annual report 2005 – 2006 - department of medicine€¦ · ¾ teleconsultations from all three...

ANNUAL REPORT 2005 – 2006

“A network without walls, without professional boundaries, and without limits on quality patient care, research, and education”

DEPARTMENT OF MEDICINE Calgary Health Region

and University of Calgary

of 71

VISION, MISSION & CORE PRINCIPLES

OF THE DEPARTMENT OF MEDICINE

(Photography by Ted Grant – used by permission)

To prevent disease, to relieve suffering and to heal the sick –

this is our work. Sir William Osler

OUR VISION Creating the medical network of the 21st Century

A network without walls, without professional boundaries, and without limits on quality patient care, research, and education

OUR MISSION

To be the best Department of Medicine in the country

To be widely recognized for advancing health and wellness, leading innovation, creating technologies and disseminating knowledge

OUR CORE PRINCIPLES

Innovation – Excellence – Patient Care – Scholarship – Education Leadership – Technology

of 71

Table of Contents

EXECUTIVE SUMMARY .....................................................................................................................................................4 SIGNIFICANT DEPARTMENTAL ACHIEVEMENTS.....................................................................................................................4 NOTEWORTHY DIVISIONAL ACCOMPLISHMENTS ...................................................................................................................4 QUALITY IMPROVEMENT & PATIENT SAFETY INITIATIVES....................................................................................................4 INNOVATIONS ........................................................................................................................................................................5 EDUCATION AND RESEARCH HIGHLIGHTS .............................................................................................................................5 CHALLENGES FOR NEXT FISCAL YEAR..................................................................................................................................5 PRIORITIES FOR NEXT FISCAL YEAR......................................................................................................................................5 DEPARTMENTAL STRUCTURE AND ORGANIZATION..............................................................................................6 ADMINISTRATIVE STAFF................................................................................................................................................7 DEMOGRAPHICS OF THE DEPARTMENT OF MEDICINE ............................................................................................................8

ACCOMPLISHMENTS AND HIGHLIGHTS...................................................................................................................10 NOTEWORTHY DEPARTMENTAL ACCOMPLISHMENTS AND HIGHLIGHTS .............................................................................10 SPECIFIC CLINICAL HIGHLIGHTS .........................................................................................................................................12 EDUCATION .........................................................................................................................................................................13 RESEARCH ...........................................................................................................................................................................14 MEDICAL LEADERSHIP AND ADMINISTRATION....................................................................................................................14

CHALLENGES AND PRIORITIES ...................................................................................................................................15 CHALLENGES FOR THE NEXT FISCAL YEAR .........................................................................................................................15 PRIORITIES FOR THE NEXT FISCAL YEAR.............................................................................................................................15

FUTURE DIRECTIONS.......................................................................................................................................................16 WORKFORCE PLANNING................................................................................................................................................17

RECRUITMENT FOR 2005 – 2006..........................................................................................................................................17 ATTRITION TO DEPARTMENT FOR 2005 – 2006....................................................................................................................19

QUALITY SAFETY & HEALTH IMPROVEMENT........................................................................................................20 EXECUTIVE SUMMARY ........................................................................................................................................................20 QUALITY, SAFETY, AND HEALTH INFORMATION .................................................................................................................20 QUALITY IMPROVEMENT/SAFETY STRUCTURE – WITHIN DEPARTMENT OF MEDICINE AND NE PORTFOLIO .......................27 QUALITY IMPROVEMENT AND PATIENT SAFETY PROGRAM HIGHLIGHTS ............................................................................28

INNOVATION.......................................................................................................................................................................32 APPENDICES........................................................................................................................................................................33

APPENDIX #1: SUMMARY OF MEDICINE QUALITY AND SAFETY IMPROVEMENT PROJECTS..................................................33 DIVISION OF DERMATOLOGY...............................................................................................................................................36 DIVISION OF ENDOCRINOLOGY AND METABOLISM..............................................................................................................37 DIVISION OF GASTROENTEROLOGY .....................................................................................................................................39 DIVISION OF GENERAL INTERNAL MEDICINE.........................................................................................................43 DIVISION OF GERIATRIC MEDICINE...........................................................................................................................52 DIVISION OF HEMATOLOGY AND HEMATOLOGIC MALIGNANCIES .......................................................................................55 DIVISION OF INFECTIOUS DISEASES .........................................................................................................................61 DIVISION OF NEPHROLOGY .............................................................................................................................................63 DIVISION OF RESPIROLOGY..................................................................................................................................................65 DIVISION OF RHEUMATOLOGY.............................................................................................................................................70

This report is respectfully submitted by: Dr. John Conly MC, FRCPC, FACP, Professor and Head

University of Calgary and Calgary Health Region, on behalf of the Department of Medicine, November 2006

of 71

Executive Summary

Significant Departmental Achievements Telehealth service delivery continues to exceed our targets Recruitment of 31 individuals • Including 3 Clinical Scholar; 7 Clinical; 12 Major Clinical; 7 GFT and 2 Adjunct positions • Canadian Chair for Therapeutic Endoscopy – sponsored by Pentax • Addition of the first Aboriginal physician in the Department of Medicine

Retention – Seeking Balance Study undertaken to identify work life balance issues Fund Raising Initiatives • $1.29 Million from Foothills Home Lottery Board for Ward of the 21st Century • $28,000 from Foothills Hospital Volunteer Association for FMC PCU 36 • $83,000 ATCO donation to support Ward of the 21st Century • $1.7 Million from Foothills Home Lottery Board for development of BMT Unit

Innovations • Integration of innovations into the Medical Service Delivery • Comprehensive framework for evaluation of innovation projects established • Baseline data collection

First Annual Awards Night for Department of Medicine • New awards established for Clinical Excellence, Innovation and Professionalism

Completion of POSP Initiative with selection of vendor – EMIS for the EMR

Noteworthy Divisional Accomplishments New pan-Alberta educational program for residents in Dermatology New Clinics for dermatology, immunodermatology and genetic skin diseases New Telehealth clinic for diabetes in pregnancy in Lethbridge Central triage for patients waiting for assessment in Gastroenterology and Rheumatology IBD Nurse Practitioner hired to help transition in-patients to out-patients Nurse clinicians help plan for Colon Cancer Screening Centre Extended GI service plan developed in collaboration with Rural Medicine Transition clinic (YARD) for Young Adults with Rheumatic Diseases functioning Geriatrics telehealth accounts for 35% of the total Departmental teleconsult service Telehealth Program for Rheumatology to Pincher Creek & Rocky Mountain House Seniors Campus has been accepted by the Reach! Campaign IMGs integrated in active work New GMU service has been established at FMC and enhanced at the RGH Urgent Assessment Clinic satellite clinic opened at RGH FACT accreditation of BMT program Nurse Practitioner Role expanded for Inpatient and HPTP in Infectious Diseases Nocturnal Hemodyalysis introduced Interventional bronchoscopy program established

Quality Improvement & Patient Safety Initiatives

Continued challenge to address cultural change, support and momentum Projects include

• GRIDLOC • Safe Spaces • Safer Health Care Now

• Medication reconciliation • Chemotherpay storage and

labeling Preparation to implement PCIS

of 71

Innovations

Hired 73% of allocated staff by fiscal year end Launched or expanded a number of specialty clinics including:

• Atrial Fibrillation Clinic • Tertiary Obesity clinic

• Cough clinic • Sputum diagnostic clinic

• Expanded the Congestive Heart Failure clinic • Young Adults with Rheumatic Disease (YARD)clinic Nurse Practitioners in Medical Services

increased to 7 • Expanded General Internal Medicine Urgent Assessment Clinic• Created central referral and triage in Gastroenterology, Nephrology and Rheumatology. • Launched education intervention to support patient knowledge and uptake of alternative

modalities of dialysis. • Piloted standardization of peri-operative referral process and lab work. • Strengthened care transitions from acute care to community in congestive heart failure, chronic

obstructive pulmonary disease, and stroke secondary prevention. • Enhanced use of clinical practice guidelines in Infectious Diseases and Osteoarthritis • Supported rural specialist access: gestational diabetes clinic via telehealth to Lethbridge. • Completed evaluation plans and related databases for all innovation initiatives.

Education and Research Highlights

Residency Training Program Increased RTP slots to 47 in the current year

Full accreditation of the program until 2009 Accreditation of Nephrology and Respirology achieved

Research Highlights

463 non peer reviewed publications (includes editorials and letters), 153 additional articles submitted to peer reviewed publications 64 articles published in non-peer reviewed publications 58 books and book chapters published 241 abstracts published 356 invited presentations

Challenges for Next Fiscal Year

Workforce deficit in meeting manpower targets Space – availability for both clinical and office space Successful implementation of the EMR project Ensure renewal process for ARP is established Meeting the expanded Regional acute care capacity Ongoing fiscal support for innovation initiatives Planning and implementation of site planning in preparation for moves to multiple sites under

development

Priorities for Next Fiscal Year Meeting recruitment targets of 25 - 30 FTEs (15 – 20 plus 10 – 15 additional FTEs to account for

attrition) per year to meet clinical service requirements and train future IM specialists Accommodating current and short term space requirements Supporting the deployment of an EMR solution in outpatient clinics as part of the overall Outpatient

Clinical Care Integration Strategy Planning for ARP renewal with strategic and tactical issues in a complex political environment Employing the Ward of the 21st Century as a template for South Hospital planning Finding operational funding for current and future innovation initiatives

of 71

DEPARTMENTAL STRUCTURE AND ORGANIZATION

Dr. John ConlyRegional Clinical Department Head,

Medicine

Division of DermatologyDr. Richard Haber

Division of Endocrinology & Metabolism

Dr. Alun Edwards

Division of Geriatric MedicineDr. James Silvius

Division of GastroenterologyDr. Ron Bridges

Division of Hematology & Hematologic Malignancies

Dr. Graham Pineo*

Division of General Internal Medicine

Dr. Robert Herman

Division of Immunology & AllergyVacant

Division of NephrologyDr. Nairne Scott-Douglas

Division of Medical & Radiation Oncology

Dr. Vivien Bramwell

Division of Respiratory Medicine

Dr. Chris Mody

Division of RheumatologyDr. Liam Martin

Division of Infectious DiseasesDr. Ron Read

Theresa Williams220-3037

Beverly Forbes 943-3775

Suzanne Buffel944-4451

Hanifa Rhemtulla944-2783

Cheri Wright 210-9356

JoAnne Taylor220-5926

Vilma Svetina-Atkins

943-5681

Marlene Kupchanko521-3707

Toby Hately220-8479

Vacant

Louise Kosmack944-2804

Vi Glover220-7725

* Dr. Doug Stewart replaced Dr. Pineo – March 2006

of 71

of 71

ADMINISTRATIVE STAFF

of 71

Demographics of the Department of Medicine

Divisions MALE FTE FEMALE FTE AVE. AGE

Left Depart-ment Recruits TOTAL

Dermatology 7 7.0 5 5.0 52.5 0 2 12 Endocrinology 9 8.9 7 5.1 45.1 0 1 16 Gastroenterology 25 24.7 5 4.1 41.5 0 7 30 Geriatric Medicine 5 4.6 3 2.2 41.3 0 1 8 General Internal Medicine 22 20.9 15 15.0 40.7 0 7 36 Hematology 10 9.8 4 3.4 44.1 0 2 14 Infectious Disease 10 9.8 3 1.2 40.6 0 2 13 Medical & Radiation Oncology 5 4.2 4 4.0 48.8 0 1 9 Nephrology 16 15.0 4 4.0 44.3 0 2 20 Respirology 17 16.5 5 4.8 43.1 0 3 22 Rheumatology 8 8.0 8 7.8 51.0 0 0 16 196 Cardiology* 17 16.5 4 4.0 50.0 0 1 21

* Cardiology appointments are secondary to Medicine.

TOTALS 146 145.8 67 60.6 44.9 0 29 217

of 71

Clinical

Scholars C MC GFT TOTAL Leaves

Months per

Fiscal Year

ARP Members

Dermatology 0 10 0 2 12 1 - MAT 3.5 2 Endocrinology 1 3 6 6 16 16 Gastroenterology 3 8 7 12 30 2 - ED 15.0 21 1 - MAT 5.0 Geriatric Medicine 0 0 8 1 9 1 - LOA 9.0 8 General Internal Medicine 0 14 15 7 36 1- MAT 5.5 23 Hematology 1 3 4 6 14 2 - MED 9.5 12 1 - MAT 12.0 Infectious Disease 1 0 3 9 13 2 - SAB 15.0 11 Medical & Radiation Oncology 0 3 0 6 9 0 Nephrology 0 4 6 10 20 1 - SAB 8.0 12 1 - LOA 9.0 Respirology 0 1 13 8 22 19 Rheumatology 0 7 2 7 16 14 Cardiology * 0 3 6 12 21 1 - ED 2.0 16

* Cardiology appointments are secondary to Medicine.

TOTALS 6 56 70 86 218 93.5 154 Legend

MAT Maternity Leave

ED Educational Leave

LOA Leave of Absence

MED Medical Leave

Recruitment by Division

SAB Sabbatical Leave

of 71

Accomplishments and Highlights

Noteworthy Departmental Accomplishments and Highlights 1) Telehealth Service Delivery

Expansion of Telehealth consultative services Department of Medicine Team based approach lead for Dr. J. Silvius and the Telehealth co-ordinator Teleconsultations from all three hospital sites implemented for geriatrics, nephrology,

infectious diseases, clinical immunology and general medicine Continue to exceed our targets

Clinical Area Clinical Consultation Hours

(June 1, 2005 – May 31, 2006) Geriatrics 622.0

Paediatrics 444.3

Mental Health 245.3

Diabetes 106.8

Clinical - Education 85.0

Cardiology 65.9

Rheumatology 48.8

Palliative 40.0

Rehabilitation 24.5

Nephrology 22.0

Case Conference (patient present) 21.3

Discharge Planning 12.3

Genetics 11.0

Internal Medicine 10.0

Forensic Mental 8.5

Emergency/ICU 3.7

Wound Care 3.5

Surgery 2.5

Infectious Disease 2.0

Neurology 2.0

Oncology 2.0

General Practitioner Consult 1.0

Group Total 1784.2

2) Recruitment

29 individuals have begun work in Calgary Health Region 7 of these were Clinical, 12 were Major Clinical and 7 were GFT 3 took Clinical Scholar positions Of these 29, 9 were Female and 17 were males 21 individuals became part of the ARP

3) Fund Raising Initiatives

Receipt of $1.29 million from the Foothills Home Lottery Board to be used for the Ward of the 21st Century (U36) medication technology and for surveillance equipment

of 71

Donation received from the Foothills Hospital Volunteer Association in the amount of $28,000 for the Foothills Medical Centre PCU 36

Additional ATCO donation of $83,000 representing the second installment of a three-year commitment in support of the Ward of the 21st Century

Receipt of $1.7 million from the Foothills Home Lottery Board to be used for the development of a new Bone Marrow Transplant Unit

4) Retention - Seeking Balance Study

The SEEKING BALANCE study was completed in October 2006 and the final report will be sent out before Christmas. The objective of this study was to identify what members of the Department of Medicine perceived as pertinent work life balance issues and to make recommendations for change. The study consisted of three parts: 1) A baseline survey sent to all members in November 2004 to assess physicians’ work attitudes and experiences, 2) A one hour face to face interview of 54 representative department members to discuss what matters and to seek ideas for change, and 3) A comprehensive mail-out survey to all members in the spring of 2006 based on themes and issues identified from the interview data. This massive input of ideas has been summarized in the final report. There is no doubt that physician wellness and work life integration are now recognized as vital to recruitment, retention and quality patient care. We look forward to the challenge of implementing these ideas for change as well as educating physicians and administrators about the importance of both healthy physicians and workplaces.

5) Innovations Integration of innovations into the Medical Service Delivery Comprehensive framework for evaluation of innovation projects established Baseline data collection

6) Initiated the First Annual Awards Night for members of the Department of Medicine

New awards established for Clinical Excellence, Innovation and Professionalism

7) Canadian Chair for Therapeutic Endoscopy

8) Addition of the first Aboriginal physician in the Department of Medicine 9) Completion of POSP Initiative with selection of vendor – EMIS for the EMR Foundations of Medicine 10) Residency Training Program

Increased RTP slots to 47 in the current year Achieved full accreditation of the program until 2009. Accreditation of Nephrology achieved Accreditation for Respirology achieved

Specific Clinical Highlights

International Medical Graduate Training In 2002, General Internal Medicine initiated a program to sponsor foreign trained Internists as ward physicians within the general medical units. The role of these physicians is to provide the primary care for the medical inpatients and extend the capacity of our attending physicians. What became evident is that after a period of time of orientation to Canadian medicine, these ward physicians showed a adequate level of competency to handle complex medical patients, and were lacking only a Canadian credential to assume full practice. The Alberta International Medical Graduate Training Program (AIMG) offers funded Internal Medicine residency positions for these physicians and we were fortunate to receive approvals on each of our requests for positions. This opportunity has allowed us to provide the primary care required on the admitting services, offer full funded Internal Medicine residency positions to our ward physicians, and maintain a high success rate in the IM training program with these Residents. Based on our success, and a similar program in Cardiology, the CHR initiated the Calgary Clinical Assistant Program in late 2006. Additional new positions were given to Medicine by this program. At the time of writing, we have 13 International Medical Graduates working as ward physicians in Pulmonary Medicine, Hematology and Bone Marrow Transplantation, Nephrology, and General Internal Medicine.

