Medicine & Quality Matters

November 2020

News for the Interior Health Medical Community

VP Message from Dr. Mike Ertel, Vice President, Medicine & Quality

As 2020 winds down and my annual reflections begin,

in no other time in my career, up till now, can I say

that health care was the newsmaker of the year.

The stories that I hear from all of our medical leaders have the

same theme – how everyone came together to meet the needs

of patients and the people in our communities. We redesigned

services, invented new care delivery models, networked with

industries around personal protective equipment, and stepped in

to virtually-enabled care like never before. Many medical staff

supported the COVID-19 pandemic response in Interior Health,

but also in their private practices. I can’t thank you enough for the

work and efforts of everyone.

The pandemic provided the opportunity to transform our entire

system in just weeks – and it has now forever changed how health

care will be delivered. It was, and still is, hard work. But we

continue persevere, to deal with information changing daily, to

provide leadership to our teams and care for our patients, while

we ourselves are impacted personally.

The IH Emergency Operations Centre (EOC) led the response for

the organization. Medical staff voices were heard through the

seven Regional Incident Commands and the COVID-19 Medical

Working Group. Dr. Sue Pollock was interim Chief Medical Health

Officer at the onset of the pandemic and her support was

invaluable. Now, with Dr. Albert De Villiers as Chief Medical Health

Officer and his team of MHOs, we continue to have great medical

leadership.

Under the guidance of Dr. Devin Harris, all of the Executive

Medical Directors in the COVID-19 Medical Working Group

(Dr. Harsh Hundal, Dr. Norm Kienitz, Dr. Douglas Smith, Dr. Sue

MacDonald, Dr. Curtis Bell, and Dr. Nick Balfour) and key programs

– such as Mental Health and Substance Use (Dr. Paul Carey),

Emergency (Dr. Aron Zuidhof), Critical Care (Dr. Ryan Foster), and

Nurse Practitioners (Louann Janicki) – were supported to provide

direction to the EOC or respond to incoming information from the

provincial health emergency coordination centre. This working

group was supported by the administrative leadership shared by

Michaela Swan and Renee Caillier.

VP Medicine & Quality Dr. Mike Ertel during an Emergency Department

shift at Kelowna General Hospital.

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Page 2 | November 2020

It was inspiring to watch and be a part of how information was shared

throughout the organization. Medical leadership worked hand-in-hand with

administrative leadership to respond quickly and effectively. From the

Communicable Disease Unit to everyone on the frontlines, we worked together

to adapt and evolve to the changing needs of this pandemic. It was also

impressive to see items Interior Health developed be endorsed or adopted

provincially.

I was further moved by the number of retired physicians who came forward to offer their services to support patient care

if the need arose. IH had the greatest number of retirees step up, which speaks volumes to the comradery of the medical

community to work together in unprecedented times.

The Pandemic Response Coordination Centre is now leading Interior Health’s response to COVID-19. Your medical leads

representing medical staff are Drs. Douglas Smith and Curtis Bell. Triggers have been identified by IH for standing up local

regional surge response teams and, only if required, will IH resume the Emergency Operations Centre.

As we moved into recovery phases of the pandemic several months ago, we also shifted to focus once again on other major

priorities for meeting the needs of our patients. This included addressing surgical backlogs with a new surgical strategy, as well

as the highly important focus on addressing racism in health care. For some time, IH has been working on system change to

ensure culturally safe care is provided across all levels of the health-care system, but we know we can and must do better.

I encourage you to watch the physician videos for Aboriginal Cultural Safety Education.

In September, Dr. Sean Wachtel joined Interior Health as our new Senior Medical Director, Aboriginal Health. This reaffirms

my commitment to have medical staff engaged to lead the change necessary to ensure all of our patients feel safe in accessing

medical care. This is sure to be a leading initiative for the Ministry of Health in 2021.

While we are still living the pandemic, and will be for some time, I wanted this issue to commemorate some of the stories of our

COVID-19 response from across IH. I hope that all of you find the opportunity to reflect on the year it has been in your careers,

and to recognize your accomplishments and those of your colleagues. Every single one of you are a part of history now – you were

a part of the amazing health care response during the COVID-19 pandemic.

Take a minute and celebrate your contributions, write down your thoughts and reflect on the learnings, but most importantly,

teach those yet to come how to prepare for what lies ahead.

VP message cont’d …

Release of the March Medicine & Quality Matters newsletter was delayed due to the onset of the COVID-19 pandemic. These important articles highlight the work by your colleagues, prior to March 2020.

NAVIG8: Engaged future physician leaders A Doctor’s Struggle: A story of violence in the workplace Simulation program earns medical education credits Emerg docs participate in mass casualty training Quality Forum 2020: Shaping Success Together

Read the March issue online.

Now sharing the Spring MQM newsletter

For some time, IH has been working on

system change to ensure culturally safe

care is provided across all levels of the

health-care system, but we know we can

and must do better.

Page 3 | November 2020

COVID-19 testing equipment in the nick of time

My grandfather, Dr. Arnold Lowden, was the Medical Health Officer for the East Kootenay region from 1975 to 1992. He held this post through the uncertain early days of HIV and, at 93 years old, will still oblige me with stories of his time in medical leadership. When he moved into long-term care last December, many of his unneeded belongings were donated to the local health-care auxiliary, of which my grandparents have been long-time supporters. The previous year, the auxiliary had graciously funded a small polymerase chain reaction (PCR) instrument called the GeneXpert for our lab at East Kootenay Regional Hospital (EKRH). In March 2020, the manufacturer announced a test for COVID-19, allowing urgent samples (such as those from long-term care facilities) to be rapidly tested. We advocated at a provincial level for the limited test kits and validated the assay in record time. Local testing at EKRH was announced April 15. Then, on April 16, a COVID-19 outbreak was declared at the Kootenay Street Village – where my grandfather resides.

