A Credit To Your Health, March 1999

Oncology Clinic Although specific funding approval for the Peel Regional Cancer Centre has yet to be announced, Dr. Robert Myers is anxiously awaiting the day when his patients, and those of his fellow oncologists, will receive radiation treatments here.

The centre, which will be included in the ambulatory care expansion to The Credit Valley Hospital, will mean several thousand cancer patients will no longer have to travel to downtown Toronto or other centres for their radiation. Approximately 3,000 patients will come from Peel, Halton and Durham regions once the new centre is built.

"About 45% of all patients diagnosed with cancer require radiation therapy at some point in their treatment," according to Dr. Myers. "Although most patients tolerate radiation reasonably well, there are some side effects such as nausea, diarrhea and fatigue. The repetitive nature of the radiation treatments coupled with the travel (to and from Princess Margaret or Sunnybrook Hospitals in Toronto) is wearing on patients." Myers says curative radiation could result in as many as 25 separate treatments.

Cancer Care Ontario agrees with Dr. Myers concerns. It recommended and the Health Services Restructuring Commission concurred, that it made more sense to provide access to radiation closer to home. "It will be more efficient."

The Credit Valley Hospital already provides chemotherapy to its oncology patients. These treatments, done on an outpatient or ambulatory care basis, account for 14,000 patient visits per year. "The existing oncology clinic can’t handle the volume of patients we’re currently seeing," Myers says. "They have more sophisticated levels of treatment. We need more space to provide those treatments."

The new Cancer Centre will provide the additional space for those patients as well as the patients requiring radiation. The oncology clinic’s space issues aren’t unlike problems facing many other areas of the hospital. Because of unprecedented growth, particularly in the area surrounding The Credit Valley Hospital (see "The Credit Valley Hospital’s Expansion Project Awaits Government Approval" also in this issue) the other ambulatory clinics such as renal dialysis, are bursting at the seams. The ambulatory expansion will allow the outpatient clinics currently housed in all-important inpatient space to move out, freeing up space in the existing hospital for more inpatient beds. This will have a positive impact on the overcrowded emergency department which is regularly backed-up with patients requiring inpatient beds.

Dr. Myers is particularly pleased that the Cancer Centre will be part of the Credit Valley Hospital complex. Cancer patients require supportive care services such as psychological support, dietary and pain control as well as laboratory and diagnostic imaging services. At times patients will require hospitalization. The inclusion of the Cancer Centre as part of the hospital will make it easier for patients and their families to access health services in one location.

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Boas, Beetles and Bow Ties - Valentine’s Gala - A Huge Success

by Anissa Conlin

Gala On February 13, Paris Cafe Society and the streets of Montmartre were spectacularly recreated for over 600 guests at The Credit Valley Hospital Foundation’s 1999 Valentine’s Gala. The evening was a wonderful success raising $150,000 for the Infrastructure Fund in preparation for the new Regional Cancer Centre at The Credit Valley Hospital.

Guests were treated to a champagne reception sponsored by The Toronto Congress Centre, under a blue sky dotted with floating clouds, accompanied with the fun and amusement of a Marcel Marceau mime and the sounds of a strolling accordionist. Our female guests felt a part of the exotic Parisian lifestyle with their feathered "Bell Boas" presented on behalf of Bell Mobility. Guests had the opportunity to bid on extraordinary silent auction packages. An exquisite dinner was served with a distinct French flare, against the backdrop of a lighted windmill. The entertainment began with a live auction with packages including a one year lease on a 1999 VW Beetle, CDs autographed by Elton John, an hour in an Air Canada flight simulator and a stunning sapphire and diamond ring. Close to $50,000 was raised on the live auction alone! But the fun was only beginning, as Aelita, "the Queen of Cabaret" dazzled the crowds with a cabaret show that was reminiscent of Paris’ Moulin Rouge. And to end an already perfect evening, guests danced the night away to the music of the Johnny Hood Orchestra.

It was a sensational evening filled with fun, friends and fundraising for the new Regional Cancer Centre at The Credit Valley Hospital. The funds raised in that one evening will have a significant impact on the healthcare of the citizens of our community.

This wonderful evening could not have been a success without the support of our principal sponsors who recognize the importance of supporting our community hospital. Thank you to Bell Mobility, Charton-Hobbs Inc., Dominion Stores, The Mississauga Fire Fighters’ Association Benevolent Fund, Sleeman Brewing and Malting Co. Ltd., and The Toronto Congress Centre.

Congratulations to Gala Chairman, Patti Dunn for her outstanding efforts. Thanks also to Foundation Vice-Chairman John Dunn, who along with Foundation Executive Committee member Ron Starr who steered the successful ticket selling efforts. Patti was ably assisted by the following team of volunteers, who also worked tirelessly for six months to prepare for such a great evening.

Carroll Nicholls Baker, Dru Betts, Gordi Ann Brisbin, Marie Clipperton, Kim Cohen, Sherri Croft, Frank Fogelman, Pat Fyffe, Lisa Guglietti, Christy Heenan, Barbara Hobson, Carol Loberg, Dr. Christine Kalbfleisch, Jane Petruzzi, Pat Rose, Lesia Tymochenko, Tish Vigna, Susan Wentzell, Hilda Yorke

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Get Your Green Thumb Ready…

Historically, the Credit Valley Hospital Associates have sponsored an annual geranium and impatiens sale. In the past, this event, although very time consuming, has been a great success. Its popularity continues to grow thanks to our very dedicated volunteers and positive comments from happy customers.

