“If a nurse is in a difficult situation, is feeling unsure, they can be connected directly to a person in ICU who can provide moral support.”
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Published Oct 26, 2023 • Last updated 3 hours ago • 4 minute read
Dr. Scott Millington compares a new virtual critical care program at The Ottawa Hospital to phoning a friend for advice. For some health providers, families and patients at smaller hospitals outside the city, the program is proving to be a lifeline.
The program, which started in April, grew out of a plan to have a critical care specialist on hand at The Ottawa Hospital to field calls from regional hospitals with COVID-19 patients in need of critical care, Millington said.
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From there, it became clear there was a need for contact between critical care specialists and regional hospitals on a regular basis. The program encourages both nurses and doctors to consult specialists at The Ottawa Hospital.
Millington said that fewer nurses have, so far, used the service than doctors, but he is hoping that changes.
“The nurses have a key role in assessing the overall condition of the patients,” he said.
“If a nurse is in a difficult situation, is feeling unsure, they can be connected directly to a person in ICU who can provide moral support.”
Kirsten Erickson, a registered nurse from Kemptville District Hospital, has used the system, which she calls an invaluable resource for rural emergency departments.
“Having the virtual critical care program available to us quickly allows us to consult with specialty critical care physicians. This allows us to provide the best possible care for our critically ill patients.”
A separate program already exists in Ontario to link smaller hospitals with bigger ones when it comes to patients in immediate need of evacuation to a larger hospital for intensive care, Millington said.
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But The Ottawa Hospital’s virtual critical care program — done by telephone or video link with shared access to patient information — aims to increase the number of patients doctors and nurses consult colleagues in Ottawa about, with the hope of preventing their conditions from getting worse, if possible, Millington said.
Tracey Cortes credits virtual critical care with keeping Nader, the young man with complex health needs that she cares for, out of hospital far from home after a health crisis. As a result, he was able to celebrate his 21st birthday at home, not in an intensive care unit hooked up to tubes and monitors, she said.
Nader, whose last name is not being used to protect his privacy, has complex and severe health issues as a result of a brain injury at birth. Cortes provides foster care to him at her home south of Ottawa.
Nader was rushed to a nearby rural hospital in August with suspected pneumonia and difficulty breathing, among other issues. Cortes expected to bring him home the next day but, instead, was called back to the hospital early in the morning as his condition worsened.
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She was hoping to avoid sending him to an intensive care unit in the city. Not only was it far from home, but after a previous ICU stay, she said depression and deconditioning (the loss of muscle mass and overall health) left Nader in worse condition and reliant on oxygen.
It was a call to the virtual care program and the resulting care that allowed Nader to return home, Cortes said.
The local physician overseeing Nader contacted the program for advice. The physician at the other end of the line, at The Ottawa Hospital, also sought Cortes’ own advice due to her experience with Nader, which helped inform care that reduced his anxiety and improved his condition.
“Families do the majority of care in the communities, so they need to be engaged in a meaningful way,” Cortes said. “The virtual critical care program has the real potential to do this effectively while saving patients, improving skillsets and quality of care in local hospitals, keeping patients close to their support systems and safeguarding against the potentially debilitating long-term health impacts of ICU admissions when alternative care plans can be formulated.”
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Millington, who visited every hospital in the region before the program started, said he was struck by how resilient staff and doctors at smaller hospitals are, especially because they have far fewer resources and are under increasing strain.
At larger hospitals, he said, it is easier for physicians and nurses to consult colleagues about cases, which has not been the case at smaller hospitals.
What happens during the first few hours is really important with critical illness, he said.
“If we can intervene early, and double check the excellent work they do, and improve outcomes, that could mean people have a more favourable course and a shorter stay in the hospital,” Millington said. “It is certainly possible that intervening early could save somebody’s life.
“It’s really nice to be able to phone a friend. We are offering that for doctors and nurses.”
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