Healthcare teams in Daajing Giids and Masset have created a virtual support network that is helping to ensure patient safety on Haida Gwaii.

The virtual network was inspired by the Real-Time Virtual Support (RTVS) Most Responsible Provider (MRP) model.

In summer 2023, rural communities across the province were struggling to recruit doctors or find locum coverage for physicians, and Masset, BC, was no different.

It looked as if there would not be enough doctors to keep the Northern Haida Gwaii Hospital’s emergency room in Masset open. So health teams based in Masset, approximately 110 kms north of Daajing Giids, and health teams based in Daajing Giids itself, met with health partners to discuss how to bring more stability to the health system.

Dr. Tracy Morton, who is based at Daajing Giids’ Haida Gwaii Hospital and Health Centre – Xaayda Gwaay Ngaaysdll Naay, said: “We’d been supporting our sister site by providing the typical in-person, on-call services, but we also had our own site to think about and our own needs. We decided to, based on the inspiration and success of a proven model of Real-Time Virtual Support, support the site virtually.”

The virtual support model existed prior to the COVID-19 pandemic, but it spread province-wide in March 2020, with the roll out of the Real-Time Virtual Support peer pathways for rural healthcare providers. Since then doctors with Emergency, Pediatric and Maternity/Delivery expertise have been available 24/7 at the click of a button over the phone or over Zoom.

Since 2021, providers on the Emergency Medicine pathway – the Rural Urgent Doctor in-Aid or RUDi pathway – have also supported 12 rural emergency departments across BC.

The RUDi MRP model sees nursing staff at small rural emergency departments get overnight support from a virtual doctor, with an in-community doctor available on call but only needing to come in for complex cases. It is designed to give on-the-ground physicians some rest in order to support retention and recruitment.

For example, RUDi MRP support has been used in Fort Nelson when there were not enough physicians to cover all night shifts. The area has since recruited sufficient physicians and RUDi MRP support is no longer a regular occurrence.

Dr. Morton said that on Haida Gwaii, they needed a RUDi-like service, but it didn’t make sense to bring RUDi itself into the community because they already had physicians that could support the patients on the island. Those physicians had easier access to the resources they needed. It was decided they could use the physicians already working at the Daajing Giids hospital to support Masset.

He explained that speaking with Rural Coordination Centre of BC Executive Director, Dr. Ray Markham, and having RTVS technical lead Dave Harris helping them with IT made it easier to get the system up and running.

Dr. Markham was able to offer advice because, in the community of Valemount, where he lives and works, they have a videoconferencing system in place where doctors based in Valemount can support nurses and other healthcare providers in the hospital in McBride. He was able to speak to Dr. Morton about his experience with cross-coverage.

Dr. Markham said: “Rural people are very adaptable and good at doing the best they can with what they have; this is another excellent example of this. It has been great to witness the dedication and innovation shown by the physicians in and communities of Daajing Giids and Masset navigating various options and successfully implementing this one.”

Dave Harris, who works for the Northern Interior Rural Divisions and also leads the technology portfolio for RTVS, helped to ensure they had the right equipment and the right videoconferencing tools.

Dr. Morton said the virtual coverage has only been required a handful of times, but it has been a success each time.

“The alternative to this service, in the event, there isn’t a physician, is the emergency department is closed, like so many rural sites are in BC,” he explained. “There’d be a sign put on the door saying, even though there’s staff inside, including nurses, the sign would say, ‘we’re closed. Please go down to Daajing Giids emergency room’.

“So we’re on call, anyway for that site. In other words, if that ambulance shows up because their site is closed, we can’t escape having to provide care for them. So why not do so in the best possible way that provides care in their own community? And keep them there and treat them there?  And save the ambulance staff to come down in the middle of the night and [have the ambulance staff] not be present in Masset for those who are really, really sick.”

Dr. Morton said working with RTVS was helpful. “We did some orientation sessions to kind of work out the kinks, and we also built some confidence by testing it with the physician team, as well as a nursing team in Masset to ensure that we had all of the technical side of things sorted out.”

Having seamless access to patient records was something that really ensured it was successful, said Dr. Morton.

For a provincial service like RUDi, because there is no provincial EMR (Electronic Medical Record), this access can sometimes take more steps.

Dr. Morton said another advantage of providing virtual coverage in a neighbouring community was that because many of the doctors have been to the hospital in person, they know the nurses and know their skillsets.

Dave Harris said: “What they have done on Haida Gwaii is really remarkable. They did not need much to get set up to do this, and they did it successfully. This can be done in other communities. We can enable these communities in the spirit of RTVS to help each other.”

Dr. Morton said that he believes the Daajing Giids/Masset model could be successfully used in other communities as well.

“There’s no reason that other communities in BC can’t use a similar model to support neighbouring communities. The patients may end up in their communities anyway, so it’s a way to ensure that health teams have a bit more control over how the system works.”

Dr. Morton said he would be willing to speak to other communities about how it worked on Haida Gwaii. Anyone with any questions can contact [email protected].

The administration team from RTVS peer supports, administered by the Rural Coordination Centre of BC, can be reached at [email protected].