Summer 2011 Holland Musculoskeletal Program Team News4

Arthritis, Activity, and You – The Results are In!This winter, the Holland Centre teamed up with the Metro Central and North York YMCAs to host two Arthritis, Activity & You workshops. The sessions offered people helpful information about how to manage their arthritis or joint replacement through

The participants all filled out feedback surveys and 90% or more:

felt the instructors were knowledgeable, engaging, and helpful.

said the practical portion of the course was educational, and useful.

said that they will be able to apply what they learned at Arthritis, Activity & You.

Overall satisfaction of participants with the program was overwhelmingly positive at close to 95%!

Presenting… Community BreakfastConnecting & Sharing:

the Joint Exchange

On May 4th, close to 100 rehab, nursing and other allied health professionals from across Toronto gathered at the Holland Centre to do as this workshop�’s title suggests; connect,

about hip and knee joint replacement.

The Holland Orthapaedic & Arthritic Centre�’s third Community Breakfast Event was the setting for a morning of information sharing by the MSK team, starting with Dr. Jeffrey Gollish addressing leg length discrepancy in total hip replacement. Dr. Chris Idestrup followed with a dynamic discussion on myths surrounding pain management after

elective surgery, and Deborah Kennedy and Amy Wainright presented on updates surrounding patient care models and community resources. Sunny Lalli, from PharmaTrust, presented on the new initiative which brought remote dispensing into the Holland Centre.

Organizer Serena Lee-Segal says she�’s

�“Feedback was overwhelmingly positive,�”

make this an annual event. It�’s a great way to showcase the work we�’re doing here at the Holland.�”

48th Annual Scientific Assembly of the Ontario College of Family Physicians

On November 25, 2010, Dr. Jeffrey Gollish, Medical Director, and Susan Robarts, Advanced Practice Physiotherapist, of the Holland Orthopaedic & Arthritic Centre

Assembly of the Ontario College of Family

Physicians attended the session titled Accessing Care for Patients with Hip and

Knee Arthritis: what you need to know. The session included practical information on the current care delivery model, clinical

joint replacement, pain management and common myths. The session was well-received and a dynamic question and answer period followed.

Making a Difference – in MSK

I LOVE Sunnybrook �– Bake Sale

A Holland Centre Bake Sale raised big bucks for the I Love Sunnybrook employee fundraising initiative! Team captain and Holland Occupational Therapist Lindsay Crawford spearheaded the efforts to raise more than four hundred dollars for the campaign. Baked goods contributed by Holland Centre team members were very popular �– everything was sold out by just after noon!

Decorate A Christmas Tree

The 2010 Decorate-a-Christmas-Tree was once again a big success! Holland Centre Physiotherapist, along with the Philippine Working Group of the International Centre for Disability and Rehabilitation collected

used will provide assistance to the group�’s partner organization in the Southern Philippines, the KAAKBAY centre. A portion will also be used to assist two Occupational Therapy students to start an OT program at the centre.

Connecting and sharing at the 3rd Community Breakfast Event It’s Hip to CareThis spring, Sunnybrook�’s Orthopedics

Unit implemented a new hip fracture

care pathway. The initiative, aptly

named �“It�’s Hip to Care�”, integrates the

most current recommendations from

the Bone and Joint Health Network

(2010) for this patient population.

Using a systematic methodology from

admission to discharge, it promotes a

holistic and time sensitive approach to

hip fracture care.

Several components have been

created to facilitate and support the care pathway. These include:

New nursing documentation:

The Patient Care Record has been replaced with a �“Care Pathway�”.

Similar to the Patient Care Record, the pathway is a 24-hour

documentation tool which has been revised to incorporate

interdisciplinary documentation. As an interdisciplinary tool, the

pathway embeds best practice guidelines, thereby promoting the

highest standard of care for patients recovering from hip fractures.

The documentation includes an assessment for delirium every

24 hours, which is new for the nursing staff. It also captures a

daily record of the patient�’s current activity (physiotherapy and

occupational therapy) and provides a section for discharge

planning (social work). The notes pages are also interdisciplinary,

allowing for improved team member communication.

