ER docs urge government to reconsider virtual care

WINNIPEG – Over 60 emergency care doctors in Winnipeg are calling on the province to hit pause on talks about possibly implementing a virtual care initiative to reduce wait times in emergency rooms.

In a letter sent to Manitoba’s health minister, emergency physicians at both Health Sciences Centre and St. Boniface Hospital expressed “significant concerns” over patients in emergency department waiting rooms potentially being assessed virtually by out-of-province doctors.

A memo sent by the Winnipeg Regional Health Authority to its emergency department staff on Oct. 21 said discussions being had about virtual care models in emergency departments were merely “informational and exploratory,” and that no commitments have been made.

According to CBC News, the memo also said any further approach toward implementation will be informed by “further engagement” with emergency department staff.

The letter sent by the group of doctors asks that no further steps be taken toward implementation without meaningful consultation with front-line clinicians. It also said doctors learned of the proposal only days before vendor site visits in mid-October, “without meaningful prior consultation with the front-line physicians and nurses who would be expected to implement the model.”

The doctors are also asking that the proposed model and supporting evidence be disclosed, and that the initiative be compared with alternatives that could reduce wait times in emergency rooms and improve patient care.

Health minister Uzoma Asagwara says the province is in the consultation phase and that no decisions have been made.

“Ultimately, the goal here is that front-line providers are the ones who inform whether or not this moves forward and what the approach would be.”

In the letter, the doctors acknowledge virtual assessment might benefit some patients by reducing the time before they see a doctor, but patients assessed remotely might still require in-person examination and care, the letter says.

The central concern the doctors share, the letter says, is about the difference between seeing a physician sooner and receiving the care a patient needs sooner.

The group says there are a number of unresolved questions relating to clinical responsibility and patient safety.

The letter calls for an “urgent meeting” with the health minister and emergency care doctors and nurses to review the proposed model, identify concerns and develop alternatives before any commitments are made.

The physicians are also asking that transparent comparisons of all options being considered, and for an independent evaluation of any pilot project.

In a statement to CBC News, Doctors Manitoba says emergency physicians were surprised to hear a virtual ER option was being considered.

“When significant changes in healthcare are being considered such as this, front-line physicians should be consulted rather than being taken by surprise,” the statement said.

Aaron Guinn (pictured), an emergency physician at St. Boniface Hospital, said describing his reaction as surprised might be an “understatement.”

“I think I may have actually started laughing out loud when I heard that this was something that was being planned,” said Guinn.

Guinn, who is one of the emergency doctors who signed the letter to the health minister, said he has a hard time understanding how potentially hiring a private, out-of-province company to triage patients will help reduce his already stretched workload. Instead, it’s likely to feel “demoralizing” knowing someone is dying and there’s not much you can do about it, he said.

“As far as I’m concerned, I don’t see a way that this would help my workload or help reduce wait times – if I could be very direct, it seems completely nonsensical to me,” he said.

“Who are these people? It’s not going to be physicians who have any familiarity with our practice setting, with our patient population, with [the] resources that are available to us.”

Guinn says many of the other physicians who signed the letter to the health minister are frustrated by the lack of consultation, and the province considering investing money in a strategy they’re not convinced will help.

“This doesn’t make any sense to any of us,” Guinn said. “Why are you doing this without getting any of our input? Because if you [provincial health ministry] had asked our input, we would have told you that this is a waste of money.”

Doctors Manitoba says that after raising concerns, the province assured the organization that front-line ER physicians would be consulted and involved in the decision-making process before any commitments are made.