In Touch newsletter: September 2017

INTOUCH SEPTEMBER 2017

NICU mom Arlene reads “Love You Forever” to her son, Logan. The NICU Books for Babies Program launched Sept. 8.

(Photo by Katie Cooper, Medical Media Centre)

NICU preemies tackle their fall reading lists

By Emily Holton

While most babies their age are still in utero, St. Michael’s preemies are hitting the books.

Starting this month, every family that stays for more than four days in the Neo-natal Intensive Care Unit will receive a small collection of free children’s books.

“Research has shown that reading with children should start at birth,” said Amanda Hignell, a social worker in the NICU. “The sounds and intonations of reading aloud can foster brain development in newborns, and it gets parents role-modeling reading right from the start.”

Printed on 100 per cent recycled paper

Some NICU babies are too little or sick to be held, and parents must get to know their babies through an incubator wall.

“Reading aloud can help parents and babies connect and bond, even when there’s that physical separation,” said Hignell.

The Books for Babies Program was launched in memory of Maryrose O’Neill, an NICU baby cuddler who loved books and reading with children.

St. Michael’s baby cuddlers are carefully selected volunteers who hold and comfort infants when their parents can’t be present in the NICU. O’Neill’s daughter, Cathy O’Neill, director of Quality and Performance,

raised the funds for the program with her family. Hignell and O’Neill also secured more than 150 donated children’s books from several publishers. They said they hoped the program would grow to include an onsite library for NICU families and volunteers.

“Books were my mom’s world, and being a NICU cuddler was her favourite thing to do,” said O’Neill.

“This program feels like the perfect way to help NICU families as well as honour my mother’s passions and creative imagination. She always knew how to connect with babies and children, Continued on page 2 SEPT 2017 | IN TOUCH | 1

OPEN MIKE with

Bev Bulmer

Vice-President of Education safe care that is evidence-informed. We also want to ensure education is provided by the most qualified staff and physicians.

Welcome to a new academic year, everyone, and especially to our students who have just joined us this month. With the announcement of the integration of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital this summer, the year promises to be a busy one filled with exciting learning and teaching opportunities for all of us.

Our organizations have similar commitments to improving care through education mandates that include a superior learner experience and educating all health-care professionals, patients and their caregivers.

Integration will provide future trainees with a wider exposure to learning in diversified contexts across the health-care continuum. Continuing education and professional and faculty development are also priorities for all three organizations to ensure we provide high-quality and NICU preemies story continued from page 1

and reading was a big part of that.”

The books are packaged for families with a quote from Winnie the Pooh: “Always remember, you are braver than you believe, stronger than you seem and smarter than you think.”

To support the Books for Babies Program, go to www. stmichaelsfoundation.com/ booksforbabies. Donations of new, children’s books are also welcome; contact HignellA@smh.ca at HignellA@smh.ca to arrange a drop-off.

SEPT 2017 | IN TOUCH | 2

I’m looking forward to witnessing the increase in activity in these areas and value for the broader health-care system, as well as for the people and communities we serve as a larger community-based network.

Within the Li Ka Shing International Healthcare Education Centre, we anticipate great activity from our Arrell Family Chair in Health Professions Teaching and the Professorship in Technology-Enabled Learning – two new positions we appointed this summer. Dr. Stella Ng, who holds the Arrell chair and is director of research at the Centre for Faculty Development, has produced a research report, called Advancing systems of care for disadvantaged patients, to identify educational needs at St. Michael’s relating to care for patients experiencing disadvantage. As a major teaching and research hospital as well as a leader in caring for the most marginalized or

Total medical trainees and health professional learners across the network:

5,779

disadvantaged among us, it’s important for us to have an education strategy around this, and we intend to rely heavily on her report.

Looking ahead, I hope you’ll take advantage of our Learning Centre (look for the purple tree on your desktop or on the intranet) and for our students, check out our mobile site. Technology-enabled learning is a priority for us and I always welcome your ideas and feedback on how we can make learning and teaching easier for all of us.

Thank you for your commitment to growth and development, and I look forward to collaborating with all of you in support of the hospital’s vision of world leadership in urban health.

Tips for reading with babies From the American Academy of Pediatrics

Cuddle up and read with emotion.

Although they may not understand the words or story in a book, babies will respond to the emotion in your voice and expression on your face.

