QEII Times - Winter 2020

SHINING A LIGHT ON THE QEII HEALTH SCIENCES CENTRE, ITS STAFF, VOLUNTEERS AND DONORS

WINTER 2020

A QEII FOUNDATION PUBLICATION IN ASSOCIATION WITH THE CHRONICLE HERALD

YOUR QEII There’s no place like home

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Q&A with Dr. Brendan Carr 6

Diversity in Health Care Bursary 7

RESEARCH & INNOVATION New IR suites

Supportive care

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Dr. Ricardo Rendon (left) and Dr. Ross Mason (right) are part of the world-class QEII team that performed the first-ever robotic surgery in Atlantic Canada. Dr. Mason is one of four surgeons who were recently recruited to the QEII Health Sciences Centre thanks, in part, to surgical robotics technology, which will be entirely donor funded. Darren Hubley

Atlantic Canada’s first surgical robotics technology $8.1-million project to be entirely funded by QEII Foundation donors

By Jon Tattrie

QEII Foundation TRIC grant 14

ALSO Photo essay

Community healthcare champions leading the charge Page 4-5

Trauma Nova Scotia

Dedicated to patient care across the province Page 13

A big investment in robot-assisted surgery by QEII Foundation donors is already helping the QEII Health Sciences Centre attract new surgeons to Atlantic Canada.

Dr. Greg Bailly, chief of urology and co-chair of the new surgical robotics council at the QEII, says the cutting-edge technology lets healthcare teams perform certain cancer surgeries with greater precision than ever before via a robot.

He says many physicians — especially those who specialize in complex cancer surgeries — see robot-assisted surgery as the standard of care they need to work with. Therefore, access to this technology plays an integral role in bringing new, top talent to the QEII. “When they’re looking for a job, they would like to use those skills because they’ve become part of the new wave of surgical techniques,” he says.

Access to robot-assisted

surgery also benefits medical students.

“Not only are we providing this technology for our patients, we’re actually exposing our trainees — both medical students and residents — to the most up-to-date, innovative technology that’s available. And that will inspire some of these trainees to pursue that sub-specialty within their surgical practices.”

The QEII competes with hospitals across North America and around the world to recruit these highly trained surgeons.

QEII urologist and cancer surgeon, Dr. Ross Mason, is a prime example. Born in New Glasgow, N.S., Dr. Mason did most of his medical training at Dalhousie University and the QEII. He then specialized in urologic oncology and robotic surgery as part of a two-year training fellowship at the Mayo Clinic in the United States.

“Robotic surgery has become such a mainstay of preventative-care

When they’re looking for a job, they would like to use those skills because they’ve become part of the new wave of surgical techniques.

– Dr. Greg Bailly

surgery in the U.S. There are over 3,000 robots in the U.S.; there are 31 robots in Canada. When Canadian graduates are looking for sub-specialty training, the majority of them do go to the United States. And with several of the disciplines, they’re being trained heavily in robotic surgery,” Dr. Mason says.

“When we were trying to recruit him, it was important that we act quickly. And I was trying to assure him we will get the robot soon,” Dr. Bailly says.

“And fortunately, it came within the first year of his practice here.”

Dr. Mason says the potential presence of a robot at the QEII — Atlantic Canada’s first — was a big factor in his decision to return to Nova Scotia.

“This is the standard of care that’s out there now. You want to be able to provide it to your patients and you also want to be able to do that operation so you can maintain your skills and be at the forefront,” he says.

FIRST SURGICAL ROBOTICS – Page 2

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YOUR QEII – WINTER 2020

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A QEII Foundation publication in association with The Chronicle Herald, QEII Times is designed to shine a light on the QEII Health Sciences Centre community.

Editor Paula Bugden Comminucations, QEII Fondation Jenn Coleman-Ford Director, Product Management, Lindsey Bunin Senior Designer, Julia Webb Contributors Allison Lawlor Bill Bean David Pretty Erin Elaine Casey Jenn Coleman-Ford Jon Tattrie Sara Ericsson

A word from the QEII Foundation

By Bill Bean President and CEO, QEII Foundation At the heart of many major innovations at the QEII Health Sciences Centre are QEII Foundation donors.

The QEII Foundation raises funds for cutting-edge technology and research initiatives that healthcare teams and their patients rely on. The generosity of our donors is experienced by Atlantic Canadians every day at the QEII, with more than 1.1 million patient visits each year.

Philanthropy plays a key role not only in acquiring the best

technology and funding medical research, but also the recruitment and retention of some of the country’s — and often the world’s — best healthcare specialists and teams.

As health care evolves, so does the need to explore and evaluate new technologies and treatments that maximize patient care.

Access to innovative technology is critical to attract these healthcare leaders to the QEII — and keep them here. A prime example of this is robot-assisted surgery, as you read in our cover story.

Robot-assisted surgery is a treatment option that’s never

gynecology-oncology, thoracic and ear, nose, throat — the QEII is home to some of the best and brightest healthcare teams in Canada.

Philanthropy is at the heart of advancing health care in our region. When you give to the QEII Foundation, you are supporting patients by helping us acquire innovative technology and fund critical research initiatives, in turn recruiting the best healthcare teams to our region.

For more information about the QEII Foundation, call 902 334 1546 or drop us a line at info@qe2foundation.ca.

First surgical robotics Continued from Page 1

– Dr. Ross Mason

THE QEII HEALTH SCIENCES CENTRE

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To learn more about robot-assisted surgery or to donate today, visit QE2Robotics.ca.

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QEII Foundation 5657 Spring Garden Road Park Lane Mall, Floor M3 Halifax, N.S. B3J 3R4

This is the standard of care that’s out there now. You want to be able to provide it to your patients and you also want to be able to do that operation so you can maintain your skills and be at the forefront.

CO G S W E L L

We want your feedback!

Share your thoughts, comments and story ideas with us at: info@qe2foundation.ca 902 334 1546 or toll-free at 1 888 428 0220.

100 per cent funded by the QEII Foundation and donors in the community,” says Donnie.

“With just under $1 million left to raise of our $8.1-million goal, this is a prime example of how philanthropy transforms health care and unlocks treatment options that otherwise wouldn’t be available to healthcare teams and patients.”

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The Chronicle Herald 2717 Joseph Howe Drive PO Box 610 Halifax, N.S. B3J 2T2 902 426 2811 thechronicleherald.ca

very fine movements inside the patient.”

Often these translated movements are so tiny and precise that they would not be possible with the human hand.

Ultimately, Dr. Bailly and Dr. Mason say the biggest benefit is to patients.

“At the time of surgery, we have less blood loss, less pain and an easier recovery with smaller incisions,” Dr. Mason says.

These patient benefits are a big reason why donors, like Donnie Clow and his family, are proud to support robot-assisted surgery at the QEII. As volunteer chair of the QEII Foundation’s surgical robotics fundraising campaign and a prostate cancer survivor, Donnie leads a committee of community champions who are dedicated to funding the region’s first surgical robotics technology.

“This is a project that will be

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© The Chronicle Herald 2020 All rights reserved. No part of this publication may be reproduced, stored in retrieval systems or transmitted in any form or by any means without prior written consent from the publisher.

Dr. Mason always hoped to return to Nova Scotia and plans to spend his career here.

Access to surgical robotics was a key driver behind that decision to return home and also played a significant role in the successful recruitment of three other new surgeons to the QEII, who will become a part of Atlantic Canada’s first-ever surgical robotics team.

