Building Strong Care Teams at UHN
What started as an innovative strategy to help meet patient care needs and create more supportive teamwork environments is also increasing job satisfaction among certified personal support workers (PSWs) at UHN.
Earlier this month, PSWs at Toronto Rehab's Lyndhurst Centre became the first cohort to participate in Building Strong Care Teams. It's a two-week education program focused on enhancing the patient-facing skills of PSWs, so they can better support nurses in meeting patient needs, and play a more meaningful role within the integrated care team, both now and in the future.
From taking vitals and collecting specimens, to supporting skin checks and wound care, Nicole Lang, a PSW at Lyndhurst, says she feels supported in her training and is looking forward to applying her new skills.
"I'm excited for the opportunity be more involved in patient care, and to have an even stronger voice in the process," says Nicole.
Rolling out across UHN from now into 2023, the program will also represent an opportunity for care teams to come together, assess the needs of their own patient populations, and establish role clarity through standardized training for PSWs.
"This initiative takes UHN one step closer to meeting the complex needs of our patients, as we continue to face severe challenges in the healthcare system, with very limited human resources," says Pam Hubley, Vice President Health Professions & Chief Nurse Executive.
"But we're also energized by the opportunity to empower PSWs with enhanced skills, so they can work more confidently and effectively within their teams."
Renovation of 6AB Fell at Toronto Western offers 'amazing boost' for all
There's a newly-renovated wing at the Toronto Western Hospital, expanding the care capacity for neurosurgical patients.
6AB Fell consists of just over 10,000 square feet of newly-renovated space, providing a total bed capacity of 47, of which we currently operationalize 16 Level 2 beds and 20 ward beds. The increase in Level 2 bed capacity will help to reduce the burden on existing ICU space, allowing those who need critical care services to be monitored regularly and safely by their care team.
Comfort for patients and staff was a big consideration when redesigning the space. The new renovation includes a window observation glass in selected rooms and room doors with glass inserts for visibility. This allows the care teams and nurses to be positioned at a safe distance, while still being able to provide care and observation.
"UHN understood our needs as nurses and care providers and truly built us a safer space," says Osmano Bello, a nurse on 6AB Fell. "I feel safe when I come to work."
Patients and their families are also happy with the renovation.
"I have had the opportunity to see patients and their families in the new spaces – and uniformly, they comment on the positive experience," explains Dr. Gelareh Zadeh, a neurosurgeon and co-Director of the Krembil Brain Institute. "It is really an amazing boost and addition to the program for all of the patients and the team."
There are now telemetry workstation units and surveillance systems installed throughout the 6AB unit. This allows the team to monitor the most high-risk patients throughout their stay, and respond quickly to their needs. In order to support telemetry workstations and monitors, there was extensive data and electrical work completed by UHN's FM-PRO and Digital team.
"We're moving into a new era of nursing, using technology to ensure our patients and their families experience no gaps in their care," says Arlene Vasconcelos, Nurse Manager on 6AB Fell.
The additional bed capacity on 6AB allows for planned expansion of Level 2 capacity in the coming months, further enhancing the Krembil Brain Institute's ability to provide high acuity neurosurgical care to Ontarians, and others in need.
Improving vascular care through a data-driven approach to treatment
The Vascular Quality Initiative (VQI) clinical registry announced a milestone of one million procedures in September, a promising achievement for the international registry dedicated to improving vascular care through a data-driven approach to treatment.
VQI data has prompted changes in practice that have saved and improved thousands of lives.
With more than 950 centres and 2,500 physicians participating internationally, the registry allows centres and providers to compare their performance to regional, national, and international benchmarks.
As a Society for Vascular Surgery (SVS) initiative, the database also serves to develop and revise clinical practice guidelines.
"Toronto General Hospital joined in 2010 as an early adopter recognizing the importance registry data provides in monitoring and improving quality care," says Dr. Graham Roche-Nagle, Interim Division Head, Vascular Surgery, Peter Munk Cardiac Centre (PMCC), UHN.
"The rapid growth of SVS VQI in Canada across seven sites is a testament to the engagement and dedication of the vascular specialists, their commitment to improving the care they deliver to patients, and the value they find in the registry."
Biannual regional meetings bring together vascular teams for a multidisciplinary discussion in a supportive environment. As a patient safety organization (PSO), VQI data cannot be used to promote individual programs or encourage competition between centres.
"VQI is aimed at creating a culture of improvement, not punishment," explains Naomi Eisenberg, Vascular Database Manager, PMCC, and Lead Regional Data Manager, SVS VQI.
"When you share your data – what you're doing well and doing poorly – then you and your colleagues can really dive in and see what's going on," she says. "What's working well, what isn't, what can be improved, and how.
"We all learn from each other."
Members have used VQI data to significantly improve the delivery of care, reducing complications for patients and expenses for hospitals.
"One of the things we've improved in our program is that we've dramatically reduced our length of stay for our endovascular aneurysm repair procedures," says Naomi.
"Ours was above the average so we looked at those cases and instituted changes across the program. Because of VQI, our length of stay went from four days to one day."
The growth of the registry enriches the data, adding to the body of knowledge that prompts centres to improve patient care. For Naomi, this evidence-based approach to vascular treatment is a passion.
"To me, vascular patients are complex on many system levels," she says. "They have so much going on and if there's something that can be done to help them, something to improve their experience with us, I want to do it. These patients deserve every opportunity."
Educating and Empowering Patients and Families
When Greg Noack, a rehab therapist at Toronto Rehab, set out to write "Collateral Damage: When Caregivers No Longer Care," his goal was clear – to educate and empower patients and families, as they navigate a health system that may not always meet their individual needs.
Drawing from his own experiences, recovering from an assault that resulted in a traumatic brain injury, as well as supporting his father's care, Greg shares the highs, the lows, and lessons learned, that may help someone else.
Recognizing our own opportunity to continuously improve the care we provide patients, UHN is committed to listening to the voices of those we serve, and partnering with patients, communities, and industry, to design a care journey that is seamless, high quality, and safe.
It's a commitment Greg, himself, exercises in his own approach with patients recovering from an acquired brain injury.
"As front line clinicians, we need to keep reflecting on the Golden Rule and asking ourselves, 'Would I want myself or my loved ones treated this way?"
