In Touch newsletter: April 2017

INTOUCH APRIL 2017

Volunteer Jannie Henkelman, the co-ordinator of the Cozy Cloth Program, tends to Benson Mark, a premature infant in the Neonatal Intensive Care Unit. (Photo by Katie Cooper, Medical Media Centre)

Cozy cloths put preemies and parents at ease

By James Wysotski

Parents of premature babies in St. Michael’s Neonatal Intensive Care Unit cannot be at their child’s side 24-7, but now a piece of them can.

With the recent launch of the NICU Cozy Cloth Program, parents can leave a triangular piece of fabric with their scent under their infant’s head in the isolette or bassinette.

“Parents worry about bonding with their baby when they leave at the end of the day, so it’s a huge source of comfort that their baby can still smell them,” said Amanda Hignell, the social worker from the NICU who developed the program.

Parents receive two cozy cloths and are encouraged to wear them under their clothes for 20 minutes so that their scent Printed on 100 per cent recycled paper

can permeate the fabric. While the cloths are sized and shaped to fit easily into bras, Hignell said both parents can take part.

However, all research to date has focused on the mother-baby relationship.

Introducing odours of the mother’s breast milk or amniotic fluid is soothing to babies and helps improve their neurodevelopment, said Hignell. Another benefit is reduced crying, she said, as well as eliciting a suckling reflex, which is important because that skill is challenging to preemies younger than 35 weeks – and NICU babies tend to be much younger.

Teaching babies to suck helps get them feeding sooner by mouth instead of nasal-gastric tubes.

While no studies explain the benefits of

fathers leaving their scents, Hignell said she hoped to facilitate paternal bonding as well.

“A lot of dads do skin-to-skin kangaroo care while in the hospital, and we know the babies thrive with that, so I can’t imagine why cozy cloths with their scents wouldn’t work the same way,” said Hignell.

While cozy cloths are new for St. Michael’s, the idea isn’t. A few babies transferred from other hospitals’ NICUs arrived with cozy cloths. Sensing the added comfort for both parents and infants, Hignell said staff here wanted to start a similar program.

Continued on page 2 APRIL 2017 | IN TOUCH | 1

OPEN MIKE with Anne Trafford

Vice-President Quality, Performance and Information Management, and Chief Information Officer our patients and staff safe. Our goal is to prevent harm to our staff as well as patients, building a singular culture of safety.

Happy spring! Every April, St. Michael’s refreshes our priorities and targets for improving the quality and safety of our care. St. Michael’s comprehensive quality strategy for 2017-18, available at www. stmichaelshospital.com/quality, is the blueprint for all of St. Michael’s quality improvement activities. It includes 2017-18 Quality Improvement Plan targets, which are the pieces of the strategy that we believe we can achieve within the next 12 months.

The strategy focuses on three central dimensions of the patient experience, summarized in three simple statements from our patients: “Protect me from harm,” “Use my time wisely,” and “Use my knowledge, build my knowledge.”

Protect me from harm Above all, St. Michael’s first responsibility and priority is to keep

This year, we will focus on protecting our patients from hospital-acquired infection through consistent hand washing; reducing unnecessary, daily blood tests for inpatients; preventing staff injury from lifting and repositioning patients; and developing better strategies for measuring and tracking our performance related to hospital-acquired pressure ulcers and bed sores, as well as medication safety.

Use my time wisely Our patients’ time matters. Inefficiencies in our patient flow system undermine the patient’s experience as well as the hospital’s quality of care.

Our patient flow priorities are reducing waits in the Emergency Department for non-complex patients; reducing delays transferring “alternate level of care” patients to their next destination; and preventing unnecessarily long stays for

mental health inpatients.

Use my knowledge, build my knowledge This theme is born of an exciting, growing movement within St. Michael’s and across health care to put patients and their families at the centre of health-care planning and delivery. The hospital’s new Family Presence Policy is an exciting example of this philosophy coming to life at St. Michael’s.

This year, we will work to empower patients with the right information for a smoother transition home; evaluate and further build our patient/public engagement strategy; and develop better processes for collecting and learning from health equity data.

