Real-Time Virtual Support (RTVS)

Real-Time Virtual Support (RTVS) connects providers in rural, remote, and First Nations communities across British Columbia with immediate access to physician support through virtual care pathways, enhancing health equity by providing timely medical advice, supporting local care teams, and ensuring access specialist consultations when needed. Through multiple pathways—including CHARLiE, VERRa, MaBAL, ROCCi, and RUDi—RTVS delivers critical real-time expertise, via phone or video, in emergency, maternity, pediatric, critical care and internal medicine. There are also eight Quick Reply pathways for specialist support. Designed for physicians, residents, nurse practitioners, nurses, midwives, and—in some cases—first responders in rural, remote, and First Nations communities, RTVS offers friendly clinical support at the click of a button, ensuring that healthcare providers never feel alone in delivering patient care.

The Real Time Virtual Support team gathered in Jan 2024

“I cannot express my gratitude at your involvement during a stressful and tragic circumstance. Your calm voice kept me more grounded than anything else. CHARLiE is so important to us rural docs and is so so invaluable.”

Rural physician

Achievements

CHARLiE Achievements

CHARLiE On Pediatric Call Rotas

CHARLiE continues to improve equity in pediatric care for rural children while supporting on-the-ground rural pediatricians. It is now directly listed on the call rota for a growing number of rural hospitals across the province. CHARLiE serves as the designated first-call for pediatrics in most of northwestern BC and at select sites on Vancouver Island. In communities with limited local pediatricians, this service alleviates the pressure of providing continuous coverage while also reducing the burden on call groups in larger regional centers, which have reported being unable to absorb additional calls. A study highlighting the benefits of CHARLiE’s inclusion on the call rota was published in October 2024. Additionally, First Nations Health Authority (FNHA) Nursing Station nurses—who often work without the support of an in-person physician—are directed to contact CHARLiE first for any pediatric concerns.

CHARLiE as a Well-Established, Essential, and Provincially Integrated Service

CHARLiE is prominently identified in the Provincial Pediatric Virtual Support Pathway, jointly endorsed by Child Health BC, the Provincial Health Services Authority, BC Emergency Health Services, and BC Children’s Hospital. It is also integrated into health authority-approved order sets, reinforcing its essential role in ensuring access to pediatric healthcare where no local pediatricians are available. Additionally, CHARLiE is specifically named in all pediatric FNHA pre-printed orders as the first point of contact for acute pediatric presentations. Beyond providing real-time guidance, CHARLiE plays a key role in navigating patient transport and advocating for higher-level care when needed.

VERRa Achievements

VERRa Established as a Separate Pathway

The Virtual Emergency Room Rural Assistance (VERRa) pathway has expanded upon the work of the RUDi MRP team and was officially launched as a standalone pathway in August 2024. Now led by Dr. Brydon Blacklaws and Dr. Caroline Walker, VERRa provides virtual physician support to small rural emergency departments facing the risk of diversion due to physician staffing shortages. Including work completed prior to its official launch, the team provided 281 hours of hospital coverage in 2024.

Five New Sites Supported in 2024

Since becoming a standalone pathway, VERRa has expanded its reach, onboarding new physicians and extending support to additional rural communities. In 2024, the team began providing coverage for Mackenzie, Bella Coola, Port McNeill, Chetwynd, and Nakusp, alongside four other sites that received regular support throughout the year.

MaBAL Achievements

Prenatal Care for Remote Indigenous Communities

The Maternity and Babies Advice Line (MaBAL) continues to be a crucial resource for maternity care across rural and remote communities, particularly those with limited access to primary care. MaBAL physicians provide guidance to healthcare providers on prenatal, intrapartum, and postpartum care, ensuring that patients receive informed and timely support. With expertise in women’s health, MaBAL helps improve maternal and infant outcomes across British Columbia.

Sharing MaBAL’s Work

In March 2024, MaBAL leads Dr. Keeve de Villiers and Dr. Amy Sawchuk presented at the UBC Learning Circle, a partnership between the Centre for Excellence in Indigenous Health and the First Nations Health Authority. Their presentation provided an in-depth look at MaBAL’s role in supporting maternity care in rural and remote communities. Watch the presentation and Q&A session here.

Expanding Provider Capacity

MaBAL has played a key role in an ongoing Learning Health Systems Grant, where a physician and midwife team are conducting monthly chart reviews with two remote First Nations communities to assist the local healthcare team’s care for pregnant patients. This innovative program may expand to more communities. The team also began facilitating a perinatal community of practice for FHNA’s rural and remote nurses.