Dr. Mason says the QEII’s surgical robot does nothing on its own. Instead, he sits in a comfortable chair, puts his face into a surgical console that resembles a virtual reality headset and operates the robot with controls. Robotic arms mounted with wristed surgical instruments are inserted into the patient via small incisions, along with a 3-D magnifying camera enabling increased range of motion, vision and control.

“The movements I make with my hands are translated into

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Photographers QEII Foundation Sara Ericsson Darren Hubley

QUEEN STREET

been available in Atlantic Canada, until now. The QEII Foundation is on a journey to raise $8.1 million to establish robot-assisted surgery at the QEII for a number of cancer surgeries.

Many physicians who specialize in complex cancer surgeries are now being trained in robotics.

Armed with the latest knowledge and skills, they are eager to use them and are attracted to health centres, like the QEII, who have robotic surgery technology.

As a direct result of trialling this technology, four new surgeons have been recruited to the QEII. With specialties across four disciplines — urology,

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HALIFAX INFIRMARY (HI) SITE 1a. Halifax Infirmary 1b. Charles V. Keating Emergency and Trauma Centre 2. Abbie J. Lane Memorial 3. Camp Hill Veterans Memorial

Patient/Family Parking Emergency Entrance General Entrances

VICTORIA GENERAL (VG) SITE 4. Nova Scotia Rehabilitation Centre 5. Bethune 6. Mackenzie 7. Centre for Clinical Research 8. Dickson 9. Victoria 10. Centennial

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The QEII’s Geriatric Ambulatory Care and Memory Disability Clinic launched a community outreach pilot program in February 2019, Halifax’s first geriatric outreach nurse position, with the aim to better serve certain patients. The team includes Jody Wells (left), RN geriatric outreach nurse; Theresa Kroeger (second from left), booking clerk; Sandra Hiscott (second from right), clinic charge nurse; Kate Newton (right), clinic nurse, RN; and Terri Buckland (missing from photo), RN geriatric outreach nurse. Sara Ericsson

There’s no place like home

New QEII outreach program providing in-home care for memory clinic patients

It became clear that reaching people at home would help on many levels.

– Terri Buckland

By Sara Ericsson Note to readers: A pseudonym has been used in this article to protect the patient’s identity.

It was after the death of her husband that Mary Jones and her family noticed her difficulty with daily tasks at home.

After Mary was assessed at the QEII Health Sciences Centre’s Geriatric Ambulatory Care and Memory Disability Clinic and diagnosed with dementia, her family realized within six months that she would no longer be able to live at home unless they could find a support system for her.

Mary then became one of the first people referred to the clinic’s newly launched community outreach pilot project, which brings the clinic to seniors like her at home, while ensuring their health is regularly assessed.

“The notion of in-home care is an essential one and better for the patient, who gets to stay where they are comfortable.

The project is helping make the best of a difficult situation — we’d be in a much different place without it,” says Mary’s family member.

The QEII’s Geriatric Ambulatory Care and Memory Disability Clinic is where seniors aged 65 and older are referred to receive a geriatric assessment. Clinic charge nurse Sandra Hiscott says the comprehensive assessment examines areas including memory testing, the patient’s physical health, social and living situation, alongside input from family, to determine whether they have a form of dementia.

The clinic’s pilot program began in February 2019 after registered nurses Terri Buckland and Jody Wells wondered whether home visits would better serve certain patients, while also increasing access for seniors not able to reach the clinic.

“We ended up not only increasing access and reaching people who’d never been seen by geriatrics but also serving current clinic patients even better with follow ups at home that fall within the scope of nursing,” says Terri.

“We also heard from families who lived away and those who could no longer transport loved ones to the clinic,” says Terri. “It became clear that reaching

people at home would help on many levels.”

Following Jody’s first visit to see Mary, she identified the need for an occupational therapist and connected her with the clinic’s geriatric OT specialist, Catherine-Anne Murray. Mary’s family was also connected with continuing care and respite services, as well as an ambulance call system.

Terri says connecting patients to the right services is a vital part of the program, as families or caregivers are often not aware of the care options available to them.

“A lot of people don’t know about these services, or need help navigating the system,” she says.

Mary’s family credits the diligent work of the outreach clinic for enabling her to remain at home. The family’s stress was also relieved, as they received education from Jody on how to approach daily interactions with someone who has dementia.

Mary’s family continues to feel comfortable calling Jody or Terri with any questions and Mary, herself, feels comfortable asking questions when care providers visit her home.

“It helps her peace of mind to talk to the people helping her to understand why she is monitored,” says Mary’s family.

Terri says the project’s biggest outcome has been helping patients with dementia live at home longer by helping them access interventions.

“It’s a matter of putting in the right interventions at the right time to help people stay home longer,” she says.

Jody and Terri are now collecting and analyzing data from the pilot project to present once the pilot has ended. Jody says family feedback has been positive, and feels the number of visits completed in the community will be reflected in a positive impact on the clinic waitlist.

Mary’s family says the pilot project moved their situation from one that was not feasible to one that now is, and Mary’s life would not be the same without it.

“It’s very difficult for a family to go through the changes of dementia, where your loved one essentially becomes someone else. The team has helped us understand and cope with what’s happening and that’s really meant everything to us.”

YOUR DONATION, TRIPLED. With your help, patients will access the best cancer imaging technology available today.

Advanced technology means detecting smaller traces of cancer than ever before.

Dr. James Clarke is a radiologist in the Department of Diagnostic Imaging at the QEII. His team is tripling all donations to PET-CT to a total of $50,000 until March 31, 2020.

DONATE NOW | QE2PETCT.CA

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COMMUNITY CHAMPIONS These community healthcare champions are leading the charge and inspiring others to make a difference with causes close to their hearts.

They continue to find creative ways to make a significant difference for Atlantic Canadians receiving care at the QEII Health Sciences Centre, and they’re just getting started!

Brian George Walk & Roll After making a cross-country move from Comox, B.C. to Halifax, Brian George found his voice as an advocate for accessibility in his new home city. Inspired to bring awareness to those who may not be in a position to advocate for themselves, Brian rallied his community together for a special fundraising event.

In 2019, the inaugural Walk & Roll took participants up Citadel Hill to raise funds for the Nova Scotia Rehabilitation & Arthritis Centre at the QEII. The Rehabilitation Centre is particularly important to him, as it offers daily support for those in his community, and those who may be recently navigating a new world of accessibility challenges.

The second annual Walk & Roll takes place June 20, with a new route that takes the participants across the Macdonald Bridge from Halifax to Dartmouth.

Jane Chen Chinatown Restaurant Jane Chen, the owner of the new Chinatown Restaurant location on the Bedford Highway, was moved to make an impact after attending the Blue Butterfly Evening, an annual community-led fundraiser in support of thyroid cancer care at the QEII. Upon opening her new restaurant in summer 2019, the new Chinatown served up generosity – one meal at a time. For every order placed at the new Chinatown Restaurant, one dollar was donated to support patients facing thyroid cancer at the QEII. Through Jane’s community leadership, Chinatown has raised over $2,050 for the cause.

Learn more about our current community fundraisers, and how you can get involved by leading your own event at QE2Foundation.ca/community

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Bryce Dart Multiple Myeloma Patient Support Like many before him, Bryce Dart had never heard of the disease multiple myeloma until he was facing his diagnosis in June 2014. While most people are aware of the emotional and physical toll a cancer diagnosis imposes, few may be aware of the financial burdens many cancer patients face.

