Photo courtesy of Julie Jocsak / St. Catharines Standard

Karen Floyd, Emergency Preparedness Coordinator, left, and Tracy Fattore, Regional Director of Risk Management, are working closely with NHS’s external partners to prepare the hospital’s pandemic plan.

A hospital needs to be ready for anything. Anytime. Anywhere.

Chemical spill, multi-vehicle accident, a fire in one of our buildings. Preparing for an emergency is critical to the safety and wellbeing of Niagara Health’s patients and staff.

So, too, is planning for a pandemic influenza outbreak to ensure the hospital is able to respond to a surge in demand for care while at the same time protect its workers from illness.

As we head into the fall, Niagara Health System is preparing for a pandemic as the second wave of the H1N1 flu virus is expected to hit in addition to the annual impacts of seasonal influenza.

“The whole premise for a pandemic is that you are dealing with thousands of patients,” says Tracy Fattore, Regional Director of Risk Management. “We have to be prepared for the surge of patients who will require care and ensure our staff members who care for these patients are protected from a health and safety point of view.”

Like other emergency preparedness planning, Niagara Health works closely with its healthcare partners to ensure its response to an influenza pandemic is properly coordinated across all government levels (local, provincial, federal) and with other emergency services (police, fire, ambulance).

Tracy also sits on the Ontario Hospital Association’s Health Emergency Preparedness Advisory Committee, which provides leadership to hospitals regarding emergency preparedness management and better system coordination in the healthcare system between government, hospitals and other providers.

“In the case of pandemic planning, the NHS works closely with our external partners at Niagara Region Public Health to ensure our plan dovetails with theirs, since Public Health will be taking the lead locally,” says Karen Floyd, Emergency Preparedness Coordinator with Niagara Health.

As the regional lead agency, Niagara Region Public Health will coordinate response activities in Niagara. The overall provincial response will be managed from the Provincial Emergency Operations Centre, along with the Ministry of Health and Long-Term Care’s Emergency Management Unit.

The NHS’s pandemic plan sets out roles and responsibilities of the hospital and its staff based on legislation applicable to emergency or disaster situations.

NHS is developing the hospital’s H1N1 plan based on the existing pandemic plan and regular updates provided by Niagara Region Public Health, Ontario Public Health Agency, the Ontario Health Plan for an Influenza Pandemic, the Canadian Pandemic Influenza Plan and the World Health Organization. This plan will continue to be a work in progress as new information comes to light about the new strain of H1N1.

New procedures for screening and personal protection, consistent with Ministry guidelines, were adopted by NHS earlier this year when the H1N1 flu virus was first introduced in April. These procedures continue to be assessed as part of the plan, along with other strategies for patient screening, triage and assessment in the Emergency Department. Also being studied is the impact the increased demand for care will have on the Intensive Care Unit, Diagnostic Imaging and Laboratory Services, patient care areas expected to feel the greatest impact of the surge in patient activity.

“In addition to ensuring the hospital is prepared to manage the surge in demand for care, NHS also has to take all possible steps to ensure our staff members are protected from illness,” says Frank Demizio, Vice President Patient Services responsible for Infection Control.

A vaccine is expected to be approved and available in late fall 2009, and all hospital employees who are in contact with patients will be considered a priority for immunization. Public Health and physicians’ offices will also be holding clinics to vaccinate members of the public.

The next wave of the pandemic is expected to last eight weeks, with the outbreak at its peak during the fourth, fifth and sixth weeks.

Niagara Region Public Health will be investing in a surveillance system that will link into the NHS’s Emergency Department registration system. Trigger points will alert health providers early on to signs related to the H1N1 virus that need to be investigated, such as a small but steady increase in patients with influenza-like illness.

Response to hospital care will be consistent with the increase in demand.

