Hospital News September 2021 Edition by Hospital News

Inside: From the CEO’s Desk | Evidence Matters | Long-term Care | Special focus: Online Education

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FEATURED

Blood clot

leads to first-ever

intervention Page 24

September 2021 Edition

Hard lessons. A lot of people fought the pandemic. Nurses were right there at the bedside, despite all the risks. We must not forget what COVID-19 exposed. Our health-care system is fragile, and nurses and healthcare professionals are its backbone. They’ve earned respect and the right to fair treatment, for a long time to come.

#KeepNursingStrong

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Contents September 2021 Edition

IN THIS ISSUE:

Under pressure: Ontario Paramedics’ experiences of COVID-19

▲ Cover story: Deadly COVID-19 blood clot leads to first-ever intervention

▲ Special focus: Online education

▲ Ketamine for agitated patients in ERmore effective than traditional methods

COLUMNS Editor’s Note ....................4 Evidence matters .............5

In brief ..............................6 Long-term Care ..............26

▲ Canine scent detection team now detectting COVID-19

Critical care: Health care HR crisis

▲ Olympic equestrian thankful for ‘unbelievable’ trauma care

What if the next federal election actually was the time to

discuss serious issues? D

uring the 1993 federal election, Kim Campbell famously said that “An election is no time to discuss serious issues.” It is time to change that thinking. There is nothing wrong with any governing party calling an election. What is wrong is if political parties do not provide Canadians with enough information on the direction they would take to revamp Canada’s health care system should they actually win the election and form government in the middle of a pandemic. Philosopher Georg Hegel famously said: “We learn from history that we do not learn from history.” We have experienced a great deal over the past 18 months, and it behooves our leaders to apply what we have learned into rebuilding a better system. Past experience from other pandemics and infectious diseases emergencies suggest that Hegel had a point: we are typically quick to want to move on and put the trauma of pandemics behind us. By now it is well understood that COVID-19 exposed the fragility of our healthcare system and exacerbated long-standing issues. Inadequate funding across the system, poor access to mental health services, a desperate need to reimagine older adult care, crumbling and outdated health infrastructure, and the lack of a national health human resources strategy to ensure appropriate levels of care are just a few of our systemic shortcomings.

Also not to be overlooked is a long overdue transformational investment needed in Canadian health research. A renewed healthcare system and a new strategic approach to capitalizing on Canada’s world-leading health research are critical to our future success both in improving the health of Canadians and our national economy. That is why HealthCareCAN and our member institutions from across the country believe that in this federal election Canadians want to hear from parties and candidates with ideas and a commitment to shoring up the healthcare system starting by focusing on its greatest resource: its people. Canadians generally are reporting worsening mental health and the situation is even more dire among healthcare workers. Described rightly as frontline healthcare heroes during the dark days of COVID, these long-suffering individuals have been left to suffer far too long and are now leaving the field in droves across the country or are planning to do so, citing overwork, burnout and even post-traumatic stress disorder as the causes. Consequently, healthcare institutions are struggling to fill staff vacancies for physicians, nurses, support workers, housekeeping and many other fields. And remember, despite widespread wishful thinking, this pandemic is not over and we may well still have to revisit the dark days of this past winter. Continued on page 6

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Monthly Focus: Mental Health and Addiction/Patient Safety/ Research/Infection control: New treatment approaches to mental health and addiction. Developments in patient-safety practices. An overview of current research initiatives. Developments in the prevention and treatment of drug-resistant bacteria and control of infectious (rare) diseases. Programs implemented to reduce hospital acquired infections (HAIs).

Monthly Focus: Medical Imaging /Year in Review/Future of Healthcare/Accreditation/Hospital Performance Indicators: Overview of advancements and trends in healthcare in 2021 and a look ahead at trends and advancements in healthcare for 2022. An examination of how hospitals are improving the quality of services through accreditation. Overview of health system performance based on hospitals performance indicators and successful initiatives hospitals have undertaken to measure and improve performance. A look at medical imaging techniques for diagnosis, treatment and prevention of diseases.

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EVIDENCE MATTERS

Overused and low-value: What to leave behind after COVID-19 By Sarah Garland he COVID-19 pandemic has reshaped our health care system. Health care workers have, for the last year and a half, put time and effort into coping with the rising numbers of COVID-19 patients. Many have also dealt with a shortage of personal protective equipment and had to quickly adjust to offering care virtually. The next challenge is navigating the limit to the services our health care system will be able to offer – especially as provinces and territories work through the backlog of surgeries and screenings that were postponed because of the pandemic and deal with the increased need for mental health services and chronic disease care. Post pandemic, as health care systems face new challenges, backlogs, and possible financial constraints, we may need to do more with less. As priorities shift to essential and necessary care, what sorts of practices can we leave behind after the pandemic? What can clinicians, hospitals, and policy experts choose not to do? Choosing Wisely Canada is an organization focused on raising awareness about the harms of low-value interventions and their overuse in health care – interventions that offer little benefit, waste resources, and sometimes are harmful to patients. A key initiative of Choosing Wisely Canada is bringing together clinician societies, patients, and the public to develop lists of recommendations – often framed as “do not do’s.” CADTH an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures – and Choosing Wisely Canada have highlighted some of their existing recommendations that could be used to inform priorities and practice in the post-COVID-19 era. The focus is on avoiding low-value care as our health care system rebounds from the COVID-19 pandemic.

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Staff from Choosing Wisely Canada short-listed 45 from their more than 400 recommendations. Then a 10-member multi-disciplinary panel of clinicians, patient representatives, and health policy experts examined the list for recommendations that could address either needs caused by the pandemic or existing backlogs as our health care systems recover from COVID-19. This process resulted in the following “19 Recommendations to Reduce Low-Value Care,” which had a high level of consensus from the panel. A few of the recommendations from this list are highlighted below (a link to the full report is provided at the end of this article): • Don’t order baseline laboratory studies (complete blood count, coagulation testing, or serum biochemistry) for asymptomatic patients undergoing low-risk non-cardiac surgery. • Don’t order a knee MRI when weight-bearing X-rays demonstrate osteoarthritis and symptoms are suggestive of osteoarthritis as the MRI rarely adds useful information to guide diagnosis or treatment. • Don’t send the frail resident of a nursing home to the hospital unless their urgent comfort and medical

needs cannot be met in their care home. • Don’t routinely transfuse red blood cells in hemodynamically stable intensive care unit patients with a hemoglobin concentration greater than 70 g/L (a threshold of 80 g/L may be considered for patients undergoing cardiac or orthopedic surgery and those with active cardiovascular disease). • Don’t send a patient for a specialist visit that requires several hours of transport if the visit can be done virtually or by a local physician.

• Don’t do imaging for lower back pain unless red flags are present. • Don’t do imaging for uncomplicated headache unless red flags are present. When the worst of the pandemic recedes, it will be important to meet the challenges ahead and focus on rebuilding our health care systems. Implementing these recommendations can help ensure high-value care after the pandemic. Health care professionals can use this list, in addition to other recommendations from Choosing Wisely Canada, to support decision-making and ensure patients receive appropriate care. Implementing these recommendations will depend on the local context and resources – this list of recommendations can be used as a guide for developing priorities based on local circumstances. To read the full list of recommendations, and to learn more about how this list was developed, you can access the report – “Using Health Care Resources Wisely After the COVID-19 Pandemic: Recommendations to Reduce Low-Value Care” – in the 5th issue of the Canadian Journal of Health Technologies. To find out more about CADTH, visit cadth. ca, follow CADTH on Twitter: @ CADTH_ACMTS, or talk to our Liaison Officer in your region: cadth.ca/ H contact-us/liaison-officers. ■

Sarah Garland is a knowledge mobilization officer at CADTH.

SEPTEMBER 2021 HOSPITAL NEWS 5

IN BRIEF

Majority of Canadian physicians planning to use virtual care post-pandemic ccording to a recent survey conducted for Canada Health Infoway (Infoway) and the Canadian Medical Association (CMA), almost all Canadian physicians say they will continue to use virtual care after the pandemic, and 64 per cent say they will maintain or increase their use. The survey was conducted online in April and May with more than 2,000 physicians – general practitioners (GPs)/family physicians, specialists and residents. Ninety-four per cent of physicians said they currently use virtual care, with 93 per cent offering telephone visits, 51 per cent offering video visits, 36 per cent offering email/messaging and five per cent offering remote pa-

tient/home health monitoring. More than 70 per cent believe virtual care improves patient access and enables quality care and efficient care for their patients. Seven out of 10 were satisfied with telephone/video and about 50 per cent were satisfied with email/messaging and remote monitoring. More than 70 per cent said they have the knowledge and skills needed to use virtual care, are satisfied with time spent with patients, and found it easy to integrate into their workflow. In addition, 93 per cent of GPs are now using electronic medical records (EMRs), up from 86 per cent in 2019 (Commonwealth Fund Survey). “It’s clear from these findings that virtual care is here to stay in Canada,”

said Michael Green, President and CEO, Infoway. “Physicians are satisfied with it and they recognize the benefits to their patients and their practice. It’s also good to see that almost all GPs are using EMRs, which can really help enable virtual care.” “The use of virtual care has increased greatly since the beginning of the pandemic but work is still required to ensure quality care and equitable access,” said Dr. Ann Collins, CMA president. “We still have work to do such as creating national licensure, developing quality standards, addressing interoperability as well as ensuring digital health literacy, education and training. These are crucial elements to the successful integration of virtual care into our health care system and

