Annual Report 2020-2021: An introduction from Daphne and Alex
Daphne Fedoruk, Chair, CHEO Board of Directors
Over a year ago, on March 11, 2020, the World Health Organization declared COVID-19 a worldwide pandemic. Nothing in our 2020-21 year was business as usual. Our top priority remained the same — ensuring children, youth and families have safe access to the best care. While the world shutdown in response to the virus, at CHEO our doors stayed open for those who needed us most. Beyond our doors, we reached into the community to provide our expertise and presence.
The COVID-19 pandemic was (and continues to be) a burdensome challenge for everyone, but especially for children, youth and families. Their patience and resilience has been inspiring. So much that is important to the physical and mental health and development of kids, not to mention their day-to-day happiness, was interrupted. Schools abruptly closed to in-person learning, opened, and then closed again. Playdates and group activities like sports were cancelled. Families were isolated from one another and kids didn’t enjoy time with their grandparents, aunts and uncles like they should.
We are proud of how Team CHEO delivered what matters to families. No matter where we were called or what we were doing, our spirit was constant. Masks, physical distancing and virtual care may have changed how we do things, but they did not change our care and compassion for kids, families, our community and each other.
As so many have said so often this past year, “We are all in this together.”
Alex Munter, President and CEO, CHEO
At CHEO
Staff and medical staff did whatever was required
On March 16, 2020 to protect the capacity of the system, health-care organizations in Ontario were instructed to temporarily stop non-urgent care, surgeries and procedures. At CHEO, this meant most appointments were temporarily halted. We went all-hands-on-deck to keep urgent services open and serving families which meant moving some staff and medical staff into new roles and departments to help out wherever the need was greatest.
For instance, many staff and medical staff were redeployed from their usual roles to ensure the safety of everyone still coming and going to CHEO. By May 11, 2020, just two months after the start of the pandemic, CHEO staff and medical staff had worked 5,500 hours and 735 shifts in new-to-them positions: nurses were screening families at entrances, physical therapists were escorting families to their appointments, and clerks were booking kids for testing at the CHEO COVID-19 Assessment Centre at Brewer Park. It was an awesome one team effort from day one!
Keeping COVID-19 out of CHEO
Screening everyone coming to CHEO for a risk of exposure to COVID-19 was a cornerstone of our safety protocols. To minimize crowding, children, youth and caregivers used the main entrance at the hospital (or the Emergency Department); staff and medical staff used different, designated entrances. Nobody coming to CHEO — children, youth, caregivers, staff, medical staff, learners, volunteers and contractors — came onsite without being met at the door and screened for symptoms, recent travel and possible exposure to COVID-19. For the year, CHEO was the only hospital in Ottawa without a single instance of staff-to-staff transmission of the virus.
Mandatory masks were handed out, temperatures were taken, and wherever risk was detected additional precautions were added to ensure everyone’s safety. For instance, if a family member was screened at risk for having contacted the virus in the community, they were routed to a new, dedicated clinic for a complete assessment and to determine what additional precautions were needed for them to still safely attend their appointment.
CHEO reconfigured all public and private areas to ensure adequate space for everyone to stay physically distanced (e.g. during wait times or for staff breaks). The Emergency Department, for instance, was redesigned to ensure ample space for a parent waiting with their child. An extra waiting room was added in the Radiology department, separating those waiting for ultrasounds and x-rays.
“We had an appointment at CHEO this week, it was our first time back since surgery in March, just before the pandemic. The precautions in place wowed us. We felt safe and secure, and knew we were in excellent hands, as we always are at CHEO. Thanks team,” said Angie H., mom of a child who visits CHEO often.
Adapting at COVID-speed
Adapting at COVID-speed, by March 24, 2020 we were screening all staff, medical staff, volunteers, and learners for the possible risk of COVID-19. Redeployed staff were deployed to staff entrances to assist their colleagues and ensure everyone stayed safe. By June, staff screening was moved completely online, freeing redeployed staff to return to their usual roles caring for kids. Throughout the year, Occupational Health and Safety updated the online screen to reflect the latest knowledge of COVID-19 and government instructions. Our entrance screening method served as a model for partner organizations throughout the region.
