Coronavirus Outbreak – Information for staff, physicians, learners and volunteers

Please note: This information is not for distribution outside of Unity Health; we are using a private section of our external website to allow staff easy access to these materials offsite and after hours.

March 30, 2020

Keep in mind:

  • Staff should self-isolate for 14 days after travel unless they are deemed too critical to continued operations. If you have returned from international travel, please connect with your leader to determine if you can self-isolate at home.
  • Give yourself extra time to get into work to accommodate entrance screening and have your badge ready to be scanned.
  • Do not use our emergency departments to enter or exit the hospital to help limit the amount of traffic in that area.
  • We are looking for staff members from across the organization to fill some urgent staffing needs – if you are interested, fill out this availability form (download) and share the completed version your manager 
  • If you are approached by the media for any comments on the situation, direct them to communications@unityhealth.to.

Latest updates

On the week of March 23, we shared details of our new process that requires all staff and physicians working in patient care areas to wear a mask at all times outside of breaks. We have created a new resource page on our website that outlines everything you need to know about this move, including frequently asked questions. Should you have any additional questions about our new universal masking process, please speak with your manager.

Unity Health Toronto staff who were tested for COVID-19 at the St. Joseph’s or St. Michael’s Assessment Centres on or after March 21st will now be able to register remotely for MyChart and access their test results – once available – through the platform. To register for MyChart remotely, please call Health Records at your respective sites (numbers below).

  • If you were tested at St. Joseph’s COVID-19 Assessment Centre, please call 416-530-6000 ext. 6047
  • If you were tested at St. Michael’s COVID-19 Assessment Centre, please call 416-360-4000 ext. 2169

Please note you will be asked to provide your full name, health card number, and you will be asked to answer a series of security questions to verify your identity. The option to view COVID-19 test results from Unity Health’s Assessment Centres in MyChart is currently only available for staff at Unity Health who received testing on or after March 21, 2020. Also note that in MyChart all COVID-19 test results will be labelled ‘COVID-19 Virus Detection’ – this does not mean the test result is positive. Please read the full result to understand whether the virus is detected or undetected in your test results.

The reality of the COVID-19 pandemic is that it is placing significant strains on our health care system’s human resources due to a dramatic increase in the use of some of our services combined with the reduction of available staff driven by quarantine and sick calls. Because we still need to be able to provide vital services to our patients at Unity Health, staff may be required to work in areas and perform duties that are different from their normal “home” positions. We all need to work together and be flexible to meet our patients’ needs. 

To help fulfill critical and urgent pandemic-related requirements for staff, we have launched Staff Redeployment Centres at each of our sites. These centres are in the process of registering employee availability which includes:

  1. Staff with availability above and beyond current role – Staff members who can volunteer time outside of their regular job can submit their availability here. Thank you to those who have already submitted availability – you will be contacted soon, if you haven’t already been, to fill critical needs.
  2. Staff whose work has slowed or stopped due to temporary closures – Managers are actively identifying where work has slowed or stopped due to closures or slowdowns. Staff in these areas are our priority to redeploy. If this applies to you, please speak with your manager about the redeployment process and if you have any questions. 

All registration for availability is done via electronic communication as there is no physical Redeployment Centre to support social distancing. During this time, we are asking all staff to work with us and be flexible to support our most urgent needs across the organization. If you are contacted to be redeployed, we will ensure that you receive proper orientation to your new role so you are supported, prepared and safe. 

Redeployment is a critical part of our emergency response to this current pandemic. The Ontario government announced under the March 17, 2020 declaration of emergency a new time-limited order (for 14 days unless renewed or revoked), to ensure health care resources are available to help prevent the spread of COVID-19 and keep individuals and families safe. This temporary order gives hospitals the ability to cancel and postpone services to free up space and valuable staff, identify staffing priorities and develop, modify and implement redeployment plans. When utilized by hospitals, these redeployment plans temporarily supersede the provisions of a collective agreement, including lay-off, seniority/service or bumping provisions. These temporary measures are necessary to ensure hospitals are able to effectively deploy personnel to where help and support is needed most in their facilities.

We remain committed to open and timely communication with our union partners about our efforts to redeploy staff in a fair, transparent and equitable manner and we will ensure that all staff redeployed to support urgent patient needs receive the support they need to be able to perform the work effectively and safely.   

Find more information about our redeployment strategy in our COVID-19 FAQ, under the ‘Redeployed staff’ section. Thank you for your help in keeping our services open for our patients.

We all have a responsibility to keep each other, our patients and our visitors safe. By following our entrance screening protocols at all times you can help to protect those around you, including those we serve.

Screening at clinical satellite locations

Over the past week, we have implemented entrance screening at the following locations:

  • 61 Queen St. East
  • Lawrence Health Centre
  • 80 Bond St.
  • Health Centre at 410 Sherbourne
  • James Town
  • Sumac Creek
  • Community Renal Centre on Islington

Passive screening at office satellite locations

All staff are reminded that they should NOT be coming to work if they are unwell or have come in contact with a COVID-19 case. You must also speak with your manager before coming into work if you have travelled outside of Canada in the last 14 days. There are posters up to remind staff of these details. For questions on screening practices in office satellite locations, please contact the property’s management. Some locations are now only accessible via access cards that are provided to tenants, so you may have to arrange access with colleagues in the building before visiting.

Reminders:

  • Remember to allow extra time for entrance screening.
  • Avoid our Emergency Department (ED) entrances.ED entrances are only to be used by patients with urgent care needs.
  • Remember to carry your photo ID badge with you at all times.
  • Do not wear scrubs outside of the hospital. Staff should change into scrubs when they arrive at work and change out of them before they leave the hospital.
  • Do not prop external doors open and please watch for tailgaters at all of our staff entrances and exits.
  • We have introduced mask distribution for patient-facing staff in the entrance screening process. Please review the update on the COVID-19 resource page, under “March 24 all staff-communication: Important update on masks for all patient-facing staff and physicians”.

In light of the evolving COVID-19 situation, we have made the difficult decision to temporarily close our residential withdrawal management services at St. Joseph’s (Glendale House) and St. Michael’s effective Monday, March 23. We know these services provide important support to members of our communities, which is why we are reaching out to make sure clients are aware they can access support through our Addiction Medicine Services at both sites that will continue to provide virtual video, telephone and walk-in options. You can find out more about these resources by calling:

  • Joseph’s: 416-530-6486 ext. 3969
  • Michael’s: 416-864-3082

Additional resources available in our communities include:

  • Residential Withdrawal Management Bed Availability (24/7): 1-866-366-9513
  • Telephone support from Coordinated Access to Addiction Services (Monday to Friday from 9 a.m. to 4:30 p.m.): 1-855-505-5045
  • Shelter Central Intake (24/7): 416-338-4766
  • Additional Resources/Supports (24/7): 211

We will continue to monitor the situation and work closely with our partners in the community to provide any service updates as the situation changes. We are also sharing this messaging on our websites so these resources are available externally as well for people who need them.

Should you have any questions, please feel free to reach out to:

  • Linda Picken (St. Joseph’s): 647-539-8245
  • Nicole Kirwan (St. Michael’s): 416-523-7098

Scrubs

Scrubs are being provided with approval of local leadership to key areas across the organization. Urgent requests for immediate needs will continue to be responded to, but please be patient as we work to ensure we have appropriate amounts where they are needed. In order to ensure a supply of clean scrubs is available when needed:

  • Please return dirty scrubs as quickly as possible
  • If you have any scrubs at home or in your locker or more than your allowable credit, please return these as soon as possible to the Scrubex receiver units (no questions asked)
  • Do not wear scrubs outside of the hospital
    • Physicians and staff should wear street clothes into work daily and change into scrubs at the start of your shift
    • At the end of your shift, change into street clothes and deposit worn scrubs into the Scrubex receiver units

Isolation gowns

Please help preserve our PPE supplies:

  • Make sure reusable gowns are not discarded
  • Ensure isolation gowns are not stockpiled in units or clinic areas

Parking supports at St. Michael’s

To support staff who require parking downtown by St. Michael’s, we are introducing new parking options.

  • The parking garage at Li Ka Shing at 209 Victoria Street is now restricted to staff and patients only (this is on a first come first serve basis, with a limited number of spots). You will be required to show your hospital ID to enter the garage and the parking rate has been reduced to $10.
  • The Eaton Centre has generously donated 150 free daily parking vouchers which are available on a first come first service basis and can be picked up from the Li Ka Shing parking attendant when you show your hospital ID. You must use this voucher when you exit the parking garage at the end of your shift. There are 100 spots available at the Yonge Street entrance (on the fourth floor) and 50 at the Dundas/Bay Street entrance.
  • When these two parking options have exceeded their capacity, staff may choose to park at other surrounding parking lots. Consider using surrounding lots located on Bond (Church) and Queen Streets (Green P).
  • Street parking may also be available – Toronto Police Services have made changes to on-street parking enforcement to allow for more parking flexibility.

Staff reimbursement – Effective Tuesday, March 24 to April 10, any staff that have utilized paid parking around St. Michael’s will be eligible to be reimbursed for part of their costs. Staff will be eligible to be reimbursed for up to $20/day after they pay the first $10. For example: if you pay $30 for parking, you will pay $10 and can be reimbursed for $20. If you pay $15, you will pay $10 and can be reimbursed for $5.

Submit your expense information electronically to accountspayable@unityhealth.to. Please continue to use the regular expense form along with scanned images of your receipts (phone images are okay). There is no need to send in originals, but please keep these for a minimum of three months. Please submit the receipts on a bi-weekly basis to coincide with pay periods. Deadline for submission is April 8 and April 22 for payment on the next pay period.

We are monitoring the parking situation at St. Joseph’s, Providence and our offsite locations and will have an update in the near future.

RESOURCES:

QUESTIONS?

If you have any questions related to infection prevention and control, contact IPAC. For any other questions related to COVID-19, you can contact the Coronavirus Management Team directly by emailing questions@unityhealth.to.

Providence
Location: OHSW, D207
Monday and Tuesday, 8 a.m. to 4 p.m.
Wednesday, 6:30 a.m. to 4 p.m.

St. Joseph’s

Location: OHS, Sunnyside room 204
Monday to Friday, 7:30 a.m. to 3 p.m.

St. Michael’s
Location: CHSS, 2-037 Shuter

Monday to Friday, 7 a.m. to 3 p.m.

Sleeping accommodations for staff and physicians

On-site and off-site accommodations have been made available to support Unity Health staff during the COVID-19 pandemic. We hope this will allow staff to rest comfortably between shifts. Click here to see what’s available. Staff who are unwell should not be working and not accessing these accommodations. We also want to thank the local companies who have generously given discounted rates at some local hotels.

Universal masking in patient care areas

Earlier this week, we shared details of our new process that requires all staff and physicians working in patient care areas to wear a mask at all times outside of breaks. We have created a new resource page on our website that outlines everything you need to know about this move, including frequently asked questions. Should you have any additional questions about our new universal masking process, please speak with your manager.

Staff are now able to access personal COVID-19 test results through MyChart

Unity Health Toronto staff who were tested for COVID-19 at the St. Joseph’s or St. Michael’s COVID-19 Assessment Centres on or after March 21 and moving forward are now able to register remotely for MyChart and access their test results – once available – through the platform.

To register for MyChart remotely, please call Health Records at your respective sites:

  • If you were tested at the St. Joseph’s COVID-19 Assessment Centre, please call 416-530-6000 ext. 6047
  • If you were tested at the St. Michael’s COVID-19 Assessment Centre, please call 416-360-4000 ext. 2169

Please note you will be asked to provide your full name and health card number, and you will be asked to answer a series of security questions to verify your identity. The option to view COVID-19 test results from Unity Health’s Assessment Centres in MyChart is currently only available for staff at Unity Health who received testing on or after March 21, 2020.

Patient COVID-19 test results now accessible through clinical systems

If you are caring for a patient at St. Joseph’s or St. Michael’s who has been tested for COVID-19, you will now be able to access their results through the following systems:

  • At St. Joseph’s, you can access COVID-19 test results through SOVERA, under ‘COVID19 ASSESSMENT’
  • At St. Michael’s, you can access COVID-19 test results through:
    • SOVERA, following this path: SOVERA  > ECHART  >  COVID19 ASSESSMENT
    • Soarian, following this path: Soarian  >  Scanned documents  >  Other documents  >  COVID19 ASSESSMENT

If you have any questions about this process, please reach out to Helpdesk or Health Records at your site.

Reminder – social media use during COVID-19

Social media is a powerful communication tool and as a staff member, resident or physician of Unity Health, what you say online can have a significant impact.

