12 minute read
COLUMNS
Window of opportunity for feds to address healthcare deficits
By Sarah Watts-Rynard
Headlines across Canada and around the world continue to be filled with news of shutdowns, widespread economic chaos and the race to vaccinate. Where we once defaulted to small talk about the weather, conversation has turned to daily case counts, ICU beds and vaccination statistics. Health has become a national obsession, with all signs suggesting it will remain so until the pandemic fades into memory.
That’s why now is the right time to talk about – and invest in – the future of Canada’s healthcare system.
For many years, investing in healthcare was a matter of boosting federal transfers to the provinces. Not terribly exciting in terms of advancing national policies or programs but, rather, a way to buy short-term peace within the federation. The COVID-19 pandemic has opened the door to something more.
Lessons from the pandemic point to two structural issues that are well within the federal government’s capacity to address: Canada’s system of long-term care and challenges within the healthcare talent pipeline. The current environment opens a window to fresh policy action and a renewed federal/provincial partnership on healthcare.
First, the pandemic has laid bare the fault lines in Canada’s long-term care system. Staffing was inadequate to meet the needs of seniors in care when family access was restricted. By all accounts, personal protective equipment was insufficient and the need for it poorly understood. As a result, those with compromised immune systems and pre-existing health conditions – the very group long-term care is designed to support – died at alarming rates.
With a Canadian population that is living longer, eldercare is a reality with which the federal government must grapple. Now is the time to activate and empower the Minister of Seniors to set national standards of care and employee training for senior living facilities. These actions would be appropriate and well-timed, not to mention welcomed by countless families who were denied the ability to visit, advocate for or support their loved ones over the past year.
If there were a federal will, there is no shortage of capacity. Polytechnic institutions, for example, have dedicated applied research expertise in eldercare and healthy aging. They are also the foremost education providers for a workforce that is well-trained and certified, rather than ad hoc and under-prepared.
While a number of the issues surrounding eldercare relate to training standards, the government needs to think bigger. Frontline workers across all health fields have been pushed to their limit for more than a year, with each subsequent wave of the pandemic accompanied by a host of new challenges.
Part of the solution lies in a much greater emphasis on professional development and upskilling. While the same can be said across sectors, the healthcare field is a critical case in point. At Polytechnics Canada, we are hearing about micro-credentials to activate a vaccination workforce and upskilling for critical care nurses. Continued on page 6
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First-in-Canada trauma recovery clinic opens at Sunnybrook
By Sybil MIllar
After years of planning and months of renovations, a new clinic that aims to improve long-term outcomes for trauma patients has opened its doors at Sunnybrook Health Sciences Centre.
The Jennifer Tory Trauma Recovery Clinic, the first clinic of its kind in Canada, will provide an innovative model of follow-up care for trauma patients navigating a new reality that can often include a combination of physical disability, pain, mental illness and impaired cognitive function.
“For many of our trauma patients, leaving the hospital is just the beginning of a long and challenging recovery process. Centralizing their follow-up care in the Jennifer Tory Trauma Recovery Clinic will help better prepare them for life outside the hospital,” says Dr. Avery Nathens, Medical Director of Trauma and Surgeon-in-Chief at Sunnybrook who also led the development of the clinic alongside his colleagues in the Tory Trauma Program.
Until now, a trauma patient who had been discharged but still required follow-up with multiple care providers would have needed to visit several different areas of the hospital.
The Jennifer Tory Trauma Recovery Clinic will instead bring those care providers to the patients in a purpose-built space consisting of five exam rooms, a dedicated registration and waiting area, staff workstations and equipment areas, and a meeting room that can support virtual appointments if needed.
Accessible features have also been incorporated into the clinic, such as doorways wide enough to accommodate wheelchairs and stretchers.
“Having this dedicated space will help us ensure patients are getting the support they need during their recovery and follow-up process,” says Corey Freedman, Manager of Trauma Services at Sunnybrook.
Dr. Nathens says the interprofessional nature of the clinic means that staff from across the hospital will be working with patients in the new space, including care providers from physiotherapy, occupational therapy, social work, physiatry, psychology, clinical psychiatry and pain services.
“As an example, surgeons might not know what to do if a patient has post-traumatic stress disorder after their injury or is asking for more opioids to help with their pain. Having access to all of that expertise in the clinic will be helpful for both the care providers and the patients,” he says.
The clinic will be managed by Grace Walter, who is also the patient care manager of Sunnybrook’s trauma unit, to ensure a smooth transition from inpatient to outpatient care.
“We will follow trauma patients for a year after they are discharged from Sunnybrook, with the ultimate goal of helping patients transition back to their home community for ongoing support,” says Walter.
The clinic was made possible thanks to a leadership gift by Jennifer Tory, which has since inspired other donors to provide support.
Jennifer’s support for trauma recovery follows her family’s long history of involvement with Sunnybrook, and in particular the Tory Trauma Program, Canada’s first and largest trauma centre. Her parents, John and Liz, are benefactors of the John A. Tory Family Regional Trauma Centre at Sunnybrook and other critical programs.
Jennifer’s own dedication to Sunnybrook began at an early age, when she was a candy striper. She is a passionate leadership volunteer and a long-time member of the Sunnybrook Foundation Board of Directors. ■ H
Sybil Millar works in communications at Sunnybrook Health Sciences Centre
Thank you from Nursing Hero winner Ordia Kelly
I would like to thank you all for your kind words and I am humbled by such a nomination and award.
To be acknowledged as a Nursing Hero leaves me overwhelmed and in shock but I remain grateful and full of appreciation for this honour and for such a moment as this.
