The Ottawa Hospital<\/a> for his ECT treatment.<\/p>\nThey arrive by 6:45 a.m. and immediately head into a special locker room, where Tommy can go to the washroom and change into his hospital gown.<\/p>\n
[\/et_pb_text][et_pb_image admin_label=”Image” src=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/03\/Locker-room-Tommy-in-gown.jpg” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” animation=”left” sticky=”off” align=”left” force_fullwidth=”off” always_center_on_mobile=”on” use_border_color=”off” border_color=”#ffffff” border_style=”solid”] [\/et_pb_image][et_pb_blurb admin_label=”Blurb” url_new_window=”off” use_icon=”off” icon_color=”#7EBEC5″ use_circle=”off” circle_color=”#7EBEC5″ use_circle_border=”off” circle_border_color=”#7EBEC5″ icon_placement=”top” animation=”top” background_layout=”light” text_orientation=”left” use_icon_font_size=”off” header_font=”PT Sans|on|||” header_font_size=”16″ header_text_color=”#4c4c4c” use_border_color=”off” border_color=”#ffffff” border_style=”solid” title=”Tommy getting into his hospital gown in the changing room (Photo \u00a9 Hayley Chazan)”] [\/et_pb_blurb][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” text_font=”Open Sans||||” text_font_size=”16″ text_text_color=”#000000″ use_border_color=”off” border_color=”#ffffff” border_style=”solid”]<\/p>\n
They are then ushered to a special waiting room with comfy chairs.\u00a0 Tommy sits down and listens to his music.<\/p>\n
The room is both quiet and comfortable.\u00a0 For Tommy, it\u2019s also familiar.\u00a0 He\u2019s been receiving ECT in the critical care wing of the hospital\u2019s general campus for the past 10 years.\u00a0 And every time he comes in for a treatment, it\u2019s the same song and dance.<\/p>\n
\u201cThe routine and consistency is very important for Tommy,\u201d said Zeno.\u00a0 \u201cIt helps calm his pre-ECT jitters.\u201d<\/p>\n
With U.S. soft-rocker Jack Johnson singing softly through his headphones, Tommy sits back, relaxes and closes his eyes.<\/p>\n
[\/et_pb_text][et_pb_image admin_label=”Image” src=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/03\/IMG_0175.jpg” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” animation=”left” sticky=”off” align=”left” force_fullwidth=”off” always_center_on_mobile=”on” use_border_color=”off” border_color=”#ffffff” border_style=”solid”] [\/et_pb_image][et_pb_blurb admin_label=”Blurb” url_new_window=”off” use_icon=”off” icon_color=”#7EBEC5″ use_circle=”off” circle_color=”#7EBEC5″ use_circle_border=”off” circle_border_color=”#7EBEC5″ icon_placement=”top” animation=”top” background_layout=”light” text_orientation=”left” use_icon_font_size=”off” header_font=”PT Sans|on|||” header_font_size=”16″ header_text_color=”#4c4c4c” use_border_color=”off” border_color=”#ffffff” border_style=”solid” title=”Tommy listening to music in the waiting room (Photo \u00a9 Hayley Chazan)”] [\/et_pb_blurb][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” text_font=”Open Sans||||” text_font_size=”16″ text_text_color=”#000000″ use_border_color=”off” border_color=”#ffffff” border_style=”solid”]<\/p>\n
About 45 minutes later, Melinda, the ECT nurse, comes in and escorts Tommy and Zeno into the hospital\u2019s surgical unit, where he waits to be prepped.<\/p>\n
The surgical area is massive and modern looking.\u00a0 It contains about 20 gurneys, all lined up in a row, where patients wait to be treated.\u00a0 Only a handful are there for ECT.<\/p>\n
The room is quiet in the early morning hours, making it easy for Tommy and Zeno to chat softly.<\/p>\n
Sporadically, Melinda will come by and check in.\u00a0 Paul, the assistant to the anesthesiologist, also stops by to say hi; at the same time, he puts in Tommy\u2019s IV.<\/p>\n