Before sharing content on social media, please consider the following:

  • Patient privacy is critical to our role as providers of compassionate care, and key to respecting the human dignity of our patients and their families. Sharing information about individual patient cases on social media is considered a privacy breach. Remember: even if a patient cannot be identified by what you share, it can still be considered a privacy breach.
  • As per our media policy, if a member of the media reaches out to you via email or social media, send their request to communications@unityhealth.to. The Communications and Public Affairs Department will advise on the opportunity as well as outline any risks and benefits of participating in a specific story.
  • There is understandably a lot of anxiety surrounding COVID-19. If you have any questions or concerns, please email questions@unityhealth.to and/or speak with your manager directly.

You can learn more about your site-specific social media policy on the St. Joseph’s intranet, St. Michael’s intranet, and Providence’s intranet.

Entrance screening reminders

Staff are reminded to use the following entrances to both enter and leave the building at our main hospital sites. Please remember to allow extra time for the entrance screening process. These hours are on the chart located on the COVID-19 resource page for your reference.

At St. Joseph’s:

  • Melnyk entrance – 24 hours, daily
  • Our Lady of Mercy entrance – 24 hours, daily
  • Our Lady of Mercy parking garage entrance – 24 hours, daily
  • NEW HOURS: Sunnyside West entrance – 8 a.m. to 4 p.m., Monday through Friday

At St. Michael’s:

  • NEW EARLIER OPENING: Bond St. entrance – 6:30 a.m. to 8 p.m., daily
  • NEW EARLIER CLOSING: Queen St. entrance – 8 p.m. to 6:30 a.m., daily
  • Reminder: If you have accessibility needs, you may use the Queen St. entrance at any time.

At Providence:

  • CLOSURE: B1 entrance – closed
  • D1 entrance – 6:30 a.m. to 5 p.m., Monday through Friday
  • Main hospital entrance – 5 p.m. to 6:30 a.m., Monday through Friday, and 24 hours on weekends

 Entrance reminders

  • We have introduced mask distribution for patient-facing staff in the entrance screening process. Please review the update on the COVID-19 resource page, under “March 24 all staff-communication: Important update on masks for all patient-facing staff and physicians”
  • Please do not use the Emergency Department entrances, as these should only be used by patients with urgent care needs.

Appropriate use of scrubs

Scrubs are being provided with approval of local leadership to key areas across the organization. Urgent requests for immediate needs will continue to be responded to, but please be patient as we work to ensure we have appropriate amounts where they are needed. In order to ensure a supply of clean scrubs is available when needed:

  • Please return dirty scrubs as quickly as possible
  • If you have any scrubs at home or in your locker or more than your allowable credit, please return these as soon as possible to the Scrubex receiver units (no questions asked)
  • Do not wear scrubs outside of the hospital
    • Physicians and staff should wear street clothes into work daily and change into scrubs at the start of your shift
    • At the end of your shift, change into street clothes and deposit worn scrubs into the Scrubex receiver units

 Environmental Services taking extra measures to ensure a clean and safe environment

On a daily basis, our Environmental Services teams are reviewing hospital activity, cleaning needs and planning staffing to ensure we have enough support for enhanced cleaning measures. The teams have priority cleaning tasks for both clinical spaces and public spaces to ensure all critical cleaning is provided uninterrupted. Currently there are 28 additional cleaning assignments across the sites that are reviewed and planned for daily, which includes additional cleaning staff in public spaces at all sites.  

If you have a concern or would like to make a cleaning request, please connect with Environmental Services at your site.

Offers to donate PPE and other supplies

There’s been a lot of work going on behind the scenes and we’re doing targeted approaches to make sure we continue to have adequate supplies of PPE including masks. We have been receiving an overwhelming number of offers to provide PPE and other supplies from organizations across our communities over the last week. If someone reaches out to you and asks if they can make a donation, please ask them to email PPE.donations@unityhealh.to. We have a team who is reviewing requests and determining what we can accept. If anyone is asking about donating food to our teams, please connect them with Heather Fletcher at heather.fletcher@unityhealth.to.

A special message from our Board of Directors:

As a thank you for your work and dedication during this pandemic crisis, Unity Health Toronto’s Board of Directors are providing coffee Thursday, March 26, in all three of our site’s cafeterias during regular business hours.

To our team at Unity Health Toronto – you are the true heroes of this crisis. We salute you and express our deepest admiration and gratitude. 

  • With sincere thanks, your Board of Directors

Important update on masks for all patient-facing staff and physicians

After careful reflection and in alignment with many of our hospital partners, we have decided to make a shift in our use of masks at Unity Health Toronto.

Staff and physicians who are patient-facing – those who work in patient care areas and those who need to travel through a patient care area (for example support services (i.e. security, nutrition services) and corporate (i.e. those who need to walk through or to a patient area to get to their office) will be required to wear a procedure mask at all times in patient areas including common spaces (lobbies, hallways, elevators etc.).

We are making this change for several reasons including:

  • The prevalence of COVID-19 is increasing in the community and there are more reports of outbreaks at long-term care homes and exposures in hospitals.
  • A small number of staff and physicians have come to work with mild symptoms or developed mild symptoms while on duty. These exposures pose a risk to patient, staff and physician safety and result in staffing shortages due to quarantines.
  • The main value of masking, like self-screening, is protecting others more than ourselves. It reduces risk of staff and physicians with very early symptomatic infection from spreading disease to others. That will in turn make everyone safer
  • We need to conserve PPE and it use rationally and equitably to maintain a safe environment for our staff, physicians, patients and residents.

When is this change starting?

  • We will be implementing this change later today: 
  • Starting tonight (Tuesday, March 24) at 1900hrs, staff and physicians who are patient-facing will get 2 masks to wear over the course of their work period when they enter the hospital and go through our entrance screening process at St. Joseph’s and St. Michael’s.
  • Starting tonight at 2300hrs, we will be rolling the same approach out at Providence.
  • Please allow for extra time at entrance screening during peak hours.

Process for patient-facing staff and physicians to get their mask:

The wearing of procedure mask (droplet mask, ear loop) will be integrated into the entry screening process that was started last week:​

  1. ​All staff will continue to perform hand hygiene when they enter the building and throughout their shift.​
  2. Prior to scanning their badge at entrance screening, staff will go through a self-assessment about specific symptoms. Anyone with symptoms will not be able to work their shift – these staff and physicians should connect with Occupational Health who may suggest a COVID-19 test, if necessary, and will help manage directions to return to work.
  3. Staff and physicians who pass the screen and self-identity as patient-facing, will be given 2 procedure masks to wear throughout their shift: one for the first half and the other for the second half of their shift, if you feel you need to change it.​ Please do not wear your mask home. Discard it appropriately at the end of your shift. If you still have one mask at the end of the day, save it for the following day to help preserve our PPE supplies.
  4. Staff who work in our corporate areas and are not patient-facing should continue to practice social distancing and proper hand hygiene. If these staff are required to work intermittently in a patient-facing area, they can ask for a mask when they enter the hospital and go through our entrance screening process.

Staff must:

  • Wear masks in the correct position
  • Refrain from touching masks while on their face
  • Wash their hands before and after manipulating the mask and before and after every patient and/or resident contact
  • Replace their mask if it gets soiled or wet during their shift – Managers and After Hour Supervisors will have access to a small supply of extra masks on the units
  • NOT remove the mask when seeing patients in droplet-contact precautions.  Clear instructions on how to do this will be provided.

Talking points for staff to use with patients:

  • Staff and physicians in patient-facing roles and patient care areas are wearing procedure masks to protect patients, staff and physicians.
  • When you are in your room, you have enough distance and space around you to keep you protected so you do not need to wear a mask.
  • We are trying to limit the number of people walking around the unit so please use your call bell or speak to a member of your care team if you need assistance.
  • Staff who work in our corporate areas and are not patient-facing are practicing social distancing and proper hand hygiene. If these staff are required to work intermittently in a patient-facing area, they will have access to a mask.

Information about mask use and Frequently Asked Questions

Mask use for staff working in clinical areas

  • Only staff providing essential clinical or support services should be entering clinical areas
  • Staff working in clinical areas will be given two masks at the beginning of their day or shift when they enter the hospital
  • Staff should wear the first mask throughout their shift while in clinical areas
  • The mask should not be changed before entering or after exiting a patient room including patients in droplet-contact precautions (see instructions for droplet-contact rooms below)
  • Masks do NOT need to be changed unless soiled or damaged. If the mask needs to be changed, it should be removed using the straps, hand hygiene should be performed and the second mask immediately put on.
  • Before taking breaks or eating, staff should perform hand hygiene, remove the mask and place it on a clean surface away from the patient care area. The inner side of the mask should be facing up. Hand hygiene should be performed again.
  • An alternative is to fold the mask (dirty side in) and place in a paper bag

Mask use for essential staff that do not work in clinical areas or patient-facing roles

  • Staff working outside clinical areas can consider working from home as per the Unity Health work from home guidelines. Those who are required on site should practice physical distancing
  • These staff do not require masks – they should not be in patient care areas for any reason

Entering the room of a patient in droplet-contact precautions

  • Staff should NOT remove their mask prior to entering the room
  • Additional required personal protective equipment should be put on (gown, gloves, face shield)
  • When leaving the room, the gown and gloves should be removed and the mask left on
  • If the staff will be entering rooms of additional patients on droplet-contact precautions prior to leaving the clinical area, the face shield should also be left on
  • The face shield should be discarded and hand hygiene performed only after all droplet-contact patient interactions have been completed
  • The mask should stay on

Entering the room of a patient in airborne-droplet-contact precautions

  • Staff should remove and discard their mask prior to entering the room
  • Staff should put on the required personal protective equipment (gown, gloves, face shield, N95 respirator)
  • When leaving the room, the gown and gloves should be removed and the N95 respirator left on
  • If the staff will be entering rooms of additional patients on droplet-contact precautions  prior to leaving the clinical area, the face shield should also be left on
  • The face shield should be discarded and hand hygiene performed only after all droplet-contact patient interactions have been completed
  • The N95 respirator can then be worn for the rest of the day/shift or changed to the second mask if it becomes soiled or damaged

Frequently Asked Questions

Who needs to wear a mask? Anyone working in clinical areas except those that are 6 feet away from patients at all times or continuously behind a Plexiglas barrier needs to wear a mask.

When should I change my mask?
You should change your mask after it is visibly soiled or damaged. We recommend taking off and discarding your first mask at the midpoint of your day and using your second one for the remainder of your shift. Some of you may only require one mask per shift.

Do I need to change my mask if I go into a room with someone on droplet precautions?
No. You can continue to wear the same mask between patients. Gowns and gloves should be removed. Face shields and masks should continue to be worn and then the face shield can be removed after all interactions with patients on droplet-contact precautions are completed.

Where should I keep my other mask? 
We recommend you keep the mask in a safe place away from patient care, such as your bag or lunch bag.

What should staff know about wearing masks for longer periods of time?

  • Do not touch your face.
  • If you do touch your face, wash your hands immediately.
  • Do not pull the mask off and put around your neck or forehead as this will increase the risk for spreading infections.
  • Make sure the mask is covering both your mouth and your nose.

Should I remove the mask at the nursing station?
No. The mask should be worn at all times while in clinical areas, including in nursing station.

Does this include offsite clinics?
Yes. This includes all clinical areas at Unity Health, both inpatient and outpatient settings. Only the clinical areas in these settings are impacted so if you are in an office with the door closed, the mask is not required, even if the office is within the clinical area.

Is wearing a mask mandatory? 
Wearing the procedure mask in clinical areas is required. 

What do I do if my mask gets soiled or rips?
The second mask can be used if the first mask becomes soiled or damaged. If both masks are used up, speak to your manager or the after-hours supervisor and they can provide a replacement.

What do I do with the mask when I take my breaks?
If you are taking a break, wash your hands, remove the mask using the straps and place it on a clean paper towel or clean surface with the inner side facing upwards and perform hand washing again. After your break, wash your hands, retrieve the mask by the straps, put it back on and wash your hands again.

Alternatively, you can wash your hands, remove the mask using the straps, fold in half (with the front (‘contaminated’) side in and the side that will be against your face out), and place in a clean bag. Wash your hands again. When your break is finished, wash your hands, take out the mask, unfold it and put it back on, then wash your hands again.

I thought we had a shortage of PPE – why are we recommending more masking?
We do have a limited supply of PPE. Unless we all work together and use PPE appropriately, we will have shortages. However, although we are asking all staff to mask, we are limiting the use of masks to 2 per person. When we crunched the numbers, this does not result in an increase in our PPE usage because some people were already wearing masks at all times, including outside clinical areas (where they are not necessary) and in some cases were changing their masks many times per day. We think this step will help us with that and we think that we can adequately do this with our current numbers of masks although we will continue to monitor our numbers and make changes as necessary to preserve this resource.