Again this year, plans are being made to host this event. As usual, the flats of flowers will be available in various shades. Pickup will be on Saturday, May 8 (the day before Mother’s Day). Orders must be placed in advance. Payment can be made in cash, VISA or Mastercard.

In the immediate future, a committee will be put together to roganize this year’s sale. Any volunteer who is interested in participating should sign up in the Associate’s Office at the hospital. For additional information call Sherri at 813-1585 or Victor Cammisa at 813-2200 ext. 6067.

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I Saw Someone Do Something Good!

Submitted by: Ms McCann

I am writing this letter to The Credit Valley Hospital, as my mother, Margaret McMann, was admitted as a patient from January 18^th until February 5^th, 1999. My Mother is 88 years old and has never been to The Credit Valley Hospital before.

The 911 Response Team of Ambulance and Fire was immediate, polite and very competent, but unfortunately they couldn’t take her to the hospital that I suggested (the emergency department was full), so we ended up at Credit Valley Hospital, which in my opinion was incredible luck and much to our advantage.

The emergency team under the scrupulous care of Dr. Adam Chen and the Nursing Staff on 3B astounded me with their knowledge, excellent care and personal kindness. The examined and cared for her until the illness was diagnosed and treated. I feel that Dr. Adam Chen and his staff saved her life.

I would very much like to thank the Hospital and it’s Staff for the dedicated service and care. Various departments visited my mother, making her stay and her discharge home easier on her and our family. The dietician carefully discussed her diet at home. The Oxygen and additional homecare were arranged upon leaving the hospital. Even a follow-up telephone call from the Doctor made us feel more comfortable.

I simply don’t think that I could have handled the responsibility at home if not for all the help that was given and arranged by the staff at this hospital.

In a time of constant complaints it should be known that the residents of Mississauga have a First Class Facility in THE CREDIT VALLEY HOSPITAL to serve us

Thanks again.

I Saw Someone Do Something Good!

Submitted by: Anonymous

On arriving for my night shift, I realized I lost my emerald from my engagement ring, Mark, a night security guard went out of is way looking for it. He got water and wet the cement at the front of the hospital looking for it. His concern, friendliness and extra help made me feel better: No, I didn’t find the emerald but Mark went way out of the way to help!!

I Saw Someone Do Something Good!

Submitted by: Helen Reilly

Through special event coordination in the hospital’s community relations department, I have had the opportunity to work with many local suppliers and businesses. I especially enjoyed working with Robert DiFilippo, Manager of the Super Fresh store at Glen Erin and the Collegeway. Robert is always willing to help with hospital events. In the last several months his store supported the hospital’s annual United Way campaign and Foundation activities. He also arrived at the hospital on New Year’s Day with a bag filled with goodies for the hospital’s New Year’s baby. I am eagerly looking forward to working with Robert again on fund raising activities for the hospital’s fitness centre.

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Juggling Patients and Priorities…The Daily Battle in the Emergency Department

by Wendy Johnson APR

Emerg Hospital Emergency Departments are the most maligned and misunderstood areas of any hospital. It’s no secret that every hospital ER is a pressure cooker. And no matter how large, or how many beds or staff you have, it will never be enough…especially in a rapidly growing area such as Mississauga. You may recall that the hospital completed a major expansion and renovation project a year ago in order to deal with the increasing patient load. The day the new ER opened, it was already overcrowded! Our rapid growth in population means we’ve seen a dramatic increase in the number of patients at our hospital. More and more of those patients are being admitted to hospital as a result of their visit to the emergency department. When the beds on the inpatient units are full, which is very often the case, patients being admitted through the ER must remain there until a bed on the unit becomes available. The CVH ER sees about 60,000 patients a year and is one of the busiest emergency departments in the country. By the year 2003 it is estimated an additional 25,000 patients will be seen annually.

About one third of those patients are children. The Health Services Restructuring Commission says the hospital will also be the regional site for paediatric care, which means more youngsters will be coming to the ER in future years. That will require additional space in the emergency department.

When the new ER was built, space was included for a paediatric playroom to help the children pass the time while they wait to be seen. There are plenty of toys for the children to play with. The toybox is managed by our young volunteers who ensure that when a child is finished with a toy, it is taken out of circulation until it is disinfected to prevent the spread of germs.

There are two triage nurses on duty at the registration desk during the peak hours of the day and night (normally 11 a.m. to 11 p.m.). This helps to speed up the triage process. Normally the triage nurse will see the new patients in order of their arrival. However, there are always exceptions when an obviously seriously ill patient requires the triage nurse’s immediate attention. The triage nurse will ask you why you came to the emergency room and the symptoms you are experiencing. She will record the information on a patient flow sheet. This is part one of the triage process. If there are no other patients waiting to be seen, the nurse will continue with part two, but usually she will ask you to have a seat for a few minutes. Part two is when the triage nurse takes your detailed medical history and vital signs (pulse, blood pressure, temperature etc.). It’s at this point that the triage nurse determines the level of severity of the your condition and prioritizes you according to a five-level triage system. The new triage system will be implemented as of April 1^st. So it really doesn’t matter when you arrived in the emergency room, the sickest patients will always be seen first (see also the Triage Process, included in this issue of "A Credit To Your Health"). However, it's important to remember that if your condition changes while you're waiting, you should tell the triage nurse. The nurse will reassess you and document the information on your chart.

