2014 - 2015 annual report - alberta health services...a vbac audit was conducted in early 2014 with...
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2014 - 2015 Annual Report
Department of Family Medicine - Calgary
Our Vision: A community of family physicians and primary care providers building collaborative, integrated, and innovative medical homes, responsive to the needs of our population.
Our Mission: 1. To serve our communities 2. To promote best practice primary health care and family medicine 3. To enable our members to build and support patient-centred medical homes 4. To translate innovations in family medicine to our physicians and communities 5. To support medical education, credentialing, recruitment and retention
Executive Summary
EXECUTIVESUMMARY
1
The Department of Family Medicine consists of 1094 family physicians with a Medical Staff
Appointment with 63 new appointments in 2014‐2015. The Academic DFM has 688 family physicians
with an Academic Appointment with 175 new appointments approved this year.
ACCOMPLISHMENTS&HIGHLIGHTSCLINICALDFMThe Clinical DFM finalized their Strategic Plan for 2015‐2018 with a number of 12 month and 3 year
goals based on four pillars of the Medical Home: System Supports, Evaluation, Education Training and
Research, and Continuity of Care.
Maternal Newborn Care
There were 18,471 deliveries in the Calgary Zone from Dec 1, 2013 – Nov 30, 2014. Family
physicians were responsible for 46.66% of admissions to Labour and Delivery Units and 33.90%
of Calgary hospital deliveries.
The section focused this year on enhancing physician engagement in a variety of different ways
with an emphasis on quality activities. A communication survey was distributed within the
section with results influencing communication strategies throughout the DFM.
A successful Collaborative Care Project was initiated this year using the Obstetrical Consultation
and Transfer of Responsibility Standard of Practice and the Care of Women who are Appropriate
for Vaginal Birth after Caesarean Section (VBAC) Protocol. A VBAC audit was conducted in early
2014 with general agreement that the protocol is effective.
Other successes included the roll‐out of an electronic process for physicians to complete their
periodic reviews which was enthusiastically adopted by the Seniors Care, Palliative Care, and
Community Primary Care sections.
Medical Inpatient Care
Hospitalists admitted 13,229 patients (excluding RAU admissions) and attended patients for
268,298 days between Jan to Dec 2014.
Results from the evaluation of the Rapid Access Unit (RAU) at the South Health Campus
demonstrate that the RAU is significantly reducing patient’s stay an average of 44 hours,
discharging twice as many patients home within 48 hours and reducing overall length of stay by
36% without increasing readmission rates.
The use of anti‐psychotic, sedative and anxiolytic medications amongst seniors is prevalent
without clear evidence based justification for efficacy and safety. The B‐SAFE project evaluated
the prevalence of these medications before, during and immediately after and admission to a
Calgary acute care hospitalist service. Individualized patient reports are developed allowing
physicians to better understand use of these medications, reflect upon possible changes and
consider participating in an educational and/or clinical intervention.
EXECUTIVESUMMARY
2
Urgent Care
The five urgent care centres in the Calgary Zone saw 182, 692 patients in 2014. Volumes,
specifically at the Sheldon Chumir have had a marked increase since 2013, averaging
approximately 156 patients per day. Acuity has also increased throughout all sites.
The section has been successful in implementing approximately 95% of the Urgent Care Review
report including reviewing documents reflecting optimization of urgent care services,
developing competencies for urgent care physicians and providing monthly data for all UCCs on
volume, acuity, LWBS and transfer information.
Palliative Care
Demand for palliative care has resulted in the Section providing care to 3880 unique patients.
On April 1, 2014 a new Level 1 AHS policy and procedure for Advanced Care Planning and Goals
of Care Designation (ACP GCD) was implemented across Alberta with representatives from the
section contributing to the policy and preparation of “toolkits” for physicians.
The Intensive Palliative Care Unit increased from 21 to 29‐31 beds in late 2013. For the 2013‐14
fiscal year 618 patients were admitted to the unit.
Starting in the summer of 2014 the section has established a dedicated palliative consult
presence at the Tom Baker Cancer Centre. This represents an expansion of the previous TBCC
Pain and Symptom Management Clinic’s scope and allows palliative expertise five days a week.
Seniors Care
Alberta Health approved an expansion to the Frail Elderly ARP as of Aug 2014. It included an
additional 14 Long Term Care and 7 Supportive Living sites. To date, recruitment efforts have
been successful for these positions.
The Community Paramedic Program will expand into Long Term Care sites in 2015. The section
also hopes to expand the awareness of the program amongst family physicians in the
community.
Community Primary Care
The DFM partnered with the PCN Secretariat to develop a Physician Web Registry that includes
up to date contact information for family physicians for use by health professionals in the
Calgary Zone.
Based on its success in providing up to date admission and discharge notifications to physicians
in the community the Path to Home Discharge Pilot Project at the Foothills Hospital has moved
beyond the pilot.
The launch of the GI Specialist Link with a GI specialist returning family physician inquiries within
30 minutes Monday to Friday has received over 67 calls in the first three months. More
specialty linkages are being forged to expand the service.
EXECUTIVESUMMARY
3
ACADEMICDFMThe Academic DFM underwent a program‐wide accreditation conducted by the College of Family
Physicians of Canada (CFPC). The programs will continue to implement the recommendations from
review and prepare for their next round of accreditation.
Undergraduate Education
95% of incoming medical students participated in MedZero this last year. Clinical preceptors
helped delivered the ever‐popular hands on workshops in casting and suturing.
This year’s clerkship class ranked family medicine at the top! The program is beginning to
experience success with the “”Morning Star” or patients as teachers program.
Postgraduate Education
As of March 31, 2015 the number of residents in the 2 year program totaled 157.
In 2014 the program graduated its first group of Triple C‐ Competency based residents. Of the
group of 113 residents 78 were from the Urban Program, 14 from the Rural Program and 21
from the Enhanced Skills Program.
In the Enhanced Skills Program there were 11 Category 1 and 7 Category 2 R3 residents in 2013‐
2014. These numbers will increase to 14 R3s in Category 1 and 7 Category 2 in 2014‐15.
EXECUTIVESUMMARY
4
CHALLENGESCLINICALDFMMaternal Newborn Care
One of the key challenges for the section was the Maternal Child Volume Redistribution
discussions which will continue throughout 2015. DFM physicians have collaborated in
discussions at each site to develop key strategies to assist with capacity issues.
The section has recognized the need to clearly outlining privileging processes for locums. Work
continues with the DFM to ensure locums are privileged correctly.
Medical Inpatient Care
The gap between population need for facility‐based community care and physical availability of
appropriate spaces continues to be a challenge. On a daily basis, patients awaiting placement
account for up to 1/3 of the total patient census.
Urgent Care
Increased acuity and number of patients at both urban urgent cares continues to present
challenges for providing patient care.
The annual Urgent Care Conference has been put on hold due to increased event costs.
Palliative Care
Recruitment challenges to all funded positions of the clinical ARP continue. Many physicians
have had to work more hours than their contracted amounts in order to ensure palliative care
service is always staffed.
Seniors Care
Recruitment of physicians to provide onsite care in supportive living sites for those patients who
do not have a family physician remains a challenge.
The issue of access to Netcare for physicians’ onsite at supportive living and continuing care
sites creates a barrier to continuity of care. This issue has been escalated and will be addressed
at a senior administrative level within AHS.
Community Primary Care
It is important to understand the various ways that patients seek and receive medical care.
With this in mind, we are trying to understand how many patients are truly "unattached" and
the factors that come in to play that lead patients to not "attach" to a medical home.
The section continues to look at medical home model with a lot of work is being done in the
area of Panel Identification in family practices. Challenges continue in providing patients with
24/7 care within the medical home.
EXECUTIVESUMMARY
5
Specialty linkages and long wait times for patients to be seen by specialists also continues to be
a challenge in the Calgary Zone. With this in mind, Primary Care and Specialist groups are
collaborating to look at innovative ways to meet some of these needs.
ACADEMICDFMUndergraduate Education
Recruitment of experienced academic physicians with undergraduate focus and experience
remains a challenge.
Competing demands on academic physician time including the necessity of scholarly input for
academic physicians in administrative roles continues.
Postgraduate Education
Rapid growth has posed a challenge for the program. Challenges for the urban program has
caused strain in the capacity for quality learning experiences, preceptor‐resident ratios; capacity
for remediation of residents and reduction of potential transfers from other programs.
EXECUTIVESUMMARY
6
FUTUREDIRECTIONSCLINICALDFMMaternal Newborn Care
The section will continue its quality initiatives as a key focus for the upcoming year. In addition
we are looking at how to enhance referral guidelines and the optimal route for communicating
this information. Ongoing work will occur to ensure alignment of the Volume Redistribution
Working Group.
Medical Inpatient Care
Future initiatives including geographic rounding, antimicrobial stewardship, physican leadership
development, implementation of the electronic periodic review process, and strengthening
academic linkages.
Urgent Care
Work continues on the implementation of the Urgent Care Review report recommendations.
Palliative Care
The Supreme Court of Canada decision that has allowed for the possibility of “Physician Assisted
Death” has implications on the section. Collaborative discussions have begun within the section
and with AHS.
Seniors Care
Through the Seniors SCM, the Seniors section is currently involved in the Primary Care Working
Group for the development of a provincial dementia strategy.
Community Primary Care
The section continues to look at ways of trying to improving communication, particularly during
transitions in and out of the Medical Home. It is recognized that this communication is key to
patients receiving quality, timely and safe patient care.
ACADEMICDFMUndergraduate Education
The U of C Cumming School of Medicine accreditation is scheduled for 2016 with mock
accreditation scheduled for Sept 2015. The program is currently working on preparing for these
activities.
Ongoing initiatives including MedZero, MDCN 400 Family Medicine Research Developing
Program, the Morning Star Program and community engagement activities are part of our
future.
EXECUTIVESUMMARY
7
Postgraduate Education
The program has a number of initiatives underway including a major curriculum review of the
Urban Residency Program in fall 2015; the development of a structured maternity and newborn
care enhanced skills curriculum; and the continuing delivery of “Home Room Series” faculty
development workshops for the family medicine teaching clinics.
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Departmental Structure & Organization
DEPARTMENTALSTRUCTUREANDORGANIZATION
11
GOVERNANCECLINICALDEPARTMENT–EXECUTIVECOMMITTEEDr. Michael Spady Acting Zone Clinical Department Head Dr. Charles Leduc Academic Department Head Mr. Rod Iwanow Department Manager Dr. Monica Sargious Section Chief, Community Primary Care Dr. Norma Spence Section Chief, Maternal Newborn Care Dr. Jim Eisner Section Chief, Medical Inpatient Care Dr. Lindy Murphy Section Chief, Palliative Care (until October 2014) Dr. Ayn Sinnarajah Section Chief, Palliative Care (starting November 2014) Dr. Marie Patton Section Chief, Seniors Care Dr. Tyson Warner Section Chief, Urgent Care (until February 2015) Dr. Matthew Hall Section Chief, Urgent Care (starting April 2015) Dr. Rick Ward Medical Director, Primary Care Ms. Kim Kiyawasew Community Practice Consultant Ms. Judy Schoen Hospitalist Specialist Ms. Darlene Befus Physician Recruitment Coordinator Ms. Danica Sharp Service Planning Consultant, Maternal Newborn Care
ACADEMICDEPARTMENT–LEADERSHIPDr. Charles Leduc Academic Department Head Dr. David Keegan Deputy Department Head; Director, Undergraduate Education Dr. Keith Wycliffe‐Jones Director, Post‐Graduate Education Dr. Dennis Kreptul Interim Director, Patient Centred Medical Home & QI Dr. Turin Chowdhury Director, Research Dr. Sonya Lee AARP Management Committee Chair Dr. Ron Spice Director, Rural Academics Dr. Juan Garcia‐Rodriguez Director, Continuous Professional Development Dr. Todd Hill Director, Behavioural Medicine Dr. Mone Palacios Medical Education Specialist Dr. Steve Mintsioulis Urban Program Director Dr. Rick Buck Rural Program Director Dr. Lara Nixon Enhanced Skills Program Director Dr. Martina Kelly Clerkship Director Dr. Behi Raissi Site Medical Lead (Central Teaching Clinic) Dr. Sonya Lee Site Education Lead (Central Teaching Clinic) Dr. Ron Garnett Site Medical Lead (South Health Campus Teaching Clinic) Dr. Divya Garg Site Education Lead (South Health Campus Teaching Clinic) Dr. Wes Jackson Site Medical Lead and Interim Site Education Lead (Sunridge)
DEPARTMENTALSTRUCTUREANDORGANIZATION
12
Mr. Rod Iwanow Department Manager Ms. Jeanine Robinson Education Manager Mr. Scott Jalbert Clinic Manager (Central Teaching Clinic) Ms. Jane Bowman Clinic Manager (South Health Campus) Ms. Nicole Phillips Clinic Manager (Sunridge)
DEPARTMENTALCOMMITTEESCLINICALDFMDFM Executive Committee DFM Obstetrics Site Leads Committee DFM Clinical Administration Committee DFM Clinical Managers Team DFM Communications
ACADEMICDFMAARP Management Committee Academic Business Committee CARMS Selection Committee Clerkship Committee Clinic Management Team Clinic Operations Team Clinic Education Committee Continuous Professional Development Committee Curriculum and Evaluation Committee Education Committee EMR Steering Committee Enhanced Skills Program Committee
Leadership Team Postgraduate Executive Committee Postgraduate Medical Education Committee Rural Family Medicine Residency Program Committee Scholarship Committee Search & Selection Committee Undergraduate Family Medicine Education Committee Urban Curriculum and Evaluation Committee Urban Family Medicine Residency Program
Committee
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DEPARTMENTALSTRUCTUREANDORGANIZATION
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ACADEMICDFM
Number of DFM Academic Appointments 688 Total Number of New Appointments 175 Full Time Academics (FTAs) 21 Major Clinicals 7 Major Clinical Academic s (MCAs) 6
Faculty Central Teaching Centre SHC Teaching Centre Sunridge Teaching Centre Dr. Jim Dickinson Dr. Ron Garnett Dr. Fariba Aghajafari Dr. David Keegan Dr. Heather Armson Dr. Martina Kelly Dr. Juan Garcia‐Rodriguez Dr. Dennis Kreptul Dr. Wes Jackson Dr. Patrick Lee Dr. Keith Wycliffe‐Jones Dr. Sonya Lee Dr. Kerry McBrien Dr. Doug Myhre Dr. Lara Nixon (The Alex) Dr. Maeve O’Beirne (sabbatical) Dr. Roger Thomas Dr. David Topps Dr. Maureen Topps
Other Dr. Lindsay Crowshoe (Elbow River Healing Lodge) Dr. Ron Spice
Major Clinical Academics (MCAs) Dr. Jean Rawling Dr. Vishal Bhella Dr. Johan Bester Dr. Wendy Tink Dr. Divya Garg Dr. Shashank Garg
DEPARTMENTALSTRUCTUREANDORGANIZATION
16
D
DEPARTMENTALSTRRUCTUREAANDORGAANIZATION
17
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Administrative Assistant
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DirectorBehavioural
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Deputy HeadAcademic
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Department omic Departme
ANIZATION
18
of Family Medent Organizat
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ManagerEducation
Jeanine Robinson
ManagerSouth Health
Campus TeachingCentre
Jane Bowman
LeadClinical
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CoordinatorClinical
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Carol Hort
Senior Analyst Finance
Jesse Walper
CoordinatoContractsSharmina Dharsee
Financial Administrati
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dicine tional Chart
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DFM Strategic Plan
DFMSTRATEGICPLAN
19
The Executive Committee ratified the Vision, Mission and Strategic Pillars for the DFM that were a result
of the first series of strategic planning exercises in 2014. To further their work they further engaged in
strategic planning exercises in the winter of 2015 in which 12 month and 3 to 5 year goals were created
using the pillars of the medical home. These goals have strengthened the direction of the Department
and were approved by the Executive in February 2015.
OURVISION
A community of family physicians and primary care providers building collaborative, integrated, and
innovative medical homes, responsive to the needs of our population.
OURMISSION
1. To serve our communities
2. To promote best practice primary health care and family medicine
3. To enable our members to build and support patient‐centred medical homes
4. To translate innovations in family medicine to our physicians and communities
5. To support medical education, credentialing, recruitment, and retention
STRATEGICPILLARS
Operational
Mandate Human Resource Management
Collaborative Partnerships
Quality and
Safety Communication
Academic Teaching Clinics Maternal Newborn Care Medical Inpatient Care Urgent Care Palliative Care Seniors Care Community Primary Care
Credentialing and Privileging Leadership Development Continuing Medical Education Training and Post‐Graduate Education Recruitment and Workforce Planning
Primary Care Networks AHS Partners Alberta Health Community Organizations Strategic Clinical Networks Patients and Families Alberta Medical Association College of Physicians and Surgeons of Alberta University of Calgary Alberta College of Family Physicians
Patient and Staff Feedback Care Pathways Quality Improvement and Best Practice Quality Assurance Research
To Physicians To Learners To Department of Family Medicine Staff To Patients and Families To Alberta Health Services Partners
DFM
STRATEEGICPLAAN
20
DFMSTRATEGICPLAN
21
12MONTHGOALS(2015‐2016)PHYSICIANSERVICES(SUPPORTSYSTEMS)ClinicalandAcademicAppointmentProcesses
1) To work collaboratively with the Medical Affairs and the U of C to clarify roles and
responsibilities and streamline departmental accountabilities and improve current Academic
and clinical appointment processes within the next 12 months.
2) To develop a streamline process for providing academic appointments to family medicine
physicians, to provide appointments for 100% of appropriate physicians within 12 months.
LeadershipDevelopment1) Develop a leadership framework which addresses succession planning, mentorship, leadership
training and appropriate compensation to improve the culture of leadership, and work life
balance within each of the clinical sections.
To establish and identify DFM leader membership based on Departmental and Clinical
section needs, within 12 months.
To identify leadership requisites of each clinical section in order to provide role clarity and
better recognise emerging leaders within 12 months.
Explore the financial environment for clinical leaders, in order to ensure that compensation
balances the time requirement and sufficient work life balance.
Develop a framework to encompass recognition of long service, awards and contributions to
Family Medicine within the next 12 months.
Develop leadership training/orientation education including opportunities for
compensation.
Recruitment/WorkforcePlan1) Create and accurate and appropriate workforce plan based on a clear understanding of the
department/section landscape and how it influences recruitment.
Assess current workforce plan/framework for appropriateness to see how it addresses
current strategic direction.
Consolidate workforce plan data and provide Actual Vs Estimated data to each clinical
section, in order to more accurately forecast needs for the next Work Force Plan cycle
within 12 months.
Develop recruitment strategies and reporting structure that better support the changing
workforce planning landscape through enhanced interaction between clinical sections
within the next 12 months.
Communicate departmental workforce plan with Academic leadership to better inform
recruitment and planning needs within 12 months, and continue as an ongoing priority.
Provide update from Medical Affairs regarding provincial workforce planning including FTE
definitions and information.
DFMSTRATEGICPLAN
22
BenefitsofBelonging1) To create a comprehensive package outlining the Department of Family Medicine Benefits of
Belonging within a 12 month period, through extensive interaction between each of the six
clinical sections.
EDUCATION/TRAINING/RESEARCH1) Collaborate with academic leadership to work with clinical sections to provide sufficient
teaching support through workshops or other specific training within 12 months.
2) Enhance communication with academic leadership to ensure that program requirements are
meeting the needs of the community, including capacity issues, expectations upon graduating
etc. within 12 months.
3) Develop clinical service guidelines, including privileging and/or mandatory requirements, clinical
procedures, which will allow each section to increase communication linkages with Academic
DFM.
4) Gain a better understanding of the DFM role in CPD and CME through interaction with each
clinical section and determine capacity for the department to increase growth in this area,
within 12 months.
Acquire a better understanding of the CME process and disseminate information throughout
the DFM.
CONTINUITYOFCARE1) In partnership with primary care and AHS partners conduct an environmental scan and gap
analysis related to patient care plans, discharge planning and roles of the MDT team and
specialists and disseminate the results.
2) Develop criteria and receive approval from Medical Affairs for “Supportive Care Privileges” that
will allow family physicians to visit their patients in acute care facilities.
EVALUATION1) Develop a Departmental Quality Assurance framework inclusive of patient safety/adverse event
reporting and patient concerns processes.
2) Engage clinical sections to develop a list of reportable events including adverse events, patient
concerns, community or provincial tracking.
3) Develop a dashboard reporting system for each clinical section within 12 months to assist with
program evaluation.
4) Engage Academic/clinical sections to better understand Quality Improvement landscape.
Initiate QI project(s) relevant to DFM medical home within 12 months’ time.
DFMSTRATEGICPLAN
23
3–5YEARGOALS(2015‐2018)SUPPORTSYSTEMSClinicalandAcademicAppointmentProcesses
1) Provide privileging services to Family Medicine Physicians in order to meet the needs of family
medicine within 30‐45 days.
Recruitment/WorkforcePlan
1) Accurately forecast the workforce planning needs based on section requirements, capacity
constraints and academic opportunities.
EDUCATION/TRAINING/RESEARCH1) Resident and medical student training will be informed through enhanced communication
linkages with each clinical section.
2) Create a robust forecasting process for CPD and CME requirements and implement section
specific activities as informed through the 12 month plan.
3) Develop a recognition program for non‐family physician educators who work within a team
based environment with the Department of Family Medicine.
CONTINUITYOFCARE1) Assist in the development of tools and templates that will assist family physicians in care
planning and discharge planning.
2) Engage AHS partners such as Information and Privacy to address flow of patient information
to/from family physicians.
EVALUATION1) Enable accurate and relevant data to be available through DIMR for each clinical section, with
reports generated quarterly.
2) Increase collaboration for transparent data/information sharing between family medicine
partners including CPSA, College, and Primary care Networks etc. within 3‐5 years.
3) Decrease the number of adverse events with strong reporting guidelines through taking an
active role in Quality assurance and patient safety within next 3‐5 years.
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27
LIGHTS
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and the
ming of
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o check that t
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tive to look
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at missed b
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nd not
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document
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outcomes
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UNICATION
unicationSwas distribute
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s have an AHS
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n Calgary
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collaborative
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on the pro
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sing how rout
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was to incre
h Trial of Labo
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ocess and w
able online in
ity Clinic, an
may require fu
s, Family Med
n between F
tinely AHS co
dit was condu
on being give
ease the educ
our documen
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worked with
nstead of pre
nd so far, po
urther review
dicine
Family
onsent
ucted.
en and
cation
ts are
Care
Web
evious
ositive
w.
MATERNALNEWBORNCARE
29
Results showed that many physicians have AHS accounts but do not use them. Our physicians also
stated that they did find an overlap in communications; however the content is consistent between DFM
and PCNs. Finally Maternal Newborn physicians tend to read emails that are sent from their Site
Lead/Section Chief as a priority.
Other feedback was generated regarding site specific challenges and successes. This information
demonstrated a further need to communicate with sites specifically.
In the summer 2014 a town hall meeting was held at the Rockyview General Hospital. The Zone Clinical
Department Head, Maternal Newborn Care Section Chief and RGH Site Lead all chaired this meeting and
gained valuable insight into culture and challenges. A follow up memo was distributed to RGH
physicians with the outcomes clearly defined. Further engagement with physicians will need to occur in
2015.
MidwiferyCommunicationsSome challenges were expressed regarding the transfer process between family medicine and
midwifery, especially those clients who are late in their pregnancy. A collaborative discussion occurred,
and a communication memo was distributed endorsing patient centered care and interaction between
family medicine and midwifery.
COMMUNITYINVOLVEMENTOne of the Maternal Newborn Care physicians is doing a walk to support pregnant women in third world
countries. CARE Canada’s I Am Powerful Council (IAP) Calgary has been tasked with raising funds for
CARE Canada’s Tabora Adolescent and Safe Motherhood (TABASAM) project in the Tabora district of
Tanzania, where there is an estimated 454 maternal deaths per 100,000 live births (UNICEF 2010).
TABASAM is working to safeguard women’s health during pregnancy, childbirth and through the
immediate postnatal period. Overall, this project is expected to impact 1.6 million people.
Specifically, for 2015 the IAP Calgary pledges to raise $231,000 to purchase 14 retrofitted vans for
emergency transportation to TABASAM. These vehicles will be located at 14 selected health
dispensaries within the Tabora region that satisfy the following criteria: remoteness, high maternal
mortality, high birth rates, extreme poverty and distance from referral centres. The vehicles will be used
to transport labouring women to safe delivery centres and those with obstetrical complications from
basic health centres to hospitals for more appropriate treatment.
