Young patient volunteers in stroke rehab clinic - HHS Share

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Young patient volunteers in stroke rehab clinic - HHS Share
Young patient volunteers in
stroke rehab clinic
Andrew Mathieson’s heart defect had to be monitored each year.

He was born with a bicuspid aortic valve instead of a
tricuspid valve, which means there are two leaflets of the
aortic valve instead of three. This reduces blood flow from
the heart to the rest of the body. Doctor’s noticed Andrew’s
aorta started to enlarge to the point of danger.

In December 2017 at 22 years old, Andrew underwent open heart
surgery with Dr. Richard Whitlock at Hamilton General Hospital
to repair the valve and the enlarged blood vessel.

Following the surgery, Andrew experienced a stroke which left
him with loss of vision when looking to his right side and
difficulty with concentration and memory.
Young patient volunteers in stroke rehab clinic - HHS Share
Young patient volunteers in stroke rehab clinic - HHS Share
Andrew left the hospital near the end of January. Just six
months after discharge, he wanted to give back. Through our
Volunteer Resources program, Andrew began volunteering as a
recreational therapist assistant in the Regional
Rehabilitation Centre’s stroke rehab clinic where he received
treatment.

“I’m helping out with the same nurses that helped me out. They
all know me by name. They find it amazing I’m helping out at
the same spot where I met them for rehab,” he says.

Andrew’s neurologist, Dr. Wes Oczkowski, says Andrew is taking
his experience in stride.

“The biggest difference compared to most people with a stroke
is that he’s only 22. That means his potential improvement –
either with further recovery (healing), remediation (working
on things to make them better) and the ability to compensate,
all have the ability to be better than someone who is 72,” he
says.

Part of Andrew’s weekly volunteer visit involves sharing his
story with patients over hot chocolate.

“Seeing what I went through really makes them motivated. Every
time I go out with them, they really light up,” he says.

They enjoy activities like playing Nintendo Wii bowling,
abstract painting together, and even decorating pumpkins in
time for Halloween.

Besides volunteering, Andrew runs six to seven kilometers
daily to strengthen his heart and support his mental health.
He is looking at different career options for his future.

“I hope my story can help connect with those who are going
through a hard time and give them a little bit of support in
the worst part of their life.”
Young patient volunteers in stroke rehab clinic - HHS Share
HHS ranks in the top three
research hospitals in Canada

Hamilton Health Sciences (HHS) has been ranked among the top
three research hospitals in Canada, as announced today by
Research Infosource Inc..

Research Infosource Inc. is an independent, leading source of
Young patient volunteers in stroke rehab clinic - HHS Share
ranking information on research universities, corporations,
hospitals and colleges in Canada. Each year, it releases
results on the top 40 research hospitals in the country, based
on total research revenue.

In 2017, Hamilton Health Sciences generated $207 million in
research revenue, a 20 per cent increase over the previous
year.

“As an academic teaching hospital with a mandate to improve
patient care and our healthcare system through research, we
take great pride in our achievement of this high ranking among
some of Canada’s most accomplished health research
communities,” says Ted Scott, vice president of research at
HHS.

 More than one million participants from across the six
 inhabited continents have enrolled in research led by HHS.

In partnership with McMaster University, Hamilton Health
Sciences conducts research through five research institutes
and centres, with expertise across the spectrum of care. To
date, more than one million participants from across the six
inhabited continents have enrolled in research led by HHS, and
its experts have made discoveries around some of the world’s
biggest health challenges.

Click here for more information on research at HHS.
Young patient volunteers in stroke rehab clinic - HHS Share
High tech hand                         makes           vet
unstoppable
Craig Tourangeau can still feel his hand. The last moment he
had it, his fist was closed. Closed tightly around a grenade,
about the size of a toilet paper tube. His hand feels exactly
as it did in those last seconds—gripped so forcefully that it
feels wrapped in layers of duct tape. Except it’s not there.

Craig was part of Joint Task Force 2, which was enlisted to
protect the 1994 Commonweath Games from potential terrorism
threats. The veteran had completed extensive training. He and
his team were running a simulation drill in advance of the
games. The scenario: a hostage rescue. Craig was armed with a
stun grenade to distract the “terrorist.” It was just a drill,
but it got very real, very quickly. The stun grenade was
faulty. When Craig pulled the pin, it exploded in his hand.
Young patient volunteers in stroke rehab clinic - HHS Share
“It felt like my hand was slammed in a car door,” he recalls.

