OUR SHARED PURPOSE June 2019
Unity Health working together X-ray readings for Providence an example of integration (pg. 3)
St. Joseph’s paediatrics program turns 70 How care has changed over the last seven decades (pg. 7)
Honouring the wishes of RESEARCH ICU 101 patients How the program is What it Three takesWishes to providing innovatecomfort (pg. 4) during difficult times (pg. 4)
Giving MS patients more power How the new BARLO MS Centre will redefine care (pg. 8)
Brand new unit opens for St. Joseph’s patients How our Reactivation Care Centre at 200 Church Street is providing specialized care (pg. 2)
Another integration milestone
St. Joseph’s opens new 30-bed unit
Digital connections bringing Unity Health sites closer than ever
Features include shared therapy and dining spaces
by Emily Dawson
by Amber Daugherty
(L to R) Ashley Machado, administrative assistant, Dr. Ashley Verduyn, interim chief and director, medical affairs, Sonia Ramdeo, medical radiation technologist (Photo: Katie Cooper)
St. Joseph’s new Reactivation Care Centre is providing specialized care to patients at 200 Church St. (Photo: Yuri Markarov)
There’s a bright, new space where St. Joseph’s Health Centre
unconventional spaces, like hallways. St. Joseph’s often experiences
After six months of planning, testing and training, St. Michael’s
we opened access to Providence’s patients to receive MRI and CT
patients are receiving care – at 200 Church Street.
surge periods where patients wait longer than usual to be admitted
Hospital radiologists are beginning to read Providence Healthcare
scans at St. Michael’s in dedicated time blocks every week. We
to a bed on one of our units.
patient and residents X-ray exams, marking an important milestone
have seen a positive improvement in wait times for patients, and this
May 5, welcoming patients who need a little more therapy before
for service integration at Unity Health Toronto.
efficiency has created a better patient experience.
being able to return home, to rehab or another care location.
part of Humber River Hospital. With government funding, it’s been
“We’re so excited to have this beautiful unit to treat our patients
renovated to accommodate patients from multiple different hospitals,
been able to have X-rays taken at Providence, we
in,” said Melissa Morey-Hollis, administrative program director of
also including Humber and Sunnybrook. The patients there no longer
didn’t have the organizational capacity or resources
Medicine and Seniors Care.
require acute care in a hospital so the focus is on occupational,
to read the exams,” said Dr. Ashley Verduyn, interim
physical and recreational therapy to get them back to their normal.
chief and director of medical affairs at Providence.
the next stage of their care journey and it’s got some great features
including shared therapy spaces and communal areas where patients
building are shared, but all of the care on our unit is provided by
at Providence and St. Michael’s can jointly review
will eat together.”
St. Joseph’s employees,” said Morey-Hollis.
X-ray reports through a single, integrated system.
“St. Joseph’s Reactivation Care Centre – Church unit opened on
“It’s specialized for those patients who are close to moving to
The new unit is part of the provincial government’s plan to end
200 Church St., where the new unit is located, was previously
“It’s a fantastic model because many of the resources in the
“Patients there are receiving the same great care they’ve
“Although patients and residents have always
With this new initiative, physicians and clinicians
Together, we’re harnessing the power of digital connections for higher
“This facilitates better communication between
“hallway medicine” – hospitals across the province are operating at full
experienced at the health centre — with a special focus on that last
the diagnostic imaging teams within the network, while
or close-to-full capacity, meaning some patients are receiving care in
bit of recovery before they’re well enough to leave.”
helping to bring a new level of electronic readiness to
DR. ASHLEY VERDUYN
INTERIM CHIEF AND DIRECTOR OF MEDICAL AFFAIRS PROVIDENCE
Providence,” said Dawn-Marie King, Our Shared Purpose is a monthly newsletter highlighting our people and the ways they are improving care, patient experience and the health of our communities.
St. Michael’s director of Medical Imaging and Laboratory Medicine.
Learn more: www.unityhealth.to
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OUR SHARED PURPOSE
“If patients have had MRI or CT tests at St. Michael’s, the radiologists can now see the complete imaging reports, including their X-ray results,” said King. This was highly co-ordinated through extensive work between Unity Health’s Information Technology, Radiology, and Imaging Picture Archiving Communications System teams. “We’re grateful to the teams involved that brought
this opportunity to fruition. Together, we’re harnessing the power of digital connections for higher quality care and operational excellence,” said Dr. Verduyn.