I always aim to do my best because I love being a Nurse. I accept this honour on behalf of everyone on our team because I could not have done it without the support of my coworkers.
I am appreciative of a workplace that allows me to aim for excellence in my daily duties as a nurse and the opportunity I was given to lead a team with many outstanding professionals.
Most of all I want to thank God for giving me the strength, courage and guidance to do what I do best. To God be the Glory! ■ H
With sincere thanks and gratitude,
Ordia Kelly RN
Reducing healthcare-related PPE and medical single-use plastic waste
In order to keep Canada’s health care workers safe and provide care in hospitals during the COVID-19 pandemic, the use of personal protective equipment (PPE) and medical single use plastics (mSUPs) increased significantly. At the same time, numerous challenges emerged during the pandemic which reduced access to PPE, mSUPs and other medical products.
A newly launched project, of the Canadian Coalition for Green Health Care (Coalition), Reducing Health Care-Related PPE and Medical Single Use Plastic Waste Through Circular Economy Principles, will demonstrate that hospital-generated PPE and mSUP materials can be successfully managed by applying the principles of a circular economy: reduce, reuse and recycle as much as possible before the materials are disposed. The project will demonstrate that waste PPE can be collected, stored and transported to a designated recycling facility operated by an industry partner. In addition, PPE and selected mSUPs reuse and reduction opportunities will be identified which will complement and further enable resource conservation.
“The Coalition and our collaborators will conduct important first-person research that can inform the sector on best practices for PPE waste management. It will also help develop operational expertise among the various stakeholders engaged in the acquisition, use/re-use, recycling and disposal of PPEs and selected mSUPs,” says Coalition Executive Director Neil Ritchie. “Ultimately, we hope to demonstrate that applying a circular economy lens to purchasing decisions in hospitals can both save money and our planet.”
Hospital partners include GreenCare, managed by British Columbia’s Energy and Environmental Sustainability team, a shared service supporting BC’s Lower Mainland health organizations and a leader in considering circular economy applications in health care, and Toronto’s University Health Network (UHN), both of which have award-winning environmental sustainability programs and have demonstrated leadership in these areas.
To learn more about the Coalition’s new PPE/mSUP initiative, please visit the website at: https://greenhealthcare.ca/ppe-msup ■ H
Dialysis patients do not develop adequate antibodies with one dose of SARS-CoV-2 vaccine
Healthcare deficits
Continued from page 4
Investments in upskilling and reskilling must be viewed as much a health issue as a workforce training priority. It isn’t enough for the courses to exist – Canadian workers need to be encouraged, supported and navigated to high-quality continuing education.
Another important way to support the current healthcare system is to enable the efficient entry of new graduates.
While late-stage students in many vital health fields made an accelerated entry into the healthcare workforce last spring, the learners behind them have struggled to find the practicums and placements critical to earning their professional designations. Work-integrated learning opportunities didn’t dry up for lack of work, but because of an overwhelmed system without the resources to offer hands-on experience to students.
Polytechnic institutions found creative ways to continue hands-on and applied learning in a largely remote environment, but investments in post-secondary digital infrastructure – simulators, augmented and virtual reality, high-tech labs and smart classrooms – will go a long way to ensuring new entrants are work-ready in high demand fields. In addition to providing teaching and learning solutions in the time of a pandemic, such investments lay the groundwork for a future that includes digital and remote healthcare.
While most Canadians will be grateful when the pandemic is over and behind us, we shouldn’t lose sight of the opportunities to address deficiencies identified in the last year. Without a doubt, one of the most important is a reimagined federal/provincial partnership for the health and welfare of Canadians. ■ H N ew research in CMAJ (Canadian Medical Association Journal) shows that most hemodialysis patients do not develop adequate antibodies after their first dose of SARSCoV-2 vaccine.
“We advise that the second dose of the BNT162b2 [Pfizer] vaccine be administered to patients receiving hemodialysis at the recommended threeweek time interval, and that rigorous SARS-CoV-2 infection prevention and control measures be continued in hemodialysis units until vaccine efficacy is known,” writes Dr. Rita Suri, a nephrologist at the Research Institute of the McGill University Health Centre, Montreal, Quebec, with coauthors.
Patients receiving hemodialysis are especially vulnerable to COVID-19 as they must leave their homes three times a week for dialysis at a health care facility, and case fatality rates are 20-30 per cent, which is 10 times higher than in the general population.
The study included 154 patients receiving hemodialysis in Quebec (135 without and 19 with prior SARSCoV-2 infection), 40 healthy volunteers (20 without and 20 with prior SARS-CoV2 infection) and convalescent plasma from 16 dialysis patients who survived COVID-19. Researchers measured antibody levels in the participants and found dialysis patients who were never previously exposed to COVID-19 had lower antibody levels than participants in the two control groups, even up to eight weeks later. Antibodies were undetectable in 57 per cent of patients receiving hemodialysis. Of the 154 patients receiving dialysis, four developed COVID-19 after vaccination.
“Patients receiving hemodialysis who did not respond at four weeks remained non-responders at eight weeks, which is an argument against the possibility of a delayed response in these individuals. Older patients and those on immunosuppression had even lower seroconversion rates, but even younger patients not on immunosuppression had a significantly lower seropositivity rate than controls,” write the authors. How well dialysis patients respond to the second dose of vaccine is being studied.
“Short-term antibody response after 1 dose of BNT162b2 vaccine in patients receiving hemodialysis” was published May 12, 2021. ■ H
