There is no question that research is

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1 Information for physicians practising at FraserHealth March / April 2009 Can a mobile falls prevention clinic reduce the risk of falls? Dr. Sonia Singh is about to find out the answer to that question. There is no question that research is crucial to fi nding cures and improving the health and wellbeing of a society. But if not put into practical application, it often doesn t benefi t those who were the subject of the research. Dr. Sonia Singh and her team of coinvestigators from the Fraser Health Falls and Fracture Prevention Research team, Dr. Fabio Feldman, Kathleen Friesen, and Dr. Vicky Scott are hoping to make sure that doesn t happen with the new research project. The team was recently awarded a $200,000 grant over three years from CIHR* to determine if a mobile falls prevention clinic traveling to seniors in their own community would improve access to falls prevention services and prevent falls and falls-related injuries from occurring. An estimated 30 per cent of individuals over 65 years of age living in the community fall at least once each year. Injuries include fractures, head concussions, bruises, and lacerations, notes Singh. Not surprisingly, people often develop a fear of falling which then leads to restricted activity, increased dependency on others and a decrease in social interaction. The injuries associated with falls in the elderly account for over $1.0 billion in annual health care costs in Canada. Falls prevention initiatives aim to reduce the frequency and risk of falls and fall-related injuries with programs targeted to seniors 65 years and older. The new research study will compare the effectiveness and cost effectiveness of two models of fall prevention intervention a mobile, interdisciplinary and individualized intervention fall prevention program provided through the Falls Prevention Mobile Clinic, and a generic falls prevention education program. The aim is to determine the best model for falls prevention in terms of cost and effi cacy. *CIHR (Canadian Institute of Health Research) is the largest research granting agency for health care research in Canada. s Table of Contents n Dr. Sonia Singh awarded $200,000 Research Grant n Update: Higher Level of Care/Life, Limb, Threatened Organ Policy... 2 n Hidden epidemic seniors addiction... 2 Appointments... 3 Two new Medical Directors appointed (Peace Arch and Delta Hospitals) New Physician Executive Lead for Primary Care Development New Hematologist at Royal Columbian Hospital n Update on Primary Care... 4 n Three new stroke prevention/tia Clinics open... 4 n Physicians discuss program management... 5 n Accessing rehab programs for your patients... 5 n HIV Education... 6 Conference Section... 6 The Impact of Genomics in the Clinic Valuing Care in Primary Care n PACS (Picture Archiving and Communication System)... 7 Dr. Sonia Singh s research work is supported by: A Clinician Based Clinical Investigator award through UBC department of Family Practice. This salary award is 80% funded by the Vancouver Foundation with a 20% matching contribution from Fraser Health as community sponsor. Without this award, Dr. Singh would not be able conduct any research, as none of the research grants provide salary support for the primary investigators. 1

2 Higher Level of Care/Life, Limb, Threatened Organ Policy REPORT BACK ON NEW POLICY Fraser Health rolled out a new policy last October to ensure that patient transfer to a higher level of care occurs in a timeframe that is clinically acceptable and to the most appropriate hospital. The new policy is being monitored closely and performance indicators show that it is working well thanks to the support from staff and physicians. Some performance indicators: Life Limb & Threatened Organ Transfers (Priority 1): Patients that require immediate transfer within two hours to a tertiary site For all Life Limb and Threatened Organ Priority 1 transfers, Fraser Health is meeting this target > 90% of the time Higher level of Care (Priority 1 & 2): Patients that require transfer within eight hours to a hospital that provides a higher level of care For all Higher Level of Care Priority 1 & 2 transfers Fraser Health is meeting this target 90% of the time No Refusal (Priority 1 & 2): Patients that require transfer within eight hours from Delta, Eagle Ridge, Mission Memorial, and Fraser Canyon Hospitals. For all No Refusal Priority 1 & 2 transfers Fraser Health is meeting this target 90% of the time What s new? Renal Support now added 24/7 at Abbotsford Regional Hospital Abbotsford Regional Hospital was only able to provide dialysis support during the day while they trained staff to full scope. Often referred to as the hidden epidemic, seniors addiction is expected to rise substantially in the coming years. Addiction in older adults can be diffi cult for physicians to diagnose for several reasons, says Crystal Allinott, older adult addictions outreach therapist with Fraser Health. One reason is that older patients often present well at the medical clinic and generally report other concerns like depression, grief, chronic pain, loneliness, insomnia, and loss of meaning and purpose. Another is that seniors typically They are now ready to provide 24/7 renal support, which will alleviate some of the pressure felt by the Royal Columbian and Surrey Memorial Hospitals. This provides a more