Inventing the Future of Health Care

SUNNYBROOK Inventing the Future of Health Care 2009 LEADING THROUGH Code STEMI: INNOVATION Saving Hearts Around the Clock BUILDING CANADA’S MOST COMPREHENSIVE Confronting BREAST CENTRE Everyday Tragedies in the TRAUMA ROOM The Holland Centre’s New UNDERSTANDING Model for Hip Anxiety Disorders and Knee Care SUNNYBROOK GOES GREEN

ONE NIGHT LIVE™ Raises Funds for Women & Babies

A HAVEN FOR VETERANS: The Dorothy Macham Home Dr. Sam Radhakrishnan, Schulich Heart Centre Interventional Cardiologist and Sunnybrook’s Physician Lead on the Code STEMI Project A Message from Board Chair David A. Leslie and President and CEO Barry A. McLellan

It is our pleasure to share with you the fifth the future home of the Women & Babies edition of Sunnybrook Magazine. Program, including a state-of-the-art Neonatal Intensive Care Unit and expanded The theme for this year is Sunnybrook inno- capacity for labour and delivery. In addition, vation. Our stories reflect how the Hospital it will house Canada’s largest and most com- is making strides across the organization by prehensive Breast Centre, and new facilities developing innovative approaches to teach- for leading-edge research in cardiac imaging ing and research, ensuring the hospital has and intervention. a sustainable future and is accountable to the many communities we serve. Each ele- Sunnybrook’s vision is to invent the fu- ment contributes to quality patient care that ture of health care. In partnership with the is at the foundation of Sunnybrook; we are University of Toronto, Sunnybrook leads by there for our patients and their families when discovery, innovation, teaching and learn- it matters most. ing. At Sunnybrook, we are fortunate to have dedicated staff, physicians, volunteers and Within the pages of this publication, you students who are committed to the one mil- will read articles that reflect Sunnybrook’s lion patients who look to Sunnybrook each new four Strategic Priorities (Cancer, year for care and their extraordinary work is Heart and Stroke, High Risk Maternal and expressed within these pages. Newborn Health, and Major Trauma) and our seven programs: Brain Sciences; We would like to thank you for your support Holland Musculoskeletal (orthopaedic and and partnership as we continue to build our arthritic); Odette Cancer Centre; Schulich organization. As members of our commu- Heart Centre; Trauma, Emergency & Critical nity, you are an integral part of how we will Care; Veterans & Community and Women achieve success. & Babies. We are very proud of all our programs, and how the organization is improving patient safety, becoming more accessible to Sincerely, the needs of elderly patients, and developing a strategy for ambulatory care. Our stories also demonstrate how Sunnybrook innovation is significantly impacting patients’ David A. Leslie lives during and after their time with us. Chair, Board of Directors

During this past year, we’ve made great progress with our construction. Our Emergency Department is double the size of the old department and its many innovations, in- Barry A. McLellan cluding a new triage and minor treatment President & CEO area, will help to improve patient flow at the hospital. Our expanded M-Wing will be Contents

in•no•va•tion Understanding Anxiety Disorders 32 Caring for Your Mind and Brain: The Brain Sciences Program 33 in-uh-vey-shuhn –noun Sunnybrook Welcomes Members of Provincial Parliament 1. Something new or different introduced 34 2. The act of innovating; introduction of new things At the Heart of the Matter: Katie Crozier Gives or methods Back to the Schulich Heart Centre EVAR Program 35 The Greening of Sunnybrook 36 Harry Taylor 37 A Message from Board Chair David A. Leslie and Making Sunnybrook More Accessible 37 President and CEO Barry A. McLellan 2 Sound Strategy and Financial Management Helps Caring for Vulnerable Babies and Their Families: Sunnybrook Invent the Future of Health Care 38 Sunnybrook’s Neonatal Intensive Care Unit 4 Sunnybrook One of The GTA’s Top Employers for 2009 39 One Night Live™ Concert Event a Great Success 5 Committed Donors Michael and Marilena Latifi see the Impact Code STEMI: Saving Hearts Around the Clock 6 of their Support for the Women & Babies Program 40 The Trauma, Emergency and Critical Care Program: The ABCs of Nursing 42 Interprofessional Team Confronts Everyday Tragedies 7 Sunnybrook’s Odette Cancer Centre Offers Less Invasive Provincial Colorectal Cancer Screening Progam Led by Sunnybrook Treatment Approaches for Men Diagnosed with Prostate Cancer 43 Scientist a Canadian First 8 Infection Reduction “In Hand” 44 Patient Safety Walk-Arounds Prompt Innovative Thinking and Change 9 Improving Access to Cutting-Edge Vascular Care 45 A Haven for Veterans and their Families: Anesthesiologist Leads Innovative Efforts in Pain Control 46 The Dorothy Macham Home 10 Veteran Profile: Murray Westgate 47 Schulich Scientist Develops a Method of Access Through Dense Artery Blockage 11 Life in the Balance 12 On the cover The Holland Centre’s New Model of Hip and Dr. Sam Radhakrishnan is photographed in Sunnybrook’s Imaging Research Knee Care Fulfilling Patients’ Needs 13 Centre for Cardiac Intervention (IRCCI), a state-of-the-art imaging centre that brings together the latest in innovative imaging technology with the best minds Sunnybrook to Build New Breast Centre 14 in clinical care and research. Uniquely designed to combine multiple medical imaging modalities, it is a Canadian first. The Code STEMI story is on page 6. Sunnybrook: An Elder-Friendly Hospital 16 Groundbreaking “eSheet” Web Technology to Benefit Patients and Staff 17 Editor: Christine Henry Interprofessional IPPOD Team Works to Prevent Delirium in Older Patients 18 Writers: Nadia Norcia Radovini, Natalie Chung-Sayers, Laura Bristow, Laurie Legere, Sandeep Deol, Christine Henry, Teams From Across the Hospital Act to Improve Patient Flow 19 Craig DuHamel, Sally Fur, Jim Oldfield, Megan Easton, Angela Bianchi, Susan Pedwell, Laura Pratt, Nekeisha Mohammed, The Sunnybrook Veterans Centre 20 Bill Saunders, Alisa Kim Sunnybrook Partners with Telus 21 Published by: The Communications & Stakeholder Relations Predicting a Healthy Pregnancy 22 Department (Public Affairs) at Sunnybrook Health Sciences Centre Benefits of New Therapy for Acute Lung Injuries 23 Photography: Media Source Construction Projects at Sunnybrook 24 (Doug Nicholson, Dale Roddick, Randy Bulmer) Partners in Veterans Care 26 Art Direction and Design: Media Source (Andrea Dixon) Veteran Profile: Clifford Guest 27 All Correspondence: Sunnybrook’s Early Fetal Ultrasound Service Sunnybrook Health Sciences Centre Detects Potential Prenatal Problems 28 2075 Bayview Avenue, Room D100 Sceening for Osteoporosis 29 Toronto, ON M4N 3M5 [email protected] An Increased Focus on Patient Safety 30 www.sunnybrook.ca Sunnybrook’s Double “Win” of Expertise in Infectious Diseases, and Infection Prevention and Control 31 © 2009 Sunnybrook Health Sciences Centre

Sunnybrook Magazine 2009 3 Caring for Vulnerable Babies and Their Families: Sunnybrook’s Neonatal Intensive Care Unit

Amy is now a thriving eight- year-old who plays piano and dances competitively, but her parents have never forgotten the care she received as a baby

Amy Evanoff, NICU graduate, with her parents Dianne and Graham

fter Amy Evanoff was born at just 26 for high-risk infants who have a serious ill- Reilly to this day. “Their continuing gratitude weeks gestation, her mother, Dianne ness and/or who are born extremely prema- makes me realize that every little thing we do A Evanoff, kept a diary of the key ture, and it will soon have expanded capacity for these families means something,” says events in her daughter’s life in Sunnybrook’s (see sidebar). “We care for the smallest and Reilly. “We have such an important job.” ME Neonatal Intensive Care Unit (NICU). There the sickest babies,” says Maureen Reilly, a were many small triumphs to record dur- NICU respiratory therapist. She remembers ing Amy’s almost two-month stay, but the the day when Amy was stable enough to be events of March 8, 2001 stood out from all held. “The first time a mom or dad holds a the rest. baby always strikes me, because it’s such a lovely moment.” The Move to Bayview “1:30: I was ready,” Evanoff wrote on the long-awaited day when she was finally able While some babies stay only a few days in to hold Amy in her arms – three weeks after the NICU, others such as Amy live there for Sunnybrook will soon have expanded her birth. “Graham was there with the cam- several months. The NICU team helps fami- capacity to care for some of Ontario’s era in hand. I held that baby from 1:45 to lies stay optimistic with holiday parties, cel- most high-risk pregnancies and 3:30.” Looking back now, she says that day ebrations on Mother’s Day and Father’s Day, critically ill newborns. The new home will live in her memory forever. and special acknowledgment for milestones of the Women & Babies Program is such as the “Kilo Club,” when babies reach When Evanoff, a Toronto-area teacher, went the one-kilogram mark. “These parents trust currently under construction with into labour more than three months before us with their babies’ lives,” says Reilly, “and a scheduled occupancy date of fall her due date, she was airlifted to McMaster we often develop a special bond.” 2010. There will be a state-of-the-art, Children’s Hospital in Hamilton, Ontario. family-centred Neonatal Intensive Amy was transferred to Sunnybrook’s Level Amy is now a thriving eight-year-old who Care Unit (NICU) with 48 beds, up III neonatal nursery two days after she was plays piano and dances competitively, but from the current 41. Each baby will born, weighing in at less than two pounds. her parents have never forgotten the care have his or her own room in the unit, she received as a baby. For several years, Sunnybrook is one of three centres in they made visits to the NICU with Amy to giving families greater privacy and Ontario’s central east region with a nursery see the staff, and they keep in touch with comfort during a stressful time.

4 Sunnybrook Magazine 2009 One Night Live™ Concert Event a Great Success

ore than 11,000 supporters of Sunnybrook’s Women & Babies MProgram attended One Night Live™ presented by Sun Life Financial, on May 21, at the Air Canada Centre. The concert fea- tured performances by world-renowned artists Sting, Sheryl Crow and The Canadian Tenors and was hosted by Chris Noth, Mr. Big from Sex & the City. The concert raised more than $2-million to support the construction of a new home for the Women & Babies Program that will include two new floors for births, high-risk pregnancies and critically-ill newborns.

World-renowned artists Sting and Sheryl Crow with event host actor Chris Noth and the Canadian Tenors at the concert on May 21 (Photos by Aric Guité)

Live to Tell With Sheryl Crow

On May 20, singer and breast cancer survivor Sheryl Crow performed for 500 Sunnybrook supporters at Live to Tell: Up Close and Personal with Sheryl Crow at the Angus Glen Golf Club. The event was hosted by former MP and breast cancer survivor The Honourable Belinda Stronach. The concert helped raise $375,000 in support of the new Breast Centre.

Sheryl Crow on stage at Live to Tell; with event host The Honourable Belinda Stronach (Photos by Flow Photos)

Sunnybrook Magazine 2009 5 Saving Hearts Around the Clock

in the field and directly transport patients to angioplasty centres such as Sunnybrook, saving valuable time and further improving outcomes. “Because of the Code STEMI initiative, I received the right care, in the right place, at the right time and my quality of life has returned to normal,” says Jamison. “That’s pretty lucky if you ask me.” LL

Here is how a Code STEMI works:

• A patient with chest pain calls 911. • An ambulance crew of advanced- care paramedics arrive at the scene. • Advanced-care paramedics obtain Terry Jamison, the first patient in Toronto to benefit from the Code STEMI Transfer Program for emergency angioplasty a targeted history from the patient and use an electrocardiogram ot many people would describe heart attacks, strokes, in-hospital length of (ECG) to determine if something is the day they had a heart attack as stay and costs. wrong. N “lucky,” but that’s exactly how Terry Jamison tells the story. The 65-year-old Ajax Jamison had his heart attack on the very first • If a STEMI (a type of heart resident and owner of a home-improvement day Sunnybrook launched “Code STEMI” attack) is confirmed, paramedics company was visiting a client in North York a new partnership with NYGH and Toronto call Sunnybrook’s Cardiac Care on Dec. 10, 2007 when he began to per- EMS co-ordinating services to offer emer- Unit (CCU) using a dedicated spire and felt a tingling sensation radiate gency angioplasty to patients presenting to STEMI hotline and relay the vital down his left arm. NYGH with a STEMI. This initiative was the information to a CCU nurse. first of its kind in Toronto. • A Code STEMI is immediately “I had no idea that I had been walking around with coronary heart disease and was at risk “Terry was the first patient in the city to ben- triggered at Sunnybrook, which for a heart attack but as soon as I felt that tin- efit from the Code STEMI Transfer Program activates catheterization laboratory gle, I knew what was happening and called for emergency angioplasty and it’s rewarding team members (interventional 911,” recalls Jamison. to see how well he’s done,” says Dr. Sam cardiologists and nursing staff). Radhakrishnan, interventional cardiolo- • The patient arrives at Sunnybrook Toronto Emergency Medical Services gist and physician-lead of the Code STEMI and is taken to a prepared cath lab (Toronto EMS) brought Jamison to the clos- project. where an emergency angioplasty est hospital – North York General Hospital (NYGH). Medical staff confirmed he was “What’s really exciting is that there now ex- is performed. Through a small having a STEMI (ST-elevation myocar- ists a co-ordinated collaboration between catheter inserted into the patient’s dial infarction) and immediately sent him to Toronto EMS and four heart centres to pro- wrist or groin, a balloon and stent Sunnybrook for emergency angioplasty. vide this cutting-edge care to virtually all are positioned at the site of the STEMI patients in the city 24-7,” says Dr. blocked heart blood vessel (artery) “I found out later that if I had this type of heart Radhakrishnan, who is also an assistant causing the heart attack. The attack before that day, I would have been professor of medicine at the University of balloon and stent are expanded to kept at the first hospital on clot-busting drugs Toronto. “This is fantastic news for heart at- [thrombolytic] until a bed opened up and I tack patients in the city, and the true credit open the blocked artery, restoring could be transferred to a larger centre like for the success of this program goes to the normal flow of blood and oxygen Sunnybrook’s Schulich Heart Centre for the efforts of the entire team: paramedics, the to the heart and stopping the heart angioplasty I needed,” says Jamison. cath lab and recovery critical care and ward attack. staff at each hospital.” • Following the angioplasty, the The benefits of angioplasty, compared with patient is transferred to a CCU bed therapy that uses clot-busting drugs alone, In addition to providing transfer services, at Sunnybrook for monitoring and include a reduction in: death rates, recurrent Toronto EMS is now able to diagnose STEMIs nursing care.

6 Sunnybrook Magazine 2009 The Trauma, Emergency and Critical Care Program: Interprofessional Team Confronts Everyday Tragedies

oan Digaetano arrived at Sunnybrook’s Emergency Department on a bitterly cold Jday in November 2005 after hearing that her 20-year-old daughter Rhiannon Rucas had been in a car crash. Dr. Fred Brenneman, medical director of Trauma Services, came out to tell her that Rucas had lost one leg and was in danger of losing the other. “I just fell to the ground,” recalls Digaetano.

Despite the nightmare of those first few days of a two-month-long stay at the hospital, Digaetano says she will never forget the personal warmth and professional excellence of the many people involved in her daughter’s care. “The whole trauma team was amazing. The crisis counsellors who met me at the door after the first time I was allowed to see Rhiannon, the nurse who stayed past the end of her shift to be with Rhiannon, Dr. Brenneman taking the time to talk to me and tell me that she was going to be OK, the surgeons explaining everything – they were all amazing.”

