OBJECTIVES
This project aimed to develop and implement an artificial intelligence (AI)-based pipeline for the real-time triage of patients with traumatic brain injury (TBI). We developed a vision transformer-based AI model, the Automated Surgical Intervention Support Tool for TBI (ASIST-TBI), designed to predict the need for acute neurosurgical intervention using head CT scans from patients with acute TBI. ASIST-TBI addresses a critical clinical gap in emergency settings where timely triage is essential but neurosurgical expertise may not be immediately available. This tool integrates seamlessly into hospital workflows, analyzes CT scans in real time and alerts emergency and neurosurgical teams when intervention is likely needed. The successful deployment of ASIST-TBI at St. Michael’s Hospital’s Emergency Department, a Level I trauma center, has provided an evidence-based triage layer that supports timely decision-making.

INNOVATION
This project was the first successful integration of an AI-driven decision support tool into real-time clinical workflows for trauma care at our institution. ASIST-TBI was fully embedded within our hospital’s PACS and EMR systems, delivering automated triage alerts directly to treating clinicians based on incoming CT scans. This end-to-end deployment—from model development to live clinical use—demonstrated that advanced AI can be safely and effectively operationalized in high-acuity settings. The insights gained, including best practices for integration, and clinician engagement, are highly transferable to other institutions across the province. Work is already underway to expand deployment of ASIST-TBI across Ontario, with collaborations established to implement the tool in multiple hospitals, ensuring broader access to timely, AI-supported neurosurgical triage.

POTENTIAL FOR SPREAD
ASIST-TBI has begun to extend its impact beyond our institution through ongoing efforts to deploy the tool across all Ontario hospitals. Collaborative work is already in progress with regional health partners to integrate the model into other emergency departments across the province. The tool is highly transferable due to its reliance on standard CT imaging and compatibility with open clinical data standards (DICOM and HL7), requiring minimal additional infrastructure. Its ability to function within existing PACS and EMR systems makes it a scalable solution for institutions with varying levels of technological readiness. Knowledge translation efforts are actively underway, including clinician education, technical onboarding packages, and policy engagement to support wider adoption. In parallel, the project team is exploring national and international expansion through academic and clinical partnerships. ASIST-TBI has also been peer-reviewed and published in a high-impact journal, supporting its clinical credibility and informing future research and deployment.

BEYOND THE INNOVATION FUND
ASIST-TBI has successfully secured next-phase funding from multiple sources. It was awarded $250,000 as the winner of the Angel’s Den innovation competition, which was matched by a private donation, bringing the total to $500,000. In addition, the project received $520,000 in provincial support from the Ontario Ministry of Health, directed toward expanding deployment and evaluating broader impact across the province. Discussions are ongoing with the Ministry to secure additional funding in support of scaling, and long-term implementation.
The innovation has been adopted by our institution and is actively running within a Level 1 trauma center. We are now working in collaboration with CritiCall Ontario and the Ontario Clinical Imaging Network (OCINet) to expand ASIST-TBI deployment across hospitals throughout the province. These organizations provide the infrastructure and coordination needed to enable province-wide imaging access and urgent care consultation, making them ideal partners for widespread implementation.

OBJECTIVES
Neuroendocrine neoplasms (NENs) are increasingly common cancers that are easily missed by health care professionals. microRNAs (miRNAs) are small RNA molecules that are made in human cells and can be excellent disease markers. The overall goal of my project is to optimize cancer care delivery using molecular diagnostics. Specifically, I addressed a clinical gap for (i) earlier NEN detection enabling faster access to effective treatment, and (ii) easier and safer disease monitoring. To date, the impact of my project is changing the way NEN specialists, researchers, and patients think about NEN diagnosis and monitoring through our discovery of a universal molecular marker for NENs. Proposed metrics of success included identifying a miRNA marker for NENs, publishing, presenting, and attracting funding.