Bryce is now working to support others facing this journey with a fundraiser of his own, helping to alleviate financial burdens for patients and families who are struggling with things such as accommodation costs, travel expenses, bills, patient comforts and more.

Along with his fundraiser, Bryce helps others living with multiple myeloma through peer support groups and has seen first-hand the strength they give to those navigating a new diagnosis.

Lori Duggan Brain Tumour Research Fund Lori Duggan is rallying her community around a cause close to her heart and in honour of her late husband, Garry Beattie. Garry and Lori are the catalysts behind the QEII Foundation’s Brain Tumour Research Fund, which they started during Garry’s brave battle against glioblastoma, a malignant brain tumour.

After Garry’s diagnosis, he and Lori, alongside his neurosurgeon Dr. Adrienne Weeks, made it their mission to make a significant impact on brain cancer research in Nova Scotia and beyond, by supporting research happening at the QEII. Lori is dedicated to keeping Garry’s legacy thriving through her annual event and fundraiser, Brain Cancer Bash, and many other activities throughout the year.

Kevin Hurst Pink Patch Project Nova Scotia’s Deputy Sheriffs donned customdesigned pink badges throughout the month of October as part of an initiative to raise funds for breast cancer research at the QEII and bring awareness to the fight against breast cancer.

Led by Kevin Hurst, the project began as a way to honour colleagues who are affected by breast cancer. The project evolved into a cause that now connects agencies across Canada, inspiring them to get involved with the movement.

The Pink Patch Project started in the U.S. in 2013 by the Seal Beach Police Department, and now has over 390 agencies involved globally. Nova Scotia Sheriff Services is the first agency in Canada to register and participate in the Pink Patch Project.

Their efforts helped to raise over $1,700 for the QEII Foundation’s Breast Cancer Research Fund and have paved the way for more agencies to get involved in the future.

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Dr. Brendan Carr, the new president and CEO of Nova Scotia Health Authority, is excited about his new role, advancing care today and creating new opportunities for health care in the future. QEII Foundation

‘What we achieve, we achieve through people’ A conversation with Dr. Brendan Carr He’s no stranger to this province, the QEII Health Sciences Centre or to health care, but Dr. Brendan Carr is new in his role as president and CEO of the Nova Scotia Health Authority.

The QEII Foundation recently sat down with Dr. Carr and got his thoughts on the road ahead.

Q:

You are entering this new role at a time where health care is a hot topic in Nova Scotia. In your opinion, what are some of the biggest challenges?

A:

I think there are a couple of big challenges and priorities for us. One is peoples’ ability to access services, in terms of primary care and emergency services in rural communities. Related to access is flow and how the system is organized. It seems that a lot of people are going to emergency departments because we haven’t designed a system that has multiple access points for different things.

Access is not about just having more human resources; it’s also about the way we construct the system so that people can get what they need, maybe without having to line up. These are big challenges but represent huge opportunities for us to re-think

the way we organize the system and the way we deliver care.

It is pretty clear through engagement surveys and the media that the tone of communication is negative. Some of that is understandable. We are a big organization that has gone through a tremendous amount of change in a relatively short period of time. We are at a natural point where people are feeling a bit disconnected, having been through a lot of change and disruption with changes in leadership.

As a leader coming into the organization, it is something that I will put a lot of energy into because, at the end of the day, our mission is about supporting people in health, being here when they are not well. Everything that we do, we do through the people that come to work here every day.

Personally, for me it’s about people being connected to their own sense of purpose. And that is truly the greatest asset we have as a province and a system. We can’t deliver excellent health care and create an excellent experience for people if the people who come to work every day aren’t feeling that connection.

Q:

What do you see as some of the good news in health care?

A:

I think the good news is that we have amazing, extremely well-trained people. We have put significant investment in collaborative teams and that is critically important to where we need to go as a system. There is significant commitment to modernizing the system and putting in place the critical infrastructure to make that happen. There is a commitment to adopt technology in a way that will significantly advance health care in the province.

QEII New Generation, to me, has special significance. Not only are we building state-of-the-art infrastructure, we are connecting innovation and discovery around the province and really accelerating it. I think it will create a hub, an anchor point.

I am particularly excited about the opportunity to intentionally create, in that hub, a connection for unusual partnerships. Bringing different people into the healthcare machine in a way that allows us to create new approaches. If we bring other partners to the table, from other industries with other perspectives, they may be able to help us see sooner where real opportunities are. This is what I get most excited about.

Q:

A lot of my focus will be on getting out into the various communities, meeting with providers and other people in the communities who have an interest and perspective on health care.

– Dr. Brendan Carr

What have you learned as a family and emergency care physician — and as a senior healthcare leader in Canada — that will influence you most in your new role?

A:

Number one, both as a frontline provider and as a leader, I am firmly rooted in the philosophy of what we achieve, we achieve through people. It is fine to have great vision, strategies and plans, but at the end of the day, we have to be able to connect that to people. If we can connect that to peoples’ own internal sense of purpose, that’s where the real magic happens.

The great news is that most people who come to work in health care do it because there is a great sense of purpose in it. It is the great privilege in what we get to do.

As a senior leader in a big system like this, we absolutely need to have clarity on our priorities and what we are trying to advance. We all need to be rowing in the same direction. And the leaders can’t figure out what we need to do without engaging people at the front line.

I have learned that my job is not to come up with the answer.

My job is to create an organization DR. BRENDAN CARR – Page 8

Tell us your story.

We want to share stories from QEII staff and physicians, and from patients who have been touched by care at the QEII. Please connect with us so that we can continue to share the good work of the QEII.

Visit QE2Foundation.ca/tell-us-your-story

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Jennifer Lane received a 2019 Diversity in Health Care Bursary, funded by the QEII Foundation. Jennifer is pursuing a PhD in nursing, with her research focused on the gap between the health services needed versus the health services offered for 2SLGBTQ populations. QEII Foundation

Supporting diversity in health care

Recipient of Diversity in Health Care Bursary working to change the future of health care for 2SLGBTQ community

By Jenn Coleman-Ford “Often when people look at me, they don’t see me as diverse. It makes me feel invisible,” says Jennifer Lane. “As a lesbian, stigma is harmful to my existence, but it also gives me a unique platform to speak from.”

Jennifer was one of 25 recipients of the 2019 Diversity in Health Care Bursaries, funded by the QEII Foundation in partnership with the Nova Scotia Health Authority and Community Health Boards.

The Diversity in Health Care Bursaries, at $1,000 each, help make a difference for post-secondary students from diverse backgrounds who are pursuing a career in a healthcare field.

With an increasingly diverse population in Atlantic Canada, there is a need to have accessible health care for all — and accessibility includes having caring healthcare teams that understand different cultures and languages, to provide the best patient care.

“It’s important to us — and to our donors — that the QEII Health Sciences Centre reflects the many communities we serve; to ensure equal opportunity and access to training and education,”

says Julie MacKean, vice-president of philanthropy at the QEII Foundation. “We want to help create a future with a vibrant work environment dedicated to improving and, in many cases, saving the lives of patients.”

For Jennifer, this means being part of the change. As a graduate student and registered nurse, her interest lies in shedding a light on the gaps in knowledge that pertain to 2SLGBTQ health concerns.

“It is a great privilege to be able to do the work that I do,” says Jennifer. “And as a nurse, I have a duty to do this work.”