Craig didn’t let the loss of his hand hold him back. If
anything, it has pushed him to work even harder on his goals.
There isn’t much he can’t do thanks to his motivation, the
team in Hamilton Health Sciences’ Prosthetics and Orthotics
Department, and some very cool technology.

 “he was showing us things he could do with it that we didn’t
 even know existed”

“Craig’s success in the use of the prosthesis is a team
effort,” says Ken Roczniak, a prosthetist at HHS who has been
treating Craig for a number of years. “The patient is very
much a part of that team.”
Young patient volunteers in stroke rehab clinic - HHS Share
The power of a myoelectric hand
                   Technology   has   kept   pace   with   Craig’s
                   desire to tackle new challenges with his
                   prosthetic hand. He currently uses a
                   myoelectric system that picks up on
                   electrical signals from his muscles. They
                   voluntarily open and close the hand. It
                   allows him impressive control. He can move
                   his hand into a range of grips by motioning
                   in different directions, or using an app on
                   his phone.

“It requires a fair bit of training to operate,” says Ken.
“Craig picked it up so quickly. Before we knew it, he was
showing us things he could do with it that we didn’t even know
existed.”

Determination is key
Craig regularly sees a team of specialists including a doctor,
prosthetist, prosthetic technician, and occupational
therapist. They ensure his prosthetic is well fitted, and able
to accomplish what he wants it to. He works as a canine police
officer, and is an avid motorcycle rider so he needs it to
perform at a high level.

“I’m always on the go,” says Craig. “I have different devices
for different activities, which allows me to do pretty much
everything.”

Ken says that while technology has enabled Craig to take on a
range of challenges, his success would not have been possible
without his attitude.

“I have the utmost respect for our veterans both past and
present,” he says. “I am inspired by Craig’s positive attitude
Young patient volunteers in stroke rehab clinic - HHS Share
about the challenges that he faces with the loss of his hand.
His determination to integrate this technology into his
everyday life is a major factor in his success.”
Young patient volunteers in stroke rehab clinic - HHS Share
Veteran no longer must ‘push
through the pain’
Chris Teer was in the military for 18 years, first as a combat
engineer, then as part of a Special Forces unit that focused
on chemical, biological and radiological threats. He spent
time in Afghanistan, Eritrea, and Ukraine. He endured
gruelling training and saw many things he cannot unsee. He
also developed severe chronic pain in his feet, knees, and
lower back.

“The training involved in military service takes its toll on
the body,” says Chris. “It was a gradual accumulation.”
Just when all hope was lost…
He sought help for his pain, but lost hope when treatment
after treatment failed to give him the relief he needed. When
he was enrolled as a patient with the Michael G. Degroote Pain
Clinic at Hamilton Health Sciences, he doubted it would be any
different. He is very happy to admit that he was wrong.

“The team is fantastic,” he says. “Positive, transparent,
open. I had lost faith in the system, and they changed that.”

Chris came to Hamilton from Trenton for a month of treatment.
The Pain Clinic’s care model includes daily sessions with a
whole team of experts including psychologists, occupational
therapists and social workers. They don’t just treat the
symptoms of pain, they treat the causes behind it.

Unlearning ‘push through the pain’
One of the specialists he worked with was physiotherapist,
Adria Fransson. She helped suppress the urge to push through
the pain.

“In patients with a military background, we commonly see this
mentality of ‘push through the pain,’” Adria says. “It may
feel okay while you’re at it, but when the endorphins wear
off, you are left depleted and in significant pain. People
sometimes then become fearful of exercise because they don’t
want to experience the pain that comes afterward.”

It’s important for people with chronic pain to move their
bodies. But too much intense movement can also trigger pain.
Adria teaches patients how to reach a happy medium, and listen
to their bodies’ signals. Chris was introduced to tai chi and
yoga, as well as pool exercises, and swimming lengths. He
learned how to exercise moderately, and manage his breathing.
He also learned how to use simple equipment at home to relieve
muscle tension.
“Learning how to feel the tension in my body, and relax it was
an ‘aha moment’ for me,” Chris says.