Discuss serious issues? Continued from page 4 Canada’s lack of a national human resources strategy to ensure a sustainable, national supply of qualified healthcare personnel is at the root of the problem. While COVID highlighted the issue of healthcare staff levels causing repeated deferments of surgeries and procedures as well as the terrible situations exposed in long-term care, it must be made clear that the situation is not new. In 2004, Canada launched a Health Human Resources Strategy “to support co-ordination and collaborative health human resources planning across the country.” Without a plan to ensure sufficiently trained healthcare personnel through a national human resources strategy, removing barriers for national licenses and addressing the importance of family in providing care, Canada’s health care system will continue to let down both healthcare providers and patients. Among other investments in the healthcare sector, a national human health resources strategy is vital to increase capacity and ensure everyone

seeking care can access it in a timely fashion. This could and should be a major plank in the election platforms of all federal parties. Before the next pandemic is upon us, HealthCareCAN, the national voice of healthcare and health research institutions in Canada, recommends that Canada urgently address the shortage of the healthcare workforce, ease regulatory barriers to cross-provincial/territorial practice and recruit, support, and implement a robust human health resources strategy. As we look to provide much-needed reinforcements in our health workforce, we must also shore up our healthcare system generally, beginning with developing a new, well-resourced national plan to better care for older adult Canadians. The COVID-19 pandemic demonstrated clearly that Canada’s patchwork approach to providing elder care is insufficient. We can and must do better. We must also not overlook the healthcare advances and tools Canada’s health researchers produced in

the battle against COVID-19. Health and biosciences is one of the fastest growing sectors of Canada’s economy and contributes $7.8 billion to Canada’s annual GDP. Our new challenge is to build on that momentum and truly harness the incredible promise of Canada’s health research sector for the future. In the spring of 2020, as COVID bared its teeth and infection rates climbed our politicians at the federal and provincial and territorial levels came together to fight the common enemy. That enemy is still with us and the upcoming federal election is an important opportunity for a true national discourse on how we can emerge stronger from the pandemic as a nation. While Canadians cherish their healthcare system, the data show that we are second to last amongst developed national healthcare systems on many key indicators. Our system is far from perfect and let’s not squander our chance for positive change. Health is H far too important. ■

Paul-Émile Cloutier is the President and CEO, HealthCareCAN. Dr. Michael Gardam is a Member of the Board of Directors, HealthCareCAN and Associate Professor of Medicine, University of Toronto 6 HOSPITAL NEWS SEPTEMBER 2021

should be part of our post-pandemic roadmap.” The survey also found that physicians believe some patients may need additional support to access virtual care. In particular, they mentioned patients with: low levels of technology literacy, disabilities, language barriers, low incomes, chronic conditions, and those who are from remote locations H and Indigenous communities. ■

Doctors report increased burnout, propose five solutions lmost three-quarters (72.9 per cent) of physicians surveyed by the Ontario Medical Association said they experienced some level of burnout in 2021, up from 66 per cent the previous year. Just over one-third (34.6 per cent) reported either persistent symptoms of burnout or feeling completely burned out in 2021, up from 29 per cent in 2020. A sweeping new report released by the OMA today found many causes of burnout. Topping the list were technology and the fact that many physicians spend more time completing required documentation than caring for patients. The OMA report includes five solutions to address burnout, starting with reducing and streamlining documentation. Studies have shown that physicians spend two hours on electronic documentation for every one hour of direct patient interaction. Primary care physicians spend about six hours a day recording patient information electronically, both during and after clinic hours. The other top solutions are: • More work-life balance through flexible work arrangements • Making digital health tools a seamless part of physicians’ workflow, including by ensuring different systems can speak to each other • Support for physician wellness at their workplaces • Fair and equitable compensation for all work, including administrative H work that cannot be reduced ■

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KREMBIL CENTRE for Health Management & Leadership

Launch and Leadership Summit LEADING THE WAY POST-COVID Made possible by a $5-million gift from the Krembil Foundation and Schulich graduate Robert Krembil (MBA ’71, Hon LLD ’00), the Krembil Centre for Health Management and Leadership will become a leading global hub of health industry outreach, education and research at Schulich. A key feature of the Centre’s work will be the development of a new, one-year professional degree, the Master of Health Industry Administration. Other core elements of the Centre are the establishment of the Krembil Chair for Health Management and Leadership; the Krembil Public Healthcare Internship Program, which allows students to gain real-world experience working under the mentorship of senior healthcare leaders; and new student scholarships. The Krembil Centre will host a Leadership Summit at its official launch later this month. Join Robert Krembil and the Krembil Foundation, Schulich Interim Dean Detlev Zwick, and Centre Director Joseph Mapa, along with health sector colleagues and the Schulich community at this thought leadership event that will explore the future of healthcare in a post-pandemic world.

Thursday, September 23, 2021 6:00 to 8:35 pm EDT via Zoom REGISTER AT: schulich.yorku.ca/krembilcentre

“ In these difficult and challenging times, it has never been more important to develop the kind of leaders in the healthcare sector who can anticipate change and provide responsible, innovative solutions. It is for that reason that I am particularly proud of this initiative with the Schulich School of Business.” ROBERT KREMBIL (MBA ’71, HON LLD ’00)

Global Reach. Innovative Programs. Diverse Perspectives. schulich.yorku.ca

SPONSORED CONTENT

Make healthcare training more realistic with a manikin o reach the required level of excellence in patient handling, healthcare professionals must undergo extensive training. Using a manikin can enhance this training. World leading training manikin manufacturer, Ruth Lee, have supplied manikins for training in the healthcare, fire and rescue services since the 1980s. They now supply a manikin range of more than 20 shapes and sizes, from a 5kg baby to a 260kg bariatric adult. During Covid, given that close contact training using colleagues has presented additional risks, the need for specialist training manikins has never been more vital. Correctly weighted manikins not only offer a solution for safe distance training, however. They allow for meaningful, realistic training in patient handling that minimizes the risk of injury to staff and patients and enables healthcare staff to provide outstanding care.

MANIKINS ACCURATELY REPRESENT AN UNRESPONSIVE BODY

In a roleplay situation there is an instinctive tendency by ‘the patient’ to assist fellow trainees by moving, lifting, transferring weight and flexing muscles. This compromises the quality of the training. A manikin can’t assist, so will realistically represent the weight and position of an unconscious or truly immobile patient. By using Ruth Lee manikins, trainees can receive meaningful training in using hoists, slings, wheelchairs, slide sheets and other equipment. Crucially, a manikin provides a realistic moving and handling experience. Case study: Occupational Therapist, Angela Brown, specialises in the care of children and young people up to the age of 25. She uses Ruth Lee

manikins for training, and says that the heavy weight of the manikins often surprises trainees. They may have been previously trained with a child pretending to be the patient who is easier to move than a manikin. The concern in practice is that, faced with a child who is unresponsive and unable to assist, the lack of realistic training will lead to panic.

SAFER TRAINING AND WORK PRACTICES

Effective training and the implementation of safe practices helps to avoid workplace injury. Statistically, Healthcare Workers are at a high risk of workplace injury, caused by lifting and handling and so it is important that all workers in the sector receive adequate training to minimise these risks. Guidance from those in the know, including the Canadian Centre of Occupational Health and Safety, offer advice on lifting and handling, including the importance of training. They state: “The physical stresses and exertion involved in caring for nursing home and hospital patients has caused rising numbers of back injuries and other musculoskeletal problems. These injuries generally result from the long-term cumulative physical effort of patient transfers as well as acute effects, which result from incidents during transfers. An ergonomic approach to patient handling that is part of an overall program to reduce musculoskeletal injuries can benefit caregivers and employers alike.” By using manikins, trainees learn the safest way to lift that will protect them from musculoskeletal injury in their daily jobs. Safe work practices start with safe training. We believe that using a manikin poses less risk for both the par-

ticipant and the volunteer. Furthermore, as we continue to steer our way through the COVID-19 pandemic, the use of manikins in training minimises person-to-person contact, making sessions safer for all participants. Joanne Caffrey, MD of Total Train Ltd, uses Ruth Lee manikins in her training sessions. She is clear that the more realism trainees experience, the higher their confidence in dealing with challenging situations. Trainees are more proactive in sessions when there is no fear of hurting each other.

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Ruth Lee manikins are not a one-sizefits-all solution, and you need to speak to the experts to make sure you find the perfect training manikin. Ruth Lee Healthcare manikins are now available in Canada with ALG Safety, and we would urge you to give us a call so that we can chat through your needs, without obligation. We’re a friendly, knowledgeable team, committed to helping you to provide outstanding care. Please contact us at 905-517-7406 Q H

References: 1. https://www.ruthlee.co.uk/manikins-dummies/child-training-manikins-for-healthcare 2. https://www.ruthlee.co.uk/case-studies/specialist-provider-total-train-ltdhighlight-the-benefits-of-training-with 3. https://www.ccohs.ca/oshanswers/hsprograms/patient_handling.html For more information call 01490 413282, or go to https://www.ruthlee.co.uk/manikins-dummies/c/hospital-care. Ruth Lee, Lambert House, Glyndyfrdwy, Corwen, Denbighshire, Wales, LL21 9HW www.hospitalnews.com

SEPTEMBER 2021 HOSPITAL NEWS 11

NEWS

Dr. Joan Cheng, the new Emergency Department Chief at St. Joseph’s Health Centre of Unity Health Toronto.

