Standardized Nursing Care Plan

♪♪♪ (patti cochrane)hello and welcome to "talk trillium:partnering for patients." my name is patti cochrane,senior vice president, clinical strategy,and chief innovation officer at trillium health partners, and we have three locations:the credit valley hospital, mississauga hospital,and the queensway health centre. i'll be your host as wetalk about how trillium

is working to createa new kind of healthcare for a healthier community. and today's show is reallyfeaturing patient-centred care, and i am really pleased towelcome my two guests this morning, dr. dante morra. he is the chief of medical staffat trillium. welcome, dante. and kathryn hayward-murray. she's the senior vice-president,patient services,

and the chief nursing executiveat trillium. (kathryn hayward-murray)morning, patti. (patti cochrane)morning, kathryn. so my first question,what is patient-centred care and why is it so importantfor hospitals? (kathryn hayward-murray)patient-centred care isan approach that we use in the hospital. it really is workingwith the patient, partnering with the patient,

so we can really determinewhat matters most to the individual patient andstrive to work towards meeting those needs and goals thatthe patient shares with us. (patti cochrane)and from your perspective,dante? (dante morra)well, just to build onkathryn's point. i think, as providers, whenwe're going to see a patient, there's a lot of thingson our mind, and there's a lot of thingsgoing on in the organization. and for me, the first key pointof patient-centred care

is actually the presence. it's actually being in thatmoment with the patient and being there completelywith them. and i think most people knowwhen you're with them completely in mindand when you're not. and you have that sense whetheryou're at a cocktail party or you're sitting insomeone's office. so i think it's actually havingthat moment of presence with the patient.

but i think there's somethingelse, building on what kathryn was saying, around havingthe care around that patient. so there's times you'retalking to a patient and in your mindyou're thinking, "oh, they have this condition. i need to get them on thismedication." so in your mind you havesomething that you want to have them do or a test or get themon a treatment. but you actually have to see itfrom their point of view

so they might be--have a whole other issue. they might have an issueof paying for that medication or they might be worriedabout one of their children or their parent. and so it's really reframing itso that you're thinking about the patient and makingsure that you're dealing with what's most importantfor that patient in that moment and being presentin that moment. (patti cochrane)so there are many people thatwork within the organization,

and teamwork is really importantin an organization, so what doesinterprofessional team care-- how do we get everyoneto center around the patient? (kathryn hayward-murray)so we have a great cadreof team members. we have physiotherapists,occupational therapists, physicians and nurses,obviously, our pharmacists. and each one of those folksbrings a specific expertise to what we call the circle of careand who's providing care with that patient.

and so that teamworking together, communicating with each other,understanding, again back to what dante was sayingaround what matters most to that particular patient,and really coming up with a plan of care that's goingto meet those needs. and looking at it from the lensof their specific profession and their specificknowledge base but putting that all togetheris really what's going to make that comprehensiveplan for the patient.

(patti cochrane)so there arehow many employees at trillium health partner--8,000 people, i think, that have encounterswith patients each and every year--every day. how do you make sure thateveryone is standardizing and being patient-centred? (dante morra)well, i think when you thinkabout trillium health partners which is such a large entitywithin the community, almost-- it's almost, close withphysicians and everyone,

about 10,000 people,there's a couple of things. there's--is first is buildingon that team-- this concept that kathrynwas talking about. you know, we've talked aboutchronic disease on this program before and what's happening is,is most patients who are coming to the hospital have multipledifferent conditions, so it's not just they're comingin with one condition. they might have heart diseaseand cancer at the same time, or mental illness.

and so one key part of it isactually understanding that team. that team of professionalsand wrapping that team around the patient. and making surethey're communicating and communicatingin a single voice and also helping withtransitions as they go out into--see their familydoctors or their nurse practitioners in the community.

so one key part of that isactually organising the hospital and designing it in such a waythat it can actually deal with multipledifferent diseases. i think another key piece andthis is something that i know kathrynand myself and our ceo, michelle diemanuele,are very passionate about, is really making surethat the entire organization has a customer servicebent to it. and, you know, our patientsand their families,

they're our clients coming inand that is having programs where the whole organizationis dedicated to ensuring they are presentin that moment and they're providingthe highest level of service despite all the thingsgoing on in the organization, all the tensions and allthe things that pull us away from that moment. and there's a whole bunchof different programs that we're rolling out justto ensure that high level

of service and that culture is-- exists and it does existbut also promoting that culture. (patti cochrane)so standardizing yourapproach, in a way. (kathryn hayward-murray)one of the things that wewant to move more towards and, historically,you know, when you think of the evolutionof the way we've provided care, the professionals haveworked as a team, but they've worked awayfrom the patient and they've had that communicationaway from the patient,

communicating with each otherbut not communicating at the same timewith the patient. so we're moving towardsthat place where we're having our communication,our conversations, with the patient,at the same time, so we're all involved,hearing what those needs are, and working with eachother to achieve those. (patti cochrane)and can you give usan example of how you engage withpatients directly.

