In Touch newsletter: February 2018

INTOUCH FEBRUARY 2018

The St. Michael's Hospital NICU

Colouring Book!

Social worker Amanda Hignell reviews a new colouring book for siblings of babies in the NICU alongside its designer, Marcelo Silles, a graphic artist with the hospital’s Medical Media Centre. (Photo by Katie Cooper, Medical Media Centre)

Colouring book helps children understand why new siblings can’t come home yet

By Leslie Shepherd

Children whose newborn brother or sister need to be in the Neonatal Intensive Care Unit often find it difficult to understand why the baby can’t come home yet or why their parents have to spend so much time away.

To help them understand where and how their new siblings are being cared for, the NICU partnered with the hospital’s Medical Media Centre to create an explanatory colouring book called “Super Siblings.”

Printed on 100 per cent recycled paper

The colouring book was the idea of social worker Jeanette Doherty, who had worked with something similar at another hospital, but that book focused only on premature babies, said fellow NICU social worker Amanda Hignell.

When Hignell and Doherty couldn’t find anything else that was more suitable, they decided to make their own colouring book, broadening it to include other reasons babies need to stay in the NICU, and making it gender neutral.

They took their script to Marcelo Silles, a graphic artist in the hospital’s Medical

Media Centre, who illustrated the 16page book.

“Sometimes babies come earlier than their families planned,” the book says. “And some babies need special medicine after they are born.

Sometimes families wonder why this happened to them. Did you ask this question? Nothing anyone did or said caused this. Some babies need more help than others and are not ready to go home yet.”

Continued on page 2 FEBRUARY 2018 | IN TOUCH | 1

OPEN MIKE with

Mary Madigan-Lee Vice-President of Human Resources and Legal Services

Welcome to the first In Touch of the year! I hope 2018 is treating you well thus far.

For all of us at the St. Michael’s site and across the network, this year is continuing much like how we ended the last – full of exciting change and opportunities, within our walls and beyond.

Integration

reforms since the 1990s and have to do with minimum wage, leaves of absences and scheduling. For a complete list of amendments, visit ontario.ca.

Because the changes are so numerous, many of them are being phased in over the year. Our HR team has been and will continue to review and update our employment practices and policies to ensure compliance with these amendments.

HOOPP

Whether you have direct reports or you report to someone, you are all leaders who have been helping to bring the integration of our three hospitals to life. You do this every time you bring your best to work despite the challenges of change. When you continue to provide excellent care, inspire and support your colleagues, and continue to believe in the possibilities of our health network, you are helping to lead change and innovation. Thank you.

We’ve been working for some time – even before integration – to have all the network pension plans merge with HOOPP to provide long-term stability and alignment with peer hospitals in Ontario. While the Providence and St. Joseph’s pension plans are farther along in the analysis and due diligence process, the St. Michael’s pension plan move to HOOPP is scheduled for a similar target date of Jan. 1, 2019. I know this is of considerable interest to all of you, so we are committed to providing you with regular updates about it.

Labour laws

Labour activity

Externally, a number of changes related to the Employment Standards Act; Labour Relations Act and the Occupational Health and Safety Act came into effect on Jan. 1. These are the most significant labour law

Whenever there is an amalgamation or integration among public sector organizations such as ours, it’s not uncommon to see heightened unionization drives. Our three sites are home to a number of different unions,

and so the Public Sector Labour Relations Transition Act has been invoked. PSLRTA will dictate the process for deciding whose contract applies and which union negotiates the next one. There will be a number of hearings this year, from OPSEU, CUPE and CNFIU. Please make sure you have all the right information so that you can make wellinformed decisions. If you have any questions, please reach out to Mona Bratan, director of Labour Relations, at bratanm@smh.ca

Leadership changes Internally, we will soon be saying farewell to our president and CEO, Bob Howard, and our chief medical officer, Doug Sinclair. St. Michael’s is certainly going to feel strange without them! In keeping with St. Michael’s custom, we will be holding farewell teas for both of them. Look for details in the Daily Dose.

While these are exciting times, we are going through significant change – all while continuing to deliver on our promise of providing excellent care for all. Thank you for your dedication to our patients and our organization and for your resilience in helping to make this another successful year.

Colouring book story continued from page 1

The colouring book is distributed as needed to NICU families with older siblings. Hignell said other hospitals have asked if they could adopt the colouring book for their NICUs. “This is a great tool to help parents explain to siblings why the baby is not able to come home and why the parents have to spend so much time at the hospital,” said Hignell.

2 | IN TOUCH | FEBRUARY 2018

Follow St. Michael’s on Twitter: @StMikesHospital

Drs. Lisa Hicks (left) and Michelle Sholzberg (right) present IRON MOM during the Angels’ Den research competition in November.

