Our Shared Purpose newsletter - November 2019

OUR SHARED PURPOSE November 2019

The role of a clinical ethicist Helping to navigate ethical dilemmas in delivering care (pg. 2)

Supporting patients through transition CHNs help patients return home safely (pg. 3)

RESEARCH MONTH

GROWING TOGETHER

What it takes Across Unity Healthto Toronto, collaboration in Research innovate (pg. 4) is growing. (pg. 4)

New study confirms benefits of cuddling Research finds cuddling by volunteers in NICU reduces length of stay (pg. 8)

Social workers awarded grant for collaboration Grant will fund the first-ever collaboration for social workers across Unity Health Toronto. (pg. 7)

What does a clinical ethicist do?

Transitioning together

Jamie Robertson explains the challenges of

Community Health Navigators help patients

examining the ambiguous nature of what is “right”

manage the potential stresses of a return home

by Jennifer Stranges

Clinical ethics promotes reflective practice and the making of “right” choices and decisions in the delivery of health care. (Photo: Jennifer Stranges)

by Emily Dawson

Often in health care, it’s not always clear what the right decision

in Sudbury working in community outreach at an ethics centre. The

Getting ready to return home after an extended hospital stay has

is. There are issues such as families struggling with the decision

experience of working to help the community understand the issues

the potential to reveal a host of emotions for both the patient and

languages, have a high-touch component. On some questions, such

to withdraw treatment for a loved one approaching end of life, or a

driving homelessness and to create more compassion for those

their family and friends. While there is often joy in the prospect of

as those that assess caregiver strain, a concerning answer will trigger

clinician debating whether it’s right to discharge a patient who has

experiencing disadvantage served as the inspiration for her.

going home, many people feel anxious about managing their new

a live call from the CHNs.

demonstrated a negligence of their own care.

Robertson describes working in health care as a constant learning

reality.

experience, and its challenge is often in the

Enhancing how we prepare people for the transition home is one

important feedback for our programs. The common things we hear

ambiguous nature of what is “right.” While cases may

of Unity Health Toronto’s quality improvement goals. Our care doesn’t

are around the logistics of their discharge, concerns about managing

appear similar on the surface – with patients around

stop once a patient is discharged, though. We know that many people

at home, and questions about home and community services,” said

the same age or with the same condition – the more

encounter issues once at home that can result in declining health or

McCullagh.

nuanced, underlying factors can make the best path

emergency department visits.

forward very different for each case.

them about community resources and encourage them to seek help

In addition to providing consultative services

navigator (CHN) role to support patients after discharge. Rehab patients

from appropriate professionals.

to patients, families and staff, Robertson and the

now receive either a live or an automated phone call – based on their

Centre for Clinical Ethics team offer education

preference – to check on how they’re doing. These calls happen at the

connect you,” explained Kelly Tough, manager of patient flow. “There’s

sessions, develop and review policy, sit as members

48-hour, 30-day and four-month points after discharge.

a sense of comfort that we’re still caring for you.”

of the St. Michael’s Hospital Research Ethics Board

and conduct research of their own.

are being followed, that physician referrals are in motion and that they

difference and mitigating some of the challenges of returning home.

have the medications they need,” said Monica McCullagh, one of three

CHNs.

appreciate knowing they’re not alone,” said McCullagh.

That’s where a clinical ethicist like Jamie

Robertson comes in. “I help make sure people

“

process all the information available and are

cognizant of the values that are revolving around

that information to then make a decision that is morally good and morally justified,” said Robertson.

“My role is to help people structure their

thoughts – to think in a structured way about the problems they’re encountering.”

Robertson officially joined Unity Health

Toronto’s Centre for Clinical Ethics as a clinical

“My role is to help people structure their thoughts – to think in a structured way about the problems they’re encountering

“

JAMIE ROBERTSON CLINICAL ETHICIST

ethicist late this summer. Clinical ethics promotes reflective practice and the making of “right” choices and decisions in

the delivery of health care. A clinical ethicist will collaborate with health

they’re trying to do, and patients and families feel heard or have a good

care teams, patients and family members to explore the reasons given

encounter with the health care system,” she said.

to their choices and actions.

of a bumpy road.”