As the Medical Director of Laboratory for Interior Health, I saw our team pushed hard in response to the COVID-19 pandemic. We had been working non-stop since early March and exhaustion was setting in. I never imagined that the importance of our work would hit so close to home. Fortunately, the outbreak was declared over with no additional cases – a fantastic job of which a retired East Kootenay Medical Health Officer can be proud.

Dr. Arnold Lowden, retired East Kootenay Medical Health Officer was

the first person to receive a visit at his long-term care home in

Cranbrook since the start of the COVID-19 pandemic.

Submitted by Dr. Launny Lowden, General Pathologist and Interim Medical Director, IH Laboratory East Kootenay Regional Hospital, Cranbrook

“What our lab team had accomplished was now

working to keep my own grandfather safe, in

the nick of time. The gratitude I felt brought

renewed energy and purpose for the months

and tasks ahead.”

Page 4 | November 2020

Adapting standards of care to protect our most vulnerable

The residents of our long-term care homes constitute a vulnerable population and are amongst the most susceptible to serious infection from COVID-19. In fact, approximately 81 per cent of COVID-19 related deaths in Canada have occurred in long-term care (LTC) residents.

It was on March 27 when Provincial Health Officer Dr. Bonnie Henry issued an Order to LTC facility operators to take significant measures to minimize risk for COVID-19 exposure. In addition to enhanced cleaning, enhanced screening, and visitor restrictions, the Order included direction to reduce movement of residents within and between facilities and provide care in place instead, where appropriate.

“We recognized early on that given the frailty of LTC residents, there was limited benefit residents to go to hospital for treatment of complications related to COVID-19 and an acute care environment could pose a greater risk of serious illness,” says Dr. Douglas Smith, Executive Medical Director, IH North.

In order to support treatment-in-place versus ambulance transport to the local emergency department, the Provincial Transport Emergency Operations Centre partnered with IH LTC medical and operations leaders to develop a person- and family-centred approach to care. This work resulted in the development and implementation of a Clinical Decision Pathway for COVID-19 in Long-term Care Residents and 911 Long-term Care Transfer Algorithm.

The Clinical Decision Pathway: introduces serious illness conversations early with the

resident and family to establish appropriate goals of care; facilitates conversations between front-line care

providers and the Most Responsible Practitioner (MRP) to assess and determine the most appropriate clinical approach;

reviews Medical Orders for Scope of Treatment (MOST) status of resident; and

facilitates the decision for provision of treatment- in-place or transfer to acute care.

Working in alignment with the Clinical Decision Pathway is the 911 LTC Transfer Algorithm. This algorithm:

focuses on upstream planning by working with the Most Responsible Practitioner before calling 9-1-1;

ensures an expedited triage process that follows the Advanced Medical Priority Dispatch System international standard; and

works with Emergency Physician Online Support for medical oversight for paramedics and real time support for changes in patient condition.

These two tools were first tested in a collaborative table-top exercise and then trialed with the Central Okanagan Divisions of Family Practice LTC physician leads in May. Formal implementation was initiated on June 1. Second-phase implementation included the South Okanagan Similkameen Division of Family Practice LTC leadership and physicians on June 15. IH-wide implementation followed on July 13.

Submitted by: Dr. Douglas Smith, Executive Medical Director, IH North Brent Hobbs, Network Director, Patient Transportation Services

Inter-facility transfers in long-term care

Clinical Decision Pathway for COVID-19 in Long-term Care

Residents

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Page 5 | November 2020

“The Clinical Decision Support Pathway and the 9-1-1 LTC Transfer Algorithm remain in place to support high standards of clinical decision making and treatment for our residents in LTC,” says Dr. Smith. “The implementation was supported by a robust knowledge translation and change management strategy to engage with clinical and leadership teams.” The project team included Dr. Douglas Smith, Executive Medical Director IH North; Dr. Nick Balfour, Executive Medical Director IH South and Transport; Brent Hobbs, Director, IH Patient Transportation Services; Andrea Tennant, IH Regional Knowledge Coordinator, LTC Services; Dr. Sandra Jenneson, Medical Director, BC Emergency Health Services; and Marlis Gauvin, Interim Director, Medical Program Transformation. Dr. Smith adds that the initial evaluation results are promising, and the project team is currently involved in ongoing evaluation related to the effectiveness, efficiency, and impacts on LTC patient care, ED transfer rates, and ED admission rates.

COVID-19 911 Long-term Care Transfer Algorithm

cont’d …

It is mandatory for all medical staff to

self-report their influenza immunization

decision.

The seasonal influenza vaccine is safe and the most effective

way of preventing the spread of influenza. Thank you for doing

your part to protect the people in our care.

https://medicalstaffhealth.phsa.ca

Page 6 | November 2020

Love is also contagious

Dr. Linda Johannson, an emergency physician at Kootenay Lake Hospital noticed that the pandemic was taking a big toll on staff morale. During the early weeks, she and her colleagues were really feeling the pressure of the changes to their daily practice and the fear and uncertainty about what lay ahead. Their team, which is normally friendly and cooperative, was noticing an impact. Soon after, she attended one of the daily online sessions being offered to support physicians. The facilitator mentioned that when someone at work displays an anxious, fearful attitude, it can be contagious to the whole team. But, she said, the reverse is also true. Positive attitudes can also be contagious, and it only takes one person to make that shift and get things started. That’s when the idea for the “Love is also contagious” campaign was born. Dr. Johannson got to work, and asked the Facility Engagement Working Group for support. “I wanted to create a visual cue to remind us that, because of the fear we are all experiencing, our behaviour may not be consistent with our usual happy, friendly personalities,” explains Dr. Johannson. “I asked my good friend, Nelson graphic designer Marian Lowe, if she could take a cartoon coronavirus image I had found, and morph it into a heart, for a more friendly virus image than the scary ones all over the news and our internal communication memos.” To help spread the visual reminder, Dr. Johannson and the Facility Engagement team had stickers and buttons made up, along with a downloadable window sign that anyone can print from home and display anywhere. “When I have time at night or in the early morning, I’ll fill up a little bag with pins and stickers and go around the hospital to “spread love.” People seem to really appreciate the message and the visual reminders to take a minute and reset if they are getting stressed on shift.”