Meet St. Joseph’s Health Centre’s new Chief of Emergency Department By Jessica Cabral ou can’t be it if you can’t see it.” That phrase resonates deeply for Dr. Joan Cheng, the new Emergency Department Chief at St. Joseph’s Health Centre of Unity Health Toronto. She has seen it repeated often in interviews by one of her heroes, Kim Ng, the first woman and first East-Asian American hired as a general manager in Major League Baseball. Now, like Ng, Dr. Cheng is in a pioneering role as the Greater Toronto Area’s (GTA) first East-Asian woman to helm a hospital Emergency Department and only the fourth female Emergency Department Chief in the region. We sat down with Dr. Cheng to discuss her new role, her hidden figure skating talent and why representation matters. What excites you most about your new role at Unity Health? “

There are many things that are exciting about this role, but I would say the most exciting thing is the idea of possibilities and potential. This department is already run by an incredibly strong group of health-care professionals. They have an amazing reputation for academic, clinical and educational excellence. Knowing that we have such a strong foundation, there is the possibility and the potential for growing this in an intentional and thoughtful way. With all of the arms of Unity Health, with Providence Healthcare and St. Michael’s Hospital, anything is possible when we’re able to collaborate with our incredible staff, physicians and learners. What are some of your priorities for your first few months in your new role? My first priority is going to be getting to know the people as well as the community. It’ll be important for me to listen with 110 per cent attention

12 HOSPITAL NEWS SEPTEMBER 2021

to find out from the community what they want from us as an Emergency Department. I’ll also listen to find out from my team what they want from me as the Chief. I want to ensure that their work is meaningful and that this work will continue to bring them joy. We all have this commonality of what brought us to Emergency Medicine in the first place – we want to provide great patient care and it’s a really fun job. I want to find out what I can do for my team to not only make it a great job, but to help them grow and continue to seek out challenges. You’re the fourth female Emergency Department Chief in the GTA as well as the first East Asian female Emergency Department Chief in the GTA. How does that make you feel? It’s really important and it makes me think of Kim Ng, the first female general manager and first Asian American, of any gender, to become

a general manager in Major League Baseball. I’ve been reading some of her interviews and she often says: ‘you can’t be it, if you can’t see it’. I work in a male-dominated profession, where, although there are many women emergency physicians, there are very few women holding leadership positions. To me, it’s important for myself and for my women colleagues to have these roles and to show our junior colleagues, not just in medicine but in every field, that we are leaders and that they should start to see themselves as being leaders. In society, it’s easy to almost internalize biases like sexism and racism, and then you don’t see yourself as being somebody who could be a leader. It’s also vital that you are able to identify and seek out your allies and mentors because they will lift you and give you opportunities. Before you can take on these leadership roles, you have to see yourself as being someone www.hospitalnews.com

NEWS who can do that job. That’s what I see myself as being in this role – someone to show people that you can absolutely do this job. My message to groups that have been oppressed, such as women, women of colour and those in the LGBTQ2SIA+ community, is to see yourself as leaders because you are. I certainly see you, I support you and I believe in you. What advice would you give to a person starting their career in health care? I would say that it’s important for you to figure out what you value and what is important to you. Is it the people, the relationships or the potential for growth and challenge that’s valuable to you? When you define for yourself what is important in your life, you can actively seek out those elements in your job. Ultimately, the goal is that you should love your job so much that it’s not really work, it’s play – that’s what Emergency Medicine is to me. But before you can find that job, you have to understand what’s important for you; that way you can work to-

MY MESSAGE TO GROUPS THAT HAVE BEEN OPPRESSED, SUCH AS WOMEN, WOMEN OF COLOUR AND THOSE IN THE LGBTQ2SIA+ COMMUNITY, IS TO SEE YOURSELF AS LEADERS BECAUSE YOU ARE. I CERTAINLY SEE YOU, I SUPPORT YOU AND I BELIEVE IN YOU. wards feeling valued and supported in your work. The other advice I would say is to be open to all opportunities. Don’t worry too much about making the right decision, because early on in your career you can’t really make a wrong decision. Even if it’s something you don’t end up enjoying, you’re still going to learn from it. My last point is that the path forward isn’t always linear, and often it’s not linear at all. Sometimes it will even feel like we’re going backwards, but that’s okay because whatever happens, you’re going to learn from it. What is your favourite activity or hobby outside of work?

I’m a competitive adult figure skater and my last competition was at the World Winter Masters Games in Innsbruck, Austria in January 2020. With the lockdown, everyone’s competitive season has gone off the rails. At this point, I’m just looking for ice at outdoor rinks near where I live, like at the local Civic Centre. I try to skate wherever I can. While skating as an adult, I’ve been extremely fortunate to find great skating coaches that have taught me almost everything I know about teaching and education. All of the things they have taught me are techniques that I use in medical education. For example, I run a workshop where I have skating coaches and a music educator

teach us about how to give effective feedback. It’s an innovative approach to bring people from completely different disciplines to teach those of us in medicine how to do something that they do so well. Is there anything else you’d like to add? I’m really excited that Unity Health Toronto has such a strong stance on anti-oppression. The fact that the CEO has made it a priority that anti-oppression is going to underpin all the work at this organization is so impressive. This is something that is very important to me and something that I value, so when I discovered that Unity Health also highly values this, I was happy that our positions aligned well. It’s important that leadership understands how complex and nuanced anti-oppression work is because without that support from the top, pushing this work forward becomes very difficult. I’m excited to have the ability to continue doing anti-oppression and EDI H work at Unity Health. ■

Jessica Cabral is a communications advisor at Unity Health Toronto

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NEWS

Under pressure: Ontario Paramedics’ experiences of COVID-19 By Anna Ding and Elysée Nouvet (PhD) ore than 500,000 cases of COVID-19 have been documented in Ontario since the start of the pandemic, placing immense strain on society (Queen’s Printer for Ontario, 2021). Paramedics on the front lines of Ontario’s pandemic response constitute a crucial part of patient care and infection management, taking measures to limit risks of contamination to themselves, other patients and providers as they deliver essential healthcare services. Their work as healthcare professionals is unique, inherently risky, and imperative as a bridge between the province’s healthcare system and the public. Despite this reality, paramedics largely operate under the radar of the communities they serve. While services have faced higher call volumes and new stressors during this pandemic, paramedics did not appear on Ontario’s List of Essential Services alongside police and fire when this list was first published in March 2020 (Ontario Paramedic’s Association, 2020). Researchers based in Health Sciences and the Schulich School of Medicine and Dentistry at Western University interviewed 21 paramedics in Ontario between June to August 2020, exploring their experiences of risk and safety while working in emergency response. The rapid study aimed to understand how paramedics were living and navigating any perceived added pressures of work in this global pandemic, with an eye to informing improved supports for this group of healthcare workers moving forward. Like so many around the world, Ontario paramedics did not know exactly what they were up against as they began to respond to calls for assistance in March 2020. With unprecedented stay at home orders in place, global shutdowns, limited understanding of the novel COVID-19 and debates on the effectiveness of masking to limit infection, being on the front lines

of the pandemic did require adjusting practice and mind to new safety risks. While paramedics are skilled at adapting quickly to unforeseen circumstances, COVID-19 represented a whole new level of uncertainty for these emergency responders. “I can say this for sure, this is the first time in my 27[year] career that I’ve been scared” (Participant 5) As the rates of infection and hospitalization rose across Canada in Spring 2020, several precautions were adopted within paramedic services. Participants in the Western University study described efforts locally and across the province to ensure their safety, but also described the stress of the new normal. Access to personal protective equipment (PPE) across the province was not uniform or easy across municipalities in the early days of the pandemic. The risk of shortages was real. Communications on what PPE was essential to stay safe kept changing, leaving some paramedics, by their own accounts, uncertain that they were in-

14 HOSPITAL NEWS SEPTEMBER 2021

deed dressed as safely as possible to respond to calls. Getting PPE on slowed patient response time, escalating patient and family emotions in already stressful crises. PPE does need to be put on upon arrival at a scene: goggles fog, and gowns are too restrictive for driving. Climbing down flights of stairs with patients in PPE felt treacherous at times, but also posed risks that PPE would slip out of place. The dynamic nature of a public health emergency also meant that internal policy was constantly changing. Best practice for safety and patient screening criteria could and did change frequently, and sometimes even between shifts. With every call, patients needed to be screened for potential COVID-19 exposure or infection. But with so many potential symptoms, participants in the study noted how difficult it was to screen patients out of the “at risk for COVID-19” category. Tending to patients in crisis also looks different in a pandemic. To lower paramedics’ risk of exposure to po-

tential infection, the option of engaging in aerosol generating procedures to treat shortness of breath was removed. Since paramedics have the public-facing role in emergency response, they also faced the difficult task of explaining to families of patients in crisis that they could not accompany their loved ones to the hospital. No paramedic interviewed questioned the importance of new safety precautions, but that did not make it easier to uphold them. As defined by Elisabeth Fortier (2019), moral distress often arises when system-level limitations constrain healthcare providers from doing what they know under different circumstances could have been done for a patient. Paramedic teams began to develop their own wipe down protocols for ambulances, being vigilant to maintain cleanliness between calls. Eating in the lunchroom felt reckless to some. One individual decided in dialogue with their spouse that they would sleep in a trailer parked outside their home for the duration of the pandemic. Others www.hospitalnews.com

NEWS had started in March 2020 to avoid all physical contact with family members and had still not hugged their kids or shared a bed with their partners at the time of interview several months later. Paramedics generally service numerous base hospitals within one region. Each hospital developed its own procedures. Different hospitals had separate rules for donning and doffing PPE, and rules for entry and transfer of patients. At times, they had to wait in hospital parking garages without air conditioning, in layers of PPE, and with patients unaccompanied by loved ones. Shifts were often truly exhausting. “I think we’re kind of just being expected to keep on showing up…when this is over I think you’re going to see a little bit of [a] mass exodus out of healthcare in general.” (Participant 17) The mental health impacts of the pandemic are becoming more recognized, for its effect on healthcare work-

AS DEFINED BY ELISABETH FORTIER (2019), MORAL DISTRESS OFTEN ARISES WHEN SYSTEM-LEVEL LIMITATIONS CONSTRAIN HEALTHCARE PROVIDERS FROM DOING WHAT THEY KNOW UNDER DIFFERENT CIRCUMSTANCES COULD HAVE BEEN DONE FOR A PATIENT. ers who have had to work through this global emergency. Multiple participants in interviews described a sense of emotional exhaustion and distance from their job, especially when call volumes increased to a level where they were sacrificing their breaks. This was intensified by a constant worry about spreading COVID-19 to their family, with many choosing to self-isolate due to the heightened danger of infection. For such a high-risk profession, there is a lack of adequate mental health support and concern in wheth-

er paramedics are easily forgotten and under considered in public health. This could be rooted in the relative novelty of their occupation, as the field has rapidly evolved from their role as ambulance drivers to the highly skilled and college educated healthcare professionals they are today. Paramedics choose this profession for the fast-paced environment and flexibility, along with the ability to help patients and continuously learn. As the field expands, it is imperative that current policy reflects their responsibilities.

