Just before Easter Helena Dunbar, Director of Service Development and Improvement at Together for Short Lives, travelled to Canada to undertake the fist leg of her Churchill Fellowship.
If you haven’t already read it, and would like to follow her, check out Helena’s other blogs here and here. In this third blog instalment, Helena shares her first few days at British Columbia Children’s Hospital.
On Tuesday I spent the day with the Home Ventilation Team – Covid precautions are still very much in place and my mask was worn all day. The Home Tracheostomy Ventilation Program supports approximately 170 patients in communities across the province who have tracheostomies and/or home ventilation. At just under 950 square kilometres British Columbia is four times the size of Great Britain. Patients come from all over British Columbia for review by the team led by Dr Marie Wright, Pediatric Respirologist. Many families who travel from afar come for one to two days to be seen by difference specialties. Some take the opportunity to have some respite at Canuck Place children’s hospice, others stay in local hotels, others in Ronald McDonald House on the hospital site.
The spectrum of conditions which children presented with were wide ranging from acute traumatic injuries and infections causing respiratory issues to obstructive respiratory problems, neuromuscular complexities and congenital anomalies. The clinic is truly multi-professional – respirologists, ENT surgeons, respiratory therapists, nurses, physiotherapists, occupational therapist, educators and learners all come to see the child and their family as they wait in each clinic room.
It was an excellent day but I was very happy to get into my taxi ‘home’ – tired from standing and thirsty from wearing a mask all day – now I understand why everyone was carrying their own water bottles. Despite the organisational abilities of the clinic, the option for virtual reviews, technological review and downloading of data from afar, the clinic was a stark reminder of what so many families deal with at home and the mammoth task and organisation for parents to travel long distances to get their child reviewed and evaluated by specialist teams.
Returning to the hospital two days later I had the privilege to tour the intensive care facilities. The Hudson Family Pediatric Intensive Care Unit (PICU) is a 28-bed facility, separated into three distinct pods, FOX, SWALLOW and FROG – one of which is dedicated to Cardiac Intensive Care. The PICU is located in the Teck Acute Care Centre (TACC) which opened in 2017. Single patient rooms, state-of-the-art monitoring and a multitude of workspaces create an airy environment which seeks to support families during the most difficult times for many of them. Looking out the windows families can see the snow peaked tops of Grouse mountain which creates a feeling of peace and nature. Parents can stay beside their critically ill child, recliners and large double pull out beds are in each room.
Identified by the lit candle on the nurse station, I was able to see the end of life care and memory making undertaken by Child Life specialist (UK play specialist equivalent). An end of life mobile cart was filled with an array of materials to create and capture specialist moments and memories for families.
Whilst too often the challenges for many of the families we support are huge, distressing and often navigate towards end of life care, I could see that BC Children’s Hospital seek to support them as best they can. Supported by a pet therapy programme, therapeutic clown programme and sibling support programme, child life specialists and volunteers provide emotional support, comfort and healing to patients, families, caregivers and staff as best they can.
Caring for children and families in large intensive care facilities is also challenging for staff, the mortality rate is high, tensions are heightened, having significant conversations with families about their child’s care can place enormous burden on all concerned. The relationship with the hospice is good and a patient record system flags those children admitted to the unit already known to the hospice. The unit are also trialling a new practice innovation – Pediatric Ethics and Communication Excellence (PEACE) Rounds, formal weekly discussions of patients with prolonged PICU stay seeks to reduce staff moral distress and decrease length of stay for patients with life-threatening illnesses.
Leaving the hospital behind, I looked back at Downtown Vancouver to be reminded of its magnificence and how fortunate I have been to sample a small part of its children’s hospital.