Life after the Pain Clinic
Since returning home from his time at the Pain Clinic, Chris
says his mood has improved, he’s spending more quality time
with his family, walking his dog more, and sleeping better. “I
can’t stress how grateful I am for the treatment I received,”
he says.

For Adria, seeing all aspects of a patient’s life improve is
proof that the team’s model is working.

“Chronic pain is not just a physical ailment” she say. “It
affects our whole life. Having a whole team involved ensures
we’re helping people to make lasting changes.”

Did Chris’ story inspire you? Click here to read about another
veteran, Glen, who regained control of his life with help from
the Pain Clinic, and watch his video below.
Halloween spirit hits HHS
Across the Hamilton Health Sciences (HHS) family of hospitals,
the Halloween spirit was alive, yesterday. Hundreds of staff
members dressed in costume and decorated their clinics to the
delight of patients young and old.

To see more photos of staff in costume, search #myHHS on
Twitter and Instagram.

Costume game strong
The Child Life Department gave McMaster Children’s Hospital
staff an extra incentive to step up their costume game. Teams
were invited to enter a costume contest judged by patients and
families. Some units went a step further, decorating their
space to match the theme of their costumes. Congratulations to
this year’s winners, the Tim Horton’s Drive Thru, 3C.
Their efforts were appreciated by patients and families who
enjoyed seeing the creative costumes while they collected
candy at the annual McMaster Children’s Hospital Halloween
Parade. Hundreds of staff, volunteers and visitors lined the
hallways of the hospital to hand out candy and toys to
patients and their families. You can watch a Facebook Live
video of the event below. Watch CHCH News’ coverage of the
Halloween parade.

Trick-or-treating for everyone
This Halloween, for the first time ever, Hamilton Health
Sciences’ Ron Joyce Children’s Health Centre (RJCHC) partnered
with Eastgate Square to host an inclusive and accessible
trick-or-treat event.

“Our annual trick-or-treat event is always a hit with
families,” says Barbara Miele, Marketing Director, Eastgate
Square. “We were excited to be expand the event this year in
partnership with Ron Joyce Children’s Health Centre.”
Halloween can be a difficult time for children with
disabilities and their families. Barriers like steps, uneven
footing, and unpredictable social interactions can make trick-
or-treating difficult, or even impossible, for kids with
physical and developmental disabilities. To ensure every child
had a chance to participate, Eastgate Square offered an
accessible hour of trick-or-treating inside the mall on
October 31st. RJCHC staff collected donations of candy that
were handed out to a group of eager trick-or-treaters.

“We heard from families that they weren’t always able to fully
participate in Halloween activities because of their child’s
challenges,” says Lindsay Bray, Clinical Leader, Developmental
Pediatrics and Rehabilitation, Ron Joyce Children’s Health
Centre. “We are so glad we found a community partner to help
us make this holiday one that everyone can enjoy.”
New ambulance decals will
help   create more  stroke
survivors
When someone has a stroke, every second counts. The ability to
recognize the “FAST” signs of stroke and call 9-1-1 can mean
the difference between life and death, or the difference
between a full recovery and lasting disability.

To create more stroke survivors in our community, Hamilton
Paramedic Service and Hamilton Health Sciences have partnered
with the Heart and Stroke Foundation to help residents
recognize the signs of stroke. To do this, Hamilton ambulances
will display “FAST” decals to remind residents of the signs of
stroke, and urge them to call 9-1-1 right away if stroke is
suspected.
“FAST” stands for:

Face – is it drooping?

Arms – can you raise both?

Speech – is it slurred or jumbled?

Time – to call 9-1-1 right away!

“We want Hamiltonians to understand that when it comes to
stroke, timing is critical. By recognizing stroke symptoms
early, Hamilton’s trained paramedics and our local stroke team
can provide you with the treatment and care you need sooner,
which greatly improves your chances at a full recovery,” says
Hamilton Paramedic Deputy Chief Russell Crocker.

 “We want Hamiltonians to understand that when it comes to
 stroke, timing is critical.”