(kathryn hayward-murray)so one of the thingsthat we're working towards is having conversationswith the patient, with the team,at the same time. so, for example, rounds. so where the patientwould be part of the team when they're discussingwhat the care is going to look likefor that patient for the day, and we're having thatconversation at the bedside, so the team isn'tbehind closed doors

having a conversationand then coming out and talking with the patient, or one member of the team comingto meet with the patient. it's the entire teamat the same time. another thing that we've--that we're working towards is having someinteractive type of tools to cue the patient aroundsome of the important elements of their care. so many of our locationsin the hospital

now have whiteboardsthat sit at the foot of the bed. and we actively use thosewhiteboards on a daily basis to make sure thatthe patient knows the name of their team members, knows what is the date thatwe're striving to discharge the patient so the family can beinvolved in preparing for what that discharge is going to looklike or perhaps some key tests that are going to happenthat particular day. so that it's all there visually

so that the patientcan see that. (patti cochrane)great communication tool. (kathryn hayward-murray)yeah. (dante morra)i think one of the otherthings that the organization is doing is havingpatient advisory councils. and also having-- inviting patients intothe decision-making in the organizationand just-- we have a quarterly retreat

where the senior teamcomes around, and we look at all our metrics and howthe organization's doing. and just last week atour quarterly retreat, we had a patientthere with us, john mckenna, who was there,and it's very powerful having patients aroundthose decision-making bodies. and so i think one of the thingsthat we try and do at trillium health partnersis live the values

from the front lineall the way out. so that's everything fromhaving those patients, as kathryn was saying,in those clinical moments and having themas part of the team and discussing itright into the places where decisions are being made, and i think that'sincredibly important in creating a patient-designedculture in the organization. (patti cochrane)wow, that's great example.

so, right from the bedside all the way up to keydecision-making tables. (kathryn hayward-murray)correct. i mean, there's a numberof our committees as well that we've startedto have patients sitting at the table with usso that when we're having our dialoguesaround how we're managing care and what we're providing, they're able to influenceour conversation.

so, for example,we have a patient, very active patienton our quality committee who just recently said,"you know, "you're talking a lotabout inpatient care "but really not as muchabout outpatient care "and you provideso much outpatient care. "maybe your conversationneeds to shift a little bit "so that you're talkingabout quality of care for your outpatients."

so that was a great observationthat he made for us. so, again, influencedthen the amount of time that we were spending on those two particularpatient populations. (patti cochrane)and kathryn, can yougive us an example of what we might have doneto improve patient-centred caresince the merger? (kathryn hayward-murray)one of the things,as you know, patti, i've been on the showbefore and spoken

about the best practicespotlight organization and the work thatwe're doing there, and so by bringingour teams together across sites, we have been able to, as we were talkingabout before, standardize care whichis really important. so, for example, in ourbpg work around pain, we've been able to take ona common pain assessment so that when patientscome to us,

they're experiencing pain,we have a common way in which we assess that painand then go forward and treat that pain. another example would beour breastfeeding work that we've done and the waythat we now provide breastfeeding educationright from the prenatal period right through to postnatal and the importanceof those partnerships. the patients haveinfluenced that.

it's the patientswho have told us that. and because we're nowone organization, we've been ableto standardize that approach for all of our patients,regardless of what site that they come to. (patti cochrane)great. and dante, you mentionedpartnerships before, partnerships that take usoutside the organization. can you give us a few examples?

(dante morra)absolutely. and i think you'regoing to be-- have some guests on, talkingabout patient-centred design and this is--if you think about patient-centred carebeing in the moment and having those providersin the teams in the moment. patient-centred design isactually designing an organization and a serviceline around patients. so it's not just aboutour providers working

within a system. it's actually designing a systemthat actually wraps so just one example aroundthat is we know patients who have a lotof chronic disease and are in the hospital, when they leave the hospital,their care isn't done there. it's not that they leave andthen they're completely fixed and then they goto their family doctor and they're completelyback to normal.

they require a lot of supportwithin the community and with the ccac and homecare. so our seamlesstransitions project, which what that did is,the team, the interprofessional team, also include ourcase managers from the ccac, or homecare,so what your-- what's happening is,is while you're taking care of that patientand you're coming up

with a care plan for them,not only do you have your pharmacists and your nurseand your doctor and your allied healthteam there, you actually have the personwho's going to be taking care of themin the community and coordinating their care. so when you're makingthose decisions, that transition as theyleave the hospital, we're actually designinga system that follows them

through when they leave. and that's really,really important, because what happens is therecan be a big voltage drop of care as you goto the community. and that's when you seepeople having difficulty with taking their medications,or they don't translate. so that's one exampleof actually having our organizationdesign a system of care around a group of patientsand helping them transition.

(patti cochrane)and when we think about it,patients stay in hospital on average maybe 5 days,and you know, they'd lived theirentire life out in the community so what we do to bridgein the community is so importantfor their health. (kathryn hayward-murray)and involving the family. and that, you know,that's one of the steps that we want to take aswell is recognizing, as you say, that the timethat they're in the hospital

is so small in comparison tothe care that their family's going to be providing for themand supporting them. so, involving the family in allof these elements that dante was talking about isreally important too. (patti cochrane)and so do you--what do you see in the futurefor patient-centred care? have we finished our work?are we done? or is there more workto be done? (kathryn hayward-murray)always more workto be done, patti.