Keeping families informed is crucial, says Dr. Brenneman, who is also an associate professor of surgery at the University of Toronto. “The traumatic injury is always unexpected, and there is often a lot of uncertainty around outcomes, long-term disability and, sometimes, survival.”

Sunnybrook’s Trauma, Emergency and Critical Care program uses an interprofessional model of care that has been emulated internationally. Within the first few hours of arrival, a trauma patient may see up to 30 different special- Rhiannon Rucas, who was treated at Sunnybrook after a serious car crash in 2005 ists whose combined expertise increases the chances of survival and ultimate quality of life. “I take pride and comfort in knowing that each patient receives the best possible trauma care in the world at Sunnybrook,” says Trauma at Sunnybrook After recent renovations, the Emergency Dr. Brenneman. Department and Tory Regional Trauma Sunnybrook’s trauma service is the Centre have expanded. With additional Dr. Hans Kreder, program chief of oldest and largest trauma program in medical imaging equipment, state-of- Sunnybrook’s Holland Musculoskeletal Canada. Since it was launched in 1976, the-art infection prevention capability, Program and associate professor of surgery more than 20,000 trauma patients more stretcher bays and a new trauma at U of T, was able to save Rucas’s remain- have received care at Sunnybrook with room, the revamped facility will further ing leg after several surgeries. “Every time I’m an overall survival rate of 89 per cent. enhance Sunnybrook’s capacity to care for at Sunnybrook I go to see him,” Rucas says. In the past five years, the survival rate Ontario’s most critically ill and injured “Words cannot describe what he and his team has increased to 91 per cent. did for me.” ME patients.

Sunnybrook Magazine 2009 7 Provincial Colorectal Cancer-Screening Program Led by Sunnybrook Scientist a Canadian First

The findings underscored powerfully the need for social marketing campaigns to raise the public’s awareness of colorectal cancer

Dr. Linda Rabeneck

fter decades of treating patients, Dr. dents aged 50 years and older were with the Designed to reduce colorectal cancer Linda Rabeneck decided to combat fecal occult blood test (FOBT), a screening deaths by increasing the rate of early de- A colorectal cancer at its most critical tool for colorectal cancer that detects micro- tection, the five-year, $193-million program point: before it appears. scopic blood in the stool. They found that funds the screening of Ontario residents only one-half of the respondents knew about aged 50 to 74 years with no family history of Working with a team from Cancer Care the test. Moreover, only 17 per cent were the disease, using the FOBT. The program Ontario, Dr. Rabeneck made the case for an willing to take it. also funds colonoscopy screenings of peo- organized provincial screening program and ple with an immediate relative who has had public education campaign to fight colorec- “The findings underscored powerfully the colorectal cancer. tal cancer. Dr. Rabeneck, who is a senior need for social marketing campaigns to scientist at Sunnybrook Research Institute raise the public’s awareness of colorectal First made available in April 2008, FOBT kits (SRI) and Chief of Sunnybrook’s Odette cancer – how common it is in our country, are distributed free by health-care provid- Cancer Centre, marshalled compelling evi- in our province—and [the existence of] ef- ers across Ontario. So far, Ontario residents dence from scientific publications and her fective screening tests that can and should have completed tens of thousands of the own research. be used,” says Dr. Rabeneck, who is also kits, and have sent them back to designated a professor of medicine at the University of labs for testing. Says Dr. Rabeneck: “It has Despite the fact that colorectal cancer is cur- Toronto. been very rewarding to be part of the initia- able if detected early, it remains the second tive. It’s not fully implemented yet, but as we leading cause of cancer death in Canada. In 2007 the Ontario government, in move forward we have no doubt that we will

This year, about 9,100 Canadians will die partnership with Cancer Care Ontario, be saving lives from this cancer.” AK from the disease, a bleak statistic confirming launched ColonCancerCheck, the first that many of the diagnoses are being made province wide colorectal cancer-screen- far too late. ing program in Canada. Dr. Rabeneck is ColonCancerCheck’s clinical lead and In a 2004 study, Dr. Rabeneck and her col- chairs the Clinical Advisory Committee. More information about the FOBT is legues examined how familiar Ontario resi- available at www.coloncancercheck.ca.

8 Sunnybrook Magazine 2009 Patient Safety Walk-Arounds Prompt Innovative Thinking and Change

Other Innovative Patient Safety Initiatives at Sunnybrook:

• An industrial engineering student is working with the Performance Improvement team to decrease the time it takes for blood specimens to reach the labs. Analyzing this process through an engineering lens is valuable in identifying process improvements. This project, which involves many health-care team members, seeks to improve the turnaround time of blood-test results. • To reduce potential errors, oxygen and air valves in patient rooms are being marked in a more distinguishable manner to prevent identification errors. • For implementing bar-coding as part of the identification and matching process, Dr. Jeannie Callum and her team in the blood-transfusion project and Dorothy Dougherty, registered nurse, in the Women & Babies Program (for identification of breast milk) have received award-winning results.

ince 2005, Sunnybrook has been on actions and progress is important. Such • Nursing staff needed to understand how conducting patient safety walk- communication builds trust and shows that to initiate contact with the Rapid Response S arounds in patient care areas as patient safety is and will remain a high priority Team when a patient is rapidly failing. Dr. a way to improve safety for patients. This for the organization. Martin Chapman, intensivist, met with staff activity also allows senior leaders and front- to explain the role of the Rapid Response line staff to exchange ideas and information “Walk-arounds are not only an opportunity to Team. about safety-related issues. fix issues. They also strengthen the commu- • One of the participating units noted that nication between senior level managers and IV poles were not strong enough to hold Patient safety walk-arounds are conducted the bedside staff who work in the reality ev- multiple pumps – in particular the newer every other week with an interdisciplinary ery day,” says Ru Taggar, director of Quality pumps. Ten new IV poles were obtained team. An assigned senior leader guides dia- & Patient Safety at Sunnybrook. “They bring for that unit and the older poles were logue with staff using questions designed to to light examples of the things that can im- removed. focus on patient-safety issues. These ques- pact a work environment, but that are fixable tions stimulate discussion and encourage and are not necessarily that costly to fix.” “Looking at the smaller issues that impede participants to share their concerns about staff is so critical to providing consistently patient safety as well as their suggestions for Of the recommendations that have been good care,” says Alison Welch, chief finan- improvement. During the walk-around, staff brought forward since 2005, a 70 per cent cial officer at Sunnybrook. “This ideology is are asked to select three key issues that, completion rate has been achieved with over continuing to spread throughout the hospi- if addressed, would improve the safety for 100 recommendations implemented. tal, evolving the culture of patient safety that their patients. The senior leader who con- we have at Sunnybrook.” LB ducted walk-arounds is then responsible for Examples of some recommendations that following-up with the most appropriate peo- have been addressed: ple to resolve the issues that were raised. • Oral liquid potassium chloride 15mL and multivitamins 15mL had similar labels and Some issues might take longer to be re- packages which made it difficult to tell solved than others; therefore providing timely them apart. Pharmacy now differentiates feedback to the front-line staff and managers these by manually highlighting the potassium chloride label in yellow.

Sunnybrook Magazine 2009 9 A Haven for Veterans and Their Families: The Dorothy Macham Home

The first facility of its kind in Canada, the Dorothy Macham Home opened in 2001 with funding from Veterans Affairs Canada

Dr. Jocelyn Charles with nurses June Chan-Tse and Perlita Garcia

hether they are baking bread in Veterans stay for however long they need in fences, which could be disturbing to former the comfortable kitchen, visiting this special environment – which is different prisoners of war. W with family around the fireplace from most behaviour units across Canada.” or taking a quiet walk in the garden, the A comprehensive evaluation showed the residents of the Dorothy Macham Home at At the Macham Home, which has 10 private Macham Home has been highly successful Sunnybrook Health Sciences Centre enjoy bedrooms and accepts residents based on in reducing challenging behavioural symp- all the comforts of home. Yet they also ben- need, an interdisciplinary team creates in- toms in its residents, while also producing efit from leading-edge care in an innovative dividualized care plans aimed at minimizing a significant decline in incidents involving facility designed specifically for Veterans with frustration and confusion in residents’ daily disruptive behaviour and aggression in the challenging behaviours due to dementia. lives. “When people lose cognitive ability, regular long-term care units. “It’s a win-win they’re not able to express their needs, to situation,” says Dr. Charles, “and it furthers “When you walk in the door, it doesn’t feel tell the people around them that they’re in our goal of improving the quality of life of all like an institution or a hospital,” says Sue pain, hungry, cold, lonely or disoriented. So our Veterans.” Whittick, whose father, Douglas Woodall, is they feel frustrated a lot of the time,” says Dr. among the current residents in the Macham Charles. “When staff really get to know the Whittick says her father has responded ex- Home. Woodall, a former RCMP officer and residents and learn to recognize changes in tremely well to the Macham Home’s unique owner of a successful insurance restora- their facial expressions and body posture, model of care. “He’s much better now. He’s tion business, began experiencing severe they can respond to the underlying needs very, very comfortable there,” she says. “The dementia five years ago at age 77. He lived and decrease the disruptive behaviour.” Staff nurses are phenomenal, and you can clearly in Sunnybrook’s Cognitive Support Unit members also know how to recognize and see the evidence of their knowledge, be- until he began having aggressive outbursts avoid the triggers of post-traumatic stress cause the place is different from anywhere which led to a referral to the Macham Home disorder, which affects many Veterans. else. But it’s not just their education, it’s their for specialized care. compassion.” In addition to specially educated staff, the The first facility of its kind in Canada, the physical environment in the Macham Home Staff members accompany Woodall on Dorothy Macham Home opened in 2001 plays a pivotal role in diminishing challenging outings geared to his long-time passions, with funding from Veterans Affairs Canada. behaviour associated with dementia. It looks whether it’s a fishing trip or a visit to the “We were seeing an increased prevalence and feels like a home, which provides crucial horse stables on Sunnybrook’s grounds. of dementia in our long-term care facility, familiarity to the Veterans, but it also boasts Residents also have access to art, music while also recognizing that some Veterans state-of-the-art design features. There and recreation therapists on staff, with a with dementia had aggressive or disrup- are floor sensors in the bedrooms to alert pharmacist, physical therapist, occupational tive behaviour,” says Dr. Jocelyn Charles, nurses to wandering residents, who can therapist, pastor, social worker and geriatric medical director of the Veterans Centre at sometimes spark conflict. An internal wan- psychiatrist available as needed. “I wish there Sunnybrook. “We decided that they needed dering path away from the bedrooms allows were Dorothy Macham Homes right across a special therapeutic environment where residents to walk without mistakenly entering Canada for all seniors with dementia,” says staff were trained to respond to their needs the wrong room. The doors that are off-limits Whittick. “They all deserve that level of care.” in a way that would reduce those behav- are camouflaged to prevent feelings of con- ME iours. It’s a different model of care because finement. And the gardens have no visible

10 Sunnybrook Magazine 2009 Schulich Scientist Develops a Method of Access Through Dense Artery Blockage

Dr. Bradley Strauss is a clinician-scientist through treating arteries that are narrowed in the Schulich Heart Research Program but not fully blocked. As such, CTO patients at Sunnybrook Research Institute and a are usually referred for more invasive bypass professor in the Department of Medicine at surgery or treated with medications and the University of Toronto. He is also forging forced to live a restricted lifestyle. paths that have stymied those who came before him. Dr. Strauss’s development is impressive because there typically isn’t room to draw a Dr. Strauss has devised a method of life-sav- wire through a CTO because the blockage is ing access through an otherwise inpenetra- too solid. “There’s no space,” he says. “The ble passage called a chronic total occlusion stuff blocking the artery is often like cement, (CTO). Chronic total occlusions are coronary and you can’t get the wire through.” arteries that have been totally blocked for at least six weeks, and they are notoriously Up until now, technicians bent on solving resistant to thoroughfare. Strauss’s inno- the CTO dilemma have concentrated their vation involves the injection of an enzyme efforts on mechanical solutions by devel- called collagenase into the occlusion to oping stronger, more deliberate guidewires. soften the dense blockade of collagen Dr. Strauss’s softening effect is a biological that has entirely obstructed the artery. solution that allows a physician to pull an angioplasty guidewire across the occlusion A major cardiovascular problem, CTOs successfully, without damaging any of the are relatively common. About 30 per normal layers of the blood vessel. cent of coronary angiograms and 50 per cent of leg angiograms reveal CTOs Dr. Strauss, who holds the Reichmann in patients. These medical conditions fre- Chair in Cardiovascular Sciences at quently cause major cardiac symptoms in Sunnybrook’s Schulich Heart Centre their victims, including chest pain and short- and is director of interventional cardiol- ness of breath, and likely contribute to de- ogy research at the hospital, is poised to creased survival. Additionally, they’re not well test a collagenase formulation in a clinical understood by the general public and are trial–the first of its kind in the world. This very difficult to treat. Angioplasty success research chair was generously funded by rates in coronary CTOs are around 50 per Paul and Lea Reichmann and will be an in- cent, far lower than the 95 per cent achieved tegral part of redevelopment of The Schulich

Heart Centre. LP

Some Facts About Chronic Total Occlusions:

• A chronic total occlusion (CTO) is include nitrates, calcium and beta- an artery that has been completely blockers). blocked for at least 60 days. • Fewer than 10 per cent of CTO • CTOs account for between 20 - 30 cases are managed by percutaneous per cent of current coronary disease intervention, about 25 per cent are cases. They are found in 20 - 30 per managed by surgical means and 65 per cent of all angiograms. They can cent are controled by medications alone. occur in isolation, or there might be • The procedure takes between 45 minutes blockages in the other arteries. and three hours to complete. • There are three methods of treating • The guidewire technique is successful 50 CTOs: percutaneous intervention - 60 per cent of the time. (in which doctors use conventional • There is evidence that opening up guidewire techniques to poke their CTOs significantly improves patient way through a blockage), coronary symptoms, can improve the function Dr. Bradley Stauss artery bypass surgery and medical of the heart and may even prolong management (drugs to treat CTOs survival.

Sunnybrook Magazine 2009 11 Life in the Balance Ten Years and Two Trials Bring Sunnybrook Researchers to the Brink of New Guidelines for Preterm Birth

Dr. Elizabeth Asztalos

“negative trial” – when a treatment outcomes. Moreover, the treatment was as- This long-term study is essential, says Dr. under evaluation fails to provide the sociated with significantly less fetal growth: Asztalos, because “we’re very concerned A outcomes that researchers were infants weighed less, were shorter and had about what the effect of steroids may be on expecting–can still positively affect clinical smaller heads. the brain, and we may not see those effects care. The MACS study (Multiple courses of until a child is older.” Rigorously compiled Antenatal CorticoSteroids for preterm birth), The study raised a red flag for clinicians, evidence from MACS-5, together with re- results of which researchers at Sunnybrook many of whom were prescribing multiple sults from an ongoing six-year Australian trial, and other Canadian hospitals published in courses of steroids, and spawned a critical promise to secure the answers. “The results 2008, is a case in point. research question: if biweekly doses can of those two trials should provide the evi- hinder fetal growth, could they impair long- dence that clinicians and their organizational Corticosteroids, when given in a single term neurological development? The answer bodies need to draft new clinical guidelines,” course to mothers at risk of giving birth lies, partly, in MACS-5, a five-year follow up says Asztalos. too early, dramatically and safely reduce study underway at Sunnybrook Research illness and death in preterm infants. But, Institute’s Centre for Maternal, Infant and The need for new guidelines is pressing: evidence shows benefits are reduced if the Child Research. between seven and 10 per cent of births in mother does not deliver within seven to 10 North America are preterm, and account for days of treatment. For these women, some Led by Dr. Elizabeth Asztalos, director of 75 per cent of newborn babies’ deaths. “If studies suggest possible benefits in addi- the centre and an associate professor at we don’t give some definitive answers about tional courses of antenatal corticosteroids. the University of Toronto, MACS-5 will enroll the long-term effect of the medication on the However, pre-clinical research also sug- about two-thirds of the 1,900 women who children, we won’t be able to say whether it’s gests potential for harm. MACS research- participated in MACS. The study will com- good, bad or doesn’t do anything,” says Dr. ers sought to determine if antenatal steroids pare the vision, hearing, motor and cogni- Asztalos. JO given every two weeks would confer benefit tive skills of the five-year-old children whose without harm; instead, they found that bi- mothers received multiple courses of ste- Results of MACS-5 should be available in weekly courses did little to improve babies’ roids with those whose mothers received a 2011. The trial is funded by the Canadian single course. Institutes of Health Research.