The first diagnostic imaging collaboration began in 2017 when
OUR SHARED PURPOSE
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Three Wishes honours lives of ICU patients More than 500 wishes have been granted by St. Michael’s staff to celebrate the lives of patients who die in the Intensive Care Unit by Michael Oliveira
Clockwise from top left: Smith and Henderson during a vacation in Squamish, B.C., taken about a month before he died. A closeup of the skateboard designed with Three Wishes. Henderson holds her original “Pinterest fail” footprint —staff helped her refine how to take the footprint for the final design. (Photos: Yuri Markarov)
Ashley Henderson holds the commemorative skateboard designed through Three Wishes to honour her late husband Darrell Smith. Orla Smith, co-leader of the Three Wishes program at St. Michael’s, holds the footprint that staff helped create for the skateboard. (Photo: Yuri Markarov)
fatigue, and so bringing back that humanity and linking it to the human
through the tension of such a raw experience, and brought a little bit of
take away and cherish for the rest of your life, it’s incredible.”
experience of dying I think is profound for all those who are involved.”
life back into the room. It was a moment of normalcy within a situation
world. He was a talented photographer with a passion for shooting on
that was anything but normal,” she said.
black and white film and developing his work in a home darkroom.
Healthcare in Hamilton with a mission to improve the experiences of
Three Wishes program and documented over 500 wishes.
And, he was the love of Ashley Henderson’s life.
patients, families and clinicians in the ICU by empowering staff to grant
laugh in the face of this horrific situation — was really quite touching
a number of low cost but emotionally powerful wishes.
bedside, to other more individualized things like having patients dressed
and beautiful and what it resulted in is incredible.”
Intensive Care Unit on Sept. 3, 2017, on the couple’s seventh anniversary
in their favourite hockey jersey when they’re passing,” said Smith.
and two days before what would have been his 34th birthday.
study if the project could be scaled out to other hospitals, explained Orla
store, the Blue Tile Lounge Skateboard Shop, and sold to Smith’s family
Smith, a registered nurse and scientist with the Li Ka Shing Knowledge
arrangements for loved ones who may actually want to be interned in
and friends in the skateboarding community around the world.
days earlier, when he was struck by a car on his way home. He never
Institute.
other countries, and in partnership with Spiritual Care, we organized a
regained consciousness and the decision was ultimately made to take
wedding to take place at the bedside.”
own clothes before his family said goodbye.
him off life support.
the lives of patients who end up dying in the ICU, a very technologically
“That week and a half was so traumatic and you’re so numb the
advanced environment where it can be difficult to see past the
personalized feature to add to a custom memorial skateboard. They
entered the room that morning to take him off life support it was this
whole time. In those moments your brain isn’t there and it’s raw and
equipment and monitors to the person, and our shared humanity,” said
discussed painting one of her common-law husband’s feet to create a
moment where it was him again, because for the whole 10 days it wasn’t
emotional and you’re kind of just going through the motions,” recalled
Smith, a co-leader of the program at St. Michael’s along with Dr. Andrew
footprint that would be applied to the special skateboard, exactly where
him to me,” Henderson said.
Henderson, who was then 34.
Baker, chief of the Department of Critical Care and medical director of
his foot would be when he was riding.
the Trauma and Neurosurgery program.
forever was really important to me.”
tragic and bleak.
“And we not only think about how we can do things to honour the
helped create a better version of the footprint that worked perfectly. The
But then to have the Three Wishes program introduced — to have
patients but also what could we do to support the families in their time
process of designing this aspect of the skateboard with other family
a very good friend who passed away from cystic fibrosis, so him being
someone reach out to you with an idea to honour your loved one —is so
of grieving, and what could we do to support staff who bear witness to
members was powerful and uplifting during an impossibly difficult time,
able to donate his organs, that was his wish,” Henderson said.
incredibly important because it’s not something you would think about
this.
Henderson said.
in that moment.