INNOVATION
My project is innovative for our institution because my team and I were the first to (i) recognize NENs as a clinical problem spanning multiple specialties1, (ii) establish a state-of-the-art miRNA profiling platform1, (iii) develop custom software to find molecular markers in big data sets2, and (iv) create/patent our methods for classifying NENs using miRNAs3,4. The insights from our project are readily transferable. Our data mining approaches and marker discoveries are now incorporated into clinical studies at Queen’s University, Sunnybrook Health Sciences Center, Princess Margaret Hospital, and the Canadian Cancer Trials Group.

POTENTIAL FOR SPREAD
Our innovation has been applied by and transferred to other regions of the province. We are currently incorporating miRNA tissue and liquid diagnostics into large NEN clinical research programs at Sunnybrook Health Sciences Center, Princes Margaret Hospital, and the Canadian Cancer Trials Group (NETretreat, STOPNET trials). In addition to our publications above, we are writing up two exciting papers on miR-375 as a powerful tissue and circulating monoanalyte marker of NENs from different anatomic sites5,6.

BEYOND THE INNOVATION FUND
Thanks to critical IF support, I have secured additional funding for my project including from the Cancer Research Society ($130,000: Sep 2021-Aug 2023), Terry Fox Program Project Grant on NENs with investigators from Sunnybrook and Princess Margaret ($200,000: Sep 2023-Aug 2027), and a more recent IF grant ($98,140: Apr 2022-Mar 2024) with Dr. Geneviève Digby (PI) on a project titled “Molecular triage of suspected lung cancer lesions using microRNA-guided diagnostics.” After submitting our new manuscripts, we will apply for CIHR funding on “Clinical and functional characterization of miR-375 in NENs.” I have presented and been invited to present my work at key annual meetings for NEN research7-9.

OBJECTIVES
The goal of the project was to reduce the volume of blood collected for diagnostic testing per patient-day in patients admitted to the St. Michael’s Hospital Medical Surgical ICU (MSICU) by 15%, by April 2020.

Blood testing is very common in hospitalized patients and can contribute to anemia and transfusion burden. This project aimed to decrease the frequency of diagnostic phlebotomy, without impacting the quality of care.

The primary outcome of the initiative the volume of blood collected for diagnostic testing per patient-day in the ICU. Secondary outcomes were red blood cell transfusion and phlebotomy tube consumption.

The project was successful. After the implementation of a multidisciplinary change strategy involving collaboration between nursing, physicians and the lab, the mean volume of blood collected for diagnostic testing decreased from 41.1ml/patient-day to 34.1 ml/patient-day. Blood tube consumption decreased by 1.4 tubes/patient-day amounting to 13,276 tubes saved over 11 months. Red blood cell transfusion decreased from 10.5/100 patient-days to 8.3/100 patient-days. Balance measures suggested no impact of quality of care.

INNOVATION
This project was innovative because it utilized robust quality improvement techniques including multidisciplinary engagement, process mapping, PDSA cycles and audit and feedback to develop a multipronged change strategy. A key component of the strategy was a novel “add-on blood work” feature that allowed teams to easily add on diagnostic tests to previously collected tubes of blood during a wide time window.

The insights gained form the project are transferrable to other institutions. Overutilization of diagnostic phlebotomy is a widely recognized problem in hospital-based care, including but not limited to intensive care units. Our work shows that teams embrace strategies to reduce testing when the strategy facilitates workflow.

POTENTIAL FOR SPREAD
Elements of this initiative have been implemented in other settings at our institution and at St. Joseph’s Hospital. In particular, “add-on” diagnostic testing has been widely adopted at St. Michael’s and St. Joseph’s Hospital both inside and outside of the intensive care units. This innovation was particularly helpful in February 2022 when supply chain problems led to a critical shortage of phlebotomy tubes at our hospital and many others. We were able to leverage strategies developed during our initiative to reduce tube utilization across both St. Michael’s and St. Joseph’s Hospital and successfully ride-out the period of acute tube shortage without any impact on patient care.

BEYOND THE INNOVATION FUND
Changes implemented during our initiative are now routine practice in the MSICU at St. Michael’s Hospital. A paper describing the initiative was published in BMJ Quality and Safety where it was highlighted by an favourable editorial. Dr. Tom Bodley (a resident who led the analytic phase of this work under the supervision of Dr. Lisa Hicks) received the American Society of Hematology Choosing Wisely Champion Award in December 2021 in recognition of this work.