12 Sunnybrook Magazine 2009 The Holland Centre’s New Model of Hip and Knee Care Fulfilling Patients’ Needs

Key Elements of the Holland Centre Hip & Knee Arthritis Program • Central intake and referral management • Advanced practice physiotherapists • Assessment centre • Surgeon consult • Post-operative followup

Hip & Knee Arthritis Program Benefits for Patients • Shorter wait times • Choice of surgeon or next available appointment • Prompt assessment • Education and community resources • Access to appropriate services sooner

“As a potter, I have to lift boxes of clay that confirmed that she qualified for a knee re- Following surgery in January 2008, Marcia weigh about 22 kilograms per box,” says placement. At the HKAP’s assessment scheduled physiotherapy sessions and Marcia. “Lifting the box and going down centre, advanced practice physiotherapists visited the post-operative follow up clinic at stairs was becoming very difficult, and I was now triage and prioritize all incoming referrals the Holland Centre to assess her progress never sure of my footing. When I was having and are the first point of contact for patients after surgery. “By the end of April, I could a bad knee day, my family definitely noticed referred with hip or knee pain – a role that work again and move about normally. I had that I wasn’t a happy camper!” was traditionally fulfilled by an orthopaedic stopped using pain medication fairly quickly, surgeon. Preoperative assessment, educa- and by the six-month mark after surgery I In September 2007, Marcia visited tion and follow up care after discharge from was totally happy,” laughs Marcia. “The staff Sunnybrook’s Holland Centre Hip & Knee the hospital is also now largely provided by at the Holland Centre was very thorough and Arthritis Program (HKAP) following a refer- advanced practice physiotherapists. helpful.” ral from her family doctor. In support of the Ministry of Health and Long-Term Care’s pri- Within eight weeks of her initial referral to In its efforts to continue providing the best pa- orities for improved access and reduction in the Holland Centre, Marcia met with an tient care possible, the Holland Orthopaedic wait times, the HKAP provides prompt ac- orthopaedic surgeon. After her surgical & Arthritic Centre is currently developing cess, triage and assessment. The HKAP is consultation, she was scheduled for knee- partnerships with a number of community based on a centralized intake and assess- replacement surgery less than six months organizations that offer programs for patients ment model where patients have the op- later. The staff at the Holland Centre pro- with arthritis, including the YMCA and the tion of requesting a specific surgeon or ac- vided Marcia with educational resources to Arthritis Society. SD cepting the first available appointment with help her prepare for surgery, including web- any one of the surgeons on the health-care based information and print booklets such Marcia has benefited from the new Model of Hip and Knee team. The program is part of the Toronto as A Guide for Patients Having Hip or Knee Care at the Holland Centre Central Local Health Integration Network. Replacement, which acts as a guide before surgery, during hospital stay and throughout On her first visit, Marcia met an advanced recovery. “I knew exactly what I was going to practice physiotherapist and a nurse who go through,” says Marcia.

Sunnybrook Magazine 2009 13 Sunnybrook to Build New Breast Centre

Dr. Eileen Rakovitch with Marguerite Ward

he Sunnybrook Breast Centre will help research including breast cancer preven- Brief highlights of breast cancer thousands of women with breast can- tion, early detection, clinical trials and psy- T cer, as well as those at risk of develop- chosocial research to find better treatments research conducted by ing the disease. that improve the survival and quality of life for Sunnybrook researchers: women with breast cancer.” To be located in the newly expanded • Hormone replacement therapy in M-Wing at Sunnybrook’s Bayview cam- “We are also extremely active in leading women with BRCA1 mutations pus, the Breast Centre will be a world-class breast cancer research that provides more shown to not lead to an increased breast centre that will provide: tailored treatment to the individual to help improve quality of life,” says Dr. Rakovitch, risk of breast cancer • leading technology in breast imaging associate professor in the Department of – Dr. Andrea Eisen to improve the early detection of breast Radiation Oncology at University of Toronto. cancer; “For example, we are conducting research • Magnetic resonance imaging for • expanded clinical space to improve into innovative and more effective radiation earlier and better detection of breast breast cancer care; treatments with reduced treatment time, cancer in women with BRCA1 and • expanded breast cancer research. more minimally invasive, image-guided BRCA2 mutations breast-conserving surgery, novel drug thera- Longer-term plans for the Breast Centre in- pies more tailored to the individual, and re- – Dr. Ellen Warner and clude a Rapid Diagnostic Assessment Unit search into imaging technologies for more Dr. Don Plewes for women with suspected disease and ex- accurate and early detection, and for rapid panded resources to screen women. tracking of individual treatment response.” • The role of HER-2 and topoisomerase II alpha as predictors “The Breast Cancer Care Program at The Breast Cancer Care Program at of response to chemotherapy Sunnybrook is a fully comprehensive pro- Sunnybrook offers care to over 2,500 wom- – Dr. Kathleen Pritchard gram,“ says Dr. Eileen Rakovitch, chair, of the en a year who are newly diagnosed with Breast Cancer Care Program, Sunnybrook‘s breast cancer and accommodates about Odette Cancer Centre. “We are very for- 20,000 patient visits per year related to • The benefits of surveillance tunate to have a team of dedicated physi- breast care. NCS mammography after treatment of cians and scientists who are international primary breast cancer leaders in the full spectrum of breast cancer – Dr. Lawrence Paszat

14 Sunnybrook Magazine 2009 Sunnybrook Magazine 2009 15 Sunnybrook: An Elder-Friendly Hospital

Sunnybrook has a distinguished history in caring for the elderly, and this tradition continues today. Here are four innovative programs designed to meet the needs of the growing senior population

IMPACT Clinic In order to develop optimal models of care Then, as needed, the other team members Outside on the putting green, a recreational for seniors with multiple chronic illnesses, meet with the patient and family to complete therapist introduces new leisure skills or re- Sunnybrook’s Department of Family and further assessments and/or review their ob- introduces activities the seniors once en- Community Medicine has created the servations and recommendations. For ex- joyed but have since given up. And in the Interprofessional Model of Practice for Aging ample, if the patient could benefit from using Falls Prevention Program, a physiotherapist and Complex Treatments (IMPACT) Clinic. a cane, the occupational therapist would en- instructs on how to prevent falls by improv- Funded by HealthForceOntario, IMPACT is ter the interview room, measure the patient ing balance. one component of the department’s current for a cane and teach him or her how to use it. research focus on better understanding the Diabetes Education experience of seniors and improving care for “The crux of the program is that it’s an inter- Diabetes requires patients to take an active those with chronic disease. professional team working in real time at the role in there own care. But if seniors develop same time,” says Dr. Nickell. “It’s incredibly the disease at age 75 or older, they might A doctor’s appointment typically lasts 15 efficient. No time is lost.” Health-care train- already be managing other health prob- minutes, but at IMPACT, appointments last ees from multiple disciplines also participate, lems. To address the elderly patients’ unique 90 minutes. Patients benefit not only from ensuring that the health-care providers of needs, Sunnybrook’s Diabetes Education the advice of a family physician, but from tomorrow develop the necessary skills to Program pared down its two full-day educa- an interprofessional team of experts that in- work in a team environment. An evaluation of tion program to two half-days. And if patients clude a pharmacist, occupational therapist, the IMPACT Clinic is underway and the early have a question, they can phone a dietitian physiotherapist, social worker, community indications are that this innovative model of or diabetes-care nurse. nurse and dietitian – all of whom are avail- care is well received by patients and families. able at each appointment. “Most patients SPPICES are amazed and are very positive about the W.P. Scott Geriatric Day Hospital The goal with the screening tool SPPICES clinic,” says Dr. Leslie Nickell, a family physi- On referral from a family physician, seniors (stability/falls, polypharmacy, pain, inconti- cian with the IMPACT team. can attend this Sunnybrook outpatient pro- nence, confusion, eating/nutrition, skin) is gram to learn new skills that will allow them to provide earlier intervention, through an At the beginning of the appointment, the to continue living at home. interprofessional team of health-care provid- patient and his or her family member meet ers, in managing the care of seniors. This with a family doctor while other health-care Seniors attend the program once or twice screening tool for patients is used within the professionals watch on a monitor in a nearby weekly for three to five months. An interpro- first 24 hours to identify and assess poten- room. During this initial discussion between fessional team helps participants improve tial screening complications associated with the patient and doctor, the team listens and memory and cognition, and addresses hospitalized adults over the age of 70. It is observes to identify potential strategies to emotional concerns. An occupational thera- intended to enhance the care already being improve the health status and function of the pist demonstrates aids to daily living, such provided for patients. Adapted from a model patient. as easy-to-grasp pens. at North York General Hospital, the screening tool is now used in four acute-care units in General Medicine at Sunnybrook. SP

16 Sunnybrook Magazine 2009 Groundbreaking “eSheet” Web Technology to Benefit Patients and Staff

unnybrook Health Sciences Centre be greatly reduced, thus ensuring they are “We knew we would have had to find an recently developed and launched a able to get their blood test or chemotherapy electronic solution for the order forms at S groundbreaking new web technol- treatment, for example, that much faster,” some point so that they would mesh with the ogy tool called “eSheet” that is enhancing says Oliver Tsai, director of information tech- eventual shift to electronic patient charts,” the patient and staff experience. nology at Sunnybrook. “Orders will now be says Tsai. “We’re ahead of the curve, which more legible, comprehensive and immedi- is a great place to be.” A provincial first, eSheet is an electronic ver- ately available to all who need to see it. In ad- sion of the paper order form used by doctors. dition to clerical efficiencies, it also improves The program is also an environmentally eSheet is now being used at Sunnybrook’s patient safety as any human errors that friendly solution, dramatically cutting out Odette Cancer Centre. With the new tech- might occur in deciphering the handwritten approximately 200,000 paper order sheets nology doctors’ orders (for requests such as reports, for example, are minimized.” every year. blood tests, chemotherapy and radiotherapy, and appointments for diagnostic imag- eSheet was developed because many staff eSheet’s pilot phase took place with the ing) are now being entered into computer members require simultaneous access to haematology oncology site group before the by physicians and then processed online by the information on the order sheet. In the full rollout in fall 2008. Currently, the software clerical staff. Pop-up reminders appear on- past, multiple steps had to take place to is specific to the Odette Cancer Centre’s screen to prompt the user for required infor- share the paper copy, and still the form might needs; however there are many compo- mation, ensuring that nothing is overlooked not be available in one place because it was nents that could be applicable to other pro- or incomplete on the form. needed in another. In addition, Sunnybrook grams and hospitals if the infrastructure for will eventually be moving toward a paperless support is developed. The development of “Ultimately patients will benefit from eSheet patient chart, a change that makes eSheet eSheet was an internally funded project. because the processing time for orders will essential. LB

Sunnybrook Magazine 2009 17 Interprofessional IPPOD Team Works to Prevent Delirium in Older Patients

reventing delirium in older patients tients. It’s our responsibility to monitor them is critical – especially in hospital on a regular basis to make sure they’re not P emergency departments, says Dr. suffering from hypoactive delirium, offer them Jacques Lee, an emergency physician at something to drink or something to eat,” Lee Sunnybrook Health Sciences Centre adds. “Let’s not assume that an older patient who is confused is always confused.” “When an older person waits a long time, his or her risk of developing delirium doubles – By keeping delirium at bay, hospital emer- which in some cases can be life-threaten- gency departments operate more efficiently ing,” says Dr. Lee, who is also a member of and that’s important for Sunnybrook’s emer- the hospital’s Interprofessional Prevention of gency department which sees an average Delirium (IPPOD) team. of 41,000 people each year – more than 35 per cent of them over 65-years of age. “Research shows that delirium often pro- longs a hospital stay for older patients by IPPOD was developed by Dr. Lee, and as much as 56 days,” adds Dr. Lee. “While Sunnybrook’s Barbara Jonathan, Dr. some patients are back to normal by the David Ryan and Sharon Ramagnano time they’re discharged, others can take up and has been in place in the emergen- to six months to recuperate from delirium.” cy department since 2007.

But preventing delirium in a busy, noisy ur- In 2007, IPPOD received $245,000 ban hospital emergency department isn’t in funding from the Ontario Ministry easy, and requires the compassion, pa- of Health and Long-term Care tience and skill of an interprofessional team, and another $482,000 in 2008 such as Sunnybrook’s IPPOD. The group to design a tool kit, called EnTICE of emergency physicians, geriatric nurses, (Enabling Teamwork, Interprofessional psychologists, security guards, paramedics Collaboration and Education). and volunteers is trained to prevent the on- set of delirium. The tool kit, completed in March, helps front-line health-care workers introduce Lee estimates 10 per cent of older patients best practices into their clinical setting are already delirious by the time they arrive in more effectively. the emergency department, but it’s IPPOD’s job to prevent delirium in those who are wait- EnTICE is based on the best available evi- ing. “For various reasons, an older patient dence on how to change clinical practice, who comes in normal can become delirious but written as a simple step-by-step guide within hours of being seen by an emergency for clinicians without expertise in implemen- doctor,” says Lee. “It can be because they’ve tation science. been waiting too long to be admitted, or sim- ply because we’ve taken their hearing aids This year Sunnybrook received $440,000 in or glasses away. Dehydration also plays a government funding to distribute the tool kit big factor as does malnutrition.” and study IPPOD teams in several Ontario

emergency departments. AB Lee stresses that placing restraints on an older patient quadruples chances of delirium.

“The bottom line is that we who work in the emergency department have to develop a more humanistic approach to treating older To learn more about IPPOD go to: patients in order to keep them from becom- Dr. Jacques Lee ing delirious,” he adds. “Especially frailer pa- www.stopdelirium.com

18 Sunnybrook Magazine 2009 Teams From Across the Hospital Act to Improve Patient Flow

eams from the across Sunnybrook quality and performance. The principles ap- Surgery Service (ACCESS) initiative, which have been coming together over the ply to creating solutions for what we’re fac- is a reorganization of how general surgical T past 10 months to develop real-time ing here on a daily basis with our high bed consults are provided for patients. ACCESS solutions that address some of the serious occupancy and difficulty moving patients in has achieved significant improvements in patient capacity issues the hospital is facing, and out of the hospital.” patient flow and in its first three months (July and the results are encouraging. The teams to September 2008) the time from consult are comprised of representatives from the For example, one of the most challenging ar- request to final decision in the Emergncy Emergency Department (ED), the wards, the eas to deal with fluctuations in the demand Department was reduced from an average operating rooms, the intensive care units, for patient care is the unscheduled volumes of nine hours to less than two hours. and a group that works on the interconnec- that rush through the doors of the Emergency tivity of the other four. Department. As a result of the workshops “Innovative initiatives such as this may seem the Emergency Department group was able obvious at first, but until there is support Using the principles of ‘kaizen workshops’ to identify 28 areas for specific improvement. across all disciplines it is difficult for these (kaizen is a Japanese word meaning More importantly, the group was able to de- kinds of projects to gain traction organiza- “change for the better”) the teams identify velop an implementable action plan with tion-wide,” says Dr. Jeffrey Tyberg, chief of key issues to address and break down the broad input from their team members and the Department of Emergency Services. solutions into manageable chunks, which others throughout the hospital. “We are seeing what is achievable when we creates a detailed action plan for implement- all come together.” ing the solutions. “It was extremely beneficial to have an open discussion as we worked through the pro- In the months to come all patient flow teams “This approach is a highly beneficial and cess,” says nurse Christene Winters. “We will build on further kaizen workshops to de- proven tool for solving complex problems,” came away with the sense that solutions to velop better processes and generate solu- says Keith Rose, executive vice-president complex issues may be possible.” tions. Discussions will also continue with the and chief medical executive at Sunnybrook hospital’s community partners in order to and chair of the Patient Flow Steering One of the successful improvements the utilize all resources optimally. Committee. “These workshops have been Emergency Department has been able to LB used for years in other sectors to improve implement is the Acute Care Emergency

Sunnybrook Magazine 2009 19 The Sunnybrook Veterans Centre

Sunnybrook’s Veterans & Community Program houses the largest Veterans Centre in Canada. Working in close partnership with Veterans Affairs Canada, Sunnybrook’s Veterans Centre offers long-term and complex hospital care to 500 Veterans of the Second World War and the Korean War. The program provides cognitive, physical and mental health support to Canada’s war Veterans. The program also provides pallia- tive care for Veterans and the community. These are two recent initiatives at the Centre.