Jennifer is referring to her ongoing work and research as she works toward her PhD in nursing.

The lack of knowledge and current training on 2SLGBTQ health is what drives her.

“I have an interest in the gap between the health services needed versus the health services offered for 2SLGBTQ populations,” says Jennifer. “And 2SLGBTQ patients are often expected to close that gap, sometimes missing out on the care they need.”

She gives the example of common questions female patients are asked during a health assessment: Are you sexually active? Or is there a chance you

could be pregnant?

For lesbians, answering “yes” to being sexually active doesn’t mean they have a risk of pregnancy.

The same goes for a trans woman, who can’t get pregnant because she doesn’t have a uterus. The standard method of questioning forces them to reveal a part of their identity or risk not receiving the best care.

It’s the first time I’ve been recognized for being diverse and, for me, that’s a very powerful acknowledgement.

– Jennifer Lane “Trans patients are a particularly disadvantaged group because there is very little education done on the impacts of medicalizing trans bodies,” she says. “If a patient wants testosterone treatments and their physician doesn’t know how to prescribe it, where do they go from there?”

As a mental health nurse, who still works casual shifts at the QEII’s Abbie J. Lane building

LUXURY RETIREMENT LIVING FROM THE HEART

while pursuing her PhD, Jennifer is focused on the therapeutic relationship with patients and assessing for vulnerabilities. She notes the importance of using neutral language when speaking with patients.

“If I use neutral language, then the patient will use language that reflects their lived reality,” Jennifer says. “I can reflect that language back to them, validating them as a person.”

Part of Jennifer’s research focuses on healthcare professionals understanding their own cultural biases when interacting with someone from a different culture — and what kind of blind spots they may have. These blind spots translate into unmet healthcare needs.

“If I’m not trained to see my blind spots, I don’t know what I’m not seeing and, thus, not addressing,” she says. “It’s really about seeing the whole person.”

Jennifer says it’s about teaching healthcare professionals how to be the experts on health, but interacting with patients in a way that the patient feels they are the expert on themselves.

As a course professor in exploratory nursing practice this past semester at Dalhousie

University’s School of Nursing, Jennifer was able to teach these skills to her class of 66 students.

Having an incredible experience as a new educator, Jennifer says working with the students has been an honour.

“To be in a position when I can influence the way nursing students understand these issues fills me with hope for the future,” she says passionately. “They’ll graduate in May and will go out in the healthcare world with this knowledge. Imagine how many patients they’re going to see throughout their careers.”

Jennifer is grateful for receiving the Diversity in Health Care Bursary. Not only is the financial assistance needed and appreciated, but it’s an important step in the progression of health care in Nova Scotia.

“I think NSHA and the QEII Foundation are doing something very important with this diversity bursary,” says Jennifer. “It’s the first time I’ve been recognized for being diverse and, for me, that’s a very powerful acknowledgement.”

To apply for the 2020 Diversity in Health Care Bursaries, funded by the QEII Foundation, visit QE2Foundation.ca/DiversityBursary.

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Dr. Brendan Carr

Q&A with new president and CEO of Nova Scotia Health Authority Continued from Page 6

that sees its role and tries to find solutions and keep iterating on those solutions. There will never be a single answer to the complex problems we are dealing with.

We need to continue to learn and advance.

Q:

With a big job ahead of you, what does the first six months look like for you?

A: The first six months will

be bringing focus to some of the challenges, immediately trying to get those issues on the table in a way that we can start to make some progress. We made some big changes to the organization’s structure, so building that leadership team is critical for me.

The other big category is about creating relationships and listening and learning. A lot of my focus will be on getting out into the various communities, meeting with providers and other people in the communities who have an interest and perspective on health care. Because I am from here, I have a familiarity with the system. But I am going to be very mindful of approaching it with real curiosity and not assuming.

There is a huge risk if I come into this with big assumptions and they are not right.

My hope is that we can get beyond the hot topics that are worrying people. I do totally get that people are worried and I expect to hear about that. But my hope is that we can go beyond that and hear conversations about

what really matters to them. If we assume for a minute that we are going to be OK with the big issues, what would matter to them for the future? Not just the burning issues of today, but the important conversations about health and how we are doing as a province.

Q: What healthcare

advancements would you like to see in the next five or 10 years as QEII New Generation evolves?

A:

The infrastructure pieces are critical. It’s so important to build state-of-the-art infrastructure, designed to enhance what we are doing today and catapult ourselves into the future. This represents a huge asset to us to move health care to a different place in the next five to 10 years.

And part of that is the adopting of new technology.

We do need a single system of information in this province that actually capitalizes on all of the information that exists in bits and pieces. OPOR (One Patient, One Record), like it or not, is an important piece of strategy for us and we do need to find our way through it. I understand how challenging that will be, but it is the right thing to do. It has huge implications on safety, system efficiency and, most importantly, how people experience their care.

Connected to that is virtual care. Most other systems in the world have moved beyond this

notion that the only way people can access care is one person at a time, face to face — and the idea that you need to line up. Most other systems, other industries and other things in our lives, work on creating simple tools that allow people, in a convenient way, to get contact with a system.

By way of example, other countries have created virtual triage systems whereby people don’t show up at the hospital for triage. Their first point of contact is electronically, through a tablet or phone, where they interact with someone for a triage process.

People are sorted into different stages — for example, an ambulance is phoned or patients are told to see a primary care provider or told to come into emergency and the current wait is three hours. The dispatcher schedules a certain time later in the afternoon. Systems are doing this now. But we are still saying show up at emergency and wait in the waiting room.

It’s not a criticism of what we are doing today. It is simply acknowledging that the way the world is changing, how technology is changing and what people expect is changing and we are not delivering. QEII New Generation creates an opportunity for a hub, a catalyst and anchor point for the whole province.

A:

It’s so important to build state-of-the-art infrastructure, designed to enhance what we are doing today and catapult ourselves into the future.

– Dr. Brendan Carr

Q:

How will you work with the QEII Foundation to drive change forward?

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I hope to be very connected to the QEII Foundation and all foundations in the province.

Where I just came from, the CEO of the foundation was a senior member of my team.

We didn’t have a strategic conversation where our foundation wasn’t involved.

The leaders of foundations have huge experience, not just with philanthropy, but insight from the community on how we can deal with complex issues.

I think for the foundation to do their job well, they need to be part of the conversation from the very beginning. The foundation plays a pivotal role in helping to change the narrative of health care. Foundations are uniquely positioned to host some of the new conversations, around dreaming big and questioning ‘What if?’ That really excites me.

Q: What is your message

for Nova Scotians who are worried about the future of health care?

A:

I understand and share your worries. This is my home and just like any other citizen, I understand how important this is.

But I do want them to feel hopeful and even a little bit excited about the future. All of the pressures that we are feeling actually create an opportunity to look at how we could do things differently. I want people to have optimism about change and how it is within our reach and how it will impact their lives in a meaningful way.

B WINTER 2020

9

Dr. Geoff Porter (left), QEII surgical oncologist and head of general surgery; Brian Martell (centre), senior director, NSHA diagnostic imaging; and Dr. Rob Berry (right), head of interventional radiology, have been collaborating to bring four new interventional radiation suites to the QEII in 2020 to advance patient care. The QEII Foundation is fundraising to provide the latest technology and equipment — CT fluoroscopy and mobile C-arm.