Choose colourful and sturdy books.

As babies get older, they’ll reach out to hold the book and explore it with their mouths.

Plan a special reading time. Turn off the TV, put away your phone and make this time special by giving baby your full attention.

Read together every day. Reading aloud together at the same time every day can create a helpful routine, especially when it’s part of your calming bedtime ritual.

Keep reading together, even when your child can read. Children are never too young or too old to enjoy reading with you.

Follow St. Michael’s on Twitter: @StMikesHospital

Demetra Turnbull and Jennifer Schultz examine T-shirts designed by Dr. Jory Simpson for his patients who have agreed to help teach his medical students about their experience and perspective. (Photo by Marcelo Silles, Medical Media Centre)

The patient as teacher

By Leslie Shepherd Dr. Jory Simpson says he can teach medical students how to become doctors.

they will have a debrief with Dr. Simpson and write a reflection.

But he can’t teach them what it’s like to be a patient about to undergo body-changing surgery or other life-saving treatment. Or what it’s like to sit in a waiting room, day after day, week after week, all the time thinking about what else is going on in their lives, whether it is exams, relationship woes or worries about how their children are coping.

Dr. Simpson said it’s up to the patientteachers to decide what they want to say in their workshops. They’ll receive training from Susan Blacker, the former director of cancer services at St. Michael’s, and Aimee Hindle from Professional Practice.

That’s why he has enlisted some of his breast cancer patients to become patientteachers starting this fall, helping thirdyear medical students understand the patient experience.

“Students often think of surgery as cut and done; that’s the image in the media and on TV,” said Dr. Simpson, assistant medical director of the CIBC Breast Centre at St. Michael’s. “But in real life, we often have long relationships with patients. I hope this new curriculum will change the way they perceive what it’s like to be a patient and emphasis the humanistic side of surgery.”

University of Toronto medical students will have two sessions with patient-teachers during their eight-week surgical rotations at St. Michael’s. At the end of their rotation

“The only rule is that no doctor is allowed in the room,” he said. “This is about empowering patients and allowing them to tell their own stories about survivorship.”

Jennifer Schultz, an academic editor and

It’s easy to do a mastectomy; it’s not as easy to see a patient through to the other side.”

Demetra Turnbull, who was diagnosed in January 2015 with stage 3 breast cancer and lymph node involvement, said she hopes to coach the students to appreciate patients as individuals.

“People handle things differently,” said Turnbull, who owns Chalkboard Publishing, a company that produces educational material to help children succeed. “Some want a lot of information, some don’t. Some are going to have caregivers, some won’t. Some will have a supportive family, some won’t.”

Diagnosis was not Day 1 of being sick, Turnbull said, it was Day 1 of getting better.

The CIBC Breast Centre has more than 20,000 patient visits a year, half from women with cancer writer who was diagnosed in December 2015 with stage 3 lobular breast cancer, said she volunteered to be a patient-teacher as “my way of giving back to St. Michael’s for the amazing care I received here.”

“It’s my way of trying to make something good out of something that was really bad,” she said. “I hope to help them realize they need more than a scalpel. They need to get to know the patient, what else is going on in their lives.

Dr. Simpson said the idea for patientteachers flowed from discussions between him, surgeon-in-chief Dr. Ori Rotstein, and Dr. Arno Kumagi, the new vicechair of education at the University of Toronto’s Department of Medicine, who had a similar program at the University of Michigan Medical School. Dr. Simpson said he believes this is the first patientteacher program anywhere in surgery.

SEPT 2017 | IN TOUCH | 3

Highlighting our labs

The lab: Behind

Patients will likely never see the inside of a hospital lab, but it’s a department that’s critical to the care they receive; 75 per cent of medical decisions that physicians and care teams make are based on lab results. And in some cases, those results are needed quickly to make lifesaving decisions.

St. Joseph’s Health Centre and St. Michael’s Hospital made the move to join labs in 2016, creating an integrated system that improves turnaround times for tests and allows clinical knowledge to be shared across both sites, improving quality of care for patients at both organizations.

“The faster we can get results to our physicians, the faster treatment can begin for our patients,” said Dawn-Marie King,

Molecular biology applies DNA

and RNA detection techniques to the diagnosis, prognosis and targeted therapy of various diseases, including colon, brain, breast and cervical cancer.

