Dear Colleagues,

We have never wavered in our commitment to patients at UHN since the onset of the pandemic – and despite these trying days, I see you carrying on. I see you showing kindness and compassion to frightened patients. I see you pausing to share in moments of humanity with your colleagues, while racking every corner of your brain for ideas and suggestions that might help us out of this dire situation. I see you putting on a brave face. But I know you are worried and scared. And I know there is not a single person here who doesn't feel the same overwhelming grief that I do over the lives we have lost to COVID-19.

I want you to know we are using every single resource we have to grab hold of Wave 3. The health system is completely united in our task of conquering COVID-19. As we continue to navigate a challenging number of weeks, I hope you will continue to support one another in the exceptional ways you always have. In return, please know that UHN's Senior Management Forum is doing everything in our power to help – and that we are joined by the full force of UHN's Board of Trustees. Thank you isn't enough for your remarkable service, TeamUHN, but please accept these words today as my deepest gratitude.

Key reminders and updates

  • Reminder: Clear your schedules of all non-essential meetings for the next two weeks so we can focus on our pandemic response. In addition, join me in following all public health measures (e.g. get vaccinated and continue to mask, physically distance, avoid in-person gathering), being a champion for mental health, and supporting accommodations for colleagues as best as we can during Wave 3. Read more in the message I sent yesterday (Corporate Intranet > COVID-19 Preparedness > Internal Communications > "What Ontario's latest…").
  • Tomorrow on Tuesday, April 20 (12:00 p.m. to 1:00 p.m.) – Virtual Open Forum on COVID-19.
    • Submit questions here including your full name or enter #UHNCOVID-19x44 on Slido.com. Including your full name will help support transparency and collegiality at UHN.
    • Livestream link here (Chrome/Firefox).
    • Back by popular demand – #ThanksUHN page on Slido.com. Thanks to Linda Flockhart (Clinical Director, Peter Munk Cardiac Centre) for being first to submit an acknowledgement. Shout out a colleague or team here or go to Slido.com and enter #ThanksUHN. We will read a selection of comments out loud at the forum. Please include your full name in order to have your comment accepted.
  • Gratitude from UHN's Board Chair Brian J. Porter, who also serves as CEO of Scotiabank. Last week at Scotiabank's Annual General Meeting, Mr. Porter thanked all of you – the members of TeamUHN – for your remarkable service, saying:

    "I want to recognize and thank the entire team at University Health Network… It's my privilege to serve as Chair of the Board of UHN and over the past year, I have seen TeamUHN's commitment, courage, and compassion firsthand. Today, Canadians are united in our appreciation for all of our medical professionals – doctors, nurses, administrators, ambulance drivers, paramedics, and volunteers. You have earned our deepest gratitude and highest respect."

 

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 other members of COVID-19 work streams. The group meets on Tuesdays and Thursdays. This is a snapshot of the discussion.

Preparing the health system for Wave 3: Critical care capacity and addressing transport challenges

  • Background: Last week, the Ontario COVID-19 Science Table reported that cases, hospitalizations and ICU (Intensive Care Unit) occupancy are at their highest levels since the onset of the pandemic. The GTA (Greater Toronto Area) IMS Table, which directs transfers across the region, is continuing to protect ICU capacity at UHN so we can continue to serve as a provincial resource for ECMO (extracorporeal membrane oxygenation). ECMO is used as a last resort when a ventilator is no longer able to support a critically ill patient – and the need for these services has grown significantly during Wave 3. Our colleagues in the MSICU (Medical Surgical Intensive Care Unit) are working to increase our capacity to manage more simultaneous ECMO cases, but we need more perfusion and nursing staff. Niall Ferguson, Shaf Keshavjee, and Fayez Quereshy are working with provincial partners to get help from other centres. Three perfusionists have already been transferred from centers within the GTA. Beyond the GTA, Ontario's Critical Care Command Table has been actively working to maximize critical care capacity – we are moving 20+ patients out of the region every day from COVID-19 hotspots including Brampton, Mississauga, Humber and Scarborough.
  • Who presented? Roundtable discussion.    
  • What do I need to know?  In addition to staffing, our biggest challenge across the health system is transport and moving patients. Last week, the GTA IMS Table (which includes Marnie Escaf and Susy Hota) transferred 155 patients over a 3-day period. We are considering moving to around-the-clock transfers (24 hours) while avoiding late-night transfers for ICUs in order to maximize transport support. The good news is everyone across the health system is working together in strong partnership. These are radical times so we are all thinking completely outside the box. Thank you all for helping us save lives.