- always.- always. (kathryn hayward-murray)i mean,as our patients change and we have theirvoice at the table, either through councilsor committees or at the time of their care,is truly as a team listening to what they have to say, it's inevitable thatwe'll have to change and we'll have to be nimbleto meet those needs. and also as we change the waywe care for patients

and our different testsand treatments that we provide, we have to continuouslybe meeting those needs. (patti cochrane)and can you speaka little bit about a 7-day-a-week hospital? what's the concept behind that? (dante morra)so when you think about howsome organizations work, you have this fixedinfrastructure of the hospital and all the ors and all the bedsand everything there. and often most organizations,

there's peoplein the hospital 24/7, but you're really running youroperations monday to friday. and that's not how peoplepresent to hospital, so people don't chooseto get sick and come in on monday to fridayat a certain time. they come in during the night,they come in on the weekend. and within the concept ofpatient-centred design, what we're looking for isthat when you come in to the hospital, even if it's3 in the morning on saturday,

that you're gettingthe same suite of services to take care of you, and we're workingvery hard on that. and that's everything fromhaving your radiology there and having all yourtechnology to having the right expertise. because, really, what we wantto do is as soon as somebody is sick, that they get the bestpossible treatment right away and it's organized for them.

and that's going to extendinto the community as well. and i think, as kathryn wastalking about, you know, we're--i think we're just inthe very early stages of patient-centred designand patient-centred care and having a system that reallyis designed around patients and also their communityand their family members. because we know family membersprovide a lot of care as well, particularly to people withchronic disease. so i think we're really excitedabout this journey.

we're trying to live itfrom the bedside right through the organization. it can be challenging at timesbecause there's tensions between the needsof providers and patients, but we're working very hardto design full systems for patients that can behighly reliable and provideoutstanding service. (patti cochrane)makes so much sense. so i just want to saythank you so much

for joining me on the show. you are the two senior leadersleading the clinical practice at the organization. such a privilege to hearwhat you're thinking about, both today and for the future. so thanks for joining us. - thank you so much, patti.- thank you, patti. (patti cochrane)thanks. (patti cochrane)welcome back

we've been talkingabout the importance of patient-centred designat trillium health partners. and i'm pleased to welcomechristine dias. christine is a clinical nursespecialist looking after seniors in our emergency department. so first, christine, tell usa little bit about yourself and what you do at trillium. (christine dias)so i'm a nurse,and i've been a nurse for about 13 years.

i started my careeractually at trillium. and i've had the experienceof working in the oncology department,rehab, and most of my careerhas been spent in the emergency department,and now most recently i'm working asthe clinical nurse specialist for geriatricsat the mississauga hospital for trillium. (patti cochrane)is there a particular reasonwhy you wanted to be a nurse?

(christine dias)it's actuallyquite interesting. i never knew i wanted to workin healthcare growing up. i never knew reallywhat i wanted to do. i knew i loved workingwith people, helping people,and things like that. but i always--i likedscience as well so i was always kind oftold to go into things like engineering or accountingor things like that, so i remembersitting down with my mom

in my final year of high school and we were going throughall the brochures of all the different programsoffered at various universities and i turned the page and therewas a picture of this nurse and she was holdinga baby. and i looked up at my momand i said, "that's what i want to do.i want to be a nurse." because i loved howit incorporated, you know, science and critical thinkingand things like that,

but then you gotto care for people and really help people,which was exactly what i wanted to do. (patti cochrane)it is a wonderful profession. i'm a nurse as well,and it's been great for me. (christine dias)it's wonderful. been very happywith my decision, so. (patti cochrane)and despite starting witha picture of a baby in arms, you now focus on seniorsand the emergency department.

(christine dias)yeah, absolutely.and i love working with seniors. i find--my first job,actually, in healthcare while i was going throughnursing school was working as a healthcare aide ina long-term care home. and i just lovedthe relationships that i formed withall the residents and hearing their stories and they were justso fascinating and i just--any waythat i could help

in their final years of life,it was just-- it was so rewarding for me, and so that's why i pickedto go into geriatrics. i just thought it wassuch a reward-- it was so rewarding for myself and how it can helpthe patients, i think was quite impactful, so. (patti cochrane)so you developed a programcalled "eat in the seat," christine.

tell us a little bitabout that program. (christine dias)so what i wanted to do is seehow we could get seniors up and moving, so i thoughtwhy not optimize meal time and get them up in a chairthree times a day instead of staying in theirstretcher all day, essentially. and the idea came fromthe fact that, as i said, i used to work in rehab, and i think when i firststarted in rehab, i was a little shocked aboutthe population that was there.

i think i used to think it wasmore strokes or, you know, orthopedic, hip replacementsor knee replacements, things like that. and then what i realizedwas that it's actually a lot of peoplewho actually got deconditioned fromtheir hospital stay, so they got weakerthroughout their hospital stay and needed some timeto get better before they can go hometo get stronger.

and so i thought, "how can westop this from happening?" so what i did is wheni started in this role, i looked aroundthe emergency department to see what was happeningand what was causing this, and i realized thateveryone was in bed. the people really weren'tgetting up and moving. and so i wanted to really seehow we could change that. so i thought of why don't wetry to get people up and moving right fromthe start of their hospital stay

and see if that helps. (patti cochrane)it's very important, and sometimes patientsstay longer in the emergency departmentwhile they're waiting for a bed. that's still important for themto keep moving. (christine dias)right, exactly. well, people startto decondition very quickly. your muscles can startto get quite weak if you don't use them withineven 24 hours, i've seen it.

