Core Clinical Sites
Toronto General Hospital
TORONTO GENERAL HOSPITAL
585 University Avenue, Toronto - Site Director: Ghislaine Douflé
The University Health Network is comprised of the Toronto General Hospital (TGH), Toronto Western Hospital (TWH), Princess Margaret Cancer Centre, and Toronto Rehabilitation Institute (TRI).
Toronto General Hospital has three ICUs: a Medical- Surgical ICU (MSICU), Cardiovascular Surgical ICU (CVICU), and a Coronary ICU (CICU).
The MSICU is a closed 24 bed general intensive care unit. It provides support to the medical and surgical services at the hospital. It has a focus on solid organ transplantation (lung, liver, intestine), thoracic surgery, vascular surgery, general surgery, and general internal medicine.
Toronto General Hospital is a Provincial referral centre for cardiac and respiratory failure and therefore is a key educational resource for the Critical Care Residency Program for training in extracorporeal life support. Currently TGH has approximately 70-80 new ECLS patients per year. Modalities include VV-ECMO, VA-ECMO, and less frequently ECCO2R and Tandem Heart.
The site provides all aspects of ICU care and have full resources including conventional and non-conventional modes of ventilatory support, hemodialysis and plasmapharesis.
Each day, a sign over and brief teaching session occurs at 0700h, followed by ECMO multidisciplinary rounds at 09.15hrs, followed by multidisciplinary rounds at 10.00. Educational rounds (provided by attendings, trainees, allied health or visiting speakers) occur immediately after sign over in the morning. Sign over rounds typically occur between 1600 and 1730 hours.
Residents and Fellows are not on call for cardiac arrests but routinely provide consultations to the wards and to the emergency department. Residents and Fellows are expected to take in-house call.
In addition to providing consultations in critical care, there is a 24/7 outreach program at each site. This team consists of a staﬀ intensivist, critical care nurse and CCM Resident or Fellow. This team follows discharges from the ICU, provides support to medical and surgical care providers (nurses, physicians) and assists in the management of patients who demonstrate signs of clinical worsening or instability.
Toronto Western Hospital
TORONTO WESTERN HOSPITAL
399 Bathurst Street, Toronto - Site Director: Ian Randall
TWH is a closed 26 bed medical - surgical and neurosurgical intensive care unit. It specializes in orthopaedic and neurosurgical patients and provides support to other medical and surgical programs at the hospital.
The unit provides all aspects of ICU care and have full resources including conventional and non-conventional modes of ventilatory support, hemodialysis and plasmapharesis
TWH MSNICU is one of the few programs in Canada that has been built with the capability to provide level 4 biocontainment. It will therefore provide critical care e.g. for Ebola virus or Middle East Respiratory Syndrome (MERS) virus infected patients arriving to or living in the Greater Toronto Area.
Each day, a sign over and brief teaching session occurs at 0730, followed by bedside rounds at 0900. Educational rounds (provided by attendings, the trainees, allied health or visiting speakers) occur at noon or 1500 daily. Sign over rounds occur at 1630 hours.
As with Toronto General Hospital, trainees are not on call for cardiac arrests but routinely provide consultations to the wards and to the emergency department. Critical Care residents and fellows are on-call in-house at Toronto Western.
In addition to providing consultations in critical care, there is a 24/7 outreach program at this site. This team consists of a staff intensivist, critical care nurse and Critical Care trainee. This team follows discharges from the ICU, provides support to medical and surgical care providers (nurses, physicians) and assists in the management of patients who demonstrate signs of clinical worsening or instability.
Mount Sinai Hospital
MOUNT SINAI HOSPITAL
600 University Avenue, Toronto - Site Director: Christie Lee
The Mount Sinai ICU is a 16 bed closed medical-surgical intensive care unit. In addition to serving Mount Sinai Hospital, it provides critical care services to the adjacent Princess Margaret Hospital. The typical patient admissions comprise of general medical cases, post-operative and surgical complications (predominantly gastrointestinal, orthopedic oncology and ENT), complications of hematological malignancies and bone marrow transplantation and obstetrical complications.
Areas of clinical expertise and research interest include the ventilator management of ARDS, management of the bone-marrow transplant patient and critical illness in pregnancy. This ICU provides conventional and non-conventional ventilator support, continuous renal replacement therapy, intermittent hemodialysis and plasmapheresis
CCM trainees will be responsible for running rounds under the supervision of the attending physician. A second fellow is allocated to work with the ACCESS (Critical Care Response) team consults and follow-up of patients recently transferred to the wards. A third fellow provides back-up for. additional clinical emergencies..
The medical Resident on call is responsible for hospital cardiac arrests during weekdays, under the supervision of a CCM Trainee. Residents and Fellows are expected to take in-house call here.