IAP Calgary launched CARE Canada’s Walk in Her Shoes campaign on March 8, 2015. Participants
pledged to walk a similar distance to women in the developing world for one week, about 8000 steps
per day. It was a resounding success! Over $35,000 in donations were collected for emergency
transportation in Tanzania and the Government of Canada has matched this 13:1 through Foreign
Affairs, Trade and Development Canada, making the positive impact on the lives of those in the Tabora
region of Tanzania even more substantial.
MATE
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Maternal
speaker a
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midwives
in the are
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very well
this event
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peers on
highly reg
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accomplis
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programs
Below is t
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he topic that
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othills Hospita
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32
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MATERNALNEWBORNCARE
33
The aim for this pilot is to facilitate exclusive breastfeeding in our mothers who have infants at risk for
receiving formula supplementation in the early neonatal period. By encouraging antenatal expressing
and storage of colostrum prior to admission to the Foothills Hospital Labor and Delivery Unit, family
physicians hope to drastically reduce the amount of formula supplementation.
This project is in direct response to the recent revisions to the Calgary Zone Blood Glucose Monitoring
and Feeding of the Infant at Risk for Hypoglycemia and L&D and Postpartum Practice Guideline which
states that health providers are to ensure the first feed is initiated within 60 minutes of birth.
This project launched April 2015 and will continue with data collection until September 2015. If this
pilot has positive results, it is anticipated that results will be presented to all the low risk clinics and
maternity care sites, with the hope of adopting a similar process.
FrenotomyThe Maternal Newborn Care section has been an active participant with the Frenotomy Working Group.
Current work includes:
Revision of the frenotomy patient handout
Work with health information to create a simple version with pictures
Engage low risk clinics and Midwifery to participate in Frenotomy referral process
Engage in cross provincial learnings to assist other health authorities in setting up this process
The Maternal Newborn Care section also hosted a Frenotomy workshop in the spring 2014. This event
was presented by Dr. Mary Jo Woolgar and well attended.
RhogamReferralandDistributionPregnant women who are Rh negative may require a Rhogam injection during the antepartum period.
The process for obtaining Rhogam within the Calgary Zone is being reviewed due to several events
during 2014 that led to some queries regarding Rhogam distribution and communication. The Maternal
Newborn Care section in conjunction with the AHS Primary Care Team are working to convene a
meeting to discuss and audit the process and make any revisions if required. It is anticipated that a
formal Rhogam referral and distribution process will be communicated in 2015.
MATE
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34
AMEWORKworking to
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physicians
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MATERNALNEWBORNCARE
35
Early 2015, another meeting was called to further the Volume Redistribution discussion. The premise of
this meeting was to make site based leadership teams have a plan for distribution of deliveries to
optimize access, quality and safety in a sustainable way. Senior Leadership was hoping to gain
consensus regarding targets set by each site. This was met with some questioning, resulting in the need
to engage each site separately to work on some key volume specific strategies. This work will continue
for 2015.
QUALITYASSURANCE,QUALITYIMPROVEMENT&INNOVATIONMATERNALBLOODLOSSThis year the Maternal Newborn Care section underwent an intensive quality improvement project to
understand and assess maternal blood loss, specifically blood loss resulting in a post‐partum
hemorrhage in the Calgary Zone.
In order to identify a postpartum hemorrhage, the practitioner must be able to quantify blood loss.
There is no systematic way of measuring blood loss at this time. In order to optimally diagnose and
therefore treat postpartum hemorrhage to prevent maternal morbidity and mortality providers’
accuracy of blood loss estimation is critical. This project will explore the accuracy of low risk obstetric
providers at estimating blood loss during vaginal deliveries.
In the Calgary Zone, statistics provided by Data Integration Measurement and Reporting (DIMR) suggest
that numbers of postpartum hemorrhages (PPH) have been trending high over the last year for Family
Medicine Maternal Newborn Care physicians in the Calgary Zone. This project will be part of a larger
project by the Maternal and Newborn Care Committee that would like to look at whether there is an
issue with reporting (due to blood loss estimation) or is patient management a possible cause for an
increase in PPH statistics.
This QI project had two components. First, a simple prospective audit was conducted, in which each
physician was asked to estimate maternal blood loss post vaginal delivery. The physician then accurately
weighed blood loss according to a pre‐determined protocol.
The second component involved a more detailed chart audit to review the charts that were involved in
the initial prospective audit stage.
MATERNALNEWBORNCARE
36
Below is a table outlining the average patient characteristics:
Patient Characteristics
Maternal Age (years) 29.5 (19‐40)
Maternal BMI 25.2 (22‐40)
Gestational Age (weeks) 39.7 (38‐41)
Birthweight (grams) 3355 (2555‐4285)
Multiparous 19 out of 38 (50%)
Primiparous 19 out of 38 (50%)
Spontaneous Vaginal Delivery (%) 35 out of 38 (92%)
Vacuum delivery 3 out of 38 (8%)
Induction (%) 7 out of 38 (18%)
Charted as PPH (%) 13 out of 38 (34%)
The outcomes of this project showed that most practitioners underestimated blood loss.
35 of 38 cases were found to be an underestimation of blood loss
Mean estimated blood loss was 371 mL (SD 154, Std error mean 25)
Mean actual blood loss was 743 mL (SD 468, Std error mean 76)
Mean difference EstMatBL – ActualBL = ‐372 mL (SD 406, Std error mean 66)
On average, practitioners underestimated blood loss by 372 mL
There was no significant correlation between maternal age or parity and blood loss
The graph below shows the differences between actual blood loss and estimated blood loss.
MATERNALNEWBORNCARE
37
The data obtained from this project was helpful for our leadership team. It is evident, that an education
intervention would be beneficial for our physicians despite some accuracy issues with the data.
Learnings will be communicated in 2015. A second data collection cycle is required, with improvement
in the gravimetric method, to improve the accuracy of the data collected.
FUTUREDIRECTIONS&INITIATIVESThe Maternal Newborn Care leadership team will be continuing to engage in quality initiatives as a key
focus. The committee will meet mid‐April to look at possible projects.
The section is also looking at how to enhance referral guidelines and the optimal route for
communicating this information. The Alberta Referral Directory is a possible solution and the leadership
team will engage with key stakeholders to assess its effectiveness.
Ongoing work will occur to ensure alignment with the Volume Redistribution working group.
This coming year will see some exciting capital works at the PLC. There are renovations in the works
that will affect NICU/Labour & Delivery, Post‐Partum and Triage. Family Medicine is working with the
Capitol project team on design and decanting unit strategies. This venture will have an impact on
Maternal Newborn distribution planning over the next few years, and will be an item of discussion in
this planning process.
One of the Maternal Newborn physicians, Dr Allison Chapman, has started up another Centering
pregnancy program out of the Alex. The Centering Pregnancy program, located in the Alex Family
Health Centre, provides prenatal group care to new mothers and their families or support person.
Groups are led by a physician and childbirth educator, or a nurse. Each session starts with an individual
check‐up with the physician and the rest of the session is spent in an interactive setting, doing activities,
sharing stories and learning about pregnancy and prenatal care from each other and health care
providers. This is a great way to make friends with others who will give birth the same month that you
are expecting.
Literature has shown that group prenatal classes are associated with positive outcomes for mom and
baby. We appreciate our family physicians initiating important services to our community, and will
review successes of program in the upcoming year.
In conclusion, the upcoming year will be geared towards engagement and implementation of changes.
There may be challenges along the way; however the leadership team will work cohesively to ensure
minimal impact to patient centered care. Our primary goal is to support our physicians through this year
of change.
MEDI
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39
arison with 1
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BESTSPatients a
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SEDATIVEAadmitted to h
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Many patien
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medications a
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that the Rapi
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without incre
a novel and
nomic efficie
ANDANTIospital under
re taking
background o
nts may not
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specialists e
edications wit
of other invo
understanda
ns provided b
under the car
presenting is
mon and add
otic, sedative
cation for eff
ug programs
related drugs
s). A recent st
s amongst se
pitalizations.
with senior’s
s Criteria for
ril 2012–vol.
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as a target fo
ell document
work has deve
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d Access Unit
w demonstra
twice as man
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PSYCHOTIr the care of d
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each of wh
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olved physicia
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by consultant
re of a hospit
sues some o
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s as reporte
s, 17.3% for
tudy has dem
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or re‐evaluatio
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41
t has been ef
ates that RAU
ny patients h
mission rates.
pproach to en
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ICFORTHEdedicated
escription
x medical
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unity yet
hom may
areness of
ans. Some
t to make
ts. This may le
talist presents
of which ma
ects.
c medication
afety. The pe
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antidepressa
monstrated th
da cost an es
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ug reaction re
nappropriate
gives strong r
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n the USA an
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nhancing pati
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ead to a “vicio
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rcentage rate
for 2009‐201
ants and 3.6%
hat ED visits a
stimated $35.
e identified in
elated admis
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evidence. Sev
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associated w
recognized
mplementatio
ducing the ov
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48 hours and
ent flow. Fur
Y(B–SAF
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nity for the a
c and attribu
eniors is preva
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10 in Albert
% for antipsy
and hospital
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n the top 10
ssions. The A
Use in Older
ations that a
eral national
ve identified
with utilization
within AHS.
n within long
erall length o
g patient’s st
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rther assessm
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alent without
ropic use am
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MEDICALINPATIENTCARE
42
The objective of the B‐SAFE project was to evaluate the prevalence of anti‐psychotic and
sedative/anxiolytic medications prescribed to Calgary seniors before, during, and immediately after an
admission to a Calgary acute care hospitalist service.
Detailed feedback is being provided to hospitalist physicians about the anti‐psychotic, sedative and
anxiolytic prescription profile of their patients before, during and immediately after an acute care
admission to a Calgary hospitalist service.
These reports will allow physicians to:
Better understand the use of anti‐psychotic and sedative/anxiolytic medications in seniors before, during and after an acute care hospital admission.
Reflect upon possible changes and consider participating in an educational and/or clinical intervention.
Re‐evaluate practice and prescribing changes after an educational and/or clinical intervention. While this project is still in progress this attention to sedative use already generated discussion amongst
physicians and practice change. For example, the Rockyview group reached consensus that the ward call
physician would redirect care givers to utilize non‐pharmacologic interventions or prescribe a “once
only” dose of sedative as required when contacted after hours for sedative orders and defer decision for
continuous therapy to the most responsible physician the next day.
In addition to educational interventions involving experts from geriatric medicine, nursing staff and
families were engaged to identify and implement strategies to mitigate the use of these medications.
After a fixed period of time, the data will be re‐collected and analyzed for changes and evaluation of
knowledge translation.
MEDI
SUPPORThe sectio
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principle o
and trans
patient’s
timely ac
medical h
coordinat
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Working t
linkage w
and other
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PatientOverall, p
2014‐201
zero is th
surveys. D
variances
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ICALINP
RTINGAHon continued
ity, appropria
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ferring care s
medical hom
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tion of compr
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ollaborating i
to meet the
with the Patie
r consultation
ability
tSatisfactipatients are v
5, 76% of res
e lowest leve
Data may be
between qua
Together, th
(excluding
PATIENT
SPERFORd with its foc
ateness, effic
al Home with
seamlessly ba
me team, col
e episodic ca
ing linkage w
rehensive care
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n the manage
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ent’s Medical
ns.
onwithHvery satisfied
spondents rat
el of satisfact
limited by s
arters might b
e Hospitalis
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RMANCEMcus on AHS
iency and eff
h a family phy
ack to the pa
llaborating w
are. Central t
with the pat
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home – ens
HospitalCawith the phy
ted their ove
tion and 10 i
ample size (N
be more attri
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238,525
talists admit
ssions) betw
43
MEASURESperformance
fectiveness. A
ysician as the
tient’s medic
with the patie
to service de
tient’s perso
ent moves thr
s personal ph
differentiated
bility and effic
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areysician comm
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N = 125), wh
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ANDTHEe measures r
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Results are de
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MEDICALelated to acc
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MEDICALINPATIENTCARE
46
AccessibilityThe section remains a key strategy and a significant contributor for access to, and provision of, inpatient
medical care for family medicine level patients. The section continues to show strong performance in
volume of service delivery and patient flow as demonstrated by “consult to decision admit” metrics.
Hospitalists admitted 13229 patients (excluding RAU admissions) between January 2014 and
December 2014. The number of admissions is almost identical to the 2013 (13179 excluding RAU). This
accounted for 94% of admissions by Family Medicine and 62% of total medical inpatient admissions
(Including admissions by Family Medicine and General Internal Medicine).
The Hospitalist Service attended patients for 168,298 days between January 2014 and December 2014,
which represents stable volumes relative to 2013. The Sub‐acute Service attended 94,359 days, a
24.0% increase from previous year, reflecting system wide challenges related to patient flow as
patients receiving care under the Sub‐acute service no longer require active medical intervention and
could receive care outside of an acute care facility if an alternative was available.
11391049
1153 1171 1106 1082 1131 1113 1076 1077996
1206
0
200
400
600
800
1000
1200
1400
Jan‐14 Feb‐14 Mar‐14 Apr‐14 May‐14 Jun‐14 Jul‐14 Aug‐14 Sep‐14 Oct‐14 Nov‐14 Dec‐14
Admissions by a Hospitalist PhysicianJanuary 2014 to December 2014
14492
12613
1442713186
14512 1430213398
1401315091
14160
11967
16137
9078 9091
6111 62567500
5661
8238
5953 6531
8289
6525
15126
0
3000
6000
9000
12000
15000
18000
Jan‐14 Feb‐14 Mar‐14 Apr‐14 May‐14 Jun‐14 Jul‐14 Aug‐14 Sep‐14 Oct‐14 Nov‐14 Dec‐14
Total Hospitalist Attending DaysJanuary 2014 to December 2014
Hospitalist Service Sub‐Acute Service
MEDICALINPATIENTCARE
47
Average Patient Census – Acute and Sub‐acute Care
2012/2013 2013/2014 2014/2015
FMC 235 236 253
PLC 177 162 176
RGH 241 228 254
SHC 71 92
Total 653 696 775
The Hospitalist program continues to be a major contributor to improving patient flow through the
Emergency Department reflected by continued efforts to reach the target of 80% of consults with
disposition within two hours.
The graphs below represent continuous improvement by all four acute care sites in reaching AHS targets
and supporting safe and efficient patient flow.
Average median time in 2014 was 104 minutes, a slight increase from 97.7 minutes in 2013 but
remaining well below the target of 120 minutes.
Appropriateness
PatientDemographics–PatientAge
Average Age (yrs) ‐ Acute Care Hospitalist Service
Site 2012 2013 2014
FMC 73.3 73.4 73.9
PLC 69.9 68.8 69.1
RGH 74.6 75.8 76.5
SHC 74.3 77.6
SHC RAU 59.5 59.1
0
30
60
90
120
150
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Hospitalist Median Time (Minutes) From Consult Requested to Decision to Admit in ED
2012 2013 2014
MEDICALINPATIENTCARE
48
Top10CMGs2012 2013 2014
Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease
Heart Failure without Coronary Angiogram
Heart Failure without Coronary Angiogram
Heart Failure without Coronary Angiogram
Viral/Unspecified Pneumonia Lower Urinary Tract Infection Viral/Unspecified Pneumonia
Lower Urinary Tract Infection Viral/Unspecified Pneumonia Lower Urinary Tract Infection
Organic Mental Disorder Organic Mental Disorder Organic Mental Disorder
Dementia Dementia Dementia
Non‐severe Enteritis Non‐severe Enteritis General Symptom/Sign
General Symptom/Sign Psychoactive Substance Use, Withdrawal State
Non‐severe Enteritis
Disorder of Pancreas except Malignancy
General Symptom/Sign Disorder of Pancreas except Malignancy
Psychoactive Substance Use, Withdrawal State
Disorder of Pancreas except Malignancy
Cellulitis
Efficiency/Effectiveness
ALOS/ELOSRatioandReadmissionRatesThe section continues to track LOS and readmission data on a site and individual physician basis to
identify, recommend and/or implement system and individual strategies for improvement. The chart
below reflects stable ALOS/ELOS ratios with a slight decrease in 7 day readmissions and a slight increase
in 30 day readmissions.
MEDI
PatientSite
FMC
PLC
RGH
SHC
SHC RAU
Total
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
ALO
S/ELOS Ratio
ICALINP
Year
2012
2013
2014
tComplexi
20
2.
3.
2.
U
2.6
0
0
0
0
0
0
0
0
Acute LOS / ELO
Linear (Acute LO
PATIENT
r AL
2
3
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ityResource In
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51
Length of Sta
48‐72 hours
y Jun Ju
OS/ELOS Ra
2013 2014
2014
48%
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ay
>72 hours
ul Aug S
atios
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ICALINP
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PATIENT
nts admitted
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and safe patie
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to RAU are a
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fety, coordin
relationships
e integral to
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section. Rec
sociation, ha
Aug‐13
Sep‐13
Oct‐13
RAU Re(excluding F
30 Day
52
admitted to a
y remain un
SiteLeadsModel: A
p is a key
th care
ty within
pport and
are well
nate care
s with fellow
the achievem
ognizing this
s developed
Nov‐13
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eadmission RFlex Service
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an inpatient u
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Feb‐14
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unit or discha
h very low r
strategic dire
ection, in pa
o identify an
May‐14
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Trendline (30
arged home i
readmission
ections outlin
rtnership wit
nd develop le
Aug14
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Day)
n less
rates,
ned in
th the
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MEDI
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CHGA to
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next six m
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strategies
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addition,
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within the
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membership t
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the course o
p positions a
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s to optimize
he preceptor
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residents t
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and 23 clinic
LENGESty/Patientbetween po
ate spaces co
nt account for
PATIENT
to ensure its
content speci
eaders/prosp
the next 12 m
ns have atten
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and all positi
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recruitment
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al clerks acro
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r up to 1/3 of
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continued su
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ree years. In
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and informat
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cruitment nig
he spring of
ramandMas establishe
representat
ion and the A
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r’s experienc
ell recognized
rce of new re
tablished to l
improvement
ency program
t and the sec
ss the four sit
ed for facilit
be a challeng
f total patient
53
uccess. Part o
ction, CHGA
rs with the ex
. Since the in
more sessions
n the last yea
een filled by
anning and c
only for prog
014‐2015 yea
owcase
tion night
icine Confere
ght has provid
2015 have co
MedicalStud the Resid
tion from
Academic
nd create
ce and to
d that the
ecruits. In
ink family
t projects
m to maximiz
ction. In 2014
tes.
ty based com
ge for the se
t census. The
of this strate
and local ne
xpectation th
ception of th
s with over 85
ar, the Sectio
PMI program
ontinuous st
gram sustain
ar, the Secti
ence
ded the mos
ommitted to
udents)ent
ze
4‐2015, the se
mmunity car
ection. On a
e “difficult to
gy is to prov
eds which is
hat participan
is strategy in
5% contribut
n has created
m participant
trong physicia
nability but a
ion targeted
st return to t
work within
ection provid
re and physi
daily basis,
o discharge” s
ide an annua
subsidized b
nts actively en
2012, 44 diff
ing in a leade
d four Deput
ts. This place
an leadership
also for grow
three event
the program.
the section i
ded learning f
ical availabil
patients aw
sub populatio
al PMI
by the
ngage
ferent
ership
ty Site
es the
p and
wth as
ts for
. Nine
in the
for 78
ity of
waiting
on has
MEDICALINPATIENTCARE
54
a significant impact on patient flow and capacity with patients remaining on the sub‐acute service for
periods of months up to two or three years. To illustrate the challenge in patient flow, one site
conducted a chart review and documented a snapshot of the discharge status of their entire census.
Barriers to Discharge Number of Patients
TOTAL LOS (days)
As of October 7, 2014
A. Issues of Capacity 4 149
i. Waiting RCAT Assessment
ii. Waiting Psychiatric Capacity Assessment
iii. Waiting OT Cognitive Assessments
B. Transition Services (T.S) 9 103
i. Awaiting Assessment for Placement
ii. Unable to Reach Facility
iii. Family Meeting Needed
C. Facility Barrier ‐ refusal to take patient back 14 467
i. Care Needs Have Become Too High
ii. Needs to Improve Mobility
iii. Behavioural issues
D. Needs Rehab to Return Home 12 313
i. RCTP/ERCTP/GARP/MSK Waitlist
ii. PT working in hospital Home
E. Psychosocial Issues ‐ Difficult to Place 7 1328
i. Patient Smokes/Drinks/Behaviours
ii. Age
iii. Financial Concerns
F. Awaiting Consults from Other Services 3 27
i. OT Functional Assessments
ii. Social Work (PD, POAs, Guardianship etc.)
G. On Waitlist for ALC 23 1310
H. Awaiting family decision re: hospice 1 4
I. Not Medically Stable (acute hospital stay medically necessary) 14 88
Total 87 3789
Systemic issues creating barriers to discharge create challenges to the section when balancing requests
to admit or transfer care of appropriate patients to the Service.
MEDICALINPATIENTCARE
55
QUALITYASSURANCE,QUALITYIMPROVEMENT&INNOVATIONThe Calgary Hospitalist Innovation Committee (CHIC) continued its mandate to identify, develop and
implement quality improvement initiatives in alignment with the vision, mission and values of the
Calgary Hospitalist Program, demonstrating an unwavering commitment to continuous quality
improvement.
MD/RNCommunicationA critical component of medical care is the communication between healthcare professionals in various
capacities. It is recognized that the majority of errors reported in healthcare situations have a
component of miscommunication involved. Part of this initiative is to minimize error, improve patient
care and improve efficiency of communication. Efficient and informative transfers of information are
needed to ensure that all patients receive the best care. Founded on frustration borne by both
physicians and nurses, discussion about communication improvement began. In order to tackle this
complicated and multi‐faceted task, a well‐designed survey was administered to validate the concerns
that had been raised and focus on areas that could be targeted for improvement
The MD/RN communication project that originated at the PLC was expanded to the other three sites. In
total, 481 RNs and close to 90 SHC hospitalists from all four sites responded to the survey. The survey
was utilized to focus quality improvement endeavours in the areas perceived as deficient and to identify
units with favourable practices to examine their communication strategies.
Differences in expectations between the two groups related to:
Level of preparation prior to paging physician
Requirement for response to “FYI” page
Availability/timing to respond to pages and follow up phone call
Degree of urgency of clinical situation
Communication and follow up of non‐urgent issues As a result a number of tools and interventions have been developed and implemented to narrow the
gap between expectations, develop a common set of principles for communication and to improve
effectiveness and patient safety.
MEDICALINPATIENTCARE
56
MosaicPrimaryCareNetworkDischargeSummaryReviewThe timely availability of discharge summaries is critical to continuity of care as patients transition from
hospital care back to the care of the family physician in the community. The Peter Lougheed Hospitalist
Program is achieving essentially 100% of discharge summaries completed at the very time of discharge.
In addition to the timely provision of discharge summaries, the quality, layout and content must meet
the needs of the community physician to achieve the desired impact of information transfer at
transitions of care. Recent attention to medication reconciliation on discharge created an impetus to
explore the elements of good medication reconciliation from the perspective of view of the receiving
physician.
Participating community physicians each reviewed two to four discharge summaries with specific
attention to the medication information and provided feedback and recommendations
Overall, the community physicians were very appreciative of the discharge summaries received. They
felt the summaries demonstrated great work by hospitalists for their patients in hospital and towards
smooth transitions. Despite that, 54 perceived medication errors were identified through these detailed
interviews referencing 23 specific discharge summaries. Most of these errors were medication omissions
with fewer in dose and frequency. Only 55% of the community physicians were confident that they
knew which home medications were changed in hospital.
MEDI
From the
should cle
listed. I d
them and
physician
before, un
and then
listed, the
The secon
“There is n
they know
uncertain
Finally, w
patient’s e
“I interpre
a)
b)
co
If the opin
extend far
opportuni
Some of t
has acces
communit
ICALINP
point of view
early list wha
on't know if
d they (the pa
finds thems
nless it relate
make a decis
e overall use o
nd recommen
no rationale f
wingly take t
ty.”
e were offere
episode in ho
et my patient
) A break or d
) An opportun
onsults) they
nions of these
r beyond the
ity to extend
the consultan
ss to them in
ty physicians
PATIENT
w of the com
at they think
he is still on
atient) didn’t
elves in, one
es to the reaso
sion on a mid
of the dischar
ndation from
for why this m
the patient o
ed a commun
ospital.
ts’ stay in hosp
disruption in t
nity for my pa
can’t get in th
e consultants
stay in hospi
the reach of t
nts in hospita
Netcare. Mo
would find a
CARE
mmunity phys
the home m
them, if they
know.” Illus
e commented
on for admiss
ddle ground.”
rge summary
m the commu
medication w
off the medic
nity doctor pe
pital as
the care plan
atient to acce
he communit
could be con
tal and influe
these resourc
l dictate thei
ore frequentl
succinct sum
57
sician, the so
medication lis
y were stoppe
trating the d
d, “In this c
sion. I try to g
” ALL docto
was reduced
nity physician
was discontinu
cation. Was
erspective abo
we both were
ess scores of r
ty.
ncisely include
ence care in th
ces by informi
r consults, in
ly, though, th
mmary valuab
lution was cl
st is. “My p
ed by the hos
ifficult and u
case, I revert
get informatio
ors found tha
d.
ns is to expla
ued. For us in
s it a mistake
out the poten
e working on,
resources (inv
ed in the D/S,
he communit
ing my care...
which case t
he consults ar
ble.
lear: the dis
patient is on
spitalists or if
unsafe situatio
t back to wh
on from the p
at if there we
ain every cha
the commun
e? You're alw
ntial opportu
, and
vestigations,
, the power of
ty. The discha
.if the decisio
the communi
re handwritte
charging phy
multiple med
if he chose to
on the comm
at she was t
patient thems
ere no home
nge. One st
ity, we wond
ways left wit
nities created
imaging, spe
of those visits
arge summary
ons are explain
ity family phy
en. For thos
ysician
ds not
o stop
munity
taking
selves
meds
tated,
der did
th the
d by a
cialist
could
y is an
ned."
ysican
e, the
MEDICALINPATIENTCARE
58
The recommendations are simple:
1) include the home medication list, and
2) explain every change.