so just starting right awayfrom day one of their hospital admissionto move and get up and try to keep as activeas possible in hospital. (patti cochrane)and for other patients maybewho cannot get out of bed, are there special exercisesthat they can do, and how important is itfor them to do that? (christine dias)absolutely. we try to do exerciseswith our patients. we have a program calledthe hospital elder life program

actually inthe emergency department, and it's wheretrained volunteers will come and help our patientsdo some exercises in bed. so anything that is--anythingthat we can do to keep moving is important, absolutely. (patti cochrane)so who's involved in yourprogram, eat and seat? (christine dias)well, definitely the nurses. they're the ones that do the vast majorityof the work there,

and they get all the patientsup and moving. and we--they can get help. we have different resourceswithin our emergency department. we have personal support worker. we have ouremergency attendants and definitelyour physiotherapist. and they can all helpwith getting patients up. but definitely, the nursesare the ones that do it the most, so.

(patti cochrane)what--how do patientsfeel about getting up in a seat for a meal? (christine dias)well, yeah, i definitelyreceive great feedback. i mean, the stretchersare not made for patients to be lying on for longperiods of time. they're not necessarilythe most comfortable, especially if you're made to lieon them for a day or so. so the feedback that i get,immediately when i put a patient into a chair is, "oh,this feels so much better.

i'm so much more comfortable." and so it's greatto see that right away. they feel more alive,they feel more independent, and it makes them justfeel better psychologically, i think, for sure. (patti cochrane)so you mentioned beforethat patients can decondition when they stay in bedfor a long period of time. and what that really meansis they get very weak and it's hard forthem to be able to get back

to their normal routineafter hospital, so it's important for themto stay moving. what other complicationsother than deconditioning does activity preventwhile they're in hospital? (christine dias)well, i mean our bodiesaren't meant to be immobile. we're not made to just layaround and do nothing. and it affects multiple systems,your respiratory system, your cardiac system. i mean, you get more refluxif you're eating, you know,

not seated up,not sitting up in bed. things like constipation, things with yourrespiratory system. psychologically,there's something called learned helplessnesswhere, you know, you're just relyingon people to do things for you a lot when you're in hospitaland you don't know that you can get upand do things yourself. and so you kind of startgetting used to that,

and unfortunately,once you lose that, it takes a lot longer to gainit back, that independence. (patti cochrane)and for our audience at home,do you have any advice for seniors that areat home about activity? (christine dias)well, i think you just needto try to do as much as you can do. if you're the type of seniorwho's very active and you can go to the gymevery day, you do that. if you could walk aroundthe block every day,

then that's what you do. if what you're able to dois walk to the kitchen for your meals three timesa day, you do that. and if you're bedridden,even just doing, as you were mentioning before,bed exercises. anything that you can do to tryto stay as active as possible and maintainthe level of function that you currently haveis definitely the most important thing.

(patti cochrane)and even for all of us, i think there's new research outthat indicates that sitting is one of the enemiesactually for fitness, that people who sit too longactually have poorer outcomes. and so we're all encouragedto even think about get movingand standing, and so it's suchan important message for everybody out there. (christine dias)keep moving.

(patti cochrane)yes. and meal-times seem to beparticularly important for seniors. is there a reason for that,quickly? (christine dias)well, the canadianmalnutrition task force says about 45% of admitted patientsare actually malnourished. and so anything that we can doto try to increase the amount of food that they eat and reallyimprove their nutrition, it ends up helpingin the long run

with outcomesand you improve-- your health can improve fasterwhen you're ill if you eat better. so we've heard that simpleactivities such as sitting up in a chair and walking aroundas much as possible and ensuring you getgood nutrition is very helpful. (christine dias)absolutely, yes. (patti cochrane)well, thank you for joiningus today, christine. (christine dias)thank you very much, patti.

we've been talking aboutpatient-centred design, and it's my pleasure to welcomethree guests now, dr. craig mcfadyen. he's the regional vice presidentof the mississauga halton central west regional cancerprogram. and chief and medical directorof oncology at trillium health partners. welcome, craig. (craig mcfadyen)thank you, patti.

(patti cochrane)you were here last year,so welcome back. (craig mcfadyen)thank you very much. (patti cochrane)sandy garraway (beckett),you also, i think, were here last year. you're the directorof outpatient medicine as well asthe trillium health partners' big renal program. (sandy garraway (beckett))yes. (patti cochrane)and rick macbean,you are a patient

with trillium health partners. (rick macbean)that's correct. (patti cochrane)and we'll get into moreinformation about you, rick, in just a minute. (rick macbean)my pleasure. (patti cochrane)but craig, can you startand describe for us, you are responsible forthe care delivery for cancer-- patients living with cancerat trillium health partners. how do you focus onpatient-centred design

in your program? (craig mcfadyen)well, there are several ways,patti. and thanks for the opportunityof talking about it today. even dating back to ourmarketing program last year where our catchphrase was,"cancer is personal," we've really triedto express to the staff and to our patients thatwhile we're a cancer centre and we're there to treat cancer, we're actuallyvery interested in you

and understand youas an individual. an individual who has a family,who has a social network, who has a religious network,and all of the other things that are a part of your lifeoutside of the cancer care. we have several things thatin order to make that an actually morethan just a saying but actually something real. ontario cancer plan iv,which is the strategic direction that cancer care ontariogives us

and writes that planevery 4 years, was actually co-written by the patient and familyadvisory committee at cancer care ontario. (patti cochrane)wow, so important. (craig mcfadyen)so they were actually--so patient input was extremely importantin writing that plan and not--it wasn't a plan justcreated by administrators we try to live that very muchin the cancer program.

