INTOUCH MARCH 2017
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Katherine Spraggett, a home hemodialysis patient, detaches her own tubing with home dialysis nurse Ramona Cook. (Photo by Yuri Markarov, Medical Media Centre)
Patients and families road-test home hemodialysis machines By Emily Holton
It was time to decide on a new model of home hemodialysis machine, and Elizabeth Anderson, the clinical leader-manager of the Home Dialysis Unit, wanted to be sure she got the decision right. Because the current models have become obsolete, St. Michael’s is in the market for a full fleet of 40 machines. “I need to make sure these machines work well for three groups: our nurses, our biomedical technologists and our patients,” said Anderson. “But our patients’ needs far outweigh the others.” Anderson wrote to all her home hemodialysis patients to invite them to have a say in the decision. Interested patients and their families came to the clinic to check out the new options, try full hemodialysis sessions if they wished and score their experiences in a short questionnaire. Printed on 100 per cent recycled paper
“I’m grateful she asked for my input,” said Kathryn Spraggett, who has been doing home hemodialysis for 13 years. “I’m the one who has to operate and clean this machine. The details really affect my life.” Hemodialysis is a treatment that does the kidneys’ job of clearing waste and extra fluid from a patient’s blood. The patient’s blood travels through a needle and plastic tubing to a filter inside the dialysis machine, where it is cleaned and then returned back into the patient’s arm. This process takes several hours, and usually needs to be performed several times a week. Sometimes, patients can learn to safely perform and manage the hemodialysis process themselves. In those cases, St. Michael’s lends the patient a dedicated machine that they can keep at home. “The machine takes up a good portion of my bedroom,” said Spraggett. “So I need to be able to move it around. Once I’m hooked up,
all the controls need to be within reach. I dialyze overnight, so noise is also a huge issue. The one I’ve got at home sounds like a train beside my head.” Spraggett said she was hoping for a new model that minimized the need for extra gels. The containers are big and heavy; she and her husband built a dumbwaiter into their home to help move the jugs and boxes around. Ted Bates, also a home dialysis patient, agreed. “We have to store a month’s worth of products at a time,” said Bates. “I have a large dresser and half a closet dedicated just for supplies.” Bates’ partner has also come to the clinic to check out the machines. “He probably does half of the setup; he’s half my process,” said Bates. “He wanted to give his input as well.” MARCH 2017 | IN TOUCH | 1
OPEN MIKE with Mike Mendonca:
Vice-President, Facilities and Support Services
visitors find their way and looking out for and supporting one another.
With construction throughout the hospital, it may feel like St. Michael’s is a different place every time you come through the hospital doors. As our contractor moves into new areas, it can be difficult to keep up with the changes, moves and closures. And it’s tough to stay patient with ongoing noise, vibrations, elevator delays and other disruptions. Despite these challenges, when I walk through the hospital I continue to see a commitment to St. Michael’s values every day, in keeping with those of the Sisters of St. Joseph who founded the hospital 125 years ago. I see compassionate staff providing exceptional care, helping patients and
more about this interesting architectural feature of the new tower on Page 4 of this issue of In Touch.
St. Michael’s may have a new look for its 125th anniversary, but it has the same feel.
The contractor is also busy completing the tower’s interior – eight new operating rooms, two new ICUs and enlarged orthopedic, oncology and respirology inpatient units. Work also continues on the bright and spacious lobby, the new front door to the hospital. By the end of the year, some areas of the tower will be operational, and we’ll be preparing for the demolition of the Shuter Wing.
Despite the difficulties of construction, the good news is that many exciting new spaces will be finished this year. In the spring, the first phase of the Slaight Family Emergency Department will be complete. The new “acute area,” designed to treat ill and injured patients who are unable to move on their own will open, with new equipment, improved privacy and more space. This year the Peter Gilgan Patient Care Tower will also be completed. Currently, the curtain wall, made up of windows covering the building’s exterior, is almost fully installed. The contractor has also started work on the cantilevered hallway on the 5th floor. You can learn
Despite the challenges, there’s a great deal to celebrate this year, both new and old. As St. Michael’s continues a journey of physical transformation, our culture and values will remain. Thank you for your ongoing patience and support. We couldn’t have done this without you.