These recommendations will be incorporated into medication reconciliation at discharge initiatives as
the program moves forward. In addition to the valuable feedback received from colleagues in the
community, this initiative demonstrates the important linkage our Hospitalists provide as part of the
patient’s medical home.
HospitalistNurseLiaisonAn important contributor to high quality patient care and efficient patient flow is the proactive
identification and resolution of factors which may delay discharge or increase the potential for
readmission early on during a patient encounter. The Hospitalist Nurse Liaison role has been in place for
many years. With increasing patient census at all sites and the evolution of many system wide initiatives
related to patient flow, the section undertook a review of the utilization of our nurses and how to best
maximize the impact for our patients and the program.
As a result of the review, processes have been put into place for the physician and other allied
healthcare providers to identify patients early in their encounter who would benefit from this resource
as they move towards discharge.
Although other issues are not precluded, the primary focus of the Hospitalist Nurse Liaison is to assist
with:
A. Transitions of care
1) arrange a family physician
2) no discharge location
3) multi‐faceted discharge/coordinating services (i.e. mobile lab)
4) Predetermined discharge date requiring planning assistance
5) follow up appointments
B. Multiple readmissions 1) education and reinforcement of information 2) identify supports in community/maintain awareness of community programs to assist with
maintenance of chronic complex disease 3) identifying contributing factors and mitigate (BOOST/8P)
C. Advance Care Planning 1) working through the “conversations matter” workbook 2) ACP tracking sheet 3) communication with care centres and family doctors re: ACP via the tracking sheet
D. Family Dynamics
1) family meeting coordination
2) ensure social work involvement
3) identify primary family contact
MEDI
4)
The sectio
Nurse Liai
ICALINP
) remain foassist with
on recently u
ison.
PATIENT
cused on resh efficiency in
nveiled an SC
CARE
solving issuesthese matte
CM based pro
59
s related to rs
ocess for phys
cause of adm
sicians and ot
mission/disch
thers to refer
harge barrier
r to the Hosp
rs and
pitalist
MEDICALINPATIENTCARE
60
FUTUREDIRECTIONS&INITIATIVES
Key initiatives in the coming year include:
Geographic rounding
Antimicrobial stewardship
Physician leadership development
Electronic periodic review process
HNL evaluation
Hospitalist physician engagement
Academic linkages
Electronic ward handover process
Foot Care (South Health Campus)
Ongoing recruitment and refinement of the privileging process
Support the Department in projects to improve patient flow and transitions of care
URGE
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2014. The
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complete
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2014‐201
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4
79
44
111
92
38
31
an‐14 Feb‐14
4.8%
4.0%
an‐14 Feb‐14
RE
6
12
74
91100 117
15
Mar‐14 Apr‐
Chum
02‐Emergent
4.2% 54%
4 Mar‐14 Apr
Chumir
15
14
130
117
168
32
22
‐14 May‐14 J
mir UCC Pati
03‐Urgent
5.4% 6.6%
r‐14 May‐14
UCC Patient
63
14
14
120 126
168
158
27
26
Jun‐14 Jul‐14
ents LWBS b
t 04‐Semi‐U
6.9%
6.4%
Jun‐14 Jul‐14
ts LWBS by P
5
21
101
141
105
26
26
4 Aug‐14 Se
by CTAS 201
Urgent 05‐N
4.8%
4 Aug‐14 Se
Percentage 2
14
141
90
162
103
22 25
p‐14 Oct‐14
14
Non‐Urgent
7.2%
5.0%
ep‐14 Oct‐14
2014
7
15
66
102
85
126
22
Nov‐14 Dec‐
4.2%
4.9%
Nov‐14 Dec‐
126
26
‐14
4.9%
‐14
URGE
SouthC
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
1
0
500
1000
1500
2000
2500
J
ENTCAR
CalgaryHe
3,853
3,392
Jan‐14 Feb‐1
1 1
329
304
1,037
984
1,792
1,457
694
646
Jan‐14 Feb‐14
01‐Resus
RE
ealthCentr
3,646
4 Mar‐14 Ap
SCHC U
1334
378
1,032
995
1,606
646
673
4 Mar‐14 Apr
SCHC UCC
citation 02
reUrgent
3,561
3,921
pr‐14 May‐14
UCC Total Pa
3
378
324
995 1,150
1,592 1,873
596
571
r‐14 May‐14
Total Patien
2‐Emergent
64
Care
3,769
3,905
Jun‐14 Jul‐1
atient Prese
8 3
321
386
1,082
1,122
1,875
1899
483
Jun‐14 Jul‐14
nt Presentat
03‐Urgent
3,765
14 Aug‐14 Se
ntations 20
4 1
354
328
1,078
1,899
1,838
495
491
4 Aug‐14 Se
tions by CTA
04‐Semi‐Urge
3,726
3,533
ep‐14 Oct‐14
014
4
328
358
1,062
1,020
1,876
1,742
459
409
ep‐14 Oct‐14
AS 2014
nt 05‐Non‐
3,222 3,899
Nov‐14 Dec‐
3 2
271
334
1,017
1,143
1,606
1949
325
Nov‐14 Dec‐
‐Urgent
3,899
‐14
1,143
1,949
470
‐14
URGE
Continu
UrgentRounds a
popular t
to space a
e‐simulThe e‐sim
coordinat
113
0
10
20
30
40
50
Jan
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
J
ENTCAR
uingMedic
CareRounre offered fiv
hat we now
available.
lationm group wo
te one to two
3
13 15
29
38
7
17
n‐14 Feb‐14
1.3%
2.1%
an‐14 Feb‐14
RE
calEducat
ndsve times a yea
have to look
orked with
sessions per
2 1
18
1720
30
4
Mar‐14 Apr‐1
SCH
02‐Emergent
1.2%
19%
4 Mar‐14 Apr
SCHC UC
tion
ar and have b
k at limiting a
each urgent
year.
2
8
30
44
20
10
14 May‐14 Ju
HC UCC Patie
03‐Urgent
1.9%
1.6%
r‐14 May‐14
C Patients LW
65
become so
attendance
t care to
29
13
25
32
8 10
un‐14 Jul‐14
ents LWBS by
t 04‐Semi‐U
1.2% 1.4%
Jun‐14 Jul‐14
LWBS by Perc
1
14 17
24
10 13
4 Aug‐14 Sep
y CTAS 2014
Urgent 05‐N
1.4%
4 Aug‐14 Se
centage 201
1
17
17
27
21
4 5
p‐14 Oct‐14
4
Non‐Urgent
1.3%
1.2%
ep‐14 Oct‐14
14/15
1 1
10 13
20
47
2
Nov‐14 Dec‐
1.0%
1.7%
Nov‐14 Dec‐
47
5
‐14
1.7%
‐14
URGENTCARE
66
SedationModulesThe AHS mandated sedation online learning modules are to be completed every one to two years
(depending on role) for UC staff involved in sedation.
CHALLENGESContinuingMedicalEducationThe Urgent Care Conference of October 17, 2014, was successful with many participants. A decision to
pause the UCC Conference for 2015 has been made due to increasing event costs.
FUTUREDIRECTIONSContinued work on the implementation of the Urgent Care Review report recommendations is ongoing.
PALLI
ACCOM
PALLIAThe pallia
of expert
currently
practition
clinicians
of health
(Foothills
Rockyview
(palliative
teams con
palliative
GRIEFSThe Grief
grief coun
has faced
program
all types
individual
clients mu
group cou
During th
2015, 1,3
in 6,491
There we
average
appointm
During th
period. Th
of Child (5
The progr
program
volunteer
program
clinician a
IATIVEC
MPLISHM
ATIVECONative consult
t level palliat
consists o
ner, 13 clinica
. The consul
care settings
Medical C
w General H
e, integrated)
ntinues to gro
care capacity
SUPPORTPf Support pro
nselling to ad
d the death o
through self
of death rel
l sessions is b
ust see a cou
unselling sess
he time perio
376 unique cl
individual
ere approxim
wait time f
ment was 28 d
his time perio
he types of gr
5), and Sibling
ram also recr
with a newl
rs is to assis
themselves.
and two‐to‐th
CARE
MENTS&
SULTTEAteam perfor
tive care in t
of 25 phys
al nurse spec
t teams funct
s including al
entre, Peter
Hospital, and
, hospices, lo
ow each year
y through edu
PROGRAMogram offers
ults 18 years
of a loved on
‐referral and
ated loss. Th
between five‐
nsellor to det
ions.
od of Januar
lients attend
and group
mately 1,28
for clients a
days.
od approxima
roups offered
g Loss (3).
uits trains an
ly developed
st with group
The facilitat
hree trained v
&HIGHL
AMSms the vast
the Calgary Z
sicians, one
cialists and fiv
tion in a wid
ll four adult h
r Lougheed
d South Hea
ong term care
r at all of the
ucation and su
Mindividual an
of age and o
e. Clients ac
the program
he average le
‐to‐eight sess
termine suita
ry 1 2014‐ M
ed services r
patient enc
0 new clien
attending th
ately 570 clie
d were: Matu
d mentors vo
d dedicated v
p facilitation
ion team for
volunteers. In
67
LIGHTS
majority
Zone. It
e nurse
ve nurse
e variety
hospitals
Centre,
lth Campus)
e, and all rura
ese sites. In a
upport for pr
nd group
lder that
ccess the
m serves
ength of
sions. All
ability for
March 15
resulting
counters.
nts. The
heir first
ents attended
re Spousal (1
olunteers. Cu
volunteer co
and most o
r groups cons
n 2014 the pr
), Tom Bake
al sites. The
addition to cl
rimary teams.
d the 31 gro
11), Mixed Lo
rrently there
oordination ro
of the volunt
sists of lead f
rogram devel
er Cancer Ce
number of p
inical provisio
.
oups provided
oss (12), Youn
are 58 active
ole. The cor
teers have c
facilitators w
loped new tr
entre, home
patients seein
on, they also
d during this
ng Spousal (5)
e volunteers
re function o
come throug
who are a pro
aining manua
care
ng our
build
s time
), Loss
in the
of the
h the
ogram
als for
PALLIATIVECARE
68
volunteers & lead facilitators. The program also developed participant manuals that are now provided to
all group clients.
In April 2014 the program introduced a new monthly single session group to support clients who are
waiting for counselling. All new clients are invited to attend and bring support people if desired. Grief
information is provided and volunteers share their grief journey as a means of support to new clients.
Each session has two program staff and four volunteers. During the months of November‐December
four single sessions were offered specifically on Managing the Holiday Season. A total of 14 single
sessions have been offered with approximately 235 clients who have attended and approximately 70
support people. Evaluations of these sessions have been very positive and have demonstrated a unique
way to support those who are on the waitlist.
Starting April 2014 the program began collecting additional statistics to be able to report on the types of
losses, the complexity of needs, and the cause of death of the individuals who have died.
The program continues to receive grant funding to support 2013 flood impacted communities. A
counsellor (.8 FTE) has participated on multiple flood response initiatives and provided grief and trauma
single session groups to those who have been impacted and multiple AHS and non AHS care providers.
During 2014 the program participated in the newly developed Calgary Homicide collaborative which has
evolved from the need for services in Calgary to collaborate in response to the increase in the number of
homicides. This collaborative included AHS mental health services, Calgary Victims’ Assistance and
numerous community counselling services.
The Grief Support Program also offers grief and bereavement education to the public community and
AHS. “The How to Care What to Say” workshop is a standard education program provided to AHS and
contracted services that care for those who die and their families. From January 1 2014 ‐ March 31 2015,
17 workshops were offered to a total of 570 participants. The program has also been heavily involved in
developing educational materials for the AHS Calgary Care after Death project.
PALLI
IATIVECCARE
32
18
0
20
40
60
80
CL(Percen
April 1, 201
Male
24
CLIE(Percen
April 1, 201
69
LIENT AGEntage of Tot14 ‐March 3
NT GENDERntage of Tot14 ‐March 3
12
tal) 1, 2015
Female
76
R tal) 1, 2015
33
18
31
51
65
8‐30
1‐50
1‐64
5+
PALLI
ADVANOn April
procedure
Designati
Alberta.
Manager,
educator,
contribute
developm
managers
the new p
Over the
into pract
patient‐te
M
re
U
e
d
Fo
IATIVEC
NCECAREP 1st 2014 a
e for Advanc
on (ACP G
The Calgary
Dr. Jessica
QA resou
ed to the
ment and pr
s and educat
policy. These t
course of 201
tice. Acting o
elephone aud
Making the AC
ecord (Dec 20
pdating the G
nhance orde
etermination
ocusing on ed
CARE
PLANNINGa new Leve
ce Care Plann
GCD) was
Zone, ACP
Simon, phy
rce and ad
provincial p
repared “too
ors to assist
toolkits have
14‐15 the tea
on a strategic
dit of ACP and
CP tracking r
014)
GCD order on
ering clinicia
.
ducation and
G,GOALSOel 1 AHS po
ning and Goa
implemente
GCD team (
ysician consu
dministrative
policy and p
olkits” for p
with the tra
been nomina
am has contin
c plan, inform
d GCD, this ha
record docum
n SCM (Feb 2
ans’ docume
engagement
CAUS(Perce
April 1, 201
70
OFCAREDolicy and
als of Care
d across
Bev Berg,
ultant, an
support)
procedure
physicians,
ansition to
ated for an A
nued to enha
med by quality
as included:
ment availabl
014 and Dec
entation of
with ACP GC
SE OF DEATHentage of Tot14 ‐March 3
DESIGNATI
HS President’
nce integrati
y‐gaps identi
e on SCM th
2014) to alig
who has
CD practice in
Htal) 1, 2015
ON
’s Excellence
on of the pol
ified by a cha
he acute care
gn with the p
been involv
primary care
Cance
Chron
Other
Homic
Suicid
Healt
Accide
Addic
Other
Award.
licy and proce
art and disch
e electronic h
rovincial form
ved in the
e networks (P
er
nic Disease
r ‐ Illness
cide
de
h Related
ent
ction
r ‐ Sudden
edure
arged
health
m and
GCD
PCN)
PALLI
As part o
Septembe
sessions t
Oct 2014)
Physicians
Practice R
to receive
conversat
In additio
Dr. Simon
Canadian
recomme
conversat
The team
participat
public for
INTENS The Inten
Medical C
patients w
care man
setting. O
clinical ph
dietician,
and trans
discharge
Palliative
with both
body of re
this need
in late 20
were adm
IPCU is le
over 90) a
Zone, but
Columbia
IATIVEC
of the latter,
er 2014. Dr
to individual
). In addition,
s Dr. Simon h
Review ‐ Pear
e a lecture of
tions during t
on to local an
n are membe
Society of P
ndations fo
tions.”
m continues
ted in the one
ums reaching
SIVEPALLI
nsive Palliati
Centre provid
with comple
nagement in
Our team is
harmacists, oc
spiritual car
sition coordin
d to appropr
Medicine is a
h a growing p
esearch to di
, the IPCU ha
013. For the
mitted to the
ss than 60 (ra
and average l
t the catchm
.
CARE
, Bev Berg p
r. Jessica Sim
practices in t
, through the
has presented
ls for Practice
ACP GCD du
heir palliative
d provincial w
ers of the Nat
Palliative Car
or Palliative
to participa
e year review
g over 500 se
IATIVECA
ve Care Un
des tertiary le
x palliative i
a comprehe
comprised o
ccupational a
re, recreation
nators. Our g
iate setting fo
a rapidly evo
atient popula
rect clinical c
ad increased
e 2013‐14 fis
e unit. The av
anging from 1
ength of stay
ment area fo
presented to
mon and Jacq
the Calgary F
University of
d an evening
e all on ACP G
ring the R1 o
e medicine ro
work the ACP
tional Task G
re Physicians
Care, whic
ate in the
w of the prov
niors at varyi
AREUNIT
it (IPCU) at
evel palliative
ssues requir
ensive interdi
of physicians
and physical t
n therapy, vo
goal is to op
or ongoing ca
olving area of
ation and an i
care. In orde
from 21 to 2
cal year 618
verage patie
18 years of a
y is less than t
r referrals ex
71
the South C
qui Pinto ha
oothills Prim
f Calgary, Con
course, webi
GCD. Addition
orientation an
otation.
P GCD team r
roup for ACP
s, Dr. Simon
ch included
provincial A
incial policy.
ng fairs.
Foothills
e care for
ing acute
isciplinary
s, nurses,
herapists,
olunteers,
ptimize sympt
are, typically h
f medicine
increasing
er to meet
9‐31 beds
8 patients
nt age on
ge to well
two weeks. M
xtends to ot
Calgary PCN
ve provided
ary Care Net
ntinuing Med
nar and work
nally, all Fam
nd a commun
remain active
P. Through he
co‐authored
“Don’t de
CP GCD im
The team al
tom manage
home or hosp
Most patients
ther parts of
Physician Ed
on‐demand
twork (about
dical Educatio
kshop at the
ily Medicine
nication skills
e nationally. B
er work as a
d the Choosin
elay advanc
plementation
lso participat
ement so tha
pice.
s admitted ar
f southern A
ducation foru
Lunch and
10 provided
on for Primary
39th Annual F
residents con
workshop on
Both Bev Ber
board memb
ng Wisely Ca
e care pla
n committee
ted in a numb
at patients ca
e from the Ca
Alberta and B
um in
Learn
since
y Care
Family
ntinue
n GCD
rg and
ber of
anada
nning
e and
ber of
an be
algary
British
PALLI
The majo
Palliative
This allow
patients a
With the
physician
palliative
recruitme
also allow
palliative
In 2014, D
been the
physician
Tom Bake
IPCU is
education
four block
including
Internal M
Neurology
and Fam
number o
clinical ex
come from
The Famil
their first
experienc
patient an
to patien
comprehe
teamwork
anesthesi
medicine,
medical l
present a
regarding
IATIVEC
ority of IPCU
Consult team
ws for timely
and their fam
increased nu
service to a
physicians f
ent for 2015,
w us more foc
care.
Dr. Leonie He
Director for t
team and is
er Cancer Cen
a principal
n, including Pa
ks of core rot
Medical Onc
Medicine, An
y, and Phys
mily Medicine
of undergrad
xperience in
m the Univers
ly Medicine r
year. Two w
ce an interest
nd family‐cen
nts’ commu
ensive comm
k; regular co
a, medical
, and surgica
iterature. IPC
recent article
g palliative car
CARE
patients are
ms supporting
access to th
ilies.
mber of beds
three physic
for IPCU. In
we will be a
cus and capac
rx became th
the past ten
leading the
ntre. This new
site for po
alliative Med
tations on IPC
ology, Radiat
nesthesia, Psy
ical Medicin
e residents.
uate trainees
palliative car
sity of Calgary
residents com
eeks of this b
ting and chal
ntered focus;
nity context
unity‐based P
ollaboration
and radiatio
al disciplines;
CU Journal Cl
e focusing on
re.
e admitted d
g the Palliativ
e system and
s and clinical
cian service m
2014, we m
ble to staff th
city for our im
he new Medic
years. Dr. Ga
program dev
w outpatient p
ostgraduate
icine resident
CU, specialty
tion Oncology
ychiatry, Crit
e and Reha
We also s
s who are loo
e, typically d
y Cumming S
mplete a man
block are typi
lenging blend
immersion i
t and integ
Palliative & E
with a wide
on oncology
; and regula
lub rounds a
n a palliative i
72
directly from
ve Home Care
d minimizatio
service work
model and w
mostly functi
he unit with
mportant acad
cal Director o
alloway contin
elopment of
program is an
residency
ts who do
residents
y, General
ical Care,
bilitation,
upport a
oking for a
during their c
chool of Med
datory four w
cally spent o
d of: full‐spec
n a practice e
gration with
nd of Life Car
e variety of
y, interventio
r reference t
re held twice
issue relevant
the commu
e Service and
on of Emerge
kload, we hav
we have been
oned with t
three physici
demic domain
of IPCU, repla
nues to work
the new Pal
n important re
clinical clerksh
dicine as well
week block ro
n IPCU, durin
ctrum acute
environment
community
re service in C
specialist ph
onal radiolog
to evidence‐
e weekly and
t to a patient
nity through
the Tom Bak
ency Departm
ve needed to
n working to
two physician
ians most of
ns of educatio
acing Dr. Lyle
k as a core me
liative Consu
eferral source
hip program.
as other prog
otation in pal
ng which time
care palliativ
characterize
y family ph
Calgary Zone
hysicians inc
gy, interven
‐based practi
d each reside
t they are foll
contact wit
ker Cancer Ce
ment visits fo
switch from
recruit addi
ns, but with
the time. Th
on and resea
Galloway wh
ember of the
lt team withi
e for IPCU.
. Medical stu
gram in Cana
lliative care d
e the resident
ve medicine w
ed by its sens
ysicians and
; interdiscip
cluding psych
ntional pulm
ice guideline
ent is expect
lowing or que
h the
entre.
or our
a two
tional
h new
is will
rch in
ho has
e IPCU
in the
dents
da.
during
ts will
with a
sitivity
d the
plinary
hiatry,
onary
s and
ted to
estion
PALLI
HOSPICThere are
beds curr
beds in 2
the open
include A
Santuari a
contracte
of collabo
various c
operation
committe
sharing, c
resource
Steering
Committe
Hospice C
Social Wo
Foothills
credit to
doors ope
ACADE The Unive
Program
wishing t
Medicine
Residency
in the
Departme
Departme
trained in
care team
the Inpat
trainees a
Symptom
Nephrolo
presentat
Rounds a
IATIVEC
CESe seven hospi
rently. This
015, with the
ing of St Dul
Agape, Chino
and Southwoo
d providers,
oration and s
ontracted ho
nalize this g
ees in place t
collaborative
sharing. The
Committee,
ee, Hospice
Clinical Nurse
orkers Meetin
Country hosp
all the staff
en.
MICPALLI
ersity of Calg
provides a
to develop
. The Univers
y Program cu
2014‐2015
ent of Fami
ent of Critic
n the both t
m environmen
ient Hospital
are exposed
Managemen
gy Clinics. Ac
tions and org
s well as Pal
CARE
ices in Calgar
is expected
e closure of S
lcina hospice
ook, Foothills
od. As a larg
it is a priorit
shared learni
ospice provid
goal, there
o provide fo
education an
ese include th
Hospice Q
Medical
e Educators
ngs and Hospi
pice in Okoto
there. They
IATIVEME
gary Palliativ
dvanced tra
added com
sity of Calga
urrently has
academic y
ily Medicine
cal Care Me
he hospital a
nts, including
Consult Serv
to multiple o
nt Clinic, Bra
cademics inc
ganization, p
liative Grand
ry, with a tota
d to increase
Santuari hos
e. The other
s Country, R
e program w
y to ensure a
ing exists am
ders. In an e
are a num
rums for info
nd project w
he Hospice E
Quality Mana
Directors M
Committee,
ice Volunteer
oks recently p
also have m
EDICINE
e Medicine R
aining for p
petence in
ry Palliative
two enrolled
ear, one f
e and one f
dicine. Resid
and commun
g the Palliativ
vices, Pediatr
outpatient cl
in Metastase
lude four pre
articipation a
d Rounds. Res
73
al of 108
e to 114
pice and
hospices
Rosedale,
ith many
a culture
mong our
effort to
mber of
ormation
work, and
Executive
agement
Meeting,
Hospice
r Coordinator
passed their
many commu
Residency
physicians
Palliative
Medicine
d trainees
rom the
from the
dents are
nity palliative
ve Home Care
ric Palliative S
inics, includin
es Clinic, ALS
esentations a
and presenta
sidents comp
rs Meetings.
accreditation
nity partners
e
e Service, the
Services and
ng the Tom
Clinic, as we
at Advanced
ation at Mor
plete a schola
n with comm
s that work h
e Intensive Pa
Calgary Hosp
Baker Cance
ell as Palliati
Practice Rou
rtality and M
arly project,
mendation tha
hard to keep
alliative Care
pices. Additio
r Centre Pain
ve Cardiolog
unds, Journal
Morbidity (M
which can le
at is a
their
e Unit,
onally,
n and
y and
l Club
& M)
ead to
PALLI
publicatio
program a
care servi
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journal ro
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Dr L. Herx
presentat
Abdul‐Raz
PROVIN The AHS
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members
initiatives
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Sinnarajah
(Dr J. Si
Advance C
Implemen
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Sinnarajah
Planning W
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ounds for the
the various p
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the division o
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tions during t
zzak, Dr S. Ch
NCIALPAL
provincial Pa
rking diligent
a more robus
to all Alber
he Calgary
have been
s. The curren
l PEOLC Innov
h), Dashboar
mon, Dr A.
