;&#x153;When someone walks into a beautiful, dignified, meaningful space it can make such a difference in how care is delivered and experienced,â&#x20AC;? says Dr. Zaheer.

THE MCCAIN COMPLEX CARE & RECOVERY CENTRE

The McCain Complex Care & Recovery Centre will house the Tour de Bleu Therapeutic Neighbourhood â&#x20AC;&#x201C; a supportive shared space where patients will learn skills they need to transition into the community and live a full life beyond CAMH. Patients themselves were involved in the early planning and design of the Neighbourhood and have also helped shape the services that are offered, such as a new gleaming teaching kitchen, a state-of-the-art computer training room, laundry facilities and educational settings for patients and their

HEALTH REDEFINED families to learn about mental illness and recovery. â&#x20AC;&#x153;The space you are in and how you feel about that space matters,â&#x20AC;? says CAMH Peer Support Worker and former CAMH patient Sara Traore, who consulted on the creation of the therapeutic indoor and outdoor spaces.

â&#x20AC;&#x153;If you have mental illness you are quite sensitive and if you are an inpatient you have probably had a lot of trauma past and present in your life. Your environment is everything. If thatâ&#x20AC;&#x2122;s the space where you are going to be coming to terms with your illness and receiving care, a surround-

Access to green space and public art have also been integrated throughout the site for patients, families, visitors and the community to experience together. This is the third step of the multiphase redevelopment of CAMHâ&#x20AC;&#x2122;s Queen Street site with a purposeful vision to replace a walled off institution H with a therapeutic urban village. â&#x2013;

Hilary Caton is the communications coordinator fat the Centre for Addiction and Mental Health.

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/DXUD 6DXYÂŠ - University of British Columbia / Children's & Women's Health Centre of BC 1DWDOLH %ULGJHU - Memorial University / Janeway Childrenâ&#x20AC;&#x2122;s Health and Rehabilitation Centre 3HGLDWULF ,QFLGHQW &RPPDQG 7HDP - University of Manitoba / Children's Hospital of Winnipeg 5RG /LP - Western University / Children's Hospital - London Health Sciences Centre 5RVHOLQH 7KLEDXOW HW OHV FKHIV GH VHUYLFH GX GÂŠSDUWHPHQW UniversitĂŠ Laval / CMES du CHU de QuĂŠbec 6DUDK .KDQ - McMaster University / McMaster Children's Hospital 7HDP RI 'UV 0\OHQH 'DQGDYLQR 7DQ\D 'L *HQRYD DQG 5REHUW 6WHUQV]XV - McGill University / Montreal Children's Hospital

DECEMBER 2020 HOSPITAL NEWS 39

Next steps in pandemic response:

EVIDENCE MATTERS

How can long-term care homes support their staff? By Deba Hafizi any countries, including Canada, have implemented strict no-visitor policies in long-term care (LTC) homes. This is in an attempt to reduce the risk of introducing coronavirus disease (COVID-19) into these facilities and to prevent further mortality and infection among its residents and staff. Although these measures have been effective, some jurisdictions are considering relaxing visitation restrictions given growing concerns about the effect of social isolation on the mental health of LTC residents. While reopening LTC homes to visitors may be beneficial for mental wellbeing, it also leaves both staff and residents at greater risk of infection given the close-contact nature within them. High rates of infection among health care workers have resulted in high levels of anxiety and intensified staff shortages and absenteeism in LTC. This has been linked to worse COVID-19 related outcomes within these facilities. Countries that have successfully limited the number of COVID-19 cases in LTC, such as Australia and Hungary, provided additional supports for LTC workers early on in the pandemic. These supports include surge staffing, specialized teams, and personal protective equipment (PPE). To support the well-being and safety of LTC staff, who play an essential role in the quality of care and the control of infection in these facilities, it is important that measures be put in place to support them during the next phase in the pandemic. CADTH recently compiled a snapshot of the clinical evidence published between January 1, 2014 and July 31, 2020 on best practices that could help support LTC staff and mitigate their concerns during the pandemic and during the reopening of LTC homes

