Annual Report 2020-21 - Caring through COVID

<p>Virtual care at KHSC was once rare, although just prior to the pandemic a successful pilot project tested virtual follow-up visits for stroke care. During the first wave of COVID-19 KHSC jumped to deploy the Reacts platform as a way to conduct&nbsp;urgent visits that did not need require an in-person visit.&nbsp;In their&nbsp;first month, video visits, in some cases, went from zero to 30 per cent. In 2020-2021, the number of health-care providers using virtual care increased to over 800, with almost 145,000 visits&nbsp;conducted by phone and 40,000 by video, giving patients access to appropriate care in the comfort of their homes.</p>

<p>As part of the government&rsquo;s COVID-19 preparedness plan, we&nbsp;opened a new inpatient surgical unit at our Hotel Dieu Hospital site and expanded the site&rsquo;s Extended Post-Anesthesia Care Unit. With more than 40 new surgical beds, KHSC was able to continue scheduled short-stay surgeries that may not have otherwise happened if bed availability had been curtailed. Along with improving patient access to surgical care, the extra beds helped KHSC to address a long-standing challenge of having the right number of beds at the right time to manage the increasing demand for acute inpatient care.</p>

<p>Faced with a potential surge in COVID-19 patients, we&nbsp;stood up a satellite site to serve as a relief valve for our two hospital sites and to support non-COVID, medically stable patients. Working with community partners over mere months, we retrofitted and equipped part of a decommissioned local hospital to create&nbsp;70 beds at the temporary Union Street site. It was an all-hands-on-deck effort that demanded a fast, agile response from more than a dozen patient care, planning and support teams. Together, they built a safety net of staffing, supplies and equipment that, ironically, they hoped circumstances would never force them to activate.</p>

<p>As COVID&rsquo;s third wave ran rampant, KHSC stepped up to accept critically ill COVID patients from elsewhere in the province who were very sick and mostly ventilated.&nbsp;While land and air transfers were not a new phenomenon, the scale this time was unprecedented. We&nbsp;bumped our&nbsp;ICU bed capacity from 65 to 95, while ramping down elective surgeries and less urgent care so staff could be redeployed and resources focused on the surge of patients. At the same time, we worked closely with our regional health care partners to transfer appropriate patients in order to free up capacity at KHSC to provide complex, acute and critical care.</p>

<p>During the third wave of the pandemic we focused on ensuring critical care beds and the staff to support them as severely ill patients were transferred to KHSC from elsewhere in the province. More than 200 staff were retrained and redeployed, including nurses, allied health professionals and administrative staff. Learners were on boarded for assistant roles in nursing, physiotherapy and occupational health, with an eye to the support and rehabilitation that recovering COVID patients would need before discharge. And physicians from all medical specialties worked around the clock, sometimes in care settings new to them, to provide care.</p>

<p>A son, a father and a husband, Lewellyn Allworth was transferred to our ICU from the Greater Toronto Area on a ventilator. While he doesn&rsquo;t remember much of his first few days at KHSC, he was left with a clear impression of how much the staff cared for him and other patients. &ldquo;The people here became my family,&rdquo; he says. &ldquo;They saved my life. It&rsquo;s the only place I&rsquo;ve ever seen this level of teamwork and camaraderie. Everyone seems like they love what they do and were all so kind to me. The Kingston community should be very proud of this hospital.&rdquo;</p>

<p>Temporary restrictions to family presence challenged our usual approach to patient and family-centred care and were a source of upset for patients, families and staff alike. Regular and robust consultation with patient and family advisors was key to helping us proactively adjust family presence. Finding alternatives to usual family presence was necessary, including linking patients, families and clinicians by phone to discuss treatment and launching a new Staying Connected program that made virtual visiting possible.&nbsp;In the pandemic environment, these strategies went a long way towards&nbsp;helping with&nbsp;collaborative decision-making and participation in care.</p>

<p>Our Microbiology Lab played a critical role in regional testing. Since coding the COVID-19 test in record time in March 2020, the lab team has tested more than 200,000 samples from across southeastern Ontario &mdash; 40 times more than a typical year. Even with the massive workload, the lab was consistently a leader in turnaround times and was selected as one of the few genomic sequencing sites to identify and manage COVID-19 variants in the province. Even so, the testing has felt like business as usual.&nbsp; &ldquo;It&#39;s no different from running any high volume test,&rdquo; remarks&nbsp;Rebecca Kooi, a medical lab technologist. &ldquo;Every sample we run has a patient behind it, and the results have an impact on that person.&rdquo;</p>

