Innovation - Department of Medicine

ANNUAL REPORT
2005 – 2006
“A network without walls, without professional boundaries, and without limits on quality
patient care, research, and education”
DEPARTMENT OF MEDICINE
Calgary Health Region
and
University of Calgary
Page 1 of 71
VISION, MISSION & CORE PRINCIPLES
OF THE
DEPARTMENT OF MEDICINE
(Photography by Ted Grant – used by permission)
To prevent disease, to relieve suffering and to heal the sick –
this is our work.
Sir William Osler
OUR VISION
Creating the medical network of the 21st Century
A network without walls, without professional boundaries, and without limits on quality
patient care, research, and education
OUR MISSION
To be the best Department of Medicine in the country
To be widely recognized for advancing health and wellness, leading innovation, creating
technologies and disseminating knowledge
OUR CORE PRINCIPLES
Innovation – Excellence – Patient Care – Scholarship – Education Leadership – Technology
Page 2 of 71
Table of Contents
EXECUTIVE SUMMARY .....................................................................................................................................................4
SIGNIFICANT DEPARTMENTAL ACHIEVEMENTS .....................................................................................................................4
NOTEWORTHY DIVISIONAL ACCOMPLISHMENTS ...................................................................................................................4
QUALITY IMPROVEMENT & PATIENT SAFETY INITIATIVES ....................................................................................................4
INNOVATIONS ........................................................................................................................................................................5
EDUCATION AND RESEARCH HIGHLIGHTS .............................................................................................................................5
CHALLENGES FOR NEXT FISCAL YEAR ..................................................................................................................................5
PRIORITIES FOR NEXT FISCAL YEAR ......................................................................................................................................5
DEPARTMENTAL STRUCTURE AND ORGANIZATION ..............................................................................................6
ADMINISTRATIVE STAFF................................................................................................................................................7
DEMOGRAPHICS OF THE DEPARTMENT OF MEDICINE ............................................................................................................8
ACCOMPLISHMENTS AND HIGHLIGHTS ...................................................................................................................10
NOTEWORTHY DEPARTMENTAL ACCOMPLISHMENTS AND HIGHLIGHTS .............................................................................10
SPECIFIC CLINICAL HIGHLIGHTS .........................................................................................................................................12
EDUCATION .........................................................................................................................................................................13
RESEARCH ...........................................................................................................................................................................14
MEDICAL LEADERSHIP AND ADMINISTRATION ....................................................................................................................14
CHALLENGES AND PRIORITIES ...................................................................................................................................15
CHALLENGES FOR THE NEXT FISCAL YEAR .........................................................................................................................15
PRIORITIES FOR THE NEXT FISCAL YEAR .............................................................................................................................15
FUTURE DIRECTIONS.......................................................................................................................................................16
WORKFORCE PLANNING ................................................................................................................................................17
RECRUITMENT FOR 2005 – 2006..........................................................................................................................................17
ATTRITION TO DEPARTMENT FOR 2005 – 2006....................................................................................................................19
QUALITY SAFETY & HEALTH IMPROVEMENT........................................................................................................20
EXECUTIVE SUMMARY ........................................................................................................................................................20
QUALITY, SAFETY, AND HEALTH INFORMATION .................................................................................................................20
QUALITY IMPROVEMENT/SAFETY STRUCTURE – WITHIN DEPARTMENT OF MEDICINE AND NE PORTFOLIO .......................27
QUALITY IMPROVEMENT AND PATIENT SAFETY PROGRAM HIGHLIGHTS ............................................................................28
INNOVATION.......................................................................................................................................................................32
APPENDICES........................................................................................................................................................................33
APPENDIX #1: SUMMARY OF MEDICINE QUALITY AND SAFETY IMPROVEMENT PROJECTS..................................................33
DIVISION OF DERMATOLOGY ...............................................................................................................................................36
DIVISION OF ENDOCRINOLOGY AND METABOLISM ..............................................................................................................37
DIVISION OF GASTROENTEROLOGY .....................................................................................................................................39
DIVISION OF GENERAL INTERNAL MEDICINE.........................................................................................................43
DIVISION OF GERIATRIC MEDICINE...........................................................................................................................52
DIVISION OF HEMATOLOGY AND HEMATOLOGIC MALIGNANCIES .......................................................................................55
DIVISION OF INFECTIOUS DISEASES .........................................................................................................................61
DIVISION OF NEPHROLOGY .............................................................................................................................................63
DIVISION OF RESPIROLOGY..................................................................................................................................................65
DIVISION OF RHEUMATOLOGY.............................................................................................................................................70
This report is respectfully submitted by:
Dr. John Conly MC, FRCPC, FACP, Professor and Head
University of Calgary and Calgary Health Region,
on behalf of the Department of Medicine, November 2006
Page 3 of 71
Executive Summary
Significant Departmental Achievements
¾ Telehealth service delivery continues to exceed our targets
¾ Recruitment of 31 individuals
• Including 3 Clinical Scholar; 7 Clinical; 12 Major Clinical; 7 GFT and 2 Adjunct positions
• Canadian Chair for Therapeutic Endoscopy – sponsored by Pentax
• Addition of the first Aboriginal physician in the Department of Medicine
¾ Retention – Seeking Balance Study undertaken to identify work life balance issues
¾ Fund Raising Initiatives
• $1.29 Million from Foothills Home Lottery Board for Ward of the 21st Century
• $28,000 from Foothills Hospital Volunteer Association for FMC PCU 36
• $83,000 ATCO donation to support Ward of the 21st Century
• $1.7 Million from Foothills Home Lottery Board for development of BMT Unit
¾ Innovations
• Integration of innovations into the Medical Service Delivery
• Comprehensive framework for evaluation of innovation projects established
• Baseline data collection
¾ First Annual Awards Night for Department of Medicine
• New awards established for Clinical Excellence, Innovation and Professionalism
¾ Completion of POSP Initiative with selection of vendor – EMIS for the EMR
Noteworthy Divisional Accomplishments
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
New pan-Alberta educational program for residents in Dermatology
New Clinics for dermatology, immunodermatology and genetic skin diseases
New Telehealth clinic for diabetes in pregnancy in Lethbridge
Central triage for patients waiting for assessment in Gastroenterology and Rheumatology
IBD Nurse Practitioner hired to help transition in-patients to out-patients
Nurse clinicians help plan for Colon Cancer Screening Centre
Extended GI service plan developed in collaboration with Rural Medicine
Transition clinic (YARD) for Young Adults with Rheumatic Diseases functioning
Geriatrics telehealth accounts for 35% of the total Departmental teleconsult service
Telehealth Program for Rheumatology to Pincher Creek & Rocky Mountain House
Seniors Campus has been accepted by the Reach! Campaign
IMGs integrated in active work
New GMU service has been established at FMC and enhanced at the RGH
Urgent Assessment Clinic satellite clinic opened at RGH
FACT accreditation of BMT program
Nurse Practitioner Role expanded for Inpatient and HPTP in Infectious Diseases
Nocturnal Hemodyalysis introduced
Interventional bronchoscopy program established
Quality Improvement & Patient Safety Initiatives
¾ Continued challenge to address cultural change, support and momentum
¾ Projects include
• Medication reconciliation
• GRIDLOC
• Chemotherpay storage and
• Safe Spaces
labeling
• Safer Health Care Now
¾ Preparation to implement PCIS
Page 4 of 71
Innovations
¾
¾
Hired 73% of allocated staff by fiscal year end
Launched or expanded a number of specialty clinics including:
• Atrial Fibrillation Clinic
• Cough clinic
• Tertiary Obesity clinic
• Sputum diagnostic clinic
• Expanded the Congestive Heart Failure clinic
• Young Adults with Rheumatic Disease (YARD)clinic Nurse Practitioners in Medical Services
increased to 7
• Expanded General Internal Medicine Urgent Assessment Clinic
• Created central referral and triage in Gastroenterology, Nephrology and Rheumatology.
• Launched education intervention to support patient knowledge and uptake of alternative
modalities of dialysis.
• Piloted standardization of peri-operative referral process and lab work.
• Strengthened care transitions from acute care to community in congestive heart failure, chronic
obstructive pulmonary disease, and stroke secondary prevention.
• Enhanced use of clinical practice guidelines in Infectious Diseases and Osteoarthritis
• Supported rural specialist access: gestational diabetes clinic via telehealth to Lethbridge.
• Completed evaluation plans and related databases for all innovation initiatives.
Education and Research Highlights
Residency Training Program
¾ Increased RTP slots to 47 in the current year
Full accreditation of the program until 2009
Accreditation of Nephrology and Respirology achieved
Research Highlights
¾ 463 non peer reviewed publications (includes editorials and letters),
¾ 153 additional articles submitted to peer reviewed publications
¾ 64 articles published in non-peer reviewed publications
¾ 58 books and book chapters published
¾ 241 abstracts published
¾ 356 invited presentations
Challenges for Next Fiscal Year
¾
¾
¾
¾
¾
¾
¾
Workforce deficit in meeting manpower targets
Space – availability for both clinical and office space
Successful implementation of the EMR project
Ensure renewal process for ARP is established
Meeting the expanded Regional acute care capacity
Ongoing fiscal support for innovation initiatives
Planning and implementation of site planning in preparation for moves to multiple sites under
development
¾
Meeting recruitment targets of 25 - 30 FTEs (15 – 20 plus 10 – 15 additional FTEs to account for
attrition) per year to meet clinical service requirements and train future IM specialists
Accommodating current and short term space requirements
Supporting the deployment of an EMR solution in outpatient clinics as part of the overall Outpatient
Clinical Care Integration Strategy
Planning for ARP renewal with strategic and tactical issues in a complex political environment
Employing the Ward of the 21st Century as a template for South Hospital planning
Finding operational funding for current and future innovation initiatives
Priorities for Next Fiscal Year
¾
¾
¾
¾
¾
Page 5 of 71
DEPARTMENTAL STRUCTURE AND ORGANIZATION
Dr. John Conly
Regional Clinical Department Head,
Medicine
Division of Dermatology
Dr. Richard Haber
Hanifa Rhemtulla
944-2783
Division of Gastroenterology
Dr. Ron Bridges
Division of Endocrinology &
Metabolism
Dr. Alun Edwards
Division of Geriatric Medicine
Dr. James Silvius
Cheri Wright
210-9356
JoAnne Taylor
220-5926
Vilma SvetinaAtkins
943-5681
Marlene
Kupchanko
521-3707
Toby Hately
220-8479
Theresa Williams
220-3037
Beverly Forbes
943-3775
Division of General Internal
Medicine
Dr. Robert Herman
Division of Hematology &
Hematologic Malignancies
Dr. Graham Pineo*
Division of Infectious Diseases
Dr. Ron Read
Division of Immunology &
Allergy
Vacant
Division of Medical & Radiation
Oncology
Dr. Vivien Bramwell
Division of Nephrology
Dr. Nairne Scott-Douglas
Division of Respiratory
Medicine
Dr. Chris Mody
Division of Rheumatology
Dr. Liam Martin
Suzanne Buffel
944-4451
Vacant
Louise Kosmack
944-2804
Vi Glover
220-7725
* Dr. Doug Stewart replaced Dr. Pineo – March 2006
Page 6 of 71
ADMINISTRATIVE STAFF
Page 7 of 71
Demographics of the Department of Medicine
MALE
7
9
25
FTE
7.0
8.9
24.7
FEMALE
5
7
5
FTE
5.0
5.1
4.1
AVE.
AGE
52.5
45.1
41.5
Left
Department
0
0
0
Geriatric Medicine
General Internal Medicine
Hematology
5
22
10
4.6
20.9
9.8
3
15
4
2.2
15.0
3.4
41.3
40.7
44.1
0
0
0
1
7
2
8
36
14
Infectious Disease
Medical & Radiation
Oncology
Nephrology
10
9.8
3
1.2
40.6
0
2
13
5
16
4.2
15.0
4
4
4.0
4.0
48.8
44.3
0
0
1
2
9
20
Respirology
Rheumatology
17
8
16.5
8.0
5
8
4.8
7.8
43.1
51.0
0
0
3
0
Cardiology*
17
16.5
4
4.0
50.0
0
1
22
16
196
21
60.6
44.9
0
29
217
Divisions
Dermatology
Endocrinology
Gastroenterology
Recruits TOTAL
12
2
16
1
30
7
* Cardiology appointments are secondary to Medicine.
TOTALS
146
145.8
67
Page 8 of 71
Dermatology
Endocrinology
Gastroenterology
Clinical
Scholars
0
1
3
C
10
3
8
MC
0
6
7
GFT
2
6
12
TOTAL
12
16
30
Leaves
1 - MAT
Months
per
Fiscal
Year
3.5
2 - ED
1 - MAT
15.0
5.0
Geriatric Medicine
0
0
8
1
1 - LOA
9.0
General Internal Medicine
0
14
15
7
1- MAT
5.5
Hematology
1
3
4
6
9
36
14
2 - MED
9.5
1 - MAT
12.0
2 - SAB
15.0
1 - SAB
8.0
1 - LOA
9.0
Infectious Disease
1
0
3
9
Medical & Radiation Oncology
0
3
0
6
Nephrology
0
4
6
10
13
9
20
Respirology
0
1
13
8
Rheumatology
0
7
2
7
22
16
Cardiology *
0
3
6
12
21
86
218
ARP
Members
2
16
21
8
23
12
11
0
12
19
14
1 - ED
2.0
16
93.5
154
* Cardiology appointments are secondary to Medicine.
TOTALS
6
56
70
Legend
MAT
Recruitment by Division
Maternity Leave
ED
Educational Leave
LOA
Leave of Absence
MED
Medical Leave
SAB
Sabbatical Leave
Page 9 of 71
Accomplishments and Highlights
Noteworthy Departmental Accomplishments and Highlights
1) Telehealth Service Delivery
¾ Expansion of Telehealth consultative services Department of Medicine
¾ Team based approach lead for Dr. J. Silvius and the Telehealth co-ordinator
¾ Teleconsultations from all three hospital sites implemented for geriatrics, nephrology,
infectious diseases, clinical immunology and general medicine
¾ Continue to exceed our targets
Clinical Area
Clinical Consultation Hours
(June 1, 2005 – May 31, 2006)
Geriatrics
622.0
Paediatrics
444.3
Mental Health
245.3
Diabetes
106.8
Clinical - Education
85.0
Cardiology
65.9
Rheumatology
48.8
Palliative
40.0
Rehabilitation
24.5
Nephrology
22.0
Case Conference (patient present)
21.3
Discharge Planning
12.3
Genetics
11.0
Internal Medicine
10.0
Forensic Mental
8.5
Emergency/ICU
3.7
Wound Care
3.5
Surgery
2.5
Infectious Disease
2.0
Neurology
2.0
Oncology
2.0
General Practitioner Consult
1.0
Group Total
1784.2
2) Recruitment
¾ 29 individuals have begun work in Calgary Health Region
¾ 7 of these were Clinical, 12 were Major Clinical and 7 were GFT
¾ 3 took Clinical Scholar positions
¾ Of these 29, 9 were Female and 17 were males
¾ 21 individuals became part of the ARP
3) Fund Raising Initiatives
¾ Receipt of $1.29 million from the Foothills Home Lottery Board to be used for the Ward of the 21st
Century (U36) medication technology and for surveillance equipment
Page 10 of 71
¾
Donation received from the Foothills Hospital Volunteer Association in the amount of $28,000 for
the Foothills Medical Centre PCU 36
¾ Additional ATCO donation of $83,000 representing the second installment of a three-year
commitment in support of the Ward of the 21st Century
¾ Receipt of $1.7 million from the Foothills Home Lottery Board to be used for the development of a
new Bone Marrow Transplant Unit
4) Retention - Seeking Balance Study
The SEEKING BALANCE study was completed in October 2006 and the final report will be sent out before
Christmas. The objective of this study was to identify what members of the Department of Medicine
perceived as pertinent work life balance issues and to make recommendations for change. The study
consisted of three parts:
1) A baseline survey sent to all members in November 2004 to assess physicians’ work attitudes and
experiences,
2) A one hour face to face interview of 54 representative department members to discuss what matters
and to seek ideas for change, and
3) A comprehensive mail-out survey to all members in the spring of 2006 based on themes and issues
identified from the interview data. This massive input of ideas has been summarized in the final report.
There is no doubt that physician wellness and work life integration are now recognized as vital to
recruitment, retention and quality patient care. We look forward to the challenge of implementing these
ideas for change as well as educating physicians and administrators about the importance of both
healthy physicians and workplaces.
5) Innovations
¾ Integration of innovations into the Medical Service Delivery
¾ Comprehensive framework for evaluation of innovation projects established
¾ Baseline data collection
6) Initiated the First Annual Awards Night for members of the Department of Medicine
¾ New awards established for Clinical Excellence, Innovation and Professionalism
7) Canadian Chair for Therapeutic Endoscopy
8) Addition of the first Aboriginal physician in the Department of Medicine
9) Completion of POSP Initiative with selection of vendor – EMIS for the EMR Foundations of Medicine
10) Residency Training Program
¾ Increased RTP slots to 47 in the current year
¾ Achieved full accreditation of the program until 2009.
¾ Accreditation of Nephrology achieved
¾ Accreditation for Respirology achieved
Page 11 of 71
Specific Clinical Highlights
International Medical Graduate Training
In 2002, General Internal Medicine initiated a program to sponsor foreign trained Internists as ward
physicians within the general medical units. The role of these physicians is to provide the primary care for
the medical inpatients and extend the capacity of our attending physicians. What became evident is that
after a period of time of orientation to Canadian medicine, these ward physicians showed a adequate level
of competency to handle complex medical patients, and were lacking only a Canadian credential to
assume full practice. The Alberta International Medical Graduate Training Program (AIMG) offers funded
Internal Medicine residency positions for these physicians and we were fortunate to receive approvals on
each of our requests for positions. This opportunity has allowed us to provide the primary care required on
the admitting services, offer full funded Internal Medicine residency positions to our ward physicians, and
maintain a high success rate in the IM training program with these Residents.
Based on our success, and a similar program in Cardiology, the CHR initiated the Calgary Clinical
Assistant Program in late 2006. Additional new positions were given to Medicine by this program. At the
time of writing, we have 13 International Medical Graduates working as ward physicians in Pulmonary
Medicine, Hematology and Bone Marrow Transplantation, Nephrology, and General Internal Medicine.
Physician Office System Project
During this fiscal year, a major effort was launched by Medicine to review the feasibility of introducing an
Electronic Medical Record system (EMR) to support the clinical care provided by our physicians in our
outpatient clinics. This effort, co - chaired by Drs. Edworthy and Mellor, and supported by Mr. R. Mohr,
made a recommendation to Medicine to proceed with the selection and implementation of an EMR. This
new system would be supported through the Physician Office System Program, and be integrated as
required within the CHR enterprise patient information environment.
