Strategic Plan 2015-19: Year 2

Strategic Plan 2015-19 - Year 2

Strategic Direction No. 1: Reinventing Cardiac Care

In 2016-17, we launched an additional Heart Team in Critical Care, further extending our multidisciplinary approach to patient care.

Heart Teams ensure better and faster access to care and focus on what is best for each patient by integrating the combined expertise of highly skilled healthcare professionals from various specialties.

By measuring immediate and long-term outcomes and looking at results beyond the hospital walls in order to optimize the patient expe-rience, Heart Teams make decisions that are informed by their patients, de-livering personalized, patient-centred medicine.

Complexe Arrhythmia Heart Team Complex Arrhythmia Heart Team
Triage Model An algorithm to triage patients with atrial fibrillation (AF) to the appropriate provider and to improve access to care and education for patients (in progress)
Hybrid AF Ablation Model A collaborative model combining surgical and catheter ablation of AF (in progress)
Stop AFIB Model

An AF preoperative prophylaxis protocol to reduce onset of post-op AF in surgery patients and a post-operative AF treatment algorithm to standardize care (in progress)

Standardization of Anti-Coagulation An AF anticoagulation algorithm to standardize care and identify novel ways to increase patient compliance (launched)
Education

Regional AF Symposium (held April 2017).

AF 101 and AF Ablation patient classes (launched)

Research

A study to improve outcomes from concomitant surgical MAZE (in progress). A study to improve outcomes from surgical stand-alone MAZE procedures (in progress).

A study to examine the utility of cardiac MRI to assess percutaneous and surgical ablation lesion sets (in progress)

Long-term Outcome Follow-Up A model to assess outcomes of all ablation patients (percutaneous and surgical), including quality of life (in progress)
Complexe Arrhythmia Heart Team Complex Revascularization Heart Team
Triage Model A model in which a multi-disciplinary team triages patients to most appropriate patient-centred care (percutaneous, surgical, medical therapy)  (in progress)

Hybrid Coronary Revascularization Model

A collaborative model which combines advances in cardiac surgery and interventional cardiology best approached in a hybrid OR (in progress)
Education Education classes for patients with coronary artery disease: A structured patient self-care management discharge tool provided to coronary artery bypass graft (CABG) patients (launched)
Research A feasibility study of coronary physiology and the effect of coronary revascularization in patients with diabetes mellitus and coronary artery disease (in progress)
Long-term Outcome Follow-up

A model to assess outcomes of all coronary revascularization patients, including quality of life (in progress)

Complexe Arrhythmia Heart Team Women’s Heart Health Team
Women@Heart A peer-to-peer support group for women with established heart disease who need to deal with psychosocial issues before they can consider lifestyle changes (launched)

Cardioprevent

12-month regional primary prevention program targeting women at medium-to-high risk of heart disease through primary care. Patients undergo risk factor screening, receive tailored education and programming supported by behavioural-based counselling, follow-up and referral, and community resource linkages. (launched)
Virtual Care An online cardiovascular health management system that provides the best practice strategies for the control and management of risk factors related to heart disease (launched)
Research Access A study to assess if women in the Champlain region are under-referred and if there are disparities in access and referral patterns (in progress) 
Research Risk

Early Vascular Aging in Women at Risk for Cardiovascular Disease: The EVA Study (in progress)

Complexe Arrhythmia Heart Team Critical Care Heart Team
Patient-Centred Model A multi-disciplinary team approach for patient rounds that emphasizes safety, efficiency and best practice care delivery (in progress)

Database

A critical care database to support research and quality improvement initiatives (in progress)
Process Alignment Alignment of processes, policies and orders among all critical care units based on clinical and process best practices (in progress)
Regional Strategy A regional strategy designed to improve referral and repatriation of patients from community hospitals (in progress)

Strategic Direction No. 2: Building Up Our Infrastructure

Building Up Our InfrastructureThe Life Support Capital Project continues to represent the most significant expansion in the life of the Heart Institute. With the support of the Ministry of Health and Long-Term Care (MOHLTC), Infrastructure Ontario and the community, more than 145,000 sq. ft. of new space will be added to our current facilities to ensure the continued provision of world-class specialized cardiac care in our region.

With the now completed superstructure for the new tower, construction is now focused on enclosing the building. Finishing of the interior spaces has also commenced and is moving along at an extremely fast pace, with the anticipated completion date being March 2018. In advance of this date, certain key rooms will be turned over earlier to the UOHI so that new state-of-the-art equipment can be installed to facilitate commencement of procedures in the tower by the beginning of April 2018.

Once the tower has been occupied, construction will move to the inside of the existing UOHI buildings where approximately 60,000 sq. ft. of existing space will be renovated to accommodate the relocation of the Cardiac Imaging Department and provide additional support space for both the cath/EP and surgical suites. In parallel, the Main Lobby will be fully renovated, including a brand new main entrance. The interior renovations will commence in April 2018.

