Anesthesia Assistants (AAs) are specially trained health care professionals that collaborate with anesthesiologists as part of the Anesthesia Care Team as physician extenders. They are Registered Respiratory Therapists or Registered Nurses who have an additional certification from a recognized college or university program.

Anesthesia Assistants are supported by the Department of Anesthesiologist and Pain Medicine at the University of Ottawa Faculty of Medicine and The Ottawa Hospital. The Anesthesia Team act as mentors and teachers in the clinical placement Anesthesia Assistants Program.

This year with an anesthesiologist critical shortage compounded with the backlog of surgical procedures, we have been utilizing our assistants more in the OR with them doing tasks that they are trained to do.  Working collaboratively with Anesthesiologists, we have been working hard to increase efficiency of anesthesia workload, lessen the backlog and expanding the use of the anesthesia care team model. It’s an efficient way to optimize patient care and further deliver the highest quality of care to our patients.

Some of the initiatives accomplished this year includes:

1. Lithotripsy/Vascular sedation lists (double coverage by anesthesia)
2. AAs in Eye Institute
3. High intensity lists, including some on the weekend  (Bariatric, Oncology, etc)
4. Working actively to obtain after hours coverage
5. Improved orientation plan, and training of RT to Anesthesia Assistants
6. Sponsored Anesthesia Assistant training
7. Introduction of Respiratory Therapist in Operating room
8. Anesthesia Assistants and Respiratory Therapist additional positions created and active recruitment remains ongoing

On behalf of DAPM, I would like to thank all the Anesthesia Assistants and Respiratory Therapists for their support and dedication. We are extremely appreciative of the collaborative effort required to support these initiatives. It is a privilege to work with such dedicated, hardworking, and engaged teams.

Respectfully,

Jennifer Racine, BSc MD FRCPC,
Assistant Professor
Department of Anesthesiology and Pain Medicine | Département d’anesthésiologie et de médecine de la douleur
Obstetric Anesthesia
University of Ottawa | Université d'Ottawa
The Ottawa Hospital | L’Hôpital d’Ottawa

The Ottawa Hospital Hyperbaric Medicine Unit (HMU) opened in 1997 with 1 duoplace hyperbaric chamber (2 patients sitting, or 1 patient in stretcher.   Our unit moved to it's current location beside the ER at the General Campus, with a 2nd duoplace chamber in 2007.  We provide 24/7 seamless physician emergency coverage, providing Hyperbaric Oxygen Therapy (HBOT) for elective and emergency patients who meet Undersea and Hyperbaric Medical Society (UHMS) indications and OHIP criteria. With increasing out of hospital (OHP) HBOT centers, TOH HMU remains one of the few hospital/university based centers providing care to medically complex patients requiring HBOT for all of Eastern Ontario.  

TOH formally removed service units from its organizational structure as part of the Medical Staff By-Law update that was approved at the Annual General Meeting of the Board of Governors in June, 2022.  With this change, the HMU now falls within DAPM’s organizational structure, with the HMU Director reporting directly to the DAPM Head instead of TOH’s Chief of Staff.  This is welcome news for our department given its natural fit with anesthesiology.  

The HMU Physician group includes:  Drs. Sylvain Boet, Peter Duffy, Sylvain Gagne, Laurie McLean, Stephane Moffett, Chris Wherrett, and Calvin Thompson.   Dr. Calvin Thompson was appointed Medical Director in September, 2022, replacing Dr. Peter Duffy.  Many thanks to Dr. Duffy who guided the HMU and worked hard in this role for the last 21 years!   Dr Sylvain Boet has recently been elected President of the International Association of French speaking Hyperbaric Centers (ICHF).  Felicitations Dr. Boet!  

The Ottawa Hospital Hyperbaric Medicine Unit has been active academically with 6 new publications since 2021, several presentations at national and international conferences, and lectures to various types of learners. A number of residents have done an elective in our unit and we are launching a hyperbaric medicine fellowship for anesthesia graduates (anticipated for 2024).