Submitted by Dr. Linda Johannson, Emergency Physician, Kootenay Lake Hospital, Nelson

Dr. Linda Johannson

Positive attitudes can also be contagious, and

it only takes one person to make that shift

and get things started.

Page 7 | November 2020

Sharing knowledge and best-care practices during a time of significant change can be a challenge. This was true at the onset of the COVID-19 pandemic.

In an effort to share new pandemic information and maintain open discussion amongst medical staff, the Interior Health Grand Rounds expanded from site-based discussions to an IH-wide forum.

“Traditionally, Grand Rounds are about specific cases, approaches to conditions, and sharing scientifically-based information among colleagues at a site,” says Dr. Harsh Hundal, Executive Medical Director, Physician Engagement & Resource Planning. “As the pandemic was declared, it became clear that we needed to communicate new best-care practices and information to medical staff across Interior Health.”

Grand Rounds transformed into a regular presentation for medical professionals by medical professionals open to medical staff across IH. The goal: to translate knowledge peer-to-peer and provide and avenue for discussion on current pandemic topics.

The first pandemic Grand Rounds kicked off on March 12 and included more than 120 participants. A total of 10 Grand Rounds took place from March to June on a variety of topics. This regular communication and connection was a resounding success.

Each Grand Round topic was identified in response to feedback from practicing IH physicians and speakers were chosen based on their expertise and subject matter.

“The Grand Rounds are a great opportunity to connect with colleagues throughout IH and share ideas and innovative changes that are happening," says Dr. Sarah Broder, Senior Medical Director, Palliative and End of Life Care and Clinical Associate Professor, UBC.

Given the need and desire for medical staff to connect on a regular basis, the Grand Rounds were refreshed and reborn into The X-Change: A Series of Rounds to Drive Change.

“The X-Change is a series of rounds that go beyond traditional Grand Rounds to further engage and drive change in health care,” explains Dr. Hundal. “Starting with ‘why’ and opening up the ‘what’ and the ‘how,’ we explore opportunities to change how we provide care by looking at ideas and concepts that will hopefully drive change and that are important in terms of how we develop as a resilient and sustainable health system.

“The Grand Rounds, and now The X-Change, takes us out of our usual way of providing care and offering an opportunity for physicians to share what they are passionate about and the benefits to themselves and their practice.”

Building connection, driving change

IH Grand Rounds and X-Change Presented to Date

March 12 Review of Severe Acute Respiratory Syndrome Coronavirus 2 and Coronavirus 2019 Disease

March 24 Telehealth Today

April 2 Prognosis and Palliative Care in COVID-19

April 7 Update on COVID-19

April 28 Post-Acute COVID-19 Recovery and Rehabilitation

April 30 IH COVID-19 Response in Long Term Care

May 19 Psychopharmacology and Magnets in the age of COVID-19

May 26 Navigating COVID-19: Considerations, Assistance and Resources

June 16 Alcohol Use Disorder (AUD) - New Name, New Standard of Care, Dramatically Better Outcomes

June 23 Surgical Reactivation Plan: IH & KB

Sept. 22 Medical Assistance in Dying 2020 Update

Oct. 20 Physician Stress, Illness and Impairment – Enhancing Resilience

Nov. 17 Crisis Inspired Creativity & Collaboration in Healthcare Redesign

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Page 8 | November 2020

All COVID-19 Grand Rounds are posted on the COVID-19 Hub for anyone who would like to listen and watch. You can also see the latest X-Change presentations on The X-Change playlist on YouTube. The next X-Change on Dec. 15 is Aboriginal Health: Physicians Journey Towards Cultural Humility, presented by Dr. Sean Wachtel, Senior Medical Director, Aboriginal Health. Register here. Further work to engage and connect with physicians during the pandemic occurred through Project ECHO® (Extension for Community Health Outcomes) – a Canadian Red Cross and Interior Health funded education program to help primary care providers manage chronic and complex diseases. Visit the ECHO® web page online for more information about upcoming sessions.

cont’d …

Resources for Physician Health & Wellness

Asking for Help is a Sign of Strength

The Physician Health Program provides personal or family help and support, including: dealing with incidents of violence, psychological health and wellness, relationship challenges, substance use, career transitions, financial

concerns, burnout, and other occupational health questions. This is a confidential program accessible on a 24/7 basis.

1-800-663-6729 www.physicianhealth.com

Preventing and Responding to Violence

The most important thing physicians can do to prevent or safely respond to a violent incident is to have a plan in place.

Learn more about the Interior Health process to report violence in the workplace. View and download the Doctors of BC Violence Prevention Guide, which outlines steps to put a plan in place.

A Practical Handbook for Physician Health and Wellbeing Throughout the handbook, each chapter acts as an introduction to issues that can and do affect all physicians at some

stage in their careers – and then provides practical information for understanding the issue.

