Welcome to GI/ Hepatology Outpatient Clinic South Health Campus (SHC)

Home , South Health Campus

7E GI/ Hepatology Clinic 7th Floor, 4448 Front Street Southeast Calgary, Alberta T3M 1M4

GI/ Hepatology Outpatient Clinic (Main number): 403-956-3804

Switchboard Number: 403-956-1111

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Table of Contents

Welcome to your SHC GI Rotation………………………………...………….. Page 3

About SHC…………………………………………………………………….… Page 5

Driving & Transit information……………………. ……………………………. Page 6

GI and Hepatology Outpatient Clinic location…. …………………………….. Page 6

Where to show up on your first day………………………………………….. Page 6

Staff on 7th Floor GI/ Hep Outpatient Clinic………………………………….. Page 7

Gastoenterologists & Hepatologists at SHC…………………………………. Page 8

How does GI & Hepatology receive its referrals…………………………….. Page 9

What outpatient services are available for GI & Hepatology at SHC……… Page 10

Calgary Gut Motility Centre at SHC…………………………………………… Page 11

Capsule Endoscopy program………………………………………………….. Page 11

NAFLD program…………………………………………………………………. Page 11

Nurse Navigator program……………………………………………………… Page 11

Endoscopy Unit…………………………………………………………………. Page 12

Topics to know about when in GI/ Hepatology………………………………. Page 12

Lodging/ About Calgary …………………………………………………….….. Page 13

Map of SHC………………………………………………………………………. Page 15

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Welcome to your SHC GI Rotation!

Your rotation will be comprised of an equal exposure to the inpatient and outpatient diagnosis, care, and management of GI issues.

While we do not have an admitting service for GI here at the South Hospital, we do run a consult service, where we are often asked to see and manage such disorders as a GI bleed, Inflammatory Bowel Disease (IBD), acute hepatitis, decompensated cirrhosis, and abdominal pain NYD. We average anywhere from 2-8 consults a day, and we follow along patients with chronic GI disorders while they are in hospital. While on the inpatient service, you are expected to see new consults, which you will review with the staff Gastroenterologist on call, and to round on previous consults. During your inpatient rotation, you may be expected to be first call during the day, depending on how busy the service is.

The outpatient GI clinics at South Health Campus (SHC) are unique amongst all the other Calgary Hospitals, since this is the only site where you can do dedicated hepatology clinics, motility clinics (where you will become familiar with various forms of motility testing and how to read them, and the management of various motility disorders), functional GI, IBD, and esophageal disorder clinics. During your outpatient rotation, you will be expected to attend at least 8 half-day clinics or endoscopy a week.

There are seven GI physicians here at SHC, and all but one Gastroenterologist, have their clinics on the seventh floor of the SHC (Outpatient Area 7E).

Dr. Mathivanan’s office is located at a different site – Zamin Medical Centre: 15229 Bannister Rd SE, Calgary; T2X 1Z3 Phone: 403-457-5877

Your point of contact for SHC GI Education related questions is Dr. Michael Curley ([email protected])– please email re: scheduling, evaluations, or concerns.

The email and contact list for your preceptors are as follows:

Dr. Michael Curley (GI Site Chief): [email protected] Dr. Alex Aspinall: [email protected] Dr. Michelle Buresi: [email protected]

Dr. Milli Gupta: [email protected] Dr. Meena Mathivanan: [email protected] Dr. Michael Stewart: [email protected]

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Please find below a sample list of clinics available each day:

Morning (8:30-12:00) Afternoon (1:00-4:30) Monday Dr. Aspinall – Hep Clinic Dr. Curley – Gen GI/Sig clinic Dr. Curley – Gen GI/Sig clinic Dr. Buresi – Gen GI clinic

