Holland Musculoskeletal prograM teaM

Welcome to the tenth edition of the Holland Musculoskeletal Team News.

Every few months, you’ ll find updates on clinical services, education

and staff activities.

We welcome your suggestions for content and your articles for future issues.

Please send any ideas and/or submissions to marie.sanderson@sunnybrook.ca

or call 416.967.8554

newsTenth Edition, Winter 2010

partnering for patientsSunnybrook and Providence work together to ensure best post-operative rehabilitation for hip fracture patients

Providence Healthcare is one of several rehabilitation

organizations that Sunnybrook is exploring partnerships

with to ensure patients receive the best possible care

after they’re discharged. Led by a team of staff from

the Orthopaedic and Neurosurgical Unit (D5) at the

Bayview Campus, the relationship began with the goal

of dev eloping a new care pathway for patients who have

experienced a hip fracture while living in the community.

The goal of this new model of care is to ensure that

Sunnybrook’s patients have a successful return to

their pre-fracture living situation. Staff first met with

Providence representatives in September 2009 during

a site visit and tour of D5. Now the Clinical Leader

of Providence’s Patient Flow Department has been

attending D5’s weekly rounds and reviewing patients

who are ready, or close to being ready, for transfer to a

rehabilitation facility.

This “pull strategy” helps to identify patients who

are good candidates for Providence’s rehabilitation

program for hip fracture patients which includes medical

management, strengthening, mobility, activities of

daily living and assistive device training. Patients were

consulted through the process as active players in their

care and were impressed by the coordination of post-

operative rehabilitation services between Sunnybrook

and Providence.

“This new partnership is a good fit for everyone,

especially our patients who receive top-notch geriatric

rehabilitation services in a timely manner at Providence,”

says Gerry Hubble, Patient Care Manager for D5. “By

pre-identifying the patients, we assist in helping to get

them transferred quickly and efficiently so that they can

begin their rehabilitation journey. We’re in the process

of exploring closer partnerships with other rehabilitation

organizations, including St. John’s Rehabilitation

Hospital and Bridgepoint Health Centre.”

This new strategy will be assessed after three months

to see if there has been a decrease in length of stay for

Sunnybrook’s hip fracture population and an increase

in transfers to Providence.

Winter 2010 Holland Musculoskeletal Program Team News2

A patient survey, compiled from February to

June 2009 in the post-operative follow-up

clinics shows that patients at the Holland Centre

are very satisfied with both the surgeon-led

and the Advanced Practice Physiotherapist-led

clinics. Among the 750 patient surveys that were

analyzed, 88 per cent indicated that they had

no further suggestions for improving the care

and services in the outpatient clinics. Qualitative

feedback on the survey reflected positively

on the reduced wait times for appointments,

pleasant and professional care and attention

to answering patients’ questions. Patient

satisfaction is an integral component of ongoing

evaluation of Sunnybrook’s Hip and Knee

Arthritis Program model of care.

ontario Hip Fracture care: removing access Barriers to return people Home

On January 22, 2010, Holland Musculoskeletal

Program leaders participated in a forum hosted

by the Ministry of Health and Long Term Care’s

Orthopaedic Expert Panel and Bone & Joint

Health Network. The invitation-only event was

developed in conjunction with the Canadian

Orthopaedic Care Strategy Group, the Canadian

Orthopaedic Association and the Canadian

Orthopaedic Foundation’s ‘Because You Can

Program’. Healthcare leaders from across

Ontario were invited to address barriers and

develop solutions to improve care for patients

following a hip fracture.

Two of the key benchmarks for the project are

reducing the time to surgery for hip fracture

patients and reducing length of stay in an acute

care setting. Sunnybrook recently implemented

a new practice of escalating the urgency of

these patients if they have been waiting for

surgery for more than 24 hours, and has been

working closely with rehabilitation partners,

like Providence Healthcare, to promote early

transfer of these patients to an appropriate

rehabilitation setting. In the third quarter of

2009/10, 92 per cent of patients had surgery

within 48 hours (previously 74 per cent in 08/09)

and the average acute care length of stay was

14.80 days (previously 19.3 days in 08/09).

working condition program presents at Best practices day 2010A group from the Working Condition Program

presented a poster titled “The Relationship

Between Fear Avoidance Beliefs and Disability

in Work-Related Injuries” at the GTA Rehab

Network’s annual Best Practices Day. Held

on March 1, 2010, the event brought together

clinicians, researchers and administrators from

across the rehabilitation sector to hear the latest

developments in research and practice.

