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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9 Clinical Care 2014, the NICU and Level 2 nursery transitioned to a mixed acuity model. This new model will streamline care and should improve access to tertiary neonatal care. In conformity with recommendations from the Provincial Council of Maternal and Child Health, we de-linked maternal admissions from NICU bed occupancy status, so that any mother needing specialized care at Mount Sinai will always be admitted and cared for. In 2013, we also implemented a fully electronic order-entry system for the NICU, and are currently preparing to implement a fully electronic medical information system in 2014. Changes in Staff Numbers and Organization Since 2009 we have increased the number of staff neonatologists in the department by 3.7 FTE, and added a Nurse Educator position, a nursing Clinical Coordinator position, and a dedicated Quality-Safety Nurse. These positions were added to improve the quality and continuity of care provided in the Department. In particular, staff neonatologists now provide coverage within the David & Stacey Cynamon Mother & Baby Unit so that the unit does not have to rely on external paediatricians to provide coverage: the coverage model was changed to a weekly format from a daily format to improve continuity of care for patients in the Level 1 nursery. The Nurse Educator provides training for nurses and the Quality-Safety Nurse coordinates and tracks the activities of the Improving Quality team. The job descriptions of staff physicians were clarified, with neonatologists assigned to distinct career tracks as academic clinicians, scientists, educators or administrators, and with clear responsibilities, expectations and performance-based reimbursement. With the expansion of the neonatologist team we welcomed Drs. Amish Jain, Shoo Lee, Sandra Leibel, Adel Mohamed, Martin Offringa, and Jennifer Young to the Department. During the same period Drs. Olufunmi Akindele, Afif El-Khuffash, Gerda Meijler, Maggie Shu, Connie Williams, and Simone Vaz moved to positions at other institutions. We are very grateful for their work and support during their tenure at Mount Sinai Hospital and wish them well in their new endeavours. Reorganization of the department and improvement in our revenue stream enabled us to reduce the annual departmental operating deficit from $1M to $0, while increasing and introducing new services at the same time. In addition, Mount Sinai is now the most cost- efficient NICU among hospitals in Toronto, delivering care at the lowest cost per patient day. Functional Echocardiography Service In 2010, we acquired state-of-the-art ultrasound equipment and recruited Dr. Amish Jain, who is fully trained in cardiac echocardiography, and now provides in-house echocardiography services for infants needing closer examination of the heart. This significantly reduces the need for transfer of patients to SickKids for assessment and shortens the time to diagnosis so that treatment can be provided promptly. During the past 2 years, the service has performed 206 in-house echocardiographic consultations, and was life saving for at least 3 infants. Mount Sinai is now 1 of 2 functional echocardiography training centres in Toronto and physicians come from across Canada and elsewhere for training. Postnatal Ambulatory Clinic (PNAC) In July 2011, PNAC was established to provide consistent outpatient care during the early postpartum and neonatal period for new mothers and their infants delivered at Mount Sinai. Lack of this type of service was noted to be a gap in the community, as many of these mothers and infants were accessing emergency rooms for routine postnatal and neonatal issues due to difficulty in accessing outpatient neonatal care, especially outside of regular working hours. Families are encouraged to identify a community provider for the care of their newborn; however, there is variability in the access to community outpatient clinics. The clinic was set up in response to this identified problem in order to prevent babies from developing more significant conditions, such as dehydration and complications of jaundice. The maternal support team provides breastfeeding support, maternal postpartum assessment, maternal staple/clip removal, and maternal blood work. The clinic paediatricians provide services, such as screening and neonatal assessments for babies less than 3 months of age for near-term infants and less than 1 month