Formal teaching on core ICU topics takes place daily for junior residents and CCM trainees at noon. Teaching is delivered by the ICU attending and members of the multidisciplinary team. There are bi-weekly simulation-based training sessions and weekly Grand Rounds. Critical Care Residents are responsible for teaching junior trainees every Monday, and have their own dedicated sessions every Wednesday and Friday morning. Tri-site Journal Club between Toronto General, Toronto Western, and Mount Sinai Hospital occur on Wednesdays on a bi-weekly basis and Morbidity and Mortality rounds occur once a month.
St. Michael's Hospital
ST. MICHAEL'S HOSPITAL
30 Bond Street, Toronto - Site Director: Simon Abrahamson
St. Michael’s Hospital has three separate Intensive Care Units within the hospital, in addition to the Coronary Care Unit.
The Medical-Surgical ICU is a 24 bed unit. Two intensivists staﬀ the unit each week. Patient admissions typically consist of medical-surgical cases.
In addition, are admissions of critically ill obstetric patients from the obstetric unit. The MSICU provides conventional and non-conventional ventilatory support, plasmapheresis and multiple types of dialysis including intermittent hemodialysis, SLED and CRRT. The unit regularly admits a wide variety of patients including: those with ARDS, acute renal failure, sepsis, complex general surgery (including pancreatitis), interventional gastroenterology, vascular surgery, neurological diseases, and acute plasma exchange.
Critical Care trainees provide back- up to more junior rotating residents via a home-call system. Call is scheduled no more frequently than 1 in 4 so fellows who wish to remain in house can do so.
Seminars are held for junior Residents 1-2 pm Monday to Thursday covering a core curriculum with one session each week given by allied health professionals. There is a hands-on half-day resuscitation course that is part of the orientation for new junior Residents. Critical Care trainees attend a separate weekly session with the attending staff. In addition the Critical Care trainees present a weekly Journal Club under guidance of a staﬀ physician as part of weekly department wide lunchtime grand rounds on Fridays.
The Cardiovascular Surgical ICU is a 15-bed unit providing care to postoperative cardiac and vascular surgery patients. There is a weekly seminar series that specifically targets Critical Care trainees. In addition many of the attending staﬀ from the Department of Anaesthesia are National Board certified in echocardiography and provide Transoesophageal Echocardiography seminars and hands-on training to the trainees in the CVICU. Trainees are exposed to temporary pacing techniques and PA catheterization in almost all patients. Intra-aortic balloon pumps, and other ventricular assist techniques such as ECMO are less frequently employed.
The Trauma-Neurosurgery ICU (TNICU) is a 19-bed unit caring for critically ill neurosurgical patients and interventional neuroradiology patients. It is one of two Level I adult trauma centres serving the Greater Toronto Area. The TNICU specializes in teaching trainees advanced neuro-monitoring techniques such as Transcranial Doppler, Licox tissue P02 monitoring, jugular bulb monitoring, and continuous bedside EEG. There is a weekly, year round seminar program on trauma, as well as separate seminars on neurosurgical ICU for all trainees.
Monthly, as part of grand rounds, a renowned local, national or international speaker is invited. In addition, every 2 months grand rounds are combined presentations from critical care/nephrology which are attended by staﬀ from both disciplines.
Sunnybrook Health Sciences Centre
SUNNYBROOK HEALTH SCIENCES CENTRE
2075 Bayview Avenue, Toronto - Site Director: Cameron Guest
The Department of Critical Care Medicine at Sunnybrook Health Sciences Centre provides primary patient care for a diverse patient population including trauma, neurotrauma, medical-surgical (including cardiovascular surgery) patients. In total, a total of 57 (closed) ICU beds comprise the department:
- 22 bed Medical-Surgical-Trauma ICU with 1200 annual admissions, including all ventilated patients from the largest trauma program in Canada,
- 14 bed General Cardiac and Vascular Surgical ICU with 1100 annual admissions,
- 13 bed Neurosurgical-Trauma Step-down ICU, and 8 bed Medical- Surgical Step-down Unit
This department also coordinates a hospital wide Critical Care Response Team service for the wards (24/7 service), and provides daily consultant care to the largest adult burn unit in Canada (10 beds, 200 acute burn admissions annually).=
Mechanical ventilation, continuous and intermittent hemodialysis and (less frequently) extra-corporeal life support is available as support therapies, as well as invasive neurologic monitoring techniques.
Critical Care trainees are expected to take 1 in 4 in-house call. There are 3 Critical Care trainees on call each night along with 2 junior residents. As a team they are collectively responsible for all of the department’s beds, and also for consultations to the various medical and surgical floors, the emergency department, and frequently requests from other hospitals. Junior residents are first responders for consults and calls for the Critical Care Response team.
Formal educational sessions include a weekly journal club, during which a CCM publication is critically-appraised and the principles of evidence-based medicine reviewed; biweekly problem-based learning (PBL) sessions; weekly fellow-led case discussions; and weekly Quality Improvement Rounds (formerly Morbidity and Mortality Rounds) during which quality and process of care issues are reviewed. In addition, there are weekly Critical Care Grand Rounds (Wednesdays) presented by an invited speaker. For Junior residents, there are daily morning report sessions and daily lunchtime lectures covering core topics in CCM.