In Touch Newsletter: October 2015

INTOUCH OCTOBER 2015

Urologist Dr. Jason Lee sets up the da Vinci Surgical System. Dr. Lee was the first surgeon in Canada to perform an autotransplant on a damaged kidney using robotic surgery. (Photo by Katie Cooper, Medical Media Centre)

St. Michael’s urologist first in Canada to perform kidney autotransplant using robotic surgery

By Corinne Ton That

A St. Michael’s Hospital surgical team was the first in Canada to save a patient’s kidney by repositioning the organ with robotic surgery.

Dr. Jason Lee had to choose between removing the damaged kidney and performing an autotransplant – a complicated procedure that preserves the damaged kidney by moving the organ into a new position.

“Unlike patients with kidney failure, this patient’s kidney was still functioning but not draining properly in its current position,” said Dr. Lee, a urologist, who led the surgery.

The patient also had diabetes and high blood pressure, putting her at risk of kidney failure in the future. Preserving both kidneys was important in the event that one kidney failed, said. Dr. Lee. An autotransplant without the use Printed on 100 per cent recycled paper

of robotics would have required a much bigger incision and made for a longer, more painful recovery.

That’s why Dr. Lee turned to the da Vinci Surgical System, a robot that gives surgeons 3D vision inside the patient and greater dexterity and precision than traditional laparoscopic surgery.

“It’s like remote-control surgery – whatever you do on the console, the same moves will occur inside the patient through the robot,” said Dr. Lee. “Robotics allowed us to perform something that would be very difficult with traditional surgery, using safe, minimally-invasive techniques.”

In just two to three weeks following the surgery, Dr. Lee’s patient was doing well and back on her feet, with only a few fivemillimeter scars on her abdomen. An open

incision would have required about six weeks of healing.

St. Michael’s was the first hospital in Toronto to acquire the da Vinci robot in 2008. Robotic systems are typically used in surgeries for prostate, kidney and bladder cancers as well as gynecologic and complex reconstruction surgeries.

While the autotransplant operation isn’t a common use of the da Vinci, Dr. Lee said he hoped to see robotic surgery used more frequently in kidney transplants, which are done about 150 times a year at St. Michael’s.

“Patients who require kidney transplants are usually sick to begin with, so the use of robotic surgery has significant benefits and can decrease risk during surgery,” said Dr. Lee. “As technology improves, surgeons also need to improve to provide patients with better options.”

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OPEN MIKE with Dr. Ori Rotstein

Director of the Keenan Research Centre for Biomedical Science By nurturing collaborative relationships, St. Michael’s is better poised than ever to bring biomedical research discoveries across the bridge and to the patient bedside.

One such collaboration is the establishment of the Institute for Biomedical Engineering and Science Technology known as iBEST. A key part of the Ryerson University and St. Michael’s partnership will be a collaborative space within the Keenan Research Centre of the Li Ka Shing Knowledge Institute. Since the agreement was signed in 2013, St. Michael’s has been working to outfit the shared space for Ryerson faculty and students whose active research involves health care.

collaborations. Some projects that come to mind were presented at this year’s iBEST Symposium, such as using ultrasound to deliver precision medicine to those with lung injury, manipulating sound to track sickle cell disease, and creating models of traumatic brain injury in Zebrafish for testing drugs.

This autumn, the collaborative space became a reality. Ryerson’s engineers, scientists and students have moved in and begun working side-by-side with St. Michael’s biomedical researchers, clinicians and students.

Ryerson’s successful zone learning model has also found a home within iBEST. The Biomedical Zone at iBEST is an incubation space for entrepreneurs, students and clinicians who are working on solutions, applications and devices that have commercial potential in clinical and health-care settings. The Biomedical Zone is led

by Dr. Linda Maxwell, a physician and surgeon with an MBA and a passion for entrepreneurship and business.

I am confident Dr. Maxwell and the Biomedical Zone will help identify challenges and rapidly pilot, modify and introduce biomedical discoveries and inventions to improve health.

I’d like to welcome Ryerson’s iBEST representatives to St. Michael’s. I’m thrilled with the potential of early

This year also marked the St. Michael’s Foundation’s first Angels’ Den event.

The competition, which may help

speed the process of bringing research to the bedside, required clinicians and researchers to pair up and create research projects that may one day impact patient care.

The foundation established a $1-million Translational Innovation Fund to support this competition over two years. Forty collaborative proposals were submitted and, after a scientific review, 10 translational teams were awarded $50,000 each in funding. An additional $100,000 was shared among the top three projects.

These are some examples of the ways St. Michael’s has focused on collaboration and I’m reminded of the African proverb: “If you want to go fast, go alone; if you want to go far, go together.”

St. Michael’s research will go far because our scientists, clinicians and students work with experts from different fields.

