In Touch newsletter: December 2016 / January 2017

INTOUCH DECEMBER 2016 / JANUARY 2017

The music of our lives courtship for elderly couples married for many years; or popular songs from a patient’s youth that conjure up memories of healthier times or perhaps things to be resolved.

“A song can stir up many emotions, but it’s a safe place because the music acts as a container for the full range of our feelings,” said Manning.

“Through observing emotional response, I then move into the opportunity to explore what the music evokes, and I help them come to terms with the emotions of that moment. For families, music therapy provides a place for grieving before the end.”

Catherine Manning sings and plays the guitar for a patient in the Palliative Care Unit.

(Photo by Katie Cooper, Medical Media Centre)

By Evelyne Jhung

When Michelle R. ran out of treatment options for her cancer and was moved to the Palliative Care Unit, music became increasingly important to her.

“She wanted her 11-year-old son to remember the music that was meaningful to them,” said Catherine Manning, a music therapist in Palliative Care. “They especially liked gospel songs and a favourite was ‘Michael Row the Boat Ashore.’ I helped create a CD of her singing favourite songs of faith for him and also recorded her reading a letter she wrote for her son. I believe it comforted her in the end knowing he would have this after she died.”

Manning has been providing music therapy at St. Michael’s since 2003. After completing a degree in Printed on 100 per cent recycled paper

psychology, she wanted to find a way of incorporating her lifelong love of music, so she pursued a music therapy degree.

“My first clinical placement was in palliative care,” said Manning. “I was fearful and drawn to it at the same time, which made me feel I was on the right track. I had some profound early experiences that sealed the deal for me.”

The type of music therapy she provides depends on the patient’s clinical state as well as life and family history. For some, she plays the piano, guitar or harp and-or sings as a means of supporting relaxation or symptom control.

For other patients, she finds the music of their “life history”: a soothing lullaby from childhood; music from their

Manning participates in Palliative Care daily rounds every Tuesday and Thursday mornings and will get referrals from other staff at that time. Sometimes families in nearby rooms will hear her play and ask for music therapy for their loved one.

“A woman whose mother died two years ago on our unit was back again recently, this time with her father. He was close to death when he arrived. When they settled after a difficult night in the ED, she mentioned that her father loved ‘Blue Velvet,’ and sang it around the house all the time. I took five minutes to learn the song, sang it along with some other Elvis favourites, and improvised gently with guitar and voice as he slipped away. I printed a small copy of the lyrics for the patient’s daughter to carry in her wallet as a gentle reminder of his last moments. The family told me it couldn’t have been better – he died the way he lived, with the music of his life.”

DECEMBER 2016 / JANUARY 2017 | IN TOUCH | 1

OPEN MIKE with Alayne Metrick,

President, St. Michael’s Foundation

In March we asked you to support Inspire 2018 to help complete the campaign, to be part of the “final piece.”

With your help and that of many, many friends of St. Michael’s, led by our dedicated volunteers, we raised $235 million, well past our $210 million goal. That makes Inspire 2018 our most ambitious and successful campaign to date. One highly visible sign of success: the Peter Gilgan Patient Care Tower reached its full height of 17 storeys last month – and many other projects are either completed or underway, including the expanded Slaight Family Emergency Department. That’s great news for our patients.

We could not have done it without you.

Your professionalism and caring attitude inspires our patients to give back. Over and over again we heard that you deliver exceptional care with warmth and compassion, and routinely go the extra mile. Thank you so much.

Health care never stands still. There are always new challenges, new opportunities. As public resources are stretched, we rely on the generosity of friends to help us acquire state-of-the-art tools for the best in patient care.

What’s next? As 3.0 moves forward, the St. Michael’s Hospital Foundation is focused on priorities to improve safety through innovative research and technology, including minimally invasive procedures, as well as chairs. We will reinforce our leadership in urban health through an expanded Neo-natal Intensive

Care Unit, for all mothers and babies, but especially from our inner city population, and through our relaunched Centre for Urban Health Solutions, testing projects to overcome urban health issues.

Securing new donors is vital to our success.

If grateful patients ask how they can help, direct them to the foundation. Fundraising relies on referrals. Ask them to share their story with us. Testimonials showcase the life-saving care that happens here every day. Your support is crucial.

Thanks also to the staff members who posed with donors and volunteers for our holiday campaign, “Spread Joy,” now up across the hospital, who are all “giving back by supporting St. Michael’s.”

On behalf of the foundation, may you and your family experience joy this holiday season. Thank you for what you make possible, and here’s to an amazing 2017.

DONATIONS TO VOLUNTEER SERVICES: WHERE DO THEY GO? Every week, Volunteer Services receives a donation of some kind from a patient, relative, staff member, another department or the general public. Donations not intended for volunteers are "re-gifted" on behalf of the volunteers to other areas of the hospital.