Hamilton General Hospital is the regional stroke centre for
Central South Ontario. There, a specialized stroke team sees
some of the most severe cases of stroke in our region. They
know firsthand the potentially devastating impacts that
delaying stroke can have on individuals and their loved ones.

“Knowing the signs of stroke could save your life, or the life
of someone you love,” says Dr. Wes Oczkowski, stroke
neurologist at HGH and medical director for the Central South
Regional Stroke Network. “We hope this initiative will help
create more stroke survivors in our community.”

In Hamilton, more than 1,000 people suffer from stroke each
year. In 2017 and 2018, Hamilton Paramedic Service has
transported approximately 1,397 suspected stroke cases. Of
those cases, half were men and half were female, with the
majority aged over 40 years.

 “Knowing the signs of stroke could save your life, or the
life of someone you love.”

Heart & Stroke Director of Ontario Mission, Karen Trainoff, is
delighted to expand the reach of the FAST campaign through
this partnership with Hamilton Paramedic Service and Hamilton
Health Sciences.

“We know that public awareness increases in communities that
have FAST decals on their vehicles. We are pleased to know
that people will be reminded of the FAST signs of stroke every
time they see a Region X ambulance,” says Ms.Trainoff. “Our
objective is to ensure that all Canadians, no matter where
they live or how old they are, know and remember the FAST
signs of stroke.”

Stroke facts
     A stroke is a sudden loss of brain function.
     62,000 strokes occur in Canada each year – that is one
     stroke every nine minutes.
     83 per cent of those who have a stroke and make it to
     hospital will now survive.
     Brain cells die at a rate of 1.9 million per minute
     during stroke.
     Each year, more than 13,000 Canadians die from stroke.
     Hundreds of thousands of Canadians are living with the
     effects of stroke.
     Stroke is a leading cause of acquired adult disability
     Stroke can happen at any age. Stroke among people under
     65 is increasing and stroke risk factors are increasing
     for young adults.
     Half of Canadians report having a close friend or family
     member who survived a stroke.

For more information about the signs of stroke, visit
www.heartandstroke.ca/FAST.

Inclusive    cheer    squad
performs at Ticats game
A group of very special kids took to the field during halftime
at the Hamilton Tiger-cats game this Saturday. Some of them
walked onto the field, some wheeled. They all cheered their
hearts out. They are the Ron Joyce Children’s Health Centre
(RJCHC) cheer squad.
The squad launched in September of 2018 with a goal of giving
clients at RJCHC a chance to participate in an inclusive
activity. Both children with physical and developmental
disabilities, and typically developing children are encouraged
to join so they can learn from each others’ experiences.

Everyone can cheer
RJCHC provides a range of services to children, youth, and
adults in our region, many of whom are dealing with life-long
health issues. The centre’s programs include Autism Spectrum
Disorder    Services,     Developmental     Pediatrics     and
Rehabilitation, Prosthetics and Orthotics, and Child and Youth
Mental Health.
“We’ve noticed that children who use our services and their
families often feel isolated because they can’t always take
part in typical community programs,” says Lindsay Bray,
clinical leader of Developmental Pediatrics and Rehabilitation
at RJCHC. “This puts them at risk for developing secondary
mental health issues which is why programs like the RJCHC
cheer squad are so greatly needed.”

 “These kids see each other for who they are.”

Lindsay and her team launched the cheer squad with support
from parents of clients at RJCHC. One of those clients is
Makayla Benner. She’s twelve years old and has been dancing
for most of her life. Her mom, April, wanted to get her
involved in cheerleading, but was unable to find a squad that
would accommodate her needs. Makayla has Pitt-Hopkins
Syndrome, a genetic disorder that affects her development,
along with autism spectrum disorder.
“There are kids in wheelchairs, in braces, and everyone is
helping everyone,” says April, of the scene she enjoys
watching during practice. “These kids see each other for who
they are.”

Makayla’s typically developing friend and classmate has also
joined the squad. April says it’s heartwarming to watch her
daughter have fun with her peers.