we have our own patient andfamily advisory committee at the cancer program. and there is not a movethat we make, there's not a formthat we okay, there's not a projectwhich we would undertake in which we don't havethe input from the patients and/or their families. so they're embedded in everyoperational committee that we have inthe cancer program right now.

there are severalother things we do. every time a patient comes tothe centre for either treatment or follow-up, we ask them todo a short nine-question survey with respect to their symptoms. it's called the edmontonsymptom assessment score. if they score high on anyof those parameters, we immediately connect themwith an allied health individual to address those symptoms. we have the conceptof multidisciplinary case

conferences in which patientswho have slightly unusual aspects to their diseaseare discussed at a meeting once weekly, attended by specialistsin all of the various areas of cancer care: surgeons,medical oncologists, radiation oncologists. so the patient hasthe benefit of having a-- of basically in a virtual way,seeing many specialists without having to travel tospecialists' individual offices.

we've initiated what we calla two-day chemo program, which breaks upa patient's physician visit with their actual treatment. and while that might seem likea bit of a paradox, to put it into two days,it is in fact highly patient-centred,much more safer for the patient because theirchemotherapy can actually be prepared the daybefore they come. and patients overall arespending far less time

at the hospital thanthey would ordinarily. and finally, we workextremely hard in terms of the survivorship partof cancer. so both withinthe cancer program and with associationwith wellspring which is a cancer supportagency, we're very interestedin helping patients after they've been throughthe cancer journey to integrate themselves back

into as normala life as possible. so we provide courseswith respect to insurance and getting yourdriver's licence and all of those practicalthings that a patient needs to be aware of as they endthe active treatment phase of their journeyand move back into as normal a lifeas possible. (patti cochrane)so, great examplesabout cancer is personal, and you spoke aboutsome of the care

that you deliver that'sactually not medical care but other aspects of what'simportant in a person's life. so, thanks for that example,craig. maybe i'll move to you now,sandy. and just talk abouthome hemodialysis and how doeshome hemodialysis help patients enhancetheir lives? (sandy garraway (beckett))well-- (patti cochrane)and what is it exactly?

(sandy garraway (beckett))well, that's good. with home hemodialysis,we encourage patients to actually dialysein their own home. they can often do itwhile they're sleeping, and it's more gentleform of dialysis and obviously doesn'tdisrupt their lives as much as it wouldto have to come into the hospitalseveral times a week. (patti cochrane)so these are for patientswho need a certain procedure

because of kidney failurein order to maintain a healthy lifestyle? (sandy garraway (beckett))right. your kidneys have failed,and you need your blood to be cleaned and so dialysis. there's different formsof dialysis, but one is hemodialysis. and so we--every patientthat's approaching the need for dialysis, our strategyis home first.

and as craig said, we alsohave an ontario renal plan, a second version,and the focus is home first. and so we'll always lookat that first. are they medically appropriateto be able to do that and then are thereany psychosocial barriers there might be that we couldwork through with them? but that's alwaysour first strategy. now, rick, tell us a little bitabout who you are and what your story is.

(rick macbean)well, i'm a retired guy,and i had high blood pressure most of my life and that'sthe cause of my kidney failure. so my kidneys started to let medown about four years ago and i went on dialysisabout two years ago. and i get that doneat credit valley hospital, which is part ofthe trillium network. and the--i think there'sabout 50 chairs there that does--do dialysis. and so they give memy blood bath

three times a week. (patti cochrane)blood bath, is thatwhat you call it? (rick macbean)well, that's what it is,right? (rick macbean)and without them, i probablywould be in big trouble. so they're great,and i'm very grateful for it. and sandy, you've recentlyadjusted the schedule, i believe, to be seven daysa week now. tell us about howthat's patient-centred. (sandy garraway (beckett))well, typically, patientscome three times a week.

there are some exceptions but most patientsthree times a week. so they'll come monday,wednesday, friday or tuesday, thursday, saturday. and so it's very restrictive. and it's a big inconveniencefor people in their lives and so by opening on sunday,it gave one more option for some patientslike mr. macbean who could-- instead of having to comeon those prescriptive days,

we could give themone other option. also nice for patients that haveto come four times a week and they can squeezean extra one in on the weekend. (patti cochrane)so you really built inflexibility into the program for these patients. (sandy garraway (beckett))yeah. (patti cochrane)now, craig, you recentlyopened a clinic, i believe, called react,and it's in response

to a patient-centreddesign program. (craig mcfadyen)so, react isa program we started at trillium health partnersto deal with the concerns that patients had whilethey're on active treatment. chemotherapyand radiation therapy, while extremely effectivein treating cancer, are powerfultherapeutic interventions. and unfortunately, as manyof our listeners will know, have occasionally complicationsassociated with them.

