In Touch newsletter: June 2016

INTOUCH JUNE 2016

Jesse Potts, a clinical assistant in the Cardiovascular Intensive Care Unit, performs hand hygiene during a Tough Scrubber session.

(Photo by Katie Cooper, Medical Media Centre)

Getting tough on hand hygiene has never been so fun

By James Wysotski

The difference between a Tough Mudder and a Tough Scrubber isn’t as vast as one might think.

The former, a military-style obstacle course, revolves around teamwork while testing mental and physical strength.

Participants in the latter – a St. Michael’s Hospital initiative to improve hand hygiene – are also tested, and they, too, have learned that everyone wins by helping colleagues succeed.

Tough Scrubber, the brainchild of the Heart and Vascular Program’s Quality Printed on 100 per cent recycled paper

and Safety Leader Group, begins with staff taking a five-question test requiring them to read about patient interactions and identify if hand hygiene is necessary.

“The questions are challenging,” said Laura Shapiro, an occupational therapist and co-chair of the group. “They give staff the opportunity to say ‘What’s Moment 1 again? What’s Moment 4?’ It was also a good refresher for Accreditation.”

Next, participants go through mock scenarios featuring co-workers as “patients.” Again, the task is to perform hand hygiene at the proper moments

while touching medications, transferring patients, giving out water or handling scanners and patient wristbands.

Despite the informal setting, the realistic situations inspire true learning.

Proof comes a month later when participants redo the test to see if they retained the knowledge. Early data suggests they do. In January, Infection Prevention and Control’s Moment 1 (before patient contact) compliance rates for Cardiology and the Cardiovascular Intensive Care Unit were 40 and 50 per cent, respectively. Following Tough Continued on page 2 JUNE 2016 | IN TOUCH | 1

OPEN MIKE with Dr. Stephen Hwang,

Director, Centre for Urban Health Solutions

On June 1, the Centre for Research on Inner City Health, or CRICH, was renamed the Centre for Urban Health Solutions. The centre remains a world research leader committed to advancing the health of people who are marginalized and disadvantaged.

The change from “inner city health” to “urban health” reflects the fact that poverty increasingly affects people living across our cities, not only those people in the downtown cores. Our new name is also in harmony with St. Michael’s Hospital’s vision of “world leadership in urban health.”

Adding “solutions” to our name emphasizes our conviction that we can and must act to address health inequities, and puts a heightened focus on our centre’s work to develop, evaluate, and scale up programs and policies that will improve people’s lives.

Examples of the centre’s new solutionsoriented research projects that are underway include an intervention to provide access to essential prescription medications for patients who cannot afford them, and an interactive training program for health-care providers to reduce bias and improve cultural safety in the care of Indigenous people.

The centre is working closely with the hospital’s clinical programs to enhance connections between research and patient care. In collaboration with our community and other partners, we are

Hand hygiene story continued from page 1

Scrubber’s creation in February, the March data jumped to 74 and 69 per cent. Of course, Tough Scrubber cannot take all the credit; other hand hygiene Quality initiatives certainly helped achieve the increase, said Shapiro.

The Heart and Vascular Program has completed all six of its planned Tough Scrubber sessions, which featured different scenarios geared toward each area of its practice, including the CVICU, Cardiac Intensive Care Unit, Cardiology and Cardiovascular Surgery. Approximately 50 staff participated.

Infection Prevention and Control is likely to run Tough Scrubber sessions next year in other units around the hospital with scenarios tailored to their disciplines, said auditor Cameron Thomas.

“There have been a lot of learning moments about what constitutes the patient environment and if you should wash your hands before or after touching things such as scanners or whiteboards,” said Shapiro. “Some even overwash their hands. We give them live feedback, so we actually audit them while they’re doing it.”

Even with up to 10 quality and safety leaders watching,

increasing our collective impact on the local and national level.

To help reach our goal, the Centre for Urban Health Solutions has grown over the past year to include additional scientists and research staff from St. Michael’s Hospital, providing a wider range of expertise. This growth has deepened the centre’s capacity in areas such as primary care interventions for addressing the social determinants of health, preventing HIV infection and improving care for people living with HIV, and workplace health and precarious work.

This is an exciting time for the Centre for Urban Health Solutions. I’m looking forward to working together with you as we seek and implement creative solutions that will help us foster a fair society where everyone can thrive.

Shapiro said they’ve done well, adding that the pressure caused by their presence mirrors the stresses of day-to-day work.

While the focus is on promoting patient care and safety, the emphasis is on fun. And staff feedback has been really positive.

“It gives them a platform to ask questions about hand hygiene,” said Shapiro. “People are a lot more engaged and the topic has become a lot more approachable.”

Tough Scrubber Knowledge Quiz 1. You perform hand hygiene (HH) and push your WOW into the patient’s room. After touching the patient, you push the WOW out of the room and perform hand hygiene at the door on your way out.