[\/et_pb_text][et_pb_image admin_label=”Image” src=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/03\/IMG_1501.jpg” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” animation=”left” sticky=”off” align=”left” force_fullwidth=”off” always_center_on_mobile=”on” use_border_color=”off” border_color=”#ffffff” border_style=”solid”] [\/et_pb_image][et_pb_blurb admin_label=”Blurb” url_new_window=”off” use_icon=”off” icon_color=”#7EBEC5″ use_circle=”off” circle_color=”#7EBEC5″ use_circle_border=”off” circle_border_color=”#7EBEC5″ icon_placement=”top” animation=”top” background_layout=”light” text_orientation=”left” use_icon_font_size=”off” header_font=”PT Sans|on|||” header_font_size=”16″ header_text_color=”#4c4c4c” use_border_color=”off” border_color=”#ffffff” border_style=”solid” title=”Tommy in the surgical unit waiting area (Photo \u00a9 Hayley Chazan)”] [\/et_pb_blurb][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” text_font=”Open Sans||||” text_font_size=”16″ text_text_color=”#000000″ use_border_color=”off” border_color=”#ffffff” border_style=”solid”]<\/p>\n
At The Ottawa Hospital, ECT is delivered three times a week \u2014\u00a0 every Monday, Wednesday and Friday.\u00a0 Both inpatients and outpatients are accommodated.\u00a0 The ECT clinic, as it is known, is only open for a short period of time on these days and the procedures are always performed first thing in the morning, to make room for other, higher priority procedures.<\/p>\n
On this morning, Tommy is the second person in line to receive ECT.\u00a0 When it\u2019s his turn, he\u2019s wheeled into a special room, which contains all the equipment needed for the procedure.\u00a0 Also in the room is Dr. Kiran Rabheru, Tommy\u2019s longtime psychiatrist, Paul, Melinda and the anesthesiologist.\u00a0 A medical student accompanies Rabheru and observes the procedure.<\/p>\n
[\/et_pb_text][et_pb_image admin_label=”Image” src=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/03\/IMG_1507.jpg” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” animation=”left” sticky=”off” align=”left” force_fullwidth=”off” always_center_on_mobile=”on” use_border_color=”off” border_color=”#ffffff” border_style=”solid”] [\/et_pb_image][et_pb_blurb admin_label=”Blurb” url_new_window=”off” use_icon=”off” icon_color=”#7EBEC5″ use_circle=”off” circle_color=”#7EBEC5″ use_circle_border=”off” circle_border_color=”#7EBEC5″ icon_placement=”top” animation=”top” background_layout=”light” text_orientation=”left” use_icon_font_size=”off” header_font=”PT Sans|on|||” header_font_size=”16″ header_text_color=”#4c4c4c” use_border_color=”off” border_color=”#ffffff” border_style=”solid” title=”Tommy getting wheeled into the ECT procedure room (Photo \u00a9 Hayley Chazan)”] [\/et_pb_blurb][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” text_font=”Open Sans||||” text_font_size=”16″ text_text_color=”#000000″ use_border_color=”off” border_color=”#ffffff” border_style=”solid”]<\/p>\n
Zeno stays with Tommy until the procedure gets underway, at which point she slips out and closes the curtain that separates the procedure room from the larger surgical unit.\u00a0 At this point, only Tommy, Rabheru, Paul, the anesthesiologist, Melinda and the medical student remain.\u00a0 The anesthesiologist places an oxygen mask over Tommy\u2019s face and within a few moments, he is completely out.\u00a0 Melinda places a bite block in Tommy\u2019s mouth and secures his head and chin, to make sure he doesn\u2019t move or bite is tongue during the seizure.\u00a0 Rabheru then delivers the electrical stimulus.<\/p>\n
[\/et_pb_text][et_pb_image admin_label=”Image” src=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/03\/IMG_1509.jpg” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” animation=”left” sticky=”off” align=”left” force_fullwidth=”off” always_center_on_mobile=”on” use_border_color=”off” border_color=”#ffffff” border_style=”solid”] [\/et_pb_image][et_pb_blurb admin_label=”Blurb” url_new_window=”off” use_icon=”off” icon_color=”#7EBEC5″ use_circle=”off” circle_color=”#7EBEC5″ use_circle_border=”off” circle_border_color=”#7EBEC5″ icon_placement=”top” animation=”top” background_layout=”light” text_orientation=”left” use_icon_font_size=”off” header_font=”PT Sans|on|||” header_font_size=”16″ header_text_color=”#4c4c4c” use_border_color=”off” border_color=”#ffffff” border_style=”solid” title=”Tommy inside the procedure room (Photo \u00a9 Hayley Chazan)”] [\/et_pb_blurb][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” text_text_color=”#000000″ use_border_color=”off” border_color=”#ffffff” border_style=”solid” text_font=”Open Sans||||” text_font_size=”16″]<\/p>\n