“Between the mental health aspect and then the physical aspect, most people didn’t retire from the job.” (Participant 24) Healthcare workers worldwide have been fighting tirelessly against the COVID-19 pandemic. Paramedics are undoubtedly essential to the public and as individuals themselves. At the time of study interviews, participants were grateful for the support received by their management, who face additional stresses when leading during crisis. For example, holding weekly town halls allowed continuous feedback to be given. For public health long-term, it is salient to acknowledge and continue to work to alleviate and understand the pressing reasons of why so few paramedics reach retirement. These lessons of the COVID-19 pandemic should be applied to future public health emergencies, so that policy can be proactive, rather than H reactive. ■

Elysée Nouvet is a medical anthropologist and assistant professor in the School of Health Studies at Western University, in London, Canada. She has received funding as Principal Investigator from ELRHA’s Research for Health in Humanitarian Crises fund (U.K.), the Canadian Institutes of Health Research, and the International Development Research Centre of Canada to explore experiences and ethics of research and care in public health emergencies across the world. Anna Ding is a research student in the Faculty of Health Studies at Western University.

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Virtual emergency service brings peace-of-mind to rural workers By Rebecca Connop Price ith fewer than 500 residents and sitting on a 137-kilometer-long lake surrounded by mountains in the far northwestern reaches of British Columbia (BC), Atlin is one of Canada’s most scenic small communities. However, getting to and from the community can be a challenge. “The nearest big centre is Whitehorse, Yukon, and that is two hours’ drive away, on a good day,” says Jen Stronge, one of only two nurses who work at Atlin’s Primary Care Centre. There are no physicians in the community, so when there is an urgent or critical case, it’s down to the nurse on call to figure out what to do next, even if it’s to navigate a way to transfer the patient to a larger centre. But in December of 2020, the nurses got a phone call that would change their lives. It was Dr. John Pawlovich, the virtual health lead at the Rural Coordination Centre of BC (RCCbc). He wondered if they’d heard of Real-Time Virtual Support (RTVS), a province-wide program, launched in April 2020, to support healthcare providers in rural, remote, and Indigenous communities in BC. The service, which operates 24/7, would give Stronge and her nursing colleague, Rosie O’Reilly, immediate help with any cases that walked through their door. “At first we were kind of skeptical… we were like, ‘What’s the catch?’ But there hasn’t been a catch. “Instead, it’s just been a huge game-changer… enhancing our practice and enhancing the lives of our community just on a daily basis, pretty much,” says Stronge. There are four 24/7 RTVS pathways and they cover a variety of situations, including Emergency (RUDi), Critical Care (ROSe), Pediatrics (CHARLiE), and Maternity and New-

Atlin Health Centre’s Rosie O’Reilly and Jennifer Stronge. Jennifer Stronge is one of only two nurses who work at Atlin’s Primary Care Centre, which is in a remote community with no physicians.

born (MaBAL) – all designed to enhance health equity in rural, remote, and Indigenous communities across BC. They do this by connecting rural healthcare providers and patients to

16 HOSPITAL NEWS SEPTEMBER 2021

RTVS virtual physicians via Zoom or telephone. The pathways provide free, friendly, and culturally safe support for case consultations, second opinions, ongo-

ing patient support, patient transport coordination, point-of-care ultrasound, and simulations. In addition, several Quick Reply pathways – Dermatology, Hematology, www.hospitalnews.com

ONLINE EDUCATION Myofascial Pain, Post-COVID-19 Recovery Clinic Referral, Rheumatology, Thrombosis – are also available weekdays during regular business hours. Dr. Pawlovich, who, in addition to his role with RCCbc, is the UBC Rural Doctors’ Chair, says he was pleased to see the impact RTVS was having, especially in the most vulnerable communities, including Atlin. “What we are seeing is technology is allowing us to reach rural, remote, and Indigenous communities and provide tangible support to the healthcare providers and their patients in these settings. “With RTVS, providers feel like they have someone who will help, who will understand their challenges, and who will not try to pass them on to someone else. It is a huge step and it has been welcomed with open arms.” Stronge agrees. She says the service had changed the way they handle emergencies and provided much-needed peace of mind. “It makes our jobs easier. I mean it’s still not easy… it’s always a challenge,

THE PATHWAYS PROVIDE FREE, FRIENDLY, AND CULTURALLY SAFE SUPPORT FOR CASE CONSULTATIONS, SECOND OPINIONS, ONGOING PATIENT SUPPORT, PATIENT TRANSPORT COORDINATION, POINT-OF-CARE ULTRASOUND, AND SIMULATIONS. but it just helps relieve some of that burden of everything, every decision, being on one person,” she says. Before RTVS, Stronge would have called into the Emergency Room in Whitehorse for help. “It’s cumbersome, to say the least. The doctors there are wonderful and the staff there are wonderful, but they’re very, very busy, so we would get put into their triage queue and we could wait. A normal wait would be two hours before a doctor could get back to us, sometimes longer.” With RTVS it’s instant. “We get somebody right away, and they have the time just for us in our situation and can talk things through. They’ve

always been so wonderful about answering questions and helping us work through problems. It’s just a game-changer. Makes my job so much easier, I feel safer, I feel supported.” Dr. Matt Petrie, who is one of the doctors in the RUDi Emergency pathway, says all the RTVS virtual physicians have experience with, or understand, the rural context. “The geography and topography of BC is incredibly complex from a patient transport standpoint. So there’s a whole knowledge-base and understanding that we all have that goes into these services to really help coordinate care for people so that we can be supportive of on-the-ground prac-

titioners. It’s hard to wrap your head around that if you’re used to working in downtown Vancouver.” The RTVS program is still only 16 months old, but it’s hoped that it will have an impact on the recruitment and retention of rural providers in BC. Petrie added: “It’s tough to recruit and retain nurses and physicians in rural places. Healthcare in rural communities, it’s tough work; medically, socially, and psychologically, in a place where you may be the sole provider. So whether it’s a new grad that we can help support through uncertain times or a particularly difficult case – it’s going to really help prevent burnout and increase retention.” Stronge says there was one other spin-off benefit of the program. “We are also finding that the education side is really useful. The information that we take away from every phone call or Zoom call we share that with the other nurses and that makes us all better, it makes us all able to provide better care to our community, and I think that’s H really what we’re all striving for.” ■

Rebecca Connop Price is a Communications Officer, Real-Time Virtual Support (RTVS), Rural Coordination Centre of BC (RCCbc).

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ONLINE EDUCATION

Pain physician’s

YouTube channel a hit t was nearly two years ago when Dr. Furlan was leading an educational session at UHN’s Pain Clinic, where she is a physician, that she thought there might be a better way to connect with patients than the typical lecture led by herself, residents and fellows. “I noticed the patient sitting there for an hour, listening to all this information being thrown at them, and I could see in their faces they are trying to absorb it all, but it can be too much,” says Dr. Furlan, who is also a Senior Scientist at the KITE Research Institute at UHN.

That moment sparked the idea to start a YouTube channel as a resource for patients once they leave the clinic, sort of “homework” they can refer to on their own time while at home. Dr. Furlan was already telling patients to watch videos on YouTube, and she had a list of useful videos about chronic pain. But those videos were from different channels, not exactly what she wanted her patients to learn. It’s part of Dr. Furlan’s approach to patient care – less about speaking, than doing. And, it’s one that appears to resonate. As of this month, Dr. Furlan’s

18 HOSPITAL NEWS SEPTEMBER 2021

YouTube channel has more than 131,000 followers with some of her videos having well over one million views. “I have posted 52 videos so far, I have over 100 more to do,” Dr. Furlan says. “If I post one video a week, I have enough topics for two years’ worth of videos.”

GOING GLOBAL

“I did this for myself and my patients at the start because I wanted to improve the flow of the Pain Clinic,” Dr. Furlan says. She quickly saw the benefits of her videos. “I have patients come in and tell me they no longer need to see me because

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ONLINE EDUCATION they have been doing the exercises at home following my videos and the pain has been relieved,” she says. Dr. Furlan is motivated to continue to help people and is inspired by how many she connects with all over the world. “I have made friends globally and I am reaching far beyond what I ever imagined,” she says. About 21 per cent of her audience is from the United States, followed by India, Australia, the United Kingdom and Canada. “There is nothing better than reading a comment from someone I have never met who says their pain is more manageable or has gone away,” Dr. Furlan says. With the ability to reach people worldwide, Dr. Furlan wants her videos to be as accessible as possible. “I have added subtitles to my videos in 30 languages,” she says. “Anytime I see a comment from someone asking for subtitles in another language, I add them as soon as I can.”

