National Nursing Week 2013: Stars of the Virtual Care Delivery System

During National Nursing Week 2013, OTN would like to commend Ontario nurses for their 
professionalism, commitment and service to the patients, families and providers 
who use telemedicine to access or provide care in their communities.

Barb Pizzingrilli: Making the multi-site connection for mental health

Barb supports mental health programming for the Niagara Health System (NHS), the largest multi-site hospital organization in Ontario. The NHS has six sites that provide services to more than 430,000 residents across the Regional Municipality of Niagara. 

Last summer, Barb was tasked with setting up the NHS’ sites in Welland and Niagara Falls with telemedicine equipment provided by the Hamilton Niagara Haldimand Brant LHIN. The choice to establish the two sites with the equipment was part of the NHS’ comprehensive mental health strategy, which would see Welland and Niagara Falls connect to the primary mental health hub in the yet-to-open new hospital in St. Catharines.   

Barb moved quickly to get both Welland and Niagara Falls up and running as telemedicine sites and they were ready for patient activity in the Fall. Despite the fact that the hospital in St. Catharines would not be open until March of 2013, Barb began familiarizing staff with the intricacies of providing virtual care in the mental health field by having Niagara Falls provide crisis coverage for three hours a day to Welland. This not only ensured that crisis care was available in Welland if required, but provided an ideal opportunity to train staff. It also provided a critical opportunity for Barb to work through the internal processes required to develop a clinical protocol that would respond to what the teams required to facilitate care delivery using telemedicine.

The NHS was subsequently advised that they were receiving an additional four systems from the LHIN: one for the Withdrawal Management program in St. Catharines; two for the Psychiatric Emergency Response Team (PERT) at the new St. Catharines site and one for the Newport Centre in Port Colborne. Barb was actively engaged in deploying the equipment across the sites and across the programs. 

On March 24 of this year, the Mental Health and Addictions Program moved into the brand new hospital in St. Catharines. The telepsychiatry service launched the same day and within 48 hours, seven crisis assessments had been completed from the new hospital for the Welland and Niagara Falls sites! 

In just a month, the program has already been expanded to include patient needs assessments, recommendations to health providers regarding patient medication adjustments, patient referrals to appropriate community care or expediting access to inpatient care. All of this is the result of Barb’s dedication and commitment to ensuring that patients continue to have access to the care they need, regardless of where they live.

Congratulations, Barb!

Doreen Grouette and Jodie Dale: Dryden Regional Health Centre’s Dynamic Duo

Dryden Regional Health Centre (DRHC), located in Northwestern Ontario, serves a local population of about 7,600. Residents in Dryden have the option of a four and a half hour one way road trip to Thunder Bay or to Winnipeg, Manitoba to get access to specialist care.

Doreen, a seasoned Telemedicine advocate, has been supporting the delivery of virtual care in Dryden for a decade. With just two years’ experience, Jodie joined DRHC’s Telemedicine program under the auspices of the LHIN Telemedicine Nursing Program and quickly became a virtual care enthusiast. Together, they are the DRHC’s “dynamic duo”!

Facilitating a robust calendar of patient appointments, Doreen and Jodie are motivated by a desire to ensure access to high quality care for residents in the North. An unspoken motto of patients and family first, they recently added a Televisitation program that connects Dryden residents with family members in health care facilities in other cities! 

Recognizing that virtual care can bring beyond the hospital, Doreen and Jodie worked closely with Dryden’s Princess Court Long Term Care home to link DRHC’s Emergency Department to each of the home’s 92 rooms so that residents can receive timely and appropriate treatment in the comfort of their home. The duo were front and centre in the development of policies and processes and ongoing staff training to make it work. The successful initiative, launched last year, was the focus of a presentation at the Nursing Leadership Network conference in Toronto this past March.

Doreen and Jodie also engage in ongoing awareness of Telemedicine through newsletters, pamphlets and even media interviews! They build partnerships to ensure greater inter-organizational cooperation and utilization of Telemedicine. Most recently, they helped to establish Caregiver Connections, a group that uses OTN to meet monthly with geriatric nurse experts at St. Joseph’s Care Group in Thunder Bay to discuss caregiver issues. 

Up next: cardiology follow-up appointments!

Doreen and Jodie have embraced virtual care delivery and are generous about sharing what they know, welcoming both nursing students and medical school learners into their work environment. They hope that leading by example, these future health care professionals will incorporate it into their practices as simply yet another way to deliver care.

Congratulations, Doreen and Jodie!

Chanelle Roy: Leading by example

Chanelle joined Seaway Valley Community Health Centre (SV CHC) less than a year ago under the auspices of the LHIN Telemedicine Nurse Initiative. SV CHC is a not-for-profit organization that provides primary health care, health promotion and community development services to the residents of Cornwall and Stormont, Dundas and Glengarry counties. 

Chanelle started developing the fledgling program with the basics – facilitating one-on-one patient consultations with specialists across the province and educational sessions for health care professionals on the management of mental health patients. She soon added Nephrology clinics with The Ottawa Hospital and added a series of free nutrition-based Education Workshops to the existing cardiac rehab the SV CHC had with the Ottawa Heart Institute. Her interest in, and compassion for, her patients guide all aspects of her work. Chanelle wants her patients to get the best care possible, but she wants them to have that opportunity without the stress and expense of travel to get it. She has seen how telemedicine makes this possible and is delighted by the positive feedback from her patients.