At age 33, Darrell Smith had been an accomplished professional
skateboarder with a community of friends and admirers around the
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Smith died at St. Michael’s Hospital’s Trauma and Neurosurgery
But Henderson says she truly lost her common-law husband 10
“You’re in this stark environment and everything’s so traumatic and
OUR SHARED PURPOSE
To have this experience offered to you with something you can The Three Wishes program was conceived at St. Joseph’s
Three Wishes was adopted at St. Michael’s through a partnership to
“The idea was to think about how we could recognize and celebrate
Staff who work in the ICU are at risk for burnout and compassion
St. Michael’s has since honoured over 150 patients through the “They’ve ranged from very simple things like playing music at the
“We’ve also helped families make complicated funeral
For Henderson, the Three Wishes team helped create a
Henderson jokes her first attempt was a “Pinterest fail” but the staff
“To share this time together and kinda laugh — like genuinely
Over 200 of the memorial skateboards were produced by a local
For another wish, the ICU staff had Smith dressed in some of his “I gave the nurses one of his tuques and a cardigan and when I
“Just to have a little piece of him back for that hour before I lost him A wish made on behalf of Smith was to donate his organs.“He had
“Overall, it all came together so beautifully.”
“Sharing that human moment of creating art in a playful way cut
OUR SHARED PURPOSE
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REPEAT ED VISITS FOR ADULTS WITH DEVELOPMENTAL DISABILITIES AND PSYCHIATRIC DISORDERS Adults who have both psychiatric disorders and developmental disabilities are more likely to visit the emergency department repeatedly than adults with one of those conditions only, according to a new study by Dr. Anna Durbin, a scientist at the Li Ka Shing Knowledge Institute. The research was recently published in the American Journal on Intellectual and Developmental Disabilities. “This study begs the question of whether there needs to be a different response to adults with developmental disabilities and psychiatric disorders during and after the initial hospital contact,” Dr. Durbin said.
THE IMPORTANCE OF EARLY MOBILIZATION FOR OLDER ADULTS Early mobilization can be tailored to different clinical contexts with the same benefits to patient mobility, suggests a study led by St. Michael’s researchers and published in BMC Geriatrics. “When we admit older adults to hospitals, the first thing we do is put them to bed - and we don’t routinely assess and optimize their mobility,” said Dr. Sharon Straus, interim physician-in-chief at St. Michael’s and director of the Knowledge Translation Program at the Li Ka Shing Knowledge Institute. Her team tailored, implemented, and evaluated the effects of an early mobilization program called Mobilization of Vulnerable Elders (MOVE) on different inpatient units. With tailoring, they found MOVE could be implemented in several inpatient units. Dr. Sharon Straus is the interim physician-in-chief at St. Michael’s and the director of the Knowledge Translation Program at the Li Ka Shing Knowledge Institute. (Photo: Yuri Markarov)
SHARING MEDICAL IMAGING DATA STUDY PREDIABETES TO CUTHIGHLIGHTS RADIATION DOSES RISKS IN IMMIGRANT POPULATIONS Patients might expect radiation doses for CT scans to be comparable from one hospital to the next, but a team at A new study highlights the need for health care providers to consider St. Michael’s Hospital says the dose variance can be startling. early diabetes prevention strategies for immigrant populations, The team is collecting and analyzing data from eight hospitals says corresponding author Dr. Ghazal Fazli. The study, co-led for the Medical Imaging Metadata Repository of Ontario (MIMRO) by St. Michael’s and ICES and published in BMC Medicine, finds to help reduce the province’s average radiation dose per scan. non-European immigrants in Ontario had a substantially higher Using artificial intelligence to sort the hospitals’ data, the team risk of developing prediabetes compared to long-term residents. generated comparative data by facility, scanner and exam to help Compared to Western Europeans, South Asian immigrants had a determine best practices. MIMRO is funded primarily by two-fold higher risk of developing prediabetes and developed it St. Michael’s and was created by two of its radiologists, an average of 15 years earlier. The study calls for the integration of Drs. Timothy Dowdell and Bruce Gray. culturally competent and accessible programs to screen high-risk Radiologist Dr. Bruce and data Concepcion review data populations earlier andGray prevent theanalyst onsetLianne of type 2 diabetes.