Once your triage has been completed, you'll be asked to register at the desk adjacent to the triage desk. The clerk will ask for the patient's address and OHIP information. This information is recorded on computer and so begins your patient chart. All health professionals who see you during your ER visit, will document information, via computer, on your chart. After you've registered, you'll be asked to take a seat in the waiting room.

"You can’t always judge how busy we are from the waiting room," nurse manager Janet Cadigan explained recently. "We may be completely full with only one doctor and several full-blown emergencies in progress." Part of the reason why is because of the way the ER department is structured. The ambulance entrance, which is where trauma and many seriously ill patients enter the ER, is adjacent to the resuscitation room, completely out of eyeshot of the ER waiting room. This allows for speedier transport into the ER and protects the patient's privacy.

"The ambulance entrance is perfectly located for the coordinating nurse who immediately discusses the patient’s condition and requirements with the emergency medical technicians (EMTs) and situates the patient in the most appropriate treatment room. The coordinating nurse really controls all the action in the emergency department. She places the patients and informs the physician and the other members of the multi-disciplinary team as to the patient’s status. She responsible for ensuring that all ER activity is managed properly."

Because of the particular layout of the department, patients in the waiting room will not be aware of the level of activity in the treatment areas. For example, there could be active resuscitation of critically ill patient going on, but you will not be aware of this from the waiting room.

The 28-stretcher department is often "gridlocked" with acutely ill patients who are too sick to be treated and released. They need to be hospitalized, on a nursing unit, in an "inpatient" bed. But as we hear and read daily in the media, those inpatient beds are at a premium, particularly at this time of year when influenza and other seasonal ailments abound. So the patients remain in the emergency department where they can be safely monitored and their treatments initiated until an inpatient bed becomes available.

"Every day we have between five to twenty patients on stretchers in the ER waiting to be taken to an inpatient bed on a nursing unit," Cadigan says. "It used to be this way only during the winter months. We started backing up last August and it's escalated since then we absolutely no relief in sight. So you can see how easily we become gridlocked. We often end up bringing in extra stretchers and lining the corridor with them just to keep the patient flow moving. This is not ideal because it means the patients don't have any privacy and it makes it difficult for our staff to examine them. But there is only so much space. If the patients need to be monitored, which many of them do, we have to place them in a treatment room which in turn decreases space for new patients waiting to be seen."

Patients who have been triaged and who have been placed inside the ER either in Care Centre One, Two or Three, have no trouble understanding how busy it is. The care centres are open-concept design. This means patients and nurses can see one another at all times. There at eight RNs on duty who are assigned to the three care centres at all times. During peak hours there are three physicians on duty. Dr. Eric Letovsky, the Chief of the Emergency Department, has developed a strong teaching program for resident physicians from the University of Toronto. The emergency department at CVH is considered one of the best teaching sites in the metropolitan Toronto/GTA area. The residents are fully qualified professionals who work with the attending physician to gain important emergency medicine experience. They do a three month residency at CVH.

The staff in the ER work as a team with the other health professionals who are called in as required such as the physician specialists, respiratory therapists and social workers. Other health professionals that provide important diagnostic services to the ER (and other areas of the hospital) are the lab technologists, diagnostic imaging technicians and radiologists.

The ER is designed so that staff can care for the patients as efficiently as possible. Caregivers can order tests or prescribe medications on computer directly from the patient's bedside. When blood tests and x-rays are completed, the patient is reassessed by the physician. There's a cart beside every bed which contains supplies and equipment so there are no delays in delivering treatment. Each cart is identical so no matter what room a physician or nurse is in, the supplies are in the same place. The patient service representatives (PSRs) keep the carts stocked as well as transporting patients to and from the ER for tests, or to the nursing units. Cadigan says the PSRs "are a vital part of the caregiver team."

The unit clerk "flags" anything that is unusual or highlighted on the patient's chart for the other health professionals. She also deals with the many calls to and from specialists.

Care Centre 2 is where the patients with less serious illnesses are placed. It also has specialty rooms where gynecology, sutures, fractures, and ear, nose and throat problems are dealt with.

Care Centre Three is the department's "fast track" area for patients with less urgent ailments. A nurse and a physician are dedicated to CC3 during the busiest times of the day -- 7 p.m. to 11 p.m. Monday to Friday and 11 a.m. to 11 p.m. on the weekends. When this area is not being used as a "fast track" service, it’s used as a "spillover" area for the more seriously ill patients who require tests or may need hospitalization. In the last few months the ambulatory care clinic, next to Care Centre Three, has also been temporarily relocated in order to place six additional stretchers for patients waiting for inpatient beds.

The Credit Valley Hospital has been proactive in establishing several other programs to assist patients and caregivers. The Quick Response Team, a team of specially trained nurses, works with the patient, the family, the physician and nurse to determine any special requirements the patient may have once they return home. Contacts may be made with community service agencies such as homemaker or VON services so the patient, who doesn't require admission to hospital, will be able to function safely at home.