Examples of typical donations: • Donuts, sandwiches and other treats for the volunteer lounge come daily from the Marketeria and Tim Hortons • Eyeglasses are taken to the Eye Clinic at 61 Queen St. E. to be assessed and offered to at-need patients • Books and magazines go to the volunteer book cart, which visits most inpatient units several times a week or to the visitors’ library in the surgical waiting room • Children's clothes and books are sent to the Baby Tuck Shop, the pediatric clinic at 61 Queen St. E. or the Sumac Creek Health Centre • Clothing is re-directed to the Rotary Transition Centre to be provided to the homeless • DVDs are sent to the Mental Health unit on 17CC for the patient movie library • Flowers are given to Spiritual Care to pass onto patients who would most benefit from them • Monetary donations through the foundation are used to support volunteer programs such as providing refreshments for families in waiting rooms

If you have something you would like to donate, please check with Volunteer Services first as they are unable to accept certain items.

Donations accepted at Volunteer Services Donnelly 4-083. For reading materials, recent paperback fiction (mysteries, thrillers or romances) as well as recent general interest magazines are accepted. Please no textbooks or damaged books.

DECEMBER 2016 / JANUARY 2017 | IN TOUCH | 2

Follow St. Michael’s on Twitter: @StMikesHospital

Dr. Maria Zorzitto, a geriatrician at St. Michael’s Hospital, assesses patient John Hamill on the new standalone ACE unit on 8 Cardinal Carter South. (Photo by Yuri Markarov, Medical Media Centre)

ACE-ing health care for frail elderly patients

By Leslie Shepherd

There’s lots of evidence that frail elderly patients admitted directly to an Acute Care of the Elderly Unit have better outcomes, says Dr. Maria Zorzitto, a geriatrician at St. Michael’s Hospital.

They tend to have less delirium and fewer falls. They get out of the hospital sooner.

They are more likely to go home or to a rehab facility than to a nursing home.

And while they are in hospital, they have a better patient experience.

Frail elderly patients (those over 70 with acute, complex medical illness or presenting with a geriatric syndrome) used to be admitted to beds on 14 Cardinal Carter. In October, those beds were consolidated in a standalone ACE unit on 8 Cardinal Carter South.

Dr. Zorzitto and Susan Camm, clinical leader manager for General Internal Medicine and the Regional Geriatric Program, said the unit aims to provide the best possible patient experience by

designing care around the particular needs of the geriatric population, with a focus on rehabilitation.

The unit is staffed by an interdisciplinary team with specialized geriatric care training, including a nurse practioner, RNs, a clinical assistant and physical and occupational therapists. Each patient’s most responsible physician will continue to be a geriatrician.

Camm said the team hoped to experiment with some new ideas such as bringing a folding table and chairs into the ward room so patients could dine together rather than have meals brought on trays to their bedside.

As a result of bed footprint and Improvement Program work, the decision was made to transfer eight beds on 8 CC South from the Heart and Vascular Program to General Internal Medicine for the ACE Unit. Due to a number of factors, including shorter length of stays,

St. Michael’s is an RNAO Best Practice Spotlight Organization

Heart and Vascular did not have enough patients to maximize utilization of those beds. GIM was often using them already to bed space its patients.

Camm said the move has been an opportunity for the GIM team to work more closely with colleagues from the Diabetes Comprehensive Care Program on the 8th floor (who are welcoming them with a potluck lunch). Members of the ACE team are attending the DCCP morning huddles and the two groups share resources including a dietitian, pharmacist and speech language pathologist. They’re also working closely with Volunteer Services, which is examining whether the space can be made more “homey” with the addition of a clock or some throw blankets.

Dr. Zorzitto said another benefit to the ACE Unit is that as a teaching hospital, it allows staff to pass on the best practices of geriatric care to trainees.

DECEMBER 2016 / JANUARY 2017 | IN TOUCH | 3

“What do you do at St. Michael’s to make When I am on call on the weekend I go to the St. Lawrence Market early Saturday morning before heading to the Palliative Care Unit. I asked some of my patients if they wanted anything.

One man said some aged cheddar. A second person said French-Canadian pea soup. So, with the help of a recipe suggested by Dr. Sarah Newbery I cooked some up at home tonight. Tastes pretty good! I’ll keep half and bring half to the hospital.

—Dr. Andreas Laupacis, executive director, Li Ka Shing Knowledge Institute

Every year, we invite people to participate in our Snowflake Wish program. Each snowflake represents a child’s Christmas wish. Anyone can choose a snowflake from the Christmas tree at the pediatric clinic at 61 Queen St. and purchase the gift someone wished for. The presents are then distributed to the kids at our clinic, as well as those as at Robertson House.