Tuesday Dr. Aspinall – Hep clinic Dr. Buresi – Gen GI/motility clinic Dr. Andrews – Motility clinic Dr. Gupta – esophageal disorder clinic Wednesday Dr. Stewart – IBD clinic Dr. Stewart – IBD clinic Dr. Buresi – Gen GI/motility Dr. Gupta- esophageal disorder clinic Thursday Dr. Stewart – IBD clinic Dr. Curley – Gen GI clinic Friday Dr. Gupta – esophageal Dr. Aspinall – Hep clinic disorder clinic Dr. Stewart – IBD clinic

Below is a sample weekly schedule of both clinics and endoscopy, please note below template schedule changes frequently based upon physician on call and physician availability:

MON TUE WED THU FRI Morning CLINIC Aspinall Aspinall Stewart Stewart Stewart (08:00- Curley Buresi Gupta 12:00) ENDO Mathivanan Curley Curley Buresi Stewart Gupta Gupta Afternoon CLINIC Curley Buresi Stewart Curley NIL (12:30- Buresi Gupta Gupta 5:00) Andrews ENDO Stewart Buresi Meena M NIL Meena M Stewart

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About South Health Campus

South Health Campus (SHC) redefines the way health care is delivered within the community by integrating leading technology, research and education with unique healing environments and progressive environmental design.

It will be our pleasure to collaborate with you during your time at SHC. The goal of this guide is to provide an overview of SHC as well as GI and Hepatology Outpatient services within SHC.

SHC has four Foundational Pillars:  Pillar One: Collaborative Practice Pillar South Health Campus (SHC) is dedicated to providing patient care in a collaborative approach. Collaborative practice is health care providers working together with patients and families to contribute their knowledge and skills to care through a process of continuous communication and shared decision making (Health Professions Strategy & Practice, AHS 2011).

 Pillar Two: Patient & Family Centred Care Pillar At the South Health Campus (SHC), Patient & Family Centred Care means working in partnership with patients, family members and citizens in the planning, delivery and evaluation of health services.

 Pillar Three: Innovation Pillar When you're starting from scratch, you can do things differently. It allows you to incorporate what is working well elsewhere. Innovation is a philosophy that will make Calgary's newest hospital, South Health Campus (SHC), a different kind of health facility. Innovation is the ability to make changes that result in more effective or efficient care. An innovation can be: • a new idea, • an existing idea or practice applied in a new setting, or • a different lens applied to an old problem leading to new insights and improvement.

 Pillar Four: Wellness Pillar The South Health Campus (SHC) is more than a place to treat illness and disease. By inspiring a wellness mindset, we focus on supporting, encouraging and assisting people along their health and wellness journey. The wellness principle is incorporated into SHC services, programs and spaces. South Health Campus Wellness Strategy includes: • Providing wellness knowledge and education • Having accessible and available wellness programs • Being responsive to the campus and community needs in guiding development and

delivery of programs and services

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Directions to SHC: 4448 Front Street Southeast Calgary, Alberta T3M 1M4

Driving instructions: South Health Campus (SHC) is located in the southeast of Calgary. Take Deerfoot Trail to the Cranston Ave/Seton Blvd exit and head one block east on Seton Boulevard. South Health Campus will be on your right. You can't miss the large building! For regular clinic visits, travel clockwise around the building to access underground parking and the main entrance. There is access to the Emergency Department entrance off of Seton Boulevard.

Public Transport: Currently, 3 routes service SHC. Calgary Transit Route 406 links the hospital with the Somerset/Bridlewood C-Train station. Route 14 travels from Somerset/ Bridlewood C-Train station, through Cranston community and circle all stops of the South Health Campus before returning to Somerset/Bridlewood. Route 302 is a Bus Rapid Transit (BRT) service coming from downtown Calgary via McKenzie Towne and 52 Street to SHC

Campus Map (see attached map)

Parking Public parking is in the underground parking Lot 1, on Level P1. You can get to it from parkade entrances A (Prairie), B (Forest) and C (Mountain). There is also handicap parking near all elevators. As well, Emergency Parking Lot 3 is available for public needing to access the Emergency Department. On the south side of SHC, by the main entrance, is free parking for two hours on Front Street.

