Nurse practitioners take on challenge

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Putting patients first

Nurse practitioner-led cardiac unit amongst first in Canada

By Dawn Smith

There were some exciting changes to the medical cardiology coronary care unit (CCU) at Calgary’s Rocky View General (RGH) hospital in 2019. On February 1, 2019, the seven-bed unit, which treats patients admitted with heart problems, became one of the first in Canada to be led by nurse practitioners, health-care leaders with advanced training in nursing. Nurse practitioner Nancy Clark, who spearheaded the initiative and is now the clinic nurse practitioner lead for the clinic, says the model provides consistent care for patients, as there is now a dedicated team of professionals on hand with advanced knowledge in cardiology and the ability to diagnose and prescribe medication. “We are the first in line to consult with the emergency room on cardiology matters,” she says. “We are available for all hours, covering all shifts. We see all patients.” Rocky View’s cardiology program is one of the busiest in Calgary. The hospital has a 35-bed cardiology ward and seven-bed CCU. Prior to the change, it operated like most across the country, although it did have support from nurse practitioners, including Clark. But when the nurse practitioners weren’t on shift, the unit was dependent on extenders and clinical assistants to cover the load. These clinicians came and went, covering shifts in hospitals around the city. According to Teresa Thurber, the executive director of critical care and women’s health at RGH, although care was excellent, it was difficult to ensure there was consistency and aroundthe-clock expertise for patients. This new model has solved these issues. Eight nurse practitioners with specialized training in cardiology look after the unit. There is always one, and often two, of these highly educated professionals on duty. They work in conjunction with a consulting cardiologist to ensure the critically ill patients have what they need. These professionals are responsible for the first line of care in the unit doing everything from assessments and urgent bedside consults to diagnostics and treatments. The nurse practitioners are also the first point of contact between the emergency department and the unit and provide cardiology consults for the emergency team. “This creates consistency and continuity in coverage,” says Thurber, noting despite the fact that the supporting

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The medical cardiology coronary care unit at Calgary’s Rocky View General hospital is one of the first nurse practitioner-led units in Canada. These health care providers have advanced nursing training. Pictured at back (left to right) are nurse practitioners Daniel Ward, Margaret Henninger, Mohamed El Hussein, Karen Parker and Adrienne Rommens. Front (left to right): Nancy Clark, Mikaela Robertson, Jen Koppel and Lisa Wieler.

cardiologist on the unit changes weekly, there are now professionals in place who “know the patients really well.” Thurber says although data is preliminary, she expects it to show that patients are having better experiences and outcomes within the unit. She is confident there will be a reduction in length of stay and readmission rates for patients. Thurber is impressed with the nurse practitioners’ commitment and passion to the model. “We have an exceptionally wonderful group,” she says. “When we talk about putting our patients first, these providers are truly committed to doing that. They follow their patients from the emergency department to CCU or the ward and even into the community.” Dr. Nakul Sharma, who has worked alongside the nurse practitioners as the lead of cardiology at RGH, agrees and notes that nurse practitioners bring a holistic approach to patient care. “There is improvement in patient care. They have gone above and beyond,” he says. “They bring a whole different angle to patient care. It was the right thing to do to have nurse practitioners in more of a leadership role.” Members of the CCU hope the model will be expanded to others centres. To that end, Clark said the nurse practitioners are working on a research project with plans to publish in a peer-reviewed journal. The research project will include both data and the patient voice. Sharma says the next steps are to expand the model in Calgary and to train the health care professionals to do simple invasive tasks. Thurber is fully supportive. “I hope this is just the beginning for nurse practitioners,” she says. “They are a very skilled, dedicated group of practitioners.” Nurse practitioners began working in cardiac surgery in Calgary in 2002. Their leadership expanded to medical cardiology in 2003. Clark was the lone nurse practitioner in cardiology for several years. Thanks in part to her leadership, leaders within the Department of Cardiac Sciences at the Cumming School of Medicine and at RGH recognized the benefit that nurse practitioners bring and supported the groundbreaking initiative at the CCU.

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Imaging centre celebrating 15 years

Ken Stephenson’s foundational gift continues to help shape landscape of cardiac care within the Libin Institute

By Steve Macfarlane, Cumming School of Medicine

It didn’t take long to convince Ken Stephenson that creating a home in Calgary for cardiovascular imaging was a worthwhile undertaking. The instant the shrewd Calgary businessman saw the image of a beating human heart projected on a highresolution screen, he was hooked. And for the 15 years since that fateful meeting at the Calgary Petroleum Club with cardiologist and cardiac magneetic resonance imaging visionary Dr. Neil Filipchuk, MD, fellow philanthropist Bud McCaig, and Eva Friesen of the Calgary Health Trust, Stephenson has been a key piece of the beating heart behind the Stephenson Cardiac Imaging Centre at Foothills Medical Centre in partnership with the Cumming School of Medicine and Alberta Health Services.