“It is an amazing feeling and I love reading all the comments,” Dr. Furlan says. “My husband laughs at me because I take a few minutes every morning and respond to every single comment.” Her passion project has gradually become a family endeavor. Dr. Furlan records a few videos at a time every three weeks to upload one a week. Her 19-year-old son edits her videos and posts them to YouTube, while her 16-year-old daughter films the videos and manages social media. “What I say to my camera is going to be a megaphone to the whole world” she says. “It is a big responsibility, I do a lot of research before pressing record. I feel the weight in my shoulders.” Dr. Furlan is looking forward to receiving her YouTube plaque celebrating her accomplishment of reaching 100,000 subscribers, and with no plans to stop, she hopes to reach many more people from all over the world in the H coming years. ■

Expanding virtual education session

to physicians across Canada or many years, the Canadian Medical Protective Association has been offering an education session in conjunction with its Annual Meeting. While previously held in different parts of the country, for the past two years the Annual Meeting and education session have been delivered virtually due to restrictions brought about by the COVID-19 pandemic. The result has been a resounding success. This year’s education session, held on August 16th, was attended by 690 people, nearly three times the number of attendees the CMPA would normally see at an in-person event. “We are so thrilled that members across the country, particularly in re-

This article was submitted by UHN News.

mote areas, now have access to our educational content,” said Dr. Lisa Calder, the CMPA’s Chief Executive Officer. “Our goal is to help reduce risk, and increase patient safety. There’s no better way to do that than to ensure physicians are equipped with the information and tools they need.” The session featured real-time polling and a question-and-answer period with the expert panel comprising CMPA physician advisors and legal counsel. Making the session accessible to doctors from coast-to-coastto-coast improved the reach of the CMPA’s risk management messages, especially important at a time when virtual diagnostic assessments have become a routine part of clinical practice owing to the pandemic. Continued on page 20

It truly helped me achieve my professional goal of working for disability policy change within Government. The PhD program is focused on clinical knowledge and skill development; however, I was able to carve out a research program that was multi-disciplinary in approach by using the knowledge I gained in the program to advance my policy development skills. I did this through courses that taught foundational skills in research, such as qualitative and quantitative methodology. Beyond the learnings derived from these courses, though, I had the most amazing supervisor and supervisory committee. My supervisor, Dr. Rebecca Gewurtz, was integral to my academic success, and my bridge to a more advanced professional role post-graduation. The right fit between supervisor and student is absolutely crucial. I had that. Rebecca advised me, guided me, taught me, encouraged me, and believed in me. Often times, Dr. Gewurtz went above and beyond her official role as supervisor to help me stay the course. She and my committee were invested in my success. I am now working as a research advisor with Employment and Social Development Canada. This role would not have been possible had I not completed my PhD, with all the requisite knowledge, skills, and confidence that the program provided me.

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SEPTEMBER 2021 HOSPITAL NEWS 19

ONLINE EDUCATION

Virtual education Continued from page 19

2021 SESSION HIGHLIGHTED INTERVENTIONS FOR SAFER DIAGNOSES

The 2021 education session focused on an area of healthcare known to contribute significantly to patient safety issues and medico-legal cases: timely and accurate diagnoses. Participants reviewed the many challenges of diagnostic decision-making, and learned strategies to overcome them through illustrative case scenarios in three clinical contexts – virtual, acute, and post-op care. Diagnostic error encompasses missed, wrong or delayed diagnoses. Any of these unintentional events can harm patients and potentially result in medico-legal difficulties for the physicians involved. Twenty-one percent of civil legal actions and College and hospital complaints in Canada feature diagnos-

tic errors. This points to opportunities for care teams to improve their processes and approaches in this key area.

WHAT THE CMPA’S DATA REVEALS

Most diagnostic errors involve common health conditions such as cancers, injuries, infections, ischemic heart disease and stroke. Errors in judgment or reasoning account for a significant proportion of diagnostic errors. These cognitive factors can rarely be attributed to a health provider’s lack of knowledge. Rather, deficient information gathering and synthesis is most often at the root of the problem. “Physicians strive to make the correct diagnosis while frequently contending with numerous complicating factors,” said Dr. Calder. “Having a structured approach to collecting and evaluating information is crucial to arH riving at the right diagnosis.” ■

THIS YEAR’S ONLINE EDUCATION SESSION WAS ATTENDED BY 690 PEOPLE, NEARLY THREE TIMES THE NUMBER OF ATTENDEES TEH CMPA WOULD NORMALLY SEE AT AN IN-PERSON EVENT.

This article was submitted by The Canadian Medical Protective Association (CMPA).

20 HOSPITAL NEWS SEPTEMBER 2021

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Digital platform Staffy is helping to fill critical pandemic staffing gaps t was a remarkable moment captured by media across Canada and a critical turning point in our fight against the pandemic: the first COVID-19 vaccine being administered to a Canadian. The historic moment in mid-December 2020 was broadcast live nationally, when a personal support worker from the University Health Network’s Michener Institute in Toronto became the first person in Ontario to be inoculated against the virus. Like millions of others, Peter Faist was glued to the news that afternoon to catch a glimpse of light at the end of what has been a very long, dark tunnel. But for Faist, the CEO of a Toronto technology start-up, there was also a deeper connection that made the achievement more personal. On news channels across the country, working hand-in-hand with the medical team at UHN to administer those first doses in the vaccine clinic, were nurses and health care workers his digital staffing platform, Staffy, had placed at the hospital. It was further validation for Faist that the platform could play an important role helping health care organizations fill critical human resources gaps during a critical time. “It was amazing to see Staffy nurses, Personal Support Workers and administrative staff, helping to administer some of the very first vaccines in Canada,” he said. “It says a lot about the level of trust UHN had in us, that they would bring in an outside organization to help on such an important and highly visible job.” Originally set up as a digital platform to connect businesses in the hospitality industry with skilled labour to fill last-minute vacancies, Staffy pivoted at the beginning of the pandemic when many bars and restaurants were forced to scale back operations because of pandemic restrictions. Staffy retooled to focus on connecting health care organizations with highly trained and skilled workers –

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including nurses, PSWs and dietary aides – to quickly fill critical staffing gaps at a fraction of the cost of traditional employment agencies. In some cases, hospitality workers who had lost their jobs because of the pandemic were able to make a similar pivot by retraining and gaining new qualifications to work in health care positions, through Staffy, at long-term care homes, retirement homes, hospitals and with home care organizations. “In the span of nine months, we went from putting dishwashers and line cooks into restaurants and hotels, to helping administer some of the first vaccines during one of the most devastating pandemics the world has ever seen,” Faist said. So, how did Staffy gain the attention and trust of the UHN, which operates some of the largest and busiest hospitals in the country? The platform first proved its value in the long-term care sector, where many homes were left significant-

ly understaffed following devastating first and second waves of the pandemic. On a daily basis, Staffy filled dozens of positions at long-term care homes, including nurses, PSWs and other roles, helping to stabilize their workforces as they battled COVID-19 outbreaks. The platform’s network of more than 5,000 pre-vetted health care candidates allows it to fill shifts for multiple job categories in an average of seven minutes and have workers on site within 90 minutes of an employer posting shifts. Staffy fills 95 per cent of the jobs posted by employers. “We were able to do it quickly and efficiently, and in such a way that we were told on a regular basis that we were helping to save lives and we were helping homes to recover from the devastation that COVID was exacting on them,” Faist said. Impressed by its performance in the long-term care sector, the UHN turned to Staffy for support as the

growing second wave put even greater pressure on its medical teams. After initially providing approximately 50 workers to assist the UHN’s first vaccine clinic, Staffy has supported more than 40 regular and pop-up vaccination clinics across the Greater Toronto Area. It also now regularly supplies dozens of qualified people to numerous UHN medical units at various hospital sites, including ERs and ICUs. Over the past several months Staffy has sent more than 500 workers to UHN sites. Beyond COVID-19, Staffy has its sights set on playing a larger role in the solution to Canada’s broader health care challenges. “We’ve got the capacity and the platform to do more,” said Faist. “We’re well-equipped to provide support for initiatives like extending hours of care for long-term care residents, giving patients more choice and better access to home care support and helping to eliminate the medical backlog created during the pandemic.”

SEPTEMBER 2021 HOSPITAL NEWS 21

NEWS

Left: Teresa Zurberg, Canine Scent Detection Specialist at VCH with COVID-19 detection dog Finn. Right: From left; Lale Aksu, Canine Detection Specialist at VCH, Dr. Marthe Charles, Head of Division of Medical Microbiology and Infection Prevention and Control at VCH, Teresa Zurberg, Canine Scent Detection Specialist at VCH, Hon. Adrian Dix, Minister of Health and Michelle de Moor, Interim Vice President, Vancouver Acute Services.

Canine scent detection team now detecting COVID-19 By Rachel Galligan or more than five years, Vancouver Coastal Health’s (VCH) canine scent detection team – Canines for Care – has been sniffing out Clostridioides difficile (C. difficile) in healthcare settings both in British Columbia and across the country, reducing infection rates and improving patient quality of care. Now the team has added COVID-19 to their scent detection roster. “We wanted to tackle COVID-19 infection prevention from every possible angle,” says Allison Muniak, Executive Director of Quality and Patient Safety, Infection Prevention and Control and Risk Management at VCH. “We are uniquely positioned to do this work with a successful C. difficile detection program led by a multi-disciplinary team of medical professionals, dog handlers and infection prevention practitioners. It was a natural evolution to build on our strengths and find a comprehensive, non-invasive approach to detecting the virus and supporting healthy communities as we work to put the pandemic behind us.” Health Canada is providing funding to VCH as part of the Safe Restart Agreement Contribution Program, which seeks to assist in the safe restart of Canada’s economy and make the country more resilient to possible future surges of COVID-19. VCH’s on-

going research project aims to explore the signature scent of COVID-19, and develop a dog training program to provide ongoing public health support. Possible applications of COVID-19 canine scent detection includes screening in airports, on cruise ships and at public events. “The ability of the healthcare workers, researchers, dog handlers, and three talented dogs at Vancouver Coastal Health to develop a new virus scent detection program from scratch is an enormous accomplishment,” says Adrian Dix, Minister of Health. “This is one of the countless examples of the way people in our health care system have stepped up to support all of us in a time of great need, keeping us safer and more protected from COVID-19.” Even with an experienced team, training dogs to detect a relatively new virus is no small feat. The Canines for Care team started from scratch six months ago. Initially, they identified “green” dogs for training and welcomed two Labrador retrievers, Micro and Yoki, and one English springer spaniel, Finn, to the pack. “Every dog can sniff but not every dog can work,” says Teresa Zurberg, Canine Scent Detection Specialist and nationally-recognized canine handler. “We worked with scent detection teams around the world to find dogs that have the right combination of genetics and also the potential to do this work.”