Physician Office System Project During this fiscal year, a major effort was launched by Medicine to review the feasibility of introducing an Electronic Medical Record system (EMR) to support the clinical care provided by our physicians in our outpatient clinics. This effort, co - chaired by Drs. Edworthy and Mellor, and supported by Mr. R. Mohr, made a recommendation to Medicine to proceed with the selection and implementation of an EMR. This new system would be supported through the Physician Office System Program, and be integrated as required within the CHR enterprise patient information environment. An exhaustive and best of practice approach was used to select the best possible commercial software product from a list of eleven POSP approved products. This approach included

• Financial review of the software vendors corporate information • Ability to meet our business requirements • Technical review by University and CHR IT staff • Clinical scenario testing against our scripted requirements using an expert panel approach • Presentations from the Software vendors on how they would approach and organize the

implementation • Site Visits to existing customers operating with similar size and scope • A “Sandbox” test environment to allow our various user groups to familiarize themselves with the

look and feel of the software product and express a preference • A “Best and Final Offer” submission b the two final vendors

From this rigorous process, a recommendation was supported by the participants in Medicine to contract with Egton Medical Information Systems for supply and installation.

of 71

Education

During the past year the enrollment of residents in the core R1 to R3 Internal Medicine Residency Program continued to increase from our traditional allocation of 30 positions. As of July 1, 2006 our core program will have 52 residents, which assists in meeting the shortage of Medical Specialists in the Calgary Region, Alberta, and Canada. This increase was due to supplementary allocations of positions from the Alberta Government, including the relatively new Alberta International Medical Graduate program which provides funding for six of our Core Program residents. In addition the Subspecialty Residency Programs support 32 additional residents or fellows at the R4 and R5 levels in Royal College of Physicians and Surgeons Accredited Residency programs. In summary, the Department of Medicine Core and Subspecialty Residency Programs are educating a total of 84 physicians who will enter practice and assist with addressing the physician shortage situation. In parallel to the increase in resident enrollment the Department has recruited clinical teachers and increased the clinical education experiences (“Rotations”). The following rotations have been added in the past year:

1). An additional senior resident role on the FMC and PLC site Medical Teaching Units with an emphasis on teaching and leadership skills. 2). A Dermatology and Allergy rotation with the leadership of Dr. Richard Haber, Regional Clinical Division Chief of Dermatology, and Dr. Tom Bowen. 3). A senior resident General Internal Medicine rotation at the Rockyview General Hospital under the leadership of Dr. Ghazwan Altabbaa.

The Program Subspecialty rotations have also increased their clinical experiences at the Rockyview General Hospital more than has been the tradition in the past, and benefiting from the learning opportunities at this sister hospital. The Program has been actively organizing teaching on the Royal College of Physicians of Canada CANMEDs competencies assisted by grants from the Faculty of Medicine and Alberta Government and provided in collaboration with the Canadian Medical Association and Alberta Medical Association Physician and Family Support Program. With respect to the coming year a strategic plan for the Program is near completion by a committee chaired by Dr. Paul Gibson. Priority areas for development and innovation will be the General Internal Medicine educational experiences, ambulatory clinical care, community care in centers outside of Calgary on the model of our traditional rotation in Lethbridge, which has been very successful for emulation. The Alberta Rural Physician Program is supportive of this outreach community rotation initiative. It continues to be our vision to educate young physicians to lead the future of medicine.

of 71

Research

During the 2006 calendar year, based on the submitted reports, Department members disseminated their knowledge in the following venues:

463 articles, editorials and letters 153 additional articles submitted to peer reviewed publications 64 articles published in non-peer reviewed publications 241 abstracts published 58 books and book chapters published 356 invited presentations

The members also contributed to the development of future medical researchers by mentoring and supervising the work of 254 learners at undergraduate, graduate and post-graduate levels.

Medical Leadership and Administration

We have added one physician to the Department of Medicine to assist in Administrative roles. Dr. Maria Bacchus has joined us in July of 2005 as Vice Chair, Strategic Planning and Clinical Affairs. Dr. Jane Lemaire also continued in her role of Vice-Chair, Career Development. We are very pleased to have both physicians work in these capacities. .

of 71

Challenges and Priorities Challenges for the Next Fiscal Year

Workforce deficit in meeting manpower targets Space – availability for both clinical and office space Successful implementation of the EMR project Ensure renewal process for ARP is established Meeting the expanded Regional acute care capacity Ongoing fiscal support for innovation initiatives Planning and implementation of site planning in preparation for moves to the

o TRW (Translational Research Wing) Building (U of C) o RRDTC (Richmond Road Diagnostic Treatment Centre) o Sheldon M. Chumir Facility o Planning for the new West Tower located at the Foothills Medical Center o Planning for the New Cancer Institute o Planning for the New South Hospital o Planning for the Obstetrics/ Gynecology Annexation to the ACH or the new West Tower at

the FMC Site

Priorities for the Next Fiscal Year

Meeting recruitment targets of 25 - 30 FTEs (plus 10 – 15 to account for attrition) per year to

meet clinical service requirements and train future IM specialists Accommodating current and short term space requirements Supporting the deployment of an EMR solution in outpatient clinics as part of the overall

Outpatient Clinical Care Integration Strategy Planning for ARP renewal with strategic and tactical issues in a complex political environment Employing the Ward of the 21st Century as a template for South Hospital planning Finding operational funding for current and future innovation initiatives

of 71

of 71

Future Directions Positioning the Department of Medicine to be leaders in innovation to promote our clinical, research and educational mission by

Strengthening our integration of care, from the in-patient setting to our Out-Patient Clinics to maintaining our patients’ health in the community. This will be facilitated by leveraging innovations, technology and the skills of our talented team members to promote a patient centered experience.

Fostering partnerships with other faculties, disciplines and the community

Promoting wellness of both our patients and our team members

Improving access to care through partnerships and innovations, building on the Medical Access to Service Conference Model and Central Referral System.

Promoting organizational and educational changes which foster teamwork as we continue to move from individual excellence to team excellence such as the Ward of the 21st Century team.

Strengthening our most valuable asset, our team members, by recruiting and retaining them through recognition, mentorship and providing opportunities for growth

Workforce Planning Recruitment for 2005 – 2006

Primary Division Last Name First Name

Starting Date Came from

Primary Site ARP?

U of C Appt. FTE Sex

Cardiology Veenhuyzen George 15-Aug-05 Kingston, ON FMC Yes MC 1.00 MDermatology Hackett Sharon 08-Jun-05 Montreal, PQ FMC No C 1.00 FDermatology Haber Richard 01-Dec-05 Victoria, B.C. FMC Yes GFT 1.00 MEndo Bhayana Shelly 01-Nov-05 Toronto, ON PLC Yes MC 1.00 F G I M Huan Susan 01-May-05 Thunder Bay, ON FMC Yes C 0.50 F G I M Altabbaa Ghazwan 24-May-05 RVH Yes MC 1.00 M

Damascus (via Sumerside, PEI)

G I M Sivakumar Chandrasekaran 01-Jul-05 England FMC Yes MC 0.40 MG I M Bacchus C. Maria 11-Jul-05 Toronto, ON FMC Yes GFT 1.00 F G I M Scott Ian 01-Sep-05 Victoria, B.C. PLC No C 1.00 MG I M Clearsky Lorne 14-Sep-05 Winnipeg, MB RGH No MC 1.00 MG I M Datta Partha 15-Nov-05 Hamilton, ON RGH Yes MC 1.00 MG I M Ali Khan 30-Jan-06 RGH No MC 1.00 M

Calgary (via Mayo, Rochester, MN)

G I M Sporina Jan 01-Mar-06 RGH Yes MC 1.00 M

Calgary (IMG from Slovakia)

Gastro Kaplan Gilaad 01-Jul-05 Windsor, ON FMC No Clin Sch 1.00 M Gastro Turbide Christian 11-Jul-05 Montreal, PQ PLC Yes C 1.00 MGastro Jones Jennifer 01-Sep-05 HSC Yes Clin Sch 0.50 F

Halifax, NS (via Rochester, MN)

Gastro Kareemi Munaa (Mani) 01-Sep-05 Halifax, NS FMC No C 1.00 M

of 71

Primary Division Last Name First Name

Starting Date Came from

Primary Site ARP?

U of C Appt. FTE Sex

Gastro Rioux Kevin P. 01-Sep-05 Edmonton, AB FMC Yes GFT 1.00 M Gastro Raza Mamoon 27-Oct-05 Winnipeg, MB PLC No C 1.00 MGastro Liu Hongquin 12-Dec-05 Calgary, AB HSC No Adjunct 1.00 MGastro Andrews Christopher 23-Jan-06 Rochester, MN FMC Yes GFT 1.00 MGeriatrics Sivakumar Chandrasekaran 01-Jul-05 England FMC Yes MC 0.60 MHaematology Geddes Michelle N. 01-Jan-06 Calgary, AB FMC Yes Clin Sch 0.40 F Haematology Daly Andrew 01-Mar-06 Toronto, ON PLC Yes C 1.00 MI D Louie * Marie 13-Apr-05 PLC No GFT F

Calgary (originally Toronto, ON)

I D Johnson Andrew 01-Sep-05 Seattle, WA PLC Yes MC 1.00 MNephrology MacRae Jennifer 01-Sep-05 Vancouver, B.C. FMC Yes GFT 1.00 FNephrology Vitale George 01-Sep-05 Toronto, ON FMC No MC 1.00 MNephrology Sun Jian 01-Mar-06 Edmonton, AB HSC No Adjunct 1.00 MRespirology Hirani Naushad 01-Apr-05 London, ON PLC Yes MC 1.00 MRespirology Fell Charlene 01-Jul-05 Toronto, ON PLC Yes MC 1.00 FRespirology Davidson Warren 01-Jan-06 Vancouver, B.C. RVH Yes GFT 1.00 M

* Dr. Louie is a member of the Provincial Labs. She is assisting with consultations and HPTP service.

of 71

Attrition to Department for 2005 – 2006

The following table indicates physicians and the reasons for their absences.

PHYSICIAN Reason for absence Months DEVLIN Shane Educational LOA 9

TURBIDE Christian Educational LOA 6 VEENHUYZEN George Educational LOA 1

FORBES Anna LOA 9 TAUB Ken LOA 9

GOLDSTEIN Cheryl Maternity 5.5 JENKINS Deirdre Maternity 12

MYDLARSKI Regine Maternity 3.5 NASH Carla Maternity 5

BROWN Chris Medical LOA 9 LOUIE Tom Sabbatical 6

MURUVE Dan Sabbatical 8 POON Man-Chiu Sabbatical 9

TOTAL MONTHS 92

No one left the Department of Medicine. A couple of senior members have decreased their FTE in preparation for retirement but all are still working a minimum of 0.2 FTE.

of 71

Quality Safety & Health Improvement Dr. Elizabeth MacKay, Jamie Stroud & Tricia McBain

Executive Summary We have been challenged with encouraging culture change, support, and momentum in the areas of quality improvement and patient safety. Significant projects with large scale change implications within the Region this year – including the preparation to implement PCIS – have competed for employee’s time and energy. Regardless of this, however, the support for quality improvement and patient safety activities continues to slowly grow. Significant work has been accomplished involving several substantial projects within the Department of Medicine. Further summarized below, these include; GRIDLOC, Safe Spaces, Safer Health Care Now – medication reconciliation, further development of Safety Action Teams, chemotherapy storage and labeling, and participation with innovation projects. Last year’s development of a VP of safety and a division within QSHI to support the patient safety agenda speak to the Region’s commitment to this important work. This safety focused infrastructure, through the addition of the “Clinical Safety Evaluation” department, has evolved and developed to provide improved identification, solution-development, and feedback of identified safety hazards and adverse events. Specific attention was given to the need for section 9 protections of such safety discussions and also for a clearer mechanism for follow-up, feedback and evaluation of developed safety strategies. Quality improvement teams and councils have evolved, over the last year, and will continue to develop in order to further integrate this patient safety component into their mandates. The following section, as this is the first time it has been discussed in an Annual Report, will provide a detailed account of the background, structure, and function of the new Clinical Safety Evaluation component of QSHI, and its relationship to the quality improvement and patient safety program of the Department of Medicine. Following this, further details and highlights of the various projects mentioned above will be provided.

Quality, Safety, and Health Information “Clinical Safety Evaluation”: The internal and external reviews into two unexpected patient deaths in 2004 served as a “wake-up call” for this Region and resulted in the re-examination of this Region’s safety practices and procedures. Clinical Safety Evaluation is a department within Quality, Safety and Health Information, and was established to provide additional support and resources to help carry the Region’s safety agenda forward. Thus, the Clinical Safety Leader position was created, with the responsibility of leading Safety Management within each Portfolio. The Clinical Safety Leader jointly reports to Clinical Safety Evaluation and to their Portfolio Executives. Specific attention was given to the need for section 9 protections of such safety discussions but a clearer mechanism for follow-up, feedback and evaluation of developed safety strategies was also clarified.

of 71

The following paragraphs and sections, under this heading of “Clinical Safety Evaluation”, serve to highlight the key roles, responsibilities, and functions of this new area within Quality, Safety, and Health Information. The end of this portion will be marked by an illustration outlining the key connections and relationships formed by the recent marriage of quality and safety within the Department of Medicine, as well as the linkages to the rest of the Northeast Community Portfolio. Clinical Safety Evaluation - Key Functions:

1. Coordinate all serious/fatal adverse event reviews with the appropriate department(s) within the NE Community Portfolio. 2. Ensure that appropriate actions are assigned to mitigate risks posed by the hazards identified. 3. Review Safety Learning Reports (incident reports) that are generated within the NE Community Portfolio, and provide feedback to

reporters about the receipt of the report and any analysis/action that has resulted. 4. Communicate those hazards and risk mitigation strategies that pertain to a broader audience to other Departments, Programs,

Services and Portfolios throughout the Region. 5. Receive reports on hazards and recommended improvements from internal sources, such as the Regional Event Safety Review

Committee, the Regional Clinical Safety Committee, and other member groups. 6. Generate a report of prioritized system improvements and recommendations for the Portfolio Vice President and Executive Medical

Director re: how to proceed. 7. Plan and review evaluations of the extent and the impact of high priority system improvements and establish plans for addressing

implementation problems. 8. Ensure that proper administrative accountability has been assigned for dealing with identified safety issues (in collaboration with

Portfolio VP/EMD). 9. Participate in education and public forums on patient safety. 10. Participate and coordinate communication strategies to inform staff and physicians about system-wide changes to

policies/procedures/practices and/or identified safety hazards. 11. Promote the importance of reporting safety events and near misses. 12. Promote the use of the Region’s Just and Trusting Culture policy and promote the support for staff/physicians who are involved in

an event. Clinical Safety Evaluation - Key Activities Include:

1. Hazard Identification: • Responsible for conducting safety analyses in order to identify, review & make recommendations that mitigate risk of hazards &

potential harm to patients.

of 71

• Five Safety Reviews have been conducted within the area of Medicine and Family Medicine from November 2005 – March

2006. • The method used to conduct safety reviews is the Health System Safety Analysis (HSSA) tool. • Developed a safety review “decision tree” to illustrate the process of carrying out a safety review.

2. Safety Committee Structure:

• Responsible for developing safety committees (protected under Section 9 of the Alberta Evidence Act) within the NE Community Portfolio. These committees are sub-committees of the Regional Clinical Safety Committee, established for the purpose of carrying out quality assurance activities. The goal of this work is to identify and analyze hazards that could place patients, staff and/or the public at risk of harm, and to communicate this information appropriately.

• The Acute Medical Services Clinical Safety Committee has been established to represent the Department of Medicine. This committee has 3 sub-committees based on physical location (FMC, RGH, PLC), for a total of 4 committees within the Department of Medicine.

• Involved with the development of Terms of Reference and determining membership for these committees. • Currently co-chair the NE Portfolio Clinical Safety Committee and the Mental Health Services Clinical Safety Committee. • Member of the Acute Medical Services Clinical Safety Committee, the Community Medical Services Clinical Safety Committee,

the Medicine Quality Council, and the Family Medicine Quality Council.

3. Communication: • Due to the nature of this position, ongoing and frequent communication with staff and physicians across the Portfolio is

required. • Continued communication and collaboration is also required between the Clinical Safety Leader and the Quality Improvement

Consultant, to ensure recommendations for system improvements are appropriate and to evaluate the impact of such improvements within the Department of Medicine (as per the safety management cycle below).

of 71

5

Safety Evaluation vs Quality Improvement

Clinical Safety Evaluation

Quality Improvement

• Learning to use critical language and committing to a standardized process which results in a recommendation is what the SBAR approach to patient safety is all about. SBAR stands for Situation, Background, Assessment, and Recommendation, the essentials in critical decision making.

• Two SBAR formatted communications, in collaboration with the QI Consultant, have been distributed thus far and have

demonstrated effectiveness in closing the loop. For example, a safety hazard was identified related to the possible tipping of portable O2 tanks, which put patients at risk for thermal injury. Through investigation of this potential hazard, it was learned that bags were available to house these portable tanks. An SBAR communication was developed and sent out to each unit/area identifying this potential risk, which also notified managers about the availability of O2 bags, including information on how to obtain them. A poster was also developed and distributed with the SBAR which included photos of how to properly position portable O2 tanks, either with or without the available O2 bag, as well as dangers to avoid. This was made available to all Clinical Safety Leaders in order to distribute this information on a Regional level.

4. Education:

• Responsible for participating in education and public forums on patient safety. • Attended several educational events related to Quality Improvement and Patient Safety.

of 71

• Future commitment to participate in teaching the Health System Safety Analysis (HSSA) course to all members of a safety

committee within the NE Community Portfolio on an ongoing basis.

5. Reporting System: • An effective, responsive safety reporting system is an important tool for creating and sustaining a safety culture. • Clinical Safety Evaluation has reached the negotiation phase with the selected vendor. • Ongoing involvement is required to ensure our new Safety Reporting System reflects both the current and future needs of the

Region. Once this new system is in place, responsibilities will include daily triaging of reports to determine higher priority reports, and providing feedback to reporters regarding any action that has resulted. Providing feedback to reporters will serve to close the loop in a way that is not possible with the current system, and to share learning on a regional level.

6. Patient Safety Leadership WalkRounds:

• As part of the strategy to carry the safety agenda forward, the Region implemented the use of Patient Safety Leadership WalkRounds.

• These WalkRounds occur on an annual basis and are attended by members of the Executive Team, as well as the Clinical Safety Leader and/or the Quality Improvement Consultant.

• The intent of Safety WalkRounds is to heighten the awareness of the role we all play in regard to safety, as well as to demonstrate the strong commitment of senior leadership to a culture that encourages safety by:

1) Connecting senior leaders with people working on the front lines. 2) Educating senior leadership about safety issues on the front lines.

• Developed/revised the WalkRound structure to be used within the Portfolio. • Developed a spreadsheet for collecting WalkRound data. • Currently setting up schedule for WalkRounds within the department of Medicine. • Data collected will be entered into spreadsheet and emailed to the participating manager/area for feedback re: action

plan to address issues. • Ongoing follow-up on a quarterly basis with the expectation that areas commit to 4 safety based changes in their area

per year. • Developing a mechanism to ensure feedback reaches staff to illustrate the value of their input and to demonstrate that

positive changes have been implemented as a result. • Working with fellow Clinical Safety Leaders to develop a database to collate and manage Safety WalkRound data. • In future, provide summary reports of collated data to Portfolio Executives and key stakeholders to illustrate progress

made and to ensure appropriate support/resources are available to units/departments to facilitate change. Example of “Closed Loop” Activity: (refer to photo of poster below)

of 71

• Initial issue identified on patient care unit – harm suffered by patient due to an oxygen canister being placed too close to their skin.