In partnership with families, the online screening tool for staff and medical staff was adapted and made available for kids and caregivers coming to CHEO. Rather than waiting in line to answer their entrance screening questions in person, they were able to complete their screening survey online prior to arriving onsite. This reduced wait time and line-ups at the CHEO main entrance and identified families who needed extra support while onsite for care.
Head-To-Toe suicide prevention screening
Whenever a child or youth first comes to CHEO as an inpatient, a nurse privately asks the patient a few screening questions to identify any possible risk suicide. This standard practice sets a tone of full support for a person’s physical and mental wellbeing from the onset. At CHEO, patients arriving in the Emergency Department or being referred to Mental Health have always been screened for risk of suicide but with the new Head-To-To program (named by a parent) screening was expanded to include medical and surgical patients too. The program aims to identify youth who are starting to have suicidal thoughts and provide early intervention, getting them the help they need.
“I find that, for a lot of families, asking these questions opens a conversation that they might not otherwise have been comfortable having,” said Emily Smith, a mental health nurse at CHEO. “When a youth responds ‘yes’ to any of these questions, it helps parents and caregivers identify those at risk of suicide and provide them with the necessary resources and appropriate monitoring of their child’s mental health needs. In this way, youth can be given the tools they need to grow into healthy, thriving adults.”
The Head to Toe at CHEO Program is made possible with community support and donations through the CHEO Foundation.
Caregivers are essential health-care partners
To reduce the number of people onsite at CHEO and minimize the risk of transmission, visitors were not permitted onsite. But, family caregivers are not visitors, they are critical partners in the care of every child and youth. Throughout the COVID-19 pandemic, one or two caregivers have always been permitted at a child’s side, whether for an Emergency Department visit, a clinic appointment, day surgery or an overnight stay. Parents and family caregivers not only provide comfort, love and peace of mind, they also provide the most important source of information about a child’s health.
Preserving our supply of personal protective equipment
In the early months of the COVID-19 pandemic, there was a worldwide shortage of personal protective equipment (PPE). Keeping everyone safe required careful use of our existing supply. CHEO supported supervisors to identify staff and medical staff who could safely and effectively work from home. This was a key part of our comprehensive PPE preservation plan — the fewer people coming onsite, the less PPE we were using. Everyone required for in-person care continued to work onsite but anyone who could work from home did — not only administrative staff but also clinicians like social workers who could still reach their patients virtually.
Our day-to-day PPE supply was reported to staff so that everyone could see the need and make their contribution to ensuring what we had would be enough to get us through until more supplies could be obtained.
The CHEO Research Institute (RI) stepped up with new research to investigate safely decontaminating and reusing N95 masks. Also thanks to original research at the CHEO RI, the National Capital Region became the first community in Canada to conduct and report daily wastewater readings of SARS-CoV-2 viral signal. Levels of the virus in wastewater became an invaluable tool in predicting whether the rate of infection in the community was likely to increase or decrease in following days, helping to shape critical public-health policy.
With non-urgent surgeries temporarily halted in the early weeks of the pandemic when the PPE shortage was at its worst, the CHEO Medical Device Rehabilitation Department shifted to focus on sanitizing PPE like face shields that previously had been disposed of. Again, everyone did what needed to be done. All hands on deck.
Canada’s first pediatric virtual Emergency Department
As soon as the pandemic began, we noticed the number of visits to the CHEO Emergency Department (ED) declined but children and youth who did come had worse symptoms than we usually see. With the start of the COVID-19 pandemic, many families were reluctant to leave their house. Concerned that children and youth we would normally see were not making it in for urgent care, we jumped into action.
CHEO became Canada’s first pediatric hospital to offer a virtual emergency department. Past and ongoing donor support for new information systems infrastructure channeled through the CHEO Foundation helped CHEO be poised to pivot quickly and maximize virtual care in the ED and elsewhere.
“We knew we needed to rally, quickly, to provide as much urgent care for kids as possible,” emphasized Dr. Lindy Samson, CHEO Chief of Staff. “Especially because a lot of family doctors’ offices were suddenly closed which is where these kids would normally go as their first choice for care.”
