Quebec begins offering virtual ED care

MONTREAL – For the first time in Quebec, certain patients who need urgent care are being offered a virtual alternative to an in-person visit to the emergency department (ED). The service, which recently went into operation, enables individuals who are 18 years old and up to connect by videoconferencing to an emergency physician at the Jewish General Hospital University Health Centre from the comfort of their home.

The primary point of access to the virtual urgent care (VUC) program is Montreal’s 811 service. After assessing a caller’s needs, a professional at 811 can refer appropriate patients to the program as an alternative to directing them to a physical emergency department.

VUC is intended for people who have an urgent medical problem that must be attended to promptly but is not so critical as to require immediate emergency treatment in person.

Dr. Joel Turner (pictured), chief of the department of emergency services at the JGH, says the program provides patients with some key benefits: improved access to urgent health care without having to wait for many hours in a hospital’s ED, as well the ability to avoid travelling to the ED unnecessarily.

The expectation is that the program will also help to relieve some of the burden in ambulatory care faced by the emergency department at the JGH, which remains the busiest in Quebec, with a total of approximately 96,000 visits per year, Dr. Turner says.

VUC is part of the rapidly growing virtual care program in the Santé Québec West-Central Montreal Health and Social Services University Network. Included are services such as Hospital@Home, Recovery@Home and ambient monitoring for seniors.

In addition, VUC is closely aligned with the organization’s Care Everywhere approach: achieving the right outcomes by providing the right care at the right time, in the safest, most appropriate and most convenient location for users.

This latest innovation further advances that vision by extending care beyond the walls of the organization’s facilities and, in this case, into the patient’s home.

The new service is offered Monday through Friday, from 9:00 a.m. to 1:00 p.m. Patients can also access the service by making a same-day appointment online through the VUC platform.

Once the appointment has been booked, the patient is able to remain comfortably at home or engage in other activities until the physician contacts the patient by video at the agreed-upon time.

The program is meant to respond to people who have an urgent – but not severe – medical problem, such as back pain, a swollen eyelid, a possible urinary tract infection, a mild burn or flu-like symptoms.

However, anyone in a critical situation – for example, having chest pain, severe breathing difficulties or bleeding during early pregnancy – should continue the current practice of calling 9-1-1 or going to the nearest emergency department.

Dr. Turner explains that in VUC, the patient has direct access to a physician and communicates by videoconferencing. This is especially helpful if ailments such as burns, rashes or other conditions need to be examined visually.

In addition, the new virtual program allows physicians to electronically forward prescriptions to the patient’s pharmacy, order necessary blood tests or x-rays, and arrange appropriate follow-up care when needed.

If the patient needs a specific test, the patient does not go to the JGH. Instead, the physician sends a requisition to a Local Point of Service or to a local imaging centre. Lab results, imaging reports and clinical summaries can be shared with the patient via a patient portal.

As much as possible, the objective is to have the hospital channel its resources toward the sickest and most vulnerable patients, Dr. Turner says.

According to Dr. Turner, similar programs have been successfully implemented (with some variations) at medical centres in Ontario, Alberta, British Columbia, the United States and several other countries.

Essential to the vision, creation and development of the program at the Santé QuébecWest-Central Montreal Health and Social Services University Networkwas the leadership and expertise of Dr. Dan Mankarios, an emergency physician at the JGH. His first-hand experience working as a virtual ED specialist in Brisbane, Australia, played a pivotal role in shaping the program’s design and implementation.

Dr. Turner hopes the service will expand province-wide, providing more patients with the ability to gain access to urgent care more easily and rapidly.