QEII Foundation

Full-focus patient care

New interventional radiology suites opening at the QEII in 2020

By Jon Tattrie Interventional radiology (IR) is one of the fastest-growing fields of medicine and the QEII Health Sciences Centre is making a big leap forward for patients who need such care.

IR is a medical subspecialty of radiology that uses minimally invasive image-guided procedures to diagnose and treat diseases in nearly every organ system from head to toe. On any given day, the QEII’s IR team may use X-ray guidance to pass a small tube through an artery to remove a stroke-causing blood clot, use CT guidance to advance a needle into a small liver tumour to destroy it with heat, or use ultrasound and X-ray guidance to pass a balloon through a blocked artery to restore circulation in a patient’s leg to prevent the need for amputation.

The precision of IR procedures reduces the need for large incisions (open surgery) in the body and can often be done with local anesthetic, improving recovery for patients.

Brian Martell, senior director of diagnostic imaging for Nova Scotia Health Authority, says the current care journey for IR

treatment is confusing and stressful for patients.

Patients register on the fourth floor of the QEII’s Halifax Infirmary, get assessed by a nurse, transfer to the fifth floor for another assessment, get the procedure done and then return to recover on the fourth floor.

Brian says the new IR suites opening at the QEII’s Halifax Infirmary building in 2020 will bring “full-focus patient care” and everything will happen in one area. “A patient will come in and be cared for in one space,” he says.

The smoother system will provide a more efficient IR service.

“The whole experience will be less stressful and less confusing for the patient,” he says. “From start to finish, the interventional team will be taking care of the patient. The patient journey should improve dramatically.”

Dr. Rob Berry, head of interventional radiology, says the idea for the new suite started in 2015.

“We consulted with interventional radiology departments across North America to determine the best

possible, most efficient setup we could to advance care for our patients,” he says. “What we ultimately came up with is building four new IR suites to replace the two we had and an 11-bed pre- and post-procedure area just for the IR patients.”

The new IR area will also have its own CT fluoroscopy scanner for performing CT-guided procedures. This will further reduce patient movement and free up time on the diagnostic CT scanners. “It’s a huge improvement for our IR patients and it’s also expected to impact wait times for patients in the emergency department who need diagnostic CT scans,” Dr. Berry says.

The team plans to start opening the new suites in spring 2020 and have them fully running by fall.

The work is part of the QEII New Generation redevelopment. The QEII Foundation is fundraising to provide the latest technology and equipment — CT fluoroscopy and mobile C-arm — for two of the suites, while provincial government funding will cover the remainder.

CT Fluoroscopy relies on

A patient will come in and be cared for in one space. The whole experience will be less stressful and less confusing for the patient. From start to finish, the interventional team will be taking care of the patient.

– Brian Martell

image guidance to conduct interventional procedures. It is vital in the diagnosis of some cancers through biopsies, and can be lifesaving in the treatment of cancer through ablation, which involves inserting a needle into a tumour and killing it. A mobile C-arm hosts simple but vital image-guided procedures. It is most commonly used for IV placement in cancer patients.

Dr. Geoff Porter, a QEII surgical oncologist and head of general surgery, says interventional

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radiology is a critical component of his work as a cancer surgeon.

He says IR has been steadily moving forward over 30 years, allowing more and more patients to avoid surgeries.

“Initially, interventional radiology had a major focus on biopsies and dealing with complications after surgery that traditionally would have required a whole new operation,” Dr. Porter says. “Now, more and more IR-delivered primary treatments are available with great benefit to patients.”

He says surgeons, oncologists and interventional radiologists work as a team; the new IR suites will let them all play on the same field. Dr. Porter says it will be easier for medical professionals to talk about cases when they’re near each other and it will improve patient care by keeping everything in one place.

With the new IR suites on the horizon, Brian notes that a significant amount of planning was necessary. Vicki Sorhaindo, IR manager, along with many staff and physicians collaborated on the best plan to benefit patients today and into the future.

10

WINTER 2020

Emma Price (right), DAMIT study research co-ordinator, takes a picture of a patient’s mole using a special camera that magnifies the mole by 20 times. The image is then analyzed by a computer to determine if it is safe or needs to be removed, detecting melanoma with a high level of accuracy. QEII Foundation

A.I. detecting skin cancer

QEII’s DAMIT study targeting Nova Scotia melanoma epidemic

By Allison Lawlor Concerned a new mole on her body might be cancerous, Jessica Howe immediately contacted a research study taking place at the QEII Health Sciences Centre.

Jessica, an administrative assistant at the QEII, spotted a bright yellow poster advertising the Direct Access to Melanoma Identification and Treatment (DAMIT) study in the elevator at work one day last fall. It called on people like her to take part in the study that detects melanoma, a life-threatening form of skin cancer, with a non-invasive machine that uses artificial intelligence.

“I had a new mole that came out of nowhere and I also had some soreness around it,” says Jessica. “I was concerned.”

The DAMIT study, supported by the Dalhousie Medical Research Foundation’s Shaw Endowed Fellowship in Melanoma Research, is aimed at the early detection and treatment of melanoma. Dr. Peter Hull, the QEII’s head of dermatology and the physician leading the study, is calling on the public to contact his team about concerning moles. Finding melanoma early is crucial. The detection of thin, curable melanomas can save lives. In Nova Scotia, this is critical.

“We have the highest rates of melanoma across the country,” says Dr. Hull. “We have a real epidemic.” Each year in Nova Scotia, there are more than 18 cases of melanoma detected per 100,000 people.

Dr. Hull attributes the province’s high rates to genetics, jobs and lifestyles.

A large proportion of residents, like fishermen, work outdoors in the sun and outdoor recreational activities are growing in popularity.

Not wanting to wait and worry, Jessica called to find out more about the study.

Emma Price, the study’s research co-ordinator, told her all she needed was to be 25 years or older and have a mole that was worrying her. She didn’t need a referral from a doctor. Jessica wasn’t sure what she should be looking for. She learned that the research team is particularly concerned about smooth moles.

“Moles rough on the surface are very unlikely to be melanoma,” says Dr. Hull.

“We talk about the ugly duckling — a mole that looks different and is changing over a month. It doesn’t matter if it is a colour change or a size change. Those are all important.”

After expressing interest in the study and signing a consent form, Jessica was told patients are seen within one or two weeks.

During a typical meeting with a patient, Emma spends about 30 minutes with them. After learning about the history of the mole and what is concerning the patient, Emma then takes a dermoscopic image using a special camera that magnifies the mole 20 times and shines non-polarized light. This allows the team to see structures of the mole that can’t be seen with the naked eye. The dermoscopic image makes it easier for the artificial intelligence to diagnose melanoma.

The image is then analyzed by a computer to determine if it is safe or needs to be removed. It detects melanoma with a high level of accuracy.

The research team also uses a special tape to sample the surface of the patient’s skin, analyzing the samples for genes only seen in melanoma.

Within 24 hours of taking the image of the mole, Dr. Hull examines it and determines whether the mole should be removed. Moles are never burned off, he explains. If removal is necessary, it will take place within two weeks.

Jessica learned her mole wasn’t cancerous, but it was removed just to be safe. “It was all completed within a three-week period,” she says. “It was very relieving to get in and get it dealt with so quickly.”

Taking part in the study allows patients to greatly reduce the amount of time they wait to see a specialist and have a mole removed, says Dr. Hull. Typically, it could take as much as six months to get an appointment with a dermatologist to check a mole.