With 24 virtual emergency appointments per day using a private and secure video connection, CHEO’s virtual ED allowed families to stay safe at home but still get access to the urgent medical care they need.
Virtual family-centred medical rounds
If you have never been part of family-centred rounds in a hospital, you have probably seen an example on a television show — a group of staff and medical staff move from room to room, patient to patient, discussing each child’s care plan. For decades, this is the way rounds have been done in hospitals all over the world. But now, CHEO is doing it differently.
We bring the CHEO care team together with patients and family caregivers for a virtual daily consultation about every patient. All the important essential components of traditional family-centered rounds remain but, most importantly, everyone can take part in a child’s care without crowding together in the patient’s room. Virtual family-centred rounds are safer and more convenient.
“Several families have told us that they prefer virtual family-centered rounds as it is easier for them to interact with the care team, without the stress and disruption of everyone gathering at the bedside or outside the patient’s room,” said Dr. Buba. The entire team meets “face-to-face” with family members remotely. Onsite, we’re physically distanced from one another too.
Responding to the second pandemic
In 2020, at CHEO and in the community at large, we saw a well-described phenomenon that is commonly associated with pandemics — the “second pandemic” — which is a surge in mental health problems. At CHEO, we saw more children and youth with mental health needs. The Inpatient Acute Care Mental Health Unit and the Eating Disorders Inpatient Unit were completely full. To make room for as many mental health patients as possible, we were able to accommodate some eating-disorder patients in Medical and Surgical units.
Thanks for the supporters thought the CHEO Foundation and a major donation from the RBC Foundation, the Kids Come First Health Team secured funding to build One Call/One Click — a unique program to improve access to mental health and addictions services in our region. This will also offer support to youth and families who experience challenges navigating the service system.
In the community
Testing children and youth for COVID-19
Seemingly overnight, CHEO redeployed staff and medical staff from their usual roles to open the COVID-19 CHEO Assessment Centre at Brewer Park on March 13, 2020. The centre provides COVID-19 testing and assessment for children and youth with added supports for those who need it like children with complex care needs or autism.
In September, CHEO setup an online booking system so families could arrange testing appointments from the comfort of their own home. The goal was to make appointments easily accessible as well as minimize the need to stand in line with others arriving for testing — particularly with the cold of winter approaching.
By the end of March 2021, the COVID-19 CHEO Assessment Centre had tested 63,375 children and youth for COVID-19.
CHEO sings about hand hygiene… to the whole world!
On May 5, 2020, World Hand Hygiene Day, a handwashing tutorial sung to the tune of Are You Sleeping, Brother John? created by Dr. Nisha Thampi, an infectious disease physician at CHEO, was featured in a cartoon series for kids called Spike and Toody. The song, written by Dr. Thampi and her daughter Lekha, was also featured in the British Medical Journal. It coaches kids through the six-step handwashing method recommended by the World Health Organization, with the aim of helping children wash their hands properly. Occasionally in the halls at CHEO you can hear kids singing, “Thumb attack … thumb attack…”
“I never expected this response when I first wrote this song last year,” said Dr. Thampi. “To have so much interest in taking this song and sharing it across languages and communities is exciting and inspiring — we are all in this pandemic response together. I hope the song can do its part to help keep everyone safe and stop the preventable spread of infection.”
To date, Nisha and Lekha’s song has been translated into 27 languages, which are all available at cleanhandssavelives.org.
Drive through or drive up!
As much as possible in the pandemic, CHEO has prioritized safe, virtual care that keeps families at home and reduces the number of people coming to the hospital. But, not everything can be done virtually. Due to temporary closures of in-person appointments, we had to be creative with how to provide some services but innovation is how we roll.
The CHEO diabetes clinic came up with an innovative way to make sure children and youth still get their crucial Hemoglobin A1c test every three months — a drive through clinic every Tuesday!
For youth getting care from our Mental Health department, regular monitoring of their vital signs is an important part of their treatment plan. Blood tests and vital sign monitoring is a necessary in-person service offered to children and youth adjusting to new medications. These check-ups are essential to monitor for any negative side-effects, order bloodwork if necessary, and detect potential problems early. Mental Health transformed our Montreal Road location into a drive-up clinic for monitoring vital signs.