They then developed a methodology to access appropriate COVID-19 samples and conduct training in a way that’s safe for the dogs and their handlers. “Working closely with the clinical teams, we have been able to collect COVID-19 saliva, breath and sweat samples from consenting patients across the diverse demographics found in our health region,” says Dr. Marthe Charles, Head of Division of Medical Microbiology and Infection Prevention and Control at VCH. “Access to this array of samples has allowed for robust scent detection training. The scent samples are prepared in a way that removes the risk of transmission of active virus, protecting our team.” Earlier this month, Micro and Finn were validated for COVID-19 scent detection by a third-party reviewer and were found to have 100 per cent sensitivity and 93 per cent specificity in identifying COVID-19 in a laboratory setting. Yoki, the third dog to go through COVID-19 scent detection training, recently passed the rigorous validation process with similar results. “The fact that we’re seeing such strong results speaks to the rigor of our training program. These findings are superior to certain antigen tests available on the market,” added Dr. Charles. “We’re very pleased with the results so far and are excited to continue this work.”

With more than 300 million olfactory receptors, dogs are known to be able to detect unseen threats to human health, including bacterial and viral infections and cancer, and that their accuracy can be comparable to certain laboratory diagnostic tests. VCH was the first healthcare organization in the world to operationalize its C. difficile detecting canine program that helps detect and reduce cases of C. difficile in the healthcare environment. Since 2016, the canine scent detection teams at VCH have searched hundreds of hospital areas for C. difficile. They’ve also visited 32 Canadian health care facilities to share their infection prevention expertise. Canines for Care is generously supported by the VGH & UBC Hospital Foundation with special thanks to the Rix Family Foundation and Peterson, and Health Canada. Learn more about the program at www.vch.ca/caninesforcare. Vancouver Coastal Health (VCH) is responsible for the delivery of $4.1 billion in community, hospital and long-term care to more than one million people in communities including Richmond, Vancouver, the North Shore, Sunshine Coast, Sea to Sky corridor, Powell River, Bella Bella and Bella Coola. VCH also provides specialized care and services for people throughout B.C., and is the province’s hub of health-care education and reH search. ■

Rachel Galligan is Communications Leader, Public Health, Vancouver Coastal Health. 22 HOSPITAL NEWS SEPTEMBER 2021

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NEWS

Critical care:

Health care HR crisis By Jaason Geerts ow will this fall go? Some health staff aree finally getting a well-earned rned rest after 17 monthss of the March that never seemed to end (2020) and, as vaccination rates rise and restrictions ease, people are ready eady for normal life to resume in Septemember. On the other hand, we are stararing a fourth wave in the face and nd public tolerance for interruptions ns is increasingly low, which isn’t a promising combination. There is hope that we can ap-ply lessons learned to address thee deplorable gaps and inequities thatt this crisis has highlighted; and yet, t, a critical need for care stands in the he way: health human resources (HR).. If this critical need is not treated ass an urgent priority, our health system m is destined to fail the people and commumunities it is tasked to serve and will fail to realize the co-created vision of one that is improved and more equitable. le. With staff vacancy, burnout, and psychological distress and trauma uma rates in high-alert territory, along with planned and delayed retirements, a key question is, how do we best support our staff and serve our patient populations, families, and communities? To prepare this article, two sources were consulted. The first is a publication in JAMA Network Open1 featuring 32 expert co-authors from 17 different countries that presents an evidence- and expertise-based framework for leadership in the Recovery Stage of a crisis. The second was a rapid research study conducted with healthcare CEOs across Canada regarding the Certified Health Executive (CHE) commencement address in June of this year. CEOs were asked, “What are the top two priorities that health leaders can address in the coming year?”

PEOPLE-FOCUS

Putting people first emerged as a top priority in both sources. In the international framework, the first two

imperatives reflect a people-focus: 1) Acknowledge staff and celebrate successes; and 2) Provide support for staff well-being. Similarly, the most frequently cited top priority by the CEOs was staff wellness and resilience. Health HR is vital on a human level, as well as to ensure that health organizations have the resilience and capacity needed to manage further developments of the pandemic, to address the service backlog, to confront exposed gaps and inequities in access and care, and to continue to innovate and collaborate as we strive to optimize healthcare equitably moving forward. No progress on any front can be made if the people priority is overlooked. Key questions are: to what extent are leaders accurately in tune with the wellness and needs of their staff? Are staff aware of available sup-

ports? Is prioritizing one’s own wellness a shame-free process? What are the best strategies for people (staff, patients, families, and community) to maintain regular operations, while also addressing the service backlog? This is no simple undertaking, but clearly, just working more or harder is not the answer. This situation forces us to make hard choices, ensuring that people are the priority, that our focus is on the heart of the matter (preeminent values and services), and that we commit decisively to cutting what should not be prioritized. These decisions should involve input from many sources, including those delivering the care.

SILVER LININGS

Despite the challenges the system now faces, the health HR crisis presents opportunities for improvement.

1. There is an opportunity to fill leadership vacancies with the most leade suitable candidates, prioritizing equity, suita diversity, and inclusion, expertise, and diver leadership capabilities of emotional leade intelligence, empathy, communicainte tion ti skills, resilience, and cultural ssensitivity 2. By addressing staff wellbeing and providing the requisite support, there is an opportunity to create a more human work culture that values its people and their health above all else, without compromising the quality of care provided 3. Similarly, by informing government of organizational and community needs related to health HR, there is an opportunity h to encourage budget allocations and policy polic changes that support people and their health 4. There is an opportunity to increase organizational resilience, cacreas pacity, and efficacy through structured pacit discussions with staff of lessons learned discu during the pandemic and training, durin with particular focus on best serving one’s people 5. As we build back better and re-introduce paused services, there is an unprecedented opportunity to re-assess priorities, address gaps and inequities, and optimize how care is provided, all centred on what is best for one’s people. To paraphrase Muriel Strode (attributed to Emerson), let’s not follow where the path may lead; let’s go instead where there is no path and leave a trail. In healthcare, this is the time to trailblaze – there are so many opportunities… not one of which we can achieve if we fail to put our people H first. ■ (** This article is the third in a series on health leadership during the pandemic and is informed by more than a year of international research projects by the Canadian College of Health Leaders (CCHL), funded in part by Healthcare Excellence Canada (HEC)).

Jaason Geerts, PhD is the Director of Research and Leadership Development at the Canadian College of Health Leaders. www.hospitalnews.com

SEPTEMBER 2021 HOSPITAL NEWS 23

COVER STORY

Deadly COVID-19 blood clot leads to first-ever intervention Calgary physicians pioneer use of new life-saving technology By Blain Fairbairn hen a blood clot caused by a COVID-19 infection landed Brenda Crowell in the intensive care unit (ICU) at Foothills Medical Centre (FMC) – leaving her clinically dead for more than 30 minutes – a team of physicians in the FMC’s new Pulmonary Embolism Response Team (PERT) immediately stepped in with a new device never before used in Canada to remove the clot and save Crowell’s life. “She went into cardiac arrest when she arrived at the emergency department and physicians rushed to revive her,” says Dr. Jason Wong, interventional radiologist and PERT member at FMC. “They weren’t very optimistic about her chances for survival, she was in very rough shape after having no pulse for such a long period of time.” Crowell’s traumatic experience began in mid-April. She first developed symptoms of COVID-19 on April 15 and tested positive four days later. She isolated at home along with her husband and son for the next two weeks. By the end of April she was feeling better, but her symptoms suddenly worsened within a few days. “I woke up on May 6 and couldn’t catch my breath,” says the self-employed 56-year-old bookkeeper. “My husband, who’s a retired paramedic, looked at me and said I was grey, so he called 911 right away and an ambulance was at the house before he was off the phone. I remember arriving in hospital but not knowing what was going on. I woke up a week later in the ICU and FaceTimed with my son who said, ‘Mom, we didn’t know if we’d be planning your funeral or not.’ I had no idea how seriously ill I had been.” Diagnostic testing showed Crowell had pulmonary embolism (PE), which occurs when blood clots break

Photo credit: Leah Hennel

Brenda Crowell, left, was the first patient in Canada to undergo an embolectomy using the new CAT12 Lightning catheter as demonstrated by interventional radiologist Dr. Jason Wong. Dr. Wong and his team saved Brenda’s life with the device after she developed deadly blood clots from a COVID-19 infection in May, 2021. off from vein walls and travel to the heart or lungs. PE is a very serious condition and can be fatal if not treated quickly. It’s the third-leading cause of cardiovascular death after coronary artery disease and stroke. COVID-19 is known to cause blood clots, and the risk increases in people with limited mobility and chronic health conditions – issues that affected Crowell. There are three treatment options for severe PE: medication to break up the clot; open-heart surgery to remove the clot; or an embolectomy – a minimally-invasive procedure where an interventional radiologist guides instruments through the patient’s vessels with the assistance of a continuous X-ray to extract the embolism. Under the guidance of Dr. Kevin Solverson, a respirologist who was part of Crowell’s care team, the PERT quick-

ly determined an embolectomy would give her the best chance of survival with the least risk for complications. Dr. Wong performed the procedure on Crowell using a new embolectomy device, the Indigo Lightning CAT12, to quickly extract the clot from Brenda’s lungs. The CAT12 is a catheter, about the size of a large drinking straw, which is specially designed for sucking out clots from large vessels like the pulmonary artery. This was the first time this device had been used in Canada. “The procedure went really well,” says Dr. Wong. “We are really pleased with the extent and speed of her recovery, and it validates PERT’s mandate of being able to mobilize quickly and determine the right intervention to save the patient’s life. We’re very happy how this turned out for Brenda and her family.”