(Photo by George Pimentel)

Forget Iron Man: IRON MOM fights low iron in pregnant women

By Kelly O’Brien Hematologists and obstetricians at St. Michael’s are working on a new project to combat low iron in pregnant women.

Created by Drs. Michelle Sholzberg, Lisa Hicks and Andrea Lausman, IRON MOM offers tools to make it easy for a medical team to recognize and treat low iron before it becomes severe, educate moms about low iron and empower women in their own health care.

Anemia is common in pregnancy and can cause problems including premature delivery, low birthweight, childhood anemia, postpartum depression and even death, according to Dr. Sholzberg, who is a hematologist at St. Michael’s.

She said the idea for the IRON MOM project came to her when she noticed that she was getting a significant number of referrals for patients with severe anemia who were well into their pregnancies.

This represented a huge missed opportunity to treat women and mitigate potential negative health outcomes for both mothers and babies, she said.

“When we see a patient with severe anemia at 37 weeks, this represents a missed opportunity,” said Dr. Sholzberg. “Low iron is easy to detect and almost as easy to treat, but is not often recognized or managed, especially in pregnancy.”

IRON MOM uses a tool kit to educate clinicians and patients. This includes posters in ob/gyn clinics with steps that guide clinicians through the process of diagnosing and treating iron deficiency anemia.

“With these tools, we’re able to provide an iron strategy for clinicians,” said Dr. Hicks, who is also a hematologist at St. Michael’s and serves as the team’s quality improvement methodologist. “We’ve had great preliminary results at St. Michael’s, so now when pregnant women are referred with anemia, they are often earlier in pregnancy and already on oral iron supplements, which is a huge improvement.”

Drs. Sholzberg and Hicks presented IRON MOM at St. Michael’s third annual Angels’ Den event in November--a reality-TV-style contest for innovation funding.

They won the Social Innovation category, which came with a $50,000 prize. Each of the

Drs. Warren Lee and XiaoYan Wen won the Biomedical Innovation category at the Angels Den competition for their research using zebrafish to find new compounds to treat the influenza virus eight finalists in the competition also received an additional $10,000 from the judges.

Dr. Hicks said the prize money will help fund an expansion and improvement of the IRON MOM project, including conversion of the current paper-based tool kit to digital tools, introducing the tools to nurses and midwives, and bringing the tool kit to hospitals and clinics across Canada, and eventually, around the world.

“Our vision and mission for IRON MOM is to emancipate and empower women, and part of that vision is not just reaching women at St. Michael’s, or in Toronto, or in Canada, but women everywhere,” said Dr. Sholzberg.

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Maggie Dubrawski, the operations leader for general imaging, prepares an X-ray for upload to the PocketHealth platform.

(Photo by Yuri Markarov, Medical Media Centre)

Convenience for patients is No. 1 with new PocketHealth platform

By James Wysotski

St. Michael’s Hospital’s new imagesharing platform, PocketHealth, puts patients first by making it easier to obtain and share medical images.

Created and run by the PocketHealth company, the online platform allows patients to use mobile devices or desktop computers to access their medical images anywhere, including from their homes. Previously, the only option was to order a CD-ROM with the images.

“The sharing of imaging records has historically been very challenging,” said Jennifer Meher, the manager of Medical Imaging Operations.

Often, patients can wait while a CD is prepared, said Meher. But some facilities require 48 hours to process the request, requiring a second trip to the hospital. Patients who had to return for a CD pick-up often incurred other costs 4 | IN TOUCH | FEBRUARY 2018

such as public transit or parking. Frequently, it also meant taking a day off of work.

“Some patients live far away, and it’s stressful for them to make the journey here,” said Cristhian Moran, a radiology software administrator who helped integrate the platform with the hospital’s systems. “By using PocketHealth, they no longer have to make the trip.”

Patients get their images from the PocketHealth website in just a few minutes. After logging in and providing a credit card to cover the $5 fee for each set of images, patients fill out an online release of information form and then enter the date of their visit. Moments after submitting the request, they have full access to all images.

Moran said patients can store images indefinitely on PocketHealth’s servers, knowing they’re always available to be downloaded or shared at no extra cost.

If patients had images taken elsewhere, there’s an upload function. They can

share the images with any number of physicians through the website’s easyto-use interface.

Patients also control how long doctors can access the images on PocketHealth’s servers, said Moran. Doctors get an email, but no images or private health information is attached. Instead, a password-protected URL points to the medical images and any accompanying reports. Patients can deactivate the link at any point.

Removing the time spent waiting for disks means patients can see doctors sooner, said Moran. They can even send access to the images before a visit, allowing doctors to preview images in advance.

PocketHealth protects personal health information with 256 bit encryption, an industry standard that Moran said is one of the strongest formats available.

It’s also compliant with the Health Information Protection Act.

