In June of 2017 the staff and patients at The Salvation Army Toronto Grace Health Centre (TGHC) returned to 650 Church Street after an extensive retrofit of the building. The retrofit included specific upgrades that would allow the TGHC to expand programs and services. In recent month’s funding to implement an expansion to the TGHC’s current respiratory program to include a 12-bed Long Term Ventilator (LTVD) program has been proposed to the Ontario Ministry of Health and Long-Term Care (MOHLTC). This program would address a need in the health care system by transferring patients requiring long term ventilation from intensive care units in acute care hospitals to the TGHC for respiratory rehabilitation and care. The goal would be to provide patients with medical stability and ultimately transfer them back to the community or home.
I spoke with Jake Tran, Executive Director Programs, at the TGHC about the proposal and the funding needed for the respiratory program. Jake before we proceed, just to clarify, you are the Executive Director Programs at the TGHC and you have specific expertise in respiratory therapy?
JT: That’s correct.
Can you elaborate?
JT: I began my career as a respiratory therapist in acute care at the Markham-Stouffville Hospital before I came to the TGHC.
What type of care do respiratory therapists provide?
JT: Respiratory therapists (RTs) are highly skilled health care professionals who care for patients by evaluating, treating and maintaining cardiopulmonary (heart & lung) function. Our specialized expertise and education allows us to treat all age groups from newborns to the elderly. We can work in many hospital settings – particularly high-risk areas such as, intensive care units, emergency departments, operating rooms, neonatal nurseries and general wards. To simplify, we provide advanced life support and treatment for extremely ill patients so they may be relieved of their respiratory problems.
When did you come to the TGHC?
JT: I came to the TGHC in 2005 initially as a respiratory therapist. My role was to review the respiratory policies and procedures given that the TGHC had a number of trach patients.
Some may not understand the term trach patient, could you explain?
JT: Sure, trach means Tracheostomy – a surgical procedure where an opening is created through the neck into the trach (windpipe). A tube is placed through the opening to provide an airway and to remove secretions from the lungs. This tube is called a tracheostomy tube or trach tube. At that time the TGHC wanted to create a concrete care plan for these types of patients.
So did you develop a care plan for these patients?
JT: Working with the health care staff we developed a respiratory program for the TGHC. The goal of the plan of care was to decannulate (the process whereby a tracheostomy tube is removed once the patient no longer needs it) and rehabilitate patients so they could be discharged back into the community.
I assume if you developed a respiratory program there would be an educational and training component?
JT: One of my responsibilities was to provide in-house education and training. I developed and implemented a respiratory curriculum, and over the years the health care staff has received on-going educational assessment and training in trach procedures. We also set-up learning sessions for the staff by inviting respiratory professionals from our health care network to share their expertise.
Would you say the number of respiratory patients you accept now are more than what you accepted say five years ago?
JT: Not only are we now accepting more respiratory patients, we are also accepting patients with a higher acuity of respiratory problems. Those needing mechanical ventilation or patients that require CPAP (continuous positive airway pressure) or BIPAP (bi-level positive airway pressure).
Can you explain mechanical ventilation and…CPAP/BIPAP?
JT: Yes, mechanical ventilation is termed ‘invasive’ as it involves an instrument penetrating the trachea through the mouth or nose such as an endotracheal tube or through the skin such as a tracheostomy tube. CPAP (continuous positive airway pressure) or BIPAP (bi-level positive airway pressure) is provided by non-invasive positive airway pressure, which applies air pressure on a continuous basis to keep the airways continuously open – for example patients that have sleep apnea require a CPAP/BIPAP machine.
The respiratory program has been operating successfully at the TGHC and senior staff believe that you are ready to expand the program to include chronically ventilated patients; can you elaborate?
JT: We have considered expanding our respiratory program to include long-term ventilator patients for some time and have approached our analysis very methodically. When the senior staff at the TGHC were preparing design plans for the retrofit at 650 Church Street we were able to propose a modern system where piped in oxygen as well as a suction system could be structurally implemented into the facility. We recognized not only the need to improve the quality of care for chronically ventilated patients, but the opportunity to enhance the health care services we provide.
Now that your facility is equipped with an internal respiratory system what are your next steps?
JT: Our goal is to partner with acute care hospitals within the Toronto Centre Local Health Integration Network (TC LHIN) to prevent unnecessary extension of acute care stays for chronically ventilated patients. This goal aligns with the Critical Care Transformation Strategy launched in 2005 by the Ministry of Health.
What is the Critical Care Transformation Strategy?
JT: The goal of the Ministry of Health is to keep Ontarians healthy, by ensuring better access to care, reduce wait times for services and provide an environment where all healthcare practitioners are able to deliver best practices.
Does the TGHC believe it is delivering on this strategy by expanding its respiratory program?
JT: Yes, because our expanded LTVD respiratory program would create an availability of ICU beds in Ontario. So, for instance ICU beds occupied by ventilator-assisted patients, who are otherwise stable and do not need other critical care services, those beds would become accessible to patients with critical care needs. By increasing the availability of beds in the system the program would also reduce wait times in acute care hospitals.
We believe this program will increase the quality of life for patients and caregivers. It will provide faster access to rehabilitation, speed the return to home or community, and would also reduce TGHC’s need to transfer other respiratory patients to acute care should they require increasing periods of ventilation.
Has the TGHC submitted its proposal to the Ministry of Health?
Your infrastructure to expand your respiratory program is in place, your staff has been trained and continues to be educated in respiratory assessment and care, and your proposal has been submitted to the Ministry of Health, what’s missing?
JT: In a word…funding. We know the amount of funding required is large, especially when you consider that the program would require three separate components: technical, education and expertise. However, without the funding it is not possible to advance our respiratory program.
Is there anything you would like to add Jake?
JT: One other thing, it is not only about providing a respiratory program for chronically ventilated patients, it is also about providing continuity of care through collaboration and communication in the health care network. We see ourselves as an integral partner to transforming critical care. Our participation will help improve the quality of care the health network is able to deliver to the patient.