Not sure if you should go to an ER?

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It’s 11pm on Sunday. After a weekend of hiking you notice an area on your arm that’s red, swollen and itchy. Upon closer examination it looks as if something is stuck in your skin. You really don’t want to go to the emergency department and you know from experience you won’t get an appointment with your doctor for at least a week. What do you do? Luckily, for most Canadians, an experienced registered nurse is just a phone call away.

“When that call came in from the hiker, he was concerned about West Nile Virus,” recalls Lynne Molyneux RN, Clinical Services Manager, Clinidata. “I asked him a series of questions, and knew it was a tick. I guided him through removing it, explained how to care for the arm and what to look for (in case of Lyme Disease). He didn’t have to go anywhere – I helped him get rid of the tick on his arm so that was a good call.”

While the name Clinidata may not be familiar, you probably know the service; they are the largest provider of telecare services in Canada providing telenursing services to Telehealth Ontario, Telecare New Brunswick, Telecare NWT, the Department of National Defence Health Information Line and Employee Assistance Programs. With over 350 registered nurses, they have answered over 6 million calls averaging 1.5 million calls per year.

Telenursing, also known as telenursing practice is defined as the delivery, management and coordination of care and services provided via information and telecommunication technologies. It encompasses all types of nursing care and services delivered across distances (Ontario College of Nurses).

In 2001 the government of Ontario introduced Telehealth Ontario, a 24/7 nursing line to improve accessibility to the most appropriate health service, increase access to health information and advise and empower the public to make better health decisions. Callers can phone 1-866-797-0000 day or night and receive medical advice from a registered nurse (with at least 3 years of clinical experience).

RNs Lynne Molyneux and Shirley Campbell have been telenurses for 5 years and each brings 20+ years of experience as a front-line nurse.

“I chose telenursing because I loved the concept of empowering people,” explains Molyneux. “As an emergency department nurse for 25 years I saw a lot of people who could have been assisted in another way. Forty-three per cent of our callers are helped in their own home – they can help themselves if they are educated and empowered.”

Molyneux’s greatest challenge transitioning from an ER to a call centre was letting go of the need for ‘hands-on’ contact with a patient. “Given that your only contact with the patient is over the phone, you have to rely on your hearing, and really listen to what is being said and any background noise [such as a crying baby].”

Campbell agrees. “Initially it was difficult doing a complete assessment on a patient that you can’t see. What the patient is telling you has to be your eyes. Also, incorporating your clinical and triaging skills with the computer and phone can be a challenge. At the beginning you’re so focused on the software but as you get comfortable you focus more on the assessment.”

Fortunately for these RNs the one-on-one time with their patients and being able to give every caller their undivided attention compensates for not being able to see them. It seems the patients appreciate the undivided attention as well.

“Caller satisfaction is really high – 98 per cent,” says Laurie Poole, RN, Vice President, Operations, Clinidata. “People really like the service and call and write letters to thank the nurses. They also tell us what they don’t like. A lot of times callers want a diagnosis and our nurses don’t do that. Overall it’s comforting to know that you can phone and talk to an RN.”

Like front-line nurses, each telenurse has their own poignant story. For Molyneux it was a call from a frantic wife whose husband was a truck driver enroute to the US. “She called and said that her husband’s thumb was blue – although he wasn’t worried she was because it wasn’t a bruise it was completely blue. While speaking with him he revealed that his other thumb had also gone blue. I knew something was not right so I suggested he get off the highway and go to an emerg immediately. He hesitated but I was adamant and he agreed to go. Three hours went by and my supervisor came and asked me if I received a call about a truck driver with blue thumbs. His doctor in emerg just called to say that I had saved his life. He had a bloodclot that could have been fatal.”

A strong endorsement for telenursing programs comes from ER departments who use the services. Ottawa General Hospital ER nurse Ioanna Genovezos says “Many people call the ER asking for advice over the telephone and we direct them to Telehealth Ontario.Ê Having used telehealth myself, I thought it was great.”

For the 15 per cent of callers advised to go to an ER, telenurses offer to call the hospital in advance. Jane Reid, Research Nurse in the ER at Kingston General Hospital explains the impact telenurses have had on her practice: “Telehealth has become a very important health care delivery partner by supporting the public’s need for health advice. Our ER has partnered to have Telehealth Ontario become the default resource to support patients who may have questions and concerns.”

Over the last decade, Canada has implemented many formal and centralized telenursing programs throughout the country. With Clinidata launching their telenursing service in Newfoundland & Labrador this fall, nine of the 13 provinces and territories have province wide telenursing service available and that number is sure to grow until all Canadians have access to health care 24 hours a day, 7 days a week.For more information on Clinidata: visit www.clinidata.com
For more information on RNAO’s Telepractice Nursing Interest Group visit www.rnao.orgTelehealth Ontario: 1-866-797-0000