Pathology examines samples from

the body for diagnosis of diseases such as cancer. The various tests performed on tissue (histology) and body fluids (cytology) in pathology enables the pathologist to make a diagnosis that will indicate to the clinician the proper course of patient treatment. Pathologists also perform autopsies to determine the cause of death.

Microbiology analyzes specimens

from the body (such as urine or blood) to look at bacteria, fungi and viruses that might be present, and tests the effectiveness of antibiotics against bacteria in the samples to allow doctors to effectively treat infections. The lab also provides support to the infection control program by screening for multi-resistant organisms and examining how infections spread throughout the hospital.

SEPT 2017 | IN TOUCH | 4

integrated director of Laboratory Services. “That’s why it’s important that we’re able to process specimens as quickly as possible. Every minute counts to the people we serve.”

St. Joe’s and St. Michael’s process almost 8 million lab tests every year. The partnership allows for more on-site testing so that fewer samples have to be sent out to third party labs, saving time and reducing costs.

“By working together, we’ve been able to expand our areas of expertise and offer even more tests at the two sites, and we’re constantly looking for more opportunities to expand our services,” said King. The integrated lab system has more than 400 staff members who work 24-7. The lab is split into five divisions that are broken down into a number of specialties, including:

Transfusion medicine is

responsible for providing blood and products for transfusion. If a patient requires a transfusion because of surgery, injury or disease, donated blood is added to his or her own blood.

Biochemistry performs a wide variety of tests for diagnostic and therapeutic purposes in blood, urine and other body fluids.

An integrated lab allows centres of excellence (i.e. the immunology lab at St. Joe’s and the specialty chemistry labs at St. Michael’s) to grow and excel for patientcentred care.

Hematology analyzes blood cells for disorders such as leukemia, anemia and possible infection. They provide a complete picture of a patient’s blood, including a blood count.

They also investigate bleeding disorders by analyzing how quickly blood clots, monitor patients taking anticoagulants and analyze other types of body fluids, such as joint fluids.

the scenes of patient care Profiles

St. Joe’s: Chunya Shi is a technical specialist in Hematology where they have a guaranteed one-hour turnaround time for results. She oversees the team to make sure members hit that timeline, troubleshooting if there are any issues. She also looks at samples and adds notes about what results might be present, sending them to a pathologist if further review is needed. “Our cells are amazing – they’re so small but so powerful; they make our bodies move.”

Lorna Whittaker is a medical lab technician in the Outpatient Lab, where she does patients’ bloodwork and sends it to be analyzed in other areas of the lab. “The only connection patients have to the lab is through us. I like talking to patients – not a lot of people like having bloodwork done so we’re there to calm them and help them through the process.”

Maria Simone is a medical lab assistant in Microbiology, where she receives specimens from other areas of the hospital and makes sure they’re the proper quality for testing.

She plants specimens on special plates that are optimized for different types of bacteria to grow so that it can be determined if that bacteria is present in the patient. “I love microbiology and the hands-on work we do here. It’s amazing what microbiology shows you.”

Sarah Kim is a point-of-care technical specialist, meaning she oversees tests that happen outside of the lab (i.e. at patient bedsides). With more than 182,000 pointof-care tests at St. Joe’s every year, she’s busy.

“My job is to make sure all point-of-care testing is being done with the same quality as

in the lab. I like it because it connects me with staff around the hospital and I’m always learning, even after 12 years here.”

Dr. Maria Pasic is a clinical biochemist at St. Joe’s who has developed a vision to create a centre of excellence in immunological disorders. These occur when the body begins to attack itself in conditions such as rheumatoid arthritis.

“Our teams are doing amazing work in this area,” said Dr. Victor Tron, joint chief of Laboratory Medicine. “A centre of excellence would make this lab a go-to resource for hospitals across Canada.”

St. Michael’s: Hina Chaudhry is a medical technical specialist in the Special Coagulation Laboratory, overseeing testing, making sure instruments are working properly and giving residents a behind-the-scenes look at what her team does. “I enjoy coming to work because I know that what I’m doing is making a difference in patients’ lives, so it’s very rewarding.”

Meghan Cuthbertson is a medical laboratory technician who has a unique role, both collecting patients’ bloodwork in Phlebotomy and then processing and registering samples in the Core Lab so they can be analyzed. “The good part about working in both areas is you get to build a relationship with patients and you’re also part of their diagnosis and treatment plan – it’s really satisfying to see their whole journey.”

