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People often say they wear their heart on their sleeve, but for Anne Marie Switzer that's not just a figure of speech. The bag perpetually slung over her shoulder contains a device that powers her mechanical heart through a wire in her left side.
Her care team recently found out firsthand how difficult – and dangerous – ordinary tasks can become for people with a left ventricular assist device (LVAD).
"When I get undressed I need to put down George – that's my LVAD controller. The table can't be too high or too low or the wire won't reach," said Switzer.
"He weighs about five pounds, heavy enough to affect my balance. I have to use a small step stool to get up on the examination table and I worry about falling."
Born with a congenital heart defect, she was the sixth 'Mustard baby' to survive the procedure developed at Sick Kids hospital and the first to have children.
In 2012 she went into congestive heart failure and by November 2014 her doctors told her she wouldn't survive the year without mechanical support.
Just two months later she became the first Mustard patient in Canada to receive a LVAD. Her cardiologist, Dr. Lucy Roche, and a surgical team comprised of specialists from SickKids and Peter Munk Cardiac Centre (PMCC), worked with an Adult Congenital Heart Disease team in the UK who had been using the device in similar patients.
Switzer recently participated in a Lean rapid improvement event aimed at reducing waits and building upon safety measures in the PMCC ambulatory cardiac care clinics.
She asked staff members participating in the event to carry her spare controller, so they could see for themselves the challenges she faces.
"We went to the examination rooms so the team could experience an appointment from my perspective," said Switzer.
"The woman wearing the controller put it on the bed while she put on a gown. I said, 'No you're dead now, the cord isn't long enough to do that.' I think that hit home.''
As a result of Switzer's input, the team will replace the current examination tables with lower, more accessible stretchers so patients can climb on without a stool, and try to do as many of the tests at the same time as possible.
"The team knew these devices limited mobility, but they were surprised at how much time is added to mundane tasks we take for granted, such as dressing and undressing," says Milijana Buzanin, Nurse Manager, Ambulatory Clinics, Peter Munk Cardiac Centre.
"We always have to take into consideration that some patients will take longer to get ready during the appointments."
"The event team worked well together to cut wait times, while taking into consideration our patients' needs," says Milijana. "The rapid improvement event is the first step in identifying issues and potential solutions that impact our ability to provide the best experience for our patients.
"The clinic staff felt energized and engaged with the Lean process. "
To date, the team has identified 62 opportunities for improvement and implemented half.