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Hospitals undergoing massive surgery to adapt to changing patient needs

A patient walks the hallway of the Royal Jubilee Hospital's new Patient Care Centre in Victoria, B.C.

Chad Hipolito for The Globe and Mail/chad hipolito The Globe and Mail

Health care is under enormous strain and many experts fear the situation will only get worse as demands on the system rise. To relieve the pressure, a growing number of hospitals are reinventing themselves in innovative ways, shifting the focus to the needs of patients instead of doctors. Using new technology, evidence-based practices and teamwork, hospitals are being restructured to accommodate the specific needs of vulnerable seniors. In addition, doctors are bringing the power of smartphones and tablets to the patient bedside, and teams of experts are experimenting with new ways to reduce the need for invasive surgery. The shift to patient-focused care is a move many experts say will define the next era of health-care delivery.

Designed with seniors in mind

As the population ages, hospitals – originally designed to treat patients with one specific ailment – are struggling to meet the needs of patients with multiple chronic conditions.

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Some, like the 500-bed Patient Care Centre at Royal Jubilee Hospital in Victoria, are adopting elder-friendly design models to take into account the complex needs of seniors. For instance, many elderly patients are susceptible to delirium, a serious condition marked by disorientation and disorganized thinking that can lead to major health problems and even death. Better hospital design can reduce disorientation and the likelihood of delirium, as well as reduce the spread of infection, the chance of falls and a host of other problems.

Principles of elder-friendly design include:

Single-patient rooms to reduce the spread of infection, decrease noise and stress levels;

No overhead paging systems to reduce noise, allowing patients to rest;

Large clocks in hallways and rooms to help orient patients;

Handrails leading from the bed to the bathroom so patients can move independently;

Distinct colours for walls and floors to help patients define the edge of the floor. Surfaces shouldn't be shiny, as glare can make it difficult to see;

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Use of signs and a simple layout to aid in orientation.

"We need to think about all those factors in the care of our patients," said Samir Sinha, director of geriatrics at Toronto's Mount Sinai Hospital, which is embarking on a project to incorporate elder-friendly design throughout and recently opened a new ward catering to seniors. "You can achieve better patient and system outcomes by better attending to those needs."

Making medical charts mobile

The rise of mobile technology has created an unprecedented opportunity for innovation in health-care institutions. But many hospitals struggle with how best to integrate the technology.

The Ottawa Hospital is emerging as a leader in the use of mobile technology, after starting an ambitious program to replace outdated paper charts and disjointed communication systems with tablet computers and smartphones. The ambition is to cut down on inefficiencies and errors among physicians, nurses, pharmacists and other staff.

Giving doctors iPads, for example, allows them to see a patient's X-rays or lab results as soon as they're available, and easily consult with other members of the health-care team. They also make it possible for doctors to visually explain to patients and family members what is happening with their care or what type of procedure they will undergo.

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"It's allowing and forcing physicians to get back to where they need to be, at the bedside and interacting with patients and explaining their care processes," said Dale Potter, the hospital's chief information officer. "In that regard, it's been very satisfying."

Smartphones let nurses call up a patient's information quickly, and the devices can fit in their pocket, freeing nurses from computer desks.

The program has required a major investment in hardware and the development of a mobile application that connects hospital staff with the information they need. Mr. Potter said everyone, including patients, has responded well to the change. In fact, the only complaint received so far was from a 77-year-old patient who said she thought it was unprofessional when her doctor came to see her and he wasn't carrying his iPad.

Reducing the need for surgery

More hospitals are experimenting with new technology that can allow them to do novel, minimally invasive procedures, such as killing cancerous tumours without making an incision or performing the most delicate heart treatments without cutting a patient open. Not only can these innovations reduce the risk of serious complications and speed recovery time, they may help reduce costs to the health-care system.

At Toronto General Hospital's Peter Munk Cardiac Centre, for instance, the new multipurpose operating room features teams of vascular surgeons, radiologists, cardiac surgeons and cardiologists using cutting-edge imaging equipment, which allows them to perform more minimally invasive procedures, such as heart-valve repair or aneurysm treatments, that eliminate the need for surgery. Not only does it speed recovery time, it also allows high-risk patients who may not have been candidates for traditional surgery to have access to these new innovative treatments.

Similarly, the new "interventional radiology suites" at the centre bring together radiologists and vascular surgeons with state-of-the-art imaging equipment to treat blood-vessel blockages, bleeding arteries and many other serious conditions without the need for invasive surgery.

A critical step is looking at how well innovative new procedures work and whether they create any risks for patients, said Vivek Rao, head of cardiac surgery at the Peter Munk Cardiac Centre. Just because something is new doesn't mean it is always best for patients, he said.

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