Staffing at UHN: Managing shortages and establishing a staffing heat map

  • Background: Our Nursing Resources Team (NRT and NRU) have been stepping up since Wave 1 to provide coverage for our COVID-19 units and most recently the Princess Margaret Surge Unit. Their flexibility and adaptability have been instrumental for our pandemic response and they have embraced any and all assignments sent their way. Last week, however, the NRT were not able to meet all COVID-19 staffing needs for the first time – further underscoring the severity of Wave 3. Our Clinical Directors have been running daily huddles with Managers to balance staffing ratios. We were also experiencing shortages with medical staff last week but our colleagues in the Departments of Medicine and Surgery quickly responded to the request for help, as well as colleagues from Women's College Hospital. There are still gaps to fill but the willingness to help across the health system is phenomenal.  
  • Who presented? Joy Richards (Vice President, Patient Experience; Chief Health Professions), Marnie Escaf (Vice President, Clinical), Kathryn Tinckam (Physician-in-Chief)
  • What do I need to know? The CAP (Collaborative Academic Practice) Team is leading the development of a staffing heat map so we can identify where we have major staffing challenges. We are focused on preparing for an ICU surge and staff redeployment to ICU is ongoing. Our medical teams continue to plan for surge capacity on the COVID-19 wards at both acute sites.

Vaccines: Limited supply and advocating for shorter second-dose intervals

  • Background: Today on April 19, we are closing one of our vaccine clinics (Toronto Western's BMO Convention Centre) at UHN and reducing our clinic at MaRS to 25% capacity due to limited vaccine supply. Though we have the ability to administer 30,000+ vaccines per week across all our clinics, we unfortunately don't have enough vaccine supply to run near full capacity. As part of this domino effect, we also had to pause the registration of people ages 18-49 living in hotspot postal codes within our catchment, as more than 21,000 people registered in less than 24 hours. Though we are encouraged by the public's enthusiasm to get vaccinated as soon as possible – which means we have overcome some vaccine hesitancy – we share your frustration in not being able to answer that call due to a lack of vaccines.
  • Who presented? Emily Musing (Vice President, Clinical; Chief Patient Safety Officer)
  • What do I need to know? While we are committed to getting as much of the public vaccinated as possible, we remain intensely focused on TeamUHN. We are advocating aggressively for the Ministry of Health to shorten second-dose intervals for healthcare workers at UHN and beyond – especially as the number of variant cases now dominate overall numbers.

     

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 April 15, 2021.

Maintaining our momentum with Synapse – our clinical transformation journey – while addressing our challenges with COVID-19

  • Background and why this was brought to ELF: Synapse represents our clinical transformation journey which will be supercharged by a new Health Information System (HIS). The value that ties Synapse with our other top priorities – UHN's COVID-19 response and TeamUHN well-being – is ensuring that the needs of patients come first. The pressures of Wave 3 are serious and the members of ELF discussed how we can maintain our momentum with Synapse without overburdening the colleagues who are involved. We recognize that impacted team members extend beyond the official Synapse project team and include colleagues who have been doing some very heavy lifting through the Working Groups.
  • Who presented? Robert Slepin (Senior Project Director, HIS), Sarah Muttitt (Chief Information Officer)
  • What do I need to know? We are fortunate to be learning from other hospitals who launched a new HIS during the pandemic. Using those lessons learned, we are modifying our stakeholder engagement process so that we can make critical decisions faster (e.g. involving fewer people without jeopardizing quality or losing any sense of transparency) and configure the system on schedule.

Closing notes

  • Please use the mental health supports we have available at UHN. Use the UHN Cares program (Corporate Intranet > COVID-19 Preparedness > Mental Health Supports). Share widely and check in with one another often.
  • This week (April 18-24) is National Organ and Tissue Donation Awareness Week (NOTDAW): Thanks to everyone working with the Ajmera Transplant Centre and Trillium Gift of Life during these very challenging times, keeping transplant patients safe during the pandemic and keeping this life-saving program running. The Centre is Canada's largest transplant program. Thanks to the generosity of organ donors, we perform more than 600 transplants every year.
  • Last week, it was my pleasure to participate in the launch of the Max Planck – University of Toronto Centre for Neural Science and Technology. The Max-Planck-Gesellschaft is one of the world's premier research organizations and this new Centre marks their first time partnering with hospital-based research institutes. UHN is proud to be one of those leading institutes, alongside SickKids and CAMH (which are all affiliated with the University of Toronto). The new Centre is co-led by Taufik Valiante (Scientist, Krembil Brain Institute) and Joyce Poon (Max Planck Institute for Microstructure Physics). Follow them on Twitter.

Feedback?

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

Have a good week,

Kevin


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