“I see this beating heart and I just loved it. Even as a layman I could understand what I was seeing. Seeing the heart beating, it just resonated with me,” says Stephenson in his downtown office, where the philanthropist and entrepreneur continues to work passionately at age 86. “I could see on that screen that day what the possibilities were. And so I decided right then I was going to do it. I was going to raise the money needed.” Generously contributing $1 million of his own funds as a foundational gift to build the Centre back in March of 2005, Stephenson was just as important as a fundraiser — bringing in another $2M from friends and associates and $1M from the Foothills Foundation Lottery on the recommendation of Dr. Chen Fong, MD. Support from the community has exceeded more than $8M since the Centre’s opening, and Stephenson just recently donated another $1M through UCalgary to the Centre bearing his name. “I am proud that, together with the wonderful support of my donors, I have been able to keep the Centre financed with philanthropy over 15 years,” says Stephenson. “The Centre’s great success would not be possible without the outstanding capabilities and dedication of the Centre’s researchers, clinicians and support staff, all under the extremely capable direction of Dr. James White, the Director of the Centre. James makes things happen, a critical contribution to the success of the Centre. I am most grateful for the wonderful contributions of our team.”

Those working at the Centre are equally appreciative of the support. “I am grateful to Ken Stephenson for redefining my perspectives on giving, and how it can achieve large-scale and sustained impact,” says Dr. White. “Over the years, Ken’s generosity and passion have seeded scientific discoveries, catalyzed innovation and enabled great ideas to grow into global success stories.” The first program of its kind in Canada, the Stephenson Centre as part of the Libin Cardiovascular Institute established Cardiac MRI as a pillar of cardiac care in southern Alberta.

Over the last decade and a half, it has grown into one of the most innovative environments for translational clinical research, the training of physicians and researchers and delivering worldclass imaging services in Calgary. “The Stephenson Centre is a shining example of what is possible through partnership between philanthropic

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individuals, the university and the health authority,” says Dr. Todd Anderson, MD, former director of the Libin Cardiovascular Institute. “The success of the Centre over the past 15 years is astounding and has been catalyzed by the ongoing dedication that Mr. Stephenson brings to the project. He is a pillar of our society and a great friend to myself and the entire medical community.” With a satellite at the South Health Campus, the Centre performs nearly 4,000 cardiac MRI studies each year in addition to research studies and collaborations in Alberta and around the world.

Experts are influencing therapy in patients with early heart disease, guiding imaging in routine patient care and are now poised toward predicting and preventing sudden cardiac death in those with heart rhythm defects. “We’re in a whole new era of diagnostics,” says Stephenson, a hint of both excitement and pride in his voice as he talks about the Centre’s work in improving quality of life for people with cardiovascular issues. “We’re going to be able to, with more research, predict heart failure, sudden death and atrial fibrillation. We can be more prepared for what’s coming.” The future of imaging lies in more personalized medicine that includes genomics and proteomics — the study of genes and the proteins in cells — and data that, through machine learning, can lead to predictors of disease and distress in patients. “The promise of the Libin Institute to lead the world in precision cardiovascular medicine will be achieved by integrating the incredible potential of the Stephenson Centre with our world-class clinicians. The Stephenson Centre is the cornerstone of our vision for the future of precision cardiovascular health,” says Dr. Paul Fedak, director of the Libin Institute. If Stephenson were to have the same meeting at the Petroleum Club today, the screen would show much more than the beating heart, it would provide a plethora of information not imagined in 2004. Making every effort to truly understand the complicated work that took place under the leadership of original director Dr. Matthias Friedrich and now

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Calgary businessman Ken Stephenson (centre) is the naming donor of the Stephenson Cardiac Imaging Centre within the Libin Cardiovascular Institute. The centre performs thousands of routine cardiac imaging tests each year and is an internationally recognized centre for research. You too can partner with the University of Calgary to spark meaningful change. Together, we are creating the future of health in Calgary and beyond. Visit libin.ucalgary.ca/giving.

White, Stephenson is better equipped to talk with fellow philanthropists on the needs of the Centre and its future.

“You have to understand what you’re raising money for, and really have your heart and soul in it. I have, for 15 years,” says Stephenson. “I just feel very responsible for the Centre and want it to continue to be successful in providing leading edge diagnostics to its patients and beyond.” Its success, by all measurements, is evidenced by the care people in Calgary receive — made possible by the great clinicians and scientists who collaborate at the Centre.

“His support has allowed the Stephenson Cardiac Imaging Centre to become the largest of its kind in North America. This has enabled unprecedented care for Albertans and growth of an innovative research program focused on personalized medicine,” says White. “I consider Ken to be a pioneer in the philanthropic community who uniquely demonstrates how investing emotionally can dramatically amplify the impact of investing financially.”

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