There is also a Crisis Intervention Team made up of social workers who assist patients with psychiatric illnesses or stress-related illnesses.

"The pressure is incredible most of the time," Cadigan says. "We want to see and treat our patients just as quickly as possible. But it's rarely possible these days. Our goal will always be to deliver the highest quality of care possible. That’s what our institution is famous for."

There's no quick fix for gridlock. You can't stop the population from growing and you can't stop people from getting sick. You can't find more space for beds where there just isn't any more space. And you can't put peoples' lives in jeopardy. That’s why it’s imperative that the CVH expansion project proceeds right away. "We're doing the best we can with what we've got, Cadigan says. "And we're thankful for what we've got. But some days it just doesn't seem to be enough."

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Keeping Healthy, Keeping Fit

by Lorel Linders, Cardiac Rehabilitation Coordinator

The Cardiac Rehabilitation Program has been operating at the Credit Valley Hospital for over ten years. There are approximately 150 participants in the program at any point in time. Total patient class visits have grown to over 6,000 per year. We are able to see a new patient every class. As a result we have managed to keep the waiting period for entrance into the program at a minimum.

Individuals following myocardial infarction, bypass surgery, heart transplant, angioplasty or diagnosis of cardiovascular disease are assessed for cardiovascular risk factors, functional ability and risk of repeat events. Individual education and exercise programs are designed, and follow-up monitoring is arranged.

We’ve seen a drastic increase in referrals to the program over the last few months. An aerobics program has been added to our walk/jog, cycling, rowing and strength training programs to accommodate these increased numbers. Special events include a Fall Walk-a-Thon and BBQ as well as our annual Christmas Party. We would like to thank the participants and volunteers whose enthusiasm and dedication have made these events hugely successful.

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New Mammography Machines Benefit Patients

by Helen Reilly

Mammography Shorter waiting times, double the throughput and lower doses of radiation -- three excellent reasons why the Diagnostic Imaging Department at CVH has installed two General Electric Senographe

DMR Systems. Lynne Clark, the Assistant Technical Director for the Imaging Department says the new machines will reduce the current three-week waiting period by nearly half by allowing them to see twice as many patients.

The Senographe DMR replaces the hospital's original mammography machine which has been in operation since the hospital opened in 1985. "Technology has improved in such a way that we can offer automatic optimization. The computer selects the appropriate exposure based on tissue density which results in a better image," Clarke says.

"The computer provides a slower and lower dose resulting in reduced risk for the patient and consistent high-quality images since the speed decreases the possibility the patient might move during imaging," she adds.

For the patient, this will mean that waiting times for testing will be reduced. In addition, the period of compression is expected to be shortened as a result of the computer's recognition of density which is otherwise determined by the mammography technician.

The hospital's imaging department has seven trained mammography technicians on staff. Two additional staff members will be trained on the new mammography machine by the beginning of April. The implementation of two Senographe machines sets the stage for the hospital to become a CAR accredited site. The Canadian

Association of Radiology grants accreditation based on its review of quality control records and mammograms for consistency of films over a one month period. The CAR reserves the right to survey the hospital at any time. Clarke says "I expect that we will move forward in the accreditation process as a result of this purchase and if we are successful, we should receive accreditation within six months."

"Based on the fact that breast imaging is more and more important to women in the diagnosis of cancer, we are very excited about this state-of-the-art equipment which will help us improve upon the service we provide to our community," she adds.

With the implementation of two new mammography machines and additional training for the mammography technicians, results will produce optimal film quality with each image. "The computerization feature is a big bonus for patients," Clarke says. Accreditation is the first step toward The Credit Valley Hospital receiving approval as an Ontario Breast Screening Site.

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Not Just Another Work Day!

by Wendy Johnson APR

Southwood Imagine every work day as "dress down day" complete with fluffy slippers and your favorite rumpled sweatshirt! Imagine taking a break from your computer to wander down stairs to throw in a load of laundry and raid the refrigerator. Doesn't sound too bad does it?

That's what life's like for Kathryn Southward and fourteen other women who work "in" The Credit Valley Hospital's Health Records Department. They are medical language specialists, often referred to as medical transcriptionists. They're the ones who type up the information that is dictated by physicians and other health professionals to become part of each patient's record. But their desks are kilometres away from the hospital set up in a private corner in the comfort of their own homes. They work when they want to - all night long if they prefer. The work gets done but according to their personal timetables which are usually adjusted to their families' needs.

The move to "work at home" happened for Kathryn in 1995. She found that it helped her manage her very busy homelife with her nine and five year old and 9 month old daughters. Her husband also travels regularly so it meant she wasn't constantly juggling schedules to accommodate their varied schedules.

"It came along at a good time for me - the year my oldest daughter started school. I'm able to drop her off and pick her up from school. I drop my five year old and baby off at the babysitter's, come home, grab a coffee and get to work!"

"We work flex hours so that if my daughter has something on at school I can go. I like to put in a few extra hours on the weekend so that I can take part of a day during the week to clean the house and go grocery shopping. If I'm not feeling well one day, I'll stop work and make up the time another day."

"It’s nice to look out the window and see the birds," fellow transcriptionist Liz Solowoniuk says. "I don’t ever have to get dressed, there’re no shoes to get dirty…in fact all of my work shoes are in boxes! In the summer I start work really early so that I can go out and play in my garden in the afternoon!"