Rashmi Sanjay walks through the snow only months after undergoing surgery to remove a tumour in her cervical spine, a procedure that could have left her paralyzed. (Photo courtesy of Rashmi Sanjay)

Complex surgery removes rare tumour from patient’s spine

By Kelly O’Brien

One year ago, Rashmi Sanjay came to St. Michael’s Hospital for a consultation with neurosurgeon Dr. Sunit Das. She had recently learned she had a large tumour growing in her cervical spinal cord.

Her first neurosurgeon told her removing the tumour would leave her paralyzed from the neck down.

cord, there was a point where I wasn’t able to distinguish it from the spinal cord itself,” he said.

A test during surgery revealed the tumour was a schwannoma, a common, benign tumour that usually grows outside of the spinal cord. Sanjay’s tumour was growing from her spinal cord, which has been reported in fewer than 70 cases worldwide.

She and her husband were devastated by the news, and sought a second opinion from Dr. Das.

“When I got the specimen back, I was shocked,” he said. “It’s exceedingly rare, and was not within my realm of expectation going in.”

“My husband and I were overwhelmed by his genuine care,” she said. He was honest about what could happen, but we left that first meeting feeling positive and hopeful.”

Despite the unexpected, the surgery was successful. Today, Sanjay is able to walk and is doing outpatient physiotherapy treatment in Kitchener to improve her mobility.

Dr. Das said he would perform the surgery, but could not guarantee that she would walk again.

“To see the energy coming from the Trauma and Neurosurgery team was just fantastic,” she said. “I can’t thank them enough for all they did for me and my family.”

“It’s one of those things where your heart sinks,” he said.

“The placement of a tumour that high in the spinal cord makes it particularly dangerous.”

Her surgery on Sept. 27 took six hours.

“The hard thing with her tumour was two-fold: No. 1 is, it was remarkably firm—it was firm like a racquetball— and No. 2 , as I was mobilizing it away from the spinal

Dr. Das said he is glad to see the progress Sanjay has made since her surgery.

“As a neurosurgeon, the line between shepherding our patients through surgery to recovery and encountering something devastating can be so thin, so it’s so gratifying to see her now.”

FEBRUARY 2018 | IN TOUCH | 5

Sandra Couto, team leader for Visitor Services (centre) looks forward to the rollout of the new Medical Support Protocol, which will be used instead of calling a Code Blue for many medical incidents in public spaces. Joshua Caesar and Ann Blanchette are two of the Emergency Department nurses who might be called on to respond. (Photo by Katie Cooper, Medical Media Centre).

New protocol for people needing medical assistance in public spaces

By Leslie Shepherd

Patients and visitors sometimes experience medical issues such as lightheadedness, dizziness and even falls when entering or exiting the hospital or while waiting in a lobby or another public space.

Code Blue team, the Diabetes Comprehensive Care Program (who made it one of their Improvement Program projects), the Emergency Department, Patient Transport and Security.

Past practice has generally been to call a Code Blue (medical emergency) but this response is often disproportionate to what is really needed.

Of the 104 Code Blues called between April and September last year, 34 of them were for people in non-clinical areas.

This new protocol means that the larger team that responds to Code Blues is not going to be called upon so often and will be available for critical situations.

To fill this gap, Senior Leadership approved a new Medical Support Protocol in January that would see a registered nurse and a clinical assistant from the Emergency Department dispatched quickly to assist anyone who is awake, responsive, experiencing a situation that requires medical assistance or first aid, and wants such help.

The protocol is the work of a wide group of hospital departments, including Visitor Services (who oversee the hospital lobbies), the 6 | IN TOUCH | FEBRUARY 2018

“Our data shows that many people requiring this type of assistance will be dialysis patients leaving the building after treatment as well as people coming into St. Michael’s in search of the Emergency Department but having used the wrong entrance,” said Pamela Robinson, clinical leader manager for infacility hemodialysis and apheresis.

“Dialysis patients in particular often feel lethargic or lightheaded and occasionally

experience vertigo after finishing their treatment. These side effects commonly occur while waiting for transportation in the Queen Street Lobby.”

Signs will be posted in non-clinical areas of the hospital advising anyone who sees someone who appears to be in need of medical assistance to either speak to staff at the Information Desk or a hospital employee, or to use a hospital phone to call Locating.

Michael Kidd, director of Volunteer and Visitor Services, welcomed approval of the new policy.

“This new protocol, in conjunction with existing code responses, will allow us to call upon the most appropriate resource to assist people in our lobbies, washrooms and other non-clinical areas,” Kidd said.

Leighanne Mackenzie, the program director whose portfolio includes the ED, implemented a similar protocol at a number of sites and said it made a difference for those visiting hospitals.

The Rapid Referral Clinic has been able to hire a full-time dedicated nurse, Avinash Solomon. (Photo by Yuri Markarov, Medical Media Centre)

Rapid Referral Clinic becoming a success story

By Leslie Shepherd

The hospital’s Rapid Referral Clinic has rapidly become a success.

