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 marie.sanderson@sunnybrook.ca

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