Printed on 100 per cent recycled paper MARCH 2015 | IN TOUCH | 1

Infection control forms the foundation of St. Michael’s redevelopment project By Kate Manicom

Bondfield Construction’s senior site superintendent Bill Verhoog secures protective hoarding on 2 Shuter. Inside the plastic hoarding, a negative air machine runs to contain mold, dust and other particles within the construction zone. (Photo by Katie Cooper, Medical Media Centre)

Blueprints, building permits and bricks and mortar are what come to mind when thinking of construction, but in hospitals infection prevention is the critical first step in any renovation project. To keep patients, visitors and staff safe during St. Michael’s 3.0 redevelopment project, the hospital’s Infection Prevention and Control team is working with Bondfield Construction to educate its crew about the risks building can pose in a hospital setting

and how to prevent them.

“Construction can cause fungal spores, bacteria or other micro-organisms that are found in dust or standing water to become airborne, resulting in illnesses such as Aspergillus infections or Legionnaire’s disease,” explained Kasey Gambeta, a St. Michael’s infection preventionist. “The hospital sees many patients who are susceptible to infection, so specific safeguards need to be in place to protect them when construction activities occur.”

St. Michael’s IPAC team has developed

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an in-class education program for all construction workers who will be on site to build the Peter Gilgan Patient Care Tower and renovate the existing hospital space. The session takes approximately one hour and teaches which patients are most vulnerable to infection and what safeguards need to be in place to protect them.

“The program shows workers how to do a risk assessment based on the patients who are in the vicinity and the type of work being done,” said

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Ellen, a 76-year old patient, has been through and recovered from emergency hip fracture surgery and is ready to go home. She needs sign-off from her St. Michael’s physician, to organize a ride from her niece and to have an adjustable bed waiting in her bedroom. She’ll need to start rehab at home as soon as possible, to get her hip active and reduce leg stiffness. It’s also important that Ellen’s family doctor is updated on her procedure and new mix of medications so he can monitor her recovery.

Discharge planning will continue to be a major focus for the hospital this year, to meet our 2015/16 Quality Improvement Plan objectives as well as our overall goal

Anne Trafford Vice President for Quality and Performance

of providing the best possible patient experience. A big piece of this planning is based on the goal of “before 11 a.m. discharge,” or BED. Different areas of the hospital have different targets, based on what’s appropriate for their patient populations. Overall, we want to make sure that as many as possible of our discharged patients leave the hospital before 11 a.m.

Why before 11 a.m.? The impact of an earlier discharge – by just a few hours – is surprisingly great. ED volumes peak around 1 p.m., so having just a few more free beds on the wards after lunch can prevent major bottlenecks for patients waiting to be admitted from the ED. The good news is, since we renewed our focus on BED in 2014, we’ve seen some big improvements in several units and programs. It’s exciting to see that when the whole interdisciplinary team gets involved, we can really make progress.

Trauma/Neurosurgery is also piloting a new process to estimate every patient’s

OPEN MIKE with

expected date of discharge as soon as he or she is admitted, and continually update that date throughout a patient’s stay. For Ellen, knowing that she’ll be discharged at a certain day and time means that she and her niece can organize her ride and her care at home. For our physicians and staff, an expected date of discharge helps us plan for beds, schedule surgeries and speed transitions for our patients. 9CC is the model for the rest of the hospital. Once we solidify the process there, we’ll roll it out hospital-wide so that all our patients can benefit.

Finally, coordinating with and updating Ellen’s family doctor is crucial to ensuring her continuity of care. Within 48 hours of Ellen leaving the hospital, her care team will send an electronic discharge summary directly to her family physician. We want our patients to be able to go home feeling confident that we are helping ensure that their care in the community will be aligned with and build upon the great care they received at St. Michael’s.

Follow St. Michael’s on Twitter: @StMikesHospital

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MARCH 2015 | IN TOUCH | 3St. Michael’s is an RNAO Best Practice Spotlight Organization

Does the patient really need that test? How can we get lab results back faster?

These are some of the questions the Centre for Evidence-based Laboratory Testing to Improve Care, or CELTIC, hopes to answer. St. Michael’s is the first hospital in Ontario to develop a centre like this.

“We want to become a national leader in terms of guiding the use of laboratory testing,” said Dr. Victor Tron, chief of Laboratory Medicine.

CELTIC’s priorities are

• to discover and study new tests that get results back to physicians faster

• to determine if existing tests are necessary, and offer laboratory tests as alternatives to more costly procedures

• to increase patient engagement and understanding of the work done in the diagnostic laboratories.

