Imagine peering over your sick child. It’s 9:00 PM, and most walk-ins are closed. It’s a situation no parent enjoys. Your options are to either take your child to the local emergency department (ED), wait until morning and try a walk-in, call your family physician (if you’re lucky enough to have one), or call 8-1-1.
You decide on 8-1-1. After speaking to the nurse, you are advised to seek care at the nearest ED.
But you’ve seen the news. EDs are swamped and the wait times for non-life-threatening conditions are horrendous. You think to yourself, “There’s got to be a better way.”
In fact, there is. Provinces across the country have begun to implement new models of virtual care delivery allowing for different ways to provide care.
In British Columbia, virtual physician consultations were added to the Healthlink nurse triage program. In the 17-week study period, they were able to reduce potential ER visits by advising only 15% of callers to go directly to the emergency room (Ho et al., 2021).
Virtual MD, a program working within Alberta HealthLink, has been working to bring medical advice from a physician. At the time of this news release, this program seems to be successful, keeping roughly 55% of patients out of EDs by managing at home (Harris, 2022).
A 2019 study in Saskatchewan examining the effectiveness of 8-1-1 call triaging found only 18% of callers were advised to go to the ED. Of those who attended, approximately 60% of patients needed investigations and/or received treatment. (Nataraj, 2020). Lumeca has been involved in further expanding 8-1-1’s capabilities utilizing a virtual physician presence to help improve care. The Virtual Triage Physician program with 8-1-1 provides a second look at patients when the care algorithm recommends patients go to the ED. Thanks to virtual triage with a physician, approximately 70% of patients who would normally have been referred to ED are either being diverted to alternate treatment centers for investigations or treated virtually.
Lumeca has also been involved with Saskatchewan’s Virtual Physician Emergency Response (ViPER) program. ViPER provides remote virtual physician support to rural EDs when no local physician is present. Without ViPER, several rural Saskatchewan centers would have continued to suffer intermittent closures of their EDs. Clearly, the role of virtual triage and virtual physician presence are growing.
Like any new approach, virtual care is not without its controversy. A recent study from Ontario showed 13% of patients presented to the ED in person within three days of a virtual visit and almost 22% did so within a month of being seen virtually (McLeod et al., 2023). With that said, we are left to wonder how many of these cases were related to a progression of symptoms. Would the ED presentation rate of these patients be 100% if virtual care services did not exist?
Virtual care is starting to show some promise and is getting more efficient. But perhaps the root of the problem lies elsewhere. In 1979 Tommy Douglas himself warned of the great danger that awaited Medicare. If we did not focus on preventive medicine (Family Practice) the costs would become so excessive that the public would ultimately decide Medicare was not in their best interest!
It is clear we do not have enough family doctors. More and more patients do not have access to regular care. This is causing problems downstream in already short-staffed emergency departments. What are we to do? Thousands of new physicians will not appear magically out of thin air. Poaching doctors from other provinces and countries only leads to inequity elsewhere.
Let’s go back to our patient calling 8-1-1. Today in Saskatchewan, it’s possible that patients could be seen virtually by a physician. This provides significant relief and comfort to both the patient and family and in many cases may improve efficiency. But then what? Imagine if we could seamlessly refer this patient for a follow-up virtual or in-person visit with a family physician or primary care team. If the patient doesn’t have a family doctor or primary care team, what if the virtual care process could attach them to one? How much ED demand could we reduce if we enabled better access and attachment to care? Let’s use virtual care to create pathways that can enable longitudinal care – then just maybe, we’ve got a shot at something sustainable.
What do you think? Lumeca would love to hear from you write us at ideas@lumeca.com
References
Douglas, T. (2009). 1979 S.O.S. Medicare Conference. In YouTube . Ottawa . Retrieved from https://www.youtube.com/watch?v=V1A0vrz36Sc.
Harris, C. H. (2022, August 4). Virtual MD connects Health Link callers directly to physicians. Virtual MD connects Health Link callers directly to physicians – Alberta Health Services. https://www.albertahealthservices.ca/news/Page16756.aspx
Ho, K., Lauscher, H. N., Stewart, K., Abu-Laban, R. B., Scheuermeyer, F., Grafstein, E., Christenson, J., & Sundhu, S. (2021). Integration of virtual physician visits into a provincial 8-1-1 health information telephone service during the COVID-19 pandemic: a descriptive study of HealthLink BC Emergency iDoctor-in-assistance (HEiDi). CMAJ open, 9(2), E635–E641. https://doi.org/10.9778/cmajo.20200265
McLeod, S., Tarride, J.-E., Mondoux, S., Paterson, J. M., Plumptre, L., Borgundvaag, E., Dainty, K. N., McCarron, J., Ovens, H., & Hall, J. N. (2023, November 6). Health care utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care. https://www.cmaj.ca/content/cmaj/195/43/E1463.full.pdf
Nataraj, J., Stempien, J., Netherton, S., Wahba, M., & Oyedokun, T. (2020). Emergency department referrals from a provincial medical call centre: Is it more than just 1-800-go-to-emerg? CJEM, 22(2), 241-244. doi:10.1017/cem.2019.420
Schmaus, A., Cooper, I.R., Whitten, T. et al. Impact of Health Link utilization on emergency department visits. Can J Emerg Med 25, 429–433 (2023). https://doi.org/10.1007/s43678-023-00504-3