Photo caption: A Holland Bloorview team supports scoliosis patients undergoing halo gravity traction (HGT) as part of a new clinical pathway and partnership with The Hospital for Sick Children.
By: Erin Pooley, Senior Media Relations Specialist, Holland Bloorview Kids Rehabilitation Hospital and Sarah Warr, Team Lead, External Communications, The Hospital for Sick Children.
An innovative partnership between The Hospital for Sick Children (SickKids) and Holland Bloorview Kids Rehabilitation Hospital (Holland Bloorview) is reshaping how children with severe scoliosis prepare for surgery, expanding paediatric system capacity while enhancing the care experience for children and families.
The new model enables children requiring halo gravity traction (HGT) before scoliosis surgery at SickKids to complete much of their pre-operative care at Holland Bloorview. Throughout their journey, patients remain under the ongoing care of their SickKids orthopaedic surgeons, nurse practitioners and multidisciplinary team.
HGT is a highly specialized treatment that uses gradual traction applied through a halo ring to correct severe spinal curvature before definitive surgery. To safely deliver this care in a rehabilitation setting, teams from both organizations worked closely to develop clinical practice guidelines, competency-based education and ongoing mentorship. Orthopaedic technologists, nurse practitioners, clinical educators, managers and nursing staff from SickKids partnered with Holland Bloorview colleagues to build expertise in HGT care. SickKids also supplied the specialized traction equipment, including the HGT chair, established the clinical standards for its use, and continues to provide maintenance oversight and clinical governance for the program.
By shifting this phase of care from an acute care hospital to a specialized paediatric rehabilitation setting, the partnership helps ensure children continue to receive highly-specialized care in the most appropriate setting, while also preserving valuable acute care capacity.
Each child transferred to Holland Bloorview frees up a hospital bed at SickKids for approximately four to six weeks, allowing those beds to be used for children requiring specialized surgical and medical care.
A New Pathway for Pre-Surgical Care
This new pathway for scoliosis patients reflects a shared commitment to providing patients with the right care in the right place. SickKids continues to lead the surgical and medical management of these highly complex patients, while Holland Bloorview provides a rehabilitation environment that includes daily physiotherapy, therapeutic recreation programs, social work services and the opportunity to attend the hospital's onsite school, allowing patients to remain active, engaged and connected to daily life while preparing for surgery.
Throughout each admission, multidisciplinary teams from both organizations remain closely connected through regular clinical communication, shared decision-making and ongoing consultation.
Innovating for Increasing Complexity
“Since the pandemic, client needs have evolved even further, putting increased pressure on the paediatric system,” says Silva Nercessian, senior director of inpatient rehabilitation and complex continuing care at Holland Bloorview. “It’s fueled the need for innovative care pathways and system partnerships like this that increase capacity, address backlogs and provide the compassionate, client- and family-centred care Holland Bloorview’s CCC team is known for across the province.”
Increasing patient complexity and growing demands for paediatric surgical services have required new approaches to care delivery in hospitals across the province and country. Recognizing that many weeks of pre-operative HGT did not require ongoing acute hospital care, both hospitals partnered to redesign a sustainable model of the care – one that would leverage SickKids' expertise in complex paediatric orthopaedic care and Holland Bloorview's leadership in paediatric rehabilitation. To date, the pathway has created more than 100 acute care bed-days of capacity.
Learning, Leading and Growing Together
The partnership has created new opportunities for clinical learning and collaboration across organizations. Through joint education, bedside mentorship and ongoing consultation, teams have developed shared expertise in delivering HGT safely within a rehabilitation setting.
"This partnership has allowed us to share the expertise of our orthopaedic program beyond the walls of SickKids," says Eloise Czekalla, clinical manager, inpatient orthopaedics at SickKids. "Our orthopaedic technologists, nurses, educators and nurse practitioners have worked closely with Holland Bloorview to build the knowledge, skills and confidence needed to safely care for these children. It's been a true collaboration that ensures families receive the same high standard of care while allowing both organizations to focus on what they do best."
The result is a coordinated model that connects acute and rehabilitation care, expands capacity across the paediatric health system and provides children and families with a more integrated, supportive care experience.