I work in the cafeteria or in a role that isn’t in a clinical setting but I still interact with patients and staff – do I need to wear a mask?
As patients do come to the cafeteria, it is appropriate to wear your mask if your role puts you within 6 feet of patients.

 Why are we not giving patients (travelling in hallways or to tests) masks? Patients are screened upon admission and once in hospital are regularly assessed for symptoms and fever.  Those that are symptomatic would be masked on route to tests.  We are asking patients to stay in their rooms as much as possible.  From a patient safety (and staff safety) perspective, masking staff is our best option as staff may interact with multiple patients, other staff and different areas within the facility.  For now, we plan to roll this out to staff and monitor the impact on our PPE supply.  

Why are we not giving all visitors (accompanying patients to ambulatory areas) masks? For now we are rolling this out to staff.  We may end up including visitors, although currently we have a no visitor policy for Unity Health so the number of visitors is quite limited.

 

Staff redeployment

The reality of the COVID-19 pandemic is that it is placing significant strains on our health care system’s human resources due to a dramatic increase in the use of some of our services combined with the reduction of available staff driven by quarantine and sick calls. Because we still need to be able to provide vital services to our patients at Unity Health, staff may be required to work in areas and perform duties that are different from their normal “home” positions. We all need to work together and be flexible to meet our patients’ needs. 

To help fulfill critical and urgent pandemic-related requirements for staff, we have launched Staff Redeployment Centres at each of our sites. These centres are in the process of registering employee availability which includes:

  1. Staff with availability above and beyond current role – Staff members who can volunteer time outside of their regular job can submit their availability here. Thank you to those who have already submitted availability – you will be contacted soon, if you haven’t already been, to fill critical needs.
  2. Staff whose work has slowed or stopped due to temporary closures – Managers are actively identifying where work has slowed or stopped due to closures or slowdowns. Staff in these areas are our priority to redeploy. If this applies to you, please speak with your manager about the redeployment process and if you have any questions. 

All registration for availability is done via electronic communication as there is no physical Redeployment Centre to support social distancing. During this time, we are asking all staff to work with us and be flexible to support our most urgent needs across the organization. If you are contacted to be redeployed, we will ensure that you receive proper orientation to your new role so you are supported, prepared and safe. 

Redeployment is a critical part of our emergency response to this current pandemic. The Ontario government announced under the March 17, 2020 declaration of emergency a new time-limited order (for 14 days unless renewed or revoked), to ensure health care resources are available to help prevent the spread of COVID-19 and keep individuals and families safe. This temporary order gives hospitals the ability to cancel and postpone services to free up space and valuable staff, identify staffing priorities and develop, modify and implement redeployment plans. When utilized by hospitals, these redeployment plans temporarily supersede the provisions of a collective agreement, including lay-off, seniority/service or bumping provisions. These temporary measures are necessary to ensure hospitals are able to effectively deploy personnel to where help and support is needed most in their facilities.

We remain committed to open and timely communication with our union partners about our efforts to redeploy staff in a fair, transparent and equitable manner and we will ensure that all staff redeployed to support urgent patient needs receive the support they need to be able to perform the work effectively and safely.   

Find more information about our redeployment strategy in our COVID-19 FAQ. Thank you for your help in keeping our services open for our patients.

Keeping our people financially healthy

The health of our staff is important to us, and this includes your financial health. For the period of March 14 to April 5, Unity Health is implementing a few changes to our payroll coding procedures. Regardless of employment status (full-time, part-time or casual), all staff will be entitled to 100 per cent of their pay for their scheduled shifts during this time period for the following scenarios:

  • Asymptomatic staff member who was sent home by Occupational Health or Public Health and placed in self-isolation due to close contact with a confirmed COVID-19 positive case
  • Staff who have traveled outside the country in the last 14 days, are self-isolating for 14 days, are deemed non-critical and unable to work from home
  • Staff with confirmed positive result of COVID-19
  • Staff who do not pass the COVID-19 screening questions

Please speak with your manager if you have any questions.

Resources to support our people

Our teams are working incredibly hard right now as we all respond to the evolving COVID-19 situation. To provide support, we have created a staff and physician wellness page where we are sharing resources and opportunities that are available to staff and physicians to support your health and well-being. Check back here frequently as we will update it as new opportunities become available.

This week, we are excited to share that we have partnered with Pizza Pizza to bring free pizza to our people. In order to maintain appropriate social distancing, we have set up pizza pickup times – you must register for a pickup time to claim your pizza slice from your site’s cafeteria. Click the link for your preferred time below to sign up.

Date

Site

Time

Wednesday, March 25

St. Michael’s

11 a.m. to 3 p.m.

3-9 p.m. 

Thursday, March 26

Providence

11:30 a.m. to 7 p.m.

Friday, March 27

St. Joseph’s

11 a.m. to 2 p.m.

3-9 p.m.

 

For more information, please reach out to:

Dear Unity Health staff and physicians,

These are extraordinarily challenging times, and we are all doing our best to keep our communities safe. For all of us who work in health care settings, we are being called upon like never before. Our communities are counting on us to care for them and their loved ones, and to be at our best during this time of crisis. We know all of you are working tirelessly and showing selfless courage in the face of risk.

Through all of this, it’s been so inspiring to see staff and physicians continue to keep Unity Health Toronto’s mission at the forefront, by continuing to care for the mind, body and spirit of everyone who comes to us in need.

Processes and protocols at our entrances and clinical areas are in place for a reason – to keep everyone healthy and safe. We must continue to work together to ensure they are followed, without exception. We know that these procedures – which sometimes change by the hour – can cause confusion, frustration, and can be anxiety inducing.  Combined with other stresses and our tiredness, it can make it difficult for us to be at our best, at all times.

Our ask of you is simple: please be patient, be calm, be supportive. We are all in this together.

Our shared legacy is one of compassion, courage and resilience. How we respond during this time of crisis will define who we are as an organization and now is the time to draw on our values for assurance and strength:

  • Show compassion to everyone who crosses your path. Provide comfort and support. Remember that everyone is affected in some way by these challenges.
  • Recognize the human dignity of each person. Every individual responds differently to crisis. Be kind to one another.
  • Perform with excellence. Draw out the best in each other. Lead when something needs doing.
  • Come together as a community. Work as a team. Communicate with honesty and sensitivity.
  • Be inclusive. Treat others as they would like to be treated.

Please take care of each other during these challenging times. We are creating a staff wellness portal on our Unity site and will share details of that as soon as they are available. We are counting on all of you to be at your best, and to be generous and forgiving in difficult moments. Thank you for all you’re doing for each other, our patients and our community.

Tim & Beth

Temporary closure: Residential withdrawal management services at St. Joseph’s and St. Michael’s

In light of the evolving COVID-19 situation, we have made the difficult decision to temporarily close our residential withdrawal management services at St. Joseph’s (Glendale House) and St. Michael’s effective Monday, March 23. We know these services provide important support to members of our communities, which is why we are reaching out to make sure clients are aware they can access support through our Addiction Medicine Services at both sites that will continue to provide virtual video, telephone and walk-in options. You can find out more about these resources by calling:

  • Joseph’s: 416-530-6486 ext. 3969
  • Michael’s: 416-864-3082

Additional resources available in our communities include:

  • Residential Withdrawal Management Bed Availability (24/7): 1-866-366-9513
  • Telephone support from Coordinated Access to Addiction Services (Monday to Friday from 9 a.m. to 4:30 p.m.): 1-855-505-5045
  • Shelter Central Intake (24/7): 416-338-4766
  • Additional Resources/Supports (24/7): 211

We will continue to monitor the situation and work closely with our partners in the community to provide any service updates as the situation changes. We are also sharing this messaging on our websites so these resources are available externally as well for people who need them.

Should you have any questions, please feel free to reach out to:

  • Linda Picken (St. Joseph’s): 647-539-8245
  • Nicole Kirwan (St. Michael’s): 416-523-7098

Appropriate use of scrubs

Scrubs are being provided with approval of local leadership to key areas such as the COVID-19 Assessment Centres, Emergency Departments and areas providing care to COVID-19 persons under investigation across the organization. Urgent requests for immediate needs will continue to be responded to, but please be patient as we work to ensure we have appropriate amounts where they are needed. Here’s how you can help:

  • In order to ensure a supply of clean scrubs is available when needed, please return dirty scrubs as quickly as possible.
  • Do not wear scrubs outside of the hospital. Staff should change into scrubs when they arrive at work and change out of them before they leave the hospital.

Let everyone on the care team know about COVID-19 PUI status

When contacting support partners (i.e. portering, security, environmental services, etc.), it is critical that you inform them if the patient you require support with is a person under investigation (PUI) or has tested positive for COVID-19 so that they can ensure they have the appropriate personal protective equipment. Please also inform the diet office of these details because they will use disposable dishes and deliver food to the unit rather than directly to the patient’s room.

Parking supports at St. Michael’s

To support staff who require parking downtown by St. Michael’s, we are introducing new parking options.

  • The parking garage at Li Ka Shing at 209 Victoria Street is now restricted to staff and patients only (this is on a first come first serve basis, with a limited number of spots). You will be required to show your hospital ID to enter the garage and the parking rate has been reduced to $10.
  • The Eaton Centre has generously donated 150 free daily parking vouchers which are available on a first come first service basis and can be picked up from the Li Ka Shing parking attendant when you show your hospital ID. You must use this voucher when you exit the parking garage at the end of your shift. There are 100 spots available at the Yonge Street entrance (on the fourth floor) and 50 at the Dundas/Bay Street entrance.
  • When these two parking options have exceeded their capacity, staff may choose to park at other surrounding parking lots. Consider using surrounding lots located on Bond (Church) and Queen Streets (Green P).
  • Street parking may also be available – Toronto Police Services have made changes to on-street parking enforcement to allow for more parking flexibility.

Staff reimbursement – Effective Tuesday, March 24 to April 10, any staff that have utilized paid parking around St. Michael’s will be eligible to be reimbursed for part of their costs. Staff will be eligible to be reimbursed for up to $20/day after they pay the first $10. For example: if you pay $30 for parking, you will pay $10 and can be reimbursed for $20. If you pay $15, you will pay $10 and can be reimbursed for $5.

Submit your expense information electronically to accountspayable@unityhealth.to. Please continue to use the regular expense form along with scanned images of your receipts (phone images are okay). There is no need to send in originals, but please keep these for a minimum of three months. Please submit the receipts on a bi-weekly basis to coincide with pay periods. Deadline for submission is April 8 and April 22 for payment on the next pay period.

We are monitoring the parking situation at St. Joseph’s, Providence and our offsite locations and will have an update in the near future.

Avoid COVID-19-related phishing scams

We have become aware of phishing scams using the COVID-19 pandemic as a lure. Alerts that may appear to be sent from a trusted party, such as the World Health Organization or university personnel, are instead fraudulent, sent in an attempt to convince the user to click on malicious links or attachments. If you receive a fraudulent email, please delete it immediately. If you receive an email that appears to be fraudulent but you would like confirmation, please forward the email to Helpdesk for assistance.

As the COVID-19 situation continues to evolve, Unity Health Toronto is taking additional precautions to keep patients, families, staff and physicians safe in accordance with the Ministry of Health recommendations, including temporary changes to our visitor policy.

Effective Saturday, March 21 at 9 p.m., we are no longer permitting family/support persons (visitors) at any of our sites, including our Reactivation Care Centre.

Our mission at Unity Health is to provide compassionate physical, emotional and spiritual care to all in need. We recognize family members and loved ones are integral to supporting our patients. “Family” is a flexible term that could include individuals with a genetic and/or legal relationship to the patient, or anyone else that the patient feels close to emotionally. It is up to patients to define who they consider as their “family.” Under normal circumstances, we promote the presence of family to support our patients in their care and recovery to the extent that is possible and safe for patients and staff. 

The following resources are available under the “Family presence (visitor) restrictions” section in the resources box on our COVID-19 page:

  • Site-specific patient letters
  • Family member/support person (visitor) letter
  • Family presence (visitor) restrictions – process for inpatients

We will make every effort to ensure that the needs of patients and families are met while this temporary restriction is in effect. This includes looking into technology-enabled solutions; our teams are looking at how to support virtual visits and we will share more details about this as they become available.

