In Touch newsletter: February 2017

INTOUCH FEBRUARY 2017

Fe br ua ry is He ar tM on th

Fiona Press (left), a dietitian, and Anna Tripodi, a social worker, both on 16CCN, share a hug during a busy work day.

(Photo by Yuri Markarov, Medical Media Centre)

What makes a great TEAM? HUGS!

By Evelyne Jhung

Vanessa Fazzari, an RN on 16CCN planned to work at St. Michael’s for only one year and then move on. That was eight years ago.

“I’m still here mainly because of my coworkers,” said Fazzari. “They’re a caring and supportive group of people, which is great because our floor is pretty stressful.

It’s nice when you’re having a rough day and you can go down the hall and ask for support from a colleague. When you get a HUG, all that stress is released – even if it’s just for that moment.”

16CCN named its team-building initiative “TEAM HUGS”– Together Everyone Achieves More, Here U Get Support/Here U Give Support. Not everyone wants a physical hug but that Printed on 100 per cent recycled paper

same support and comfort can be shown in words and other actions.

Based on the results of the last employee engagement survey, staff selected building respect and teamwork as an area they felt could be improved. The team started by determining what makes a good team.

“We created a survey in which the first step was evaluating ourselves – ‘Am I a team player?’,” said Joan Park, the case manager for 16CCN. “Characteristics of being a good team player include continuous selfimprovement and helping our colleagues prioritize their care. We scored ourselves quite high. Most people considered themselves a team player. The second step was looking at the team and asking if we thought our colleagues were team players.

We scored others a bit lower on this question.”

Park, along with Joanne Bennett, the clinical leader manager for 16CCN, Katherine Mansfield, a clinical nurse educator, and Jo Hoeflok, a nurse practitioner, developed a plan that included creating a team pledge, or code of conduct, to enable team members to work better with each other.

“Our behaviour and conduct is about only two things: things we do and things we say,” said Park. “Therefore, our pledge is about what we say or don’t say and do or don’t do, for example, ‘I will welcome and encourage new team members’ and I will not say ‘It’s not my job to do that.’ We’re proud because I believe we’ve given some concrete examples of things staff can say and do to support each other; we didn’t just have an information session about it.

We’ve given them tools to do better.”

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OPEN MIKE with Dr. Robert Howard, President and CEO

hardship. It’s at the heart of who we are as an organization.

At St. Michael’s, we have always celebrated our diversity. It makes us stronger.

When the Sisters of St. Joseph’s founded our hospital 125 years ago, they welcomed and provided excellent, compassionate care, recognizing the inherent dignity in everyone. Moreover, they prioritized care for the sick poor who had nowhere else to go. We still prioritize care for those who experience marginalization or disadvantage, such as people with HIV and AIDS, people who are homeless or vulnerably housed, people with serious mental illness, women and children at risk, people with addictions, seniors in isolation, the Aboriginal community and people fleeing violence, persecution or

St. Michael’s Hospital has always been, and will continue to be, made up of staff, physicians, researchers, students, volunteers, patients and families from all around the world and from all backgrounds and faiths. I believe our dedication to treating all with respect, compassion and dignity is representative of our country as a whole, so it was horrifying to learn about last month’s tragedy in Quebec City. That act of violence does not represent the Canada I know and love.

In my years as president, I’ve refrained from political comment. I’ve always felt my role was to lead a hospital – not lead political discussion. But now, I can’t stay silent. The travel ban announced south of the border along with last month’s tragedy has motivated me to speak out.

It is a short-sighted policy based on fear and ignorance. It is wrong.

Please be assured that St. Michael’s has been, is and will remain a place of hope – providing comfort, healing, research and learning for all who enter its doors.

University of Toronto President Meric Gertler rightly said that the strength of research and teaching has always been based upon our ability to welcome the most talented individuals from around the world, and the freedom of our faculty and students to travel abroad for purposes of scholarship and study.

I agree.

Our values – Canadian values and St. Michael’s values – cherish human dignity and value each person as a unique individual with a right to be welcomed. I believe in contributing to making our hospital and our society inclusive and respectful of diversity. I hope you’ll join me in supporting one another and standing strong in the beliefs and values of our organization and our country.

DID YOU KNOW? THE EXTERIOR OF THE PETER GILGAN PATIENT CARE TOWER WILL HAVE MORE THAN 3,330 PANES OF GLASS WHEN IT IS COMPLETED LATER THIS YEAR. (Photo by Yuri Markarov, Medical Media Centre).

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Follow St. Michael’s on Twitter: @StMikesHospital

Volunteer Pauline Aarons hands items from the seniors’ activity cart to Maria Raso, a patient in the Acute Care of the Elderly Unit.