An exhaustive and best of practice approach was used to select the best possible commercial software
product from a list of eleven POSP approved products. This approach included
• Financial review of the software vendors corporate information
• Ability to meet our business requirements
• Technical review by University and CHR IT staff
• Clinical scenario testing against our scripted requirements using an expert panel approach
• Presentations from the Software vendors on how they would approach and organize the
implementation
• Site Visits to existing customers operating with similar size and scope
• A “Sandbox” test environment to allow our various user groups to familiarize themselves with the
look and feel of the software product and express a preference
• A “Best and Final Offer” submission b the two final vendors
From this rigorous process, a recommendation was supported by the participants in Medicine to contract
with Egton Medical Information Systems for supply and installation.
Page 12 of 71
Education
During the past year the enrollment of residents in the core R1 to R3 Internal Medicine Residency
Program continued to increase from our traditional allocation of 30 positions. As of July 1, 2006 our
core program will have 52 residents, which assists in meeting the shortage of Medical Specialists in
the Calgary Region, Alberta, and Canada. This increase was due to supplementary allocations of
positions from the Alberta Government, including the relatively new Alberta International Medical
Graduate program which provides funding for six of our Core Program residents. In addition the
Subspecialty Residency Programs support 32 additional residents or fellows at the R4 and R5 levels
in Royal College of Physicians and Surgeons Accredited Residency programs. In summary, the
Department of Medicine Core and Subspecialty Residency Programs are educating a total of 84
physicians who will enter practice and assist with addressing the physician shortage situation.
In parallel to the increase in resident enrollment the Department has recruited clinical teachers and
increased the clinical education experiences (“Rotations”). The following rotations have been added in
the past year:
1). An additional senior resident role on the FMC and PLC site Medical Teaching Units with an
emphasis on teaching and leadership skills.
2). A Dermatology and Allergy rotation with the leadership of Dr. Richard Haber, Regional
Clinical Division Chief of Dermatology, and Dr. Tom Bowen.
3). A senior resident General Internal Medicine rotation at the Rockyview General Hospital
under the leadership of Dr. Ghazwan Altabbaa.
The Program Subspecialty rotations have also increased their clinical experiences at the Rockyview
General Hospital more than has been the tradition in the past, and benefiting from the learning
opportunities at this sister hospital. The Program has been actively organizing teaching on the Royal
College of Physicians of Canada CANMEDs competencies assisted by grants from the Faculty of
Medicine and Alberta Government and provided in collaboration with the Canadian Medical
Association and Alberta Medical Association Physician and Family Support Program.
With respect to the coming year a strategic plan for the Program is near completion by a committee
chaired by Dr. Paul Gibson. Priority areas for development and innovation will be the General Internal
Medicine educational experiences, ambulatory clinical care, community care in centers outside of
Calgary on the model of our traditional rotation in Lethbridge, which has been very successful for
emulation. The Alberta Rural Physician Program is supportive of this outreach community rotation
initiative. It continues to be our vision to educate young physicians to lead the future of medicine.
Page 13 of 71
Research
During the 2006 calendar year, based on the submitted reports, Department members disseminated
their knowledge in the following venues:
¾ 463 articles, editorials and letters
¾ 153 additional articles submitted to peer reviewed publications
¾ 64 articles published in non-peer reviewed publications
¾ 241 abstracts published
¾ 58 books and book chapters published
¾ 356 invited presentations
The members also contributed to the development of future medical researchers by mentoring and
supervising the work of 254 learners at undergraduate, graduate and post-graduate levels.
Medical Leadership and Administration
We have added one physician to the Department of Medicine to assist in Administrative roles. Dr.
Maria Bacchus has joined us in July of 2005 as Vice Chair, Strategic Planning and Clinical Affairs. Dr.
Jane Lemaire also continued in her role of Vice-Chair, Career Development. We are very pleased to
have both physicians work in these capacities.
.
Page 14 of 71
Challenges and Priorities
Challenges for the Next Fiscal Year
¾
¾
¾
¾
¾
¾
¾
Workforce deficit in meeting manpower targets
Space – availability for both clinical and office space
Successful implementation of the EMR project
Ensure renewal process for ARP is established
Meeting the expanded Regional acute care capacity
Ongoing fiscal support for innovation initiatives
Planning and implementation of site planning in preparation for moves to the
o TRW (Translational Research Wing) Building (U of C)
o RRDTC (Richmond Road Diagnostic Treatment Centre)
o Sheldon M. Chumir Facility
o Planning for the new West Tower located at the Foothills Medical Center
o Planning for the New Cancer Institute
o Planning for the New South Hospital
o Planning for the Obstetrics/ Gynecology Annexation to the ACH or the new West Tower at
the FMC Site
Priorities for the Next Fiscal Year
¾ Meeting recruitment targets of 25 - 30 FTEs (plus 10 – 15 to account for attrition) per year to
meet clinical service requirements and train future IM specialists
¾ Accommodating current and short term space requirements
¾ Supporting the deployment of an EMR solution in outpatient clinics as part of the overall
Outpatient Clinical Care Integration Strategy
¾ Planning for ARP renewal with strategic and tactical issues in a complex political environment
¾ Employing the Ward of the 21st Century as a template for South Hospital planning
¾ Finding operational funding for current and future innovation initiatives
Page 15 of 71
Future Directions
Positioning the Department of Medicine to be leaders in innovation to promote our clinical, research
and educational mission by
¾ Strengthening our integration of care, from the in-patient setting to our Out-Patient Clinics to
maintaining our patients’ health in the community. This will be facilitated by leveraging
innovations, technology and the skills of our talented team members to promote a patient
centered experience.
¾ Fostering partnerships with other faculties, disciplines and the community
¾ Promoting wellness of both our patients and our team members
¾ Improving access to care through partnerships and innovations, building on the Medical
Access to Service Conference Model and Central Referral System.
¾ Promoting organizational and educational changes which foster teamwork as we continue to
move from individual excellence to team excellence such as the Ward of the 21st Century
team.
¾ Strengthening our most valuable asset, our team members, by recruiting and retaining them
through recognition, mentorship and providing opportunities for growth
Page 16 of 71
Workforce Planning
Recruitment for 2005 – 2006
Primary
Division
Last Name
First Name
Starting
Date
Came from
Primary
Site
ARP?
U of C
Appt.
FTE
Sex
Cardiology
Veenhuyzen
George
15-Aug-05
Kingston, ON
FMC
Yes
MC
1.00
M
Dermatology
Hackett
Sharon
08-Jun-05
Montreal, PQ
FMC
No
C
1.00
F
Dermatology
Haber
Richard
01-Dec-05
Victoria, B.C.
FMC
Yes
GFT
1.00
M
Endo
Bhayana
Shelly
01-Nov-05
Toronto, ON
PLC
Yes
MC
1.00
F
GIM
Huan
Susan
01-May-05
Thunder Bay, ON
FMC
Yes
C
0.50
F
GIM
Altabbaa
Ghazwan
24-May-05
Damascus (via
Sumerside, PEI)
RVH
Yes
MC
1.00
M
GIM
Sivakumar
Chandrasekaran
01-Jul-05
England
FMC
Yes
MC
0.40
M
GIM
Bacchus
C. Maria
11-Jul-05
Toronto, ON
FMC
Yes
GFT
1.00
F
GIM
Scott
Ian
01-Sep-05
Victoria, B.C.
PLC
No
C
1.00
M
GIM
Clearsky
Lorne
14-Sep-05
Winnipeg, MB
RGH
No
MC
1.00
M
GIM
Datta
Partha
15-Nov-05
Hamilton, ON
RGH
Yes
MC
1.00
M
GIM
Ali
Khan
30-Jan-06
Calgary (via Mayo,
Rochester, MN)
RGH
No
MC
1.00
M
GIM
Sporina
Jan
01-Mar-06
Calgary (IMG from
Slovakia)
RGH
Yes
MC
1.00
M
Gastro
Kaplan
Gilaad
01-Jul-05
Windsor, ON
FMC
No
Clin Sch
1.00
M
Gastro
Turbide
Christian
11-Jul-05
Montreal, PQ
PLC
Yes
C
1.00
M
Gastro
Jones
Jennifer
01-Sep-05
Halifax, NS (via
Rochester, MN)
HSC
Yes
Clin Sch
0.50
F
Gastro
Kareemi
Munaa (Mani)
01-Sep-05
Halifax, NS
FMC
No
C
1.00
M
Page 17 of 71
Primary
Division
Last Name
First Name
Starting
Date
Came from
Primary
Site
ARP?
U of C
Appt.
FTE
Sex
Gastro
Rioux
Kevin P.
01-Sep-05
Edmonton, AB
FMC
Yes
GFT
1.00
M
Gastro
Raza
Mamoon
27-Oct-05
Winnipeg, MB
PLC
No
C
1.00
M
Gastro
Liu
Hongquin
12-Dec-05
Calgary, AB
HSC
No
Adjunct
1.00
M
Gastro
Andrews
Christopher
23-Jan-06
Rochester, MN
FMC
Yes
GFT
1.00
M
Geriatrics
Sivakumar
Chandrasekaran
01-Jul-05
England
FMC
Yes
MC
0.60
M
Haematology
Geddes
Michelle N.
01-Jan-06
Calgary, AB
FMC
Yes
Clin Sch
0.40
F
Haematology
Daly
Andrew
01-Mar-06
Toronto, ON
PLC
Yes
C
1.00
M
ID
Louie *
Marie
13-Apr-05
Calgary (originally
Toronto, ON)
PLC
No
GFT
ID
Johnson
Andrew
01-Sep-05
Seattle, WA
PLC
Yes
MC
1.00
M
Nephrology
MacRae
Jennifer
01-Sep-05
Vancouver, B.C.
FMC
Yes
GFT
1.00
F
Nephrology
Vitale
George
01-Sep-05
Toronto, ON
FMC
No
MC
1.00
M
Nephrology
Sun
Jian
01-Mar-06
Edmonton, AB
HSC
No
Adjunct
1.00
M
Respirology
Hirani
Naushad
01-Apr-05
London, ON
PLC
Yes
MC
1.00
M
Respirology
Fell
Charlene
01-Jul-05
Toronto, ON
PLC
Yes
MC
1.00
F
Respirology
Davidson
Warren
01-Jan-06
Vancouver, B.C.
RVH
Yes
GFT
1.00
M
F
* Dr. Louie is a member of the Provincial Labs. She is assisting with consultations and HPTP service.
Page 18 of 71
Attrition to Department for 2005 – 2006
The following table indicates physicians and the reasons for their absences.
PHYSICIAN
Reason for absence
Months
DEVLIN
TURBIDE
VEENHUYZEN
Shane
Christian
George
Educational LOA
Educational LOA
Educational LOA
FORBES
TAUB
Anna
Ken
LOA
LOA
GOLDSTEIN
JENKINS
Cheryl
Deirdre
Maternity
Maternity
MYDLARSKI
NASH
Regine
Carla
Maternity
Maternity
BROWN
LOUIE
Chris
Tom
Medical LOA
Sabbatical
MURUVE
Dan
Sabbatical
POON
Man-Chiu
Sabbatical
9
6
1
9
9
5.5
12
3.5
5
9
6
8
9
TOTAL MONTHS
92
No one left the Department of Medicine. A couple of senior members have decreased their FTE in preparation for retirement but all are still
working a minimum of 0.2 FTE.
Page 19 of 71
Quality Safety & Health Improvement
Dr. Elizabeth MacKay, Jamie Stroud & Tricia McBain
Executive Summary
We have been challenged with encouraging culture change, support, and momentum in the areas of quality improvement and patient
safety. Significant projects with large scale change implications within the Region this year – including the preparation to implement PCIS –
have competed for employee’s time and energy. Regardless of this, however, the support for quality improvement and patient safety
activities continues to slowly grow. Significant work has been accomplished involving several substantial projects within the Department of
Medicine. Further summarized below, these include; GRIDLOC, Safe Spaces, Safer Health Care Now – medication reconciliation, further
development of Safety Action Teams, chemotherapy storage and labeling, and participation with innovation projects.
Last year’s development of a VP of safety and a division within QSHI to support the patient safety agenda speak to the Region’s
commitment to this important work. This safety focused infrastructure, through the addition of the “Clinical Safety Evaluation” department,
has evolved and developed to provide improved identification, solution-development, and feedback of identified safety hazards and adverse
events. Specific attention was given to the need for section 9 protections of such safety discussions and also for a clearer mechanism for
follow-up, feedback and evaluation of developed safety strategies. Quality improvement teams and councils have evolved, over the last
year, and will continue to develop in order to further integrate this patient safety component into their mandates.
The following section, as this is the first time it has been discussed in an Annual Report, will provide a detailed account of the background,
structure, and function of the new Clinical Safety Evaluation component of QSHI, and its relationship to the quality improvement and patient
safety program of the Department of Medicine. Following this, further details and highlights of the various projects mentioned above will be
provided.
Quality, Safety, and Health Information
“Clinical Safety Evaluation”:
The internal and external reviews into two unexpected patient deaths in 2004 served as a “wake-up call” for this Region and resulted in the
re-examination of this Region’s safety practices and procedures. Clinical Safety Evaluation is a department within Quality, Safety and
Health Information, and was established to provide additional support and resources to help carry the Region’s safety agenda forward.
Thus, the Clinical Safety Leader position was created, with the responsibility of leading Safety Management within each Portfolio. The
Clinical Safety Leader jointly reports to Clinical Safety Evaluation and to their Portfolio Executives. Specific attention was given to the need
for section 9 protections of such safety discussions but a clearer mechanism for follow-up, feedback and evaluation of developed safety
strategies was also clarified.
Page 20 of 71
The following paragraphs and sections, under this heading of “Clinical Safety Evaluation”, serve to highlight the key roles, responsibilities,
and functions of this new area within Quality, Safety, and Health Information. The end of this portion will be marked by an illustration
outlining the key connections and relationships formed by the recent marriage of quality and safety within the Department of Medicine, as
well as the linkages to the rest of the Northeast Community Portfolio.
Clinical Safety Evaluation - Key Functions:
1. Coordinate all serious/fatal adverse event reviews with the appropriate department(s) within the NE Community Portfolio.
2. Ensure that appropriate actions are assigned to mitigate risks posed by the hazards identified.
3. Review Safety Learning Reports (incident reports) that are generated within the NE Community Portfolio, and provide feedback to
reporters about the receipt of the report and any analysis/action that has resulted.
4. Communicate those hazards and risk mitigation strategies that pertain to a broader audience to other Departments, Programs,
Services and Portfolios throughout the Region.
5. Receive reports on hazards and recommended improvements from internal sources, such as the Regional Event Safety Review
Committee, the Regional Clinical Safety Committee, and other member groups.
6. Generate a report of prioritized system improvements and recommendations for the Portfolio Vice President and Executive Medical
Director re: how to proceed.
7. Plan and review evaluations of the extent and the impact of high priority system improvements and establish plans for addressing
implementation problems.
8. Ensure that proper administrative accountability has been assigned for dealing with identified safety issues (in collaboration with
Portfolio VP/EMD).
9. Participate in education and public forums on patient safety.
10. Participate and coordinate communication strategies to inform staff and physicians about system-wide changes to
policies/procedures/practices and/or identified safety hazards.
11. Promote the importance of reporting safety events and near misses.
12. Promote the use of the Region’s Just and Trusting Culture policy and promote the support for staff/physicians who are involved in
an event.
Clinical Safety Evaluation - Key Activities Include:
1. Hazard Identification:
• Responsible for conducting safety analyses in order to identify, review & make recommendations that mitigate risk of hazards &
potential harm to patients.
Page 21 of 71
•
•
•
Five Safety Reviews have been conducted within the area of Medicine and Family Medicine from November 2005 – March
2006.
The method used to conduct safety reviews is the Health System Safety Analysis (HSSA) tool.
Developed a safety review “decision tree” to illustrate the process of carrying out a safety review.
2. Safety Committee Structure:
• Responsible for developing safety committees (protected under Section 9 of the Alberta Evidence Act) within the NE
Community Portfolio. These committees are sub-committees of the Regional Clinical Safety Committee, established for the
purpose of carrying out quality assurance activities. The goal of this work is to identify and analyze hazards that could place
patients, staff and/or the public at risk of harm, and to communicate this information appropriately.
• The Acute Medical Services Clinical Safety Committee has been established to represent the Department of Medicine. This
committee has 3 sub-committees based on physical location (FMC, RGH, PLC), for a total of 4 committees within the
Department of Medicine.
• Involved with the development of Terms of Reference and determining membership for these committees.
• Currently co-chair the NE Portfolio Clinical Safety Committee and the Mental Health Services Clinical Safety Committee.
• Member of the Acute Medical Services Clinical Safety Committee, the Community Medical Services Clinical Safety Committee,
the Medicine Quality Council, and the Family Medicine Quality Council.
3. Communication:
• Due to the nature of this position, ongoing and frequent communication with staff and physicians across the Portfolio is
required.
• Continued communication and collaboration is also required between the Clinical Safety Leader and the Quality Improvement
Consultant, to ensure recommendations for system improvements are appropriate and to evaluate the impact of such
improvements within the Department of Medicine (as per the safety management cycle below).
Page 22 of 71
Safety Evaluation vs Quality Improvement
Clinical Safety
Evaluation
Quality
Improvement
5
•
Learning to use critical language and committing to a standardized process which results in a recommendation is what the
SBAR approach to patient safety is all about. SBAR stands for Situation, Background, Assessment, and Recommendation, the
essentials in critical decision making.
•
Two SBAR formatted communications, in collaboration with the QI Consultant, have been distributed thus far and have
demonstrated effectiveness in closing the loop. For example, a safety hazard was identified related to the possible tipping of
portable O2 tanks, which put patients at risk for thermal injury. Through investigation of this potential hazard, it was learned that
bags were available to house these portable tanks. An SBAR communication was developed and sent out to each unit/area
identifying this potential risk, which also notified managers about the availability of O2 bags, including information on how to
obtain them. A poster was also developed and distributed with the SBAR which included photos of how to properly position
portable O2 tanks, either with or without the available O2 bag, as well as dangers to avoid. This was made available to all
Clinical Safety Leaders in order to distribute this information on a Regional level.
4. Education:
• Responsible for participating in education and public forums on patient safety.
• Attended several educational events related to Quality Improvement and Patient Safety.
Page 23 of 71
•
Future commitment to participate in teaching the Health System Safety Analysis (HSSA) course to all members of a safety
committee within the NE Community Portfolio on an ongoing basis.
5. Reporting System:
• An effective, responsive safety reporting system is an important tool for creating and sustaining a safety culture.
• Clinical Safety Evaluation has reached the negotiation phase with the selected vendor.
• Ongoing involvement is required to ensure our new Safety Reporting System reflects both the current and future needs of the
Region. Once this new system is in place, responsibilities will include daily triaging of reports to determine higher priority
reports, and providing feedback to reporters regarding any action that has resulted. Providing feedback to reporters will serve to
close the loop in a way that is not possible with the current system, and to share learning on a regional level.
6. Patient Safety Leadership WalkRounds:
• As part of the strategy to carry the safety agenda forward, the Region implemented the use of Patient Safety Leadership
WalkRounds.
• These WalkRounds occur on an annual basis and are attended by members of the Executive Team, as well as the Clinical
Safety Leader and/or the Quality Improvement Consultant.
• The intent of Safety WalkRounds is to heighten the awareness of the role we all play in regard to safety, as well as to
demonstrate the strong commitment of senior leadership to a culture that encourages safety by:
1) Connecting senior leaders with people working on the front lines.
