Our Shared Purpose newsletter - July/August 2019

OUR SHARED PURPOSE July/August 2019

Learning from patients How care is being improved through patients’ feedback. (pg. 3)

“Getting back to myself” How a St. Michael’s clinic is helping patients with back pain. (pg. 2)

Bridging another gap in our system What it takes to Bringing peritoneal innovate (pg. 4) dialysis care to Providence addresses a pressing need. (pg. 4)

Expanding care where patients live New off-site St. Michael’s dialysis centre to open in 2020. (pg. 8)

Hospitals learning together St. Joseph’s role in the Joint Centres for Transformative Healthcare Innovation. (pg. 7)

Getting back on your feet

Listening to patients Reimagining patient education by building better tools to improve health literacy

New clinic at St. Michael’s is improving the quality of care for people with low back pain

by Emily Dawson

by Anna Wasserman

Neng Li says he’s “back to my old self” thanks to the Rapid Access Clinic (RAC) for Low Back Pain. (Photo: Yuri Markarov)

Nurses Honeylet Rivera (left) and Ranjeeta Rungta (right) discuss what to add to a patient’s whiteboard.(Photo: Katie Cooper)

Neng Li was playing ice hockey with his two young children when

it lessens the burden on the system by reducing wait times for surgical

Registered nurses Katherine Mansfield and Sarah Kreher never

of their care team members. Bennett and Mansfield were surprised

he suddenly felt a pain in his lower back. On the advice of his wife,

consults and MRIs. ”So far, only 15 per cent of the clinic’s patients have

would’ve thought that bedside whiteboards could dramatically

to hear that patients feel demoralized when staff don’t take time to

he visited his family doctor, who provided him with a referral for a new

needed a surgical assessment, and even fewer have required surgery.“

affect the care experience until they heard it directly from

update the whiteboards. “One patient told me he ‘feels like he matters’

St. Michael’s clinic that would help get him back on his feet.

patients.

when clinicians incorporate information from the board into his plan of

Opened earlier this year, the Rapid Access Clinic (RAC) for Low

to step in. An orthopedic surgeon at St. Michael’s Hospital, Dr. Ahn

care,” said Bennett.

Back Pain is one of three sites across the city designed to help improve

meets with patients who’ve been pre-screened by Dr. Bigness and

lower adherence to medication, poor chronic disease management,

the speed, access and quality of care for people with low back pain.

deemed a possible candidate for surgery, like Li.

and increased hospitalization.

cares for patients who live with chronic illness. She recently attended

In response, the Patient and Family Education program at Unity

a session on developing patient videos to help people with disease

Within four weeks of a referral, patients are scheduled for a

But when they do, Dr. Henry Ahn, the clinic’s surgical lead, is ready

“I don’t see every patient, which is the goal in order to reduce clinic

Research suggests that low health literacy is associated with

In St. Joseph’s renal outpatient clinic, dietitian Fiona Bellefeuille

consultation. At the consult, they receive a standardized assessment

load,” said Dr. Ahn. “I only see patients who need surgery, so I can focus

Health Toronto created workshops and courses that help staff,

management. “Our clinic patients on hemodialysis sit in chairs for

and self-management strategies, or a referral for a surgical or other

on the area that I can serve best.”

physicians, and learners develop more impactful patient education

four hours and each chair has a TV,” said Bellefeuille. “Simple, visual

specialist consult.

strategies and resources.

materials are so effective and transcend barriers.”

The system, says Dr. Andrew Bigness, practice lead at the

more assessors to work in the clinic, allowing them to continue to help

St. Michael’s clinic, is intended to help patients self-manage their

other patients like Li. Two months after his injury, Li said he’s feeling

information provided by health care providers. We’re trying to bridge

her most valuable learnings was about the teach-back technique – an

back pain and reduce unnecessary diagnostic imaging and specialist

better every day.

these gaps,” said Katrina Grieve, a patient education specialist in

approach to teach or present complex information by breaking it down

referrals.