There is a daily charge associated with parking underground. (~ $ 14.25 per day). If require weekly or monthly parking this must be done at the SHC parking office on Level 2 within the Hospital. Weekly fee is ~ $40.00 with a monthly student fee cost of ~ $95.00

GI & Hepatology Clinic location: The SHC GI and Hepatology Outpatient clinic is located on the Outpatient wing on the 7th floor in Clinic 7E (Outpatient Tower across from the Good Earth Coffee Shop).

Hours of Operation: Monday- Friday 0800-1615 hours (except statutory holidays)

SHC GI/ Hep Endo Unit location: 3rd Floor Outpatient Services

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Where to show up on your First Day?

FIRST DAY ROTATION IN CLINIC: Please meet Greg (program lead) at Good Earth on the main level of south Health Campus at 0800 hrs, he will take you to get card access and take you on a tour of the clinic and meet up with your assigned physician that day.

If Greg is not available (you will be notified via email by Viviana or Greg), please show up at the front desk of the GI/Hepatology Clinic (Outpatient Clinic 7E) at 0800 hrs and mention your name, your designation (i.e. GI elective rotation as a pre- clerk/clerk etc.) to the front reception clerks. You will then will meet up with your assigned physician that day.

The SHC outpatient elevators are located across from the Good Earth on the main floor. Take elevator to the 7th floor and go to right towards Clinic 7E for the GI/Hepatology Outpatient Clinic. Main number to SHC GI/Hep Outpatient Clinic Front Desk is 403-956-3804. If get lost arriving at SHC, go to information desk on the main level and call the Clinic or call 403-956- 1111 (main SHC switchboard) and have them transfer you to GI/Hepatology.

FIRST DAY ROTATION IN ENDO: (you will have been informed when provided your rotation). Please meet Greg (program lead) at Good Earth on the main level of south Health Campus at 0800 hrs, he will take you to get card access and take you to SHC GI/ Endo located on the 3rd floor.

If Greg is not available (you will be notified via email by Viviana or Greg), please show up at SHC GI/Hep Endo is located on the 3rd floor. Take the SHC Outpatient elevator to 3rd floor, turn right and follow the signage to the Endo Unit.

IF ON CALL THE FIRST DAY OF YOUR ROTATION: Please find the doctor you will be on call with and schedule a time and place to meet them. On-call times are from 08:00 to 17:00. Best to email them ahead of time to set up location and time to meet up at.

If going to Dr. Mathivanan’s clinic please be aware that her clinic is located at a different site(external clinic):

Dr. Mathivanan’s office - Zamin Medical Centre: 15229 Bannister Rd SE, Calgary, AB. T2X 1Z3 Phone: 403-457-5877

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Staff at SHC GI/ Hepatology Outpatient Clinic: Front Reception: . Leanne . Lauren Day to Day operations on the Clinic: . Jamie Frew (Nurse Clinician) Manager: . Travis Toman (Clinic) . Paul Stewart (Endoscopy) LPN’s: . Dawn . Nikki . Denise Booking Clerks: . Gladdylyn (for Dr. Buresi/ Dr. Gupta) . Stacey (for Dr. Curley + capsule program) . Gail (for Dr. Stewart/ (vacant)) . Shyhrete (Dr. Andrews/ Dr. Aspinalll) . Evelyn (Viral Hep) Nurse Clinicians: . Wendy (NAFLD program) . Sandra (Hepatology) . Bobbi (IBD) Social Worker: . Susan Dietitian: . Jennifer Capsule Endoscopy Program: . Tara . Tasha Nurse Navigator (GERD/ Functional dyspepsia/ IBS)/ Quality Improvement . Greg Motility . Shirley . Wendy Motility Clerk: . Lauren Research Nurse (GI/ Hepatology) . Breean Research Assistant . Joel