Dr. Hull hopes his study will continue for at least two years and include 1,000 patients. Eventually, he would like to see the technology used to establish public centres in the province that would screen for cancerous moles, similar to breast-screening centres.

Approved by Nova Scotia Health Authority’s Research Ethics Board, the study is free for participating patients. For more information or to take part in the study, contact damit.program@gmail.com.

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WINTER 2020

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Dr. Ayman Hendy (left), anesthesiologist, Dr. Edgar Chedrawy (centre), head of cardiac surgery, and Dr. Hashem Aliter (right), cardiac surgeon, are part of a collaborative team at the QEII applying Enhanced Recovery After Surgery — or ERAS — a multidisciplinary care improvement approach to how patients recover from cardiac surgery. QEII Foundation

Enhanced recovery after surgery

New cardiac surgery approach changing care for patients at the QEII

By David Pretty A team of healthcare professionals at the QEII Health Sciences Centre is applying a comprehensive new strategy for cardiac surgery called ERAS — Enhanced Recovery After Surgery.

“ERAS is a multidisciplinary care improvement approach to how patients recover from surgery,” says Dr. Edgar Chedrawy, head of cardiac surgery at the QEII and an associate professor in the Department of Surgery at Dalhousie University.

As Dr. Chedrawy explains, ERAS is designed to prepare and guide cardiac patients through every stage of their procedure.

“Prior to surgery, we assess patients from a nutritional standpoint and we check the medications they’re currently taking,” he explains.

The ERAS team also performs a series of “engagement and pre-habilitation” measures, which are designed to improve the candidate’s functional capacity. “This helps patients to better deal with the stress of surgery,” says Dr. Chedrawy.

Another major part of ERAS is addressing the patient’s anxiety. As cardiac surgeon Dr. Hashem Aliter explains, this is accomplished by making social workers available for counselling and demystifying the process via an informational booklet, as well as a series of informative videos.

“This allows the patient and their family to know the expectations, such as physiotherapy, nutrition and activity at home,” he says.

According to anesthesiologist Dr. Ayman Hendy, the tradition of fasting before surgery has also been challenged.

“We now allow patients to drink clear fluids and consume specific carbohydrates,” he says. “The body can preserve it’s proteins for healing and other important functions.”

This level of care continues into the procedure itself.

“We implement different measures to help monitor the patient’s body temperature, control their blood sugar and reduce their chances of bleeding,” says Dr. Chedrawy.

With the stress of surgery elevating the patient’s glucose levels and, in turn, increasing their chance of infection, strict temperature and sugar controls are enacted.

“We also treat the patient’s pain and post-surgery delirium much more aggressively,” adds Dr. Chedrawy.

As Dr. Hendy points out, the historical use of powerful opioids for pain mitigation could be problematic, since they often render patients completely uncommunicative.

“By using shorter-acting pain

medications, the patient’s mind is clearer faster after surgery,” he says. “Now, they can be given instructions and quantify their pain experience.”

Applying local anesthetics for targeted nerve blocks also helps to cut down on the use of debilitating painkillers. “This way, we can freeze the area and not give the patient something that makes their mind foggy,” says Dr. Hendy.

This cumulative level of care also gives the ERAS team a chance to liberate patients from the restrictive surgical tubing used to drain any blood accumulating after cardiac surgery, a lot sooner. Not only does this reduce pain and the threat of obstruction or infection, but it also gives patients back their mobility much sooner which, in turn, expedites their release from hospital.

“Almost a third of our patients will have some sort of kidney or lung injury, which is a potential side effect of the heart-lung machine used during surgery,” says Dr. Chedrawy. “While temporary and reversible, this injury prolongs their intubation time and their length of stay after surgery. But ERAS reduces that by almost 25 to 30 per cent.”

“We wait three or four hours and if the patient is stable, we remove the breathing tube and start with early mobilization if the patient’s condition permits,” says Dr. Aliter.

Hydration and the early stabilization of body functions is another key component in the ERAS recovery process.

“We start with a clear fluid four to six hours after removing the breathing tube and we give them chewing gum if their condition permits,” says Dr. Aliter. “This will help normalize their gastrointestinal system after surgery and help prevent any further complications.”

As soon as it becomes feasible, light physical activity is encouraged.

“We get patients to use an incentive spirometer as soon as possible, even before surgery,” Dr. Aliter explains. “It’s a device designed to improve their lungs and respiratory function, so it’s easier for us to discharge them home.”

The QEII is the only medical site in Atlantic Canada to feature a cardiac surgery ERAS program. As such, it brings together a unique and talented pool of personnel from such diverse disciplines as anesthesia, nursing, social work, cardiology, pharmacy, nutrition and physiotherapy.

“It’s been shown many times to have an overall reduction in complication rates and length of stay, as well as an improvement in cost and the patient experience,” says Dr. Chedrawy.

“When the patient goes home, they’re in stable condition, they’re feeling well and everything is taken care of,” adds Dr. Aliter.

ERAS is a multidisciplinary care improvement approach to how patients recover from surgery. – Dr. Edgar Chedrawy

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Supportive care for cancer treatment QEII’s nurse-led clinic one of a kind in Canada

By Erin Elaine Casey Terra Thibault, health services manager for Ambulatory Oncology Clinics in the Cancer Centre at the QEII Health Sciences Centre, is one of the driving forces behind the QEII’s Supportive Care Clinic (SCC), where patients going through radiation therapy can receive timely and personalized treatment for side-effects.

Certified oncology nurse Charlene Rodrigues is one of two nurses who run the SCC, the only nurse-led clinic of its kind in Canada.

“When patients have ongoing radiation treatment, they can have side-effects like skin problems, dehydration and pain,” Charlene explains. “The nurses who work here have always known that there was a need for this clinic and that need has now been recognized.”

Before, patients experiencing side-effects could be seen at the cancer centre, but there was no specialized clinic. “If we can support them, we can decrease hospital admissions and emergency department visits,” says Terra.

“From a nursing perspective, you feel like you can take that extra time to take care of that patient.

It’s the right care at the right time.”

The SCC opened in September 2018 as a pilot project running three or four days a week in a borrowed space. Today, the clinic is permanent and has two dedicated nurses and a dedicated physician on call five days a week.

Patients are assigned to one nurse and there’s a phone line where they can leave messages.

From the time it opened to the end of November 2019, the SCC

has carried out 1,424 supportive care activities, including rehydration, dressing changes, IV line and feeding tube care and pain management.

As the largest specialized cancer care centre for Atlantic Canadians, the QEII delivers world-class care to address some of Canada’s highest cancer rates.

“The challenge we face is patients having to travel up to hundreds of kilometres for care, which is really different than if you live in Toronto,” explains Dr. Jean-Philippe Pignol, head of the Department of Radiation Oncology and a professor at Dalhousie University.

Patients typically require a few weeks of daily radiation treatment and can experience side-effects for several weeks after finishing. “These side-effects can be very scary for everyone, including the local doctor.”

Dr. Pignol and his team knew they needed radiation oncology custom-made for Nova Scotians.

“We focus on a one-stop shop,” he says.

That includes the SCC and the newly established Rapid Response Clinic. Another pilot project currently running one day a week, the Rapid Response Clinic provides urgent care for patients who need immediate relief from symptoms like pain.

