Please see below for the following updates:

• Chief Medical Resident Update
• Conserve blood culture bottles to maintain supply
• Epic Systems training registration opened in Unity Health’s Learning Management System (LMS) on June 26
• Video Link: Unboxing EPR devices
• Portfolio changes in Kidney and Metabolism Program
• Awards and Honours

 With every new academic year, we say goodbye to our Chief Medical Resident.  Please join me in extending our sincere thanks to Dr. Orly Bogler for the tremendous job she has done over the past year! Her support and advocacy for the residents has been outstanding! We wish her well as she embarks on her GIM fellowship.

Please join me in welcoming Dr. Daniel Huang, who will become Chief Medical Resident as of July 1!  We all look forward to working with Daniel!

On June 18, we shared a message informing physicians of a global shortage of BD blood culture bottles impacting our St. Joseph’s and St. Michael’s sites and requesting that clinical staff and physicians follow best practices for blood culture draws to help us maintain our supplies. We also shared this message to all staff, via Twice a Week.

Since sending these messages, we have not seen a change in usage levels across the two acute care sites. It is imperative that we work together to minimize unnecessary blood draws and help prevent a more significant supply issue.

Please help us by following these best practices:

1. Collect two sets of blood cultures (one aerobic and one anaerobic bottle) for each febrile episode within 24 hours. Take up to three sets if there is a high suspicion of endocarditis in adults. Please review previous orders to avoid duplicate collections.
2. Pay close attention to the fill volume to meet 8-10 mL per bottle for adults. For pediatric patients, follow the volume collection guidelines.
3. Closely adhere to aseptic technique (disinfecting the bottle stopper) and skin preparation.
4. Favour collections from peripheral venipuncture sites.
5. Repeat blood cultures are only warranted to test for clearance of select patients (i.e. staphylococcus aureus, candida species blood stream infections, patients with endocarditis). Test for clearance is not required for patients with gram negative bacteremias with clinical improvement.
6. Do not inoculate blood culture bottles at the bedside with other sterile bodily fluids. Instead, aseptically collect and send the fluid in sterile containers.

We will continue to share updates, as needed. Thank you for your assistance in this important matter.

Original message below

Date: June 18, 2024

Subject: Key actions to conserve blood culture bottles

We were recently informed of a global supply chain disruption to BD blood culture bottles. This shortage is impacting all Canadian hospitals and blood collection centres that use BD supplies. We anticipate the shortage to last for the next three months, at minimum, and we are collaborating with other organizations and the vendor for alternatives.

To conserve our supply of blood culture bottles at Unity Health Toronto, it is essential that you follow these best practice recommendations for blood culture draws:

1. Collect two sets of blood cultures (one aerobic and one anaerobic bottle) for each febrile episode within 24 hours. Take up to three sets if there is a high suspicion of endocarditis in adults. Please review previous orders to avoid duplicate collections.
2. Pay close attention to the fill volume to meet 8-10 mL per bottle for adults. For pediatric patients, follow the volume collection guidelines.
3. Closely adhere to aseptic technique (disinfecting the bottle stopper) and skin preparation.
4. Favour collections from peripheral venipuncture sites.
5. Repeat blood cultures are only warranted to test for clearance of select patients (i.e. staphylococcus aureus, candida species blood stream infections, patients with endocarditis). Test for clearance is not required for patients with gram negative bacteremias with clinical improvement.
6. Do not inoculate blood culture bottles at the bedside with other sterile bodily fluids. Instead, aseptically collect and send the fluid in sterile containers.

As we currently have limited control over blood culture bottle supply, the main way we can help is to minimize unnecessary blood culture draws. These conservation efforts must continue over the coming months to help prevent a negative impact on patient care.

We will provide updates regularly. We appreciate your assistance in helping to stretch our supply as we work through this global supply chain shortage.

To prepare the organization for our Epic EPR system, all Unity Health staff, physicians and learners who will use the new system once it launches on Nov. 30 are required to complete training on the new system ahead of go-live. The training program consists of e-learning, classroom training, a proficiency assessment and hands-on practice. Training will take place between Sept. 30 and Nov. 22, with registration opening on June 26.   

Unity Health nurse practitioners, learners and physicians, including medical students, fellows and residents, will register themselves. Midwives will also self-register for midwife-specific training. More information on this process will be provided to these groups directly in the coming days. Please stay tuned.    

More information, including the classroom training requirements, expectations and exemption process for staff, physicians and learners with recent and relevant Epic experience, will be provided later this summer. In the meantime, ALL staff, physicians and learners who will use our new EPR system once it launches will need to secure a spot for training.

Thank you in advance for your cooperation with this. We understand that training takes time out of your busy schedules but ultimately, our new EPR system will improve workflows, efficiency and the provision of care across all Unity Health hospital sites. If you have any questions, please email [email protected]. 

A video from the Project Connect team: Unboxing EPR devices with Giuseppe Cammisa

Unboxing EPR devices with Giuseppe Cammisa on Vimeo

With the upcoming retirement of Elizabeth Anderson, Clinical Leader Manager for Home Dialysis and Multi-Care Kidney Clinics, the Kidney and Metabolism Program has re-aligned the management structure. Effective July 15, Michelle Gabriel will transition to managing the following teams: Home Dialysis, Multi-Care Kidney Clinics, Kidney Transplant and the Nephrology/Urology Ambulatory Clinics. Recruitment is underway for a new manager to lead the 8CS Transplant/Nephrology/Urology inpatient unit. In the interim effective July 15, Dayoung Sohn, Clinical Educator for 8CS will provide day to day coverage on the unit with Michelle continuing to support as needed. For any questions related to this opportunity or transition please contact Dana Whitham.

Congratulations to:

• Sharmistha Mishra received the inaugural University of Toronto Infectious Diseases 2023-2024 Early Career Contribution Award
• Malika Sharma received one of the University of Toronto Infectious Diseases 2023-2024 Early Career Teaching Awards