Learning to cheer from the pros
There are already nearly 50 children enrolled in the squad.
Former Hamilton Tiger-cats cheerleaders, Tanisha McDermott-
Hansen and Dominique Krawchenko, coach them through weekly
practices. Knowing they would be performing at the Tiger-cats
game gave the squad great motivation to perfect their routine.
“As a mom who has a child with special needs, it’s always
emotional to see her perform,” April says, of watching her
daughter cheer at the half-time show. “It’s a different world
for her, so when she gets to have these experiences, it’s
meaningful.”

 “We want to make our kids and families feel that they truly
 “belong” in our community.”

Lindsay says she and her colleagues have already seen a
tremendous impact on the kids.

“We provide services to support these kids physically,
mentally and developmentally, but this social support is also
greatly needed. We want to ensure our kids and families feel
that they truly “belong” in our community.”

The cheer squad is funded in part by a grant from the Hamilton
District Society for Disabled Children.
Cancer-free and paddling to
victory
As of this month, Geri Schweinbenz has been officially cancer-
free for a full year. It’s a major milestone for the X-ray
technologist who works at Hamilton Health Sciences’ Main
Street West Urgent Care Centre. Since her diagnosis with Stage
3 breast cancer six years ago, she has experienced painful
lows and incredible highs.

“I was in total shock by my diagnosis,” says Geri. “I hadn’t
been feeling sick and I have no family history of breast
cancer.”

Her family was a great support, but Geri still struggled with
anxiety during her treatment. Her oncologist and nurses helped
reduce her stress, but treatments were still incredibly tough
on Geri. One day during her chemotherapy treatment at
Juravinski Hospital & Cancer Centre (JHCC), Geri struck up a
conversation with her nurse about support groups. She was
receiving the physical treatment she needed, but knew
emotional support was equally important in her cancer journey.

 “I was in total shock by my diagnosis.”

“I had never used a support group before so I had no idea what
to expect,” says Geri. “But, I knew I needed help with what I
was going through.”

Knowing Geri played recreational sports, her nurse suggested
the “Knot A Breast” (KAB) dragon boat racing team. It’s
comprised of breast cancer survivors from the Hamilton area.
Her nurse referred to it as a “floating support group”.

This piqued Geri’s interest, not just from an emotional
perspective, but physical as well. She struggles with
lymphedema, a build-up of fluid, in her right arm, which is a
side-effect of cancer treatment. She learned that paddling
helps manage lymphedema while building one’s strength back.

Eight months after her last treatment, she decided it was
time.
“I, like the majority of the ladies who join KAB, didn’t know
anyone on the team. So, I was nervous heading to my first
meeting,” says Geri. “But as soon as I was there, I knew I had
found my support group.”

 “It gives us breast cancer survivors hope and a feeling of
 belonging.”

This summer Geri and the team competed at the International
Breast Cancer Paddlers’ Commission Dragon Boat Festival in
Florence, Italy. While they started from behind, they managed
to paddle past their competitors and cross the finish line in
front with an astounding personal best time of 2 minutes and
20 seconds. This was their third consecutive first place
finish at the international competition.

Geri credits her survival to the incredible team at JHCC, and
her recovery to her floating support group—KAB.

“I wouldn’t have been here to join KAB without the team at
Juravinski, and I wouldn’t be who I am today without KAB,” she
says. “It brought back my confidence and taught me to push
beyond my limits. It gives us breast cancer survivors hope and
a feeling of belonging.”

Superheroes       celebrate
Halloween with MacKids
Spider-Man and Batman rappelled down the exterior of McMaster
Children’s Hospital (MCH) on October 17. Black Panther was
also seen posing for photos as Mr. Incredible chatted with
Captain America.

The party at MCH was a hit with patients and families as the
front lobby was transformed into the ultimate Halloween
celebration.
High-spirited fun
Spirit Halloween generously donated new costumes for patients
and their siblings, who enjoyed dressing up as ghoulish
ghosts, beautiful princesses and fearless superheroes. More
than 100 patients and siblings from MCH and Ron Joyce
Children’s Health Centre signed up for the celebrations, which
included face painting, pumpkin decorating and many other fun
activities.

The big surprise of the evening came when participants were
invited outside to watch members of the Hamilton Police
Service Emergency Response Unit rappel down the front of the
building dressed as comic-book crimefighters. The crowd went
wild to the sight of these real heroes in action.

