INTOUCH DECEMBER 2017 / JANUARY 2018
Which doctor is all shook up as he celebrates the launch of Code ELVIS—a code to streamline treatment for patients during a specific kind of stroke. To find out, keep reading. (Photo by Yuri Markarov, Medical Media Centre)
ELVIS is in the building By Geoff Koehler
An ischemic stroke occurs when a blood vessel is blocked and the brain’s blood supply is cut off. Every minute that blood can’t reach the brain, 1.9 million neurons are lost. Without timely treatment, this brain clot can cause severe disability and even death. For nearly 20 years, a clot-busting drug called tissue-type plasminogen activator, or tPA, has been the only therapy with proven clinical benefit for patients experiencing an ischemic stroke. When the blockage is in a large blood vessel, however, research has shown that rapidly removing the clot Printed on 100 per cent recycled paper
can lead to better outcomes than tPA alone. “To implement these findings, stroke at St. Michael’s was all shook up so that we coined a new code, ELVIS, to get the patients who would benefit from this intervention into the neuroangiography suite faster,” said Dr. Tom Marotta, an interventional neuroradiologist with the Medical Imaging Department. “Now there’s a little less conversation that needs to happen before patients can get their clot removed.” Code ELVIS, which stands for Endovascular Large Vessel Ischemic Stroke, was launched Dec. 4 to reduce
process times and improve patient outcomes. Under Code ELVIS, patients with a large vessel ischemic stroke who are coming to St. Michael’s in an ambulance are registered as patients even before arriving at the Emergency Department. When paramedics arrive at the hospital with a stroke patient, the patient will stay on the ambulance stretcher through the ED, up to the CT scanner for assessment, and then to the neuroangigraphy suite if the blockage meets the criteria. Continued on page 2 DECEMBER 2017 / JANUARY 2018 | IN TOUCH | 1
OPEN MIKE by
Lili Litwin
President, St. Michael’s Foundation and now I look forward to helping St. Michael’s carry out its historic mission. As the new president of St. Michael’s Foundation, I consider it an honour to be part of a team that is making such a difference in our community. I am grateful to all the donors, physicians, staff and volunteers with whom I have the privilege of working, and I appreciate the warm welcome I’ve received from so many of you during these last few months. To me there is no greater legacy than to help make a difference in our world. I’ve spent the last two decades of my career leading non-profit foundations
One thing that stands out to me is the foundation’s tremendous fundraising success. Thanks to the incredible generosity of our supporters, the hospital added new space, state-of-the-art equipment and specialty care, created a hub for world-class research and now a completely transformed St. Michael’s can proudly assert its status as the premier critical care hospital in Canada. These accomplishments are truly remarkable, but as many of you well know, the work of the foundation never ends. I look forward to an exciting and challenging year as we forge ahead
with new ideas and embrace new opportunities. There will be new campaigns to increase support of the important work being done daily by the caregivers, scientists, clinicians, volunteers and all the staff at St. Michael’s, and even more reasons to be excited and proud of what we’re doing. On behalf of the foundation, I would like to take this opportunity to extend best wishes to you and your family this holiday season. I hope that for all of you, it is a time for relaxation. Merry Christmas and all my very best for 2018! I encourage you to find a way to help those whose lives may be less blessed, whether it’s a family member, friend, a neighbour or someone on the street.
ELVIS story continued from page 1
“Code ELVIS is similar to the hospital’s Code STEMI–which is for someone having a blocked heart blood vessel best treated by angioplasty–but this is for a blocked blood vessel in the brain causing a stroke,” said Dr. Daniel Selchen, director of St. Michael’s Regional Stroke Centre. With the addition of Code ELVIS, each patient group will receive the best urgent and possibly life-saving stroke treatments for which St. Michael’s is known.”
Code ELVIS was developed in consultation with patients and families, the Neurointerventional group, the Emergency Department, Stroke Neurology, Medical Imaging, the hospital’s Critical Care Response Team, Toronto Paramedic Services and CritiCall.
