It’s our top stories of 2017, eh?
It’s not every year that you sequence the genome of a Canadian icon, so before we dive into a new year, let’s take a step back and reflect on what’s been a stellar 2017 at SickKids!
A once-in-a-lifetime opportunity to change the future of children’s health
SickKids Foundation launched the largest fundraising campaign in Canadian health-care history in October. The SickKids VS Limits campaign, with a fundraising goal of $1.3 billion, will support three key elements: re-imagining the SickKids campus, including building a new patient care centre on University Avenue ($600 million); continuing breakthrough paediatric health research ($600 million); and establishing partnerships for better, coordinated patient care ($100 million). The campaign period is anticipated to run through to March 31, 2022.
Many of the world’s top paediatric health experts work right here at SickKids, but our facilities and infrastructure don’t match the level of expertise of our people. Twenty-first century medicine shouldn’t be held back by a 1949 building. Our facility is becoming technologically and functionally obsolete. Our vision for the hospital of the future includes design features for optimal family-centred care, state-of-the-art technology, and best-in-class patient safety and infection control.
Highest standards of safety, quality and service
SickKids was awarded Accreditation with Exemplary Standing, the highest standing possible from Accreditation Canada, an independent, not-for-profit organization that works with health-care organizations to help them evaluate and improve quality, safety and efficiency so they can offer the best possible care and service. Accreditation also provides recognition that an organization's services are meeting national standards of quality.
Every four years, SickKids undergoes an accreditation process by Accreditation Canada, whose surveyors visited SickKids in October to observe practices and obtain feedback from staff, patients and families. In their report, the surveyors evaluated SickKids on 2,686 different criteria, observing everything from governance and leadership to infection control and clinical care. SickKids fully met 99.9 per cent of these criteria.
Enhancing our safety culture and reducing preventable harm
Since kicking off over two years ago, the Caring Safely initiative continued to make strides this year in enhancing our safety culture and reducing preventable harm. As the project transitions to the sustainability phase by the end of the 2017-18 fiscal year, the focus has been on celebrating success to date and implementing programs that will continue for years to come.
Over 85 per cent of staff (6,500 across the organization) have now been trained in the error prevention curriculum that represents the core of this initiative. To sustain these learnings and ensure they become practice, we launched the Safety Coach program, with over 200 safety coaches trained to date in strategies to support their peers.
Safety Coaches have received additional training in error prevention and the four expected safety behaviours and tools. Based on a peer feedback and coaching model, safety coaches act as experts who review the tools with their peers, observe their use, and provide both positive reinforcement and constructive criticism when they observe missed opportunities. Many staff have also self-identified or been nominated as peer supporters for our soon-to-be launched Peer Support Program. Additionally, we have started to see reductions in the frequency of hospital-acquired conditions and serious safety events and look forward to sharing more achievements in the new year.
Empowering health-care providers to make smart and effective choices for our patients
It’s well known now in the health-care community that some tests and treatments do not add value to care; at SickKids we are working to reduce the use of these unnecessary tests and treatments to ensure our patients receive the most effective care.
Following successful reductions of the use of uncomfortable nasal swabs and routine unnecessary X-rays for ankle injuries, among others, SickKids launched phase two of our Choosing Wisely campaign.
The programs that were implemented in 2016 have driven notable reductions; for example, the use of unnecessary nasopharyngeal testing for respiratory viruses has decreased by more than 80 per cent in the Emergency Department and by 27 per cent for patients admitted to General Paediatrics.
Some of the items on the 2017 list of tests we should question share a common thread – there is increased focus on antibiotic stewardship and that is reflected by the inclusion of three antibiotic-focused recommendations. This aligns nicely with the work being done by the hospital’s Antimicrobial Stewardship Program.
Other groups, such as the Utilization Management Committee, are working to maximize patient benefit in part through a focus on minimizing waste. The UMC successfully implemented changes in our health information system to remove redundant or obsolete tests from routine testing order sets, resulting in a 40 per cent drop in the ordering of almost 20 tests. Initiatives at the local unit level also contribute to reductions in the use of unnecessary tests and treatments.
One patient, one record, one team, one connected system
This year, SickKids took on the largest transformational project to date – implementing a new integrated electronic health information system, Epic. The project will fundamentally change the way SickKids provides care, helping the hospital significantly improve efficiencies, enhance patient safety and access to patient information, and create a more seamless care experience for children and their families.
No matter where a patient is in the hospital, their care provider will be able to see their entire medical record. The system will also provide patients and their families with access to their health information through an online patient portal. Patients and families can view their lab results, upcoming appointments and even send a message to their care team. This is a radical departure from the limited access many patients and families currently have.