Incident report filled out by staff, and manager contacted Clinical Safety Leader • Incident investigated, and recommendations made • Poster, and education is not enough to induce behavior change, staff need cues to make the right decision as to where to place

oxygen canisters • Storage bag (middle photo) highlights this function, by giving staff a safe location to store canisters while transporting patients • Instructions given to all nursing units as to how to receive storage bags, and posters circulated – via “SBAR” format - to further

outline issue, recommendations, and ways in which risk can be mitigated

of 71

Oxygen Tank Safety

WARNING

upright outside

Patients Are At Risk For InjuryIf you are transporting patients with a portable oxygen canister, please ensurethe canister will not come into contact with the patient.

The oxygen canister must be hung on the of the stretcher orplaced in a protective carrying bag ung on de of the stretcher. and h the outsi

QSHI

Outside of Rails Outside of Rails in Protective Bag Inside of Rails

of 71

of 71

Quality Improvement/Safety Structure – Within Department of Medicine and NE Portfolio

Quality Improvement and Patient Safety Program Highlights Safety Action Teams:

Over the last year, the Quality Improvement and Patient Safety team continued to develop the patient safety infrastructure in the department and supported the start up of additional unit-based, safety action teams (SAT’s). We have helped to implement a total of 13 teams to date, with several more to be developed in the near future. In an effort to improve upon communication, we began to look at ways to share safety concerns among teams and more effectively with the new Clinical Safety Evaluation group and the Region. We are developing a database and web-based exchange mechanism to further assist in the communication, organization, and sharing of common safety concerns and the solutions used to remedy these. Refer to the Appendix to view additional details outlining current initiatives of these various teams.

Safer Health Care Now! Campaign:

Involvement in the ongoing National ‘Safer Health Care Now’ initiative continued with a focus on medication reconciliation. Medication reconciliation represents one of the six key strategies, identified by this campaign, to reduce adverse events in health care. Within the Department of Medicine, participating in the Region’s medication reconciliation project is a pilot team from Patient Care Unit 74, RGH. Despite recent management and team member changes, and other major projects competing for their time, the team continues to trial tests of change on the unit, all aimed at improving the following knowing what regular medications their patients are taking prior to admission, and ensuring that these medications are either continued on admission, or making sure it is clearly documented why they have been changed or omitted. Highlights to date have included: education blitzes to provide better understanding for nursing staff regarding project and their role in obtaining medication histories; providing nursing staff with a better form in which to document medications which have been missed on admission; and, better communicating with unit pharmacists to indicate when histories are complex and in need of further expertise. We hope to work with SCM to develop an electronic version of the ‘best medication history’ to be incorporated into the electronic health record.

Safe Spaces:

Safe Spaces, a Regional Initiative, was officially launched January 25, 2006. This initiative is sponsored by the Chief Nursing Office, and is a collaborative project between Quality, Safety and Health Information (QSHI) and Professional Practice and Development (PPD). The aim of this project is to develop and test an education and implementation plan designed to enhance and support inter-disciplinary communication and teamwork in the delivery of safe patient care. Six pilot teams have been formed, representing different portfolios across the Region. Medicine is represented by the NE Community Portfolio team – with members from Patient Care Unit 61, FMC. The team is composed of physicians, registered nurses, respiratory therapists, physiotherapists, social work, and a unit clerk. A culture survey will be distributed on the unit, as a baseline measure, and team members attended two full day workshops. These workshops provided an educational background and foundation to the project, as well as provided team members with the opportunity to discuss areas in which teamwork and communication can be improved in their area, and strategize as to how this could be accomplished. Discussion to date has emphasized the importance of knowing your team members,

of 71

role-definition, and strategies to improve the exchange of critical information. A tool, called the SBAR tool, is being used to specifically address the information sharing needs of nursing staff with physicians but can be used by any team members to guide transfer of critical information.

GRIDLOC: GRIDLOC, an acronym for “Getting Rid of Inappropriate Delays the Limit Our Capacity to Care”, is an initiative which is looking at patient flow through the emergency department but also on the continuum of care including discharge planning efforts. Most of the early work has been on defining and operationalizing a measurement strategy of important steps in the patient’s trajectory as it begins in the ED. The team has just begun to get together with the data and its early interventions to improve patient flow. The primary focus for the project will be at the FMC but there will be ongoing communication and spread of proven strategies to the other sites.

Chemotherapy Storage, Delivery, and Labeling: Prompted by a realization that current practices could potentially result in adverse events, a consultation was made to QSHI’s Human Factors Consultant, by the Patient Care Manager of Unit 51, PLC. The unit’s current storage and delivery practices of cyto-toxic chemotherapy medications consisted of a shared fridge for chemo and non-chemo medications, shared medication boxes combining chemo and non-chemo medications of several patients, poor labeling, and the inconsistent and unreliable delivery of medications to the unit from pharmacy. The ensuing report and recommendations prepared by the Human Factors Consultant highlighted these concerns, and included suggestions for improved labeling and storage of these agents. Local fixes implemented thus far include separate storage fridge for chemo medications, and a new process to sign for medications once received from pharmacy. Further work continues, in combination with larger Regional initiatives, to improve the labeling of these and other medications.

Figure 1. Current Storage Practices • Non patient specific, and mixture of chemo, and non-chemo meds together

of 71

Figure 2. Proposed labeling improvements

• Picture on left outlines current practice – label is folded and can often inhibit the accurate reading of pertinent drug information and identification. Picture on right features a proposed improvement.

Involvement with Innovation Projects:

The QI team has also been involved with a number of the DOM innovation projects, providing process mapping, development of evaluation and measurement strategies, training and support for the use of QI tools to develop project solutions. In particular there has been significant direct involvement with the VTE prophylaxis project and the Clinical Decision Support projects. The VTE prophylaxis project is focused on increasing the use of VTE prophylaxis strategies across the region by development of decision support tools and providing education and feedback on appropriate use of prophylaxis by clinical groups and units. Development and implementation of decision support tools using the electronic health record is a key component of this project as well as using the EHR to measure use and balancing measures related to use of prophylaxis. The decision support project is focused on developing an appropriate framework for development, implementation and evaluation of decision support initiatives and evidence-based medicine initiatives within the DOM to allow the department to get the most out of these initiatives and to allow for an appropriate approval process and necessary ongoing ownership of these strategies.

Website Development:

In an effort to improve communication regarding Quality Improvement and Patient Safety initiatives, a website has been developed and published. Reachable through links from the Department of Medicine and QSHI homepages, this site also illustrates the various structures which support the quality improvement program within Medicine. A work in progress, future plans include further strengthening this resource to better meet the needs of those we serve.

of 71

Challenges and Future Directions:

We will continue to be challenged with encouraging culture change and spread in the areas of quality improvement and patient safety, and to maintain gains achieved through this work. With plans to further develop and support safety action teams, in both our inpatient and outpatient areas and departments, it is our belief that frontline employees will become empowered as change agents, and join us in this challenge. The larger scale support for quality and safety activities continues to grow in this Region, as do the concepts of patient centered care, decision support, evidence-based practice, and the area of quality indicators. We remain dedicated to improving communications with the multiple stakeholders involved with quality and safety with the hopes to further advance these concepts, and the practices supporting them, within the Department of Medicine.

of 71

Innovation In March 2005, the Calgary Health Region Department of Medicine and Medical Services launched into comprehensive planning and implementation of 17 Innovation Initiatives designed to improve access to medical specialists, improve care quality, safety and effectiveness, improve service integration and sustainability. The Innovation Initiatives received a total of $7.4 million over 2 years at the beginning of this current fiscal year. Half of this funding is from Alberta Health & Wellness, and half from the Calgary Health Region.

This interim evaluation report demonstrates significant progress has been made across all of the initiatives summarized as follows:

Hired 73% of allocated staff (official start of the projects was September 2005), with additional 20% in process and hiring expected to be 93% complete by May 2006.

Launched or expanded a number of specialty clinics including: • Atrial Fibrillation Clinic to support management of complex cases of atrial fibrillation. • Young Adults with Rheumatic Disease clinic to support care transition from pediatrics

to the adult system. • Tertiary Obesity clinic. This also includes a community based exercise, healthy eating

and self-management program and integration with Surgery for laparoscopic banding when indicated.

• Expanded the Congestive Heart Failure clinic from the Foothills Medical Center (FMC) to the Peter Lougheed (PLC)and Rockyview General Hospital (RGH)

• Expanded General Internal Medicine Urgent Assessment Clinic from the FMC to the RGH, and maintained central triage.

• Cough clinic, staffed by an asthma educator to support quality patient care and reduce unnecessary consults to Respiratory Medicine.

• Increased the number of Nurse Practitioners in Medical Services from 2 to 7 (expected).

• Created division specific central referral and triage in Gastroenterology, Nephrology and Rheumatology.

• Launched education intervention to support patient knowledge and uptake of alternative modalities of dialysis.

• Launched sputum diagnostic for improved clinical management of asthma. • Piloted standardization of peri-operative referral process and lab work. • Strengthened care transitions from acute care to community in congestive heart

failure, chronic obstructive pulmonary disease, and stroke secondary prevention. • Enhanced use of clinical practice guidelines in Infectious Diseases and Osteoarthritis.

Developing a standardized approach to guideline development and adoption. • Supported rural specialist access: launched gestational diabetes clinic via telehealth

to Lethbridge. Provided increased human resources and Soprano Chronic Disease Management software to support diabetes management in rural areas. Enhanced diabetes training for nurses and dietitians. Evaluated telehealth feasibility for congestive heart failure, dermatology and respiratory medicine (sleep).

• Completed evaluation plans and related databases for all innovation initiatives. Challenges faced include lack of space and recruitment and retention of staff.

A significant effort on behalf of 17 subproject teams, including physicians, management and staff, enabled early successes for the innovation initiatives. The next year will be critical to further refine implemented services and ensure sufficient time has elapsed to adequately assess the impact of changes.

of 71

Appendices Appendix #1: Summary of Medicine Quality and Safety Improvement

Projects

SITE TEAM RECENT INITIATIVES PCU 36

Hazard Identification/Resolution: issue identified by team involving the common error made by nursing staff where IV medication is hung at the wrong time – ie bag with time of ‘1600’ is mistakenly hung at ‘0800’. This common error results in confusion for staff, and rework. Issue relayed to larger Regional group and plans made to consult with Human Factors consultants to address Regional labeling standards

PCU 37

Hazard Identification/Resolution: Currently completing PDSA cycles involving medical air/oxygen project. Involves assumption that errors will be reduced if all medical air regulators are kept away from the bedside, hooked up only when medications need to be given, and taken out of room immediately following. Also trialing a new type of regulator which looks very different from oxygen regulator. Good Catch Reporting: look alike medications identified and project initiated with pharmacy leading to new packaging and labeling of morphine vials – this intervention led to the team being presented with a Good Catch Award, and featured on the cover of the March 2005 edition of Frontlines.

PCU 61 Hazard Identification/Resolution: issue involving ported IV tubing identified by team as potential hazard. When certain medications are hung using this tubing, the possibility exists that nursing staff could infuse another medication at the same time, therefore interrupting the flow of the other medication. With certain meds, such as heparin, this could lead to an adverse event. Portless tubing was added to the supply cart, and plans to educate staff regarding this potential situation, and team remedy to this was made

FMC

PCU 62 Team Formation/Education: interest has been identified on unit, and initial education session provided. Once membership further defined, initial hazard identification to be completed.

PCU 47

Hazard Identification/Resolution: New safety team recently formed on the unit. Current safety issues identified and initial project involving infection prevention and control issues, as well as unit clutter identified as priorities – work to commence in near future

of 71

SITE TEAM RECENT INITIATIVES

PCU 59 Hazard Identification/Resolution: Communication boards installed in each patient room to facilitate easy communication from caregiver to caregiver. Narcotic cupboard reorganized – unit was pilot unit for Regional initiative to improve standards for narcotic storage and narcotic counting

PCU 61

Hazard Identification/Resolution: Issues identified on unit involving poor communication between nursing students and nursing staff. Project underway to better identify communication standards and expectations, as well as providing tools to facilitate thorough communication Clutter in hallways identified as a concern, ideas for improvement include equipment stations, and regular sweeps of unit to better determine unit inventory and to get rid of unused or broken equipment

RGH

PCU 73 Team Formation/Education: interest has been identified on unit, and initial education session provided. Once membership further defined, initial hazard identification to be completed

PCU 51

Hazard Identification/Resolution: issues identified regarding the unit’s current storage and delivery practices with cyto-toxic chemotherapy medications. Report and recommendations prepared by Human Factors Consultant including suggestions for improved labeling, and storage of these agents. Local fixes implemented thus far include separate storage fridge for chemo medications, and new process to sign for medications once received from pharmacy.

PLC

PCU 43

Hazard Identification/Resolution: project underway to provide better guidance and expectations to staff new to unit - orientation checklist being formulated. Safety issue raised surrounding ASAP or STAT meds not being signed off in a timely manner. While PCIS should help in addressing components of this issue, alternate ideas also being considered by team. Work has also been done to address concern of poorly identifying patient code status. Unit experimenting with placing red dots above patient beds.

PHARM

Hazard Identification/Resolution: RN’s not checking unit clerk order entry – new process being trialed where Pharmacists will call or info-gram the units any time they see unit clerk type ins or incorrect orders. Some look alike, sound alike medications identified - D5W/NS 50 mL and 100 mL identified as being too close together on the counter – staff has now separated them to opposite sides of the binders and also changed the color of bins they are stored in

SAC

Hazard Identification/Resolution: This group met for an initial meeting and participated in a hazard identification process. They have since decided to not form a SAT at this time, but have addressed many of the identified hazards, and will communicate their work and future plans in a staff meeting format. They are a small clinic, and thought it would be best to concentrate on safety

of 71

SITE TEAM RECENT INITIATIVES

issues as a whole group rather than a team of representatives.

Leth. Dialysis

Hazard Identification/Resolution: Electrical plugs replaced due to difficulty engaging same, mirror installed above high traffic area, cleaning process for various equipment clarified, maintenance department made aware of items in general disrepair Communication and Reporting: communication board to be installed which will be used to outline identified hazards on unit and what the team has resolved as well as future projects.

Health on 12th

Hazard Identification/Resolution: initiative undertaken aimed at improving the unit’s attention to infection prevention and control issues. Hand washing stations set up at unit’s entrance – and initiatives underway as well to engage patients with better hygiene and IP&C practices (no bare feet on unit’s scales, proper disposal of tissues, and placing of hand wash bottles closer to dialysis chairs)

REGIONAL

REHAB

Communication and Reporting: Project initiated to improve communication between rehab staff and other health care professionals. SBAR template customized by group to highlight typical areas of concern, and typical issues needing to be addressed by medical and nursing staff. Information sessions presented at staff meetings at all three acute care sites, and trial of SBAR form underway at PLC site

Diabetes, Hypertension, and Cholesterol Centre

Team Formation/Education: interest has been identified on unit. Once membership further defined, initial hazard identification to be completed

Outpatient

Chronic Disease Management

Team Formation/Education: interest has been identified on unit. Once membership further defined, initial hazard identification to be completed

of 71

Appendix #2 – Division Reports (presented in Alphabetical Order by Division)

Division of Dermatology Division Chief – Dr. Richard Haber

ADMINISTRATION The Division of Dermatology is a recently formed division within the Department of Medicine at the University of Calgary. In 2005, it consisted of 2 full time GFT members:

• Dr. Regine Mydlarski – a clinician-researcher • Dr. Richard Haber - Started December 1, 2005 as Head of the Division of

Dermatology. Dr. Haber is a clinician-teacher/administrator.

The Division had 18 active community based dermatologists affiliated with the University of Calgary in 2005. RESEARCH In 2005, Dr. Mydlarski continued to develop a translational science program in dermatology with a focus on GW bodies and the skin, translational research in pemphigus and genetics of vascular malformations. In addition, she ran an immunodermatology clinic and a genetic skin disease clinic in collaboration with the Department of Genetics. CLINICAL AND INNOVATIONS Dr. Haber set up 2 dermatology clinics to begin January 1, 2006 and future plans for the Division include:

• establishing a pediatric dermatology service – Fall of 2006 • teledermatology service for rural Alberta -Fall 2006 • setting up a dermatology rotation for internal medicine residents to rotate

through Dermatology service in the teaching hospitals and private clinics • working on an alliance with Edmonton for a joint “pan –Alberta”

Dermatology Residency • recruiting for a GFT dermatology faculty position for 2006.

Dr. Mydlarski continues to develop the science program

New immunodermatology

& genetic skin disease clinic

New Dermatology residency program

of 71

Division of Endocrinology and Metabolism Division Chief: Dr. Alun Edwards

ADMINISTRATION New initiatives in care increase administrative demands. Increasing numbers of undergraduate and graduate trainees are increasing administrative requirements in the educational arena. CLINNICAL AND INNOVATIONS The Division has been very active in the last year with a number of initiatives enabled by ARP innovations funding. The main focus has been to support primary care physicians in the management of chronic disease such as diabetes, hypertension and cholesterol by working with diabetes nurses in the various rural communities to consult on management of specific cases. A weight control clinic was also established in association with the Diabetes Hypertension and Cholesterol Centre (DHCC) at Health on Twelfth. This multidisciplinary service is integrated with the new bariatric surgery program at the PLC. A major development in Lethbridge was the creation of a telehealth clinic for the management of diabetes in pregnancy which contributed greatly to meeting an urgent clinical demand in the Lethbridge area. Plans are underway for the expansion of telehealth services in rural southern Alberta, to include service for diabetes, hypertension and lipid management. Providing support to nurses in the community who have diabetes expertise can be done remotely, by telephone or telehealth. The nurses can then relay the information to the primary care physician at a convenient time, thereby building the capacity of physicians to manage diabetes in the community. This will translate into more patients receiving care closer to home, reducing the inefficiency and inconvenience of traveling into Calgary for specialist care. EDUCATION The Division had two endocrine resident trainees throughout the year.(one position was taken by a physician from Saudi Arabia). The number of requests for training in endocrinology, (both undergraduate and from various graduate training programs) is increasing yet we lack both physical space and teaching faculty to educate more people in the clinical areas. CLINICAL The clinical workload of endocrinologists is increasing steadily. One factor is the increasing prevalence of diabetes and osteoporosis. A second factor is the changing pattern of provision of care. In the past, general internists provided much of the ambulatory care for patients with diabetes and osteoporosis; more recently, they are focusing on inpatient care while endocrinologists are providing more of the ambulatory care. The resultant increase in chronic outpatient activity is a serious issue for endocrinologists.