what we wanted to providewas a service for patients so that they didn't have to usethe emergency department to have thesesystems addressed. we really don't want cancer-- we would prefer patients not bein the emergency department. we are giving them drugs whichwill affect their immune system, so if there was a waythat we could see them outside of the emergencydepartment and see them quickly, that was really the goalof the react centre.

so what we have is a programwherein a patient who's on active treatmentcan call in and will be assessedby one of our nurse navigators and basically triagedover the phone through a series ofstandardized questions about what's been happening. based on that assessment,one of three things will happen. we'll either reassurethe patient, "things are okay. we'll keep yournext appointment."

we'll reassure the patientand say, "no, we should move upyour next appointment." or we'll say, "no,you should come in today. we should have a look at youand reassess things." so they can come in today--they can come in the same day and the same day they'llhave their blood work done, appropriate chest x-raysdone if necessary and be seen bya specialist in oncology to assess their symptoms.

by doing this, we've first ofall been able to keep people out of the emergency department,but more importantly, we've actually been ableto keep people out of hospital because we can dealwith these symptoms-- because a specialistis seeing them who's used to dealingwith these symptoms, we can frequently treat themand send them back home with close follow-up. so we can not only keep them outof the emergency department

which is not only good for thembut relieves the wait in the emergency departmentbut we can actually keep them out of the hospitaland at home as long as possible. (patti cochrane)that's great. and for our patient at home,they've got a place to call now if they're worriedabout something, rather than fretting about it. (craig mcfadyen)absolutely. (patti cochrane)yeah, wonderful.

now, rick, i understandyou come to the hospital three times a week,if i understand your needs for dialysis. that's a lot of time. (rick macbean)yes. (patti cochrane)and so do youget to know your-- the staff in that clinic? (rick macbean)pretty well. the nursing staff arethe ones that i deal with

most of the time. and there's doctors that visitus three days a week, too, so. (patti cochrane)i imagine it becomesalmost like family after a couple of years. (rick macbean)it does. the charge nurse there,carol, is-- she's a godsend for me. i like to go traveling and-- (patti cochrane)oh, do you?

(rick macbean)yeah. part of that isgoing on cruises, so i can get the dialysis doneon a cruise ship now, and they require a lotof documentation and carol makes sure that-- carol and another girl there,fabulon, make sure that the dialysispeople on the cruise ship get all the informationthat they need, so. (patti cochrane)and that really ispatient-centred design

because you reallythen are able to travel even thoughyou are tied somewhat to this dialysis treatment. (rick macbean)absolutely, absolutely. and their change to the sunday,offering that sunday, to me, was a great advantage. i'm retired,and i don't particularly like traffic congestionswhen i drive, and sunday's a good timeto drive.

there's nobody on the road,so it's a great thing. the hospitals,no matter what you say, they're busy places, and the quietest dayof the week is sunday. so you never have a problemparking or anything else at the hospital on a sunday, so the sunday has beena godsend for me. it's great savings. now, sandy, i understandyou're opening up

a transition unit at watline, and it's for patientswho are going from a clinic setting to home. can you tell us more about that? (sandy garraway (beckett))yeah, one of the challengeswe have is when you do decide to go to a home dialysis,you have to learn everything. you have to learn howto set up the machine, how to cannulate--put the needles in, and so it's a bit scaryfor people.

the concept of the transitionunit is that these patients will dialyse onthe same kind of machine they'll have at home. they'll still havenursing support but they'll startto introduce the concepts and understandthat it's not so scary and just downat the end of the room are the patients that arealready starting their training and you can see,

"if they can do it,i can do it." and so it just sets upan atmosphere of learning. so we're slated to begin thaton march 1 (2016). we're very excited. and i also understand you'vegot a new partnership with saint elizabeth? (sandy garraway (beckett))yeah, this is a project,we call it the psw project, which isa personal support worker through the ontariorenal network.

and so it's a projectto see if this-- if the psw can take the placeof a family member. so maybe i live alone and i'mnervous to do this by myself. i don't have a family memberto train with. a psw could be that familymember, train with me. (patti cochrane)wonderful.good support. (sandy garraway (beckett))yeah, it's exciting. (patti cochrane)and craig, you've gotdiagnostic assessment programs also as a patient-centreddesign.

can you describethat quickly for us? (craig mcfadyen)so what we have triedto do is remove all of those multiple stepsbetween suspicion and diagnosis. it provides a one-stop shoppingavailability for patients, so the breast dap is probablythe easiest example for most people to understand. currently, outsideof dap process (diagnostic assessment programs) for a woman to be evaluatedfor an abnormal mammogram,

it can take up to three months. but we know that if we move themthrough a dap process, where they'll be seenby a nurse navigator, seen by a breast cancer surgeon, and their films will all bere-evaluated by a radiologist, we can shorten that processdown to approximately 21 days. and that includes the timeit takes to read the biopsy. so a woman could come in, having had an abnormalscreening mammography.

we'll review those films,we'll see her, examine her, take her history. and if appropriate,do the biopsy on the same day. then seven days later havethe results of that biopsy and then moveforward from there. so, removing all of the stepsor all of the lines that a patient needsto get into to move from the suspicionto diagnosis phase,

all of those are removedwith a multi-specialty, one-stop shopping approachof a dap. we also have those functioningin thoracic surgery for lung cancer. we also have onefor prostate cancer, and we've just recently startedone for rectal cancer at the credit valley siteof trillium health partners. (patti cochrane)so these are great examples,i think, of thinking about a patient'ssleepless nights

and trying to remove the time that they're anxious to find outtheir final diagnosis, so. (craig mcfadyen)it's a highly stressful time. (patti cochrane)yeah, it is. (craig mcfadyen)i mean, it's a--and yeah, a lot of these are resolved to the--without cancer. but that stressful time betweenwhen a suspicion is raised to when there'sactually an answer, it's very difficultfor patients and their families.