OBJECTIVES
Goal & Clinical Gap
Exercise Trillium Cura, conducted November 6–8, 2024 at Unity Health Toronto, was a strategy-level tabletop simulation designed to ready Ontario’s health system for a sustained influx of warzone casualties — roughly 45 complex trauma cases per week or more including potential radiological, biological, and chemical weapons victims — while maintaining routine care access. It was led by the St. Michael’s Hospital Trauma and Critical Care leadership including Dr. Beckett who holds a joint appointment as the lead trauma surgeon for the Canadian Armed Forces. It addressed a critical preparedness gap: the lack of tested structures to coordinate civilian-military healthcare integration during large-scale combat operations (LSCO). No exercise of this kind had been done since the 1950’s in Canada.
Impact on Health Care Delivery
The exercise fostered clearer leadership and governance through creation of a provincial Patient Evacuation Coordination Cell (PECC) and flagged the need for a national oversight layer . It highlighted key service delivery needs—such as designating a central triage hub, deploying ethical AI for triage, and ensuring capacity for burn, rehabilitation, mental health, and non-Canadian patients. It also identified human resource vulnerabilities — the risk of workforce depletion and burnout — and logistics challenges, including critical supply chain and information-sharing weaknesses.
Measuring Success
Success was gauged via mixed methods:

• Pre- and post exercise surveys (35 ➝ 41 participants) measured gains in participants’ preparedness and clarity around roles — particularly inter-organizational coordination.
• Qualitative data: A “red team” and note-capture process documented evolving challenges and emergent strategies across governance, service delivery, workforce, product, and IT domains.
• Actionable outputs included flow charts, organizational diagrams, triage algorithms, and comprehensive recommendations testable in future exercises

INNOVATION
Contextual Novelty
Exercise Trillium Cura was Ontario’s first simulation of its kind — bridging civilian and military sectors under an “all-hazards” framework. It applied wargaming methodologies, real-time injects, and structured roles (e.g., red team, media, PECC) to test high-stress decision-making, governance, and logistics — an approach distinct from conventional exercise models.
Transferability
The insights extend beyond military-trauma readiness. The all-hazards design means principles apply to any prolonged surge in healthcare demand (e.g., pandemics, natural disasters). The PECC model, triage hub concept, surge workforce planning, supply-chain resilience, and interoperable information systems are replicable across other provinces and jurisdictions.

POTENTIAL FOR SPREAD / BEYOND THE INNOVATION FUND
The project has now been adopted by the Canadian Federal Government and a Federal tabletop exercise is planned to be led by the same group as Operation Trillium Cura in the fall of 2025. This project will be funded through federal agencies and government branches. Operation Trillium Cura has been broadly published in the academic literature, popular press (Toronto Star), and presented at numerous specialized meetings around the world including to NATO committees.

OBJECTIVES
Epidemiological data suggest that posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) are highly comorbid. Clinical guidelines recommend behavioral interventions before considering pharmacotherapy. However, current interventions have high rates of treatment attrition, pose a risk of inducing relapses, and their efficacy in patients with comorbidities is unclear. This study aimed to address the gap in interventions that can provide efficacious and tolerable treatment for patients with PTSD and SUD. This study assessed the safety, tolerability, acceptability, and efficacy of a modified mindfulness intervention known as the Mantram Repetition Program (MRP) for patients with PTSD-SUD. Mantram repetition is a type of grounding meditation that can be practiced anywhere. It is a “mind-body-spiritual technique”, where individuals recite a mantram (a word or phrase imbued with spiritual significance) during periods of emotional stability. This practice is designed to be helpful when PTSD symptoms or substance cravings arise. MRP differs from other types of mindfulness because it is easily accessible, spiritually based, and specifically tailored to address PTSD, making it tolerable and effective. The study’s results indicated that the modified MRP was acceptable, tolerable (71.6%, retention rate), and statistically significant in reducing PTSD symptoms and substance craving in patients with comorbidities (n = 74) over 8 weeks. The reductions in symptoms were maintained at follow up (week 12). This initiative positively influenced healthcare delivery by engaging patients with PTSD-SUD with the healthcare system and establishing an access point for patients encountering difficulties (high level of treatment avoidance). We employed a mixed-methods approach with an explanatory sequential design to collect quantitative and qualitative data. Quantitative data were collected utilizing subjective and objective validated scales.

