Holland Musculoskeletal prograM teaM newssunnybrook.ca/uploads/HMRT09Sum.pdf · Welcome to the...
Transcript of Holland Musculoskeletal prograM teaM newssunnybrook.ca/uploads/HMRT09Sum.pdf · Welcome to the...
Holland Musculoskeletal prograM teaM
Welcome to the eighth edition of the Holland Musculoskeletal Team News.
Every few months, you’ ll find updates on clinical services, education
and staff activities.
We welcome your suggestions for content and your articles for future issues.
Please send any ideas and/or submissions to [email protected]
or call 416.967.8554
newsEighth Edition Spring/Summer 2009
caring for sunnybrook’s spine patients
Spine patient Patricia Bracken speaks with Dr. Joel Finkelstein, an orthopaedic surgeon in
Sunnybrook’s Holland Musculoskeletal Program who specializes in spinal surgery and treatment.
Photo by: Doug Nicholson
A new care pathway was implemented at
the beginning of March 2009 for patients in
Sunnybrook’s Spine Program. A care pathway
is an outline of anticipated care, placed in an
appropriate timeframe, to help a patient with a
specific condition move progressively through a
clinical experience to positive outcomes. Selected
patients requiring a hospital stay of more than
one night following surgery (for example, lumbar
spinal fusion) are able to have their surgery at
Sunnybrook’s Bayview campus, recover overnight
in the designated Short Stay Unit for the first 24
hours, followed by hospital transfer to the Holland
Centre for additional post-surgical recovery and
care. This care pathway promotes efficient use of
resources across the organization and minimizes
the chance of last-minute cancellations for
patients if necessary resources are not available.
the Holland centre leads Innovative efforts in pain controlDiscomfort af ter surgery is a normal part
of the healing process for most patients.
However, over 30 per cent of all patients suffer
severe pain after surgery, which can lead to
poor recovery and chronic pain. Uncontrolled
pain can also potentially produce damaging
effects on the heart and lungs.
Dr. Colin McCartney, an anesthesiologist at
the Holland Centre, leads a team of experts
to promote the latest innovations in pain
management with the goal of improving the
post-operative experience and to help patients
return to their daily activities sooner. Through
a unique method called preventive analgesia,
patients are given a combination of pain
medications before surgery and continuing
for several days af ter surgery in order to
reduce the levels of pain they might typically
experience.
At the Holland Centre, pain management
starts early; every patient is evaluated by an
anesthesiologist in the pre-operative clinic
about two weeks before surgery. At this time,
aspects of anesthetic care are discussed
in a calm environment where patients can
properly evaluate the benefits and risks of
the common approaches to pain relief. Nerve
block techniques, common in the Holland
Centre because of their superior pain relief,
are often used instead of general anesthesia,
and th is is d iscussed in depth wi th the
patient. The patient is then made aware of the
preventive pain medication regime that they
can expect to be prescribed when they are
admitted to the hospital. Prolonged pain relief
is provided by applying a local anesthetic
around the nerves that supply the surgical
site. This treatment is only stopped two to
three days after surgery when the patient
requires a less potent pain reliever.
D e sp i te i t s c l e a r b e ne f i t s , p reve n t i ve
analgesic methods including nerve blocks
are the exception rather than the rule in
many hospitals. However, with other staff
and scientists at the Holland Centre, Dr.
McCartney is investigating how to promote a
wider usage of preventive analgesia in medical
organizations across Canada.
June 2009 Holland Musculoskeletal Program Team News2
Innovation Funding for Holland Msk program projects
canadian orthopaedic Foundation recognizes Holland Msk program researchers
Researchers at Sunnybrook are the recipients of three grants and awards from the Canadian Orthopaedic Foundation. These grants and
awards are made possible by the Foundation’s donors and support the mission of achieving excellence in bone and joint health, mobility and
function through the advancement of research, education and care. The three projects to receive funding are:
1. Dr. Markku Nousiainen: Training Femoral Neck Screw Insertion Skills to Surgical trainees: Computer-Assisted Surgery Versus Conventional
Fluoroscopic Technique ($20,000). This project was the recipient of the Canadian Orthopaedic Research Legacy Award
2. Dr. John Cameron: Long Term Outcomes of Rotational Osteotomy of the Tibia for Patellofemoral Instability ($4,285)
3. Dr. Richard Jenkinson: Immediate Weightbearing and Mobilization versus Immobilization after ORIF of Bimalleolar Ankle Fractures: a
Randomized Control Trial ($5,000)
dr. Yee to study photodynamic therapy’s role in Breast cancer Bone Metastasis
The Research Project Grant Program of the Canadian Breast Cancer Foundation has awarded
Dr. Albert Yee $300,850 over three years for the project A Phase I Trial on the use of PDT in the
Treatment of Breast Cancer Vertebral Metastasis. Photodynamic therapy (PDT) combines a drug,
called a photosensitizer or photosensitizing agent, with a specific type of light to kill cancer cells.