<p>KHSC scrambled to open Kingston&rsquo;s first Assessment Centre (AC) in less than a week in March 2020.&nbsp; As the demand for testing grew, the Centre relocated three more times in the next year, always supported by strong community partners. It weathered heat waves, pop-up sites, long line-ups and outbreaks that could send swabs skyrocketing to 700 per day.&nbsp;In March 2021, the AC marked a one-year total of more than 80,000 tests. Every step of the way the AC team was committed to making the experience as positive as possible, going through thousands of lollipops, stickers and finger puppets to ease the stress for patients and families.</p>

<p>The first Pfizer-BioNTech COVID-19 vaccine dispenser in southeastern Ontario, KHSC worked in partnership with Public Health (PH) agencies in early 2021 to vaccinate about 1,700 health-care workers and essential caregivers in long-term care and high-risk retirement homes throughout the region. KHSC also supported the work of PH mobile vaccination teams to vaccinate the residents of care homes to decrease the risk of deadly COVID-19 outbreaks in those vulnerable settings.&nbsp;And by April 1, 2021, we had put the first dose of vaccine into the arms of almost 6000 KHSC employees.</p>

<p>When people picture a team of healthcare workers during a pandemic, it likely doesn&#39;t include electricians, carpenters and plumbers. But those teams were&nbsp;essential in keeping our sites safe and operational.&nbsp;Carpenter David De Sousa likens his team to one of many branches on a tree.&nbsp; &quot;Our roots provide a strong trunk, and all the people who work here are the branches. If you remove some branches the tree can suffer but together we thrive.&quot;&nbsp;Since March 2020, he has been churning out endless plexiglass barriers. &quot;Now people want to keep the screens year round,&rdquo; he says.&nbsp; &ldquo;If I had known, I would have started building them earlier!&quot;</p>

<p>Thanks to an incredibly strong Decision Support team, we hit the ground running in the early days of the pandemic to produce the situation dashboards needed to track beds, staff, ventilators and personal protective equipment (PPE).&nbsp;Decision Support boosted its efficiency in mining new data pipelines and building automatic processes for pulling that data. The dashboards &mdash; along with others created, for example, to manage allocation of surgical cases or to&nbsp;&nbsp;identify patients by &ldquo;hot&rdquo; Public Health Unit zones&nbsp;&mdash; were vital to decision-making about patient flow, PPE stewardship, infection control measures and more.</p>

<p>The job of tracking the infection status of admitted patients has never been more critical.&nbsp;COVID-19 prompted us&nbsp;to revamp our&nbsp;process for flagging patients who require infection control precautions, further streamlining and automating it to produce real-time electronic flagging&nbsp;when a patient requires precautions. The alert&nbsp;also&nbsp;aims to ensure that everyone on the patient care team &mdash; from physician&nbsp;to porter &mdash; can&nbsp;access a patient&rsquo;s infection status from doorway to discharge. Strengthening and expanding the&nbsp;flagging process only reinforces the fact that infection control is always a team effort at KHSC.</p>

<p>COVID-19 ushered in a new world of remote work at KHSC. Information Management (IM) launched remote access technologies almost overnight in March 2020 with a&nbsp;SWAT team swinging into action to handle up to 40 requests per day for remote work station set-ups. Now, about 700 employees have access to a seamless computer experience between work and home. At the same time, IM accelerated a planned roll-out of the Microsoft Teams virtual meeting tool.&nbsp;The remote work model has broadened our thinking about its potential as we look at decanting of staff and space for KHSC&rsquo;s upcoming Phase 2 Redevelopment Project.</p>

<p>Smart screening tools played a major role in keeping the virus at bay. For staff &mdash; who logged more than a million screenings in 2020 &mdash; the big logistical challenge was getting hundreds of people through screening quickly.&nbsp;The answer was a custom-built tool with an&nbsp;algorithm that instantly identified people who may be a risk.&nbsp;As the screening protocol changed, the software did likewise. To support more efficient flow for outpatients, we built a mobile pre-screening tool that let patients&nbsp;complete their screening prior to arriving at the hospital.&nbsp;With input from our patient advisors, the tool exemplified&nbsp;partnership and innovation at KHSC.</p>