Pre and Post Operative Order Sets:

The pre-operative and post-operative orders were also revised

to promote use of the new care pathway. Orders draw attention

to early discharge planning, improved pain management, and a

standardized approach to management of nausea and vomiting.

Patient education:

Patients and family members were surveyed to identify key gaps

in information during their time at Sunnybrook and educational

materials were designed to integrate this feedback. A new hip

fracture poster is now on display on the unit which illustrates types

recovery.

It is hoped that the �“It�’s Hip to Care�” initiative will bring attention

to the merits of the care pathway and in turn improve outcomes

for patients while decreasing their length of stay.

Welcome to the twelveth 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 mairianna.bachynsky@sunnybrook.ca

or call 416-480-6100 x 87703.

Twelveth Edition, Summer 2011

The Hip to Care Team Explaining the new model of care

HOLLAND MUSCULOSKELETAL PROGRAM TEAM NEWS

Summer 2011 Holland Musculoskeletal Program Team News2

Small Pill…Big DifferenceThough they�’re considered �“lifestyle�” operations, having hips and knees replaced is no small undertaking. In the post-operative period, patients risk developing blood clots in their veins, or even worse, having one of those clots travel from their legs to their

in death.

Those odds are slim, but they were still too high for Dr. John Murnaghan, Associate Scientist at Sunnybrook�’s Research Institute.

Until the end of 2008, Dr.Murnaghan and his team were using Coumadin, an oral anticoagulant (blood thinner), which provided protection for the Holland Centre�’s joint replacement patients from the risk of clot-related conditions such deep vein thrombosis (DVT) or pulmonary embolisms (PE). This medication took several days to become effective and not all patients achieved a therapeutic level of anticoagulation by the

time they were discharged. With hospital stays after surgery becoming shorter and shorter,

faster and more effectively.

In collaboration with Dr. W. Geerts and the Thromboembolism Service, they looked into the evidence to support the use of

name Xarelto), an oral anticoagulant recently approved for marketing by Health Canada in 2008, but still not widely used. Dr. Murnaghan and his group are conducting a prospective observational study with the drug. The team has followed-up seven hundred joint replacement patients for a three-month period since June of 2010. Their goal is 4000

Early results are promising, says Dr. Murnaghan. �“It seems to be minimizing the complications we�’re trying to avoid without creating another whole group of problems.�”

As the trial continues, Dr. Murnaghan and his team are cautiously optimistic. �“I think it�’s more effective than what we were using before, and I think overall, it�’s good for the patients. We continue to be vigilant in our follow up. It requires a major effort on the part of the clinical and research team to follow-up this number of patients.�”

Saving Time…and Space – through SpineLINKEach year, nearly 400 Ontarians are in need of emergency spinal care. Whether they�’ve just

moment counts when it comes to recieving critical care.

Scientists in the Holland MSK program have been very active in a city-wide UT Spine Program project to make the most of each minute through UT-SpineLINK. This tri-hospital collaboration (funded through an AFP Phase III Innovation Grant) between Sunnybrook, Toronto Western Hospital, and St. Michael�’s Hospital has already resulted in improvements to timely critical care access for patients from across Ontario.

UT Spine Program Co-Directors (Orthopaedic sp ine su rgeon, D r. A lbe r t Yee and Neurosurgeon, Dr. Michael Fehlings) as well as Fiona Webster, PhD, Associate Scientist with Holland MSK Program and Sunnybrook Research Institute, are at the forefront of academic efforts aimed to help streamline the provincial triaging and transfer system. With Toronto being one of the few trauma centres in

Ontario, research in areas such as emergency times, wait lists, access to care, and critical care capacity lead to both challenges and opportunities.

�“We�’ve taken this knowledge,�” says Yee, �“and advocated through a variety of mechanisms. Now there are processes in place that have seen improvements to the system quite quickly.�”

Criticall Ontario is the provincial triaging program at the hub of the collaboration.