“We are extremely grateful to Spirit Halloween and the
Hamilton Police for making this special evening possible,”
says Parker Neale, the senior business and community
engagement development officer at McMaster Children’s Hospital
Foundation. “This is an inspiring way to bring the community
together and put smiles on the faces of patients during their
journey.”

Supporting Child Life
Spirit Halloween’s Spirit of Children campaign supports the
Child Life program at MCH by collecting donations at store
locations throughout south-central Ontario. Nearly $170,000
has been raised since the Foundation began participating in
the program two years ago.

 “Supporting the amazing work done by the Child Life team at
 MCH is a matter of pride for us.”

“The communities we serve are extremely generous and we are
very thankful,” says Tracy Akitt, the clinical leader of Child
Life at MCH. “The support of Spirit Halloween and their
customers helps to supplement the programs and activities we
offer, which makes a real difference for children and
families.”

Caring for Communities
Staff at Spirit Halloween stores across the region eagerly
await the Spirit of Children campaign each year and are
excited to begin their fundraising for such a worthwhile
cause.

“Supporting the amazing work done by the Child Life team at
MCH is a matter of pride for us,” says Dave Kerr, the
operations manager at Spirit Halloween. “Children are our
future and we are committed to caring for our communities.”
Stopping a stroke before it
happens

Too young for a stroke?
Sheila Price works as a program secretary at Ron Joyce
Children’s Health Centre (RJCHC). Every day, she walks past
Hamilton General Hospital (HGH), home to the Stroke Prevention
Clinic (SPC). The possibility of having a stroke never really
crossed her mind—she was just 50, too young to be at risk, she
thought.

Then she started to experience numbness and weakness. Her
family encouraged her to visit her family doctor who
immediately connected the dots between her symptoms. She
suspected Sheila was experiencing transient ischemic attacks,
also known as TIAs, or warning strokes. They are often
followed by a full-blown stroke, especially if left untreated.
Sheila’s family doctor referred her to the SPC.

“I’m really lucky she knew exactly what to do,” says Sheila.
“Sending me to the Stroke Prevention Clinic was the right
choice.”

The right team at the right time
A few years ago, the SPC completed an improvement process to
significantly reduce its wait times for new patients. The
average wait time went from 35 days to just three. Sheila was
seen the very next day after her referral.

At that appointment, her family doctor’s suspicions were
confirmed. Sheila had experienced two TIAs.

“Her carotid artery, the tube that sends blood to the brain,
was blocked,” says Dr. Kelvin Ng, who treated Sheila in the
SPC. “Clots from the carotid artery in her neck were
travelling to her brain and eye and causing the TIAs.”

 “She was fortunate she recognized the symptoms”

Dr. Ng says Sheila was lucky she, her family, and her family
doctor took quick action.

“She was fortunate she recognized the symptoms of a TIA and
got appropriate medical attention before she had a life
changing stroke,” he says.

Sheila immediately underwent a series of tests, and was
admitted to the inpatient stroke unit at HGH. HGH is the
regional stroke centre for central south Ontario, and provides
complete stroke care from prevention to rehabilitation. Dr.
David Szalay performed surgery to clear the blockage in her
artery June 8th—just four days after she visited her family
doctor.
“It was amazing how fast it all happened,” Sheila says.

Making changes to prevent stroke in
the future
Her surgery was a success, but her journey was far from over.
Sheila continued to meet with the team at the SPC to reduce
her risk of future TIAs and strokes.

“There are a number of factors that can affect risk of stroke,
and we work with patients to manage them,” says Lisa Fronzi,
clinical nurse specialist in the SPC.

Sheila was a smoker when she first visited the SPC. The team
worked with her to create a plan for quitting, since smoking
is the second leading risk factor for stroke. Sheila also
started taking medication to manage her cholesterol and blood
pressure, and the SPC team worked with her family doctor on
ongoing diabetes management.

Sheila has been smoke-free since her stroke, her cholesterol
is within normal range, and her blood sugar levels have gone
down considerably. She was discharged from the SPC last month
as a result of her progress.

“She has done remarkably well,” says Lisa. “She made numerous
lifestyle changes which will significantly reduce her risk of
future stroke.”

Both Sheila and her care team know that things could have gone
very differently if she didn’t recognize her TIA symptoms. She
says the experience was a wakeup call.