Every year, I create gift baskets for the first Christmas and New Year’s babies. Baskets include goodies such as a special blanket, scratch mittens, a night light, toys and rattles – and some lip balm, breast pads and hand lotion for mom. I truly enjoy doing this for our babies.

—Kelly Ferris, RN, OB-GYN

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—Lorna Bartholomew, RN, Pediatric Clinic

We have a number of clients who live in the shelter system or come from a low-income household. They may not have the financial means to participate in some of the festivities that cost money. We try our best to make the holidays more festive for them. Some of our upcoming groups include DIY Christmas ornaments, Christmas movie at the Carlton Cinema and an outing to the Toronto Christmas Market at the Distillery District. Every year we have Christmas gifts for our clients. These gifts usually include mittens, scarves, socks, and toques – mostly necessities for the cold weather.

—Vi Ensoy-Landicho, RN, STEPS for Youth

the holidays special for patients?”

Each year, the Family Health Team organizes a fundraiser for their Laurie Malone Patient Comfort Fund, which provides patients with necessities like TTC tokens, food vouchers, infant needs, and other items for patients and their families.

The Comfort Fund is especially important to patients around the holidays, and the staff and community generously donate items for a silent auction and raffle to raise money for this important cause.

—Sam Davie, quality improvement decision support specialist, Family Health Team

Four times each year, including Christmas, our craft group of 11 volunteers makes 280-300 pouches for the small lotion bottles that, with the help of Food Services, go on patients’ trays at mealtime on Dec. 25. Patients who are on their own during the holidays appreciate the little gift. We often get letters of thanks.

—Norma Tay, St. Michael’s volunteer for 25 years

Our unit decorates doors. One year, I decorated a door to look like a chapel. I used bristol board and tissue paper to make the stained glass windows and lit them from behind. We actually had people trying to get in because they thought it was the chapel! The doors really lift our patients’ spirits; we even have patients from other floors visit.

—Shannon Steele, RN, GIM

During the holidays, members of the Living Kidney Donor Team dispense hope to potential kidney donors that 2017 will be the year that they may be able to donate their kidney to improve the life of a loved one.

—Maureen Connelly, living donor coordinator, Renal Transplant Program

DECEMBER 2016 / JANUARY 2017 | IN TOUCH | 5

An architect’s rendering of the St. Michael’s Slaight Family Emergency Department exterior, as viewed from Shuter Street.

(Rendering by NORR Architects)

Business as usual for St. Michael’s Emergency Department during expansion

By Kate Manicom

With designs for the Emergency Department expansion and renovation finalized, the ED team is preparing to care for patients while the department is under construction.

“We anticipate meeting all clinical needs, but will need to be creative in now we do this, from space, process and safety perspectives,” said Dr. Glen Bandiera, chief of Emergency Medicine. “Our priority is maintaining the number of treatment spaces to meet the increasing volumes we expect to see over the course of the renovation.”

As construction moves throughout the department, patient care areas will shift into the renovated spaces. The phasing of the construction ensures patients will be seen in the most appropriate spaces for their needs. The department has also increased its staffing model to accommodate the larger spaces and distances staff will travel.

Patient care areas will be carefully separated from construction to ensure patient and staff safety, with all appropriate infection prevention and control measures in place.

Dr. Bandiera and the ED team have been involved in the planning for the new department since it began in 2009. The Emergency Department was last renovated to meet an annual capacity of 45,000 visits. Last year, 75,000 patients came through its doors, a number that continues to rise annually with Toronto’s growing population.

“We have had a team of physicians, nurses, clinical assistants and clerical assistants participate at every step of the way,” said Dr. Bandiera. “We visited a number of sites to learn about best practices and adopted many of these into the design of a new ED to specifically meet our unique needs.”

These needs include plans for a purpose-built, dedicated mental health area, with eight beds physically separated from the rest of the ED. The quiet, secure area will be staffed 24-7 with staff specially trained to care for patients with urgent mental health needs. There will also be an integrated medical imaging suite inside the department – with CT scan, X-ray and ultrasound – decreasing time required for important diagnostic imaging.

All of these enhancements, along with the addition of a third trauma bay and expanded ambulance bay, will allow St. Michael’s to continue its mandate as a regional level 1 trauma centre.

In the meantime, staff in the ED, who are accustomed to unpredictability, prepare for the coming changes.

“The staff and physicians have been tolerant of planning and uncertainties, but also generous with their ideas and critiques, leading to constant improvements in the final design,” said Dr. Bandiera. “I am grateful they have been willing to look beyond the disruption towards a new and better Emergency Department.”

The Emergency Department renovation was funded in part by a $10 million donation by the Slaight family.

The Slaight Family Emergency Department will open in 2019.

