Virtual care service aspires to expand its know-how across Canada

HAMILTON, ONT. – By combining clinical care with research, the virtual care program at Hamilton Health Sciences and McMaster University – now called Continuus Health – has been able to reduce the length-of-stay of certain groups of hospital patients by two days.

It does this by safely transferring patients home earlier than before and monitoring them with a combination of technology, including an easy-to-use tablet computer and devices to measure blood pressure, heart rate, respiratory rate, oxygen saturation, temperature and weight.

If patients have questions and concerns, they can communicate with nurses through the tablet.

The Continuus Health program has also helped keep those patients from returning to hospital, too, an important measure of its effectiveness. By providing ample care in the home, it has reduced readmission rates by 40 percent.
Under the scientific leadership of Drs. PJ Devereaux, Michael McGillion and Mark Levine and the operational leadership of Jennifer Lounsbury, the program has been able to transition from research trials to clinical practice in a seamless way.

“Our approach is based on six years of research and clinical practice,” said Dr. Ted Scott, VP of innovation and partnerships at Hamilton Health Sciences. “The program now runs so smoothly. We are delighted with the improved efficiency, clinical outcomes and most importantly, the enhanced connection between patients and providers.”

Continuus Health first emerged in 2016 and focused on post-op cardiac patients. When COVID-19 struck, in 2020, it became increasingly important to keep patients in hospital for as little time as possible and the virtual care program expanded its scope and volume of patients.

At the same time, Continuus Health refined its procedures for caring for discharged hospital patients at home.
As Dr. Scott notes, the program “is a leading-edge model of care that provides patients with a continuous connection to specialized care teams after they leave the hospital. It’s a dynamic model that combines scientific research, healthcare operations and real-time data analysis to continually evolve and enhance the effectiveness of care patients receive outside a hospital setting.”

Significantly, Continuus Health now hopes to take that time-tested approach and deploy it at other sites across Canada, so that more patients, clinicians and researchers can benefit from these learnings.
It’s currently seeking funding to extend its methodology to remote care and other research centres in Alberta, Ottawa and Nova Scotia.

Dr. Scott notes that many centres across Canada deliver virtual care to patients, but there are many different approaches. Most of them are uninformed by research and haven’t established best practices.
“Virtual care is a challenging area for hospital providers,” he noted. “Many do it, but they don’t have a structured approach to delivery or evaluation.”

Continuus Health hopes to transfer that knowledge, enabling others to benefit from it.
For its part, Continuus Health has delivered remote care to over 2,400 patients from its start to March 2024. During that time, the nurses staffing the lab have completed more than 72,000 interventions, providing assistance to patients in areas such as wound management, psychosocial support and pain management.

They’ve also ordered tests and changed drug doses.

There have been 8,591 escalations from nurses to physicians and from physicians to surgeons. Moreover, remote care is delivered around the clock, seven days a week.

Something Continuus Health has led the way on is providing ‘accommodated’ working nurses, who are unable to continue working at the bedside, with meaningful employment at its virtual care lab. Those nurses have brought a high level of skills to the lab.

Currently, six registered nurses and four registered practical nurses are working within the Continuus Health lab facility. “In light of the human resources shortage in healthcare, this has been a real opportunity to retain talent,” said Dr. Michael McGillion, assistant dean of research at McMaster University’s School of Nursing. “It’s an exciting part of this project.”

Much has been learned about operating the lab in the best way possible. “So, the idea is to hopefully expand our virtual care infrastructure across some partner sites, now that we’ve learned how to organize an effective physical environment to provide remote care,” he said.

Among the things that Continuus Health has learned is that it’s best to have clinicians working together at a physical site, and not remotely. In this way, it’s much easier to collaborate on problems and issues that come up, and to share ideas.

“When staff work in isolation, it’s less effective,” said Dr. McGillion.

He noted that by working as a group, it’s easier to do virtual patient rounds each morning and rounds with physicians at mid-day. “It also builds a culture of success and clinical competence,” he added.

Dr. McGillion said the Continuus Health lab makes use of command centre principles, in terms of monitoring. There are six nurse stations with a clear view of a patient status grid offering real-time data about patients being monitored from home. Previously the Continuus Health lab has focused on post-surgical care. Its now expanding its scope by working with cancer patients receiving treatments such as chemotherapy, radiation, and immunotherapy as outpatients.

Virtual care and remote monitoring will improve patient support while oncology patients go through treatment, enhancing the patient and family experience.