“Within four hours, they’ve been seen, received their radiation treatment and developed a pain management plan with their nurse,” adds Terra. “And some people are coming from Yarmouth, for example. So, a process that used to take all day and be very hard on

Yvonne Pettipas (left) and Charlene Rodrigues (right), registered nurses, run the QEII’s Supportive Care Clinic, the only nurse-led clinic of its kind in Canada. This clinic allows patients going through radiation therapy access to timely and personalized treatment for side-effects, such as dehydration, skin problems and pain. QEII Foundation

the patient is much easier now.”

The clinic has also had a positive impact on patients who previously needed to stay in hospital to manage their symptoms.

“Hospital admissions are reduced by almost 30 per cent,” says Dr. Pignol.

Charlene, along with Yvonne Pettipas, the clinic’s other dedicated nurse, recently presented at the annual Canadian Association of Nurses in Oncology conference in Winnipeg.

“It was standing room only,” says Charlene. “We’re patientfocused and patient-centred. As front-line nurses in supportive care, we feel so empowered to make decisions and carry out interventions to help patients right away.”

Everyone agrees making the SCC a reality was a team effort,

Hospital admissions are reduced by almost 30 per cent.

— Dr. Jean-Philippe Pignol

from the highest levels of leadership, including health services director for the cancer care program Jill Flinn and every member of the cancer centre staff. Dr. Pignol gives a great deal of credit to Terra and the nursing team.

“What they’ve developed is quite unique,” says Dr. Pignol.

“The Supportive Care Clinic is a smart and inexpensive idea with a huge return.”

At the end of the day, it’s the patients who reap the greatest rewards of this high standard of care. For Charlene, that means patients feel seen.

“This is what we do and what we love doing,” she says. “We’re validating their questions and validating their experience: You’re important and your challenges are important.”

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WINTER 2020

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Reducing the impact of trauma

Trauma Nova Scotia dedicated to patient care across the province

By Allison Lawlor Thousands of Nova Scotians experience traumatic injuries every year, from falls and motor vehicle collisions, to stabbings and gunshot wounds.

The dedicated team at Trauma Nova Scotia works hard to continuously improve and ensure consistencies in the quality of care people receive throughout the province. Based at the QEII Health Sciences Centre, the team also offers ongoing professional education, conducts research and finds effective ways to reduce the burden of trauma — on both patients and the healthcare system.

“Our program has a provincial scope with a goal of providing the best patient care possible, no matter where an injury occurs,” says Dr. Robert Green, the medical director of Trauma Nova Scotia.

Established in 1997, Trauma Nova Scotia takes a provincial approach to reducing the impact of traumatic injuries for Nova Scotians. In 2018, the program was formally integrated with Nova Scotia Health Authority’s Trauma Program, creating greater opportunity for collaboration throughout the province.

“Through this collaboration, we are continuously evolving to provide the best possible patient care and outcomes,” says Lewis Bedford, NSHA’s provincial director for trauma and urgent care.

Reducing the number of traumatic injuries and improving patient outcomes is essential.

Trauma is the leading cause of death for Nova Scotians under the age of 45 — and the number of trauma-related incidences in the province is growing. Between 2008 and 2018, these types of

injuries increased by more than six per cent.

Across the province, the team is working with clinicians in places like Yarmouth and Cape Breton to advance trauma care.

The IWK Health Centre, for pediatric care, and Emergency Health Services are key partners in providing comprehensive, integrated trauma care, including pre-hospital care.

“It’s important for us to work together, across organizations and the province, to best facilitate care for patients,” says Dr. Green.

“Having a collaborative trauma system is what saves lives.”

Part of this collaboration is the healthcare teams beyond the trauma room. Depending on the traumatic injury, a patient may need immediate surgery or be admitted to an ICU. As their condition improves, they often spend weeks as an inpatient before moving on to the QEII’s Rehabilitation and Arthritis Centre to regain strength and mobility or even relearn daily life activities. Some may need followup care for years to come.

“Working with our partners throughout the healthcare system ensures optimal quality of patient care throughout their journey,” says Lewis.

Since its inception more than two decades ago, Trauma Nova Scotia has developed and evolved the province’s trauma system through some of its core functions, such as maintaining the Trauma Registry, education and research.

“We really believe in using our data to inform practice,” says Dr. Green.

Nova Scotia is one of the

Lewis Bedford (left), provincial director, urgent and trauma care; Rob MacKinley (centre), health services manager, trauma and emergency programs; and Dr. Rob Green (right), medical director, Trauma Nova Scotia, work with their dedicated teams to continuously evolve practice and provide the best possible patient care and outcomes. QEII Foundation

country’s only provinces to have a population-based trauma database that captures information on major traumas from hospitals across the province. With 14,000 patients, the registry helps monitor and ensure the quality of the trauma system and provides data for research that informs trauma-related policies and clinical practice.

Using data from the registry, Dr. Green and his team can also recognize challenges, develop solutions and change practice.

Through the data, they monitor critical events like the time between a patient’s arrival at the hospital and when they undergo a CT scan. Now, a trauma patient will receive a CT scan within 25 minutes of arriving at the QEII. “The shorter that time is, the better the patient’s outcome,”

says Dr. Green.

Education is another big part of what Trauma Nova Scotia does well. As many as 10 times a year, Dr. Green and his team teach a hands-on course to physicians, nurses and paramedics, mostly within their home towns across Nova Scotia. Using clinical-grade cadavers — one of the only organizations in North America to do so — they teach how to assess a patient’s condition, resuscitate, stabilize and arrange inter-facility transfers in the trauma system.

“We educate hundreds of people over the course of a year across the province,” says Dr. Green.

On Trauma Nova Scotia’s website, healthcare professionals can find information on a range of educational programs and watch instructional videos on

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procedures such as basic airway management and inserting a chest tube. New videos are continuously added with the goal of improving patient care.

“It’s a way clinicians across the province can keep updated on the latest procedures,” Dr. Green says.

In March 2020, the Trauma Association of Canada will hold its annual conference in Halifax.

This will be the second time in four years that national and international clinicians and trauma system leaders have gathered in our province to share leading practices in trauma care and research.

For more information about trauma care in Nova Scotia, visit trauma-ns.com.

WINTER 2020

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The world at your fingertips

Interpreter on Wheels makes 24-hour interpretation possible

By Erin Elaine Casey Imagine you’ve just woken up from surgery. You’re sleepy, confused and probably a little worried about how everything went. A nurse approaches to check on you and your first instinct is to ask for reassurance: “Was my surgery a success? Where is my family?

How long do I have to stay here?”

Now, imagine the nurse doesn’t understand what you’re saying and can’t offer any information in your own language. Maybe you don’t have to imagine — maybe it’s happened to you or someone close to you.

In perioperative care — the journey from pre-admission assessment to surgery to recovery and discharge — at the QEII Health Sciences Centre, those days are over. In the fall of 2019, perioperative care teams at the QEII received Interpreter on Wheels equipment and technology, thanks to funding from the QEII Foundation Comfort & Care grant program.

Comfort & Care grants were established in 2005 by the QEII Foundation to directly enhance care for patients and their families. These grants support projects that typically would not receive funding from operating or capital budgets.

“In the Post Anesthetic Care Unit (PACU) our patients are in crisis and it can be hard to communicate with a patient whose first language isn’t English,” explains health services manager Patricia Jennex. “With the Interpreter on Wheels, physicians and nurses can ask questions about things like pain and post-surgery concerns.”

