In Touch Newsletter: Summer 2015

INTOUCH SUMMER 2015

Let the games begin!

By Melissa Di Costanzo

For Dr. Ashna Bowry, volunteering as a family doctor during the Pan Am/ Parapan Am Games is about proudly representing the place she now calls home.

“I’m doing something for my country and I’m proud to be Canadian,” she said.

The family physician at St. Michael’s Health Centre at 80 Bond became a Canadian citizen in February. Born in Kenya, Dr. Bowry completed her medical school training in England, where she keenly followed soccer, rugby and cricket.

By the time she landed in Ontario’s capital, Dr. Bowry was ready to take on her next athletic interest: learning about hockey. This prepared her for the Vancouver 2010 Winter Olympics, which she attended as an avid spectator.

“I loved being part of that spirit,” she said. “It was so great to see Canadians come together and celebrate the sport at home.”

This summer Dr. Bowry will work in the polyclinic – a temporary facility set up for the Pan Am/Parapan Am Games – treating athletes from other countries who may experience dehydration, heat stroke, coughs and colds, or asthma flare ups. She’ll also provide care to basketball and baseball players in the Ryerson Athletic Centre.

“I thought I might as well join the mania and apply my skills outside of work in a meaningful way,” she said.

Almost 20 kilometers away in Etobicoke, Dr. Julia Rackal will help care for BMX bikers in Centennial Park

Drs. Julia Rackal, Lee Schofield and Ashna Bowry will be volunteering with the 2015 Pan Am/ Parapan Am Games, taking place in Toronto and various locations across the Greater Toronto Area.

(Photos by Yuri Markarov, Medical Media Centre)

Continued on page 2 Printed on 100 per cent recycled paper

SUMMER 2015 | IN TOUCH | 1

OPEN MIKE with Peter Longo

Director, Strategic Sourcing and Logistics some point. Either we find a source to purchase the goods or service, we order it, we receive it and-or we make sure it gets to the right unit on time.

In the two years since I have been at St. Michael’s (not including the few days when I was born here), I have been impressed every day with the organization’s laser focus on patient care.

Our mission and values are truly alive within all clinical and support teams.

The Supply Chain team tries to do its part by ensuring people have the right product or service at the right time, for the right price, in the right quantity, with the right level of quality expected by those who placed the order.

That’s a lot of moving pieces. So when I heard the hospital was bringing in Ernst & Young to help us conduct an operational review, to find ways of being more efficient and effective, I wanted to be part of Phase One. If we can standardize some of the products we use and reduce the number of suppliers we buy them from, we can better manage our relationships with our vendors and leverage our buying power to obtain better overall value for the products and services we buy.

Let me give you an example. The hospital spends at least $400,000 a The hospital (including research and education) purchases $230 million a year year on printer toner cartridges. There are lots of different kinds of cartridges in goods and services and the majority – brand names, generic, refilled, etc. of that passes through Supply Chain at

If we could agree on one cartridge for each model of printer we have in the hospital and hardcode that into the Staples ordering website, we could save at least $80,000 a year. Imagine the potential savings if we did the same thing with other more expensive goods and services across the hospital.

It is important to note that physicians, clinicians and other users of goods and services will still drive the clinical, quality, functional and technical requirements for the things we purchase. The Supply Chain Team can help you obtain the best overall value of what you need, when you need it. When we reduce costs, reduce wastage and operate more efficiently, that’s quality improvement. Everyone benefits, particularly our patients.

Pan Am Games story continued from page 1

and taekwondo athletes at the Mississauga Sports Centre.

“This is a fun, exciting time for Toronto,” she said. “Why not get involved?”

The family doctor at St. Michael’s Family Practice Unit at 61 Queen St. E. has volunteered in the Special Olympics and the Toronto International Film Festival – but not at anything quite like Pan Am. “I enjoy the excitement of the city surrounding the games, and the energy and excitement of meeting and hosting international athletes,” she said.

Dr. Lee Schofield has treated figure skaters, divers and triathlon participants, having volunteered with national and provincial recreational and high-performing athletes in various sporting events.

This summer, the sports and family medicine doctor will be part of the core Canadian medical team caring for Canadian athletes, coaches and team leaders, as lead physician for the Parapan athletes at York University. He’ll help develop emergency plans, provide coverage where athletes play and will work at the medical clinic in the Pan Am athletes village for the Canadian team.