It’s a big year ahead and St. Michael’s is well positioned to take on the challenge. I want to thank the staff, physicians, patients and families who contributed their expertise and energy to the development of this year’s quality priorities. Together, we can provide the best possible experience for our patients and families.

Story continued from page 1.

Hignell enlisted the help of volunteer Jannie Henkelman, a NICU baby-cuddler, to run the new program. Together, they got Fabricland to donate all of the materials. Henkelman co-ordinates the distribution of patterns and materials to volunteer sewers, as well as the pickup of finished products.

A crew of five assembles cloths by diagonally folding 10 by 10 inch squares of cotton flannel, pre-cut by Henkelman, and sewing all of the open edges except for a small hole through which the cloths will be turned inside out. But first, to keep infants safe, excess material at the corners is trimmed, thereby assuring flat, rounded corners after inversion. Then the opening is stitched shut. Each cloth

takes about eight minutes to sew. For infection control, the cloths are laundered upon pickup before being placed into plastic bags that get added to the NICU’s Family Welcome Packages.

The crew has already made 250 cozy cloths. But with 30 admissions per month to the NICU, Henkelman said the need for more is great.

Volunteering for this task is rewarding, said Henkelman.

“How satisfying it is to be able to do something as simple as this to enhance the bonding process between preemies and their parents.”

To help make cozy cloths, email Jannie Henkelman at cozycloth.smh@gmail.com.

APRIL 2017 | IN TOUCH | 2

Follow St. Michael’s on Twitter: @StMikesHospital

Dr. Jerry Teitel examines a blood sample from one of his patients. Dr. Teitel is a collaborator with a U.S.-based gene therapy trial for hemophiliacs.

(Photo by Katie Cooper, Medical Media Centre)

“You leave your hemophilia at the door”

By Leslie Shepherd

People with severe hemophilia don’t produce enough clotting proteins on their own, requiring regular infusions in order to prevent or control bleeding. While safe and effective, the infusions can be expensive and time-consuming, and repeated bleeds can result in damaged joints.

Hemophilia patients from St. Michael’s Hospital are taking part in a small gene therapy trial based in the United States, in which participants have gone weeks, months and in one case a year without any bleeds.

“The results so far are wonderful, even better than what we had dared to hope,” said Dr. Jerry Teitel, medical director of the Hemophilia Treatment Program at St. Michael’s. Dr. Teitel, who is a collaborator with the lead researchers at the Children’s Hospital in Philadelphia, called it a “revolutionary therapy.”

Hemophilia is a rare and potentially fatal genetic disorder in which people – specifically males – lack a blood clotting factor, or protein, such that they can suffer prolonged or uncontrollable bleeding, spontaneously or after minor injuries.

It affects about 3,100 Canadians. People with severe hemophilia often bleed spontaneously into their muscles or joints.

Dr. Teitel said preliminary data from the first nine patients suggests that a single dose of the experimental gene therapy may help patients with hemophilia B, who have a deficiency of St. Michael’s is an RNAO Best Practice Spotlight Organization

blood clotting factor IX. He stressed that the treatment was still experimental and that the long-term effectiveness and safety had not been proven. Of the nine patients, four are Canadian, from St. Michael’s.

One of those patients, John Konduros, 53, a bakery owner from Cambridge, Ont., hasn’t had a bleed or a need for treatment since his gene therapy on June 6, 2016. The IV procedure took about one hour. In the IV bag were engineered genes encased in inactivated viruses that signaled his body to produce its own clotting factor IX. Konduros was diagnosed with hemophilia shortly after he was born, as his older brother also had the disease, so he has spent a lifetime being careful not to hurt himself. When he hit himself shoveling snow a couple of years ago he was in hospital for 10 days and couldn’t walk properly for six months.

He said the gene therapy has made him less anxious about the future.

“You spend so much time looking after yourself, avoiding injuries, that to have no bleeds nine to 10 months later is almost too good to be true,” he said. “It’s still hard for me to believe.

You go in for a one-hour IV drip and, like one of the doctors in Philadelphia said, ‘You leave your hemophilia at the door.’ ” APRIL 2017 | IN TOUCH | 3

Dr. Flora Matheson leads a Gambling Research Exchange Ontario Knowledge HUB specializing in research on complexity and problem gambling.