TWO HUNDRED NEW BEDS ARE BEING ROLLED OUT ACROSS THE HOSPITAL THIS MONTH FEATURES INCLUDE: built-in scale integrated bed extender bed exit alarm capacity to incorporate new technology MARCH 2017 | IN TOUCH | 2
Follow St. Michael’s on Twitter: @StMikesHospital
Ophthalmic technician Vladimir Evlampiev takes pictures of Eustace Nembhard’s right eye using wide-angle angiography. (Photo by Yuri Markarov, Medical Media Centre)
Retinal unit eyes better safety with new technology By James Wysotski There’s no limit to better, even for the largest retina unit in the country. The Eye Clinic at St. Michael’s already uses a diagnostic machine that is unique among Canadian hospitals and soon it will get another kind that’s even better, said Ophthalmologist-in-Chief Dr. David Wong. Since July 2016, the clinic has been taking pictures of blood vessels at the back of the eye using wide-angle angiography, which involves injecting fluorescein dye into a patient’s arm that flows to blood vessels in the eyes and allows them to be seen more easily by doctors’ cameras. Typically, angiography machines offer a narrow field of view, but the hospital’s wide-angle unit allows St. Michael’s physicians to see more than anyone else in Canada, said Dr. Wong. By injecting a second dye, indocyanine green, the field of view expands to the retina’s periphery. “We’re finding diseases in the eye that we couldn’t see in the past,” said Dr. Wong. “Now, we can actually view what we had
always assumed to be true.” Dr. Wong said the clinic sees a lot of people with diabetes, but also vascular diseases such as hypertension and eye strokes. There’s also talk of detecting Alzheimer’s disease earlier through thinning of the retina. The clinic also deals with uveitis – inflammation of the eye – and Dr. Wong said that once inflammation is found in the eye, it’s usually somewhere else in the body, often in the form of arthritis, colitis or Crohn’s disease. “We’re defining what’s normal and, ultimately, what’s abnormal,” said Dr. Wong. “And it’s changed the way we do patient care.”
Instead of injecting dye to see the eye’s blood vessels, new optical coherence tomography, or OCT, machines use lasers to obtain cross-sectional images non-invasively. The technology scans so quickly that “we can actually see the retina in living detail,” said Dr. Wong. Like many clinics, St. Michael’s already owns OCT machines. However, Dr. Wong said that by fall, the hospital will be the first in Canada to get the next generation of the technology, swept source OCT, which provides a wideangle view and even greater resolution.
Diagnostics used to be somewhat qualitative, said Dr. Wong, but the new machines offer enough scope and refinement to make accurate measurements down to five onethousandths of a millimeter. As a result, therapies are safer since the effectiveness of drug treatments can be better evaluated.
The new machine has other benefits. While the technology with the dye requires 20 minutes with a nurse and a photographer, OCT needs one technician for just two minutes, meaning that more patients can be seen at less of a cost to the health-care system. And since two per cent of patients have an allergy to the fluorescein dye, OCT’s non-invasiveness improves safety.
As good as wide-angle, fluorescein angiography is, the future is digital.
“We’re going from a safe technology to an ultra-safe one,” Dr. Wong said.
St. Michael’s is an RNAO Best Practice Spotlight Organization
MARCH 2017 | IN TOUCH | 3
Windows have been installed on every floor of the 17-storey Peter Gilgan Patient Care Tower except 5, 11 and 12. Installing the cantilevered perioperative corridor on the fifth floor will be one of the last structural elements to be erected. (Photo by Yuri Markarov, Medical Media Centre)
Walking on air By Kate Manicom
Building in the confined spaces of downtown Toronto takes creativity. In the case of the Peter Gilgan Patient Care Tower, it means building into the air over the Victoria Street sidewalk with a cantilevered corridor. The glass-covered hallway, which will run alongside the new operating rooms on the hospital’s fifth floor, will be attached to the west side of the new tower and suspend over the street. The innovative design combines functional and architectural features. It frees up space to allow the hospital’s operating rooms to incorporate new and future technology and upholds best practices in health-care design, while showcasing activities inside the hospital. Although the windows of the corridor will be glazed to protect patient privacy, movement will still be visible from below.