DECEMBER 2017 / JANUARY 2018 | IN TOUCH | 2
Follow St. Michael’s on Twitter: @StMikesHospital
Filled with comfort By Kelly O’Brien
Vaishali Sengar, a patient safety specialist at St. Michael’s, has assembled “comfort pouches” for women undergoing cancer treatment with the help of colleagues from across the hospital. Sengar said she has friends who assembled and donated comfort pouches at cancer centres across the city in years past, and was inspired to bring the initiative to St. Michael’s. She approached the Medical Daycare Unit with the idea, and said they were eager to be a part of the intitiative. In October, Sengar, in collaboration with the Medical Daycare Unit staff, began Daniela Muscatello and Vaishali Sengar drop off comfort pouches in the Medical Daycare Unit. collecting donations of $30 or $45 for Sengar and her team collected enough donations to fill 350 pouches for cancer patients. small and large pouches, respectively. (Photo by Yuri Markarov, Medical Media Centre) Each pouch is filled with items to help make chemotherapy treatment more In addition to the IT Department, the comfortable: lip balm, fuzzy socks, Pharmacy Department was one of the crossword puzzles and mints biggest contributors to the initiative. A similar initiative and candies. “Everyone, whether you see patients Her goal was to raise enough money to assemble every day or not, can relate to the idea to purchase and fill 75 pouches. When comfort pouches for of being cold or scared or nervous, and she posted about the initiative on social even having a few little things to help hemodialysis patients media, it was immediately clear her with that can make a huge difference,” colleagues were on board to help her is being led by Julie said Rayna Giobbe, business manager achieve it. in the Pharmacy Department. “I’m so Saccone, a former Starting this month, nearly 350 pouches proud to be able to give back through communications will be delivered to patients. such a beautiful initiative.” “So many people in the St. Mike’s adviser at St. Michael’s. Sengar said she also received generous community wanted to help, and within donations from nurses across the For more information or the first day the donations were pouring hospital, in addition to those from the to contribute, contact in from staff,” she said. “I was completely physicians, social workers and other overwhelmed.” stylebyjewls@gmail.com. staff from Medical Daycare. Daniela Muscatello, an applications “These packages will show that staff specialist in the IT department, was one from all departments care about what of those people. She said as soon as she these women are going through,” she heard about the initiative, she rallied said. “It’s something to give them a hospital, so for me, helping patients in her co-workers and collected enough boost, especially for people who are this way was an opportunity for us to donations to purchase 10 pouches on here over the stay connected to the front lines and behalf of the department. holidays.” remind ourselves what’s going on “We aren’t physically located in the where we work,” she said. DECEMBER 2017 / JANUARY 2018 | IN TOUCH | 3
like the best of all worlds. However when the ramp arrived, he realized there was another, equally important requirement: stability. “With the weight of a truck driving over it, I’m sure it would work fine,” said Barrett. “But when I tested it with water lines pulling or one person pushing an IV pole across, the ramp skated across our smooth floors.” He needed something to make the base of the ramp stickier, but it had to meet the hospital’s strict infection-control criteria. Anything used in an inpatient room has to be frequently cleaned and disinfected. The solution was right under his nose. Physiotherapists use Dycem self-adhesive strips to help patients grip surfaces such as wheelchair arms, walker handles and cutlery. Dycem is flexible, can be cut to size and most importantly, Barrett already knew exactly how to adhere and clean it. Physiotherapist Ian Barrett prepares to help his patient safely cross a neighbour’s dialysis lines. (Photo by Yuri Markarov, Medical Media Centre)
Physiotherapist’s invention sets patients free By Emily Holton
When physiotherapist Ian Barrett sees a problem, he sees a project. That’s why, when he spotted a falls risk in Nephrology/Urology, he made it his mission to fix it properly. Many of Barrett’s patients receive dialysis, which requires a machine with a water line to be hooked up to a tap and sink. In a shared inpatient room, this means a spaghetti trail of quarter-inch tubes will often cross a neighbouring patient’s area. “Whether they’re loose or taped down, tubes across the floor would be a falls risk for anyone,” explained Barrett. “But if someone is using a walker or wheelchair, they’re basically trapped. They can’t go for therapy and we set DECEMBER 2017 / JANUARY 2018 | IN TOUCH | 4
them up with a commode because they can’t even get to the bathroom for several hours. My job is to get people up and moving, so I really wanted to find a solution.” On his morning commute, Barrett noticed a heavy-duty cable ramp in a construction area. He consulted with colleagues and his manager, and then his search began for the ideal cable ramp for the unit. It had to be light weight, to make it easy to carry from room to room. It needed a shallow gradient to be easy to cross – but not so shallow that the width created excess weight. The ramp also had to be short enough to be used in tight spaces, but longer than the wheel base of a walker or wheelchair. Barrett found an option that seemed
“I love being a physio because when I help solve mobility problems for patients, I’m improving their quality of life.”
It worked. Today, Barrett is working with Environmental Services to perfect his cleaning technique – he wants to make sure the products he uses don’t degrade the ramp’s plastic over time. Next, he’s planning to train more staff to safely use and disinfect it. The appeal of problem solving is what drew Barrett to physiotherapy. “I love being a physio because when I help solve mobility problems for patients, I’m improving their quality of life,” said Barrett. “I never have to question why I’m coming to work in the morning.”