(patti cochrane)it is. so i want to thank you allfor joining me today to talk aboutpatient-centred design. good luck, rick, on yourjourneys going forward, and i mean that quite literally. and thank you sandy and craigfor joining us at "talk trillium:partnering for patients." thanks. - thanks, patti.- thank you.

(patti cochrane)yes, thank you. at trillium health partners,our staff, doctors, volunteers, and students arededicated to creating a new kind of healthcarefor a healthier community. for today's "faces of trillium"we will hear from kim green who is a patient flowcoordinator at the mississauga hospital. and next we will hearfrom michelle buma, a linen & mail attendantat the queensway health centre.

(kim green)my name is kim green. i'm patient care coordinatorhere the night is usually busyand we start at seven at night until seven in the morning. we start off with connectingwith our bed desk team. it's a leadership position,and i collaborate with bed desk tofacilitate patient flow through the emergency departmentto inpatient units, including critical care unitsand recovery room.

i also provide supportto the staff in regards to operation, decision-making,staffing issues, and communicationchallenges. also help conflict resolutionand provide support to the staff when there are patientand family complaints. we're a resource for the staffwith any issues that they're havingduring their shift. and we also communicate to theon-call senior leadership team with any patient issues or anyissues regarding patient flow

as well or staffing concerns. my first memory here is when i was interviewedby patti cochrane and she hired me inthe emerg department. [laughing] so i've always wantedto be a nurse since i was a young childbecause i just always liked helping peopleand especially my grandparents. i was around them a lotand i liked to be there

and just to help them. i started hereat trillium in 1999 as an emergency room nurseand i was there for 14 years and i've been a patient carecoordinator the last 5 years. as an emergency room nurse,i just saw the emerg, i didn't see the restof the hospital, so working in emerghelps me with my job now. it's the critical thinking andbeing able to problem solve and making decisionson very short timeframes.

the most memorable onewas when our icu department, our critical care department, one of the sprinkler headsin an empty room went off and the icu departmentstarted flooding, so we actually hadto evacuate eight patients from that department. so, initially was a code redand then it was a code brown and then it was a code greyand then a code green. so as a patient care coordinatorwas during the weekend,

so it was just me, and i hadto organize and facilitate that. (kim green)hey, ryan,how's it going? (ryan)hey, kim, how are you?good, thank you. - good, good.- very good. - how's your day going?- so far so good. (kim green)the challenges we haveis when our emerg department has a large--high "no bed admits." so a "no bed admit" inthe emergency department is a patient that's admittedto the hospital but has--

doesn't have a bed assignedto the inpatient unit. so what happens is patientswill be admitted to hospital but they stay inthe emergency room department until a bed is available. so i'm married. i've been married for 22 years,and i have two sons. my oldest son is in his fourthyear at brock university and my youngest isin his second year at a college in nova scotia.

i am from nova scotia,and we've-- we moved here 20 years ago and-- due to my husband's job,and i still miss nova scotia, but ontario's homefor me now. hobbies? i enjoy yoga,i enjoy walking and going on hikesand travelling. my colleagues are great. i love working withthe team here,

the whole organization,all the nursing units. i love my job. i love being a patient carecoordinator, helping the staff,resolving issues, and being a supportto them. (michelle buma)hi, my name is michelle buma. i work for corporate servicesfor the trillium health partners,the queensway site. and i do linen and mail.

i start at 7 o'clockin the morning, and i end my shift at 3 o'clock. so between 7:00 to 9:30i deliver all the linen and make sureeverybody's got-- is all set up for their dayto start with. after my breaki come up and do-- fill up the scrubex machineto make sure that there's enough scrubs therefor all the doctors that come inbetween the entire day.

and then i startdoing the mail. deliver the mail. and then i go out to allthe units and start delivering all the mail to all the units and then by that timeit's about 11:00, which i have to make surethat the mail is done to be picked up, to deliverto the mississauga site. i enjoy it because i get to,you know, mingle and, you know,socialize with every--

all the managers, directors,that are in within the hospital, you know,hold conversations with them, talk to a lot of myco-workers, you know. i also have to make surethat they let me know what they need for the next day. it's important that you havethat rapport with the patients. if they need your help,then yes, we can go beyond what we do to help a patientto get where they want to go. they may need directions,so we will help them out.

they may need a wheelchair, so we'll help themget the wheelchair. and i enjoy it.i do. in my family, it's always beenthe medical field or law. so that's how istarted out as, right? and we have a lot of doctors,nurses, you know. my oldest sister worksin the university network. she's in communications. my younger sister was also--she used to work in the or

at east general somy whole family's basically all in the medical field. i have for my family, two kids,a boy and a girl. they're both married.i have six grandchildren. my oldest is 18,my youngest is 4. we have a lot of funas a family, you know? we have scottish, irish, dutch,you know, english. my father was from barbados. i enjoy workingin the medical field.