Operators at this 1-800 number used by emergency physicians across the province would often have numerous phone calls, in

as bed space, to care for a patient with an acute spine injury. Now there are systems and checkpoints in place enabling faster and more direct feedback on timelines to consultation, physician availability, and access issues.

A new imaging system put in place by Criticall allows doctors to review CAT (CT) scans of patients in more remote areas online,

as opposed to relying on a doctor�’s report over the phone. This also helps in reducing unnecessary transfers, in turn freeing up beds for more urgent conditions.

Streamlining through a variety of Provincial, Hospital as well as UT-SpineLINK initiatives has also lead to a drop in the number of patient transfers outside of the province for acute care. In previous years, an average of 30 patients (of the 400 each year) was transferred acutely out of province due to lack of space and physician availability. That number has now been reduced to less than a dozen each year.

The SpineLINK collaboration is now embarking

plan is to implement more initiatives that

and programmatic development, including the development of a continuing medical education course related to acute spine care that will be made available to community clinicians. Future goals include applying these initiatives to other clinical areas.

A pelvic x-ray illustrating a patient�’s

right hip replacement.

Holland Musculoskeletal Program Team News Summer 2011 3

For Paul Bertin, giving back is easySandeep Punia

For over 20 years, Paul Bertin has served the Hospital as both a donor and a volunteer. During that time, he�’s seen

the Holland Musculoskeletal Program, especially the Holland Orthopaedic & Arthritic Centre, evolve into a world-class

�“Sunnybrook has been there for my family when it matters most, and when it matters most for many, many other people,�” says Bertin. �“This is an opportunity for me to give back, because I can.�”

That�’s why, for Bertin, giving back to Sunnybrook is natural.

things that make a difference in someone�’s life.�” And, he adds, �“it�’s so easy to get involved.�”

To recognize Bertin�’s impact, Sunnybrook created the Bertin Awards for Customer Service, which honour non-clinical staff who go above and beyond to enhance the

And the outcomes are phenomenal,�” says Bertin. �“Sunnybrook is not just names and a building�…. It�’s about the people.�”

the Holland Centre and be a part of the Campaign for Sunnybrook, visit

sunnybrook.ca/foundation/

Holland Centre Staff to Access Patient Hospital Charts Electronically Anytime, Anywhere Starting this Fall!

opportunity to start accessing patient hospital char ts online through a new system called Sovera starting as early as this September 2011. Sovera has been

and will allow users to view the most recent scanned patient documents right in electronic patient records (EPR). After an inpatient encounter or an outpatient visit, new documentation that is currently sent

now be scanned and filed electronically in the patient�’s electronic record. This will be for new documentation only, historical charts will still be available from HDR as they are today.

This new online access for all clinicians

24/7 immediate and simultaneous

secure access to patient charts from

any computer that is connected to the

Sunnybrook network

No need to reserve charts from HDR and

no more competition with other services

trying to retrieve the same charts

Physicians will no longer have to go to

will be able to do this online at a time

and place that is convenient for them.

Stay tuned for further communications this summer as the project is rolled out at the Holland Centre!

Paul Bertin stands in a hallway at the Holland Centre.

Katie Maloney is now Patient Care

Manager for 3 East /Specia l Care

Beds, Orthopaedic Equipment, and

the Hospital Coordinators.

Kathy Workman, Social Worker in

the Holland Musculoskeletal Program

is a recipient of the Schulich Award

for 2011.

Mona Sawhney, Edna Quammie, Cheryl

Denton, Frayda Gorenstein, Judy Lucas,

Alayne Kealey and Fiona Campbell-

Gavin and Eri Maeda are recipients of

the 2011 Interprofessional Nursing Project

award through the Canadian Pain Society

and Purdue Pharma for their project titled:

Home Continuous Peripheral Nerve Block

Program for Pain Management in Patients

Undergoing Upper Extremity Surgery

Awards & Appointments

Recipients of the 2011 Interprofessional

Nursing Project Award