In order to ensure the best possible patient care, Chanelle understands the importance of processes and procedures required to make that happen. In keeping with the College of Nurses’ guidelines on documentation, as well as those within the SV CHC, Chanelle created guidelines for documentation of telemedicine events that can be easily replicated outside the CHC. 

While more than willing to lead when required, Chanelle is also a wonderful team player. She is always willing to help new nurses and other Telemedicine Coordinators enhance their skill sets and promotes telemedicine best practices whenever possible. Bilingual, Chanelle is presently working with the Centre de Santé Communautaire de L'Estrie two days a month to help staff at that location enhance access to care via telemedicine for the Francophone population.

Understanding the importance of getting the word out about telemedicine, Chanelle worked with the Champlain LHIN on a video explaining just that. In just a month on YouTube, it has nearly 900 views!

Chanelle enjoys being able to build new programs and create opportunities for the CHC’s clients, saying that “clients with smiling faces is very rewarding."

Congratulations, Chanelle!

Christine Dias: Nursing a program to new heights

The Sault Area Hospital (SAH) is a state-of-the-art facility that opened in 2011 and serves a population of approximately 115,000 residents across the Algoma District.

Christine joined the SAH as a Telemedicine Nurse two years ago, when the hospital’s telemedicine program was facilitating just 900 patient visits annually. Christine seized the opportunity provided by a fresh start in a brand new hospital and set about growing the program.

What did that mean? Pre-admission consults for all seven anesthetists, two gastroenterologists, and a hematologist. Adding telemedicine to some aspects of the hospital’s rehabilitation and nephrology departments. And working with Sudbury’s Regional Cancer Program on the development of a protocol that provides support for medical oncologists during a physician shortage. Seeing an opportunity to facilitate rheumatological assessments using telemedicine, Christine expanded her clinical skills to do just that. All of this activity has resulted in increasing the delivery of virtual care at the SAH to more than 2500 clinical events per year, making it the site with the most patient-hosted activity in the North East.

And hosting patients is something that means a great deal to Christine. Beginning with ensuring that they understand what the consultation will entail to taking notes for them when that is necessary, she is far more than their nurse; she is their advocate. She covers all the bases in between, too, facilitating lab requisitions and blood work and even following up with the family physician if that is required. She enjoys watching their reaction to the technology and their satisfaction with their appointments.

Christine recognizes that increasing the reach of the program requires some outreach within the hospital and so she has made presentations to the Medical Staff and to the Medical Advisory Committee. And she worked with staff to develop a five-year strategic plan that aligns the telemedicine program with activity in other departments, something Christine sees as a real benefit of virtual care. 

Christine feels fortunate to have been given the opportunity to develop the Telemedicine program at the Sault Area Hospital, and looks forward to facilitating its further expansion.

Congratulations, Christine! 

Katrine McCarl: Proof that small can be mighty

The Georgian Bay Family Health Team (GB FHT) is a patient-centered, primary health care team that provides care to the population of Georgian Bay.

Katrine started with the Team as its Telemedicine Coordinator more than five years ago, charged with introducing virtual care not only to the Team, but to the residents of the immediate Collingwood area. A daunting challenge for someone with no Telemedicine experience, but Katrine embraced the challenge, fully supported by the medical staff of the GB FHT.

Katrine began building her program while also building her own knowledge of telemedicine. She developed her own network of Telemedicine Coordinators with which she could liaise, finding answers to questions she had and hearing about other opportunities where she could apply telemedicine to facilitate care delivery. She applies what she learns to the development of telemedicine policies and processes and spends time educating her peers and the community.

Katrine started by facilitating appointments with individual specialists, then added regular clinics for Diabetic patients and for specialists in nephrology and child and adolescent psychiatry. Most recently, Katrine established oncology clinics with the Royal Victoria Regional Health Centre in Barrie. The success of the pre and post chemo clinics (supported by five oncologists) has resulted in the Royal Victoria offering similar clinics in Bracebridge, Huntsville and Orillia.

Back in 2009, Katrine jumped at the chance to be part of the OTN store forward pilot (sending photographs of a patient’s skin condition for assessment, diagnosis and treatment by a dermatologist). She loves the fact that in the pilot, it was taking about a month to process the assessment – still a faster turnaround than a traditional face-to-face consult would take – but that it now takes just five days! Otn.teldermSF is a service that she continues to use frequently.

Her effort is motivated, first and foremost, by the desire to help the patient. However, Katrine believes that her role goes beyond merely facilitating the consultation – that where necessary, it includes advocating on the patient’s behalf – for more time with the specialist, or perhaps another appointment. And while helping the patient comes first, Katrine gets some satisfaction that providing virtual care also saves the broader healthcare system money in avoided travel and even better, saves the environment from unnecessary pollutants.

It doesn’t come without effort, but Katrine’s have helped to make the GB FHT one of the busiest users of virtual care delivery in the North Simcoe Muskoka LHIN!

Congratulations, Katrine!