<p>With family presence strictly limited, we needed a safe and seamless solution for documenting essential care partners for patients. On cue, our information and project management teams built, tested and launched a web-based tool that lets hospital staff register family members approved to visit or accompany a loved one.&nbsp;And the tool makes it easier to do contract tracing.&nbsp;We know how crucial care partners can be to loved ones in hospital, which made landing the visitor registration tool a priority. It creates the right balance between ensuring patient and family-centred care and protecting the safety of all those in our hospital.</p>

<p>Navigating the uncharted waters of COVID-19 called for a steady hand at the helm. That hand was Incident Command, a core group of&nbsp;leaders&nbsp;with the collective organizational expertise to ask &mdash; and answer &mdash; the right questions about safety, capacity, infection control, staffing, testing, supply chain and more.&nbsp; Over 14 months, it acted upon countless&nbsp;directives, dashboards and briefing notes to develop optimal solutions in real time. Always, it&nbsp;made transparency a priority:&nbsp;&ldquo;We created a discipline of telling people here is what we know and&nbsp;don&rsquo;t know.&nbsp;It was clear that we performed better when people had as much clarity as possible,&rdquo; says now-retired Incident Commander Troy Jones.</p>

<p>Our Infection Prevention &amp; Control (IPAC) team set a relentless pace in adapting and implementing rigorous protocols around PPE, precautions, contact tracing and infection tracking.&nbsp;In the middle of the pandemic, they implemented&nbsp;a custom software solution to complete whole-house infection surveillance; streamlined&nbsp;electronic flagging and documentation of a patient&rsquo;s infection status from doorway to discharge; created a new outbreak management toolkit; and developed a critical IPAC safety playbook. The team&rsquo;s unswerving&nbsp;leadership was absolutely key in managing risk, which was critical in minimizing anxiety for patients and staff alike.</p>

<p>As the science of COVID-19 rapidly evolved, our Occupational Health, Safety &amp; Wellness (OHSW) team was&nbsp;challenged every day to protect&nbsp;our workplace.&nbsp;Undaunted, they constantly revised safety guidelines; assessed masks, gloves, sanitizer and other personal protective equipment; fit tested 5,000 N95 respirators; reworked screening questions; conducted&nbsp;contact tracing and swabbing; and helped to prioritize health care workers for vaccine.&nbsp; &ldquo;And anxiety resulted in huge influxes of staff&nbsp;calls,&rdquo; says OHSW Leader Beth Spratt.&nbsp;&ldquo;We provided a lot of emotional support, conscious&nbsp;that staff&nbsp;were&nbsp;dealing with COVID-19 at home as well as in the workplace.&quot;</p>

<p>He has become one of the most sought-after and reassuring voices in the world of COVID-19.&nbsp;As KHSC medical director of infection prevention and control, Dr. Gerald Evans has spent the last year protecting patients and staff amidst a swirl of protocols and practices. He kept his balance by staying current with the fast and furious medical science of COVID-19: &ldquo;I worked really hard at keeping everyone calm and not being fearful of what seems scarily unknown.&rdquo;&nbsp;In the face of dire stats or projections, he stuck to what wins the day:&nbsp;evidence-based solutions, good teamwork and common sense.&nbsp;His biggest COVID takeaway?&nbsp; &ldquo;Never losing sight of all the good people and good work happening around me.&rdquo;</p>

<p>During the first wave of the pandemic, Herbert Rae became the first KHSC patient to be recruited to a national study to test the effectiveness of using technology to remotely monitor patients after surgery. Approximately 200 KHSC patients made up the 900 adults in Canada who participated in the study. Connecting regularly with surgical patients during the 30 days after they&rsquo;ve returned home, holds the possibility of helping patients seek needed medical treatments early and potentially reducing the number of hospital re-admissions.&nbsp;This research has developed into an important pilot project at KHSC to expand this type of virtual care to more surgical patients.</p>

<p>At just the right time, the&nbsp;Accelerated Remote Consultation Tele-POCUS in Cardiopulmonary Assessment (ARCTICA) research project&nbsp; is helping to provide life-saving tools and training in point-of-care ultrasound for physicians working in remote healthcare locations. &ldquo;Point of care ultrasound is a powerful tool for assessment in people who have shortness of breath,&rdquo; says KGHRI&nbsp;researcher Dr. Amer Johri. &ldquo;But while ultrasound is available even in remote areas of Canada, many physicians lack the opportunity to develop expertise in this potentially life-saving skill.&rdquo; The project uses&nbsp;real-time remotely supervised ultrasound consultations and education modules to provide training and support for cardiopulmonary assessments.</p>