INNOVATION
Our team modified the MRP composition to address substance use and cravings in patients with PTSD for the first time. The program facilitated the introduction of MRP as a public health intervention that offers a rapid, tolerable, and efficacious intervention for highly vulnerable populations, characterized by high dropout rates, at a low cost. The virtual delivery was prompt due to the COVID pandemic at the study’s inception, yet participants reported additional benefits of virtual delivery that made them feel “safer.” The qualitative findings facilitated enhancement in program components, including group size, craving-reduction skills, delivery methods, and session duration. This program is manualized, allowing most mental health staff to implement it without extensive training. This advantage is particularly significant when considering the unmet requirements of the study population alongside the limited availability of affordable mental health specialists. Therefore, the results are essential for the prompt implementation of MRP in other institutions or regions of the province.

POTENTIAL FOR SPREAD
The principal investigator was contacted by a staff member (Dr. Kavita Prasad) at Zumbro Valley Health Center, Rochester, Minnesota, regarding the potential for undertaking MRP at their institution. We are collaborating to evaluate the implementation of MRP for their staff during working hours. MRP would benefit healthcare providers facing challenges in delivering adequate services. Our study’s diverse demographics assure generalizability of the results. We are envisioning transferring the MRP to be accessible through a smartphone application. We believe that ongoing drop-in MRP groups may be beneficial, and the content of MRP can be adapted to be culturally sensitive to a specific population. Our findings resulted in two peer-reviewed papers, with a third article under review.

BEYOND THE INNOVATION FUND
An application for a randomized control trial to compare MRP with conventional treatment was submitted to the Canadian Institute of Health Research (Fall 2024 Project grant: RN569337-540983) and is under review. MRP has been adopted by our institution the Centre for Addiction and Mental Health (CAMH) as an ongoing clinical treatment option for patients with PTSD-SUD. It is offered by six clinicians. A brief YouTube video was developed to introduce the concept of self-compassion and feature the MRP skill.

OBJECTIVES
The goal is to find out whether a pill called apixaban, which helps prevent blood clots, is better, worse, or about the same as not using any blood thinner after certain types of abdominal or pelvic surgeries. These surgeries include common procedures like gallbladder removal, hysterectomy, and prostate surgery.
Doctors do not always agree on whether patients should get blood thinners after these surgeries, because the risk of blood clots and the risk of bleeding are both moderate, not clearly high or low. This creates a clinical gap: we do not know what is safest or most effective for these patients.
This study is the first large international trial to compare apixaban to no blood thinner in this specific group. It aims to help doctors make better decisions and reduce unnecessary injections or medications.
We are measuring success by tracking:

• How many patients develop serious blood clots (like deep vein thrombosis or pulmonary embolism)\
• How many patients experience major bleeding.
• How patients feel about their health and quality of life
• The overall costs and benefits of each approach

INNOVATION
This project is innovative because it tackles a major unanswered question in surgery: Do patients with moderate risk of blood clots and bleeding really need blood thinners after surgery? Until now, no large study has directly compared a modern oral blood thinner like apixaban to no medication at all in this group of patients.
What makes this study especially unique is how it was designed:

• It uses real-world data to carefully select surgeries where the risks of clotting and bleeding are balanced.
• It avoids using placebo pills, making the trial simpler, cheaper, and more like everyday clinical practice.
• It is the first international trial of its kind, led by researchers rather than pharmaceutical companies.

These insights are highly transferable as hospitals and health systems across Ontario, and around the world, face the same uncertainty about when to use blood thinners after surgery. The results of this study will help create clearer, evidence-based guidelines that can be used in many different regions and institutions.

