Candis Kokoski had recently graduated from the University of Toronto with a degree in biochemistry when she decided to volunteer with an NGO in the Dominican Republic. Before she left her home country, a colleague in the lab where Candis worked said, “You like science and you like to help people, so you’d make a good nurse.”
Candis thought her co-worker could be right, so she applied to nursing school before leaving the country.
But it wasn’t until she was down in the Dominican Republic that Candis felt confident that she was making an excellent life choice. For nearly five months, Candis worked with people from different medical fields, including social workers, dental students, medical residents and nurses.
“It was a cool chance to check out what all the positions looked like in real life,” she says.
However, it was one afternoon in particular that solidified her decision to pursue nursing. The memory of that afternoon in the Dominican Republic would remain with Candis more than a decade into her career.
Candis, who speaks Spanish, was assisting a male nursing student with translations at a pop-up clinic. A younger woman arrived at the clinic with a few kids in tow and said, “I really would like some Tylenol and Advil to have at my home in case my children get a fever.”
As Candis explains it, the nursing student gave the woman the medication she came for.
“But that was just the beginning of what he did,” she says. “This nursing student asked the woman, ‘Are you okay? Is there anything else I can do for you? Can I check your blood pressure? Do you mind if I quickly examine your children?’ The woman really appreciated the extra care.”
Fast forward 12 years: Candis now works at St. Michael’s Hospital, one of three hospitals within the Unity Health Toronto hospital network. The Catholic teaching and research hospital was founded by the Sisters of St. Joseph in 1892 to care for the sick and poor of Toronto’s inner city. Affectionately known as the Urban Angel, St. Michael’s is renowned for providing exceptional patient care. As downtown Toronto’s adult trauma center, the hospital is a hub for neurosurgery, complex cardiac and cardiovascular care, diabetes and osteoporosis care, minimally invasive surgery, and care of people experiencing homelessness and those disadvantaged. St. Michael’s is also one of the province’s major sites of care for critically ill patients.
As one of the Co-Clinical Leader Managers in St. Michael’s Emergency Department, Candis is responsible for supporting the emergency room staff, which includes a multidisciplinary team of over 200 staff.
What Candis likes most about her work harkens back to the feeling she got when she watched the nursing student in the Dominican Republic help that young mother. “Not every patient who comes to our emergency room is critically ill,” she says. “Maybe they just need something to eat or a place to sit for a few minutes or someone to listen to them. That’s what I really like about St. Mike’s. We can be a resource for the patient in our community who doesn’t have anywhere else to go. We can show empathy and that we care.”
Candis has worked in the emergency department at St. Michael’s since 2010 as both a nurse and an educator. Now, as a manager, she doesn’t work directly with patients anymore. Although she really misses that, she still finds most days rewarding.
“If I can help support our staff, even if it’s just listening, it’s a good day for me,” she says.
In addition to offering one-on-one support to staff, Candis also works with families around the visitors’ policy, she makes sure all supplies and equipment are stocked, she coordinates with the bed flow manager, and she interviews potential hires.
Of course, COVID has changed basic operations in the St. Michael’s emergency department, which includes an acute care area, a new trauma bay, a mental health emergency services area, and an ambulatory care area. Pre-pandemic, the emergency department also had a rotary transition center, where patients who had been discharged could return for follow-up or medication. However, now with COVID, the rotary transition center has closed.
But that’s just the beginning of the changes to daily operations that are a result of the coronavirus. With new isolation precautions, Candis explains, it’s much harder to coordinate patient movements from one part of the hospital to another and there are fewer spaces available for patients.
“Now any staff entering a patient room needs to don PPE and then take it off when they leave. It’s exhausting and everything takes more time,” Candis explains. “Zello allows us to connect with each other wherever we are. We use it every day. The acute care space is pretty big and people can be anywhere. Especially now that staff is in PPE, they can call for help or for things they need in the room, without having to leave the patient. They can get assistance right away wherever they are.”
Candis has 12 different Zello channels on her phone. These channels include one for clericals, one for all clinical assistants, one for each different area of the emergency department (i.e. ambulatory care, trauma, mental health, etc.) and one to connect the emergency department with the general internal medicine unit. Candis says that the channel connecting her team to internal medicine is great for coordinating the transfer of patients between departments, changing room numbers on-the-go, and sharing specific plans for patient care.
Using Zello at St. Michaels has introduced some other benefits as well. Since St. Michaels is a stroke center, there is a protocol called Code Stroke that requires a nurse and a clinical assistant to attend to each stroke patient that arrives in the emergency room. Before the department had Zello, the team leader used to go on the intercom and call Code Stroke so that everyone in the unit could hear the message over the intercom. The float nurses might be anywhere in the department, and often more float nurses than were needed would show up to treat the stroke patient. There were definitely opportunities to streamline the process and increase efficiencies.
Now with Zello, the team leader can message only the float nurses and say, “Is someone available for Code Stroke? The patient is arriving in 10 minutes.”
A float nurse can respond and say she’s available. That nurse then finishes up her task and goes to care for the new stroke patient. Meanwhile, the other float nurses will hear that their colleague has accepted the incoming patient and don’t disrupt their own work to see if they’re needed.
“Also,” Candis adds, “using Zello greatly decreases our use of the overhead intercom, which pages everyone in every area of the emergency department. The overhead pages are loud and can disturb patient sleep and interrupt what the staff is doing. The disruptions make it harder for staff to focus.”
Now, with the introduction of Zello, the emergency department limits overhead pages to a select group of protocols like Code Resus, when a patient needs resuscitation and a large team is needed to respond, or Code White, which is called when a patient is violent and security is required.
The Zello rollout has been part of a larger initiative launched by St. Michael’s Hospital leadership to modernize communications among its clinical staff as a means to optimize patient care. Up until early 2020, clinical staff would communicate with each other via desk phones or the phone connected to the nurses’ Workstation on Wheels (“WOW”). Direct patient care was interrupted in the minute it took for a member of the clinical team to leave a patient room to place a call.
A focus of the organization was to optimize communication among its clinical staff, and further improve the effectiveness of its operations.
This coincided with the opening of a new tower, the Peter Gilgan Patient Care Tower, which significantly expanded St. Michael’s hospital space. In conjunction with the opening of the tower, St. Michael’s Hospital’s introduced mobile devices with a goal to improve communication among staff. These phones were preloaded with the Zello app to support clinical workflow on the various units. So far the mobile devices have been rolled out in the emergency department as well as on several inpatient wards. The end goal is to distribute the phones to all nurses, clinical assistants and clerical staff across the entire hospital. The hope is that in doing so, the hospital will reduce noise, increase communication, and improve patient care.
“[Zello] definitely makes me more accessible and streamlines my workflow,” Candis says. “It’s as simple as that.”