Care Planning
ntation Work
Clinical Netw
Group (Dr A.
G. Ho, Dr A. S
orking Group
ateway Work
Hospice Cap
iative On‐Cal
h, Dr R. Spic
Working Grou
CARE
palliative ph
programs (i.e
interesting pa
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of palliative
nference in M
mbers of the
e: Dr S. Chary
he conferenc
ary, Dr R. Spi
LLIATIVEP
alliative and
tly at many i
st, evidence‐b
rtans and pr
Palliative Ca
very involve
nt list of wo
vations Steer
rd and Indica
. Sinnarajah,
g/Goals of Ca
king Group (
work (SCN) Pa
Abdul‐Razza
Sinnarajah), E
(Dr L. Murph
ing Group (D
acity Workin
ll Support W
e), Business
up and Volun
ysician group
e. hospice, ho
atient case to
am will once
medicine is p
May 2015 in C
Palliative Car
y, Dr L. Gallow
ce (Dr M. Slaw
ce).
PROGRAM
End of Life t
nitiatives in
based PEOLC
omote patie
re section p
ed with all o
rking groups
ing Committe
ators Workin
, Dr E Was
are Designatio
Dr J. Simon)
athways & Gu
k, Dr S. Colga
MS Assess, T
hy, Dr A. Sinn
Dr S. Chary), P
g Group (Dr
Working Grou
Casing and S
teer Initiative
75
p. M&M roun
mecare, cons
o use as a lear
again run th
pleased to ho
Calgary. It's ru
re section are
way, Dr A. M
wnych, Dr E. W
team has
order to
program
nt‐based
physician
of these
include
ee (Dr A.
g Group
sylenko),
on Policy
), PEOLC
uidelines
an, Dr L.
reat and
narajah),
Palliative
D. Falk),
p (Dr A.
Strategic
es Working G
nds are held o
sulting teams
rning opportu
e Mary O'Co
ost the 11th
un by the Can
e involved in t
Murray, Dr J. S
Wasylenko, D
Group (Dr E. Fo
on the last Fr
s, Intensive P
unity.
onnor confere
Annual Adv
nadian Societ
the planning
Simon, Dr M.
Dr M. Labrie, D
oster).
riday of the m
alliative Care
ence in May
vanced Learn
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committee (
. Labrie) as w
Dr A. Murray,
month
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2015.
ing in
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Chair:
well as
, Dr A.
PALLI
SPECIATomBaStarting i
dedicated
Baker Ca
existed f
delivery a
the prev
Clinic’s s
palliative
excellent
outpatien
communit
Palliative
system in
physician
partnersh
Baker, an
We are w
tumour si
Home Car
Palliative
1. P
2. Pa
3. Em
4. In
ca
PALLIA“To enpalliati The Pallia
to clients
offered a
program i
program
variety o
IATIVEC
LPOPULAakerConsuin the summ
d Palliative c
ancer Centre
or in‐hospita
across the zon
ious TBCC
scope, in th
expertise fiv
opportunity
nt Cancer
ty (home c
Care Unit)
the zone. W
and 0.5
hip with Dean
d Renee Lee,
working to es
ites, including
re, Radiology,
consultant in
hone/email/h
alliative Cons
mbedded Pal
n‐person cons
ases.
ATIVEHOMhance digvecareat
ative home Ca
at the end
as part of th
in Calgary. Ty
in the last s
of illnesses in
CARE
ATIONSultServicemer of 2014,
consultant p
(TBCC) sim
al and comm
ne. This repre
Pain & Sym
at it allows
ve days a we
y for better
Care system
are) and ac
aspects of
We are curren
Nurse Pra
n England and
our nurse co
stablish a reg
g representat
, Psychosocia
nvolvement at
hallway consu
sultant presen
liative Consu
sults, either o
MECAREgnity, comhome”
are team is a
of life. It's
he Palliative
ypically clien
ix months of
ncluding can
ewe’ve estab
presence at t
ilar to what
munity sites
esents an expa
mptom Mana
s regular ac
ek. This has
integration
m with bo
cute care (I
the Palliati
ntly working
actitioner F
d Chris Ralph,
oordinator. D
gular “Tumou
tion from Me
al Resources,
t TBCC can ta
ults,
nce at Tumou
ltant in select
on‐demand fo
mfort, and
a 24/7 service
one of the p
& End of L
nts are referre
f life and can
ncer, CHF, en
76
blished a
the Tom
t already
of care
ansion of
agement
ccess to
been an
of the
oth the
ntensive
ve Care
with 1.0
FTEs, in
the excellen
r Lyle Gallow
ur Group” fo
dical Oncolog
and Spiritual
ake the form o
ur Board roun
t oncology cli
or urgent situ
d choice
e offered
programs
Life Care
ed to the
n have a
nd stage
t pain/sympt
way is leading
rum, similar
gy, Radiation
Care.
of:
nds,
inics (e.g. Bra
uations, or bo
through s
tom clinical p
this effort.
to that whic
Oncology, Ph
ain Mets Clini
ooked electiv
sustainabl
harmacists at
ch exists for
harmacy, Pall
c),
vely for less u
le, special
t Tom
other
liative
urgent
lized
PALLI
renal dis
Palliative
centered,
geograph
Nurses (R
collaborat
therapists
social wo
physician
The team
goals of c
clients w
support t
collaborat
the family
specialists
to suppo
family ph
care patie
The Pallia
palliative
covers an
Calgary c
however,
to be less
admission
new refer
The majo
access to
1630‐083
urgent sy
psychosoc
access fo
can be in
support.
nights tha
are consid
Home Car
IATIVEC
sease, COPD
Home Care
holistic app
ic caseloads
RNs), and th
tive suppor
s, physiothe
orkers, license
and clinical n
m provides ed
care planning
with equipm
hem through
te with the
y physician, T
s to coordinat
ort a primary
ysicians to st
ent.
ative Home Ca
experts acr
ny referred e
city limits. O
, due to the p
s than six mo
n to client de
rrals per mon
rity of staff w
the Palliativ
0 seven days
ymptom ma
cial support
r clients and
n the form o
There are tw
at provide thi
dered palliat
re who requir
CARE
, ALS/MS a
e team pra
proach. The
that are ma
ere is also m
rt from re
erapist, occu
ed practical
nurse speciali
ducation, sym
g, psychosocia
ent, and fi
h their disease
larger health
Tom Baker Ca
te optimal cli
y medical ho
tay involved
are team has
ross a variet
end of life cli
On average t
palliative natu
onths and ove
eath or hosp
nth.
work 0830‐164
e Home Care
s a week. Th
anagement,
and can faci
families who
f either a ho
wo RNs on ev
is support to
ive. They ar
re palliative e
and dementi
ctices with
team consis
anaged by Re
multi‐disciplin
egistered re
upational th
nurses and
st consultant
mptom mana
al support an
nancial guid
e trajectory.
h care team
ancer Centre
ent care. It c
ome by enc
in the palliat
a staff of clo
ty of discip
ients living w
there are 35
ure of these
er the past fe
pice transfer.
45, but the cl
e Response T
his small team
end of life
litate on‐call
o are in distr
ome visit or
venings and o
all Palliative
re also availa
expertise.
77
ia. The
a client
sts of 26
egistered
nary and
spiratory
herapists,
palliative
ts.
agement,
nd assists
dance to
The RNs
including
or other
continues
couraging
tive home
ose to 100
lines and
within the
50‐380 client
clients the av
ew years has
The Palliati
ients have
Team from
m provides
support,
physician
ress. This
telephone
one RN on
Home Care c
ble as consu
ts on the pr
verage length
s been movin
ive Home Ca
clients and a
ltants to sup
rogram at a
h of stay on t
ng towards th
are team rece
ll Rural Home
pport any clie
ny point in
the program
hree months
eives about
e Care clients
ents on Integ
time:
tends
s from
80‐95
s who
grated
PALLIATIVECARE
78
LEADERSHIPMany members of the section are taking on leadership roles by participating in many local, provincial
and national medical committees related to palliative care primarily but also other medical areas. Some
highlights (not already mentioned in other parts of the report) include:
Dr Ted Braun has many key leadership positions within AHS including Acting Associate Zone Medical
Director and Medical Leader for Public Health, Primary Care, Chronic Disease Management and Allied
health all for the Calgary Zone.
Dr Srini Chary is the Chair of the Pallium Foundation of Canada, which is involved in national educational
activities related to palliative care. It has a $3 million funding from the Federal Economic Action Plan
2013.
Dr Marisa Dharmawardene is on the FMC Site Leaders committee as well as the Residency Program
Committee. She was also an invited speaker at the Harvard School of Public Health.
Dr David Falk is involved in the DFM residency program as Domain Lead in Palliative Care, attending
monthly Curriculum Evaluation Committee, FMRPC meetings, Domain Lead meetings, meetings with
Care of the Elderly lead and meetings with hospice preceptors. Next step is to help out with the
evaluation of curriculum and resident assessment process.
Dr Eleanor Foster is on the Palliative Home Care Quality Improvement committee. She made a couple of
palliative care presentations at the 35th CDMA Continuing Medical and Dental Education Conference in
Thailand in 2014.
Dr Lyle Galloway led a presentation on the use of neuraxial analgesia in Calgary at the 25th Annual
Palliative Education and Research Days in 2014.
Dr Leonie Herx on the working group that is creating the new Royal College of Physicians and Surgeons
of Canada's Palliative Medicine training program as well as being on the Board of the Canadian Society
of Palliative Care Physicians.
Dr Hubert Marr is a member of the PLC Ethics committee and will make presentations at the Calgary
Hospitalist conference as well as the Canadian Bioethics Society annual conference.
Dr Alison Murray led a presentation on the use of Denosumab in palliative care at the 20th International
Congress on Palliative Care in 2014. She was also the runner‐up when she presented on Managing End
of Life Symptom Crises in the Home at the 10th Annual Advanced Palliative Medicine Update in 2014.
Dr Sara Pawlik is our Palliative Medicine Residency Program Director and recently successfully had our
residency program accredited.
Dr Jessica Simon has made many presentations on palliative care and advance care planning both to
residents as well as family physicians (Lunch and Learn). She also sits on the National Advance Care
Planning Task Group and the Canadian Hospice and Palliative Care Association. She co‐authored the
Choosing Wisely Canada palliative care list. She was also promoted from Assistant Professor to
PALLIATIVECARE
79
Associate Professor at the University of Calgary within the Division of Palliative Medicine, Department of
Oncology.
Dr Aynharan Sinnarajah sits on the Alberta Scientific Assembly Planning Committee and
Nominations/Awards Committee of the Alberta College of Family Physicians. He is also a member of the
Clinical informatics team for AHS Calgary and co‐chairs the Electronic Laboratory and Diagnostic Imaging
Advisory Committee. He also completed a Master’s in Public Health degree at Harvard University in
2014.
Dr Eric Wasylenko is the Medical Advisor of the AHS Provincial Advance Care Planning/Goals of Care
Designation Initiative, Ethics and End of Life Care Consultant for Health Quality Council of Alberta, Chair
of the Public Health Ethics Consultative Group of Public Health Agency of Canada. He has made
numerous presentations over the year to various groups on ethics, advance care planning, and physician
assisted suicide.
PALLIATIVECARE
80
FOCUSONCANCERPATIENTS.THETOMBAKERCANCERCENTREANDCALGARYZONEPALLIATIVECOLLABORATIVEPROJECT[Excerpts from the Alberta Cancer Foundation's Leap magazine, Winter 2014] At times, it can seem that cancer is surrounded by powerful words and strong language. But one word that’s hard to come to terms with is “palliative.” For many, it implies the end of life, surrender. It’s a word that individuals living with cancer, their families and their health‐care teams, struggle to raise in conversation. Yet it’s a word and a conversation that are essential to those whose cancer continues to advance and requires complex medical care, and for those who are facing the end of their life. According to the World Health Organization, palliative care is a dimension of care “that improves the quality of life of patients and their families facing the problems associated with life‐threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” “While the definition of palliative care is supportive, in reality few of us are ever prepared to hear that our life will end,” says Bert Enns, a spiritual care specialist and project lead at the Tom Baker Cancer Centre and Calgary Zone Palliative Care Collaborative. “Life is precious. As healthcare providers, we face a dilemma. How can we explore palliative and end‐of‐life care in a gentle and timely way to ensure that people have the necessary support through one of life’s most challenging transitions?” Alice Campbell, a retired nurse who has been living with cancer for several years, remembers the first time she heard the term “palliative” in
relation to her care, in 2009. “As I woke up from a surgical procedure, the nurse co‐ordinator told me I was being referred to the palliative home‐care team. I recall how frightening that was. No one had told me that I was dying.” The palliative care team was uniquely qualified to deal with a case as complex as Campbell’s. “I needed that specialized care but my goal was to recover,” she says. Recover she did. “That word, palliative, is loaded emotionally and for most patients and families, it indicates that their loved one is dying,” she says. To her way of thinking, the word palliative covers intricate cancer care on a spectrum, including people who will graduate from care and those who are terminally ill and will progress toward the end of life with the support of a palliative team the entire way. When she was diagnosed with stage four non‐Hodgkin’s lymphoma in 2009, Campbell’s doctor told her there was no cure. “It’s a very hard conversation when your doctor says, ‘This cancer’s not going away. You can count on it coming back but when it does hopefully we will have a new treatment.’ ” With the most recent reoccurrence, Campbell was told she could access palliative care again, if and when she needs it. According to Enns, recent research has identified the benefits of an early palliative approach. By working with individuals and their families, health‐care professionals can help patients access a multitude of services for their physical, emotional and spiritual well‐being. With this support, patients can make decisions that reflect their values and personal goals for living with
PALLIATIVECARE
81
cancer, including the last stretch of life. For example, incorporating a palliative approach into care can ensure that quality of life issues are integrated into discussions regarding treatments at the point of diagnosis. If treatments are not successful and cancer advances, appropriate supports are added to ensure symptoms are well managed and decisions regarding treatments continue to reflect an individual’s priorities and values. Patients need to be well informed about treatment options and services available at all points of their journey with cancer. Enns is leading a two‐year project, funded by the Alberta Cancer Foundation, to enhance the care for Tom Baker Cancer Centre patients and their families in the Calgary Zone. The project examines current services and identifies gaps and opportunities for best practices required to integrate an early palliative approach to care. Despite Calgary having one of the best‐resourced and utilized palliative care programs in the country, there is recognition that cancer patients and their families are not always accessing these services in a timely manner.
In Phase 2 of the project, the committee will develop pathways that guide patients, families and health‐care teams to ensure these conversations about care decisions and resources are proactive and enhance the integration of palliative services. To better integrate early access to palliative care, the committee will develop pilot opportunities to address current gaps. It will also develop educational resources that support health‐care professionals to have these difficult early conversations. The challenge is clear. What’s the best way to introduce palliative care to ensure its entire scope is provided? Is it a term that can become acceptable and supportive without diminishing a patient’s sense of hope? “We recognize we have work to do and are committed to finding better ways to integrate an early palliative care approach into all aspects of our cancer care,” says Enns.
PALLI
FACTS
0
500
1000
1500
2000
2500
3000
3500
4000
4500
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0
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1000
1500
2000
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IATIVEC
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lliative Cons2002/03 ‐ 20
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Hospice ‐
33457
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sult Teams 013/2014
1184
‐ Admissions
814
3880
PALLI
0
500
1000
1500
2000
2500
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3500
4000
4500
5000
uniq
initi
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IATIVEC
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AlberIni
que patients
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aths
charges
0
500
1000
1500
2000
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3000
3500
4000
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AlbertUniqu
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2291 229
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FMC P
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ta Health Seue Patients,
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962452 2
ervices, CalgEvents by Fi
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109 242
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ervices, CalgInitial Serviy Team by F
83
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SHCHomeCare
357 1086
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3422
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eCOPD SL/
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nsult Teamsand Deaths
41814404
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400
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# of Admissions# beds
th ofwho
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vices, CalgarDeaths and D98/99 ‐ 2013
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ar
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IATIVEC
89%
2007/08
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92%
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ta Health Seby
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ervices, Calgay Fiscal Year
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PALLIATIVECARE
90
HospicesFoothills Country Hospice in Okotoks main challenge continues to be the need to raise operational
funds.
QUALITYASSURANCE,QUALITYIMPROVEMENT&INNOVATIONADVANCECAREPLANNING/GOALSOFCAREDESIGNATION(ACP/GCD)Ongoing Quality Improvement activities are complimented by the team actively contributing to research
in ACP. For example, Dr H. Wrigley, Calgary Primary Care Physician, has just completed a study with Dr
Simon looking at patient‐rated acceptability of the Conversations Matter Guidebook provided at
admission to acute care. Dr Simon co‐leads the Alberta Innovates Health Solutions Collaborative
Research and Innovation Opportunities Program grant on ACP (www.ACPCRIO.org), which completed
year two of the five year study in April 2015, yielding insights into local barriers, facilitators and
readiness for further uptake of ACP GCD.
INTENSIVEPALLIATIVECAREUNITThere are now two new therapy programs that are being piloted on IPCU for patients and families
centering on art and music. The Alberta Cancer Foundation has provided funding for the Healing Arts
Program for a two year pilot project 2014‐2016. Through this grant, IPCU receives a dedicated art
therapist for one half day per week. In addition, there are a number of other art therapy programs being
offered through the Tom Baker Cancer Center that our IPCU patients can participate in, including
Healing Arts in Medicine, Healing Arts Music Therapy and a Therapeutic Doll Making Workshop. There is
also a dedicated music therapist on IPCU for one day per week through the support of a six month grant
from the Canadian Music Therapy Trust Fund for harpist Jan Pearce. Data will be collected from these
two pilot projects that will allow advocacy for ongoing funding for these important programs.
The IPCU is currently developing best practice unit‐specific medication protocols for all clinicians to
access electronically, including guidelines for use of infusions for ketamine, lidocaine, midazolam, as well
as methadone rotations. This is a collaborative project between the clinical pharmacists, physicians and
nursing educators. We continue to adapt to ongoing AHS initiatives such as the new procedural sedation
policy, whereby our physician team is undertaking additional training to ensure patient safety and
optimized patient care, and we are engaged in ongoing dialogue regarding the role of IPCU in the new
cancer centre.
PALLIATIVEHOMECARESome recent quality improvement and innovative accomplishments for the Palliative Home Care Team
in the last year have included the roll out of the provincial End of Life assessment, Care Planning and
Medication Reconciliation to ensure consistent, standardized documentation that is all entered directly
into the electronic health record.
PALLIATIVECARE
91
HOSPICESThe Hospice Transfer of Information Quality Improvement Project was launched in 2014. It is grounded
in the Alberta Improvement Way process and supported by an AHS Quality Improvement Specialist.
Steering committee includes stakeholder representatives from all Calgary zone hospices, Hospice
Medical Directors group, IPCU, Palliative Home Care, AHS Palliative Consult Service (MD & CNS), Hospice
Access, and AHS PEOLC Medical Director. The goal of the project is to identify/ create sustainable
resources and processes to ensure efficient and effective transfer of information when patients are
admitted to hospice from home or acute care sites.
FUTUREDIRECTIONSFor the Tom Baker Consult Service, opportunities for growth moving forward are:
Discussions about the role of a Provincial Palliative “Tumour Team”
Integration with the current medical/radiation oncology fellowship training programs to allow
outpatient palliative/symptom consult experience
Research possibilities in the outpatient cancer setting
Role in education regarding primary palliative care for existing outpatient clinics
Our on‐the‐ground clinical operations are occurring at the same time as the Alberta Cancer Foundation‐
funded Calgary Zone TBCC and Palliative/End‐of‐Life Collaborative Project, under the leadership of Bert
Enns, continues its important work to define needs and make recommendations for future growth and
development in this area. Both teams continue to benefit from sharing of information and ideas as we
take this work forward.
The Collaborative Project was recently profiled in the LEAP Magazine, Winter 2014 titled "Bridging the
Gap: Integrating a palliative care approach within cancer care". Several of our section members are
involved in this important project including on the Management Committee (Dr Aynharan Sinnarajah),
and Advisory Committee (Dr Jessica Simon, Dr Srini Chary and Dr Lyle Galloway. With permission from
the LEAP magazine, snippets from that article are shown in the Special Populations section.
The palliative home care is in the midst of a quality assurance project underway looking at the impact of
the after‐hours team in regards to client support and decreasing distress and emergency visits.
The palliative consult teams, palliative home care and hospices are involved in a Palliative and End of
Life Care quality improvement project "Hospice Information Transfer Project" to ensure that the
program is optimizing transitions for our patients and families who are transitioning from the various
inpatient and community sites to the various hospices in Calgary. This started officially in early 2015 and
will be ongoing through the year.
The provincial 24/7 Palliative On‐Call initiative was successfully rolled out in Calgary as of April 1 2015,
where community physicians can now more easily access the palliative physician on call service for
PALLIATIVECARE
92
urgent phone consultation. We partnered with the RAAPID service (Referral, Access, Advice, Placement,
Information & Destination) to improve this access.
Calgary has had an EMS protocol to allow palliative patients at the end of life to access medications on
an urgent basis without needing to go into hospital for a few years. With the province implementing
this protocol this year, Calgary will be looking to expand this to include the rural areas of the Calgary
zone, as well as palliative patients who aren’t already in palliative home care. This should lead to
improved patient care by allowing them to stay in the community longer.
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COMMUNITYPRIMARYCARE
105
• Provincial Gastroenterology (Pediatric) Referral Guidelines provide care for children between
birth and 18 years of age with intestinal, liver and complex nutritional disorders. The pediatric
gastroenterologists work collaboratively with other disciplines (e.g. Pediatrics, Nutrition
Services, Feeding and Swallowing Services, Provincial Pediatric Weight Management Program)
to provide the most appropriate disease management.
• Pulmonary Central Access & Triage provides services for adults with acute and chronic lung
diseases.
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COMMUNITYPRIMARYCARE
107
CHALLENGESRecognizing the diverse nature of primary care in the Calgary Zone, work force planning continues to be
a challenge. Specifically, it is important to understand the various ways that patients seek and receive
medical care. With this in mind, we are trying to understand how many patients are truly "unattached"
and the factors that come in to play that lead patients to not "attach" to a Medical Home.
Continuing to look at Medical Home model, a lot of work is being done in the area of Panel Identification
in Family Practices. Challenges continue in providing patients with 24/7 care within the medical home.
However, various strategies have been developed to look at supporting this care: there is ongoing
collaboration with Health Link and a pilot project with Foothills Hospital Emergency Department and
Calgary Foothills PCN to ensure that patients with primary care concerns may have these addressed
within the Medical Home.
Specialty linkages and long wait times for patients to be seen by specialists also continues to be a
challenge in the Calgary Zone. With this in mind, Primary Care and Specialist groups are collaborating to
look at innovative ways to meet some of these needs. One example of this is the development of
Specialist Link: a telephone consultation service with gastroenterology with the goal of expanding to
other areas of specialty care.
FUTUREDIRECTIONSCommunity Primary Care continues to look at ways of trying to improving communication, particularly
during transitions in and out of the Medical Home. It is recognized that this communication is key to
patients receiving quality, timely and safe patient care.
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ACADEMICFAMILYMEDICINE
110
UNDERGRADUATEMEDICALEDUCATIONFamily physicians continue to contribute substantively at all levels of governance and curriculum
delivery in the University of Calgary medical school.
Dr. Maureen Topps, Associate Dean Post‐Graduate Medical Education; Dr. Doug Myhre,
Associate Dean for Distributed Learning and Rural Initiatives; Dr. David Keegan, Department of
Family Medicine Undergraduate Director; Dr. Martina Kelly, Department of Family Medicine
Clerkship Director and Dr. Johan Bester, Department of Family Medicine, Assistant Clerkship
Director.
