N.S. is expanding virtual care for patients in the ER. Here's how it works
‘We're able to do all the same things we can do in person,' says Dr. Jan Sommers
In an effort to reduce emergency-room wait times, the Nova Scotia government says it's expanding a program that allows patients with less urgent needs to see a doctor virtually.
The province announced on Wednesday that more patients will be able to access VirtualEmergencyNS, a program piloted at the Colchester East Hants Health Centre in Truro, N.S.
Three hospitals have now implemented virtual care in emergency departments, Nova Scotia Health President and CEO Karen Oldfield said during a news conference about changes coming to the health-care system. Wait times for the roughly 1,300 patients who have used the virtual option have been reduced to an average of 63 minutes, she said.
Dr. Jan Sommers, chief of the Truro emergency department, told CBC Radio's Mainstreet Halifax after the announcement that the aim of the program is to improve wait times for anyone visiting the emergency room.
"It's the patients who are relatively stable who are likely going to have a longer wait – that's where we're hoping to move the needle with this program."
Virtual ER appointments can cover back pain, skin infections, chest pain that isn't related to the heart, simple fractures, urinary tract infections and abdominal pain. Sommers said she has diagnosed appendicitis and has treated broken bones virtually.
She spoke with Mainstreet host Jeff Douglas about the program and what it means for patients. Their conversation has been condensed and edited for clarity and length.
You can listen to the full interview here:
Why don't we start with you telling me what VirtualEmergency is and how it works?
The VirtualEmergencyNS program is a way for us to offer emergency services to lower-acuity patients over a broad geographic area in ways that you couldn't actually do in person. So we have an emergency physician who is usually at home and using a platform called Maple. We're able to take a history and do a physical examination with a nurse or a paramedic in our emergency departments. And we're able to do all the same things we can do in person.
We can, as I said, take our history, do our physical exam, order investigations, provide prescriptions and advice. I can jump from Truro to Yarmouth on the same shift ... so it overcomes some of the geographic barriers that our province has around providing physician coverage.
I'm assuming that during the pilot you would have debriefed patients who received their care via this virtual service. What did they report?
People initially, sometimes are a little skeptical. They can't really envision what the care is going to look like. But, I mean, almost always the patients are very satisfied with the encounter. We endeavour to create an experience that's as close to a real-person assessment as possible. I think having the provider in the room with the patient, either a nurse or an advanced care paramedic [helps]. As well … we have some technology that allows us to look in ears and throats and a stethoscope that allows us to listen to the breath sounds of the patient's chest or their heart sounds.
Can you talk a bit about that technology?
So the stethoscope links with our Nova Scotia Health computer and it is able to stream the audio in real time to the physician at home so that they're able to hear the breath sounds, the heart sounds, even the sounds of the bowels and the abdomen in real time as they would as if they were there in person.… There's no recording and there's no patient identifiers, and as I said, it's as if the physician is sitting at the bedside.
After seeing hundreds of patients virtually now, I can say that the technology is very good.- Dr. Jan Sommers, chief of the Truro emergency department
And you're satisfied as a physician that what you're hearing ... gives you as good a vantage, I guess, on what's happening in someone's chest as in person?
The great advantage that we have is that myself and the nurse can both hear what's going on. Initially, you know, I was skeptical. I didn't know what the quality would be. So it was nice to also have the nurse's assessment to kind of say, 'Are you hearing that?' But after seeing hundreds of patients virtually now, I can say that the technology is very good, and I can hear very subtle findings, sometimes even better than I can in real life, simply because I'm at home with over-the-ear headphones, and I don't have the dinging and the usual noise of the emergency department in the background.
Over the course of the 12 months that it was piloted in Truro, what did this do for wait times in the ER there? Did you notice a difference?
It would be really difficult to say. Wait times are such a moving target. I know for the patients that we saw it definitely shortened their wait time because these are patients that typically, due to their lower triage score, would be seen after our sickest patients are seen. But when you look at wait times as a whole, it's very difficult to move that needle just based on the volume of patients that we're seeing.
What does it do for the folks who have a higher triage score, if some lower-acuity folks are getting seen this way?
It frees up the in-person physician to direct their attention to those higher-acuity patients. So at this point in time, we're really not able to offer higher acuity patients assessment through the virtual emergency department. I think that day is coming, but we're not there yet. So this frees up your in-person physician resource to really focus on those sickest patients without needing to worry that there's huge volumes of patients in the waiting room waiting to be assessed.
I work full-time as an emergency physician and it's very difficult as a provider to know that you have 20 people in the waiting room who are all waiting to be seen and you just can't get to them because you have, you know, an ambulance that's arrived with a sick patient and you need to see that person first. It just creates another offering, or option to provide service to the patients who are presenting to us and alleviate some of that pressure on the in-person staff.
My understanding is that the patient opts in for this?
I think one of the unique aspects of this program is that you can be offered it. You can choose to wait and be seen in person and a small percentage of patients do choose that. But also if the virtual physician assesses you and is concerned that, you know, there needs to be further ongoing assessment or that an in-person assessment is warranted, they're able to communicate with the physician and the department and then you're able to be moved back to the in-person system....
So even if you do end up being seen in the virtual emergency department and need to go back to in-person, likely you've already had some tests and investigations initiated. At that point you're already kind of further along than you would have been had you waited in person.
With files from CBC Radio's Mainstreet Halifax
