Guest editorial

Unnecessary tests

strain Canada’s already stretched health care system

By David O’Toole and Wendy Levinson

Canadians are waiting longer than ever before for elective surgeries. Across the country, health care systems are experiencing record backlogs in surgery due to successive waves of the pandemic and shortages of nurses, doctors and other health professionals.

There is an urgent need to ensure Canadians receive care in a timely manner by improving our health policies and systems. But there are also everyday practices and processes we can address right away to help improve delays and backlogs.

“Low-value care” describes tests and treatments that are commonly ordered despite clear evidence that they do not help with patient care – and may even cause harm.

A new report released from the Canadian Institute for Health Information and Choosing Wisely Canada evaluates this problem across 12 different low-value tests and treatments. The report looks at trends across the country before the pandemic, as well as during the first year of COVID-19.

Overall, the report shows that Canada has made good progress, with eight of the 12 areas of tests or treatments declining by 10 per cent or more between 2014 and 2019. But, given that most of these tests and treatments are unlikely to be necessary in the first place, we can do even better – saving our valuable health care resources for care that is truly needed. What are examples of low-value care in surgery?

Knee arthroscopy is a surgical procedure that’s appropriate for treating common knee problems, such as torn ligaments. But for adults aged 60 and older, this procedure offers little to no benefit compared to safer options like exercise therapy, injections or medications.

The good news is that Canada has reduced the number of low-value knee arthroscopies. The rate of knee arthroscopies has dropped by 46 per cent in adults over 60 between 2014 and 2019. Still, 99 out of every 100,000 older adults are getting the procedure each year, with differences in rates among the provinces.

If all of Canada could achieve the rates of the lowest province, which is currently Newfoundland and Labrador, it is estimated that an additional 7,500 knee arthroscopies could be avoided across the country each year – freeing up significant surgical resources to provide more necessary patient care.

Another example is pre-operative testing. If you are getting cataract surgery or other low-risk procedures, you may be asked to go for additional testing before the operation. Evidence shows that these tests – electrocardiograms, cardiac stress tests, echocardiograms or chest x-rays – rarely change a surgeon’s decision to operate or make surgery safer and may lead to additional unnecessary testing and delays in getting the surgery done.

Continued on page 6

UPCOMING DEADLINES

FEBRUARY 2023 ISSUE

EDITORIAL: January 12 ADVERTISING: Display – Jan. 20 | Material – Jan. 24 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. + WOUND CARE SUPPLEMENT

MARCH: 2023 ISSUE

EDITORIAL: February 9 ADVERTISING: Display – Feb. 24 | Material – Feb. 28 Monthly Focus: Facilities Management and Design/Health Technology/Greening Healthcare/Infection Control: Innovative and efficient healthcare design, the greening of healthcare and facilities management. An update on the impact of technology , including robotics and artificial intelligence on healthcare delivery. Advancements in infection control in hospital settings. + INFECTION CONTROL SUPPLEMENT

610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 TEL. 905.532.2600|FAX 1.888.546.6189 www.hospitalnews.com

Editor Kristie Jones

editor@hospitalnews.com Advertising Representatives Denise Hodgson

denise@hospitalnews.com Publisher Stefan Dreesen

stefan@hospitalnews.com Accounting Inquiries accountingteam@mediaclassified.ca

Circulation Inquiries info@hospitalnews.com

Director of Print Media Lauren Reid-Sachs

Senior Graphic Designer Johannah Lorenzo

ADVISORY BOARD

Barb Mildon,

RN, PHD, CHE VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences Helen Reilly,

Publicist Health-Care Communications Bobbi Greenberg,

Health care communications Sarah Quadri Magnotta,

Health care communications Dr. Cory Ross,

B.A., MS.C., DC, CSM (OXON), MBA, CHE Vice President, Academic George Brown College, Toronto, ON

ASSOCIATE PARTNERS:

Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers. Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: subscriptions@ hospitalnews.com Canadian Publications mail sales product agreement number 42578518.

Rare transplant offers mother of four “a future now”

Ottawa police officer Dawn Ethier cured following groundbreaking procedure at UHN’s Ajmera Transplant Centre

By Ana Fernandes

When Dawn Ethier looks back at the past decade of her life, it is a blur. The ordeal of taking several medications, almost a hundred pills per day, constantly having to measure mineral levels in her blood, and several visits to hospital was extremely taxing for the Ottawa police officer and mother of four, who battled with hypoparathyroidism.

“This disease took a lot of time away from me, from my family, from work, from caring about myself,” says Dawn, who is now cured after receiving a ground-breaking transplant at UHN’s Ajmera Transplant Centre.

“For a long time, I didn’t think I was worthy of anything, because I was so ill.”

Dawn had thyroid cancer over 10 years ago. The cancer was treated, but a complication she was left with was hypoparathyroidism – when someone has little or no parathyroid function.

The condition caused severe symptoms and even threatened Dawn’s life. She had cardiac episodes, pulmonary embolisms, seizures, loss of muscle control, and longterm impacts to her mental health.

After a lot of research and conversations with her care team in Ottawa, Dawn was able to connect with Dr. Karen Devon, an Endocrine Surgeon at UHN’s Sprott Department of Surgery, and discuss with her a bold idea – trying a parathyroid transplant.

With only one other case of this exact type of transplant recorded in the scientific literature, this was no small undertaking.

Dr. Devon had to do a lot of homework for a couple of years, including connecting with specialists around the world to discuss this case.

She had unwavering support from the Ajmera Transplant Centre, one of the largest transplant programs in North America, recognized for leading ground-breaking procedures.

“I was apprehensive of bringing this idea forward to leadership at the Ajmera Transplant Centre, and I was extremely encouraged by the response, which was to tell me that we have an obligation to help this patient,” says Dr. Devon, who’s also an Assistant Professor with the University of Toronto.

“That was very motivating for me,” she adds. The journey was long, through listing and matching with potential donors, one failed transplant attempt in 2021, and managing all of this during a global pandemic. But on May 19, four healthy parathyroid glands were implanted on Dawn’s right forearm and they started functioning a few weeks later. “This saved my life, it changed everything,” says Dawn, who has come off all the medications she was taking for her disorder, doesn’t need any infusion or regular visits to hospital day units, and has none of the symptoms of hypoparathyroidism.

“My mood, my personality is coming through. I’m no longer exhausted, I’m able to spend more time with my children.

“I can see a future now. This is not going to end up being something that will take me.”

Dawn seen here with her youngest daughter, Rebecca, says she is very happy to be able to spend more time with her children now.

Small but mighty: transplant of glands the size of grains of rice gave Dawn Ethier her life back.

Photo credit: UHN DIVING INTO THE TRANSPLANT WORLD

Through this exciting case, Dr. Devon had her first experience as a transplant surgeon and worked closely with the transplant team at Toronto General Hospital. An important ally was UHN’s Physician-in-Chief, Dr. Kathryn Tinckam, who is also a transplant nephrologist at the Ajmera Transplant Centre.

As with other organ transplant candidates, Dawn had to go through extensive testing. Dr Tinckam, who is also a consultant with UHN’s HLA Lab – the largest histocompatibility laboratory in Canada – helped guide the process.

“We test the blood of potential recipients frequently to quantify what percentage of all potential organ donors could be a suitable match. This helps us understand what chances that patient will have of a donor organ becoming available,” explains Dr. Tinckam, who is also Associate Professor of Medicine at U of T. Continued on page 9