Introduction to Clerkship, Family Medicine Clinical Experience, Physical Examination Course and
Evidence Based Medicine Course
MDCN 330, 430 and 440 teaching in UCMC clinics, and urban and rural community clinics
Family Medicine and Rural Medicine Interest Group support
The Master Teacher Program continues to be led by family physician Dr. Heather Baxter and 12
of the 30 contracted physicians with the medical school are family physicians. Teaching and
leadership in all systems‐based pre‐clerkship courses are provided by Master Teachers.
In total, more than 200 community‐based and academic physicians provide teaching in the UME
curriculum.
Many preceptors teach in courses such as Global Health and Population Health (in topics such as
Aboriginal Health, Addiction & Homelessness, Immigrant & Refugee Health, and the Elderly
population) and work with students in the Undergraduate Global Health Stream. Often family
medicine UME preceptors are active in mentoring and contributing to medical student initiatives
such as the Student Run Clinic (with sites at Inn from the Cold, the Alex and the Mosaic Refugee
Health Clinic) and Women’s Health Interest Group.
The percentage of medical students at the University of Calgary choosing Family Medicine as
their career has increased steadily since the all‐time low in 2008. The 2014 CaRMS match
results indicate that we have now surpassed Canada’s national average.
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ACADEMICFAMILYMEDICINE
114
NEWFORTHEUPCOMINGYEARDOPsVariation
This year we are re‐introducing a modified version of the Direct Observation of Procedural Skills (DOPs)
Program. New for this year, students will be asked to have two procedural skills (examples include
inhaler technique and glucometer) signed off by a non‐physician member of the healthcare team. In
addition, groups of students will develop and test their own procedural skills checklists prepared before
going into clinics to enhance self‐directed learning skills. They will pick a skill, develop an evidence‐based
procedure, create an assessment form and field test the form before reporting back to the larger group
following their clinical placement.
PatientCenteredHomeTeaching
Midway during clerkship, students return to the medical school for a full‐day of teaching. New for this
year, we are introducing a more discursive session on the Patient Centered Medical Home (PCMH).
Dr. Charles Leduc and other speakers will address students on issues vital to thriving communities:
access, economics and patient‐centeredness.
CHALLENGES Physical space for students and clerks to see patients independently of other learners in family
medicine clinics
MDCN 330 and 430 provide excellent learning opportunities for UME learners in our family medicine
clinics. University policies mean that preceptors must have faculty appointments in order to teach
medical students, and many of our community faculty fall outside of this boundary. Each spring and
fall coordinators and administrators scramble to find the approximately 164 clinical placements for
our students. This remains a challenge.
Recruitment of experienced academic physicians with undergraduate focus and experience
Large medical school classes, combined with a university mandate to increase the number of family
physicians from our university translate into increased numbers of family physician administrators
required at the medical school. Recruiting family physicians to help assess clerkship projects is an
ongoing issue.
Competing demands on academic physician time including the necessity of scholarly output for
academic physicians in administrator roles
Physicians with small amounts of time dedicated to research continue to struggle to meet
production targets in this area.
Providing family medicine clinical research learning opportunities to University of Calgary medical
students
ACADEMICFAMILYMEDICINE
115
Many students enter medical school with the intention of learning how to perform research in our
specialty as part of the undergraduate learning. To date, very few of these requests have been
accommodated. The new research development stream in MDCN 440 is intended to begin to
address the shortfall.
Attracting students to our specialty
The 2009 Task Force in Family Medicine targeted 50% of the graduating medical school class going
into Family Medicine by 2013. Despite our concerted effort to increase numbers entering our field,
work remains to be done.
FUTUREDIRECTIONSThe University of Calgary Medical School accreditation is scheduled to take place in 2016 with a mock
accreditation scheduled for September 2015. Much administrative energy will be focused on preparing
for these activities.
Ongoing initiatives including MedZero, MDCN 440 Family Medicine Research Development Program, the
Morning Star Program and community engagement activities are part of our future.
QUALITYASSURANCE,QUALITYIMPROVEMENT&INNOVATIONFeedback from our students and clerks, and new evidence from the literature continue to be the
cornerstones of our continuous quality improvement activities. Four specific items highlighted here
include:
1) MedZero programming evolution to reflect the changing practice of family medicine in Southern
Alberta
2) MDCN 440 Family Medicine Research Development Program to reflect the University’s ‘Eyes
High’ research initiative
3) Morning Star Program highlights the movement of patients, particularly members of vulnerable
populations, to center stage. This cultural shift, while in the infant stage, promises to increase
community engagement.
4) Site visits and regular personal communication with our widely dispersed preceptors holds
promise for us to be able to update regularly, resolve emergent issues early, and increase the
quality of our relationships with those who teach for us.
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POSTGRADUATEMEDICALEDUCATIONBACKGROUNDIt has been an eventful year for the Postgraduate Program in Family Medicine. The Program graduated
its first group of Triple C‐ Competency‐based residents and underwent a program‐wide accreditation
conducted by the College of Family Physicians of Canada (CFPC). The Program continues to address
challenges related to recent growth while enhancing its program offerings to ensure it continues to
graduate highly skilled Family Physicians.
There were a few leadership transitions during 2014‐2015. During 2013‐2014, Dr. Lara Nixon took on
the role of acting Postgraduate Director while Dr. Keith Wycliffe‐Jones was on sabbatical. Upon Dr.
Wycliffe‐Jones’ return to this role, Dr. Nixon assumed the role of Enhanced Skills Program Director as of
September 2014. Since then, she has taken a leading role in redeveloping the Enhanced Skills Program
to better meet the needs of both residents and ultimately of the patients they will care for upon
completion of their enhanced skills training. Dr. Wycliffe‐Jones, who became Family Medicine Program
Director in 2009 and then Post‐Graduate Director in Family Medicine in 2011, will be stepping down
from his role as of July 2015. The Department is currently seeking someone to take over this position.
The Postgraduate Program is comprised of three Programs: Urban, Rural, and Enhanced Skills.
Joining us in the Urban Program Curriculum “Domain Lead” roles are:
Dr. Lisa Coffey Care of the Adult Dr. Leah Genge Vulnerable and Underserved Populations (VUPS) Dr. Diana Grainger Care of the Child Dr. Turin Chowdhury Research, Scholarship, QI and Patient Safety
In our Rural Program over the last year Dr. Rick Buck, Lethbridge Site Director, has been sharing the role
of acting Rural Program Director with Dr. Bobbi‐Jo Whitfield, Medicine Hat Site Director. As of April 1st
2015 Dr. Buck has taken on the position of Rural Program Director on a permanent basis and will be
stepping down from his role as Lethbridge Site Director in May 2015.
Dr. Buck is a graduate of the first cohort of residents in the Rural Residency Program, bringing excellent
experience and commitment to the Rural Program. Recruitment is underway to fill the soon to be vacant
Lethbridge Site Director position while Dr. Bobbi‐Jo Whitfield continues in her role as Site Director for
Medicine Hat.
In the Enhanced Skills (ES) Program, new additions to the team include:
Dr. Heather Baxter Maternal and Newborn Care Program Director
Dr. Victor Lun Sport and Exercise Program Director (Interim)
Dr. Margriet Greidanus & CCFP‐EM Program Director (co‐directors)
Dr. Todd Peterson
ACADEMICFAMILYMEDICINE
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URBANRESIDENCYPROGRAMThe Urban Residency Program is managed in three geographic Divisions: Northeast, Northwest and
South. Each Division is led by a Division Director and each has the support of a Division Program
Coordinator. For the first time since the introduction of the new curriculum in the Urban Program in
2012, the program has a full complement of program leaders.
This year the Urban Program participated in two iterations of CaRMS. Across Canada over 100 Family
Medicine positions were unfilled requiring the majority of the programs to offer a second iteration.
During the first iteration the Department of Family Medicine had successfully filled all but five of its
Canadian Medical Graduate (CMG) positions. The second iteration went well and the program is
looking forward to welcoming its incoming residents for 2015‐2016. As of March 31, 2015 the number
of residents in the 2 year program totaled 157.
The recent accreditation visit was a great opportunity to show off the many strengths and innovations
implemented by the Program in the move to the Triple‐C Curriculum. Specific highlights of these
strengths included:
A very open program with outstanding preceptor‐resident interactions which are collegial and
supportive
Nation‐leading implementation of the Triple‐C Curriculum
An “amazing” new assessment program
Strong leadership across all positions
An enviable program evaluation model and
An excellent service‐to‐learning ratio.
The Accreditation team identified some areas for continued focused attention as we launch into a
formal curricular review this fall, including:
Streamlining some of the Ambulatory Clinical Experiences (ACEs) to enhance learning and cut
down on travel
Ensuring access to video observation and call rooms to enhance learning opportunities
Broadened demographic exposure and learner opportunities at some of our Home Clinics
The Urban Program continues to enhance its offerings while constantly evaluating, reviewing and
improving existing elements of the curriculum. In 2014‐2015, the program welcomed its first Integrated
MSc Family Medicine resident into the program. This individual will complete the program attaining a
specialty in Family Medicine in addition to a Master’s degree in Education.
Recognizing the specific health care needs of Vulnerable and Underserved Populations (VUPS) in Alberta
and the requirements around teaching in this domain, the program also successfully filled the position
of a VUPS Curriculum Domain Lead and continues to work on developing additional learning experiences
for residents in this domain.
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RURALRESIDENCYPROGRAMThe Rural Stream of the Family Medicine program in Calgary has some exciting times coming up in the
near future!
Accreditation has come and gone. The Rural Program is excited that the draft report from the CFPC
accreditation team identified many strengths in the Rural Program including the strong leadership team,
excellent supportive administrative staff, and acknowledgement of the important role that the training
program has in accomplishing its social mandate of preparing rural family physicians for practice in
Southern Alberta.
There are challenges in the next two years. With the Rural Program trying to transition to a curriculum
that is “Triple‐C” and competency‐based, the program will be looking at changes in areas of
assessment in addition to developing a more formalized competency based curriculum.
Great attendance was had this year at the faculty development focused event “Cabin Fever”. The initial
reports reflect that the rural preceptors appreciated the opportunity for faculty development. In
conjunction with the Department of Distributed Learning & Rural Initiatives (DLRI), the Rural Program
will be looking at bringing the faculty development to the teachers at or closer to their home base in the
near future.
The Rural Program is managed in two geographic sites: Medicine Hat and Lethbridge. Each site is led by
a Site Director and each has the support of a Site Coordinator. Dr. Bobbi‐Jo Whitfield is the Site Director
for Medicine Hat and Dr. Rick Buck is the current Site Director for Lethbridge. He will be stepping down
from this position in May 2015. A search is underway to replace him in this role.
ENHANCEDSKILLSPROGRAMThe 2014‐15 academic year has been a busy one with Dr. Lara Nixon stepping in as the new Enhanced
Skills (ES) Director on September 1st, 2014 and everyone pulling together for the CFPC Accreditation
survey team visit in February 2015. The surveyors were impressed by the leadership, curriculum and
strong social mandate of many of the Enhanced Skills programs.
A new Enhanced Skills resident orientation was launched in July 2014 to welcome all ES residents and
to help prepare them for the busy year ahead. Significant policy and procedure work has occurred
this year to provide clarity for ES residents, Program Directors and administrative staff in key areas.
ACADEMICFAMILYMEDICINE
119
The Residency Program offers nine Enhanced Skills (or “R3”)
Programs:
Category 1
1. Care of the Elderly 2. CCFP‐Emergency Medicine 3. FP‐Anaesthesia 4. Palliative Medicine (conjointly accredited by the CFPC &
RCPSC) 5. Clinician Scholar Program
Category 2
1. Addiction Medicine 2. Global Health 3. Maternal and Newborn Care 4. Sport and Exercise Medicine
The conjoint oversight of the Palliative Medicine Program will
continue until July 2016. Active discussions are underway to
determine the future of this program, in hopes that a one year
Enhanced Skills Palliative Medicine Program can continue to be
offered to Family Medicine graduates, given the ongoing high
demand for Palliative Care expertise in Alberta’s communities.
The Enhanced Skills Programs continue to grow in resident
numbers. In 2013‐2014, there were eleven Category 1 and seven
Category 2 R3 residents. These numbers will increase to
fourteen R3s in Category 1 Programs and seven in Category 2 in
2014‐2015.
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ACADEMICFAMILYMEDICINE
123
Resident Involvement in Special Populations The Postgraduate Program is committed to training Family Physicians in providing care to vulnerable and
underserved populations (VUPs) in Alberta. It is currently in the process of formalizing core
competencies for this domain, in addition to creating academic and clinical teaching opportunities for all
residents.
Currently, residents learn about the needs of unique patient populations largely through their
Behavioural Medicine & Mental Health core rotation which includes clinical opportunities in addiction
medicine (Renfrew Detox, 1835 Recovery House, Aventa Treatment Program, Opioid Dependency
Program, Methadone Program at CUPS), Aboriginal Health (Adult Aboriginal Mental Health Services),
low‐income and homeless populations (CUPS Shared Care Mental Health), and patients living with FASD
(John Howard Society and Med Gene).
As the VUPs competencies and curriculum are further developed, the goal is to increase clinical
exposure in this domain to all residents. The program is exploring core learning opportunities to expand
exposure in Aboriginal health, low‐income & homeless populations and addiction medicine in addition
to creating new experiences in refugee & immigrant health, prison medicine, LGBTQ health, and
disability medicine.
In addition, residents have elective opportunities in the following areas:
Aboriginal Health (Elbow River Healing Lodge, Siksika First Nation, Aboriginal Health Services)
Addiction Medicine (Opioid Dependency Program, CUPS Methadone Program, Aventa,
Claresholm Centre for Mental Health & Addictions, Addiction Services at FMC/RGH/PLC,
Renfrew Detox Centre, Medigene Services)
Low‐income and Homeless Populations (CUPS Medical Clinic ‐ which includes outreach clinics at
the Mustard Seed, Alpha House, and the Calgary Drop‐In Centre; The Alex; Pathways to Housing;
The Alex Seniors Clinic, East Calgary Family Care Clinic)
Immigrant and Refugee Health (Mosaic Refugee Health Clinic, NE Calgary Women’s Clinic, East Calgary Family Care Clinic)
Finally, the Department of Family Medicine offers R3 Enhanced Skills programs in Global Health (which
encompasses domestic and international health) and Addiction Medicine. These programs enable
residents to gain specialized knowledge in order to enhance their competency in providing care for
these populations (e.g. rotations at specialized clinics such as TB services, Viral Hepatitis, Southern
Alberta HIV clinic, Odyssey Travel and Tropical Medicine Clinic, rotations in Northern Canada and Low
Risk Obstetrics in under‐resourced communities). A recent survey of R3 graduates from the Global
Health Program showed that all graduates now work clinically with marginalized populations in one
form or another and actively act as mentors for learners interested in work in this area. The majority
indicated that the skills earned in their training are fundamental to allowing them to now work with
these patient populations.
ACADEMICFAMILYMEDICINE
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CHALLENGESThe CFPC accreditation survey highlighted a number of challenges, most of which are already known to
the programs, including:
The need for a more formal program of evaluation in the Rural Program
The lack of competency‐based outcomes and assessment processes in the Rural Program
Sub‐optimal ambulatory clinical experiences in the Urban Program
The lack of functioning video observation equipment in the teaching clinics
Low patient volumes and restricted demographics in some of the academic teaching clinics in
Calgary
Insufficient full time academic physicians (FTA’s) and
Administrative, curriculum and organizational issues mostly affecting the Category 2 Enhanced
Skills programs
In addition, rapid growth has posed a challenge for the Program. The Urban Residency Program has
maintained its expanded resident numbers for the third year in succession. While expansion has
certainly contributed to the graduation of more family physicians for Alberta it has caused considerable
strain on the Urban Program in the following areas:
Capacity for quality learning experiences
Preceptor‐resident ratios
Capacity for remediation of residents
Reduction of potential transfers from other programs
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ACADEMICFAMILYMEDICINE
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FUTUREDIRECTIONS&INITIATIVESIn addition to the ongoing program evaluation and quality improvement work in each of the programs,
the following specific initiatives are either underway or about to commence:
Rural Program curriculum review with planned implementation of changes in July 2016
Review and implementation of competency‐based assessment in the Rural Program 2015‐2016
Definition and development of Global Health Enhanced Skills curriculum
Development of structured Maternity & Newborn Care Enhanced Skills Curriculum
Major curriculum review of the Urban Residency Program in Fall 2015
Continuing delivery of “Home Room Series” faculty development workshops for Urban Program
Family Medicine Clinics
Delivery of other specific faculty development events around teaching and assessment of FM
residents similar to the evening workshop delivered to over 50 low‐risk FM Maternity Care
Physicians on assessment of the FM resident, in March 2015
The development of better outcome measures as an additional element of program evaluation
Ongoing exploration and consultation with other stakeholders in Calgary around access to
educationally appropriate learning experiences for FM residents.
ACADEMICFAMILYMEDICINE
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RESEARCHNEWFACULTYANDSTAFFOn July 1, 2014, the Department welcomed Dr. Turin Chowdhury as the new Scholarship Director. Dr.
Chowdhury joined the Department of Family Medicine, coming from the Department of Community
Health Sciences at the University of Calgary. He is a health services researcher with a medical degree,
Ph.D. training in chronic disease epidemiology, and four years of postdoctoral research experience. Dr.
Chowdhury replaced Dr. Maeve O’Beirne who began a one‐year sabbatical on July 1, 2014.
We welcomed Tasnima Abedin, PhD candidate, to the Department in November 2014 in the role of
biostatistician.
The Department filled the Scientific Advisor role with a new staff member, Gary Barron, PhD candidate.
Gary began his new role in January, 2015 with the intent he would help faculty members in the areas of
grant preparation, research methodology refinement, data collection, manuscript preparation, editing,
and journal submission.
RESEARCHTOOLSSECUREDFORTHEDEPARTMENT Fluid Surveys, an online surveying platform, was made available to the Department’s faculty and
residents conducting survey data collection
A separate Skype account was set up for scholarship meetings and to facilitate collaboration
with researchers off‐site
Improvements were made to the Academic Department’s website with the research aspect of
the website expanded considerably. The content that was added included additional resources
for faculty, upcoming conferences and events, funding opportunities, updated faculty and staff
profiles and photos, and links to abstracts and photos from past Research Days
A Family Medicine Twitter account, @UCalgaryFamMed was created at the end of April 2015 in
an effort to connect with our community, stakeholders, and physicians.
Whiteboards with valuable information were installed in the Research Hub area at the Health
Sciences Centre at Foothills Campus. Notices are posted about upcoming events, funding
opportunities with deadlines and QR codes, and other valuable information. This information
can also be found in the Department newsletters and on the website, but this whiteboard is up‐
to‐the‐minute current
Faculty publications and presentations are now more easily referenced because the existing
archive of faculty publications has been funneled into a central database that will make it much
easier to cross reference and report accurately for our annual reports
A Research Approval Pathways document was created in collaboration with the Scholarship
Committee, and will serve to guide residents, community practitioners, and faculty through the
route of Departmental approval for quality improvement and research activities prior to ethics
submission
ACADEMICFAMILYMEDICINE
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RESEARCHRESOURCESSECUREDFORTHEDEPARTMENTFamily Medicine faculty located in the Health Sciences Centre now benefit from an analyst on site
beginning November 2014. The analyst is skilled at extracting data from our billing records and can
make physicians’ own clinical data available when considering 59 accessible variables.
RESIDENTSCHOLARSHIPReviewofExistingMaterialsIn 2014/15, the Scholarship Director and hub staff reviewed and refined processes related to scholarship
for faculty and residents. Key updated documents include:
a) Resident Quick Guide to Scholarly Work
b) Resident Handbook for Scholarly Work
c) Elective Research Request Requirements
d) Process for Handling Resident Research Elective Requests
e) FAQ’s for Residents Undertaking QI and Research Projects
ResearchDay2015Research Day was held March 19, 2015 with a fantastic turnout of residents and faculty, as well as high
quality and thought‐provoking presentations by Dr. Todd Anderson from the Libin Cardiovascular
Institute and Dr. Jim Dickinson, our faculty presenter from the Department of Family Medicine. We had
very positive reviews in the event evaluation and posted the resident abstracts and photos from the
event on the Department website.
EVENTSTOENGAGEPOTENTIALRESEARCHERSWe were active in participating in events to meet and engage faculty and community physicians
interested in research. Through a number of events including Family Medicine Showcase, Fall Together,
and the R3 enhanced skills wine and cheese, we extended our reach a little bit more and are looking
forward to developing some research ideas that have been brought to us.
The Primary Care Research Group (PCRG) is being re‐invigorated under the umbrella of the Institute of
Public Health. The PCRG got its start several years ago under a previous Scholarship Director. Beginning
in 2014/15, the Department will dedicate time and resources to make it relevant once again. It is
anticipated that our commitment will be to provide speakers for the IPH speaker series, and we will
focus our efforts on showcasing the Patient Centered Medical Home as well as supporting the primary
care elements of the Calgary Inner City Research Group.
MEASUREMENTWhile QI and evaluation continues to take place in the Academic Department, outside of our University
of Calgary we are represented at several tables. Maeve O'Beirne, Allison Mirotchnik, Chris Diamant,
Lucie Vlach, and Agnes Dallison represent the department at the Calgary Zone level on several
committees of the Calgary Zone Primary Care Network Action Plan Initiative. These include sub‐
committees focused on EMR and IT needs, Medical Home, and the Evaluation Working Group.
ACADEMICFAMILYMEDICINE
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In addition to the Calgary Zone level, we are represented provincially by Agnes Dallison at the
Measurement and Evaluation Implementation Working Group (MEIWG) that is led by Lee Green, Chair
of the Department of Family Medicine at the University of Alberta. This group is comprised of
representatives from University of Calgary, University of Alberta, Alberta Health, the Alberta Medical
Association, Health Quality Council of Alberta, and AHS. The intent of the MEIWG is to guide the
implementation of primary care measures in the province. The Academic Department has an
opportunity here to interface with the policy makers and to influence the direction of primary care
measures in our own clinics and community. Towards the end of the 2014/15 academic year, work
continues on refining the metrics for physicians and clinics in the measurement of primary care
outcomes and service delivery. Ongoing consultations with PCN Executive Directors and physicians
throughout the province have resulted in defining and operationalizing the measures. Currently toolkits
to support the measurement work are being designed.
Agnes Dallison also represents the Department at the Measurement Capacity Initiative: The Next
Generation (MCI), where we have been accepted into three streams of measurement. Through this
work, the Academic Department is committed to contributing significantly to the provincial work being
done collaboratively with PCNs, AHS, and community groups around primary care measurement.
Ultimately, these initiatives will lead to meaningful primary care measures that are a cornerstone of the
Patient Centered Medical Home.
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CENTRALFAMILYMEDICINETEACHINGCLINICThe Central Family Medicine Teaching Centre (CFMTC) had a focus for 2014‐2015 to “lay the
foundational blocks at the site level to prepare for advancing the Academic Patient‐Centered Medical
Home”. Key areas of focus for this fiscal period revolved around three main components:
Reaching a baseline level of enhanced clinical resources to meet the needs of our patients and
families healthcare needs
Early review and initiation of Panel Management awareness and strategies to address the
need to boost utilization of clinical services
Facility enhancements and supply management improvements to provide a safer, more
efficient practice environment
Though the clinic faced several challenges within the 2014‐2015 fiscal year, all three of these key targets
achieved high levels of outcome success, in addition to several other foundation building targets being
accomplished as well.
The staffing model was re‐designed to boost much needed clinically focused staffing capacity and
capability and streamlined our clerical resources; allowing for enhanced direct service delivery during
clinic visits and stakeholder satisfaction levels. Transition to a 2 LPN: 1 MOA per microsystem staffing
model and redesign of routine clinical and clerical duties has allowed for an estimated 60% increase in
clinical focused capacity without any impact to our routine clerical services.
Panel Management understanding and efforts towards improvement lead to the “re‐attachment”,
“clean‐up”, and increased intake of new patients within our community. With continued physician
workforce modifications, 3 exiting physician panels required having their panels “re‐attached” with our
clinic providers, which totaled a transition of almost 700 patients. Recent efforts near the end of the
fiscal year saw the “clean‐up” of more than 900 patients within one panel, which has allowed for a more
accurate understanding of this physicians demand/capacity. As for new patient volumes to the clinic,
we saw an increase of approximately 3200 new patients compared to same time from the previous fiscal
(10500 in 2013‐14 versus 13720 in 2014‐15); a new patient growth of 30%.
In addition a Department level renovation to our site lead to several clinic focused environment
improvements, including the move and modification of the clinic reception area, new administration
spaces for site based clinic support team members, and significantly improved waiting space for our
patients and families that raised the bar both in function and aesthetics. Lastly, a vast review of many
supply chain processes and practices was conducted, from clerical focused supplies, to surgical
instruments and medications. These thoughtful and systematic quality improvement projects to date
have lead to greatly enhanced product management practices, user friendly spaces and tools, enhanced
user satisfaction, and recognizable cost savings.
