Perspectives magazine is an annual glossy supporting the Mount Sinai Hospital Auxiliary, Mount Sinai Hospital and the Samuel Lunenfeld Research Institute.
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8 Clinical Care Clinical Care Overview Mount Sinai Hospital has one of the largest academic obstetrical, gynaecological, and neonatal programs in Canada. Close to 7,000 infants a year are delivered in the hospital; of these approximately 1,600 are born to mothers with high-risk pregnancies and over 1,100 are admitted to our neonatal intensive care unit (NICU). To serve this patient population, the Department of Paediatrics provides a full range of services including: • Antenatal consults for women with high-risk pregnancies in our Labour and Delivery Unit, Antenatal Ward, and Special Pregnancy Clinic; • Resuscitation and stabilization of all newborn infants in Labour and Delivery; • Level 2 and Level 3 neonatal care in our 57-bed NICU using a mixed acuity model; • Normal newborn care in the 55-bed David & Stacey Cynamon Mother & Baby Unit; • Outpatient postnatal and postpartum care in our Postnatal Ambulatory Clinic (PNAC); • Breastfeeding support in our breastfeeding clinic; and • Developmental follow-up for high-risk infants. The numbers of patients we provide these services to annually are shown in Table 1. The Department of Paediatrics continually strives to improve the care we provide to patients. In the last 5 years, under the guidance of Dr. Shoo Lee, significant changes have been made to improve the quality and continuity of care provided to our patients, with a significant focus on providing patient- and family-centred care. Changes in the department include improvement to the facilities; expansion of our staff numbers and reorganization of the department; establishment of a functional echocardiography service, postnatal ambulatory clinic, the Neonatal Developmental Follow-Up Clinic, and the Rogers Hixon Ontario Human Milk Bank; implementation of a quality improvement process; and development of new patient- and family-centred programs and models of care, such as the Parent Partner Program and the Family Integrated Care Program. Improvements to Our Facilities In May 2012, the Mother and Baby Unit moved into a brand new state-of-the-art facility. The new David & Stacey Cynamon Mother & Baby Unit has 40 more beds; decentralized care stations that allow clinicians to be closer to the point of care and enable computer charting outside patient rooms; a clean and safe environment for patients that includes more sinks closer to patient rooms; and more enhanced security for our patients. The number of beds in the NICU was also increased by 3 in 2009 to 57. In September 2013, our department moved to a newly built office space on the 19th floor, which enabled our increased number of staff to work together within the same area. The arrangement of the offices around a central administrative area is much more efficient than our previously spread out accommodations. In addition to improving the facilities over the last 5 years, we are preparing to move to a new NICU that is currently being built and will be ready in fall, 2014. The new NICU will be a single-room design where each infant will be cared for in a separate room, thereby providing adequate privacy and space for families while spending time with their infant, better environmental control for noise and light, as well as facilitation of infection control principles. The model of care within the NICU will be a mixed acuity model where Level 2 and Level 3 neonatal care can be provided in any bed, thereby limiting movement of patients due to acuity. In preparation for this, in January Table 1: Patient Contacts in the Department of Paediatrics (2009–2013) Year # of Antenatal Consults # of Newborn Admissions to Mother & Baby Unit # of NICU Admissions # of PNAC Visits # of Follow-Up Clinic Visits Follow-up Rate 2009 937 5773 1083 0 0 NA 2010 944 5779 1214 0 454 76.8% 2011 1002 5802 1212 302 1003 75.6% 2012 1035 5571 1220 584 1073 82.7% 2013 1054 5846 1118 660 1083 82.1%