An increase in patient volumes of five to 10% will be considered a minor surge in demand for care, at which time the NHS’s Command Centre and pandemic plan would be put into operation. A moderate surge is considered when volumes increase by 11 to 15%; a major surge is a 16-20% increase, and a large-scale emergency would be declared if the increase in patient volumes reaches beyond 20%.

The primary challenge in a pandemic will be capacity across NHS sites to care for the increased volume of patients. At the height of a pandemic, non-life threatening hospital services could be curtailed, consolidated or suspended to divert resources – people, equipment, supplies and facilities – to essential services. Services deferred may include elective surgeries and outpatient clinics, and decisions would be overseen by a Decision Review Team made up of key medical leaders. These decisions would be based on a careful and compassionate assessment of patients’ conditions and any directives issues by the Provincial Emergency Operations Centre.

“A revised visiting policy would likely be implemented that is compassionate and flexible to meet the need for changing priorities while maintaining the overall safety of the patients, staff, physicians, visitors, volunteers and the general public,” says President and CEO Debbie Sevenpifer.

“We appreciate that families and visitors will be concerned about their loved ones and will want to visit, and the visiting policy will reflect that while protecting the health and safety of everyone,” she says. “As this policy is developed, it will be shared with the public as part of our extensive communications efforts that will be underway.”

At this stage in the planning, there are various opportunities available to the NHS’s 6,000 physicians, staff and volunteers through the source•net Intranet to review the plan and provide feedback. Education and training continues and will be offered using a variety of methods, including source•net, lunch-and-learn sessions and other strategies. The hand hygiene sessions being offered by the NHS and via public messaging provide a great means for staff and the public to understand their role in preventing the transmission of viruses, including H1N1. Good hand hygiene is the cornerstone to preventing the spread of influenza.

“We continue to work closely with Niagara Region Public Health, the Regional Infection Control Network, Ontario Hospital Association and our Infection Prevention and Control staff to monitor the situation closely,” says Frank. “We are committed to keeping our staff, volunteers and physicians informed with updates as we are made aware of new information.”

The public is encouraged to practice proper hand hygiene and educate themselves about the H1N1 flu virus. Niagara Region Public Health keeps its site up to date with the latest information and provides links to other key sources of information.

“I think the best advice we could give people is not to panic but to keep themselves informed,” says Tracy. «

The SARS experience left an indelible mark on healthcare and healthcare workers across the province, underscoring the serious risks infectious outbreaks pose to patients as well as healthcare providers.

It seems like yesterday when I think about the rigorous protocols that were put in place to screen everyone entering hospital buildings. Hand sanitizers became new features along with the screeners and their questionnaires and the dot stickers that adorned identification cards. At first, some of us thought the precautions were a bit much – but very rapidly we came to recognize the serious risks and life or death consequences of the SARS outbreak when hundreds became critically ill in Ontario and 44 people tragically died.

The lessons from SARS will certainly guide us through the next wave of the H1N1 outbreak of 2009. It’s already evident in the increased vigilance and advanced measures in infectious disease management and preparedness. «

Christine Clark, Chief Communications Officer

Debbie Sevenpifer,
President and Chief Executive Officer

When it comes to healthcare, the importance of being informed cannot be emphasized enough.  We encourage patients to be active participants in their healthcare by being informed and working with their healthcare providers to ensure their questions are answered and their needs are met.

At a broader, more public level, Niagara Health holds dozens of public information sessions, speaking engagements, health forums and community open houses throughout the year. I would encourage everyone to attend some of these sessions in the coming weeks and months to learn more about healthy living, ask questions about the changes taking place across our hospital system as we work through the Hospital Improvement Plan (HIP) recommendations, get the latest construction update on the new Healthcare Complex and Walker Family Cancer Centre, and participate in various fundraising activities to improve healthcare in Niagara.

As part of our ongoing commitment to community engagement, we are introducing a new column in this issue of Niagara Health Now entitled Upcoming Events. By turning to page 8 on a regular basis, we are hoping to make it easier for you to keep up to date on the various upcoming events being held across our region.