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ACADEMICFAMILYMEDICINE
132
LPN to fill the previous scope of the LPN Float role (supporting QI initiatives, clinic staff resource,
education, etc.).
In addition a Primary Care Nurse (RN) was hired December 2014 as a key member of the Clinical
Leadership Support Team; a new recognized group within the clinic consisting of the Clinic Manager, Site
Medical Lead, Primary Care Nurse, lead LPN, and Head Receptionist. The RN role has provides leadership
support to the clinical team including the shared responsibility of overall day‐to‐day operations of the
clinical area. Other key components for the role include design, development, implementation and
evaluation of clinical education needs, as well as management/facilitation of various site level QI
projects designed to advance the Patient Centered Medical Home initiative. The RN works closely with
the clinical staff, physicians, Allied Health team members, and site leadership to ensure proper clinical
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ACADEMICFAMILYMEDICINE
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The Procedure Rooms “Makeover” incorporating:
All room storage elements reorganized, labelled and standardized, including min‐max
stocking level identification
Systematic review of current surgical supplies leading to removal of unused tools,
boosted supply levels where required, and improved labeling practices for each widget
stocked
Modifications to standardize stocked suture supplies
Introduction of Gyne Carts to each microsystem
Review of routine gyne procedure focused supply needs, all to be housed in portable carts
for use in any appropriate patient space
Continuation of same standardized labelling practices within the clinic, including min‐max
stocking level identification
1 cart per microsystem (total of 4)
Module Carts Renovations
All Module Carts were re‐organized, labelled & standardized, including min‐max stocking
level identification
Pertussis Kit Expansion – increased to 2 kits within the clinic
Medication Room Organization Project
all room storage elements reorganized, labelled and standardized, including min‐max stocking level identification
reduction and update of current / relevant poster materials
boosted supply of nourishment products for patient needs clinically
Clean Utility Room Fall Cleaning Project
Review and re‐organization of all stocked “clean” supplies for the clinic
Enhanced relationships and service agreements with both vendor groups and AHS supply management group
Streamlined ordering practices
Collection of baseline expired product levels, and collection receptacles for future evaluation of expired product waste within the entire clinic (medications, supplies, etc.)
Overall, these efforts taken have led to significant quality improvement outcomes, from improved safety
and access by ensuring products are not expired, in the room when needed, well labeled products for
reduced supply use error, and providers have the “right tool for the job”. Efficiency increases, with less
walking time to get missing products, or scrambling to find what you are seeking. As well as enhanced
cost effectiveness, in streamlining provider time, resources for stocking, and wasted products. Though
our hope is to have more future resources for evaluation measurement to show data focused outcome
measures, some early quality assurance efforts are hoping to indicate significant cost savings for next
fiscal.
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ACADEMICFAMILYMEDICINE
137
Transitioning of policy and guidelines that align with AHS, especially those related to clinical
practices
Resource support to address large volume of QI projects and initiatives, and it can be difficult to
support this improvement work “off the side of the desk” when many roles are dedicated to
routine clinical services. Despite this gap, creative resourcing (scope expansion of various roles,
staffing based on visit demand, etc.) have allowed for reaching many successful QI outcomes as
previously mentioned (especially since reaching baseline staffing levels)
Clinical space limitations – with the growth of staffing levels, and expansions of Allied Health
services creative solutions have been implemented to maximize room utilization. But any
further growth will certainly be limited by our physical space in the near future
QUALITYASSURANCE,QUALITYIMPROVEMENT&INNOVATIONThough formally the sites Clinic Improvement Team (CIT) will be launched May 19, 2015, all pre‐work to
determine the site level starting point for a Quality Management Framework (QMF) went into full stride
in Q4. In tandem with progress at the department level to determine the starting direction for the
advancement of the Patient Centered Medical Home, the Site has been confirmed to pilot the AHS
Improvement Way (AIW) as “an approach to informed problem solving” and the primary framework to
work through many of the QI initiatives into the next fiscal. Early efforts to glean out key performance
indicators relevant to the site level for enhanced operational service and outcome monitoring has
begun, and foundations are being laid, both structurally and culturally within the site for the up and
coming events planned for the next fiscal. In general the site is excited to not only have a clear vision for
the future of an Advanced Academic Patient‐Centered Medical Home, but also the early bricks being laid
for how we will approach this vast and promising model of care.
FUTUREDIRECTIONSBoostedHealthManagementProgramIn collaboration with the two other sites we hope to work together to:
Development of standing orders (standard care plans) for the health management nurses to
adjust treatment within specific parameters, allowing them to practice to their full scope
Reach new levels of Interdisciplinary care by building stronger workflows and collaboration of
allied services, though predominantly provided by external parties (multiple PCN groups, outside
AHS service groups, etc.) finding new ways to connect the allied services directly to the clinical
providers and staff more routinely thus reducing “transition of care points”, more real time
information transfer
Potential launch of a Patient Care Coordinator role
More data driven decision making and collaboration with our partners in care, such as the PCN’s
and other provider groups within the community
ACADEMICFAMILYMEDICINE
138
PanelManagement Completion of the site level panel identification efforts including all individual provider panels
being “cleaned” to ensure all patients identified in our systems see themselves being patients
within our clinics medical home, as well as each patient “Profile Tab” being up to date. We will
also launch a robust strategy to maintain regular panel cleaning activities so as to not slip back
to our previous pre‐cleaning baseline state
Initiation of elements of ASaP, for enhanced screening practices
Clearly identify and implement a site level approach to panel size determination and
management process to ensure we are routinely ensuring we are optimizing our clinical
resources and significantly improving our “supply / demand mismatch”
FormalInitiationofaSiteLevelQMF Launch of CFMTC – CIT on May 19, 2015
Commence next level of AIW training with CIT members as a start (Core Training Level), to
include belting
Set foundational elements for CIT operations including Terms of Reference, implementation of
an “Opportunity Intake, Tracking, and Prioritization” system
Build stakeholder relationships, and workflows for effective QI projects, and
evaluation/sustainment strategies
Further define linkages to other system levels within the broader QMF both at a more
microsystem level as well as Departmental / Organizational levels
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ACADEMICFAMILYMEDICINE
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providers, with the emphasis on targeting patients that do not present for screening. In order to
implement the ASaP initiative effectively, we needed to know who our patients were and how screening
was being offered to them already and what our current use of the EMR was.
The first step our clinic needed to take was to identify and assess our current processes surrounding
patient panels, how our clinic panels were managed and what roles our team members played in this
process. Throughout this past year, we have worked to identify our current processes around panel
management, areas of inconsistencies, ways to standardized electronic medical record (EMR) use to
assist with panel identification and we have worked to identify what team members are involved in the
day to day management of our clinic panels. Team members including management, RN’s and clerks
have participated in formal courses on Panel Management offered by Towards Optimized Practice (TOP)
and have in turn shared with colleagues the knowledge gained to help facilitate this process.
We worked on, and continue to refine our processes, through both formal and informal meetings, and
discussions as part of our commitment to continuous quality improvement. We have and continue to
work on ensuring that our patients have and are aware of who their primary care physicians and
secondary care physicians (residents) are. Patient demographics are continuously updated to ensure
they are accurate. We strive to ensure that we are providing optimal continuity of care ensuring that
patients are booked with their primary and /or secondary care providers (residents) whenever possible,
employing our clinic booking process to guide us. We have worked to ensure our documentation in the
EMR is entered in a standardized way and that patient status is defined and utilized to differentiate our
Active patients in the EMR from those who are no longer attending the clinic. We have also developed
and are refining a process by which we will have ongoing, routine panel reviews to ensure accuracy and
continuously updated panel lists for each physician in our clinic. Our process includes the participation
of most of our multidisciplinary team here at the SHC, including management, our physicians, residents,
nurses, both RN’s and LPN’s, clerks and reception clerks and our patients.
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ve allowed u
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ACADEMICFAMILYMEDICINE
144
The creation of a new document in the Profile page of the EMR that summarizes, at a glance,
what screening has been done
Participation has allowed us to operationalize the Goals tab in the EMR. The goals tab provides
staff and clinicians with a summary of screening pertinent to any given patient. At a glance we
can see what screening is up to date and what screening is outdated or required.
Overall increased familiarity of the Med Access EMR and functions such as Clinical Decision
Support (CDS) triggers that can assist us in providing better care to our patients.
Increased efforts to outreach to patients that are overdue for screening and increased offers of
screening to patient’s opportunistically.
Enhanced teamwork, the prescreening completed by nursing staff prior to the patient visit has
enhanced patient care and decreased the amount of time physicians spend online searching for
patient labs and diagnostic test results pertinent to screening. This is gathered and attached to
patient charts prior to visits and provides clinicians with a more complete picture of their
patient’s health histories and screening thereby enhancing use of the appointment time spent
with the patient.
Increased awareness, education and dialogue with our patient’s about the importance of
screening and early detection as well as the importance of continuity of care, patient’s getting to
know their physicians and physicians knowing their patients more thoroughly.
Moving forward:
We continue to face some EMR challenges in working with goals and we continue to evaluate
the ASaP Questionnaire created in the Profile tab to ensure that it is functional and that it is
meeting the needs of the physicians. With the assistance of Chris Diamant, Carol Hort, and Med
Access, we continue to make changes and evolve as required and where we identify limitations
of the EMR we work to resolve the limitations if possible or develop workflow processes that
best support our screening efforts.
We continue to educate staff and clinicians on EMR usage, including standardizing where and
how we enter screening data, and the importance and benefits of an accurate Goals tab.
We are beginning to move our focus in the direction of Panel Management so we can better
identify patient’s that do not self‐present for PHE’s. We will be offering them opportunities to
come in for screening. We are also trying to identify what the barriers to preventive care/ health
screening are for these patients. We would also like to ensure that our panel sizes accurately
reflect the patients who are active in our clinic.
We also plan to begin moving in the direction of opportunistic screening of patients to capture
patients that frequently visit the clinic for other concerns, but are outdated in their screening.
We are also planning to ensure continued engagement of our staff and clinicians. By continuing
to emphasize the importance of screening and early detection and intervention, as well as,
prevention using continuing education initiatives such as an ASaP improvement board, and
ongoing lunch and learn sessions that will involve our learners and residents.
ACADEMICFAMILYMEDICINE
145
Accu‐MedTeamThe past year has been one where we have been developing a collaborative care model. In the
development and implementation of the model we applied the concept of collaborative practice literally
and made the program truly multi‐disciplinary and inter‐disciplinary. Within the collaborative care
model we went one step further and involved the family of the patient as well. The patient in all
encounters must be treated as the head of the collaborative care team involved when providing care.
The healthcare professionals involved in providing care can only provide the care if the patient is seen
as, and treated as the central part of the team. In developing the relationship with the patient we also
develop a relationship with the family. Family is defined as any significant person who is involved in
providing care to the patient. This professional relationship may involve full disclosure with the family or
partial disclosure depending on the situation between the patient and the family.
In developing the Accu‐Med program we have nursing staff, residents, physicians, family and community
pharmacists all involved in maintaining a current and up to date EMR profile of medications for the
patient. The collaborative practice model works well when we have all the team involved since we are
then able to better document meaningful and relevant information. We started off with the premise
that Accu‐Med within the clinic was a triad partnership: the patient/families, the care team and the
community pharmacist, thus collaborative practice. This has borne out well over the past year as we
have developed relationships with the community pharmacies and they now have a contact to the clinic
to convey relevant information.
The inclusion of all medications, including over the counter (OTC) and naturopathic medications is also
important since during an Accu‐Med intervention we will also perform an interaction check on all
medications; any interactions are also documented in the EMR. The role of the interaction check is to
ensure patient safety and to exhibit to the patient that we take all of the medications they ingest as
being important parts of their therapy. In situations where we do uncover interactions we will plan an
education session with the patient and the family/caregivers to ensure they understand the risks
involved in certain combinations.
During the time of assessment we not only look at medication interactions but we also look at
medications that may be affected by changes in lifestyle. An example of this is a patient being treated
for migraine prophylaxis with a beta blocker who suddenly wants to start an aggressive exercise
program; the beta blocker may limit the ability of the individual to exercise and at that point we would
have to work with the patient to find an alternate treatment agent for the migraine prophylaxis. During
this interview we will also assess the patient’s ability to pay for the therapy prescribed since the best
therapy cannot financially fit into the budget so is not going to be used and alternate treatments will
have to be accessed. In cases of consultant changes we may find that the patient will be provided with
samples of “new and improved” medications that the patient’s medical coverage will not pay for; at this
point we will assess if the medication needs prior authorization or if it is not on the insurance formulary.
If it is not on the formulary we will not include it in the EMR and will resort to agents that are covered
for patients with limited means. Working in the team we have developed a way to document all of this
information into a chart note and also document that the Accu‐Med intervention has been completed
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ACADEMICFAMILYMEDICINE
153
SUNRIDGEFAMILYMEDICINETEACHINGCENTRESunridge currently has 16 teaching physicians (8 FTE) and 21 staff (including three casuals) who managed 5935 patients and approximately 24000 patient visits in 2014. More than 125(1) learners, including residents, externs, clinical clerks, medical students and various allied health students were both taught and supported in their research activities during the year. In an effort to improve our ongoing patient care, teaching and research responsibilities, several initiatives were started or continued. Two of the initiatives started or undergoing significant change this year were the Health Management Program and our resident academic teaching program. The Health Management Program, encompassing six pillars of the Patient Centred Medical Home, was developed with the goal to provide high quality, patient‐centred care while reducing visits to attending physicians, therefore allowing for increasing panel size and more efficient patient access. The resident academic teaching program was modified, increasing the frequency of the rounds and presenters, leading to more diversity of topics, record attendance, increased discussions and knowledge acquisition and collaboration between all members of the clinical team at Sunridge. The most significant challenge Sunridge faced this year was the turnover in physicians. We had one full time academic physician retire and by June 30, 2015 we will have lost six other physicians for various reasons. Some have moved, some are taking advantage of opportunities to following their passions in other areas and others are looking at clinics closer to home. All of these physicians have provided excellence in patient care and resident/learner teaching and have been a pleasure to work with. Even though they will be missed, we are happy for them and the new paths they are exploring. Sunridge is progressing towards a fully functional Patient Centred Medical Home. In line with this progression, Sunridge has several ongoing and new initiatives planned for 2015‐2016. One future direction of the Health Management Program is to enhance teamwork and patient care through regular team meetings. Efforts are under way to develop in several areas (Mosaic PCN, PLC ER, Coagulation clinic, etc.) to develop more community partnerships in order to better respond to local needs.
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needs an
recomme
At the end
for impro
Health ma
offered ex
making de
education
the clinic.
The surve
DEMICFA
esults were p
sfied with th
nd to suppor
nd this servic
d of the surve
vements. Be
anagement n
xcellent infor
ecisions on lif
n opportunitie
They look fo
ey will be dist
AMILYM
positive indic
he manageme
rt lifestyle c
ce to their fam
ey, participan
low is an ove
nurses were v
rmation and
festyle chang
es. They app
orward to follo
ributed again
MEDICIN
cating the He
ent of their h
changes to k
mily and frien
nts were free
erview of the
very knowledg
suggestions.
es and impro
preciated kno
ow up session
n in Sept 2015
NE
157
alth Manage
health needs,
keep themse
nds.
to add gener
comments re
geable and in
Patients fel
oving their hea
wing about r
ns.
5 to evaluate
ment progra
, felt better
elves healthy
ral comments
eceived from
nformative.
lt their conce
alth is best su
resources ava
the program
m was well r
able to cope
y. Patients st
s about the p
patients.
The nurses w
erns were imp
upported thro
ailable in the
six months a
received. Pa
e with their h
tated they w
program, and
were conscien
portant. The
ough guidanc
community a
after initiation
tients
health
would
areas
ntious,
ey felt
ce and
and in
n.
ACAD
PANEL All physic
patients
paneled t
actively m
physician
Funding h
care coo
position is
Sunridge
Campus T
data in th
and SHC.
defined p
developed
All patien
age; less t
Each age
Le3
Gw
* In
The prima
patients a
with thei
diagnostic
DEMICFA
MANAGEM
cians at Sun
have a prim
to residents.
monitored fo
at Sunridge c
has been secu
rdinator pos
s panel mana
works coll
Teaching Clin
he EMR as the
In collabora
atient status
d to address a
nts are divid
than 40 years
category is fu
ess than 40 yyears = inact
reater than 4within 2 years
active: deceas
ary care coo
at Sunridge. A
r doctor, wil
c codes for sp
AMILYM
MENT
ridge are pa
mary physicia
Physician p
or at least on
currently acce
ured from Mo
sition. One
gement, inclu
laboratively
ic on decisio
e EMR is shar
tion with SH
within the EM
active/inactiv
ed into two
s old and grea
urther divided
ears: seen intive.
40 years: see= inactive.
sed; transferre
rdinator will
Any patient c
ll be reactiva
pecific conditi
MEDICIN
aneled. All
n and many
panel sizes h
ne year. The
epting new pa
osaic PCN for
of the roles
uding cleanin
with South
ons to modify
red between
HC, we confir
MR. Strategy
ve patients.
categories b
ater than 40 y
d into two gro
n the clinic wit
en in the clin
ed (moved to a
contact all p
classified as i
ated. Furt
ions, will follo
NE
158
Sunridge
y are also
have been
ere is one
atients.
a primary
s for this
g and manag
h Health
y existing
Sunridge
rmed and
has been
based on
years old.
oups:
thin the last 3
nic within the
nother physici
patients liste
inactive who
ther refineme
ow this initial
ging physician
3 years = acti
e last 2 years
ian or city); dis
ed as inactive
calls the clin
ent of panel
panel cleanu
n panels on a
ive, not seen
= active, not
scharged (fired
e to determin
nic requestin
ls, including
up.
routine basis
in the clinic w
t seen in the
d, terminated)
ne if they ar
g an appoint
review of cu
s.
within
clinic
re still
tment
urrent
ACAD
RNHIR A Primary
projects
leadership
reception
day funct
are adequ
and staff.
The clinic
implemen
managem
health ma
processes
The initia
required
immuniza
education
majority
education
Sunridge
Initial edu
LPNs in M
The clinic
in the clin
in Decem
TEACHITeachinTeaching
discussion
providers
health tea
Topics, ch
below:
DEMICFA
REDFORC
y Care Nurse
and clinica
p to the cl
staff and is
tioning of the
uate to maint
c RN is a key
ntation and
ment program
anagement te
s are in place.
al focus of st
Annual Com
ations were u
n (CPR, N95,
of staff are
n and immuni
received a ne
ucation and c
March 2015.
RN facilitate
nic and has b
ber 2014.
INGngRoundsrounds are h
n and colla
at Sunridge.
am all take tu
hosen by the
AMILYM
CLINIC
e (RN) was hi
al education
inic team o
responsible
e clinical area
tain a safe en
y contributor
d evaluatio
m. The RN w
eam to ensur
.
taff educatio
mpulsory Educ
up to date as
, anaphylaxis
e up to dat
izations.
ew Blood Glu
certification w
es coordinatio
een active in
sheld two day
aboration am
Residents, p
urns presentin
e presenters,
MEDICIN
ired for clinic
n. The RN
of LPN’s, M
for the overa
a, ensuring st
vironment fo
r to the dev
on of the
works closely
e proper wor
on was to en
cation (ACE)
s well as oth
s and back c
te on all co
ucose Meter
was complete
on of researc
this role sinc
ys a week to
mong all he
hysicians and
ng topics for d
are listed in
NE
159
c support,
provides
OA’s and
all day‐to‐
taff levels
or patients
elopment,
e health
y with the
rkflow and
nsure AHS
and staff
her annual
care). The
ompulsory
from AHS.
ed with all
ch projects
ce starting
encourage
ealth care
d the allied
discussion.
n the table
ACADEMICFAMILYMEDICINE
160
Date Teaching Rounds Topic Group Responsible Oct. 21 & 22, 2014 “Insulin In Practice: A Simplified
Approach“ Pharmacist, Diabetes Nurse Educator
Oct. 28, 2014 “Transitioning After Residency” Preceptor
Oct. 29, 2014 “Mobile Resources & EMR” Preceptor
Nov. 04, 2014 Review of CFPC Priority Topic: Chemic Heart Disease
MS 1 Resident
Nov. 05, 2014 Lower GI Bleeding in Children MS 1 Resident
Nov. 12, 2014 "Integrative Medicine” MS 2 Resident
Nov. 19, 2014 “Concussion” MS 3 Resident
Nov. 25 & 26, 2014 “Counselling Support at Sunridge” Behavioural Health Consultant, Mental Health Consultant, Mental Health Therapist
Dec. 02, 2014 “Chronic Kidney Disease and the new Alberta Pathway”
MS 1 Resident
Dec. 03, 2014 "Differential of an Infant Skin Rash" MS 1 Resident
Dec. 09, 2014 “ Irritable Bowel Syndrome” MS 2 Resident
Dec. 10, 2014 "Management of Community Acquired Pneumonia as an Outpatient and When to Admit"?
MS 2 Resident
Dec. 16, 2014 “Mirena – New Insertion Kit” (Presentation and Demonstration)
Bayer Pharmaceutical Representative
Dec. 17, 2014 “Ring‐a‐ding‐ding: Left sided weakness in a 46 year old"
MS 3 Resident
Jan. 07, 2015 “Approach to Hypocalcaemia” MS 1 Resident
Jan. 13, 2015 “The Shingles Vaccine” Preceptor
Jan. 14, 2015 “Celiac Disease” MS 2 Resident
Jan. 21, 2015 “Vitamin D Deficiency” MS 3 Resident
Jan. 27, 2015 “Nutrition Education with Simple Games” Dietician Living Well
Jan. 28, 2015 “Protecting Patient Privacy ‐ Case Study” Medical Social Worker
Feb. 04, 2015 “The Experience of New Family Medicine Faculty”
Search and Selection Candidate
Feb. 10, 2015 “Common Skin Disorders in Family Medicine”
MS 2 Resident
Feb. 11, 2015 “Insomnia” MS 2 Resident
Feb. 18, 2015 “Red Eye” MS 3 Resident
Mar. 03, 2015 “Abnormal Head Shapes ‐ Paediatrics MS 1 Resident
Mar. 04, 2015 “Restless Legs” MS 1 Resident
Mar. 10, 2015 “Screening Tools for Domestic Violence in a Busy Family Practice
MS 2 Resident
Mar. 11, 2015 "CKD Screening in Diabetic Patients" MS 2 Resident
Mar. 17, 2015 Croup MS 3 Resident
Mar. 24, 2015 Programs, Workshops and Classes Available to Patient
Chronic Disease Management and Pharmacist
Mar. 25, 2015 Health Management Nurse and Comprehensive Care Plans
Chronic Disease Management and Pharmacist
Mar. 31, 2015 Fundaments for MSK Radiograph Interpretation
Preceptor
Apr. 1, 2015 The New Oral Anticoagulants Preceptor
Apr. 7, 2015 Dyspepsia MS1 Resident
Apr. 8, 2015 An Approach to Vertigo MS1 Resident
ACAD
Attendan
higher th
amongst t
Pharmace
health tea
quite usef
PatientA “Living
Sunridge
managem
educators
guide pa
conversat
participan
each othe
to traditio
opportun
participan
the class
Overall, t
positive, e
education
appointm
we would
unique to
The dietic
Through
Participan
Learners(1
R
R
M
C
V
M
M
O
Ex
DEMICFA
ce at the tea
an in previo
the team.
eutical rep p
am and staff
ful.
tEducationg Well with
diabetic p
ment nurses a
s) from the a
articipants t
tion map,
nts to interac
er. This teach
onal lecture/
ity for visual
nts valued th
and apprecia
the feedback
emphasizing
n. The class w
ments with the
d like to offer
o Sunridge.
cian at Sunri
the use of g
nts’ feedback
1) in Sunridge
1 (First year r
2 (Second yea
Mandatory Cle
lerks (Elective
isiting Clerks:
Med 330: 14
Med 430: 23
Off‐site reside
xterns: 3
AMILYM
aching round
ous years. Inc
resentations
may all atten
nClassesh Diabetes”
patients by
and the phar
allied health
through var
encouraging
ct with one a
hing style is ve
/classroom le
learning and
e socializatio
ated the sup
k from the
the value of
worked well
e allied health
more group
idge provided
games the di
suggested th
Clinic 2014:
resident): 19
ar resident): 2
erks: 8
e): 5
: 5
nts: 3 (Remed
MEDICIN
ds has been v
crease in att
are held th
nd. Feedback
class is pro
one of th
rmacist (both
team. The f
rious topics
questions,
nother and l
ery different
earning allow
d active dialo
n/interactive
pport from ea
participants
f providing th
in linking pa
h team in the
classes to ou
d interactive
ietician show
hat the sessio
22
dial rotations
NE
161
very good (a
tendance has
ree times a
on these pre
ovided to
he health
h diabetes
facilitators
on the
allowing
earn from
compared
wing ample
ogue. The
e aspect of
ach other.
was very
his type of
rticipants bac
clinic after th
r diabetic pop
nutritional e
wed innovativ
ns were both
s)
average numb
s improved t
month whe
esentations is
ck into the m
he class for re
pulation as w
education cla
ve and fun w
h enjoyable an
ber is 7‐12 p
the discussio
re physicians
s that some o
medical home
egular follow‐
well as other s
asses called
ways to build
nd beneficial.
participants)
on and intera
s, residents,
of them have
e as most ha
‐ups. In the f
special popula
“Ask a Dieti
d a healthy
.
much
action
allied
been
ad 1:1
future
ations
cian”.
meal.
