By Interior Health

Sandi Gowda is a farmer who lives near Walhachin, in the interior of British Columbia. Her three-acre crop is grapevines, which she hopes will eventually mature into viable fruit for one of the many emerging wineries in the province’s Thompson region.

Even in the midst of winter, she prefers not to stray too far from her vines. That’s why Sandi didn’t hesitate when the call came to attend a virtual pre-surgical appointment at Ashcroft Hospital, about 30 minutes from home. It made for a much shorter day than a two-hour drive would have been to Lillooet Hospital and Health Centre, where she was scheduled for an upcoming colonoscopy.

“It was convenient to go to Ashcroft and have the video conference there,” says Sandi, 55, who had her procedure on Jan. 25. “I may not have opted to have my colonoscopy at Lillooet if I would have had to drive there for the pre-operative appointment as well. I would have probably asked to go to Kamloops (30 minutes away, where the wait time for the procedure was longer) instead.”

Sandi is one of about 50 patients served by Interior Health, one of B.C.’s regional health authorities, who as of mid-April had taken advantage of the new virtual perioperative clinic at Lillooet Hospital. Lillooet performed approximately 230 elective daycare procedures in 2016/17, including esophagus and digestive system biopsies, hernia repair, vasectomies, gynecologic surgery, hand surgery, laparoscopy, and dental and periodontal interventions.

Lillooet may not seem like the obvious choice for patients in the Ashcroft region to have a surgical procedure, given its more remote location and smaller size as compared to Royal Inland Hospital in Kamloops, where patients from communities such as Ashcroft, Walhachin, Savona, Cache Creek, Bonaparte Reserve, Nicola Reserve, and Clinton may normally go.

However, Dr. Nancy Humber, who is a general practitioner with enhanced surgical skills (GP-ESS) at Lillooet Hospital, saw an opportunity to make the surgical experience better for patients in the region. She envisioned a person-centred approach using technology that would reduce overall travel time and, at the same time, build an innovative surgical service delivery model for rural patients. It’s the latter that was especially important to Nancy, who is also Interior Health’s Executive Medical Director for IH West-Rural.

Thus, the Lillooet virtual perioperative clinic was born.

“We responded to a need,” says Nancy. “It was an opportunity for Lillooet Hospital to be a leader. It was an opportunity to mitigate barriers that geography creates by using technology, and to create a service delivery model from a regional lens instead of a community lens.”

Continuous improvement in connecting patients from hospital to home

Here’s how it works:

Using funding from B.C.’s Rural and Remote Divisions of Family Practice and Facility Engagement, Nicole Hochleitner-Wain, project coordinator in Lillooet, books patients to attend a video conference at Ashcroft  Hospital. She travels there, sets up the telehealth equipment, meets the patients, and gets them settled – which is especially important for older patients who are apprehensive about technology, says Nicole.

The patient then meets virtually with the surgical team, a consultation that includes a GP surgeon, GP anesthesiologist, and an operating room nurse. With this complete, the patient only needs to travel for the procedure itself. Follow up is also done virtually or by telephone.

That the appointment is done with a team approach was intentional, says RN Bobbie-Jo Allen.

“It cuts down on time for patients, nurses, and physicians, because it’s all being covered in one appointment,” says Bobbie-Jo. “If we take a good, solid history and ask good questions, that covers everything, because most of the questions we would ask were the same.”

There is some patient travel for the video conference, because it requires the use of a telehealth mobile unit. But operating room lead Maria Mascher says the use of video was an important component. Patients like the opportunity to meet the entire team. The team has the opportunity to hear the answers and ask questions together. It’s team building and high-quality communication between the team and the patient for the best quality of care.

“This way, patients can see the person behind the voice of their physicians and nurses. We thought it would be nice, getting to see a face,” Maria says, adding that helps make patients more comfortable before their procedures.

And, adds Bobbie-Jo, the consultations normally are between 20 to 30 minutes, making a short commute to Ashcroft preferable to a longer drive to Lillooet.

“If a patient has to travel two hours for a 20-minute appointment, and then two hours home, that’s a lot of time for a 20-minute appointment. That’s a whole day,” says Bobbie-Jo.

The first virtual perioperative clinic was held July 24, 2017, with 14 clinics now complete. The Ashcroft hospital site is hoping to expand its network access to services with its own portable videoconferencing unit.

This virtual clinic model also exists in other communities in Interior Health, like Trail, and work is underway to incorporate more telehealth options for pre-surgical screening at several sites in the health authority.

Feedback for Lillooet’s clinic has been positive, says Dr. Suman Sharma, a GP anesthesiologist.

“Patients are very happy. One of the reasons it works is the one-to-one care given in a smaller centre. In a bigger centre they can feel lost.”

Sandi echoed that sentiment.

“I thought it was very efficient,” she says. “Even though it wasn’t in person, you’re still in contact. You’re still on real time. It’s very convenient. It’s private. You never have to feel uncomfortable if asking questions about personal issues. The doctor was thorough in explaining the process and what to expect. It was comfortable – the same as if I visited in an office.

“It’s a great model for the future for rural areas, for people who have a hard time getting to hospitals and clinics.”

Nancy says that it’s a model that can be built on for the future, too, as it identifies a good and efficient way to use health-care funding. In this case, they had help from the Rural Division of Family Practice, and Interior Health’s Telehealth working group is also supportive. A blended model of face-to-face and virtual care is a way to address equity and access with fewer resources in rural and remote communities.

“It shows that when a highly functioning team of people are resourced, they can address what is possible locally,” says Nancy. “It’s about seeing a need and having a team of people work well together to develop a service to meet need and respond and adapt to what the needs are.”

This article was submitted by Interior Health.