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We saw the glass corridor as an opportunity to show the inner workings of St. Michael’s. It reveals the choreography of the hospital.
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– Matthew Smith, Principal, Diamond Schmitt Architects
“We saw the glass corridor as an opportunity to show the inner workings of St. Michael’s,” said Matthew Smith, principal at Diamond Schmitt Architects and head of Planning, Design and Compliance for St. Michael’s 3.0, the hospital’s redevelopment MARCH 2017 | IN TOUCH | 4
project. “It reveals the choreography of the hospital.” It is an extension of Diamond Schmitt’s designs for the hospital that move away from heavy stonework and instead, according to Smith, incorporate transparency and light to reinforce St. Michael’s connection with the community. The cantilevered corridor also allows for larger operating rooms than what the hospital now has. The new ORs were designed to take advantage of developments in surgical technology, where imaging equipment can be integrated directly into the ORs. “The footprint of the tower site is narrow,” said Smith. “The size works for the layout of intensive care and inpatient units, with rooms on either side of the hall and a core of nursing stations down the middle. But surgical floors need more floor space.” Catherine Hogan, program director of Perioperative Services, compared the ideal design of a perioperative unit to a race track built around a sterile centre. The core contains surgical supplies, surrounded by operating rooms, then ringed by a clean corridor where patients and scrubbed staff and physicians travel to and from the ORs. “It’s the model we currently have at St. Michael’s,” said Hogan. “But with larger ORs, we need to take up some space in the great outdoors for our clean corridor.” The corridor will be one of the last structural elements to be erected on the tower. One end will connect to the existing Cardinal Carter Wing, linking new and old facilities.
Margaret Harvey, with orthopedic trauma surgeon Dr. Aaron Nauth, stands in front of St. Michael’s, where she was treated after being hit by a garbage truck in 2012. (Photo courtesy of Bruce Zinger)
New group provides resources and peer support for trauma survivors By Kelly O’Brien
After she was hit by a garbage truck in 2012, doctors told Margaret Harvey’s husband she had only a 30 per cent chance of survival. Harvey pulled through, but the road to a full recovery would prove long and difficult, both physically and emotionally. After being treated for a few weeks at St. Michael’s Hospital, she was transferred to another hospital, and then a private retirement home to complete her rehabilitation. When she returned home, she realized how much her trauma had changed her life. “I thought that when I went home, I would be better, but I wasn’t, and it took me a while to realize that things were just beginning,” she said. She tried to go back to work, at the Terry Fox Foundation, but she said even one day a week was too much for her, so she was forced to take medical leave. It was then that she discovered the Trauma Survivor Network. “I felt so alone, and I thought, who has been through this? I need to talk to somebody so I can know how this is going to end for me,” she said. “I couldn’t sleep and I was up all night, so I went online and found it, and I thought, this is exactly what I need.” However, there was no Trauma Survivor Network branch in Canada. She approached St. Michael’s Hospital with the idea of establishing a group to connect outpatient trauma survivors with support services. The group, called My BeST (Beyond Surviving to Thriving), is being organized by Harvey and Amanda MacFarlan, a trauma
