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

  • Last week, the Indigenous Health Program at UHN held a ceremony honouring the children and those affected by the discovery of the remains of 215 Indigenous Children in Tk'emlúps te Secwépemc Territory (Kamloops). This was a sobering and extremely moving event, and I extend my thanks to the organizers, participants and everyone who attended. We must all recognize the trauma, pain and grief that the Indigenous peoples of this country bear as a result of the residential school system, colonialization and the actions of those who came to this land with no understanding, respect or empathy for the people who lived here. May we recognize, remember and support Indigenous peoples as we continue the important work to foster mutual understanding and healing. A video of the ceremony will be shared tomorrow.
  • Last week, UHN and the Gattuso Centre for Social Medicine announced a first-in-Canada Social Medicine Modular Housing in Parkdale, in partnership with the City of Toronto and United Way Greater Toronto Area. This project will create a four-storey, 51 unit building offering housing to marginalized groups and high-users of hospital services. Read the press release here.
  • The provincial government has announced that second doses can be given to anyone who had their first dose on April 18th or earlier. Anticipating this, UHN has moved all eligible registrants and Groups A, B, C and D have all received an email with a link to reschedule your second dose. Once re-booked you will also receive a reminder from Vaxie (our robot caller) reminding you of this information the day prior to your appointment.
    • If you have been vaccinated, please remember to notify Health Services after receiving each dose by completing this form.

What happened at the Executive COVID-19 IMS Table

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

COVID-19 prevalence at UHN and in the Community

  • Background: Dr. Susy Hota (Medical Director, Infection Prevention & Control) provides the Executive COVID-19 IMS Table with regular updates on COVID-19 trends within the hospital and surrounding community, which helps inform any potential impact to the health system. Last week, the table heard about the increasing prevalence of the Delta Variant of Concern (also known as the B 1.617.2 variant and as the variant originating in India), which the Ontario Science Advisory Table estimates now accounts for up to 23% of the positive cases in the province. This development has increased the calls for accelerated second doses – particularly for healthcare workers – as a single dose of vaccine appears to provide lower protection from this variant. Other discussed topics included:
    • The National Advisory Committee on Immunization's (NACI) recommendation that individuals who received a first dose of the AstraZeneca vaccine could opt to receive a Pfizer or Moderna vaccine for their second dose. NACI's recommendations for vaccine interchangeability are available here.
    • The continued inquiries from TeamUHN around travel restrictions and the desire to return to in-person teaching.  
    • That COVID cases in the community and at UHN continue to decline. And the very welcome news that, as of June 3, there are no outbreaks at UHN.
  • Who presented? Dr. Susy Hota (Medical Director, Infection Prevention & Control)
  • What do I need to know? Due to the increasing presence of the Delta Variant in Ontario, it is critical that everyone receives both doses of vaccine as soon as they are able, continues adhering to all public health measures (masking, handwashing, physical distancing, and limiting the number of contacts) and a reminder to report vaccination status to Health Services. Travel restrictions and quarantine requirements for TeamUHN remain in effect in compliance with the Government of Canada's Quarantine Act, and larger group in-person teaching will continue to be considered based on how essential it is to providing care and the ability to physical distance.

UHN's Critical Care and Emergency Departments

  • Background: Critical care areas remain very busy both caring for COVID patients in all of the Intensive Care Units (ICUs), including those needing Extracorporeal Lung Support (ECLS), and working to return recovering COVID patients to the hospitals which referred them to UHN. One point of concern is that we continue to care for upwards of 140 patients who have recovered from COVID-19 but still have symptoms requiring acute care.
    • Our Emergency Departments (EDs) are also seeing an increase in volumes, acuity and a growing number of patients with delayed presentations of serious conditions – which in turn cause an increase in hospital admissions as well as pressures on staffing and physical capacity. In mid-April, tents were set up outside UHN's EDs to support physical distancing in the waiting rooms during periods of higher volume. Safety and other issues identified during simulations run prior to operationalizing the tents have since been solved and incorporated into ED protocols allowing us to use the tents, if needed. The flow from the EDs to the inpatient units has been well managed throughout the pandemic, but as our clinical activity ramps up there is concern that this flow will suffer.
  • Who presented? Dr. Niall Ferguson (Head, Critical Care) and Dr. Sam Sabbah (Medical Director, Emergency Medicine)
  • What do I need to know? UHN's COVID volumes (including both active and recovered cases), the recovery of patients, and the repatriation of patients to other hospitals all affect our ability to return currently redeployed staff to their home assignments. The hope is that vaccination efforts and adherence to public health protocols will enable a manageable summer in terms of any COVID response allowing the health system to turn its focus to addressing the needs of patients whose scheduled care has been delayed. 

What happened at the Executive Leadership Forum meeting

UHN's Executive Leadership Forum (ELF) represents a broad range of voices and skill sets from across the organization and provides direction and oversight in service of patients, TeamUHN and our vision of A Healthier World. See the full membership on UHN.ca. The last ELF meeting was held on June 3, 2021.