About five minutes later, when the procedure is over, Tommy is wheeled back into the larger unit.\u00a0 The anesthesia wears off quickly; an orderly helps him get dressed and offers him apple juice and some breakfast.<\/p>\n
He is then reunited with Zeno, who waits for him patiently in the ICU waiting room.\u00a0 Tommy\u2019s still a little groggy, but he\u2019s well enough to walk on his own. The whole process \u2014 from arrival at the hospital until they\u2019re back to the car \u2014 takes between two and three hours.\u00a0 Before long, Tommy is back home in bed.<\/p>\n
While ECT at The Ottawa Hospital operates smoothly and is well organized, with designated rooms and a sufficient amount of privacy, offering patients a comfortable and relaxing experience, this is unfortunately not always the case at other facilities.<\/p>\n
[\/et_pb_text][et_pb_image admin_label=”Image” src=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/03\/IMG_1526.jpg” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” animation=”left” sticky=”off” align=”left” force_fullwidth=”off” always_center_on_mobile=”on” use_border_color=”off” border_color=”#ffffff” border_style=”solid”] [\/et_pb_image][et_pb_blurb admin_label=”Blurb” url_new_window=”off” use_icon=”off” icon_color=”#7EBEC5″ use_circle=”off” circle_color=”#7EBEC5″ use_circle_border=”off” circle_border_color=”#7EBEC5″ icon_placement=”top” animation=”top” background_layout=”light” text_orientation=”left” use_icon_font_size=”off” header_font=”PT Sans|on|||” header_font_size=”16″ header_text_color=”#4c4c4c” use_border_color=”off” border_color=”#ffffff” border_style=”solid” title=”The ECT procedure room is blocked off by a small curtain (Photo \u00a9 Hayley Chazan) “] [\/et_pb_blurb][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” text_font=”Open Sans||||” text_font_size=”16″ text_text_color=”#000000″ use_border_color=”off” border_color=”#ffffff” border_style=”solid”]<\/p>\n
Dr. Nicholas Delva, head of psychiatry at Dalhousie University in Nova Scotia and chair of the 2006 Canadian ECT survey, said ECT facilities vary significantly, depending on an institution\u2019s location and resources.<\/p>\n
\u201cECT has a high priority in single-specialty psychiatric hospitals and in those locales, there\u2019s not too much of a barrier, and high caseload volumes can be handled,\u201d Delva said.\u00a0 \u201cBut in some of the smaller places, ECT might be a lower priority and might have to be done by some arbitrary hour in order to make space for other medical procedures.\u201d<\/p>\n
The Royal<\/a>, a centre in Ottawa devoted exclusively to mental healthcare, fits this description.\u00a0 As a single-specialty psychiatric institution, ECT is delivered three times a week, from 8 a.m. to 12 p.m., but treatments can sometimes go as late as 2 p.m., depending on the demand. \u00a0Because the clinic doesn\u2019t compete for space with other higher priority surgeries, as is the case at The Ottawa Hospital, psychiatrists can accommodate more patients.<\/p>\n[\/et_pb_text][et_pb_image admin_label=”Image” src=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/03\/gurney1.jpg” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” animation=”left” sticky=”off” align=”left” force_fullwidth=”off” always_center_on_mobile=”on” use_border_color=”off” border_color=”#ffffff” border_style=”solid”] [\/et_pb_image][et_pb_blurb admin_label=”Blurb” url_new_window=”off” use_icon=”off” icon_color=”#7EBEC5″ use_circle=”off” circle_color=”#7EBEC5″ use_circle_border=”off” circle_border_color=”#7EBEC5″ icon_placement=”top” animation=”top” background_layout=”light” text_orientation=”left” use_icon_font_size=”off” header_font=”PT Sans|on|||” header_font_size=”16″ header_text_color=”#4c4c4c” use_border_color=”off” border_color=”#ffffff” border_style=”solid” title=”The pre-ECT waiting room at The Royal is closed off from the rest of the hospital and offers patients a lot of privacy (Photo courtesy of The Royal) “] [\/et_pb_blurb][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” text_font=”Open Sans||||” text_font_size=”16″ text_text_color=”#000000″ use_border_color=”off” border_color=”#ffffff” border_style=”solid”]<\/p>\n