2) Educating senior leadership about safety issues on the front lines.
• Developed/revised the WalkRound structure to be used within the Portfolio.
• Developed a spreadsheet for collecting WalkRound data.
• Currently setting up schedule for WalkRounds within the department of Medicine.
• Data collected will be entered into spreadsheet and emailed to the participating manager/area for feedback re: action
plan to address issues.
• Ongoing follow-up on a quarterly basis with the expectation that areas commit to 4 safety based changes in their area
per year.
• Developing a mechanism to ensure feedback reaches staff to illustrate the value of their input and to demonstrate that
positive changes have been implemented as a result.
• Working with fellow Clinical Safety Leaders to develop a database to collate and manage Safety WalkRound data.
• In future, provide summary reports of collated data to Portfolio Executives and key stakeholders to illustrate progress
made and to ensure appropriate support/resources are available to units/departments to facilitate change.
Example of “Closed Loop” Activity: (refer to photo of poster below)
Page 24 of 71
•
•
•
•
•
Initial issue identified on patient care unit – harm suffered by patient due to an oxygen canister being placed too close to their skin.
Incident report filled out by staff, and manager contacted Clinical Safety Leader
Incident investigated, and recommendations made
Poster, and education is not enough to induce behavior change, staff need cues to make the right decision as to where to place
oxygen canisters
Storage bag (middle photo) highlights this function, by giving staff a safe location to store canisters while transporting patients
Instructions given to all nursing units as to how to receive storage bags, and posters circulated – via “SBAR” format - to further
outline issue, recommendations, and ways in which risk can be mitigated
Page 25 of 71
QSHI
Oxygen Tank Safety
WARNING
Patients Are At Risk For Injury
If you are transporting patients with a portable oxygen canister, please ensure
the canister will not come into contact with the patient.
The oxygen canister must be hung upright on the outside of the stretcher or
placed in a protective carrying bag and hung on the outside of the stretcher.
Outside of Rails
Outside of Rails in Protective Bag
Inside of Rails
Page 26 of 71
Quality Improvement/Safety Structure – Within Department of Medicine and NE Portfolio
Page 27 of 71
Quality Improvement and Patient Safety Program Highlights
Safety Action Teams:
Over the last year, the Quality Improvement and Patient Safety team continued to develop the patient
safety infrastructure in the department and supported the start up of additional unit-based, safety action
teams (SAT’s). We have helped to implement a total of 13 teams to date, with several more to be
developed in the near future. In an effort to improve upon communication, we began to look at ways to
share safety concerns among teams and more effectively with the new Clinical Safety Evaluation group
and the Region. We are developing a database and web-based exchange mechanism to further assist
in the communication, organization, and sharing of common safety concerns and the solutions used to
remedy these.
Refer to the Appendix to view additional details outlining current initiatives of these various teams.
Safer Health Care Now! Campaign:
Involvement in the ongoing National ‘Safer Health Care Now’ initiative continued with a focus on
medication reconciliation. Medication reconciliation represents one of the six key strategies, identified
by this campaign, to reduce adverse events in health care. Within the Department of Medicine,
participating in the Region’s medication reconciliation project is a pilot team from Patient Care Unit 74,
RGH.
Despite recent management and team member changes, and other major projects competing for their
time, the team continues to trial tests of change on the unit, all aimed at improving the following
knowing what regular medications their patients are taking prior to admission, and ensuring that these
medications are either continued on admission, or making sure it is clearly documented why they have
been changed or omitted.
Highlights to date have included: education blitzes to provide better understanding for nursing staff
regarding project and their role in obtaining medication histories; providing nursing staff with a better
form in which to document medications which have been missed on admission; and, better
communicating with unit pharmacists to indicate when histories are complex and in need of further
expertise.
We hope to work with SCM to develop an electronic version of the ‘best medication history’ to be
incorporated into the electronic health record.
Safe Spaces:
Safe Spaces, a Regional Initiative, was officially launched January 25, 2006. This initiative is
sponsored by the Chief Nursing Office, and is a collaborative project between Quality, Safety and
Health Information (QSHI) and Professional Practice and Development (PPD).
The aim of this project is to develop and test an education and implementation plan designed to
enhance and support inter-disciplinary communication and teamwork in the delivery of safe patient
care. Six pilot teams have been formed, representing different portfolios across the Region. Medicine
is represented by the NE Community Portfolio team – with members from Patient Care Unit 61, FMC.
The team is composed of physicians, registered nurses, respiratory therapists, physiotherapists, social
work, and a unit clerk. A culture survey will be distributed on the unit, as a baseline measure, and team
members attended two full day workshops. These workshops provided an educational background and
foundation to the project, as well as provided team members with the opportunity to discuss areas in
which teamwork and communication can be improved in their area, and strategize as to how this could
be accomplished. Discussion to date has emphasized the importance of knowing your team members,
Page 28 of 71
role-definition, and strategies to improve the exchange of critical information. A tool, called the SBAR
tool, is being used to specifically address the information sharing needs of nursing staff with physicians
but can be used by any team members to guide transfer of critical information.
GRIDLOC:
GRIDLOC, an acronym for “Getting Rid of Inappropriate Delays the Limit Our Capacity to Care”, is an
initiative which is looking at patient flow through the emergency department but also on the continuum
of care including discharge planning efforts. Most of the early work has been on defining and
operationalizing a measurement strategy of important steps in the patient’s trajectory as it begins in the
ED. The team has just begun to get together with the data and its early interventions to improve patient
flow. The primary focus for the project will be at the FMC but there will be ongoing communication and
spread of proven strategies to the other sites.
Chemotherapy Storage, Delivery, and Labeling:
Prompted by a realization that current practices could potentially result in adverse events, a
consultation was made to QSHI’s Human Factors Consultant, by the Patient Care Manager of Unit 51,
PLC. The unit’s current storage and delivery practices of cyto-toxic chemotherapy medications
consisted of a shared fridge for chemo and non-chemo medications, shared medication boxes
combining chemo and non-chemo medications of several patients, poor labeling, and the inconsistent
and unreliable delivery of medications to the unit from pharmacy. The ensuing report and
recommendations prepared by the Human Factors Consultant highlighted these concerns, and
included suggestions for improved labeling and storage of these agents. Local fixes implemented thus
far include separate storage fridge for chemo medications, and a new process to sign for medications
once received from pharmacy. Further work continues, in combination with larger Regional initiatives,
to improve the labeling of these and other medications.
Figure 1. Current Storage Practices
• Non patient specific, and mixture of chemo, and non-chemo meds together
Page 29 of 71
Figure 2. Proposed labeling improvements
• Picture on left outlines current practice – label is folded and can often inhibit the accurate reading of
pertinent drug information and identification. Picture on right features a proposed improvement.
Involvement with Innovation Projects:
The QI team has also been involved with a number of the DOM innovation projects, providing process
mapping, development of evaluation and measurement strategies, training and support for the use of
QI tools to develop project solutions. In particular there has been significant direct involvement with the
VTE prophylaxis project and the Clinical Decision Support projects. The VTE prophylaxis project is
focused on increasing the use of VTE prophylaxis strategies across the region by development of
decision support tools and providing education and feedback on appropriate use of prophylaxis by
clinical groups and units. Development and implementation of decision support tools using the
electronic health record is a key component of this project as well as using the EHR to measure use
and balancing measures related to use of prophylaxis. The decision support project is focused on
developing an appropriate framework for development, implementation and evaluation of decision
support initiatives and evidence-based medicine initiatives within the DOM to allow the department to
get the most out of these initiatives and to allow for an appropriate approval process and necessary
ongoing ownership of these strategies.
Website Development:
In an effort to improve communication regarding Quality Improvement and Patient Safety initiatives, a
website has been developed and published. Reachable through links from the Department of Medicine
and QSHI homepages, this site also illustrates the various structures which support the quality
improvement program within Medicine. A work in progress, future plans include further strengthening
this resource to better meet the needs of those we serve.
Page 30 of 71
Challenges and Future Directions:
We will continue to be challenged with encouraging culture change and spread in the areas of quality
improvement and patient safety, and to maintain gains achieved through this work. With plans to
further develop and support safety action teams, in both our inpatient and outpatient areas and
departments, it is our belief that frontline employees will become empowered as change agents, and
join us in this challenge. The larger scale support for quality and safety activities continues to grow in
this Region, as do the concepts of patient centered care, decision support, evidence-based practice,
and the area of quality indicators. We remain dedicated to improving communications with the multiple
stakeholders involved with quality and safety with the hopes to further advance these concepts, and the
practices supporting them, within the Department of Medicine.
Page 31 of 71
Innovation
In March 2005, the Calgary Health Region Department of Medicine and Medical Services launched into
comprehensive planning and implementation of 17 Innovation Initiatives designed to improve access to
medical specialists, improve care quality, safety and effectiveness, improve service integration and
sustainability. The Innovation Initiatives received a total of $7.4 million over 2 years at the beginning of this
current fiscal year. Half of this funding is from Alberta Health & Wellness, and half from the Calgary Health
Region.
This interim evaluation report demonstrates significant progress has been made across all of the initiatives
summarized as follows:
¾ Hired 73% of allocated staff (official start of the projects was September 2005), with additional 20%
in process and hiring expected to be 93% complete by May 2006.
¾ Launched or expanded a number of specialty clinics including:
• Atrial Fibrillation Clinic to support management of complex cases of atrial fibrillation.
• Young Adults with Rheumatic Disease clinic to support care transition from pediatrics
to the adult system.
• Tertiary Obesity clinic. This also includes a community based exercise, healthy eating
and self-management program and integration with Surgery for laparoscopic banding
when indicated.
• Expanded the Congestive Heart Failure clinic from the Foothills Medical Center (FMC)
to the Peter Lougheed (PLC)and Rockyview General Hospital (RGH)
• Expanded General Internal Medicine Urgent Assessment Clinic from the FMC to the
RGH, and maintained central triage.
• Cough clinic, staffed by an asthma educator to support quality patient care and
reduce unnecessary consults to Respiratory Medicine.
• Increased the number of Nurse Practitioners in Medical Services from 2 to 7
(expected).
• Created division specific central referral and triage in Gastroenterology, Nephrology
and Rheumatology.
• Launched education intervention to support patient knowledge and uptake of
alternative modalities of dialysis.
• Launched sputum diagnostic for improved clinical management of asthma.
• Piloted standardization of peri-operative referral process and lab work.
• Strengthened care transitions from acute care to community in congestive heart
failure, chronic obstructive pulmonary disease, and stroke secondary prevention.
• Enhanced use of clinical practice guidelines in Infectious Diseases and Osteoarthritis.
Developing a standardized approach to guideline development and adoption.
• Supported rural specialist access: launched gestational diabetes clinic via telehealth
to Lethbridge. Provided increased human resources and Soprano Chronic Disease
Management software to support diabetes management in rural areas. Enhanced
diabetes training for nurses and dietitians. Evaluated telehealth feasibility for
congestive heart failure, dermatology and respiratory medicine (sleep).
• Completed evaluation plans and related databases for all innovation initiatives.
Challenges faced include lack of space and recruitment and retention of staff.
A significant effort on behalf of 17 subproject teams, including physicians, management and staff, enabled
early successes for the innovation initiatives. The next year will be critical to further refine implemented
services and ensure sufficient time has elapsed to adequately assess the impact of changes.
Page 32 of 71
Appendices
Appendix #1: Summary of Medicine Quality and Safety Improvement
Projects
SITE
TEAM
PCU 36
PCU 37
FMC
PCU 61
RECENT INITIATIVES
Hazard Identification/Resolution: issue identified by team
involving the common error made by nursing staff where IV
medication is hung at the wrong time – ie bag with time of ‘1600’ is
mistakenly hung at ‘0800’. This common error results in confusion
for staff, and rework. Issue relayed to larger Regional group and
plans made to consult with Human Factors consultants to address
Regional labeling standards
Hazard Identification/Resolution: Currently completing PDSA
cycles involving medical air/oxygen project. Involves assumption
that errors will be reduced if all medical air regulators are kept
away from the bedside, hooked up only when medications need to
be given, and taken out of room immediately following. Also
trialing a new type of regulator which looks very different from
oxygen regulator.
Good Catch Reporting: look alike medications identified and
project initiated with pharmacy leading to new packaging and
labeling of morphine vials – this intervention led to the team being
presented with a Good Catch Award, and featured on the cover of
the March 2005 edition of Frontlines.
Hazard Identification/Resolution: issue involving ported IV
tubing identified by team as potential hazard. When certain
medications are hung using this tubing, the possibility exists that
nursing staff could infuse another medication at the same time,
therefore interrupting the flow of the other medication. With certain
meds, such as heparin, this could lead to an adverse event.
Portless tubing was added to the supply cart, and plans to educate
staff regarding this potential situation, and team remedy to this was
made
PCU 62
Team Formation/Education: interest has been identified on unit,
and initial education session provided. Once membership further
defined, initial hazard identification to be completed.
PCU 47
Hazard Identification/Resolution: New safety team recently
formed on the unit. Current safety issues identified and initial
project involving infection prevention and control issues, as well as
unit clutter identified as priorities – work to commence in near
future
Page 33 of 71
SITE
TEAM
PCU 59
RGH
PCU 61
PCU 73
PCU 51
PLC
PCU 43
PHARM
SAC
RECENT INITIATIVES
Hazard Identification/Resolution: Communication boards
installed in each patient room to facilitate easy communication from
caregiver to caregiver.
Narcotic cupboard reorganized – unit was pilot unit for Regional
initiative to improve standards for narcotic storage and narcotic
counting
Hazard Identification/Resolution: Issues identified on unit
involving poor communication between nursing students and
nursing staff. Project underway to better identify communication
standards and expectations, as well as providing tools to facilitate
thorough communication
Clutter in hallways identified as a concern, ideas for improvement
include equipment stations, and regular sweeps of unit to better
determine unit inventory and to get rid of unused or broken
equipment
Team Formation/Education: interest has been identified on unit,
and initial education session provided. Once membership further
defined, initial hazard identification to be completed
Hazard Identification/Resolution: issues identified regarding the
unit’s current storage and delivery practices with cyto-toxic
chemotherapy medications. Report and recommendations
prepared by Human Factors Consultant including suggestions for
improved labeling, and storage of these agents. Local fixes
implemented thus far include separate storage fridge for chemo
medications, and new process to sign for medications once
received from pharmacy.
Hazard Identification/Resolution: project underway to provide
better guidance and expectations to staff new to unit - orientation
checklist being formulated. Safety issue raised surrounding ASAP
or STAT meds not being signed off in a timely manner. While
PCIS should help in addressing components of this issue, alternate
ideas also being considered by team. Work has also been done to
address concern of poorly identifying patient code status. Unit
experimenting with placing red dots above patient beds.
Hazard Identification/Resolution: RN’s not checking unit clerk
order entry – new process being trialed where Pharmacists will call
or info-gram the units any time they see unit clerk type ins or
incorrect orders.
Some look alike, sound alike medications identified - D5W/NS 50
mL and 100 mL identified as being too close together on the
counter – staff has now separated them to opposite sides of the
binders and also changed the color of bins they are stored in
Hazard Identification/Resolution: This group met for an initial
meeting and participated in a hazard identification process. They
have since decided to not form a SAT at this time, but have
addressed many of the identified hazards, and will communicate
their work and future plans in a staff meeting format. They are a
small clinic, and thought it would be best to concentrate on safety
Page 34 of 71
SITE
REGIONAL
TEAM
Leth.
Dialysis
Health on 12th
REHAB
Outpatient
RECENT INITIATIVES
issues as a whole group rather than a team of representatives.
Hazard Identification/Resolution: Electrical plugs replaced due
to difficulty engaging same, mirror installed above high traffic area,
cleaning process for various equipment clarified, maintenance
department made aware of items in general disrepair
Communication and Reporting: communication board to be
installed which will be used to outline identified hazards on unit and
what the team has resolved as well as future projects.
Hazard Identification/Resolution: initiative undertaken aimed at
improving the unit’s attention to infection prevention and control
issues. Hand washing stations set up at unit’s entrance – and
initiatives underway as well to engage patients with better hygiene
and IP&C practices (no bare feet on unit’s scales, proper disposal
of tissues, and placing of hand wash bottles closer to dialysis
chairs)
Communication and Reporting: Project initiated to improve
communication between rehab staff and other health care
professionals. SBAR template customized by group to highlight
typical areas of concern, and typical issues needing to be
addressed by medical and nursing staff. Information sessions
presented at staff meetings at all three acute care sites, and trial of
SBAR form underway at PLC site
Diabetes,
Hypertension,
and Cholesterol
Centre
Team Formation/Education: interest has been identified on unit.
Once membership further defined, initial hazard identification to be
completed
Chronic Disease
Management
Team Formation/Education: interest has been identified on unit.
Once membership further defined, initial hazard identification to be
completed
Page 35 of 71
Appendix #2 – Division Reports
(presented in Alphabetical Order by Division)
Division of Dermatology
Division Chief – Dr. Richard Haber
ADMINISTRATION
The Division of Dermatology is a recently formed division within the Department
of Medicine at the University of Calgary.
In 2005, it consisted of 2 full time GFT members:
• Dr. Regine Mydlarski – a clinician-researcher
• Dr. Richard Haber - Started December 1, 2005 as Head of the Division of
Dermatology. Dr. Haber is a clinician-teacher/administrator.
Dr. Mydlarski
continues to develop
the science program
The Division had 18 active community based dermatologists affiliated with the
University of Calgary in 2005.
RESEARCH
In 2005, Dr. Mydlarski continued to develop a translational science program in
dermatology with a focus on GW bodies and the skin, translational research in
pemphigus and genetics of vascular malformations. In addition, she ran an
immunodermatology clinic and a genetic skin disease clinic in collaboration with
the Department of Genetics.
New
immunodermatology
& genetic skin disease
clinic
CLINICAL AND INNOVATIONS
Dr. Haber set up 2 dermatology clinics to begin January 1, 2006 and future plans
for the Division include:
• establishing a pediatric dermatology service – Fall of 2006
• teledermatology service for rural Alberta -Fall 2006
• setting up a dermatology rotation for internal medicine residents to rotate
through Dermatology service in the teaching hospitals and private clinics
• working on an alliance with Edmonton for a joint “pan –Alberta”
Dermatology Residency
• recruiting for a GFT dermatology faculty position for 2006.
New Dermatology
residency program
Page 36 of 71
Division of Endocrinology and Metabolism
Division Chief: Dr. Alun Edwards
ADMINISTRATION
New initiatives in care increase administrative demands. Increasing numbers of
undergraduate and graduate trainees are increasing administrative requirements
in the educational arena.
CLINNICAL AND INNOVATIONS
The Division has been very active in the last year with a number of initiatives
enabled by ARP innovations funding. The main focus has been to support
primary care physicians in the management of chronic disease such as diabetes,
hypertension and cholesterol by working with diabetes nurses in the various rural
communities to consult on management of specific cases. A weight control clinic
was also established in association with the Diabetes Hypertension and
Cholesterol Centre (DHCC) at Health on Twelfth. This multidisciplinary service is
integrated with the new bariatric surgery program at the PLC.