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The following physicians are part of South Health Campus (SHC) GI and Hepatology Service: Gastroenterology focus: GI and Hepatology focus: Dr. Andrews Dr. Jayakumar Dr. Buresi Dr. Curley Dr. Gupta Dr. Mathivanan Dr. Stewart

Dr. Christopher Andrews

Specialty: Motility/ General GI

Dr. Alex Aspinall

Specialty: Hepatology/ General GI

Dr. Michelle Buresi

Specialty: Capsule endoscopy/ Motility/ General GI

Dr. Michael Curley, Site lead

Specialty: Motility/ IBD/ General GI

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Dr. Milli Gupta

Specialty: Barrett’s esophagus/ Motility/ General GI

Dr. Meena Mathivanan

Specialty: IBD/ General GI

Mathivanan’s Clinic: 15229 Bannister Road SE

Calgary, Alberta, Canada T2X 1XZ3

(403)457-5877 or (587)349-0786

Dr. Michael Stewart

Specialty: IBD/ Capsule endoscopy/ General GI

Where does GI and Hepatology receive its referrals? SHC GI and Hepatology Outpatient department receives its new referrals from GI Central Access and Triage (GI CAT) or Hepatology Central Access and Triage (Hepatology CAT) located at Foothills Medical Department in the GI/ Hepatology Outpatient Clinic in the Health Sciences Building (Area 2).

What is CAT? GI & Hep CAT provides a single point of entry for referrals within Calgary and surrounding area. It receives faxes from referring physicians 24 hours a day (via fax machine)

How many referrals does GI/ Hep CAT receive a month? Since GI CAT development in 2007, referral volume has steadily increased and as of September 2015 it receives approx. 1700- 1900 referrals per month whereas Hepatology CAT receives 400-600

referrals/month.

How many referrals are on the GI wait lists? What about Hepatology? Due to 10 increasing referral volumes, wait lists are long. At any given time there may be > 4000 Page GI and Hepatology Outpatient Resident/ Clerk Service Reference Guide April 2017

patients on the GI clinic wait list and 800-1000 for GI Direct to Procedure (DTP). Whereas Hepatology waitlists has the following: General Hep ~ 700-1200 referrals, HBV ~ 400-450 referrals, HCV ~400 referrals

What is the difference between these wait lists? GI-referral wait list is for clinic appointments whereas a direct to endoscopic unit (DTP) is available for some patients where they are assessed and proceed immediately to endoscopic procedure. In regards to Hepatology, there exists a wait list for all Hepatology patients with breakdown if hep general, HBV or HCV. Both systems (GI & Hep) utilize SnoMed/ICD9 ® codes to allow identification of cases on the waitlists as well as aid with waitlist reduction strategies.

Why was CAT developed? In 2005, there existed over 100 referral forms for many speciality services in Calgary and referring physicians were extremely frustrated. There was no consistency within specialities, communication was limited, referrals just fell into black holes at times and thus the system was complex and a mess. The goal of a central triage was to improve wait times and referral management in Calgary. It was recognized that the health system can be confusion and difficult to navigate and therefore worked with Medical Access to Service (MAS) to launch CAT teams within the Calgary region.

What is the GI and Hepatology booking system? Presently the IT scheduling system is Cerner Millennium® with SCM® ambulatory as the EMR. Presently all referrals remain paper based.

Are all Gastroenterologists in Calgary part of GI CAT? When GI Central Access and Triage (CAT) was created, not all Gastroenterologists wanted to participate in this new referral system and thus does not have all the Gastroenterologists in the city. GI CAT has all Foothills Medical Centre (FMC) Gastroenterologists (except Dr. Price) and all Gastroenterologists at South Health Campus (SHC). In regards to the Peter Lougheed Hospital it has all the Gastroenterologists (except Dr. Ma). Rockyview Hospital Gastroenterology group has never joined GI CAT since want their own practices where the referrals go directly to their office.

Whereas, Hepatology CAT contains all the Hepatologists within Calgary area.

