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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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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OUR SHARED PURPOSE
“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. OUR SHARED PURPOSE
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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