Using Big Data to improve patient care “We’re providing data back to doctors for the first time using a provincewide standardized format,” Dr. Razak said. “They will have access to a quality compass which includes important measures related to patient outcomes or use of hospital resources.” GEMINI will also open the lines of communication so doctors and care teams from different divisions and hospitals can learn from each other said Dr. Verma.
Drs. Fahad Razak and Amol Verma presented GEMINI during a CAHO event at Queen’s Park on Oct. 25. By Kelly O’Brien
A team led by two physicians from St. Michael’s Hospital hope to use the vast quantities of routine clinical data collected in hospitals to improve patient care.
across Ontario. The project is aimed at collecting, standardizing and analyzing internal medicine patient data at the individual, hospital and system-wide levels.
“Internal medicine patients are a large and growing population that reflects the changes in the population of Canada, as average age and the number of co-morbidities increase,” said Dr. Fahad Razak, an internal medicine physician. “This is a large and complex population that consumes a lot of resources. If you can improve care for these patients, you can improve care for a lot of people, and make the system more sustainable.”
Seven hospital sites at five organizations in the GTA are participating in GEMINI. Over the next three years the team plans to develop a network of 30 academic and community hospitals across Ontario to participate in GEMINI and use data to support quality improvement.
To improve those health outcomes, Dr. Razak, along with Dr. Amol Verma, another internal medicine physician, started GEMINI, or the General Medicine Inpatient Initiative. GEMINI is a physician-led and datadriven quality improvement network for general medicine hospital patients
The team has collected, standardized and analyzed data from all internal medicine hospitalizations at the seven participating hospitals from 20102015, covering 140,000 visits and approximately 80,000 patients. All data is anonymized in accordance with provincial privacy laws. Physicians and clinical care teams will be able to access data within their organization and hospitals will be able to use the data to inform efforts to improve care across the health-care system.
“Our focus is about sharing this data so that front-line care providers can be informed about how they’re delivering care and engage in a community of practice across the province that focuses on a data-driven approach to improving quality,” he said. The data will also have enormous research potential, said Dr. Razak.
General medicine inpatients account for about 40 per cent of hospital admissions from the Emergency Department and occupy 25 per cent of all hospital beds
“Before we started this project, we realized that the patients we’re seeing—aging patients with multiple chronic diseases—weren’t reflected in the medical literature,” he said. “Through GEMINI, we’ve created an infrastructure to share clinical data and study how to continuously improve care for our patient population.” DECEMBER 2017 / JANUARY 2018 | IN TOUCH | 5
Nadia Gorgi sits up and does a crossword with her son, Adel Shoucri, in the Cardiology Unit while recovering from a stay in the Medical Surgical Intensive Care Unit. Keeping her mind active is a non-pharmacological strategy recommended by her MSICU team to help prevent the return of delirium. (Photo by Yuri Markarov, Medical Media Centre)
Preventing delirium with an activity box By Evelyne Jhung
When Nadia Gorgi was in the Medical Surgical Intensive Care Unit, she was on a host of medications and was having many procedures and tests done – all of which contributed to her delirium. “She was confused, she didn’t know night from day and she wasn’t herself – she threw things and kept trying to pull out her tubes,” said her son Adel Shoucri.
for the Elderly unit and includes crosswords, playing cards, donated iPads, Wii games, headphones, and eye masks and earplugs to help patients sleep at night. Either a staff member will suggest an activity to the patient or let visitors know about the box so they can use it together.
“For our patients who are awake, mobility is an issue”, said Deanna Feltracco, a physiotherapist. “Lying in the MSICU all day, they might not know night from day, so these activities are As ICU patients are at extremely high intended to try to get them back into risk of developing delirium, the MSICU their regular routine and occupy team came up with the idea of creating their mind.” an activity box to help occupy its Once Gorgi started coming out of her patients. delirium, the team worked with Shoucri “We felt like the medical side of managing delirium was already well dealt with, so we wanted to focus on a non-pharmacological solution,” said Melissa Guiyab, a clinical nurse specialist in the MSICU. The activity box is similar to the activity cart used on the Acute Care DECEMBER 2017 / JANUARY 2018 | IN TOUCH | 6
to find out what activities his mother enjoyed. Now she sits up and does crosswords or plays other games on an iPad. “We’re trying to keep these patients as active as possible and on a regular schedule to prevent delirium or any future episodes,” said Jennifer Martin,
The MSICU team of Melissa Guiyab, a clinical nurse specialist; Jennifer Martin, a registered nurse; Deanna Feltracco, a physiotherapist; Shannon Swift, a clinical nurse educator; Christine Lee, a social worker; Prafulla Savedra, a resource nurse; and Johanna Proceviat, a pharmacist, won the 2016 SOAPEE grant for its project, “nonpharmacological delirium prevention and management in the MSICU” and presented its findings at the 2017 REID event in October. a registered nurse in the MSICU. “Non-pharmacological strategies are just as important as managing medications to prevent and manage delirium, especially in intensive care units where the risk of delirium is high.”