The Royal Canadian Legion through long-term excercise. Research also members, grandchildren, great-grandchil- Physiotherapy Gym shows that with improvements in physical dren and school groups who come to visit functioning comes an increase in social our Veterans will all stop to pause and reflect. participation. It will serve as a lasting memorial and tribute Through the generous support of the to a generation of great Canadians,” says Dr. Ontario Command of the Royal Canadian “We are truly delighted to support Veterans McLellan. Legion (RCL), the physiotherapy gym in the at Sunnybrook. Through the new RCL Kilgour Wing has undergone a complete Physiotherapy Gym, we are able to make a The Veterans Honour Wall, measuring 28 renovation. The new Royal Canadian Legion difference in the care provided to Veterans feet wide, is a creative endeavour that fea- Physiotherapy Gym offers group and individ- who have had a stroke, enabling them to tures the work of renowned Canadian wood- ualized therapeutic activities and programs achieve their best possible quality of life,” carver Siggi Buhler. The focal point of the for residents of the Sunnybrook Veterans says George O’Dair, president of the Royal wall is the large collage of military scenes Centre. It now also specializes in stroke care. Canadian Legion, Ontario Command. from the First World War, Second World War and Korean War. Also hand-carved by “With the Legion’s generous support, the Buhler are Canada’s military badges (Army, physiotherapy team has covered all the bas- Navy, Air Force and Merchant Navy), along es, embracing this project to make sure the The Veterans Honour Wall with a historic quote from former prime min- new gym will offer the best environment and ister William Lyon Mackenzie King, who gave equipment for our Veteran residents,” says At a ceremony celebrating the hospital’s the key address at Sunnybrook Hospital’s Theresa Kay, chief of health disciplines and 60th anniversary last June, a special me- official opening on June 12, 1948. manager of rehab services at Sunnybrook. morial wall commemorating Sunnybrook’s Veterans was unveiled by Dr. Barry McLellan, The wall also depicts a waterfall, with the The Royal Canadian Legion Physiotherapy president & CEO of Sunnybrook, and words “Lest We Forget” inlaid in solid brass, Gym now offers a large variety of therapy Brig.-Gen. John Collin, Land Force Central and a history book to symbolize Canada’s equipment that will meet many health-care Area commander. past military services. The wall also includes needs of residents, and will specifically help an overview of Sunnybrook’s history as a those who have had a stroke. Four Canadian The Veterans Honour Wall is reflective of Veterans hospital and transformation into a landscape photographs taken by Leonard Sunnybrook’s legacy as a Veterans hospital. leading health sciences centre. The Nelson Rubin, a Second World War veteran and It honours Canadian Veterans while provid- Arthur Hyland Foundation generously sup- resident, adorn the walls and add a feeling ing an inviting and inspiring entrance for resi- ported this project. SF of greater space in the gym. dents and family members of the Veterans Centre. “This new wall will recognize and re- Nonie Sovka, physiotherapist and Stephen Little, Dis- Research shows that the elderly, and people trict Director, Veterans Affairs Canada, at the opening member Canada’s Veterans each and every of the new physiotherapy gym; Chief Warrant Officer, who have had strokes, improve their bal- day of the year. Hospital staff, visitors, family Lucien Durelle and Lieutenant Colonel (retired) Bob Dale at ance, endurance and physical functioning the new Honour Wall

20 Sunnybrook Magazine 2009 Sunnybrook Partners with Telus Sunnybrook-Developed MyChart™ System Acquired by Telecommunications Carrier

MyChart™ was developed by Sunnybrook over the past three years and is used at the hospital by more than 2,600 caregivers, patients and their families

n January, Canada’s third-largest tele- “Patients are demanding more say in the Network (LHIN). The LHIN is interested in communications carrier, Telus, acquired way their health is managed and MyChart™ implementing MyChart™ across all of the I the MyChart™ personal health-record was an innovative way to achieve this goal,” health-care institutions that fall under its um- system from its creator, Sunnybrook Health said Sam Marafioti, vice president and chief brella and Sunnybrook was starting to guide Sciences Centre. information officer of Sunnybrook Health them on how to do that. With Telus’s brand Sciences Centre. “More and more, patients strength, this plan should now accelerate. MyChart™ was developed by Sunnybrook wish to be involved in the management of over the past three years and is used at their health situation, and this is helping them Next steps for MyChart™ include continuing the hospital by more than 2,600 caregiv- get there.” to work closely with the Sunnybrook com- ers, patients and their families. At MyChart’s munity, and learning from our clinicians, pa- user-friendly website, patients can set up a This is not the first time that Telus and tients and their families so that MyChart™ personal and family health record, manage Sunnybrook have partnered. Sunnybrook continues to evolve and improve the way we personal health information, share health in- has been a long time user of Telus’s Oacis manage, share, access information and care formation with care providers and caregivers electronic health record system, which is a for healthier living and continuity of care. LB and access accurate disease-specific infor- tool for clinicians. The MyChart™ partner- mation from trusted sources at Sunnybrook. ship builds on this history and will draw on Patients have access to test results, online the hospital’s health-care expertise and the questionnaires, appointment scheduling, technology capabilities of Telus enabling the their own personal information in case of system to reach an even bigger audience as emergency, and links to educational infor- needs for more interactivity with health-care mation to help better manage their own care. providers increase. Patients can also set up a personal health diary, create care-team contact lists, ac- Another aspect of this new venture relates cess videos on disease-specific information, to a partnership Sunnybrook’s MyChart™ maintain medication history and request team had previously developed with the Visit MyChart™ at www.mychart.ca prescription refills online. Central Ontario Local Health Integration

Sunnybrook Magazine 2009 21 Predicting a Healthy Pregnancy Senior Scientist Helping to Develop Test for Pre-eclampsia

“We’re on the cusp of making an important contribution”

Dr. Clifford Librach

“We’re on the cusp of making an important genes–from the father. HLA-G “disguises” or ney disease and having had pre-eclampsia contribution,” says Dr. Clifford Librach. The “cloaks” the baby’s genetic material from the in a previous pregnancy. Expecting twins, senior scientist at Sunnybrook Research mother. triplets – or even more babies also increases Institute and staff physician in Sunnybrook’s the risk. Women & Babies Program is helping devel- In a study published in the American Journal op a new genetic test to predict if a woman of Obstetrics and Gynecology in July 2008, But often, the hallmark symptoms of excess is likely to develop pre-eclampsia, a preg- Dr. Librach and colleagues reported that protein in the urine and high blood pressure nancy complication that can threaten both women who develop pre-eclampsia have at the 20th week of pregnancy seem to de- the mother’s and baby’s life. a lower-than-average level of HLA-G. In a velop out of nowhere. “The majority of wom- new study, Dr. Librach’s team is testing 350 en who develop pre-eclampsia don’t have This innovative test will allow physicians to pregnant women at Sunnybrook and Mount any of the risk factors,” says Dr. Librach, improve prenatal care by enabling them to Sinai hospitals for the HLA-G mutation. They who is also an assistant professor in the monitor the pregnancy more closely and in- are also checking the fathers’ DNA. It may Department of Obstetrics and Gynaecology tervene sooner if the complication develops. be that Dad’s HLA-G is just as important in at the University of Toronto. “Regular prena- “If we know that a woman is predisposed to predicting pre-eclampsia as Mom’s. tal exams are extremely important because pre-eclampsia, we’re going to be watching they allow doctors to pick up on any unex- her pregnancy like a hawk,” says Dr. Librach. In Canada, about one in 20 pregnancies is pected changes.” AB affected by pre-eclampsia. The complica- Dr. Librach has what he calls “intriguing evi- tion affects the arteries carrying blood to the dence” that a mutation in the human leuko- placenta, so the developing baby doesn’t re- cyte antigen-G (HLA-G) gene is associated ceive sufficient oxygen and nutrients–which with the development of pre-eclampsia. He can lead to a premature birth. In the mother, says HLA-G plays a critical role in prevent- pre-eclampsia can permanently damage the ing the mother’s immune system from re- brain, liver and kidneys. Conditions that in- jecting the fetus because it contains foreign crease the risk of pre-eclampsia include kid-

22 Sunnybrook Magazine 2009 Using the Internet to Teach Clinicians about Benefits of New Therapy for Acute Lung Injuries

“Great innovation can come through small and relatively simple acts”

Sunnybrook physician is leading an cords, so Dr. Rubenfeld’s team is currently Toronto. “The website will inform visitors of innovative study on how to use the recruiting 40 American hospitals to partici- the benefits of the therapy, which has been A Internet to teach clinicians about pate in its Internet study. shown to reduce mortality in these patients.” acute lung injuries (ALIs). Staff at the recruited hospitals will be able When using LPV, there’s a tendency to force “ALI is under-recognized, partly be- to click on Dr. Rubenfeld’s website at any too much air into the lungs. This practice cause it can be hard to identify,” says Dr. time. On the site they’ll find case scenarios, might occur because the patient appears Gordon Rubenfeld, the inaugural chief of interactive exercises, references to scientific short of breath on a lower volume of air. “The Sunnybrook’s Trauma, Emergency and literature and resource materials for family patient breathes very quickly and looks un- Critical Care and program (TECC). “There members who have a loved one with a lung comfortable,” says Rubenfeld. “In fact, he or isn’t a blood test for ALI; rather, it’s a matter of injury. she is not in distress.” Forcing too much air recognizing the constellation of symptoms.” into the lungs, though, can lead to further There will even be filmed demonstrations, damage. A severe burn, pneumonia or trauma can and several Sunnybrook patients have cause parts of the lungs to collapse and consented to be filmed for the website. The website will encourage clinicians to fluid to pool in the lungs, suggesting ALI. Visitors can also submit questions, which Dr. base the volume of air on height and gender. The website will guide critical-care physi- Rubenfeld and his team will answer. Dr. Rubenfeld believes that for many, this cians, nurses and respiratory therapists in calculation will lead them to turn down the diagnosing lung injuries. ALI should be treated with lung protective ventilator’s volume dial. “It’s all about turn- ventilation (LPV), which is a way of setting ing the dial down,” he says. “Great innova- To be eligible, the hospital must keep elec- a ventilator so that patients receive breaths tion can come through small and relatively tronic health records so the Sunnybrook of air that don’t injure sick lungs. Some cli- simple acts. In this case, turning a dial a bit team can track the care of patients both nicians are reluctant to use LPV for severe to the left can save a life.” SP before and after the web-based education. lung injuries, says Dr. Rubenfeld who is also Many Canadian hospitals don’t use e-re- a professor of medicine at the University of

Sunnybrook Magazine 2009 23 Construction Projects at Sunnybrook

Sunnybrook Health Sciences Centre is busy Schulich Heart Centre Sunnybrook’s matching campaign. The group, with many construction projects that are part Redevelopment Project called the Honorary Patrons Council, set a goal of the Hospital’s $300-million capital expan- of raising $1.5-million. Their final figure was sion. Our main projects include: The M-Wing Sunnybrook’s Schulich Heart Centre $2.5-million. Vertical Expansion that will house the Women Redevelopment Project will create new facilities & Babies Program and Research Facilities, the for the centre. These new facilities include: a These investments and others will help revital- Schulich Heart Centre Redevelopment Project, cutting edge cardiac acute care unit on C3, ize the centre’s 40-year-old acute care unit that the Emergency Department and Tory Regional high-intensity cardiology beds on C3, a new will include expanded and modernized patient Trauma Centre Expansion, the Odette Cancer procedural unit on B3, a renovated cardiol- rooms and visitor facilities and updated equip- Centre Redevelopment and Parking Garage 3. ogy, cardiac and vascular surgery unit on D3, ment, ensuring the best technologies are avail- It’s clear to see, Sunnybrook is building a bright medical/radiation oncology unit on C2 and a able to all patients when they need it most. future. surgical oncology unit on D6. The project will achieve clinical realignment for the Schulich Heart Program and Surgical Oncology Emergency Department and Tory M-Wing Vertical Expansion Program on the third and sixth floors respec- Regional Trauma Centre Expan- tively. Construction is expected in June 2009. sion Thanks to our generous donors who contribute The full project is expected to be completed in to the construction of this $43-million facility, March 2011. The demand for Sunnybrook’s Emergency two of the four new floors added to M-Wing of and Trauma services has outgrown the fa- the Bayview Campus will be the future home of The Schulich Heart Centre’s $46-million recon- cility built in the 1970s. With the support of the Women & Babies Program. Last February, struction and revitalization project received a John and Liz Tory, and many other generous the Women & Babies program was the benefi- $20 million fundraising boost from Mr. Seymour donors, Sunnybrook has invested $31-million ciary of an unprecedented $8-million donation Schulich who put a challenge to Sunnybrook: into the construction of a new and innovative from Aubrey and Marla Dan. The renovation for if the hospital raised $10-million by the end of Emergency Department that is capable of the program facilities, which will include a state- 2008, it would be matched, dollar-for-dollar. dealing with all patients’ needs and is nearing of-the-art Neonatal Intensive Care Unit and Sunnybrook accepted the challenge and do- completion. The Emergency Department has expanded capacity for Labour and Delivery, nors from across the GTA stepped up to help doubled in size and now houses additional is expected to be complete in mid-2010 with Sunnybrook achieve the matching goal. The occupancy in fall 2010. challenge also inspired 16 business leaders from Toronto’s Chinese community to come The top two floors (M6 and M7) will house re- together with the purpose of raising funds for search facilities and a new Breast Centre. The space will be built in stages, with completion of the first labs in 2011. The Centre for Research in Image Guided Therapeutics will consist of 10 interrelated labs in M-Wing, plus facilities else- where at Sunnybrook. The Breast Centre will combine clinical, imaging and research functions in an interdisciplinary setting. Sunnybrook is investing $27-million to construct the new Centre to provide women with single-point access to rapid diagnosis and complete care.