A major development in Lethbridge was the creation of a telehealth clinic for the
management of diabetes in pregnancy which contributed greatly to meeting an
urgent clinical demand in the Lethbridge area. Plans are underway for the
expansion of telehealth services in rural southern Alberta, to include service for
diabetes, hypertension and lipid management. Providing support to nurses in the
community who have diabetes expertise can be done remotely, by telephone or
telehealth. The nurses can then relay the information to the primary care
physician at a convenient time, thereby building the capacity of physicians to
manage diabetes in the community. This will translate into more patients
receiving care closer to home, reducing the inefficiency and inconvenience of
traveling into Calgary for specialist care.
Focus has been
- management of
chronic diseases
- working with diabetic
nurses in rural
communities
Telehealth clinic in
diabetes established in
Lethbridge
EDUCATION
The Division had two endocrine resident trainees throughout the year.(one
position was taken by a physician from Saudi Arabia). The number of requests
for training in endocrinology, (both undergraduate and from various graduate
training programs) is increasing yet we lack both physical space and teaching
faculty to educate more people in the clinical areas.
2 endocrine resident
trainees
CLINICAL
The clinical workload of endocrinologists is increasing steadily. One factor is the
increasing prevalence of diabetes and osteoporosis. A second factor is the
changing pattern of provision of care. In the past, general internists provided
much of the ambulatory care for patients with diabetes and osteoporosis; more
recently, they are focusing on inpatient care while endocrinologists are providing
more of the ambulatory care. The resultant increase in chronic outpatient activity
is a serious issue for endocrinologists.
Workloads steadily
increasing
Page 37 of 71
AWARDS
Dr. Hanan Bassyouni received the Calgary Department of Medicine 2005 Silver
Tongue Award for Internal Medicine Residency Teaching as well as the
Undergraduate Medical Education Award for clinical clerkship teaching. The
Faculty Award in Undergraduate Medical Student education was awarded to Dr.
Greg Kline. In 2005, Dr. Hanley was honoured to receive the Canadian Society of
Endocrinology and Metabolism’s Robert Volpé Distinguished Service Award,
recognizing contributions to education, research and the endocrinology
community in Canada. He was also elected the President Elect of the Society.
5 members receive
Major awards
RECRUITMENT
In November the Division gained one new recruit, meeting its allocation under the
recruitment plan of the ARP. In the future, the Division will need more than one
per year to keep up with service demand, but since new endocrinologists are
scarce, the Division will need to find alternate solutions to the recruitment
challenge.
1 New recruit – Dr.
Shelly Bhayana
CHALLENGES
The wait list for diabetes and osteoporosis showed an increase in 2005. This is
due to the increasing prevalence of diabetes and osteoporosis. The shifting
patterns of practice within the Department of Medicine has resulted in an
effective decrease in specialists able and willing to undertake long-term follow-up
of patients with complex chronic diseases.
Challenges - increase in
wait lists for both
diabetes and
osteoporosis
Page 38 of 71
Division of Gastroenterology
Division Chief: Dr. Ronald Bridges
ADMINISTRATION
The Division of Gastroenterology has had an outstanding year with considerable
growth and development in all areas, significant accomplishments and many
changes. Further integration of patient care activities with educational programs
and research activities has occurred as a result of a strong collaborative effort.
Innovative program development and physician recruitment to improve patient
access to gastroenterology services and funding efforts to endow clinical
research chairs are divisional priorities.
CLINICAL and INNOVATIONS
The clinical workload for the division is steadily increasing with very busy
inpatient and outpatient activities. Recent national data demonstrate that wait
times to access GI consultation in Calgary are longer than any other region in the
country. The Division provides continuous clinical care at all acute care hospital
sites, the University of Calgary Medical Clinics (UCMC) and community private
practice clinics. Recognized as a national leader in clinical gastroenterology the
group continues to develop innovations to enhance the delivery of GI services in
the Calgary Health Region (CHR). Innovation programs to improve access to GI
care include:
1. Central triage, referral and telephone consultation at UCMC to more
effectively triage referrals and provide management suggestions to family
physicians and alternate care providers while patients wait for assessment.
2. An Inflammatory Bowel Disease (IBD) Nurse Practitioner to transition
inpatient to outpatient care more efficiently and reliably. Ms. Heatherington
has started her own clinic with mentorship from the faculty. This has reduced
the waiting list in the IBD clinic and has been very positively received by
patients and their families.
3. Nurse clinicians to assist with colon cancer screening, clinical care for
hepatology and gastroenterology and patient education.
4. Planning for the development and implementation of the Colon Cancer
Screening Centre continues. Ms. Anne Czapski has been hired as the project
manager to assist with the development and implementation of this unique
Canadian program.
5. An extended GI service plan is being developed in collaboration with the
Department of Rural Medicine to provide specialty care to rural areas in the
CHR.
Members of the Division have developed nationally recognized programs in
Inflammatory Bowel Disease, Therapeutic Endoscopy and Hepatology:
Inflammatory Bowel Disease Program
Increasing workloads
- longer wait times than
any other Region in the
country
Innovations
- Central triage effective
for family physicians,
ACP’s, waiting for
assessment.
- Nurse Practitioner hired
for IBD
- Nurse clinicians helping
plan for Colon Cancer
Screening Centre
-Extended GI service plan
developed in collaboration
with Rural Medicine
IBD program flourishes
- great recruitment
- additional training
The clinical IBD program under the direction of Dr. Remo Panaccione continues
to expand and flourish. Dr. Kevin Rioux was recruited from the University of
Alberta and Dr. Jennifer Jones was recruited after completing an IBD fellowship
at the Mayo Clinic. In addition, Ms. Joan Heatherington has been hired as a
nurse practitioner in IBD. She is the first nurse practitioner in Gastroenterology
with a focus on IBD. She has played an important role in the day-to-day
management of patients with IBD and has been pivotal in providing follow up
Page 39 of 71
care to patients discharged from hospital. Dr. Shane Devlin has gone for IBD
training to Cedars Sinai in Los Angeles and Dr. Gil Kaplan has gone off for
training in Epidemiology and IBD at Harvard and the Massachusetts General
Hospital in Boston. Following the completion of training they will return to further
augment the growth of the IBD program. Fund raising for the Lloyd Sutherland
Chair in Inflammatory Bowel Disease continues as part of the CHR and
University of Calgary Reach! Campaign. To date more than $1.1 million dollars
has been donated.
Lloyd Sutherland Chair
fundraising is ongoing
Therapeutic Endoscopy Program
The Therapeutic Endoscopy Program lead by Dr. Jon Love at the Peter
Lougheed Centre (PLC) continues to evolve. Interventional techniques including
ERCP, stent placement, endoscopic ultrasound, capsule endoscopy and new
technologies are provided through a regional program that is unique in Canada.
A CHR Request for Proposal (RFP) was completed and awarded to Pentax
Medical Equipment Corporation Canada for endoscopic equipment at all sites.
The service is utilizing the regional endoscopy database to perform detailed
quality assurance initiatives and is moving to standardize protocols across the
region to improve efficiency and further enhance patient care. Fund raising for
the Chair in Therapeutic Endoscopy continues as part of the CHR and University
of Calgary Reach! Campaign. Pentax Canada has donated $1.2 million towards
the Chair.
Therapeutic Endoscopy
Program
- Pentax is a great
contributor
- Fundraising for Chair in
Endoscopy continues
Hepatology Program
The viral hepatology clinics continue to expand with the aid of nurse clinicians in
an extended clinical role. Plans have been developed to move the Southern
Alberta Transplant Program to the PLC to accommodate program expansion
including plans to perform liver transplant surgery in Calgary. Dr. Kelly Burak,
Director of the Southern Alberta Liver Transplant Clinic has significantly
increased the profile of liver transplantation in Southern Alberta. Fund raising for
the Chair in Hepatology has been initiated as part of the CHR and University of
Calgary Reach! Campaign.
Hepatology Program
- SATP moves to PLC
- liver transplant surgery
- Fundraising for Chair in
Hepatology
EDUCATION
During the year several excellent people have been recruited. Each brings
specific expertise to complement existing divisional activities and future planned
growth.
Members of the Division are committed to providing high quality educational
programs to fulfill education objectives in undergraduate medical education,
clinical clerkship, residency training, GI specialty training, post graduate GI and
Hepatology fellowships and continuing medical education. The 2005
undergraduate GI course was again very highly rated by the students. Very little
modification has been done to this course in anticipation of the development and
implementation of the new Course 1. This will begin in August 2006 and will
amalgamate the Fever/Sore Throat (Principles of Medicine) with the Blood and
GI Courses. This has been a very labour intensive process that began in 2005.
Dr. Kelly Burak (Co-Chair Course 1) and Dr. Sylvain Coderre (Assistant Dean,
Undergraduate Medical Education) have been instrumental in the design of the
new course. The fall of 2006 will be very demanding on the GI faculty, as the new
Course 1 for the incoming medical school class will run from August to October
and the GI Course for the second year students will run from November to
December. Furthermore, the increased class size of the incoming class, with 25
New course developed
in GI medicine
GI Training Program
- recognized as a leading
training program
Page 40 of 71
new students, has lead to the need to recruit more small group and clinical core
faculty preceptors from the Division.
The Royal College of Physicians and Surgeons GI Training Program led by Dr.
Eldon Shaffer continues to be recognized as a leading training program in
Canada. The program has expanded in recognition of the need for more
gastroenterologists regionally and nationally. We hope to retain many trainees at
the completion of training to improve the manpower situation in the Division in the
years to come. An education retreat was held in February 2006 to review the
strengthen the program. Graduating fellows continue to be successful in
completing the Royal College of Physicians and Surgeons of Canada Specialty
examinations. The GI trainees won several awards:
1. Dr. Brian Yan received an award for the Best Trainee Presentation at the
World Congress of Gastroenterology in September 2005. Following the
completion of the GI training program he will go to Stanford University for
further training in Endoscopic Ultrasound.
2. Dr. Carla Coffin received a Fellowship Award from the American Association
for the Study of the Liver. This award is rarely awarded to an individual
outside the United States. She also received the CSCI Resident Research
Award, the CAG-Altana GI Fellow Research Prize and the CASL Best
Trainee Presentation Award. Following the completion of training she will go
to the University of California at San Francisco for further training in
Hepatology.
The Therapeutic Endoscopy Training Program has two trainees who have rapidly
acquired the skills and knowledge related to the specialty. Dr. Mamoon Raza was
the recipient of a Cook Canada Grant to assess the regional situation pertaining
to the use of Surgery and Endoscopy for the Removal of Difficult Polyps. The
Alberta Heritage Fund for Medical Research (AHFMR) and a CAG/CIHR grant
have provided funds for Dr. Steve Heitman to assess Capsule Endoscopy versus
Standard Care for Obscure Overt GI Bleeding in the CHR. Dr. W. Al-Hamoudi is
the fourth fellow to participate in the The Hepatology Training Program. Following
the completion of training he will be going on for further training in liver
transplantation.
Another year of dynamic seminars and meetings have benefited all from an
educational standpoint and have successfully intertwined basic and clinical
science. In collaboration with the Gastrointestinal Research Group and Industry
partners we have had more than 20 national and international speakers visit the
Division during the past year. A GI Endoscopy Refresher Course coordinated by
Dr. Jon Love was held at the PLC in March 2006. This was a combined
interactive presentation with live endoscopy aimed at paramedical and medical
personnel with an interest in GI Endoscopy. Guest faculty included Dr. D.
McIntosh from Halifax and Dr. J. Devier from The Free University of Brussels,
Belgium. A Western Canada IBD meeting coordinated by Dr Remo Panaccione
was held in November 2005.
GI Trainees win awards
- Dr. Yan – Best Trainee
Presentation
- Dr. Coffin – Fellowship
Award
Therapeutic Endoscopy
Training program
succeeds
- Dr. Raza
- Dr. Heitman
- Dr. Al-Hamoudi
Seminars/ Meetings
- more than 20 national
and international speakers
- GI Endoscopy Refresher
Course
- Western Canada IBD
Meeting
Members of the Division were also actively involved in the organization of
national and international continuing medical education and research programs.
Dr. Kelly Burak is Co-Chair of the CAG/CASL Gastroenterology Residents in
Training Program. Dr. Remo Panaccione is Co-Chair of the national IBD
Residents Training Program. Dr. Eldon Shaffer is Chair of the American
Association of Gastroenterology Liver Biliary Section. Dr. Sylvain Coderre is
President of the Alberta Society of Gastroenterology. Dr. Ron Bridges is
Page 41 of 71
President-Elect of the CAG and Co-Chair of the Canadian Digestive Disease
Week implementation committee.
RESEARCH
Continued development of basic science research, clinical trials and translational
research is a priority within the division. The division remains very active in
research activities in the Gastroenterology Research Group and the Institute of
Infection, Immunity and Inflammation with more than one hundred high quality
scientific peer reviewed papers published or in press during the year. Members
of the division participate on several editorial review boards, actively supervise
research trainees and have been invited to give numerous presentations
regionally, nationally and internationally. Division members have received new
grant funding from AHFMR, CIHR, the Crohn’s and Colitis Foundation of Canada
and the Canadian Liver Foundation. The IBD and Hepatology Clinical Trial
Programs continue to excel and are considered international leaders in the
implementation and performance of clinical trials. Epidemiology and health
outcomes research is a divisional area of strength that will be reinforced by
further faculty recruitment. A research retreat is scheduled for June 2006 to
identify specific translational research projects for members of the Division, III
Institute and GIRG. Members of the division have also actively participated in a
number of recognized national clinical guideline committees in hepatology, IBD,
colon cancer screening, irritable bowel syndrome and patient wait times.
CHALLENGES
The Division of Gastroenterology faces several challenges to sustain and
enhance existing clinical, educational, research and innovation programs. A high
priority and considerable challenge is the ongoing recruitment of clinicians,
educators and scientists to continue to provide comprehensive care and meet the
education and research goals and aims of the Department of Medicine and
Faculty of Medicine. Significant challenges are being experienced obtaining
office and laboratory space for new recruits. The administrative load related to
the planning and implementation of the Colon Cancer Screening Program and
the Liver Transplantation Program is significant. The expansion of GI educational
programs at all levels necessitates a review of funding from all parties to ensure
there are adequate resources for training. Secure funding for the Research
Chairs in IBD, Hepatology and Therapeutic Endoscopy is an important divisional
challenge that is being ably assisted by the Reach! campaign. The division
optimistically looks forward to securing the funds for these Chairs to enhance
divisional research activities, recruitment and access to new technologies in the
years to come. Finally, the Division of Gastroenterology would like to
acknowledge the ongoing excellent assistance provided by nursing, paramedical,
administrative and support personnel. Their contribution has been vital to the
success of the division. It is imperative that their services are retained in the
years to come.
Research Programs
- CAG/CASL GI Residents
in Training Program
- National IBD Residents
Training Program
- Chair of the American
Association of GI Liver
Biliary Section
- AB Society of GI
- CAG – President-Elect
-Co-Chair of Canadian
Digestive Disease Week
Research, clinical trials
and translational research
is a priority in the division
Challenges
- ongoing recruitment of
clinicians, educators &
scientists
- office and laboratory
space issues
- Implementation of Colon
Cancer Screening
Program & Liver
Transplatation Program
- Expansion of GI
educational program
- Securing funding for
Research Chairs
Acknowledgement of
excellent assistance
provided by nursing,
paramedical, admin &
support personnel
Page 42 of 71
DIVISION OF GENERAL INTERNAL MEDICINE
Division Chief - Dr. R.J. Herman, MD
EDUCATION
The University of Calgary Medical College has recently expanded its enrollment
to 125 students and together with commitments to Malaysian and other foreign
trainees, we are now accepting close to 145 students/year. At the same time,
the IM Residency Training Program has grown to 47 core residents plus a
number of Fellows in subspecialty training. This along with other successes in
our GIM R4 Fellowship and IMG programs has meant that we have had to create
new and innovative learning opportunities in order to accommodate all these
people.
Presently, our group contributes over 400 hours of lectures to the University of
Calgary Undergraduate medicine curriculum; 5616 hours of structured bedside
and small group teaching in Clinical Sciences, over 73,000 hours of supervisory
clinical support and over 80 hours of Continuing Medical Education in Calgary
and throughout the CHR
Expansion in IM Education
- over 400 hrs of lectures
- 5616 hrs of bedside
teaching
- 73,000 hrs of supervisory
clinical support
- over 80 hrs of Continuing
Medical Education
The U of C Clinical Clerkship & Internal Medicine Residency Training Programs
Dr. Paul Gibson, Assistant Director of the Internal Medicine Residency Training
Program is heading up a Strategic Planning Initiative for the Residency Training
Program Committee looking at populating the GIM Teaching Units at the
Rockyview Hospital with IM residents. Also under consideration are plans to
enter into formative agreements with General Internists and sub-specialists in
midsized cities such as Lethbridge, Medicine Hat and Red Deer to broaden their
experience and at the same time expose them to practice opportunities within
these communities. In times of severe physician shortages, it is very important
that the University of Calgary, and with it, the College of Medicine and IM
Residency Program, be seen as meeting the educational physician resource
needs of all Alberta constituents, not just tertiary care hospitals in Calgary and
Edmonton. In January 2006, Dr. Marcy Mintz was appointed Director of the
Clerkship Course Chair for the College of Medicine. Dr. Dunne is the Clerkship
Evaluation Coordinator. These are important accomplishments, which along with
our other commitments to undergraduate teaching, solidifies our relationship to
the Clerkship and core IM Residency Training Programs.
GIM Clinical Scholar Program
Dr. Caren Wu defended her thesis entitled 'Accelerated Care versus Standard
Care of Transient Ischemic Attack: A Preliminary Analysis of Effectiveness and
Cost’. She commenced a faculty appointment with GIM at FMC in January 2006.
We are currently looking for a replacement.
GIM R4 Fellowship Program
Dr. James Kennedy completed his training and examinations in Internal Medicine
in June 2005 and has moved on to a position in stroke research with Dr. Alistair
Buchan at Oxford. Drs. Khan Ali and Jessica Simon finished their Fellowships in
2005. Dr. Simon is doing a further Fellowship in Palliative Card with a focus on
pain control in patients with non-malignant disease. Dr. Ali completed his
RCPSC examinations and joined the Division of GIM at the RGH in Jan 2006.
Dr. Paul Gibson is heading
up a Strategic Planning
Initiative in RGH as well as
Lethbridge, Medicine Hat
and Red Deer
Dr. Marcy Mintz appointed
Director of the Clinical
Clerkship Program for the
College of Medicine.
Dr. Caren Wu
- Joined GIM at FMC in Jan
2006 after defending her
Masters
Dr. James Kennedy
- in stroke research with Dr.
Alistair Buchan at Oxford
Dr. Khan Ali
- joined GIM at RGH
Dr. Jessica Simon
- Further Fellowship in
Palliative Care
Dr. Johan Conradie
- joined GIM at FMC
Page 43 of 71
Dr. Johan Conradie did the same, and joined GIM at FMC. Dr. Heather
Anderson (UBC) is presently doing her GIM Fellowship in Calgary and, as such,
is a regular contributor at monthly Journal Club.