i do. i like this because queenswayis like a family. it's a smaller clinical hospitalso, yeah, we get to intertwinewith everybody. we get to know everybody. so i like working for trillium.i do. i honestly can't even tell youhow much i walk internally*. it's always back and everywhere. everywhere.

by the end of the day, i just--sometimes your feet feel like, you know, your legsfeel like lead. but you know,you start moving again and then you're okayagain, yeah. everybody asks me that. how many kilometresdo you think you walk? i don't know. i've never measured myself.i don't want to. (patti cochrane)oftentimes membersof our community have questions

about what to do whenthey get to the hospital either as a patientor as a visitor, what services areavailable for them, and how to access them. stay tuned to hear our staffand physicians answering those questions. and don't forgetto watch to the end of "tick tock trillium,"where dr. seema marwaha, one of trillium health partners'physicians,

who is also a scientist withour institute for better health, tells us the differencebetween a cold and the flu. if you have any questionsthat you would like answered, please send us an email at talk.trillium@trilliumhealthpartners.ca take a look at ourcommunity q&a. (sabine finkenauer)advance care planningis really about having a conversation with yourself,with your family members, and with your healthcare team,

as you consider whatyour health conditions are and what future treatmentsmay be available to you. it's important to havethese conversations early and often in the comfortof your own home. we understand that coming tohospital is a stressful time. we're here to support youduring this time and to continuethese conversations with you as we explore what yourtreatment options may be. it's important, though, that youhave the conversations early

so that you can be preparedfor when you come to hospital and may have to makesome important decisions. for example,whether you would prefer more conservative measuresof treatment or something more aggressive. we're here to support you,and i know that you have the support of your familyand friends as well during your hospitalization. oftentimes when we startto talk about discharge,

there's a lot of feelingsthat come up: anxiousness,fearfulness. i'd say that that's oneof the main challenges that i work to addresswith families and with patients. we understand that youwant to feel prepared and we want to help support youto feel that way. oftentimes as you're gettingready to leave the hospital, your functioning mayhave changed

and you may require someadditional help at home, whether that be providedthrough the assistance of your family and friends or through communitysupport services. we are here to help support you,to answer your questions, and to make suggestionsso that you feel prepared when it's time to leavethe hospital. it's common to feel nervouswhen you're getting ready to leave the hospital.

you've had an admissionto one of our units and you've been cared forby our healthcare team. we're here to help make surethat you're ready to continue that care at home with the available supports thatyou have through your family, your friends,and the community supports that are availableto help you. perhaps you may wishto write down your questions. it's okay to ask for help.

perhaps you may wish to ask oneof your family or friends to help you withsome very specific tasks as you get readyto leave the hospital. we are here to make surethat your transition back into the community isas smooth and as easy for you as possible. (carlijn moester)let the hospital team knowearly if you have concerns about transitioning homeafter your hospital stay. we welcome friendsand family to visit often

so that the manyhealthcare team members can meet with your family to discuss arrangementsfor home. we also appreciate whenfamily members are available by telephone or to meetwith us in person so that we can make many arrangementsfor your safe plan home. when needed, a social workeror discharge planner will meet with youand your family to discuss the recommendationsfor discharge.

we work very closelywith all members of the multidisciplinary teamto determine the best services or programs that canmeet your needs outside of the hospitalwhen you are ready to leave. we recommend that friendsand family be available to help withthe many logistic needs associated with a patient beingdischarged from the hospital. this can include things such aspicking your friend or loved one up from the hospital early onthe day of discharge.

you can also be helpfulby helping with having prescriptions filled,picking up groceries, or helping to follow upwith community services so that the patient iswell cared for at home. (seema marwaha)your nose is stuffy,your throat is scratchy, and your head is pounding. is it a cold or the flu? what's the difference? first, let's start withthe similarities.

the flu and the common coldare both caused by viruses and therefore do not respondto antibiotics. they can cause similar symptoms which can make it difficultto tell them apart. both can also bequite contagious, spread by dropletsreleased when a person sneezes or coughs. now, the differences. the cold is caused bya hundred different viruses

and this is oneof the reasons why there is no vaccine. colds arenot exclusively seasonal and can happenin the summer months. cold symptoms are usuallymuch milder and resolve quickly. and the common coldtruly is common. it's the leading causeof family doctor visits and missed school and work days.

now, the flu is caused byonly one group of viruses, the influenza viruses. there is a vaccine but it hasto be different every year because the virus mutates. and unlike the cold,the flu is generally seasonal, infecting peoplebetween fall and spring. flu symptoms tend to bemore severe than the cold, you feel tired,feverish more quickly. but the biggest and mostimportant difference

is that the flu actually canbecome a serious infection and cause hospitalizations,especially in young children, older adults,pregnant women, and people withchronic health conditions. while for healthy adults,the flu is mostly a nuisance, we need to be ascareful as possible to limit the spread of the fluto high-risk people. the best way to prevent the fluis by getting a flu shot and washing your hands.

(patti cochrane)welcome back. thanks for joining our segmenton patient-centred care. this concludes our programand thank you for watching "talk trillium."