24 Sunnybrook Magazine 2009 medical imaging equipment (including a new ment of the Odette Cancer Centre. This expan- Parking Garage 3 CT Scanner Suite) and 18 new stretcher bays. sion will increase the number of chemotherapy These facilities will help to improve patient flow suites, giving our patients the comfort and pri- In early May, construction of a new multi- at Sunnybrook and reduce ambulance off- vacy they need, and the pharmacy will be ex- level parking garage accommodating 765 loading delays. panded. The cancer in-patient unit will also be cars started in current parking lots 10 and 11, renovated to accommodate 36 patient beds. which are located on the southeast part of The Chemotherapy unit was originally built to Sunnybrook property. When completed in May Odette Cancer Centre accommodate approximately 5,800 patient 2010, the garage will be used for staff parking. Redevelopment visits per year; the demand today is for more The structure is being built to reduce existing than 17,000 visits per year. The Odette Centre parking pressures and to address the park- redevelopment project will address this growth. In 2007, the Odette Cancer Centre was named ing needs of the campus when construction is to recognize the landmark contributions made near completion. This project is being handled in phases over by Edmond and Gloria Odette to the future of a number of years and is expected to begin cancer care at Sunnybrook. The Odette Centre To support Sunnybrook’s construction proj- this June. is renowned for its treatment and care of can- ects, visit www.sunnybrookfoundation.ca or cer patients and our medical staff is known call (416) 480-4483. worldwide for inventing the future of cancer care.

To keep pace with our need to accommodate increasing patient visits, Sunnybrook is making a $57-million investment into the redevelop-

Sunnybrook Magazine 2009 25 Partners in Veterans Care A Lesson in Communication and Collaboration

“Understanding the resident from the perspective of their family and their family relationships is key to really knowing and understanding what is important to them and how they would like to achieve their best life experience at Sunnybrook” Raymond Holland, Second World War veteran and his wife Rosemary with Christine Westerhoek, social worker and Carlene Wallen, RPN. The cognitive support unit was the first one to complete the Partners in Veterans Care program at the Sunnybrook Veterans Centre

ommunication is key in our lives, but and Foundation for Long Term Care called “Involving and partnering with the family in how well do we do it? And do we “Partners in Caregiving in a Special Care the care of a loved one is key to achieving C really listen when others are speak- Environment.” the best care for our residents. It’s about ing? At the Sunnybrook Veterans Centre, helping staff understand the person as an health-care professionals and family mem- The Sunnybrook workshops incorporated individual with unique needs and prefer- bers of Veteran residents are participating sections on the experiences of war Veterans ences. Studies have shown that when staff in workshops that focus on communication and post-traumatic stress disorder (PTSD), really know their patients as real people, the and collaboration–leading to enhanced resi- as well the Veterans Centre’s philosophy care provided is improved,” says Dr. Charles. dent and family-centred care. of care. This allowed the hospital to meet the specific needs of caregivers and family Many of the health professionals at the “Understanding the resident from the per- members of Veterans. Veterans Centre are from countries out- spective of their family and their family re- side Canada and have never learned about lationships is key to really knowing and un- The six-hour training session for staff Canada’s war history. Through special train- derstanding what is important to them and teaches advanced listening skills, conflict ing, staff gain a better understanding of what how they would like to achieve their best life resolution, coping strategies, bridging cul- it means to be a war Veteran and also what experience at Sunnybrook,” says Dr. Jocelyn tural and ethnic differences, handling blame it means to be married to someone who has Charles, medical director of the Sunnybrook and criticism in positive ways, giving posi- gone to war so they can better understand Veterans Centre. tive feedback, and understanding one’s own the experiences of some of the Veterans’ values, as well as the values of others. The spouses. The Partners in Veterans Care initiative be- training also promotes learning how to listen gan in the fall of 2007 and today it continues well and see things through the eyes of oth- “Partners in Veterans Care has been well to be rolled out with great success across ers. Family members are invited to take part received by both staff and family members, the 17 resident-care units at the Veterans in a similar four-hour workshop. and is a big step in the right direction in caring Centre, Canada’s largest Veterans’ care for our elderly residents here at Sunnybrook,” facility. In both staff and family workshops, partici- says Dorothy Ferguson, operations director pants role play and learn about each other of the Veterans Centre. “Our staff are better In 2007, a Sunnybrook team working on through interactive activities that reveal in- able to anticipate and recognize family con- improving communications on one resi- dividual values and attitudes. Then both cerns and address them immediately. Staff dent unit looked at a project, which was groups join together for a third and final and family members feel that they are all part jointly developed by the Braceland Center workshop to brainstorm ways to improve of the same team and are looking at things for Mental Health and Aging, and the communication on an ongoing basis. through the same lens.” SF Cornell Gerontology Research Institute

26 Sunnybrook Magazine 2009 Veteran Profile Clifford Guest Second World War, Royal Canadian Air Force

In 1940, at age 34, Guest felt the need to help and was inspired to join the Royal Canadian Air Force

t the Sunnybrook Veterans Centre, Guest has been a resident at Sunnybrook Working in close association with the trauma 103 year-old Clifford Guest is reclin- only since July 2008. “I’ve been lucky and and emergency teams, the Critical Care Unit A ing in a comfortable chair with his healthy all my life; the worst pain I’ve ever at Sunnybrook contains 50 beds and is the earphones on, so as not to disturb his next- had was a pain in my neck for a few days. largest single-site resource of critical-care door neighbour. On the large flat screen I have had minor surgery and that’s it,” he beds in Ontario. Patients come from across TV, Guest is watching the Business News says. “I think if we all had a good laugh every the province for treatment of serious injuries, Network–a regular favourite. After a 44-year day, there would be no sickness.” cancer, cardiovascular disease and other career in finance with the Bank of Nova life-threatening illnesses. Scotia, he still follows the markets every day. At Sunnybrook, he enjoys breakfast time with his fellow comrades the most. “It’s a Sunnybrook is a recognized leader in the Guest remembers well when the markets wonderful way to start the day,” he says. “I’m care of veterans who are no longer able crashed in October 1929. “We lived in also very thankful for all of my nurses. They to live at home independently. Caring for Barrie, Ontario and my father was working as look after everything for me. I think they do a more than 500 veterans from the Second a truck driver for the Barrie Creamery,” says marvellous job and I’m very grateful.” World War and Korean War, it is the largest Clifford. “Everyone was talking about inter- Veterans’ care facility in Canada. national nickel in those days. I remember a Across the campus, and on the other side friend of mine who held onto it right through of the hospital, a younger member of the “I’m very proud of my grandfather,” says Dr. the Depression.” Guest clan is caring for the most critically Guest. “He has a wealth of experience from ill. Clifford’s grandson, Dr. Cameron Guest, over the years and loves to share his old In 1940, after meeting a recruiter for the is an intensivist in the Department of Critical stories. He was a little apprehensive to leave Second World War, Guest felt the need Care Medicine. his apartment but he’s happy here in the to help and was inspired to join the Royal Veterans’ residence–and the added bonus Canadian Air Force. “My wife and I were “The Critical Care Unit provides care to pa- is that I am able to visit him more often now.” living in Ottawa at the time with our infant tients who either have or are at risk of get- SF son. She and I discussed the war at great ting a life-threatening disease or injury,” says length. It was a joint decision. I was commit- Dr. Guest. “Our main job as specialists in Dr. Cameron Guest with his grandfather Clifford who lives ted,” he says. At 34, Guest travelled over- this area is to provide care for patients on in the Sunnybrook Veterans Centre seas and became a staff equipment officer life-support, who are at high risk of dying for the Canadian Bomber Group, contribut- from a “fixable problem”. ing two years to the war effort.

Sunnybrook Magazine 2009 27 Sunnybrook’s Early Fetal Ultrasound Service Detects Potential Prenatal Problems

that we can offer at an earlier stage in a woman’s pregnancy.”

Using conventional ultrasound equipment and transvaginal ultrasounds, the centre provides pregnant women with greater information about their fetus early in their pregnancy. At a stage when most possible anomalies are already present, with only a few anomalies developing later, the benefits of early scanning include greater testing options and earlier treatment for those fetal problems that are amenable to therapeutic interventions, such as the treatment of twin- twin transfusion syndrome and treatment of certain urologic problems.

While most of the scientific articles and case reports relating to early fetal ultrasound examination have been submitted by researchers in Israel, Italy, the Netherlands, Germany and other countries, the service remains relatively unknown and unavailable across North America. Sunnybrook Health Sciences Centre is the first profession- Dr. Ori Nevo with Ayelet Lahat ally accredited facility to offer this service to women in Canada. hen Ayelet Lahat visited the very important for me to know at this early “The women we are seeing are either at risk new Toronto Centre for Early stage that everything is OK,” says Lahat. for fetal anomalies or are obese, and in that Fetal Ultrasound of the Women “In addition, I believe the early ultrasound is W case, the later ultrasound may be of lim- & Babies Program at Sunnybrook Health more detailed and that it can detect more ited resolution,” says Dr. Nevo, who is also Sciences Centre for an ultrasound during fetal conditions than the ultrasound that is an assistant professor in the Department her second pregnancy she was only 14 typically done later.” of Obstetrics and Gynaecology at U of T. weeks pregnant. “However, ideally, any pregnant woman Congenital anomalies, which are defects would benefit from early fetal ultrasound The Toronto Centre for Early Fetal Ultrasound present in a baby since birth, occur in two examination.” is the first of its kind in Canada performing to three per cent of low-risk pregnancies. early stage fetal targeted ultrasound exami- In Canada, the first targeted ultrasound for Happy with the results of her early fetal ultra- nation. These exams detect potential fetal detection of anomalies is traditionally per- sound exam, Lahat felt less stressed for the conditions such as structural anomalies formed at 18 - 20 weeks. The Toronto Centre remainder of her pregnancy. She has since – which are complications that may occur for Early Fetal Ultrasound performs targeted given birth to a healthy baby girl. with the development of the fetal skull, brain, ultrasounds for detection of possible fetal spine, abdominal wall, limbs, stomach and problems six to eight weeks earlier, at 12 - Until construction for the new home for bladder – and also detect chromosomal dis- 15 weeks. Sunnybrook’s Women & Babies Program orders such as Down syndrome. is completed in the fall of 2010, the Toronto “Our aim is to get ultrasounds for pregnant Centre for Early Fetal Ultrasound will be lo- Lahat, who was referred to the centre by a women done sooner, so that women have cated at 76 Grenville Street. fetal assessment specialist in Israel who ex- more possibilities and testing options,” says SD amined her during her first pregnancy, says Dr. Ori Nevo, a maternal fetal medicine spe- that since the early fetal ultrasound involves cialist and lead physician at the Toronto very minimal risk, if any, she wanted to try Centre for Early Fetal Ultrasound. “We have it. “I didn’t have any specific concerns but I the same equipment as everyone else, but know that even healthy women often have the performance and interpretation of the babies with various abnormalities and it was scan requires a different level of expertise

28 Sunnybrook Magazine 2009 Sceening for Osteoporosis

ne in four women and at least one in A Bone Mineral Density (BMD) test is a sim- eight men over the age of 50 suffer from ple and painless procedure that compares a O osteoporosis, according to Osteoporosis person’s BMD with that of a young adult. The Canada. In fact, bone density declines with age test assesses the hip and spine. If the test and so the number of Canadians afflicted with results show osteoporosis, there are drug this silent disease is predicted to increase as treatments available that work to maintain or Canada’s population continues to age. increase bone density and reduce fracture risk. Both lifestyle modifications and medica- Osteoporosis, which literally means “porous tions can be used to prevent and treat this bone” is a skeletal disorder. In this condition bone condition. tissue deteriorates, resulting in low bone mineral density and weakened bones. As the bones The good news is that osteoporosis is both become less dense, they more easily break. preventable and treatable. Unfortunately, many people are unaware that they even have this condition as there are no At Sunnybrook, Dr. Cohen works with warning symptoms. Thus, in its early stages, other rheumatologists in the Division of osteoporosis remains a “silent” disease un- Rheumatology to see patients for various til it is complicated by fractures, which can problems affecting bone and joints. A num- occur with minimal or sometimes even no ber of Dr. Cohen’s patients are post-meno- trauma at all. pausal women and elderly men, all of whom are screened for risk factors and tested for “Many people don’t realize this, but the skel- osteoporosis. eton is a highly specialized and dynamic or- gan that undergoes continuous regeneration,” “At Sunnybrook, we are testing large num- says Dr. Dana Cohen, a rheumatologist at bers of patients for osteoporosis. It’s an Sunnybrook Health Sciences Centre. “Old enormous problem,” says Dr. Cohen. bone is removed and new bone is added in “I recommend adequate calcium and order to maintain the structural integrity of the vitamin D intake to all my patients, which skeleton. With advanced age or with various supplements bone loss and improves bone medical conditions this balance is altered – mineral density. We are now realizing more you have more bone being removed than re- and more that vitamin D deficiency is ex- placed, and your risk of fractures increases tremely high in Canada due to our northern exponentially.” latitude and very long winters. This is especially true for housebound and institutional- There are a number of factors that increase ized people. Proper nutrition and weight- a person’s risk for the development of os- bearing exercises, such as walking, also teoporosis. Dr. Cohen says that all post- benefit bone mass.” menopausal women over the age of 50 should be screened by their physician to “Patients should also be counselled on fall determine if they are at increased risk of prevention,” adds Dr. Cohen. “Things like osteoporosis. Everyone over the age of keeping floors clutter-free, removing loose 65 should have a bone mineral density rugs and wires, using handrails on stairs or test to look for the disease itself. in bathrooms and having proper lighting in rooms can all help to prevent falls, and there- by decrease the risk of fractures.” SD

What You Need to Know about Osteoporosis

• Canadian guidelines now recommend that The risk factors for osteoporosis are: all men and post-menopausal women over • An age of 65 years or older; the age of 50 take 1500 mg of elemental • Past history of fractures; calcium and 1000 IU of vitamin D a day. • A family history of osteoporosis • Bones, like muscle, become stronger (particularly if your mother experienced and denser with exercise. There are two a hip fracture); types of exercise recommended for good • The use of glucocorticoid therapy (such Dr. Dana Cohen bone health: weight-bearing or muscle- as prednisone) for more than three strengthening, and resistance-training. years.