2007 promises to be a very big year for GIM as 8 high-level internal candidates
and 1 external candidate have applied to our program. The success of our
Fellowship Program is visible proof of the strength of GIM in Calgary and of the
growing stature of GIM as an end career for young graduates across the country.
We have always had the most interesting patients. Now, with the ARP, we have
the lifestyle and remuneration to match.
As a result, the Director of our R4 GIM Training Program, Dr. Troy Pederson, has
recently secured funding to re-write the Training Objectives and focus our
program on providing an exceptional year of training experience to a larger
number of potential candidates. We are hoping that by July 2007 most of our
ambulatory clinics at RRDTC (see below) can be combined into discrete
disciplines with centralized booking (General Medicine Clinics, Perioperative
Medicine Clinics, Cardiovascular Risk Clinics, Maternal Health Clinics, Atrial
Fibrillation/Congestive Heart Failure Clinics) and that we will be well on the way
towards developing additional research Fellowship opportunities (besides Clinical
Epidemiology and Medical Education which we presently support) in areas such
as Hypertension, Clinical Pharmacology, Informatics and Knowledge Transfer.
This will provide a broad variety of unique GIM services across the Region and
offer exciting new learning opportunities for both post-graduate and Fellowship
trainees.
Dr. Troy Pederson
- re-writing Training
Objectives
IMG Program
Three years ago the Division of GIM made a commitment to begin training
International Medical Graduates for possible entry into the Canadian Health Care
System. Thus, each July over the last 3 years, we have contributed 1 or 2 of our
IMGs to the IM Residency Program in Calgary. These individuals now support
an expanded IM Training Program and allied IM and subspecialty services
across the Region. In July 2007, we will begin to see the products of this
investment as these people begin to resurface as graduates of the core IM
program. The expectation is that many of them will join our Division as GIM R4
Fellows and eventually qualify as fully licensed General Internists for
independent practice in Calgary, Lethbridge, Medicine Hat or Red Dear and
adjoining rural communities. This program has been so successful that the
Region has recently expanded the number of IMG-funded positions available to
all specialties by 15 and our Program is now the model for integrating foreign
trained physicians into professional practice across Canada.
Also, we have recently come to recognize the need for a second pathway for
IMGs, separate from re-qualification through the Residency Program.
Specifically, there is a need for highly trained professional support on some of
our acute care in-hospital admitting services and on specialized outpatient
services such as bone marrow transplant and oncology. Thus, over the last year
we have supported 1 of these individuals, Dr. Jan Sporina, as a Physician
Extender on our non-resident supported General Medicine Admitting Unit (GMU)
at the Foothills. He has been so successful in this venture that, in April of this
year, we sponsored Dr. Sporina through CPSA for a Part II license and he is now
working as a staff General Internist at Rockyview Hospital. The plan is for him to
complete his RCPSC qualifying examinations through FMRAC in June 2008.
IMG Program
- 1 or 2 have joined
Residency Program for
last 3 years
- First ones to complete
residency in 2007
- Program expanded
Dr. Jan Sporina
- Physician Extender
receives his Part II license
- will begin work at RGH
as a staff General Internist
Page 44 of 71
In 2005 we recruited 5 new IMGs and, in February through July 2006, our
program grew to 8 new IMGs plus another FP-IMG Physician Extender working
at the Rockyview. These people have enabled us to continue to provide highlevel admission and consultation support within the Region. There are now 5
competitive positions available each year through AIMG for entry into IM
residency. Physicians with international training wishing to immigrate to Canada
are now coming to Calgary specifically because they have heard of the success
of our programs and know that we provide first-class training and unparalleled
opportunities.
IMG’s
- 5 recruited in 2005
- Feb – July 2006 grew to 8
+ additional Physician
Extender
- AIMG residency positions
increased to 5
CHALLENGES
Above all, it is important to protect the academic mission of the University of
Calgary and the Faculty of Medicine. However, we must recognize that our
educational programs do not work in isolation, in that they also serve an
important clinical service role. With the planned major expansion of clinical
services over the next 5 years, we have, likewise, experienced major growth in
our educational mandate, largely through enhancement of the Clerkship and IMG
Programs and to a lesser extent the IM Residency Training Program. While
changes in these sectors are welcome, such growth is clearly insufficient to
support the needed introduction of new Medical Teaching Units at the RGH and
proposed South Calgary Campus and certainly not the expanding need for
community-based General Internists throughout the province. Thus, we support
senior administration and others in leadership roles within the University and
CHR to consider the Report of the Kirby Commission when it recommends the
number of ministry-funded post-graduate positions be increased from 100 per
100 undergraduate positions to a more favorable 125 per 100 positions.
Furthermore, the Department of Medicine must effectively recruit to the 7.86
positions allotted to education in the 2003 PRPWG document (only 1 has been
filled to this date). This will be particularly important should enrollment to our
Medical School be allowed to increase to the targets currently proposed by the
Dean.
Must increase our ministryfunded post-graduate
positions
CLINICAL AND INNOVATIONS
CHR tracking statistics indicate that the 10-year mean population growth rate for
patients aged 20 to 64 years cared for by General Internists in Calgary is 2.62%
per annum and 3.06% per annum for patients aged 64 years and older.
However, the number of hospital discharges and total patient days attributable to
the Division of GIM as a measure of our total in-hospital admitting activity in 2005
increased by over 32% and 27% compared to 2004 figures to 3412 patients
(26% of the total DOM inpatient activity) and 35,555 patient days (34% of the
total DOM inpatient activity), respectively. Indices of disease acuity increased
22% over the same period, while average length of stay remained the same at
10.4 days. Corresponding stats on our consultation services suggest that inpatient assessments likewise increased 12.2% over 2004 figures to 13,281
patient visits (29% of the total DOM activity). Thus, we continue to carry a large
percentage of the DOM in-patient load and have significantly increased our
clinical activity since the new ARP was launched in Aug 2004.
Clinical load continues to
increase and GIM carries a
large portion of the in-patient
load
Consolidation of GIM In-Patient Admitting Services at the Rockyview Hospital
As the volume and complexity of acute, in-hospital care has increased
throughout the Region, the private General Internists at the Rockyview Hospital
have successfully merged their common interests into a single, group practice
Page 45 of 71
including an integrated call and teaching schedule. They have regularly had
Clinical Clerks, PGY-1 Family Medicine and Anesthesia residents on their
services, but over the last couple of years we have added IMGs, nurse
practitioners and the occasional GIM R4 Fellow. They have proven themselves
to be enthusiastic and capable educators at all levels of training, and as evidence
of their commitment, in July 2006 core IM senior residents started attending on
their MTUs and Consult services. Also, we have recently added a second on-call
schedule comprising the IM resident and IMGs to assist with teaching and
support of the PGY-1 residents in the ER and on wards at nights in this busy
hospital. Patient census on GIM supported services presently stands at 45 inpatients versus historical highs of 18 to 20, and length of stay has dropped from
15 to 10.3 days. This is a huge success story and speaks strongly to the future
of GIM at this site.
Rockyview Hospital has
merged into a group practice
with excellent results
The Ward Of The 21st Century (W21C)
Work on the Ward-of the 21st Century continues under the able leadership of Drs.
Barry Baylis and Bill Ghali. A CFI application was submitted on Feb 13, 2006
and passed the first level (MAC) of evaluation. It has now moved on to the final
evaluation process, the results of which should be known by late November.
Other successful applications and recipients of awards have been to project
leads Dr. Steve Friesen and Deb White, Faculties of Environmental Design and
Nursing, respectively for 70K from the Alberta Health Quality Council, and to Dr.
John Conly, Head Department of Medicine for 60 K from the Canadian Institute
of Health Research. Also, Drs. Jean Wallace and Jane Lemaire recently
received an award from the Canadian Patient Safety Institute. The University of
Texas has joined the collaboration and the group has been successful in
recruiting several new high-level faculty this year, Dr. Sharon Straus, among
others. A number of innovative projects are underway including a mechanism for
Web-Based Discharge involving Clarity (industry sponsor), Transition Services,
Chronic Disease Management, Home Care, the ED and IT. Publications are
pending. A 3rd Retreat is planned for October 31, 2006 and all interested parties
are welcome and encouraged to attend. Again, I would emphasize, this will be
the academic focus of the Division of General Internal Medicine over the next 510 years.
Opening of a General Medicine Admitting Service (GMU) at the Foothills Hospital
The General Medicine Admitting Unit officially opened on PCU 62 at Foothills
Hospital on March 14, 2005. It added a further 11 acute care beds to set a total
GIM complement at FMC at 47 in-patients and was designed to work as a high
flow unit, accepting patients from the MTUs and Hospitalists, thereby creating
capacity on these other services to accept new patients from the ED. It is
supported by a single GIM attending and a Physician Extender and, initially, was
only open for transfers 8AM to 6PM and only accepted stable patients. As such,
the GMU was an innovation in health service delivery.
This year, the GMU has expanded its in-hospital support staff and hours to 24/7
and is accepting a higher level of patient acuity. It has moved from 6200 to Units
46 and 36 in the SSB, and presently takes an average of 2 new patients each
day (range 1-4) and is at census most days. It is an important resource for
offloading patients from the MTU and is contributing immensely in a secondary
fashion to improving patient flow through the ED. This high functioning Unit is not
W21C
- passed first level (MAC)
of evaluation
- additional awards
- will be the academic
focus of Division
General Medicine Admitting
Service opened at FMC –
PCU 62
- Adds 11 beds
- Admits only stable patients
- supported by GIM
attending & Physician
Extender
PCU 62
- hours expanded to 24/7
- moved to Units 46 & 36 in
SSB
- average of 2 new patients
daily
Page 46 of 71
matched any other acute care service in the Region or, as far as I am aware, in
Canada.
Splitting of the GIM In-Patient Consultation Service at the Foothills Hospital
Last year, our in-hospital GIM Consultation service at Foothills became
oversubscribed. There were questions whether patients were being cut too
quickly from follow-up, thereby potentially compromising care, and workload was
severe and unrelenting, contributing to physician job stress and dissatisfaction.
This was resolved by opening a second, complementary, service with the 2 Units
taking calls for new patients on alternate days. At the same time, it created
additional learning opportunities for residents, clerks and others as we employed
more staff and provided better patient follow-up. In an attempt to evaluate this
initiative, Dr. Ravi Agarwala collected billings data from our consult services
before the expansion and employed a business model of service demand/service
delivery to decide on the most appropriate solution to the problem. He reported
the results of his study to the FMC group in September and showed that before
the intervention we were seeing, on average, 18-25 new consults each Monday
and Tuesday and lower numbers later in the week. It was also clear that since
that time, our total numbers of new consults have dropped to more reasonable
ranges of 5-8 daily and that this is more constant day-to-day. The question
remains whether our previous high numbers post weekend were inflated due to
‘bounce back’ and poor care, or we have simply improved the flow and
distribution of consults by better supporting the service. Dr. Agarwala is
presently preparing a manuscript for publication.
GIM In-Patient Consultation
is split into 2 complementary
services
Expansion of the Urgent Assessment Clinic (UAC) to the Rockyview Hospital
A year ago last spring, the RGH group expressed an interest in developing a
UAC and had the space to support it. The final piece was built on our existing
strengths in triage, booking and the organizational structure in Area 1b to support
a satellite clinic at Rockyview Hospital. Additional staff has been recruited and
the new unit opened September 2005. Recent clinic data show an 80% increase
in referrals from 2005 through 2006 with a drop in wait times from 2.7 to 1.8
days. Also, our referral base has expanded into rural areas. This model of
expedited consultation to Emergency Departments and primary care physicians
keeps people out of hospitals has been profiled on television and in local
newspapers. Recently, lessons learned with the GIM UAC have been applied to
similar clinics in other specialties.
UAC expanded to RGH
September 2005
- staff has been recruited
- drop in wait times from 2.7
to 1.8 days
- expansion into rural areas
Preop Consultatons for the Health Resource Center (HRC) at the Old Grace
Hospital
In fall 2005, physicians from the PLC and RGH started doing preop assessments
for the HRC. This is an exciting initiative by Orthopedic Surgery to see whether
low acuity patients can receive their joint replacements and reconstructive
support medical environment. Our Divisional commitment is to provide expert
preoperative assessment and urgent perioperative consultative support, as
needed over the phone, to physicians at HRC. Also, we attend to emergencies
on those infrequent occasions when their patients are transferred to one of our
acute care adult hospital sites. Finally, a series of care maps for common
medical complications (blood sugar control, pain management, fever, confusion,
SOB, hypo- or hypertension, poor urine output and others) are being prepared to
Health Resource Center
- Preop consultations
- provide preoperative
assessment & urgent
perioperative support
- attend to emergencies
- care maps for consultations
have been prepared
Page 47 of 71
assist HRC on-site physicians in managing their patients and indicating when IM
consultation may be preferred.
Opening Of The Mind And Body Clinic At The Rockyview Hospital
The Mind and Body Clinic opened in December 2004 at the RGH to accept
patients with complex somatic and psychosomatic illness. Emphasis is on non
drug treatment. It employs a full time Psychologist and nurse and has the parttime support of the Department of Psychiatry. Dr. J. Schaefer acts as the CoDirector IM support physician to the Clinic. Drs. Schaefer and Bakal recently
published a paper profiling their clinic in Medical Hypotheses (2006) 67, 14431447.
Mind & Body Clinic – RGH
- non-drug treatment
- Drs. Schaefer & Bakal
published paper in Medical
Hypotheses
Ambulatory Clinics
Plans are underway at all CHR sites to implement a centralized computer
booking service in order to take full advantage of time and existing clinic space.
If you are unable to attend or have your clinics only partially booked on a
particular date, others will be offered use of the rooms. Likewise, you may be
able to make up extra clinics by booking into other's unfilled clinic allotments.
This is likely to cross traditional divisionally assigned space.
The Dean’s Office is planning to recover space in the UCMG Clinics area of the
Health Sciences Building for the proposed new Veterinary College, so all clinics
and offices must vacate by December 2007. Thus, all GIM ambulatory clinics,
save possibly the UAC which will probably re-locate to the Special Services
Building under Day Medicine, will be moving to the RRDTC. The building
requires some renovation before any move can be considered, so this is not
likely to occur before April 2007. Initial plans are for 6 examination rooms plus a
procedures room with expansion to 25 rooms over the next 3 years. While the
FMC group will be first on site, this is a Divisional resource and will be open to
other new and existing faculty at the PLC and RGH as numbers accrue and clinic
space becomes limited through the recruitment process.
Changes are underway in the Preop (PAC) Clinics to reduce the number of low
risk patients that are being referred as this is taxing physician capacity and
causing delays in attendance for higher risk patients. Also, unnecessary testing
is routinely being performed. Thus, a screening tool has been developed as part
of the Innovation Strategy to assess the necessity of referral and a list of
suggested preop tests has been prepared. These are presently being reviewed,
and will be trialed at the FMC site before potential implementation elsewhere.
Centralized computer
booking service will be
implemented
All GIM ambulatory Clinics to
move to RRDTC
approximately April 2007
Preop Clinic develops a
screening tool to assist in
determining patients most
needing the Clinic
CV Risk Initiative
A multi-disciplinary cardiovascular risk project that expands the boundaries of the
traditional consultation process has been started at the FMC. All of the variables
we measure and follow in cardiac risk are eminently amenable to collection by
the patient, a laboratory and/or an alternate care provider. Thus, it was conceived
that all this information could be obtained and an assessment and care plan
designed for over 90% of referrals without ever seeing the patient. Thus, the
consultative process for these people would change from a patient- centered
approach to a telephone discussion between the consultant, the clinic nurse
coordinator and the primary care physician and/or their nursing or professional
(dietician, kinesiologist, psychologist, pharmacist, etc) counterparts. This would
have several potential advantages over the existing process. First and foremost,
CV Risk initiative determines
that 90% of referrals do not
require a visit and reestablishes link between PC
and counterparts
Page 48 of 71
it re-establishes a critical link between the consultant and the primary care
physician,which itself is in desperate need of repair. Secondly, direct involvement
of the referring physician in the consultation algorithm brings buy-in and learning
so that they may start to employ many of the assessment and treatment
strategies on other patients earlier in the process and perhaps without the
engagement of the consultant. Third, since the consultation focuses on
treatment rather than information gathering, the time for assessment should be
much shorter so that more patients could be attended on a single half-day clinic.
Finally, precious resources such as parking, clinic space, nursing and even the
patient's own time would be reserved for those that truly need to be seen in clinic
by a physician specialist. This model, if proven effective, is easily adaptable to
other chronic diseases such as COPD, CHF, atrial fibrillation, diabetes, IBD, RA,
psoriasis and a host of others.
The project was formally launched in the late winter of 2006 and at this point only
accepts patients following discharge from the Stroke Unit. It is presently seeing
30-35 new patients a week with follow-up. Our plan is to evaluate the impact of
the project on risk targets and patient outcomes to confirm the validity of the
hypothesis before investing further and inviting other groups such as Cardiac
Rehab to participate. Finally, the clinic also collects core statistics on all of its
patients and thereby is creating an invaluable resource for research in the
coming years.
Advantages
- critical link established
between consultant and PC
physician
- brings buy-in and learning
to referring physician
- time for assessment is
shortened
- clinic space, nursing, time,
parking are all reserved for
those needing to be seen
CHALLENGES
The CHR Master Plan is to open 753 acute care beds over the next 5 years at
RGH, FMC, PLC and the new South Calgary Campus. Assuming the historical
25/75 split between medical and surgical beds and the current division of
workload of 33% Internal Medicine and 67% Hospitalist, of which GIM carries a
major portion of in-patient IM care, we will likely be asked to assume
responsibility for an additional 60 to 100 beds. How this will play out in terms of
new MTUs, other high level assisted care like the GMU and possibly a Day
Hospital, remains to be determined. However, what is clear is that we can
expect see further significant expansion of our in-patient admitting and
consultative services. Thus, recruitment will continue to be a necessary
component of our Divisional service plan.
RESEARCH AND AWARDS
In 2005/2006, the Division of GIM collectively contributed over 54 papers in peerreviewed publications, 35 invited reviews or papers in non-peer reviewed
publications and 1 book chapter. We had 42 abstracts and presentations at
research meetings around the globe and published in proceedings thereof. We
are the principle investigator orco-investigator on research projects that received
close to $3 million dollars in new and $10.5 million in ongoing support from
competitive peer-reviewed bodies and many of us made significant contributions
on national scientific committees relating to research, education and professional
specialty societies. Finally, 7 of our members currently hold funding and lead
projects supported by DOM ARP Innovation dollars.
Project sees 30 – 35
patients following discharge
from Stroke Unit weekly with
follow-up
Recruitment will be
necessary with expansion
Research
- 54 peer-reviewed
publications
- 35 invited reviews
- 1 book chapter
- 42 abstracts &
presentations
- close to $3 million in new
- $10.5 million in ongoing
support
- 7 members hold funding &
lead projects supported by
ARP innovation dollars
Page 49 of 71
Drs. Ghali, Lemaire and Sargious have applied and received approval for
sabbaticals in the 2006/2007 academic year. Dr. Caren Wu recently defended
her Masters Thesis entitled “Cost Effectiveness of Accelerated Management of
Transient Ischemic Attack” as Compared to Standard Care under the supervision
of Dr. Braden Manns and Dr. Alistair Buchan, Department of Community Health
Sciences, University of Calgary. Dr. Jeff Schaefer was appointed Chair of the
Department of Medicine ARP Management Committee in the fall of 2005. Dr.