Charmaine Shaw, the Director of Health Records at CVH says the transcriptionists' productivity has actually increased since they introduced the "work at home" scenario. "We projected a ten percent increase but we have actually achieved a 15% increase in productivity. The transcriptionists used to have the highest sick time in the department. Now they're close to perfect attendance." And the elimination of ten workstations at the hospital netted an additional 1200 square feet of space in the hospital which is hungry for additional patient space.

The medical language specialists are much more than transcriptionists. "At CVH we do all types of dictation," Kathryn explains. "We take dictation from physiotherapists, psychiatrists, psychologists, surgeons, radiologists, pathologists and others. We need to know all of the medical terminology associated with each of those professions and the differences between certain terms that are the same."

Just the other day transcriptionist Kath Toth heard the term "miracle study" on her dictation. "This was a new term for me. So I went online to the transcriptionists users group and asked if anyone else was familiar with it. I had my answer within minutes. Everyone is very helpful."

Each of the transcriptionist's home offices are ergonomically correct. Kathryn recalls, "We were the first in the hospital to have ergonomically correct chairs. We were given assessment sheets by occupational health so that we could ensure that our computers andchairs were positioned to meet our personal needs."

Health Records Director, Charmaine Shaw, says when they decided to move transcription into the home in 1995, she and Mark Farrow, Director of the hospital's Information Systems developed a protocol that would ensure patient confidentiality. "The transcriptionists do not create a hard copy of the health record. All of the information they transcribe is transmitted back to the hospital. All information is protected by passwords. The computers time-out automatically which means the transcriptionists will have to reenter a password in order to return to their work. We do regular system audits to ensure our transcriptionists (and all other hospital personnel) are not accessing information that would breach patient confidentiality."

Tricia Ladouceur supervises the medical transcriptionists. She says she never worries that the work won’t get done. "The staff is very dedicated. There’s always someone on-line so the customer is always being served."

The work at home scenario isn’t for everybody. "I tried it for a few months but I missed socializing with people at work." So Lydia Butkovic opted to return to CVH as the lone full-time, in-house transcriptionist. She works a more regimented, nine to five, Monday through Friday, which she says, is much more to her liking.

Unlike Lydia, Kathryn doesn't miss the chats around the coffee machine or the personal contact with fellow transcriptionists. "We meet every other month at the office the odd time we'll send each other a message or a joke to lighten our day." Besides, she has the company of her husband, James, who also works at home. Asked if that's just too much togetherness Kathryn quips, "We tease each other that that's how our third daughter came about!"

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Laughter Truly Is The Best Medicine

By Helen Reilly

Adams When Ian Sinclair, Associate Vice President at The Credit Valley Hospital attended a health care design symposium in California in 1995, he didn’t expect he would be shopping in a "Good Will" used clothing shop for the most outrageous outfit he could find and wandering the streets of San Diego. Part of the symposium was a hands-on "clowning" workshop offered by Hunter (Patch) Adams – yes, the same Patch Adams featured in the Robin Williams big screen movie. Patch believed, and obviously the symposium organizers agreed, that humour should be integrated into the health care continuum.

When Sinclair, along with 18 others from the conference who selected Patch’s workshop, emerged from the used clothing store, they were sized up by Patch personally. Upon careful examination, he decided Sinclair’s outfit required something he couldn’t quite put his finger on. In one fell swoop, the 6’6" Patch grabbed Sinclair’s ankles and slid his pants up past his knees to reveal his bare legs under the oversized colourful pants – "Perfect!" he declared as he moved on to the next clown participant.

Equipped with their clown clothing and related paraphanalia, the group boarded a bus and departed for the local children’s hospital. A public relations representative met the group at the door and outlined the numerous rules pertaining to their visit. When she finished her spiel, Patch promptly offered a prize from his bag of goodies to thank her and approached with a tightly closed hand. As his hand unclenched, the public relations director was the recipient of a small plastic pile of "doggie doo-doo." She, like many more to follow, could only laugh!

Patch promptly positioned himself behind the hospital administrator’s desk. Spinning in his chair and making pretend telephone calls, the administrator admitted Patch’s small intervention "made his day," Sinclair says. The group members dispersed to units around the hospital and were warmly greeted with hugs and squeals from nurses, physicians and hospital staff.

Sinclair recalls a moment when he and his clowning partner entered the room of a motionless five-year-old boy. His mother sat quietly at his bedside while his father lay back asleep in a chair. Given the opportunity, they began to work the magic of clowning. Together, with an oversized comb and scissors, they pretended to apply shaving cream to the sleeping father in "mime" and proceeded to shave him and give him an imaginary hair cut while he slept! While his mother thought the clowns were hilarious, the boy didn’t move, save for the few tears rolling down his face. "There was no laughter but we knew that inside, he was laughing," Sinclair says. "The purpose of this exercise was as much to explore ourselves as it was to bring fun to a solemn environment – it’s an experience I’ll not soon forget," he continues.

Sinclair, who is responsible for the hospital’s existing and future building projects, hopes to bring more to The Credit Valley Hospital’s physical structures to foster a healing environment for our patients. Only now that the concept has been popularized by pioneers such as Patch Adams will the opportunity to build healing environments be supported by health care institutions. Of future planning projects, Sinclair says "I hope to incorporate healing environments into plans for the cancer centre." The concept that laughter can improve upon one’s health, despite its intangible quality, is becoming an accepted form of therapy in more and more medical circles including The Credit Valley Hospital.