Focus has been - management of chronic diseases - working with diabetic nurses in rural communities

Telehealth clinic in diabetes established in

Lethbridge

2 endocrine resident trainees

Workloads steadily increasing

of 71

AWARDS Dr. Hanan Bassyouni received the Calgary Department of Medicine 2005 Silver Tongue Award for Internal Medicine Residency Teaching as well as the Undergraduate Medical Education Award for clinical clerkship teaching. The Faculty Award in Undergraduate Medical Student education was awarded to Dr. Greg Kline. In 2005, Dr. Hanley was honoured to receive the Canadian Society of Endocrinology and Metabolism’s Robert Volpé Distinguished Service Award, recognizing contributions to education, research and the endocrinology community in Canada. He was also elected the President Elect of the Society. RECRUITMENT In November the Division gained one new recruit, meeting its allocation under the recruitment plan of the ARP. In the future, the Division will need more than one per year to keep up with service demand, but since new endocrinologists are scarce, the Division will need to find alternate solutions to the recruitment challenge. CHALLENGES The wait list for diabetes and osteoporosis showed an increase in 2005. This is due to the increasing prevalence of diabetes and osteoporosis. The shifting patterns of practice within the Department of Medicine has resulted in an effective decrease in specialists able and willing to undertake long-term follow-up of patients with complex chronic diseases.

5 members receive Major awards

1 New recruit – Dr. Shelly Bhayana

Challenges - increase in wait lists for both

diabetes and osteoporosis

of 71

Division of Gastroenterology Division Chief: Dr. Ronald Bridges

ADMINISTRATION The Division of Gastroenterology has had an outstanding year with considerable growth and development in all areas, significant accomplishments and many changes. Further integration of patient care activities with educational programs and research activities has occurred as a result of a strong collaborative effort. Innovative program development and physician recruitment to improve patient access to gastroenterology services and funding efforts to endow clinical research chairs are divisional priorities. CLINICAL and INNOVATIONS The clinical workload for the division is steadily increasing with very busy inpatient and outpatient activities. Recent national data demonstrate that wait times to access GI consultation in Calgary are longer than any other region in the country. The Division provides continuous clinical care at all acute care hospital sites, the University of Calgary Medical Clinics (UCMC) and community private practice clinics. Recognized as a national leader in clinical gastroenterology the group continues to develop innovations to enhance the delivery of GI services in the Calgary Health Region (CHR). Innovation programs to improve access to GI care include: 1. Central triage, referral and telephone consultation at UCMC to more

effectively triage referrals and provide management suggestions to family physicians and alternate care providers while patients wait for assessment.

2. An Inflammatory Bowel Disease (IBD) Nurse Practitioner to transition inpatient to outpatient care more efficiently and reliably. Ms. Heatherington has started her own clinic with mentorship from the faculty. This has reduced the waiting list in the IBD clinic and has been very positively received by patients and their families.

3. Nurse clinicians to assist with colon cancer screening, clinical care for hepatology and gastroenterology and patient education.

4. Planning for the development and implementation of the Colon Cancer Screening Centre continues. Ms. Anne Czapski has been hired as the project manager to assist with the development and implementation of this unique Canadian program.

5. An extended GI service plan is being developed in collaboration with the Department of Rural Medicine to provide specialty care to rural areas in the CHR.

Members of the Division have developed nationally recognized programs in Inflammatory Bowel Disease, Therapeutic Endoscopy and Hepatology: Inflammatory Bowel Disease Program The clinical IBD program under the direction of Dr. Remo Panaccione continues to expand and flourish. Dr. Kevin Rioux was recruited from the University of Alberta and Dr. Jennifer Jones was recruited after completing an IBD fellowship at the Mayo Clinic. In addition, Ms. Joan Heatherington has been hired as a nurse practitioner in IBD. She is the first nurse practitioner in Gastroenterology with a focus on IBD. She has played an important role in the day-to-day management of patients with IBD and has been pivotal in providing follow up

Increasing workloads - longer wait times than any other Region in the country

Innovations - Central triage effective for family physicians, ACP’s, waiting for assessment. - Nurse Practitioner hired for IBD - Nurse clinicians helping plan for Colon Cancer Screening Centre -Extended GI service plan developed in collaboration with Rural Medicine

IBD program flourishes - great recruitment - additional training

of 71

care to patients discharged from hospital. Dr. Shane Devlin has gone for IBD

d

herapeutic Endoscopy Program

training to Cedars Sinai in Los Angeles and Dr. Gil Kaplan has gone off for training in Epidemiology and IBD at Harvard and the Massachusetts General Hospital in Boston. Following the completion of training they will return to further augment the growth of the IBD program. Fund raising for the Lloyd Sutherland Chair in Inflammatory Bowel Disease continues as part of the CHR anUniversity of Calgary Reach! Campaign. To date more than $1.1 million dollars has been donated. T

lead by Dr. Jon Love at the Peter

epatology Program

The Therapeutic Endoscopy Program Lougheed Centre (PLC) continues to evolve. Interventional techniques including ERCP, stent placement, endoscopic ultrasound, capsule endoscopy and new technologies are provided through a regional program that is unique in Canada. A CHR Request for Proposal (RFP) was completed and awarded to Pentax Medical Equipment Corporation Canada for endoscopic equipment at all sites. The service is utilizing the regional endoscopy database to perform detailed quality assurance initiatives and is moving to standardize protocols across the region to improve efficiency and further enhance patient care. Fund raising for the Chair in Therapeutic Endoscopy continues as part of the CHR and University of Calgary Reach! Campaign. Pentax Canada has donated $1.2 million towards the Chair. H

s continue to expand with the aid of nurse clinicians in

DUCATION

uring the year several excellent people have been recruited. Each brings d

embers of the Division are committed to providing high quality educational

December. Furthermore, the increased class size of the incoming class, with 25

The viral hepatology clinican extended clinical role. Plans have been developed to move the Southern Alberta Transplant Program to the PLC to accommodate program expansion including plans to perform liver transplant surgery in Calgary. Dr. Kelly Burak, Director of the Southern Alberta Liver Transplant Clinic has significantly increased the profile of liver transplantation in Southern Alberta. Fund raising for the Chair in Hepatology has been initiated as part of the CHR and University of Calgary Reach! Campaign. E Dspecific expertise to complement existing divisional activities and future plannegrowth. Mprograms to fulfill education objectives in undergraduate medical education, clinical clerkship, residency training, GI specialty training, post graduate GI and Hepatology fellowships and continuing medical education. The 2005 undergraduate GI course was again very highly rated by the students. Very little modification has been done to this course in anticipation of the development and implementation of the new Course 1. This will begin in August 2006 and will amalgamate the Fever/Sore Throat (Principles of Medicine) with the Blood and GI Courses. This has been a very labour intensive process that began in 2005. Dr. Kelly Burak (Co-Chair Course 1) and Dr. Sylvain Coderre (Assistant Dean, Undergraduate Medical Education) have been instrumental in the design of the new course. The fall of 2006 will be very demanding on the GI faculty, as the new Course 1 for the incoming medical school class will run from August to October and the GI Course for the second year students will run from November to

Lloyd Sutherland Chair fundraising is ongoing

Therapeutic Endoscopy Program - Pentax is a great contributor - Fundraising for Chair in Endoscopy continues

Hepatology Program - SATP moves to PLC - liver transplant surgery - Fundraising for Chair in Hepatology

New course developed in GI medicine

GI Training Program - recognized as a leading training program

of 71

new students, has lead to the need to recruit more small group and clinical core

culty preceptors from the Division.

he Royal College of Physicians and Surgeons GI Training Program led by Dr. ldon Shaffer continues to be recognized as a leading training program in anada. The program has expanded in recognition of the need for more astroenterologists regionally and nationally. We hope to retain many trainees at

as held in February 2006 to review the trengthen the program. Graduating fellows continue to be successful in

for

ly awarded to an individual outside the United States. She also received the CSCI Resident Research

Theacqthe to tAlbhav ds for Dr. Steve Heitman to assess Capsule Endoscopy versus

tandard Care for Obscure Overt GI Bleeding in the CHR. Dr. W. Al-Hamoudi is

s held at the PLC in March 2006. This was a combined teractive presentation with live endoscopy aimed at paramedical and medical

gy Liver Biliary Section. Dr. Sylvain Coderre is resident of the Alberta Society of Gastroenterology. Dr. Ron Bridges is

fa TECgthe completion of training to improve the manpower situation in the Division in the years to come. An education retreat wscompleting the Royal College of Physicians and Surgeons of Canada Specialty examinations. The GI trainees won several awards: 1. Dr. Brian Yan received an award for the Best Trainee Presentation at the

World Congress of Gastroenterology in September 2005. Following the completion of the GI training program he will go to Stanford University further training in Endoscopic Ultrasound.

2. Dr. Carla Coffin received a Fellowship Award from the American Association for the Study of the Liver. This award is rare

Award, the CAG-Altana GI Fellow Research Prize and the CASL Best Trainee Presentation Award. Following the completion of training she will go to the University of California at San Francisco for further training in Hepatology.

Therapeutic Endoscopy Training Program has two trainees who have rapidly uired the skills and knowledge related to the specialty. Dr. Mamoon Raza was recipient of a Cook Canada Grant to assess the regional situation pertaining he use of Surgery and Endoscopy for the Removal of Difficult Polyps. The erta Heritage Fund for Medical Research (AHFMR) and a CAG/CIHR grant e provided fun

Sthe fourth fellow to participate in the The Hepatology Training Program. Following the completion of training he will be going on for further training in liver transplantation. Another year of dynamic seminars and meetings have benefited all from an educational standpoint and have successfully intertwined basic and clinical science. In collaboration with the Gastrointestinal Research Group and Industry partners we have had more than 20 national and international speakers visit the Division during the past year. A GI Endoscopy Refresher Course coordinated by Dr. Jon Love wainpersonnel with an interest in GI Endoscopy. Guest faculty included Dr. D. McIntosh from Halifax and Dr. J. Devier from The Free University of Brussels, Belgium. A Western Canada IBD meeting coordinated by Dr Remo Panaccione was held in November 2005. Members of the Division were also actively involved in the organization of national and international continuing medical education and research programs. Dr. Kelly Burak is Co-Chair of the CAG/CASL Gastroenterology Residents in Training Program. Dr. Remo Panaccione is Co-Chair of the national IBD Residents Training Program. Dr. Eldon Shaffer is Chair of the American Association of GastroenteroloP

GI Trainees win awards - Dr. Yan – Best Trainee Presentation - Dr. Coffin – Fellowship Award

Therapeutic Endoscopy Training program succeeds - Dr. Raza - Dr. Heitman - Dr. Al-Hamoudi

Seminars/ Meetings - more than 20 national and international speakers - GI Endoscopy Refresher Course - Western Canada IBD Meeting

of 71

President-Elect of the CAG and Co-Chair of the Canadian Digestive Disease Week implementation committee. RESEARCH

ontinued development of basic science research, clinical trials and translational search is a priority within the division. The division remains very active in search activities in the Gastroenterology Research Group and the Institute of fection, Immunity and Inflammation with more than one hundred high quality

c d papers published or in press during the year. Members on several editorial review boards, actively supervise

re n invited to give numerous presentations re rnationally. Division members have received new g IHR, the Crohn’s and Colitis Foundation of Canada a Foundation. The IBD and Hepatology Clinical Trial P xcel and are considered international leaders in the

tion and performance of clinical trials. Epidemiology and health utcomes research is a divisional area of strength that will be reinforced by rther faculty recruitment. A research retreat is scheduled for June 2006 to entify specific translational research projects for members of the Division, III stitute and GIRG. Members of the division have also actively participated in a umber of recognized national clinical guideline committees in hepatology, IBD, olon cancer screening, irritable bowel syndrome and patient wait times.

HALLENGES

ge is the ongoing recruitment of clinicians, cientists to continue to provide comprehensive care and meet the research goals and aims of the Department of Medicine and

CrereInso

ientific peer reviewef the division participatesearch trainees and have beegionally, nationally and inte

rant funding from AHFMR, Cnd the Canadian Liver rograms continue to eplementaim

ofuidInnc C The Division of Gastroenterology faces several challenges to sustain and enhance existing clinical, educational, research and innovation programs. A high

riority and considerable challenpeducators and seducation and Faculty of Medicine. Significant challenges are being experienced obtaining office and laboratory space for new recruits. The administrative load related to the planning and implementation of the Colon Cancer Screening Program and the Liver Transplantation Program is significant. The expansion of GI educational programs at all levels necessitates a review of funding from all parties to ensure there are adequate resources for training. Secure funding for the Research Chairs in IBD, Hepatology and Therapeutic Endoscopy is an important divisional challenge that is being ably assisted by the Reach! campaign. The division optimistically looks forward to securing the funds for these Chairs to enhance divisional research activities, recruitment and access to new technologies in the years to come. Finally, the Division of Gastroenterology would like to acknowledge the ongoing excellent assistance provided by nursing, paramedical, administrative and support personnel. Their contribution has been vital to the success of the division. It is imperative that their services are retained in the years to come.

Research Programs - CAG/CASL GI Residentsin Training Program - National IBD Residents Training Program - Chair of the American Association of GI Liver Biliary Section - AB Society of GI - CAG – President-Elect -Co-Chair of Canadian Digestive Disease Week

Research, clinical trials and translational research is a priority in the division

Challenges - ongoing recruitment of clinicians, educators & scientists - office and laboratory space issues - Implementation of ColonCancer Screening Program & Liver Transplatation Program - Expansion of GI educational program - Securing funding for Research Chairs

Acknowledgement of

support personnel

excellent assistance provided by nursing,

paramedical, admin &

of 71

DIVISION OF GENERAL INTERNAL MEDICINE Division Chief - Dr. R.J. Herman, MD

EDUCATION The University of Calgary Medical Colle e has recently expanded its enrollment to 125 students and together with commitments to Malaysian and other foreign trainees, we are now accepting close to 145 students/year. At the same time, the IM Residency Training Program has grown to 47 core residents plus a number of Fellows in subspecialty training. This along with other successes in our GIM R4 Fellowship and IMG programs has meant that we have had to create new and innovative learning opportunities in order to accommodate all these people. Presently, our group contributes over 400 hours of lectures to the University of Calgary Undergraduate medicine curriculum; 5616 hours of structured bedside and small group teaching in Clinical Sciences, over 73,000 hours of supervisory clinical support and over 80 hours of Continuing Medical Education in Calgary and throughout the CHR The U of C Clinical Clerkship & Internal Medicine Residency Training Programs Dr. Paul Gibson, Assistant Director of the Internal Medicine Residency Training Program is heading up a Strategic Planning Initiative for the Residency Training Program Committee looking at populating the GIM Teaching Units at the Rockyview Hospital with IM residents. Also under consideration are plans to enter into formative agreements with General Internists and sub-specialists in midsized cities such as Lethbridge, Medicine Hat and Red Deer to broaden their experience and at the same time expose them to practice opportunities within these communities. In times of severe physician shortages, it is very important that the University of Calgary, and with it, the College of Medicine and IM Residency Program, be seen as meeting the educational physician resource needs of all Alberta constituents, not just tertiary care hospitals in Calgary and Edmonton. In January 2006, Dr. Marcy Mintz was appointed Director of the Clerkship Course Chair for the College of Medicine. Dr. Dunne is the Clerkship Evaluation Coordinator. These are important accomplishments, which along with our other commitments to undergraduate teaching, solidifies our relationship to the Clerkship and core IM Residency Training Programs. GIM Clinical Scholar Program Dr. Caren Wu defended her thesis entitled 'Accelerated Care versus Standard Care of Transient Ischemic Attack: A Preliminary Analysis of Effectiveness and Cost’. She commenced a faculty appointment with GIM at FMC in January 2006. We are currently looking for a replacement. GIM R4 Fellowship Program Dr. James Kennedy completed his training and examinations in Internal Medicine in June 2005 and has moved on to a position in stroke research with Dr. Alistair Buchan at Oxford. Drs. Khan Ali and Jessica Simon finished their Fellowships in 2005. Dr. Simon is doing a further Fellowship in Palliative Card with a focus on pain control in patients with non-malignant disease. Dr. Ali completed his RCPSC examinations and joined the Division of GIM at the RGH in Jan 2006.

g

Expansion in IM Education - over 400 hrs of lectures - 5616 hrs of bedside teaching - 73,000 hrs of supervisory clinical support - over 80 hrs of Continuing Medical Education

Dr. Paul Gibson is heading up a Strategic Planning

Initiative in RGH as well asLethbridge, Medicine Hat

and Red Deer

Dr. Marcy Mintz appointed Director of the Clinical

Clerkship Program for the College of Medicine.

Dr. Caren Wu - Joined GIM at FMC in Jan 2006 after defending her Masters Dr. James Kennedy - in stroke research with Dr. Alistair Buchan at Oxford Dr. Khan Ali - joined GIM at RGH Dr. Jessica Simon - Further Fellowship in Palliative Care Dr. Johan Conradie - joined GIM at FMC

of 71

Dr. Johan Conradie didAnderson (UBC) is prese

ributor at monthly Jou

secured funding to re-write the Training Objectives and focus our

art Failure Clinics) and that we will be well on the way

at or Red Dear and s program has been so successful that the number of IMG-funded positions available to

the Residency Program. hly trained professional support on some of

dmitting services and on specialized outpatient

the same, and joined GIM at FMC. Dr. Heather ntly doing h

er GIM Fellowship in Calgary and, as such,

rnal Club. is a regular cont 2007 promises to be a very big year for GIM as 8 high-level internal candidates and 1 external candidate have applied to our program. The success of our Fellowship Program is visible proof of the strength of GIM in Calgary and of the growing stature of GIM as an end career for young graduates across the country. We have always had the most interesting patients. Now, with the ARP, we have the lifestyle and remuneration to match. As a result, the Director of our R4 GIM Training Program, Dr. Troy Pederson, has recently program on providing an exceptional year of training experience to a larger number of potential candidates. We are hoping that by July 2007 most of our ambulatory clinics at RRDTC (see below) can be combined into discrete disciplines with centralized booking (General Medicine Clinics, Perioperative Medicine Clinics, Cardiovascular Risk Clinics, Maternal Health Clinics, Atrial Fibrillation/Congestive Hetowards developing additional research Fellowship opportunities (besides Clinical Epidemiology and Medical Education which we presently support) in areas suchas Hypertension, Clinical Pharmacology, Informatics and Knowledge Transfer. This will provide a broad variety of unique GIM services across the Region and offer exciting new learning opportunities for both post-graduate and Fellowship trainees. IMG Program Three years ago the Division of GIM made a commitment to begin training International Medical Graduates for possible entry into the Canadian Health Care System. Thus, each July over the last 3 years, we have contributed 1 or 2 of our IMGs to the IM Residency Program in Calgary. These individuals now support an expanded IM Training Program and allied IM and subspecialty services across the Region. In July 2007, we will begin to see the products of this investment as these people begin to resurface as graduates of the core IM program. The expectation is that many of them will join our Division as GIM R4 Fellows and eventually qualify as fully licensed General Internists for independent practice in Calgary, Lethbridge, Medicine Hadjoining rural communities. ThiRegion has recently expanded the all specialties by 15 and our Program is now the model for integrating foreign trained physicians into professional practice across Canada. Also, we have recently come to recognize the need for a second pathway for IMGs, separate from re-qualification throughSpecifically, there is a need for higour acute care in-hospital aservices such as bone marrow transplant and oncology. Thus, over the last year we have supported 1 of these individuals, Dr. Jan Sporina, as a Physician Extender on our non-resident supported General Medicine Admitting Unit (GMU) at the Foothills. He has been so successful in this venture that, in April of this year, we sponsored Dr. Sporina through CPSA for a Part II license and he is now working as a staff General Internist at Rockyview Hospital. The plan is for him to complete his RCPSC qualifying examinations through FMRAC in June 2008.