In the meantime, patients at St. Michael’s and Providence are able to use their bedside phones, free of charge and patients at all sites can use their own devices to access the guest WiFi by searching for available networks:

  • Joseph’s: sjhc_wifi
  • Michael’s: SMH_Guest
  • Providence: Providence Guest

There will be limited exceptions to this policy including:

  • End of life patients (including palliative, critical care and Emergency Department)
  • Patients under the age of 16 – limited to one designated parent or guardian
  • Women giving birth – limited to one partner or coach
  • Patients who lack capacity to consent to treatment and for whom other means of communication with their substitute decision maker have failed
  • Patients who require support to access critical ambulatory services (i.e. day oncology, dialysis, medical imaging)

Please note: we will continue to screen visitors at the door. If any visitors fail the screening, they will not be allowed entry even if they fall under the list of exceptions.

We anticipate that units will receive more call from families inquiring about their family members. Please take the time to help them understand this step is being taken to keep their loved ones safe.

Please connect with your manager should you have any questions or concerns.

Update: Entrance screening

We all have a responsibility to keep each other, our patients and our visitors safe. By following our entrance screening protocols at all times you can help to protect those around you, including those we serve.

Hours changing at St. Michael’s and Providence

Hours are changing at the following staff entrances and exits for St. Michael’s and Providence during evenings and weekends.

At St. Michael’s:

  • Bond Street entrance – Effective at 8 p.m. today, open 7 a.m. to 8 p.m., daily. Overnight – from 8 p.m. to 7 a.m. – staff and physicians may use the Queen Street entrance.
    • Reminder: If you have accessibility needs, you may use the Queen Street entrance at any time.

At Providence:

  • B1 entrance – Effective today, open 7:30 a.m. to 5 p.m., Monday through Friday. Please use main hospital entrance over the weekend.
  • Main hospital entrance – Effective Monday, March 23, open to staff and physicians overnight from 5 p.m. to 6:30 a.m., Monday through Friday, and 24 hours on weekends. It will remain open to patients and visitors 24 hours, daily.
  • D1 entrance – Effective Monday, March 23, open 6:30 a.m. to 5 p.m., Monday through Friday, to staff and physicians only.

Here is a chart outlining the designated staff, physician and contractor entrances to use:

Screening at clinical satellite locations

Over the past week, we have implemented entrance screening at the following locations:

  • 61 Queen St. East
  • St. Lawrence Health Centre
  • 80 Bond St.
  • Health Centre at 410 Sherbourne
  • St. James Town
  • Sumac Creek

We will be implementing entrance screening at the Community Renal Centre on Islington in the coming days.

Passive screening at office satellite locations

All staff are reminded that they should NOT be coming to work if they are unwell or have come in contact with a COVID-19 case.

NEW: Speak with your manager before coming into work if you have travelled outside of Canada in the last 14 days. In the coming days we will be putting up posters to remind staff of these details.

Reminders:

  • Avoid our Emergency Department (ED) entrances. ED entrances are only to be used by patients with urgent care needs and one accompanying visitor.
  • Remember to carry your photo ID badge with you at all times.
  • Do not prop external doors open and please watch for tailgaters at all of our staff entrances and exits.
  • Remember to allow extra time for entrance screening.

Virtual care support

A virtual care working group has been working diligently to expedite virtual care to support our patients in accessing necessary care while also supporting our need to minimize unnecessary in-person interactions. A virtual care resource hub with toolkits and guidelines is now available at http://remote.unityhealth.to/virtualcare/. It includes key information on our guiding principles and standards for IT supported tools. We are continuing to add directions around important clinical processes. Please continue to check the webpage as resources continue to be added. The information is also available on our COVID-19 resource page.

Submitting paper purchase requisitions via e-mail – St. Michael’s Only
Paper purchase requisitions for the SMH site have to be submitted for processing via e-mail starting immediately. SMH paper purchase requisitions and associated documents should be scanned in full and submitted via e-mail to PurchaseRequisitions@smh.ca. There are no changes to the e-requisition process for purchases at SMH. As well, there are no changes to any purchase requisition processes at the SJHC or PHC sites. Should you have any questions, please contact the e-mail address above.

Closures – Gym spaces at St. Joseph’s and Providence and Adult Day Program

In light of the evolving COVID-19 situation, the decision has been made to temporarily close the Sun Life Financial Lakeside Wellness Centre at St. Joseph’s and the George Macri at Providence to help protect our people, patients and communities. There will be updates provided as to when you can expect to be able to come back into the two gyms.

Providence will also be temporarily suspending its Adult Day Program (ADP) effective Friday, March 20. At this time, we anticipate that the program will be suspended for four weeks, but given the rapidly evolving situation, this timeframe will be re-evaluated in the upcoming weeks. The ADP will continue its services to clients currently booked for consecutive-stay overnight visits (i.e., respite care), but has not accepted new clients for respite as of March 17.

Updated requirements for interfacility patient transfers

Effective immediately, the Ministry of Health is requiring that all interfacility patient transfers, including emergency transfers, between Ontario hospitals require a Provincial Transfer Authorization Centre (PTAC) issued Medical Transfer Authorization Number before transport. This is required for all methods of patient transport (air ambulance, land ambulance and private transfer service).

Informing patients on why they may not be tested for COVID-19

As cases of COVID-19 increase in the community, we understand that patients may want to be tested when they are feeling unwell or nervous. However, during a pandemic situation, we must carefully consider who to test in order to ensure demand for supplies are not overwhelmed. To support teams at our assessment centres with these conversations, we’ve created a letter that will be given to patients who are not being tested following their assessment. It is available here on our COVID-19 resource page.

Reminder – social distancing protocol

To minimize the risk of infectious disease transmission, we are recommending staff and physicians reduce close physical interactions where possible. Here are some guidelines:

  • There should be no in-person gatherings of 25 or more people at Unity Health
  • Smaller in-person gatherings should strive to ensure a distance of two metres between individuals
  • Smaller meetings can still pose a risk to the organization if they include an essential group
  • For some events, participants may not all present at the same time, but risks such as shared food still need to be considered

Here are some tips on social distancing and staying healthy.

Where to find more information

As always, please keep an eye on our COVID-19 resource page for the latest information. Should you have any questions or concerns, please connect with your manager or email questions@unityhealth.to.

To all Unity Health staff and physicians,

Providing excellent patient care and ensuring staff safety are two essential priorities at Unity Health. To do so during the COVID-19 pandemic requires the appropriate use of personal protective equipment (PPE), a precious resource during a pandemic that must be used wisely.

Unnecessary use of PPE puts health care workers at risk. PPE becomes contaminated after prolonged use and can then transmit infections to health care workers, their patients and their colleagues. Health care workers who wear additional PPE that they are not familiar with may also contaminant themselves by improper donning and doffing.

We need to reserve PPE for when it is really needed. Use of PPE when it is not required unnecessarily contributes to PPE shortages and is currently a major issue of concern both at Unity Health and across the health care system.

Tips we cover in this bulletin:

  • Use PPE consistently only when required – avoid the use of PPE when it is not required
  • Minimize the number of staff entering the room of patients on precautions
  • Minimize the number of times staff enter the room of a patient on precautions

When is PPE required for staff and physicians?

PPE is required when providing care to a patient with suspected or confirmed COVID-19, or when providing care to other patients in Additional Precautions as per Infection Prevention and Control.

PPE is required when providing care to any patient where exposure to blood or body fluids is anticipated or when required as part of a sterile procedure.

  • Droplet precautions – There is very strong evidence that COVID-19 is not spread an airborne illness, but rather spread via droplets. Health care workers wearing appropriate droplet/contact PPE (eye protection, surgical mask, gown, gloves) have generally not acquired the infection from their patients.
  • Aerosol Generating Medical Procedures (AGMPs) – AGMPs, such as intubation, are the exception where we recommend the use of N95 masks when the procedures are performed on patients in droplet precautions, similar to influenza and other respiratory pathogens.

Please make sure you are using the right type of PPE for every situation.

When is PPE not required for staff?

  • PPE is not required in hallways, common areas or anywhere outside the patient’s room.
  • PPE is not required when caring for patients that are not in Additional Precautions, unless there is a risk of blood or body fluid exposure or a sterile procedure is required.

How can we help safely reduce of the amount of PPE we are using? 

  • Reduce the number of staff entering a patient’s room if they are in Additional Precautions – no non-essential staff should enter the room.
  • Limit the number of trips into patients’ rooms by batching tasks (e.g. RN can take vitals and deliver meal tray in same visit) and by checking in with patients using phones, intercoms, etc.
  • We want to underline that this does not mean we are asking you to provide less patient care – just consider new strategies as a team that could make things more efficient and help conserve our stockpile of PPE. 

When do patients need PPE?

Most patients do not require PPE – patients that are coughing, or have suspect or confirmed COVID-19 should wear a surgical mask when outside of their room (for medically necessary procedures or transport only).  

To all staff and physicians,

It’s important to balance the protection of the health system and our ability to continue to provide safe patient care during this pandemic. It’s also essential that our people continue to be safe while caring for our patients.

As we continue to implement enhanced public health measures to mitigate the spread of COVID-19 in Ontario in coordination with the government and our partner hospitals, it is vital that health services and our people continue to provide care to our patients and residents.

Today the Chief Medical Officer of Health issued new guidance: “Managing Health Worker Illness and Return to Work COVID-19” that says health care workers should self-isolate for 14 days after travel unless they are deemed critical to continued operations.

Unity Health Toronto will be putting these changes into effect as of 7 a.m. on Friday, March 20.

Here’s what that means for you

For anyone who has returned from international travel on or after March 5, you should connect with your leader (Manager or Department Chief) to determine if you can self-isolate at home. That decision will be made using the following guidelines:

  • Can you do your job from home?
  • Is your on-site availability critical to the operation of your department and/or the organization?

If you are a staff member or physician and able to work from home: you should follow Public Health’s self-isolation guidelines (see links below) for 14 days after your return date. If, over the course of your isolation, you are needed to provide essential services on site and you are asymptomatic, your Manager or Chief will call you and you will be required to return to work while taking the appropriate precautions.

If you are a physician and you are able, with input from your Chief, to cancel non-urgent care or provide virtual care, and obtain coverage for inpatient, essential ambulatory or call responsibilities: you should follow Public Health’s self-isolation guidelines for 14 days after your return date. If, over the course of your isolation, you are needed to provide essential services on site and you are asymptomatic, your Chief will call you and you will be required to return to work while taking the appropriate precautions.

If your job is critical to providing patient care and you cannot work from home: you should come to work and do the following:

  • undergo regular screening
  • use appropriate PPE (surgical mask) at all times for the 14 days from your return date
  • undertake active self-monitoring including taking your temperature twice daily to monitor for fever
  • immediately self-isolate if symptoms develop (fever, new cough, difficulty breathing) and contact their manager and Occupational Health.

If your job is not immediately critical to providing patient care and you cannot work from home: you will be asked to self- isolate at home, and may be required to return to work while taking the appropriate precautions should circumstances change.

If at any point you feel unwell at work: you must immediately self-isolate and contact your manager and Occupational Health.

Returning to work

At the end of the 14 day period, normal terms of work apply for asymptomatic employees. If you fail the screening tool or are symptomatic, you must call Occupational Health:

    • St. Joseph’s: 416-530-6800
    • St. Michael’s Corporate Health: 416-864-5400
    • Providence: 416-285-3666, ext. 4386

Scenario: I am planning to come in for my next shift and I have travelled in the last 14 days outside of Canada. What should I do?

  • Contact you manager
  • Contact Occupational Health and provide them the date you returned to Canada. You may be asked to provide proof of travel 
  • Discuss with your manager if your role is critical to the continued operations and patient care of your department/service.
  • Refer to ‘Here’s what that means for you’ section above for next steps.

What does self-isolate mean?

If you have recently travelled outside of Canada and have been advised to self-isolate, you should follow these guidelines:

What PPE should we be using and why?

If your job is critical to providing patient care and you must be at work within the 14 day period after returning from travel outside of Canada, you should wear a procedure/surgical mask when around others. 

For staff and physicians who work at multiple sites across Unity Health Toronto

We are not currently limiting cross-site movement of our people. If you have any concerns, please speak with their Manager, Director or Chief.

Going forward

We are now in a scenario in which there is community transmission of COVID-19 in Ontario. Therefore, travel is no longer the only risk factor. Our staff and physicians who have not travelled recently will also be at some risk of exposure to COVID-19, and this risk will likely increase over time which is why tracking of symptoms is essential for all health care workers.

Our system needs frontline health care workers along with all of those with critical support roles, including our personnel in food services, security, information technology staff, housekeeping, portering, supplies management and distribution, facilities maintenance, registration and leadership.