(Photo by Katie Cooper, Medical Media Centre)

Helping people get the treatment they need for problem gambling

By Greg Winson

Problem gambling affects one in nine Ontarians over their lifetimes. The prevalence is even higher among those experiencing homelessness and housing instability. However, treatment programs for gambling aren’t always available or are not well integrated with other services.

A Gambling Research Exchange Ontario Knowledge Hub established within the Centre for Urban Health Solutions has set out to focus on the complex needs of homeless gamblers.

The genesis for this knowledge hub began four years ago when Dr. Flora Matheson collaborated with the Good Shepherd Ministries to study the links between problem gambling and homelessness. The study revealed that 35 per cent of homeless men had lifetime pathological or problem gambling, compared to 8 per cent in the general population.

Dr. Matheson then studied the link between problem gambling and homelessness through qualitative APRIL 2017 | IN TOUCH | 4

interviews with 30 men. Dr. Matheson’s research showed a connection with factors including substance use, chronic illness and childhood trauma.

“Many people who started gambling in their youth continue as adults,” said Dr. Matheson. “They gamble to make ends meet, or for self-esteem.”

Despite the identified need, few services were available for problem gambling.

Family doctors and service providers often don’t understand problem gambling and are unsure where to refer them to.

Dr. Matheson and her team have partnered with the Problem Gambling Institute of Ontario at the Centre for Addiction and Mental Health and Good Shepherd Ministries to develop a manual for service providers to enhance care for their clients with gambling problems. It is set to be launched later this year.

“It’s really to help service providers start a conversation about problem gambling

with their clients and to provide them with screening tools,” said Dr. Matheson.

Patients with complex issues need an integrated approach to their care – having multiple treatment services in one place is important.

“Travelling around the city for different services can be hard, said Dr. Matheson.

“Even a subway token can be expensive for someone experiencing poverty.”

Through the collaboration between Good Shepherd Ministries and Dr. Matheson and her team, Good Shepherd is implementing a pilot project of services to support clients experiencing problem gambling and homelessness.

Services provided will include individual counselling, case management focusing on the specific needs of the client and a life-skills group focusing on issues related to gambling. Dr. Matheson’s team will evaluate this program which was funded through the Local Poverty Reduction Fund of the Ministry of Housing.

Dr. Aditya Bharatha, an interventional neuroradiologist with St. Michael’s, with Saad Ahmed and Samara Seepersad—two upper-year Ryerson biomedical engineering students. The trio developed a new patient booking system for the hospital’s Neurovascular Clinic.

(Photo by Yuri Markarov, Medical Media Centre)

From paper-based to ironclad

By Geoff Koehler

St. Michael’s Neurovascular Clinic is a hub of technology. The clinic’s team uses advanced imaging and state-of-the-art devices to treat blood vessel leaks, blockages or malformations in patients’ brains using minimally invasive techniques.

said Dr. Linda Maxwell, executive director of the Biomedical Zone.

“We then bring in upper-year Ryerson students who have the skills to co-create a solution with the guidance and expertise of St. Michael’s clinical and administrative leaders.”

But when it comes to booking patients, the clinic’s approach has been decidedly low-tech.

The two student volunteers spent eight months working with Dr. Bharatha to develop an electronic booking system that met the specific needs of these patients and the clinic’s workflow. With this program, when a new patient comes in, the clinic staff will add them to the system and be prompted to schedule visits and procedures.

“Right now, when I see a patient in the clinic, I’ll write down when the patient should be booked next for followup imaging or procedures on a paper form,” said Dr. Aditya Bharatha, an interventional neuroradiologist and part of St. Michael’s Medical Imaging Department. “If I want to see them next in August, that page gets put in a binder that will be re-opened in July to start scheduling. It’s not a perfect system.”

Dr. Bharatha said regular followup is crucial because neurovascular illnesses can progress without warning signs or symptoms. He said sometimes the only way to tell if a patient is doing well or is at risk of a sudden stroke is to perform imaging, such as magnetic resonance imaging or a computerized tomography scan.