<p>The COVID-19 pandemic is a societal stressor that has&nbsp;overwhelmingly increased the demand for mental health care.&nbsp;Dr.&nbsp;Nazanin Alavi, a psychiatrist at KHSC was among 13 recipients of Queen&rsquo;s University&rsquo;s Rapid Response funding competition supporting COVID-19 research. Through this research, nine weeks of online cognitive behavioural therapy (CBT) is offered to help people manage the burden and stress caused or increased by the pandemic. The CBT modules are focused on coping skills and resilience building, which have been shown to be effective in the treatment of mood and anxiety disorders, and ultimately improving quality of life.</p>

<p>KGHRI researcher Dr. Steven Brooks has teamed up with colleagues across the country to develop a new emergency department (ED) network that uses big data to improve patient care.&nbsp;The Canadian Emergency Department Rapid Response Network is a 51-site, pan-Canadian network of EDs building a registry of suspected and confirmed COVID-19 ED patients.&nbsp;By collecting detailed information about the patients, the network aims to better understand and test clinical processes, and monitor patient outcomes once they return home.&nbsp; The network is receiving in-kind support from partnering hospitals, as well as funding from the Canadian Institutes of Health Research and the Government of Ontario.</p>

<p>KGHRI researchers Drs. Anne Ellis, Stephen Vanner and Prameet Sheth received over $200,000 in federal funding to advance research that examines SARS-CoV-2 transmission and immunity among students and staff in clinical placements, with a goal of testing for SARS-CoV-2 and monitoring the seroprevalence of health professional students at Queen&rsquo;s University.&nbsp;The study is&nbsp;recruiting 500 asymptomatic students from the Faculty of Health Sciences who routinely interact with each other, the public and ambulatory and inpatient populations.&nbsp;Researchers test the students&nbsp;for active COVID-19 infection and virus antibodies. The results are expected to help shape pandemic management policies and procedures.</p>

<p>Our MIcrobiology Lab tested more than 200,000&nbsp;samples for COVID-19 over the last year.&nbsp;Typically, in previous years, we did about 5500 PCR tests annually.&nbsp; The pandemic boosted us to 40 times more or a 3,000 per cent increase.</p>

<p>Remote work setups are now more commonplace for KHSC employees. Every day, 830 people log onto&nbsp;Microsoft Teams. In the last 90 days alone there have been approximately&nbsp;20,000 meetings and 250,000 chat messages.</p>

<p>It takes a lot of hands to tackle a pandemic.&nbsp; To meet the challenge, we hired over&nbsp;900 new employees.&nbsp; And recruiting continues!</p>

<p>In a matter of months we worked with community partners to transform off-site decommissioned hospital space into the 70-bed Union Street site, an alternate health care facility ready to hand in the event of surging patient volumes due to COVID-19.</p>

<p>Our clinical engineering team deployed 400&nbsp;medical devices&nbsp;to support our temporary Union Street site, along with&nbsp;our main site COVID-19 unit, Intensive Care Unit and&nbsp;inpatient surgical expansion.</p>

<p>Everyone who enters our&nbsp;buildings must complete strict COVID-19 screening.&nbsp;There have been close to&nbsp;1.7&nbsp;million&nbsp;total electronic screening&nbsp;transactions including those for patients, visitors, caregivers and staff.</p>

<p>As the first distributor of the Pfizer-BioNTech vaccine in&nbsp;the South East, we set up a KHSC vaccination clinic to get&nbsp;thousands of doses of vaccine into the arms of health-care&nbsp;workers in long-term care and high-risk retirement homes,&nbsp;and in the community and hospitals. So far, we have administered over 25,000 doses.</p>

<p>Our Sprinkle Some Joy campaign has been a bright&nbsp;spot this year, as a grateful community said thank-you to KHSC staff through the donation of&nbsp;50,000 gifts&nbsp;including gift cards, meal vouchers, sweets and beverages.</p>

<p>We opened a new inpatient surgical unit at our HDH site, bringing 40 new surgical beds online so we could continue to perform scheduled surgeries, minimize further backlogs&nbsp;and also address a longtime challenge of having the right number of beds at the right time.</p>

<p>Our Community Assessment Centre team stood&nbsp;up four different locations over the year and has taken more than 115,000 test swabs, always bringing a warm smile, care and&nbsp;compassion to anxious members of our community.</p>