These collaborations will help translate scientific discoveries and improve patient health.

In September, the Peter Gilgan Patient Care Tower entered a new construction phase with the installation of a tower crane at Queen and Victoria streets.

Using the second-largest type of mobile crane in Toronto, the process of assembling the tower crane took two days and 15 crew members. With excavation complete and the crane in place, we’re ready to build!

• Height: 316 ft (approximately 22 storeys) • Jib length: 135 ft • Maximum lifting capacity: 16,000 lbs • Number of steps to the cab: 325 OCTOBER 2015 | IN TOUCH | 2

Follow St. Michael’s on Twitter: @StMikesHospital

Emergency Department nurse Kate Coffin and clinical nurse educator Lee Barratt ensure a patient’s documentation is consistent with the information on the patient’s arm band. This helps to ensure his or her blood transfusion is as smooth as possible (Katherine Cooper, Medical Media Centre)

Keeping transfusions flowing for trauma patients

By Melissa Di Costanzo Jane or John Doe trauma patients will no longer experience delays to their transfusions, thanks to an agreement between the Emergency Department and the blood lab.

director of transfusion medicine. “Although we were able to work around it quite rapidly, and eventually did provide these patients with blood, we didn’t want to have to keep running into this roadblock.”

TRANSFUSION FACTS

Trauma patients often arrive in the Emergency Department without any identification. They’re admitted as John or Jane Doe and standard unidentified information is inputted to create a new chart and other identification items, including a wrist band.

Members of the admitting, ER, lab and risk management teams began working together at the start of 2015 on a quality improvement and safety planning initiative that now means information is updated in Soarian only when patients are not actively receiving blood. The admitting clerk now calls the lab before making any changes to John or Jane Doe patient’s health or personal information.

• People in high-income counties donate more blood than in other countries

In some cases, identification is retrieved or brought in to the ED by police or family during a transfusion. The admitting clerk then enters the patient’s real name into the Soarian information system.

However, patients’ armbands, transfusion record labels and transfusion medicine labels must match at all times. If one piece of patient identification is different as a result of a change to the patient’s date of birth or name in Soarian, for example, then no blood or blood products can leave the lab, delaying the transfusion.

“It was a particularly challenging barrier because in some cases, the care team was abruptly prevented from continuing to give these patients blood halfway during a transfusion,” said Dr. Katerina Pavenski,

“Anything that helps the blood lab function and deliver products in a timely fashion also helps us to deliver safe and efficient care,” said Lee Barratt, clinical nurse educator for the ED. “The last thing we’d want to do is cripple the lab’s process, which is why emergency was happy to partner with others to devise a strategy to tackle the issue.”

Transfusion safety nurse Yvonne Davis-Read said communication between the lab and the ED has improved.

• Around 108 million blood donations are collected globally every year

• In low- and middle-income countries, transfusions are used more often for management of pregnancyrelated complications, childhood malaria complicated by severe anemia, and traumarelated injuries Source: World Health Organization

“Once we were able to identify the problem, we knew it was imperative for both teams to be at the table,” she said. “This quality improvement initiative allows us to deliver the best possible care.”

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

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St. Michael returns to Bond Street

By Kate Manicom

The statue of St. Michael the Archangel is returning to the Bond Wing where it stood watch over the lobby from the late 1890s to 1996.

The statue must be moved to a temporary location to protect it during the hospital’s redevelopment project, St. Michael’s 3.0.

The Cardinal Carter lobby, where it now stands, will be turned over to Bondfield Construction for renovations in early 2016 and will ultimately become part of the expanded Emergency Department.

Eventually, St. Michael – commonly known as “the Angel” – will have a permanent home in the Peter Gilgan Patient Care Tower following its 2017 completion.

In the meantime, the historic Bond Wing is the most suitable location for what has become an intrinsic part of St. Michael’s identity. The statue has stood in a hospital entrance for almost as long as the hospital has been open.

In the meantime, the historic Bond lobby is the most suitable location for what has become an intrinsic part of St. Michael’s identity. The statue has stood in a hospital entrance for almost as long as the hospital has been open.

In the late 1890s, the Sisters of St. Joseph – who founded the hospital in 1892 – purchased the statue from a secondhand store on Queen Street for $49 with money they had saved from selling old newspapers. It was blackened with dirt and soot, but they cleaned it carefully and revealed the marble beneath.

“For the sisters, setting the statue of St. Michael at the entrance was like placing the cornerstone of the hospital,” OCTOBER 2015 | IN TOUCH | 4

Feast day: Sept. 29 Patron saint of: grocers, mariners, paratroopers, police and sickness Height: 1.5 metres Weight: Approximately 680 kilograms The statue of St. Michael the Archangel has been located in the Cardinal Carter Wing since St. Michael’s Feast Day in 1996. In early 2016, St. Michael will return to its original home in the Bond Wing. (Photo by Yuri Markarov, Medical Media Centre)

said Filomena Machado, St. Michael’s director of mission and values. “The angel made it feel like home.”

to a pawn shop in Toronto continue to be a mystery.