coordinated and effi cient use of the existing resources in our network while we work together to meet the needs of our rapidly growing communities. How you can help: Continue to follow the guidelines set out in the new policy. We want to thank our physicians and our staff for making every effort to adhere to this new policy. Given the congestion in our hospitals we do understand it has its challenges; but this policy is one of many initiatives happening across our networks of care to help us achieve our goal of providing the best level of care possible. Reminder to all Physicians: The Hidden Epidemic seniors addiction misuse alcohol, prescription and over the counter medications rather than street drugs (which present with more obvious symptoms), although this is changing with the boomer generation. Several years ago Columbia University did a study that included testing 400 physicians with a hypothetical case study of an elderly alcoholic. Less than 1% of the physicians were able to identify the problem. Problematic use can considerably constrict a person s quality of life, and lead to depression, suicide, hip fractures, heart, The HLC/LLTO policy is supported by a physician on-call 24/7. If you have diffi culties accessing Higher Level of Care for your patient please contact the on-call physician through the Access coordinator. Please see fhpolicies/pages/llto.aspx. For a copy of the Policy (and Algorithm), Q&A, Higher Level of Care Escalation Algorithm, and Revised Repatriation Policy. If you have any questions regarding the policy, please Dr. Roy Morton at roy.morton@fraserhealth.ca and/or Leanne Heppell at AskLeanne@fraserhealth.ca. s kidney, and liver disease as well as brain damage. Most physicians are aware of AA which is helpful for a small percentage of clients but, because patients and their addictions are complex, more is needed. Professional treatment is tailored for the individual patient. For referral and consultation contact Crystal Allinott (MSW), older adult addictions outreach therapist or Dr. Reyes-Smith, Addictionologist s Doctors in the Know - March / April

3 APPOINTMENTS Two new Medical Directors appointed Announcement from Dr. Urbain Ip, Interim Executive Medical Director, Operations Delta Hospital Daniel Rubin, MD DABEM accepted the position of Medical Director for Delta Hospital effective February 2nd. Dr. Rubin has been an Emergency Room (ER) Physician with Delta Hospital since He has also been an ER Physician with Surrey Memorial Hospital since 1996, and as a locum for Mount St. Joseph Hospital since 2003, as well as doing locum ER work at Richmond and Peace Arch Hospitals. I would like to thank Dr. Jean Segal for all that he has done since taking on the position of Medical Director on May 1, Dr. Segal has been a strong advocate for the hospital and the community, working tirelessly to improve patient care. Dr. Segal will still provide surgical services at Delta Hospital, and continue with his private practice in the community. s Peace Arch Hospital Anne Clarke, MD, FRCPC accepted the position of Medical Director for Peace Arch Hospital effective February 2, Since 2006, Dr. Clarke has been the Director of Emergency Medicine in Hornsby Ku-ring-gai Hospital (a teaching hospital for the University of Sydney in Australia) while completing her Masters in Health Administration. Prior to leaving Canada, Dr. Clarke was the Clinical Director of the Emergency Medicine Program for Surrey Memorial Hospital, as well as the Medical Advisor to BC Bedline for Fraser Health. She also served as the Interim Chief of Internal Medicine at Langley Memorial Hospital from 2001 to I would like to thank Dr. Brenda Hefford for her contributions in her role as Medical Director of Peace Arch Hospital since November During this time she demonstrated a collaborative leadership style forming strong relationships with Administration, Clinical and Regional partners. s New Physician Executive Lead for Primary Care Development Dr. Brenda Hefford, a White Rock-South Surrey-based GP and the former Medical Director of Peace Arch Hospital, is the new Physician Executive Lead for Primary Care Development. In the fi rst role of its kind in Fraser Health, Dr. Hefford will liaise with GPs, community partners, and regional and provincial leads on a number of existing and emerging Primary Health Care initiatives. Her work will initially concentrate on supporting the newly-formed Divisions of Family Practice in White-Rock / South Surrey and Abbotsford. It is anticipated that an additional two Divisions will be announced shortly. Dr. Hefford s work will also support the continued implementation and expansion of the iconnect Health Network (integrated health network) and promoting further integration of existing Fraser Health programs. s See page 4, Update on Primary Care New Hematologist at Royal Columbian Hospital Dr. Maggie Constantine was welcomed as the new Hematologist to the Medical Staff at Royal Columbian Hospital. Constantine began her new role on Monday, March 9, Her schedule is as follows: Out-Patient Consults Tuesday and Thursday mornings In-Patient Consults Tuesday and Thursday afternoons Wednesdays All Day Location Medical Day Care Dr. Constantine may be reached on her pager for Urgent consults. Non- Urgent consults may be faxed to Dr. Roy Morton, Executive Medical Director, Royal Columbian Hospital Dr. Ken Atkinson, Department Head of Medicine s Doctors in the Know - March / April

