Losing the wait
New virtual care model is helping to get patients through Western Hospital emergency department faster
ALBERTON, P.E.I. – Just 19 months after becoming the first in Canada to pilot a new virtual health program, Western Hospital has launched another first-in-Canada treatment innovation.
Since Feb. 26, five to 10 patients a day have been given the option of having their medical issues handled by a doctor who examines them via the internet and a television screen.
According to Paul Young, administrator for P.E.I.'s Community Hospitals West, as of Thursday morning, everyone who was given the option – about 40 at that time – had accepted the new treatment method.
“We’re calling it Virtual Care Emergency Department Decanting,” Young said, describing the working title for the new six-month pilot project. “So, we’re decanting low-acuity patients out of the emergency department.”
Because of community awareness of the earlier tele-rounding program (where patients without a family physician are seen by doctors via audio-video connection), the new pilot program is easily explained to patients who might qualify for the new ER option. A nurse is also in attendance during the tele-visit.
EARLY SUCCESS
On the very first day, the ER telehealth option was provided, Michelle Coughlin drove to the emergency department from her home in O’Leary to have her twoyear-old daughter, Ava, seen by a physician.
The mother of three had been to the emergency department with her children before, so she had expectations of a long wait.
“Usually, when you go there you’re there half the day,” she told the Journal Pioneer.
On this visit, however, they were there about 45 minutes before the triage process was completed, she said.
Their total visit lasted only an hour.
“They just told me it would probably be six hours (wait). If we didn’t want to do it that way, there was a new way they were trying out that would be a lot faster,” Coughlin said.
Ava is a busy two-year-old and Mom was anxious to have her seen quickly. Coughlin admitted she was skeptical about the new option at first.
“I was really confused why Alberton would be the one place in Canada, where it was the very first place in Canada, to have it. I was kind of surprised.
“Everything seemed to get along fine,” she said of the experience. “The doctor was just right across from me on the screen.”
“I would definitely do it again because it was a lot faster than waiting there half the day.”
Young stressed there is no guarantee that any or all lowacuity patients who show up at the emergency department will be offered the virtual visit option. Certainly not during the six-month pilot phase.
Typically, and depending on the time of their arrival, the length of stay in the Western Hospital’s emergency department for patients presenting with low-acuity (or less severe) issues, could range from six to 12 hours.
“Our physicians are staying late; our staff are staying late. Providers are getting pretty burnt out. Patients are upset,” Young said, adding a change was needed.
He said patients sometimes leave in frustration without being seen and staff hear the frustrations.
P.E.I. has some of the longest wait times in the country, but Health P.E.I. Young said, is committed to reducing them.
“The big thing is the wait time,” said Bev Ashley, a clinical lead in the emergency department, explaining how the new option is changing things. “The patient gets seen within a much shorter time”
Although the option dramatically reduces the wait time for those who qualify, Young added it should also cut the wait for everyone else. He estimated the overall wait time, on the very first day the option was provided, was reduced by three hours.,
“If you qualify for this program, we can give you the option, and it is an option. Wait eight hours to see the physician in-person, or we can give you Door No. 2 and we’ll connect you with a physician over a TV screen through video conferencing technology using the Maple platform and the Maple physician group,” Young explained.
Maple, an Ontario-based company, is Canada’s largest telemedicine provider and is the same company that pioneered and still operates Western Hospital’s tele-rounding platform.
Dr. Brett Belchetz is the company’s founder and CEO. He said tele-rounding has produced great outcomes at Western Hospital and helped to stabilize staffing there.
When that program was being developed, a secondary issue of long wait times in the emergency department was identified.
Belchetz said the great relationship between his company and Western Hospital and Health P.E.I. has helped pave the way for this latest collaboration.
“We were able to shave a lot of the difficult work off and really focus on just the important stuff that needed to be built for the clinical pathways,” he said. He called the outcome “a fantastic demonstration of how building one program and putting in place all the infrastructure for that program to succeed can enable a hospital and a health care infrastructure that is dedicated to innovation to leap-frog forward with even more innovation.
He said Maple has a network of hundreds of doctors and any of them that are licenced in P.E.I. can support the Western Hospital initiative.
So far, said Young, there are eight Maple doctors available for virtual care in the emergency department. They function based on an on-demand queue. The expectation is that a call would be picked up within 30 minutes or less but, so far, the response has been in the five-minute range.
“The technology is working well, the feedback from staff and patients has been tremendous. Maple has been an incredible partner to work with. We‘re pretty confident that once – Maple is very interested in this and we are, too – we get the word out that this is something that can help manage capacity and wait times in the emergency department, we think it has a really good chance that it can make a difference right across the national health care system for ERs rural and urban,” Young said of the expectations that the program will expand quickly.
It didn’t take long for the expansion to begin.
“Given the success we’ve seen so far, we’re looking at expanding this model to Kings County Memorial Hospital to improve emergency department access for people and benefit communities at that end of the province as well,” P.E.I. Health Minister James Aylward said after announcing Western Hospital’s innovative approach to reducing emergency department wait times.
“I would definitely do it again because it was a lot faster than waiting there half the day.”
Michelle Coughlin