When the angel was relocated to the Cardinal Carter lobby almost a century later, the movers found a puzzling inscription: the word “Pietrasanta” – a Tuscan town whose marble was used by Michelangelo – was found chiselled in its back.

But the statue’s sculptor, where and when it was carved and how it came

“It’s crucial the angel can be found easily by staff, patients and families,” said Machado. “Regardless of a person’s system of faith, the statue of St. Michael is a symbol of healing and hope. It brings a spiritual comfort to anyone who needs it.”

Nonetheless, its value to those who visit the hospital endures.

Sumac Creek Health Centre: a cut above

By offering a new minor surgery clinic at the Sumac Creek Health Centre, Dr. Jory Simpson will provide surgical care to patients and surgical education to family practice residents. (Photo by Katie Cooper, Medical Media Centre)

By Jordyn Gibson

The Sumac Creek Health Centre opened in July and has already expanded its services for the community of Regent Park. A minor surgical procedures clinic, led by Dr. Jory Simpson, will bring a number of routine surgeries out of the hospital and into the community.

Patients in need of minor surgeries— such as a biopsy to test for skin cancer or the removal of cysts or lipomas, a benign tumour of fatty tissue—often require a referral to a surgeon. These patients will either spend some time on a waiting list or will visit the Emergency Department for treatment if their situation worsens.

“Offering minor surgical services in Regent Park caters to the needs of the neighborhood and may reduce some of the strain on the ED,” said Dr. Simpson.

“Sumac Creek Health Centre even

has part of the St. Michael’s Laboratory Medicine Program and Medical Imaging Department on site so test results and imaging scans are only a few feet down the hall.”

“I’ll be able to treat the lumps and bumps but I’ll also be able to provide education and training to the family health team,” says Dr. Simpson. “Surgical management is a recognized gap in residents’ family practice education.”

Clinical staff at Sumac Creek is given an opportunity to learn more about preand post-operative procedures, wound care and pain management. Dr. Simpson will work with a nurse trained in minor surgery, who will be able to identify signs and symptoms of infections and assist during procedures.

an in-house surgeon and surgical nurse to bounce ideas off,” said Dr. Simpson. “It’s a very collaborative way to practise.”

Dr. Simpson began running the clinic Sept. 28 but the surgical clinic had been incorporated in the planning and design stages of the Sumac Creek Health Centre.

Room #13 at Sumac Creek Health Centre looks similar to the other 29 exam rooms in the clinic, but is outfitted with special surgical equipment such as a cautery machine to help close wounds and a special bed that ensures comfort and perfect positioning of the patient during procedures.

“Having this clinic embedded within Sumac Creek means the clinic staff have OCTOBER 2015 | IN TOUCH | 5

Laser beam test identifies specific strain of bacterial infection

By Heather Brown

Patients suffering from a bacterial infection such as strep throat or methicillin-resistant staphylococcus aureus are being prescribed the right medication sooner thanks to an innovative diagnostic test being used in St. Michael’s microbiology laboratory.

The test, known as the matrix-assisted laser desorption ionization time-of-flight mass spectrometry, can identify a strain of bacteria within seconds, which is what makes this test so advanced. Traditional microbiology tests can take up to 24 hours to produce a result because the bacteria must grow in a small plastic dish, known as an agar plate, before a lab technologist can view it under a microscope and use a series of tests to identify it.

To produce the faster result, a lab technologist takes a sample of the growing bacteria and smears it onto one of the small indents on a small stainless steel plate, then places it into the machine. A laser beams onto the sample, breaking it into tiny particles. The particles are analyzed and matched to strains of bacteria in a database.

Physicians and nurse practitioners use the result to guide antibiotic prescription sooner to treat a patient’s infection instead of waiting for the traditional tests to identify the bacteria.

The lab started using the new test in January and processes approximately 150 tests per day.

“Not only has this test enhanced patient care at the hospital but it has also enabled our lab to operate more efficiently,” said Dr. Larissa Matukas, head of the Division of Microbiology at St. Michael’s. “We are able to report results sooner and have reduced our costs associated with bacterial organism identification.”