After pursing her master’s degree in philosophy, Robertson landed

“I like helping health care workers feel they’re achieving what

“I like to help encounters go smoothly when perhaps there’s a bit

At Providence Healthcare, we introduced the community health

“The basic things we cover are making sure the discharge plans

Kelly Tough (L) and community health navigator Monica McCullagh say people appreciate that care doesn’t stop once they return home. (Photo: Emily Dawson)

Even the automated calls, which can be dialled in five different

“We get great insights through these conversations that lead to

For patients or caregivers who are struggling, the CHNs will talk to

“We may not always have the answers but we know how to

The data provides evidence that these calls are making a “We’re a safety net; we’ve even been called angels. People

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.

Learn more: www.unityhealth.to

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OUR SHARED PURPOSE

OUR SHARED PURPOSE

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RESEARCH MONTH

THIS IS

COLL ABOR ATION

At Providence, Dr. Ashley Verduyn, director of medical affairs,

was curious about how to help patients with anemia in the

Academics and Research at Providence, wanted to support bone health

rehabilitation setting. At St. Joseph’s, hematologist Dr. Christie Kim

in rehabilitation patients. For many patients, the first indication that they

wanted to be able to know in advance which surgical patients with

are at high risk for fracture is upon admission to rehabilitation after their

anemia would need her team’s support before their procedures. And

first fall or hip fracture. Dr. Ori Rotstein, vice-president of Research and

Dr. Michelle Sholzberg, a hematologist at St. Michael’s and researcher at

Innovation, connected them to two researchers at St. Michael’s who

the Li Ka Shing Knowledge Institute (LKSKI), was involved in a program to

had explored this work in the acute care setting.

target anemic patients before surgery to try to support them – but she

It started with three clinicians working at three separate hospitals who

knew that those at highest risk for poor outcomes were not necessarily

were interested in researching the same problem: how do we improve

Dr. Verduyn and Dr. Shane Journeay, physiatrist and director of

With Dr. Earl Bogoch, an orthopedic surgeon, and Dr. Joanna Sale,

getting the treatment they needed.

So, they teamed up on a new research collaboration that will aim

to help identify which anemic patients need most support.

outcomes for patients with anemia?

“This is a widespread problem that’s generalizable to all of our

institutions,” Dr. Sholzberg said. “Anemia is associated with bad outcomes after surgery and in rehabilitation settings. We want to be able to catch patients at the right time, when we can help them with

DR. MICHELLE SHOLZBERG

interventions that will improve their outcomes.”

HEMATOLOGIST ST. MICHAEL’S HOSPITAL

Dr. Muhammad Mamdani, vice-president of Data Science and

Advanced Analytics, and the data science team at Unity Health plan to help Dr. Sholzberg develop an algorithm to identify patients in need

Dr. Ori Rotstein (L) said he hopes more research collaborations find ways to come together across the organization. (Photo: Yuri Markarov)

a researcher at the LKSKI, Dr. Verduyn and Dr. Journeay are now aiming to apply the principles of fracture prevention at Providence.

DR. ASHLEY VERDUYN CHIEF AND DIRECTOR, MEDICAL AFFAIRS PROVIDENCE HEALTHCARE

This project would flag people at risk of fragility fractures – bone

breaks that occur after a fall from standing height or less – in order to prevent future, more serious fractures. The model Dr. Bogoch and Dr. Sale work with in acute care has not yet been researched in the inpatient rehabilitation setting.

DR. GREG HARE

which decreases quality of life,” said Dr. Sale. “It would be wonderful if

ANESTHESIOLOGIST ST. MICHAEL’S HOSPITAL

we could help patients in rehab avoid this devastating impact to health.”

Dr. Shane Journeay and Dr. Ashley Verduyn are working with colleagues from across Unity Health Toronto on research collaborations. (Photo: Yuri Markarov)

DR. MUHAMMAD MAMDANI

DR. TOM SCHWEIZER

DR. CHRISTIE KIM

VICE-PRESIDENT DATA SCIENCE AND ADVANCED ANALYTICS

DIRECTOR, NEUROSCIENCE RESEARCH PROGRAM PROVIDENCE HEALTHCARE

HEMATOLOGIST ST. JOSEPH”S HEALTH CENTRE

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“Each fragility fracture brings a patient closer to a hip fracture,

Fragility fractures and anemia are only two areas in which

researchers and clinicians from the three sites are coming together to

of high intensity support. They would then evaluate the success of

find far-reaching solutions to tough health care questions. Pediatrics,

targeted treatment in improving outcomes.

neuroscience and dementia researchers have also started to collaborate.

