Virtual doctor, virtual waiting room: New tech holds promise of speeding up ER wait times

A few steps inside the front door at Twin Oaks Memori‐ al Hospital there's a new sign on the wall directing people to "Virtual Urgent Care."

What was once a confer‐ ence room for hospital ad‐ ministration has been turned into a private space with large padded chairs and two iPad stations.

It's part of licensed practi‐ cal nurse Samantha Langer's job to seat patients in the chair and connect them to a video call with an emergencyroom doctor working far from the hospital in Musquodoboit Harbour, N.S.

"A lot of [patients] say pretty positive things," said Langer in a recent interview. "They're like, 'That's so cool, didn't know this even exis‐ ted.' I get a lot of that."

As the Canadian healthcare system struggles to deal with staffing shortages, many hospitals are increasingly seeing patients without ac‐ cess to primary care showing up in emergency rooms and facing long waits for rela‐ tively simple health issues.

To deal with the problem, some hospitals are turning to virtual technology, which they believe could move pa‐ tients through the emer‐ gency room more efficiently.

The province didn't use virtual care much before the pandemic and "might have been quite late in the uptake even across Canada," said Tara Sampalli, a senior direc‐ tor at Nova Scotia Health whose work deals with sci‐ ence, innovation, and health systems planning.

But after the pandemic hit, the number of virtual vis‐ its jumped by 200 per cent, she said.

"All of us were surprised at how much we were able to [set] up in a rapid timeline." 100 visits a week so far The iPad stations at Twin Oaks are one of nine up and running at hospitals around the province. The first started operating in November 2023 and the others started to come online in February.

The facilities are meant for "low-acuity" patients with problems such as coughs, colds, sprains, ear infections or urinary tract infections. Doctors who are working from home or even from an‐ other province are able to see patients, and prescribe next steps such as medica‐ tion, tests, or a referral for other hospital services. The doctors have to be licensed to practice in Nova Scotia.

The virtual-care sites are currently seeing about 100 visits per week, Sampalli said. She expects every one of the 48 hospitals in Nova Scotia will have a virtual urgent care station in place by June.

Three hospitals also have a different virtual program in which a nurse or paramedic stays in the consulting room with the patient to assist the remote doctor. It's for patien‐ ts whose symptoms are more severe, but still within the scope of what remote medicine can handle. The eventual goal is to combine the two programs.

Program must be evalu‐ ated

Some front-line staff agree that virtual care in emergency rooms is the way to go.

Last fall, the province ran a contest to gather ideas from health-care workers, and many of the responden‐ ts wrote about the issue of patients coming to emer‐ gency rooms for routine mat‐ ters such as prescription re‐ fills or bloodwork. Some sug‐ gested virtual care could solve that issue.

"I think placing a virtual care 'booth' in emergency rooms would improve the ef‐ ficiency of patient care greatly," one submission said. "Something like a phone or computer station that would connect patients to a care provider that can handle minor ailments."

Since the program ex‐ panded in February, Sampalli said Nova Scotia Health has been calculating the costs and needs to analyze whether it's a net gain in ter‐ ms of the financial invest‐ ment and the amount of staff time it saves.

It is also too early to mea‐ sure the effect of the pro‐ gram on wait times, she said, because it's being rolled out together with other mea‐ sures like mobile clinics. But reports so far suggest the ex‐ perience has been positive, she said.

Virtual queue idea

The health-care ideas con‐ test also received at least eight versions of a sugges‐ tion inspired by the restau‐ rant industry.

"Give them a buzzer or send them a text or call when it's their turn," one person wrote. "Then patients can wait from the comfort of their own home where they'll be more comfortable, and waiting rooms will be less crowded."

Humber River Health, a large hospital in Toronto, has been reconsidering the issue of where patients should wait for treatment since 2019. Chief information of‐ ficer Peter Bak said they even briefly explored the idea of using a buzzer, simi‐ lar to one you might receive when waiting for a table at a restaurant.

"We thought, why do we do this to people? Why can't you sit at home or go to a Tim Horton's, or whatever it might be, and have a more relaxing time than sitting in a waiting room?"

Bak said the pandemic's arrival made the idea even more attractive.

In October, Humber River Health received a $1.5-mil‐ lion grant from a federal in‐ novation fund to develop an online platform that would tell people coming to the emergency room to arrive immediately or give them a time slot to arrive, after ask‐ ing a set of triage questions.

"Essentially we're just say‐ ing, 'stop waiting for us, don't come into the [emergency room] and wait. Wait at home,'" Bak said. "So it isn't changing the amount of time that you need to wait, but it's changing where you're wait‐ ing."

Bak said the hospital's clinical team has evaluated the platform and doesn't be‐ lieve there's any increased risk to patients. He said it asks the same questions as standard telehealth services, and patients are encouraged to come in person if they feel their condition is getting worse.

Patient buy-in key

The platform will be pi‐ loted this summer, Bak said. He hopes it will allow the emergency department to better understand when pa‐ tients are coming and what type of treatment they will need.

"I think the greatest mea‐ sure is whether citizens adopt this and are comfort‐ able and trust it," he said.

"The other measure of success is, if we are seeing the benefits back in the de‐ partment itself: that we're seeing smoother flows, we're getting patients in and out faster."

If Humber River Health can make the technology work, its goal is to scale it up for other hospitals.

At Twin Oaks Memorial Hospital, so far the patients who are diverting from the emergency room into virtual urgent care have said they

are open to receiving virtual treatments, according to Langer.

"Some people can still have a bit of a wait with virtu‐ al care, especially if there's a few patients that need to be seen before them. But so far it's been much quicker than the typical emergency de‐ partment wait times," she said.

Do you have an experi‐ ence with virtual emer‐ gency-room care in Nova Scotia to share? Write to us at cbcnsinvesti‐ gates@cbc.ca.

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