“Many of kids and teens we care for need this in-person service and can’t keep waiting for it,” said Dr. Marjorie Robb, CHEO’s acting Chief of Psychiatry. “We are happy to be able to provide this important, in-person service in a way that makes them feel comfortable coming in, and is convenient, quick and, above all, safe.”
Kids Come First Health Team makes an impact
Infants, children, and youth are not tiny adults — their health-care needs are totally different. They are still developing, they live with different illnesses, experience mental health and addictions differently. They require a wider range of health-care providers, have parents or guardians who co-manage their care, and attend daycare or school. For these reasons and more, we need to better connect health services for kids, making it easier and faster to access.
The Kids Come First Health Team includes over 60 organizations, family and youth partners, nearly 1,100 physicians, and thousands of individuals including children, youth and families — all working to improve care for kids.
As part of pandemic response, the Kids Come First Health Team rallied at COVID-speed to fill gaps in the health-care system and assist those affected by the virus. Hundreds of kids with colds and flu symptoms who could not be seen in the community by their family physician were able to be seen in-person by a doctor at the COVID-19 Kids Come First Care Clinic at the Brewer Park Arena. Respite services were organized for families who needed a break. A special immunization clinic was set up for children under two years of age to get their routine first series of immunizations who otherwise could not due to COVID-19 closures. A youth isolation centre opened for vulnerable youth, including those experiencing or at risk of homelessness, so that they would have a safe place to recover from COVID-19 or await test results at this site.
The Kids Come First Health Team also came together numerous times to support kids, parents, school boards, teachers and other health-care professionals in their return to school during COVID-19. They created a Virtual Back-to-school Backpack, which included resources such as tips for parents and caregivers, back-to-school recommendations for children with special needs and virtual town halls where questions could be answered first hand.
Supporting the grandparents of CHEO kids
When it first became clear that residents and staff at long-term care homes in Ontario were the hardest hit by the COVID-19 pandemic, the Ministry of Health asked hospitals throughout the province to lend staff and expertise to assist bringing the outbreaks under control.
CHEO was there, lending a helping hand. CHEO mobilized staff, medical staff, personal support workers, cleaners, infection prevention and control experts etc. to support targeted long-term care homes. Suddenly, over 60 staff were providing care to the grandparents of the kids we care for every day.
“I stepped up because they were desperate for help and I was in a position to provide that help,” said Strider Armstrong, a CHEO respiratory therapist that was deployed to a long-term care home. “We all wanted to do whatever we could to make a difference. Their staff were very welcoming, as well as staff from The Royal who were onsite too. It was a great team effort.”
CHEO staff and medical staff met so many amazing residents. These seniors taught us lessons with their presence, through their eyes and with their thanks. It is an unforgettable chapter in CHEO’s story and a great reminder that compassion is what sets us apart.
Our vision: the best life for every child and youth
Our mission: We provide exceptional care and advance how children, youth and families obtain it through partnership, research and education.