Beginning next week, we are holding Community Open Houses in Niagara-on-the-Lake, St. Catharines and Thorold to give the public an opportunity to view interior design options and the layout for the new Healthcare Complex and Walker Family Cancer Centre, learn about building safe radiation treatment facilities and provide an update on construction of the facility.

Also beginning next week, three specialist physicians will speak about men’s health issues including sexual health and aging, osteoporosis, and prostate diseases at Men’s Health Forums to be held in Welland and St. Catharines.

As HIP recommendations are implemented, our commitment to public education about changes taking place continues in the coming months with information sessions in Fort Erie to help residents understand what the conversion of the Emergency Room to an Urgent Care Centre means for them.

Niagara Health is fortunate to have the fundraising support of seven hospital foundations. These foundations are busy planning a growing number of big and small fundraising events to support site specific and regional healthcare needs in Niagara. Please go to www.niagarahealth.on.ca and click on the Foundations link at the top of the home page for a full list of these events.
I encourage everyone to take the time to check out the Upcoming Events listing on page 8 to see if there are events in your community that are of interest to you. You will also notice stories on some of these events on the other pages of Niagara Health Now.

As part of our Speakers Bureau, we welcome the opportunity for our healthcare experts to speak to community organizations. Please check
www.niagarahealth.on.ca/health/education/speakers-bureau/ and let us know if your group would like to arrange for a speaker.

Being in the know about your health and your healthcare system is “good medicine” for everyone, and I appreciate the opportunity to share this important
information with all.  «

Pictured here from the Douglas Memorial Site are, from left, Registered Nurse Joanne Jackson, Dr. R.J. Kamatovic and Administrative Assistant Pam Mackie.

On Monday, Sept. 28, at 8 a.m., the Emergency Room at Douglas Memorial Site will convert to a 24/7 Urgent Care Centre, treating a wide range of Fort Erie patients with non-emergent
conditions.

Following on the heels of a similar conversion at Port Colborne Site in July, a number of Public Information Sessions are being held across the municipality of Fort Erie to help inform and educate residents about what the change to Urgent Care means to them.

The Public Information Sessions have been well attended by local residents. An additional information session will be held Sept. 23 at Stevensville Memorial Hall, 6 p.m.

See details on this and other Niagara Health events.

In addition to the Public Information Sessions, a number of seniors groups and local community organizations have invited Niagara Health clinical leaders to speak about the difference between ER and Urgent Care.

A brochure titled From Emergency to Urgent Care … We’re here for you will be available in the Sept. 26 issue of the Fort Erie Times and will also be distributed to elementary and secondary school students in the area.

Fact sheets, presentations and other information are posted on the Niagara Health System website «

These issues have an impact on men as well as on their families, and it is important that men are aware of screening tests and treatments available. Thanks go to Sanofi Aventis and GlaxoSmithKline for their sponsorship to make this health forum possible and to help support Welland Hospital Foundation in raising funds for urology equipment.
In St. Catharines, a Men’s Health Forum Oct. 21, at Club Roma, 6 p.m., will have a different focus from previous years, this time covering osteoporosis and the aging male. For the past several years, speakers at this annual education evening have focused on prostate cancer, and this year, organizer Dr. Dianne Heritz, St. Catharines Urologist, and the Blue Ribbon Committee thought it was time for a change.

“We were delighted when local Endocrinologist Dr. Brenda Rempel agreed to give a presentation on osteoporosis,” Dr. Heritz says. “This disease has high rates in women, but it certainly impacts men as well and can be very debilitating. Our session will target what men need to know and whether they are at risk.”
In addition, the evening will focus on physical changes as to men’s health as they age, and speaker Dr. Michael Greenspan, Director of the Sexual Medicine Clinic at Hamilton General Hospital, will cover a wide range of issues on this topic.