to visitors. CADTH is an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures to find out what the evidence says. To respond to the immediate research needs during the rapidly evolving pandemic, CADTH identified 14 documents from a variety of sources relevant to the topic, including peer-reviewed and non-peer-reviewed articles. Based on the findings, many safety concerns expressed by LTC staff are related to the proximity of staff to residents during an infectious outbreak in the home. Staff are worried about both the health of residents and about becoming infected themselves, which has led to high levels of anxiety in these health care workers. They are also concerned about the lack of pandemic preparedness and infection prevention control (IPC) training; the shortage of PPE (at the start of the pandemic); insufficient staffing levels; delays in testing for residents and staff; confusion stemming from the evolving guidance (especially with respect to PPE); and challenges in fulfilling IPC

responsibilities, such as enforcing social distancing among residents who may not comprehend the reasons for it (e.g., because of dementia). The CADTH review identified general guidance on ways to prevent infection in LTC facilities or to directly support staff throughout the pandemic and/or reopening processes. One observational study specific to reopening LTC homes to visitors found that residents, staff, and visitors reported a positive experience during reopening, and no new COVID-19 infections were reported within the timeline of the study. However, both staff and residents were worried about the increased risk of infection, with staff being concerned not only about their own health but also about their spouse’s health. Staff also reported that the protocol for visits – planning each visit, screening the visitors, communicating risks to residents, and entering related information in each patient’s file – was at times stressful and time consuming. It has been suggested that leveraging digital technology to improve the efficiency

of charting might make this process more efficient. Multiple literature sources recommend having adequate staff-to-patient ratios, which is approximately four hours of direct nursing and personal support care per day per resident (according to a report on nurse staffing levels). Other notable recommendations for supporting staff include offering adequate education and thorough training on IPC measures related to infectious outbreaks; having adequate PPE and resources for staff; mandating the use of appropriate PPE; actively screening all staff, residents, and visitors; testing when appropriate, such as during an outbreak or when signs and symptoms of infection are present; having IPC specialist teams or medical staff on site; and implementing policies and incentives to limit staff from working in multiple facilities and to promote the use of sick leave when appropriate. Lastly, transparent communication is recommended to help alleviate the anxiety felt by staff, residents, and their families. For example, directors, managers, and policy-makers are encouraged to pay attention to the impact of infection outbreaks on the psychological well-being of health care staff and to have transparent communication regarding updates on the pandemic. These supports, along with regular monitoring of staff well-being, would help LTC workers continue to make meaningful contributions, even as visitor restrictions are relaxed. For more information, you can find the Synopsis Document at cadth.ca/ quickstarts/synopsis-of-referencesearch-results-for-topics-in-long-termcare. 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. ■

Deba Hafizi MPH, is a Knowledge Mobilization Officer at CADTH. 40 HOSPITAL NEWS DECEMBER 2020

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LONG-TERM CARE NEWS

Aging and brain health solutions making impact in diverse communities By Arielle Townsend OVID-19 has placed a spotlight on the need for senior care reforms in Canada. Yet, while more attention has been given to improving the well-being of older adults during this time, not much has been given to solving the equity gap that exists for racialized seniors and those born outside of Canada. Existing challenges that older adults face, such as loneliness and social isolation, are amplified at the intersection of age, culture, and race. In fact, cultural and linguistic barriers are some of the most significant hurdles seniors born outside of Canada encounter when trying to access healthcare, according to the Toronto Central LHIN. Being able to connect with a healthcare professional from

a similar ethnocultural background, who speaks your language and understands your cultural needs, is an often overlooked component of providing comprehensive care to seniors. As Canada’s population grows increasingly multicultural, and as the pandemic continues to widen the equity gap among racialized people, we can no longer ignore the unique needs of diverse seniors, or those for whom English is a second language. Aging and brain health innovators across Canada are working to make an impact in ethnoculturally diverse communities by creating solutions that improve quality of life and support equitable access to healthcare for all older adults. We’ve highlighted some of these solutions and their impact below.