The ECT clinic at The Royal has its own designated area, which is tucked away and not visible to the public.\u00a0 At The Ottawa Hospital, the clinic is part and parcel of the larger surgical unit.<\/p>\n
While both The Ottawa Hospital and The Royal offer state-of-the-art ECT, the facilities clearly differ.<\/p>\n
In rural and remote communities, such as Newfoundland and Labrador, where one has to drive five hours on average just to reach an ECT centre, the facility might be very basic.\u00a0\u00a0 With fewer resources, there may be less space dedicated to ECT. And with fewer staff, the facility likely can\u2019t accommodate as many patients.<\/p>\n
The survey revealed striking differences between ECT centres, in many areas of practice.\u00a0 As a result, Delva and a group of psychiatrists from across the country decided that something needed to be done in order to ensure a more standardized form of ECT, which they believed would improve both the quality of care and the patient experience.<\/p>\n
Using the survey findings and best practices from years of experience in the field, Delva and a team of ECT practitioners embarked on a journey to create a standards document that would significantly raise the bar for ECT in Canada.\u00a0 While the guidelines covered multiple areas relevant to ECT, such as training, equipment, treatment technique and follow-up care, Delva was responsible for the guidelines relevant to \u201cfacilities and environment.\u201d A draft version of the guidelines has been penned and is currently undergoing peer review.\u00a0 In particular, Delva\u2019s section focused on the space a hospital dedicates to ECT services and how that space should best be allocated to ensure the highest quality of care, both from the point of view of the patient and the treatment team.<\/p>\n
[\/et_pb_text][\/et_pb_column][et_pb_column type=”1_4″][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section admin_label=”Section” fullwidth=”off” specialty=”off” transparent_background=”off” background_color=”#4c4c4c” allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”off” padding_mobile=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”off”][et_pb_row admin_label=”Row”][et_pb_column type=”4_4″][et_pb_audio admin_label=”Audio” audio=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/04\/Dr.-Delva-facilities-and-environment1-1.wav” title=”Facilities and environment standards” artist_name=”Dr. Nick Delva” image_url=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/03\/Dr.-Delva-headshot.jpg” background_layout=”dark” use_border_color=”off” border_color=”#ffffff” border_style=”solid”] [\/et_pb_audio][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section admin_label=”Section” fullwidth=”off” specialty=”off”][et_pb_row admin_label=”Row”][et_pb_column type=”1_4″][\/et_pb_column][et_pb_column type=”1_2″][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” text_font=”Open Sans||||” text_font_size=”16″ text_text_color=”#000000″ use_border_color=”off” border_color=”#ffffff” border_style=”solid”]<\/p>\n
Delva said that what\u2019s most important is that the standards are practical and achievable so that all facilities, big and small, can comply.<\/p>\n
\u201cNow we have to keep in mind that some of the sites are going to be low-volume and they\u2019re not going to do as much ECT, so they may not have all the facilities of a big centre,\u201d Delva said.\u00a0\u00a0 \u201cIn these cases, it\u2019s important to remember that ECT in a somewhat cruder environment in some rural type facility is better than no ECT at all, as long as the standards are good.\u201d<\/p>\n
[\/et_pb_text][\/et_pb_column][et_pb_column type=”1_4″][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section admin_label=”Section” fullwidth=”off” specialty=”off” transparent_background=”off” background_color=”#4c4c4c” allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”off” padding_mobile=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”off”][et_pb_row admin_label=”Row”][et_pb_column type=”4_4″][et_pb_code admin_label=”Code”]<iframe width=”560″ height=”315″ src=”https:\/\/www.youtube.com\/embed\/d41iz3hwBs0?rel=0″ frameborder=”0″ allowfullscreen><\/iframe>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section admin_label=”Section” fullwidth=”off” specialty=”off”][et_pb_row admin_label=”Row”][et_pb_column type=”1_4″][\/et_pb_column][et_pb_column type=”1_2″][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” text_font=”Open Sans||||” text_font_size=”16″ text_text_color=”#000000″ use_border_color=”off” border_color=”#ffffff” border_style=”solid”]<\/p>\n