“Our goal is to help athletes do the best they can, and be the best they can possibly be,” he said.

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ST. MICHAEL'S PAN AM ROLES • St. Michael’s will remain a designated trauma hospital, and receive trauma patients under the hospital’s usual guidelines • Increased walk-in traffic to the ED is anticipated during the games • St. Michael’s is not a specific designated hospital for the games.

Patients may be sent to our ED from the Pan Am Polyclinic, under normal EMS guidelines. Designated receiving hospitals are Toronto East General Hospital, and the University Health Network

Follow St. Michael’s on Twitter: @StMikesHospital

Andrea Dedrick working on one of her illustrations. (Photo by Yuri Markarov, Medical Media Centre)

St. Michael’s clerical assistant engages people through illustration

By Roshni Jayawardena

Andrea Dedrick’s ability to bring a smile to a person's face extends beyond the walls of the Live Donor Program at St. Michael's Hospital. While organizing tests and appointments for patients in the program are her top priorities in her job as a clerical assistant, capturing people's attention through illustration is where her heart lies when she's at home.

It is through this passion that she has become a published illustrator in a children’s book called Apple Saucy.

“I have always been a creative person and someone who views family time and educational opportunities in high regard,” said Dedrick. “When I met Barbara Dingle, the author of Apple Saucy, through a colleague at St. Michael’s, I felt an instant connection.

Her book resonated with me because it

encourages family time

through games, a healthy recipe and a song, which are important elements to pass onto children growing up and I knew I wanted to be a part of it.”

As a mom of two girls, Dedrick has always read to her children and spent time with them in the kitchen, which is the premise of Apple Saucy. The story revolves around a grandmother spending time with her grandchildren in the kitchen making apple sauce. As an artist, Dedrick loves the human face and capturing lifelike images, so being involved with this book really was the “best of both worlds” for

her. Many of the illustrations in the book are close-ups of the characters with expressions on their face that demonstrate they are having fun.

“I was excited to hear about the Department of Family and Community Medicine’s Reach Out and Read program that launched earlier this year,” said Dedrick. “Promoting literacy is so important and helping our patients build a home library is a fantastic idea.”

Dedrick and Dingle are building on the success of Apple Saucy by working on Carrot Picnic, the second book in Dingle’s series.

“When I met Barbara Dingle, the author of Apple Saucy, through a colleague at St. Michael’s, I felt an instant connection. Her book resonated with me because it encourages family time through games, a healthy recipe and a song, which are important elements to pass onto children growing up and I knew I wanted to be a part of it.”

St. Michael’s is an RNAO Best Practice Spotlight Organization

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Go with the flow: Improving hospital navigation with St. Michael’s 3.0

By Kate Manicom

In addition to the transformations in patient care that will be generated

by St. Michael’s 3.0, the redevelopment project includes improvements in the ways that patients, visitors and staff navigate the hospital.

These changes will be evident from the moment visitors arrive at the renovated Queen Street entrance through a new front door into a lightfilled, welcoming lobby. The information desk will be front and centre for those who need help to find their way.

From here, a new pedestrian highway will run throughout the first floor. Known as Element Financial Way, this artery will connect Queen Street with the historic Bond Street lobby and improve wayfinding between the hospital’s wings. An atrium in the new Peter Gilgan Patient Care Tower, which will be named the Element Financial Atrium, is intended to be the heart of the hospital and will bring 10 storeys of natural light to the building’s interior.

Along with better navigation across St. Michael’s will be improved access to the hospital’s upper levels with the installation of 10 new elevators.

With separate designated elevator banks for visitors and ambulatory patients, patient transfer and hospital services, people travelling among the hospital’s 17 storeys will be able to reach their destinations quickly and easily.

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Designs for the new public circulation route through the hospital’s first floor.

The hospital’s new public circulation route will run through the future Element Financial Atrium, bringing 10 storeys of natural light to the building’s interior. (Rendering by NORR)

Mark Peterson Cardiovascular Surgery “I have over 5,000 songs on my phone, and I play it on random. So we listen to everything from opera and classical to Led Zeppelin, David Brubeck, Johnny Coltrane (jazz), Queen, Lenny Kravitz and pop music.”