“It can follow patients into pre-admission assessment, into the ORs if needed, into recovery and then help with discharge teaching,” adds perioperative nurse Heather Aikens.

But what exactly is an Interpreter on Wheels and how is it different from an in-person interpreter?

“It’s an iPad locked into a stand with wheels,” says Patricia. “You turn it on and select the language you want on a touchscreen.

Interpreters are on call all over the world, 24 hours a day. They receive specific training in a variety of scenarios, including health care.”

Heather Aikens, a registered nurse with the QEII’s perioperative care, guides a patient through communication using the Interpreter on Wheels. With 400 available languages, the Interpreter on Wheels — provided by a QEII Foundation Comfort & Care grant — allows QEII healthcare teams to communicate with all patients, 24 hours a day.

QEII Foundation

If it sounds simple, it is — and quite amazing. Four hundred languages are available through a service called LanguageLine, most with both live video and audio interpretation. Declining video streaming is always an option if the patient wants more privacy. “But most people find it reassuring to have a face to talk to,” says Patricia.

Before Interpreter on Wheels, interpreters had to be booked in advance through the Nova Scotia Health Authority’s Interpretation and Language Services.

“This works well, but has limitations,” says Patricia, “such as emergencies, surgical delays and a limited menu of languages.

If we needed immediate interpreting, we would sometimes ask staff members. They’re more than happy to do it, but it means removing a staff member from their other patients or duties. This can impact the flow of patients in and out of the PACU and care of

patients in the unit.”

Interpretation and Language Services supports the Interpreter on Wheels program by providing software, staff training and support.

Interpretation is now available at any point in the patient’s perioperative care journey.

“The consent leading up to surgery is so important,” says Heather. “Things with your health status can change between pre-admission and the actual surgery and patients need to understand all the things they can and can’t do before surgery.”

Patricia points to a more diverse population as a key reason for improving interpretation services at the QEII. Even if the patient or family speaks English as an additional language, they might not be familiar with medical vocabulary and they might feel stressed. “In addition to welcoming immigrants and refugees, there are university students from all

It’s reassuring to know we can provide the safest, most holistic care we can for our patients.

— Heather Aikens

over the world and cruise ship patients on a regular basis.”

The Nova Scotia population is also aging, which can pose challenges in the recovery room.

“Maybe the patient doesn’t have their glasses or dentures or hearing aids,” adds Patty. “The Interpreter on Wheels provides a sense of comfort and security.”

The benefits extend to nurses and other healthcare providers as well.

“It’s a comfort because if I’m sending patients home and I am unsure if they understand what they need to do for post-operative care, that’s not a good feeling,” says Heather. “It’s reassuring to know we can provide the safest, most holistic care we can for our patients. Patients are thanking the interpreter and you can see the relief and feel the anxiety coming down when they know they can communicate and get the help they need.”

Local study improving access to HIV care QEII Foundation TRIC grant supporting community-based research

By David Pretty In 2018, the number of new HIV infections in Halifax Regional Municipality (HRM) doubled among those who use injection drugs, compared to the previous two years. This is a trend that deeply concerns Matt Bonn, a frontline harm reduction support worker with Mainline Needle Exchange.

“I hear about unsafe using patterns from people first hand and I see more and more people contracting HIV,” he says. “A lot of youth as well, which is alarming.”

This sentiment is echoed by Dr. Lisa Barrett, an infectious diseases specialist at the QEII Health Sciences Centre and an assistant professor at Dalhousie University.

“HIV is a chronic infection and once you get it, you have it for life,” she explains. “While we can treat the infection well, we have to know about it. In the early days of the infection, a person may not know they have it, so getting tested is important.”

The medications that treat HIV are typically quite successful and, about 10 years ago, a medication became available to prevent future infection. When taken daily and combined with other harm reduction strategies — a process known as pre-exposure prophylaxis, or PrEP — it’s highly effective for preventing HIV from sex or injection drug use.

“PrEP is not just a pill; it’s a whole plan to reduce exposure to infections,” Dr. Barrett says.

“This includes having safer sex, harm reduction if you inject drugs, as well as understanding your risk for infections spread through blood and sexual encounters. PrEP is a plan and an important part of that plan is this medication.”

With funding from a QEII Foundation Translating Research Into Care (TRIC) grant, Dr. Barrett and her team are monitoring the effectiveness of a communitybased PrEP rollout in the HRM. QEII Foundation TRIC grants fuel

direct and positive changes for health care, such as better patient outcomes and improved access to care.

Dr. Barrett’s innovative approach in combating HIV infection embodies the uniqueness of the grants — closing the often decades-long gap between research and practice. Matt is particularly enthused by the prospects.

“I’m excited for the QEII Foundation TRIC grant to give access to providers in a communitybased setting because we lose so many people while trying the referral method,” he notes.

Dr. Barrett’s study involves a three-pronged strategy to target those most at risk.

“PrEP involves education around HIV, easy testing for a patient to know their status and then access to PrEP if they need the medication,” she says.

Dr. Barrett first needed to understand what people in the at-risk community knew about

I’m excited for the QEII Foundation TRIC grant to give access to providers in a community-based setting because we lose so many people while trying the referral method.

— Matt Bonn

HIV — from how it’s contracted to how to prevent it. With Matt’s help she was able to engage people in the community and provide awareness cards urging people to get tested.

The second part of the study

saw Dr. Barrett and her team using a “point-of-person” blood test in the community. Approved

by Health Canada but not normally offered for routine testing in Nova Scotia, the test is similar to a diabetes blood sugar test, with results available within minutes. But before treatment can start, the results need to be confirmed in a more comprehensive lab at the QEII, presenting another challenge unique to the high-risk community.

“The point-of-care finger prick test gives HIV results within five minutes,” Dr. Barrett says. “But if a random person gets a positive test, how do we make that part of the public health reporting and make this practical for patients with no health card, no driver’s licence and no fixed address?”

As Charles Heinstein, the manager of the QEII’s microbiology lab, can attest, these challenges extend into his realm as well.

“We’ve got incredible testing mechanisms and equipment LOCAL STUDY – Page 15

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Charles Heinstein (left), manager of the QEII’s microbiology lab, and Dr. Lisa Barrett (right), QEII infectious diseases specialist, demonstrate a point-of-care finger prick test that gives HIV results within five minutes.

This test is an important part of PrEP, a prevention and treatment program for HIV infection. QEII Foundation

Local study improving access to HIV care Continued from Page 14

and staff, but there are groups of the population that can’t access that,” he says. “With no health card number or social insurance number, there are no unique lab identifiers to ensure we’ve got the right person tested.”

Charles’ solution for this was the creation of unique codes that can be referenced back to individuals.

“Typically, it’s done with testing for sexually transmitted infections,” Charles says. “We get a code that has no other identifiers, which allows us to get around that barrier of identification while still maintaining the safety that’s required for this type of testing.”

The need for standard forms of identification to treat marginalized

people is also frustrating for Dr. Barrett, especially when it concerns obtaining PrEP medications for those who need it most.

One aspect of the QEII Foundation TRIC grant’s two-year timeline is trying to reconcile these traditional administrative criteria for the people who need it most.

PrEP is not just a pill; it’s a whole plan to reduce exposure to infections.

— Dr. Lisa Barrett

“This research let us identify that availability is accessibility and then work toward changing a system to allow access,” Dr. Barrett says. “We haven’t changed that barrier yet, so part of the research will be to see if we make progress with that barrier still in place and other barriers removed.”

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