4/6/2021

Good morning, TeamUHN!

It is a pleasure to connect with you across care, research, and education through this weekly CEO update – all in service of A Healthier World.

Key reminders and updates

  • Deepest thanks to everyone who worked in service of patients and TeamUHN over the Easter weekend, so that other members of TeamUHN could hopefully relax and recharge.
  • This week on Thursday, April 8 (1:00 p.m. to 2:00 p.m.) – Virtual Open Forum on COVID-19.
    • Submit questions here including your full name or enter #UHNCOVID-19x43 on Slido.com. Including your name will help support transparency and collegiality at UHN.
    • Livestream here (Chrome/Firefox).
    • Read answers to FAQs here – updated regularly (Corporate Intranet > COVID-19 Preparedness > Virtual Open Forum (top right box) > Open Forum FAQ).
  • Reminder about our shared commitment to respect and civility: It has been reported that a small number of members of TeamUHN are arriving at vaccine clinics demanding their second dose ahead of schedule or suggesting that they had not received a first dose when they had, as well as behaving aggressively towards clinic staff. This directly opposes our values at UHN – incidents will be reported and treated as serious infractions, which will result in the strongest discipline, up to and including termination.

    • What happened at the Executive COVID-19 IMS Table

    In response to the concerning state of COVID-19, UHN activated its Executive COVID-19 IMS (Incident Management System) table. Membership includes our Executive Leadership Forum and other members of COVID-19 work streams. The group meets on Tuesdays and Thursdays. This is a snapshot of the discussion.

    Variants of Concern and focus on the E484K mutation

    • Background: In the Ontario COVID-19 Science Advisory Table's March 29 Science Briefing, it was reported that Variants of Concern are associated with a 63% increased risk of hospitalization and a 103% increased risk of ICU admission. We are troubled by this as Toronto Public Health now reports that 73% of COVID-19 cases in Toronto are associated with Variants of Concern (Note: There is a reporting lag with the data meaning the percentage is likely higher). We are at the point across the region where we must assume that most cases involve a variant, and are now focused on the ones that have the E848K mutation which may allow the virus to escape the body's immune defences. We are seeing the P1 variant taking hold in B.C. and must be concerned about it spreading to Ontario.
    • Who presented? Susy Hota (Medical Director, Infection Prevention & Control (IPAC)), Brad Wouters (Executive Vice President, Science & Research)
    • What do I need to know? UHN's IPAC team and other IPAC departments are exploring how COVID-19 patient placement may need to be altered by the presence of the E484K mutation. Impact of the E484K mutation on vaccine effectiveness is unclear for all COVID-19 vaccines, but promising findings have come forward regarding good effectiveness with the Pfizer vaccine. Overall, vaccination remains a critical defense for COVID-19 and we are working with the UHN-Sinai Microbiology Lab to identify hot spots across the province, in the hopes we can work with the Ministry of Health to direct vaccines to communities where there are more outbreaks. We must also keep up our strongest public health measures as well as increase vaccinations.

    Wave 3: Critical care capacity at UHN and the Greater Toronto Area (GTA)

    • Background: Ontario is approaching 500 patients in its ICUs due to COVID-19, and we are already past the highest number of ICU patients we've seen since the start of the pandemic. We are also approaching an all-time high of critical care bed use at UHN. This concerning growth is attributed to the rising rates of Variants of Concern. Provincial modelling projects that Ontario will hit 800 cases by the third week of April if we continue on this trajectory of 5-7% growth.
    • Who presented? Susy Hota (Medical Director, Infection Prevention & Control), Marnie Escaf (Vice President, Clinical), Fayez Quereshy (Vice President, Clinical), Niall Ferguson (Head, Critical Care), Shaf Keshavjee (Surgeon-in-Chief)
    • What do I need to know? UHN is Ontario's most acute hospital which means we are experienced in caring for the sickest patients. Part of this role includes serving as the provincial resource for ECMO (extracorporeal membrane oxygenation), a highly specialized service we use when a ventilator is no longer able to support a critically ill patient. There are currently 16 patients on ECMO at UHN and we anticipate there will be more of a demand for our ECMO services as COVID-19 continues to rise in the community. For now, we are able to manage our case loads using our existing staffing plan, but are prepared to move forward with our coordinated surge capacity plan at Toronto General and Toronto Western, if this trajectory continues. The GTA IMS Table also recognizes the need to protect UHN's unique ability to offer specialized services. They are looking to help us create more capacity by transferring less acute patients out of UHN to other centres.