Our biggest priority is managing the volume of patients requiring HBOT, as there are significant patient wait times.  Because of the limitations of our current technology with aging duoplace chambers, it is difficult to manage and support treatment of critically ill patients.    We have begun the process to expand the program and replace our 2 duoplace chambers with 6 monoplace chambers (1 patient in chamber, ventilator capabilities).  This will be a significant TOH planning project which will elevate our program capacity and ensure we continue as a leader with HBOT services in Ontario. 

The Ottawa Hospital Pain Clinic is a multidisciplinary, interprofessional clinic devoted to the evidence-based treatment of multiple types of chronic pain in a tertiary care, academic environment. Numerous medical specialties are represented at TOHPC, including Anesthesiology, Physiatry, Gynecology, Urology, Emergency Medicine, and Pain Medicine, providing medical and interventional pain management. Our outstanding Interprofessional Team consists of psychology, physiotherapy, social work, and occupational therapy. The Interprofessional Team provides one-on-one and group sessions. A team of nurses also plays an important role in patient care. From an academic perspective, Anesthesiology residents have a required rotation in the clinic, and many choose to return on electives. We have welcomed elective residents from a host of other specialties, including Physiatry, Internal Medicine, Palliative Care, Geriatrics, Family Medicine, Emergency Medicine, Neurology, Rheumatology, Sports Medicine, and others. Increasingly, medical students are also enjoying rotations with us.

The overarching goal of the clinic is not only to decrease patients’ pain, but more importantly to improve their functioning. While chronic low back pain is the commonest type of chronic pain globally, our clinic also has specialty programs in cancer pain, pelvic pain, MSK pain, spinal cord stimulation, sickle cell pain, pediatric pain, craniofacial pain, and others. Our team collaborates with other services both within The Ottawa Hospital and at other institutions. Several research projects are also always ongoing. Our clinic is fortunate to have a devoted fluoroscopy suite and ultrasound machine. We have four monitored beds for infusion therapies and recovery after procedures requiring sedation, as well as five examination rooms. We strive to provide an inclusive environment that supports our patients, and to provide patient-centred care that reflects The Ottawa Hospital’s vision.

In November 2020, the TOH Substance Use Program submitted a proposal to the Ministry of Health for program funding. In December 2020, the Program Advanced Practice Nurse, Sara Olivier, moved to a new position within TOH with the MAiD program, and the role of APN support to the program was left vacant.

On April 30, 2021, the SUP had to pause our clinical activities due to understaffing.

In April 2022, we received news that the Ministry had approved program funding. In December 2022, we posted a position for a full time Advanced Practice Nurse for the program. We were able to hire a superlative candidate, Tali Cahill, who started in January 2023. We restarted clinical services shortly thereafter, and in April 2023, reopened the consult order in Epic for the Civic campus and Heart Institute. Our intention is to expand to the General site and TRC when resources permit and our team is well-established in the initial location.

The program funding also covered a part-time RN and part-time Social Worker, who were hired in April 2023.

We currently have a team of 6 part-time Addiction Medicine physicians, most of whom are community-based. The APN provides full time weekday coverage, with part time support from the RN and SW. The physicians provide rotating part-time coverage two days per week. As consult volumes increase, we anticipate being able to increase the MD coverage time.

We have already supported residents for elective rotations. Our goal is to be able to support learners during all academic blocks.

We have updated our TOH internal web page on the Sharepoint site. We are listed in the Departments and Teams section of the website.

What we do:

• Provide clinical expertise in the assessment and treatment of the spectrum of substance use in hospital patients.  
• Assess substance use disorder severity and stage of change.  
• Use Motivational Interviewing tools to enable meaningful discussions with the patient about recovery goals and prevention of return to use. 
• Implement evidence-based substance use treatment aligned with patient goals, specifically focused on Opioid Agonist Treatments (OAT), management of symptoms of pain and withdrawal, and medications to reduce cravings. 
• Model trauma-informed, mutually respectful communication and interaction with people who use substances and support the de-stigmatization of substance use within the hospital through education and policy. 
• Facilitate treatment planning and connection with community resources post discharge. 
• Provide harm reduction education to patients and increase the confidence of hospital staff in working alongside harm reduction supports. 
• Collect data on our activities for accountability and Quality Improvement. 
• Build capacity among prescribers to initiate opioid agonist therapy and other substance use treatment.