(Photo by Yuri Markarov, Medical Media Centre)

Cart full of fun helps seniors ACE their hospital stay

By James Wysotski

For patients on St. Michael’s Acute Care of the Elderly Unit, the new activity cart helps pass time more enjoyably.

For their caregivers, it contributes to getting the seniors home sooner.

Full of newspapers and magazines, colouring books, radios, large-print novels and games like bingo, cards and dominos, the cart features activities to stimulate the mind and keep patients engaged, said Joanna Stanley, a physiotherapist from the Regional Geriatric Program who works on the unit.

In keeping with the unit’s philosophy of designing care around seniors’ needs, the cart also offers specific activities tailored to each patient, such as embroidery or knitting, if they’ve been requested.

“Some of the activities on the cart help keep the patients oriented, and that’s important because it can help prevent delirium,” said Stanley.

Along with RGP occupational therapist Lisa Vandewater and PT/OT assistant Edma Apostol, Stanley helped create the cart in November 2016, a month after the ACE Unit opened on 8 Cardinal Carter South. Created for the Volunteers Involving Seniors in Activities Program – or VISA – which has been running at St. Michael’s for several years, the cart allows volunteers to engage patients in activities and conversation during friendly visits.

“It’s a good launching point for further conversations,” said Stanley. While the VISA visits help with orientation, they also improve the patients’ hospital experience.

Each day, the trio sets up the cart for the volunteers and provides a list of patients for them to visit. Equipped with fresh newspapers and sometimes an iPad, the volunteers discuss current events or search for images such as places where the patients grew up. Since many of the patients have short-term memory impairments, these activities help to provide mental stimulation through reminiscence.

There’s also the added benefit of more time spent sitting up or out of bed, both of which further therapy goals, said Stanley.

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

Passing time more enjoyably has another benefit.

“Interactions with the volunteers help reduce the stress and anxiety related to being in the hospital environment,” said Vandewater.

While many of the items on the cart were on the unit before its inception, Stanley said Volunteer Services has also been a huge support by offering funds to make rooms more senior-friendly, as well as providing new cart items to improve the patient experience.

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An architect’s rendering of a patient room in the CICU. (Rendering by NORR Architects)

Hearts in the right place

By Kate Manicom

St. Michael’s Cardiac Intensive Care Unit treats some of the most critically ill patients in the region – typically those recovering from acute coronary syndromes such as heart attacks. As part of the 3.0 redevelopment project, the unit is making a much-needed move from its current location in the hospital’s Bond Wing to new space in the Peter Gilgan Patient Care Tower, now under construction.

“The CICU team provides excellent care in a small space, but day-to-day we face multiple challenges,” said Dr. Neil Fam, an interventional cardiologist and director of the CICU. “The rooms are so small that we can’t fit all of the necessary equipment in at once and still have room for patients’ families.

It’s always very crowded.”

The new, twice-as-large, modern CICU has been designed with more than just space in mind. The layout is patient-centred, with dedicated family space in each room. There will be lockers for family members to safely store their belongings and each room will have a roll-out cot so they can sleep close by.

“When a patient has a crisis, it’s a crisis for the family, too,” said Stephen Penticost, a registered nurse in the CICU. “It’s important that there is space for families to be part of a patient’s care.”

The rooms are all single-patient, each with its own washroom.

These elements not only improve patient and family comfort, but are best practices in infection prevention and control.

Access to natural light will be available in each room, which is FEBRUARY 2017 | IN TOUCH | 4

shown to help improve healing.

The layout of the rooms and optimization of new technology will give staff and physicians the ability to better observe patients without disturbing them unnecessarily. Ceilingmounted articulating arms for lights and monitors means that staff can move equipment out of the way to improve access to patients and make efficient use of the space.

Dr. Fam said the location of the unit also will improve care.

“There is a direct path to the catheterization lab – where patients are typically taken after a heart attack and before they are brought to the CICU. The cardiology unit, where patients recover after transfer from the CICU, is also adjacent,” said Dr. Fam. Planning for the new CICU took several years and involved a multi-disciplinary team, including physicians, the clinical leader manager, nurses, physiotherapists, respiratory therapists and clerical staff working with the Planning Department and the hospital’s architects.

Penticost, who has been a part of the planning for the new CICU since it began, was happy to have had the opportunity to help shape the designs.

“The most exciting change is going to be the space: more space for frontline staff to do their jobs, to consult with other team members and for families,” said Penticost. “We’re looking forward to the move.”

Dr. Doug Campbell (centre) looks on as Catherine Bishop, a clinical nurse educator in the NICU, and Dr. Ethel Ying work to revive an infant during a Code Pink training session in the Allan Waters Family Simulation Centre. (Photo by Katie Cooper, Medical Media Centre)

Code Pink training tests knowledge and ability to work as a team

By Greg Winson

It’s a high stakes operation when a tiny newborn stops breathing.