New Features

  • More than 145,000 sq. ft. of new space
  • Five operating rooms and one shelled-in operating room
  • Nine catheterization/electrophysiology labs
  • An additional surgical critical care unit for 27 beds
  • A central registration area in the lobby
  • Escalator access to upper and lower floors
  • A shelled-in floor for future expansion

Strategic Direction No. 3: Growing Our Institute Model

The Heart Institute is a unique cardiac centre that integrates care (treatment, prevention and rehabilitation), research (clinical and laboratory) and education (medical and allied health) in a single facility.

Each of these activities informs the others, allowing us to continually improve our outstanding care, advance the standards of cardiac treatment, extend the knowledge base and understanding of heart disease and train the next generation of cardiovascular professionals.

Patient and Family Engagement

Patient- and family-centred care is at the heart of everything we do. A key component of this is patient and family engagement and development of a culture of engagement among the hospital leadership, board, researchers, staff, patients and families. Robust patient engagement is a strategic priority that is integral to the quality of both clinical care and research.

To further our goal of becoming a world-class patient-centred heart institute in Canada, we have created a management framework and a committee structure to inform and manage engagement efforts, supporting the Institute’s research activities and contributing to the improved delivery of services to patients.* A senior management steering committee provides oversight and stewardship of two operational committees:

  • The Patient Engagement in Research Advisory Council advises and develops strategies and activities to engage patients in all aspects of research at the Institute.
  • The Patient Partnership Committee works to enhance the patient experience at all levels of clinical care.

Both operational committees are comprised of management, researchers and clinical staff, patients, family members and members of the Patient Alumni Association.

*Definition of patient in this context: patients, family members, relatives, friends and caregivers

At the Heart of Patient Care

930+ Clinical staff including:

  • 500+ Nursing staff
  • 160+ Health professionals
  • 250+ Support staff

Achievements Through Our Multidisciplinary Model

  • STEMI – Pioneering heart attack program in Canada
  • ROSC – A standardized, multidisciplinary regional program for patients having out-of-hospital cardiac arrests
  • Advanced transcatheter ablation of atrial fibrillation
  • Heart transplantion and ventricular assist devices
  • Complex valve repair – Leading program in Canada
  • Canadian leader in advanced arterial conduit for surgical coronary revascularization
  • Percutaneous valve replacement (TAVI) and repair (MitraClip)
  • Percutaneous left atrial appendage closure to prevent stroke
  • High-risk percutaneous coronary intervention
  • Multimodality cardiac imaging (MRI, PET, CT, 3D echo) for personalized medicine
  • Canadian leader in prevention for smoking cessation and women’s heart health

Measuring and Evaluating Quality and Outcomes

The University of Ottawa Heart Institute prides itself on its quality of care and high levels of patient satisfaction. As we see more patients every year, our patient satisfaction ratings remain among the very best in Ontario.

Patient Satisfaction

Graphic illustrating an 84% patient satisfaction rate

*The Ministry of Health and Long-Term Care has modified its reporting of patient satisfaction. The result reflects this new mandated methodology.

Caring in Both Official LanguagesCaring in Both Official Languages

As a public service agency designated by the Ministry of Health and Long-Term Care under the French Language Services Act, the Heart Institute must guarantee access to quality services in French for designated services on a permanent basis, including:

  • Permanence and quality of services
  • Guaranteed access to services
  • Adequate representation of Francophones
  • Responsibility for French language services (Accountability)

Every three years, designated agencies must show how they have maintained this level of service. In June 2016, the Heart Institute submitted a report to the Ministry, detailing how this was achieved. In addition, an annual report was submitted to local networks and internal committees.

Expanding Our Clinical Services

Procedure and Diagnostic Test Volumes

Procedures 2014-15 2015-16 2016-17
Coronary Artery Bypass Grafts (CABG) & Other 792 833 1,019
Valve/CABG (combined) 227 223 215
Valve Surgery 543 516 466
Transplants 26 29 29
Ventricular Assist Devices 15 12 9
Total Surgical Procedures 1,603 1,613 1,738
Catheterizations 6,030 6,415 6,607
PCI (Angioplasty) 2,541 2,518 2,591
Electrophysiology Studies 517 505 528
Ablations 585 578 608
Pacemakers 659 791 779
Defibrillators 430 460 470
TAVIs (Percutaneous valve replacement) 97 92 106
Mitraclip (Unfunded procedure) 25 25 25
Total Non-Surgical Interventions 10,884 11,384 11,714
Total Diagnostic Tests 51,020 53,156 55,634

Sharing Our Story

UOHI Website

Sharing Our Story - UOHI Website

HeartHub

Sharing Our Story: HeartHub

Social Media

Sharing Our Story: Social Media

myOttawaHeart patient portalPutting Patients First with myOttawaHeart.ca

The myOttawaHeart patient portal was launched in 2016. The secure online information system enables patients to access their personal health information and educational resources to support self-care, as well as share information with caregivers and physicians. More than 1,700 patients are now registered.

Procedure Management and Supply Cost Tracking with PICIS

This new management system for the catheterization labs, electrophysiology labs and operating rooms facilitates scheduling, wait list management, patient flow, charting and budgeting. In addition, PICIS is linked to the inventory system to better track supply usage and cost capture for each procedure performed.