Dr. Albert Yee in the lab
Photo by: Doug Nicholson
Two projects from the Holland Musculoskeletal Program have received innovation funding from the Ministry of Health and Long Term Care’s Alternative
Funding Plan: the University of Toronto Spine Collaborative and an investigation into identifying barriers to timely treatment for hip fracture patients.
the university of toronto spine collaborative: creation of a collaborative model to enhance the triage and care of acute spine patients
Suffering a hip fracture is a serious and
devastating event for patients. Data from
the Canadian Hospitals Injury Reporting
and Prevention Program indicates that hip
fractures are the most common type of
hospitalized injury in both men and women
over the age of 65. The current benchmark
for treatment for a hip fracture, as outlined by
the Ontario Wait Times Strategy, is 48 hours.
It has been well documented that getting
patients to the operating room in a timely
fashion is important in order to reduce the
negative outcomes associated with delays.
Principal investigator Dr. Hans Kreder, together
with co-investigators Fiona Webster and Dr.
Richard Jenkinson will identify patient flow
and assess factors delaying time to treatment.
Based on this analysis, the project will seek
to implement new and innovative strategies
to improve access to surgery for hip fracture
patients within 48 hours. “By examining the
flow of patients through the system, from
when the patient arrives at the Emergency
Department to hip surgery to post-operative
care, we will identify the barriers and delays
to moving patients through the system in a
timely manner,” explains Fiona Webster, co-
investigator of the study. The project will draw
in qualitative analysis by speaking with both
patients and their family members.
The majority of spinal care, including traumatic
and non-traumatic cases, is delivered across
Ontario by spine specialists practicing in the
Academic Health Science Centres. Referrals
are of ten made to these centres by an
integrated provincial communication program
called CritiCall Ontario. Current barriers that
exist in patient access include the availability
of spinal expertise and access to tertiary care
centers for not only initial assessment but the
potential resources required for in-hospital
care. Sunnybrook, University Health Network/
Toronto Western Hospital and St. Michael’s
Hospital will develop a framework to enhance
patient triage and access to care for emergent
adult spinal conditions. The impact will be
improved patient access to timely emergent
spinal care and impact the broader health
care system including remote access to care.
Identifying Barriers to Meeting the ontario standards for time to treat for Hip Fracture patients
Holland Musculoskeletal Program Team News June 2009 3
schulich awards Honour Holland centre staff
In-House Hospital doctor Helps to Improve efficiency and patient safety
Dr. Vikas Bansal visiting a patient
at the Holland Centre
Photo by: Doug Nicholson
Inpatients and staff at the Holland Orthopaedic
and Arthritic Centre have welcomed a new
member to the centre’s healthcare team:
Dr. Vikas Bansal, a hospitalist who focuses
on general medical care for patients. Since
beginning in April 2008, Dr. Bansal has managed
the day to day medical care needs of inpatients
and coordinated this care with the rest of the
centre’s interdisciplinary team.
Dr. Bansal is a graduate of the Hospitalist
Training Program at Sunnybrook’s Bayview
campus. A family physician, Dr. Bansal entered
the hospitalist field to gain additional training
on caring for patients while they are in hospital,
with a focus on patient safety and quality
improvement to contribute to hospital efficiency.
Working from Monday to Friday, Dr. Bansal
has developed close relationships with all
members of the patient care team. As the
primary ‘go-to’ person for nursing staff, as well
as pharmacy and allied healthcare staff, Dr.
Bansal helps to implement coordinated care,
including medical care, discharge planning
and transition of care.
Dr. Bansal plays a critical role in overseeing the
care of patients in the Holland Centre’s Special
Care beds which accommodate patients needing
cardiac or respiratory monitoring after surgery.
“My role is to liaise with all members of the
healthcare team to ensure that patients who may
have a higher risk of complications are cared
for in a safe environment,” explains Dr. Bansal.
In Canada, there is a shortage of general
internists and it can be dif ficult for family
physicians to manage their office practice and
also visit patients at a hospital. The hospitalist
role fills this gap. Since the hospitalist’s “office” is
the hospital, they are also more familiar with the
hospital’s policies and activities. The hospitalist
role is still relatively new, coined by Dr. Robert
Wachter in a 1996 New England Journal of
Medicine article. Currently hospitalists represent
one of the most rapidly growing forms of medical
practice in the United States and interest in
building in Canada as well.
With over a year at the Holland Centre under his
belt and a high comfort level managing surgical
patients, Dr. Bansal is looking ahead to his
next challenges, to continue to implement best
practices for the care of these patients. “My
two main goals are patient safety and improved
efficiency,” says Dr. Bansal.