All medical professionals in the Neonatal Intensive Care Unit need to work together to bring the infant back to life.

Teamwork is one of the key lessons in the NICU’s Code Pink training, a program run twice a month involving physicians, nurses, respiratory therapists and residents. The training, named after the hospital code called for a neonatal medical emergency, is led by Dr. Doug Campbell, director of the NICU and medical director of the Allan Waters Family Simulation Centre, and supported by the simulation centre team.

“The Code Pink training not only tests our staff’s knowledge, but perhaps more importantly our ability to come together as a team in a crisis situation,” said Dr. Campbell.

The SimNewB and SimBaby mannequins are used to simulate babies up to three months old. The mannequin is controlled by simulation specialists to respond as an infant would to create a realistic scenario.

Dr. Campbell. At other times the sessions are held in the simulation centre to take advantage of additional audio and video equipment.

Scenarios are developed based on input from physicians and other clinical staff.

“The scenarios are often based on real events that have happened in our hospital,” said Nazanin Khodadoust, program manager of the Allan Waters Family Simulation Centre. “So it’s very realistic and close to the heart of the staff participating.”

Much of the learning occurs afterward during a video-based debriefing. The team discusses both technical and non-technical issues that came up during the scenario and how they can improve.

“The idea is to translate simulation activity into clinical practice,” said Dr. Campbell.

The sessions are often held in the NICU on the 15th floor to make them even more realistic.

The team also influences practice beyond St. Michael’s. The simulation centre recently hosted the national launch of the revised Neonatal Resuscitation Program guidelines in part related to the expertise at the Simulation Centre. More than 80 practitioners from across Canada attended the event.

“The in situ training can also help to identify gaps with equipment, and design of the actual clinical space,” said

“We’re very active in training our people but also involved in the bigger community,” said Khodadoust.

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CT operations leader Shadi Mossaed sets up the GE Revolution CT scanner. (Photo by Katie Cooper, Medical Media Centre)

Speedy CT scanner can cut radiation doses in half

By James Wysotski

Even before 2017 upgrades are complete, the speed of St. Michael’s Hospital’s newest computerized tomography, or CT, scanner has revolutionized the treatment of patients.

A CT or CAT scan is a diagnostic medical test that produces multiple images of the inside of the body by making use of many computer-processed combinations of X-rays taken from different angles to produce cross-sectional (tomographic) images (virtual “slices”) of a specific body part.

Installed in fall 2015, the GE Revolution CT scanner will soon acquire images from a full rotation in 0.2 seconds, significantly faster than our other scanners according to CT operations leader Shadi Mossaed. The increased speed means agitated patients who move in the bore rarely cause blurry images, resulting in far fewer wasted scans.

“Before we would have to scan several cardiac cycles and then the scanner would combine the image data to get one clear picture of all the cardiac anatomy,” said Mossaed. “But now because it’s so fast, we can get all of that information in one rotation with very little motion and at one-quarter of the dose.”

Adding to the efficiency is a wider detector that increases scans from 4 cm to 16 cm, meaning 256 slices instead of 64. Faster than the blink of an eye, one rotation can now capture an entire FEBRUARY 2017 | IN TOUCH | 6

head. As a result, Mossaed said patients undergoing head scans are on the machine for a quarter of the usual time.

More importantly, with fewer, faster scans comes a dramatic radiation dose reduction.

“We’ve been working hard on reducing doses,” said Dr. Tim Dowdell, radiologist-in-chief. “They had dropped by about 15 per cent even before getting the Revolution, and now we’ve noticed an even further drop of 25-60 per cent less radiation for body CT scans.”

A 2017 upgrade will reduce the dose even further. New “dual energy” software will let one scan do the job of two by editing images to remove the effects of a contrast agent injected by IV into arteries to highlight blood vessels. Previously, a separate scan without the contrast agent was required to see coronary calcification.

Dr. Dowdell said that by dose, the images are better. They’re clearer because the Revolution causes less blur and gets rid of noise and artifacts – interference caused by metal in the body.

“We now use a lot less radiation to get quality images,” said Dr. Dowdell. “And that’s great for patients because we’re looking for pictures that answer clinical questions at the lowest possible dose.”

New tool helps radiologists study ordering patterns to reduce unnecessary tests

By Kelly O’Brien

St. Michael’s Hospital plans to install a clinical decision support system in the hospital’s family practice clinics to study how to improve the appropriateness of imaging tests ordered by physicians.

Health-care providers across the country suspect a large number of MRIs and CTs ordered and performed in hospitals are unnecessary.

“Unnecessary tests also contribute to longer wait times and potentially decrease access for patients who need the tests urgently,” said Kate MacGregor, the quality improvement and radiation protection manager in the Department of Medical Imaging. “Unnecessary tests can also potentially put patients’ health at risk. Some tests use ionizing radiation, so from that standpoint it’s a public health problem.”