When he returned from the symposium, Sinclair brought a new perspective to the planning table. The transformation of the hospital’s playground outside the paediatric unit into a "Musical Garden" reflects his plan to create healing environments as part of the hospital. The garden features arches providing children with access to chimes from a wheelchair, bed or on foot. At night, the garden is lit with mini lights giving it a fairy-tale atmosphere.

Patch Adams, Founder of the Gesundheit Institute, is best known for his unique approach to medicine in the 1960’s. He broke new ground with his belief in treating the whole person; not only the patient’s physical ailments. To this day, he does not charge patients for treatment at the Institute because he does not believe healing should be conducted within the business model. Sinclair says "Patch maintains practitioners should have passion for healing. He has practiced for 30 years in the United States without malpractice insurance. He believes that insurance implies the physician and patient don’t trust one another. As far as Patch is concerned, healing is all about trust."

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Streetsville Childrens Centre Benefits CVH Oncology

by Heather Hadden

Many thanks to the Streetsville Childrens Centre (SCC) for its successful Fifth Annual Valentine’s Day Dance to benefit the oncology program at The Credit Valley Hospital.

The evening was in memory of former CVH cancer patients, Donna Graham & Cathy Cox, whose children attended SCC. The event was also dedicated to those whose lives have been touched by cancer. A large card was signed by many people in attendance remembering friends and relatives. Previously this event has raised over $4,646.00 to purchase a blanket warmer and a commode chair for 2C. This year’s event raised another $1,000.00 for the oncology programme.

Jacky Sheppard & her "dance team" organized the event this year at Otello's Banquet hall. It included a dinner dance and plenty of wonderful door prizes. Dozens of generous vendors from the community made donations to the prize bank.

Jacky Sheppard is a remarkable woman. Not only does she direct two locations of The Streetsville Childrens Centre but she is constantly running events through the school that benefit the community. Most recently, their fall "M&M's" sales went to help rebuild the Anglican Church in Streetsville and in March, the children will raise money for muscular dystrophy. Jacky is also a volunteer member of The Credit Valley Hospital Palliative Care Team.

To you Jacky and from the oncology programme of The Credit Valley Hospital we thank you and your staff for your time & efforts.

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The Alcohol and Drug Treatment Program

by Gwenne Woodward, Clinical Coordinator

The Credit Valley Hospital Alcohol and Drug Treatment Program is an outpatient community-based service for adults who are experiencing physical and emotional complications from their substance use. These substances will include alcohol, prescription medication, and what I known in the field as illicit drugs. Our service begins with an Information Night for prospective clients and their families and may include medical assessment and follow-up; psychiatric assessment; pre-treatment groups; day treatment (three week outpatient lifestyle change program); recovery groups (Stage I, II,III); alumni group; relapse prevention; family day and family workshop series. All inquiries about our service can be forwarded to (905) 813-4402, 8:30 a.m. to 4:30 p.m. Monday through Friday.

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The Credit Valley Hospital Expansion Project Awaits Government Approval

It’s no secret The Credit Valley Hospital is literally bursting at the seams. The community hospital serves a population of 350,000 in its primary catchment area.

The area right outside our doors – between highways 403 and 401 is the highest growth area in the province. The population has grown by 18 % (35,275) within the last two years --from 190,320 in 1996, to 225,595 in 1998. The experts say the area will grow again by an additional 32% between now and 2003.

As noted in "Juggling Patients and Priorities" article, also in this edition of the newspaper, the demands on our system are most evident in the emergency room. Although most emergency rooms experience long waits and huge influxes of patients during the winter months, the problem is critical at The Credit Valley Hospital because of the rapid growth in population. Sicker people, many requiring admission to hospital, but few, if any, inpatient beds, result in serious backlogs in the emergency department.

"Just send them to the nursing units anyway…put them in the halls!" many people suggest. It’s really not that simple. First and foremost, many of the patients need special beds and monitoring devices. You simply cannot put them on a stretcher in a hall – it’s a matter of patient safety.

"What about beds that were closed as a result of restructuring?" others ask. Last year, despite the lack of funding to do so, The Credit Valley Hospital opened ____ beds in order to deal with the bed crisis. You may recall, in December, the Ministry announced special funding in order to cover the additional costs associated with opening those beds.

The additional one-time funding was welcome relief to balance this year’s budget. But it was a temporary solution to a problem that’s growing out of hand in our hospital. What is really necessary, is a review of our funding formula based on our increasing demand on our services. The good news is, a review is taking place. It will take into account the population growth and the resulting demand for more beds and other services.

More money alone will not solve our problems. In order to meet the existing needs of our population and those projected for the next five years, we must expand. Part of the reason is because many of our ambulatory (walk-in, walk- out) care services are housed in space formerly used for inpatient care. These services, such as renal dialysis and oncology, require the support services such as laboratory and diagnostic imaging (x-ray, CATscan, ultrasound etc.) so they need to be in, or in close proximity, to the hospital.