What is available at the SHC in regards to outpatient GI & Hepatology Sevices? Located on the 7th Outpatient Floor is the GI and Hepatology clinic. It offers Gastroenterology or Hepatology assessments as well as Fibro scans, Sigmoidoscopy and Thin scope Endoscopy (TSE (non-sedated) within this outpatient unit. If a patient rd requires an endoscopic procedure (i.e. gastroscopy/colonoscopy) it is done on the 3 floor at SHC. Unique to SHC is the Calgary Gut Motility Centre which is located on the 6th Outpatient floor. 11 Page GI and Hepatology Outpatient Resident/ Clerk Service Reference Guide April 2017

What is the Calgary Gut Motility Centre? The Calgary Gut Motility Centre provides diagnosis and management of a comprehensive range of adult motility and functional disorders including:

. Esophagus (Achalasia, jackhammer esophagus, esophageal spasm, scleroderma esophagus, gastroesohageal reflux disease, Eosinophilic Esophagitis (EoE) . Stomach (Gastroparesis, Cyclical Vomiting Syndrome, Cannabis Hyperemesis, Functional or Non-Ulcer Dyspepsia, Rumination Syndrome) . Small Intestine (Intestinal Pseudo-obstruction, small bowel bacterial overgrowth, diabetic diarrhea) . Colon (Constipation, colonic inertia, microscopic colitis, Hirschsprung's disease post- surgery (adults only), functional diarrhea) . Anorectum (fecal incontinence, pelvic floor dyssynergia, anismus, obstructive defecation)

Capsule endoscopy Program: Video capsule endoscopy (VCE) is a powerful diagnostic tool that has proven especially useful in imaging the small intestine. VCE technology offers greater magnification than traditional endoscopy while also providing excellent resolution. It is a clinically useful tool for detecting occult bleeding and superficial lesions that are not radiographically observed; it may also provide functional information as the capsule moves passively through the small intestine. This service is available at SHC via referral to this program, when a gastroscopy and colonoscopy have not ruled out cause for the patients symptoms.

NAFLD program: NAFLD (non-alcoholic fatty liver disease) is the most common liver disease in Canada, occurring in up to 25% of the population. NAFLD is often associated with obesity, diabetes and/or hyperlipidemia, and results from accumulation of fat (triglycerides) within liver cells, which in turn can lead to liver damage. Due to large numbers of NAFLD on General Hep wait list, an existing program (IFLEW) that dealt with low risk NAFLD transitioned to deal with high risk NAFLD patients in ~ January 2017. As a result all NAFLD referrals are assessed for liver fibrosis (fibroscan or shear wave elastography) and if stiffness score > 8.0 Kpa they are brought to SHC NAFLD Multidisciplinary clinic for assessment/ treatment, If liver stiffness score <8.0 Kpa the patient remains in their medical home for management and care. Repeat non-invasive test for liver fibrosis is ordered q3 years. If no significant liver fibrosis suspected care remains in medical home

Nurse Navigator (NN) program: Innovative strategies to manage increasing wait times for common GI complaints is imperative, while maintaining high quality, patient-centered subspecialty care. This physician-lead, Nurse Navigator addresses key areas of need

within GI, with the goal being improved resource utilization, reduction of wait times and

better access to patient care. Presently some patients with GERD/ Functional 12 Dyspepsia and IBS may be managed thru this program. As a result of this program Page GI and Hepatology Outpatient Resident/ Clerk Service Reference Guide April 2017

management letters have been created to allow patients with IBS, Dyspepsia, GERD and/or chronic constipation to be managed in their medical home. If management fails in their medical home the physician is to make a referral to GI to return back into the NN program stream and/or receive Gastroenterologist assessment.

IBD program: Launched in ~ December 2016, SHC has a Nurse Clinician dedicated to assisting and help managing patients with IBD for all SHC Gastroenterologists.