Dr. Troy Pederson - re-writing Training Objectives

IMG Program

re- Program expanded

- 1 or 2 have joined Residency Program for last 3 years - First ones to complete

sidency in 2007

Dr. Jan Sporina - Physician Extender receives his Part II lic- will begin wo

ense RGH

ternist rk at

as a staff General In

of 71

In 2005 we recruited 5 new IMGs and, in February through July 2006, our program grew to 8 new IMGs plus another FP-IMG Physician Extender working at the Rockyview. These people have enabled us to continue to provide high-

vel admission and consultation support within the Region. There are now 5

HALLENGES

onsider the Report of the Kirby Commission when it recommends the umber of ministry-funded post-graduate positions be increased from 100 per

uate positions to a more favorable 125 per 100 positions. urthermore, the Department of Medicine must effectively recruit to the 7.86

days (34% of the tal DOM inpatient activity), respectively. Indices of disease acuity increased

lecompetitive positions available each year through AIMG for entry into IM residency. Physicians with international training wishing to immigrate to Canada are now coming to Calgary specifically because they have heard of the success of our programs and know that we provide first-class training and unparalleled opportunities. C Above all, it is important to protect the academic mission of the University of Calgary and the Faculty of Medicine. However, we must recognize that our educational programs do not work in isolation, in that they also serve an important clinical service role. With the planned major expansion of clinical services over the next 5 years, we have, likewise, experienced major growth in our educational mandate, largely through enhancement of the Clerkship and IMG Programs and to a lesser extent the IM Residency Training Program. While changes in these sectors are welcome, such growth is clearly insufficient to support the needed introduction of new Medical Teaching Units at the RGH and proposed South Calgary Campus and certainly not the expanding need for community-based General Internists throughout the province. Thus, we support senior administration and others in leadership roles within the University and CHR to cn100 undergradFpositions allotted to education in the 2003 PRPWG document (only 1 has been filled to this date). This will be particularly important should enrollment to our Medical School be allowed to increase to the targets currently proposed by the Dean. CLINICAL AND INNOVATIONS CHR tracking statistics indicate that the 10-year mean population growth rate for patients aged 20 to 64 years cared for by General Internists in Calgary is 2.62% per annum and 3.06% per annum for patients aged 64 years and older. However, the number of hospital discharges and total patient days attributable to the Division of GIM as a measure of our total in-hospital admitting activity in 2005 increased by over 32% and 27% compared to 2004 figures to 3412 patients (26% of the total DOM inpatient activity) and 35,555 patientto22% over the same period, while average length of stay remained the same at 10.4 days. Corresponding stats on our consultation services suggest that in-patient assessments likewise increased 12.2% over 2004 figures to 13,281 patient visits (29% of the total DOM activity). Thus, we continue to carry a large percentage of the DOM in-patient load and have significantly increased our clinical activity since the new ARP was launched in Aug 2004. Consolidation of GIM In-Patient Admitting Services at the Rockyview Hospital As the volume and complexity of acute, in-hospital care has increased throughout the Region, the private General Internists at the Rockyview Hospital have successfully merged their common interests into a single, group practice

IMG’s 5 recruited in 2005 Feb – July 2006 grew to 8 additional Physician xtender AIMG residency positions creased to 5

- - +E- in

Must increase our ministry-funded post-graduate

positions

Clinical load continues to ease and GIM carries a

rge portion of the in-patient load

incrla

of 71

including an integrated call and teaching schedule. They have regularly had

linical Clerks, PGY-1 Family Medicine and Anesthesia residents on their

historical highs of 18 to 20, and length of stay has dropped from 5 to 10.3 days. This is a huge success story and speaks strongly to the future

come and encouraged to attend. Again, I would emphasize, this will be e academic focus of the Division of General Internal Medicine over the next 5-

ew patients each ay (range 1-4) and is at census most days. It is an important resource for

fashion to improving patient flow through the ED. This high functioning Unit is not

Cservices, but over the last couple of years we have added IMGs, nurse practitioners and the occasional GIM R4 Fellow. They have proven themselves to be enthusiastic and capable educators at all levels of training, and as evidence of their commitment, in July 2006 core IM senior residents started attending on their MTUs and Consult services. Also, we have recently added a second on-call schedule comprising the IM resident and IMGs to assist with teaching and support of the PGY-1 residents in the ER and on wards at nights in this busy hospital. Patient census on GIM supported services presently stands at 45 in-patients versus 1of GIM at this site. The Ward Of The 21st Century (W21C) Work on the Ward-of the 21st Century continues under the able leadership of Drs. Barry Baylis and Bill Ghali. A CFI application was submitted on Feb 13, 2006 and passed the first level (MAC) of evaluation. It has now moved on to the final evaluation process, the results of which should be known by late November. Other successful applications and recipients of awards have been to project leads Dr. Steve Friesen and Deb White, Faculties of Environmental Design and Nursing, respectively for 70K from the Alberta Health Quality Council, and to Dr. John Conly, Head Department of Medicine for 60 K from the Canadian Institute of Health Research. Also, Drs. Jean Wallace and Jane Lemaire recently received an award from the Canadian Patient Safety Institute. The University of Texas has joined the collaboration and the group has been successful in recruiting several new high-level faculty this year, Dr. Sharon Straus, among others. A number of innovative projects are underway including a mechanism for Web-Based Discharge involving Clarity (industry sponsor), Transition Services, Chronic Disease Management, Home Care, the ED and IT. Publications are pending. A 3rd Retreat is planned for October 31, 2006 and all interested parties are welth10 years. Opening of a General Medicine Admitting Service (GMU) at the Foothills Hospital The General Medicine Admitting Unit officially opened on PCU 62 at Foothills Hospital on March 14, 2005. It added a further 11 acute care beds to set a total GIM complement at FMC at 47 in-patients and was designed to work as a high flow unit, accepting patients from the MTUs and Hospitalists, thereby creating capacity on these other services to accept new patients from the ED. It is supported by a single GIM attending and a Physician Extender and, initially, was only open for transfers 8AM to 6PM and only accepted stable patients. As such, the GMU was an innovation in health service delivery. This year, the GMU has expanded its in-hospital support staff and hours to 24/7 and is accepting a higher level of patient acuity. It has moved from 6200 to Units 46 and 36 in the SSB, and presently takes an average of 2 ndoffloading patients from the MTU and is contributing immensely in a secondary

Rockyview Hospital has merged into a group practice

with excellent results

W21C - passed first level (MAC) of evaluation - additional awards - will be the academic focus of Division

General Medicine Admitting Service opened at FMC – PCU 62 - Adds 11 beds - Admits only stable patients - supported by GIM attending & Physician Extender

PCU 62 - hours expanded to 24/7 - moved to Units 46 & 36 in SSB - average of 2 new patients daily

of 71

matched any other acute care service in the Region or, as far as I am aware, in

anada.

plitting of the GIM In-Patient Consultation Service at the Foothills Hospital

ast year, our in-hospital GIM Consultation service at Foothills became versubscribed. There were questions whether patients were being cut too uickly from follow-up, thereby potentially compromising care, and workload was

and that this is more constant day-to-day. The question mains whether our previous high numbers post weekend were inflated due to ounce back’ and poor care, or we have simply improved the flow and

porting the service. Dr. Agarwala is resently preparing a manuscript for publication.

physicians from the PLC and RGH started doing preop assessments r the HRC. This is an exciting initiative by Orthopedic Surgery to see whether

upport medical environment. Our Divisional commitment is to provide expert

C S Loqsevere and unrelenting, contributing to physician job stress and dissatisfaction. This was resolved by opening a second, complementary, service with the 2 Units taking calls for new patients on alternate days. At the same time, it created additional learning opportunities for residents, clerks and others as we employed more staff and provided better patient follow-up. In an attempt to evaluate this initiative, Dr. Ravi Agarwala collected billings data from our consult services before the expansion and employed a business model of service demand/service delivery to decide on the most appropriate solution to the problem. He reported the results of his study to the FMC group in September and showed that before the intervention we were seeing, on average, 18-25 new consults each Monday and Tuesday and lower numbers later in the week. It was also clear that since that time, our total numbers of new consults have dropped to more reasonable ranges of 5-8 dailyre‘bdistribution of consults by better supp Expansion of the Urgent Assessment Clinic (UAC) to the Rockyview Hospital A year ago last spring, the RGH group expressed an interest in developing a UAC and had the space to support it. The final piece was built on our existing strengths in triage, booking and the organizational structure in Area 1b to support a satellite clinic at Rockyview Hospital. Additional staff has been recruited and the new unit opened September 2005. Recent clinic data show an 80% increase in referrals from 2005 through 2006 with a drop in wait times from 2.7 to 1.8 days. Also, our referral base has expanded into rural areas. This model of expedited consultation to Emergency Departments and primary care physicians keeps people out of hospitals has been profiled on television and in local newspapers. Recently, lessons learned with the GIM UAC have been applied to similar clinics in other specialties. Preop Consultatons for the Health Resource Center (HRC) at the Old Grace Hospital In fall 2005,folow acuity patients can receive their joint replacements and reconstructive spreoperative assessment and urgent perioperative consultative support, as needed over the phone, to physicians at HRC. Also, we attend to emergencies on those infrequent occasions when their patients are transferred to one of our acute care adult hospital sites. Finally, a series of care maps for common medical complications (blood sugar control, pain management, fever, confusion, SOB, hypo- or hypertension, poor urine output and others) are being prepared to

GIM In-Patient Consultation is split into 2 complementary

services

UAC expanded to RGH eptember 2005 staff has been recruited drop in wait times from 2.7 1.8 days expansion into rural areas

S- - to-

Health Resource Center - Preop consultations - provide preoperative

sessment & urgenrioperative support

as t

attend to emergencies care maps for consultations ve been prepared

pe- - ha

of 71

assist HRC on-site physicians in managing their patients and indicating when IM onsultation may be preferred.

pening Of The Mind And Body Clinic At The Rockyview Hospital

ened in December 2004 at the RGH to accept tic and psychosomatic illness. Emphasis is on non

ent. It employs a full time Psychologist and nurse and has the part-e Department of Psychiatry. Dr. J. Schaefer acts as the Co-

to the Clinic. Drs. Schaefer and Bakal recently g their clinic in Medical Hypotheses (2006) 67, 1443-

mbulatory Clinics

lans are underway at all CHR sites to implement a centralized computer o rvice in order to take full advantage of time and existing clinic space.

have your clinics only partially booked on a offered use of the rooms. Likewise, you may be by booking into other's unfilled clinic allotments.

nally assigned space.

an’s Office is planning to recover space in the UCMG Clinics area of the ealth Sciences Building for the proposed new Veterinary College, so all clinics nd offices must vacate by December 2007. Thus, all GIM ambulatory clinics, ave possibly the UAC which will probably re-locate to the Special Services

e renovation before any move can be considered, so this is not ely to occur before April 2007. Initial plans are for 6 examination rooms plus a

e the MC group will be first on site, this is a Divisional resource and will be open to

ge from a patient- centered pproach to a telephone discussion between the consultant, the clinic nurse

nal ietician, kinesiologist, psychologist, pharmacist, etc) counterparts. This would

have several potential advantages over the existing process. First and foremost,

c O The Mind and Body Clinic op

atients with complex somarug treatm

pdtime support of thDirector IM support physician published a paper profilin

447. 1 A Pb oking se

you are If unable to attend or articular date, others will bp eble to make up extra clinicshis is

aT likely to cross traditional divisio

he De THasBuilding under Day Medicine, will be moving to the RRDTC. The building requires somlikprocedures room with expansion to 25 rooms over the next 3 years. WhilFother new and existing faculty at the PLC and RGH as numbers accrue and clinic space becomes limited through the recruitment process. Changes are underway in the Preop (PAC) Clinics to reduce the number of low risk patients that are being referred as this is taxing physician capacity and causing delays in attendance for higher risk patients. Also, unnecessary testing is routinely being performed. Thus, a screening tool has been developed as part of the Innovation Strategy to assess the necessity of referral and a list of suggested preop tests has been prepared. These are presently being reviewed, and will be trialed at the FMC site before potential implementation elsewhere. CV Risk Initiative A multi-disciplinary cardiovascular risk project that expands the boundaries of the traditional consultation process has been started at the FMC. All of the variables we measure and follow in cardiac risk are eminently amenable to collection by the patient, a laboratory and/or an alternate care provider. Thus, it was conceived that all this information could be obtained and an assessment and care plan designed for over 90% of referrals without ever seeing the patient. Thus, the consultative process for these people would chanacoordinator and the primary care physician and/or their nursing or professio(d

Mind & Body Clinic – RGH - non-drug treatment - Drs. Schaefer & Bakal published paper in Medical Hypotheses

Centralized computer booking service will be

implemented

All GIM ambulatory Clinics to move to RRDTC approximately April 2007

Preop Clinic develops a screening tool to assist in determining patients most

needing the Clinic

CV Risk initiative determinesthat 90% of referrals do not require a visit and re-establishes link between PC and counterparts

of 71

it re-establishes a critical link between the consultant and the primary care physician,which itself is in desperate need of repair. Secondly, direct involvement

f the referring physician in the consultation algorithm brings buy-in and learning o that they may start to employ many of the assessment and treatment trategies on other patients earlier in the process and perhaps without the ngagement of the consultant. Third, since the consultation focuses on eatment rather than information gathering, the time for assessment should be uch shorter so that more patients could be attended on a single half-day clinic. inally, precious resources such as parking, clinic space, nursing and even the atient's own time would be reserved for those that truly need to be seen in clinic y a physician specialist. This model, if proven effective, is easily adaptable to ther chronic diseases such as COPD, CHF, atrial fibrillation, diabetes, IBD, RA, soriasis and a host of others.

he project was formally launched in the late winter of 2006 and at this point only ccepts patients following discharge from the Stroke Unit. It is presently seeing 0-35 new patients a week with follow-up. Our plan is to evaluate the impact of e nt outcomes to confirm the validity of the y rther and inviting other groups such as Cardiac

e clinic also collects core statistics on all of its atients an is creating an invaluable resource for research in the oming years.

HALLENGES

he CHR Master Plan is to open 753 acute care beds over the next 5 years at GH, FMC, PLC and the new South Calgary Campus. Assuming the historical 5/75 split between medical and surgical beds and the current division of orkload of 33% Internal Medicine and 67% Hospitalist, of which GIM carries a ajor portion of in-patient IM care, we will likely be asked to assume sponsibility for an additional 60 to 100 beds. How this will play out in terms of

ew MTUs, other high level assisted care like the GMU and possibly a Day etermined. However, what is clear is that we can

nificant expansion of our in-patient admitting and cruitment will continue to be a necessary

ce plan.

DS

2005/2006, the Division of GIM collectively contributed over 54 papers in peer-viewed publications, 35 invited reviews or papers in non-peer reviewed

ublications and 1 book chapter. We had 42 abstracts and presentations at search meetings around the globe and published in proceedings thereof. We

re the principle investigator orco-investigator on research projects that received lose to $3 million dollars in new and $10.5 million in ongoing support from ompetitive peer-reviewed bodies and many of us made significant contributions

mittees relating to research, education and professional lly, 7 of our membe

OM ARP

ossetrmFpbop Ta3th project on risk targets and patie

pothesis before investing fuehab to participate. Finally, th

d thereby

hRpc C TR2wmrenHospital, remains to be d

xpect see further sigonsultative serv

ec ices. Thus, reomponent of our Divisionc al servi

RESEARCH AND AWAR Inrepreaccon national scientific com

inaspecialty societies. F rs currently hold funding and lead Innovation dollars.

projects supported by D

Advantages - critical link established between consultant and PC physician - brings buy-in and learning to referring physician - time for assessment is shortened - clinic space, nursing, time,

ed for ose needing to be seen

parking are all reservth

Project sees 30 – 35 patients following discharge from Stroke Unit weekly with follow-up

Recruitment will be necessary with expansion

Research - 54 peer-reviewed publications - 35 invited reviews

1 book chapter - - 42 abstracts & presentations - close to $3 million in new - $10.5 million in ongoing support - 7 members hold funding & lead projects supported by ARP innovation dollars

of 71

Drs. Ghali, Lemaire and Sargious have applied and received approval for sabbaticals in the 2006/2007 academic year. Dr. Caren Wu recently defended her Masters Thesis entitled “Cost Effectiveness of Accelerated Management of Transient Ischemic Attack” as Compared to Standard Care under the supervision of Dr. Braden Manns and Dr. Alistair Buchan, Department of Community Health Sciences, University of Calgary. Dr. Jeff Schaefer was appointed Chair of the Department of Medicine ARP Management Committee in the fall of 2005. Dr.

arcy Mintz was appointed Director of the Clerkship Course Chair.

am anitoba) and Dr. Jayna Holroyd-Leduc (Toronto). Finally, Dr. Jean Wallace

versity of Calgary) received an adjunct appointment in ur Division this summer.

cently obtained funding for a Canada Health Research Chair in Hypertension. r. Jeff Schaefer received a 2006 University of Calgary Canadian Association of edical Educators (CAME) Certificate of Merit Award. Ms. Rosanne Dreschler ursing) was given a Calgary Health Region Peoples First Award for her work in e GIM Urgent Assessment Clinic. Department of Medicine Awards this year ent to Dr. Terry Groves for the inaugural Terry Groves Award for Clinical

lizabeth MacKay for the Professionalism Award and the Innovation Award. Resident Teaching Awards included

to Dr. Troy Pederson, The Silver Tongue Award to Dr. pic Teacher Award to Dr. Andre Ferland. Dr. Jane

eived the Gold Star Award and Dr. Marcy Mintz received a ecognition Award for teaching in the Clinical Clerkship Program.

r. Lemaire is the physician lead in the DOM Physician Wellness/Work Life alance initiative and she and Dr. Ghazwan Altabbaa are doing some preliminary ork on mentoring of new recruits. Both of these should bring important payoffs our Division in the future.