There’s another wrinkle in this whole picture. Not only is The Credit Valley Hospital meeting the needs as a community hospital, it also has a regional responsibility. The hospital provides a regional services for renal dialysis and genetics research. In this role, The Credit Valley Hospital serves the people of Mississauga (597,000) as well as those living in Halton and Peel Regions – close to a million people!

Maternal and Child Services and Oncology are also to become regional services as directed by the Health Services Restructuring Commission. The HSRC recognized that a population of our size requires these types of special care services closer to home.

We agree. But even more patients means even more demand on inpatient as well as outpatient services and the support services that are required for diagnostic purposes.

The Ministry of Health has asked us to come up with a plan to house the programs and the equipment required to meet the HSRC directives. Although many people refer to the plan as the plan for the new Regional Cancer Centre, it truly is much larger than that. It is an expansion plan that incorporates the needs of both our community patients – for more inpatient and ambulatory care services -- and our responsibilities as a regional centre for cancer, paediatric, renal and genetics services.

At the end of 1998, the CVH submitted a plan to the Ministry of Health for its review and approval. We hope to have a decision from the ministry very soon. One thing is for certain, we’re going to have to have the public’s financial support to pay for a share of the project. We’ll keep you abreast of our progress in upcoming issues of "A Credit To Your Health."

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The Credit Valley Hospital Foundation: For Your Good Health

by Anissa Conlin

A special word of thanks is due to the Shoppers Drug Mart Stores of Mississauga who presented The Credit Valley Hospital Foundation with a cheque for $4,000 raised at their 11^th Annual Shoppers Drug Mart Slo-pitch tournament.

The Credit Valley Hospital Foundation is grateful to The Park Mansion Social committee for donating a number of toys and $225 to the Hospital at Christmas time.

We applaud the initiative and generosity of Sherri Croft, Sales Representative with Prudential Realty, who is donating 10% of her sales commission to The Credit Valley Hospital Foundation at the request of her clients.

A special thank you to the Meadowvale Streetsville Bridge Club members who donated their registration fees to our Hospital. Anyone interested in playing with the club and supporting CVH at the same time, can contact Sheila Elston at 820-3500.

We thank our generous donors and urge members of our community to support The Credit Valley Hospital Foundation.

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Tom’s Story – Confessions of An Addict

by Tom R.

Try to understand that the terrible fear seems to have no source. It is ubiquitous and paralyzing. We shake and rattle inside. We talk incessantly or not at all. We eat sporadically and sleep little, lying to everybody automatically. "Sure I slept fine thank you." To ‘sleep well’ meant a couple hours on the couch -- the bed staying empty and cold.

We haven’t had any booze or drugs in a day or a week and the effort to quit is why we are at the information night of the Credit Valley Drug and Alcohol program (see "The Alcohol and Drug Treatment Program" also in this issue). It is a Wednesday at 6:00 p.m. over in the basement of the professional building and the place is filled with boozers and users like me and one straight person, the "facilitator". The room yells ‘institution!’ at my paranoid brain but there is no smell. The place vibrates and gets smaller….at least it seemed that way to me.

We come in for different reasons. One of my group came via the courts and stayed in denial. A woman came via the psychiatric ward and learned she was an alcoholic in the program. I came from the streets and had an awful surety that I was thoroughly addicted to many substances and I was going to die if I didn’t get my act together.

But when you asked me why I came to the program I didn’t say it was because my intestines were shot (I passed nothing but blood and water for months) and it wasn’t because someone said I had to. I came in because I was so unbelievably lonely. Please believe me when I say that it was a physical pain in my chest. It wasn’t a knot. It was a flame. I couldn’t take it any more. And suicide is a question of degrees you know. I had tried emotional suicide: obliteration of self with substances. It sucked. And real death had little appeal for me. I sat in the information night and inside I was screaming. It was a constant wail in me. What lay ahead was a huge se of unknown. But I chose to trust the people at the program give it a go.

My name is Tom and I went through the program in the Fall of 1995. Since then I have done an awful lot of hard work on how I live. The largest chunk of that work was in the three week day program. I am fond of letting people know that over three years later, I knowingly use things I was taught at the program every single day. They keep me in line and that keeps me sober.

Now, to look at what I was taught one could use life as a metaphor. It was that large. I was taught the basic of living and coping and now do it on my own. I have my health, the love of my family and respect of my friends. Next year my little business will most likely pay taxes! That would be humorous if it wasn’t such a sad indicator of my life in the previous twenty years. I hadn’t paid a dime in over 15 years, I had been scamming welfare for about eight years, was constantly involved in petty fraud and in the last year was visiting my MD weekly, getting costly ultrasounds, x-rays and bloodwork.

Next time I see my doctor it will be may yearly check-up. I will get weighted and get prodded and get out for another year.

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Triage – What’s It All About?

by Eric Letovsky, MD, CM, MCFP(EM), FRCP(C)

Chief, Department of Emergency Medicine, The Credit Valley Hospital

The word "triage" is derived from the French verb "trier", meaning "to sift or sort". The first medical use of this term was actually on the battlefields, where injured soldiers were triaged, or sorted, as to who would require immediate life-saving treatment, and those who could wait for delayed treatment. Today, if you have ever been to a hospital emergency department, the first individual you usually see is a triage nurse. This individual is usually one of the more experienced emergency department nurses, whose primary function is to obtain a very focused and brief history, and a rapid physical assessment, in order to determine the severity of illness. Triaging is essential because of the nature of emergency departments. Patients often arrive in large numbers at the same time, with varying severity of problems, to facilities that have limited resources. Therefore, it is essential to have an efficient triage system that can rapidly and safely determine which patients need to be seen as a priority, and which patients can safely wait to be seen.