What started as a six-month pilot project in May 2016 to provide expedited care for patients who present in the Emergency Department with acute medical issues but who can be managed safely as outpatients, has become a five-day-a-week clinic that’s now accepting referrals from the Family Health Team, GIM as well as some community physicians.

“We’ve gone from concept to full ambulatory clinic is just a little over one year, funded and supported by the hospital,” said Dr. Robert Sargeant, head of the Division of Internal Medicine, which runs the clinic.

The numbers tell the story: In the first six months, as the clinic ramped up from three mornings a week, it had 358 patient visits. The average wait time from being referred from the ED to seeing a rapid health-care provider was 62 hours, well within the 48- to 72-hour goal. The clinic diverted 116

patients who might otherwise have been admitted; but also directly admitted 15 patients they felt really needed inpatient care.

The clinic was also able to hire a fulltime dedicated nurse, Avinash Solomon.

In the morning, the clinic sees patients referred by the ED. Most afternoons it sees post-discharge patients from medicine to both encourage timely discharges from 14 Cardinal Carter and prevent readmissions.

“We can more safely discharge patients on weekends, for example, if we know they will get a timely followup in the clinic,” said Dr. Sargeant.

The clinic has also added five referral slots in the afternoons for Family Health Team patients, which Dr. Sargeant said he believes is a first for a rapid referral clinic in Canada. Instead of sending patients to the ED, family physicians can refer suitable patients to the clinic.

The clinic has also played a key role in the St. Michael’s rollout of a Toronto

Central LHIN-funded project known as SCOPE (Seamless Care Optimizing the Patient Experience) that helps solo family physicians gain better access and integration with community and hospital services, including general internal medicine and medical imaging.

The current phase of the SCOPE rollout involves 20 individual family practitioners in the LHIN’s mid-east Toronto subregion who can call Rapid Referral Clinic internists for telephone advice and possible referral to the clinic.

Dr. Sargeant said his biggest surprise has been the wide range of patients and ailments the clinic is seeing.

“We’re consistently seeing patients who are actually sick, who can use our interventions, and who have been appropriately referred to us,” he said.

“I’ve also been surprised by how much residents love working in the clinic. They want to be prepared to see whatever comes their way when they are out in the real world and they are getting a great breadth of experience.”

FEBRUARY 2018 | IN TOUCH | 7

Q&A

By Kelly O’Brien

DR. LEE SCHOFIELD Dr. Lee Schofield is a family physician at the St. Lawrence Health Centre who also works as a sports and exercise medicine physician. He is in South Korea as part of Team Canada’s core medical team for the Winter Olympics.

Q. Tell us about your role with Team Canada.

A. The Canadian Olympic Committee sponsors a core group of medical volunteers who support multiple sports and also run the Canadian Medical Clinic in the two Olympic villages.

I am working primarily with long track speed skating, so I cover all of the competition events for those 19 athletes and many of their practices.

Q. How did you get involved with Team Canada?

A. I began in 2011, volunteering and working at the local or provincial level, and started getting more experience with senior level national competition and multisport games. My first experience with the Canadian Olympic Committee was in 2014 when I traveled to China as chief medical officer for Team Canada for the Youth Olympic Games. I was part of the core medical team at the Toronto 2015 Pan Am Games, the Rio 2016 Summer Games and now the 2018 Pyeongchang Winter Olympics. This has been a dream come true for me.

Q. How does this Olympic experience compare to the Rio 2016 games?

A. Rio was incredible. The atmosphere was electric! The people of Brazil were so proud to host the first Olympics in South America. I was covering four sports: equestrian, beach volleyball, triathlon and track cycling. These Games have been

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FEBRUARY 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

very different so far. It is much colder than I expected! I am covering primarily one sport, so I can focus my time and energy on its athletes.

Q. What are you most excited about for these Olympics?

A. The most exciting thing to me is always the atmosphere. We are fully integrated into the Canadian team, and live here in the village with the athletes and mission team. That creates such an exciting vibe, and we get the chance to experience the highs (and sometimes the lows) of the Canadian Olympic experience. I have never been to Korea before, so the cultural adjustment is always an interesting experience for me.

Q. Do you have a best/favourite story from your time with Team Canada?

A. One thing that people don’t realize is that our role is entirely volunteer and we often step into other roles apart from a traditional medical role. When I worked with equestrian, I would help to cool the horses down after the cross country event with large cold sponges. The support staff had a good laugh at my fear of getting kicked by the horse. My other amazing story was from Rio 2016. I was covering the beach volleyball venue, which faced out into the ocean from Copacabana Beach. Our first men’s match was against the host country and when we walked into the stadium to see 10,000 people in the stands, it was almost overwhelming!