St. Michael’s Patient and Family Education program.

into simple pieces and having patients repeat in their own words what

Li. “My kids are always asking me to play hockey or basketball outside

they just learned.

and it’s nice to be able to say yes again.”

from patients and families and share ideas. Kreher, Mansfield and

clinical leader manager Joanne Bennett say patient voices have left a

may think you’ve given great information but you don’t always know

lasting impression on their work.

what they’ve absorbed,” said McWhinnie.

“Eighty per cent of people will experience back pain in their

lifetime,” said Dr. Bigness, who also works as the clinic’s advanced practice practitioner. “If people learn to manage their pain on their own,

Working with Dr. Bigness, Dr. Ahn said he hopes to recruit and train

“Thanks to the clinic, I’ve been able to get back to my old self,” said

“Many patients have difficulty understanding or remembering

Community of Practice sessions provide a forum to hear directly

that should be – but isn’t always – updated daily with information like

Learn more: www.unityhealth.to

how the patient is feeling, what they prefer to be called, and names

OUR SHARED PURPOSE

“I now ask patients ‘can you tell me what you understand?’ You

On St. Michael’s general surgery unit, each bed has a whiteboard

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.

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For Valerie McWhinnie, a physiotherapist at Providence, one of

OUR SHARED PURPOSE

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Collaborating for better care St. Michael’s and Providence work together to expand peritoneal dialysis care.

by Emily Dawson

Across Toronto, few rehab facilities have staff trained to provide

disease. Peritoneal dialysis, sometimes called PD, uses the lining of the

Providence in April. Mark requires 10 hours of PD each night, and his

peritoneal dialysis. That could’ve been an issue for Ray Mark.

abdomen and a cleaning solution called dialysate to clean the blood. It’s

nurses are responsible for beginning the process every night and ending

usually self-managed by patients as part of a home-dialysis treatment

it each morning. On-the-job refreshers supplement the training they

significant health issues last winter that left him unable to use both of

plan but was provided by his care team at St. Michael’s.

received from Benjamin-Wong.

his legs. Mark had lived a full and busy life. He was working at a job he

enjoyed, loved spending time with his young granddaughter and had

for rehab, a new Unity Health Toronto initiative meant he could continue

is their lifeline. They become the teachers. So while I’ve been able to train

work in some capacity soon.

an active social life with his partner, Nettie.

to receive peritoneal dialysis there.

staff to get the service up-and-running, their ongoing learning comes

But last November, everything suddenly changed.

from patients themselves,” said Benjamin-Wong.

and the physician. Right away, they wanted to know what my recovery

When he experienced some unusual shortness of breath, Mark

the new initiative saw Fatima Benjamin-Wong, a home dialysis case

Seizing this opportunity helps position Unity Health Toronto as a

goals were. For me, it was simple: to walk down the hall at Providence

made the drive from Ajax to St. Michael’s to have it checked out. A few

manager from St. Michael’s, train 30 Providence staff with the goal of

leader in bridging gaps across our system. By bringing the right care

with my walker. I knew if I could do that, I’d be well on my way,” said Mark.

weeks later, he woke up from a coma in the Intensive Care Unit, with

being able to admit rehab-eligible patients needing peritoneal dialysis.

to the right setting, we’re ensuring that everyone can access the

barely a memory of what had happened.

treatments they need to thrive.

in the near future. I’ve come to grips with this setback. So for now, I’m

“I remember sitting in the waiting room in emerg and hearing my

care manager Sofia da Silva,” said Benjamin-Wong. “I’m so impressed

working on being totally comfortable and mobile in a wheelchair. If I can

name called,” said Mark. “I learned later that I’d had two heart attacks,

with how staff have embraced this learning opportunity, wanting to

other programs, such as Palliative Care and the Cardinal Ambrozic

accomplish this, we’ll start working on my long-term goals.

and then a mini-stroke in the coma.”

understand the holistic view of the renal patient and gaining confidence

Houses of Providence long-term care home, to benefit even more

in providing PD.”

patients with PD needs.

there. I don’t know what I would have done without the rehab at

Providence. The care has been marvelous.”