View and download CanMEDS Physician Health Guide: A Practical Handbook for Physician Health and Well-being, developed in partnership with the Royal College of Physicians and Surgeons of Canada.

Dr. Harsh Hundal s leading the X-Change series to drive change in health care.

Reach out to Harsh directly with any questions or topic suggestions.

Page 9 | November 2020

This is the work of the community

There have been many instances over the past months when I’ve felt proud of our team at Kootenay Lake Hospital. The example that immediately springs to mind is getting the respiratory assessment clinic off the ground. This was a project that went from concept to reality in the span of about three weeks. Under ordinary circumstances a project of this scale and scope would likely have taken a year or more.

It was a success because all of the key players involved were willing to do whatever was required in order to get the job done. I was particularly impressed by upper levels of medical leadership at Interior Health. While often constrained by

bureaucracy and protocol, medical leadership were nimble, generous, and wholly supportive, fast-tracking conventional process in order to get our project off the ground in the timely manner required. We came out of the gates a little rough, but we continue to smooth the edges as we go, with support from Jackie Malcolm, Director of Clinical Operations, and her team of awesome nurses, plant services, local physicians, and the Kootenay Boundary Division of Family Practice. And while a lot of people are doing a great job during this crisis, I believe that the number of accolades that go out to physicians is probably disproportionate. In my view, so many people in the medical community and beyond deserve to be applauded. I don’t feel like I’m stepping up any more than anyone else is, whether the staff here at the clinic or the clerk at the grocery store across the street. Everyone is having to work in a different way for the greater good. The work is the work of the community, of respecting social distancing, and having to do things in different ways so we can continue to conform to the guidelines across all walks of life.

Submitted by Dr. Kevin McKechnie, Family Physician, Kootenay Lake Hospital, Nelson

“It was amazing to see that, at all levels, there was a

willingness and eagerness to help. This includes the people

that brought the idea forward and germinated it into a

practical plan, plant services that pulled out tools and

made it happen, and administration, which fast-tracked

and green-lighted decisions when needed.”

Dr. Kevin McKechnie

Page 10 | November 2020

Community engagement support response

to pandemic, community risks

March 2020 burst us into a pandemic unlike anything most of us have experienced in our lifetime. Around the world, big cities and small towns entered variations of lockdown as the battle against COVID-19 began. This included small towns in the Elk Valley in southeastern British Columbia, near the Alberta border: Elkford, Sparwood, Fernie, South Country, and Jaffray. Together, these towns are home to more than 12,000 residents and are serviced by the Elk Valley Hospital (EVH). At the time the global pandemic was declared, little was known about the virus. What was known with absolute certainty among medical staff at the hospital was that there was an urgent need to prepare and limited resources to do so. Preparing for a pandemic was one thing. Preparing for a pandemic when so many people travel to and from the region from other communities and provinces on a regular basis was quite another. Many of those travelling to and from the Elk Valley are employed by Teck, a diversified resource company headquartered in Vancouver. It’s also one of the largest employers in the Elk Valley, with more than 4,000 employees and many hundreds of contractors performing work each day at the company’s four steelmaking coal mining operations. The risk created by inter-community and inter-provincial travel was recognized early on by EVH’s Medical Staff Association (MSA), as was the need to work closely with Teck to mitigate or manage that risk. To help in this regard, a communications committee was establish to provide a regular flow of information and updates to address fears and concerns being voiced by residents and medical staff, particularly about employee bussing, the Elk Valley Lodge and the number of workers travelling to and from the region. Weekly meetings with Teck and Interior Health were also held and provided an important forum for open dialogue and real-time information on pandemic preparation, collaborative sharing of COVID-19 protocols and controls, and providing updates on COVID-19 case identification. These regular meetings also helped ensure consistent messaging, communications sharing, and key contacts were identified when cross-border issues arose. This engagement between Elk Valley medical staff, Interior Health, and industry partners has:

built trust that a key industry partner is taking appropriate steps to keep their staff and the community safe;

created an opportunity for dialogue around any concerns identified by patients and medical staff;

provided information for our medical staff to assist with patient care; and

established teamwork in contact tracing and cross boarder issues. Engaging and working with our industry partners is key to managing this pandemic as it continues through 2020. If you have questions or would like to learn more, contact Dr. Tara Chalmers-Nixon, Chair of the Elk Valley Hospital Medical Staff Association.

Submitted by the Elk Valley Hospital Medical Staff Association

Page 11 | November 2020

Innovative technology

supports increased need for virtual care

The COVID-19 pandemic has spurred the use of innovative technology to “check in” on people as they shelter at home and also keep people healthy in their communities. Interior Health has capitalized on such innovations in a new partnership with Curatio Networks Inc., a digital technology company spearheading a project that combines remote monitoring technology with a private social network to keep outpatients healthy and supported at home. This private social network platform, Stronger Together, provides content about specific health conditions and can be tailored to support a variety of health challenges, including chronic diseases, rare conditions, lifestyle issues or neurological disorders. Patients download the app to their smartphone giving health providers a tool to remotely connect with their patients. Dr. Michelle Scheepers, Anesthesiologist at Penticton Regional Hospital and Physician Advisor for Interior Health’s Physician Quality Improvement (PQI) Initiative, has been leading the use of this technology as a pilot project for Interior Health. Starting with roughly 20 to 25 hip and knee replacement surgeries, Dr. Scheepers is using this new virtual technology to guide patients through their surgical journey and support them in achieving pre-op goals advised by their physician, such as weight loss, smoking cessation or blood pressure management. The pilot program will support IH’s ongoing surgical optimization work, which includes the launch of an outpatient “surgical school” where patients met face-to-face in groups led by a nurse navigator and occupational therapist prior to the pandemic. “Surgery is a team sport – there are multiple players in preparing a patient and the patient needs to drive that process as well,” explains Dr. Scheepers. “Our optimization work has really looked at restructuring the process so that we’re able to get our patients on-boarded earlier with opportunities to improve their chronic disease co-morbidities that will be relevant and effective in improving their surgical outcomes.” Using Stronger Together to support virtual pre-surgical optimization, the project partners are now building a

