Proximity to “quite a nice community hospital” was one of the reasons that prompted former Ottawa residents Ron and Valerie Egan to retire to Blackfish Bay. Little did they expect that a dramatic rollercoaster 24 hours would demonstrate the benefit of living so close to St. Francis Memorial Hospital (SFMH). But on Aug.16 when Valerie lost consciousness and collapsed in the shower, their choice was proved right. Above: Ron and Valerie Egan
The patient’s story
Ron called 9-1-1 when he and her Personal Support Worker were unable to rouse Valerie. Once the paramedics arrived and assessed her condition using a portable electrocardiogram machine (ECG), the driver told Ron their next stop was SFMH and warned, “Don’t try to follow me, I’m going fast.”
Ron described his arrival at the hospital: “Here we are one o’clock in the afternoon. Emergency is packed to the rafters. Nobody is being seen. And everybody in the ER is in the room with Valerie including Dr. Malinowski.”
Dr. Jason Malinowski, Chief of Staff at SFMH, was on ER duty that day, and also happens to be the Egan’s family doctor. She was semi-conscious as the ambulance reached SFMH; Valerie said, “I remember saying ‘Hi Dr. Malinowski.’”
Dr. Malinowski updated Ron briefly: “She presented with a heartbeat of 15 beats per minute and at one point it went to zero. We had to stop what we were doing and do CPR…. We’re trying to stabilize her now.” Knowing that Ron and Valerie’s daughter-in-law, Melanie, is a doctor in Ottawa (who coincidentally once worked at SFMH), Dr. Malinowski told Ron the diagnosis was Stage 3 Heart Block and that Valerie would go by ORNG helicopter to the Ottawa Heart Institute, so Ron went home to pack a bag and notify his son, Kevin, that he was on his way.
When Ron called the Heart Institute from Ottawa after 9 p.m. to speak to Julie, the Critical Care Unit charge nurse, she immediately put Valerie on the phone to reassure Ron. Valerie was fitted with a permanent pacemaker the next day and returned home on Wednesday Aug.18.
“I didn’t want to bother the doctor”
Valerie told The Current: “I have no memory of the helicopter ride at all. I had symptoms for about a month – chest pain and a slow heartbeat. This is going to sound crazy, but I didn’t want to bother the doctor. Well, I sure bothered him on Monday Aug.16.”
The SFMH Team’s perspective
Dr. Malinowski remembers, “It was a busy summer day. We were keeping up with the waiting room which was filling consistently throughout the day until this [when] we put everything on hold for maybe an hour. [Then] Marissa looked after her when she was stabilized until the Air Ambulance came. And then I and nursing staff tried to pick up the pieces with the rest of the department.”
He outlined the SFMH critical emergency process: “When we get the call that a critical emergency is inbound, we need to make some instant decisions to prepare.”
- Make room in ER and assemble the team, anticipating need for staff from other areas of the hospital.
- Prepare ourselves with limited information from despatch and assign roles. (Team lead, IV access, medication administration, airway management, etc.)
- Maintain effective and clear communication during the assessment and treatment of a critical patient. “It’s not acceptable to just be standing back and giving orders that may or may not be completed. The whole team needs to be on the same page with respect to addressing current [and the next] priority.
Dr. Malinowski praises the team at SFMH, saying they work extremely well together, not only performing specific tasks but coming together for common problem-solving. He can ask, “What are you seeing from your end?” Or “Are we missing anything here?” He said everyone has a chance to contribute – and the insight that their training and experience brings is welcome. He said, “We are blessed to have such a dedicated staff, and also top-notch equipment that the community has provided for us through the St. Francis Valley Healthcare Foundation.”
Now in her final year of residency, Marissa Ukos is in a two-month rural residency at SFMH that began the first week of August. Her role was to stay with Valerie until the air ambulance left. As her first critical case here, the contrast with an urban Emergency Department was evident: “I think the biggest thing is patient resources. I did my medical school in Ottawa – bigger facility, more equipment … multitudes of nurses for more hands on deck … spare docs that can run the rest of the department or come give a hand if you need someone else to do similar tasks in the room…. So it’s definitely a challenge to work in a more resource-limited setting. But when you have an awesome team – everyone was super great at communicating – that is the key factor that makes it a lot easier. It doesn’t matter how many bodies you have if you’re not talking.”
Gregory McLeod, Chief Operating Officer at SFMH, said, “The University of Ottawa Heart Institute is also using EPIC so they already had everything that was in the chart and [knew] everything that had been done.” Cheryl Pecarskie, ER nurse at SFMH for 20 years, was on duty with Katlynn Aleck in ER that day. Pecarskie said, “They can watch what we’re doing pretty much real time…. pull up our blood work, our results, our notes, all our stuff, while [the patient is still here].”
SFMH conducts ongoing training
The Egans told The Current that Valerie’s condition prompted a training exercise a month after her incident (see poster).
Mary-Ellen Harris, Chief Nursing Officer & Director Patient Care Services, explained that the ER nurses require specialized training, but with limited staff resources, developing multiple skill sets is crucial: “We try to prepare our In-Patient Unit nurses similarly with orientation [in ER], some guidelines to know how to help in a situation … emergency-type things can also happen upstairs.”
Definition of Bradycardia: When the heart does not operate as it is supposed to and develops an abnormally slow heart rate that is less than 60 beats per minute, the condition is known as bradycardia. Source: cedars-sinai.org
The Egans are grateful for the care Valerie received. Ron said, “We feel so fortunate that Ottawa [Heart Institute] knew [her condition] exactly. SFMH is in the same hospital system so there weren’t any issues in terms of transmission or communication.” Valerie added, “If it’s a life or death emergency, you’re seen right away.”
Editor’s Note: This article was amended after publication. The EPIC EMR alliance includes St. Francis Memorial Hospital, Renfrew Victorial Hospital, The Ottawa Hospital, University of Ottawa Heart Institute, and Hawkesbury hospital.