4 Update on Primary Care What s happening in Primary Care? Over the past 24 months, a number of Primary Care initiatives, collaboratives and partnerships have gained momentum to provide more comprehensive support for GPs and their patients. Dr. Brenda Hefford, a White Rock-South Surrey-based GP and former Medical Director of Peace Arch Hospital, has agreed to take on the position of Physician Executive Lead for Primary Care Development to help support these activities. In this role - the fi rst of its kind in the Fraser Health region - Dr. Hefford will liaise with GPs, community partners, and regional and provincial leads. Meanwhile, Laurie Gould, Primary Care s long-time champion is moving on to lead the new integrated Children s Hospital and Women s Health Centre in Western Ontario. Taking her place as interim Executive Director is Colleen Hart, who has led many successful community-based health care initiatives. Divisions of Family Practice Where: Abbotsford and White Rock/South Surrey When: 2009 ongoing, with expansion to other communities This is a formal infrastructure for GPs with annual operational costs funded by GPSC*, which provides a framework for doctors who wish to work together to discuss common issues, promote and support family practice, and address gaps in patient care; in partnership with the Ministry of Health Services, GPSC, BCMA and FHA. Approximately 10 Divisions will be established across the province by end of The iconnect Health Network (Integrated Health Network) Where: White Rock/South Surrey, Surrey and New Westminster When: 2008 ongoing This community-based network continues to grow to support the care of patients with complex chronic conditions. Primary care providers and community partners are collaborating, sharing and coordinating care. As one of many delivery points in the network, multi-disciplinary iconnect Health Centres have opened providing integrated chronic care services, group education and care coordination. Integrated Health Teams in Enhanced Family Practices Where: 25 Group Practices in the region When: 2006 ongoing GPs in group practices are seeing measurable improvements in the health status of patients with chronic conditions, and their adherence to CPGs, with the support of an electronic medical record and CDM-focused nurse. They are also reporting greater professional satisfaction. Patient as Partner Program Where: Across Fraser Health (and the province) When: 2009 ongoing This new focus on patient collaboration is designed to increase a patient s health literacy and confi dence as a participating partner in managing their own health. It includes GP education sessions that provide methods of enhancing collaboration with patients at the clinical level; and formal patient advisory roles that bring patients perspectives into the planning of health care services. Practice Support Program Where: Across Fraser Health (and the province) When: 2007 ongoing Physician-led sessions support GPs and MOAs with techniques to increase effi ciencies and enhance capacity, and build a more rewarding, fl exible family practice. Shared Comprehensive Care Plan Where: White Rock South Surrey, Surrey, New Westminster When: In Development A secure, web-based planning tool that follows a patient wherever they go in the system. All health care partners can contribute and access the same patient information and goals. *GPSC The General Practice Services Committee is a joint committee of the BC Ministry of Health, the BC Medical Association, and the Society of General Practitioners of BC. The General Practice Services Committee consists of tri-lateral representation from the Ministry of Health, the BC Medical Association and the Health Authorities. s Three New Stroke Prevention/TIA Clinics Open Approximately 1 in 20 patients diagnosed with a TIA (Transient Ischemic Attack) will have a stroke within the next 48 hours. Providing rapid access to preventative treatment at one of Fraser Health s three new Stroke Prevention Clinics may help reduce the risk of stroke, and save lives. One clinic has opened for each major region in Fraser Health: at Royal Columbian, Surrey Memorial, and Abbotsford Regional Hospitals. Patients with signs and symptoms of a TIA, who are being discharged home after assessment in an emergency department, can be referred to a clinic, regardless of where they live in the region. Referrals are made by the ER physician and unit clerk through Meditech to a central intake clerk. The goal is to see urgent referrals within 48 hours and all others within 72 hours. The clinics provide outpatient service staffed by a neurologist and nurse. The Stroke Prevention Clinics are the fi rst step of many to be taken by the Fraser Health Stroke Strategy team, who are working with the BC Ministry of Health and the Heart and Stroke Foundation to develop a comprehensive stroke care strategy across the province, and to coordinate and integrate protocols, activities and services in the region. More info: s Doctors in the Know - March / April