You didn't need to perform HH Moment 1 was missed Moment 4 was missed Moment 1 and Moment 4 were missed To see the full quiz, go to www.stmichaelshospital.com/toughscrubber.

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Follow St. Michael’s on Twitter: @StMikesHospital

Fostering hope for stroke patients JUNE IS STROKE MONTH

By Elizabeth Kosturik

On Tuesdays, Ron LaCombe comes to St. Michael’s Hospital and goes to the Stroke Unit on 14 Cardinal Carter. He checks in with Mary Van Impe, an occupational therapist, and Judy Kelly, a discharge planner, about his first visit of the day.

LaCombe isn’t a nurse or therapist. He is a stroke survivor and volunteer at St. Michael’s, and one of the new “peers” in the Peers Fostering Hope program for stroke patients.

“There are a lot of unknowns after having a stroke,” LaCombe said. “It affects people differently, but I can answer questions about my experience and provide hope for patients.”

After his stroke in 2012, LaCombe was treated at Sunnybrook Hospital for more than a year and regained most of his speech and mobility. One day while receiving treatment, he saw a pamphlet for Peers Fostering Hope.

“I was looking for a way that I could give back,” he said.

He was connected with Donna Cheung, one of the Toronto Stroke Networks coordinators based at St. Michael’s, about becoming a peer.

“We heard from patients that they wanted to hear positive recovery stories,” said Cheung.

Potential peers learn about the best ways to communicate with patients who have trouble speaking or moving, such as asking yes or no questions or repeating information.

LaCombe’s visits range from five to 30 minutes.

“Some patients are more responsive than others,” he said. “But I try my best to put a smile on their faces and be positive.”

When Ron LaCombe, a volunteer and one of the first “peer” stroke survivors, comes to the Stroke Unit he finds information about the patients he will be visiting in a binder.

(Photo by Katie Cooper, Medical Media Centre)

Cheung said she hoped to increase the number of peers at St. Michael’s and eventually reach outpatient and community facilities. Recruitment for more peers is ongoing through wordof-mouth and regional partnerships.

“For health-care providers, we can provide our best professional knowledge, but we’ve never had a stroke,” said Judy Kelly. “Ron gives a personal perspective to overcoming a stroke which is life-changing for our patients to see.”

The benefit goes both ways.

“I was one of the lucky ones with my stroke,” said LaCombe. “The patients I work with are sometimes worse off than I was, and their resilience inspires me.”

The Peers Fostering Hope program is a Toronto-wide partnership between March of Dimes Canada and the Toronto Stroke Networks and is supported by the Dr. Ed & Bobby Yielding Fund for Stroke Recovery. The program launched at St. Michael’s, one of the three regional stroke centres, in mid-May.

St. Michael’s treats approximately 425 stroke patients per year.

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

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Dr. Patricia Houston has been vice-president of education since 2009.

Thank you Patricia

Patricia with Julie Maggi, director of postgraduate medical education.

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On July 1 she becomes Vice Dean, MD Program at the University of Toronto.

for teaching us that we are all teachers and we are all learners. Best wishes for continued success in your new role.

Bob Howard with Patricia and Nora Aufreiter, chair of the Research and Education Subcommittee of the Board of Directors, at the Accreditation Celebration Ceremony in the Allan Waters Family Simulation Centre.

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5

Registered nurse Mary Lou Sulcs consults with a pre-surgical patient by phone in the new Pre-Admission Facility on 10 Donnelly.

(Photo by Katie Cooper, Medical Media Centre)

Pre-Admission Facility moves to a new floor and a new model of care

By Kate Manicom

With new space on the 10th floor of the Donnelly Wing, it’s surprising that Nancy Rudyk, clinical leader manager for the Pre-Admission Facility, doesn’t want to show it off. But based on feedback from patients and families and to improve efficiency, the facility is increasing its use of telephone and telemedicine consultations to improve the patient experience.

“Transitioning to a new, renovated space has been a great opportunity to improve how we provide patient care,” said Rudyk. “In our new space we have five exam rooms that are connected to enable telemedicine, a new conference room connected to all hospital systems and improved technology for web-based meetings.”

The PAF is a patient’s first step in preparing for surgery.

It provides a centralized approach to perioperative care by uniting all pre-admission services and day surgery preparation in one physical area. Preparing for surgery includes pre- and post-op education and some medical testing. Patients learn when to stop taking medications and what to expect after surgery.

The facility is now able to conduct about 15 per cent of all appointments by either telemedicine or telephone.

Telephone consultation is best-suited for patients who JUNE 2016 | IN TOUCH | 6

are undergoing low-risk surgery and meet specific criteria. In collaboration with the hospital’s anesthesia department, nurses can conduct the standard preoperative assessment over the phone, saving patients and their families’ personal time.