leading-edge social prescribing platform that Dr. Scheepers expects will live on once COVID-19 restrictions are lifted. The patient-centred online tool is being co-designed with input from a patient advisory board and focus groups, and, in addition to peer support and teaching, will offer “nudges” to change behaviour along with tools for self-monitoring. At the same time, it will provide a safe, online platform for sharing between hip and knee surgical candidates in the region and will eventually include post-operative monitoring as well. “Within medicine, we’re finding that social determinants of health really have a significant impact,” says Dr. Devin Harris, IH Executive Medical Director, Quality and Patient Safety. “Having a social prescribing platform, meaning a community that’s curated to be able to assist with navigation for something like surgery, is where we can have a lot of impact from a quality and safety lens.” In addition to improved patient and family satisfaction, reduced length of stay, and reduced risk of infection, social prescribing also increases satisfaction among surgeons and anaesthesiologists who “see their patients show up healthy and well, and mentally prepared,” he added. At Interior Health, Drs. Harris and Scheepers also see endless opportunities for remote technology moving forward, such as vitals monitoring of COVID-19 patients as they isolate at home. The technology could serve as a home check-in and patients would only be sent to hospital when symptoms escalate, keeping hospital resources at a sustainable level. “I think the last few months have changed the way we do and offer medicine,” says Dr. Scheepers. “We’ve been able to see that remote care can be done safely and appropriately. How can we build from here?”

Dr. Michelle Scheepers

Story credited to Curatio Networks Inc.

Page 12 | November 2020

Everyone jumped in How Vernon Jubilee reinvented itself to fight COVID-19

In hours, and then in minutes, everything changed. Over and over and on the greatest scale the Vernon Jubilee Hospital had ever experienced. Every step anyone took – literal and figurative – had to be understood, reimagined, and simulated. It began with a warning of an atypical pneumonia spreading rapidly. Then the news hit that a novel coronavirus, referred to as COVID-19, could be on its way, and the hospital needed to get ready along with the rest of Interior Health. Now! At a high level, Interior Health created an Infectious Disease Emergency Response Steering Committee and an Emergency Operations Centre. As the impact of COVID-19 evolved, a formal Incident Command was established in March. Divided by region, the North Okanagan Incident Command assumed responsibility for all clinical services throughout Vernon, Salmon Arm, and Revelstoke. “One of the most pressing questions our teams faced was this: How do we create the capacity in the hospital to enable us to manage a surge of respiratory and critically ill patients, while ensuring we still have the capability to provide care to the regular population?,” says Richard Harding, Executive Director – North Okanagan Acute. “We still had people coming to the hospital with trauma or other life threatening health-care events that were requiring emergency care. At the same time, we needed to ensure we were meeting the emerging – and evolving – infection prevention and control standards.” The Emergency Department layout had to be addressed immediately. Since emergency patients typically all wait in one area, staff had to turn patient flow upside down and divide the department, more than once, into zones, each with their own workflow and staff. Sarah Kohlman, ER Clinical Operations Manager, says ER staff met all challenges head-on. “I always knew they were great with change, it’s the nature of the job here. They’ve been great with supporting the changes while supporting education and each other. What helps is that it hasn’t been just one department or one group. Everyone is in it together, and everyone has similar challenges.” The Level 7 Acute Medical in-patient unit became the respiratory isolation floor, ready to accept suspected and confirmed COVID-19 patients and meet containment measures. Within hours, Level 7 completely overhauled every way of existence

staff had known: workflow and processes were quickly adapted, and patients were either discharged or placed in other areas. Fortunately, with the addition of Polson Tower and its state-of-the-art equipment, negative pressure rooms were readily available to support infection control practices. “There were plenty of questions, but when it came to asking everyone to be there and show up, they came together and did what they needed to do. I think one of the most humbling things I saw, when the chips were down, was just how everyone jumped in and how willing they were to work together,” describes Jenna Dietz, Clinical Operations Manager, Inpatient Level 7. In those early hours and days especially, all staff showed great resilience and bravery as they overcame inner worries: Will I get infected? Will I infect my loved ones? Protecting staff was no small feat. While lead technicians managed the Medical Device Reprocessing (MDR) department, which ensures sterility of surgical instruments, supplies and equipment, MDR Supervisor Shona O’Connor stepped out of her regular role to help Purchasing Clerk Jody Thiem with Personal Protective Equipment (PPE) distribution, including restricting stock to a 24-hour supply. "With the support of Administration, the team quickly established a supply hub for PPE. Thanks to our relationships with all the units at the hospital, we were well positioned to preserve our PPE supply. Staff knew if they needed something, they’d be taken care of in the best way possible,” says Shona. Areas at higher risk of spread were stripped of all products that could become contaminated by aerosol generated droplets, all cupboards were emptied, anesthesia resources were scaled back to a minimum, and all paper was removed. Throughout this period, two operating theatres remained open for emergency and urgent surgeries and trauma services. Day surgeries were cancelled while 65 per cent of elective surgeries were postponed. To stay open, operating theatres had to adjust every step in a new environment of negative air. “Every 18 minutes, 99 per cent of the air was exchanged in the operating rooms, so the surgeons had to wait until the air generating process was over to enter the room and begin their positioning for surgery,” explains Chad Rideout, Peri-operative Services Clinical Operations Manager. “Surgical scheduling, as to when staff entered and left the operating room, became based on the air exchange cycles in

Submitted by Vernon Jubilee Hospital Physician Society, adapted from Vernon Jubilee Hospital Foundation newsletter

Read more on Page 15 ...