    Wave 3: Staffing challenges across the health system

    • Background: In response to the pressures of Wave 3, we are further reducing our surgical activity at UHN this week (exceptions include transplant, cancer, cardiac and neurosurgery – the areas where UHN serves as a provincial resource). This means that some staff will be available for redeployment to other clinical areas where they are needed. But since we are still maintaining certain levels of activity at UHN – which is a good thing for patients – we do not have the same surplus of staff available for redeployment as we did in Wave 1.
    • Who presented? Diana Elder (Vice President, Human Resources), Joy Richards (Vice President, Patient Experience; Chief Health Professions), Fayez Quereshy (Vice President, Clinical)
    • What do I need to know? Our colleagues in Human Resources and Collaborative Academic Practice are working together on creative solutions. We are looking at team-based models of care, adjustments to staffing ratios where it is safe, and UHN's previous acuity based staffing work. We are also focused on recruitment and retention of staff, and looking at new opportunities which includes working with an organization that helps internationally trained nurses get the credentialing they need to work in Canada.

    Overview of last week

    Quality and Safety Committee of the Board meeting: Discussing escalation of care and Serious Safety Events

    • Background: UHN's Quality and Safety Committee is chaired by Ross Baker (UHN Board Trustee). This Board-level committee reviews the quality of care at UHN and makes recommendations to UHN's Board of Trustees as required.
    • What happened last week? The committee convened for their regularly scheduled meeting. They discussed COVID-19, TeamUHN well-being, and escalation of care. In healthcare, we know that failure to escalate issues is often a contributing factor to Serious Safety Events and this is unfortunately the case at UHN. In response, we created a working group for Escalation of Care at UHN which is led by Jane Heggie (Medical Director, Cardiovascular Intensive Care Unit) and Laura Pozzobon (Quality Improvement and Patient Safety Specialist). The group was temporarily put on hold due to the pandemic but has now resumed their work.
    • What do I need to know? Thanks to the Escalation of Care working group, we now have standards for escalating issues at UHN and our Emergency Departments and CVICU (Cardiovascular Intensive Care Unit) have already adopted them into their practice. The working group is also developing a Failure to Escalate Prevention Bundle which will be rolled out across the organization. The purpose of the bundle is to provide teams with tools to confidently escalate clinical and administrative issues.

    Medical Advisory Committee meeting: Discussing COVID-19 and impact on non-emergent care

    • Background: UHN's Medical Advisory Committee (MAC) is chaired by Patricia Murphy (Chair, MAC) and includes representation from all departments, divisions and programs. On behalf of UHN's Board of Trustees, its role is to oversee quality of care at UHN and address issues that impact patients, as well as physicians within the broader context of TeamUHN. The MAC's vision is to promote excellence and distinguish UHN as a global leader in patient care. On April 1, the MAC convened to discuss the current state of COVID-19, new escalation processes for Serious Safety Events, and a number of other topics.
    • What happened last week? Last week, one of the main points of discussion was concern around the potential surge in patients with COVID-19 and how this would strain the health system. The MAC reviewed the implications of increased community spread on hospital admissions, percentage of ICU beds occupied by patients with COVID-19, and the subsequent reduction in clinical activity for non-COVID patients awaiting treatment, procedures and surgery at UHN. There was also significant discussion about a continued focus on quality of care across UHN programs and how we can make UHN the highest quality hospital.
    • What do I need to know? The MAC provides input on our clinical activity levels to UHN's CART (Clinical Activity Recovery Team) – and we are all very concerned about the delay in therapeutic and diagnostic procedures for patients at UHN as a result of the pandemic. Last week, in anticipation of further service reduction, MAC leadership asked all departments, divisions and programs to prioritize patients on waiting lists based on urgency of care and equity.

    Closing notes

    For those who may have missed last week's Anti-Racism and Anti-Black Racism discussion presented by UHN and Urban Alliance on Race Relations, read the recap on UHN News and find the recording at the bottom of the story. Andrew Boozary (Executive Director, Social Medicine and Population Health) and Sheila O'Brien (Executive Director, People, Culture and Community) provided opening and closing remarks.

    World Health Day is April 7 and the 2021 theme from the World Health Organization is "Building a fairer, healthier world for everyone" [Editor's Note: Link is no longer available] which is completely aligned with our vision of A Healthier World at UHN. The theme specifically focuses on health inequities and we are proud to be making advancements to address the social determinants of health – including income and food insecurity – through UHN's Social Medicine Program and the Memorandum of Understanding we signed with the City of Toronto and United Way.

    Last Thursday, the Michener Institute of Education at UHN opened registration to its new Digital Health and Data Analytics program, designed to meet our healthcare system's need for digitally-literate health professionals. The program begins in September 2021. Interested candidates and anyone wanting to learn more can visit Michener.ca/program/DHDA.

    Feedback?

    Your feedback is welcome and valued. Please reply directly to me or leave anonymous feedback here.

    Have a good week,

    Kevin


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