5 Physicians discuss program management Fraser Health is taking next steps in developing its program management framework. This framework is one foundational element of our imperative to create an integrated health system in which we can provide coordinated, high quality care and service. A multidisciplinary steering committee, chaired by Linda Revell, VP Clinical Integration, is guiding this initiative. Currently the Committee is seeking input and feedback from the clinical care and service leadership, support leadership and physicians across Fraser Health. More than 20 hosted conversations have been scheduled to discuss the key concepts. Early consultations and an open dialogue with our clinicians and leaders are key to success, says Linda Revell. We know how challenging it is for busy physicians to make time for discussions that help to shape the future of our organization. We highly appreciate the fact that so many physicians have signed up for the hosted conversations. Program management is not new to Fraser Health: Many patients, clients, residents and families across the region have already benefi tted from established programs, such as our End of Life Care and Mental Health and Addictions programs. In our complex organization one size will not fi t all. The emerging model will be guided by a set of principles and criteria aimed at improving the quality of care and services. Successful program management models require a strong and integrated clinical governance model. To further implement program management Fraser Health will need to re-orientate the clinical governance and leadership model as well. This work is intended to start this spring. Our commitment to transparency, open dialogue and timely physician engagement will apply to the clinical governance initiative as well, says Linda Revell. The Committee plans to complete the program management framework in April. Physicians who are unable to join a hosted conversation can still provide input until the end of March by contacting the Steering Committee via shirley.hoffman@ fraserhealth.ca. The key concepts on program management can be requested from Shirley as well. s Accessing rehab programs for your patients Rehabilitation is an integral and essential component of the continuum of health care, reinforcing positive health behaviours, rebuilding lives and reintegrating individuals in the community. The Acute Care Capacity Initiative reports identifi ed rehabilitation as a priority need within Fraser Health. So, in 2006, the Rehabilitation Clinical Services Planning and Delivery (CSPD) team was created to ensure that our patients have access to high quality rehabilitation. The Rehab CSPD team has been actively planning and developing categories of rehab programs to meet a variety of patient needs. Some recent changes will help ensure patients are able to more readily access the right level of rehab programs, thereby ensuring better fl ow from acute, and improved patient outcomes. These changes include: Increase in the number of high intensity rehab beds from 20 to 39 across Fraser Health. High intensity Rehab beds at SMH and ERH now have a regional referral process, with both sites taking patients with high intensity rehabilitation needs (2-3 hours/day) from all FH sites. Patients with more moderate rehab requirements ( > 2 hours/ day) can also access Subacute beds at most sites within Fraser Health. Currently we have 185 Sub acute beds within Fraser Health. When determining which category of rehab programs your patients are suitable for, here is what you need to keep in mind: High Intensity Rehab programs provide acute rehabilitation for patients requiring intense interdisciplinary rehab treatment. These patients must be medically stable, able to participate in therapy and have an attainable rehabilitation goal. Generally they must require 2-3 hours therapy to regain functional independence, and need 2 or more therapies / day. The length of stay varies depending on diagnosis but is expected to be 3-8 weeks. These programs exist at Eagle Ridge Hospital and Surrey Memorial Hospital although all patients in Fraser Health have access. Subacute is a component of acute care for patients who have had an acute episode and experienced functional limitation as a result of their illness or injury. There patients require a moderate level of combined individual and group therapy (1-2 hours / day) and / or medical intervention/ teaching in order to achieve functional improvement before going home. The length of stay is intended to be shorter and be within 3-30 days. These programs are site specifi c and exist at most Fraser Health sites. s Doctors in the Know - March / April

6 HIV Education Session Medical Health Offi cer, Doctor Veronic Ouellette, led a HIV Education Session on January 22, 2009, at Ridge Meadows Hospital. Acute Care staff, Residential Care staff, Home Health and all Physicians were invited to attend. The presentation covered topics such as risk factors, post exposure prophylaxis and eligibility in consideration of the risk of the exposure, general complication in relation to initiation of common classes of ARV, diagnosis of HIV including the new point of care testing, consideration in following up HIV patient in primary care and associated treatment, life expectancy with new regimen as well as HIV primary care and HIV surveillance/ prevention/reportability. Educational Sessions Offered to Primary Care Providers and other Physicians Involved in the Care of HIV Positive Individuals Many patients with HIV need the care of a family physician across all areas of Fraser Health. In Fraser Health, an estimated 350 patients are eligible for highly active antiretroviral therapy Mavis Nordstrom, Critical Care CNE, RMH helped coordinate the HIV Education Session with Dr. Veronic Ouellette, MHO (pictured