Hundreds of staff have been involved in this project from all areas of the organization with the goal of realizing our vision of one patient, one record, one team, one connected system. The project team has collaborated with stakeholders all across the organization to validate the build of the system and are rigorously testing now to ensure a safe and working system. The system will go live on June 2, 2018.
To work towards creating a more coordinated paediatric system in the province, SickKids and the Children’s Hospital of Eastern Ontario (CHEO) have partnered to develop and implement the first integrated Canadian paediatric instance of Epic.
Changing the face of cancer care at home and around the world
Paediatric brain tumour biopsies from across Canada and around the world are being analyzed at SickKids using new, state-of-the-art diagnostic, prognostic and predictive tests for childhood cancers. Using the latest technologies, SickKids scientists have developed and are offering novel diagnostic tests that are beginning to change how kids’ cancers are treated. These tests are giving oncologists more information than was previously available, enabling them to give their patients the right treatment at the right time, and avoiding unnecessary therapies and associated side-effects. These diagnostic tests are laying the groundwork for individualized cancer care.
Over the past decade, there have been many high-impact, genomics-driven cancer discoveries in paediatrics. The challenge is moving these discoveries from the lab to the clinic where they can impact how kids are diagnosed and treated. A team at SickKids has done just that. They have taken these discoveries from the research setting and developed robust and clinically validated tests for childhood cancers, including low-grade glioma, medulloblastoma, sarcoma and acute lymphoblastic leukemia. These tests are looking at the molecular biology of the patient’s cancer and providing information indicating how a patient will respond to specific drugs, how their tumour will behave over time and likely outcomes for the patient’s specific cancer.
We sequenced the genome of the beaver
Channelling some of the most distinctive traits of the quintessentially Canadian symbol they were studying, a team of scientists from The Centre for Applied Genomics at SickKids sequenced the genome of Castor canadensis – the Canadian beaver. The beaver in question was none other than Ward, a resident of the Toronto Zoo. Understanding the fundamentals of what makes Ward, Ward, could help scientists advance research into human conditions like autism.
Improving outcomes for babies – even before they are born
In May, doctors from SickKids and Mount Sinai Hospital performed a lifesaving in-utero heart procedure on a baby diagnosed prenatally with a severe form of a congenital heart defect called transposition of the great arteries. Complicating his heart disease was the fact that all the walls in the baby’s heart – the atrial and ventricular septa – were closed shut, which would have prevented his blood from receiving oxygen after birth. Doctors inserted a balloon into the baby’s heart while he was still in his mother’s womb to open up the atrial septum. It is believed that this is the first time in the world that this procedure – a balloon atrial septoplasty – has been performed before birth to treat this particular condition.
The procedure did not address the baby’s transposition of the great arteries – the baby still needed open-heart surgery after birth, which was successfully completed a week after birth at SickKids. However, the in-utero procedure was the bridge doctors needed to allow the baby to have open-heart surgical correction of his transposition of the great arteries.
The very next month, in a Canadian first, a team from SickKids and Mount Sinai Hospital repaired a form of spina bifida in a fetus at 25 weeks gestation. Since her birth, the baby has needed no further intervention for this usually debilitating condition. This is the first case in Canada where the mother has not had to travel to the United States for this specialized surgery.
Myelomeningocele is a form of spina bifida, affecting approximately 120 to 150 babies in Canada each year. It is caused when the spinal column fails to close early in fetal development, causing permanent damage to the baby’s spinal cord and nervous system. Research shows that brain malformations are reversed by one-third; the need for walking aids or a wheelchair is halved; and the need for brain shunts is reduced by half for babies who undergo the in-utero procedure experience.
The team from SickKids and Mount Sinai Hospital is Canada’s only provider of fetal surgery.
Learning Institute celebrates a decade of excellence in education
The SickKids Learning Institute celebrated 10 years of raising the bar of knowledge translation. At SickKids, applying new knowledge keeps us on the leading edge, providing the best quality care for our patients and families. Equally important is sharing that knowledge with all of our educational partners around the world, to influence medical practice beyond our walls. Education has been an integral part of SickKids since the beginning.
The Learning Institute continues this tradition of learning, bringing patient, family, staff and professional education initiatives together under one umbrella. From e-Learning modules to front-line learning in simulation labs to health education resources like AboutKidsHealth, the Learning Institute uses innovative tools to support the learning needs of staff and families.