Marcy Mintz was appointed Director of the Clerkship Course Chair.
New appointments in GIM at the FMC site are: Dr. Maria Bacchus (Toronto),
FMC Site Chief and Division Head, and Vice-Chair of Strategic Planning and
Ambulatory Care, Dr. Lorne Clearsky, Deputy Officer of Health, Aboriginal Health
Program (Manitoba), Dr. Chandrasekarin (Siva) Kumar (Madras), Drs. Jonathon
Yau (Alberta) and Susan Huan (Phillipines), Dr. Caren Wu (London, Ont), Dr.
Johan Conradie (Calgary), Dr. Sharon Straus (Toronto), Dr. David Sam
(Manitoba) and Dr. Jayna Holroyd-Leduc (Toronto). Finally, Dr. Jean Wallace
(Faculty of Sociology, University of Calgary) received an adjunct appointment in
our Division this summer.
Newly appointed at the PLC is Dr. Ian Scott (Calgary).
New appointments at RGH include Dr. Ghazwan Altabbaa (Damascus), Dr.
Partha Datta (McGill), Dr. Jan Sporina (Slovakia) and Dr. Khan Ali (Mayo’s). Dr.
Michele Burns was recently appointed RGH Division Head at that site.
On a national forum, Dr.Jane Lemaire received a CSIM Osler Award for her
leadership and work with the RCPSC GIM Subspecialty Committee. Dr. Norm
Campbell received the CSIM Senior Investigator Award. Dr. Campbell has also
recently obtained funding for a Canada Health Research Chair in Hypertension.
Dr. Jeff Schaefer received a 2006 University of Calgary Canadian Association of
Medical Educators (CAME) Certificate of Merit Award. Ms. Rosanne Dreschler
(Nursing) was given a Calgary Health Region Peoples First Award for her work in
the GIM Urgent Assessment Clinic. Department of Medicine Awards this year
went to Dr. Terry Groves for the inaugural Terry Groves Award for Clinical
Excellence for RGH, Dr. Elizabeth MacKay for the Professionalism Award and
Dr. Peter Sargious for the Innovation Award. Resident Teaching Awards included
the Silver Finger Award to Dr. Troy Pederson, The Silver Tongue Award to Dr.
Paul Leblanc and the Ectopic Teacher Award to Dr. Andre Ferland. Dr. Jane
Lemaire received the Gold Star Award and Dr. Marcy Mintz received a
Recognition Award for teaching in the Clinical Clerkship Program.
Staff added to FMC
- Dr. Maria Bacchus
- Dr. Lorne Clearsky
- Dr. C. Sivakumar
- Dr. Jonathon Yau
- Dr. Susan Huan
- Dr. Caren Wu
Staff added to PLC
- Dr. Ian Scott
Staff added to RGH
- Dr. Ghazwan Altabbaa
- Dr. Partha Datta
- Dr. Jan Sporina
- Dr. Khan Ali
Dr. Michelle Burns appointed
Division Head at RGH
Staff
- Drs Ghali, Lemaire &
Sargious have approval for
sabbaticals in 2006/07.
- Dr. Wu defended her
Masters’ thesis
- Dr. Schaefer appointed
Chair of ARP Management
Committee
- Dr. Mintz appointed
Clerkship Course Chair for
the College of Medicine
Dr. Lemaire is the physician lead in the DOM Physician Wellness/Work Life
Balance initiative and she and Dr. Ghazwan Altabbaa are doing some preliminary
work on mentoring of new recruits. Both of these should bring important payoffs
to our Division in the future.
Page 50 of 71
CHALLENGES
Research and innovation hold the key to solving many of our most difficult
service and patient-related problems. Recognition that a problem exists is the
first step in finding a solution. Having the appropriate tools and support to test
one’s ideas are the necessary seconds. Alberta’s success has brought immense
resources to Calgary and Calgary possesses one of the few great health care
facilities where these resources are truly regionalized. GIM is a team and
together we are already heavily invested in research and innovation. However, if
we are to be successful, we must devote greater attention to mentoring and the
ongoing professional development of our existing faculty. The W21C and
Buchanan Chair are effective tools that we possess and must be brought to bear
on these needs. More effective and reproducible methods of accountability also
need to be developed in order to obtain the largest possible returns on our
human resource investments. These are our challenges and goals for the next
2-3 years.
AWARDS
- Dr. J. Lemaire – CSIM
Osler Award
- Dr. N. Campbell – CSIM
Senior Investigator Award &
funding for Canada Health
Research Chair in
Hypertension
- Dr. J. Schaefer – 2006
CAME Certificate of Merit
Award
- Ms Roseanne Dreschler –
Peoples First Award
- Dr. T. Groves – Terry
Groves Award for Clinical
Excellence for RGH
- Dr. E. MacKay –
Professionalism Award
- Dr. P. Sargious –
Innovation Award – Resident
Teaching Awards
- Dr. T. Pederson – Silver
Finger Award
- Dr. P. Leblanc –Silver
Tongue Award
- Dr. A. Ferland – Ectopic
Teacher Award
- Dr. J. Lemaire – Gold Star
Award
- Dr. M. Mintz – Recognition
Award for Teaching
Page 51 of 71
DIVISION OF GERIATRIC MEDICINE
Division Chief: Dr. James Silvius
ADMINISTRATION
Issues/challenges from last year
a. Changes to existing services and expansion related to needs
b. Planning for Regional Falls Initiative
c. Planning for Regional Cognitive Impairment (CI) Strategy
d. Balancing service needs with requirement/interest in pursuing academic
interests
Update on their status/ progress/ outcomes
a. No specific service changes have been initiated. We have planned for
some changes that have not been implemented as resources have not
been available; fortunately the delays in the Falls Initiative and the nonprioritization of the CI Strategy have been to our advantage in this
regard.
b. Regional Falls Initiative was prioritized as #3 Regionally in the PBMA
process. However, limited funds for growth initiatives have meant that no
budget had been approved at year end.
c. Regional Cognitive Impairment Strategy was not prioritized through the
PBMA process in ’05/’06. We will continue planning and limited further
work on the initiative with the intent of re-submitting in ’06/’07.
d. Several members have expressed a frustration with service demands
intruding on other aspects of work life. The perspective within the
Division is that we have responsibilities in a number of areas, not just
clinical service, and that all areas need to be equally respected. We have
therefore agreed that requests for service expansion will not be agreed
to until such time as resources allow. This puts pressure on for either (or
both) service re-design to reduce the requirement for physician time
and/or recruitment to meet increasing service demands.
INNOVATIONS
Work continues on our one line access system with the hiring of staff and
reorganization of triage at sites. It has been limited by lack of a consistent
database though approval is awaited for this, and it is anticipated that the system
will be in place by September ’06.
No new programs have been started this year.
CLINICAL
Service redesign was undertaken at the RGH ambulatory site to streamline
referrals and amalgamate geriatric mental health and geriatric medicine team
care into one combined service. Work on this realignment is ongoing.
Telehealth has been a phenomenal success. Statistics from the Department of
Telehealth indicate that Geriatrics accounted for 622 (35%) of the 1,784 clinical
hours recorded for fiscal 2005, significantly more than any other single group in
the Region.
Changes to existing
services
- resources not available
Regional Falls Initiative on
hold
Regional Cognitive
Impairment Strategy to be
resubmitted in 06/07
Division believes that all
areas of work need equal
respect
- service re-design needed
- recruitment needed
One line access system
- hiring of staff
- reorganization of triage
- limited by lack of
consistent database
- Service redesign to
amalgamate mental health
and medicine
- Telehealth is a
phenomenal success
Page 52 of 71
RECRUITMENT
Negotiation was underway with one full time recruit for Geriatrics; there had been
acceptance in principle but licensing issues prevented completion of the
recruitment. The individual will be based at the RGH, assuming the licensing
issues can be addressed.
At year end there was an expression of interest from a second individual for a
limited role with Geriatric Medicine.
EDUCATION
Amalgamation of the Aging and the Elderly Undergraduate course (MDCN 423)
with Clinical Neurosciences was underway.
Seniors Campus was accepted by the Reach! Campaign and word at year end
was that negotiations were underway with a major donor.
RESEARCH
Scholarship (Research & Education/Teaching)
No specific new initiatives. Dr. Hogan remains involved in dementia care
nationally; Dr. Schmaltz continues to develop her program of research; Dr.
Silvius remains involved with the DementiaNet and with a number of Net projects
Patient Care
The work done with the rural components of the Region and Calgary Family
Physicians has amply demonstrated frustration with the referral process to
specialists, including those within the Department of Medicine. Discussions were
underway at year end as to a mechanism to address the issue of the disconnect
between DOM and family physicians.
One new recruit to join
Geriatrics
Amalgamation of Aging
& Elderly Course with
Clinical Neurosciences
Seniors Campus
accepted by Reach!
campaign
Clinical laboratory
planned for Seniors
Campus
Major frustration
between DOM and
family physicians
Dissemination of Knowledge
Knowledge Translation will be augmented if one of the individuals expressing an
interest in relocation to Calgary does move here.
CHALLENGES (April 1, 2006 – March 31, 2007)
Given the timing of this report, I am aware of the addition of three recruits with at
least some commitment of time to Geriatric Medicine. This will create a challenge
as we look at rearranging services and using different models of service structure
than has historically been true. While more than welcome, accommodating the
numbers of new individuals will create it’s own challenges as this is possibly the
largest influx in one year in the history of the Division. We have
• decided as a group to review services and structures in the winter. of
services at current sites
• Redevelopment of services at current sites
• Ongoing planning for services at new sites
Further work on both major initiatives (Falls and Cognitive Impairment) to prepare
for PBMA in ’07/’08
Potential recruit could
help with Knowledge
Translation
New recruits will
necessitate a review of
services and structures
Page 53 of 71
Visuals (graph/chart) for banner programs/services
Telehealth Clinical Hours
Clinical Area
Geriatrics
Paediatrics
Mental Health
Diabetes
Clinical - Education
Cardiology
Rheumatology
Palliative
Rehabilitation
Nephrology
Case Conference (patient present)
Discharge Planning
Genetics
Internal Medicine
Forensic Mental
Emergency/ICU
Wound Care
Surgery
Infectious Disease
Neurology
Oncology
General Practitioner Consult
Group Total
Clinical Consultation Hours
(June 1, 2005 – May 31, 2006)
622.00
444.25
245.25
106.75
85.00
65.92
48.75
40.00
24.50
22.00
21.25
12.25
11.00
10.00
8.50
3.73
3.50
2.50
2.00
2.00
2.00
1.00
1784.15
AWARDS
“People First” Award for
Dr. D. Hogan
Accolades from patients & families & visitors (for people or programs/services)
Dave Hogan received a “People First” Award from the Region in ’05 for his
service to the patients in the Cognitive Assessment Clinic
Page 54 of 71
Division of Hematology and Hematologic Malignancies
Division Chief: Douglas Stewart, MD, FRCPC
ADMINISTRATION AND RECRUITMENT
Douglas Stewart became the Hematology Division Chief when Graham
Pineo stepped down in March 2006. The Division of Hematology/Hematological
Malignancies recently welcomed the addition of two new staff members; Drs.
Michelle Geddes and Andrew Daly. Michelle Geddes completed her Hematology
residency in Calgary and accepted a Clinical Scholar position within the
Department of Medicine effective January 2006 through August 2008. During
this time she will contribute 0.4 FTE clinical and academic work to the Division of
hematology and spend the remainder of her time completing fellowship training in
Calgary’s Blood and Marrow Transplant Program. This position is intended to
bridge Dr. Geddes through her fellowship into a 1.0 FTE position in Calgary.
Andrew Daly completed his Hematology residency as well as a Blood
and Marrow Transplantation Fellowship in Toronto. He joined the Hematology
Division in Calgary on March 1st of this year, will base his Hematology practice at
the Peter Lougheed Centre, attend clinics at the TBCC, and supervise the Blood
and Marrow Transplant inpatient service at the Foothills Hospital 8 weeks each
year.
In addition to these new appointments, we have recently welcomed
back Chris Brown from leave of absence to his clinical role with the Blood and
Marrow Transplant Program in Calgary, and as well as the role of Director,
Southern Alberta Cancer Research Institute. Dr. Deirdre Jenkins returned from a
one year maternity leave in April 2006, and we are looking forward to the return
of Man-Chiu Poon from sabbatical in August 2006.
On Dec 1, 2005, the Program welcomed Reanne Booker to an APN
position within the BMT Program at the TBCC, and Stephanie Hubbard joined the
TBCC Hematology Tumor Group as an APN in April 2006. We are also pleased
to announce that Deana Hickey has started her orientation as the Clinical
Educator for the BMT Program.
The Hematology/BMT Program has worked with the CHR’s IMG
program to hire and train two IMG clinical associates who later entered specialty
residency programs in 2005 (Pedro Camacho – Internal Medicine) and 2006
(Tatjana Zdravkovic – Family Medicine). We currently have hired three other
IMG clinical associates.
New Recruits
- Dr. Michelle Geddes
- Dr. Andrew Daly
New Division Chief
- Dr. Douglas Stewart
Dr. C. Brown & Dr. D.
Jenkins return from leaves
Dr. M. Poon currently on
sabbatical
BMT staff added
- Reanne Booker – APN
- Dr. Tatjana Zdravkovic –
Clinical Assistant
Recruitment priorities for 2007
- general hematologist with the ability to participate in malignant and
benign hematology programs and foster research, particularly in the area of
acute leukemia/bone marrow transplant/cell therapy.
- Bone Marrow Transplant Program Director to replace Dr. Jim Russell
who is planning to retire in 2007.
- A leader for the Hemostasis Program.
Recruitment priorities for 2008.
- A hematologist with special training and interest in rare blood
disorders/hemoglobinopathies who could lead program development in this area.
- A hematologist with special training in hemostasis to help develop the
Hemostasis Program for Calgary.
Page 55 of 71
Creation of Hematology/BMT Program for CHR and Tom Baker Cancer Centre
(TBCC)
Initial meeting of this Program occurred in July 2006. Marie-Josee
Paquin will be recruited as the Administrative Leader for the Program
New Hematology/ BMT
joint program
CLINICAL
Hematologists provide consultative services at all CHR hospitals as well as the
Tom Baker Cancer Centre (TBCC). Inpatient services and ambulatory clinics for
Hematology are provided at the FMC and PLC. The recent development of the
program for BMT and Hematologic Malignancies within the TBCC which is
headed by the Division Head for Hematology and Hematologic Malignancies
within the CHR and the University provides responsibility and accountability for
all hematologic activities within the CHR and the cancer centre.
Of the 17 members of the division, 12 are based at the FMC and 5 at the PLC.
The Hematology Division in Calgary includes 3 fulltime fee-for-service clinicians
at the PLC and 11 members within the Department of Medicine ARP (4 at the
FMC and 1 at the PLC with major clinical appointments, and 6 GFT appointments
based at FMC including 2 clinical scientists). Two individuals heavily involved
with Bone Marrow Transplantation and Hematologic malignancies are based in
the TBCC, have primary appointments within the academic Department of
Oncology, and are funded the Province Wide Services Blood and Marrow
Transplant Program via the TBCC. Two members of the division are crossappointed with the Division of General Medicine. From a clinical standpoint, the
members of the division at the PLC/RVH account for four FTE clinician, the two
at the TBCC account for 1.5 FTE, and the members of the division at the FMC
who are part of the ARP account for approximately four FTE. Therefore, a major
proportion of the clinical activities within the Division of Hematology and
Hematologic Malignancies are carried out by individuals who are not part of the
ARP but who make a major contribution to the management of hematologic
diseases within the CHR and the TBCC.
Graham Pineo chaired the Comprehensive Program for the Prevention of
Venous Thromboembolism, the Task Force on Diagnostic Algorithms for Deep
Vein Thrombosis and Pulmonary Embolism, and the Task Force on
Anticoagulant Order Sets for the CHR. Dr. Hull also contributed greatly to these
initiatives. These algorithms and order sets are now being implemented by the
CHR.
The Department of Medicine recently established awards for members of the
Department who were nominated by their peers as being excellent clinicians. For
2005, two of these prestigious awards went to Dr members of the Division of
Hematology and Hematological Malignancies. The 2005 winner of the Dr. John
Dawson Award for the Foothills Hospital was Ben Ruether, and the 2005 winner
of the Dr. Howard McEwen Award for the Calgary General Hospital/ Peter
Lougheed Centre was Walt Blahey. In addition to these awards, Ted Thaell
received the 2005 Rockyview General Hospital Medical Staff Association Award
for Clinical Excellence in the Department of Medicine and Graham Pineo
received the People First Award for lifetime achievement in thrombosis. Finally,
Man-Chiu Poon received the Alberta Centennial Medallion Award with Certificate
of Alberta Centennial in Dec 2005 as recognition by the Province of Alberta for
outstanding work, achievements and volunteering efforts for the people,
communities and province of Alberta.
Major contributions from
all areas.
Dr. Pineo and Dr. Hull make
great contributions to new
algorithms and order sets in
Thrombosis & Pulmonary
Embolism
Awards Presented
- Dawson Award to Dr. Ben
Ruether
- Dr. Howard McEwan
Award to Dr. Walt Blahey
- 2005 RGH Medical Staff
Association Award to Dr.
Ted Thaell
- People First Award to Dr.
Graham Pineo
- Dec 2005 - AB Centennial
Medallion Award to Dr. ManChiu Poon
Page 56 of 71
INNOVATIONS
1) A proposal was submitted to Province Wide Services to create a Rare
Blood Disorders Clinic in Edmonton and Calgary. The proposal was not
funded by PWS, but will be refined and submitted to the CHR to support
these activities locally.
2) Jan Storek spearheaded the development of a unified CHR/CLS/TBCC
BMT Database and Standard Practice Manual.
CHR/CLS/TBCC BMT
Database and Standard
Practice Manual developed
by Dr. Jan Storek
3) In the fall of 2005, the Calgary BMT Program underwent a requested
accreditation review by the Federation for the Accreditation of Cell
Therapy (FACT). The BMT Program was granted FACT accreditation in
June 2006.
BMT undergoing FACT
accreditation
4) The malignant Hematology Program established an amalgamated
account for clinical trial research, hired more Clinical Research
Coordinator and Clinical Research Nurse staff, increased clinical trial
accrual, and was invited to become a member of the National Cancer
Institute of Canada Clinical Trials Group Lymphoma Site. Clinical
Practice Guidelines for Hematological malignancies were reviewed and
updated. These CPGs will be formatted and placed on the Alberta
Cancer Board website.
Staff hired to aid in new
clinical trial research and
accrual
5) Innovations program through ARP may facilitate establishment of a rare
blood disorders clinic for adult patients with hemophilia and
hemoglobinopathies, and restructuring the benign hematology program
for the CHR (especially FMC/UCMC site)
- with central referral, triaging, and creation of a role for an APN or
clinical associate.
