The workforce at Dartmouth General Hospital has been on the forefront of patient-centred innovation, despite the challenges facing health-care systems across the country.
From introducing the province’s only drive-through blood collection site to completing the nation’s first robot-assisted total hip replacement surgery, Dartmouth General has become a site for medical innovation in Nova Scotia.
The hospital is working to foster an atmosphere where systemic problems can be not just solved but anticipated ahead of time by positioning Dartmouth General as a collaborative culture where ideas are not only heard but welcomed.
“I think Dartmouth is uniquely placed for innovation,” says Dr. Natalie Cheng, the medical site leader at Dartmouth General Hospital. “The health-care system is under enormous strain right now. We know that need breeds innovation, and Dartmouth General has the right culture to support and foster that innovation.”
In February 2022, Dartmouth General wrapped up the Above and Beyond campaign, a significant expansion and renovation project. The six-year, $150 million undertaking has led to improved capacity across Dartmouth General; including eight new operating rooms, more hospital beds, a new intensive care unit and the creation of the Fred Smithers Centre for Orthopedic Care, among other improvements.
“The expansion and renovation at Dartmouth General are amazing,” says DGH Foundation president and CEO Stephen Harding. “The new spaces and upgrades have allowed for improvements in efficiency, safety and access to care. It has also allowed staff to think bigger in terms of the innovation they want to see at the hospital.”
With the Above and Beyond campaign completed, Dartmouth General Hospital is turning its focus to bringing in state-of-the-art equipment, more health-care professionals and new innovations which will all coincide with the roll out of the new ‘Lead On’ campaign.
At the same time, it’s looking to grow its involvement in its local communities, investing in programs to work toward equity and accessibility to ensure the care at Dartmouth General reflects and reaches the diverse communities it is meant to serve.
“We have been expanding, and we are a regional hospital, but we still maintain that community hospital feel in terms of relationships and the fact that we all know and support each other,” says Cheng. “There is a level of collaboration that’s quite special at Dartmouth General.”
ON THE CUTTING EDGE
One of the innovations made possible by donors and the DGH Foundation is the addition of the Stryker Mako SmartRobotics system, an orthopedic surgical robot that is transforming how surgeries like hip and knee replacements are performed.
Made possible through a partnership with the Nova Scotia Health Innovation Hub and through DGH Foundation donors, the technology is helping orthopedic surgeons improve accuracy, while reducing recovery time and the need for repeat surgeries. The Foundation has launched a campaign to fund the $2.2 Million robotic technology.
The surgical robot is part of the Fred Smithers Centre for Orthopedic Care, which was created to reduce wait times for hip and knee surgeries in the community and province.
“This level of orthopedic innovation wouldn't have been able to happen in the old days,” says Cheng. “Now that we are expanding our overall surgical program, we're going to be looking at a short stay unit to streamline and optimize the care of surgical patients that require short admissions — for example, things like knee and hip replacements or prostate surgeries.”
“While DGH has been leading the way in innovation, these many initiatives would not be possible without community support and funding from donors. The John and Judy Bragg Innovation Fund, which was created in 2020 to support innovation at Dartmouth General with a pledge of $1 million over ten years, has been a significant driver of these efforts, says Cheng.
One new addition made possible through the fund is the GI Genius, a computer-aided detection system that uses artificial intelligence technology to detect polyps during colonoscopies. Last spring, Dartmouth General became the first hospital in the country to use the new technology.
“It improves the detection rate over the naked eye, so it supplements the existing screening processes,” says Cheng. “When our endoscopists do these colonoscopies, they will be able to catch more precancerous lesions and save more lives.”
“We now have a GI Genius for each of our endoscopy rooms. As we now have the largest colorectal screening program in the province, we're really leading the way on that.”
PLANNING AHEAD
In addition to these technologies, Dartmouth General is also piloting new programs to improve accessibility, capacity and quality of care.
From implementing the National Early Warning Scores (NEWS2) system — an early warning scale used in emergency departments to monitor the physiological condition of patients — to using predictive analytics to help predict what the hospital’s flow and capacity pressures are going to be, the hospital is planning ahead to anticipate gaps and bottlenecks.
The hospital has also worked toward improving accessibility by introducing the province’s only drive-through blood collection clinic and its first drive-through COVID-19 vaccination site.
“It's a great option for patients who have mobility challenges,” says Cheng. “There's also a lower risk of infection because you're not having to sit in a crowded waiting room. It’s a safer, convenient option that's been very well received.”
