Located in Toronto, the University Health Network (UHN) is Canada’s top-ranked research hospital network and a leader in geriatric care. Current care for older adults combines multidisciplinary clinical support, education, quality improvement, research and community partnerships to improve outcomes in the ED.
Now, UHN is preparing to expand its focus on providing care for the aging population.
The multi-campus network is the highest funded research hospital in Canada, and a generous philanthropic gift on behalf of Myrna Daniels has made way for Canada’s first center of excellence for emergency care for older adults. The Myrna Daniels Seniors Emergency Medicine Centre will allow for expanded geriatric care and research to set the standard of care for older adults across the nation.
Daniels’ philanthropic contributions are motivated by her personal connection; she was a speech pathologist well-versed in the challenges of cognitive and functional impairments. When her husband, John Daniels, experienced dementia and other health conditions later in life, she saw the struggles of EDs firsthand.
“She would have to accompany [John] to the emergency department and she had a lot of really eye-opening and challenging experiences navigating the healthcare system, seeing how vulnerable older adults were. For years she has been trying to find a place, a home, for this type of work,” said Dr. Tessa Ringer, MD, JD, MPhil, director of the Myrna Daniels Seniors Emergency Medicine Centre. “Her philanthropy is very much grounded in her lived experience.”
Daniels’ landmark $52 million contribution to UHN will provide a physical location to continue their team’s current care practices while implementing additional evidence-based strategies to care for patients.
“What’s amazing about Myrna is that she really understands that it’s the care and the personal level of interaction that matters and makes the difference. The space is important; it’s hard not to be dazzled by what we’re building and it truly is amazing to see it coming together,” said Dr. Ringer. “But Myrna is completely aligned that it’s the people that matter and it’s the care that matters. How people are treated with dignity is really, really important.”
Going into the expansion, the research program is closely tied to clinical work as the team navigates criteria for admission for the Seniors Emergency Medicine Centre. Quality care will continue in the ED at UHN’s hospitals, and the team is building the groundwork for how these practices will have shared benefits.
“The program as a whole will have the unique feature of us being able to implement and study two different models,” said Nazek Abdelmutti, MPH, director of Seniors Emergency Medicine Centre and Older Adult Strategy at UHN. “One with a dedicated space for seniors, which we know most EDs will not have that benefit of, and one integrating the geriatric practices within an existing ED.
“Layering on the quality improvement, the clinical implementation, education and research into [the program] offers such a unique opportunity for us to be able to have some knowledge of translation of what it means to implement geriatric that’s practices in different environments.”
This level of research will allow UHN to diversify its care and learning to meet a diverse community. Between Toronto General and Toronto Western, diverse cultures and backgrounds bring older adults to the ED with varying needs.
“One of the challenges is that this is not a model that’s available in very many places. It hasn’t been extensively studied,” said Dr. Ringer. “There haven’t been a lot of cohort studies looking at what the right selection criteria are and even things like risk stratification tools for older adults have limited performance.”
UHN has already integrated geriatric best practices into its emergency departments at Toronto General and Toronto Western. Their multidisciplinary care team is made up of occupational therapy, social work and a geriatric emergency management nurse. In addition to screenings for delirium and frailty, the team prioritizes admission avoidance and early disposition in order to optimize their resources.
The program is one of the only completely female-led programs in academic emergency medicine. Proof of the high standard of care, UHN has applied for GEDA Level 1 Accreditation and will soon be the first Level 1 site in Canada, as well as one of the only multi-level hospitals with this accreditation.
Sharing insights from UHN’s success with GEDC’s worldwide network is part of the impact that will continue the research hospital network’s lasting legacy.
“Part of our mandate is to look at how we translate our best practices, the research, and the pinnacle work that’s being done to other different healthcare contacts at UHN,” said Abdelmutti.
With new physical changes coming to UHN, the quality of care is sure to remain. Thanks to Myrna Daniel’s philanthropic contribution, the new space is ready to showcase the skilled team who care for patients in the ED.
“The people and the specialists are the program,” said Dr. Ringer. “The space is just designed to help them really do their work better.”