'Now they have the vaccines, and with them, hope'

"It's been tough for them for many months but now they have the vaccines, and with them, hope.

"It's truly an honour for us to be part of this. We are so proud of the teamwork that's gone into it. And, hearing the feedback from recipients, their smiles and thank yous, is overwhelming to see."

It's an effort that's brought together Toronto Public Health, city staff and teams from nine hospitals and about 160 LTCs, retirement homes and congregate living sites, to protect Toronto's most vulnerable.

Starting just after 11 a.m. on Dec. 31 at Castleview Wychwood Towers and continuing daily for nearly three weeks, mobile vaccination teams administered about 15,000 doses of the Moderna vaccine. The second round of inoculations began last Thursday and is expected to wrap up in mid-February.

"This is a story about amazing individuals in the homes and on our teams who are pouring their hearts into this every day because they know it's going to make a difference," says Dr. Brian Hodges, UHN's Executive Vice President Education & Chief Medical Officer. His photos and tweets have chronicled the efforts since the first day with such hashtags as #TeamVaccine, #DeliveringHope and #StrongerTogether.

"Long-term care is where the biggest amount of death and suffering has been so being able to get there with help and hope is such a positive thing that really resonates with people," he says. "The teams are tired but the thing that buoys them along is the gratitude they encounter when they arrive."

Mobile Team Vaccine came together quickly. UHN provides the backbone support for the coalition of partners and is the central supply depot for Moderna in Toronto. Based on allocations and prioritizing set out by Toronto Public Health and the provincially-mandated Toronto Central Local Health Integration Network, LTC residents are vaccinated by staff from their hospital partners, which were established earlier in the pandemic. UHN has 13 LTC partners.

At lunchtime on Dec. 29, Shiran Isaacksz, Vice President Altum Health & UHN Connected Care, was tasked with leading the organization's mobile vaccination rollout. With the first Moderna shipments scheduled to arrive the next day and the goal of starting shots in arms the day after that, his team had 48 hours to assemble all the key players at UHN and in the community to make it happen.

It was Connected Care on full display – pulling together inter-disciplinary teams who each use their expertise to make a positive impact, collectively. It was about being able to pivot and scale quickly internally, while also working with community partners and city and provincial health authorities.

These are the principles of UHN's Integrated Care Program and what allowed the team to get mobile vaccination in the community up and running so quickly. Among the key contributors:

• UHN Pharmacy, leading the way on the rollout of the Pfizer-BioNTech vaccine since mid-December, oversees Moderna distribution and delivery;
• The Family Health Team at TWH, which in April proactively began swabbing residents and staff at many LTCs and has largely staffed the COVID Assessment Centre at TWH, does the vaccinations;
• The UHN Long-Term Care Support Team, which has been providing ongoing assistance and Infection Prevention and Control (IPAC) expertise to LTCs and retirement homes since early in the pandemic, works with each of the homes to ensure they're ready for the arrival of the mobile vaccine team;
• The LTCs themselves obtain consents from residents, ensure there's a place for vaccinations to happen and have staff on hand to help organize on-site needs, complete the necessary documentation and monitor recipients for adverse reactions for 15 minutes;
• Members of UHN Connected Care ensure the needs and experience of residents, staff and essential caregivers are prioritized. They also provide the critical backbone support, including education, training, and logistics, which ranges from clearly delineating who handles what tasks at each site and determining how many doses of vaccine are required, to ensuring data on who is vaccinated gets added to the provincial registry and making sure the team has food and water.

At the outset, all teams were governed by two key principles: safety and speed.

"We have a collective focus. We know that for every vaccination there's another life that's on its way to being protected from this horrible virus," Shiran says. "There was urgency; we knew we couldn't leave this in the freezer."

A mobile vaccination model was developed and at work in LTCs within 48 hours. Each evening, an Operations Team featuring representation from all UHN teams involved, met virtually to review that day's events. Over the course of its first week of meeting, workflows were improved, the drawing of doses was refined to ensure no vaccine was wasted and overall efficiency of the process was polished.

UHN worked through vaccinations at its 13 partner LTCs and quickly jumped to help others with their homes alongside other Toronto hospitals. Teams shared best practices and soon joined forces to complete all 87 LTCs in the city in nine days – six days ahead of schedule – then more than 70 retirement homes and congregate living sites.

"It's a testament to how we work in primary care," says Dr. Camille Lemieux, Chief of Family Medicine at UHN and one of the team members who has been administering Moderna vaccines. "We're very collaborative and used to working across sectors and inter-professionally."

Collaborating with counterparts from across the health system, including family medicine teams from other hospitals – Humber River, Michael Garron, North York General, Scarborough Health Network, Sinai Health, Sunnybrook, Unity Health Toronto and Women's College – brought different skills and strengths together to improve the vaccination model, she says.

"We want this approach to continue, to put down our hospital badges and work collaboratively with other endeavours, not just in an emergency," she says. "There are so many opportunities for us to come together for the benefit of our hospitals, and more importantly, for the benefits of all patients.

"I really hope this is a sign of things the come."

Another key to the success of the mobile vaccine teams is the relationship between hospitals and LTCs.

Lori Seeton, Operational Lead for UHN's Long-Term Care Support Team, says the ongoing contact she and UHN IPAC's Leah Gitterman have led since the hospital-LTC partnerships were established last spring has "built trust" – the homes know UHN offers expertise, is focused and can mobilize quickly.

"Long-term care and acute care are now functioning more as a system," Lori says. "That's new, it's positive and without that connection, we would have been starting (the vaccine rollout) from zero.

We wouldn't even have known who to call at the homes. It would have been a snail's pace by comparison."

Helen Lampi, Director of Nursing at Castleview Wychwood, the largest of the City of Toronto's 10 LTCs, says her team was "excited to get the great news" from Lori on Dec. 30 that UHN's mobile vaccine team planned to come the next day. Staff at the home set about getting consents from residents, phoning and emailing families, and answering questions to help overcome vaccine hesitancy. Floors were set up so the dining room on each floor was for vaccinations and any staff available got people there and back.

"It went like clockwork," Helen says. "All of our residents were extremely excited and our families breathed an enormous sigh of relief because we've been so worried that we would have an outbreak."

That first day, 323 residents were vaccinated. UHN held three smaller clinics at the home, giving first doses to additional residents, more than 100 essential caregivers and staff who had not received their Pfizer vaccine at the clinic for healthcare workers at the Michener Institute of Education at UHN.

All told, nearly 1,000 doses were given, with about 95 per cent of residents vaccinated.

The second doses at Castleview Wychwood began last Thursday, 28 days after the first ones.

"It's been an amazing ride with the UHN team," says Noreen Grange, Nurse Manager of IPAC at Castleview Wychwood, who has worked with staff from the hospital throughout the pandemic.

Dr. David Esho, a staff physician on the Family Health Team at TWH and part of the mobile vaccine team, says a key thing that excites his group about this work is that it takes healthcare into the community.

"When we heard the vaccines were coming, we definitely saw it as another way we could apply our skills and push healthcare out of hospitals and into communities to hopefully prevent more COVID admissions," he says. "And, throughout, it's felt like we were all on the same team.

"There's no turf, we all just work together for a common goal, focused on how best to get it done."