We know that these are challenging times as this situation continues to evolve. Things are changing fast and we are aligning our practices with new information as it comes out to ensure your safety at work and also that we can continue to provide care to our patients and residents during this pandemic outbreak. If you have any questions at all, please contact your manager or email questions@unityhealth.to.

It is critically important for all of us to practice proper and frequent hand hygiene, and stay home if we develop any symptoms of infection. We will get through this together. Thank you for the important work that you do.

Tim

President and CEO
Unity Health Toronto

Good evening all staff, physicians and learners,

This afternoon, in response to a question from the media, Ontario’s Minister of Health Christine Elliott indicated that all individuals who have returned from travel outside of Canada should self-isolate, including health care workers. This is a change from previous guidance we received from local, provincial and federal public health officials.

There have been no formal directives shared by the Ministry of Health (MOH) or Public Health providing information on the effective date or any provisions for exceptions. We continue to be in contact with other hospitals and we are currently seeking further clarity from the MOH. When we receive additional direction, we will communicate with you as quickly as possible.

If at any time you are experiencing any symptoms of illness, you should immediately report to your manager and contact Occupational Health:  

  • St. Joseph’s: 416-530-6800
  • St. Michael’s Corporate Health: 416-864-5400
  • Providence: 416-285-3666, ext. 4386

We thank you for your patience as this continues to be a rapidly evolving situation. We will continue to provide you with the most up to date information.

Tim

President and CEO

Unity Health Toronto

What to expect when you come to work on Wednesday
Starting at 7 a.m. on Wednesday, March 18, we will be implementing the following changes to entrance screening:

  • At St. Joseph’s:
    • East entrance (ground floor) – closed. There will be no entry for ANYONE through this door.
    • Melnyk entrance – open 24 hours to staff, physicians and contractors only.
    • Our Lady of Mercy entrance and parking garage – open 24 hours to patients, visitors, staff, physicians and contractors.
    • Sunnyside West entrance – closed on weekends. Current hours of 7 a.m. to 5 p.m. will continue Monday through Friday.
    • NOTE: Staff and physicians should use the Melnyk entrance where possible to relieve pressure at the OLM entrance.
    • Tranquility entrance – open 6:30 a.m. to 10 p.m. to patients and visitors only.
  • At St. Michael’s:
    • Queen St. entrance – closed to staff, physicians and contractors; open to patients and visitors only.
    • Bond St. entrance – open to staff, physicians and contractors 24 hours, daily. All staff physicians and contractors should use the Bond Street entrance.
    • Li Ka Shing Knowledge Institute (LKSKI) – Victoria Street entrance – closed. If you work in in the LKSKI building, you will need to use the Bond entrance and use the bridge to access the LKSKI building. 

Here is a chart outlining the designated staff, physician and contractor entrances to use:

Upcoming changes for clinical satellite locations
With entrance screening now implemented at the main hospital sites, we are looking to implement entrance screening at our clinical satellite locations as soon as possible.

Tomorrow we will be implementing entrance screening at:

  • 61 Queen St. East
  • St. Lawrence Health Centre

Important reminders:

  • All staff and physicians are required to be screened before entering our main hospital sites.
  • Avoid our Emergency Department (ED) entrances. ED entrances are only to be used by patients with urgent care needs and one accompanying visitor.
  • Remember to carry your photo ID badge with you at all times.
  • Do not prop external doors open and please watch for tailgaters at all of our staff entrances and exits.
  • Remember to allow extra time for entrance screening.
  • For questions, email questions@unityhealth.to

Updates at a glance

  1. State of emergency declared – update for Unity Health
  2. Staff are expected to report to work after travel outside Canada unless ill
  3. All patients admitted with fever or new respiratory symptoms to be tested for COVID-19
  4. Entrance screening update – watch your email for entrance changes
  5. We are cancelling elective procedures/appointments effective Wednesday, March 18
  6. Virtual care guidelines are coming soon
  7. Practice social distancing where possible
  8. More information can be found on our COVID-19 resource page

State of emergency
Earlier today, the provincial government issued a state of emergency, mandating the closure of restaurants, libraries, private schools, movie and concert venues and other social locations. This update also prohibits any organized public events over 50 people including events and services in places of worship. Essential services and needs will remain available including groceries, pharmacies, public transit, construction sites and office buildings.

What this means for Unity Health: We know that many of you have family and friends who are staying home right now. It is important to remember that health care is considered an essential service and our role at this time is more important than ever. This message was echoed from the premier around the critical role we are playing right now in helping to curb the spread of COVID-19. We realize news is coming at an incredible speed – please continue to check our COVID-19 resource page, ask questions at questions@unityhealth.to and check your email.

Staff travel and reporting to work
The government has recommended that anyone returning from international travel self-isolate at home for 14 days before returning to work, except for those people who work in essential services, including health care workers. All Toronto Academic Health Science Network hospitals, including Unity Health, are expecting that staff, physicians and learners come to work after travel outside of the country unless you have symptoms. You are no longer required to contact Occupational Health upon return from travel unless you have any symptoms – the travel hotline has now been disconnected. Please remember that we are all in this together and it’s important that we support our colleagues during this time.

No one should be coming to work when feeling unwell. Regardless of travel, if you have symptoms consistent with COVID-19, do not come to work, notify you department/manager of your absence and contact Occupational Health. Symptoms include:

  • new or worsening cough or
  • new sore throat or
  • new runny nose or
  • new shortness of breath or
  • close contact with someone who has tested positive for COVID-19 in the last 14 days

In the event symptoms develop while you at work, stop working, perform hand hygiene, put on a procedure mask, notify your department/manager and contact Occupational Health:  

  • Joseph’s: 416-530-6800
  • Michael’s Corporate Health: 416-864-5400
  • Providence: 416-285-3666, ext. 4386

Approach to COVID-19 testing
Due to the increasing spread of COVID-19 in the city, effective immediately, all patients admitted with fever or new respiratory symptoms need droplet contact precautions and should be tested for COVID-19. This means we are no longer focusing on recent travel history in determining whether to test for COVID-19.

Entrance screening
To help protect everyone inside our hospitals, including our patients who are more vulnerable than most to adverse reactions from viruses, we are screening everyone coming into our main hospital sites. By scanning your ID, you are attesting that you are feeling well are able to work and do not have any symptoms. We are making changes to the entrances that staff and patients will be using tomorrow. We will be sending out a separate communication later today titled “What you need to know coming into work on Wednesday.” Please make sure you arrive early to allow for extra time to get into the building. We also ask for your patience as we continue to tweak this to make it as efficient as possible for people coming into our buildings.

Elective procedures/appointments
In line with our partner hospitals, we are moving to cancel all non-urgent and elective procedures and appointments including in our ambulatory areas effective Wednesday, March 18 to keep our beds ready to support anyone who comes in with COVID-19-related care needs. Our teams are currently reaching out to patients who are scheduled to come in this week to ensure they are aware of this change.

Virtual care support – coming soon
We know that many of you have questions about how to deliver care virtually (by video or phone), and some people are already putting together plans to do it. We have a working group that has been working to expedite virtual care to support our patients in accessing necessary care while also supporting our need to minimize unnecessary in-person interactions.

In the coming days, you will be receiving further information and “go-kits” that will guide clinicians on how to enable virtual care. This will include key information on our guiding principles and standards for IT solutions including supported tools, guidance around important clinical processes like registration/scheduling/documentation/consent, and information on who to get in touch with for more detailed help. This is a new process for many clinics – we will share details as soon they are available and ensure you have support as you work to implement a virtual process.

 Social distancing protocol
To minimize the risk of infectious disease transmission, we are recommending staff, physicians and learners reduce close physical interactions where possible. Here are some guidelines:

  • There should be no in-person gatherings of 25 or more people at Unity Health
  • Smaller in-person gatherings should strive to ensure a distance of two metres between individuals
  • Smaller meetings can still pose a risk to the organization if they include an essential group
  • For some events, participants may not all present at the same time, but risks such as shared food still need to be considered

Where to find more information
As always, please keep an eye on our COVID-19 resource page for the latest information. Should you have any questions or concerns, please connect with your manager or email

First and foremost, I want to say thank you.

I am truly blown away by the team work I am seeing as I walk through our buildings. In a very short time, we were able to get some key pieces of our COVID-19 preparedness in place to help to make our sites and everyone in them stay safe. Teams and leaders have been working tirelessly over the weekend to get our COVID-19 Assessment Centres up and running at St. Joseph’s and St. Michael’s, as well as our entrance screening launched across our three main hospital sites. The way our people have stepped up to help out is incredibly inspiring.

We will continue to adjust our processes around the assessment centres and main entrance screening in real time as we learn new efficiencies and adjust to any new direction from the Ministry of Health. 

Our Assessment Centres were built over a period of a few days thanks to the incredible work of our teams. There has been an enormous amount of planning and training put in place to make sure we are prepared and able to support our communities as people come in with their concerns. They are very safe environments with all of the correct procedures and precautions in place. We are all so grateful to all of our people who have stepped up to staff them.

There is a lot of information being shared right now and we know it’s difficult to stay on top of what’s happening. We are sending out this email that has all you need to know to date about our COVID-19 response. There are two very important things we need you to do:

  1. Practice excellent hand hygiene and proper precautions, and
  2. Check your emails regularly – at least once a day – to make sure you are getting the latest updates.

At any time, you can check our COVID-19 resource page for the latest information. If you have any questions or concerns, please don’t hesitate to connect with your manager.

We’re all in this together folks. We so appreciate everything you’re doing to keep our people, patients and communities safe.

With best regards,

Tim
President and CEO
Unity Health Toronto

Updates:

  1. Practice changes
  2. Occupational health
  3. COVID-19 Assessment Centres update
  4. How to keep yourself healthy

Practice changes

  • Screening at main hospital entrances for all staff, physicians, learners, patients and visitors started Monday, March 16. Staff can attest and screen themselves into the building, confirming they have no new symptoms and no recent contact with someone with COVID-19. Staff and physicians who fail the screening must contact Occupational Health to obtain clearance to return to work.
    • At St. Michael’s: Please use the Bond St. entrance which is staff only to help relieve pressure on the Queen. St. entrance at peak times – 6:30 to 10 a.m. and 3 to 8 p.m.
  • A reminder that staff should not be wearing scrubs to/from work. Please put them on after you arrive and remove them before you leave.
  • Student placements are on pause until at least April 4. This includes unpaid, pre-licensure student placements and any other on-site clinical learning (e.g. on-site half day clinical visits/labs) in clinical areas (i.e. nursing, health discipline and medical office administration students)  
  • Droplet contact precautions should be used for any patients with suspected COVID-19. In any case where COVID-19 is suspected, you must contact IPAC before ordering a test.
  • New visitor restrictions
    • in the hospitals: no more than one visitor per patient room unless a patient requires end-of-life care. This includes ambulatory areas.
    • in the Houses: no non-essential visitors – (essential would include in cases where residents are very ill or requiring end-of-life care). Note: this does not apply to private caregivers – they will be required to pass entrance screening.
  • The volunteer program has been suspended.

Occupational health updates

  • Non-essential international travel is strongly discouraged.
  • Anyone returning from international travel must contact Occupational Health at 416-864-5415 BEFORE returning to work to be cleared to come back to work
  • No gatherings of more than 50 people. Try to have virtual meetings where possible for smaller gatherings.
  • No visits to any of our sites by anyone from outside of Canada. This includes delegations, meetings, conferences or external student/observer placements
  • Do not come to work if you are sick. Contact Occupational Health if you are feeling unwell:
  • Joseph’s: 416-530-6800
  • Michael’s Corporate Health: 416-864-5400
  • Providence: 416-285-3666, ext. 4386

COVID-19 Assessment Centres update
COVID-19 Assessment Centres opened on Monday, March 16, at St. Joseph’s (first floor Sunnyside building) and St. Michael’s (Li Ka Shing, room 136) in partnership with Toronto Public Health. The goal of the assessment centres is to provide comprehensive screening, assessment and testing for mildly symptomatic members of the public who either self-present or are referred for assessment by Toronto Public Health. Those who are determined to require self-isolation will be provided instructions and support materials. Check the section on assessment centres in our COVID-19 FAQ for more details.