Congratulations to three staff members from the Holland Centre who received the Schulich Award
for Nursing and Clinical Excellence. This annual award recognizes and honours the clinical work
of individuals who demonstrate the values of Sunnybrook in their daily work with patients, families
and colleagues.
Left to right: Susan Robarts, Advanced Practice Physiotherapist; Veronica Palinkas,
Physiotherapist, Working Condition Program; Yvonne Ramlall, Registered Practical Nurse, 3E.
Photo by: Doug Nicholson
the c.s. wright education FundThe Dr. Charles S. Wright Education Fund
p rov i d e s s t a f f w i t h a n o p p o r tu n i t y to
par t ic ipate in professional development
and educational initiatives. Dr. Charles S.
Wright, Orthopaedic Surgeon and Medical
Administrator, served the former Orthopaedic
and Arthritic Hospital for thirty years. This
year’s call for applications to the fund took
place in February 17, 2009. The review of
applications was conducted in April, with
the total amount awarded being $8,295. The
program appreciates the ongoing support of
the Sunnybrook Foundation and its generous
donors in continuing to grow this fund.
the challenge of change: october 2009The Holland Centre’s annual symposium is
taking place on Friday, October 30, 2009. The
theme is “The Challenge of Change” and will
feature sessions on inter-professional care
particularly on in-hospital and post-operative
pain management; the referral to surgery
process including pre-admission education and
the importance of community partnership. The
symposium will take place at the Holland Centre
at 43 Wellesley Street East.
For more information, please contact
Elisa Park at 416.967.8646.
June 2009 Holland Musculoskeletal Program Team News4
We would like to express our appreciation and
congratulations to all of the Holland Centre
staff who contributed to successfully achieving
our Program’s Hip & Knee Target Volumes of
2,100 procedures in 2008/09. You invested a
tremendous amount of effort over the past year,
and particularly over the last month, in reaching
this milestone. The volumes in March reached
an all-time high of 214 procedures. This is due
to the great team work and dedication shown
by all staff and you can be sure that all of your
patients would add their vote of thanks as well.
Thanks everyone and keep up the great work!
nursing week in photos
Left to right: Margaret Blastorah, Anne Marie MacLeod,
Beth Goudie, Frances Flint, Jan Flynn, Marilyn Bogle,
Shalimar Santos-Comia, Betsy Jackson.
Left to right: Marilyn Bogle, Shalimar Santos-Comia, Margaret Blastorah,
Anne Marie MacLeod, Yvonne Ramlall, Frances Flint, Betsy Jackson
Photos by Randy Bulmer
a Brief Message from the sunnybrook Foundation
On May 21, 2009, Sunnybrook hosted One Night
Live™ with Sting and Sheryl Crow. Thank you to
all staff in the Holland Musculoskeletal Program
who attended and supported the exciting event.
The Sunnybrook Foundation has been having
many tours come through the Holland Centre in
the past few months and we would like to thank
everyone for being so courteous, warm, and
helpful to all our donors. Our donors always have
such a great experience when we show them
highlights of the centre and their interactions
with everyone speak so highly to the great
atmosphere we have here. As always please feel
free to drop by the Foundation Office to look at
floor plans, to let us know if a patient is interested
in donating, or just to say hello.
- Paul McIntyre Royston, Campaign Director, and Catherine Argiropoulos, Development Officer
achieving Hip & knee target Volumes
gta rehab network recognizes
Holland centre physiotherapists
Congratulations to Colleen Kilroy (primary
author), Cecilia Nguyen, Trish Dickson and Deb
Kennedy on receiving the People’s Choice Award
for Research at the GTA Rehab Network Best
Practices Day. Selected by conference attendees,
the winning poster was entitled, “Assessing the
Home Environment (the ‘At Home’ Study) in
Patients Undergoing Hip and Knee Replacement”.
The purpose of the study was to compare the
accuracy of the patient self-report questionnaire
to the findings during a preoperative in-home
visit by a therapist. Preliminary findings find that
a self-report questionnaire alone may not be
sufficient in determining the home environment
in all patients, and concluded a larger study is
needed to determine which patients undergoing
joint replacement require a preoperative in-home
assessment to facilitate safe postoperative
discharge planning.
Deb Kennedy, Manager of Hip and Knee
Program Development, was awarded the
Ontario Physiotherapy Association’s Special
Award for Research. This award is a symbol
of appreciation for Deb’s demonstration
of leadership in scholarly activities and
recognizes her signif icant contributions
to resea rch w i th in the phys io the rapy
profession.
ontario physiotherapy association’s special award for research
- Anne Marie MacLeod, Chief Operating Officer
and Dr. Jeffrey Gollish, Medical Director of the Holland Orthopaedic and Arthritic Centre
A warm congratulations to registered nurses Jan Flynn and Beth Goudie of the Holland Centre,
who were named in the honour role for the Toronto Star Nightingale Award