ROCCi Achievements

Recruiting and Hiring the ROCCi Physician Team

The Rural Outreach for Critical Care and Internal Medicine (ROCCi) team, led by Dr. Scot Mountain, successfully established a group of well-qualified, compassionate, experienced, and enthusiastic physicians to launch the program. Dr. Mountain shared: “It has been great working with them so far, and I look forward to the year ahead.”

Launch of ROCCi in October 2024

The launch of ROCCi has allowed RTVS to provide enhanced support to rural communities for both critical care and internal medicine cases. There are already numerous examples of how ROCCi has helped patients and providers manage complex cases, ensuring better outcomes for some of BC’s sickest rural patients.

RUDi Achievements

Busiest Year Yet for RUDi

2024 was the busiest year on record for the Rural Urgent Doctor in-Aid (RUDi) pathway. With a team of 45 members, the pathway managed an unprecedented volume of calls, including a record-breaking 2,282 calls logged in May 2024.

RUDi Remains a Vital Resource

RUDi continues to be a critical resource for nursing stations, where nurses often work without in-person physician support. In 2024, RUDi had a major impact on patient safety in communities with nursing stations, particularly in First Nations communities. In one case, RUDi coached a team of on-the-ground nurses through the placement of an Intraosseous (IO) line, a crucial procedure used when IV access is not possible due to the patient’s condition. The team was able to administer IV fluids and insulin, stabilizing the patient until Coast Guard transport arrived to transfer them to hospital.

Quick Reply and Consultation to Conversation Achievements

RTVS PoCUS Pathway and RTVS Oncology Pathway launched

The Quick Reply Pathways adopted two new pathways, the POCUS Pathway and an Oncology Pathway, bringing the total number of Quick Reply specialties to eight. In addition to these new pathways, the Quick Reply team also welcomed a new clinical lead, Dr. Daisy Dulay, a Cardiologist supporting rural communities within Northern British Columbia. Quick Reply providers continue to offer specialty services on a week-day basis and it is expected that expansion of these pathways will continue to take place to offer additional specialty services in 2025.

Consultation to Conversation 2.0 Launched

Learnings from the first iteration of the Consultation to Conversation (C2C) model allowed the team to restructure and strategically pivot to trial and implement a new version of C2C (C2C 2.0). A clinical lead was brought on in November 2024 to support the updated program alongside a virtual Medical Office Assistant (vMOA) to assist with the scheduling of all future C2C appointments. Updates surrounding program implementation and program impact will be shared in the 2025 RCCbc Annual Report.

Advancing Cultural Safety

Cultural Safety Journey Continues

As part of RTVS’s ongoing commitment to cultural safety and humility, providers participated in several faculty development sessions focused on Indigenous Cultural Safety and Humility in 2024.

A cross-pathway Cultural Safety and Humility session was led by Harley Eagle.

A collaborative discussion with Len Pierre and Harley Eagle was held in June 2024.

An additional cultural safety session was included in the RTVS Virtual Retreat in November 2024.

The RTVS Fire Department team also secured grant funding to begin work on a Cultural Safety and Humility Orientation video, set for release in 2025.

Leadership Achievements

RTVS Recognized for Innovation

RTVS was recognized at the Premier’s Awards in Victoria on November 26, 2024, placing as runners-up in the Innovation category.

Alongside RTVS peer pathways, other recognized pathways included:

First Nations Virtual Doctor of the Day

First Nations Virtual Substance Use and Psychiatry Service (operated by FNHA)

Northern Health’s Virtual Primary Care Call Centre

More details on the recognition can be found here.

Explore the numbers

4 New Pathways

During 2024, 2 new instant access pathways were launched (ROCCi and VERRa) and 2 new Quick Reply pathways were launched (PoCUS and Oncology).

11 New ROCCi Physicians

In 2024, 11 new virtual ROCCi physicians were onboarded

281 Shifts covered

281 hospital shifts covered by RUDi MRP/VERRa in 2024

2,282 RUDi Calls

A record 2,282 calls to RUDi were logged in a single month in 2024

Making a Difference

RTVS recognized for innovation at Premier’s Awards

RTVS VERRa features on CBC's White Coat, Black Art

RUDi expertise helps nursing teams save lives

Rural hospitals get lifeline with VERRa virtual emergency support

RUDi MRP program brings support to sites facing staffing challenges

RTVS Sim program celebrates milestones

Introducing ROCCi: Critical support for rural providers

Plans for the Future

Dr. Brydon Blacklaws, VERRa co-lead, said: “We are excited for VERRa to grow into 2025 and hit its stride for the predictably busy summer season when ER staffing and ER diversion rates are often at their worst.”

Dr. Scot Mountain, ROCCi lead, said: “This year, we are focused on building the sense of team and belonging for the new ROCCi providers, extending our reach and ensuring that more communities and patients are aware of and have access to ROCCi support, and continuing to gather and tell the stories of the fantastic work we do!”