How to keep yourself healthy
In this ever evolving situation, it becomes more important than ever that our staff, physicians and learners take steps to protect their own health. Here are some practices you should keep in mind:

  • Stay home when sick
  • Reach out to Occupational Health or our Employee and Family Assistance Provider if you need to connect with someone about any aspect of your physical or mental health
  • Practice social distancing – limit close contact with others (2m or less) and avoid busy public gatherings
  • Wash your hands often using an alcohol-based hand sanitizer or soap and water
  • Avoid touching your eyes, nose and mouth with unwashed hands
  • Avoid contact with people who are sick
  • Cover your cough with a tissue or sneeze in your elbow
  • Frequently clean and disinfect touched objects and surfaces

The situation with COVID-19 continues to rapidly evolve and we appreciate everyone’s attention to these emails as we share important updates. Please read this all the way through and connect with your manager if you have any questions.

What to expect for entrance screening on Monday
We are taking additional steps to help ensure the safety of everyone inside of our hospital buildings. Beginning Monday, March 16, everyone coming into the main hospital sites at St. Joseph’s, St. Michael’s and Providence will be screened, meaning staff, physicians, learners, patients and visitors will be asked about symptoms and recent close contact with people who are ill.

We ask for your patience as we work through this process and ask that you try to arrive early on Monday morning for entrance screening, if possible.

Entrances and exits for staff, physicians and students to use on Monday
Please only use the designated staff screening entrances for both entering and exiting the building.

Site

Building

Entrance

Hours

St. Joseph’s

30 The Queensway – main hospital

East entrance (ground floor)

24 hours, daily

Our Lady of Mercy entrance

8:30 a.m. to 10 p.m.

Our Lady of Mercy parking entrance

8:30 a.m. to 10 p.m.

Sunnyside building

Sunnyside west entrance

7 a.m. to 5 p.m.

St. Michael’s

30 Bond Street – main hospital

Queen Street entrance

24 hours, daily

Bond Street entrance

6:30 a.m. to 10 a.m.
3 p.m. to 8 p.m.

209 Victoria Street – Li Ka Shing Knowledge Institute

Victoria Street entrance

7 a.m. to 8 p.m.

Providence

3276 St. Clair Avenue East – main hospital

Main entrance

24 hours, daily

B1 entrance

6:30 a.m. to 5 p.m.

Houses of Providence

Main entrance

6 a.m. to midnight

Link to main hospital

6 a.m. to midnight

 St. Joseph’s staff, physicians and learners: The Sunnyside parking garage bridge entrance will now be closed. If you are parking in the Sunnyside garage, you will need to enter and exit through the East entrance. 

Badge scanning
Please ensure you have your photo ID badge with you at all times. Your badge will be required for scanning as part of the screening process. If you forget your badge, you will be required to fill out paper documentation.

Providence staff, physicians and learners: Providence badges do not have a barcode, which is required for scanning. Providence staff, physicians and learners will be provided with an additional barcoded badge upon arrival to the main entrance of the hospital on Monday. You will be required to keep both your photo ID badge and your barcode badge with you at all times.

Staff, physician and learner self-screening
You will be asked to attest and screen yourself upon entering the building. By scanning your badge you are confirming that you are feeling well, are able to work and you do NOT have any of the following:

  • fever or
  • new or worsening cough or
  • new sore throat or
  • new runny nose or
  • new shortness of breath

AND in the last 14 days, you have NOT

  • had close contact with a confirmed or probable case of COVID-19 or
  • had close contact with a person with an acute respiratory illness  

If you answered YES to any of the criteria listed above:

  1. Do not enter the building
  2. Contact your department and notify them of your absence
  3. Contact Occupational Health to obtain clearance to return to work:
    • Joseph’s: 416-530-6800
    • Michael’s Corporate Health: 416-864-5400
    • Providence: 416-285-3666, ext. 4386 

At this time we will not be doing temperature screening at our entrances. Current evidence suggests that symptomatic individuals may not have a fever. For this reason, we are focusing on the symptoms listed above.

Note: Those who have travelled in the last 14 days and meet the screening criteria above should be coming into work, as per usual, unless advised otherwise by Occupational Health. 

New visitor restrictions

At St. Joseph’s, St. Michael’s and Providence
Effective Tuesday, March 17, we will be restricting the number of visitors to one visitor in a patient room at a time until further notice. Only patients who require end-of-life care will be allowed to have more than one visitor at a time. This update is out of an abundance of caution to keep our people, patients and visitors safe and healthy.

Please let visitors on your unit know of this upcoming change today and tomorrow so they are able to plan appropriately. We will be communicating this change on our websites and social media on Monday.

At the Houses of Providence
The Ministry of Health and Long-term Care has issued new recommendations for long-term care homes to suspend all non-essential visits until further notice. Effective Monday, March 16, only people visiting residents who are very ill or requiring end-of-life care are permitted to enter the building.

This suspension of visits does not apply to private caregivers who are hired by families to care for their loved ones. Private caregivers will be required to pass the same screening measures that we require of staff and physicians. 

Reminders:

  • Do not come to work if you are feeling ill, have a fever or have any respiratory symptoms.
  • Keep reading our FAQs which we are updating daily and send any questions you have to questions@unityhealth.to.

The situation with COVID-19 continues to rapidly evolve and we appreciate everyone’s attention to these emails as we share important updates. Please read this all the way through and connect with your manager if you have any questions.

Effective immediately: COVID-19 requires droplet contact precautions
The Ministry of Health has shared a new directive on caring for patients with suspected COVID-19 to droplet contact precautions after finding no evidence for COVID-19 transmission through the airborne route. Here’s what you need to know:

  • Effective immediately, Unity Health will use droplet contact precautions for caring for patients with suspected COVID-19 which includes the use of surgical/procedure mask, eye protection, full sleeved gown and gloves.
  • An N95 respirator should only be used when performing an aerosol-generating medical procedure such as an airway intubation or CPR, for example.

Please ensure you are aware of the proper use of personal protective equipment, including donning and doffing procedures. You can find more resources related to this on our staff COVID portal.

Assessment centres opening Monday at St. Joseph’s and St. Michael’s
In partnership with Public Health, we are opening two COVID-19 Assessment Centres on Monday – one at St. Joseph’s on the first floor of the Sunnyside building and one at St. Michael’s located in the Li Ka Shing Knowledge Institute, in and outside of room 136. The goal of these assessment centres is to provide comprehensive screening, assessment and testing for mildly symptomatic members of the public who either self-present or are referred for assessment by Toronto Public Health or local clinics. Those who are determined to require self-isolation will also be provided instructions and support materials. We are finalizing hours – they will be open from 10-12 hours a day based on volumes and need.  

In both centres, we are taking all precautions to ensure the safety of our people and those visiting the centres. The assessment centres are being designed and built with appropriate precautions. We will be sharing more details on the COVID resource page as they become finalized.

Staff, visitors and patient screening starts Monday
As we continue to anticipate the official declaration of community transmission of COVID-19, we are taking additional steps to help ensure the safety of everyone inside of our hospital buildings. Beginning Monday March 16, everyone coming into the main hospital sites at Providence, St. Joseph’s and St. Michael’s will be screened, meaning they will be asked about symptoms and recent travel.

ACTION ITEM: Please check the COVID resource page and your email before coming to work on Monday as there may be specific information on the process of screening including which doors to use.

There may be patients coming for appointments who have COVID-19-like symptoms that are part of another underlying illness, such as lung disease. These patients will be provided with a mask and they will then be escorted to their appointments with appropriate precautions.

Any staff or visitors who don’t pass the screening will be not be allowed into the hospital and asked not to return until they are symptom-free. We are still finalizing details on our screening processes, but wanted to provide advance notice that you can expect to be stopped on your way into work beginning Monday morning. As a reminder, staff, physicians, learners and volunteers should not be coming to work if feeling unwell – please connect with your manager or Occupational Health at your site if you have any questions or concerns:

  • Joseph’s: 416-530-6800
  • Michael’s Corporate Health: 416-864-5400
  • Providence: 416-285-3666, ext. 4386

Update on upcoming school closure
An announcement went out yesterday about all publicly funded schools being closed for the two weeks following March break (until April 5). We recognize this is likely causing a lot of stress for many of our people and we appreciate your efforts to find alternative child care arrangements. We will be sharing more in the days ahead on how we can work together to ensure that you are supported.

Additional things to remember

  • Do not come to work if you are feeling ill, have a fever or are having any respiratory symptoms.
  • Review the Travel Risk Screening Tool (in the resource section on the COVID resource page) for steps to take if a patient screens positive.
  • Do not use our emergency departments to enter or exit the hospital to help limit the amount of traffic in that area.
  • We have an urgent need for staff from across the organization to support our preparation and response efforts to the COVID-19 situation. If you are a clinical or administrative employee who would like to support the organization’s efforts in this regard, please fill out this availability form (download) and share the completed version with your manager who will share it with Human Resources.
  • Keep reading our FAQs which we are updating daily and send any questions you have to questions@unityhealth.to.

Second and third positive COVID-19 cases
A patient who presented to St. Joseph’s ED on March 10 and another who presented to the Family Health Team at 410 Sherbourne on March 10 have both been confirmed positive for COVID-19. Neither patient required admission so they were both discharged home with support from Public Health with instructions to self-isolate. As per our screening guidelines and infection control protocols, both patients were cared for using the appropriate precautions. We expect that we will continue to see patients presenting with symptoms and travel histories and ask everyone to continue following precautions to help keep yourselves, our patients and our communities safe.

Immediate staffing needs
We have an urgent need for staff from across the organization to support our preparation and response efforts to the COVID-19 situation. If you are a clinical or administrative employee who would like to support the organization’s efforts in this regard, please fill out this
availability form (download) and share the completed version with your manager who will share it with Human Resources. Managers have been asked to identify staff for potential redeployment as early as end of day today so please act quickly on this if you are interested. Our staffing needs cover a wide variety of areas, but include the following:

  • Emergency Departments
  • Assessment Centres
  • Patient information and support
  • Entrance screening

Should you have any questions, please contact rcstaffsmh@unityhealth.to.  

Non-urgent elective procedures and appointments
This is a reminder that all non-urgent, elective procedures and appointments should be delayed in any case where a patient has travelled outside of Canada within the last 14 days or had contact with someone with symptoms who was in a country other than Canada within 14 days prior to their illness onset. Please follow the Travel Risk Screening Tool (see
here under resources > screening tools) to make these decisions as appropriate.

CP24 mistake
A CP24 article yesterday mistakenly identified the spouse of a Hamilton physician confirmed positive with COVID-19 as working at St. Joseph’s Toronto. They have since corrected their story to clarify the spouse works at St. Joseph’s Hamilton.

Virtual Town Hall
Finally, as a reminder, we are holding a virtual Town Hall at noon today. Join us to hear the latest updates from our leaders on the COVID-19 situation and our response. 

You can also submit questions in advance of the Town Hall here and take a look at our COVID-19 FAQ which will be updated with the latest information after the Town Hall.

As a reminder, please do not come to work when you are feeling unwell. This not only helps you recover faster, it helps keep our patients, your colleagues and our communities safe. If you have any questions or concerns about this, please connect with Occupational Health (Corporate Health at St. Michael’s) or your manager.

Good afternoon everyone,

I want to update you on some important decisions that have been made as part of our ongoing preparation and management of the Novel Coronavirus (COVID-19) situation. With the continuously evolving situation, it is our primary goal to ensure the safety of our people, patients and communities at Unity Health. The World Health Organization has declared this a pandemic this afternoon, which means there is community level spread in multiple countries. It was only a matter of time before this declaration was made. As of this morning, there was suggestion of community transmission in Toronto. For these reasons, we are making the decision to cancel all large gatherings effective immediately to limit potential spread.

Cancelling and postponing large gatherings

Effective today (March 11) all gatherings of over 50 people internally and in our external locations need to be changed to virtual meetings or telephone conferences where possible, be postponed to a later date or cancelled. This direction applies to any events for the remainder of March and the entire month of April, and it includes meetings, events, conferences and rounds, whether they involve staff, invited guests, families, patients or combinations of these groups. Please note we may also have to start cancelling meetings of smaller groups to free up capacity to refocus on other important priorities.

We will be putting plans in place for specific areas where groups of people come together regularly for compassionate care in our inpatient and outpatient settings. As we work with those areas we will be communicating directly with the teams and their patients/clients and sharing out information to the broader network and community as needed.

I know these changes will have significant impacts across all of our areas, especially for those events we’ve had to cancel and postpone on short notice today and annual gatherings that are coming up including Mission Day at St. Joseph’s on March 19. This is the right thing to do for everyone’s safety and I really appreciate your understanding and cooperation.

Our education and research leaders are connecting with their colleagues at the Toronto Academic Health Sciences Network (TAHSN) hospitals, as well as the University of Toronto to discuss ongoing planning to support academic activity not only at Unity Health but across the city.

