Our Shared Purpose newsletter - June 2019

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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“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

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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