right) (HAART) but have not been able to receive it. Another 755 are currently receiving treatment outside of Fraser Health. For many it is because they have not been able to fi nd a physician to care for them in Fraser Health. Expending access to HAART signifi cantly improves not only the health of the patient, by increasing See HIV on page 7 Conferences BC Clinical Genomics Network (BCCGN) Annual Conference The Impact of Genomics in the Clinic Vancouver, April 20, 2009 The Impact of Genomics in the Clinic conference will be held at the Plaza 500 Hotel. Geared towards physicians, this one day event will reveal the impact genomics has in the clinic. Presentations will provide an overview of current technologies, each followed by examples of BC Clinicians who have improved patient diagnosis, treatment and care by using genomics to study a wide range of diseases. The keynote speaker, Ian Brown, will talk about his experiences as a father with a child who has a rare genetic disorder and his interactions with scientifi c researchers. Mr. Brown is a well-known feature writer for the Globe and Mail, and host for radio shows on CBC. Cost: no charge (limited seating), travel awards available. Register at or contact: Lesley Philips, Business Manager (604) x5980 lesleyp@interchange.ubc.ca Celebrate the launch of the UBC Centre for Relationship-Based Care Valuing Care in Primary Care Wednesday, March 25, :00 a.m. Keynote Speaker Barbara Starfield, Internationally-renowned physician, health services researcher, professor and author Primary Care and its Contribution to Health Systems and Health. There is compelling evidence that a strong health system orientation towards Primary Care positively affects patients, physicians and health care systems. Highlighting the case for patient-centeredness, Dr. Starfi eld will review how relationshipbased care over time ( longitudinality ) fi ts in to structures and processes of health services. New Lecture theatre St. Paul s Hospital Providence Level1, Room debra.hanberg@familymed.ubc.ca Learn more about the UBC Centre for Relationship-Based Care at: s Doctors in the Know - March / April

7 PACS (Picture Archiving and Communication System) Preliminary Reports (Exam Notes) in PACS All Medical Imaging exams (images and reports) can be viewed on PACS on any PC within Fraser Health. PACS web training is recommended. Training You can access an online training module from home, offi ce or within Fraser Health. Or you can arrange to have a PACS coordinator train you directly. To request access to the PACS training module or to arrange a personal training session, please fhapacsriscoordinators@fraserhealth.ca or call the Service Desk at Preliminary Reports In PACS, preliminary reports are referred to as Exam Notes. Exam notes can be entered by both Emergency Physicians and Radiologists but can be read by everyone who has access to PACS and/or Meditech. Did you know: Emergency Physician Exam Notes (preliminary reports) are available for: General x-rays on Emergency Patients Radiologist Exam Notes (preliminary reports) are available for: CT, MRI, US procedures on Emergency and In patients General x-rays on Emergency and in patients with signifi cant or unexpected fi ndings If the result of the exam requires urgent clinical intervention then the Radiologist will communicate directly with the Most Responsible Physician (MRP) or an appropriate representative. Exam notes should only be referred to when the transcribed report is not yet available. Exam notes are not in Meditech, but you can launch PACS from PCI or EMR to view them. As per Radiologists request please check for an Exam Note or transcribed report before calling the Medical Imaging for results. s HIV Continued from page 6 life expectancy substantially, but also likely improves the health of the whole community by decreasing transmission of HIV to others. Physicians have expressed they would benefi t from training and support in HIV care in order to care for those patients. In addition, about a third of those who have HIV are unaware of their diagnosis, representing an estimated 700 people in Fraser Health. Increasing identifi cation of HIV patients can help reduce transmission. Beginning January 2009, monthly educational sessions will be offered covering a broad range of topics accredited for Mainpro Credit M1. The Fraser Health HIV team offers primary care providers (Nurse Practitioners, General Practitioners, Family Physicians) and other physicians involved in the care of HIV positive individuals support for: 1. A continuing medical education program, 2. Opportunities to obtain phone consultations, 3. Joining a community of practice, and 4. Providing more support to physicians willing to care for HIV patients referred by Fraser Health HIV team. We can assist with clinical support, strategies to maximize attendance to appointment, adherence to treatment and with some community support to patients who most need it. For more information please visit and click on Continuing Medical Education for HIV Care for the list of sessions and dates on education sessions. s... is published by the Communications and Public Affairs Department of Fraser Health. If you have story ideas for future issues, please Kathleen Butler at: kathleen.butler@fraserhealth.ca Editor: Kathleen Butler Contributors: Jennifer Grover, Ute Kranefeld, Kyla Betker Design and production: Koch Ink Doctors in the Know - March / April