TAMADUNI CONNECT

Tamaduni, a word in Swahili that means “culture or traditions,” forms the foundation for a new project led by registered nurse, Sharon Kiptoo. The project, which has been aptly called Tamaduni Connect, brings seniors and caregivers from similar cultural backgrounds together. Currently in its pilot-phase, Tamaduni Connect helps seniors feel supported by pairing them with caregivers who share similar cultural values, languages, and traditions. In doing so, seniors will be better equipped to advocate for their own care needs and preferences. According to Kiptoo, culturally sensitive senior care is something we aren’t talking about enough – which she hopes to challenge. “Culture is an important part of people’s determinants

of health. We can’t afford to leave it out.”

INDIGENOUS LANGUAGE APP

A CABHI-supported study, led by Dr. Carrie Bourassa, scientific director of the Canadian Institutes of Health Research, Institute of Indigenous Peoples’ Health, is exploring the effects of language development technology on the quality of life for Indigenous seniors, as well as helping caregivers adopt technology into their care routines. The study introduced a group of First Nations older adults to apps that use learning games and quizzes to engage users in five languages (Cree, Saulteaux, Dakota, Lakota, and Nakota). The project will assess both how engagement with language

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42 HOSPITAL NEWS DECEMBER 2020

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LONG-TERM CARE NEWS stimulates brain activity, as well as user needs in adopting the technology. The 15-month study predicts app use will benefit Indigenous older adults by making it easier for them to thrive in their setting of choice and receive support from caregivers in their communities.

NEW DEMENTIANS CHOIR

Singing in front of others can be daunting, but as members of the New Dementians Choir have discovered, it can also be a fun way to connect a diverse community that embraces all people, regardless of their age, culture, or level of cognition. Program coordinator, Dorothy Leclair, and music therapist, Jennyfer Hatch, started the New Dementians Choir once they realized how much people living with dementia in their community enjoyed singing and being around music. Choir members hail from a wide range of countries, including Iran, Hong Kong, Singapore, and Russia. The choir’s diversity helps make it a place where people can cel-

ebrate their differences, but also learn more about what makes others unique.

ELDER-LED CARE IN INDIGENOUS COMMUNITIES

Having access to community resources can promote independence in older adults and increase their ability to stay at home for longer. That’s why Dr. Sangita Sharma, a professor at the

University of Alberta, is building an Elder-led training program that promotes social engagement, healthy living and education among Indigenous seniors. The project will connect Indigenous seniors and caregivers living in the Northwest Territories to information on nutrition, physical activity, and healthcare services through community-based events. Activities will include peer-led exercise classes, recipe

sharing, and berry or medicine picking. With an approach that merges expertise from community Elders, knowledge holders, policy makers, caregivers and healthcare professionals, the program will be enriched with culturally relevant knowledge that can help Indigenous seniors age well at home. The final list of activities will be determined by community members who will beneH fit directly from the project. ■

Arielle Townsend is the Marketing and Communications Content Specialist at CABHI.

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DECEMBER 2020 HOSPITAL NEWS 43 www.tenaprofessionals.ca

LONG-TERM CARE NEWS

Learnings from COVID-19 outbreaks at

continuing care centres By Lisa Laferriere bout four months after a COVID-19 outbreak was declared at the Manoir du Lac Continuing Care Centre in McLennan and the J.B. Wood Continuing Care Centre in High Prairie, the North Zone communities reflect on shared experiences and learnings as they move forward in these unprecedented times. Only about 30 minutes away from each other, itâ&#x20AC;&#x2122;s not unusual for local staff to work at sites in both communities. But when a COVID-19 outbreak was declared at Manoir du Lac on April 2 and one at the J.B. Wood Continuing Care Centre in High Prairie on April 5, AHS staff and physicians came together as a team like never before. â&#x20AC;&#x153;This was unlike anything weâ&#x20AC;&#x2122;ve ever had to deal with before,â&#x20AC;? says