6) A new administrative structure for the Division within the CHR and TBCC
including an overarching Hematology/BMT Steering Committee, and
several subcommittees including Benign Hematology, Malignant
Hematology Tumor Group and BMT Program. An administrative leader
dedicated to Hematology/BMT has been hired; Marie-Josee Paquin.
7) Funding to recruit Hematologists:
EDUCATION
The Division continues to fulfill its education obligations with three individuals
heavily involved in educational administration. Deirdre Jenkins is the Blood
Course Director, and a committee member of the undergraduate Curriculum
Design and Implementation Committee. Dr. Jenkins has been accepted into a 3
year, thesis track, Master's in Health Professions Education through the
University of Illinois at Chicago. Karen Valentine received the prestigious 2005
Golden Bull Award for excellence in teaching, Department of Medicine, and
continues to direct the Hematology Residency Training Program. During the last
fiscal year there were 2 residents within Calgary’s Hematology Program, and a
graduate of the Residency Program entered a 2 year BMT Fellowship in Calgary.
Allan Jones continued in his role as Associate Dean of Undergraduate Medical
Education during the last fiscal year. Nizar Bahlis, Deirdre Jenkins and Karen
Valentine each received a Gold Star Award and Calgary Medical Student
Association Letter of Excellence Award (class of 2008) for teaching.
Awards
- 2005 Golden Bull Award
and directs Hematology
Residency - Dr. Valentine
- Gold Star Award & Letter
of Excellence Award to
Dr’s. Bahlis, Jenkins and
Valentine
Page 57 of 71
RESEARCH
This Division remains very active in research and publications. Five individuals
have major research commitments. During 2005, however, Man-Chiu Poon was
on sabbatical and Chris Brown was on prolonged leave following a skiing
accident. Nevertheless, members of the Hematology Division published 14 peerreviewed manuscripts in scientific journals, an equal number of scientific
abstracts, and several other articles were accepted for publication and are in
press. This work mainly relates either to the Blood and Marrow Transplant
Program or to the Thrombosis Research Unit. The Calgary BMT Program has
become established as one of the premiere programs nationally and is
developing an international reputation of excellence. Jan Storek has received a
$500,000 Canada Research Chair in Immunology (2005-2009), a $384,983
Canada Foundation for Innovation establishment grant (2004-2009), a $100,000
Alberta Heritage Foundation Major equipment grant (2005), and $452,500 from
the University of Calgary to pursue research into immune reconstitution following
hematopoietic stem cell transplantation, and correlation with infectious and graft
versus host disease complications. Nizar Bahlis is establishing a comprehensive
clinical and translational research program for multiple myeloma. In addition to
dramatically enhancing clinical research activity for myeloma patients at the
TBCC, he has received grant funding from Calgary Laboratory Services (CLS) to
establish a tissue microarray on bone marrow biopsies of myeloma patients, as
well as an Alberta Cancer Board grant to evaluate Protein Kinase C delta: a
novel therapeutic target in multiple myeloma. In December 2005, Nizar Bahlis
received a Merit Award, Department of Medicine and Calgary Health Region.
Dr. Hull and Pineo continue to operate the Thrombosis Research Unit and
published several review articles (including Up To Date), editorials, and 4 book
chapters last year. Their research activities have impacted directly on local,
national and international care, and include publications in high impact journals.
Their PIOPED II study is in press in the New England Journal of Medicine and
their cancer-related work is in press in the American Journal of Medicine. Dr.
Russell Hull is Principal Investigator, and Graham Pineo is Clinical Scientist for a
National Institutes of Health, National Heart, Lung and Blood Institute study
named PIOPED III (Prospective Investigation of Pulmonary Embolism Diagnosis
III). This study will evaluate the sensitivity and specificity of MRI for the diagnosis
of pulmonary embolism. The $751,442 funding commenced July 2005. Dr.
Russell Hull is Chair for a GlaxoSmithKline grant of $510,000 as Independent
Central Adjudication Centre (ICAC); Trial of Odiparcil for the Prevention of
Venous Thromboembolism (Dr. Pineo is an Adjudicator). Dr. Hull is coinvestigator on a Canadian Institutes of Health Research grant to study Health
System Capacity and Infrastructure for Adopting Innovations in Venous
Thromboembolic Disease Care.
Research
- 14 peer-reviewed
manuscripts
- several articles accepted
for publication
Dr. Jan Storek
- $500,000 Canada
Research Chair in
Immunology
- $384,983 Canada
Foundation for Innovation
grant
- $100,000 AB Heritage
Foundation Major
equipment grant
- $452,500 grant from
University of Calgary
Dr. Nizar Bahlis
- grant funding from CLS
for myeloma
- ACB grant to evaluate
Protein Kinase C delta
- Merit award in Dec 2005
Thrombosis Research Unit
- Dr’s Hull & Pineo
- 4 book chapters
- several review articles
- editorials
- $751,442 funding from
PIOPED III
- $510,000 grant from
GlaxoSmithKline
CHALLENGES
The main challenges for the coming year include:
1) planning for new hospitals (South Campus, CHR and new cancer
institute, ACB),
2) lack of rare blood disorders clinic for adult patients with hemophilia
and hemoglobinopathies,
Page 58 of 71
3) desire from the CHR to contribute to care of patients who require
blood products for non-hematological conditions such as immune deficiency
disorders and hereditary angioedema,
4) lack of residents to provide on-call coverage for BMT service as well
as hematology services resulting in Hematologists taking primary call, and
5) development of a new administrative structure for the Hematology
Division within the CHR and TBCC including an overarching Hematology/BMT
Steering Committee, and several subcommittees including Benign Hematology
(Directed by Karen Valentine), Malignant Hematology Tumor Group (currently
lead by Doug Stewart) and BMT Program (Directed by James Russell).
Other issues that must be addressed include recruitment, benign hematology
program development, and research productivity. Traditionally, the Division has
experienced difficulty recruiting academic staff, in part due to high clinical
workload, frequency of on-call duties, lack of protected academic time, and
inability to focus academically on area of interest. Many of these issues have
been reduced through recruitment of more clinical staff over the past 2 years.
There has been a lack of program development for benign Hematology which
has resulted in long waiting lists, lack of triaging, duplicate booking at PLC and
FMC, and no comprehensive research program or CGPs. Creation of the new
administrative structure and subcommittee of Benign Hematology should address
this issue. Finally, our research programs are underdeveloped. Our goals
include increasing accrual to Clinical Trials, expanding research in BMT/Cell
Therapy and Benign Hematology, improving support for translational research
(protected time, start-up money), and initiating Health Services Research.
Challenges
- planning for new
hospitals
- lack of rare blood
disorder clinics
- contribution from CHR in
the area of nonhematological conditions
- need more residents
- new administrative
structure within CHR and
TBCC
- recruitment
- benign hematology
- program development
- research productivity
Division goals and objectives for the subsequent year.
1) Contribute to planning of new hospitals (South Campus, CHR and new
cancer institute, ACB) in an effective manner that will optimize patient
care through 2020.
2) Create a rare blood disorders clinic for adult patients with hemophilia and
hemoglobinopathies and if possible recruit a director of this program who
has special expertise in hemostasis.
3) Work with CHR and Department of Medicine to facilitate care of patients
who require blood products for non-hematological conditions such as
immune deficiency disorders and hereditary angioedema. This will likely
require creation of the rare blood disorders clinic described above and
the establishment of collaboration with Immunologists and
pulmonologists.
4) Create a new administrative structure within the CHR and TBCC
including an overarching Hematology/BMT Steering Committee, and
several subcommittees including Benign Hematology, Malignant
Hematology Tumor Group and BMT Program.
5) Restructure the benign hematology program for the CHR (especially
FMC/UCMC site) with central referral, triaging, create a role for an APN
or clinical associate, and foster clinical research.
6) Recruit a new BMT Director for 2007.
Page 59 of 71
7) desire from the CHR to contribute to care of patients who require blood
products for non-hematological conditions such as immune deficiency
disorders and hereditary angioedema.
8) lack of residents to provide on-call coverage for BMT service as well as
hematology services resulting in Hematologists taking primary call.
9) difficulty recruiting academic staff, in part due to high clinical workload,
frequency of on-call duties, lack of protected academic time, and inability
to focus academically on area of interest. Many of these issues have
been reduced through recruitment of more clinical staff over the past 2
years.
10) There has been a lack of program development for benign Hematology
which has resulted in long waiting lists, lack of triaging, duplicate booking
at PLC and FMC, and no comprehensive research program or CGPs.
Creation of the new administrative structure and subcommittee of Benign
Hematology should address this issue.
11) Finally, our research programs are underdeveloped. Our goals include
increasing accrual to Clinical Trials, expanding research in BMT/Cell
Therapy and Benign Hematology, improving support for translational
research (protected time, start-up money), and initiating Health Services
Research.
12) The main issues involving the Department of Medicine include:
a) the increasing teaching responsibilities of staff to accommodate
increasing numbers of medical students and residents
b) collaboration and good working relationship with the TBCC/ACB
including functional planning for malignant hematology/BMT, EMR,
Patient Flow, Space Allocation, Research Staff for Clinical Trials.
c) functional planning for the South Campus
d) bed capacity issues
e) office space and secretarial support for new recruits.
Issues & Challenges
- increasing teaching
responsibilities
- foster collaboration with
TBCC/ ACB
- planning for South Campus
- bed capacity issues
- office space & support
- ARP
Page 60 of 71
DIVISION OF INFECTIOUS DISEASES
Division Chief: Dr. Ronald Read
RECRUITMENT
The establishment of a formal ID consultation service at the
Rockyview General Hospital left the remainder of the Division spread
thinly throughout the existing acute care hospitals. The movement of
Dr. Megran out of the clinical arena and into the Chief Medical
Officer position additionally left a significant shortfall at the PLC site.
This position was filled with the recruitment of Dr. Andrew Johnson,
and ID/Med Micro dual trained individual previously working as a
post-doctoral research fellow in Seattle, Washington. Dr. Johnson
has moved to the PLC to fill Dr. Megran’s clinical slot and, in
addition, will bring expertise around transplant related infections to
our group and will be working on protocols around infections in
implantable ventricular assist devices with cardiovascular sciences.
Expansion to RGH
New recruitment of Dr.
Johnson helps fill gap
Dr. Marie Louie becomes
Associate member
Dr. Marie Louie, who is currently the Associate Director of the
Southern Alberta Provincial Laboratory of Public Health, has joined
as an Associate Member of the Division and will be providing clinical
inpatient consultation and HPTP service in addition to her role as a
microbiologist.
Sabbatical Leave of Dr. Tom Louie
Dr. Louie undertook a 6 month sabbatical leave to further his
research in the area of Clostridium difficile colitis. The clinical gap
left during this sabbatical break was filled by making use of the skills
of Dr. Gisela Macphail and Dr. Athena McConnell (Pediatric
Infectious Diseases) to fill in HPTP service time. This worked very
well and Dr. Macphail will likely continue in this role into the future.
Dr. Louie’s research
benefited from sabbatical
INNOVATIONS
The Division has been very active in the last year in a number of
innovation projects. The use of Nurse Practitioners in the HPTP
Program has been very successful with the addition of Patti Long as
the Nurse Practitioner to work both within the clinic and on the wards
with potential HPTP patients. An innovation project involving the 8th
& 8th Medical Centre looking at development of Clinical Practice
Guidelines for antibiotic management as well as streamlining their
intravenous at development of Clinical Practice Guidelines for
antibiotic antibiotic therapy program is well underway and will be
evaluated later in 2006. Dr. Laupland and his team completed the
extremities/soft tissue infection assessment in the HPTP Program
which has generated a tool that can be used to help streamline
patient triage within HPTP. The Infection Prevention & Control group
has successfully initiated a clinic housed at UCMC and at the 8th &
8th Medical Centre for decolonization of MRSA colonized patients
and also for the assessment of patients who may be eligible for nonoccupational HIV post-exposure prophylaxis. This clinic is staffed by
Dr. Athena McConnell temporarily pending funding for ongoing
operations. Dr. Manuel Mah has initiated and rolled out a very
Innovation projects are
successful
New ‘tool’ developed by
Dr. Laupland to streamline
patient triage within HPT
Page 61 of 71
successful project related to hand hygiene with a goal to reducing
spread of nosocomial pathogens within the acute care environment.
Dr. Andrew Pattullo has been very busy working with the PCIS team
to roll out the Sunrise Clinical Manager Patient Care computer
system to the acute care sites. This system will be considerably
more functional than the existing TDS system and will be particularly
useful for the ID Division allowing graphical displays of patient data
not previously possible. The Division has been a leader in using
teleconference facilities to spread their weekly seminar and case
round presentations to all the acute care sites, Southport, and CLS.
The Division has worked cooperatively with the Medical Teaching
Unit on Nuring Unit 36 at FMC and the MTU residents now regularly
attend these rounds as part of their education.
Successful hand hygiene
project
EDUCATION
Drs. Read, Rabin, and Church have been active in the
Undergraduate Medical Education Program as the Curriculum
Committee restructures the undergraduate curriculum and coalesces
a number of existing courses into mega-courses. The HPTP
Program continues to grow in terms of patient volumes and a
number of initiatives are underway to streamline patient flow, reduce
the number of follow up visits required, and improve patient
outcomes. The Cystic Fibrosis Program, under the leadership of Dr.
Harvey Rabin, has continued to expand with ever increasing patient
numbers and increasing numbers of post-lung transplant patients.
Dr. Rabin has initiated a research project with Dr. Mike Surrette of
the Bacterial Pathogenesis Research Group to evaluate the role of
various members of the normal upper respiratory flora on
exacerbations of Cystic Fibrosis lung disease. The Southern Alberta
HIV Clinic also continues to see increasing patient numbers and is
continuing to actively research new drug development and to
undertake economic analyses of HIV patient care with a view to
reducing the economic impact of this disease.
Dr. Tom Louie’s
Clostridium difficile research program benefited greatly from his 6
month sabbatical during this timeframe and he has been able to
wrap up a number of research projects in this area, establish new
research collaborations, and expand basic and clinical research into
Clostridium difficile disease. The Infection Prevention & Control
group is focusing on outbreak prevention and using an innovative
dramatic program for hand hygiene dissemination. The STD Clinic
has initiated a number of outreach activities to reach the highest risk
areas of our population. This includes collaboration with the
Safeworks Needle Exchange Program to provide testing and
treatment to intravenous drug users and sex trade workers, in
collaboration with the Calgary Refugee Health Clinic to screen
refugees arriving from countries where STD’s are still endemic, a
satellite clinic in Banff to provide accessible STD testing and
treatment to transient members of the service industry in the Bow
Corridor.
Finally, Dr. Read is negotiating with the website
Nexopia,which caters to teenagers and is an excellent vehicle for
dissemination of information about STD’s and sexual health to high
risk teenagers.
Undergraduate curriculum
restructured
CF Program continues to
expand
Southern Alberta HIV Clnic
sees patient growth
IP & C’s focus is on
outbreak prevention &
hand hygiene
STD clinic
- Safeworks Needle
Exchange
- collaboration with
Calgary Refugee Health
- satellite clinic in Banff
Negotiations in place
with website Nexopia
Page 62 of 71
Division of NEPHROLOGY
Division Chief: Dr. Nairne Scott-Douglas
ADMINISTRATION
This past year has been a very exciting year for the Division of Nephrology.
Clinical care has continued to improve, research is proceeding at a very fast
pace and the training Program has received full accreditation. The Southern
Alberta Renal Program (SARP) continues to expand with the opening of a
hemodialysis unit at the Sunridge Medical Gallery slated for later this year.
Home dialysis therapies continue to expand with a 10 % increase in the number
of patients on Peritoneal Dialysis and the Nocturnal Hemodialysis Program being
almost too popular. The introduction of Nocturnal Hemodialysis is being
implemented as the first prospective randomized controlled clinical trial
compared to conventional hemodialysis and is looking at efficacy and cost
effectiveness under the guidance of Drs. Culleton and Manns.
CLINICAL
The recruitment of two nephrologist in the past year has helped the Division meet
its’ needs. Dr. Jennifer MacRae has initiated a very extensive program involved
in all aspects of hemodialysis vascular access. She has recently replaced Dr.
Ron Hons (after nearly 30 years) as the Director of Hemodialysis. Dr. Hons is
going to use his large clinical experience to help run the Residency Training
Program. A Nephrology Central Referral system has been set up with support of
the ARP innovation fund and under the guidance of Dr. Braden Manns. This
system with referrals triaged by a nephrologist is proving very successful in
prioritizing patients, decreasing unnecessary referrals as well as decreasing
patient wait times. The trainees and staff particularly enjoy the new “urgent
assessment clinic”. Also referring physicians are giving positive feedback
regarding ease of use.
Dr. Culleton will now be Director of the Chronic Kidney Disease which is the most
rapidly expanding area of nephrology care in Southern Alberta. The electronic
patient data base Renal PARIS developed by Dr. Garth Mortis continues to be a
cornerstone to clinical care and is also being used for research purposes. PARIS
continues to go through improvements and the Pediatric Nephrologists have now
started to use an adapted version. The goal is to have a wed-based version in
2007.
Dr. George Vitale joined the Division and is Director of Peritoneal Dialysis. He is
very clinically active and his hard work allows for protect time for faculty
members to complete there non-clinical responsibilities.
Exciting year for the
Division of Nephrology
Dr. Jennifer MacRae
- new recruit
- now Director of
Hemodialysis
Dr. Ron Hons
- will help run Residency
Training Program
Dr. Braden Manns
- has set up Central
Referral System
Dr. Bruce Culleton
- now Director of the
Chronic Kidney Disease
Program
Dr. Garth Mortis
- developed an electronic
patient data base - PARIS
Full Accreditation for
Nephrology
EDUCATION
The Nephrology Training Program received a very strong external review and
has received full accreditation. Under the guidance of Dr. Kevin McLaughlin this
program continued to attract superior internal and external candidates. Dr.
McLaughlin will go on a sabbatical to learn more about medical education and
will return as Assistant Dean of Undergraduate Medical Education Research. Dr.
Ron Hons has taken over administering the training program during Dr.
McLaughlin’s absence and will continue to co-administer the program on his
return. The Division has recruited within the ARP one of our trainees, Dr. Sophia
Chou. She will work part-time for the first year while she completes her Master’s
Undergraduate Medical
Education
- Dr. K. McLaughlin on
sabbatical Sep 2006
- Dr. R. Hons will
administer program
Page 63 of 71
Degree in Medical Education. We look forward to her future contributions to the
education of physicians. Another of our fellows, Dr. Mike Walsh, has received
funding to pursue a PhD working on Glomerulonephritis in the England.
RESEARCH
The Division of Nephrology continues to excel in academic areas with more than
15 first authored papers over the past year. The Alberta Kidney Disease Network
(AKDN) continues to be a very productive group combining clinical researcher
from all over Alberta. In addition, Drs, Manns, Culleton, and Hemmelgarn have
received over $750,000 in AHFMR funding within the AKDN to investigate
cardiovascular and renal protective medication in patients identified through the
Alberta wide laboratory prompts for increased serum creatinine levels. Dr. Bruce
Culleton has chaired the Canadian Society of Nephrology Guidelines Committee.