registry manager and quality improvement specialist at St. Michael’s, along with a committee including social workers, trauma surgeons, psychiatrists, physiotherapists, patient experience advisers and spiritual care providers. The group will help trauma survivors manage the psychological and social impact of their injuries. “You can fix bones and you can fix muscles, but you also need to treat minds, and you need to respect that when someone goes through a physical trauma, their whole life could change on a dime,” said Harvey. “How are you going to deal with that?” How people deal with trauma is determined by a number of different factors, Harvey said. She was lucky to have the resources necessary to seek out the treatment she needed. My BeST aims to help people who don’t have access those resources on their own. “I was so lucky that I had a home, money, kids, people around me, I had lots of support,” she said. “But a lot of people don’t have any of that, and trauma has very real impacts on peoples’ mental health, so it’s something that needs to be addressed.” Harvey said she wants people to understand that post-traumatic growth is possible. “People go through trauma every day, and they can move past it, but first they need to address it,” she said. “If we offer the help and people seek the help, they can improve, they’re not doomed to have post-traumatic stress disorder forever. You can move on from that.” MARCH 2017 | IN TOUCH | 5
Dr. General Leung, one of the co-founders of MIMOSA, inspects the device designed to detect poor blood circulation in the feet. (Photo by Katie Cooper, Medical Media Centre)
Early-detection tool improves foot surveillance for patients with diabetes By Kelly O’Brien
More than 3 million Canadians have diabetes, a number that has nearly doubled since 2002 and continues to grow. They have tools to manage their glucose levels, but not to manage foot wounds that often lead to infection and amputation. MIMOSA (Multispectral Mobile Tissue Assessment Device) is an early-detection tool developed by Dr. Karen Cross, a surgeonscientist at St. Michael’s Hospital, and Dr. General Leung, a magnetic resonance physicist at St. Michael’s. The device detects poor blood circulation in the feet, which can lead to diabetic foot ulcers, by photographing the skin with near-infrared light. “It’s just beyond the range of human vision , so it’s safe, but also it has deep penetration into the skin, so it’s going to get below that top layer,” said Dr. Cross. “It can see things that we can’t.” Dr. Cross likened the light MIMOSA uses to the technology used to discover that Leonardo da Vinci was the artist behind The Adoration of the Magi, the painting most often attributed to Filippino Lippi. The light allowed art historians to view the different layers of the painting without damaging it. “We’re doing the same thing,” said Dr. Cross. “Before, to see how much hemoglobin you have, you’ve got to take blood. You’re damaging something by putting a needle in there. We can actually do it by not damaging anything.” Between 15 and 25 per cent of people with diabetes will have a MARCH 2017 | IN TOUCH | 6
foot ulcer at some point. These ulcers often become infected and as a result, diabetics are 23 times more likely than the general population to have a lower limb amputation. The technology MIMOSA uses to monitor wounds was originally developed as an early detector and triage tool for determining burn depth. But what has changed is the size of the tool. “Because of the way the technology’s changed, and because we have so much computing power in our pockets with our cell phones, we’re able to shrink it down,” said Dr. Leung. “So now it’s evolved from being ten or twelve feet tall to being a little clip-on device.” The device is designed to work for all diabetics, no matter their age or level of mobility. “This is something you could put on a selfie stick and put it down below and take a picture,” said Dr. Cross. The team has already seen success using MIMOSA to monitor wound development in a recently completed pilot study, and will soon begin work on a two-year, multicentre randomized controlled trial. Evidence has also shown prevention strategies such as MIMOSA can result in a 20 to 40 per cent reduction in treatment costs. “Diabetes is a global tsunami,” she said. “More than 300 million people worldwide have diabetes, and that number is only growing. So something that can be made quite simply and can reduce those costs is an easy sell. That’s what we want to do.”