DECEMBER 2016 / JANUARY 2017 | IN TOUCH | 6

An interdisciplinary team rehearses a breech birth using the new SimMom mannequin during an OB-GYN education day in the Allan Waters Family Simulation Centre. (Photo by Katie Cooper, Medical Media Centre)

SimMom brings simulation closer to reality

By Kelly O’Brien

A team of six health-care professionals wheels a distressed mother into an operating room. Her baby is breech and the delivery is difficult. But when the team members hear the baby cry and confirms the mother is stable, relief washes over their faces.

In the midst of all the action, it’s easy to forget the mother is a mannequin.

SimMom is a high-fidelity, or highly realistic, computerized mannequin that simulates five different childbirth scenarios, including breech birth. It is one of the most realistic models available: it can talk, has a pulse and has flexible joints that allow it to move as a real woman would.

The mannequin was recently purchased by the Allan Waters Family Simulation Centre and the Department of Obstetrics and Gynecology to improve educational, quality improvement and other simulations. Dr. Michael Geary, chief of Obstetrics and Gynecology at St. Michael’s, said improving simulation was one of his main goals when he arrived two years ago.

“It’s possible to effectively recreate emergency scenarios using role play, but the value SimMom’s heightened reality adds is huge,” he said.

Dr. Geary said this combination allows for comprehensive skills development days, such as those hosted by the More OB (Managing Obstetric Risk Efficiently in OB) program.

Dr. Tatiana Freire-Lizama, a perinatologist and the More OB site co-lead at St Michael’s, said SimMom helps participants fully suspend disbelief to make the most of the development days.

“You can actually help her pick up her legs like you would a real patient, and she feels a lot like a real person,” Dr. FreireLizama said. “People buy in a lot more when things are highly realistic.”

But the mannequin itself is just one piece of the puzzle, she said.

“The tools are constantly improving, but creating an effective simulation is really about combining the features of the mannequin with the principles, information and scenarios we develop through the More OB program,” said Dr. Freire-Lizama.

Dr. Geary, Dr. Freire-Lizama and Sharon Adams, a registered nurse and More OB site co-lead, said that one of the most valuable things about SimMom is that the simulations create an opportunity for people from different professional areas to come together and improve team processes.

“There’s no point in having people who are individually great, but can’t work together,” said Dr. Geary. “Working together in SimMom was purchased in combination with low-fidelity, these simulated situations improves morale, communication or less realistic, pregnant mom and baby simulators. and team spirit.”

SimMom is just one of the simulation mannequins used in the Simulation Centre.

Others include SimMan, SimBaby, and the Harvey cardiopulmonary simulator mannequin.

DECEMBER 2016 / JANUARY 2017 | IN TOUCH | 7

Q&A

KYLE WEIR SECURITY GUARD, SECURITY SERVICES

(Photo by Katie Cooper, Medical Media Centre)

By Emily Holton

Kyle Weir has been a security guard at St. Michael’s for 10 years.

He works nights.

Q: Why did you decide to become a security guard?

I kind of fell into it, but as soon as I started I fell in love. I love the challenges. You go from the highest of highs to the lowest of lows.

You go from helping a woman in labour to giving a homeless person a sandwich. Sometimes you’re in the trauma room, sometimes you’re on the roof to meet a helicopter. It’s exciting. It teaches you about life and what’s important to you. I’m happy to come to work every single night.

Q: Why have you stayed at St. Michael’s for so long?

It’s the people. You need first-class people in a hospital. When we had that bad flood in the ED, it didn’t matter what your role was, we all pulled together to do whatever was needed at the time.

That’s really what I love about St. Mike’s.

You can become whoever you want to be here. If you want to be that hard-working person who moves up the ladder, the management team will help you get there. I plan on staying here for my whole career.

INTOUCH

DECEMBER 2016 / JANUARY 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: Tell me about an “I love my job” moment you’ve had.

I was at the Queen Street entrance and a woman in labour had driven herself to the hospital but couldn’t make it any farther. I called a Code OB and waited with her, told her it was going to be OK and that help was on the way. The whole OB team came running but she was out of time and they delivered her baby right there. It was miraculous to be part of that moment.

Q: Do your family or friends worry about you while you’re at work?

My wife and my daughter worry sometimes. But I tell them I have lots of good training, and I work with a lot of good people.

I tell them if, God forbid, anything bad happens to me… I’m in the right place.

Q. If you won the lottery tomorrow, what would you do with the money?

I’ve actually thought about this, and I know exactly what I’d do.

My grandmother was my favourite person. She passed away at St. Mike’s a couple of years ago. If I won the lottery, I’d donate some money and create a conference room, a security room or a wing in my grandparents’ name. I’d love to be able to do that one day.