ACAD
LP
M
R
P
D
M
M
CONTIN Sunridge
templatin
appointm
assigned
primary
relationsh
The num
resident p
resident
Block rota
EMR. Slot
needs. Slo
the appoi
longer v
Benchma
patient nu
Below are
(R1) First
B
B
B
B (R2) Seco
B
B
Fit‐ins are
urgent he
needs to
DEMICFA
PN: 3
MOA: 2
N: 2
harmacist: 1
ietician: 3
Mental Health
Masters Public
NUITYOFC
continues t
ng for EM
ments with t
to them. R
preceptor,
hips with resid
mber of appo
per clinic is
(primarily sta
ation the res
ts can be ad
ots are 15 mi
intment tem
visits as n
rks are for
umbers.
e the number
year resident
locks 1‐2
locks 3‐6
locks 7‐9
locks 10‐13
nd year resid
locks 1‐9
locks 10‐13
e a common
ealthcare nee
be seen and
AMILYM
Therapist: 1
c Health Inter
CARE
to provide r
R continuity
the resident
Residents wo
providing c
dents and pro
ointment slo
determined
atus as R1 o
sident is in a
justed as ne
nutes in lengt
plate can be
needed (PHE
slots of pat
rs of booking
ts:
4 s
6 s
7 s
8 s
ents:
8 s
9 s
occurrence a
eds are seen
d their reside
MEDICIN
rn: 15
resident and
y. Patients
(secondary
ork mainly
continuity o
oviders.
ots available
by the senio
or R2) and th
and template
eded to mat
th, but adjace
combined to
E, counselli
ient care, ra
slots availabl
lots
lots
lots
lots
lots
lots
at Sunridge.
n same day.
ent/provider i
NE
162
physician
schedule
provider)
with their
of patient
for each
rity of the
he current
ed into the
tch learner
ent slots in
o allow for
ng, etc.).
ather than
e per residen
Patients with
If a patient
is not in, the
nt per clinic:
h
t
e
ACAD
patient w
patients’
generally
All micros
Patient ca
been seen
Patients r
their heal
Sunridge
behaviour
mental he
respirator
diabetes
managem
work coll
to provide
those mo
allied hea
Central re
Patients a
time.
COMMUPeter Lo
negotiate
be seen
emergenc
referral p
physicians
consider f
DEMICFA
will be seen b
microsystem,
covered with
systems have
are often con
n and chartin
receive indivi
thcare conce
has a large a
ral health co
ealth consulta
ry nurse edu
nurse educ
ment nurses.
aboratively w
e comprehen
st in need. Th
lth team on s
eferral maint
are referred
UNITYINITougheed Ho
ed with Sunri
at Sunridg
cy departme
atients were
s’ clinics. Fu
further partn
AMILYM
by another ph
, the patient w
hin the micros
regular meet
ntinues beyo
g is complete
dualized pers
erns.
allied health
onsultant, me
ant‐shared m
ucator, pharm
ator, dieticia
The Health
with the allie
nsive care and
he primary ca
site. Team me
tains an accu
back to spec
TIATIVESospital eme
idge for influ
e to decrea
ent. Volume
low and ther
rther discuss
erships in thi
MEDICIN
hysician withi
will be seen b
system and su
tings to discu
nd clinic hou
ed. Some phys
sonal care th
team, consis
ental health
mental health,
macist, socia
an and thre
managemen
d health team
d continuity o
are coordinat
eetings involv
urate and up
ialists they h
rgency dep
enza “A” pat
ase volume
e of influen
re were easily
ions are unde
s area.
NE
163
in their micro
by another ph
upported by
ss processes
urs. Physician
sicians will do
rough staff c
sting of a
therapist,
, certified
l worker,
ee health
nt nurses
m on site
of care to
tor position w
ving the patie
p to date da
ave seen in t
artment
tients to
in the
nza “A”
y fit into
erway to
osystem. If t
hysician in the
clinic adminis
and patient c
ns and reside
o home visits
ontinuity. Sta
will ensure co
ent will occur
atabase of sp
the past to p
there is no c
e clinic. Phys
stration.
care.
nts stay unti
on days not
aff know pati
ntinuity thro
on a regular
pecialists and
provide conti
capacity withi
sician absence
l all patients
in clinic.
ients by nam
ugh referral t
basis.
d specialty c
inuity of care
in the
es are
s have
e and
to the
clinics.
e over
ACAD
A new i
Managem
ready for
within Su
with seve
involved i
Sunridge
CHALLThe turno
greatest
three new
the trans
challenge
smooth fo
Sunridge
changes a
to ensure
Other cha
C
an
us
th
C
st
fo
p
ex
N
N
th
En
tr
ge
Pa
p
to
DEMICFA
nitiative wa
ment Services
r discharge a
unridge. Sun
eral Mosaic
n other areas
physician on
LENGESover in physic
challenge at
w teaching ph
ition of patie
for patients
or all involved
for their care
and who they
they are com
allenges Sunri
apacity to ev
nd trained st
sers who hav
hird super use
apacity to m
taffing. Sunrid
or cleaning a
rimary care
xpectations f
umber of off
umber of pa
hree staff tha
nglish as a se
ranslation ser
etting more i
arking is a ch
atients. There
o replace the
AMILYM
s created w
s where their
are provided
nridge has be
PCN initiat
s of PCN deve
the PCN boar
cians this pa
t Sunridge.
hysicians and
ent panels a
s, residents, p
d. Patients ar
e. Residents a
y will be work
mfortable in t
idge faced ov
aluate, clinic
taff to assist
ve received s
er has recent
anage physic
dge is in the
and managing
coordinator
or this role.
schedule res
tients with E
at speak othe
econd langua
rvices. We ha
nformation in
hallenge for a
e are only 3 h
m. In the win
MEDICIN
with Anticoa
r unattached
d a family p
een actively
ives and is
elopment, inc
rd.
st year has b
Sunridge in
are in the p
nd residents
physicians an
re reassured t
and staff have
king with. New
heir new env
ver the last ye
processes, p
in running re
some training
ly started tra
cian panels ha
process of hi
g physician p
position will
sidents at Sun
English as a s
er languages
age. Cordless
ave some pati
n other langu
all patients b
handicap stal
nter with no
NE
164
gulation
patients
physician
involved
actively
cluding a
been the
tegrated
rocess of rec
into other p
nd staff. Sunr
they will have
e been given
w physicians
vironment and
ear are:
atient care a
eports and g
g in running
ining.
as been a ch
iring a primar
panels on a
not be eno
nridge makes
econd langua
so they are
s phones hav
ient educatio
ages.
ut in particul
ls and the sig
signs and sno
cruiting four m
physician’s p
ridge is work
e a family phy
as much noti
are given inc
d positions.
nd initiatives
generating m
reports but
allenge due t
ry care coord
routine basis
ough for the
scheduling a
age. We curr
able to care
ve been insta
on informatio
lar is an issue
gns are often
ow covering t
more. This in
panels and cl
king to ensur
ysician if they
ice as possibl
reased traini
due to the la
etrics. Sunrid
further train
to the lack o
dinator who w
s. We are pr
size of Sun
challenge.
rently have tw
for most of
alled in each
on in Spanish
e for our sen
n knocked dow
the ground, t
tegration inc
linics present
re the transit
y choose to s
e in regards t
ng and orient
ack of IT reso
dge has two
ning is requir
of IT resource
will be respo
redicting tha
ridge and th
wo physician
our patients
teaming roo
and are look
niors and han
wn. Impark is
the handicap
cluded
ting a
tion is
tay at
to the
tation
ources
super
red. A
es and
nsible
t one
he job
ns and
s with
m for
king at
ndicap
s slow
stalls
ACADEMICFAMILYMEDICINE
165
are virtually impossible to see and are often utilized by those not needing them. This forces our
handicap and seniors to park further away, making access to the clinic a challenge.
QUALITYASSURANCE,QUALITYIMPROVEMENT&INNOVATION
A Clinic Improvement Team (CIT) was established at Sunridge in January 2014 with the aim of promoting
and supporting quality improvement initiatives. The Clinic Improvement Team’s mandate is to assess,
evaluate and implement projects that will lead to improvement in overall care and education. The CIT is
a multidisciplinary group consisting of the clinic manager, clinic RN, site medical lead, academic service
planning consultant, physician, resident representative, LPN, MOA, reception, clinic scheduler and
administration.
One of the first projects under exploration by the CIT has been evaluation of stocked inventory in exam
rooms. Concerns were raised regarding excessive stocking in exam rooms which were leading to a high
volume of unused supplies being thrown out due to expiration. The stocking of exam rooms was thus
brought under scrutiny and analyzed in relation to the amount that was being stocked versus the
amount that was expiring and being thrown out. This has been an essential project for the clinic because
there were also concerns raised about the possibility of using expired supplies on patients. Sunridge’s
goal is to balance clinic costs for supplies in relation to adequately meeting patient needs without
compromising care. Members of the CIT came up with a list of recommended quantities for each supply.
Currently the different Microsystems are running trials in their exam rooms based on this list. A future
goal of the committee will be to evaluate whether this list has been helpful in reducing wastage of extra
supplies as well as explore further directives in this field.
Another important project by the committee is reducing patient wait times. In this aspect, posters have
been put up around the clinic asking patients to arrive 15 min prior to their scheduled appointment. In
addition to this cycle times at the clinic are being monitored at three month spans in order to improve
access.
The team will also be involved in the implementation and evaluation of projects such as the Health
Management Program, ASaP, and EMR related projects, with the goal of improving our patient centered
medical home.
On the education front, roadmap and documentation has been created for incoming residents to plan
their QI projects in an organized manner. This will help residents gain support from the CIT in terms of
resource planning, local relevance of projects and removing obstacle to successful completion of their
projects.
ACADEMICFAMILYMEDICINE
166
FUTUREDIRECTIONS&INITIATIVES Health Management Program
Future direction for this program includes:
‒ Development of standing orders (standard care plans) for the health management nurses to
adjust treatment within specific parameters, allowing them to practice to their full scope
‒ Establishment of a dedicated Health Management team, which includes providing a secure
time and place for all members of the health care team, including the patient, to meet
together to discuss patient care
‒ The Patient Care Coordinator will eventually be a single point of contact for patients and
staff to arrange appointments with the health management nurse
‒ More in‐depth evaluation, in collaboration with the Mosaic PCN, including monitoring
healthcare indicators such as: BP, A1Cs, waist circumference, etc.
Panel Management
The primary care coordinator will clean and monitor physician panels on a routine basis. They will
act as a panel management resource to the team including submitting monthly panel reports, be a
key member in the identification of patients qualifying for the health management program and
participate on a team for data collection and programmatic evaluation related to the Patient
Centered Medical Home and quality improvement initiatives.
Initiation of ASaP
Plan is for the initiation of ASaP in Sunridge in the fall of 2015.
Emergency Department (ED) to Primary Care
Sunridge has entered discussion with Calgary Zone Primary Care Team, Calgary Zone PCNs, Calgary
Zone Emergency Department and CZ Health link Alberta to assess the feasibility of Sunridge being a
part of the ED to Primary Care initiative. The purpose of the initiative is to refer patients presenting
to the Peter Lougheed Hospital ED with non‐urgent issues to the Sunridge clinic to be seen by our
primary care physicians, to decrease volume in the ED and improve patient access to care.
Med Reconciliation
Sunridge would like to establish a med reconciliation program, but this initiation would require more
pharmacy time. Currently Sunridge has a pharmacist on site one day a week.
Staff Clinical Education
The clinic RN is working in collaboration with the RN’s from the other two DFM teaching clinics to
share ideas and resources on department related competencies. Learning activities for the clinic
staff are being developed in the following areas: ear irrigation, performing ECG’s, IP&C, measuring
vital signs, documentation, sterile technique, back safety and urinalysis.
ACADEMICFAMILYMEDICINE
167
i The Patient and Citizen Innovation Council in Family Practice: Ron Garnett M.D., CCFP(EM), FCFP, Site Medical Lead Academic Family Medicine South Health
Campus, Calgary; Jane Bowman R.N., M.N., Manager Academic Family Medicine South Health Campus, Calgary; Joanne Ganton B.Comm., Manager Patient Family Centred Care South Health Campus, Calgary 2014 ii Guide to Panel Identification for Alberta Primary Care, April 2014 iii Family Practice: The Patient’s Medical Home – Objectives and Goals. September 2011; A Vision for Canada Family Practice – The Patient’s Medical Home iv Accu‐meds: An Approach to Medication Reconciliation in a Family Practice Setting: Ron Garnett M.D., CCFP (EM), FCFP, Site Medical Lead Academic Family
Medicine South Health Campus Calgary; C. Joe Tabler B.Sc.Pharm. Pharm D (Candidate), Pharmacist Academic Family Medicine South Health Campus Calgary; Jane Bowman R.N., M.N., Manager Academic Family Medicine South Health Campus Calgary 2014
Workforce Planning
WORK
CURRThe DFM
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WORKFORCEPLANNING
170
PHYSICIANRECRUITMENTACTIVITIESThe Department of Family Medicine (DFM) in Calgary has developed a reputation among physicians of
being a supportive environment for physicians desiring to relocate to Calgary. Over the last 14 years the
DFM has worked to provide one‐on‐one support, relevant information regarding opportunities, practice
readiness information and an overview of how the DFM functions within the City, Zone and Provincial
Alberta Health Services. The key role of the DFM through the Physician Recruitment Coordinator has
been to assist physicians to navigate a process that can prove to be complicated and challenging to
physicians relocating or for new graduates ready to enter practice in Calgary.
The recruitment initiatives of the DFM align with the Medical Home Model that encourages, timely
access to primary care services, allows for comprehensive care and continuity of care where each
patient has their own family physician in Calgary.
In the past year over 210 physicians contacted the DFM for support to find opportunities to practice
within the sections of family medicine. From April 1, 2014 to March 31, 2015 over 40 physicians have
been recruited to work in many different sections and areas of interest. The Physician Recruitment
Coordinator (PRC), Darlene Befus, has met with many of these personally and communicates by phone
and email to find practice opportunities within Calgary for these physicians. She connects those with
focus practice such as hospitalist to the appropriate section and works with the sections to ensure a
smooth transition for the relocating physician. A number of the physicians have been able to take
advantage of Alberta Health Service (AHS) funding for visits and relocation (a two year return of service
required), based on AHS policy and DFM guidelines.
The DFM and the Primary Care Networks have taken a collaborative approach to recruitment in Calgary.
The DFM connects physicians with the PCN in the appropriate areas of the city to explore opportunities
and services and the PCNs connect physicians with the DFM to provide visit and relocation support and
for an introductory meeting to discuss family medicine in Calgary.
Once again this year the FM Residency program incorporated, as part of their academic half‐day, the
opportunity for the DFM to speak to the FM residents about transition to practice covering everything
from opportunities, privileging and practice readiness. Our Physician Recruitment Coordinator meets
with many of the new grads who desire to stay in Calgary, to talk about the opportunities and connect
each graduating resident according to their area of interest.
The landscape of physician recruitment is ever changing with the needs in specialized practice areas
often changing from year to year. During the past 18 months there have been limited opportunities in
some desired area of practice (i.e. maternal newborn care, women’s health etc.) specifically for new
grads. Community practice opportunities continue to be available with over 50 practices advertising on
our family medicine website www.calgaryfamilymedicine.ca for full‐time or part‐time positions.
In September of 2014 the Urban Locum Program was discontinued after 12 years of service to family
physicians in Calgary. The DFM has continued to support community family physicians by advertising
their opportunities on the website and providing them with a list of physicians who have expressed
WORKFORCEPLANNING
171
interest in providing locum coverage. There are currently over 30 locum opportunities on the DFM
website.
On September 29, 2014 157 medical
students, residents and practicing family
physicians attended the 14th Annual
Family Medicine Showcase with 68 booths
displaying supports, services and
opportunities available to family
physicians. This event has become a
highlight for many of the attendees and has
serves to promote and support family
medicine within Calgary.
The DFM continues to have a presence at
the family physician conferences such as
the Family Medicine Forum and the Annual
Scientific Assembly in Banff, to promote
Calgary to the physician attendees.
Our Physician Recruitment Coordinator
also works with the Academic DFM to
recruit physicians for the academic three
teaching clinics. Checklists and processes
have been implemented to ensure the
recruitment process is a fair and
transparent with each new physician
receiving consistent orientation to the
teaching clinics. Two academic conferences were attended to promote teaching opportunities in
Calgary,
Recruiters have are an important role in supporting physicians to transition from one community to the
other. New graduates, especially, expect that there will be someone to support them to transition in to
practice and many practicing family physicians now look for the point of contact to assist them as they
move from around the world and across our country.
Appendices
EXAM
IntegraMedicin
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EXAM
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repe of services
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m) ‐Design (Acadare (AcademicProgram (Acadademic FM – ses (Academi(Academic FM
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dical Inpatienre Unit (PalliaPalliative Cargistry (Commg Group (Comge Pilot Projenity Primary C‐Design (Acads; Coordinatnic) Program (Acadademic FM –
TRATING
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r the Elderly (Care) are) ative Care)
ve Care) re) eniors Care) mmunity Primmmunity Primommunity Prict (Communiting Every Pa
demic FM – Cc FM ‐ South Hdemic FM – SSunridge Famic FM – SunridM – Sunridge
ppointments.
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demic FM – SSunridge Fam
GMEDIC
174
by teams or n
(Medical Inpa
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entral FamilyHealth CampSunridge Famimily Medicinedge Family MFamily Medic
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nic)
41 67 67 71 73 76 76 94 99 101 102 102 121
131 143 155 159 161 163
50 71 77 100 101 102 104 131 146
155 159
EXAM
Continuity
Communi
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ComprPMH will
ProvincialTom BakePalliative Path to CaGraduatinPlaying aPostgraduStaffing WFacility EnMedicine Goal 5: CClinic) Health MaRN Hired Patient Ed
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ContinPMH will
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rehensiveprovide patie
l Palliative Proer Consult SerHome Care (Pare (Communng Highly Train Integral Rouate ProgramWorkforce Re‐nhancementsTeaching Clinomprehensiv
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uityofCaprovide cont
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EMONST
ademic FM –
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eCareents with a co
ogram (Palliarvice (PalliativPalliative Carnity Primary Cned Family Pole in Ensuri
m) ‐Design (Acads and Supply nic) ve Care (Acad
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munication Upways (Commuole in Ensuri
m) ‐Design (Acadnagement (AcCare, Relationhing Clinic) Program (Acadademic FM – ademic FM –
TRATING
Sunridge Fam
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omprehensive
ative Care) ve Care) re) Care) hysicians (Acaing Every Pa
demic FM – CManagement
demic FM – S
demic FM – SSunridge Famic FM – Sunrid
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(Maternal Ne
pdate (Medicnity Primary ing Every Pa
demic FM – Ccademic FM –nships and Inf
demic FM – SSunridge FamSunridge Fam
GMEDIC
175
mily Medicine
Family Medic
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ademic FM –atient Has a
entral Familyt Improveme
South Health
Sunridge Famimily Medicinedge Family M
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ewborn Care)
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Sunridge Famimily Medicinemily Medicine
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rvices.
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Campus Fam
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eaching Clinic)mic FM – Cent
mily Medicine
Teaching Clininic) hing Clinic)
sician (Acade
eaching Clinic)Teaching Clin– South Healt
Teaching Clininic) inic)
ARS
mic FM –
) tral Family
e Teaching
nic)
4
mic FM –
) nic) th Campus
nic)
162
163
75 76 77 103 120 121
131 134
147
155 159 161
31
44 104 122
131 133 148
156 159 162
EXAM
Communi
Goal7:
ElectroPMH will
communit
Transfer oGoal 7: ETeaching Panel MaContinuity
Goal8:
TraininPMH will
AcademicBedside UPregnancyTeaching Urgent CaIntensive AcademicUndergraContinuinContinuin48th AnnuFaculty DeFamily MeMedZero Family MProgram) Evidence Family MeGoal 8: EdTeaching RN Hired Teaching
MPLESD
ity Initiatives
:
onicMedimaintain ele
ty needs.
of Care CommElectronic MeClinic) nagement (Ay of Care (Aca
:Educatio
ng&Reseserve as sites
c EngagementUltrasound Cey Parables (M(Residency Pare Rounds, ePalliative Carc Palliative Med Medicine Eng Medical Edng Medical Edual Mackid Syevelopment (edicine/Rural(Academic FM
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munication Upedical Record
cademic FM ‐ademic FM –
on,
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t (Maternal Nertification CoMaternal Newrogram and Me‐simulation (re Unit (Palliaedicine (Pallialectives (Palliucation (Palliucation (Senimposium (Co(Academic FMl Medicine IntM – Undergraical Experien
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TRATING
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students and
Newborn Careourse (Maternwborn Care) Medical Stude(Urgent Care) ative Care) ative Care) iative Care) iative Care) iors Care) ommunity PrimM‐ Continuingterest Group aduate Progrance (MDCN
40) (Academi502) (Academearch (Academ
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GMEDIC
176
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or patients. A
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mily Medicinemily Medicine
residents an
e) nal Newborn
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mary Care) g Professional(Academic FMam) 330 or 430)
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mily Medicineily Medicine T
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rogram) rogram) ampus Family
inic) nic)
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ch activities.
ram)
ergraduate
y Medicine
164
e and
45 149
158 162
27 27 30 53 65 72 73 74 74 94 98 109 111 111 112
112 113 150
159 159
EXAM
Goal9:
EvaluaPMH will
CollaboraPeriodic RReportabSouth HeaReadmissHospices ProvincialAppropriaStaffing WFacility EnMedicine Goal 9: EvHealth Ma
Goal10
SystemGovernan
CollaboraCommuniPeriodic RReportabLeadershiUrgent CaContinuedPhysician DFM HomMedical HGoal 10: Clinic)
MPLESD
:
ationcarry out ong
tive Care ProReview Electrole/Adverse Evalth Campus ion Rates (Me(Palliative Cal Palliative Proate Use of AnWorkforce Re‐nhancementsTeaching Clinvaluation (Acaanagement P
0:
mSupportnce policies an
tive Care Proication SurveyReview Electrole/Adverse Evp Developmeare Review Imd Physician ReWeb Registry
mePage – E‐neHome WorkinSystem Supp
EMONST
going evaluat
ject (Maternaonic Process vent FramewRapid Access edical Inpatieare) ogram (Palliatipsychotics (‐Design (Acads and Supply nic) ademic FM – Program (Acad
tsnd practices i
ject (Maternay (Maternal Nonic Process vent Framewent – Deputy mplementatioecruitment (Sy (Communityewsletter (Cog Group (Comports (Academ
TRATING
ion of effectiv
al Newborn C(Maternal Neork (MaternaUnit (RAU) Eent)
ative Care) (Seniors Care)demic FM – CManagement
South Healthdemic FM – S
n place.
al Newborn CNewborn Care(Maternal Neork (MaternaSite Leads (Mon (Urgent CaSeniors Care) y Primary Carmmunity Primmmunity Primmic FM – So
GMEDIC
177
veness of its s
Care) ewborn Care)al Newborn Cavaluation (M
) entral Familyt Improveme
h Campus FamSunridge Fami
Care) e) ewborn Care)al Newborn CaMaternal Newre) re) mary Care) mary Care) outh Health
CALHOM
services as pa
are)
Medical Inpatie
y Medicine Teents (Academ
mily Medicineily Medicine T
are)
wborn Care)
Campus Fam
MEPILL
art of its com
ent)
eaching Clinic)mic FM – Cent
e Teaching ClinTeaching Clin
mily Medicine
ARS
mmitment to Q
4
) tral Family
nic) nic)
e Teaching
QI.
28 32 34 38 40 73 75 93 131 134
150 156
28 28 32 34 52 61 93 97 97 101 152
DFMSCHOLARLYACTIVITY
178
ACADEMICDFMSCHOLARLYACTIVITY(JULY1,2014‐JUNE30,2015)GRANTSChowdhury T. Lifetime risk of cardiovascular diseases and life expectancy for patients with these
conditions. Heart and Stroke Foundation $42,500. Jul 1, 2014 to Jun 30, 2015.