Sunnybrook Magazine 2009 29 An Increased Focus on Patient Safety

“That’s what’s so exciting. The hospital isn’t just switching around resources; we’re upping the ante by investing in this centre, which opens up an academic focus for patient safety”

Dr. Kaveh Shojania

r. Kaveh Shojania, a scientist in com- “Some of [those] problems…have obvious vidually identify a problem and make a move bined health services sciences at academic potential. Now we have, with the to solve it, as someone else has before,” he D Sunnybrook Research Institute and Centre for Patient Safety, the resources to says. “It’s reinventing the wheel and, unfortu- professor at the University of Toronto, has tackle them,” Dr. Shojania says. “That’s nately, the wheel is often a flat tire.” assumed the role as director of the new U of what’s so exciting. The hospital isn’t just T Centre for Patient Safety. switching around resources; we’re upping The centre will also offer a consultation ser- the ante by investing in this centre, which vice, wherein a clinician can spend an hour Dr. Shojania, who holds the Canada opens up an academic focus for patient with a scientist to learn strategies for solv- Research Chair in Patient Safety and Quality safety.” ing a problem in front-line safety. Both par- Improvement, appreciates that this new ven- ties benefit from this exchange. Says Dr. ture – a partnership among U of T’s Faculty Dr. Shojania’s focus is on identifying both Shojania, “There’s a limited extent to which of Medicine, Sunnybrook Health Sciences evidence-based patient-safety interven- researchers can roll up their sleeves and get Centre and the Hospital for Sick Children – tions and strategies for translating them into involved in enacting change at the hospital. will enable safety-improvement initiatives that practice. One of his goals is to establish an They need a clinician who can take the job would otherwise remain shelved. “inventory repository” of all safety-based re- and run with it.” LP search studies. This way, Dr. Shojania says, The centre provides an intersection for those duplication of efforts should become a thing safety issues local to the hospital and to all U of the past. of T–affiliated hospitals across the city, says Dr. Shojania, who arrived at Sunnybrook “One of the problems in patient safety and in April 2008, but only started his new role quality improvement is that you’ll often end early this year. up with a situation where people will indi-

30 Sunnybrook Magazine 2009 Sunnybrook’s Double “Win” of Expertise in Infectious Diseases, and Infection Prevention and Control

Members of Sunnybrook’s Microbiology and Infection Prevention and Control group are system leaders and participate in federal and provincial advisory groups to inform best practice

o better manage and further reduce mycin-resistant Enterococcus) and respira- Prevention and Control at Sunnybrook and infections and infection risk for pa- tory viruses such as Influenza. associate professor, department of labora- T tients, health-care professionals and tory medicine and pathobiology, at U of T. the community, Sunnybrook’s Microbiology Sunnybrook Health Sciences Centre is one “Our protocols, which have been in place for and Infection Prevention and Control group of only a handful of Canadian hospitals using years, proactively identify patients at higher is focusing on faster, more accurate diag- molecular-based results technology, which risk of infection and quickly identify new cas- nostics to detect, identify and perform typ- yield more rapid and accurate diagnostics, es among current patients and newly admit- ing of potential pathogens. The group also and which require significant microbiology ted patients from the community.” actively surveys and screens for infections expertise. “Use of molecular-based tech- and audits infection-prevention practices. nologies in complement with conventional Sunnybrook’s Microbiology and Infection methods helps us develop the most effec- Prevention and Control group also moni- “To minimize the impact of infectious tive interventions to manage infection and tors the hospital’s infection-prevention diseases on the health-care system, we better prevent transmission,” says Dr. Simor, practices and has implemented a hand- continue to provide accurate and rapid diag- professor in the departments of medicine, hygiene initiative that includes education noses and to lead in infection surveillance,” and laboratory medicine and pathobiol- and hand-hygiene compliance audits, a says Dr. Andrew Simor, chief of Microbiology ogy, University of Toronto. “In some cases core competency training and certification and Infectious Diseases at Sunnybrook. molecular-based technologies detect 30 to program every two years for all staff, and 40 per cent more strains of infection than a supportive healthy-workplace philosophy People who are hospitalized for complex with conventional methods and can isolate led by the hospital’s Joint Health and Safety medical conditions and might develop weak- and confirm an organism’s drug sensitivity or Committee to help staff better manage their ened immunity are at greater risk of infec- resistance.” own health and well-being. NCS tious disease. Infections include Clostridium difficile, antibiotic-resistant organisms or su- “We also use an aggressive active surveil- perbugs such as MRSA (methicillin-resistant lance and screening strategy,” says Dr. Mary Staphylococcus aureus) and VRE (vanco- Vearncombe, medical director of Infection

Sunnybrook Magazine 2009 31 Understanding Anxiety Disorders: The Difference between a Disorder and “Everyday” Anxiety

ne in four people are affected by However, such everyday anxiety is generally much it affects them,” says Dr. Richter who an anxiety disorder at some point occasional, mild and brief, while the anxiety is also an associate professor of psychiatry O in their life, and this can cause pro- felt by the person with an anxiety disorder at the Universtiy of Toronto. “Individuals and found personal suffering and significant bar- occurs frequently, is more intense, and lasts society don’t always understand that this is riers in relationships, employment, school, longer – up to hours, or even days.” a condition that is diagnosable and requires finances and everyday tasks. treatment.” The crossover point occurs when the anxi- Anxiety disorders are characterized by ex- ety becomes excessive and causes persis- In addition, a lack of understanding of the ill- cessive, unrealistic, intense and prolonged tent and significant distress to the individual ness has contributed to a mistaken percep- feelings of fear, worry or distress, sometimes and when it makes it hard to work or study, tion of it as a weakness or a character flaw, for no obvious reason, that interfere with dai- manage daily tasks or relate well with oth- and therefore has discouraged many with ly life. This can cause people to avoid situ- ers. “A diagnosis is not given until the anxiety the illness to seek help. “Stigma is still an is- ations that might bring on anxiety. In some hits a threshold and impairs one’s ability to sue, but it is diminishing as there is a move- cases, they develop compulsive rituals to function,” says Dr. Peggy Richter a psychia- ment towards awareness and better un- help lessen symptoms. trist and director of the Clinic for Obsessive derstanding. Public awareness campaigns Compulsive Disorder and Related Disorders have helped in recent years, including those These disorders represent the most com- at Sunnybrook. by Sunnybrook and the Centre for Addiction mon of all mental illnesses and yet they are and Mental Health,” says Dr. Rector. not well understood. “A certain amount of People can live with anxiety disorders anxiety is normal and necessary,” says Dr. for years before they are diagnosed and “It is helpful to be an informed consumer, to Neil Rector, a psychologist and research treated. They might consider their symp- seek information online, and it is important scientist, and director of the Mood and toms normal, or the symptoms themselves to discuss any concerns with your doctor as Anxiety Treatment and Research Program might prevent them from seeking help. “This soon as possible,” says Dr. Richter. “Anxiety at Sunnybrook. “Everyone feels anxiety from is partly because we all have some level of disorders are treatable, and early treatment time to time. We may feel anxious when anxiety but an anxiety disorder greatly im- can help to ensure treatment success.” we’re facing an exam or job interview, or pacts one’s life, and the person suffering NNR when we perceive some threat or danger. more often than not does not realize how

Types of Anxiety Disorders

Panic Disorder: Repeated unexpected panic Obsessive-Compulsive Disorder: Recurrent Post-Traumatic Stress Disorder: Following attacks, which include heart palpitations, obsessions (uninvited or intrusive thoughts, exposure to an extreme traumatic stressor, sweating and trembling, followed by at least urges or images) or compulsions (behaviours the person’s response to the event involves one month of persistent concern about or rituals to try to reduce or suppress obsessive intense fear, helplessness or horror. Symptoms having another panic attack. These might be thoughts) that are severe enough to be time usually begin within three months, although accompanied by the avoidance, or endurance consuming or cause significant distress or there might be a delay of months or years. with marked distress of specific situations. impairment. An example of obsessions is The experience is repeatedly relived through concerns about contamination. An example of intrusive memories, distressing dreams and Social Phobia: A persistent fear of social or cumpulsions would be chronic handwashing or flashbacks. performance situations (meeting strangers, the constant checking of something such as a playing sports or participating in small groups) locked door. Generalized Anxiety Disorder: Excessive in which embarrassment might occur. anxiety and worry occurring more days than Acute Stress Disorder: Occurs within one not for a period of at least six months, about Specific Phobia: A persistent fear of distinct month after someone has experienced, a number of events or activities; difficulty in objects or situations, such as a fear of specific witnessed or was confronted with an event that controlling worry. animals (for example, spiders); natural involved actual or threatened death, serious environment conditions (storms, heights); injury or a threat to the physical integrity of The material is drawn from Rector et al., 2005, sight of blood or injections; situations (public self or others. Disturbing memories of the The Centre for Addiction and Mental Health transportation, elevators or enclosed spaces); traumatic event cause an emotional reaction Anxiety Disorders Information Guide. and choking or vomiting. and a sense of reliving it.

32 Sunnybrook Magazine 2009 Caring for Your Mind and Brain: The Brain Sciences Program

Research into Anxiety s the population ages, the number Rethinking “Mind and Brain” Disorders of Canadians living with brain-related A conditions at home, in the community Sunnybrook’s Brain Sciences team is and in residential-care settings is increasing. Sunnybrook is working to treat anxiety dedicated to increasing knowledge of and depression at every stage of life, with how the human brain works; an area Sunnybrook’s newly named Brain the development of the new Mood and still not well understood by scientists. Sciences program (formerly known as Anxiety Treatment and Research Program. The Neurosciences program) brings Sunnybrook researchers and clinicians The team is rethinking the notion of together professionals in clinical care, are working together to investigate how “mind and brain,” as they are encour- provides eduction and conducts re- these disorders interact. They are cur- aging health-care professionals to be search into the health and disorders rently working on the following projects: more sensitive to the psychological, of the brain and mind, which have a emotional and cognitive features of significant impact on the quality of • Development of treatment guidelines “brain” diseases such as stroke and life of patients, their families and their to inform family doctors and other Alzheimer’s disease. For example, caregivers. primary-care providers how to treat experts are now looking at ways to those presenting with symptoms. assess and work with the behav- The program provides comprehensive ioural and psychological symptoms of care which includes prevention, acute • Investigation of the genetic basis of dementia. intervention, long-term management, obsessive compulsive disorder. outreach and connections to com- The team is also increasingly aware munity providers. The three major • Prediction of responses to treatment by of the neurobiologic origins of psychi- themes are among the greatest pub- looking at genetic, cognitive and other psy- atric disorders such as depression, lic health challenges of the coming chological factors that give rise to illness. bipolar disorder and post-traumatic generation: stress disorder. • Training health-care professionals to be • Stroke; better able to detect and treat mood and Sunnybrook has led many advance- • Dementias; anxiety disorders. ments and developments in the • Mood and anxiety disorders. knowledge, treatments and tools used in brain sciences from the local These three focal areas are support- to the international level. ed by a range of clinical services and teams, which work together to ad- Researchers, together with front- dress the overlap and interplay that line caregivers, are finding innova- exists between conditions. For ex- tive ways to understand the brain, its ample, patients who have suffered a health and its disorders, which will stroke might also have dementia and make a significant impact on patients experience a mood disorder such as and the community. Sunnybrook is depression. pioneering new interventions and imaging analysis techniques to optimize The program offers specialists in brain recovery and rehabilitation. traumatic head injuries, brain tu- mours, sleep and other brain-related Together, the best in clinical practice, conditions. There are also specialists teaching and research come together Joe Newton (R), stroke survivor, with Sunnybrook Presi- in brain development, sensation and dent and CEO Dr. Barry McLellan at the Heart and Stroke at Sunnybrook’s Brain Sciences pro- Foundation Centre for Stroke Recovery plaque unveiling perception, learning and memory, gram to provide an unprecedented and celebration at the hospital in March. movement, attention, stress and ag- kind of care. NNR ing. The different disciplines include psychiatry, neurology, geriatric medicine, family medicine, neuroimag- ing, neurosurgery, neuropsychology, nursing and allied health professions.

Sunnybrook Magazine 2009 33 Sunnybrook Welcomes Members of Provincial Parliament

Sunnybrook plays an important role in the health care system of Ontario. We value the support of our Members of Provincial Parliament and the government of Ontario. The Honourable Kathleen Wynne, Minister of Education and MPP for Don Valley West, where Sunnybrook’s Bayview Campus is located, has attended a number of functions at Sunnybrook. This past year, she toured our new Emergency Department and most recently, she visited with staff and patients in our Odette Cancer Centre. Sunnybrook is always pleased to welcome Minister of Health and Long Term Care, The Honourable David Caplan. During his most recent visit he had the chance to meet some of our staff pharmacists and members of our Department of Family and Community Medicine.

The Honourable Kathleen Wynne, MInister of Education and The Honourable David Caplan, Minister of Health and Long Term Care, are pictured at recent visits to Sunnybrook

34 Sunnybrook Magazine 2009 At the Heart of the Matter: Katie Crozier Gives Back to the Schulich Heart Centre EVAR Program

“The accident has changed my life,” says Crozier. “My spirit has been lifted. I’m eating healthier. I’m more active, and I’ve almost completed my master’s degree in elementary education”

Katie Crozier

atie Crozier, a North Carolinian with Crozier was airlifted to Sunnybrook’s Tory for the care she received at Sunnybrook, dual citizenship, loved spending the Regional Trauma Centre for her leg and Crozier has made a generous donation to K summer months at her family cottage head injury but upon further assessment an the Endovascular Aneurysm Repair (EVAR) in Muskoka, Ontario. MRI revealed that her aorta – the main blood program at Sunnybrook. vessel – was severely torn and immediate NM In the summer of 1998, Crozier and 10 of her surgery was needed to repair the damage. friends went skydiving in Orillia. They spent half of the day learning about skydiving and “I got to Sunnybrook just in time,” says What is EVAR? the remainder taking turns jumping out of an Crozier. “Dr. Daryl Kucey saved my life.” airplane. For Crozier, the third to jump, what EVAR is a novel minimally invasive should have ended as a huge adrenaline “My mother noted in her journal that she rush instead resulted in a horrific accident. began shaking with relief when Dr. Kucey technique used to treat patients informed her of the positive outcome of my with potentially lethal abdominal “I remember being petrified to jump, but surgery,” says Crozier. “I really can’t thank the aortic aneurysms. The EVAR I don’t recall jumping out of the plane,” trauma team and Dr. Kucey enough for what technique is particularly important says Crozier. “After I jumped my parachute they’ve done for me.” for Sunnybrook, not only because opened automatically, the wind picked me the Schulich Heart Centre is known up and I came crashing to the ground.” Six days after her aorta was repaired a rod for its excellence and innovations Crozier landed half a kilometre past the land- was inserted into her right femur by ortho- ing site, causing her instructor and friends to paedic surgeon Dr. Hans Kreder to repair in the treatment of complex aortic frantically search for her. her broken leg. “I recovered at Sunnybrook diseases, but also because the Trauma, for two weeks and then I went back to the Emergency and Critical Care program “When they found me, my most obvious in- United States for rehab,” says Crozier. “I was treats a high number of patients with jury was my fractured right femur and I com- in the right place at the right time because traumatic aortic injuries. The EVAR plained of a severe headache,” says Crozier. the care at Sunnybrook was extraordinary.” technique results in decreased patient “They called 911 and I was taken to a local risks, shortened length of hospital stay hospital but they were not equipped to deal Eleven years after the accident, Crozier’s with a potential brain injury.” heart is ticking and her leg and brain have and saved lives. healed. When Crozier’s mother was informed of the accident she insisted that her daughter be “The accident has changed my life,” says brought to Sunnybrook. “My mother is a Crozier. “My spirit has been lifted. I’m eat- To make a donation in support of the retired nurse and knew that Sunnybrook is ing healthier. I’m more active, and I’ve al- Schulich Heart Centre or EVAR, visit a leader in innovative and interdisciplinary most completed my master’s degree in www.sunnybrookfoundation.ca or call care,” says Crozier. elementary education.” Forever grateful (416) 480-4483

Sunnybrook Magazine 2009 35 The Greening of Sunnybrook

“At Sunnybrook, we see greening and patient care as very complementary. From scav- enging gas in our operating rooms, to retrofitting our heating and ventilation systems, we’re greening Sunnybrook to be there for patients and our planet in the years ahead,” says Amrein. “Our 10,000 staff members are committed to environmental sustainability. They show their commitment daily through carpooling, recycling and their willingness to incorporate environmentally friendly practices at work. They recognize that their con-

tributions have far-reaching effects.” AB

Sunnybrook Green Facts

The Harry Taylor Solar Energy Wall • Sunnybrook has replaced its medical unnybrook is batting 1,000 when it “The installation of photovoltaic panels, vacuum and medical air systems comes to conservation and environ- which use a technology that converts sun- with a new air-cooled system that S mental protection. light directly into electricity is incredibly excit- reduces water use immensely. ing,” says Beverley Townsend, Sunnybrook’s • Honeywell’s Energy and Facility The only hospital to make Canada’s 2009 manager of environmental sustainability. Renewal Program will result in Greenest Employers list, Sunnybrook con- annual savings of $2.7 million. tinues to win awards and public recognition The current from the photovoltaic array will • Sunnybrook replaced an inefficient for its dedication to environmental sustain- be fed to a power conditioner located in ability through innovation and leadership. close proximity to the photovoltaic panels. wooden cooling water tower with The numbers tell the story. When the sun shines, the power conditioner an energy-efficient aluminum tower will feed electricity into Sunnybrook’s existing that has cut annual water usage by By replacing aging infrastructure with utility distribution system. 36,838 m3. energy-efficient, state-of-the-art equipment • Sunnybrook is retrofitting more over the years the hospital has drastically Another first for Sunnybrook is the introduc- than 23,300 lighting fixtures reduced utility consumption by millions of tion of Deltasorb in its operating rooms. throughout the hospital. watts. This device, developed by Blue-Zone Technologies, is used by anesthesiologists • Sunnybrook’s first Earth Matters But nothing compares with the Honeywell to selectively capture anesthetic gas that’s Showcase held last September Energy and Facility Renewal program. not inhaled by the patient. “Only five per cent was well attended by staff and This $28-million, multi-year project will see of the gas is actually metabolized by the community members. It promoted Sunnybrook reduce its annual greenhouse patient,” explains Townsend, “which means the hospital’s environmental gas emissions by an estimated 9,000 metric the rest escapes into air and contributes to initiatives. tons – an amount equivalent to taking 1,400 global warming.” • Sunnybrook handed out 1,000 cars off of the road. As of August 2008, Deltasorb kept 474 white spruce seedlings last year “We’re a hospital first, but we know we’re tonnes of CO2 equivalent from entering the during Environment Week. part of a larger system. Our partnership with atmosphere. Anesthetic gas contains volatile • You can learn more about Honeywell will result in the implementation halogenated ethers, which are 3,766 times Sunnybrook’s green programs of over 100 energy-management initiatives, stronger than carbon dioxide. by visiting http://earthmatters. like the 100-kilowatt photovoltaic Harry Taylor sunnybrook.ca Solar Energy Wall that will produce electricity Sunnybrook also advocates the use of safer from the sun,” says Rudy Amrein, director of Green Seal-approved cleaning products for plant operations and maintenance. “It takes use in patient rooms, reception areas, wash- an entire community to create change; to- rooms, corridors and high-risk areas, as well gether we are partners in responsible energy as kitchen and laundry rooms around the management and sustainability.” hospital.