Chaplain Joel Aguirre shows what’s available in the Emergency Department’s Kosher Cabinet. (Photo by Yuri Markarov, Medical Media Centre)
New Kosher Cabinets exemplify hospital’s commitment to spiritual care By James Wysotski
A new Kosher Cabinet in the Emergency Department will help Jewish patients and families practice their faith while hospitalized on days of worship. The cabinet provides free kosher food, battery-operated Sabbath candles and prayer books. Filomena Machado, director of Mission, Values and Spiritual Health, said adding the cabinet in October 2017 has helped alleviate the challenges of finding kosher food on weekends and holidays. It also helps patients heal, said the Rev. Joel Aguirre, a United Church minister and chaplain at St. Michael’s Hospital. “Spirituality promotes healing,” said Aguirre. “That’s part of St. Michael’s values. We are a Catholic hospital, but we recognize and respect all faiths.”
Bikur Cholim, a volunteer-driven social service organization providing resources and support to vulnerable individuals and families, set up the cabinet and restocks it regularly. St. Michael’s is one of seven Toronto hospitals with a cabinet. The organization distributes location information and access codes for the cabinets to the Jewish community through its pamphlets and newsletters. Hospital chaplains can also access them. Patients and families who use the cabinet will also find Bikur Cholim’s pamphlets, which detail other free services such as the delivery of meals and driving patients to and from appointments after discharge. Adding the ED cabinet only “enhanced our services,” said Machado. “It is just a small piece of what we’ve already been providing
to Jewish families for many years.” The hospital meets the needs of this community though the services of the Jewish Family and Child organization. The organization sends a rabbi several times a week – or by request – to visit Jewish patients and pray, support or provide whatever is requested. Like those of other faiths, the Jewish community can also use the hospital’s multi-faith room. Machado said whether it’s a request for bedside Eucharist or to set up an Aboriginal smudging ceremony, the hospital has chaplains of many religions who will try to fulfill any spiritual requests. “After all, our values are not Catholic values,” said Machado. “They’re life values.” DECEMBER 2017 / JANUARY 2018 | IN TOUCH | 7
Q&A
By Kelly O’Brien (Photo by Yuri Markarov, Medical Media Centre)
JOANNE BENNETT CLINICAL LEADER MANAGER OF INPATIENT GASTROENTEROLOGY/ GENERAL SURGERY/PLASTICS
Q: How did you arrive in your current role? I’ve been a manager for at least 20 years, and to be honest, when I first started, I never thought I’d be a manager. It just wasn’t in the cards. I was a very quiet person; I never sought that leadership position. I was a staff nurse for a few years and then became a clinical educator, and I think that’s where I changed and grew a lot more. All of a sudden I had to help others move forward and teach them and encourage them. The managers at the time really encouraged me to pursue a leadership role, so I did, and I’ve absolutely loved every minute of it.
Q: How does it feel to be the first recipient of the Ella Ferris Culture of Leading Award? When I was told, I was actually speechless, which is not like me! I always have something to say. But I couldn’t put into words how touched and humbled I was. Once I got over the shock, I was very emotional, and the first thing that popped into my mind was a picture of Ella. She has been part of my career basically since the beginning. She inspired you, and she brought you back to what we were really here for. Yes, we are going to debate about budgets and staffing and all those things, but at the end of the day, when we walk out of here what matters is how we are with our staff, and how we are with our
INTOUCH
DECEMBER 2017 / JANUARY 2018
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 Marcelo Silles, Medical Media Centre
Joanne Bennett was the winner of the inaugural Ella Ferris Culture of Leading Award. The award, created in honour of the former executive vice-president, programs and chief nursing and health disciplines executive, will be given annually to a transformational leader exemplifying the essence of St. Michael’s Hospital. patients and families. And Ella had a knack for that. To even be associated with someone I admire so much, it just melted me.
Q: What, in your opinion, makes a good leader? You have to care about the people, and you have to really be committed to what you need to achieve. And it’s about really seeing the best in people. When I think of how I grew as a leader, I didn’t believe in myself in certain periods of my career, but other leaders worked with me on coaching and mentoring and building that confidence.
Q: What do you like to do outside of work? I’m a big reader. This summer I must have read about 20 books. I like historical fiction, so one I would recommend is Barkskins by Annie Proulx. I also read Bruce Springsteen’s autobiography, Born to Run, and right now I’m reading Hillary Clinton’s book, What Happened. It’s inspiring to read other peoples’ stories, because we all have different experiences and you can learn something from everybody.