Page 13 | November 2020

the OR, and not just when the surgeon was ready to begin or when the patients were awake. It involved science-based mathematical calculations of air exchanges.” Chad adds that these steps significantly increased the duration of each surgery, but did not negatively impact patient outcomes. When the provincial order was issued to suspend all routine and elective cases, including X-ray exams for orthopedic patients, this had a significant impact on VJH’s Ortho clinic as it’s typically open Monday to Friday. Surgeons and the entire Ortho team had to figure out how they were going to remove casts and staples and provide follow up X-rays to check on patients’ bone alignment and healing. Together with other departments, a creative solution was sought to relocate the Ortho clinic and the OR’s mini C-arm to Priest Valley Physiotherapy. As the mini C-arm deals with patients that have smaller body part injuries, a plan was made to send those with larger injuries to the Vernon Radiological Associates (VRA) clinic, while trauma injuries continued to be treated in the Emergency Department. “A process was set up for all three sites to accommodate patients’ needs,” explains Travis Thompson, Medical Imaging Professional Practice Lead. “Open-mindedness and willingness to find innovative solutions in an unprecedented time delivered great results. I am happy to have been a part of a group committed to work in an atmosphere of restrictions and change and to come up with new ideas on how to continue to provide service to patients.” In delivering this innovative change, it created an opportunity to create a separate Emergency Department, a minor treatment area for patients screened as non-COVID-19 suspected patients. This enhanced the flow of patients through emergency procedures. Up in the maternity ward, babies continued to come into the world and families were cared for.

“What changed were the processes,” says Leslie Murphy, Women’s and Children’s Health Services Manager. All patients were screened at the site entry doors, and a separate triage area was placed outside the department for mothers and support people. Ongoing simulations were conducted with OR team members, including anesthetists, physicians, educators and unit staff, to prepare in the event mom presented with COVID-19 and needed surgical intervention. “We worked very closely with OBs and pediatrics, and pulled in anesthetists and Dr. Bosma to look at the department layout on how we were going to put together a standard work process,” Leslie explains. Helping cancer patients safely access their treatment was another priority that had to be addressed, and quickly. With eight to 12 ambulatory oncology patients visiting the hospital pharmacy department to receive their oral and injectable cancer treatments every day, the pharmacy department minimized patients’ risk of exposure and promoted social distancing and self-isolation with a delivery service. “Pharmacy staff provided phone consults for our patients to ensure that the same level of care was maintained during the pandemic,” says Greg Egan, Pharmacy Manager. On the frontline, the “unsung heroes of the unsung heroes,” Support Services, including Housekeeping and Food Services, were essential in keeping work environments clean, safe, and operational. Cleaning staff went above-and-beyond to make sure all high-touch areas, from elevator buttons to hand railings, were thoroughly and continuously disinfected. “One of the best things the hospital did was to draw on Chris Crawford’s JOHSC experience as a Safety Advisor to help us navigate all the questions around staff safety,” says Jennifer Diemer, Support Services Manager. “He has been a huge asset and resource for Vernon Jubilee. Having peer-to-peer conversations with Chris’s knowledge and health and safety background made all the difference.” Looking back, change at this pace and scope could have only been successful with hospital leadership guiding proactive preparation as well as consistent responsiveness to staff needs. This time saw unprecedented site-wide levels of collaboration and teamwork from every single person, regardless of their role. “As our province continues its slow and steady reopening, VJH continues to adapt and change,” says Dr. Peter Bosma, VJH Chief of Staff. We will continue to be nimble, creative and be as prepared as we can to continue to help flatten the curve."

Page 14 | November 2020

Intubation video promotes tips to stay healthy

Out of Dr. Helmcken Memorial Hospital in Clearwater, Dr. John Soles and the team provided an intubation simulation video of how medical professionals are preparing for what could happen if they are required to care for COVID-19 patients. In the video, Dr. Soles says it is “up to you, and me, and all of us to prevent this from happening” and provides reassurance and a reminder to public and patients to follow recommended practices, stay safe, and stay home. The full video can be found on the Physicians of Clearwater Facebook page.

Dr. John Soles demonstrates simulation intubation for a COVID-19 patient.

The Canadian Medical Association is pleased to launch the Wellness Connection – a virtual space where physicians and medical learners can find a range of tools and resources for those looking for support, as well as those looking to support others. The Wellness Connection offers:

A “Gratitude Space” to share experiences and positive reflections.

Education and resources to help you set up a peer support group in your own community.

Virtual support groups such as “compassion rounds”, moderated group discussions, and facilitated formal peer support sessions.

Peer support is a way to help each other and navigate difficult challenges, such as the ongoing COVID-19 pandemic. Understanding what your colleagues are going through, relating it to your own experiences, and sharing coping strategies can provide insight and hope, while also supporting recovery. Join the Wellness Connection today!

Page 15 | November 2020

KGH Medical Staff Association

recognizes physicians

For the outstanding COVID-19 work done over the past few months by our physician colleagues at Kelowna General Hospital (KGH), appreciation and thanks to:

Dr. Amanda Wilmer, Discipline Lead for Medical Microbiology Before the first travel-related cases of the novel coronavirus were reported, Dr. Wilmer, discipline lead for medical microbiology, drafted testing and management algorithms for the emergency departments. Following countless trips to and consultation with the emergency department, intensive care, and the operating rooms, she spearheaded the development of donning and doffing documents to keep all staff safe. Read more.