Dr. Rotstein hopes to see more collaborations emerge as the portfolio of

With Dr. Tom Schweizer, interim director of the the Keenan Research

Centre for Biomedical Science, and Dr. Greg Hare, an anesthesiologist at

research grows across the sites.

St. Michael’s, the team would also look at why anemia affects surgical

and rehabilitation patients. “With the three sites represented, we have

care experiences together,” he said.

all sides of the equation,”

find inspiration in the collaborations that are taking form.”

Dr. Kim said. “You often see research from an academic hospital

“Every bridge built in research better positions us to create the best “For those interested in research across our three sites, I hope they

and wonder how it applies to your practice in a community hospital,

or a rehabilitation institute. We’re working on something that will be

celebrate the research that’s being done at our organization, create

applicable to all of us.”

new collaborations and share projects underway. Thank you to those

who participate in research – your support of our impactful research

A similar common goal was also brewing between clinicians and

researchers interested in bone health.

November is Research Month across Unity Health, a time to

and innovation changes lives.

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DISPELLING MYTHS IN MEDICINE Female surgeons in Ontario earn 24 per cent less per hour while operating compared to male surgeons, suggests a study led by St. Michael’s. Female surgeons also performed fewer of the highestpaid primary procedures than male surgeons, the research suggested.

Published in JAMA Surgery and led by Dr. Nancy Baxter, surgeon and scientist at the Li Ka Shing Knowledge Institute, the study found no differences in time taken by male and female surgeons to perform common procedures. It also found that female surgeons are driven towards the less remunerative specialties and perform the less remunerative procedures within those specialties.

“Our findings dispel the myth that women don’t earn as much because they don’t work as hard,” Dr. Baxter said.

Dr. Nancy Baxter and her team at examined differences in earnings between male and female surgeons in Ontario. (Photo: Medical Media)

EXPLORING DIFFERENT WAYS TO TREAT AGGRESSION IN DEMENTIA For patients with dementia who have symptoms of aggression and agitation, interventions such as outdoor activities, massage and touch therapy may be more effective treatments than medication, suggests a study led by St. Michael’s and published in Annals of Internal Medicine.

The systematic review and meta-analysis suggest outdoor activities were more clinically effective than anti-psychotic medication for treating physical aggression in patients with dementia. For patients with physical agitation, massage and touch therapy were more efficacious than usual care or caregiver support.

“This study shows us that multidisciplinary care is effective, which is consistent with a patient-centred approach to care,” said Dr. Jennifer Watt, geriatrician and scientist at the Li Ka Shing Knowledge Institute.

SHARING MEDICAL IMAGING DATA TO CUT RADIATION LONG-TERM IMPACTDOSES OF CONCUSSIONS IN YOUNG Patients might expect radiation dosesATHLETES for CT scans to be comparable from one hospital to the next, but a team at One year afterHospital receivingsays full medical clearance, the brains of young St. Michael’s the dose variance can be startling. concussed athletes still continued to show signs of injury, according The team is collecting and analyzing data from eight hospitals to the longest follow-up studies of brain recovery in athletes to forone theof Medical Imaging Metadata Repository of Ontario (MIMRO) date, led by researchers at St. Michael’s. to help reduce the province’s average radiation dose per scan.

Using According research led Dr. Tom Schweizer,data, interim director artificial to intelligence toby sort the hospitals’ the team of the Keenan Research Centre for Biomedical Science, and Dr. generated comparative data by facility, scanner and exam Nathan to help Churchill, a research associate in the Neuroscience Research determine best practices.

MIMRO is funded primarily byProgram, the course of recovery was not complete even after the St. Michael’s and was created by two of its radiologists, athletes’ symptoms andDowdell cognitive functions Drs. Timothy and Bruce returned Gray. to normal.

“The brain continues to evolve much longer than previously Radiologist Dr. Brucesaid.

Gray and data analyst Lianne Concepcion review data thought,” Dr. Churchill

Grant supports social work New funding will help research how to best support social work students’ learning goals and needs

On Oct. 8, Unity Health Toronto’s Social Work department accepted the grant cheque from the University of Toronto. Featured here are staff from Unity Health Toronto and the University of Toronto. (Photo: Yuri Markarov)

by Selma Al-Samarrai

Unity Health Toronto’s Social Work department has been awarded

a $45,000 grant through the Bertha Rosenstadt Trust Fund in

specific research and engage in curriculum development, facilitation

Health Research to support the first-ever collaboration for social

and knowledge translation collaboratively. We hope our learners across

workers across the network.

all three sites will be provided a standardized and rich transition to

placement and given critical knowledge and skills to enhance their

This grant, provided by the University of Toronto’s Factor-

“This grant is providing the opportunity to engage in social work-

Inwentash Faculty of Social Work, is awarded to partner organizations

learning throughout,” said Massey.

that offer placements for the school’s students and funds research

The participating social workers are:

work in the area of social work field education.