The PERT was conceived in 2017 at FMC and launched in 2019 under the co-leadership of interventional radiologist Dr. Eric Herget and intensivist Dr. Paul Boiteau. The need arose out of concern that some PE patients may benefit from invasive and advanced medical therapy, but these decisions require complex, multi-disciplinary coordinated care. Through the PERT, a comprehensive rapid response team is assembled to assist in diagnosis, treatment and follow-up for high-risk PE patients. Similar response teams have been in place at FMC for years to treat stroke or heart attack patients, and these teams have had high rates of success in achieving positive patient outcomes. “Through collaboration with emergency medicine, radiology, cardiac sciences, medical specialties and critical care, an evidence-based PE risk pathway was developed,” adds Dr. Wong. “This allows clinicians to flag high-risk PE patients and have PERT on standby for quick response. It’s another great example of how many different care teams work together in a complex, fast-paced environment to streamline and enhance patient care.” Crowell and her family have since received both COVID-19 vaccinations and she’s feeling ‘amazingly well.’ Despite taking all precautions to avoid infection, it’s unknown where she picked up the virus. She says this experience has been an eye-opener – and she’s grateful to not only have survived, but to feel better than she did before getting sick. “When I was leaving the ICU, one nurse said, ‘You know they think of you as a medical miracle.’ Well that’s because there were literally people all over the world praying for me,” she laughs. “Part of their prayers was that I would heal in double time – and I think that’s why everyone was H so surprised.” ■

Blain Fairbairn works in communications at Alberta Health Services. 24 HOSPITAL NEWS SEPTEMBER 2021

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LONG-TERM CARE NEWS

Bringing vaccines to one of the highest need neighbourhoods By Isabel Terrell or many months, hospitals and numerous health and community care organizations have been working together to vaccinate eligible populations against COVID-19. In Toronto, this collaborative effort, known as ‘Team Toronto’, is focused on getting as many residents vaccinated as quickly as possible based on available supply. On July 10, Toronto Mayor John Tory and the City of Toronto launched the Home Stretch Vaccine Push to connect with people on the ground, in their communities and remove the barriers to accessing vaccines. As part of these efforts, a new COVID-19 vaccine clinic was opened in the northwest area of Toronto, an area that has one of the lowest rates of COVID-19 vaccination in Toronto and which has experienced higher

rates of COVID-19 infection than the provincial average throughout the pandemic. In response to the changing needs of Ontario’s healthcare system and the urgency of the provincial vaccine rollout in the wake of a third wave, VHA Home HealthCare (VHA) created THRU, which stands for Tactical HealthCare Response Unit, a strategic team of experienced nurses, pharmacists, pharmacy technicians and non-clinical staff who can urgently respond to community health needs and challenges anywhere in the Greater Toronto Area. THRU is now running this COVID-19 vaccine clinic at Albion Arena in Toronto’s northwest in partnership with University Health Network, City of Toronto and Rexdale Community Health Centre. “I’m really glad to see that most Torontonians have taken the opportuni-

ty to begin the COVID-19 vaccination process. But until we remove barriers for all Torontonians to make an informed decision, we as a health system haven’t done our job. THRU is proud to be part of this important work in the Rexdale community to ensure everyone who wants a COVID-19 vaccine can easily access both first and second doses in their community,” says Susan Chang, Director, Strategic Transformations and Partnerships who created THRU. To date, THRU has proven themselves to be an innovative resource from the local home care sector, providing a “clinic-in-a-box” service that can be leveraged by the healthcare system across the GTA during this pandemic. The team has creatively operationalized popup vaccine clinics in many different locations across Toronto, including Toronto Community Housing build-

ings, Naturally Occurring Retirement Communities (NORCs), parks, schools, buses, etc. “I love working as part of THRU because we are able to go directly into communities and provide information and vaccines to individuals in their own neighbourhood. We’re able to reach those who may not have access otherwise,” says David Yam, Resource Pharmacist Lead on VHA’s THRU. THRU’s Lynn Sheppard, a team member at the Albion Arena clinic who has also been part of mobile vaccine teams as a Clinical Nursing Lead, has taken note of the team’s success throughout the vaccine rollout. “I’ve had the opportunity to be part of vaccination efforts all over the city and have heard from individuals from many cultures and backgrounds who have been falling through the cracks and don’t have family support or a pri-

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Home care is about trust. It is feeling comfortable with a provider ĐŽŵŝŶŐ ŝŶƚŽ ǇŽƵƌ ŚŽŵĞ ĂŶĚ͕ ƉŽƐƐŝďůǇ͕ ĂƐƐŝƐƟŶŐ ǇŽƵ ǁŝƚŚ ƚŚĞ ŵŽƐƚ ŝŶƟŵĂƚĞ ĐĂƌĞ͘ Bayshore’s home care services are extensive and varied, depending on your needs. They ƌĂŶŐĞ ĨƌŽŵ ŵĞĂů ƉƌĞƉĂƌĂƟŽŶ͕ ŵĞĚŝĐĂƟŽŶ ƌĞŵŝŶĚĞƌƐ͕ ĐŽŵƉĂŶŝŽŶƐŚŝƉ Žƌ ĂƐƐŝƐƟŶŐ ǁŝƚŚ errands to nursing, respite care, wound care, ƐĞƌŝŽƵƐ ŝŶũƵƌǇ ĐĂƌĞ͕ Žƌ ƉĂůůŝĂƟǀĞ ĐĂƌĞ͘

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LONG-TERM CARE NEWS

mary physician to help them through the process of seeking a COVID-19 vaccine. What THRU is doing is really exciting. We’re able to provide support for those individuals by bringing the vaccine to them and provide health teaching resources for communities,” says Lynn. The new fixed clinic is located at the Albion Arena at 1501 Albion Road. For current hours and eligibility information, please refer to Rexdale Community Health Centre. Looking forward past the vaccination needs of the pandemic, Chang added, “We look forward to evolving THRU into a team that continues to help local communities fight other urgent health needs moving forH ward.” ■

Toronto Mayor John Tory (centre) and Councillors Joe Cressy (left) and Michael Ford (right) with VHA leaders Courtney Bean (front-left) and Susan Chang (front-right)

Isabel Terrell is a Communications Specialist at VHA Home HealthCare.

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NEWS

Olympic equestrian thankful for

‘unbelievable’ trauma care By Shelley McLean wo-time winner of the Show Jumping World Cup and Olympic equestrian silver medalist Ian Millar knows his way around horses. His long and storied career even led to his nickname, Captain Canada. But after a rare accident on his farm in Perth, he was rushed to The Ottawa Hospital Trauma Centre with a severe arm injury. Ian was quickly losing blood, causing deep concern for his life. In late October 2020, Ian was riding a young mare when something startled her. She reared up on her hind legs, and then came down hard and spun around, causing Ian to be tossed over her head and onto the ground. “I was sailing through the air; I knew exactly what I was going to do in terms of landing to make sure there was no damage. Normally, the horse will do what it can to avoid stepping on you, but this one came down on me three times,” says Ian.

SIGNIFICANT BLOOD LOSS

The 74-year-old could feel pain through his ribs and one leg. However, the real concern was the damage to his left arm, just above the elbow. “I tried to get up but the bleeding was significant. The wound was about eight inches in length and I could see the nerves and muscles. My main barn guy, who has medical training, rushed to help, along with my family. They thought I was in big trouble because of the amount of blood I was losing.” A tourniquet was quickly created to stop the bleeding while a call went out to 9-1-1 for help. Within minutes, paramedics arrived and whisked him to a nearby community hospital, where the helicopter was waiting to fly him to The Ottawa Hospital Trauma Centre. Ian says an exceptional team awaited him. “They were beyond words. I

Ian Millar want to say there were about six team members there when I arrived and they were ready to rock and roll.”

TRAUMA CENTRE SERVING EASTERN ONTARIO

With the uncertainty over the extent of damage to Ian’s arm, he would need the most advanced treatment options available. The Ottawa Hospital has the only Level 1 Trauma Centre in eastern Ontario – this is where the most critically-injured patients from across the region, including Québec in some cases, come for lifesaving care, often bypassing smaller community hospitals. Today, when patients like Ian arrive by air ambulance to the Civic Campus, they need to be rushed across a busy street from the helipad to the hospital. All that will change when the new Civic development is complete in 2028. This new hospital campus will save crucial time with dedicated highspeed elevators that will bring critically-ill and severely-injured patients directly from the rooftop helipad to a trauma bay.

SPECIALIZED TEAMS READY

When Ian arrived, Dr. Edmund Kwok, an Emergency Department

Photo credit: Millarbrook Farm

(ED) physician and Director of Quality Improvement Unit for the ED, was waiting. He still vividly remembers that day. “It was the beginning of my shift. I had just walked into the resuscitation bay when we received the call that an ORNGE air ambulance was on the way, and there was the risk of the life-threatening arterial bleed.” With that call, Dr. Kwok and his team prepared the trauma bay for the patient’s arrival. Ian was conscious and stable, but the main concern remained his arm. “Arterial injuries can bleed out very quickly. Therefore, it is a potentially life-threatening situation. It’s like plumbing. When we release the pressure it has to be done in a very controlled manner,” explains Dr. Kwok.

EXPERT TEAM COLLABORATION

Once they removed the tourniquet, Ian started to bleed out. “We put a call out to vascular, orthopaedic, and plastic surgeons. We needed these specialists involved and their response was prompt. We had the vascular team at the bedside before Ian’s imaging was completed.” Ultimately, the vascular physician determined it was not an arterial bleed and repaired the damage to the veins

before handing it off to the plastic surgeon to close the wound. “This is a classic example of an injury which involved different specialists. Vascular and plastic surgeons provide highly specialized services and to have them all in one location and able to respond promptly made a huge difference in this patient’s outcome because the tourniquet couldn’t have been left on for much longer.”