Danny Whelan Orthopedics

Melinda Musgrave PLASTIC Surgery

"The drinkin bone" by Tracy Byrd, or any country music

"Try" by Blue Rodeo

MICHAEL Cusimano Neurosurgery “I’ll play a song from an assistant's, nurse's or anesthetist's country. If that fails, then I’ll play something

by Adele, Lady Gaga, Pucini, Verdi or Mozart. Or nothing. One day, we played Neil Young while doing a craniotomy because the patient, who was awake, liked him.”

Kenneth PACE Urology “I'm an Alt Rock guy. The playlist keeps changing with new music as it comes out, but right now it includes Weezer, Foo Fighters, AWOLNATION, Saint Motel, Vance Joy, Coin, Andrew McMahon in the Wilderness, Mumford & Sons, Cage the Elephant and Jack White.”

John Honey Urology

ELISA GRECO

"The very best of Buddy Guy" and "Frankie Valli and the Four Seasons"

Thievery Corporation

VASCULAR SURGERY

Sunit Das Neurosurgery “During craniotomies, I typically listen to ‘Kind of Blue’ by Miles Davis, ‘Bach’s Goldberg variations’ by Glenn Gould and ‘The Trinity Sesssions’ by The Cowboy Junkies. During my more conventional cases, I listen to a playlist with about 1,400 songs ranging from alternative, to hip hop and country (such as Johnny Cash and Hank Williams, but not Shania Twain).”

Adena Scheer General Surgery “I listen to a variety of music from Drake to Cyndi Lauper.”

RalpH George General Surgery “I do not play music in the OR. I prefer the sound of silence - and I don’t mean the song by Simon and Garfunkel."

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During her Wound Care Fellowship, Katie Marinzel, a nurse with the Trauma and Neurosurgery Unit on 9CC, designed and led training to share best practices with her colleagues. In this photo she uses a synthetic leg to teach how to assess an ulcer. (Photo by Katie Cooper, Medical Media Centre)

Healing the gap

By Geoff Koehler

The wounds seen by wound care specialists can spark visceral reactions in some people, but for Katie Marinzel, they struck a chord.

Marinzel, a nurse with the Trauma and Neurosurgery Unit on 9CC, felt drawn to wound care management. In her first year at the hospital, she took all four wound care education courses available.

When she heard that the Mobility Program was offering a 12-week Wound Care Fellowship, Marinzel was ready for her next challenge.

Patients who are immobile, have compromised circulatory systems or have diabetes are each prone to different types of complex wounds.

Given the hospital’s expertise in critical care, cardiovascular issues and endocrinology, Marinzel saw something new nearly every day.

“Any patient at St. Michael’s with a SUMMER 2015 | IN TOUCH | 6

complex wound can be referred to the wound care team for assessment and recommended treatment,” said Marinzel. “I spent January to March learning from our tremendous team and following those patients on the units or in clinic.”

Marinzel was required to complete a project to satisfy the fellowship. She chose to focus on quality improvement, addressing the learning needs for wound care among the nurses on 9CC. “I knew from my own experience that it can be hard to accurately assess, let alone treat, some of the complex wounds our patients have and sensed others may have felt the same,” said Marinzel.

Marinzel surveyed nurses about what they knew about wounds and what more they wanted to learn. She also audited charts to get a sense of how wounds are documented in patient files.

Marinzel said nurses reported a lack of confidence in wound assessment terminology. She believed this knowledge gap affected the detail of

wound data in some charts.

“With the help of the wound care team, I compiled resources, developed additional wound care education and trained 42 nurses across the Trauma and Neurosurgery Unit,” said Marinzel. “It was empowering to share what I’d learned with my colleagues, especially because it ultimately helps our patients.”

After the fellowship concluded in March, Marinzel returned to 9CC, but was recently seconded to the wound care team for the summer to provide temporary support. Her wound care experience won’t end there, however, as she’s set to begin her Masters of Clinical Science in Wound Healing at Western University in September.

“I can’t believe how much I’ve been able to achieve in my time at St. Michael’s,” said Marinzel. “The focus on wound care at this hospital is special and I can’t wait to come back after this next opportunity with even more knowledge to share.”

Mary Choi, a lab technologist, prepares a blood sample to be run through the ROTEM® test. (Photo by Yuri Markarov, Medical Media Centre)

Patients benefit from innovative blood clot technology

By Heather Brown

Time is of the essence for a patient suffering from massive blood loss. For the health care team to treat his or her injuries, every effort must be made to control or stop the bleeding first.