Proposed UHN COVID-19 Vaccine and Testing Policy     

  • Background and why this was brought to ELF: UHN's Board of Trustees and Executive Leadership Team are compelled to do everything possible to protect patients and staff.  Vaccination with two doses, coupled with strict adherence to public health practices recommended by Infection Prevention and Control are the best measures possible to overcome the pandemic and ensure everyone's safety. Furthermore, our patients expect that they are being offered the maximum protection possible, while being cared for at UHN. This has prompted the development of a Vaccination and Testing Policy to account for staff who choose not to receive the COVID-19 vaccine, choose not to disclose their vaccination status, or cannot receive the vaccine due to a medical condition. A draft of the policy and the recommendations for rapid testing came to ELF for approval which was received.
  • Who presented? Dr. Bradly Wouters (Executive Vice President, Science & Research)
  • What do I need to know? The policy has been developed and planning is underway to put it into operation – likely by the end of June. UHN continues to encourage all staff to get their vaccine, report their vaccination status to Health Services and follow public health guidelines. In the weeks ahead the policy will be discussed with leaders, made available to everyone at UHN and discussed with our union partners.

Work Being Done to Raise the Full Cost of Research

  • Background and why this was brought to ELF: The full cost of research includes the Direct Costs (laboratory staff, trainee salaries, lab supplies, core facility fees, travel and publication costs) and the Organizational Costs/Indirect (PI and administrative salaries, services such as RSS, UHN Digital, Finance, Legal etc.) as well as infrastructure costs such as facilities, including space, Housekeeping, HVAC and maintenance. Many funders, including granting agencies, do not fully cover the costs of research which means we heavily rely on our foundations – UHN Foundation, the Princess Margaret Cancer Foundation – and UHN itself to support research. The goal is to put the funding of research on a firm foundation so that deficits are not a constant worry and this is being implemented across the TAHSN hospitals.     
  • Who presented? Dr. Bradly Wouters (Executive Vice President, Science and Research)
  • What do I need to know? This work has been underway for some time. Next steps include involving UHN's entire Research community to provide input and address any questions that arise.

Virtual Emergency Department Pilot

  • Background and why this was brought to ELF:  The benefits of the service and what's ahead for the program were presented to ELF. You can read about this forward-thinking project in UHN News.
  • Who presented? Dr. Sam Sabbah (Medical Director, Emergency Medicine), Dr. Sameer Masood (Lead, Virtual Emergency Department)
  • What do I need to know? The Virtual Emergency Department Pilot has been a success, and UHN will seek the funding needed to expand the service and make it available to the right patient populations. Patients who have used this service to date, have reported being extremely satisfied.

Overview of last week

Quality and Safety Committee of the Board

  • 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? Fayez Quereshy (VP, Clinical) updated the Committee on the strategies and challenges related to clinical activity recovery. Sheila O'Brien (Executive Vice President of People, Culture and Community) shared the initiatives underway to support TeamUHN wellness and to address burnout associated with the pandemic. Sarah Muttitt (VP, Chief Information Officer) and Robert Slepin (Senior Project Director, HIS, Synapse) provided an overview of how quality and safety issues will be addressed by Synapse.
  • What do I need to know? The majority of the discussion focused on the challenges related to healthcare human resources both within UHN and across the broader health system. There was recognition that due to the immense efforts of TeamUHN throughout the pandemic, and that staff need some time to rest before they are able to support increased clinical activity. A number of strategies to support TeamUHN were discussed. In addition, innovative recruitment strategies to increase healthcare human resource capacity were discussed.  

Closing notes

  • June is Stroke Awareness month in Canada. Stroke is the third leading cause of death in Canada and the leading cause of disability in adults. Every year, nearly 14,000 Canadians die from stroke. That's one every 10 minutes (source: Ontario Stroke Network). The Krembil Brain Institute at Toronto Western Hospital is the only accredited Acute Care Regional Stroke Centre (RSC) in Toronto providing both tPA thrombolysis ('clot-busting' drug) and endovascular thrombectomy (EVT). As well, Toronto Rehab's stroke program was the first organization to achieve Stroke Distinction in Canada. Since 2010, TR's stroke program has been awarded Stroke Distinction for three consecutive cycles, by Accreditation Canada. On the research side, scientists at KITE are actively focused on developing accessible therapies and treatments for individuals impacted by stroke. 
  • June is also Brain Injury Awareness month. According to the Brain Injury Association of Canada, 452 Canadians suffer a serious brain injury every day (one every three minutes). There are also 150,000 concussions each year in Ontario alone and with 10% having persisting symptoms, there is significant morbidity from what is often labeled a 'mild traumatic brain injury.' The Krembil Brain Institute (KBI) is a world leader in clinical care and translational research for injuries of the central nervous system. The Canadian Concussion Centre at KBI is an academic, research-oriented, clinical treatment centre for patients with persisting concussion symptoms, now closely aligned with ALTUM Health. Toronto Rehab is a provincial leader in specialized Acquired Brain Injury (ABI) rehabilitation services – the only program within the Greater Toronto Area that provides services on a fully secured unit, allowing us to care for more vulnerable patients. At KITE, scientists are studying the impacts of acquired brain injury and actively working to bring quality care to marginalized communities.
  • For anonymous and confidential emotional support, call UHN's peer-to-peer support line at 416-340-5443. You can reach a professional peer counsellor during the evening and on weekends  (Monday to Friday 11:00 a.m. to 10:00 p.m.; Weekends 10:00 a.m. to 4:00 p.m.). For additional mental health support, please consider using the UHN Cares program (Corporate Intranet > COVID-19 Preparedness > Mental Health Supports). 

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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