Dr. Jared Baylis, Emergency Physician, Clinical Instructor, Med Ed Sim Lead, Medical Director of Simulation, UBC SMP In early March, with short notice, Dr. Baylis led multiple educational simulations to prepare the ED physicians and staff to deal with the complex nature of COVID-19 airway management, which was invaluable to prepare the ED for critically ill patients. He was also a critical member of the CARTeam providing simulation-based education to teach the airway protocols and cardiac arrest management. Read more.

Dr. Sarah Sunderland and Dr. Jennifer Whittingham, Department of Anesthesia Special thanks to Drs. Jennifer Whittingham and Sarah Sunderland for service above and beyond the call of duty during the COVID-19 crisis. The Department of Anesthesia was asked to urgently develop airway management and resuscitation protocols for potential COVID-19 patients. These two physicians immediately stepped forward. Countless hours were spend implementing and teaching staff. Much appreciated!

Dr. Vikas Chaubey, Infectious Disease & Critical Care Medicine Consultant Dr. Chaubey, an intensivist colleague, is one of the outstanding young medical leaders at KGH who really stepped up to help shepherd the intensive care unit team and the KGH patients that we all shared there, through the first phases of these unprecedented COVID-19 times. Read more.

Dr. Ngan Lyle, UBCO Student / Physician Dr. Lyle, a Master of Data Science student at UBC Okanagan, and medical doctor, was being summoned to return to work to support Interior Health’s COVID-19 response team while studying for an upcoming quiz. With the support of her professors, and her physician-husband, she returned to work full-time as an infectious disease doctor. Read more.

Dr. Jen Williams, Emergency Physician, Clinical Assistant Professor, UBC Department of Emergency Medicine Dr. Williams was the first ED physician to volunteer to help with preparations for COVID-19. She has a long history in promoting wellness to staff and residents and appreciated early on that the emotional toll of COVID-19 on the ED staff was going to be significant. Dr. Williams organized the multiple resources related to physician wellness into a manageable newsletter that she initially distributed to the ED group and was eventually distributed hospital-wide. Thank you for everything!

KGH Addiction Medicine Consult Team (AMCT) This team of addiction medicine specialists – Drs. Ewelina Zaremba, Leslie Lappalainen, Nicholas Baldwin, and Megan Hill – assess and provide evidence-based treatment for patients with substance use disorders at KGH. Despite being acutely short-handed as a service during the onset of COVID-19, the AMCT increased on-site physician hours during the unprecedented high volume of hospital presentations for substance use related issues. The team recognized early on in the pandemic that patients with substance use disorders would be inordinately affected by pandemic restrictions and social instability. Read more.

Dr. Aleks Tkach, Neurologist In early March, the IH Stroke Network was working on a ZOOM toolbox to improve access to neurological consultation for the four IH TIA / Minor Stroke clinics in Kamloops, Kelowna, Nelson, and Cranbrook. When the need materialized for the shift to a virtual platform for all but the most invasive assessments, Dr. Tkach worked to trial, educate, support, and refine this initial toolbox to become the IH-wide ZOOM platform for multiple physician disciplines so that patient access to physician care would not be compromised. Read more.

Submitted by the Kelowna General Hospital Medical Staff Association

Page 16 | November 2020

Are you getting reports meant for someone else?

There’s a fix for that!

Meditech functionality can apply a flag to similarly named physicians. New patient registrations or new order entries will prompt the user with a pop-up screen, ensuring they double check the name before updating the entry. If you are receiving reports intended for another physician, you can request this flag be added to your profile. Email MeditechProviderRequests@interiorhealth.ca to make this request. Include your name, Meditech mnemonic, and the names of similarly named physicians of whom you are receiving reports. Flags will be applied to all names.

“Similar Names” Alert available in Meditech

Dr. Barker, Joe Dr. Barker, Jane

Information sharing agreements have been added to Cactus, which enables Medical Staff Associations to better communicate to physicians about local activities, events, opportunities, and initiatives. Interior Health medical administrative assistants are now able to download contact lists (name and email only) of physicians who have agreed to the sharing agreement from Cactus and share these with the Medical Staff Associations and Physician Societies across IH acute care facilities. Only physicians who agree to the sharing agreement in the Cactus release will be included in these contact lists, so please be sure to make this selection. The sharing agreement is included in the privilege reappointment package and confirming your agreement is easy! Simply check the box that YOU DO consent to sharing your contact information (see below). If you have previously declined this option and would like to change your selection, please contact your IH Credentialer directly or email MedicalStaffCredentialing@interiorhealth.ca.

Get connected with Facility Engagement

Page 17 | November 2020

Making a difference: UBC medical students

support patients in self-isolation

Physicians at Kelowna General Hospital, together with UBC emergency medicine residents and Southern Medical Program students, have come together to develop a phone follow-up service for self-isolating patients. In the early days of the COVID-19 outbreak, testing in the emergency department at Kelowna General Hospital (KGH) was primarily reserved for those patients needing hospitalization to treat their disease. Patients diagnosed with mild-disease symptoms were instead directed to self-isolate at home for a minimum of ten days without being tested.

It was a knowledge gap that Dr. Tony Kwan, a KGH emergency physician and UBC clinical instructor, looked to fill with the support of Southern Medical Program (SMP) student volunteers from UBC Okanagan. “We needed to eliminate confusion and ensure our patients could effectively manage their symptoms and limit the further spread of COVID-19 in the community,” explains Dr. Kwan. He enlisted the help of UBC emergency medicine residents and a group of SMP students to operationalize a phone follow-up service for self-isolating patients. “Self-isolation is a new concept for most members of our community and we wanted to support patients in understanding the importance and guidelines,” says Dr. Kerry Spearing, a UBC emergency medicine resident. “We also wanted to identify common barriers preventing patients from self-isolating effectively, and develop solutions to assist patients in navigating those barriers.”