The clinic’s paper-based booking system may soon change with the help of Saad Ahmed and Samara Seepersad—two upper-year Ryerson University biomedical engineering students.

Ahmed and Seepersad found their way to the Neurovascular Clinic’s project through the Biomedical Zone—a partnership between Ryerson and St. Michael’s that fosters clinical innovation and health-care commercialization.

“Our Co-Development Lab works with St. Michael’s clinicians, patients and other health experts to identify clinical challenges,”

“If an appointment is missed, the system alerts us right away to follow up,” said Dr. Bharatha. “This tool will optimize patient safety and tracking. It’s an ironclad way to make sure referred patients and treated patients are not lost to followup.”

The booking system has been developed with feedback from the clinic’s physicians and staff. The project team, including Dr. Bharatha, is working with St. Michael’s IT to implement the system on trial basis. Dr. Bharatha said, if successful, the long-term goal is to integrate this program into the hospital’s systems.

“What’s special about this Biomedical Zone’s Co-Development Lab project, is that the work Saad and I are doing affects people and their lives,” said Seepersad, who has since graduated and begun working as an associate technical analyst at Techna Institute. “Not every student has a chance to work with clinicians on real-world projects and I think it’s part of why I got this great job. I was able to show that I could help create a product that’s useful for a client and will be used for years to come.”

APRIL 2017 | IN TOUCH | 5

Sheila Deans-Buchan, an NP on the Palliative Care Unit, completes the bereavement care screening questionnaire after meeting with the family of a patient. (Photo by Yuri Markarov, Medical Media Centre)

Providing personalized bereavement care

By Evelyne Jhung

When Jessy Mathai, an oncology-hematology social worker, joined the Palliative Care Unit a few years ago, she would often get referrals for families whose loved ones had just passed away. But because the Palliative Care Unit was one of three areas she was covering, she couldn’t always connect with the family in a timely manner.

“I wanted caregivers to be able to access bereavement support whenever they needed it from any member of the health-care team,” said Mathai.

Mathai and Sheila Deans-Buchan, a nurse practitioner on the Palliative Care Unit, set about creating a bereavement risk screening process in response to the lack of a formal bereavement care program.

“A couple of years ago, we realized we didn’t fully understand what the Bereavement Program, as it was called, really meant,” said Deans-Buchan. “Volunteers were mostly spearheading that type of work – for example, making followup calls and sending condolence letters to friends and family – with little staff involvement.”

Since then, accountability has transferred from the volunteers to staff, and all staff can be involved. Bereavement care doesn’t just fall on the shoulders of a social worker or spiritual care staff member.

The screening tool helps staff identify in advance who would want or need followup. It is a set of 15 yes-or-no questions divided into APRIL 2017 | IN TOUCH | 6

three themes – psychological, social and circumstances of illness or death – that any member of the care team can fill out based on knowledge or observation of the patient’s family or caregiver. The result is more individualized and effective bereavement care.

“A family member or friend who would be considered at high risk and needing followup would be someone who is unaccepting of the illness; is experiencing family conflict; and where the patient is younger and with a new or sudden onset diagnosis,” said Mathai.

“This is someone who needs more than a phone call; we would make a referral to a family doctor or psychologist or external bereavement-grief organizations.”

Included in the bereavement care pathway is providing support to caregivers before their loved one dies. For example, the care team holds meetings for every patient where family members are given an update, asked how they’re coping and whether they need help with funeral planning. The team also has daily interactions with family members at the bedside. For children, members of the team provide grief resources and connect with the child’s school, if necessary.

“Families were grieving but because they weren’t under our care, we had no way of providing therapeutic care for them,” said DeansBuchan. “With our new bereavement risk screening process, any member of the care team can provide families and caregivers with appropriate and individualized support.”

Dr. Bruce Gray is part of a team of radiologists using natural language processing to refine searches of the hospital’s radiology information system.

(Photo by Yuri Markarov, Medical Media Centre)

Radiologists using natural language processing for better search results

By Kelly O’Brien

If a radiologist wanted to know how many patients at a hospital experienced claustrophobia in an MRI, but who had written on a questionnaire that they weren’t claustrophobic, it would be an extremely time-consuming process.

