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Northeast Ontario launches critical care project

Derek ManchukSUDBURY, Ont. – A first-of-its-kind program has started in Northeastern Ontario that benefits patients needing critical care support at small, rural regional hospitals. Every hour of every day, a Virtual Critical Care Unit (VCCU) team will be available to provide its expertise through technology.

The NE LHIN-funded project will extend intensive care consultation to smaller hospitals across the enormous region.

“I strongly believe this is a first in Canada; it’s definitely a first in Ontario,” said Dr. Derek Manchuk (pictured), the North East LHIN’s Critical Care Lead, and the project’s lead. He is also Chief of Critical Care at Health Sciences North, in Sudbury.

This new model of care delivery will provide a patient at a community hospital with the benefit of experts skilled in critical care, and less need to be transported away from home and family to a larger regional hospital.

“When you survey the resources across our hospitals, there are discrepancies in what critical care is available,” said Dr. Manchuk. He has tested the Northeastern ICUs against a set of 10 provincial metrics on what an ICU should have as standards. He determined that two of the larger hospitals scored well, but many of the smaller ones are lacking human resources.

“This VCCU adds real value to the care of patients for the smaller hospitals in our region,” said Dr. Manchuk.

“Providing quality patient care, close to home, is a priority for the North East LHIN,” said Louise Paquette, CEO, NE LHIN. “This patient-focused project is a tremendous accomplishment that has been achieved through collaboration. I commend Dr. Manchuk for his innovative thinking, and for his leadership.”

The VCCU team includes: an Intensivist (a specialist in ICU care), a critical care pharmacist, a nurse with extra critical care training, a dietitian and a respiratory therapist. They will operate what is called a “passive model” of Virtual Critical Care Unit, meaning that the team will respond to requests to provide consultative advice to small hospitals.

The VCCU will start in May with three hospitals – Kirkland Lake, New Liskeard and Elliot Lake – and engage 14 other sites over the summer that have ERs but no ICU. The plan is to have all ICUs connected by technology to the VCCU by this fall.

Dr. Manchuk said the Ontario Telemedicine Network is a key part of the VCCU and will be used for videoconferencing. Enhancements being made to regional IT will allow hospitals to transmit diagnostic and lab results, to be read by the VCCU team.

“This is an ambitious use of telemedicine for critical care,” said Dr. Manchuk.

He recalls two examples from a project pilot that illustrate the project’s benefit. After “seeing” each of the patients using videoconferencing, the virtual critical care team was able to provide guidance to staff at a smaller hospital on mixing and administering a IV medication that Dr. Manchuk recommended for a patient with an irregular heartbeat; the other was to remove a breathing tube with the direction from the remote respiratory therapist, sparing the patient a trip to a larger hospital.

Three hospitals participated in a North East LHIN pilot of this project in 2009/10. In the pilot, both referring and consulting partners indicated that they liked the approach, and it helped avoid the transfer of patients in about one-third of the cases. All thought quality was improved.

Later this fall, the project will also include providing care to regional Emergency Rooms (ERs). Northeastern Ontario has 14 hospitals with ERs, but not ICUs. Dr. Manchuk said the project’s goal with ERs is to provide earlier care and to have consultations done faster.

The Virtual Critical Care Team is from Health Sciences North, Sudbury.

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