Louise Reid, AHS Seniors Health Manager for Area 6. â&#x20AC;&#x153;Not only were we facing a major health crisis, but we were also facing a major staffing crisis.â&#x20AC;? When a COVID-19 outbreak is declared at a continuing care site, staff who work there are not permitted to work at any other facility, to help protect residents and prevent the spread of COVID-19. â&#x20AC;&#x153;Staff from all different departments made tremendous efforts to come together and provide care for residents and support their colleagues,â&#x20AC;? says Reid. â&#x20AC;&#x153;Staff were re-deployed from other departments, from other areas across the Zone, and from across the province. Everyone really stepped up in this time of need.â&#x20AC;? Barbara Mader, site manager for the Sacred Heart Community Health Centre, says that one of the crucial parts of managing the outbreak was

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ROYALMEDIC.CA 44 HOSPITAL NEWS DECEMBER 2020

the dedication they had from the local physicians. â&#x20AC;&#x153;When the outbreak was declared in McLennan, we had a meeting with local physicians that very same evening, and they adopted a new care plan right away,â&#x20AC;? says Mader. She says it wasnâ&#x20AC;&#x2122;t long before residents at the Centre were being provided levels of care that they typically would have received in hospital. Dr. Pieter De Wet, community medical director for McLennan, says the experience was stressful, but without the support from local staff the outcome would have been much worse. â&#x20AC;&#x153;We had no cases in the community and then suddenly we heard that we had three cases at Manoir du Lac,â&#x20AC;? says De Wet. â&#x20AC;&#x153;We knew we had to make a plan, but there were still a lot of unknowns at that time.â&#x20AC;?

In McLennan, De Wet and the two other two physicians in the area, Dr. Ukulu Owanga and Dr. Pierre Cloete, rotate on-call shifts every three days. This means they are each on call about 10 times a month, on top of their regular hospital and medical clinic coverage. In order for them to be able to continue to provide care to patients at the hospital and in the community, it was decided that the physicians would treat Manoir du Lac residents remotely. This way, none of the physicians would have to quarantine and everyone in the community could continue to have access to physician care. â&#x20AC;&#x153;Heart attacks still happenâ&#x20AC;Śother people still need to see a doctor,â&#x20AC;? says De Wet. â&#x20AC;&#x153;So I must give credit to our long term care facilities staff. It was

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LONG-TERM CARE NEWS Louise Reid, left, and Barbara Mader, right, were two of the AHS managers who worked with staff, physicians, residents and families during the COVID-19 outbreaks in McLennan and High Prairie earlier this year.

because of them supporting us that we could carry on and continue to service the community during this time. They helped us treat our patients and stay connected with them and their families, without entering the site. They did a hell of a job.” Mader says it’s hard to name every team who stepped in to help, as every single one played an important role. “So many people stepped up into non-traditional roles, because there was a need for staff in so many different departments,” says Mader. “For example, a registered nurse could come to work one day and end up taking on the work of a healthcare aide. Wherever there was a need, someone was there to step in.” Reid remembers how supportive the community health partners were in High Prairie, including the home care, public health, and clinic department nurses who were redeployed to the J.B.

Wood Continuing Care facility. “In High Prairie, for example, we called the home care team for additional support and every single one of those nurses came to help without question or complaint. They hit the ground running, pulling 12 hour shifts, working nights…they really came through for us in a pinch,” says Reid. De Wet says he would read the CEO updates from Dr. Verna Yiu on a daily basis and found them very reassuring. He said knowing other healthcare professionals were getting through COVID-19 outbreaks and infections helped him mange all the unknowns of the disease. Mader says looking back, every single person and team deserves to be celebrated. “We never met any barriers when working through this - right up to the top senior leaders, who took seats on the ground.” Continued on page 46

Photo credit: Louise Reid

Care after hospitalization

about where to turn, how to cope and where to get help. can be an overwhelming process. Our goal is to ensure that feel most comfortable – home.

Support is just a phone call away.