“I’m lucky to be here,” she says. “I’ve made some big changes
in my life, and I’m looking forward to living a long and
healthy life.”
Signs of stroke
If you suspect a TIA or stroke, call 9-1-1 immediately.
Remember the signs of stroke:

F – FACE – Is it drooping?
A – ARMS – Can you raise them?
S – SPEECH – Is it slurred or jumbled?
T- TIME – Time to call 9-1-1 right away

Code         Blues              become    a   rare
occurrence
Originally published by Canadian Healthcare Technology
Spring 2017

Code Blues used to sound every day at Hamilton Health Sciences
(HHS), but an early warning system that measures six vital
signs has been used to dramatically reduce their incidence.
Now, it can be days before one hears a Code Blue at most of
the hospital’s acute care sites.

The Hamilton Early Warning System (HEWS) was developed in 2010
by a team of clinicians at Hamilton General Hospital (HGH) led
by Dr. Alison Fox-Robichaud, a critical care physician. By
monitoring vital signs such as oxygen saturation, pulse and
respiratory rate, the system can quickly determine if a
patient is deteriorating to the point that the response team
should be called for help.

In most cases, a cardiac or respiratory arrest can be
prevented with appropriate intervention. HEWS is the system
that triggers that early response from care teams and, so far,
the impact has been significant.

By not alerting the team in a timely manner, patient lives can
be lost. The situation has been dubbed “failure to rescue”,
and can also become a source of costly litigation between
hospitals and patient families.

 Now, it can be days before one hears a Code Blue.

With HEWS, the vital signs are manually collected and entered
and the electronic medical record calculates a score. Based on
the number, the nurse is given an alert to call the physician
and/or the response team.

While the province of Ontario started funding resuscitation
teams in 2006, the concept of a response team was foreign to
staff and physicians. Rigorous education and training was
implemented at HHS to foster uptake of this new change of
practice. Today, the resuscitation – also known as “RACE” –
teams are a vital resource.

Dr. Fox-Robichaud observed that with the use of HEWS, the
volume of calls to the response team has risen, but the number
of transfers to the intensive care unit (ICU) has dropped
considerably.

“You do increase the workload, but at the same time, you
decrease the transfers to the ICU,” she says.

The original HEWS pilot project in 2010 showed an increased
call volume to the critical care response team, but only a
minor increase in the number of ICU admissions and a 50 per
cent reduction in cardiac arrests on the pilot unit compared
to the previous year.

In addition to vital signs, HEWS also scores delirium, which
is monitored by nurses.

“It’s a unique factor at Hamilton Health Sciences, and it
helps recognize the evolution of sepsis,” said Dr. Fox-
Robichaud.

Sepsis is also a major cost for hospitals; in the United
States alone, said Dr. Fox-Robichaud, the cost reaches $23
billion per year. She noted that HEWS scoring may be superior
to traditional forms of monitoring for sepsis development.

Using the collected data, a score is tallied and the
appropriate action can be taken. With a score of three, the
charge nurse is informed; with a score of four, a call is made
to the patient’s most-responsible physician; with a score of
five, the response team is called for an assessment; and for
six, a very important intervention must be made. A score of
seven will trigger a Code Blue alert.
The system integrates with the hospital’s electronic patient
record, which is supplied by Meditech. Currently nurses
manually input the data into the system, where the analytics
engine calculates scores.

A recent improvement has been the addition of smartphones,
which make data collection easier and automates the alerting
process.

“We’re moving to mobile,” said Chris Probst, director of HITS
Informatics at HHS, who noted the mobile app was created in
just ten weeks. The Android phones, which also have integrated
bar code scanners to check wristband codes for patient safety,
are now being used in the HEWS project.

The app prompts nurses to enter the necessary information
about vital signs and delirium. Scoring is automatic, and
notifications are sent immediately.

Hamilton Health Sciences is working on analyzing the numbers
to determine how many patients have been prevented from ICU
transfers since the rollout of the system in 2014. It also has
a grad student assessing the selection of vital signs that are
used, to determine if they are the best mix.

 “This is a prime example of frontline-driven healthcare
 innovation that’s having a significant impact on patients’
 lives.”