Seventy years of paediatric care in Toronto’s west end St. Joseph’s Health Centre has everything needed to care for the children in our community by Amber Daugherty
Parents in Toronto’s west end know that when their child is sick or
At St. Joseph’s, children have access to our paediatric consultation
needs urgent care, help is just a short trip away. From emergency
clinic, which started with endocrinology and nephrology specialized
to walk-in and longer stay support, St. Joseph’s Health Centre has
services and has expanded significantly, now providing outpatient
everything needed to care for the children in our community. And it’s
services including care for asthma, dermatology, cardiology, speech
that support that we’re celebrating this year as we recognize the 70th
and language, nutrition support and much more.
anniversary of our Paediatric program.
“St. Joseph’s is a one-stop shop for parents,” said Dr. Dilip Mehta,
Clinic. Renovated just a few years ago, the clinic has a bright, beautiful
a paediatrician who’s been with the health centre for 35 years and
waiting room for the thousands of visits we see every year. It’s where
helped establish parts of the program.
many in our community bring their children for non-emergent issues
“Over the last seven decades we’ve seen our program expand
and to be referred for other specialized services. And for emergency
in response to our community changing and everything we’ve done
situations, there’s a separate area in our Emergency Department for
has been to make sure families get the care they need when they
those 18 and younger.
need it most – without having to travel far.”
In 1949, St. Joseph’s became the first hospital in the Greater
patients we see at the health centre – as young as 30 weeks old. Our
Toronto Area outside of the Hospital for Sick Children to open a
Neonatal Intensive Care Unit is a level 2C which means we can care
paediatric program. Our inpatient unit grew to where it is today with
for sicker and smaller babies than ever before, helping keep families
17 beds in rooms large enough for family members to sleep over.
close to home during what can be a very challenging time in their
Today, St. Joseph’s and SickKids work together, transferring patients to
lives.
The busiest area in our paediatric program is the Just For Kids
Our paediatric program has also grown to support the youngest
one another depending on the level of care needed and the location that makes the most sense for the family.
submitted to MIMRO. (Photo: Katie Cooper)
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Integrating technology and patient voice in MS care The BARLO MS Centre aims to make the patient experience more seamless for those living with Multiple Sclerosis (MS). by Ana Gajic
MS is a neurological disease with the highest prevalence in Canada. It affects two to three times as many women as men and generally strikes people in their early 30s. While there are treatments, there is currently no cure.
Dr. Xavier Montalban, medical director of the BARLO MS Centre,
Dr. Xavier Montalban is the medical director of the BARLO MS Centre at St. Michael’s and an internationally recognized scientist in multiple sclerosis research at the Li Ka Shing Knowledge Institute. (Photo: Medical Media)
sees patients in the hospital’s current MS clinic and conducts global-
objective disability measures or relapses, but not PROs. Integrating
reaching research into fighting the disease and enhancing the patient
PROs gives patients power.
experience.
PROs. Imagine if a patient tells me today that they think their memory
We sat down with him to learn about the vision for the centre and
MS care at our organization.
We also want to study and understand the predictive value of
is failing and their speed in processing information is slow, but nothing shows up on tests. Then after three years we see that the patient has a
What is a focus area for your team in the lead-up of the BARLO MS
higher degree of disability, as shown by objective tests such as MRIs.
Centre opening?
Patients’ perspectives could impact the way we deliver care.
With the new centre and even before it opens, our team is integrating the importance of the patient voice into our care. We call this Patient-
How will your team work with patients to integrate PROs and
Reported Outcomes, or PROs. PROs track what the patients think
enhance their experience?
is happening to them. You can have PROs for many things, such
We are looking at working with different technology not only to
as quality of life, fatigue, cognitive dysfunction, emotional state or
enable PROs, but also to extend our care. Some of our patients drive
depression.
many hours to see us once a year. Using technology, maybe we can increase their access to us.
Why is it important to measure PROs for MS?
Sometimes there is a clear disassociation between what the
to capture more granular data about MS symptoms than traditional
neurologist thinks and what the patient feels. Nowadays to make a
assessments. This could modify our therapeutic decisions and
decision to switch to a new treatment, you base your decision on
improve the patients’ prognoses.
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Devices such smartphones or smartwatches offer the potential