See details on these Men’s Health Forums and other upcoming Niagara Health events

Dr. Heritz is also part of the organizing committee for the annual Blue Ribbon Gala, coming up Saturday, Sept. 19, at the St. Catharines Golf and Country Club. This annual event has raised $400,000 for the Walker Family Cancer Centre targeting prostate cancer treatment. For more info or tickets, call Donna Genge 905-934-6150 or Judy Casselman 905-685-1627. «

Every three years, healthcare facilities across Canada bring in surveyors from Accreditation Canada for a rigorous examination of programs and services.

Using Accreditation Canada’s new model, NHS staff and physicians have organized into 17 accreditation teams to prepare for the survey. These teams include: Governance/Board; Infection Prevention & Control; Oncology; Critical Care; Maternal Child; Mental Health; Chronic Kidney Disease.

“The hospital accreditation process is a continuous quality improvement program with specific standards to guide us,” says Tracey Davey, Director of Quality and Education and co-ordinator for accreditation. “Surveyors examine hospitals with the following eight dimensions of quality in mind: population focus, accessibility, safety, worklife, client-centred services, continuity of services, effectiveness and efficiency.”

Self Assessment

“In prepping for the site visit, Accreditation Canada provided a series of online questionnaires which were sent out to staff and physicians earlier this year to gauge how we see ourselves and our delivery of programs and services,” Tracey says.

Altogether, 735 staff and physicians filled in these questionnaires, giving their impressions on Niagara Health compliance to Accreditation Canada standards. The answers were collated by Accreditation Canada a few months ago.

“What came back to each of our teams were electronic results showing where we are doing well and in full compliance,” says Tracey. “We also received back areas that were flagged for improvement, and each team is completing action plans to ensure all standards are being met.”

Surveyors will focus questions around 22 priority processes when they come in November and meet with teams, visit departments and units. These broad categories cover the essence of hospital functions and include emergency preparedness, medical devices/equipment use, patient flow and surgical procedures.

The surveyors will visit the clinical units, asking questions and talking to patients and staff to find evidence of quality and safe patient care. They will trace an entire treatment process from start to finish to examine our compliance to standards.

Tracer Methodology

This new type of examination involves the surveyors looking closely at or tracing the patient and staff experience as it happens. The surveyors will talk to staff about policies and procedures to ensure the patient care process is efficient and timely in and between departments.
Surveyors may start with a patient in Emergency and examine how that department works with Diagnostic Imaging, Lab and Pharmacy to provide efficient care for that patient. Then, the surveyors could follow the patient through the admission process to an inpatient unit. While they are tracing the process, they will review Niagara Health’s compliance to standards, priority processes and patient safety practices.

Patient Safety Goals

“In addition to the 22 priority processes covering broad categories such as blood services and competency, a major focus of our survey will be ensuring we are compliant with Accreditation Canada’s Patient Safety Goals and Required Organizational Practices (ROPs),” Tracey says.

“Altogether, there are 31 ROPs to be measured during the survey visit, such as patient safety culture and quarterly reports, patient/client education, patient/client identification, narcotic safety, suicide prevention, infection control guidelines and more.”

“Our teams are working diligently to ensure staff members are fully prepared.” «

The Niagara Health System Board of Trustees is made up of volunteers who live and work in Niagara. Each Board member brings unique skills and expertise to this leadership role. The Board is responsible for governing the NHS and providing strategic direction to the hospital system in Niagara to ensure it meets the healthcare needs of the community within available resources.
Niagara Health Now is publishing a series of question-and-answer profiles on individual members of the Board to help our readers get better acquainted with them.

This issue’s profile is of Al Simpson.

Where were you born and educated?
Born in Hamilton, raised in Burlington, and earned my Business Degree from Wilfrid Laurier University in Waterloo.

Number of years living in Niagara:
Niagara’s been my home for most of my adult life including nine years in Grimsby and the past 17 years in St. Catharines.

Occupation:
Chartered Accountant and Partner with Partridge Iggulden LLP.