What is known is that the system has made a noticeable
difference at Hamilton Health Sciences. “Code Blue is now
rare, at least during the day,” said Dr. Fox-Robichaud. “You
can go for several days without hearing one, at least in the
daytime. Now, we’re working on the night-time,” she said,
noting there are fewer nurses and other professionals working
the evening shifts.

The team is also developing a set of indicators for pediatric
care.

Dr. Fox-Robichaud said that other hospitals interested in
starting an early warning system must put a premium on
communication and training.

“You have to engage your front-line staff,” she said. “Without
that, you won’t have success.”

She noted there is a cultural shift that goes along with the
new system, as it flattens the hierarchy in the hospital.
Nurses can’t be overridden by senior nurses, residents or
physicians. “Nurses shouldn’t be prevented from contacting the
team,” she said. “It’s not about saving face, it’s about
saving lives.”

Recently, HHS has involved IBM Canada through a collaborative
innovation partnership to bring advanced analytics to the
project, and to explore opportunities to deploy HEWS to other
hospitals across the healthcare system.

“This is a prime example of frontline-driven healthcare
innovation that’s having a significant impact on patients’
lives,” said Ted Scott, chief innovation officer at HHS.

“By infusing this unique, HHS-born innovation with the world-
class technology and business insights of IBM, we’ll be able
to develop an effective, invaluable product that will continue
to transform healthcare delivery, beyond Hamilton and,
perhaps, around the world.”

This is just one of the many digital health projects that are
part of our Digital Health Plan.
Three things an ER                              doctor
wants you to know
NOTE: ALWAYS call 9-1-1 if you think you’re having a medical
emergency.
Written by: Dr. Bill Krizmanich, emergency physician, Hamilton
Health Sciences

As an emergency doctor, a common concern I hear from my
patients is that they’re not always sure where to turn for
basic medical care. Often, the emergency department (ED) is
seen as the best and quickest place to access a doctor’s
expertise, but there’s usually a more convenient option. For
health issues that aren’t emergencies, a family doctor or
urgent care centre can offer the same level of expertise as an
ED, and you’ll usually have a shorter wait.

The next time you’re feeling unwell, consider your options.
There may be a better option for you than visiting the
emergency department. Here are three things you should know:

Family doctors offer more services
than you might think.
When it comes to managing your overall health, a family doctor
is an excellent resource. From treatment for minor illnesses
and injuries to support for mental health concerns, a family
doctor can help you with a wide variety of issues. And, more
and more, doctors’ offices are offering extended hours, after-
hours clinics and 24-hour on-call services so that you can get
the help you need, no matter the time of day.

If you’re unsure about the types of services available through
your family doctor, check with their office to learn more. If
you don’t have a family doctor, click here to find one.

Can’t wait to see your family doc?
An urgent care centre can help.
Except in the event of emergencies, urgent care centres (UCCs)
are excellent options for medical issues that need quick
attention, or when your family doctor is unavailable. Many
people don’t know this, but Hamilton has two urgent care
centres which are open 7 days a week, 365 days a year and are
staffed by emergency-trained doctors. Our UCC teams are
qualified to deal with minor fractures, sprained ankles,
respiratory illnesses, and even minor cuts that need stitches.

Aside from the high level of expertise you’ll receive at a
UCC, you’ll probably also wait for less time than at an
emergency department, where the sickest patients are always
prioritized to be seen first.

For information about Hamilton’s two urgent care centres,
click here.

Sometimes, the best remedy is ‘home
sweet home’.
None of us like being sick. Illnesses like the cold or flu are
uncomfortable and take us away from our daily activities like
work, school and family time. And while it’s tough to wait out
that pesky cough or runny nose, the best remedy is usually to
stay home, get rest, and drink plenty of fluids.

If you’re ever unsure about what you’re feeling or where to
find care, call your family doctor for advice. As always, if
you think you’re having an emergency, call 9-1-1 right away.

For more information about your      healthcare   options   in
Hamilton, visit NeedADoc.ca.

Preparing for flu season
As flu season approaches, it’s even more important to protect
yourself and those around you from infection. The first step
is getting your flu shot. Learn more about the flu shot and
other ways to prevent the spread of flu.
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