Mark knew he’d need extensive rehabilitation following a series of

During his five months at St. Michael’s, he stabilized and received

the medical care he needed, including peritoneal dialysis for his kidney

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OUR SHARED PURPOSE

Fortunately for Mark, before he would be transferred to Providence

Identifying the need for better integrated care for our communities,

“It was a pleasure working with Providence’s A5 team, led by patient

The team on A5 was ready when Mark was transferred to

Clockwise from top left: The team in St. Michael’s Home Dialysis/Kidney Care Centre; the Providence team on A5; staff get the PD cycler ready for the next treatment; Ray Mark and Fatima Benjamin-Wong share a laugh in his room at Providence.

(Photo: Katie Cooper)

“Patients on PD will watch their care team like a hawk, because PD

Over time, Providence hopes to extend its new PD expertise to

Mark’s rehab is progressing nicely and he believes he’ll be back to

“On the day I arrived, I met the physio and occupational therapists

“Shortly into rehab, though, I realized that was not going to happen

“I’m still gaining strength in my legs, arms and core but I’m getting

OUR SHARED PURPOSE

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REVOLUTIONIZING OPTIONS FOR KIDNEY TRANSPLANT To help doctors make better decisions about which kidneys to accept for transplantation, a research team at St. Michael’s is testing a firstof-its kind kidney-imagining technique in clinics. In collaboration with Ryerson University through the Institute for Biomedical, Engineering and Technology (iBEST), the team aims to perfect ultrasound-based methods that measure scarring in transplant kidneys.

Kidney failure is a growing problem in Canada, and with few kidneys available for transplantation, doctors have begun to accept kidneys from sicker donors. While some perform well, others are not as effective. “We currently have no way of assessing donor kidneys,” said Dr. Darren Yuen, a scientist in the Keenan Research Centre for Biomedical Science. “Our study has the potential to revolutionize how we allocate kidneys for transplantation.”

KRCBS scientist Dr. Darren Yuen is collaborating with Ryerson University’s Dr. Michael Kolios on an innovation for transplant. (Photo: Medical Media)

CONCUSSION ASSESSMENT IN SOCCER NOT UP TO EXPERT RECOMMENDATIONS An average of at least one potential concussive event occurred per game during the 2016 UEFA European Championship and most incidents did not result in a medical assessment by a sideline healthcare personnel, according to research published in the journal BMJ Open.

The research shows there’s a need to mandate the proper assessment and management of players suspected of concussion, said Dr. Michael Cusimano, neurosurgeon and scientist at the Li Ka Shing Knowledge Institute, who led the research.

“It’s imperative that the highest levels of the sport assess potentially concussed athletes appropriately,” said Dr. Cusimano.

“Given the ‘trickle-down’ effect from professional levels, the health of players at all levels demand that groups like FIFA and UEFA follow the protocols to which they were a signatory.”

OPPORTUNITIES TOIMAGING IMPROVEDATA SHARING MEDICAL ESSENTIAL MEDICINES LISTS TO CUT RADIATION DOSES Countries’ essential medicines lists vary greatly one another Patients might expect radiation doses for from CT scans to be and from the WHO’s model list, pointing to a potential need comparable from one hospital to the next, but a team for at greater care in selecting medicines that meet the health-care priorities St. Michael’s Hospital says thebest dose variance can be startling. of a population, suggests a study led by Dr. Nav Persaud, a scientist The team is collecting and analyzing data from eight hospitals at the MAP Centre for Urban Health Solutions. for the Medical Imaging Metadata Repository of Ontario (MIMRO) to help Thereduce research recently published in thedose World thewas province’s average radiation perHealth scan.

Organization Bulletin.

Using artificial intelligence to sort the hospitals’ data, the team generated “Countries must select their lists comparative datamedicines by facility,for scanner andappropriately, exam to help in order to facilitate sustainable, equitable access to medicines, and determine best practices. MIMRO is funded primarily by to promote their appropriate use,” said Dr. Persaud.