Dr. Darren Yuen holds a slide with samples of scarred kidney tissue. He and Dr. Richard Gilbert are two-thirds of the co-founders of a new company called Fibrocor. (By Katie Cooper, Medical Media Centre)
St. Michael’s scientists “mind” their own business By Geoff Koehler
Dr. Richard Gilbert, head of the Division of Endocrinology and Metabolism for St. Michael’s Hospital, and Dr. Darren Yuen, a nephrologist with the hospital, work together on cases where diabetes and kidney disease intersect. Also scientists with the Keenan Research Centre for Biomedical Science, they both have labs on the 5th Floor of the centre. On top of stethoscopes and microscopes, the pair has added business scope to their frequent discussions—with the launch of a company called Fibrocor. Drs. Gilbert and Yuen are two of the three scientific cofounders of Fibrocor, who will work to identify targets and develop therapies to prevent, slow and ultimately reverse organ scarring. “Scarring, or fibrosis, can help people in the short-term—such as healing after a cut or sealing off an infection so that it does not spread—but when an injury is chronic, such as with diabetes, the amount of scar tissue formed can cause organ malfunction,” said Dr. Gilbert, who also holds the Canada Research Chair in Diabetes Complications. The researchers and fellow co-founder Dr. Jeff Wrana, a professor in the University of Toronto’s Department of Molecular Genetics and senior investigator at Mount Sinai Hospital’s Lunenfeld-Tanenbaum Research Institute, will test biopsy samples of scarred human tissue. They will measure
which genes the body activates when scarring begins. “Once we know what pathways are involved in activating the body’s scarring response, we’re well on our way to understanding how to block it,” said Dr. Yuen. “And because we’ll identify these pathways using human tissue samples, we think they’ll have a much better chance of being effective in future clinical trials.” Although scarring underlies the development of liver failure, heart failure and certain type of lung disease, the company’s initial focus will be on kidney disease—reflecting Dr. Gilbert’s and Dr. Yuen’s clinical backgrounds and the tremendous unmet need. By 2018, Fibrocor expects to have developed a new antiscarring drug that will be ready for testing, not only in kidney disease but also in other diseases that involve fibrosis, the doctors said. The world-class academic team is complemented by management and business development from MaRS Innovation and drug discovery and development services from Evotec AG. “Because drug development is incredibly expensive and most granting agencies don’t fund this sort of activity, forming the company was a necessity,” said Dr. Yuen. “With Fibrocor, we’ll be part of the developmental strategy, taking our knowledge from the clinic, to the lab, to the boardroom and, hopefully, all the way back to the bedside.” MARCH 2017 | IN TOUCH | 7
Q&A
By Leslie Shepherd
A.J. (ART JEROME) LOPEZ CLINICAL LEADER MANAGER, NURSING RESOURCES TEAM
A. J. (Art Jerome) Lopez is the clinical leader manager of the new Nursing Resources Team Q: What is a nursing resource team? It’s a team of staff nurses dedicated to covering vacations, absences and other short-term vacancies. It’s made up of nurses equipped with the knowledge, skills and judgement to work in various clinical setting. It’s designed to ensure that St. Michael’s can properly staff units and continue to provide the best quality patient care. Q: What kind of people would enjoy working on an NRT? We’re looking for dynamic and energetic nurses who have a knack for forming collaborative relationships with various teams and therapeutic relationships with various patient populations. Nurses who are interested in practicing in a variety of patient care settings, caring for a broad range of patients, integrating with several teams across the hospital -- while developing a broad range of skills -- will find the NRT to be enjoyable and professionally rewarding. Q: Why did you want to become a nurse? I always knew I was going to work in health care. After researching roles and reflecting on my career goals, nursing resonated the most. It’s a profession that provides many opportunities, such as direct patient and family care, administration and research. It provides boundless opportunity to positively impact patient care at local and system levels.
INTOUCH
MARCH 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: You were a director of hospital operations. What about that role prepared you for being the clinical leader manager of the NRT? It gave me valuable insight into process, practice and culture through an organizational lens. Having a bird’s eye view of the hospital has given me a firm understanding of the challenge of maintaining staffing to care for patients around the clock. Q: You and your wife recently had a baby. Any stories you want to share? We were recently blessed with our third child and when I mention that I have three kids, almost everyone is surprised by the “big number.” They’re taken aback even more when I say (up until a month ago) my wife and I have three kids under 3 years old. It’s a busy time for our family, but a time I absolutely love. Thank goodness for my wife – the rock of our family! Q: Tell us about an “I love my job moment” you have experienced. I have had the privilege of being mentored and supported to grow as a leader and I try to do the same now for others. A colleague recently said that when I speak, she listens, and tries to model her practice after me by being genuine, collaborative and thoughtful. She said she respected me as a leader. I’m so humbled to have the opportunity to influence the development of leaders and professional practice.