The telemedicine program, in collaboration with the Kingston Regional Bariatric Care Centre, allows physicians and clinicians at St. Michael’s to connect camera-to-camera with those in Kingston. Lab tests are conducted by a patients’ personal health-care team and they are able to stay close to home until it’s time for their surgery.

While based on patient and family feedback, the changes are also a part of the hospital’s Improvement Program, an initiative to improve efficiency while maintaining – or even improving – patient care.

“We love the new space,” said Rudyk. “But we love to improve how we care for patients even more.”

THE NEW PRE-ADMISSION FACILITY, BY THE NUMBERS:

Approx. 9,400 square feet 16 exam rooms 30 staff Typical volume: 54 appointments per day

Respirologist Dr. Kieran McIntyre, respirology RN Lee Monette and Jennifer Carvalho, an administrative assistant, comprise the EASE team, and are pictured with an ultrasound provided by foundation donors. The ultrasound helps with the insertion of a catheter that helps remove fluid collection in cancer patients. (Photo by Katie Cooper, Medical Media Centre)

Enhancing quality of life for cancer patients

By Melissa Di Costanzo

Patients with cancer experiencing a build-up of fluid around their lungs (also called a malignant pleural effusion) will be able to breathe easier, thanks to an initiative that improves quality of life and either keeps them out of the hospital or ensures they are discharged earlier.

The Early Assessment of Symptomatic Effusion (EASE) program allows patients to have a catheter (or in some cases, catheters) inserted between the lung and chest wall. The catheter helps to remove fluid that collects in this area (also known as pleural effusion) due to cancer cells that block drainage. This blockage causes patients to become short of breath, often leading to a hospital admission that can last as many as 15 days.

The insertion of a catheter is an outpatient procedure that takes less than 20 minutes. Dr. Kieran McIntyre, a

respirologist, follows up with patients and nurses make regular home visits to drain the fluid. In some cases, the catheter can be removed, as the fluid does not return.

“It’s a much less invasive process than pleurodesis, which may require surgery and may not work in all cases,” he said.

“Some patients are not even candidates to undergo this procedure, and are left without options.”

Recovery from pleurodesis means patients require up to a three- to five-day hospital stay, which is not ideal for many patients.

Now, instead of staying at St. Michael’s, patients with this kind of cancer and shortness of breath are flagged as soon as they come to the Emergency Department or are seen in outpatient clinics with symptoms including shortness of breath.

The EASE program team is called and

offers patients the option of receiving pleurodesis or a catheter, often on an outpatient basis.

“Catheters enable patients to experience better quality of life at the end of their lives,” said Dr. McIntyre. “Some even go so far as to book trips with their families to experience lasting memories with loved ones for one last time.”

The program, which started here in 2011, was initiated by a team from Respirology with support from Complex Care. It also involves members from Hematology/ Oncology, and Thoracic Surgery. A total of 85 patients have been followed, and the program is being expanded to allow patients with malignant ascites, or fluid in the abdomen, to also benefit from longterm drainage and relief of symptoms.

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Q&A

CIAN KNIGHTS

(Photo by Katie Cooper, Medical Media Centre).

By Marc Dodsworth

Cian Knights is the community engagement specialist for St. Michael’s Academic Family Health Team. She’s based at the Sumac Creek Health Centre in Regent Park but represents all six sites.

Q: What does the Family Health Team’s community engagement specialist do?

Part of my job is developing connections to resources within the community. I work to build partnerships that enhance our St. Michael’s family practice services and meet the needs of patients, their families and the community. For example, I recently joined a network of local agencies to explore how the FHT can play a role in filling health service gaps at a seniors building in Regent Park.

The Community Residents’ Panel, led by the hospital, is another example of how the Family Health Team is working to collaborate with community residents to implement their input toward strategic priorities for the hospital.

Q: Why is community engagement important?

Our hospital’s history is rooted in being community-connected.

My role is about using community engagement to reduce health inequities by reaching disenfranchised patients, community members and community organizations. Knowing how the

INTOUCH

JUNE 2016

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

community and its members feel leads to more informed decision-making. Engagement also increases community partners’ involvement and responsibility, produces more ideas and options for improving care, leads to better access and outcomes, and increases transparency and accountability.

Q: Did you have any connections to Regent Park before working with the Family Health Team?

Before I joined St. Michael’s, I had implemented a few projects in Regent Park, including equity education training and youth development programming. Because of that, I was already familiar with some of the key players in the area and understood the community’s history. This knowledge provided a network to start building with.

Q: What is the hidden gem of Regent Park?

There are a few. One is the spirit of Regent Park residents. They are passionate about their community and transforming it into a place where all, young and old, can thrive. Another is Daniels Spectrum –Regent Park’s cultural hub—which has helped incubate community arts in the area. Finally, the restaurant Sukothai is a must for Thai food lovers!