36 Sunnybrook Magazine 2009 Harry Taylor Making Sunnybrook To honour his memory it’s fitting that his name be More associated with a cause close to Accessible his heart – energy conservation.

Sunnybrook has named its ince its inception in 2003, the state-of-the-art solar panel Accessibility Working Group of S Sunnybrook has dedicated signifi- installation the Harry Taylor cant time and resources toward identifying, removing and preventing barriers that impact Solar Energy Wall persons with disabilities.

“At Sunnybrook, we have over 10,000 staff, physicians and volunteers and one-million When Harry Taylor died tragically on tients while ensuring staff safety. As well, he patients come to the hospital every year,” November 5, 2008, at the age of 53, not was also influential in initiating the Greening says Jim Shuparski, chair of the Accessibility only did his family lose a wonderful and car- Health Care Committee, a membership that Working Group. “There are a lot of people ing man, but Sunnybrook and the commu- helps hospitals work together to improve en- with different accessibility needs and it’s nity-at-large lost an important advocate for ergy and water efficiency and reduce solid been our mission for the past six years to environmental conservation. waste generation. identify and remove any barriers that impede their ability to work at Sunnybrook or receive Taylor was Sunnybrook’s popular, innova- Taylor also co-chaired the Energy and care here.” tive and gifted facility services director. Environment Committee for the Toronto “Harry was a natural-born leader, respected Central Local Health Integration Network and Sunnybrook’s corporate accessibility by all staff and a true advocate for a safe served on the board of directors of Booth plan, “Universal Access and a Culture of work environment for staff. This was con- Centennial Healthcare Linen Services. Inclusion,” outlines the hospital’s continuing firmed by his leadership as co-chair of the efforts to eliminate accessibility barriers, in- hospital’s Joint Occupational Health and To honour his memory it’s fitting that his cluding those that are physical, architectural, Safety Committee,” says Marilyn Reddick, name be associated with a cause close to informational, technological and attitudinal, Sunnybrook’s vice-president of Human his heart – energy conservation. Sunnybrook and those related to policy and practice. Resources. has named its state-of-the-art solar panel installation, the Harry Taylor Solar Energy Wall. Here are just a few of ways the Accessibility Under Taylor’s leadership, the hospital re- Working Group at Sunnybrook is improving ceived numerous awards and rebates for And in September, during the hospital’s Earth access for community members: water and energy conservation and was ap- Matters Showcase, the newly created Harry plauded for its work in recycling and adopt- Taylor Innovation Award will be presented to • Installation of TTY telephones and in- ing sources of renewable energy. a staff member who has shown innovation in bound TTY phone lines at both the his or her work and shown achievement in Sunnybrook Bayview campus and the Taylor was also the go-to man in a crisis, as inventing the future of health care. AB Holland Centre; was the case during the SARS outbreak. • Increased number of wheelchair-accessi- Overnight, his team transformed sections ble washrooms; of the hospital into safe-care areas for pa- • Creation of larger shower rooms for patients with mobility issues; • Increased accessible parking spaces around the campus; • Replacement of sliding doors at some entrances to provide greater access; • Installation of a new wheelchair ramp at entrance to the Geriatric Day Hospital.

This year, plans include the development of an online access guide that will provide patients and visitors with better directions and information for both the Bayview campus

and the Holland Centre. LL

Sunnybrook Magazine 2009 37 Sound Strategy and Financial Management Helps Sunnybrook Invent the Future of Health Care

espite a near constant demand for organization and by achieving the commit- to invent the future of health care such as their services, Canadian hospitals ment of your leaders to strive for it, difficult the construction of a new electrophysiology D are far from recession proof but conversations become easier to have.” suite to correct abnormal heart rhythms. meeting the challenges of the new economic reality is nothing new to Sunnybrook. Through its Strategic Focus, Sunnybrook A recent report from the Toronto Central The Hospital has a well-defined strategic defined four areas of emphasis called stra- Local Health Integration Network found that plan and through the hard work of its 10,000 tegic priorities and these include: Sunnybrook is a highly efficient organization employees and physicians, the organization but there are a few further opportunities for has not only achieved a balanced budget • Cancer, specific to breast, colorectal and efficiencies and partnerships with other or- for the past seven consecutive years but it prostate; ganizations to align services. has also been able to reinvest strategically to • Heart and Stroke with respect to finding develop innovative programs and services. innovative methods of imaging the heart “There seems to be more of a willingness to detect and treat cardiac disease, and in the system right now to explore partner- Each year, Sunnybrook cares for about one acute interventions and rehabilitation for ships with fellow hospitals, health agencies million patients and has an annual expense stroke; and others to ensure patient care is as co- budget of about $750 million, one of the • High Risk Maternal and Newborn Health ordinated and as seamless as possible from largest in the province. With costs such as as it pertains to high risk pregnancies and acute care to rehabilitation and home care,” medications, supplies and energy prices ris- critically-ill and low-birth-weight newborns; says Dr. McLellan. “In the next year we will ing each year at a rate of about five per cent, • Major Trauma and Burns, including caring continue to look for partnerships with orga- compared to average two per cent annual for those who are critically injured as well nizations that can complement the services funding increases, much of Hospital financ- as those who have severe burns. we provide and who can help us improve ing is about managing the gap between in- care for our patients. We will be sticking to flationary costs and actual revenue. These four areas are where Sunnybrook has our plan and ensuring Sunnybrook is able to an international reputation for innovation and do what it does best and be there for people Sunnybrook President and Chief Executive significant research, patient care and edu- when it matters most.” Officer Dr. Barry McLellan, suggests that the cational acumen. Patients from across the key to success in tough economic times is province come to Sunnybrook to receive Sunnybrook by the Numbers to have a well-articulated game plan that ev- care in these areas and health profession- eryone supports. Recently, the Hospital up- als from around the world come to learn dated its strategic plan to ensure the organi- about the Hospital’s research and clinical • 1,200 beds, including 535 Long zation was clear on its priorities. After broad work in these areas. In addition to the four Term Care/Veteran beds (our Veterans consultation in and outside of the Hospital, Strategic Priorities, Sunnybrook has seven residence is Canada’s largest Veterans Sunnybrook’s Strategic Focus document programs, that have focused areas of clini- facility) and 74 bassinets was produced. It outlines the organization’s cal services and academics; Brain Sciences • 125 critical care beds, including 41 strategic priorities as well as focus for all Program, Holland Musculoskeletal Program, clinical and research and teaching activi- Odette Cancer Centre Program, Schulich neonatal intensive care bassinets ties. (The plan can be viewed at www.sun- Heart Program, Women & Babies Program, • 42,000 emergency visits, the highest nybrook.ca). Trauma Emergency & Critical Care Program admission rate of any hospital in the and the Veterans & Community Program. Greater Toronto Area “There are harsh economic realities all orga- • 4,000 births, one quarter of which are nizations have to face and one of the best By defining its priority areas, Sunnybrook’s high risk, and Sunnybrook cares for one strategies to manage these challenges is Strategic Focus ensures the organization in five babies born in the province who to be abundantly clear about what you are is sufficiently nimble to weather economic going to focus on and that you are not go- storms and has a definitive road map for weigh less than three pounds ing to be able to grow in every area of the where the Hospital wants to invest for fu- • 6,500 heart procedures Hospital,” says Dr. McLellan. “Sometimes ture growth and development. This past • 8,800 MRI hours defining where you are not going to grow year, Sunnybrook identified solutions of • Over 2,100 hip and knee replacements can be more difficult than understanding $22.3 million that will be implemented in the — The Holland Orthopaedic & Arthritic your strengths and areas for future invest- 2009-10 fiscal year, while investing $5 million Centre is the largest centre of its kind in ment, but by articulating a clear vision for the in areas that will achieve the Hospital’s vision Canada • 10,000 staff

38 Sunnybrook Magazine 2009 Sunnybrook One of The GTA’s Top Employers for 2009

unnybrook Health Sciences Centre cess, describing its business, workforce, Some of the reasons why has been selected from an exten- physical environment, work and social at- Sunnybrook was selected as S sive list of entrants as one of Greater mosphere and health, financial and family- one of Toronto’s Top 75 friendly benefits. The hospital also detailed Toronto’s Top 75 Employers for 2009. Employers for 2009: compensation, vacation and personal day Greater Toronto’s Top 75 Employers is an policies, internal communications, per- annual competition organized by Mediacorp, formance management, continuing edu- • Greening initiatives, such as the the editors of Canada’s Top 100 Employers. cation, and professional and community Earth Matters symposium that This special designation recognizes Greater development. involved staff and affected change Toronto Area employers that lead their indus- throughout Sunnybrook; tries in exceptional workplaces. “Sunnybrook is an incredible place to work • Staff Quality and Life Program, for so many reasons but we are particu- which includes a variety of staff “It is an honour to be named among the larly proud of our numerous programs sup- city’s top working environments,” says, Dr. porting staff wellness and safety,” says safety, wellness and health initiatives; Barry McLellan, president and chief execu- Marilyn Reddick, vice-president of Human • Staff recognition and celebrations, tive officer of Sunnybrook. “I am so proud Resources. “We will continue to improve lauding staff for their contributions of our dedicated staff, physicians and vol- them in the future and provide the support and celebrating achievements unteers who play such an important role in and resources needed to help our staff together; ensuring the hospital’s overall success. This balance their personal and professional • Working environment includes achievement is a testament to their unwav- priorities.” beautiful grounds, parkland setting ering commitment and it confirms what we have felt for a long time: Sunnybrook is an Winners of this year’s Greater Toronto’s with walking paths, and a fitness incredible organization to come to work at Top Employers were announced in a spe- centre. every day.” cial section of the Toronto Star on Oct. 18, 2008. LL To be considered for this award, Sunnybrook participated in an extensive application pro-

Sunnybrook volunteers make a difference when it matters most

For more information about Volunteering at Sunnybrook please call (416) 480-4129 or visit www.sunnybrook.ca

Sunnybrook volunteers make a diﬀerence Sunnybrook Magazine 2009 39 Committed Donors Michael and Marilena Latifi see the Impact of their Support for the Women & Babies Program

In recognition of the Latifis’ ongoing commitment to Sunnybrook, the new high-risk birthing unit will be named Sofina Foods Inc. and the Latifi Family High Risk Operative Birthing Suite

Ed Bush, of Corporate Planning and Development, with Michael and Marilena Latifi on a tour of the M-Wing construction site

ichael Latifi, president of Sofina own. These values were carefully considered The generosity of donors such as Michael Foods Inc., and his wife, Marilena, when deciding where to direct their philan- and Marilena will give every baby the best are generous donors to the Women thropy. It was clear to Michael and Marilena possible start, when it matters most. M BS & Babies Program, and in March they saw that the work of Sunnybrook’s Women & first-hand the impact of their support. Babies Program is perfectly aligned with the community-oriented vision of Sofina Foods Dr. Andrew Shennan, chief of the Women & Inc. Babies Program, gave the Latifis a tour of the new two-floor facility, which is currently un- “Sofina Foods Inc. is committed to support- der construction at Sunnybrook’s Bayview ing the communities in which we live and Avenue campus. Scheduled for completion work. By supporting the Women & Babies by fall of 2010, the state-of-the-art facility Program, we are contributing to the well-be- will be equipped to deliver and care for the ing of our entire community,” says Michael. 4,250 babies born each year at Sunnybrook, as many as one in four of whom are high Last year, the Latifis also raised an incred- risk. ible $224,000 for the Women & Babies Program through two events in support The new facility will boast the most ad- of Sunnybrook: the Sofina & Amici Golf vanced medical technology in a warm, Classic and the Latifi Ace Invitational Tennis Kevin Goldthorp, CEO of Sunnybrook Foundation, Dr. Andrew Shennan, chief of the Women & Babies family-centred environment, and will provide Tournament. Program with Marilena and Michael Latifi at the cheque Sunnybrook’s world-renowned medical staff presentation ceremony with the innovative resources they need to In recognition of the Latifis’ ongoing commit- give the very best care to many of Ontario’s ment to Sunnybrook, the new high-risk birth- most critically ill babies and their mothers. ing unit will be named Sofina Foods Inc. and the Latifi Family High Risk Operative Birthing Family and commmunity are very important Suite. to the Latifis, who have four children of their

40 Sunnybrook Magazine 2009 Sunnybrook Magazine 2009 41 The ABCs of Nursing Sunnybrook Nursing Education Partners with U of T’s Lawrence S. Bloomberg Faculty of Nursing

his past year, Nursing Education teaching hospital and are designated as at Sunnybrook partnered with the the ABC group for that hospital. Their pro- T Lawrence S. Bloomberg Faculty of fessional development takes place directly Nursing at U of T to offer the Agency Based in health-care settings where they apply Clinical (ABC) Placement, which creates content learned in the classroom and labs new learning opportunities for students at to patients, families and communities under The New Wave in Nursing Sunnybrook. the supervision of nursing clinical instructors Education: Sunnybook and nurse preceptors. ABC Placement offers the opportunity for Interactive students to complete the majority of their “We are pleased with how quickly this came clinical placements at Sunnybrook during about. Sunnybrook came on board enthusi- Nurses at Sunnybrook can now go their two-year program. Depending on the astically and willingly assisted with the stu- online to learn about everything from focus of a specific course, practice will take dent placements,” said Mary Ann Fegan, blood transfusions and patient safety place on different units within the hospital. co-ordinator of clinical education at U of T’s to pandemic planning and hand For example, in their entry year, students will Faculty of Nursing. “This is an important op- hygiene in an interactive way. Nursing complete clinical experiences in perinatol- portunity for students to get to know an or- leaders embarked on an eLearning ogy, the Veterans Centre, mental health and ganization, build their confidence and build journey in 2004 with the purchase medicine and/or surgery. In their senior year, their learning over the two years. And the students will practice on other units such as hospitals involved are enthusiastic and keen of a Learning Management System, neurosurgery and trauma, and in primary to be involved with building relationships with which stores in-house built content health-care settings that might include out- our students and supporting their learning in an online format. This approach to patient clinics. over time.” teaching saves educators time so they can be more available to patients and “We are thrilled to have these students There are significant advantages for stu- their families and staff. In addition, with us for the next few years,” says Sue dents in the program. They become familiar staff nurses can access eLearning 24 VanDeVelde-Coke, executive vice-presi- with the hospital setting and therefore expe- dent of Programs and chief of Nursing & rience reduced stress and anxiety, reduced hours a day and seven days a week. Health Disciplines at Sunnybrook. “There time acclimatizing to new settings, hospital- truly is a continuum of life and patient care specific policies and procedures, charting This online approach represents how at Sunnybrook. Students can apply them- and medication delivery systems, and re- millennial nurses and new grads learn, selves in any specialty. We have the largest sources for patients, families and students. work and even socialize. They expect number of critical-care beds in Canada and They are comforted knowing they will be components of nursing education and have specialties such as oncology, cardiac, at one hospital most of the time, not hav- development to be offered online, as trauma, musculoskeletal, medicine and ob- ing to worry about their clinical placements. stetrics, and over 500 long-term care beds. Students also have enhanced opportunities well. At Sunnybrook, the in-house- In addition, there are ongoing opportunities to participate in interprofessional activities. built-content is constructed by and for learning, specialized training, continuing reviewed by front-line nurses before it education and career laddering.” “These students truly feel that they are part gets posted online. of our Sunnybrook family,” says Shalimar The ABC Placement format is a fairly new Santos-Comia, director of Nursing Education Sunnybrook shares courses created model for clinical education that has been and eLearning. “Their confidence level in be- with other Toronto Academic very successful in other countries. It was ing present and practicing on-site for the implemented at the University of Toronto two extended time frame, truly experiencing how Health Sciences Network (TAHSN) years ago and U of T nursing students com- Sunnybrook lives our mission, vision and organizations and also receives content pleted their first program this past June at St. values are all significant benefits to both the from them. Other organizations Michael’s Hospital and Mount Sinai Hospital. students and to Sunnybrook.” NNR are interested in joining up for During the placement a small number of stu- partnerships, too. dents are assigned to a U of T – affiliated