St. Michael’s blood lab is using an innovative test known as the rotational thromboelastometry or ROTEM® to help clinicians determine the most appropriate clotting product, whether it be plasma, platelets or medications such as tranexamic acid.

St. Michael’s is the first hospital in Canada to use this test in a clinical environment. Most facilities are still using it in research settings and many are looking to St. Michael’s for insights into how best to implement it clinically.

“ROTEM® has changed the way we care for patients suffering from

massive bleeding,” said Dr. Sandro Rizoli, trauma director at St. Michael’s and one of two physicians who championed implementing this test at the hospital.

“We no longer have to wait for multiple tests to be run or guess which clotting products may work.”

This technology enables the trauma team to watch a clot form in real-time on a monitor in the trauma room via a computer in the lab. As soon as the team sees how the clot is forming and how strong it is, a member from the team calls the hospital’s blood bank and orders the specific clotting product needed to stop the bleeding. This typically happens within 10 minutes.

Previously the trauma team would receive a standard delivery of six units

of red blood cells and four units of plasma, followed by four units of red blood cells and four units of plasma, every 20 minutes. This was done for every patient suffering from massive blood loss regardless of size, gender or whether he or she actually needed plasma or red blood cells.

“While it is still too early to tell how much blood has been saved since introducing ROTEM®, we are hoping to see a more appropriate usage of blood components that are ordered to treat a patient suffering from massive bleeding and fewer components being wasted,” said Katerina Pavenski, medical director of the Transfusion Medicine Laboratory at St. Michael’s.

More than 400 blood samples have been processed through the ROTEM® blood test machine since November 2014 SUMMER 2015 | IN TOUCH | 7

Q&A

DR. JUDITH PERANSON and DR. DANYAAL RAZA

By Geoff Koehler (Photo by Katie Cooper, Medical Media Centre)

for us to serve the communities by working positively with community partners to provide primary care for the area.

Dr. Judith Peranson and Dr. Danyaal Raza are family doctors and cophysician leads of the new Sumac Creek Health Centre – a clinic of new and established St. Michael’s health disciplines, nurses, physicians and staff who are committed to providing a team-based approach to care. Sumac Creek is St. Michael’s sixth Family Health Team site and shares space with teams from the hospital’s laboratory medicine, diagnostic imaging and the FOCUS mental health programs.

Q. Do either of you have any other doctors in your family?

Q. What does your average day look like?

There really is no average day! Just in the past week, we’ve split our time between our core work–providing care to patients– with planning for the Sumac Creek Health Centre, teaching residents, medical students and graduate students, and working on research and quality improvement projects.

Q. Are there themes or major questions every patient wants to know?

As generalists, we see patients with very different needs and questions but at the end of the day, patients most want to know that you and your team will be there for them when they need it.

That’s what we strive to do for every patient.

Q. What specifically attracted you to Sumac Creek Health Centre?

Nearly 10,000 adults living in Regent Park, Moss Park, St. James Town and the surrounding areas do not have access to a primary care provider. Being a part of Sumac Creek is a great opportunity

INTOUCH

SUMMER 2015

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 Dermot Covel, Medical Media Centre

DR: My grandfather was a GP in British-occupied India. After his family was displaced post-partition, he rebuilt his practice with house calls on his bicycle. One of my proudest moments was when my dad gave me my grandfather’s stethoscope, just days after I graduated with my MD. JP: I come from a long line of engineers.

Q. After a stressful day, how do you unwind?

DR: When I’m caught up on the day’s clinical, research and administrative tasks, I like to end the day with my partner, on a lighter note. We love catching up on our favourite TV show. Right now, it’s the always funny and often subversive “Fresh off the Boat.”

JP: I like to catch up with friends, maybe check out a new restaurant or grab a frozen yogurt for a stroll in the park if the weather is nice.

Q. Is there a book or activity you're looking forward to this summer?

DR: My summer reading pile is constantly growing! At the top is The Body Economic. Written by two epidemiologists, it uses an evidencebased approach to reveal the often devastating health consequences of austerity budgets and associated government decisions. With a federal election around the corner, it’s a timely read.

JP: Ha! I usually gravitate towards anything fiction. Preferably on a deck somewhere overlooking Georgian Bay.