• Magda Doran in Providence’s A5 Orthopaedic and Amputee Rehab

• Julia Gibran in Providence’s Stroke and Neuro Rehab

“Field education is the cornerstone of the Masters of Social

Work education experience; it provides our students with exceptional

• Heather Hrobsky in St. Joseph’s Psychiatry Unit

learning opportunities,” said Eileen McKee, the university’s assistant

• Denise Kwan in St. Joseph’s Mental Health Short Stay Unit

dean in Field Education.

• Rebecca Norlock in St. Michael’s Inpatient Psychiatry

• Katie Sussman in St. Michael’s Academic Family Health Team

“We selected Unity Health Toronto for the grant because our

faculty has enjoyed a long-standing positive relationship with the three

The two practice leaders are Massey and Shelley Allen,

partners and is aware of the excellent learning opportunities that their

professional practice leader in Social Work at Providence.

social workers can provide.”

Lauren Massey, manager of Collaborative Practice and Education,

challenging to transfer all the hard-earned classroom knowledge

said the grant will allow six clinical social workers and two practice

into clinical settings with real life patients. It’s a combination of both

leaders to research the issues faced by students in transitioning

competence and confidence,” explained Kwan.

from the classroom to clinical placement. The goal will be to create

standardized education sessions for all of Unity Health Toronto’s social

with patients and families, and preceptors will be better able to support

work students. The research plan was developed in consultation with

students’ learning goals and needs. It’s the research that keeps on

the Faculty of Social Work.

giving!”

“In my personal and professional experiences, it can be

“Through this grant, students will be more comfortable engaging

submitted to MIMRO. (Photo: Katie Cooper)

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Caring for the tiniest of patients Study on volunteer cuddling program at St. Michael’s featured in Paediatrics & Child Health journal

Volunteer cuddlers at St. Michael’s comfort infants when families can’t be present in

by Anna Wassermann

the NICU (Photo: Yuri Markarov)

Karen Carlyle, a registered nurse practitioner at St. Michael’s, was

and cuddling.

tending to an infant in the Neonatal Intensive Care Unit (NICU)

when another infant started to cry.

said Hignell. “But the evidence was purely anecdotal.”

“I remember thinking how great it would be to have a second set

“We’ve known for years that cuddling benefits babies with NAS,” Using data from St. Michael’s, Hignell and Carlyle found that

of hands to cuddle the crying infant,” recalled Carlyle.

infants with NAS spent six fewer days in the NICU when they received

consistent cuddling. The first-of-its-kind study was published in

In 2015, this thought became reality when Carlyle and Amanda

Hignell, a social worker at St. Michael’s, launched a volunteer cuddling

October by Paediatrics & Child Health journal.

program. Seven days a week, from 8 a.m. to 4 p.m., trained volunteers

provide cuddles, hand-holding and verbal stimulation to infants whose

and volunteers.

families can’t be present in the NICU.

of joy and accomplishment that keeps her coming back.

The program was established with support from St. Michael’s

The team also found that program benefits extend to NICU staff Cindy Nguyen, a volunteer cuddler since 2017, said there’s a sense

Interprofessional Practice Based Research (IPBR) program, which

helps frontline staff engage in the implementation and evaluation of

said Nguyen. “When they stop crying, it’s one of the most rewarding

best practice through research.

feelings in the world.”

Working with IPBR, Carlyle and Hignell launched a study to

“It’s hard to describe the experience of calming an irritable infant,”

This feeling is sought by dozens of prospective volunteers.

evaluate the feasibility and impact of their program, focusing on infants

Currently, the program has more than 80 people on its waitlist.

with neonatal abstinence syndrome (NAS).

involved, Carlyle and Hignell say they’re excited to keep growing their

NAS refers to a group of symptoms experienced by infants

Given the substantial interest and positive feedback from those

withdrawing from in-utero exposure to opioids. These symptoms,

program.

which include seizures, irritability and excessive and high-pitched

crying, tend to be minimized with supportive therapies, such as rocking

hospitals across Canada.

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They also hope to see more cuddler programs introduced in other