Digital tools and virtual care in emergency services

With Ontario undergoing a phased reopening, emergency department volumes, which dropped during the first few months of the COVID-19 pandemic (see sidebar), are beginning to normalize (see sidebar) That, along with planning for possible future outbreaks, has highlighted opportunities for virtual models of care to help optimize access to emergency services and keep patients safe. Virtual models of care can assist in assessment, allow providers to offer self-care advice, and direct patients to appropriate care settings. Beyond improved access, however, they can also enable enhanced patient choice, maximize hospital and health system resources, and improve convenience for patients and their families.

The Electronic Canadian Triage Acuity Scale, or eCTAS, developed by Cancer Care Ontario (now a business unit of Ontario Health), has been instrumental in improving patient safety and quality of care by enabling consistent triage since it first launched in 2017. eCTAS has also been a key enabler in providing insight into emergency departments trends for health system planning and management. Now used in 115 Ontario hospitals, the cloud-based, electronic, triage decision-support tool is primarily used by front-line nurses to calculate an acuity score based on combinations of 169 different presenting complaints—such as chest pain, confusion or vomiting—and more than 400 other variables, including pain level or fever. Today, more than 90 per cent of all emergency-department patients in Ontario are triaged using eCTAS, which also shares real-time data and information, including infection-control updates from Public Health Ontario. Research has demonstrated eCTAS has improved consistency and accuracy of triage significantly, and it can certainly be further leveraged in pre-hospital settings to enhance virtual emergency care.

OTN, the virtual care division of Ontario Health, has been working closely with its Cancer Care Ontario unit and hospital partners to support two key facets of emergency care remotely: clinical assessment and treatment for non-life-threatening concerns. The potential upside is considerable. Patients seeking medical care or advice and who may be considering a trip to an emergency department, for instance, could log on to a hospital webpage that includes ED information and a live link to initiate a virtual visit from their own device. An individual could then be assessed in one of three ways: through direct contact with an attending physician, or triaged remotely by either an actual nurse (using a tool like eCTAS) or an artificial-intelligence platform, such as a chatbot using sophisticated algorithms, that pre-screens them before connecting them with a clinician. After triage, that same patient can then be placed in a “virtual waiting room” to see an available physician based on acuity score or sent a scheduled time via text or email for a video or audio visit. Prescriptions or lab tests could also be ordered when appropriate—or, if necessary, the patient could be redirected to an in-person emergency department or an appointment with a primary care provider.


Two great examples of virtual care in Ontario that have shown promise in relieving pressure on emergency departments can be found at Ottawa-based CHEO and the Renfrew County Virtual Triage and Assessment Centre (RC VTAC). The latter connects OHIP-insured Renfrew County and South Algonquin residents unable to access a primary care provider to a family physician or nurse practitioner for non-threatening health concerns, 24/7, including for COVID-19.  (Those who suspect they may be having a heart attack or stroke or who are experiencing major bleeding or severe breathing problems should still contact 911.) After calling a special number (1-844-727-6404) and answering some basic health questions posed by a medical receptionist, patients are either directed to seek immediate emergency care or are booked into a same-day video or telephone appointment.

CHEO, meanwhile, in early May became Canada’s first pediatric hospital offering a virtual emergency department for similarly non-life-threatening medical concerns. Families are first asked to reach out to their primary care physician or pediatrician, but in the event they are unavailable they can visit www.cheo.on.ca, where, after completing a self-triage assessment to determine suitability, they can book a same day video visit with an emergency physician specializing in pediatric care. Since early May, 81 per cent of all CHEO’s virtual ED visits avoided the need for an in-person visit at the hospital.

Hospitals and care organizations, including Ontario Health Teams, interested in further exploring how virtual access to emergency care can help patients during the pandemic—and beyond—are encouraged to visit the COVID-19 online resources of Ontario Health (OTN), Ontario Health’s virtual care system response section or email info@otn.ca.

This article was submitted by the Ontario Telemedicine Network.

 

Emergency Department Visits in Ontario

2019 2020
January 494,726 512,552
February 444,589 450,598
March 500,642 376,971
April 491,389 245,750
May 507,590 332,449
June 499,788 394,258

Source: National Ambulatory Care Reporting System (NACRS) provided by Canadian Institute for Health Information (CIHI)