42 Sunnybrook Magazine 2009 Sunnybrook’s Odette Cancer Centre Offers Less Invasive Treatment for Men Diagnosed with Prostate Cancer

o care for men with prostate cancer, Image-Guided Radiation Therapy use this approach to benefit patients, and Sunnybrook’s Odette Cancer Centre Approaches allow for greater capacity in the health-care T Prostate Cancer Group (part of the Sunnybrook’s Odette Cancer Centre system. Genitourinary Cancer Care Team) brings Prostate Cancer Group also offers innovative together one of the largest, highly special- image-guided radiation-therapy treatment Treatments are delivered with higher preci- ized teams of its kind in Canada. The Group options for patients diagnosed with low, in- sion and at higher doses per day. For ex- offers less invasive treatment approaches, termediate and high-risk prostate cancer, as ample, for patients with intermediate-risk which include: well as those who develop recurrence after prostate cancer, Dr. Gerard Morton is lead- surgery. ing a trial using a combination of high dose Active Surveillance Approach rate-brachytherapy and hypofractionated Low-risk prostate cancer patients are care- For example, patients with intermediate or external beam radiation therapy. Dr. Patrick fully monitored on an ongoing basis. If the high-risk prostate cancer might be offered Cheung is conducting research with high- cancer starts growing indicated by a rapid a combination of high dose-rate brachy- risk patients on the use hypofractionated rise in PSA (prostate specific antigen) or therapy and a short course of external beam external beam radiation therapy, grade progression on repeat biopsy, patients radiotherapy. The High Dose Rate brachy- are offered surgical or radiotherapy interven- therapy Program is the largest in Canada Overall results of hypofractionated treat- tion. Dr. Laurence Klotz is leading an inter- with the most experienced multidisciplinary ments and treatment combinations to date national, multi-centre trial called Surveillance team in the field. show fewer treatments are needed, and Therapy Against Radical Treatment to further patients experience less acute toxicity and validate this approach which is aimed at re- Sunnybrook’s Odette Cancer Centre is a report better quality of life. Though this early ducing over-treatment and radical treatment leader in Canada in hypofractionated (fewer data also shows promise for more effective side-effects in men with low-risk prostate doses at a higher dose per fraction) image- control of the disease, validation continues cancer. guided radiation therapy, and has developed through further follow-up. NCS a large number of treatment protocols to Dr. Laurence Klotz and Tom LePoidevin

Sunnybrook Magazine 2009 43 Infection Reduction “In Hand” Sunnybrook Leads Provincially in Hand Hygiene Education and Compliance

leaning your hands is the single • At point of care, and key entry and exit Sunnybrook has closely analyzed hand- most effective way to reduce the points, placement of a hand-hygiene hygiene practice and has helped inform the C spread of most infections. product (an alcohol-based hand rub); Ministry of Health and Long-Term Care’s • Auditing feedback with individual health- “Just Clean Your Hands” campaign to health- With its strong leadership focus on safety, care professionals to develop a culture of care professionals. NCS Sunnybrook continues to support Ontario’s change and continuous improvement in initiatives in hand-hygiene education and compliance; compliance. • Intensive refresher education and learn- Help protect yourself and others: ing modules as part of core competency clean hands protect lives. “We started about four years ago to look at training and certification for health-care hand-hygiene practice and ways we could professionals and students; As a patient or visitor to a hospital, enhance and sustain compliance,” says • Auditing tool to measure actual compli- you, too, can help prevent the spread of Sandra Callery, director, Infection Prevention ance rates. and Control Program at Sunnybrook. “We germs. Think about the times you would carried out audits at the time to research “Over the past year, hand-hygiene compli- clean your hands at home, such as: the process, and conducted interviews and ance at all Sunnybrook campuses has mod- focus groups to better understand barri- erately increased overall by 34 per cent,” • Before and after eating; ers to hand hygiene. We also drew from a says Dr. Mary Vearncombe, medical direc- • After going to the washroom; substantive literature review to include hand- tor of Infection Prevention and Control at • After sneezing or coughing. hygiene strategies from the World Health Sunnybrook, “and though there is room for Organization.” improvement, we acknowledge the contin- ued and substantial efforts of our staff.” By cleaning your hands at these times “We developed an evidence-based hand- and even more often when you are in a hygiene compliance program, which we vali- “On a day-to-day basis, we see compliance hospital, you can help protect yourself dated in consultation with health-care pro- steadily on the increase,” says Callery, “and and others. viders and other professionals,” says Callery. we know studies indicate even a 20 per cent increase in hand-hygiene compliance can Sunnybrook’s Infection Prevention and reduce health care–associated infections by Sunnybrook recently launched a hand-hygiene campaign Control team implemented the following key up to 40 per cent.” encouraging best practices components for a successful program:

44 Sunnybrook Magazine 2009 Improving Access to Cutting-Edge Vascular Care Schulich Heart Centre a Leader In Minimally Invasive Endovascular Surgery

“Because of the advanced techniques available at Sunnybrook, I was able to have the surgery I needed and can look forward to seeing my daughter get married this year”

n November 2006, Tony Vandermale Tony’s wife of 45 years. “Once that happens, minimally invasive procedure is much easier paid a visit to his doctor to investigate there is only a 10 to 15 per cent chance of on the body and safer for people with pre- I the source of the back pain he had been survival, which is a pretty difficult thing to live existing medical conditions, making repair experiencing. with every day.” an option for many patients who would have had to go without.” “I was fairly sure the pain was caused by my Every day in Ontario, three people die from reoccurring kidney stones but I wanted to be a ruptured aneurysm. Vandermale was In addition to improving access to the best sure,” recalls Vandermale. “Through the ex- spared that fate when he was referred to Dr. vascular care, advantages of this surgical amination, we discovered that I actually had Andrew Dueck, an endovascular surgeon technique include reduced pain and less an aneurysm.” at Sunnybrook’s Schulich Heart Centre. need for postoperative pain medication, as Dr. Dueck had some good news for him: well as smaller scars and a shorter stay in An aneurysm is a weak point in a blood ves- Vandermale was actually a perfect candi- the hospital. The total recovery time is about sel wall that swells like a balloon and can date for the cutting-edge endovascular sur- one or two weeks, compared to six weeks burst, leading to uncontrolled bleeding and gery being preformed at Sunnybrook. with more invasive surgery. even death. One option for treatment is to surgically replace the damaged portion of “In the past, we would have to use drugs “Because of the advanced techniques avail- the aorta (the largest artery in the body) with alone to treat patients like Tony who are not able at Sunnybrook, I was able to have the an artificial graft through a large incision. good candidates for traditional endovascular surgery I needed and can look forward to Unfortunately, Tony had pre-existing medical surgery,” says Dr. Dueck, who is also an as- seeing my daughter get married this year,” conditions and was not well enough to with- sistant professor in the Division of Vascular says Vandermale “That’s the greatest advan- stand this life-saving surgery. Surgery at the University of Toronto. “Now, tage I can think of.” LL we are able to insert the stent-graft through a “We knew that without surgery, we would tiny incision at the top of each leg and attach Tony Vandermale, who underwent innovative have been living in limbo waiting for Tony’s it to the weak part of the aorta to prevent endovascular surgery to treat an aneurysm aneurysm to burst,” says Nellie Vandermale, the aneurysm from rupturing. This type of

Sunnybrook Magazine 2009 45 Anesthesiologist Leads Innovative Efforts in Pain Control Preventive Analgesia Reduces Pain for Surgery Patients

tient is then made aware of the preventive pain medication regime that they will be pre- scribed when they are admitted to the hospital. Prolonged pain relief is provided by ap- plying a local anesthetic around the nerves that supply the surgical site. This treatment is stopped two to three days after surgery when the patient requires a less potent pain reliever.

A month prior to his total knee replacement surgery, Atkinson began a regimen of ex- tra strength Tylenol and ice to manage the sore knee. He consulted with his anesthesiologist three weeks prior to surgery, who provided an individualized assessment and encouraged Richard to continue his existing pain-control regimen. On the day of surgery, Atkinson recalls being wheeled into an area n January, Richard Atkinson, 73, was dis- called preventive analgesia, patients are giv- separate from the operating room prior to charged from the Holland Orthopaedic & en a combination of pain medications before surgery where he was administered analge- I Arthritic Centre campus at Sunnybrook af- surgery and for several days after surgery in sic medications and nerve blocks. ter total knee replacement surgery on his left order to reduce the level of pain they might knee. In July 2008, Atkinson had undergone typically experience. Despite its clear benefits, preventive analge- knee replacement surgery on his right knee sic methods, including nerve blocks, are the at the Holland Centre. For both procedures, “It is my responsibility to facilitate imple- exception rather than the rule in many hos- he praises the medical staff at Sunnybrook mentation of best practice and to inves- pitals. However, with other staff and scien- for a smooth and painless experience. tigate new and better ways of controlling tists at the Holland Centre, Dr. McCartney is post-operative pain,” says Dr. McCartney, investigating how to promote a wider usage “There has never been a problem,” Atkinson director of Regional Anesthesia Research of preventive analgesia in medical organiza- says. “After my right knee was replaced, I and Education at the Holland Centre, and tions across Canada. was doing things I wasn’t supposed to be an associate professor at the University of doing! With each day, I am improving. I didn’t Toronto. “Preventive analgesia has been Fiona Webster, a knowledge translation need any Percocet [a pain reliever] after the shown to reduce pain and drug-related side- scientist at Sunnybrook, is working with Dr. first evening at home, which was just five effects by decreasing pain signals from the McCartney to understand the barriers and days after surgery.” surgical site. As a result, this technique has facilitators of best practices in pain manage- been shown to reduce the risk of developing ment. “We will be studying these issues em- Discomfort after surgery is a normal part acute and chronic pain after surgery.” pirically in order to help us develop effective of the healing process for most patients. strategies that will support practice change However, more than 30 per cent of all pa- At the Holland Centre, one of the largest both here at Sunnybrook and provincially.” tients suffer severe pain after surgery, which hip and knee joint replacement centres in can lead to poor recovery and chronic pain. Canada, every patient is evaluated by an When Shirley Atkinson helped her husband Uncontrolled pain can also potentially pro- anesthesiologist in the preoperative clinic move around after his surgery, she could not duce damaging effects on the heart and about two weeks before surgery. At this time, help noticing how quiet and calm the patient lungs. aspects of anesthetic care are discussed so wards were. As a former nurse, she was very that patients can properly evaluate the ben- impressed by the innovations and improve- Dr. Colin McCartney, an anesthesiologist at efits and risks of the common approaches ments in patient care. Sunnybrook, leads a team of experts to pro- to pain relief. Nerve block techniques, com- mote the latest innovations in pain manage- monly used at the Holland Centre because Adds Richard: “I hope I don’t have to come ment to improve the post-operative experi- they offer superior pain relief, are often used back for more surgery but if I do, I hope everything is exactly the same.” ence and help patients return to their daily instead of general anesthesia, and this is SD activities sooner. Through a unique method discussed in depth with the patient. The pa- Dr. Colin McCartney and Fiona Webster

46 Sunnybrook Magazine 2009 Veteran Profile Murray Westgate Second World War, Royal Canadian Navy

After six years devoted to the war, Westgate took up acting. His face became synonymous with Hockey Night in Canada broadcasts for 16 years

t was Murray Westgate’s “nice guy” look ing in productions at Vancouver’s Everyman stroll around the campus. “I’m a big news that landed him a legendary role that Theatre, to a multi-faceted career that junkie. I love Charlie Rose and watch him I many Canadians still remember: that of spanned television and stage, Westgate was daily on PBS. I’m also big Seinfeld fan,” he Imperial Oil’s friendly gas station dealer and definitely born to perform. says. original pitchman. Westgate recalls his favourite television ex- Westgate was married to CBC Radio ac- In 1952, gas was 25 cents a gallon. Hockey periences: “The Discoverers: The Story of tress Alice Hall until her death in 1983. Hall fans tuned in faithfully to the new box called Dr. Banting in which I played Dr. Banting was well known for her work in dramas such a television, and Westgate’s Imperial Oil alongside Canadian actor John Drainie. I as, The Craigs and Maggie Muggins. Their pitchman sang the song “Happy Motoring” also really enjoyed the plays The Gin Game two daughters live in Burlington, Ontario, along with the famous slogan “Put a tiger in and On Golden Pond.” and visit often along with Westgate’s four your tank!” His face became synonymous grandchildren. with Hockey Night in Canada broadcasts for Along with acting, Westgate is also proud 16 years. of his service in the Second World War A letter dated April 30, 1979, and signed by and for the last four years, he has lived at former prime minister Pierre Trudeau hangs For Canadians from coast to coast, Saturday the Sunnybrook Veterans Centre. In 1939, on the wall in his room. The letter congrat- Night was special. First there was the Jackie he joined the Royal Canadian Navy and ulates Westgate on receiving an ACTRA Gleason Show followed by Hockey Night in was posted to Halifax where he trained as award for best supporting actor in the play Canada. During Hockey Night’s intermission, a telegraphist, learning Morse code in order called Tyler. “I’ve had a great life with won- viewers watched the Hot Stove League and to communicate by radio lines while at sea. derful opportunities, things fell my way,” Westgate, who wore the spotlessly clean Westgate devoted six years of his life to the says Westgate. “And now Sunnybrook is the Esso uniform consisting of a zippered jacket war effort – three on a British ship on convoy best place I could possibly be.” SF and pants, a blue shirt, dark bow tie and duty in the North Atlantic sailing to the strate- cap. gic harbour of Gibraltar. Murray Westgate, as the friendly gas station attendant and Imperial Oil’s original pitchman. Westgate is now a From performing in high school plays at At Sunnybrook, Westgate, 91, enjoys the oc- resident in the Sunnybrook Veterans Centre Central Collegiate in Regina, to working casional bingo game, and has taken a few throughout the west for CBC Radio, to act- guitar lessons. Every day he tries to take a

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