Ongoing planning and keeping up to date with changes

We are carefully reviewing other functions that may need adjustment over the coming days and weeks including screening practices for staff and visitors, our visitor policies and where we might need to look at prioritizing the work that we are doing that could be considered non-essential. 

I know this is an uncertain time and, especially now that we are hearing the word pandemic, there will inevitably be some anxiety among our staff and our families. Our aim is to be very transparent about what we know and what steps we feel are important to ensure the safety of our people, patients and families. As this is a quickly changing environment, we will likely need to make certain changes fairly quickly, and we will endeavour to do this in alignment with our partners and the ministry. We will also make every effort to be sure there is ample communication. 

To help us in communicating the details of our planning and any changes we make to guidelines or protocols in a timely and transparent way, please regularly check your emails and visit the information section on the homepages of our intranets. I can’t emphasize enough that this is an evolving situation and our first priority is the safety of our staff, physicians, volunteers, and our patients and families.

We are holding a virtual town hall tomorrow at noon and I encourage you to please join us if you can. We will make sure to allow time for questions and answers from a panel of our experts. You can also continue to ask any important questions you have by emailing questions@unityhealth.to.

With March break coming next week, I ask that you review our travel policy that has been put in place for the network by clicking here

In closing, I want to sincerely  thank everyone for your efforts, and for the incredible amount of planning that has gone into our COVID-19 readiness. This truly has been a team effort across all of our programs, services and departments.

With best regards,

Tim
President and CEO
Unity Health Toronto

Dear staff, physicians, learners and volunteers,

On March 9, an adult patient arrived at St. Joseph’s Emergency Department (ED) with symptoms after traveling from Switzerland to Canada.

As per our screening guidelines and infection control protocols, the patient was cared for using the appropriate precautions and was tested for COVID-19. As the patient was mildly ill, they were discharged home from the ED with instructions to self-isolate. We worked with Toronto Public Health and the Ontario Public Health Laboratory and confirmed the patient has tested positive for COVID-19. At this time, there have been no cases of local community transmission. According to Toronto Public Health, the risk remains low.

As you know, an incredible amount of work has been done in the last couple of months across Unity Health to prepare for a patient presenting who has COVID-19. Some of the preparation has included refresher training on appropriate use of personal protective equipment, additional screening across the organization, ensuring mask fit testing is up to date, and the creation of a dedicated online resource with regularly updated information for staff, physicians, learners and volunteers.

Given the increasing numbers we have been seeing of COVID-19 globally, we knew it was a matter of time before Unity Health Toronto experienced our first confirmed presumptive positive patient. It’s important to understand that all of the processes we’ve been putting into place planning for a situation just like this worked very well.

Given the ongoing spread of COVID-19, it is likely that we will see more individuals presenting with symptoms and a travel history to affected areas. Early identification of patients and familiarity with our screening tools will help ensure we continue to be well prepared. We are setting up another virtual Town Hall this Thursday so you can hear directly from our Infection Prevention and Control and clinical leaders about the situation and have the opportunity to ask questions. Please keep an eye on your calendars for details about how to tune in. You can send questions in advance to questions@unityhealth.to.

I know that the preparation for and response to COVID-19 has brought a lot of anxiety across our organization and I want to reassure you that our routine practices are in place to help protect all of us and our patients. The most important thing you can continue to do is follow those procedures including appropriate hand hygiene and the use of personal protective equipment as required. If you have any additional concerns or questions, please don’t hesitate to reach out to your manager, Occupational Health or Infection Prevention and Control.

More than ever, the role you play at work is critically important in helping not only keep our patients safe but also reassuring patients and families that they are safe and in good hands and we have attached talking points you can use in those conversations. Thank you so much for your continued dedication to our community and the patients and families we care for.

Thank you,

Tim
President and CEO

Unity Health Toronto

Dear Unity Health staff, physicians, learners and volunteers,

Given the rapidly evolving spread of COVID-19 in many parts of the world, we are sharing updated travel policies for all staff, physicians, learners and volunteers, including the process for being cleared to come back to work. These are in line with all of our partner Toronto hospitals and are being put in place out of an abundance of caution to help protect you and those around you.

Work-related travel
All travel outside of Canada for hospital-related purposes must be cancelled or postponed indefinitely. In addition, all international travel to Canada for work-related purposes, including delegations, meetings, conferences or external student/observer placements, should be cancelled until further notice.

Personal travel
All travel outside of Canada by staff, physicians, learners and volunteers needs to be reported to Occupational Health (Corporate Health at St. Michael’s) BEFORE you come back to work. A quick phone call will ensure Occupational Health is aware of your situation and can clear you to return to work. Occupational Health can be reached at their new hotline: 416-864-5415.

To countries with active government travel advisories: Anyone considering travel should always check on government travel advisories. Vacation travel to areas where the government has recommended avoiding non-essential travel is strongly discouraged, but if you do go on vacation in these countries, you must:

  • Report that travel to your manager and Occupational Health and Safety before you go.
  • Understand that you will not be able to come back to work for 14 days after your return home.
  • You will not be paid during this required quarantine period.

To countries not currently covered by a travel advisory:

  • You may be quarantined while on vacation or be quarantined upon return if the country you travel to is added to the list with travel advisories while you are there.
  • In countries with limited health care services, you may not be able to access what you need in the event that you become ill. This applies to all illnesses – not just COVID-19.
  • Upon return from your vacation, you may be quarantined at home if that country has reported cases of COVID-19 or you have travelled on an aircraft or other vessel with reported cases of COVID-19.

Travel precautions
In any travel that you are doing, ensure you are following regular health precautions including:

  • washing your hands often using an alcohol-based hand sanitizer or soap and water
  • avoiding touching your eyes, nose and mouth with unwashed hands
  • avoiding contact with people who are sick
  • covering your cough with a tissue or sneeze in your elbow
  • frequently cleaning and disinfecting touched objects and surfaces

Should you have any questions at all, please connect with your manager or contact Occupational Health (Corporate Health at St. Michael’s). Thank you for helping keep our people, patients and communities safe.

Dear staff, physicians, learners and volunteers,

I know you are all working diligently to stay up to date with practices related to COVID-19 which continue to evolve as the situation changes daily. Over the last week, we have seen additional cases present in Ontario as well as continued spread globally including in the United States. We have not had a patient present with COVID-19 at any of our sites at Unity Health, though we are doing everything possible to ensure we are prepared should that happen.

Our goal is always to keep all of you, our patients and our communities as safe as possible and, for that reason, we are taking additional precautions including:

  • Screening for travel anywhere outside of Canada. This is being done proactively out of an abundance of caution given the continued spread around the world, including in the United States. For a patient to screen positive and be managed as a Person Under Investigation, they should have both (1) non-Canadian travel or contact with someone who is ill with non-Canadian travel and (2) one of the following symptoms: fever, new or worsening cough or pneumonia. Patients who have travelled outside of Canada but do not report any symptoms will not need to be put into precautions. Please note: specimen collection for symptomatic patients with a travel history will be a single NP swab for outpatients, and NP and throat swab for admitted patients.
  • Reporting to Occupational Health after travelling anywhere outside of Canada. If you are travelling anywhere outside of the country, you will need to contact Occupational Health on your return to be cleared before you can come back to work. Again, this is out of an abundance of caution to help protect you, your peers, our patients and our communities.
  • Increased surveillance for admitted patients in our EDs. Although there remains no evidence of community transmission of COVID-19 in Toronto, we – along with several other Ontario hospitals – are working with Public Health Ontario to expand our surveillance approach to ensure we have a system capable of identifying community transmission as early as possible. As part of this surveillance, a subset of patients that have nasopharyngeal swabs sent to the laboratory for influenza and other viral testing will also automatically have their specimens forwarded to the public health laboratory for COVID-19 testing.

This has been implemented in our Emergency Departments at both St. Joseph’s and St. Michael’s for admitted patients. This means you may see COVID-19 test results on patients who did not have that test ordered by the ordering physician. These patients will only require flu precautions unless there is an unexpected positive test, in which case appropriate urgent action will be taken. Currently, we expect to receive results within 24-48 hours, but this may increase as demands increase.

As always, the most important actions you can take are to continue regular practices – follow routine precautions, use appropriate PPE, clean your hands frequently and if you are feeling sick, don’t come to work – call Occupational Health. The more we can do to keep ourselves healthy, the better we are able to help protect our teams and patients.

I know there is a lot of anxiety surrounding COVID-19 and I highly recommend you keep an eye on our COVID-19 resources page for the latest information. You can also connect with your manager, Occupational Health, Infection Prevention and Control, access the Employee and Family Assistance Program or reach out directly to the Coronavirus Management Team by emailing questions@unityhealth.to. Please don’t hesitate to ask for support if you have additional questions or concerns – we are all in this together.

I want to thank each and every one of you for the incredible response you have provided over the last several weeks. I so appreciate your dedication to keeping our people and patients safe.

Thank you,

Tim
President and CEO

Unity Health Toronto

We are in the middle of flu season and seeing a continued global spread of COVID-19. While the risk to Torontonians for COVID-19  remains low right now, we wanted to remind all staff, physicians, learners and volunteers of the following Occupational Health reporting requirements to help keep our people, patients and communities safe.

  1. Symptoms – If you are experiencing any symptoms of an influenza-like illness, contact Occupational Health and do not come to work. This is standard practice at all times and is essential regardless of whether you have travelled or not. We need to protect our patients and colleagues from communicable diseases, including COVID-19.
  1. Travel – We are updating a list of countries affected by COVID-19 in real time. If you have travelled to one of these countries within the last 14 days, or are planning on travelling to one of these countries, you are required to notify Occupational Health BEFORE returning to work. Because this list has the potential to change rapidly, we ask that you keep an eye on it and reach out to Occ. Health as required (i.e. you should contact Occ. Health if you recently travelled to Italy or any of the other affected countries currently on the list).
  1. Contact – If you have had contact with a person under investigation for COVID-19, you are required to contact Occupational Health immediately as well as self-monitor for signs and symptoms of COVID-19.

Occupational Health contacts at each site:

  • St. Joseph’s: 416-530-6800
  • St. Michael’s: 416-864-5400
  • Providence: 416-285-3666, ext. 4386

These practices are in place to help keep everyone in and around Unity Health as safe as possible and we appreciate your support in protecting our people, patients and communities. Should you have any questions, please connect with your manager or IPAC at your site.

Dear Unity Health staff, physicians, learners and volunteers,

As we continue to hear updates about the spread of the novel coronavirus (now called COVID-19) in China, Unity Health is doing everything possible to ensure that we are prepared should a case present at one of our sites. Our Coronavirus Management Team continues to meet regularly to ensure appropriate coordination and response across our sites and our Infection Prevention and Control (IPAC) team is helping support our frontline teams in screening patients. Please do not hesitate to contact IPAC if you need any support, or to reach out directly to the Coronavirus Management Team with any questions by emailing questions@unityhealth.to.

As a reminder, any staff members, physicians, learners or volunteers who have travelled to China, Hong Kong or Macao within the last 14 days are required to contact their site’s Occupational Health team before returning to work:

  • St. Joseph’s: 416-530-6800
  • St. Michael’s: 416-864-5400
  • Providence: 416-285-3666, ext. 4386

There is understandably anxiety in our organization and our communities right now as we continue watching this situation develop in China, however we want to emphasize that the current risk to Canadians is low and that there are no patients with COVID-19 admitted to hospital in Ontario and none have been identified at Unity Health Toronto. If you have any personal concerns about the COVID-19 outbreak, you can always reach out to the Employee and Family Assistance Program for support.

Please continue to check the coronavirus resource page we have created that is being updated in real time. Submitted questions are being added to our frequently asked questions and we will continue to share updates through Twice a Week as more information becomes available.

In times like this, it is more important than ever that we all work together, keep an open dialogue and help our patients and their families understand the low risk. We are so grateful for your dedication to serving our communities and for everything you do.

Tim

President and CEO
Unity Health Toronto

Thank you to those who tuned in for our Virtual Town Hall on Jan. 31 about coronavirus preparations at Unity Health. If you weren’t able to attend, you can watch the video and read our FAQs. Timestamps have been provided for the start time of each agenda item.

To watch the video at St. Joseph’s and St. Michael’s, go to SMHTube.
(Open in Internet Explorer; if the site is blocked, click “advanced,” then proceed to site)

To watch the video at Providence, go to this intranet page.