The authors of the research study, Taucha

Inrig, Bev Amey, Dorcus Beaton and Cheryl

Borthwick, administered the “Fear Avoidance

Beliefs Questionnaire” to a group of injured

workers in the Workplace Safety and Insurance

Board (WSIB) Shoulder and Elbow Specialty

Clinics. Their goal was to see if specific fear

avoidance beliefs about physical activity and

work could be identified. As experienced

clinicians, the group had seen these beliefs

demonstrated among workers in the past. If

a questionnaire could be validated for use in

the clinics, these workers could possibly be

referred to other treatment, such as cognitive

behaviour therapy, so that the cycle of chronic

pain might be avoided.

The group learned that there was a so-called

“high ceiling effect” in the statistical analysis as

most of the questions, centered around work

causing pain, compelled the workers to answer

with “completely agree.” The group concluded

that the questionnaire was perhaps more of a

measure of WSIB claim status versus true pain

behaviours.

patient satisfaction High with post-operative Holland centre clinics

Advanced Practice Physiotherapy role receives high scores from patients

Advanced Practice Physiotherapist Shahiroz

Juma explains the results of an x-ray with

Holland Centre patient Jeannette Mercer.

Photo by Geoff George.

Holland Musculoskeletal Program Team News Winter 2010 3

Sunnybrook’s Night of Stars, to be held on May 17, 2010 at the Princess

of Wales Theatre, will be showcasing a stellar lineup of Canadian talent.

Tickets are available, starting at just $49 for staff, and all proceeds go

to Sunnybrook’s Holland Centre.

Canada’s best in music, comedy and dance are donating their time

to the event, including pianist and artistic director of the Art of Time

Ensemble Andrew Burashko; Cirque de Soleil choreographer Debra

Brown; stars of the upcoming production Rock of Ages Yvan Pedneault

and Elicia Mackenzie, known for her role as Maria in The Sound of

Music; Canadian Idol Eva Avila; comedians Jessica Holmes and Ron

James; Glass Tiger front man Alan Frew; The National Ballet of Canada’s

Sonia Rodriguez, Aleksander Antonijevic and Karen Kain and classical

violinist James Ehnes.

Ross Petty will produce the show which will raise money for

redevelopment of the Holland Centre and will allow Sunnybrook to

continue to provide the exceptional hip and knee care for which the

hospital is renowned.

“We are thrilled that such amazing Canadian talent have thrown their

support behind Sunnybrook’s Holland Centre,” says Marilyn Wright,

co-chair, Night of Stars and member of the Holland Musculoskeletal

Program Campaign Cabinet. “The Holland Centre is Canada’s largest

centre for joint replacement surgery, where the most severe cases are

treated using techniques developed by our own specialists.”

Ticket prices start at $49 and can be purchased online at

nightofstars.ca or by calling 416.967.8628.

Fast-tracking patients after surgery could lead to Improved efficiency

Pilot study develops new criteria for discharge from the post anesthesia care unit

A pilot study at the Holland Centre has

developed new criteria to help safely fast-track

patients through the post anesthesia care unit

(PACU) to a step-down unit or the ward.

The Holland Centre’s PACU provides care for

patients recovering from general and regional

anesthesia. Staff in the unit monitor patients’

vital signs, manage post-operative pain, treat

symptoms of postoperative nausea and vomiting

and monitor surgical sites for excessive bleeding,

discharge, swelling and redness.

The new study, led by Dr. Imad Awad, a staff

anesthesiologist at Sunnybrook, modifies the

commonly used Aldrete scoring system, which

helps determine when patients can be safely

discharged from the PACU. The Aldrete scoring

system looks at consciousness, respiration,

motor function, as well as pain, nausea and

vomiting to determine when a patient is ready

to be moved. Dr. Awad noted that there

were no well-defined criteria to discharge

patients having intrathecal anesthesia from the

PACU. Intrathecal anesthesia is a local spinal

anesthetic that is commonly paired with regional

anesthesia for the 2200 total joint replacements

at the Holland Centre last year.