M New appointments in GIM at the FMC site are: Dr. Maria Bacchus (Toronto), FMC Site Chief and Division Head, and Vice-Chair of Strategic Planning and Ambulatory Care, Dr. Lorne Clearsky, Deputy Officer of Health, Aboriginal Health Program (Manitoba), Dr. Chandrasekarin (Siva) Kumar (Madras), Drs. Jonathon Yau (Alberta) and Susan Huan (Phillipines), Dr. Caren Wu (London, Ont), Dr. Johan Conradie (Calgary), Dr. Sharon Straus (Toronto), Dr. David S(M(Faculty of Sociology, Unio Newly appointed at the PLC is Dr. Ian Scott (Calgary). New appointments at RGH include Dr. Ghazwan Altabbaa (Damascus), Dr. Partha Datta (McGill), Dr. Jan Sporina (Slovakia) and Dr. Khan Ali (Mayo’s). Dr. Michele Burns was recently appointed RGH Division Head at that site. On a national forum, Dr.Jane Lemaire received a CSIM Osler Award for her leadership and work with the RCPSC GIM Subspecialty Committee. Dr. Norm Campbell received the CSIM Senior Investigator Award. Dr. Campbell has also reDM(NthwExcellence for RGH, Dr. EDr. Peter Sargious forthe Silver Finger Award

aul Leblanc and the Ectoemaire rec

PLR DBwto

Staff added to FMC - Dr. Maria Bacchus - Dr. Lorne Clearsky - Dr. C. Siv

Sta- Dr. Ian Scott Staff added to RGH - Dr. Ghazwan Altabbaa - Dr. Partha Datta - Dr. Jan Sporina - Dr. Khan Ali

akumar - Dr. Jonathon Yau - Dr. Susan Huan - Dr. Caren Wu

ff added to PLC

Dr. Michelle Burns appointed Division Head at RGH

Staff - Drs Ghali, Lemaire & Sargious have approval for sabbaticals in 2006/07. - Dr. Wu defended her Masters’ thesis - Dr. Schaefer appointed Chair of ARP Management Committee - Dr. Mintz appointed Clerkship Course Chair for the College of Medicine

of 71

CHALLENGES Research and innovation hold the key to solving many of our most difficult service and patient-related problems. Recognition that a problem exists is the first step in finding a solution. Having the appropriate tools and support to test

ne’s ideas are the necessary seconds. Alberta’s success has brought immense

veloped in order to obtain the largest possible returns on our uman resource investments. These are our challenges and goals for the next

oresources to Calgary and Calgary possesses one of the few great health care facilities where these resources are truly regionalized. GIM is a team and together we are already heavily invested in research and innovation. However, if we are to be successful, we must devote greater attention to mentoring and the ongoing professional development of our existing faculty. The W21C and Buchanan Chair are effective tools that we possess and must be brought to bear on these needs. More effective and reproducible methods of accountability also need to be deh2-3 years.

AWARDS - Dr. J. Lemaire – CSIM Osler Award - Dr. N. Campbell – CSIM

stigator Award &

er –

- Dr. E. MacKay – Professionalism Award

nt

ederson – Silver Finger Award - Dr. P. Leblanc –Silver To

- Dr. J. Lemaire – Gold Star

cognition g

Senior Invefunding for Canada HealthResearch Chair in Hypertension - Dr. J. Schaefer – 2006 CAME Certificate of Merit Award - Ms Roseanne DreschlPeoples First Award - Dr. T. Groves – Terry Groves Award for Clinical Excellence for RGH

- Dr. P. Sargious – Innovation Award – ResideTeaching Awards - Dr. T. P

ngue Award - Dr. A. Ferland – Ectopic Teacher Award

Award - Dr. M. Mintz – ReAward for Teachin

of 71

DIVISION OF GERIATRIC MEDICINDivision Chief: Dr. James Silvius

DMINISTRATION

E

gress/ outcomes a. No specific service changes have been initiated. We have planned for

d as resources have not been available; fortunately the delays in the Falls Initiative and the non-

e PBMA process. However, limited funds for growth initiatives have meant that no budget had been approved at year end.

ed er (or

of staff and organization of triage at sites. It has been limited by lack of a consistent

LINICAL S dertaken at the RGH ambulatory site to streamline re ate geriatr mental health and geriatric medicine team c service. Work on this realignment is ongoing. T a phenomenal success. Statistics from the Department of T at Geriatrics accounted for 622 (35%) of the 1,784 clinical h iscal 2005, sig ificantly more than any other single group in th

A

Issues/challenges from last year a. Changes to existing services and expansion related to needs b. Planning for Regional Falls Initiative c. Planning for Regional Cognitive Impairment (CI) Strategy d. Balancing service needs with requirement/interest in pursuing academic

interests Update on their status/ pro

Changes to existing services - resources not available

some changes that have not been implemente

prioritization of the CI Strategy have been to our advantage in this regard.

b. Regional Falls Initiative was prioritized as #3 Regionally in th

c. Regional Cognitive Impairment Strategy was not prioritized through the PBMA process in ’05/’06. We will continue planning and limited further work on the initiative with the intent of re-submitting in ’06/’07.

d. Several members have expressed a frustration with service demands intruding on other aspects of work life. The perspective within the Division is that we have responsibilities in a number of areas, not just clinical service, and that all areas need to be equally respected. We have therefore agreed that requests for service expansion will not be agreto until such time as resources allow. This puts pressure on for eithboth) service re-design to reduce the requirement for physician time and/or recruitment to meet increasing service demands.

INNOVATIONS Work continues on our one line access system with the hiringredatabase though approval is awaited for this, and it is anticipated that the system will be in place by September ’06. No new programs have been started this year. C

ervice redesign was unferrals and amalgam ic

are into one combinedelehealth has been elehealth indicate thours recorded for f n

e Region.

Regional Falls Initiative onhold

Regional Cognitive Impairment Strategy to be

resubmitted in 06/07

Division believes that all areas of work need equal respect - service re-design needed - recruitment needed

One line access system - hiring of staff - reorganization of triage - limited by lack of consistent database

- Service redesign to amalgamate mental health and medicine - Telehealth is a phenomenal success

of 71

RECRUITMENT Negotiation was underway with one full time recruit for Geriatrics; there had been acceptance in principle but licensing issues prevented completion of the recruitment. The individual will be based at the RGH, assuming the licensing issues can be addressed. At year end there was an expression of interest from a second individual for a limited role with Geriatric Medicine.

DUCATION

malgamation of the Aging and the Elderly Undergraduate course (MDCN 423) ith Clinical Neurosciences was underway. eniors Campus was accepted by the Reach! Campaign and word at year end as that negotiations were underway with a major donor.

ESEARCH

cholarship (Research & Education/Teaching) o specific new initiatives. Dr. Hogan remains involved in dementia care ationally; Dr. Schmaltz continues to develop her program of research; Dr. ilvius remains involved with the DementiaNet and with a number of Net projects

atient Care he work done with the rural components of the Region and Calgary Family hysicians has amply demonstrated frustration with the referral process to pecialists, including those within the Department of Medicine. Discussions were nderway at year end as to a mechanism to address the issue of the disconnect etween DOM and family physicians.

issemination of Knowledge nowledge Translation will be augmented if one of the individuals expressing an terest in relocation to Calgary does move here.

HALLENGES (April 1, 2006 – March 31, 2007)

iven the timing of this report, I am aware of the addition of three recruits with at ast some commitment of time to Geriatric Medicine. This will create a challenge s we look at rearranging services and using different models of service structure an has historically been true. While more than welcome, accommodating the

umbers of new individuals will create it’s own challenges as this is possibly the rgest influx in one year in the history of the Division. We have

• decided as a group to review services and structures in the winter. of services at current sites

• Redevelopment of services at current sites • Ongoing planning for services at new sites

Further work on both major initiatives (Falls and Cognitive Impairment) to prepare for PBMA in ’07/’08

One new recruit to join Geriatrics

Amalgamation of Aging & Elderly Course with Clinical Neurosciences

Seniors Campus accepted by Reach!

campaign

Clinical laboratory planned for Seniors

Campus

Major frustration between DOM and family physicians

Potential recruit could help with Knowledge

Translation

New recruits will necessitate a review of services and structures

E AwSw R SNnS

PTPsub DKin C Gleathnla

of 71

Visuals (graph/chart) for banner programs/services

Telehealth Clinical Hours

Clinical Area Clinical Consultation Hours (June 1, 2005 – May 31, 2006)

Geriatrics 622.00 Paediatrics 444.25 Mental Health 245.25 Di tabe es 106.75 Clinical - Education 85.00 Cardiology 65.92 Rheumatology 48.75 Palliative 40.00 Re 24.50 habilitation Nephrology 22.00 Case Conference (patient present) 21.25 Discharge Planning 12.25 Genetics 11.00 Internal Medicine 10.00 Forensic Mental 8.50 Emergency/ICU 3.73 Wound Care 3.50 Surgery 2.50 Infectious Disease 2.00 Neurology 2.00 Oncology 2.00 General Practitioner Consult 1.00 Group Total 1784.15

AWAR

tients & families & visitors (for people or programs/services)

“People First” Award for Dr. D. Hogan

DS Accolades from pa Dave Hogan received a “People First” Award from the Region in ’05 for his service to the patients in the Cognitive Assessment Clinic

of 71

Division of Hematology and Hematologic Malignancies

ddition of two new staff members; Drs. s and Andrew Daly. Michelle Geddes completed her Hematology algary and accepted a Clinical Scholar position within the

sition in Calgary. Andrew Daly completed his Hematology residency as well as a Blood

ansplantation Fellowship in Toronto. He joined the Hematology ary on March 1st of this year, will base his Hematology practice at

e Peter Lougheed Centre, attend clinics at the TBCC, and supervise the Blood

splant Program in Calgary, and as well as the role of Director, rta Cancer Research Institute. Dr. Deirdre Jenkins returned from a

n APN in April 2006. We are also pleased announce that Deana Hickey has started her orientation as the Clinical

o later entered specialty sidency programs in 2005 (Pedro Camacho – Internal Medicine) and 2006

y have hired three other G clinical associates.

Jim Russell who is plann - is Program. Recruitm

nopathies who could lead program development in this area. - A hematologist with special training in hemostasis to help develop the Hemostasis Program for Calgary.

Division Chief: Douglas Stewart, MD, FRCPC ADMINISTRATION AND RECRUITMENT Douglas Stewart became the Hematology Division Chief when Graham Pineo stepped down in March 2006. The Division of Hematology/Hematological

alignancies recently welcomed the aMMichelle Geddeesidency in C

N cruits - Dr. Michelle Geddes - Dr. Andrew Daly New Division Chief

rDepartment of Medicine effective January 2006 through August 2008. During this time she will contribute 0.4 FTE clinical and academic work to the Division of hematology and spend the remainder of her time completing fellowship training in Calgary’s Blood and Marrow Transplant Program. This position is intended to

ridge Dr. Geddes through her fellowship into a 1.0 FTE pob and Marrow TrDivision in Calgthand Marrow Transplant inpatient service at the Foothills Hospital 8 weeks each year. In addition to these new appointments, we have recently welcomed back Chris Brown from leave of absence to his clinical role with the Blood and Marrow TranSouthern Albeone year maternity leave in April 2006, and we are looking forward to the return of Man-Chiu Poon from sabbatical in August 2006. On Dec 1, 2005, the Program welcomed Reanne Booker to an APN position within the BMT Program at the TBCC, and Stephanie Hubbard joined the TBCC Hematology Tumor Group as atoEducator for the BMT Program. The Hematology/BMT Program has worked with the CHR’s IMG program to hire and train two IMG clinical associates whre(Tatjana Zdravkovic – Family Medicine). We currentlIM Recruitment priorities for 2007 - general hematologist with the ability to participate in malignant and benign hematology programs and foster research, particularly in the area of acute leukemia/bone marrow transplant/cell therapy. - Bone Marrow Transplant Program Director to replace Dr.

ing to retire in 2007. A leader for the Hemostas

ent priorities for 2008. - A hematologist with special training and interest in rare blood disorders/hemoglobi

ew Re

- Dr. Douglas Stewart

Dr. C. Brown & Dr. D return from

. Je ins leaves Dr. M. Poon currently on

sabbatical

nk

BMT staff added - Reanne Booker – APN - – C

Dr. Tatjana Zdravkovic linical Assistant

of 71

Creation of Hematology/BMT Program for CHR and Tom Baker Cancer Centre (TBCC)

Program occurred in July 2006. Marie-Josee P d as the Administrative Le CLINICAL H rovide consultative services at all CHR h as well as the T Cancer Centre (TBCC). Inpatient services and atory clinics for H ided at the FMC and PLC. The rece elopment of the p Hematologic Malignancies within ch is h Division Head for Hematology and Hem c Malignancies within the CHR and the University provides responsibility countability for all hematolo within the CHR and the cancer ce O of the division, 12 are based at the F d 5 at the PLC. T ry includes 3 fulltime fe rvice clinicians a ers within the Department of M ARP (4 at the F at the PLC with major clinical appointments, an T appointments based at FMC including 2 clinical scientists). Two individw Transplantation and Hematologic malig s are based in t primary appointments within the acad Department of O re funded the Province Wide Services d and Marrow T gram via the TBCC. Two members of the division are cross-a with the Division of General Medicine. From a c l standpoint, the m ision at the PLC/RVH account for four nician, the two at the TBCC account for 1.5 FTE, and the members of the division at the FMC w of the ARP account for approximately four FTE. Therefore, a major p ctivities within the Division ematology and Hematologic Malignancies are carried out by individuals who are not part of the A make a major contribution to the manag f hematologic

the CHR and the TBCC.

eo chaired the Comprehensive Program for the Prevention of enous Thromboembolism, the Task Force on Diagnostic Algorithms for Deep

nticoagulant Order Sets for the CHR. Dr. Hull also contributed greatly to these

he Department of Medicine recently established awards for members of the Department who were nominated by their peers as being excellent clinicians. For 2005, two of these prestigious awards went to Dr members of the Division of Hematology and Hematological Malignancies. The 2005 winner of the Dr. John Dawson Award for the Foothills Hospital was Ben Ruether, and the 2005 winner of the Dr. Howard McEwen Award for the Calgary General Hospital/ Peter Lougheed Centre was Walt Blahey. In addition to these awards, Ted Thaell received the 2005 Rockyview General Hospital Medical Staff Association Award for Clinical Excellence in the Department of Medicine and Graham Pineo received the People First Award for lifetime achievement in thrombosis. Finally, Man-Chiu Poon received the Alberta Centennial Medallion Award with Certificate of Alberta Centennial in Dec 2005 as recognition by the Province of Alberta for outstanding work, achievements and volunteering efforts for the people, communities and province of Alberta.

Initial meeting of this aquin will be recruite ader for the Program

ematologists p ospitals om Baker ambulematology are prov

BMT andnt dev

rogram for the TBCC whieaded by the atologi

and acgic activities ntre.

f the 17 members MC anhe Hematology Division in Calga e-for-set the PLC and 11 memb edicineMC and 1 d 6 GF

uals heavily involved ith Bone Marrow nancie

he TBCC, havencology, and a

emic Bloo

ransplant Proppointed linicaembers of the div FTE cli

ho are part roportion of the clinical a of H

RP but who iseases within

ement od Graham PinVVein Thrombosis and Pulmonary Embolism, and the Task Force on Ainitiatives. These algorithms and order sets are now being implemented by the CHR. T

Major contributions from all areas.

New Hematology/ BMT joint program

Awards Presented - Dawson Award to Dr. Ben Ruether - Dr. Howard McEwan Award to Dr. Walt Blahey - 2005 RGH Medical Staff Association Award to Dr. Ted Thaell - People First Award to Dr. Graham Pineo - Dec 2005 - AB Centennial Medallion Award to Dr. Man-Chiu Poon

Dr. Pineo and Dr. Hull make great contributions to new

algorithms and order sets in Thrombosis & Pulmonary

Embolism

of 71

INNOVATIONS

1) A proposaBlood Disorders Clinic

submitted to the CHR to support

ch

Cancer Board website.

tion of a role for an APN or

d

l its education obligations with three individuals

ear, the

olden B Department of Medicine, and ontinues to dire ing Program. During the last

ts within Calgary’s Hematology Program, and a

Star Award and Calgary Medical Student rd (class of 2008) for teaching.

l was submit ted to Province Wide Services to create a Rare

in Edmonton and Calgary. The proposal was not funded by PWS, but will be refined andthese activities locally.

2) Jan Storek spearheaded the development of a unified CHR/CLS/TBCC

BMT Database and Standard Practice Manual.

3) In the fall of 2005, the Calgary BMT Program underwent a requested accreditation review by the Federation for the Accreditation of Cell Therapy (FACT). The BMT Program was granted FACT accreditation in June 2006.

4) The malignant Hematology Program established an amalgamated

account for clinical trial research, hired more Clinical ResearCoordinator and Clinical Research Nurse staff, increased clinical trial accrual, and was invited to become a member of the National Cancer Institute of Canada Clinical Trials Group Lymphoma Site. Clinical Practice Guidelines for Hematological malignancies were reviewed and updated. These CPGs will be formatted and placed on the Alberta

5) Innovations program through ARP may facilitate establishment of a rare

blood disorders clinic for adult patients with hemophilia and hemoglobinopathies, and restructuring the benign hematology program for the CHR (especially FMC/UCMC site) - with central referral, triaging, and creaclinical associate.