“Differences St. Michael’s and was created by two of its radiologists, between lists that are not explained by country characteristics may Drs. Timothy Dowdell and Bruce Gray. represent opportunities for improvement 6

Radiologist Dr. Bruce Gray and data analyst Lianne Concepcion review data submitted to MIMRO. (Photo: Katie Cooper) Dr. Nav Persaud, a scientist at the MAP Centre for Urban Health Solutions, led a study examining essential medicines lists across 137 countries. (Photo: Medical Media) OUR SHARED PURPOSE

Learning and improving together Health care professionals share best practices at annual event

by Amber Daugherty

St. Joseph’s shared new initiatives with hospital partners at this year’s InnovationEx event

St. Joseph’s is part of the Joint Centres for Transformative

from the seven hospitals come together to learn with and about one

Healthcare Innovation, a group of seven hospitals across the

another. The event includes guest speakers as well as a poster fair –

city who work together on making care better and safer for

each hospital shares some of the exciting work they have on the go

patients. They do this in several ways: they share best practices with

and members of the team are available to answer questions and talk

one another, allowing other teams to build on great work that’s already

about how they could help bring their initiative to partner hospitals.

shown to be successful; they collaborate on initiatives that impact all

This year, St. Joseph’s teams shared information about the patient-

hospitals such as workplace violence and medication safety; and they

oriented discharge summary project that gives easier-to-understand

bring teams together to learn with and about one another to build

information to patients at discharge so they’re better able to manage

connections and increase knowledge at all hospitals. Here’s a quick

at home. They also shared the Emergency Department (ED) reduction

snapshot of what you need to know about this important work.

project where the ED has partnered with community resources to help reduce repeat visits.

Who else belongs to the Joint Centres for Transformative Healthcare Innovation?

What else has the Joint Centres collaborated on?

The six other hospitals who belong to the Joint Centres with

The Joint Centres hospitals have also worked together on:

St. Joseph’s are: Humber River Hospital, Mackenzie Health, Markham

•

preventing workplace violence

Stouffville Hospital, Michael Garron Hospital, North York General

•

reducing C-section rates

Hospital and Southlake Regional Health Centre.

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spreading Choosing Wisely initiatives to reduce the number of unnecessary tests and treatments patients experience

What is InnovationEx?

•

reducing C. difficile infections for inpatients

InnovationEx is the Joint Centres’ biggest annual event where teams OUR SHARED PURPOSE

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Improved access for dialysis patients Construction begins on St. Michael’s satellite dialysis clinic in Thorncliffe Park.

Alison Thomas, a nurse practitioner in the St. Michael’s hemodialysis unit, is pictured here

by Selma Al-Samarrai

speaking to hemodialysis patient Paulette Caine. (Photo: Yuri Markarov)

Dialysis patients of St. Michael’s will soon have the option to

neighbourhood that has underserviced dialysis needs, its free parking

dialyze in one of two neighbourhoods in Toronto.

and TTC access, and its accessible location on the ground floor.

Next year, a brand new 20,000-square-foot dialysis centre will be

“I think it’s important that we don’t always bring dialysis patients

opening in the East York Town Centre in Thorncliffe Park, expanding

to the hospital for their treatment,” said Elizabeth Anne Anderson,

St. Michael’s dialysis services that are currently only offered inside the

the clinical leader manager for the Multicare Kidney Clinic, Home and

hospital.

Satellite Dialysis Clinics at St. Michael’s, and one of the team members

who chose the location of the satellite clinic.

The new St. Michael’s Kidney Care Centre, presently undergoing

the first phase of construction, will offer 21 dialysis stations for patients,

with an additional six for home hemodialysis training, transition and

be provided in an acute hospital setting. We’re hoping that going to

support.

an offsite satellite clinic for their treatments will allow patients to view

dialysis as a way to maintain wellness, rather than to treat illness.”

“The value of this satellite centre is that it meets the needs of

“Dialysis is a life sustaining therapy that often does not need to

patients in their own community,” explained Alison Thomas, a nurse

practitioner in St. Michael’s hemodialysis unit.

satellite clinic will remain connected to their St. Michael’s team. There

will be no transfer of care if they choose to dialyze outside of the main

“It also allows us flexibility with new patients. We’re now able

St. Michael’s dialysis patients who choose to dialyze in the new

to offer them an alternative location for their care, away from the

hospital site.

downtown core.”

a centre that has been designed with patients, family members, and

The space for the multidisciplinary care centre was selected

specifically due to its central and convenient location in a 8

OUR SHARED PURPOSE

“We look forward to providing dialysis care in the community in

caregivers in mind,” said Anderson.