Up until now, most Canadian emergency departments have used the three-level system of triage. Patients have been classically triaged into Emergent, Urgent, or Non-Urgent. This system, while seemingly simple and obvious, has major disadvantages and drawbacks. The most obvious disadvantage is that those patients who are categorized as having an urgent problem may vary tremendously in the conditions that they have, and it has become clear that we need a more sophisticated system of categorizing patient severity. In 1998, the Canadian Association of Emergency Physicians, in association with the National Emergency Nurses Association, decided to adopt a five-level triage system in an effort to make the triage system more accurate and easier to differentiate sicker patients. This five-level triage system is scheduled to be implemented at Credit Valley on April 1, 1999, and will be up and running in most Canadian hospitals by June 30, 1999. Currently, emergency departments all over Ontario are training their physicians and nurses about how to implement this new system, and a recent provincial symposium was hosted by Credit Valley Hospital’s Emergency Department to train nurses from across the province.

We are confident that this new system will enhance our ability to sort out the more urgent and sicker patients who present to emergency departments, and allow us to more quickly implement treatments and improve patient outcome. While the average patient going to an emergency department may not notice any major changes to the system, several changes to the process will undoubtedly help us better evaluate patient illnesses when they present to emergency departments.

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Volunteering - Then and Now

by volunteer, Wendy Johnson

When I heard that The Credit Valley Hospital was going to open in 1985, I decided that I would offer my services as a volunteer. I knew that I would like to work in the Gift Shop even though I had no experience in that area.

With a feeling of apprehension I approached Square One where the Volunteer Offices were located. The interview seemed to be all right and I settled back to await the outcome. Many weeks later when I was sure I failed to meet their requirements, I received a call and was told to come to an initial meeting of all volunteers. We were warmly welcomed. After a period of reticence and shyness, we began to relate to one another.

The great thing about a totally new venture is that you are not the odd one out or the newest volunteer. We were given our areas to work in and I began to meet the Gift Shop volunteers with whom I’d be working. We had many training sessions learning how to use the cash register, how to make a float, how to tally at the end of the shift, and what was most important to us, the Gift Shop location and how to get there.

The Gift Shop, painted in wedgewood blue, was very small but the buyers had done a good job of getting things in place for the opening. We began our jobs before the hospital opened for patients, so we had a chance to practice. Our jobs included replenishing the supplies of candy, magazines and cards, keeping the shop clean and serving customers. At the end of the shift we rejoiced if we balanced and if we were over or under twenty-five cents. I remember waking up in the middle of the night suddenly realizing where we had gone wrong! The treasurers, who would follow a paper trail that led them to our mistakes, have been a patient lot.

Although we have made over a million dollars for the Hospital, I don’t think this is the bottom line for most of us. As we became more confident in our work, we knew that this job is a special place to relate to staff, patients and visitors. We cried with the parents whose baby was very ill; we looked forward each week to the doctor who always bought special chocolate bars from us; we cheered as Tony, one of the first patients, got better each week.

We came to know each other better as we worked together. I have grown so much from watching and listening to the women who go by the title of "Monday Girls". We have lost some of our members over the years, but new ones who have come along seem to be ideal replacements. Most of us have put in over a thousand hours of volunteer time. Our get-togethers at the social level outside the hospital are always great fun.

Currently, we are learning how to use a new register, just as we learned how to operate a register in 1985. We are proud that all money raised goes to the hospital and in this way we are continuing to be a service for others. With the many experiences behind us, we’re ready for the new millennium and the challenges and friendships that go with it!

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Wayne’s World

by D. Wayne Fyffe, B.A., DHA, CHE

President and Chief Executive Officer, The Credit Valley Hospital

Wayne We hope you find this first edition of "A Credit To Your Health" interesting and informative. Our intent is to inform you about health care and the future of The Credit Valley Hospital.

Some of you will remember when the hospital opened in 1985, in what was then, an empty field. Who would have imagined that 14 years later we would be a large, sophisticated hospital that is running out of physical space to serve our growing community?!

It is probably no surprise to you that the Region of Peel is the fastest growing community in Ontario. And the City of Mississauga is now the 6^th largest city in Canada. Did you know that the population served by The Credit Valley Hospital grew by 48% in the last 5 years and will grow by 32% over the next 5 years? If it sounds like "my world" is preoccupied by growth issues, you’re right!

We are doing everything we can to maximize the use of our existing physical buildings so that we can serve you better. We are acutely aware that waiting times for emergency services and for tests and surgery, are too long. We are hopeful that the government of Ontario will soon announce new funding strategies which will be sensitive to the needs of rapidly growing communities like ours. We also anxiously await approval to move ahead with long-awaited construction projects like the Peel Regional Cancer Centre, the regional program for high risk Child and Maternal Care, and the additional inpatient beds and related outpatient diagnostic testing and support services.

If this newsletter receives a positive response, we intend to use it to keep you informed as we proceed with the necessary construction and new programs and services at The Credit Valley Hospital. As always, your comments and feedback are welcome!

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