Vidya Beharry is a medical laboratory technologist who works in the Immunohistochemistry Lab where markers are identified to diagnose cancerous tumours. “What we do is a continuous process – there’s always something to tweak. I make sure I stay up to date on current practices so that we can continue to evolve and get better.”

The microbiology team of Drs. Larrisa Matukas, Manal Tadros, Ramzi Fattouh and Yan Chen specializes in diagnosing infectious disease, and has been working across both sites developing an integrated vision to assist with the multitude of infections that occur in busy hospitals. “We know that every one hour delay in diagnosing a septic patient results in a seven per cent increase in mortality,” said Dr. Tron, joint chief of Laboratory Medicine, “so what they’re doing is absolutely critical.”

By the numbers The lab is open 24-7

75% of medical decisions are based on lab results Almost 8 million tests are done per year More than 400 staff members work in the lab SEPT 2017 | IN TOUCH | 5

Bringing the geriatric medicine community online, one tweet at a time

Drs. Camilla Wong and Laura Budd engage in a #GeriMedJC Twitter discussion at the Elders’ Clinic while colleague Dr. Amanda Gardhouse tunes in online via FaceTime. (Photo by Yuri Markarov, Medical Media Centre)

By Skaidra Puodziunas

Dr. Camilla Wong, a geriatrician at St. Michael’s Hospital is encouraging the geriatric medicine community to expand its horizons and embrace social media.

When the geriatric medicine journal club at the University of Toronto holds its monthly meetings, Dr. Wong and her team simultaneously live-tweet the proceedings through the handle @GeriMedJC and hashtag #GeriMedJC. This offers people who are not able to attend the in-person meeting an option to participate online.

“We’ve been able to connect thought leaders and allied experts in the small, geriatric space, that may never have connected in the physical world,” said Dr. Wong.

What began as an informal project grew into a formal part of the club, explained Dr. Wong.

Twitter and publicize it ahead of time, personally inviting featured journal club authors to join in,” she said. “We even created how-to-guides for colleagues and allied organizations interested in joining the platform.”

Beyond the journal club, the #GeriMedJC hashtag has engaged multiple audiences interested in geriatric health, explained Dr. Wong.

“This has forced us to think more creatively and has infused an interdisciplinary way of thinking,” she said. “It also highlights there are multiple ways to solve the same geriatric health problem.”

The conversations on Twitter have also translated to real-world connections for geriatricians across Canada and abroad, said Dr. Amanda Gardhouse, a geriatrician at the Leacock Care Centre in Orillia, Ont.

“Twitter has helped break the ice for “We noticed increased engagement geriatric professionals,” she said. “For levels from participants internationally example, just recently at the 37th which led us to formalize the use of Canadian Geriatric Society Annual SEPT 2017 | IN TOUCH | 6

The team behind the @GeriMedJC Twitter handle built a following of more than 1,300 users from six continents including physicians, health advocacy organizations, trainees and allied health practitioners.

Scientific Meeting, we connected with other geriatric professionals because of discussions we’d had on social media.”

Both Drs. Gardhouse and Wong are avid users of social media and said it’s important for the broader scientific community to embrace platforms such as Twitter.

“There’s a lot of misinformation that occupies the social media space,” said Dr. Wong. “I truly feel as a scientist I have an academic and moral obligation to promote the integrity of science online.”

Planning makes perfect in stairwell demolition project

By Kate Manicom

More than one year ago, planning started for the demolition of the Cardinal Carter South stairwell. The 17-storey structure stood in the way of linking the new Peter Gilgan Patient Care Tower to the existing hospital.

After seven months of demolition that dismantled 410 stairs and 2,317 cubic metres of concrete, the project is complete.

“The stairwell had to come down so that we could finish building something great,” said Michael Keen, senior director of Planning and Redevelopment. “We knew the work would be noisy and could potentially generate vibrations. We planned the project with safety and patient care as our top priorities, and as a result of collaboration within the hospital and with our external construction partners, we succeeded in completing the project safely, with minimal impacts to patients and their loved ones.”

In June 2016, the hospital’s Department of Operational Readiness initiated planning with teams across the hospital. Operational Readiness’s role is to ensure that each patient has the right care, in the right space with the right equipment and technology, at the right time, regardless of construction activities in the hospital.