Dr. Awad and his colleagues modified the

scoring system to include measures related

to spinal anesthesia that PACU nurses can

use to monitor before a patient’s discharge

to the ward. The results showed that the

new modifications work very well, improving

efficiency by expediting patients’ discharge

from PACU while at the same time ensuring

patient safety.

As this was a pilot study, next steps include

testing and validating the modified scoring

system in other centres and clinical settings to

ensure it can be applied outside the Holland

Centre clinical environment.

canada’s Best in Music, dance and comedy support sunnybrook’s night of stars

Great tickets for May 17 event available at nightofstars.ca

Members of The National Ballet of Canada

dazzle at the 2007 Night of Stars event.

Winter 2010 Holland Musculoskeletal Program Team News4

Sunnybrook is pleased to be lending a hand to

‘Caring Crutches’, a program that is donating

new and used crutches and canes to Haitian

amputees. With a goal of rounding up 500

crutches and/or canes, Sunnybrook is one of

several GTA hospitals participating. If you have

walking aids that you would like to donate, there

are two drop-off locations, both at the Holland

Centre, one in the main lobby and another in

the Rehabilitation Department in the basement.

For more information on the project,

please contact Lindsay D’Andrade

or Val Jenner at caringcrutches@live.com.

remembering dr. robert Jackson

Dr. Robert Jackson, pictured

at the 50th anniversary celebration of the

Orthopaedic and Arthritic Hospital in 2007.

Photo by Doug Nicholson.

M e m b e r s o f S u n n y b r o o k ’ s H o l l a n d

Musculoskeletal Program were saddened to

learn of the passing of Dr. Robert Jackson on

January 6, 2010. As Chief of Staff and Surgery

at the Orthopaedic and Arthritic Hospital from

1985 to 1991, Dr. Jackson touched many of the

staff working at the site. “He was so influential

and such a caring man,” says Dr. Veronica

Wadey, orthopaedic surgeon at the Holland

Centre, who first met Dr. Jackson in 1976 when

she was a 15-year-old volunteer at the Toronto

Paralympics.

Dr. Jackson is known for his role in bringing

arthroscopy for knee surgery and other joints

to Canada after a study trip to Japan. The

technique greatly reduced the time needed for

a patient to heal. Dr. Jackson began teaching

the procedure to both Canadian physicians

and to those from abroad. In 1994, Sports

Illustrated recognized the “particular genius”

of Dr. Jackson by honouring him as one of the

40 individuals who have dramatically changed

the games we play, as a result of bringing the

“miracle of arthroscopy” to sports medicine.

Dr. Jackson a lso founded the Canadian

Wheelchair Sports Association of Canada in 1967,

the precursor for the creation of the Canadian

Paralymic Committee. Over his lifetime, awards

received included the Order of Canada, the

Olympic Order, the Paralymic Order and induction

into the Hall of Fame of the American Orthopaedic

Society for Sports Medicine.

caring crutches: sunnybrook Helps Haiti Move Forward, one step at a time

pharmacy kiosk provides convenient option for picking up post-surgery

Medication Sunnybrook’s commitment to innovation was

recently showcased by the launch of a new

PharmaTrust MedCentre kiosk in the main lobby

of the Holland Centre on February 23, 2010. The

Holland Centre performs 2200 hip and knee

replacements each year and pain management

is a key factor in helping to restore quality of

life and mobility. The convenient location of the

kiosk, centrally located in the hospital’s main

lobby, will make it easier for patients to pick up

their medication before they leave the hospital.

The kiosk offers a live two-way video link with

a pharmacist who guides patients through the

dispensing process, counsels on the medication

and answers any questions. Each step of the

medication dispense is completely controlled

by the pharmacist to ensure patient safety and

personal information is secure and protected.

Only the patient can hear the pharmacist

over the phone and the technology enables

patients to speak quietly and privately with the

pharmacist.

Since the summer of 2008, Sunnybrook has

taken the lead role in assessing this medication

dispensing system, with a similar kiosk for

patients at the Bayview Avenue campus.

Holland Centre patients now have access

to a PharmaTrust MedCentre kiosk,

a telepharmacy that dispenses prescription

drugs, in the main lobby of the hospital.

PharmaTrust pharmacist Sunny Lalli

speaks with Sabina Dizdar, pharmacist

at the company’s call-centre.

Photo by Doug Nicholson.