6) A new administrative structure for the Division within the CHR and TBCC including an overarching Hematology/BMT Steering Committee, and several subcommittees including Benign Hematology, Malignant Hematology Tumor Group and BMT Program. An administrative leader

edicated to Hematology/BMT has been hired; Marie-Josee Paquin. 7) Funding to recruit Hematologists:

EDUCATION

The Division continues to fulfilheavily involved in educational administration. Deirdre Jenkins is the Blood Course Director, and a committee member of the undergraduate Curriculum Design and Implementation Committee. Dr. Jenkins has been accepted into a 3 y sis track, Master's in Health Professions Education through the University of Illinois at Chicago. Karen Valentine received the prestigious 2005 G ull Award for excellence in teaching,

ct the Hematology Residency Traincfiscal year there were 2 residen

aduate gr of the Residency Program entered a 2 year BMT Fellowship in Calgary. Allan Jones continued in his role as Associate Dean of Undergraduate Medical

ducationE during the last fiscal year. Nizar Bahlis, Deirdre Jenkins and Karen Valentine each received a Gold

ssociation Letter of Excellence AwaA

P

BMT undergoing FACT accreditation

Staff hired to aid in new clinical trial research and

accrual

Awards - 2005 Golden Bull Award and directs Hematology Residency - Dr. Valentine

Gold Star Award & Letter Award to

Dr’s. Bahlis, Jenkins and Valentine

- of Excellence

CHR/CLS/TBCC BMT Database and Standard ractice Manual developed

by Dr. Jan Storek

of 71

RESEA

his Division remains very active in research and publications. Five individuals search commitments. During 2005, however, Man-Chiu Poon was

n sabbatical and Chris Brown was on prolonged leave following a skiing

k has received a 500,000 Canada Research Chair in Immunology (2005-2009), a $384,983

e publications in high impact journals. heir PIOPED II study is in press in the New England Journal of Medicine and

onary embolism. The $751,442 funding commenced July 2005. Dr. ussell Hull is Chair for a GlaxoSmithKline grant of $510,000 as Independent

RCH Thave major reoaccident. Nevertheless, members of the Hematology Division published 14 peer-reviewed manuscripts in scientific journals, an equal number of scientific abstracts, and several other articles were accepted for publication and are in press. This work mainly relates either to the Blood and Marrow Transplant Program or to the Thrombosis Research Unit. The Calgary BMT Program has become established as one of the premiere programs nationally and is developing an international reputation of excellence. Jan Store$Canada Foundation for Innovation establishment grant (2004-2009), a $100,000 Alberta Heritage Foundation Major equipment grant (2005), and $452,500 from the University of Calgary to pursue research into immune reconstitution following hematopoietic stem cell transplantation, and correlation with infectious and graft versus host disease complications. Nizar Bahlis is establishing a comprehensive clinical and translational research program for multiple myeloma. In addition to dramatically enhancing clinical research activity for myeloma patients at the TBCC, he has received grant funding from Calgary Laboratory Services (CLS) to establish a tissue microarray on bone marrow biopsies of myeloma patients, as well as an Alberta Cancer Board grant to evaluate Protein Kinase C delta: a novel therapeutic target in multiple myeloma. In December 2005, Nizar Bahlis received a Merit Award, Department of Medicine and Calgary Health Region. Dr. Hull and Pineo continue to operate the Thrombosis Research Unit and published several review articles (including Up To Date), editorials, and 4 book chapters last year. Their research activities have impacted directly on local, national and international care, and includTtheir cancer-related work is in press in the American Journal of Medicine. Dr. Russell Hull is Principal Investigator, and Graham Pineo is Clinical Scientist for a National Institutes of Health, National Heart, Lung and Blood Institute study named PIOPED III (Prospective Investigation of Pulmonary Embolism Diagnosis III). This study will evaluate the sensitivity and specificity of MRI for the diagnosis of pulmRCentral Adjudication Centre (ICAC); Trial of Odiparcil for the Prevention of Venous Thromboembolism (Dr. Pineo is an Adjudicator). Dr. Hull is co-investigator on a Canadian Institutes of Health Research grant to study Health System Capacity and Infrastructure for Adopting Innovations in Venous Thromboembolic Disease Care. CHALLENGES The main challenges for the coming year include: 1) planning for new hospitals (South Campus, CHR and new cancer institute, ACB), 2) lack of rare blood disorders clinic for adult patients with hemophilia and hemoglobinopathies,

Res14anuscriptseveral articles accepted r publication

earch peer-reviewed

s - m- fo

Dr. Jan Storek 00 Canada

esearch Chair in munology

$384,983 Canada oundation for Innovationant

$100,000 AB Heritage oundation Major uipment grant

$452,500 grant from niversity of Calgary

- $500,0RIm- Fgr- Feq- U

Dr. Nizar Bahlis grant funding from CLS

ACB grant to evaluate otein Kinase C delta

ard in Dec 200

- for myeloma - Pr

Merit aw 5 -

Thrombosis Research Unit

review articles

line

- Dr’s Hull & Pineo - 4 book chapters - several - editorials - $751,442 funding from PIOPED III - $510,000 grant from GlaxoSmithK

of 71

blood pdisorde ema,

4) lack of residents to provide on-call coverage for BMT service as well as h e for the Hematology

ivision within the CHR and TBCC including an overarching Hematology/BMT Ste(Directelead by

ther issues that must be addressed include recruitment, benign hematology proexperieworkloainabilitybeen reThere hhas resFMC, a search program or CGPs. Creation of the new

dministrative structure and subcommittee of Benign Hematology should address thisinclude Therapy(protect lth Services Research. Division s for the subsequent year.

2) ho

s. 3) Work with CHR and Department of Medicine to facilitate care of patients

re blood products for non-hematological conditions such as ciency disorders and hereditary angioedema. This will likely

3) desire from the CHR to contribute to care of patients who require roducts for non-hematological conditions such as immune deficiency

rs and hereditary angioed

ematology services resulting in Hematologists taking primary call, and 5) development of a new administrative structur

Dering Committee, and several subcommittees including Benign Hematology

d by Karen Valentine), Malignant Hematology Tumor Group (currently Doug Stewart) and BMT Program (Directed by James Russell).

Ogram development, and research productivity. Traditionally, the Division has

nced difficulty recruiting academic staff, in part due to high clinical d, frequency of on-call duties, lack of protected academic time, and to focus academically on area of interest. Many of these issues have duced through recruitment of more clinical staff over the past 2 years. as been a lack of program development for benign Hematology which ulted in long waiting lists, lack of triaging, duplicate booking at PLC and nd no comprehensive re

a issue. Finally, our research programs are underdeveloped. Our goals

increasing accrual to Clinical Trials, expanding research in BMT/Cell and Benign Hematology, improving support for translational research

ed time, start-up money), and initiating Hea

goals and objective1) Contribute to planning of new hospitals (South Campus, CHR and new

cancer institute, ACB) in an effective manner that will optimize patient care through 2020. Create a rare blood disorders clinic for adult patients with hemophilia and hemoglobinopathies and if possible recruit a director of this program whas special expertise in hemostasi

who requiimmune defirequire creation of the rare blood disorders clinic described above and the establishment of collaboration with Immunologists and pulmonologists.

4) Create a new administrative structure within the CHR and TBCC including an overarching Hematology/BMT Steering Committee, and several subcommittees including Benign Hematology, Malignant Hematology Tumor Group and BMT Program.

5) Restructure the benign hematology program for the CHR (especially FMC/UCMC site) with central referral, triaging, create a role for an APN or clinical associate, and foster clinical research.

6) Recruit a new BMT Director for 2007.

Chap

lack osorder clinics cone amatolog

need more residents new administrative ructure within CHR and BCC recbeprogram de nt research productivity

llenges lanning for new spitals

f rare blood

- ho- di- tribution from CHR in

rea of non-ical conditions

thhe- - stT- ruitment

nign hematology velopme

- - -

of 71

7) desire from the CHR to contribute to care of patients who require blood

products for non-hematological conditions such as immune deficiency rs and hereditary angioedema.

8) lack of residents to provide on-call coverage for BMT service as well as

d) bed capacity issues

disorde

hematology services resulting in Hematologists taking primary call. 9) difficulty recruiting academic staff, in part due to high clinical workload,

frequency of on-call duties, lack of protected academic time, and inability to focus academically on area of interest. Many of these issues have been reduced through recruitment of more clinical staff over the past 2 years.

10) There has been a lack of program development for benign Hematology which has resulted in long waiting lists, lack of triaging, duplicate booking at PLC and FMC, and no comprehensive research program or CGPs. Creation of the new administrative structure and subcommittee of Benign Hematology should address this issue.

11) Finally, our research programs are underdeveloped. Our goals include increasing accrual to Clinical Trials, expanding research in BMT/Cell Therapy and Benign Hematology, improving support for translational research (protected time, start-up money), and initiating Health Services Research.

12) The main issues involving the Department of Medicine include: a) the increasing teaching responsibilities of staff to accommodate

increasing numbers of medical students and residents b) collaboration and good working relationship with the TBCC/ACB

including functional planning for malignant hematology/BMT, EMR, Patient Flow, Space Allocation, Research Staff for Clinical Trials.

c) functional planning for the South Campus

e) office space and secretarial support for new recruits.

Issues & Challen- increasing

ges teaching

oration with TBCC/ ACB - planning for South Campus - bed capacity issues - office space & support - ARP

responsibilities - foster collab

of 71

DIVISION OF INFECTIOUS DISEASES

ohnson, as a

research in the area of Clostridium difficile colitis. The clinical gap making use of the skills

phail will likely continue in this role into the future.

ention & Control group C and at the 8th &

8 Medical Centre for decolonization of MRSA colonized patients and also for the assessment of patients who may be eligible for non-occupational HIV post-exposure prophylaxis. This clinic is staffed by Dr. Athena McConnell temporarily pending funding for ongoing operations. Dr. Manuel Mah has initiated and rolled out a very

Division Chief: Dr. Ronald Read

RECRUITMENT The establishment of a formal ID consultation service at the

New recruitment of Dr. Johnson helps fill gap

comDr. Marie Louie beAssociate member

Rockyview General Hospital left the remainder of the Division spread thinly throughout the existing acute care hospitals. The movement of Dr. Megran out of the clinical arena and into the Chief Medical Officer position additionally left a significant shortfall at the PLC site. This position was filled with the recruitment of Dr. Andrew Jand ID/Med Micro dual trained individual previously working

es

Innovation projects are successful

New ‘tool’ developed by Dr. Laupland to streamline patient triage within HPT

Dr. Louie’s research benefited from sabbatical

Expansion to RGH

post-doctoral research fellow in Seattle, Washington. Dr. Johnson has moved to the PLC to fill Dr. Megran’s clinical slot and, in addition, will bring expertise around transplant related infections to our group and will be working on protocols around infections in implantable ventricular assist devices with cardiovascular sciences. Dr. Marie Louie, who is currently the Associate Director of the Southern Alberta Provincial Laboratory of Public Health, has joined as an Associate Member of the Division and will be providing clinical inpatient consultation and HPTP service in addition to her role as a microbiologist.

Sabbatical Leave of Dr. Tom Louie

Dr. Louie undertook a 6 month sabbatical leave to further his

left during this sabbatical break was filled by of Dr. Gisela Macphail and Dr. Athena McConnell (Pediatric Infectious Diseases) to fill in HPTP service time. This worked very well and Dr. Mac

INNOVATIONS

The Division has been very active in the last year in a number of innovation projects. The use of Nurse Practitioners in the HPTP Program has been very successful with the addition of Patti Long as the Nurse Practitioner to work both within the clinic and on the wards with potential HPTP patients. An innovation project involving the 8th & 8th Medical Centre looking at development of Clinical Practice Guidelines for antibiotic management as well as streamlining their intravenous at development of Clinical Practice Guidelines for antibiotic antibiotic therapy program is well underway and will be evaluated later in 2006. Dr. Laupland and his team completed the extremities/soft tissue infection assessment in the HPTP Program which has generated a tool that can be used to help streamline patient triage within HPTP. The Infection Prev

housed at UCMhas successfully initiated a clinic th

of 71

successful project related to hand hygiene with a goal to reducing spread of nosocomial pathogens within the acute care environment. Dr. Andrew Pattullo has been very busy working with the PCIS team

rably

d presentations to all the acute care sites, Southport, and CLS.

EDUCA

ber of existing courses into mega-courses. The HPTP and a

th ve patient

Hn

ith Dr. Mike Surrette of esis Research Group to evaluate the role of

ry flora on exacerbations of Cystic Fibrosis lung disease. The Southern Alberta HIV Clinic also continues to see increasing patient numbers and is continuing to actively research new drug development and to undertake economic analyses of HIV patient care with a view to reducing the economic impact of this disease. Dr. Tom Louie’s Clostridium difficile research program benefited greatly from his 6 month sabbatical during this timeframe and he has been able to wrap up a number of research projects in this area, establish new research collaborations, and expand basic and clinical research into Clostridium difficile disease. The Infection Prevention & Control group is focusing on outbreak prevention and using an innovative dramatic program for hand hygiene dissemination. The STD Clinic has initiated a number of outreach activities to reach the highest risk areas of our population. This includes collaboration with the Safeworks Needle Exchange Program to provide testing and treatment to intravenous drug users and sex trade workers, in collaboration with the Calgary Refugee Health Clinic to screen refugees arriving from countries where STD’s are still endemic, a satellite clinic in Banff to provide accessible STD testing and treatment to transient members of the service industry in the Bow Corridor. Finally, Dr. Read is negotiating with the website Nexopia,which caters to teenagers and is an excellent vehicle for dissemination of information about STD’s and sexual health to high risk teenagers.

to roll out the Sunrise Clinical Manager Patient Care computer system to the acute care sites. This system will be considemore functional than the existing TDS system and will be particularly useful for the ID Division allowing graphical displays of patient data not previously possible. The Division has been a leader in using teleconference facilities to spread their weekly seminar and case roun

Undergraduate curriculum restructured

CF Program continues to expand

IP & C’s focus is on outbreak prevention &

hand hygiene

The Division has worked cooperatively with the Medical Teaching Unit on Nuring Unit 36 at FMC and the MTU residents now regularly attend these rounds as part of their education.

TION

Successful hand hygiene project

Southern Alberta HIV Clnic sees patient growth

STD clinic - Safeworks Needle Exchange - collaboration with Calgary Refugee Health - satellite clinic in Banff

Negotiations in place with website Nexopia

Drs. Read, Rabin, and Church have been active in the Undergraduate Medical Education Program as the Curriculum Committee restructures the undergraduate curriculum and coalesces a numProgram continues to grow in terms of patient volumesnumber of initiatives are underway to streamline patient flow, reduce

e number of follow up visits required, and improoutcomes. The Cystic Fibrosis Program, under the leadership of Dr.

arvey Rabin, has continued to expand with ever increasing patient umbers and increasing numbers of post-lung transplant patients.

Dr. Rabin has initiated a research project wthe Bacterial Pathogenvarious members of the normal upper respirato

of 71

Division of NEPHROLOGY

ADMINISTRATION This past y as been a very exciting year for the Division of Nephrology. Clinical carpace and tAlberta RenhemodialysiHome dialyof patients oalmost too implementecompared effectivenes CLINICAL The recruitmits’ needs. in all aspecRon Hons (going to us ical experience to help run the Residency Training Program. A s been set up with support of the ARP idance of Dr. Braden Manns. This system withprioritizing patient waitassessmenregarding e Dr. Culleton will now be Director of the Chronic Kidney Disease which is the most rapidly f nephrology care in Southern Alberta. The electronic patient ta cornerstonecontinues tostarted to u2007. Dr. George very clinicamembers to EDUCATIOThe Nephrohas receiveprogram coMcLaughlinwill return aRon Hons McLaughlinreturn. TheChou. She

Division Chief: Dr. Nairne Scott-Douglas

ear h Exciting year for the Division f Nephrology e has continued to improve, research is proceeding at a very fast

he training Program has received full accreditation. The Southern al Program (SARP) continues to expand with the opening of a

s unit at the Sunridge Medical Gallery slated for later this year. sis therapies continue to expand with a 10 % increase in the number n Peritoneal Dialysis and the Nocturnal Hemodialysis Program being popular. The introduction of Nocturnal Hemodialysis is being

d as the first prospective randomized controlled clinical trial to conventional hemodialysis and is looking at efficacy and cost s under the guidance of Drs. Culleton and Manns.

ent of two nephrologist in the past year has helped the Division meet Dr. Jennifer MacRae has initiated a very extensive program involved ts of hemodialysis vascular access. She has recently replaced Dr. after nearly 30 years) as the Director of Hemodialysis. Dr. Hons is e his large clinNephrology Central Referral system ha

innovation fund and under the gu referrals triaged by a nephrologist is proving very successful in

patients, decreasing unnecessary referrals as well as decreasing times. The trainees and staff particularly enjoy the new “urgent t clinic”. Also referring physicians are giving positive feedback ase of use.

expanding area oda base Renal PARIS developed by Dr. Garth Mortis continues to be a

to clinical care and is also being used for research purposes. PARIS go through improvements and the Pediatric Nephrologists have now se an adapted version. The goal is to have a wed-based version in

Vitale joined the Division and is Director of Peritoneal Dialysis. He is lly active and his hard work allows for protect time for faculty complete there non-clinical responsibilities.

N logy Training Program received a very strong external review and d full accreditation. Under the guidance of Dr. Kevin McLaughlin this ntinued to attract superior internal and external candidates. Dr. will go on a sabbatical to learn more about medical education and s Assistant Dean of Undergraduate Medical Education Research. Dr. has taken over administering the training program during Dr.

’s absence and will continue to co-administer the program on his Division has recruited within the ARP one of our trainees, Dr. Sophia will work part-time for the first year while she completes her Master’s

o

Dr. Jennif- new recruit - now Director of Hemodialysis Dr. Ron H - will help n Residency Training Program Dr. Braden Manns - haR Dr. Bruce ulleton - now Director of the Chronic Kidney Disease Program Dr. Garth Mortis - pa

er MacRae

onsru

s set up Central eferral System

C

developed an electronic tient data base - PARIS

Full Accreditation for Nephrology

U

-sabbatical Sep 2006 - Dr. R. Hons will administer program

ndergraduate Medical Education Dr. K. McLaughlin on

of 71

Degree in Meducation ofunding to p RESEARC The Division15 first auth(AKDN) confrom all overeceived ovardiovascu entified through the

mpts for increased serum creatinine levels. Dr. Bruce haired the Canadian Society of Nephrology Guidelines Committee.

highlight HemmelgarYoung Inve The Divisiodollar Endoresearch in the Division

Trainees - Dr. Sophia Chou will complete Master’s in Medical Education - Dr. Mike Walsh will pursue a PhD in England

edical Education. We look forward to her future contributions to the f physicians. Another of our fellows, Dr. Mike Walsh, has received ursue a PhD working on Glomerulonephritis in the England.

