Welcome to the new SickKids eNewsletter. Distributed quarterly, this publication will focus on a topic and highlight where we’ve been, where we are and where we are going: the THEN, the NOW and the NEXT. Please enjoy our most recent publication, and if you like what you see, subscribe now!
In recognition of Canada 150+, we are celebrating SickKids’ contributions to Canadian health-care by highlighting moments of the past, present and future that have shaped the hospital and the nation.
Since we opened our doors in 1875, our footprint has enabled the collaborative and innovative spirit of SickKids. As the patient care we provide has become increasingly complex and the research we conduct has expanded, so have our walls.
In 1892 we finished constructing the bricks and mortar of our first purpose-built hospital building at 67 College St. with the capacity to treat over 140 patients. Our campus has grown over the years to encompass two downtown city blocks between University and Bay, most recently bringing together 2,000 scientists and research staff that were spread across the SickKids campus into one tower dedicated to paediatric research.
As we reach this important national milestone, we find ourselves looking toward building the health-care facility of the future. This is an exciting time for SickKids, as we have the opportunity to re-imagine new technologies and approaches to health care and ensure that Canada’s future generations receive the best care possible.
More than 140 years ago, a group of women led by Elizabeth McMaster rented an 11-room house in downtown Toronto, set up six iron cots and declared The Hospital for Sick Children open. The hospital thrived and grew and by 1886, a building committee was struck to build a permanent, purpose-built institution. The sod was turned in a ceremony in 1889 and in May 1892 the official opening for the newly built hospital, located on 67 College Street (now the headquarters of Canadian Blood Services), took place. The new building was described at the time by one correspondent to the UK-based Lancet as, “probably the “most complete” children’s hospital in all of North America.”
The hospital was cutting-edge in its design and function, incorporating over the next decade, a series of state-of-the-art facilities and services such as mechanized washing facilities, elevators, mechanized heating and ventilation, electricity powered by an onsite electric plant as well as new X-ray equipment (the first of any children’s hospital in North America), bacteriological room, orthopaedic machine shop and surgical appliance shop. These industrial shops provided new efficiencies and fostered innovation, enabling collaborations between the medical staff and technicians to design, prototype and implement new devices, personalized to the unique needs of patients.
Advancements in surgical innovation were huge at this point, thanks to new understanding of the importance of sterile environments as well as the capacity provided by new facilities developing within the hospital. The number of operations performed rose from half a dozen in 1875, to close to 200 in 1891, prior to the opening of the new facility, to more than 500 surgical operations by 1906.
To read more about historical SickKids innovations, read the recently published The History of The Hospital for Sick Children.
To make scientific breakthroughs that really impact child health, researchers have to collaborate across disciplines.
That’s exactly what Drs. Robert Bandsma and Peter Kim did at the SickKids Research Institute, melding the worlds of basic science and clinical research on a recent study on severe malnutrition in children.
In 2013, the Peter Gilgan Centre for Research and Learning (PGCRL) opened, bringing together 2,000 scientists and research staff that were spread across the SickKids campus into one tower dedicated to paediatric research.
Kim, a Senior Scientist in the Cell Biology Program and Bandsma, a Clinician-Scientist who is both a gastroenterologist and a researcher in the SickKids Centre for Global Child Health and the Translational Medicine Program, were among those that moved into the PGCRL.
Together with a scientist from the Netherlands, the research team found that severe malnutrition in children could lead to dysfunctional liver mitochondria, which are essential for energy production, and a loss of peroxisomes, which are important for normal liver metabolic function. The results could potentially lead to novel treatment strategies for severely malnourished children in areas such as sub-Saharan Africa, where Bandsma regularly works.
While their work began in the Elizabeth McMaster building in 2010, the unique design of the PGCRL, the new home of the Research Institute, was crucial to their continuing collaboration.
Team members from each of their labs, located on the 10th and 19th floors attend regular joint meetings, ensuring that both clinical and basic science approaches are embraced in experiments.
"In my own lab, I had this incidental finding that there was the loss of peroxisomes in malnourished children but I had no idea what it meant on a cellular level," says Bandsma. “The best part of our partnership is that we ask completely different questions that pertain to the same bigger research questions. By doing that, we bring unique perspectives.”
Unlike other facilities that are spread wide across a research campus, collaboration was integral to the design of the PGCRL, which is arranged into neighbourhoods based on areas of research. Open collaboration spaces allow staff to work together to solve problems and modular equipment encourages sharing of resources and facilities.
The highly collaborative spirit of the building is one reason why Kim moved to Toronto to work at the Research Institute.
"I came here because of how close we are to the hospital and the high number of clinician scientists that work here. I would have never thought that my peroxisome work could have related to malnutrition until I met Robert,” says Kim, who studies Zellweger syndrome, a neurodegenerative disease that is characterized by the absence or reduction of functional peroxisomes.
Malnutrition still contributes to 45 per cent of all global childhood deaths below the age of five. Bandsma and Kim’s study identified a protein, which when turned on by severe malnutrition, causes the loss of peroxisomes. The two are now trying to understand the mechanisms that may point to new interventions for repairing liver function.
"Even though I speak the language of basic scientists, here you are able to find scientists with very specific expertise to help you answer clinically relevant questions. This study was all about teamwork and collaboration. There's not many institutions like SickKids that facilitate that like ours does."
This is a time of incredible and very exciting change across health care. We’ve never had so much capability, yet we find ourselves at a crossroads. At SickKids, we want to bring the promise of new technologies and new therapeutic approaches to the bedside but we’re being held back by our aging physical infrastructure.
Today’s patient cases are increasingly complex. The type of patients treated at SickKids has changed dramatically in the last 25 years. Technological innovations in health care are driving advancements in child health, but modern, flexible space is needed to accommodate these changes to how care is provided.
Much of the current hospital complex was constructed in the early 1950s and 1960s and has become practically and functionally obsolete. Even our newest wing, the Atrium, was designed in the 1980s. The design, layout, size and condition of these facilities are limiting our ability to provide the highest quality care for Ontario’s sickest children.
SickKids needs a new facility to ensure that Ontario’s future generations receive the best care possible and that SickKids continues to be one of the world’s great hospitals.
Our vision for the future of paediatric health care is guiding the development of our facilities plan. We have been doing a lot of thoughtful re-imagining of clinical care as we plan for the new building. It is very exciting (and a little bit daunting!) to plan the hospital of the future – we need to be able to predict new care delivery models, the burden of diseases in the future, the role of new technologies and the promise of things like artificial intelligence, robotics, personalized medicine, genetic therapies and other innovations.
Our planned patient care centre, designed around the needs of our patients and families, will house clinical areas desperately in need of infrastructure renewal, like the critical care units, surgical services, bone marrow transplant unit and image-guided therapy, as well as an expanded emergency department that will accommodate larger volumes of patients. In addition, the centre will allow for an efficient and contemporary organization of our outpatient clinics, which are presently distributed throughout the existing facilities. The building would replace the older buildings along University Avenue.
We have shared our redevelopment plan with the Ontario government, and look forward to continuing to work with them to make our plan a reality. We will also be engaging the support of the community for our ambitious plans, beginning this fall. This is a long-term project, with the planning and approvals process for the new patient care centre taking three to five years. We are poised to continue to make a real difference in the lives of children and families. It’s an exciting time and we look forward to sharing updates with you as we move along with our plans.
Peter Goldthorpe is the Vice President of Transformation at SickKids.