Chowdhury T. Domperidone and sudden cardiac death sub‐project. Canadian Network for
Observational Drug Effect Studies (CNODES). CIHR $20,000. Apr 1, 2015 to Dec 31, 2015.
Crowshoe L. First peoples, second class treatment: Examining the role of racism in the health and well‐
being of Indigenous peoples. CIHR Meeting Grant $12,000. Sep 1, 2014 to Sep 30, 2015.
Crowshoe L. Case Managers to improve management of Arthritis and associated comorbidities with
Aboriginal communities: A proof of concept study. Canadian Initiative for Outcomes in Rheumatology
Care (CIORA) $120,000. July 1, 2014 to June 30, 2016.
Dickinson J. Sentinel Physician Surveillance Network (SPSN) to monitor circulating influenza and vaccine
effectiveness. Public Health Agency of Canada $34,357. Aug 1 to Dec 31, 2014.
Dickinson J. Alberta Provincial Pediatric EnTeric Infection Team (APPETITE): Epidemiology, Emerging
Organisms, and Economics. AIHS program grant $4,999,166. Jul 1, 2014 to Jun 30, 2018.
Hill T. Insomnia Treatment Preferences of Pregnant Women. Alberta Center for Child, Family and
Community Research $10,000. Oct 1, 2014 to Aug 30, 2016.
Kidd M. Maternal diet choice in breastfeeding. College of Family Physicians of Canada JANUS grant
$7,800. Jul 1, 2014 to Jun 30, 2015.
Leduc C and Crowshoe L. Innovating Indigenous Primary Care in Alberta: moving the agenda forward
together. AIHS conference grant $4,000. Mar 17, 2015 to Nov 30, 2015.
Nixon, Lara. Enhanced Multidisciplinary Care for Inner City Patients with High Acute Care Use. AIHS
$124,199. Apr 1, 2015 to Mar 31, 2016.
Spice R. Web‐based videoconferencing for rural palliative care consultation in the home. TVN:
Technology Evaluation in the Elderly Network. Health Technology Innovation grant $20,000. Apr 1,
2015 to Mar 31, 2016.
PUBLICATIONSAl Mamun M, Ibrahim H, Turin T. Social media in health information and communication: an analysis of
Facebook groups related to hypertension. Preventing Chronic Disease Jan 2015; 12: e11.
Azad M, Fraser K, Rumana N, Abdullah A, Shahana N, Hanly P, Turin T. Sleep disturbances among
medical students: a global perspective. Journal of Clinical Sleep Medicine Mar 2015; 11(1): 69–74.
DFMSCHOLARLYACTIVITY
179
Crutcher R, Duop D, Clayton J, Parent R, Dennis A, Shannon S, Ross Shelley. Competence, confidence,
and conflict: The Sudanese Physician Reintegration Program. In: Madibbo A. Canada in Sudan, Sudan in
Canada. Quebec: McGill‐Queen's University Press; 2015: 124‐151. (Book Chapter)
Darak S, Parchure R, Darak T, Talavlikar R, Kulkarni S, Kulkarni V. Advances in the prevention of mother‐to‐child transmission of HIV and resulting clinical and programmatic implications. Research and Reports in Neonatalology 2014; 4: 111‐123. de Koning L, Henne D, Woods P, Hemmelgarn B, Naugler C. Sociodemographic correlates of 25‐
hydroxyvitamin D test utilization in Calgary, Alberta. BMC Health Services Research Aug 2014; 14: 339.
Gibson C. Educational tool for hospital‐based training in family medicine. Canadian Family Physician
Oct 2014; 60: 946‐948.
Giesbrecht G, Dewey D, O'Beirne M, APrON Study Team. The effects of 'does not apply' on
measurement of temperament with the infant behavior questionnaire‐revised: a cautionary tale for very
young infants. Early Human Development Oct 2014; 90(10): 627‐34.
Gorday, W, Sadzradeh H, de Koning L, Naugler C. Association of sociodemographic factors and prostate‐specific antigen (PSA) testing. Clinical Biochemistry Nov 2014; 47(16–17): 164–169. Hishida A, Wakai K, Naito M, Suma S, Sasakabe T, Hamajima N, Hosono S, Horita M, Turin T, Suzuki S,
Kairupan T, Mikami H, Ohnaka K, Watanabe I, Uemura H, Kubo M, Tanaka H. Polymorphisms of genes
involved in lipid metabolism and risk of chronic kidney disease in Japanese ‐ cross‐sectional data from
the J‐MICC Study. Lipids in Health and Disease Oct 2014; 13(1): 162.
Hofmeister M, Spice R, Jackson W, McClurg C, Kelly M. Evaluation of tablet computers as an education
resource by community Family Medicine preceptors. Oral presentation (abstract) presented by M. Kelly
at Society of Teachers of Family Medicine Conference Atlanta, GA, USA. Feb 1, 2015.
Hosein F, Roberts D, Turin T, Zygun D, Ghali W, Stelfox H. A meta‐analysis to derive literature‐based
benchmarks for readmission and hospital mortality after patient discharge from intensive care. Critical
Care Dec 2014; 18(6): 2558.
Jun M, Turin T, Heerspink H, Woodward M, Manns B, Tonelli M, Perkovic V, Hemmelgarn B. Assessing
the validity of surrogate outcomes for ESRD: a meta‐analysis. Journal of the American Society of
Nephrology. Published online before print Jan 2, 2015.
Kassam A, Horton J, Shoimer I, Patten S. Predictors of well‐being in resident physicians: a descriptive
and psychometric study. Journal of Graduate Medical Education March 2015; 7(1).
Kelly M. The road to Ithaka, Forum, Journal of the Irish College of General Practitioners Jul/Aug 2014; 20‐
21.
Kelly M. Tear‐stained sepia. Family Medicine Jul 2014; 46(7): 552‐3.
Kelly M, Dornan T, Yardley S. New opportunities in health care education evidence synthesis. Medical
Education Oct 2014; 48(10): 1029.
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Kelly M, Tink W, Nixon L. Keeping the human touch in medical practice. Academic Medicine Oct 2014;
89(10): 1314.
Kelly M. From acquisition to participation: theorizing virtual patient use in family medicine education.
Family Medicine Oct 201; 46(9): 734.
Kelly M, Jackson W, McClurg C, Hofmeister M, Spice R, Myhre D. Let me look it up! An evaluation of
the application of evidence based on practice in family medicine clerkship. Oral presentation (abstract)
presented at Society of Teachers of Family Medicine Conference, Atlanta, GA, USA. Feb 1, 2015.
Kelly M, O'Flynn S, Bennett D. The art of assessment. In: Keeping reflection fresh: top educators share
their innovations in health professional education. Editors: Peterkin A, Brett‐MacLean P: Kent State
Press. Jan 1, 2015. (Book Chapter)
Kidd, M. Shadows, slicksters and soothsayers: physicians in Canadian poetry. Canadian Literature Jun
2014; 221: 37‐54.
Kidd M. Evolving ideas in primary care. Commentary, Canadian Family Physician Apr 2015; 61: 307‐309.
Lau C, Guo M, Viczko J, Naugler C. A population study of fasting time and serum prostate‐specific
antigen (PSA) level. Asian Journal of Andrology Sep 2014; 16(5): 740 ‐ 744.
Lee J, Turin T, Nicholl D, Ahmed S, Loewen A, Hemmelgarn B, Azad A, Hanly P. Predictors of successful
completion of diagnostic home sleep testing in patients with chronic kidney disease. Sleep and Breathing
Nov 2015; 19(2): 669‐675.
Lockerbie S. Infertility, adoption and metaphorical pregnancies. Anthropologica 2014; 56: 463‐471.
Lockerbie S. Public Mothering: how celebrity mediascapes shape public understandings of
transnationally adopted families. Journal of the Motherhood Initiative for Research and Community
Involvement. Mothering and Reproduction Fall/Winter 2014; 5: 2.
Loewen A, Korngut L, Rimmer K, Damji O, Turin T, Hanly P. Limitations of split‐night polysomnography
for the diagnosis of nocturnal hypoventilation and titration of noninvasive positive pressure ventilation
in amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis Frontotemporal Degeneration Aug 2014;
15(7‐8): 494‐498.
Mann M, Exner D, Hemmelgarn B, Hanley D, Turin T, MacRae J. Ahmed S. VITAH trial: vitamin D
supplementation and cardiac autonomic tone in hemodialysis ‐ a blinded, randomized‐controlled trial.
BMC Nephrology Aug 2014; 15: 129.
Myhre D, Adamiak P, Pedersen J. Specialty resident perceptions of the impact of a distributed
education model on practice location intentions. Medical Teacher Dec 2014; 01: 1‐6.
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Oandasan I, Lawrence K, Authier L, Palacios M, Ross S, Archibald D, Plant H, McEwen L, Slade S. Giving
Curriculum planners an edge: using entrance surveys to design Family Medicine Education. Canadian
Family Physician Apr 2015; 61: e204‐210.
Ohsawa M, Okamura T, Ogasawara K, Ogawa A, Fujioka T, Tanno K, Yonekura Y, Omama S, Turin T, Itai K,
Ishibashi Y, Morino Y, Itoh T, Miyamatsu N, Onoda T, Kuribayashi T, Makita S, Yoshida Y, Nakamura M,
Tanaka F, Ohta M, Sakata K, Okayama A. Relative and absolute risks of all‐cause and cause‐specific
deaths attributable to atrial fibrillation in middle‐aged and elderly community dwellers. International
Journal of Cardiology Apr 2015; 184: 692‐698.
Onyura B, Legare F, Baker L, Reeves S, Rosenfield J, Kitto S, Hidges B, Silver I, Curran V, Armson H, Leslie
K. Affordances of knowledge translation in medical education: a qualitative exploration of empirical
knowledge use among medical educators. Academic Medicine Apr 2015; 90(4): 518‐24.
Ponka D, Dickinson J. Five things to know about; screening with the Pap test. Canadian Medical
Association Journal Dec 2014; 186(18).
Premji S on Behalf of the MiGHT Global Research Group (Amunga D, Asmai D, Dahinten S, Ghani F, Iqbal
S, Jehan I, Kanji Z, King A, Letourneau N, Mawji A, Mohamed A, Musana J, Naqvi H, Naugler C, Okoko C,
Rose M, Samia P, Shaikh K, Shazad R, Sulaiman S, Swai R, Wambua J, Wasim S). Perinatal distress in
women in low and middle‐income countries: allostatic load as a framework to examine the effect of
perinatal distress on preterm birth and infant health. Maternal and Child Health Journal Dec 2014;
18(10): 2393‐2407.
Prey Bd, Talavlikar R, Mangat R, Freiheit E, Drummond N. Induced abortion and contraception use among immigrant and Canadian‐born women in Calgary, Alberta. Canadian Family Physician Sep 2014; 60(9): e455‐63. Ramesh S, Holroyd‐Leduc J, Wilton S, Turin T, Sola D, Ahmed S. Testosterone is associated with the
cardiovascular autonomic response to a stressor in healthy men. Clinical and Experimental Hypertension
Apr 2015; 37(3): 184‐91.
Ratti J, Ross S, Stephenson K, Williamson T. Playing nice: improving the professional climate between physicians and midwives in the Calgary area. Journal of Obstetrics and Gynaecology of Canada Jul 2014; 36(7): 590‐7. Rumana N, Kita Y, Turin T, Nakamura Y, Takashima N, Ichikawa M, Sugihara H, Morita Y, Kawakami K,
Hirose K, Okayama A, Miura K, Ueshima H. Acute case fatality of stroke and acute myocardial infarction
and their trends in a Japanese population: Takashima stroke and AMI Registry, 1989‐2005. International
Journal of Stroke May 2014; 9(Suppl A100): 69‐75.
Samimi A, Ramesh S, Turin T, MacRae J, Sarna M, Reimer R, Hemmelgarn B, Sola D, Ahmed S. Serum
uric acid level, blood pressure and vascular angiotensin II‐responsiveness in healthy men and women.
Physiological Reports Dec 2014; 2(12): e12235.
Shaw M, Rypien C, Drummond N, Harasym P, Nixon L. Seniors’ perspectives on care: a case study of
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The Alex Seniors Health Clinic. BMC Research Notes Feb 2015; 8: 53. Sidhu D, Naugler C. Break the Fast? An update on patient preparation for cholesterol testing. Canadian
Family Physician Oct 2014; 60(10): 895 ‐ 897.
Skowronski D, Chambers C, Sabaiduc S, De Serres G, Dickinson J, Winter A, Drews S, Fonseca K, Charest
H, Gubbay J, Petric M, Krajden M, Kwindt T, Martineau C, Eshaghi A, Bastien N, Li Y. Interim estimates of
2014/15 vaccine effectiveness against influenza A (H3N2) from Canada’s Sentinel Physician Surveillance
Network European Surveillance Jan 2015; 20(4).
Thomas R. Are influenza‐associated morbidity and mortality estimates for those >65 in statistical
databases accurate, and an appropriate test of influenza vaccine effectiveness? Vaccine Nov 2014;
32(51): 6884‐6901.
Thomas R. Are cognitive interventions for Multiple Sclerosis effective and feasible? Restorative
Neurology and Neuroscience Nov 2014; 32: 623‐638.
Thomas R, Kreptul D. Systematic review of evidence‐based medicine tests for family physician
residents. Family Medicine Feb 2015; 47(2): 108.
Turin T, Kita Y, Rumana N. Acute‐onset atrial fibrillation and ambient air temperature: a linear or a non‐ linear association? Journal of Epidemiology and Global Health Feb 2015; 5(1): 99‐101. Turin T, Tonelli M, Manns B, James M, Jun M, Ravani P, Grasvenpoort R, Hemmelgarn B. Kidney function, albuminuria and life expectancy. Canadian Journal of Kidney Health Disease Dec 2014; 1: 33. Turin T, James M, Jun M, Tonelli M, Coresh J, Manns B, Hemmelgarn B. Short‐term change in eGFR and
risk of cardiovascular events. Journal of the American Heart Association Sep 2014; 3: e000997.
Virani A, Green T, Turin T. Understanding phantom limb pain: a nursing perspective. Nursing Standard
Sep 2014; 29(1): 44‐50.
Williamson T, Green M, Birtwhistle R, Khan S, Garies S, Wong S, Natarajan N, Manca D, Drummond N.
Validating the 8 CPCSSN case definitions for chronic disease surveillance in a primary care database of
electronic health records. Annals of Family Medicine Jul/Aug 2014; 12(4): 367‐372.
Woloschuk W, Myhre D, Jackson W, McLaughlin K, Wright B. How do graduates of longitudinal
integrated clerkship fare on the medical council of Canada qualifying exam part II? Creative Education
Nov 2014; 5: 1‐4.
PUBLICATIONSINPRESS Abdi‐Ali A, Mann M, Hemmelgarn B, Macrae J, Turin T, Benediktsson H, Sola D, Ahmed S. IgA nephropathy with early kidney disease is associated with increased arterial stiffness and renin‐angiotensin system activity. Journal of the Renin‐Angiotensin‐Aldosterone System. In press, 2014. Bell K, Del Mar C, Wright G, Dickinson J and Glasziou P. Prevalence of incidental prostate cancer:
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A systematic review of autopsy studies. International Journal of Cancer In press, Mar 2015. Bennett D, O'Flynn S, Kelly M. Peer assisted learning in the clinical setting: an activity systems analysis.
Advances in Health Science Education Theory Practice In press, 2015.
Kelly M, Bennett D, Muijtjens A, O’Flynn S, Dornan T. Can less be more? Comparison of an 8‐item
placement quality measure with the 50‐item Dundee Ready Educational Environment Measure
(DREEM). Advances in Health Science Education Theory Practice In press, 2015.
Naugler C, Snodgrass R. Response to Pap smear: Epidemiological approach and multifactorial individual
approach. Journal of Obstetrics and Gynaecology of Canada In press, 2015.
Naugler C, Lau C, Guo M, Viczko J. Fasting times in serum PSA assay ‐ author response. Asian Journal of
Andrology In press, 2015.
Naugler C, Thomas R, Turin T, Guo M, Vaska M. Yearly clinical laboratory test expenditures for different
medical specialties in a Canadian city. American Journal of Clinical Pathology In press, 2015.
Skowronski D, Chambers C, Sabaiduc S, De Serres G, Winter A, Dickinson J, Gubbay J, Fonseca K, Charest
H, Krajden M, Petric M, Mahmud S, Van Caeseele P, Bastien N, Eshaghi A, Li Y. Integrated sentinel
surveillance linking genetic, antigenic and epidemiologic monitoring of influenza vaccine‐virus
relatedness and effectiveness during the 2013‐2014 season. Journal of Infectious Disease In press, Mar
2015.
Zaman M, Choudhury S, Ahmed J, Hossain S, Sobhan S, Turin T. Prevalence of stroke in a rural
population of Bangladesh. Global Heart In press, 2015.
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PALLIATIVECAREGRANTSANDPUBLICATIONSGRANTS Abdul‐Razzak A (Co‐PI) et al. “Talk to me: A mixed methods study on patients’ views on physician
behaviours that influence the quality of advance care planning communication." 2012‐2014. $64,378.
Technology Evaluation in the Elderly Network (TECHVALUENET).
McBrien K (PI), Manns B (PI), Tonelli M (PI), Braun T (Co‐I) et al. "Describing the characteristics and
patterns of health care in people with high risk diabetes." 2013‐2014. $157,225. Canadian Institute for
Health Research.
Tonelli M (PI), Braun T (Co‐I) et al. "Epidemiology; costs and consequences of multimorbidity." 2012‐
2014. $320,750. Canadian Institute for Health Research.
Hemmelgarn B (PI), Tonnelli M (PI), Manns B (PI), Braun T (Collaborator) et al. "Implementation and
evaluation of a clinical pathway for chronic kidney disease in primary care." 2012‐2014. $524,421.
Canadian Institute for Health Research.
Chary S (PI), et al. "School Children and Their Understanding of “Major Change or Losses in Life” and
How They Communicate With Their Parents and Teachers to Improve Coping and Life Skills." 2015.
$25,000. Pallium Foundation of Canada.
Myers J, Downar J, Herx L (Co‐I) et al. “Developing and validating a set of entrustable professional
activities for palliative medicine: Phase One in designing a summative postgraduate learner
assessment.” 2012‐2014. $14,928. Department of Family & Community Medicine Educational
Development Fund Grant, University of Toronto.
Simon J (Co‐PI), et al. Improving decision‐making about goals of care for hospitalized, elderly patients: a
“multi‐incubator unit” study (iDECIDE). $70,980. Technology Evaluation in the Elderly Network
(TECHVALUENET).
Simon J (PI), Sinnarajah A (Collaborator) et al. "Division of Palliative Medicine Research Assistant
Support Funding". 2014‐2015. $ 47,000. Alberta Cancer Foundation.
Simon J (Co‐PI), Wasylenko E (Collaborator) et al. “Advance Care Planning and Goals of Care Alberta: A
Population Based Knowledge Translation Intervention Study” 2013‐2018. $2.5 million. Collaborative
Research and Innovation Opportunities, Alberta Innovates Health Solutions.
Davison S (PI), Fassbender K (PI), Sinnarajah A (Collaborator) et al. "Development, Implementation and
Evaluation of a Provincial Kidney Conservative Care Clinical Pathway". 2015‐2017, $750,000. Alberta
Innovates Health Solutions.
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Read Paul L (PI), Spice R (Co‐I), Sinnarajah A (Co‐I) e al. "Web‐Based Videoconferencing (WBVC) for Rural
Palliative Care Consultation in the Home". 2015. $20,000. Technology Evaluation in the Elderly Network
(TECHVALUENET).
Kadaroo R, Clement F, Holroyd‐Leduc J, Padwal R, Wagg A, Sinnarajah A (Collaborator), et al.
“Optimizing Seniors Surgical Care ‐ The Elder Friendly Surgical Unit”. 2013‐2016. $739,388. Alberta
Innovates Health Solutions.
PUBLICATIONSAbdul‐Razzak A, You J, Sherifali D, Simon J, Brazil K. “Conditional candour” and “knowing me:” an
interpretive description study on patient preferences for physician behaviours during end‐of‐life
communication. BMJ Open 2014; 4:e005653. doi:10.1136/bmjopen‐2014‐005653
Abdul‐Razzak A, You J, Sherifali D, Simon J, Brazil K. Patient Preferences for Physician’s End‐of‐Life
Communication Behaviours. J Palliat Care 30(3) Abstr.F12‐B. 2014
Abdul‐Razzak A, Murray A, Sinnarajah A, Galloway L. Pulsed radiofrequency neuromodulation for
cancer pain. Poster proceedings International Congress on Palliative Care. Montreal. September 2014.
Kelly E, Ivers N, Zawi R, Barnieh L, Manns B, Lorenzetti LD, Nicholas D, Tonelli M, Hemmelgarn B,
Lewanczuk R, Edwards Al, Braun T, McBrien AK. Patient navigators for people with chronic disease:
protocol for a systematic review and meta‐analysis. Systematic Reviews 2015, 4:28.
Weaver RG, Manns BJ, Tonelli M, Sanmartin C, Campbell DJT, Ronksley PE, Lewanczuk R, Braun TC,
Hennessy D, Hemmelgarm B. Access to Primary Care and Other Health Care Use Among Western
Canadians with Chronic Conditions: a population‐base survey. CMAJ Open March 7, 2014 vol. 2 no. 1.
Dharmawardene M, Givens J, Wachholtz A, Makowski S, Tjia J. A systematic review and meta‐analysis of
meditative interventions for informal caregivers and health professionals. BMJ Support Palliat Care 2015
Mar 26. [Epub ahead of print]
Okoroh JS, Chia V, Oliver EA, Dharmawardene M, Riviello R. Health Systems of Developing Countries:
Inclusion of Surgery in Universal Health Coverage. World J Surg. 2015 Mar 24. [Epub ahead of print]
Bush SH, Bruera E, Lawlor PG, Kanji S, Davis DH, Agar M, Wright DK, Hartwick M, Currow DC, Gagnon B,
Simon J, Pereira JL. Clinical practice guidelines for delirium management: potential application in
palliative care. J Pain Symptom Manage. (2014) 48(2):249‐58. doi: 10.1016/j.jpainsymman.2013.09.023.
Epub 2014 Apr 21.
Sweet L, Adamis D, Meagher DJ, Davis D, Currow DC, Bush SH, Barnes C, Hartwick M, Agar M, Simon J,
Breitbart W, MacDonald N, Lawlor PG. Ethical challenges and solutions regarding delirium studies in
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palliative care. J Pain Symptom Manage. (2014) 48(2):259‐71. doi: 10.1016/j.jpainsymman.2013.07.017.
Epub 2013 Dec 31.
Green T, Gandhi S, Kleissen T, Simon J, Raffin‐Bouchal S, Ryckborst K. Advance care planning in stroke:
influence of time on engagement in the process. Dovepress (2014) Volume 2014:8 Pages 119 – 126 DOI:
http://dx.doi.org/10.2147/PPA.S54822
Hill MD, Chen S, Simon JE. There is Always Something We Can Do—Palliative and End‐of‐Life Care in
Stroke. Available in: American Heart Association Learning Library.
http://my.americanheart.org/professional/ScienceNews/There‐is‐Always‐Something‐We‐Can‐Do‐‐‐‐
Palliative‐and‐End‐of‐Life‐Care‐in‐Stroke_UCM_461984_Article.jsp. Posted March 27, 2014.
Simon J, Wasylenko E, Barwich D. Beyond resuscitate and do‐not‐resuscitate. CMAJ. 2014 Dec 9;
186(18):1398. doi: 10.1503/cmaj.114‐0092.
Simon J. Why physician‐assisted death? CMAJ. 2014 Jul 8; 186(10):778. doi: 10.1503/cmaj.114‐0047
Simon J. Rights may conflict with assisted‐dying ruling by Laura Eggertson Feb 9 2015
DOI:10.1503/cmaj.109‐4994
Simon J, Labrie M. Improve dying process rather than allow suicide by doctor. Calgary Herald. June 20
2014. http://www.calgaryherald.com/opinion/op‐
ed/Labrie%20Simon%20Improve%20dying%20process%20rather%20than%20allow%20suicide%20docto
r/9960088/story.html
Simon J (quoted). http://healthydebate.ca/2014/08/topic/euthanasia‐assisted‐death.
Grendarova P, Sinnarajah A, Trotter T, Card C, Wu JS. Variations in intensity of end‐of‐life cancer
therapy by cancer type at a Canadian tertiary cancer centre between 2003 and 2010. Support Care
Cancer. Impact Factor 2.597. doi: 10.1007/s00520‐015‐2676‐y
Department of Family Medicine - CalgarySheldon M. Chumir Health Centre
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