The concept of the clinical decision support system is relatively simple. When ordering a test, clinicians will enter patient information into a computer, such as symptoms and relevant medical history. The software will then display whether the test should be ordered, or whether a different test would be more appropriate. The clinician will have the option to override the recommendation.

“We’ll then be able to identify how often each clinician is overriding the system, and what types of cases they are overriding most often,” said Dr. Bruce Gray, a radiologist and one of the project leads. “When we see they’ve been overriding, we can ask, why is that? Maybe they have a legitimate reason for overriding it. We hope to make this a positive and engaging experience for the family practice physicians.”

The tool is designed to be combined with the patient’s electronic health records, with only a few clicks needed to determine whether a test is appropriate.

A number of hospitals throughout North America use similar software to determine whether an imaging test is appropriate. What’s different about the St. Michael’s project is that it will be the first in Canada to use a clinical decision support tool embedded with appropriateness rules tailored for the Canadian context.

The system will also improve the ordering process for imaging tests for both patients and clinicians. Currently, the ordering of imaging tests is almost entirely paper-based and goes through a number of people and departments before an appointment is scheduled. The clinical decision support system will be added to the ordering process electronically to give the patient an appointment at the same time the test is ordered.

Dr. Bruce Gray says he hopes the clinical decision support system will be a positive and engaging experience for family practice physicians.

(By Yuri Markarov, Medical Media Centre)

Dr. Gray said this increase in efficiency will be a main selling point for family physicians to use the system.

But before the group leading the project can assess the effectiveness of the clinical decision support tool, they first have to determine what the current ordering patterns are.

The team is using a natural language processing tool called Montage to understand these baseline ordering patterns and better evaluate the effectiveness of the clinical decision support system when it’s installed in the spring.

Ultimately, the tool won’t reduce the cost to the system, but it will help ensure each dollar spent was an appropriate one, said Dr. Gray.

“You want to have value for whatever you do and increasing appropriateness will increase value.”

The clinical decision support system will serve 80 family practice physicians and 60,000 patients.

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Q&A

DR. LINDA MAXWELL EXECUTIVE DIRECTOR OF THE BIOMEDICAL ZONE

Photo (Courtesy of Biomedical Zone)

By Geoff Koehler Dr. Linda Maxwell is executive director of the Biomedical Zone— an incubator for health-care technology formed by a partnership between Ryerson University and St. Michael’s Hospital. The Women’s Executive Network recently named her one of Canada’s 100 Most Powerful Women.

Q: What is the Biomedical Zone?

The Biomedical Zone is best known as an incubator for health-care startups. We currently house 13 companies and are working with our parent institutions (St. Michael’s and Ryerson) and external networks to help our companies continually refine their products and bring their innovations to market. We’re more than a traditional incubator, though; we’re an innovation engine for commercialization and entrepreneurship.

Q: Okay, I’ll bite. What is an innovation engine?

Think about wind turbines. Wind is everywhere but you need to place the turbine in the right place and build it a certain way before it can convert wind into energy. As part of both Ryerson and St. Michael’s, we’re tied to two institutions that are full of people with creativity, ingenuity and passion for making things better. The Biomedical Zone is an outlet for those who are passionate enough to take health-care solutions to market. We want be the engine that harnesses big ideas and converts them to innovations that can make lives better for our patients.

Q: What makes for a good Biomedical Zone innovation?

Just because something is new doesn’t mean it’s necessary, or even useful. That’s why we identify startup companies and projects that

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

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address an important clinical or patient need—such as Swift Medical’s smartphone app that allows clinicians to track and measure chronic wounds or AceAge’s device to make it easier for patients to remember to take their medication.

Q: Once you have the idea, how does the Biomedical Zone advance it?

Because of our focus on health-care solutions, there is no better place to be than St. Michael’s. The hospital is full of clinicians who have worked with our companies to refine their product to fit the end-user’s needs. Most startups don’t look for clinician input until the product is finalized. We get clinical and commercial together early and frequently.

The zone offers a safe, innovation-driven environment with clinical and business development married together.

Q: The Biomedical Zone just celebrated its first birthday. How has the zone grown over the year?

Our engagement with doctors and nurses has grown immensely. We’re continuing to engage with clinicians more and more through measures such as: our Innovation Roundtable, where clinicians hear elevator pitches and demonstrations from companies and provide insights as experts; our Co-Development Lab, which is a program bringing clinicians who have identified a clear challenge to the table with upperyear technology students to develop practical, low-cost solutions; and last month we had our first Demo Night for St. Michael’s, where we showcased some of the Biomedical Zone’s latest health-care innovations and gave staff and physicians a chance to provide feedback and ask questions about tools they or our patients may one day be using.