By far, the two biggest concerns for patients were how to obtain groceries and prescriptions without leaving the home. These common challenges led the team to compile a self-isolation handout including a detailed list of grocery stores and pharmacies willing to deliver within the community. Over the past two months, SMP student Kyla Freeman has been one of the volunteers checking on patients by phone. They review self-isolation protocols, share community resources, and field non-medically related questions. Patients are contacted within the first 48 hours of discharge and again five to seven days later. “Hearing patient stories about the virus impact and barriers to self-isolation has been an eye-opening experience,” says Freeman. “Patients can find it incredibly challenging to self-isolate, especially when trying to minimize transmission to their household contacts.” In addition to the KGH Emergency Department, the phone service has grown to include self-isolating patients seen at the Urgent Primary Care Centre in Kelowna. Dr. Kwan and the team have also connected with colleagues in the Lower Mainland to share the model and best practices. “I’m definitely grateful to be able to support patients in some way to help make a difference,” says Kyla. “It’s a challenging time for everyone, and we’re hopefully able to make their lives a little bit easier.”

Submitted by Southern Medical Program, UBC Okanagan

As COVID-19 treatments and testing protocols

continued to evolve, discharged patients weren’t

necessarily getting the most up-to-date information

on how to effectively self-isolate.

Page 18 | November 2020

Health-care innovation in the age of COVID-19

Here are some learnings from the Medicine & Quality in spring 2020, at the onset of the COVID-19 pandemic.

Page 19 | November 2020

Random Acts of Appreciation and Recognition

Recognition is an important part of everyone’s employee experience. Increasing morale at work helps create a more welcoming workplace and improves connection between colleagues. Random Acts of Appreciation and Recognition – RAAR – is a fast, easy, and instant way to recognize a co-worker and spread appreciation in the workplace. Every person matters at Interior Health and you’re encouraged to RAAR someone – it could be for pitching in to help out, for providing great care or customer service, or for just done a little something extra to make your day. Simply go to the RAAR web page on InsideNet, fill out the RAAR form, and the person you select will receive a notification of your message. Check out the RAAR How-To Guide for step by-step instructions. Don’t delay, RAAR someone today! Here’s a few RAARs from, and for, medical staff that have already been shared ...

Compassionate end-of-life-care

From Dr. Shauna Tsuchiya to Jo Babcok Thank you for your compassion and the care you showed to our patient and their family during

their end of life. You advocated for the patient and ensured a patient-centred plan for care was in place. Thank you!

Urgent Primary Care Centre in Kelowna steps up

From Dr. Silvina Mema to Deb Preston and Melissa Roe I would like to recognize the work of the staff, nurses, and physicians at the Kelowna UPCC.

I don't know all of your names so I am naming those from whom I get updates. Over the past week, the UPCC has answered thousands of calls and done hundreds of tests to find cases

of the Kelowna cluster. Your hard work meeting the demand of the public is excellent and deserves recognition. Keep it up, you are making a difference!

Superior support for leadership

From Amanda Anderson to Drs. Sue Pollock and Silvina Mema Special thanks for your support, guidance, compassion, understanding, and direction throughout this pandemic.

You have shown exceptional leadership in difficult times and I want to acknowledge all the hard work you have been doing during and after business hours.

Kind and approachable

From Dr. Tarinder Grewal to Dr. Niall Davidson Dr. Davidson is always helpful, kind, and approachable. He has often provided medical advice

outside of formally being on call. He always shares his knowledge and provides useful insight. He understands the difficulties a physician may face in a rural setting.

Page 20 | November 2020

IH Executive & Senior Medical Leadership

Dr. Mike Ertel, Vice President, Medicine and Quality 250-469-7070 ext.12806

Dr. Zoe Ayling, Senior Medical Director, Credentialing & Privileging 250-488-8720

Dr. Nick Balfour, Executive Medical Director, IH South 250-470-8938

Dr. Sarah Broder, Senior Medical Director, Palliative & End of Life Care 250-809-7973

Dr. Curtis Bell, Executive Medical Director, Primary & Community Care 250-718-6950

Dr. Nattana Dixon-Warren, Senior Medical Director, Kootenay Boundary 250-469-7070 ext. 12208

Dr. Glenn Fedor, Senior Medical Director, Thompson Cariboo 250-398-0777

Dr. Devin Harris, Executive Medical Director, Quality & Patient Safety 778-214-4833

Dr. Harsh Hundal, Executive Medical Director, Physician Engagement & Resource Planning 250-868-5200 ext. 70679

Dr. Sue MacDonald, Executive Medical Director, Aboriginal Health, Physician Leadership, & KB 250-469-7070 ext.12208

Dr. Andrew Sellars, Senior Medical Director, North Okanagan 250-833-3600 ext. 34825

Dr. Douglas Smith, Executive Medical Director, IH North 778-214-4657

Dr. Sean Wachtel, Senior Medical Director, Aboriginal Health 250-469-7070 ext. 12209

The Virtual Care Team, once known as the Telehealth Team, is here to support the integration of virtual care into your practice. Check out the standardized process in the Virtual Care Toolkit. Contact us today: 1-855-870-4755 VirtualCare@interiorhealth.ca

2,700

March 15 - Sept. 15, 2020

28,000 Zoom clinical appointments

800

Telehealth Site based appointments

Providers set up with Zoom

We’re here to help!