1.877.289.3997 clientservice@bayshore.ca

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DECEMBER 2020 HOSPITAL NEWS 45

LONG-TERM CARE NEWS

Researchers receive grant to help long-term care homes protect themselves from COVID arleton University’s Chantal Trudel, a professor in the School of Industrial Design and a team made up of Susan Braedley, Amy Hsu, Dennis Kao, Frank Knoefel, Sophie Orosz, Heidi Sveistrup, and Bruce Wallace – received nearly $40,000 from the Foundation for Health Environments Research in the United States to study the design of Canadian long-term care homes (LTC) in the wake of the COVID-19 pandemic. The work reflects Carleton’s research commitment to supporting pandemic efforts and strategic initiatives in health, wellness and sustainability. The funds will be used to design LTC work and living spaces for the protection of residents and staff. Partners include the Bruyère Research Institute and the Ontario Centres for Learning, Research and Innovation in Long-Term Care. “Unlike hospitals, which are clinical in nature, LTC environments are residents’ homes,” says Trudel. She added this situation presents a challenge in designing for infection prevention and control. Steve Crawford, chief executive officer of McCormick Care Group in London, Ont., is working with Trudel on design studies. He shares Trudel’s concern. “There’s a potential disconnect between making LTC safe in terms of infection prevention and control, and creating spaces that are comfortable and warm for residents and workers alike.” Trudel’s previous work in neonatal care showed that aspects of our

environments may get in the way of health-care workers trying to complete their tasks safely. There is a critical problem health-care workers are experiencing – a tension between trying to be as cautious as possible, while trying to finish the variety of tasks to serve patients. The team’s goal is to identify and address these conflicts in LTC to prevent outbreaks, as workers do everyday tasks while wearing cumbersome personal protective equipment. The team will also study how to assist residents who are living with dementia, which can be particularly challenging, according to team member Frank Knoefel from Bruyère. “It may be hard for someone living with cognitive impairment to remember

46 HOSPITAL NEWS DECEMBER 2020

to wash their hands after coming in contact with high-touch surfaces or to remember physical distancing rules.” Normally Trudel and her team would visit LTC homes, but due to the pandemic the team will begin the work remotely with at least three LTC workers per facility, at four locations, to capture a range of living and working environments. Trudel’s team will also review the plans of future LTC homes or those under renovation to co-create infection-prevention design strategies. The initial phase of the study will last a year. The team will create a COVID-friendly design plan for participating LTC homes that could also be used to prevent future respiratory H outbreaks. ■

Continuing care centres Continued from page 45

Greg Cummings, Chief Zone Officer for the AHS North Zone, and Cindy Harmata, Senior Operating Officer for Areas 5-8, travelled to work at Manoir du Lac during the outbreak. “Seeing Greg and Cindy at the site – helping out on the ground and connecting with the families – was really positive. We all felt really supported,” adds Mader. Reid says overall, her experience with COVID-19 was emotional. “It was more of an experience than I ever could have thought it would be,” says Reid. “But it was also incredible to see people come together. Today, we are highly aware of what we experienced. We are closely following the sites and monitoring the situation. We know that no one is completely out of the woods when it comes to COVID-19.” Dr. De Wet wants to remind people to stay cautious and take COVID-19 seriously. “I have never been through anything like this before in my whole life,” he says. “People should not discredit the disease, and you have to stick to the rules: wear masks, clean your hands, and keep your distance.” They all agree that if they gained anything from this experience, it was knowing that the value of everyone working together, and coming together as a team, is stronger than ever. A COVID outbreak was declared at Manoir du Lac on April 2. There were 43 confirmed COVID positive resident cases, 18 staff cases and, sadly, 10 COVID-related deaths. On May 27, 2020, AHS’ North Zone Medical Officer of Health declared the Manoir du Lac COVID-19 outbreak over. A COVID outbreak was declared at the J.B. Wood Continuing Care facility on April 5. There were 16 confirmed COVID resident cases, 10 staff cases and unfortunately, three COVID-related deaths. On May 28, 2020, AHS’ North Zone Medical Officer of Health declared the J.B. Wood Continuing Care facility COVID-19 H outbreak over. ■ Lisa Laferriere works in communications at Alberta Health Services. www.hospitalnews.com

DATA PULSE

Putting patients at the center of hospital performance measurement H

ow do patients feel about their hospital experiences? Do they feel heard by their doctors and nurses? Do they feel they received complete and helpful information before leaving the hospital? Understanding patientâ&#x20AC;&#x2122;s experiences throughout their hospital stay â&#x20AC;&#x201C; from arrival to discharge â&#x20AC;&#x201C; is critical for understanding hospital performance. Patient reported information about hospital experiences provides meaningful insights that can help drive improvements in patient-centered care.