  1. Update from Tim Rutledge, President and CEO (0:00)
  2. Infection Prevention and Control update
    • Coronavirus overview – Dr. Mark Downing, Division Health and Education Lead, Infectious Disease, St. Joseph’s Health Centre (5:14)
    • What we’re doing locally – Dr. Matthew Muller, Medical Director, Infection Prevention and Control, St. Michael’s Hospital (8:34)
  3. Emergency Department update
    • Carolyn Snider, Chief of Emergency Medicine,  St. Michael’s Hospital (12:15)
    • Steven Rhee, Chief of Emergency Medicine, St. Joseph’s Health Centre (16:18)
  4. Questions (21:25)

More info

If you have any questions related to infection prevention and control, contact your site’s IPAC department directly:

For any other general questions, contact questions@unityhealth.to.

Dear Unity Health staff, physicians, learners and volunteers,

I wanted to reach out because I know the last week has been incredibly busy for teams across our sites as we prepare to meet challenges we may face related to the coronavirus outbreak. In addition to our regular work, many have fielded questions from patients, residents, families and visitors about the steps Unity Health is taking to protect them, and many of our own people are understandably anxious as they provide care on the front lines. I want to reassure you that risk to Canadians for 2019-nCoV still remains low. While there is a large focus from the media on the outbreak in China, the situation here is quite different; our health care system in the province has been monitoring and preparing since the outbreak first emerged earlier this month and, as a result, we feel confident in our ability to respond to this, should we need to.

Teams across Unity Health have done an enormous amount of work in the last few days, implementing consistent screening measures across our units, including putting in enhanced triage processes, collaborating with Infection Prevention and Control (IPAC) and updating mask fit testing. We have also established a Coronavirus Management Team chaired by Dr. Tom Parker that is meeting daily to share updates and determine action plans. This group will continue meeting regularly and you can connect with them directly if you have any questions or concerns by emailing questions@unityhealth.to. We are also continuing to work with our partners including the Ministry of Health to ensure we have the latest recommendations and guidelines in place.  I am so proud and appreciative of the way our teams have come together in such a short time. It’s been all hands on deck and, because of that, I am confident we will be ready to meet any challenges ahead.

I know some of you will have questions. We have resources available for all staff, physicians, leaders and volunteers on the Unity Health website that you can access from work or home – there’s a link to it from the home page of all three of our intranets. On there, you will find the latest communications as well as frequently asked questions which we are updating in real time. On that page, you can also find a general patient and visitor information sheet that you can print and share as needed with anyone who has questions or wants additional information about the outbreak and what we are doing to protect everyone across our sites.

The work you do every day is important, and the role you play during a challenging time like this is even more significant – you are the ones connecting with our patients, residents, families and visitors, and your reassurance to them means a lot in helping them feel more secure and confident in their safety across our sites. If you have any questions or concerns, please don’t hesitate to connect with your manager or our Coronavirus Management Team. We will be using all of your questions to inform our ongoing communications.

I want to sincerely thank each and every one of you for the important role you have during this time, and for everything you have done to go above and beyond over the last few weeks.

Tim

President and CEO
Unity Health Toronto

Dear colleagues,

This is an update following yesterday’s communication related to the first confirmed case of 2019 novel coronavirus (2019-nCoV) admitted to Sunnybrook.  Since yesterday, the global situation continues to evolve with an increasing number of cases of 2019-nCoV in Wuhan, China.  There have not been further cases identified in Canada and the overall number of cases outside China remains very small.  No transmission to healthcare workers has been recognized outside of China.

We are continuing to work closely with our emergency departments and ambulatory areas across our sites to ensure that appropriate and safe screening is in place with patients being assessed for fever, respiratory symptoms and a travel history.  Infection Prevention and Control is being notified about all symptomatic patients that have returned from China within the last 14 days and assisting with the assessment and disposition of these patients.

Over the next several days there will be significant activities occurring to ensure that we are fully prepared for any case that may arrive at Unity Health. I am asking you all to continue to read these updates and the information available on the homepage of our intranets as we develop answers to frequently asked questions (FAQs) and new materials as needed over the coming days to help keep you informed.

As a reminder, please do not use our emergency departments to enter or exit the hospital; please use an alternate route. This will help limit the amount of traffic in that area to patients who need care.

Is your N95 mask fit testing up to date?

Please check your fit testing card for the make and model and the date in which you were tested. Fit testing is valid for a period of two years. If you need to get re-tested, please visit the Occupational Health and Safety office at your site:

Today (Jan. 26) at St. Michael’s, 8 to 11 p.m. and Monday to Friday, 7 a.m. to 3 p.m.
At St. Joseph’s, Monday to Friday, 7:30 a.m. to 3:30 p.m.
At Providence, Monday to Wednesday, 8 a.m. to 4 p.m.

Infection Prevention and Control will also be offering in person refreshers on how to safely don and doff the personal protective equipment (PPE) required to assess and care for patients with suspected 2019 nCoV infection – watch for announcements about the timing of these sessions at all sites.

Staff who have travelled to Wuhan, China:

If you have travelled to Wuhan, China and are about to return to work, please get in touch with your site’s Occupational Health and Safety team before coming in:

Providence: 416-285-3755
St. Michael’s: 416-864-5400
St. Joseph’s: 416-530-6800

Visitor policy and screening:

There is currently no restriction for visitors to our hospitals. All of our sites have signage posted indicating that visitors who are ill should not visit.  If you notice a visitor who appears unwell, please remind them of this policy.  While this does not apply to all visitors, family members or others accompanying a patient with suspected 2019 nCoV should be screened for fever and respiratory symptoms and if symptomatic should be managed as a suspect case. Please speak to your manager for more information.

Questions?

If you have specific questions related to Infection Prevention and Control (IPC) please contact your IPC department directly. For other general questions please email our Communications Department at communications@unityhealth.to and they will do their best to help direct inquires to the most appropriate person or department. You can also visit www.ontario.ca/coronavirus for more information.

We recognize these developments may cause some anxiety for our people. Please remember that the risk remains low, with only a single confirmed case in Toronto, and be assured we are taking all steps to ensure staff safety.  Staff, including physicians, experiencing significant anxiety should also feel free to contact our Employee and Family Assistance Program (EFAP) line: guidanceresources.com or 1-866-606-6367.

As always, we ask that if you are approached by the media for any comments on the situation, please adhere to our Media Policy and direct any media inquiries to communications@unityhealth.to.

Thanks to all of you for your patience and professionalism as we respond to this evolving situation and for your continued dedication to our patients and to each other.

Sincerely,
Tim

Dear colleagues,

As you may be aware, the first case of the 2019 novel coronavirus in Canada was reported today, and the patient has been admitted to Sunnybrook. Toronto Public Health is working to identify and monitor all contacts of this patient.

While we understand that this news will likely cause some anxiety, we want to reassure you that we have been planning for this possibility and working to ensure that Unity Health Toronto is prepared to assess and treat patients with the 2019 novel coronavirus since it was first identified in China. The safety of our staff and patients is paramount to us and we are taking every precaution.

We have been screening patients for the 2019 novel coronavirus in our emergency departments and several key ambulatory areas since Jan. 6 and are now expanding screening to all clinics and ambulatory areas. There has been regular communication with our emergency departments and we are confident that they will identify and appropriately isolate and manage any patient that presents with a suspected coronavirus infection.

The St. Joseph’s Emergency Department has already dealt with two suspected cases that required investigation based on triage screening. In both cases, the process went smoothly, and the patients were discharged after they were ruled out.

Our ask of you

  • Please do not use our emergency departments to enter or exit the hospital; please use an alternate route. This will help limit the amount of traffic in that area to patients who need care.
  • If you have travelled to Wuhan, China and are about to return to work, please get in touch with your site’s Occupational Health and Safety team before coming in
    • Providence: 416-285-3755
    • St. Michael’s: 416-864-5400
    • St. Joseph’s: 416-530-6800
  • If you are approached by the media for any comments on the situation, please adhere to our Media Policy and direct any media inquiries to communications@unityhealth.to.

More information

  • If you have any questions about the situation, please don’t hesitate to contact the Infection Prevention and Control team at your site, or any of us directly. We want to keep you informed and up to date, so we’ll do our best to provide you with an answer as soon as possible
  • Visit www.ontario.ca/coronavirus

We are staying abreast of the situation and will let you know about any new information and any directives from the Ministry of Health or Toronto Public Health as the situation evolves.

Sincerely,

Matthew Muller, Medical Director, Infection Prevention and Control, St. Michael’s Hospital Mark Downing, Infection Control Officer, St. Joseph’s Health Centre Paula Podolski, Director, Infection Prevention and Control, Unity Health Toronto

We are closely monitoring the development of a novel coronavirus that emerged in China associated with respiratory illness.

  • Cases have been detected outside of China, including in the United States.
  • All international cases were travelers who had recently arrived from Wuhan, China.
  • Health care organizations in Ontario are now required to report suspected and confirmed cases of the novel coronavirus to Public Health.
  • The World Health Organization has opted to not declare this a public health emergency of international concern but is continuing to actively monitor the situation.

What Unity Health is doing

  • Our emergency departments are screening patients from China for febrile respiratory illness at triage.
  • Key outpatient areas that routinely assess patients for fever and respiratory illness are also already screening.
  • Ambulatory and inpatient areas will be receiving screening tools next week.
  • All patients under investigation for 2019 novel coronavirus must be assessed using airborne, droplet and contact precautions.
  • If you have any questions, contact Infection Prevention and Control.

No, seasonal coronavirus and COVID-19 are different types of coronavirus. Seasonal coronavirus is common in Canada and is one of the causes of the common cold and usually results in a mild illness. COVID-19 is a new coronavirus and much remains unknown about it. While it also causes a cold- or flu-like illness, it can also result in severe disease although we do not yet know how often this occurs. Note that when patients with a fever and respiratory illness are tested for COVID-19, they are also tested for more common viruses like influenza and regular coronavirus – so you may see test results positive for coronavirus but these are NOT the COVID-19 coronavirus.

  • Use safe practices for every clinical interaction. By using appropriate routine practices for all clinical encounters, including performing hand hygiene, disinfecting shared equipment and wearing personal protective equipment as required, we can significantly reduce the risk of COVID-19 transmission even from an unrecognized case. See our ‘Routine Practices and Additional Precautions’ policy for further information.

    AND

  • Perform admission and daily screening for acute respiratory infections (ARI) and other infectious symptoms. All patients presenting should be screened on presentation/admission and daily for new infectious symptoms, including (but not limited to) fever and respiratory symptoms.

    AND

    • Take a travel and exposure history for all patients upon presentation. Screening tools are in the resource section on the COVID-19 page.

     

  • Ask the patient to clean their hands and provide them with a surgical mask
  • Move the patient to a private room or designated area away from other patients and staff
  • Put up a sign indicating that the patient is on Droplet and Contact precautions
  • Staff must use Droplet and Contact precautions for all routine interactions with suspected cases (i.e. surgical/procedure mask, eye protection, gown and gloves in addition to routine practices)
  • A fit-tested, seal-checked N95 respirator should be used instead of a surgical/procedure mask when performing an aerosol-generating medical procedure such as an airway intubation or CPR, for example
  • Contact Infection Prevention and Control if you require any further assistance or have questions 

Soarian admission orders are now available for admitting COVID-19 positive patients  to the general ward or to the ICU.

Our guidelines are designed to protect staff so as long as guidelines are followed, staff shouldn’t need to be quarantined. If something goes wrong with donning PPE, please reach out to Occupational Health.

A normal number of people should accompany the patient wearing appropriate PPE. There should be one extra person who is “non-contaminated” to open doors, push elevator buttons, etc.

Please let everyone on the care team know about the person under investigation (PUI) status. When contacting support partners (i.e. portering, security, environmental services, etc.), it is critical that you inform them if the patient you require support with is a PUI or has tested positive for COVID-19 so that they can ensure they have the appropriate personal protective equipment. Please also inform the diet office of these details because they will use disposable dishes and deliver food to the unit rather than directly to the patient’s room.

Effective March 20, 2020, the Ministry of Health outlined that all patient transfers between Ontario hospitals, including emergency transfers, require a Provincial Transfer Authorization Centre (PTAC) issued Medical Transfer Authorization Number before transport. This is required for all methods of patient transport including air ambulance, land ambulance and private transfer service. For Ontario hospitals looking to arrange a patient transfer, please follow the steps below:

  • Login to the online PTAC Portal
  • Complete the PTAC Screening Report. If the patient does not screen positive for COVID-19, a Medical Transfer (MT) Number will be issued immediately.
  • If the patient is flagged positive, an MT Number will not be issued automatically. The sending facility is to contact the Ornge Operations Control Centre (OCC) to process the generation of an MT Number manually.

The only exclusion to the steps outlined above is for Federal Nursing Stations that follow a different process with Ornge. For more information, please refer to the Ornge PTAC Frequently Answered Question page.