Endoscopy Unit: Endoscopic procedures take place on the 3rd floor at SHC and residents/ clerks are encouraged to attend endoscopies on patients/consults they have seen. Although clerks are not expected to learn endoscopic interpretation or skills during this rotation, they should gain a basic understanding of indications and contraindications of routine procedures. ERCP (endoscopic retrograde cholangiopancreatography) procedures are performed at the PLC. With special arrangement, one may be able to observe some of these procedures during the rotation. Typically if there are no clinics scheduled for a morning or afternoon, the clerk is expected to go to the GI unit and observe endoscopies.

Topics: Clerks will be expected to distinguish the following conditions/symptoms and have an approach to:

Symptoms: - Upper and Lower GI Bleeding, - Abdominal Pain - Nausea/Vomiting - Diarrhea, - Dysphagia - Constipation - Weight loss - Jaundice - Ascites Conditions: - Peptic Ulcer Disease - Inflammatory Bowel Disease - Irritable Bowel Syndrome - Colorectal Cancer - Viral Hepatitis - Abnormal Liver Tests -

The clerk is expected to be competent to perform an abdominal exam and scrutinize for signs of liver disease.

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CALGARY WEBSITES THAT MAY INTEREST YOU

VISIT CALGARY WEBSITE (about Calgary)

• Website reviewing Calgary as well as surrounding area

• http://www.visitcalgary.com/

TOURISM CALGARY

• http://www.visitcalgary.com/explore-calgary

CALGARY ATTRACTIONS

• Website reviewing Calgary Attractions

• http://calgaryattractions.com/

CALGARY ATTRACTIONS COUPONS

• Website having coupons to common Calgary Attractions

• http://calgaryattractions.com/coupons/

TO OBTAIN BUS TICKETS TO TRAVEL AROUND CALGARY https://cityonline.calgary.ca/Pages/Category.aspx?cat=CITYonlineDefault&category=Ca lgaryTransitPassesTickets&gclid=CLOvmtOG-MwCFYqPfgodwGQEuw

• Tickets can also be purchased at many of the convenience stores such as 7-11, Mac’s as well as some pharmacies in Calgary . Rexall drug store located at South Health Campus sells bus passes.

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BED and BREAKFAST LISTINGS IN CALGARY

• If looking for a Bed and Breakfast to stay at, here is one

• http://www.bbcalgary.com/

HOTEL Across the street from South Health Campus

• COURTYARD MARRIOTT Calgary South (across the street from South Health Campus)3710 Market Street SE Calgary, AB. T3M 1M4 1-866-675-0411 or (587) 349-7599

o Marriott has AHS Corporate Room Rates to decrease the cost to stay at this Hotel (see attached Corporate rate information sheet that you may use while here at South Health Campus)

HOTELS in Calgary

o There are many hotels in Calgary depends where you would like to stay. If planning to stay near South Health Campus, there are hotels/ motels in Sundance/ Shawnessy area (which is ~ 15-20 minutes away by car)

o Here are some examples: . Super 8 Calgary Shawnessy (403) 254-8878

. Wingate by Wyndham Calgary South (403)-770-9073

o Off the Deerfoot Trail (about 15- 20 minutes by car)(north of South Health Campus on Deerfoot Trail)

. Deerfoot Inn and Casino (403)236-7529

. Service Plus Inns and Suites (403_256-5352

DRIVING TO SOUTH HEALTH CAMPUS

. The distance from Calgary Airport to South Health Campus is approx. 38 kms and depending upon traffic may take 30- 60 minutes.

. There are many car rental websites available, one that lists cars at the Calgary Airport is http://www.rentalcars.com/us/airport/ca/yyc/?affiliateCode=google&label=yyc- eRzv4RFI66VYsTotSDesuwS82866176787&ws=&gclid=CJ3Ej4nCgs0CFQqsaQ

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GI/ Hepatology Outpatient Clinic Map

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GI/ Hepatology Endoscopy Suite Map

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