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November 23, 2018 • read
Tele-rounding in PEI: solving rural physician shortages
As the administrator for community hospitals in Western PEI, Paul is directly responsible for the operation of two hospitals. This includes Western Hospital, located in the rural community of Alberton, population 4,000. Western Hospital is the acute care centre of excellence for the region. It serves about 15,000 people, and with 50 full-time employees, it is one of the community’s largest employers.
Paul was losing sleep, because like many rural communities, Western PEI is experiencing a doctor shortage. Western Hospital had traditionally relied on a team of dedicated family physicians making the trip up to the hospital. There, they would round on their individual in-patients and track their progress.
With existing chronic vacancies in the physician complement and several retirements, it had become impossible for local doctors to manage all the in-patient care needs for the Hospital. Instead, Western Hospital had become reliant on locum doctors (like supply teachers, but for doctors), to bridge the gap. There would often be a different doctor each week and sometimes every day. The administration was struggling to fill the gaps in coverage week in and week out, which was not sustainable.
The situation wasn’t working
Locums were becoming extremely difficult to find. Because of this, Western Hospital needed to identify a sustainable model to ensure consistent physician coverage by the end of summer 2018.
Paul’s team made it their mission to reach out to other rural hospitals across Canada, in hopes of finding solutions. But their research provided no viable options. What they found was that hospital after hospital was reducing services or closing completely when up against this same challenge.
Working so intimately with the communities, Paul knew first-hand what residents were facing.
“There’s a large number of folks who cannot afford to travel back and forth to other cities, or who don’t have the means to do so for appointments or to visit their loved ones in the hospital. We’re in a rural area where transportation is a challenge; there are no taxis, there is no Uber. They’re often dependent on family and friends, and what we were hearing from folks is that if they couldn’t get care here, in some cases, they’re just not going to get it.”
So Paul kept searching for solutions. But as 2018 advanced, he says he could no longer “see a light at the end of the tunnel.”
All this was playing out in Paul’s head one morning, driving to Western Hospital, when he turned on CBC radio. The interviewer was speaking with Dr. Brett Belchetz, the CEO of Maple, and Paul realized that he was hearing an answer to his problem: telemedicine.
Within minutes of sitting down at his desk, Paul fired off an email and soon found himself in talks with the Maple team, discussing how to help Western Hospital.
After looking at several ways to ease the hospital’s staffing issues, Health PEI and Maple landed on using Maple’s physician network to manage a tele-rounding process. Though used in hospitals in other countries, this would be the first time a tele-rounding platform would be used in Canada. Complicating that, it needed to be built from scratch and implemented in only 88 days.
Paul knew he had to have every member of the hospital staff on board to make the project successful. He took the idea to the various departments and remembers saying: “This will only work if we are all in. We can’t promise it will work — but we do know what will happen if we don’t at least try. We need everyone collaborating and being more creative than we have ever been before. We all have to make that commitment. If not, we may as well throw in the towel now.”
He left with consensus — everyone was in, and willing to do whatever it would take to make the project work. Paul continues, “They also knew, that if the pilot was a success, they would have a role in possibly changing the course of history for rural healthcare coverage in the rest of the country.”
The initial hurdles were huge, but the team was committed and determined, and had the full backing of the community and the province. Once the required regulatory huddles were addressed to make the program possible, a group of more than 50 members, from the local community, hospital staff, Health PEI, MS PEI and Maple, set out to build design the tele-rounding program.
The project launched in August of 2018. Every morning since then, a registered nurse at Western Hospital logs into the custom-developed technology on a specially designed cart. Through the platform, they connect with a remote physician located outside the region, often in another part of the county. The nurse then wheels the cart into each patient’s room. Once there, the doctor talks with both the patient and hospital staff through multi-way video. Though the doctor might be in Ontario or Nova Scotia, they travel room to room with the cart to see each patient, conducting rounds much the same as they would in person.
Nurses conduct any physical examination maneuvers, such as listening to hearts, feeling abdomens or getting patients up and walking. To help them, the platform can also integrate with other technologies like digital stethoscopes which can make live recordings of hearts and lungs.
Doctors take detailed patient notes and nurses can include images (such as wounds over time) or referral letters, directly in the Maple platform. These innovative features make communication between the hospital staff and doctors across the country easy, ensuring seamless tracking of care.
Patient experience is central to Health PEI, so initially there were nerves, as the team wondered how patients would respond. But once the interactions between the patients and the doctor began, these fears slowly melted away. “We’ve had a great response from our patients; after the first day, some of them noted they didn’t even notice the TV anymore, it just seems like a regular interaction,” says Paul.
The application also has additional benefits. Patient action plans are streamlined, as multiple healthcare providers can view patient notes, message and video-conference as a team. All of this without the “telephone tag” that often happens.
For Paul Young, there is no question that the Maple platform provides access to the medical services the community deserves: “Telemedicine has allowed us to provide the access to care that otherwise wouldn’t be available in Alberton. If I hadn’t heard that CBC interview, I’m not sure what we would have done.”
He continues, “Before this project, staff at Western Hospital were spending their time putting out fires, just to keep things going. With tele-rounding in place, we have been able to take a proactive approach. Resources are now being used to support levels of care, and to deliver the highest level of service while we actively recruit to fill our physician vacancies. And in this case, we have been very impressed with the calibre of the physicians provided through Maple. They are really going the extra mile to provide good quality care and are really experienced.”
The project is still in its pilot phase, and everyone is waiting for the six-month mark to assess comprehensive data. But so far there has been no downtime for the platform and staff have embraced the technology. Most importantly, the community surrounding Alberton has stable, accessible, physician care for the hospital.
To learn more about the Maple Hospital Platform, click here.