Virtual ER service in Sussex and St. Stephen cuts workloads and waits, Horizon says
Use of Teladoc gives patients with non-life-threatening problems an 'alternative pathway to care'
An option of virtual care in two New Brunswick emergency departments has already reduced the workload of the on-site ER doctors by 20 per cent, according to the Horizon Health Network.
Horizon launched a one-year pilot at the Sussex Health Centre and Charlotte County Hospital in St. Stephen in late November to try to reduce wait times and improve access.
About 500 patients with non-life-threatening medical issues have been seen by a remote physician so far, using Toronto-based Teladoc Health Canada technology, said Dr. Serge Melanson, the executive director of emergency medicine for Horizon.
"We've calculated that about one patient in five who present to these facilities are seen using the virtual care system," he said, which frees up doctors in the ER to focus on more critical patients and helps to ease staffing shortages.
Patients who visit the ER are assessed by an on-site triage nurse and registered, as usual. If they meet certain criteria, they're offered the option to see an emergency-trained physician working remotely, via video, Melanson said.
Conditions suitable for this "alternative pathway to care" include a rash, cough or fever, vomiting and diarrhea, breathing problems, stomach and even chest pain, he said.
On-site nurses and other hospital staff assist the virtual doctor to diagnose and prescribe treatment by taking the patient's vitals and performing assessments using various electronic devices that mimic an in-person experience.
A Horizon video posted online, for example, shows a nurse using an electronic stethoscope to listen to a patient's lungs and a handheld camera to view the back of the patient's throat, which the virtual doctor can see and hear in real time.
The virtual doctors, all Canadian-based and licensed to practise in New Brunswick, also co-ordinate followup care.
Horizon did not respond to questions about the cost of the pilot. Greg Doiron, vice-president of clinical operations, said only that it's being funded by the provincial government. The Department of Health did not immediately provide the cost.
Asked whether patients who are eligible for virtual care will always be given the choice, Doiron replied in an email, "It is always a patient's choice whether or not to participate in virtual care."
Project leads at the two hospitals report "very few eligible patients declining the virtual care option," he said. Doiron did not say why those patients opted out.
Patient feedback 'overwhelmingly' positive
Cindy Stillman commented online about her experience with virtual care in Sussex. She wrote that she was skeptical at first, but it was "great."
"Will definitely use it again."
Whitney Dunn-Borthwick tried the Charlotte County service before Christmas, when she suspected her 11-year-old daughter had pneumonia. Online, she called it "one of the best experiences" she's had in the ER.
"We were in and out … in [one] hour with [X-ray] results and a prescription in hand."
The feedback from the patients has been "overwhelmingly" positive, based on survey results, Melanson said.
"On a scale of 10, 10 being outstanding service, they're rating it well above nine, 9.5."
Staff also anecdotally report that patients are asking for the virtual service again if they return to the ER.
Expansion possible
Virtual care is only available one or two days a week at the two hospitals, Melanson said, but Horizon is evaluating how effective it is and looking at potential expansion, including to other hospitals and communities.
As it stands, patient "flow and throughput" virtually are about the same as being seen in-person, he said.
Although the majority of the virtual patients to date have been triaged as non-urgent or less urgent — levels five and four on the Canadian Triage and Acuity Scale — up to 17 per cent have been urgent or emergent, or levels three and two, Melanson said.
"So this is really pushing virtual care … safely and effectively into a whole new realm of medicine," he said.
Sussex ER remains closed overnight
While the virtual service hasn't created an opportunity to restore or extend the Sussex emergency department's hours, Marc Thorne, mayor of the town of about 4,400, said it is helping to keep some people from leaving the ER out of frustration without getting help. "And that is a win."
Of the 50 to 60 patients the ER typically sees a day, "it was not unusual to have 10 to 20 leave," Thorne said.
A doctor shortage forced the overnight closure of the Sussex ER in September 2022. At the time, Horizon hoped the cut would last "less than a year," but it continues to close overnight.
"My choice is to always have a doctor present in any emergency department but [I] recognize that recruitment is challenging," and "gaps are still quite significant," said Thorne, who is on a steering committee overseeing the Sussex & Area Health Action Group.
Horizon has said Teladoc serves as a valuable tool for maintaining ERs in rural communities, but if a physician is not on site, only urgent care, meaning care for people with non-life-threatening problems, will be offered virtually.
"In these situations — which will be communicated to the public well in advance — all patients in need of immediate emergency care or who are experiencing potentially life-threatening symptoms should still call 911."
Horizon noted it's also working with the provincial government to establish a community care clinic in Sussex in 2025, which will give patients a primary care option instead of resorting to the ER.
Physician on site remains 'gold standard'
St. Stephen Mayor Allan MacEachern described the virtual service at the Charlotte County Hospital ER as a "good addition."
"There's nothing worse than hearing the stories of someone sitting there for hours in pain" in a waiting room "full of all sorts of things that could be taken care of by this online version."
MacEachern, whose town has about 4,500 residents, believes it's also a more efficient use of the virtual doctors' time, eliminating the need for travelling to the rural ER.
The introduction of virtual ER care in some provinces has raised concerns that doctors will no longer have an incentive to physically set up shop in rural locations, or that private companies like Teladoc Health might poach existing doctors away from their community-based practices.
But MacEachern said he's not worried yet.
Virtual care is not meant to replace having a physician on site, Melanson stressed. That remains the "gold standard" and "aggressive" recruitment strategies continue, he said.
No New Brunswick doctors have signed up with Teladoc yet, but any who do "would have to continue to commit to their in-person requirements."
Virtual work is not more lucrative than in-person work. Doctors get paid the same, he added.
Melanson plans to sign up "very soon" and hopes to see "a large cohort" of New Brunswick doctors join before the pilot ends.
He believes it will be easier to squeeze a few extra hours of virtual work into their schedules than commit to eight- to 12-hour in-person shifts, especially those requiring a commute.
Medical society reserves comment
The New Brunswick Medical Society declined to comment on the virtual ER care pilot until it meets with Horizon and better understands "the mechanics of it and the potential benefits/risks."
The College of Physicians and Surgeons of New Brunswick "recognizes the role of virtual solutions like Teladoc in providing access to care for patients," Dr. Laurie Potter, registrar and CEO, said in an emailed statement.
"Virtual care should be used as a complement to in-person care and should not be used as a replacement," she said. "The College encourages physicians to use virtual care when it is in the best interest of the patient."