Dr. Larissa Matukas, head of the Division of Microbiolog, inserts a stainless steel plate into the mass spectrometry device to identify a strain of bacteria. (Photo by Yuri Markarov, Medical Media Centre) OCTOBER 2015 | IN TOUCH | 6

Registered nurse Stew Granger from the Trauma and Neurosurgery Intensive Care Unit discusses a transfer with 9CC ward nurses Alex Roll and Melissa Farne. (Photo by Yuri Markarov, Medical Media Centre)

Patients win as Ticket to Ward sets bar high

By James Wysotski

Trauma and Neurosurgery has streamlined the Ticket to Ward tool, making it easier to ensure all of a patient’s belongings and valuables are transferred with him or her to the ward and that families know when such moves are taking place.

The tool has been transformed into a legal-style accountability checklist that intensive care nurses present to ward nurses at the time of transfer.

“Before, it was just inconsistent practice,” said Mary Copeland, the clinical leader manager of the Trauma and Neurosurgery ward on 9 Cardinal Carter. “There was no standard way that information was shared. Something like a lack of family knowledge about transfers used to be a common occurrence, but I don’t hear such complaints anymore.”

As a Best Practice Spotlight Organization, it was important and in the best interests of patient care and safety for St. Michael’s to improve the quality of these transitions. Before

the tool was revised, usage by nurses was 25 per cent. An all-time high of 45 per cent was achieved in August. As a result, communications go much more predictably.

“It’s a form the nurses are actually using about things they really want to know about,” said Liz Butorac, the clinical leader manager of the Trauma and Neurosurgery Intensive Care Unit. “Ensuring that transfer orders by physicians are completed is on the form, so they make sure it’s done. I think they’re that much more satisfied because the patient’s transition to the ward is much smoother.”

Registered nurses Alex Manzo, from the ward, and Stew Granger, from the intensive care unit, led the project to improve the form. Each spent time on the other’s unit to learn what needed change, such as making sure patients were actually ready for discharge.

“You’d think that working side-by-side with patients going back and forth that it would be obvious, but it’s not,”

said Copeland. “There were a lot of revisions, such as removing a reference sheet that overloaded the form with too much information. It was a tremendous learning experience with a lot of good stakeholder involvement.”

While all hospital units work on transfer of accountability from shift to shift, Trauma and Neurosurgery’s undertaking differs because it’s at a point of transition from unit to unit. Accreditation Canada identifies such transition points as key areas of focus for patient safety. The refined communications are expected to improve patient outcomes. Similar initiatives will be rolled out in other areas of the hospital.

“Our next step will be to continue to encourage people to use Ticket to Ward,” said Granger. “I am encouraged by the fact that people are taking it seriously and therefore patients are being transferred with care even in urgent transfer situations.”

OCTOBER 2015 | IN TOUCH | 7

Q&A

CATHERINE (KATIE) HOGAN

By Leslie Shepherd (Photo by Yuri Markarov, Medical Media Centre)

Q. You’re the program director of Perioperative Services and the program director of Infection Prevention and Control, plus you volunteered to be one of the first programs to take part in the Improvement Program.

How do you juggle all your responsibilities?

Having a strong support team enables me to delegate some of the work and manage the different focal points in Perioperative Services and IPAC.

Q. What does a typical day look like for you?

I start about 7 a.m., trying to engage with the teams and ensure 7:45 a.m. patient flow for the OR. Throughout the day I have meetings around the building, everything from soup to nuts.

I engage with different teams, usually in problem-solving situations, finding solutions that focus on providing excellent patient care. My day ends around 5:30.

Q. Why did you volunteer to go first in the Improvement Program?

There were several events that allowed us to step forward, including the redevelopment of the ORs and Medical Device Reprocessing Department in St. Michael’s 3.0. The transition from a former director to myself was an opportunity for a good review of the program and identification of areas where we could develop further and strengthen the program’s offerings.

Q. What is the most significant change you have implemented under the program?

The work we did on case cost variation, reducing the variation

INTOUCH

OCTOBER 2015

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.

in products and supplies among physicians performing the same procedure, means we will be more efficient and save $242,000 this year. Standardization also has a positive impact on patient outcomes and safety. We have engaged all members of the team—physicians, support staff and caregivers—all along this important road. Every person has had a voice and an opportunity to come forward with ideas.

It’s important to enjoy working with the group – and to have a good laugh along the way.

We’re starting work now to look at our supply chain, following the model that was developed in Heart and Vascular. A balance must be maintained, to make sure we do not have too much stock on hand, so that products are not wasted or expired, but that we have enough to do our scheduled procedures and significant emergency cases volumes.

Q. You are Dr. Hogan, PhD – where did you go to university and what field did you specialize in?

I have a bachelor of science in nursing and a dual MA in education and administration from UBC. My PhD in nursing from Loyola University’s Niehoff School of Nursing in Chicago focused on patient safety, in particular the prevention of medical errors.

Q. You’re from the Maritimes – what do you miss most about the East Coast?

Fresh fish caught in the morning and served for dinner.