A highlight for the Division was the most deserving selection of Dr. Brenda
Hemmelgarn as the Canadian Society of Clinical Investigators “Joe Doupe
Young Investigator’s Award”.
The Division is actively involved in obtaining funding for a proposed 5 million
dollar Endowed Chair in Clinical Renal Research. Continued development of
research in basic science, medical education and clinical trials is a priority with in
the Division.
Trainees
- Dr. Sophia Chou will
complete Master’s in
Medical Education
- Dr. Mike Walsh will
pursue a PhD in
England
Over $750,000 in
AHFMR
Morefunding
than 15 first
- Drsautho
Manns,
red Culle
papeton
rs &
Hemmelgarn
Dr. Bruce Culleton
- Chair of the Canadian
Society of Nephrology
Guidelines Committee
Dr. B. Hemmelgarn
receives the Joe Doupe
Young Investigator’s
Award
Endowed Chair in
Clinical Renal Research
- actively obtaining
funding for Chair
Page 64 of 71
Division of Respirology
Division Chief: Christopher H. Mody MD, FRCPC, FCCP, FACP
ADMINISTRATION
The Division of Respirology has had an exciting and productive year in 2005.
There have been a great many changes, and many accomplishments.
Additionally, the division is facing a number of enormous challenges, which we
face with hope, optimism and determination.
Access to private clinics,
outpatient service and
soon Lung Cancer
Telehealth
The Division consists of 23 members based at three hospital sites and in private
clinics in the Calgary Health Region. The Division provides continuous
consultative service and in patient ward service at three acute care hospitals,
while maintaining a very busy outpatient clinical service across the region.
Additionally, the Division provides innovative outreach programs. Lead by Dr. Jeff
Mellor, the Division has outreach respirology clinics in rural Alberta, and under
the leadership of Dr. Alain Tremblay will soon be implementing a telehealth
program for lung cancer.
COPD Program nationally
recognized
New Program assessing
sputum inflammation
CLINICAL
The Calgary Asthma and COPD Program is nationally recognized for providing a
cohesive service that links together family physicians offices, hospitals, and
emergency departments. Dr. Bob Cowie leads this team of dedicated health care
providers, including physicians, respiratory therapists, kinesiologists and nurses.
Under the direction of Dr. Richard Leigh, and with the assistance of Innovation
Initiative Funding, a program for assessing sputum inflammation has been
initiated. This is an extremely valuable tool that now allows respirologists to
assess the affect of asthma therapies in the most challenging patients. To date,
141 tests have been done, and in half the results have changed management
and improved asthma control. Additionally, with the recent recruitment of Dr.
Warren Davidson, who is interested in the epidemiology of asthma and airways
disease, and strong collaboration with the Asthma and Airways Inflammation
Research Group under the direction of Dr. David Proud, this group is moving into
a leadership position in Canada.
The Interventional Pulmonary Medicine Service is one of only two such services
in the country. Dr. Alain Tremblay is the leader of this program, and along with
Dr. Gaetane Michaud, is using a variety of innovative tools and techniques
including endobronchial ultrasound, permanent and removable stents, and
indwelling pleural catheters. Helped by a $1M private donation, this program has
been able to purchase the equipment necessary to perform this highly technical
and ground-breaking service. The Service is also dedicated to training young
respirologists in the advanced techniques, and an Interventional Pulmonary
Medicine Fellow will begin training in July 2006.
Leadership in Asthma and
Airways Inflammation with
Dr. Davidson and Dr.
Proud
Interventional Pulmonary
Medicine using innovate
tools
Establishment of a
Pulmonary Hypertension
Program
The Division of Respirology has also established a Pulmonary Hypertension
Program. Dr. Doug Helmersen is the leader of this program and along with Dr.
Sid Viner and Dr. Naushad Hirani, the Program provides day to day management
as well as comprehensive diagnostic services including right heart catheterization
and pharmacologic treatment. Aided by a private donation, Dr. Helmersen has
purchased the equipment, including a dedicated fluoroscopic system that is
required for right heart catheterization studies. Together, this group is providing a
Page 65 of 71
world-class service for patients that would have died only a few years ago. In
keeping with our goal of providing cutting-edge service and research in Calgary,
Dr. Hirani will be doing a 6-month sabbatical with Dr. Nazzareno Galiè at The
University of Bologna, Italy, who is one of the world’s leaders in clinical trials in
pulmonary hypertension.
Members of the Division are also one of Canada’s leaders in Sleep Medicine.
Under the direction of Dr. Pat Hanly, The Sleep Centre has developed a unique
and successful working relationship in the assessment and management of
Sleep Disordered Breathing within the Calgary Health Region. This has improved
patient access to diagnosis and treatment both for uncomplicated obstructive
sleep apnoea and more severe sleep disordered breathing, and has reduced
waiting lists. This is the first time that this Public Private Partnership with home
care companies has been employed in Canada. As an extension of this, Dr. Bill
Whitelaw is conducting a study (funded by the Alberta Heritage Foundation for
Medical Research), which is evaluating the management of obstructive sleep
apnoea in the primary care setting. Recently, Dr. Whitelaw published a landmark
scientific paper demonstrating the efficacy of this approach that was featured in
the Globe and Mail, the Calgary Herald and TV and radio. Under the Innovation
Initiative Funding, the sleep service introduced an alternative care provider to
augment the care team and support patients with complex sleep issues. This
program has already reported a trend toward increased access to alternative
care providers.
A group has been established, under the guidance of Dr. Brent Winston, with an
interest in interstitial lung disease. We have recently recruited Dr. Charlene Fell,
a respirologist with a special interest in interstitial lung disease, epidemiology and
clinical trials. Dr. Fell will be seeking additional training, in interstitial lung disease
at the University of Michigan with Dr. Fernando Martinez, who is one of the
world’s leaders in clinical trials in interstitial lung disease. Upon her return, Dr.
Fell and Winston will continue to develop Interstitial Lung Diseases as a clinical
and academic focus for the Division.
Improved patient access
Reduced waiting lists
Evaluation of obstructive
sleep apnea in the primary
care setting
Landmark scientific paper
published by Dr. Whitelaw
in the management of
Sleep Apnea
Interstitial Lung Disease
develops as a clinical and
academic focus
INNOVATIONS
Through the Innovation Initiative Funding, a number of new and exciting
programs have been established. The program for the assessment of
inflammation in asthma via analysis of induced sputum has been mentioned
previously. Additionally, a cough clinic, staffed by an asthma educator to support
quality patient care and reduce unnecessary consults in respiratory medicine has
been established. Additionally, a program has been established to strengthen
care transitions from acute care to community in chronic obstructive pulmonary
disease.
EDUCATION
The Division of Respirology Residency Education Program is fully accredited by
the Royal College of Physicians and Surgeons of Canada. Under the direction of
Dr. Karen Rimmer, the program is recognized as one of the best in the country.
Additionally, a number of members of the division set the standard of
competence in respirology by participating in the Royal College Examination
Program. Recently, the Division received the highest teaching rating by
Residents in the Department of Internal Medicine, and the division was also
honoured when Dr. Stephen Field, Dr. Ward Flemons and Dr. Chris Mody
became “Great Teachers” at the University of Calgary. Other awardees include
Innovation funding
establishes new programs
Accredited Residency
Education program
Residents rate Division as
the highest teaching in
Internal Medicine
Page 66 of 71
RESEARCH
Dr. Richard Leigh, who was a finalist for the Wilbert J. Keon Award Competition
for Junior Faculty at the National Research Forum for Young Investigators in
Circulatory and Respiratory Health, and Dr. Karen Rimmer who won the Golden
Bull award for excellence in teaching residents in Internal Medicine.
Members of the Division provide leadership nationally and internationally in a
number of medical societies and organizations. Dr. Gordon Ford is the president
of the Canadian Thoracic Society. Dr. Stephen Field is the Governor for Alberta
for the American College of Chest Physicians, and Dr. Chris Mody is the
Governor for Alberta for the American College of Physicians.
Members of the division have been involved in research. Highlights include a
publication on the experience in tuberculosis in Calgary between 1995-2002 (Int
J Tuberc Lung Dis. 2005;9:288), and a paper outlining the diagnosis and
management of pergolide-induced fibrosis (Mov Disord. 2005;20:512). Member
of the Division have reported a highly innovative way to measure cardiac output
during exercise (Eur J Appl Physiol. 2005;94:670), and a paper is in press
describing the utility of chronic indwelling catheters for the management of
malignant pleural effusions (Chest 2006;129:362). Members of the division
participated in the New England Journal of Medicine paper describing the utility
of continuous positive airway pressure for central sleep apnea and heart failure
(N Engl J Med. 2005;353:2025), and the clinical usefulness of home oximetry
compared with polysomnography for assessment of sleep apnea has been
reported (Am J Respir Crit Care Med. 2005;171:188). Additionally, new and
exciting discoveries were made in the area of asthma remodeling (Am J Respir
Cell Mol Biol. 2005;32:99).
Division members obtain
multiple awards
National and international
leadership
Research
- Tuberculosis
- Cardiac output during
exercise
- Assessment of sleep
apnea
- Asthma remodeling
Salary supported research
Members of the division are also active in basic science research. Three
members of the division had salaried positions from the Alberta Heritage
Foundation of Medical Research, and one has salary support from the CIHR.
We have established a partnership with the Ministry of Innovation and Science to
increase the endowment for the “GSK Professorship in Inflammatory Lung
Disease” to $1.75M. The position will provide leadership in research, education
and patient care in airway inflammatory lung disease. Dr. Richard Leigh has
been nominated to be the first GSK Professor in Inflammatory Lung Disease.
Leadership in
Inflammatory Lung
Disease
CHALLENGES
Provision of outpatient services continue to be a pressing problem. Clinic space
at all three sites (UCMG, RGH and PLC) is insufficient. More outpatient offices
are needed. At the UCMC site, the space needs to be used more efficiently. A
coordinated system of booking is needed so that utilization of space is optimal.
We are unable to provide adequate pulmonary function testing in the region.
Waiting lists to obtain pulmonary function tests have increased to unacceptable
levels. Patient care is now impaired because we are waiting for pulmonary
function tests. Personnel need to be provided immediately to deal with the
backlog of testing that must be performed.
Clinic space insufficient
Lack of personnel – results
in wait lists for tests
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We urgently need a coordinated system of booking patients, tests, and
appointments across the region. Currently, each individual respirologists’
secretary is performing these tasks. The system is cumbersome, complex and
has great potential for misadventure. A streamlined, coordinated central system
would increase the efficiency of providing services, in addition to being required
to respond to sudden or emergency changes in provision of services (e.g. Flu
outbreak or pandemic).
Provision of community services needs to be improved. While great progress has
been made, we are still only touching a tiny fraction of the patients with chronic
respiratory illness. Medical staff barely manages their present load. We are not in
a position to provide the community rehabilitation, spirometry, patient diagnostic
and education program that have been identified as a priority for the Division in
the Region. Additionally, with digitized electronic radiology imaging, there is the
potential for Respirology to expand and provide telehealth services.
Manpower is inadequate. It is anticipated that 5 members will be required at the
new South Campus Hospital to establish a functional self-sufficient group.
Further, it is anticipated that 3 members of the Division will retire from the
Foothills Medical Center staff over the next 5 years, and an additional 2 members
from the interventional pulmonary medicine service may be leaving the Foothills
Medical site. At the Peter Lougheed Center, it is anticipated that 1 member will
be retiring. Thus, 11 respirologists will need to be recruited over the next 5 years
to maintain the current manpower at each site.
Recruitment will be targeted to the following areas:
3 Sleep Medicine (2 members will be retiring)
2 clinician scientists (2 members will be retiring)
1 Non-tuberculous mycobacterial disease and tuberculosis (1 member will be
retiring)
1 Neuromuscular diseases
1 Non invasive ventilation
1 Lung transplantation
1 Cystic fibrosis and pulmonary infections
1 Occupational and Environmental Medicine
1 COPD and rehabilitation
1 Interstitial lung diseases
The academic and scholastic contribution of the division is inadequate. In a time
motion study performed in the department, the division spent only 4% of its time
in academic activity. This activity is mandated by the burden of clinical and
administrative service provided by the members of the Division; however, it
equates to less than 1 FTE in academic activity among a division of 23 members.
This is inadequate for a University affiliated division. To increase the academic
activity to 20%, 4 new recruits will need 50% of there time to research, and 2
members will be required that will devote the 75% of their time to investigation
and the pursuit of new knowledge.
Central patient booking
needed
Potential for telehealth
services for
improvement of
community services
Recruitment and
retention is critical
Time spent on academic
activity is only 4%
Possible move of
Thoracic Surgery
presents significant
challenges
We will face significant challenges if Thoracic Surgery moves to the RGH site. If
this occurs, the care of patients with cancer will become spread over multiple
sites, which will present many challenges. Additionally, interventional pulmonary
Page 68 of 71
medicine, which has a close working relationship with Thoracics, will continue to
be at the Foothills Medical Centre and will need to function and develop
independently.
We will soon face renegotiation of the ARP. Our hope is to continue to provide an
opportunity within the ARP for all respirologists in the Calgary Health Region.
However, the requirement to recruit may force us to consider positions outside
the ARP. If is this is necessary, planning and integration will be paramount.
The developing South Hospital will present great challenges. The goal will be to
provide a full complement of respirology inpatient and outpatient services and 24hour call coverage. It is anticipated that this hospital will be functional in 200102011, and an additional 5-6 recruits will be required for this purpose. Since there
is no indication that 6 recruits will be available in the year prior to the hospital
opening, this will need to be accomplished over the next 5 years.
The Division of Respirology looks forward to the future with enthusiasm. We
anticipate that we will be able to continue to provide the exemplary service and
care, and improve upon the academic and investigative initiatives of the Division.
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Division of Rheumatology
Division Chief: Dr. Liam Martin
CLINICAL AND INNOVATIONS
In the past 12 months the Division has planned and put into place through the
efforts of the entire membership the majority of the innovations for which we
received funding. These innovations included: a central triage system; a
transition clinic for young adults with systemic rheumatic diseases; hiring a nurse
practitioner; hiring a clinical nurse specialist.
The central triage system has evolved from the planning stages during which all
division members reviewed their practice activities to include their wait list times
and clinical activities. The members also participated in numerous reviews of a
proposed referral form for central triage and reviews of how central triage would
affect their practices. The nursing staff at the 3 CHR based clinics as well as the
administration staff from these clinics and the administration staff at the private
practice clinics also participated in round table discussions in preparation for the
launch of this new system. The start date for the clinic is set for April 3rd 2006.
This date was chosen to allow all members to deal with the back log of referrals
that were currently in their offices. We are about to hire and train 2 unit clerks,
one at level 5 and one at level 3, who will play an integral role in management of
the system.
The transition clinic, for children with arthritis who are moving from paediatric to
adult care, referred to as the YARD clinic (Young Adults with Rheumatic
Disease) is also set to start in March 2006. It will be held every 2nd Wednesday
in Area 5A with a team consisting of an adult and paediatric rheumatologist, a
clinical nurse specialist.
As the clinic evolves a social worker and a
physiotherapist will be hired to complement the clinical service.
Our Telehealth Program is in place under the leadership of Dr. Sharon LeClercq
with support form Dr. Liam Martin. Drs LeClercq and Martin have each traveled
to Pincher Creek to offer training sessions to the family physicians who are
participating in this innovative project. Dr. LeClercq has also traveled to Rocky
Mountain House to offer training sessions to the participating family physicians
there on 2 occasions. The first live Telehealth clinic was delivered by Dr.
LeClercq and the family physicians in Pincher Creek in the Fall. All participants,
especially the patients, felt that this approach to care was beneficial. We look
forward to further encounters and to evaluating the process over time.
Plans to expand the Early Inflammatory Arthritis Clinic are in place.
Currently this clinic is held at the Peter Lougheed Centre every 2 weeks.
The number of clinics at the PLC will increase to one per week and a
second clinic will be offered at the Rockyview General Hospital also on a
once weekly basis. Support staff for this clinic will be hired in 2006 using
Innovation funds. An ongoing evaluation of this clinic is taking place.
Innovations in place
- central triage
- transition clinic
- NP hired
- Clinical nurse specialist
hired
Central Triage
- Additional staff hired
- Start date is April 3,
2006
Y.A.R.D.
- Starts March 2006
- Additional staff will be
hired
Telehealth Program
- Training provided in
Pincher Creek & Rocky
Mountain House
Early Inflammatory
Arthritis Clinic
- PLC clinic increases to
weekly
- additional weekly clinic
to be held at RGH
Page 70 of 71
EDUCATION
Under the leadership of Dr. Chris Penney a standardized method for joint
examination is being taught to the medical students, clinical clerks and the
medical residents. This method referred to as the GALS exam provides all
learners with the technique to perform a standardized and efficient method of
screening a patient for musculoskeletal problems. In the past year Dr. Penney
has developed a CD version of the examination for all students.
GALS exam & CD
version
- standardized screening
method for everyone
RECRUITMENT
We have recruited a scientific member to our division whose research is focused
in the area of autoimmunity. She will work closely with Dr. Fritzler and other
division members and trainees in developing research projects and in
educational activities.
CHALLENGES
The success that we have achieved in putting into place our clinical innovations
represents a two edged sword for the division. We are able to offer a more
efficient service and as a result we are receiving more referrals, resulting in an
increase in our chronic patient load. While this is a good result for the patients
and their referring physicians it has created a new set of challenges for our
members. This increased pressure can potentially detract from the educational
and research activities of our members.
We need to recruit more
rheumatologists to address this need.
However, recruitment of suitable rheumatologists continues to be a major
challenge in spite of the great opportunities that are offered by the ARP. Our
Division members have the distinction of being the oldest with respect to our
average age. In order to address the issue of recruitment we have advertised
widely for rheumatologists. Division members have used their networks to
identify such individuals but to no avail. These efforts continue as we are
anxious to find a replacement for Dr. Marvin Fritzler as he moves towards
retirement. While the ARP has helped to improve the compensation for
rheumatologists there need to be more efforts made at the Department level to
address the disparity between our specialty and others with regards to earning
potential.
We continue in our efforts to recruit specialty residents to our training program.
We are fortunate to have recruited for July 1, 2006 a specialty resident trainee in
Rheumatology from the University of Manitoba. We are hoping that another
specialty resident trainee will be recruited through offering a 1 month elective to
an out of province medical resident in October 2005. We continue our efforts to
make residents aware of the opportunities in Rheumatology as a career choice.
Dr. Chris Penney has developed a Residents Arthritis Day which will be offered
again this year to residents in year one and two from both Calgary and
Edmonton. This year’s event will take place in Edmonton with residents from
both centres being invited. We are expecting that the event will be as successful
this year in Edmonton as it was in Calgary last year.
Success brings
- more efficient service –
increase in referrals
- need to recruit more
rheumatologists
Recruitment is great
challenge
- resident trainee from U
of Manitoba
Residents Arthritis Day
developed by Dr.
Penney joint for Calgary
& Edmonton
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