Masked or not, CHEO kept being CHEO
Our place in a year like no other |
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In 2020, amidst the urgent worldwide response to the COVID-19 pandemic, the Black Lives Matter movement shone a light like no other. CHEO has always stood against discrimination and racism and championed the importance of inclusivity and justice. Our vision at CHEO is the best life for every child and youth — every child, regardless of who they are or the circumstances of their birth. In 2020-21, we saw that we needed to do more. Racism harms the health and well-being of teenagers and children and has enduring impacts well into adulthood. Anti-racism is not a finish line to reach, it is ongoing work we all must do. Together, CHEO, the CHEO Research Institute and the CHEO Foundation formed an Equity, Diversity, Inclusion and Indigeneity Task Force made up of over 20 staff, medical staff, volunteers, patients and families across our three organizations. We will heed the call to listen and learn, to review our practices and to create ever safer, respectful, and equitable spaces. We are committed to engaging Black, Indigenous and other racialized voices internally and in the broader community to create a renewed plan of action. |
Butterfly Memorial |
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Our annual Butterfly Release is an opportunity to come together, reflect on and remember the lives of infants, children and youth lost too soon. It is presented by CHEO and Roger Neilson House in collaboration with The Compassionate Friends. As this event is such a special one, close to the heart of CHEO and families, it was important that we held it, despite COVID-19 restrictions on in-person gatherings. CHEO’s Butterfly Memorial went virtual. We created an online space for families, friends and CHEO staff and medical staff to come together in both remembrance and celebration of life, regardless of when their loss took place. We aimed to include all those who are coping with the loss of a child, wish them love, support and healing. We shared video footage of the butterflies to all those wishing to see this gesture and symbol. |
The CHEO Preschool, class of 2020 |
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Every year at the end of June, we have the absolute joy of celebrating the amazing little graduates from the CHEO School and Preschool — often taking the form of a fashion show or other unique ceremony. But, just like all graduating kids and teens across the world, this particular school year ended very differently. Thanks to the creativity of our school staff, we found a new, safe, pandemic-friendly way to celebrate our Class of 2020 and we think it was just as special! Keeping public health recommendations in mind, our School and Preschool each organized their own physically distanced ceremony, filled with the fanfare kids deserve. Our CHEO School organized a drive-by parade onsite at our Smyth Road location, where graduates and their caregivers drove by the school, honking and cheering in celebration of their amazing accomplishments. The CHEO Preschool also celebrated its little ones with a drive-by event but put a different spin on it — they took the parade straight to the kids. They drove to each child’s home with banners and balloons and presented each of them with their graduation certificate and a special round of applause. |
Smile buttons |
| Universal masking, regardless of who or where you were, quickly became mandatory to protect our fragile patient population and health-care providers. But wearing a medical-grade masks can make it difficult for folks in a pediatric setting to establish a warm connection with a sick child or worried parent. The eyes may be the mirror to the soul, but there is something to be said about a warm smile. So when CHEO was approached by Printer Plus, a local print shop, we accepted their generous offered to come on site for a day, photograph our staff and make individual lapel buttons featuring the staff’s smiling faces. More than 430 CHEO staff and medical staff turned up on photo day to smile for the camera. Printer Plus delivered the completed lapel buttons which were picked up by staff. The lapel button allowed patients and visitors to put a human face behind the mask and reminded us all that hidden behind every mask is a unique individual. |
What support from the community! |
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It’s been said that it is better to give than to receive. At CHEO we may beg to differ, especially when we are receiving a donation of a hot meal after a long shift. The generosity of individuals, restaurants and corporations during the pandemic was nothing short of amazing. At the start of the pandemic, community donors quickly began to reach out to wanting to provide gifts in kind to essential staff, working the front lines. CHEO and the CHEO Foundation sprang to action and created a COVID generosity team who put together a coordinated system to accept and re-direct the kindness that was pouring in. From pizza to subs and rotisserie chicken to cookies, close to 4,000 meals and 3,500 cookies from 26 different community organizations were donated and distributed to tired and hungry staff over the year. These meals were a consistent bright point to each week during our pandemic response. In addition to food, many items such as lip balms, lotions and chocolates were received and used to create and distribute 300 handy “survival kits” to staff. A one-stop COVID generosity page was created on CHEO’s intranet which listed all the discounts offered by local stores and uniquely available to staff and medical staff at CHEO. And sewing machines were busy! Hundreds of individuals sewed and donated cloth masks which we got into the hands of families for them to use in the community (onsite at CHEO it was all medical grade masks). Nancy and Keith McGruer even invented and donated masks with clear plastic windows so that kids who are deaf or hard of hearing can still read lips.
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Financial Operating Statement
Revenue: $340,117
(in thousands)
| Percentage | Funding source |
|---|---|
| 56% | MOH/OH Funding |
| 20% | Other Funded Programs |
| 13% | Patient Services |
| 9% | Other Revenue |
| 2% | Amortization |
Expenditures: $337,123
(in thousands)
| Percentage | Funding source |
|---|---|
| 53% | Salaries & benefits |
| 20% | Other Funded Programs |
| 15% | Supplies & Other |
| 5% | Medical & Surgical Supplies |
| 4% | Amortization |
| 3% | Drugs & Medical Gasses |