A study underway of bacterial resistance to antibiotics by Dr. Alexander Romaschin, head of clinical biochemistry, demonstrates

the benefit of diagnostic testing to patient outcomes. Current tests can take 10 to 24 hours before they can determine if a bacterial sample is resistant to antibiotics.

“We’ve been working on methods to shorten this period to less than three hours,” said Dr. Romaschin.

Being able to more quickly identify the most appropriate antibiotic for care is essential to patient safety.

“If you have people who are severely infected their mortality rate is 7 per cent per hour,” said Dr. Romaschin. “The sooner you can get a patient onto the right antibiotic, the better chance we can minimize severe complications.”

Tests under development by CELTIC could play a big role in hospital efficiency. In one study, a protein marker present in patients with mild to moderate head injury could reduce or eliminate the need for the patient to undergo a CT scan.

“With the introduction of cost-effective tests, you can avoid more labor-intensive and costly diagnostic procedures,” said Dr. Romaschin.

CELTIC to raise the profile of laboratory testing

Dr. Alexander Romaschin loads samples into a mass spectrometer. (Photo by Katie Cooper, Medical Media Centre)

By Greg Winson A new laboratory test can be studied and evaluated in about two years, a much shorter timeframe than drug tests, which can take up to 10 years to evaluate, bringing improvements to patient care faster.

CELTIC will also offer laboratory tests for other hospitals, thus having a potential impact on the entire health-care system in Ontario. Dr. Tron said he hoped the revenue generated would make CELTIC sustainable and allow the labs to purchase instruments for which the hospital might not have the money.

Dr. Tron said he hopes CELTIC will raise the public profile of laboratory medicine. Lab tests play a critical role in diagnoses, but their function isn’t as well known by the public because of their somewhat behind-the-scenes role.

“We want to have engagement with clinicians, with the public, and increase their understanding of what lab testing is all about,” said Dr. Tron. “At the end of the day, I think that increased understanding is going to lead to a healthier patient.”

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A cancer diagnosis often comes with a litany of new information. Health professionals and patients must quickly discuss treatment plans, survival rates and how to manage medications and symptoms. Joanna Vautour, an aboriginal patient navigator in cancer services, approaches things in a different way.

“When I meet with a new client, we often start by talking about where they’re from,” said Vautour. “We connect about language, the land, how our ancestors have lived their lives. This is the right place to start from an aboriginal perspective. It’s how we learn about each other and build trust.”

Compared to non-aboriginal Ontarians, aboriginal people in Ontario face striking, persistent health inequities and challenges accessing health care. Cancer incidence and mortality rates are higher among aboriginals, and cancer tends to be diagnosed at a later stage.

Employed by Cancer Care Ontario’s Toronto Central Regional Cancer Program and based at St. Michael’s, Vautour is one of 10 aboriginal patient navigators across Ontario. The roles were created to help improve cancer outcomes for people in Ontario’s First Nations, Inuit and Métis communities, and help aboriginal cancer patients negotiate a large and complex health care system that doesn’t always align with aboriginal ways of knowing and doing. Each navigator serves all hospitals in his or her region.

Vautour’s hope is that she can help build more cultural competency into the system and bridge the divide between non-aboriginal health-care providers and aboriginal patients.

“It starts with building that trust,” said Vautour. “Over time I’m seeing patients be more open to their relationships at the hospital, and more of a collaboration between aboriginal patients and their providers. It’s exciting.”

Vautour’s background is in social work

By Emily Holton and mental health. Her family is from Serpent River First Nation, an Anishinaabe First Nation in Northern Ontario.

Most of Vautour’s referrals come from within St. Michael’s, but her connections are growing with other hospitals in the region. She offers a range of supports to patients, from answering questions about navigating the cancer system and talking through emotions, to help with organizing appointments and arranging transportation to the hospital. Vautour often meets her clients at the hospital entrance to help them find their way.

“Our traditions are a foundation and a core for me,” said Vautour. “But I must always remember that not all aboriginal peoples share the same belief system. Whatever beliefs our patients have, wherever they’re coming from, we start from there.”

Joanna Vautour, St. Michael’s new aboriginal patient navigator for cancer services, in the Multifaith Meditation Room. (Photo by Yuri Markarov, Medical Media Centre)

Toward better outcomes for aboriginal cancer patients

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Making multiple sclerosis treatment personal

Tailoring treatment to each patient is the backbone of good health care. And for patients with multiple sclerosis, Dr. Jiwon Oh thinks the key to finding that backbone is in the spinal cord.