GOING HOME SIX HOURS LATER

Remarkably, Ian went home about six hours after he was rushed into hospital. Even more amazing, there were no broken bones – only a dislocated rib and a superficial leg wound. For Ian, it was an eye-opening experience. “Before this, I didn’t know the Civic Campus was the only Trauma Centre in our region. The care I received was unbelievable. We’re fortunate to have that team of experts ready for any injury. It seemed to me every specialty was waiting and ready to help.” The Olympian was back riding within a couple of weeks with full use of his arm. And for that, he’s grateful for the team that cared for him. “They were a well-oiled machine,” he says. “It made me proud to be a H Canadian.” ■

Shelley McLean is a Senior Marketing Officer for The Ottawa Hospital Foundation. 28 HOSPITAL NEWS SEPTEMBER 2021

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Virtual emergency department visits help

patients get urgent care from home By Robyn Cox ince piloting a new virtual Emergency Department in late 2020, the team at St. Michael’s Hospital of Unity Health Toronto has received positive feedback about the service, which allows patients to connect with an emergency physician to speak about non-life threatening health issues online, or over the phone. We spoke to two people who have used the service to learn more about their care experience.

DAVE’S ‘SOAP OPERA’

It all started with a switch to a new foaming hand soap. While Dave had never experienced allergies, he formed a strange rash – first at his hairline and then spreading to his arms and legs. When the rash started to swell, he knew he needed to speak to a health professional. “I wasn’t in extreme physical danger but it was very uncomfortable,” says Dave. “My family physician had been in a state of semi-retirement for a number of years so my wife recommended that I try out a virtual ED.” After signing up online and speaking to a St. Michael’s staff member on the phone to confirm all his details, he had his appointment. “The whole process was very simple and the doctor was very personable,” says Dave. “I sent over some photos of

the rash to help him make a diagnosis and he gave me a prescription for a cream and a referral to a dermatologist.” Later, Dave faced some difficulties getting his dermatology appointment lined up, so he called the virtual ED and they connected him with a clinic closer to home. “They really went above and beyond to help me get the care I needed. I would use the service again in a heartbeat if something else were to come up.” How is Dave doing now? “In the end, the dermatologist thought the rash was likely due to using a new kind of foaming hand soap – the offending soap is long gone and I’m feeling much better.”

RONIT’S CARE EXPERIENCE FROM THE COMFORT OF HOME

“I woke up one day and I had a terrible pain in my left hip,” says Ronit. “The pain was debilitating and it was impeding my ability to walk – I have four small kids at home and I wanted to get back on my feet for them.” She heard about the St. Michael’s virtual ED through an email forum in her community. Wanting to avoid a hospital visit when her family doctor wasn’t available, she made her appointment. “The doctor was great – very helpful and empathetic,” says Ronit. “He told me to order a cane so I wasn’t com-

Left: Dave with the new soap he and his family purchased to replace the soap that likely caused his rash. Right: Ronit in the space where she had most of her virtual ED visits – right at home. pensating so much and causing pain in other areas of my body.” Since her first virtual ED visit, she has connected with the virtual ED a few times for further support and direction. After one of her virtual visits, the doctor suggested she come in for some tests. “It was honestly the best experience I’ve ever had in an emergency department. The doctor had already briefed the team by the time I arrived, I didn’t have to wait long and the tests I needed were already ordered – everything was so smooth.” While Ronit is still experiencing pain and waiting for an appointment with a specialist, she is grateful for the virtual ED service. “It gave me such peace of mind to be able to speak with a doctor from home – especially when I would need to arrange for childcare if I had gone into the ED in-person each time,” says Ronit. “When you’re at home you feel calm – and the doctors have been so engaged and present during the virtual appointments.”

WHAT YOU NEED TO KNOW ABOUT ST. MICHAEL’S VIRTUAL ED

The goal behind the virtual ED is to give people access to care when they are unable to make an urgent appointment with their family doctor. In this way, it can help you avoid an unnecessary in-person ED visit. It also makes the process easier if you are asked to come into the ED after your virtual visit or you require a follow-up appointment with your family doctors or a specialist. Learn more about how to book a virtual ED visit. This initiative received provincial funding to enhance the pandemic response through appropriate virtual care options, which are key in ensuring continuity of health services while preventing the spread of COVID-19. There are similar virtual ED services in the Greater Toronto Area available at Sunnybrook Health Sciences Centre and H University Health Network, as well. ■

Robyn Cox is a senior communications advisor at Unity Health Toronto

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NEWS

Canada’s first smart hospital leverages digital devices to enhance emergency preparedness By Zeeshan Ahmed and Vaso Charitsis ortellucci Vaughan Hospital, Canada’s first smart hospital and the first net new hospital in Ontario in more than 30 years, has taken emergency preparedness to the next level. In February 2021, Cortellucci Vaughan Hospital implemented a digital platform for clinical communication and workflow, to become the first Canadian hospital to fully integrate its overhead communication system with smartphones using a mobile application. The smartphones allow staff to respond to emergency codes and use voice command to receive and make calls. Additionally, staff can send secured text messages and access critical information on touch screens helping direct them to where they are needed most in an emergency or crisis. “The digital platform prioritizes incoming communications using real time alerts that are secure, providing the situational awareness needed to make timely and informed decisions,” said Felix Zhang, Chief Technology Officer at Mackenzie Health. “The platform enables the right person to receive the right information at the right time, and to know which information is important, like when a cardiac arrest code is activated, it not only alerts staff of a medical emergency, but the hands-free capabilities let staff provide hands-on patient care improving patient outcomes.” In the months leading up to the opening of Cortellucci Vaughan Hospital, the Risk Management team co-ordinated more than 10 full-scale training exercises during a period of three months, replicating real-life scenarios using the handheld devices to activate codes. Fullscale exercises were designed to validate emergency plans and preparedness and test the smartphones and the communication platform. The exercises and drills were unannounced and performed under varying and nonideal conditions, such as different times of day, during absence of key staff and originated in different areas of the hospital, including the emergency department. “Cortellucci Vaughan Hospital staff and physicians had the unique oppor-

tunity to experience full-scale exercises using the smartphones in their natural setting before opening our doors as a full-service community hospital,” said Mary-Agnes Wilson, Executive Vice President, Chief Operating Officer and Chief Nurse Executive. “This opportunity gave each group the time needed to identify any deficiencies in emergency preparedness processes so that protocols could be enhanced and test the new smartphones to ensure the right information could be transmitted instantly, securely and efficiently.” Several scenarios were tested, with the largest exercise involving more than 50 participants, and included multiple external emergency responders. Each full-scale exercise lasted more than three hours. “We know emergencies can escalate in scope and severity quickly impacting hospital resources and threat-

Cortellucci Vaughan Hospital is Canada’s first smart hospital and the first net new hospital in Ontario in more than 30 years. ening the vital and often lifesaving care we provide to patients and the community,” said Zeeshan Ahmed, Manager of Enterprise Risk at Mackenzie Health. “So, when every second counts, technology is helping to connect teams to respond faster and more effectively.”

Smart technology helps reduce response times in emergencies, especially when it is a life-or-death situation. Cortellucci Vaughan Hospital is paving the way for smart technology to be added to all levels of health care and service delivery, no matter the H circumstances. ■

Zeeshan Ahmed is Manager of Enterprise Risk at Mackenzie Health and Vaso Charitsis is a Senior Communications Consultant at Mackenzie Health.

Increasing cost-effectiveness for TAVI – the standard of care for aortic stenosis By Carmela Reyes ranscatheter Aortic Valve Implantation (TAVI) is becoming an increasingly common and cost-effective alternative to open-heart surgery that benefits patients and decreases hospital stays. A minimally invasive, catheter-based procedure, TAVI addresses the narrowing of the aortic valve (aortic stenosis, AS) by replacing the function of the valve with a bio-prosthetic valve implanted into the patient’s heart via a catheter inserted in their groin. While TAVI was initially reserved primarily for extreme high-risk patients, its use has been expanded to patients in lower-risk categories in some provinces, with funding varying by province. About 30 hospitals across Canada currently perform TAVI procedures but many of their program directors

Dr. Wijeysundera

30 HOSPITAL NEWS SEPTEMBER 2021

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

have been grappling with how to improve access to this minimally invasive surgery when the funding favours standard surgical aortic valve replacement (SAVR). Dr. Harindra Wijeysundera and his colleagues have figured it out. Dr. Wijeysundera is chief of the Schulich Heart Program at Sunny-

brook Health Sciences Centre and an interventional cardiologist at Sunnybrook, which performs 300-325 TAVIs per year. “TAVI is no longer an innovative procedure, it’s the standard of care for certain patients who have AS,” he said. “So really, it becomes incumbent on us as providers in the system to be able to provide that standard of care.” Two key factors have made it challenging to provide TAVI to all eligible candidates. First, the per-patient funding approach for TAVI doesn’t allow treatment for as many patients as are referred. Second, the prosthesis can be more expensive up front than what is used for SAVR. But Dr. Wijeysundera believes these issues related to TAVI costs can be mitigated by early discharge and fewer complications, both of which save on hospital resources. Continued on page 31 www.hospitalnews.com

NEWS

Increasing cost-effectiveness Continued from page 30 “The value proposition for TAVI is not the prosthesis itself,” he said. “Instead, it is the ability to rapidly mobilize patients and allow them to get home earlier. Because of this, the hospital stay for the TAVI procedure is cheaper than SAVR,” he said, adding that 99 per cent of the procedures are using femoral access (through a small incision in the thigh), with local anesthetic and sedation. At Sunnybrook, the median length of stay for SAVR is five to seven days, whereas for TAVI it is one day. “To lower the cost of delivering care in the hospital, we were very aggressive in adopting pathways to help discharge patients sooner.”

For the past several years, Dr. Wijeysundera has been working to demonstrate that there is a clear need for greater funding for TAVI procedures, and is a member of an advisory group that offers recommendations to the health ministry on how best to allocate funding and improve patient access to life-saving medical treatments. “TAVI has become a safe, minimally invasive option preferred by patients, and is now affordable for the healthcare system,” says Dr. Wijeysundera. “Despite this, there is still substantial inequity in access across Canada that should be addressed so patients can get H the care they need.” ■

Carmela Reyes is a Sr. Communications Lead at Medtronic.

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