When rural physicians face high-stakes situations with limited backup, having expert support on the line can make all the difference.

That’s exactly what the RTVS Rural Outreach in Critical Care and Internal Medicine (ROCCi) pathway provides — virtual access to specialists on demand. The service is getting high praise from rural providers across British Columbia.

The Real-Time Virtual Support program launched the ROCCi pathway in October 2024. The team is made up of Internists and Intensivists who can take calls every day of the week between 8 a.m. and 9 p.m. All team members are either rural doctors themselves or have experience supporting rural sites.

Rural providers are saying the newest pathway is making a difference for patient care and giving them peace of mind.

Recent cases supported by ROCCi include the successful intubation and transfer to Victoria of a patient in a remote northern Vancouver Island community whose head injury led to a series of seizures, as well as a young patient on the Sunshine Coast with diabetic ketoacidosis (DKA).

In this story, community and doctor names have been left out to protect patient identities.

Sunshine Coast

ROCCi was a lifeline for a Sunshine Coast doctor when she was on call at her local hospital.

The family doctor with obstetrical training had previously taken herself off the call rota at the hospital because of a lack of local Internal Medicine backup. It meant managing complex patients on her own and she didn’t feel equipped to do it.

“Our group managed to get more locum coverage available on weekends, so I agreed to go back to the coverage,” she says.

“But then I found myself, one of my first weekends back, with no local Internal Medicine coverage again. We had a very unwell patient, a young woman with diabetic ketoacidosis.

“The initial algorithm present in our hospital gets you to a certain point. But then she started to not follow that algorithm, and that’s when it became very scary for me.”

“Luckily, thank goodness, ROCCi is in existence. So I called ROCCi and ROCCi was the lifesaver,” she says.

With ROCCi physician Rémy Wong’s help, she was able to talk through all the next steps.

The ROCCi physician also immediately provided her with a written note that came in via fax with care instructions. Rémy was also able to reassure the Sunshine Coast physician that she could call back anytime.

The family physician says: “It’s like having a caregiver in your back pocket that can make you feel like you’re providing good care locally, and preventing you from being scared of the case.

“I just haven’t managed a diabetic ketoacidosis in over six years. We don’t see it that often, and so it’s just out of my wheelhouse.”

While internal medicine support is available at Lionsgate, the community’s referring site, the Sunshine Coast physician said she did not like to rely on that service. “I prefer to call ROCCi, because I know that this doctor will be like all doctors on the RTVS services,” she says.

In addition to ROCCi, RTVS includes virtual support for Emergency Medicine (RUDi), Pediatrics (CHARLiE) and Maternity/Obstetrics (MaBAL).

“I know they’re going to be friendly. I know they’re going to be compassionate, and I know they’re going to have time for me, and they’re not managing their own local service and ICU and such. So I know I get that undivided attention, and I know I’m not scared to call, because I know they’re going to help.

“Honestly, I would have been scared to call VGH or Lionsgate. It’s just historical trauma from training.”

Another spin-off benefit of ROCCi is that the Sunshine Coast doctor is now more willing to be on the call rota, taking the pressure off the other physician team members who might be taking the bulk of the call.

“The host of services where you’re guaranteed to have kindness is actually a key component to continuing to do the work,” she says.

Vancouver Island

Dr. Sarah Fraser was the ROCCi doctor on call for the patient on Vancouver Island with the serious head injury.

The physician on the ground in the remote community had called the Rural Urgent Doctor In-aid (RUDi) physician, who assisted with the initial assessment of the patient. The RUDi doctor, Dr. Sean Wormsbecker, then called ROCCi to assist after it was discovered there was an intracranial hemorrhage.

Sarah says: “We were able to walk through and plan a neuro-protective intubation. The family physician did an outstanding job and I was able to check in frequently to support their management of this critically ill patient while waiting for the transport team.”

While Sarah stayed online with the rural provider, Sean spoke to the Patient Transfer Network to arrange transport.

Sarah revealed: “The patient was intubated really well, supported, and was transported to Victoria where he accessed full support by neurocritical care without delay and avoided neurosurgery.”

He was transferred out of the ICU days later on the road to recovery.

Peace of mind

Dr. Dani Pichie, a family physician in Hazelton and one of RTVS’s rural advisors, said ROCCi made a huge difference to how she felt about dealing with critical cases or cases with multiple comorbidities.

Dani says: “It’s one of the most reassuring things for people. We have all been working in places where there’s one Intensivist/Internist for the whole region—their own hospital and 16 hospitals. That system is not sustainable.”

Dani hopes that ROCCi will become a 24-hour line, as she believes this will be even more reassuring for people who work in communities like Hazelton.

As rural care continues to evolve, ROCCi offers not just advice, but reassurance when it’s needed most.

For more information, visit the ROCCi page on the RCCbc website.