The future looks bright: a new, state-of-the-art learning management system, featuring interactive and dynamic learning to support teams across the organization, has just gone live; and patient and family education will get a boost with new programs and simulation spaces. The goal is to help families learn new, personalized techniques to care for their child at home, such as managing a child’s gastrostomy tube (G-tube), in a safe space where they can hone their skills and provide feedback.
Kids Health Alliance: ensuring timely access to health care for Ontario's children and youth
Three of Ontario’s largest paediatric health-care providers launched a new partnership called Kids Health Alliance. Founded by SickKids, Holland Bloorview Kids Rehabilitation Hospital and the Children’s Hospital of Eastern Ontario – Ottawa Children’s Treatment Centre, the partnership will strengthen our region’s paediatric health system by improving access to more coordinated, consistent, high-quality care for children, youth and their families.
Kids Health Alliance will evolve to include other paediatric health-care providers, including community hospitals, paediatricians, rehabilitation services, home health agencies, mental health services, and other service providers, who all share a common goal of improving the health of children and youth in Ontario. Markham Stouffville Hospital and Orillia Soldiers’ Memorial Hospital are the first community hospitals to join the alliance.
Building bridges to mental health services for children and youth
As we strive to champion the evolution of the paediatric health system, SickKids integrated with The Hincks-Dellcrest Centre in February 2017 with the vision of bringing child and youth mental health clinical, research and education services of both organizations under a shared governance and leadership structure. The newly named SickKids Centre for Community Mental Health aims to deliver more seamless and coordinated care by combining specialized hospital and community-based mental health services.
One in five Ontarians under the age of 17 experiences a mental health disorder and while the number of children and youth seeking help is growing, complexity is also increasing and many do not get the help they need. The integration uses a holistic approach to health by helping to streamline access to the children’s mental health system and providing children and families with a clear point of entry into care and defined care pathways.
Celebrating a two-year partnership with the Nelson Mandela Children’s Hospital Trust in South Africa
The SickKids International team continues to lead global efforts, including our partnership with the Nelson Mandela Children’s Hospital (NMCH) in Johannesburg, South Africa. Signed in April 2016, this two-year partnership is supported through a C$2.5 million investment from the Government of Canada, through Global Affairs Canada. SickKids has provided capacity-building support for the establishment of NMCH.
The first year of the project focused on commissioning the hospital; while in the second year there has been greater focus on education and on-site training. As the project comes to completion in the spring of 2018 the team will close out the project and undertake evaluation work.
This is SickKids’ first partnership in Africa involving commissioning a hospital and it has given our staff an amazing opportunity to explore a new location, environment and culture. We are grateful to Global Affairs Canada and several generous donors for their support in enabling this partnership.
Advancing the health of women, children and their families globally
The SickKids Centre for Global Child Health continued to focus on global child health priorities and challenges within the United Nations’ Sustainable Development Goals (SDGs) and welcomed the Government of Canada’s Feminist International Assistance Policy targeting gender equality and the empowerment of women and girls globally. Working with local health systems partners, the centre is training 178 nurses across three education sites in Ghana (Kumasi, Tamale and Accra) with the goal of training 500 paediatric nurses by 2020. Sixty-one frontline health workers were trained in specialized newborn care in Malawi and Tanzania, while 27 nurses from across five Caribbean partner countries were trained in paediatric haematology/oncology.
Throughout the year, the centre contributed to major international reports on nutrition, early childhood development, stillbirths, adolescent health and other pressing global child health issues. The centre also launched its International Program Evaluation (IPE) unit, offering technical support and expertise to implementing agencies, governments and funders in the areas of design and implementation of large-scale evaluations.
A great place to work - SickKids is one of Canada's Top 100 employers
From wellness initiatives to employee assistance programs to education and training opportunities, SickKids wants to make sure its staff find meaning and value in their work and continue to provide the best for our patients and families. It’s a great place to work, with great people, so when the annual “best places to work” lists come out, we’re not surprised to see our name near the top of the list!
In August, job site Indeed released its first-ever list of the 25 best places to work in Canada. We came in at an impressive #5 – the only hospital on the list. The list was compiled using feedback from thousands of company reviews from current and past employees. Employees commended the hospital for providing a great work-life balance, workplace culture and an environment that is collaborative and supportive. A few months later, SickKids was named one of Canada's Top 100 Employers for 2018 by Mediacorp, as well as one of the Greater Toronto Area's Top Employers for 2018. SickKids was also recognized as being one of Canada's Best Employers for Recent Graduates.
That’s a wrap on 2017! Thank you to all our staff, volunteers, patients, families, community partners and supporters for everything you do to help us along our journey. Happy New Year from everyone at SickKids!