Radiologists don’t use templates or follow specific structures when dictating reports. Because every report is different, using standard software to search a hospital’s radiology information system may not turn up everything they’re looking for.

Adding natural language processing to a software, like Montage, isn’t as simple as flicking a switch, however.

“Let’s say 1,000 reports have what you want, that’s where the natural language processing piece comes in,” said Dr. Bruce Gray, a radiologist in St. Michael’s Medical Imaging Department. “We work with a statistics analysis software programmer to create algorithms that parse out the data or text, then we work to determine whether the results are useful.”

“Standard searches can find where the radiologist had dictated, ‘Exam stopped because of claustrophobia,’ but if one doctor doesn’t use the word ‘claustrophobia,’ they won’t have a complete list,” said Kate MacGregor, the quality improvement and radiation protection manager in the Medical Imaging Department at St. Michael’s Hospital.

SAS programmers are needed to account for differences in the terminology radiologists use when dictating a report, according to MacGregor.

MacGregor and her colleagues are improving the quality of their searches by incorporating natural language processing, a branch of computer science concerned with the interactions between computer and human languages.

“How often does it actually pull out what we’re looking for, versus finding something else?” she said. “Once we’ve validated that that string of code picks out 99.9 per cent of what we’re looking for, then we consider it done and we go on to the next one and start working on the next iteration.”

Natural language processing allows search tools such as Montage, the software used at St. Michael’s, to understand human speech as it occurs naturally, both spoken and written, which allows for more accurate search results.

In the past, gathering this information could have been done only by chart review, said MacGregor.

Now, she said, radiologists have the tools to mine all the data in electronic medical records and the radiology information system, which houses all the reports.

Until they can find enough examples, she said, the process is focused on getting to the sensitivity and specificity of the code itself.

Once they’re able to categorize a particular report, said Dr. Gray, the radiologists can then use the report to develop and evaluate quality improvement initiatives, such as a clinical decision support tool radiology is developing with St. Michael’s Family Health Team to reduce unnecessary imaging tests.

“Natural language processing is a way of creating and validating these other tools, like the clinical decision support tool, and making sure our quality improvement projects deliver,” said Dr. Gray.

APRIL 2017 | IN TOUCH | 7

Q&A

LEUL GARDNER

(Photo by Katie Cooper, Medical Media Centre)

By Kate Manicom

Leul Gardner is one of two specialty mechanics in St. Michael’s Engineering and Plant Services Department.

Q: What is your educational background? How did you end up working in health care?

I studied to be an electromechanical technician, which combines knowledge of mechanical technology with electrical and electronic circuits. I worked in the mechanical and biomedical fields for several years, which helped to give me the technical experience to work at St. Michael’s.

Q: How is your role different than a typical mechanic?

Although I work on many of the same pieces of equipment and infrastructure that other mechanics work on, like sump pumps, pneumatic tubes and fans, my focus as a specialty mechanic is repairing equipment and systems that are specific to health care.

This includes critical equipment for sterilizing medical devices, like autoclaves, and vital systems, like medical gas. Each has its own challenge, but our priority is always critical care equipment to ensure there are no impacts to patients in the hospital.

INTOUCH

APRIL 2017

In Touch is an employee newsletter published by Communications and Public Affairs.

Please send story ideas to In Touch editor Leslie Shepherd at shepherdl@smh.ca.

Design by Lauren Gatti

Q: What do you love about your job?

Every day is different. Most equipment we repair has an electronic component – a brain – that involves troubleshooting a problem, and I like that challenge. But mostly it’s the team I work with. The people at St. Michael’s are what makes it great.

Q: The hospital is changing a lot through its redevelopment project, St. Michael’s 3.0. Will this affect the work that you do?

Our work won’t change much – we will continue to maintain and repair equipment and systems. But I’ve been inside the construction site, and it’s exciting to see the new and modern technology that forms the skeleton of the Peter Gilgan Patient Care Tower, especially compared to the older infrastructure that we have in the Shuter Wing.

Q: Where could we find you when you aren’t at work?

You might find me in the air – I’m working on my pilot’s license.

I also love being outdoors and doing activities related to that, like woodworking, climbing and trap shooting.