Because the stairwell was built adjacent to critical patient care areas, including the Medical-Surgical Intensive Care Unit, the perioperative floor and medical imaging, mitigation plans were established in case noise levels or vibrations were unsafe or affected patient care. Vibration monitors were placed throughout the hospital, and protocols were developed to monitor equipment, infection prevention and control, and patient and staff safety. The hospital also acquired ear plugs and ear muffs for patients in areas close to the demolition.

The Planning and Redevelopment team worked closely with the project’s contractor to find alternate demolition methods. To reduce noise and vibrations, the contractor saw-cut the staircase from the existing structure, crushed the slabs into smaller pieces, then removed them from the site using a tower crane.

Once demolition started in early 2017, an operations centre was established that met twice daily to monitor progress and resolve issues quickly. Program directors and the director of hospital operations submitted daily reports to

A view from the hospital’s 11th floor, the blue strip indicating where the Cardinal Carter South stairwell previously stood.

(Photo by Katie Cooper, Medical Media Centre)

inform the operations centre of any construction issues, noise or vibrations. Over the course of demolition, the operations centre committee held 198 meetings.

The hospital’s complex clinical environment also required the contractor to work flexible hours.

“While demolition was adjacent to the hospital’s operating rooms, there were some challenges in managing busy periods in the operating rooms and demolition schedules,” said Catherine Hogan, program director for Perioperative Services.

“The contractor worked with us to change their schedules and enable safe patient care.”

With the stairwell demolition complete, the hospital is looking to its next demolition project: the Shuter Wing will come down in 2018 as part of the expansion of the new Slaight Family Emergency Department.

“As a result of collaboration within the hospital and with our external construction partners, we succeeded in completing the project safely, with minimal impacts to patients and their loved ones.” – Michael Keen, senior director, Planning and Redevelopment SEPT 2017 | IN TOUCH | 7

Q&A

FERAS MALAWI, PROJECT MANAGER FOR CAPITAL, EQUIPMENT AND PLANNING

By Skaidra Puodziunas (Photo by Katie Cooper, Medical Media Centre)

Q. That’s a long title. Tell us about your role.

My main role is overseeing the furniture, fixtures and equipment that will go into the Peter Gilgan Patient Care Tower and other areas being renovated through St. Michael’s 3.0. I meet with user groups from each area and help to identify what they will need in their new spaces to provide the best patient care. I’m also overseeing two design projects: the Pathology renovation and the IT and Clinical Equipment suite on the 10th floor of the Peter Gilgan Patient Care Tower.

Q. Can you give examples of furniture, fixtures and equipment?

Furniture ranges from the chairs and sleepers for loved ones in patient rooms to the specially built centralized care stations where staff and physicians will assemble to collaborate on a patient’s treatment. Fixtures refer to anything mounted on walls, including paper towel racks, soap dispensers and art.

Equipment varies by department but includes defibrillators, ultrasound machines and carts. This is done with the tremendous support of the Procurement team.

A space and its function will determine the furniture, fixtures and equipment we use. Whatever we place in a patient care area must meet infection prevention and control standards and help

INTOUCH

SEPTEMBER 2017

In Touch is an employee newsletter published by Communications and Public Affairs.

Please send story ideas to In Touch editor Leslie Shepherd at shepherdl@smh.ca.

Design by Marcelo Silles, Medical Media Centre

to provide exceptional care. But it’s also important that it look good. Aesthetics play a role in helping patients and their loved ones feel comfortable.

Q. What is your educational background? How did you end up at St. Michael’s?

My background isn’t in health care; I’m an architectural technologist by training. At Sheridan College I learned about design, construction and materials. After a co-op placement here as an architectural student in the Engineering Department, I realized how dynamic and interesting it is to work in health care at St. Michael’s. I’ve worked almost my entire career here.

Q. You’re also working on the Pathology renovation. What’s been a highlight for you on this project?

Furniture, fixture and equipment decisions are usually made at the end of a project. For the Pathology renovation, I’ve been involved in the designs from the beginning. It’s rewarding to be on a project from start to finish, especially one that will see such a huge improvement in the Pathology team’s space.

Q. What’s your favourite part about working at St. Michael’s?

The diversity of staff and diversity of work. I work with a wide range of health-care professionals and every day I navigate a new set of challenges. I absolutely love it.