POTENTIAL FOR SPREAD
This study has strong potential to influence care far beyond our institution. Because the surgeries and clinical questions involved are common across Canada and internationally, the findings will be highly transferable to other hospitals and regions.
We have already built a global network of participating sites, including centres in Finland, the United Kingdom, and Canada, with plans to expand further. The study’s design, simple, cost-effective, and based on real-world practice, makes it easy for other institutions to adopt similar approaches.

BEYOND THE INNOVATION FUND
The ARTS trial has secured over €1.5 million in funding from Finnish sources and $5,000 from McMaster University. The study runs from 2024 to 2028, with additional Canadian funding actively being pursued.
The trial is already underway in multiple countries, showing strong potential for broader adoption.

OBJECTIVES
Surgical patients with frailty, a multidimensional state of vulnerability, face markedly increased adverse outcomes after discharge from hospital1,2, yet there are no evidence-based interventions designed to improve recovery in this vulnerable population. Virtual care offers a promising solution to delivery timely, tailored and coordinated care for patients with frailty. The Virtual, Innovative, postsurgical Care To Optimize Return Home for Older People with Frailty (VICTORY) is testing the feasibility of Virtual Recovery After Surgery (VRAS) to improve outcomes in patients with frailty who have undergone surgery.

INNOVATION
Virtual Recovery After Surgery (VRAS) is an innovative multidisciplinary program that provides post-discharge remote monitoring and virtual care for surgical patients. Patients receive virtual care from nurses and perioperative physicians following hospital discharge, which is facilitated by purpose-built software and
monitoring equipment to provide a direct link and continuity of care with the hospital from home. Vitals are remotely checked twice daily, patients complete daily surveys, have scheduled virtual visits, and there is assistance available around the clock. In the VICTORY trial, the intervention has been enhanced using core concepts of geriatric co-management, with aa focus on the ‘5Ms’ of age-friendly healthcare3,4: Multicomplexity, Mobility, Medications, Mentation; the 5th ‘M’, Matters most, is addressed in our outcome framework. The program includes active medication management/reconciliation, evaluation of mental state (delirium), and mobility
(activities of daily living), so that older adults with frailty can achieve what matters most to them after surgery (i.e., getting and staying home5). The underlying VRAS infrastructure is already in use in multiple hospitals in Ontario and across Canada, and our frailty-specific enhancements can be implemented in other settings using
similar processes and interdisciplinary approach. We are testing this in our multi-centre trial (see below).

POTENTIAL FOR SPREAD

Our knowledge mobilization strategy is built on the foundation of the Aging Innovation in perioperative Medicine and Surgery (AIMS) program at the Ottawa Hospital, which is focused on advancing the care and outcomes of older adults who need surgery. We have worked with our patient partners and knowledge users (Canadian
Frailty Network, Office for Patient Engagement in Research Activities, Ontario Ontario Health Remote Care Management and Surgical Transition working group), prior to the inception of the VICTORY Trial protocol to ensure we understand their needs and priorities, allowing us to tailor our research studies, subsequent designs
and knowledge translation and mobilization strategies to their unique needs. Through the launch of the full VICTORY trial, the innovative frailty-tailored VRAS program has been implemented at all five trial sites. We havebeen approached by other sites across Ontario who would like to implement the program and join the VICTORY trial. T he protocol has been presented at local and national conferences, and we plan to publish the protocol and
results paper in peer-reviewed medical journals.

BEYOND THE INNOVATION FUND
The project has secured additional competitive funding from CIHR Strategy for Patient-Oriented Research and Accelerating Clinical Trials Canada ($1,473,804 total). We are now conducting a for a full-scale effectiveness trial (n=1000) that was initiated in January 2025. This multicenter trial employs registry linkage and sequential
Bayesian learning. This will innovatively estimate the efficacy of frailty specific VRAS to increase the number of days alive and at home experienced by surgical patients with frailty. Other trial sites are Kingston Health Sciences Centre and Hamilton Health Sciences in Ontario and the University of Alberta Hospital in Alberta.