Virtual Desktops with MyWorkspace

To support clinical staff whose must move about the Heart Institute and access information systems from the nearest available workstation, myWorkspace provides a virtual version of their desktop from any computer. With the swipe of a badge and a single password, staff have access to their software, data systems and files throughout the Institute. myWorkspace is being implemented in phases and will be complete in the summer of 2017.

Integrated Clinical Research Data with Cardiocore

Cardiocore is a new data integration platform that will span all clinical research activities. This effort will improve harmonization of data and allow for broader analyses across treatment areas. Heart Valve represents the first area to be integrated. Arrhythmia, Revascularization and Biobank are in process.

STS Database

Developed in the United State, the Society of Thoracic Surgeons (STS) database is a powerful source of risk-adjusted outcomes, allowing surgeons and hospitals to measure their results, using accurate data, against an accepted standard that accounts for the varying risk of their patients.

Recognizing the importance of continuous quality improvement, in 2016 the Heart Institute in conjunction with the Cardiac Care Network (CCN) of Ontario began the process of implementing the STS database at the Institute. Participation will allow the Heart Institute to compare its surgery outcomes both provincially and internationally, will provide numerous quality performance measures and will be an excellent resource for quality improvement and patient safety.

Strategic Direction No. 4: Enhancing Our Global Research Impact

Enhancing Our Global Research ImpactSuccesses in 2016-17 included an excellent grant success rate, the installation of new multi-million dollar research equipment and the recruitment of new scientists and clinician scientists. To ensure that we maintain momentum, we undertook an international review of our research enterprise. The panel was chaired by Dr. Joseph Wu, MD, PhD, Director, Stanford Cardiovascular Institute. The panel commended the major strides that have been made in regional collaboration and recruitment of promising early career investigators, as well as recent grant successes. We are now consulting broadly in developing ORACLE 2.0 (2017-21).

Featured Publications

Journal: Science Advances
Dr. Katey Rayner, PhD, and her team in the Cardiovascular microRNA Laboratory uncovered a major role for inflammatory cell death in driving the potential for atherosclerotic plaques to rupture. When excessive cholesterol accumulates in macrophages in the vessel wall, a process called necroptosis is activated, which causes cells to explode and promote inflammation. In coronary arteries from humans with very large and advanced disease, necroptosis was activated and, in mice, necroptosis inhibitors reduced progression of disease. This work has formed the basis of the commercial development of necroptosis tracers for non-invasive imaging.

Journal: JACC Cardiovascular Interventions
Dr. Michel Le May, MD, and colleagues published a study investigating the safety and efficacy of a pharmacoinvasive strategy, compared with a primary percutaneous coronary intervention (PCI) strategy for STEMI heart attacks. It was found that the efficacy of a pharmacoinvasive strategy is similar to that of the preferred primary PCI strategy, but there was a tendency for more bleeding with a pharmacoinvasive strategy. The study demonstrates that the use of a regional STEMI program (such as that at UOHI) that uses both primary PCI and pharmacoinvasive strategies, based on geographical proximity to the PCI centre, is safe and effective. These results are encouraging for centres that do not have rapid access to PCI.

Key Highlights of the Year

  • New Recruits: Two new PhD scientists were recruited in partnership with the University of Ottawa, Faculty of Medicine: Dr. Benjamin Rotstein, Director of the Molecular Imaging Probes and Radiochemistry Laboratory, and Dr. Mireille Ouimet, Director of the Cardiovascular Metabolism and Cell Biology Laboratory. Both have already been successful in obtaining operating grants.
  • Stellar Success Rate at Granting Agencies: The success rate of our researchers was once again above the national average in the open competitions at both the Canadian Institutes of Health Research (CIHR) (22-25% UOHI versus 13% National) and the Heart and Stroke Foundation of Canada (50% UOHI versus 20% National).
  • Minister of Health Visit: The Honourable Jane Philpott, Minister of Health, visited in January to announce $2.9M in funding from the Canadian Institutes of Health Research to Institute researchers.
  • Globally Recognized Smoking Cessation Program: The Ottawa Model for Smoking Cessation team was awarded $2.3M from the Ontario’s Ministry of Health and Long-Term Care for the continued implementation and evaluation of this world-renowned program.
  • Awards and Fellowships: Six endowed graduate awards and research fellowships were awarded in a highly competitive process. These trainee awards assist the Institute in recruiting the best and brightest graduate students and fellows from all corners of the globe.
  • Hosting International Conferences: A successful Ottawa Heart Research Conference, in collaboration with the Toronto Ottawa Heart Summit, was held in June 2016 on the topic of atrial fibrillation with the world leaders in afib research in attendance.

Major Awardees

Research by the Numbers

  • 69 research faculty, including 24 scientists and clinician scientists
  • $13.8M awarded in peer reviewed grants
  • 272 published research articles
  • 274 active clinical research studies
  • Over $7M of grant-funded new research infrastructure installed, including a state-of-the-art confocal microscopy suite and preclinical MRI scanner
  • Hosted 3 international conferences, including the Ottawa Heart Conference, Toronto Ottawa Heart Summit and the Ottawa Model for Smoking Cessation Conference