MS affects nearly 100,000 Canadians, making it the most common disabling neurological disorder of young adults in the country. The condition is caused by the immune system attacking the insulating covers of nerve cells in the brain and spinal cord. The insulated covers, called myelin sheaths, transmit impulses from the brain and spinal cord.

“My research looks at the damage MS causes to spinal cord tissue,” said Dr. Oh, a neurologist with the MS Clinic of St. Michael’s Hospital. “I’m hoping to find biomarkers that will help clinicians monitor and more accurately predict how patients will do decades down the road.”

Dr. Oh is one of the only researchers in the world using multiple advanced imaging techniques to look at the impact of MS on spinal cord tissue. Each of these techniques –including diffusion tensor imaging, magnetization transfer imaging and functional MRI– allow her to look at specific tissues in vivid detail.

“The standard of care for MS is to begin by treating all patients with milder drugs and adjust treatment if symptoms progress, but we could do more for our patients if we had some way to decide who will have very bad MS and give those individuals stronger treatment from the beginning,” said Dr. Oh.

Some of the more potent MS treatments have serious side effects, such as brain infections or auto-immune disorders of the blood. Those risks are serious enough that specialists avoid using stronger drugs for all MS patients.

Dr. Oh said the benefits of aggressively treating MS for patients with severe symptoms are worth the risks. But if the spinal cord holds the biomarker key to MS severity, Dr. Oh and her research team will help specialists personalize treatment and reduce risk for each patient with the disease.

St. Michael’s is home to Canada’s largest MS clinic and one of the busiest in North America. The clinic has a roster of more than 7,000 patients, many of whom

Neurologist Dr. Jiwon Oh is using advanced imaging techniques to find differences between patients with multiple sclerosis. She hopes those differences will serve as biomarkers that help personalize treatment for each patient. (Photo by Katie Cooper, Medical Media Centre)

By Geoff Koehler

are part of clinical trials and research studies. Dr. Paul O’Connor, director of the Multiple Sclerosis Clinic, sees nearly 1,500 patients – that alone is more than most Canadian MS clinics.

The clinic recently received funding from the Ministry of Health and Long-Term Care for an additional full-time nurse, which will allow the clinic to care for the growing number of patients followed in the MS Clinic.

THE ST. MICHAEL’S MULTIPLE SCLEROSIS CLINIC TEAM IS COMPRISED OF:

• five full-time MS neurology specialists

• three part-time MS neurology specialists

• one full-time nurse

• one part-time nurse

• another full-time nurse will be joining the team soon

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Resident wellness top of mind at St. Michael’s

Finding a work-life balance can be challenging. Juggling the demands of family, personal activities and work can be overwhelming. Add in long hours at the hospital required by residents and that balance becomes even trickier.

Drs. Julie Maggi, Molly Zirkle and Najma Ahmed are developing a new resident wellness initiative to prevent or minimize fatigue and promote wellness.

By Iram Partap“Wellness is an important part of our training and it’s nice to know it is a priority at the hospital,” said Dr. Amanda Sawyer a fourth-year psychiatry resident at St. Michael’s. “If we’re not well or feel we have a balance in our life, we can’t treat our patients to the best of our ability.”

In her role as director of Postgraduate Medical Education at St. Michael’s, Dr. Maggi acts as a champion for residents, both as a mentor and as their voice at decision-making tables.

“Through this initiative we want to focus on the institutional factors such as opportunities for sleep, adequate and accessible nutrition, physical spaces, and supports, that may impact fatigue among our residents,” said Dr. Maggi, who is also a psychiatrist. “We know that life balance shifts depending upon the stage of training and the stage of life. We hope that by learning more about what factors lead to fatigue and adjusting them we’ll be able to better support our residents during their time at St. Michael’s.”

Over the next year Dr. Maggi, Dr. Zirkle the director of the

FitzGerald Academy and Dr. Ahmed, director of the University of Toronto’s General Surgery Program for residents, will be consulting with residents to get their input into what would make a difference in their lives.

To assist with the development of the initiative Dr. Maggi, Dr. Zirkle and Dr. Ahmed have applied for a grant through the Royal College of Physicians and Surgeons.

Amanda Sawyer a fourth-year psychiatry resident at St. Michael’s juggles her files and email in between appointments. (Photo by Katie Cooper, Medical Media Centre)

Gambeta. “The high-risk areas are where we see patients who are undergoing chemotherapy, dialysis, are immunocompromised, such as those with HIV or AIDS, and the very young or old. Construction near these areas requires the strictest protocols, including measures like building a clean ante-room that

Redevelopment project story continued from page 1 contains a HEPA filter vacuum to ensure all workers are dust free when they exit the contained area.”