Delva\u2019s challenges are many.\u00a0 In establishing the facilities and environment guidelines \u2013 and other categories identified for standardizing ECT treatment in Canada \u2013 Delva is up against the country\u2019s vast geography, the inevitable limits to healthcare funding and the limited time and energy available among psychiatric doctors to help shape and implement reforms, all while managing their own heavy caseloads.<\/p>\n
Furthermore, at general hospitals, where ECT is viewed as a low priority procedure, psychiatrists often face resistance from hospital administration when they try to expand their ECT services.\u00a0 This makes it difficult for practitioners to increase their clinic hours and not all patients in need can be accommodated.\u00a0 It is also a challenge to secure the dedicated space required to perform ECT at a high level.<\/p>\n
\n\n\t\t\n\t\t\t
\n\t\t\t\tTransparency and clarity on what\u2019s happening is very important with ECT, so the public knows what\u2019s happening and it\u2019s all open and above board and done to the highest possible standards \u2014 to reassure the public.
\u2013 Dr. Nick Delva<\/span>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t<\/span>\n\t\t<\/div>\n\t\n
\nBut despite the obstacles, Delva is hopeful that overtime, the standards document will help practitioners get the resources they need in order to provide the type of care and the volume of care necessary to accommodate all patients in their service.\u00a0 Delva believes that the support of a national organization like CANECTS will help give ECT more credibility in the eyes of hospital administrators.<\/p>\n
Delva said that while he\u2019s proud of the group\u2019s work on the guidelines, it is only the first step in what he hopes to be a continuous cycle of improvement in the field of ECT.\u00a0 Once the standards document is reviewed and finalized, the plan is to start undertaking audits of ECT facilities across the country.\u00a0 While the details have yet to be worked out, experienced ECT practitioners, known as accreditors, would visit hospitals in different regions of the country to evaluate the ECT facilities against the guidelines.\u00a0 The centres found to be in compliance with the standards would receive accreditation certifying that they are delivering ECT at the highest possible level.<\/p>\n
Delva said that a high-quality peer assessment process is part of the recipe for good performance.\u00a0 He said that while it\u2019s important to have a critical third-party accreditor evaluating each facility, the goal of the audits wouldn\u2019t be to reprimand hospitals, but rather to help them improve.<\/p>\n
\u201cTransparency and clarity on what\u2019s happening is very important with ECT, so the public knows what\u2019s happening and it\u2019s all open and above board and done to the highest possible standards \u2014 to reassure the public,\u201d said Delva.<\/p>\n
[\/et_pb_text][\/et_pb_column][et_pb_column type=”1_4″][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"
Every second Wednesday, Zeno Jaworski takes her son Tommy, who suffers from catatonia, to The Ottawa Hospital for his ECT treatment. They arrive by 6:45 a.m. and immediately head into a special locker room, where Tommy can go to the washroom and change into his hospital gown. They are then ushered to a special waiting […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-307","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/pages\/307","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/comments?post=307"}],"version-history":[{"count":65,"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/pages\/307\/revisions"}],"predecessor-version":[{"id":890,"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/pages\/307\/revisions\/890"}],"wp:attachment":[{"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/media?parent=307"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}