Meanwhile, Dartmouth General has also taken steps toward innovating its procedures. In 2017, the hospital implemented an ambulance offload team to expedite the process by which patients are transferred from the Emergency Hospital Services to the hospital.
An analysis of the program conducted by Dalhousie University and the Nova Scotia Health Authority found the offloading time for nine out of 10 patients improved by 65 per cent. Now, the team is being modelled at the QEII in Halifax.
“We're really looking at how we can use every person who has health-care training and use them to the best of their scope,” says Cheng.
Dartmouth General has also introduced a space at the hospital for the Victorian Order of Nurses (VON) for outpatients who do not need in-home care but cannot travel to the VON clinic in Halifax. Given the shortage of VON nurses in the community, this clinic will improve the use of limited health-care resources and improve access for our local residents.
A COMMUNITY OF CARE
For Cheng, none of the changes at Dartmouth General would have been possible without the hospital’s local communities; not just doctors and health-care professionals but patients, families, community and business leaders, research institutions and others.
“To innovate, you need to have that culture where you collaborate, where you feel safe talking to people about new ideas. You must be able to try something and potentially fail, to revamp and go back to the drawing board until you get it right,” she says. “You need strong relationships, within the health-care system, and with community partners, to be able to do that, and that's something I think we really have going for us.”
To ensure those relationships continue to grow and reflect Nova Scotia’s diverse cultures and communities, the Dartmouth General Hospital Foundation recently partnered with RBC Future Launch to announce a $50,000 donation to the DGH Foundation to partner with Dalhousie University’s Promoting Leadership in Health for African Nova Scotians (PLANS) co-op program.
The donation is part of a push to grow diversity and equity throughout Dartmouth General, from making sure the team of health-care professionals at the hospital reflects the diverse population it serves, to finding new ways to reach patients and remove barriers to care.
“As our hospital supports the health of our communities, our communities also come through for us by supporting our efforts at innovation. Then, we're able to provide better care, which comes back to help them,” says Cheng.
“This cycle of positivity that I've seen, I think, is very unique to our hospital.”
A CANADIAN FIRST
On Jan. 13, 2023, Dr. Jennifer Leighton stood in the atrium of the Dartmouth General Hospital, holding what looked like a futuristic pen. In front of her stood a simulated ‘knee,’ which she tapped with the instrument.
“What we're doing right now is just calibrating and making sure that these positioning arrays can be seen by our high-speed camera,” Leighton told the crowd. “When we're completing this surgery, typically we're able to do a lot of this before we even open the patient.”
This demonstration was part of Dartmouth General’s unveiling of the Stryker Mako SmartRobotics system, a revolutionary new technology that allows for more precision and accuracy in orthopedic surgeries.
In November 2022, Leighton became the first surgeon in Canada to perform a total hip replacement surgery using the robot. The innovation reduces things like pain and swelling after surgery, as well as the need for narcotics.
The DGH Foundation saw the need for this incredible technology and is working hard to fund this innovation. The $2 million project will be fully funded by DGH Foundation donors, with the foundation actively raising funds to support the robot’s continued use.
“Having the Mako SmartRobotics System join the Fred Smithers Centre for Orthopedic Care is another amazing example of innovation at Dartmouth General Hospital,” says DGH Foundation President and CEO Stephen Harding. “None of this would be possible without our incredible donors and their belief in the innovation happening, and the incredible staff, at Dartmouth General.”
With the introduction of the system to Dartmouth General, Nova Scotia became the first province in Canada to have two surgical robots. Currently, Leighton is one of four surgeons who know how to use the technology. Three of those four live in Nova Scotia.
“It’s really a renaissance we're seeing,” says Leighton. “We’re able to do precise 3D imaging that we couldn’t do before, and we're able to do it faster and better than previously. We've got robotic technology in surgery, and we're using motion capture cameras after surgery to see how people work.”
Leighton says these innovations will allow for more personalised approaches to orthopedics surgery, allowing clinicians to tailor procedures toward each patient.
While Leighton stresses that traditional orthopedic surgeries are reliable and precise, she says the innovative system, which was made possible through community partners like Dalhousie University and the Nova Scotia Health Authority’s Innovation Hub, is a step toward the future.
“This is adding a level of accuracy and precision that we've never been capable of before,” she says. “This is going to be groundbreaking not only for Nova Scotians but for all of Canada.”
To learn more about the Lead On Campaign for Dartmouth General Hospital, the Stryker Mako SmartRobotics system and how to donate, visit dghfoundation.ca.