THE PATIENTâ&#x20AC;&#x2122;S VOICE: REPORTING PATIENT EXPERIENCE

Hospitals use patient survey responses to better understand patient perspectives, preferences and focus quality improvement efforts. To ensure that the data was comparable across the country, the Canadian Institute for Health Information (CIHI) worked with health system stakeholders to develop a standardized survey

Collecting and reporting patient experience information is an important part of CIHIâ&#x20AC;&#x2122;s work on health system performance measurement and CIHI has been working with provinces to support the implementation of the survey.

WHAT PATIENTS ARE SAYING ABOUT THEIR HOSPITAL EXPERIENCES

Receiving timely information on diagnosis and treatment options, being able to ask questions, or feeling like the staff care can mean the difference between a positive and a negative patient experience in hospital. Results from CIHIâ&#x20AC;&#x2122;s report Patient Experience in Canadian Hospitals, which included over 90,000 survey respondents from over 300 hospitals in the five reporting jurisdictions (New Brunswick, Ontario, Manitoba, Alberta and British Columbia), showed that â&#x20AC;˘ 62 per cent of patients said that their overall hospital experience was very good

role in understanding patient outcomes, including hospital readmissions, complications, or medication adherence.

CIHI is continuing to expand the collection and reporting of patient experiences across the country â&#x20AC;&#x201C; with hospital patient experience data being made publically available in 2022.The goal is to drive improvements in patient-centred care and help amplify the voice of patients within the health system. Evaluating patient experience along with other components such as access, effectiveness and safety of care will be essential to providing a complete picture of health care quality in Canada. If you would like to learn more, please visit CIHIâ&#x20AC;&#x2122;s patient experience webpage or email prems@ H cihi.ca. â&#x2013;

OPTIMIZING HOSPITAL PERFORMANCE THROUGH PATIENT EXPERIENCE

Comparable pan-Canadian patient experience data is a major step in fostering a system that places the patient at the centre of hospital performance measurement. The data can facilitate benchmarking, peer-to-peer learning and best-practice sharing, driving quality improvement.

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to collect patient-reported experience information. The Canadian Patient Experiences Survey â&#x20AC;&#x201C; Inpatient Care, in use since 2015, collects patient feedback about the quality of care patients experienced during their most recent stay in a Canadian acute care hospital. Survey results provide valuable insight into a patientâ&#x20AC;&#x2122;s experience. When analyzed alongside other important hospital indicators â&#x20AC;&#x201C; like readmission rates and cost of a standard stay â&#x20AC;&#x201C; they help provide a fuller picture of overall hospital performance. www.hospitalnews.com

â&#x20AC;˘ More than two in three patients said doctors and nurses always listened to them carefully and explained things in a way they could understand. â&#x20AC;˘ Almost half of patients felt that communications among health care providers could be improved and that health care providers could be more informed about their hospital care Results like these are integral to improving patient-centered care in hospitals by playing an important

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DECEMBER 2020 HOSPITAL NEWS 47

Infection Control Risk Assessment

ICRA

Best Practices In Health Care Construction

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

any given moment

1.7 million patients suffer from healthcare associated infections every year nationwide

100,000 deaths resulting from healthcare associated infection occur each year

Safety is priceless. ICRA training is free.

Learn more at ubc-icra.org

@carpenters27

www.ubc27.ca 222 Rowntree Dairy Rd., Woodbridge, ON L4L 9T2 905-652-4140 | www.ubc-icra.org Email: organizing@thecarpentersunion.ca

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