This article was originally published in the 2020 Summer digital issue of Invest In Style Magazine.
Dr. Howard Ovens greets me with an elbow bump as I enter his office in early March. The COVID-19 crisis is just beginning in Ontario and social distancing has not yet begun. As Chief of the Emergency Department at Mount Sinai Hospital during the time of SARS, 17 years ago, Dr. Ovens is not unfamiliar with all that is to come.
“The challenge will be to slow community transmission,” he says, speaking about what we now know to be ‘flattening the curve.’ “The last thing we want is to overwhelm our emergency rooms, especially since there will be the normal visits to the Emergency Department [ED] for other medical emergencies. Amidst the virus it will still have to be business as usual.”
That business has been Howard Ovens’ life work. He has been an emergency physician at Mount Sinai Hospital since 1982, 30 of those years spent as chief of the department. For the past 11 years he has been Ontario Expert Lead for Emergency Medicine and holds the rank of Professor at the Department of Family and Community Medicine at the University of Toronto. In April 2017, Ovens was appointed Chief Medical Strategy Officer for the Sinai Health System, a role created for him with the mandate of expanding the vision of Sinai Health as a seamless system for patient experience.
“The vision of Sinai Health is to unite different parts of the healthcare system. The system tends to work in silos. We are trying to change that,” Dr. Ovens tells me.
Nowhere has that seamlessness been achieved more effectively than through the alliance with Bridgepoint Active Healthcare – a world class rehabilitation and complex care facility. Through their amalgamation in 2015, patient care was dramatically improved as patients could now be transferred there, sometimes without even being admitted to hospital.
“Normally we can get beds quickly,” says Ovens, “and have achieved efficiencies in moving people who don’t require acute care because we are part of one organization.” Ovens is currently working as co-leader with Sinai’s Chief of Family Medicine, David Tannenbaum, to assess what community family doctors require to ensure continued seamless care between Mount Sinai, Bridgepoint, and home.
Ovens says that it is this kind of communication that is at the root of seamless care. Communication that can be improved through technology and innovation. “I personally wanted to see us support innovation through information technology. Many of our doctors have developed apps that work to help patient care and we work with them to bring their ideas to life.”
One such app was developed by Dr. Erin Kennedy, a colorectal surgeon who believed her patients could go home sooner and recover in their own environment by uploading information onto the app that would then be assessed by a designated doctor at the hospital. Another app allows ED doctors to better assess tremors in a patient experiencing alcohol withdrawal, one of the most common presentations in the ED.
In another area of the hospital, communication is a little more hands-on, as seen in Mount Sinai’s flagship Women’s and Infants’ Program. “We have more than 7000 births a year at our hospital,” says Ovens, “and 60% of those births are high-risk pregnancies. Our neo-natal intensive care unit is the largest and highest acuity ICU in Canada.” The neo-natal program is a world leader in their Family Integrated Care Program that teaches parents to administer care to their babies as much as possible within 24 hours of delivery. The result is better bonding, earlier discharge, and better outcomes for families.
To help Ovens in his initiatives, Sinai has created a quality improvement committee comprised of doctors who have taken advanced training in the area of studying, assessing and evaluating needs of the hospital. It is their job to collaborate, to share ideas and to mentor others, all with an eye to improving the quality, safety and efficiency of care at the hospital.
“Quality improvement or implementation science is a growing area in medical knowledge and education,” says Ovens. “It simply comes down to offering the best patient care.”
That patient care, and business as usual, has been anything but usual of late. Just weeks after we first met, Ovens was asked to join the Ontario Health Response Table, and found himself out of the ED and instead working seven days a week on the COVID-19 pandemic response.
“We prepared and prepared for the tsunami of cases that was possible in our EDs,” says Ovens, “and while we certainly had a lot of cases and a lot of tragedy, we managed it well.”
Ovens says that it helped that the virus came late to Ontario, and that we were able to learn from other places that were overwhelmed with cases. “Our actions worked,” he says, citing a combination of social distancing and the closing of our businesses and schools, along with hospital preparedness and the availability of dedicated medical staff as positive forces in the battle.
“The EDs are also operating at lower than usual capacity,” says Ovens, although he points out that is not always a good thing.
“Ambulance arrivals and hospital admissions are almost the same,” he says, “so we know that the most ill are still coming for medical attention, but we also heard stories of people delaying other issues. That is not a good thing and we want everyone to know that visiting our emergency departments is safe. If you need intervention for an urgent medical problem, it is best not to put things off.”
Good advice, especially given the chance that COVID-19 will make a resurgence.
“Yes, a second wave is coming,” says Ovens, “but exactly when it will be and how bad it will be remains to be seen.”
He says that continued vigilance and getting a seasonal flu shot will be critical this year so medical personnel can know quickly who has the flu and who might have COVID-19.
In the meantime, as cases are being managed and as he turns his sights to his continued mandate, Dr. Ovens is back for shifts in the ED.
“If I am not on the front lines, I can’t be doing this work.”
Business as usual.