What are the greatest rewards from your job?
Working closely with clients to help guide them in reaching their business and personal goals.

What influenced you to become a member of the NHS Board of Trustees?
Several things including:
1. On a personal level, cancer has touched the lives of members of my immediate family and I have experienced the drive for cancer care outside of Niagara. I want to help ensure that the new healthcare complex and regional cancer centre will be the most modern care facilities for our region.
2. Gaining a better understanding of the financial aspects of the Niagara Health System. The issues related to deficits need to be solved if we are going to have a strong, robust health system in Niagara.
3. In my opinion, the healthcare model in Canada is fundamentally challenged given our demographic patterns. Alternatives must be found, and as a Board member I hope to assist in finding solutions to the looming challenges.

How many years have you served on the NHS Board?
Celebrated my first anniversary this past June.

What is your greatest achievement or reward as a member of the Board?
In my first year on the Board, I set a goal to learn and understand significant issues facing the NHS. I have come to more greatly appreciate the complexities of healthcare in Niagara. My reward is being part of the dedicated team that is working diligently to improve Niagara’s hospital and healthcare system.

What is the greatest opportunity for the NHS?
Today, the NHS’s greatest opportunity is to use the new healthcare complex and cancer centre as a catalyst to substantially improve Niagara’s healthcare for this and future generations.

What is its greatest challenge?
The NHS’s greatest challenge continues to be achieving positive change for healthcare in Niagara by getting our Niagara communities to work together to improve healthcare for all of our citizens.

Other involvement as a member of a volunteer Board, past or present?
Numerous, but most significantly nearly 15 years with the St. Catharines – Thorold Chamber of Commerce including President (2005-2008) and in the mid 1980s Trustee and Treasurer West Lincoln Memorial Hospital and a founding director of Deer Park Villa.

How would you describe yourself to someone who doesn’t know you?
Type A to the core, an advocate, strategist and work/sports-aholic.

What is your greatest personal achievement?
Two great marriages = one great blended family that resulted from my second wife May’s and my too early in life losses through death of our first spouses (Joe & Kathy). «

View interior design options and layout for the new Healthcare Complex and Walker Family Cancer Centre, learn about building safe radiation treatment facilities and get a construction update.

September 21, 2009
Our Lady of the Holy Rosary Church Hall
21 Queen Street South, Thorold
3 – 7 p.m. (presentation at 6 p.m.)

September 24, 2009
NHS Ontario Street Site
6th Floor Boardroom
155 Ontario Street, St. Catharines
3 – 7 p.m. (presentation at 6 p.m.)

September 30, 2009
NHS Niagara-on-the-Lake Site Wooll Room
176 Wellington Street, NOTL
3 – 7 p.m. (presentation at 6 p.m.)

Men’s Health Forums

Learn from the experts about men’s health issues including sexual health as we age, osteoporosis and prostate diseases.

September 22, 2009
Welland Lions Club, River Road
6:30 – 8 p.m. Presentation at 7 p.m. by
Dr. Tom Song (prostate, sexual health)

October 21, 2009
Club Roma, Vansickle Road, St. Catharines
6 – 8:30 p.m. Presentation at 7 p.m. by
Dr. Brenda Rempel (osteoporosis) and
Dr. Michael Greenspan (sexual health)

Urgent Care Info Session

Know your options as we convert the ER at Douglas Memorial Site in Fort Erie to a 24/7 Urgent Care Centre.

September 23, 2009
Stevensville Memorial Hall
Stevensville Road, Fort Erie
6 – 8 p.m. (presentation at 6:30 p.m.)

Fundraising Events

A growing number of fundraising events are scheduled to benefit our hospital foundations, including a Black Tie Dinner and Fashion Event Oct. 24 at the Hilton Niagara Falls and a Take it to Heart Gala fundraiser Nov. 14 at the Crown Plaza Hotel, Niagara Falls. Go to www.niagarahealth.on.ca and click on the Foundations link for events.