Montreal Children’s Hospital is a beautiful brand new hospital which only got moved into last year. It is bright and colourful and the PICU is a very light and airy feeling unit with large single rooms. Quitea change from their old unit I am told, as they used to have a big bay with several beds – much like the layout in Nottingham is now! They also have an HDU equivalent – the Advanced Care Unit which is staffed by the ICU team as well, although it is on a different floor to the ICU.
One of the things I was most impressed by was the inclusion of the psycho-social team in the everyday PICU routine. Every weekday morning there is a psycho-social ward round where the social worker (SW), child life specialist (CLS), psychologist and spiritual care are given a handover by one of the senior nurses, covering the patients diagnosis, treatment plan and family dynamics. They discuss if there have been any challenges or concerns, what support the family need, who would be best suited to provide it and make a plan for them. Weekly, a psycho-social grand round is held which includes the bioethicist, the senior nursing team and the intensivists and the care needs of the families are discussed in more detail.
There is also Family Care Group, which includes the psycho social team and some bedside nurses. This is a committee initially formed to help ensure that the move from the old unit to the new was family friendly and was then continued as they could see the need for new projects once the move was complete. They have created a orientation pamphlet for new families, made improvements to the family lounge and are developing some family guidelines. On talking to the CLS, I found that she also runs a coffee afternoon for the families to give them an opportunity to get away from the bedside. She provides tea, coffee and cookies that she bakes in her lunch break (this is also very popular with the staff as she always bakes extra!) and give the parents a safe space to talk to her and with each other and share how they are feeling. The idea is that the conversation is spontaneous, not forced and the atmosphere stays relaxed so it is something to look forward to for the parents.
I was very impressed with the patient and family centred care (PFCC) focus that was shown throughout the whole hospital. I met the PFCC coordinator who told me about the projects they have running. They have a We Need to Talk campaign which is to encourage better communication between staff and families and to help them feel confident to express any concerns they might have and feel listened to. They are also building a team of parent advisors to help give a strong parent voice to what goes on in the hospital. I was particularly interested in the mutual learning communication workshops that they hold, where they cover how to deal effectively with challenging situations and conversations. One of the examples they use with PICU staff is when you have told a parent that their child is improving and will got the ward after another 24 hours, but two hours later there has been several admissions and the bed is needed, how do you go back in and tell that parent the child needs to go to the ward now and not later – a scenario I think we have all had to deal with on occasion!
The only downside to Montreal was my embarrassment of my total lack of French, my German A level helped nothing here, fortunately, everyone was very kind and bilingual!