The IPAC team also consults with Bondfield as they set up necessary safeguards like hoarding and negative air machines, and will audit these systems at random for the duration of the project.

To date, 20 Bondfield workers have taken the IPAC education course, but it’s

expected more than 200 will go through the program as construction continues.

Bill Verhoog, Bondfield Construction’s senior site superintendent, has worked on several health-care projects and said the training is crucial for his crew.

“Infection control is what sets hospitals apart from all other projects,” said Verhoog. “It’s our top priority.”

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The blue box is coming to the bedside.

Environmental Services is launching a bedside recycling program this month in an effort to increase waste diversion by 5 per cent in 2015-16.

The initiative will initially roll out on 9 Cardinal Carter and be fully implemented in all inpatient units in six months.

Paper, tin, glass and plastic will be the initial focus of the program. Each patient room will be given a recycling bin and a sign showing patients, visitors and staff what can be placed in the bin. Unit service workers will be provided with new collection bins so they can separate the recyclables and waste at the source.

This program builds on St. Michael’s recycling program, which was rolled out in the administrative and public areas five years ago. The hospital has since diverted 49 per cent of its waste from

the landfill, the equivalent of the weight of 225 elephants each year.

“While our waste diversion rate is heading in the right direction, we have committed to achieving a 60 per cent diversion rate by 2017,” said Michael Camara, manager of Environmental Services.” To meet this target we needed to expand our recycling opportunities and this program is the next step in our expansion.”

Training sessions will be held for unit service workers and information sessions will be held for clinical staff to ensure everyone knows what can be recycled and how to collect the materials. Environmental Services leaders will also meet with unit leaders before rolling out the program on each unit to assess the amount of waste generated in that area and determine what other diversion opportunities

Ready, set, recycleRaul Diaz, an environmental service worker, demonstrates what items will be recycled at the bedside.. (Photo by Katie Cooper, Medical Media Centre)

By Heather Brown and Iram Partap

exist, such as providing larger bins in key areas or more recycling bins throughout the unit.

xxx x

Glass Metal Paper Plastic Cardboard

Do NOT Recycle these

No Gloves! No Styrofoam! No Paper towels!No Combo Plastic& Foil Wrappers!No Food!

x

Mixed Recycling

All recyclable, but detach lids & sleeves

By the Green Team!Ext. 5767 Greenteam@smh.ca

Poster that will be on the recycling bins

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In Touch is an employee newsletter published by Communications and Public Affairs. Please send story ideas to In Touch editor Leslie Shepherd at shepherdl@smh.ca.

Design by Dermot Covel, Medical Media Centre

Q & AAnn Leung started at St. Michael’s as a pharmacy resident five years ago. She’s spent time in the Trauma-Neurosurgery Intensive Care Unit, Cardiovascular Intensive Care Unit, Operating Room and Preadmission. Today, she’s a clinical pharmacist in the Cardiac ICU.

Q. What is your role in the Critical Care Unit?My role is to promote the safe and effective use of medications. Day to day, I make sure that our patients are on all the medications they need, in the right combinations and at the right dosage. Along with the Pharmacy Department, I help our team manage drug shortages and access medications that are not available in Canada but are essential for our patients.

Another big part of my job is interacting with patients. I ask patients about their medication history when they first come in, and check what’s been ordered for them to ensure that we don’t miss any home medications unintentionally. Throughout a patient’s stay, I’ll drop by to see how they’re responding to their medications. Before discharge, I educate patients on their new medications and how their home medications have changed, so that they are confident they can manage it all at home.

ANN LEUNG, CLINICAL PHARMACIST, CRITICAL CARE UNIT

Q. What’s the most rewarding part of your job?It’s simple, but I like being part of a patient’s journey to recovery and wellbeing. When I know that I’ve helped a patient really understand why they’re taking a medication, or improved someone’s quality of life by preventing and resolving medication issues, it feels great.

Q. Is this what you pictured being a pharmacist would be like?

When I started pharmacy school, I knew only what pharmacists do in the community. By the end of university, I knew I wanted to practice in a hospital. It’s so diverse – not just in terms of patient care, but I have the chance to contribute to corporate initiatives to improve care. I’m currently working with my team on streamlining the medication reconciliation process in CICU.

Q. Tell us something your coworkers may not know about you?

I bought a very tiny turtle at a night market a few years ago. There was a whole stand of hundreds of them, and they looked so cute. But now, it’s not tiny anymore! It’s grown to the size of my palm. I don’t know what kind it is, so who knows how big it will get!

By Emily Holton

(Photo by Katie Cooper, Medical Media Centre)

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