H

of Nephrology continues to excel in academic areas with more than ored papers over the past year. The Alberta Kidney Disease Network tinues to be a very productive group combining clinical researcher r Alberta. In addition, Drs, Manns, Culleton, and Hemmelgarn have er $750,000 in AHFMR funding within the AKDN to investigate lar and renal protective medication in patients id

More than 15 first red papeautho rs

Over $750,000 in A- Drs Man ton & Hemmelg

HFMR funding ns, Culle

cAlberta wide laboratory pro

ulleton has cCA for the Division was the most deserving selection of Dr. Brenda

n as the Canadian Society of Clinical Investigators “Joe Doupe stigator’s Award”.

n is actively involved in obtaining funding for a proposed 5 million wed Chair in Clinical Renal Research. Continued development of basic science, medical education and clinical trials is a priority with in .

arn

Dr. Bruce ulleton - Chair of the Canadian Society of Nephrology Guidelines ommittee

C

C

Dr. B. Hemmelgarn s the Joe Doreceive upe

Young Investigator’s Award

EndowedClinical Re al Research - actively obtaining

Chair in n

funding for Chair

of 71

Division of Respirology Division Chief: Christopher H. Mody MD, FRCPC, FCCP, FACP

DMINISTRATION

s. Lead by Dr. Jeff ellor, the Division has outreach respirology clinics in rural Alberta, and under

ip of Dr. Alain Tremblay will soon be implementing a telehealth rogram for lung cancer.

ne, and in half the results have changed management nd improved asthma control. Additionally, with the recent recruitment of Dr.

untry. Dr. Alain Tremblay is the leader of this program, and along with

nation, this program has een able to purchase the equipment necessary to perform this highly technical

aking service. The Service is also dedicated to training young

A The Division of Respirology has had an exciting and productive year in 2005. There have been a great many changes, and many accomplishments. Additionally, the division is facing a number of enormous challenges, which we face with hope, optimism and determination. The Division consists of 23 members based at three hospital sites and in private clinics in the Calgary Health Region. The Division provides continuous consultative service and in patient ward service at three acute care hospitals, while maintaining a very busy outpatient clinical service across the region. Additionally, the Division provides innovative outreach programMthe leadershp CLINICAL The Calgary Asthma and COPD Program is nationally recognized for providing a cohesive service that links together family physicians offices, hospitals, and emergency departments. Dr. Bob Cowie leads this team of dedicated health care providers, including physicians, respiratory therapists, kinesiologists and nurses. Under the direction of Dr. Richard Leigh, and with the assistance of Innovation Initiative Funding, a program for assessing sputum inflammation has been initiated. This is an extremely valuable tool that now allows respirologists to assess the affect of asthma therapies in the most challenging patients. To date, 141 tests have been doaWarren Davidson, who is interested in the epidemiology of asthma and airways disease, and strong collaboration with the Asthma and Airways Inflammation Research Group under the direction of Dr. David Proud, this group is moving into a leadership position in Canada. The Interventional Pulmonary Medicine Service is one of only two such services in the coDr. Gaetane Michaud, is using a variety of innovative tools and techniques including endobronchial ultrasound, permanent and removable stents, and indwelling pleural catheters. Helped by a $1M private doband ground-brerespirologists in the advanced techniques, and an Interventional Pulmonary Medicine Fellow will begin training in July 2006. The Division of Respirology has also established a Pulmonary Hypertension Program. Dr. Doug Helmersen is the leader of this program and along with Dr. Sid Viner and Dr. Naushad Hirani, the Program provides day to day management as well as comprehensive diagnostic services including right heart catheterization and pharmacologic treatment. Aided by a private donation, Dr. Helmersen has purchased the equipment, including a dedicated fluoroscopic system that is required for right heart catheterization studies. Together, this group is providing a

A

soon Lung Cancer Telehealth

ccess to private clinics,outpatient service and

New Program assputum infla

sessing mmation

Leadership in Asthma and s Inflammation with

Dr. Airway

Dr. Davidson andProud

Interventional PulmoMedicine using innovate

nary

tools

Establishment of a ulmonary Hypertension

Program P

COPD Program nationally recognized

of 71

world-class service for patients that would have died only a few years ago. In

l trials in ulmonary hypertension.

e Division are also one of Canada’s leaders in Sleep Medicine.

y Herald and TV and radio. Under the Innovation

group has been established, under the guidance of Dr. Brent Winston, with an terest in interstitial lung disease. We have recently recruited Dr. Charlene Fell, respirologist with a special interest in interstitial lung disease, epidemiology and linical trials. Dr. Fell will be seeking additional training, in interstitial lung disease t the University of Michigan with Dr. Fernando Martinez, who is one of the orld’s leaders in clinical trials in interstitial lung disease. Upon her return, Dr. ell and Winston will continue to develop Interstitial Lung Diseases as a clinical nd academic focus for the Division.

INNOVATIONS Through the Innovation Initiative Funding, a number of new and exciting programs have been established. The program for the assessment of inflammation in asthma via analysis of induced sputum has been mentioned previously. Additionally, a cough clinic, staffed by an asthma educator to support quality patient care and reduce unnecessary consults in respiratory medicine has been established. Additionally, a program has been established to strengthen care transitions from acute care to community in chronic obstructive pulmonary disease. EDUCATION The Division of Respirology Residency Education Program is fully accredited by the Royal College of Physicians and Surgeons of Canada. Under the direction of Dr. Karen Rimmer, the program is recognized as one of the best in the country. Additionally, a number of members of the division set the standard of competence in respirology by participating in the Royal College Examination Program. Recently, the Division received the highest teaching rating by Residents in the Department of Internal Medicine, and the division was also honoured when Dr. Stephen Field, Dr. Ward Flemons and Dr. Chris Mody became “Great Teachers” at the University of Calgary. Other awardees include

keeping with our goal of providing cutting-edge service and research in Calgary, Dr. Hirani will be doing a 6-month sabbatical with Dr. Nazzareno Galiè at The University of Bologna, Italy, who is one of the world’s leaders in clinicap

embers of thMImproved patient access

ists

Under the direction of Dr. Pat Hanly, The Sleep Centre has developed a unique and successful working relationship in the assessment and management of Sleep Disordered Breathing within the Calgary Health Region. This has improved patient access to diagnosis and treatment both for uncomplicated obstructive sleep apnoea and more severe sleep disordered breathing, and has reduced waiting lists. This is the first time that this Public Private Partnership with home care companies has been employed in Canada. As an extension of this, Dr. Bill Whitelaw is conducting a study (funded by the Alberta Heritage Foundation for Medical Research), which is evaluating the management of obstructive sleep apnoea in the primary care setting. Recently, Dr. Whitelaw published a landmark scientific paper demonstrating the efficacy of this approach that was featured in he Globe and Mail, the Calgar

Reduced waiting l

Evaluation of obstructive sleep apnea in the primary

care setting

Lpublished by Dr. Whitelaw

in the management of

andmark scientific paper tInitiative Funding, the sleep service introduced an alternative care provider to augment the care team and support patients with complex sleep issues. This program has already reported a trend toward increased access to alternative care providers.

Sleep Apnea

Aina Interstitial Lung Dise

evelops as a clinical and

ase d

academic focuscawFa

Innovation funding establishes new programs

Accredited Residency Education program

Residents rate Division as the highest teaching in

Internal Medicine

of 71

r. Richard Leigh, who was a finalist for the Wilbert J. Keon Award Competition

5;9:288), and a paper outlining the diagnosis and anagement of pergolide-induced fibrosis (Mov Disord. 2005;20:512). Member

n have reported a highly innovative way to measure cardiac output uring exercise (Eur J Appl Physiol. 2005;94:670), and a paper is in press

e have established a partnership with the Ministry of Innovation and Science to

fficient. More outpatient offices re needed. At the UCMC site, the space needs to be used more efficiently. A

RESEARCH Dfor Junior Faculty at the National Research Forum for Young Investigators in Circulatory and Respiratory Health, and Dr. Karen Rimmer who won the Golden Bull award for excellence in teaching residents in Internal Medicine. Members of the Division provide leadership nationally and internationally in a number of medical societies and organizations. Dr. Gordon Ford is the president of the Canadian Thoracic Society. Dr. Stephen Field is the Governor for Alberta for the American College of Chest Physicians, and Dr. Chris Mody is the Governor for Alberta for the American College of Physicians. Members of the division have been involved in research. Highlights include a publication on the experience in tuberculosis in Calgary between 1995-2002 (Int J Tuberc Lung Dis. 200mof the Divisioddescribing the utility of chronic indwelling catheters for the management of malignant pleural effusions (Chest 2006;129:362). Members of the division participated in the New England Journal of Medicine paper describing the utility of continuous positive airway pressure for central sleep apnea and heart failure (N Engl J Med. 2005;353:2025), and the clinical usefulness of home oximetry compared with polysomnography for assessment of sleep apnea has been reported (Am J Respir Crit Care Med. 2005;171:188). Additionally, new and exciting discoveries were made in the area of asthma remodeling (Am J Respir Cell Mol Biol. 2005;32:99). Members of the division are also active in basic science research. Three members of the division had salaried positions from the Alberta Heritage Foundation of Medical Research, and one has salary support from the CIHR. Wincrease the endowment for the “GSK Professorship in Inflammatory Lung Disease” to $1.75M. The position will provide leadership in research, education and patient care in airway inflammatory lung disease. Dr. Richard Leigh has been nominated to be the first GSK Professor in Inflammatory Lung Disease. CHALLENGES Provision of outpatient services continue to be a pressing problem. Clinic space at all three sites (UCMG, RGH and PLC) is insuacoordinated system of booking is needed so that utilization of space is optimal. We are unable to provide adequate pulmonary function testing in the region. Waiting lists to obtain pulmonary function tests have increased to unacceptable levels. Patient care is now impaired because we are waiting for pulmonary function tests. Personnel need to be provided immediately to deal with the backlog of testing that must be performed.

National and international leadership

Division members obtain multiple awards

Re- Tuberculosis - Cardiac output during

- A

search

exercise - Assessment of sleep apnea

sthma remodeling

Salary supported research

Leadership in Inflammatory Lung

Disease

Clinic space insufficient

Lack of personnel – results in wait lists for tests

of 71

We urgently need a coordinated system of booking patients, tests, and appointments across the region. Currently, each individual respirologists’ secretary is performing these tasks. The system is cumbersome, complex and as great potential for misadventure. A streamlined, coordinated central system

ntional pulmonary medicine service may be leaving the Foothills edical site. At the Peter Lougheed Center, it is anticipated that 1 member will

Neuromuscular diseases tilation

Lung transplantation

ic activity. This activity is mandated by the burden of clinical and dministrative service provided by the members of the Division; however, it

than 1 FTE in academic activity among a division of 23 members. University affiliated division. To increase the academic

hwould increase the efficiency of providing services, in addition to being required to respond to sudden or emergency changes in provision of services (e.g. Flu outbreak or pandemic). Provision of community services needs to be improved. While great progress has been made, we are still only touching a tiny fraction of the patients with chronic respiratory illness. Medical staff barely manages their present load. We are not in a position to provide the community rehabilitation, spirometry, patient diagnostic and education program that have been identified as a priority for the Division in the Region. Additionally, with digitized electronic radiology imaging, there is the potential for Respirology to expand and provide telehealth services. Manpower is inadequate. It is anticipated that 5 members will be required at the new South Campus Hospital to establish a functional self-sufficient group. Further, it is anticipated that 3 members of the Division will retire from the Foothills Medical Center staff over the next 5 years, and an additional 2 members from the interveMbe retiring. Thus, 11 respirologists will need to be recruited over the next 5 years to maintain the current manpower at each site. Recruitment will be targeted to the following areas: 3 Sleep Medicine (2 members will be retiring) 2 clinician scientists (2 members will be retiring) 1 Non-tuberculous mycobacterial disease and tuberculosis (1 member will be retiring) 11 Non invasive ven11 Cystic fibrosis and pulmonary infections 1 Occupational and Environmental Medicine 1 COPD and rehabilitation 1 Interstitial lung diseases The academic and scholastic contribution of the division is inadequate. In a time motion study performed in the department, the division spent only 4% of its time in academaequates to less

his is inadequate for a Tactivity to 20%, 4 new recruits will need 50% of there time to research, and 2 members will be required that will devote the 75% of their time to investigation and the pursuit of new knowledge. We will face significant challenges if Thoracic Surgery moves to the RGH site. If this occurs, the care of patients with cancer will become spread over multiple sites, which will present many challenges. Additionally, interventional pulmonary

Central patient booking needed

Potential for telehealth services for

ent of

improvemcommunity services

Time spent on academic activity is only 4%

R d retention is critical

ecruitment an

Possible move of Thoracic Surgery

presents significant challenges

of 71

medicine, which has a close working relationship with Thoracics, will continue to

e at the Foothills Medical Centre and will need to function and develop dependently.

e will soon face renegotiation of the ARP. Our hope is to continue to provide an in the ARP for all respirologists in the Calgary Health Region.

owever, the requirement to recruit may force us to consider positions outside

to

al in 20010-011, and an additional 5-6 recruits will be required for this purpose. Since there

mplary service and are, and improve upon the academic and investigative initiatives of the Division.

bin Wopportunity withHthe ARP. If is this is necessary, planning and integration will be paramount. The developing South Hospital will present great challenges. The goal will beprovide a full complement of respirology inpatient and outpatient services and 24-hour call coverage. It is anticipated that this hospital will be function2is no indication that 6 recruits will be available in the year prior to the hospital opening, this will need to be accomplished over the next 5 years. The Division of Respirology looks forward to the future with enthusiasm. We anticipate that we will be able to continue to provide the exec

of 71

Division of Rheumatology Division Chief: Dr. Liam Martin

LINICAL AND INNOVATIONS

has evolved from the planning stages during which all ivision members reviewed their practice activities to include their wait list times

of referrals at were currently in their offices. We are about to hire and train 2 unit clerks,

olves a social worker and a hysiotherapist will be hired to complement the clinical service.

eadership of Dr. Sharon LeClercq and Martin have each traveled

are oject. Dr. LeClercq has also traveled to Rocky

ining sessions to the participating family physicians he first live Telehealth clinic was delivered by Dr.

physicians in Pincher Creek in the Fall. All participants, ach to care was beneficial. We look

the process over time.

rly Inflammatory Arthritis Clinic are in place.

C In the past 12 months the Division has planned and put into place through the efforts of the entire membership the majority of the innovations for which we received funding. These innovations included: a central triage system; a transition clinic for young adults with systemic rheumatic diseases; hiring a nurse practitioner; hiring a clinical nurse specialist. The central triage systemdand clinical activities. The members also participated in numerous reviews of a proposed referral form for central triage and reviews of how central triage would affect their practices. The nursing staff at the 3 CHR based clinics as well as the administration staff from these clinics and the administration staff at the private practice clinics also participated in round table discussions in preparation for the launch of this new system. The start date for the clinic is set for April 3rd 2006. This date was chosen to allow all members to deal with the back logthone at level 5 and one at level 3, who will play an integral role in management of the system. The transition clinic, for children with arthritis who are moving from paediatric to adult care, referred to as the YARD clinic (Young Adults with Rheumatic Disease) is also set to start in March 2006. It will be held every 2nd Wednesday in Area 5A with a team consisting of an adult and paediatric rheumatologist, a clinical nurse specialist. As the clinic evp Our Telehealth Program is in place under the lwith support form Dr. Liam Martin. Drs LeClercqto Pincher Creek to offer training sessions to the family physicians who participating in this innovative prMountain House to offer trathere on 2 occasions. TLeClercq and the familyespecially the patients, felt that this approforward to further encounters and to evaluating

lans to expand the EaPCurrently this clinic is held at the Peter Lougheed Centre every 2 weeks. The number of clinics at the PLC will increase to one per week and a second clinic will be offered at the Rockyview General Hospital also on a once weekly basis. Support staff for this clinic will be hired in 2006 using Innovation funds. An ongoing evaluation of this clinic is taking place.

Central Triage Additional staff hired Start date is April 3, 06

- - 20

Y.A- Starts M- Addithired

.R.D. arch 2006

ional staff will be

Teleh- TraPincheMountain House

ealth Program ining provided in

r Creek & Rocky

Early Inflammatory rthritis Clinic PLC clinic increases to eekly additional weekly clinic be held at RGH

A- w- to

Innovations in place - central triage

transition cl- -

inic NP hired

- Clinical nurse specialist hired

of 71

EDU

nd f Dr. Chris Penney a standardized method for joint xamina taught to the medical students, clinical clerks and the edical residents. This method referred to as the GALS exam provides all arners with the technique to perform a standardized and efficient method of

creening a patient for musculoskeletal problems. In the past year Dr. Penney as developed a CD version of the examination for all students.

ific member to our division whose research is focused

for the patients nd their referring physicians it has created a new set of challenges for our

owever, recruitment of suitable rheumatologists continues to be a major hallenge in spite of the great opportunities that are offered by the ARP. Our ivision members have the distinction of being the oldest with respect to our verage age. In order to address the issue of recruitment we have advertised idely for rheumatologists. Division members have used their networks to entify such individuals but to no avail. These efforts continue as we are

anxious to find a replacement for Dr. arvin Fritzler as he moves towards retirement. While the ARP has hel mpensation for rheumatologists there need to be more ade at the Department level to address the disparity between our specialty and others with regards to earning potential. We continue in our efforts to recruit specialty residents to our training program. We are fortunate to have recruited for July 1, 2006 a specialty resident trainee in Rheumatology from the University of Manitoba. We are hoping that another specialty resident trainee will be recruited through offering a 1 month elective to an out of province medical resident in October 2005. We continue our efforts to make residents aware of the opportunities in Rheumatology as a career choice. Dr. Chris Penney has developed a Residents Arthritis Day which will be offered again this year to residents in year one and two from both Calgary and Edmonton. This year’s event will take place in Edmonton with residents from both centres being invited. We are expecting that the event will be as successful this year in Edmonton as it was in Calgary last year.

CATION

er the leadership otion is being

Recruitment is great challenge - resident trainee from U of Manitoba

GALS exam & CD version - standardized screening method for everyone

Success brings - more efficient service – increase in referrals - need to recruit more rheumatologists

Residents Arthritis Day developed by Dr. Penney joint for Calgary & Edmonton

Uemlesh RECRUITMENT

e have recruited a scientWin the area of autoimmunity. She will work closely with Dr. Fritzler and other division members and trainees in developing research projects and in educational activities. CHALLENGES The success that we have achieved in putting into place our clinical innovations represents a two edged sword for the division. We are able to offer a more efficient service and as a result we are receiving more referrals, resulting in an increase in our chronic patient load. While this is a good result amembers. This increased pressure can potentially detract from the educational and research activities of our members. We need to recruit more rheumatologists to address this need. HcDawid

Mped to improve the co efforts m

of 71

annual report 2005 – 2006 - department of medicine€¦ · ¾ teleconsultations from all three...

Documents