The COVID-19 pandemic continues to impact rural and remote regions in northern BC at a disproportionate rate compared with the rest of the province.

Over the fall and winter, more than 100 patients have had to be transferred out of Northern Health to hospitals with more ICU capacity. The vast majority of those were COVID-positive.

And with vaccination rates lower than in other areas of the province, a higher percentage of the population is at risk of getting critically ill from the fifth wave.

The impact on healthcare workers in a remote community like Chetwynd – population just over 3,000 – is far-reaching.

The result is that the help being offered by Real-Time Virtual Support (RTVS) physicians – available 24/7 over Zoom – has been welcomed with open arms. And physicians are reporting that RTVS is having an impact on outcomes and helping to alleviate the challenges of rural medicine during the pandemic.

A colleague Zoomed into the ER

RTVS Virtual Providers are all physicians with experience of rural medicine and are dedicated to offering shoulder-to-shoulder support to physicians, residents, nurse practitioners, nurses – any rural health care worker – over Zoom. The physicians, who are based all over the province, can help with both urgent and non-urgent cases and questions, including case consultations, second opinions, ongoing patient support, point-of-care ultrasound, and simulations.

When a critically ill patient cannot be managed at a rural site, RTVS physicians can also step in to coordinate their transfer to a larger centre through the Patient Transfer Network (PTN) run by BC Emergency Health Services. The transfer is made to a centre with free ICU capacity. In recent months, due to critically ill COVID-19 patients, patient transfer has become more common.

Dr. Bron Finkelstein, a new-to-practice doctor in Chetwynd, where the hospital has just five beds, said RTVS physicians had been instrumental in making stressful situations manageable.

“They have the advice for you, the guidance through the medicine part where you need that colleague to confer with.  And then when you are in the depths of a difficult situation you don’t have to also now think about arranging the PTN, making those three to four plus phone calls to different ICUs.”

He said in one case in the fall, it took multiple phone calls to find a hospital that could accept the patient. “I can only imagine the amount of time the [RTVS] doctor spent on the phone coordinating. If I hadn’t had this support and had to make these calls myself, it would have taken away either from me being able to provide care for the patient in the moment or it would have resulted in them having to delay the transfer because I’m spending that time getting the patient stabilized.”

With RTVS support, the patient can be stabilized while transfer is being arranged.

“It blends it together beautifully to have someone taking care of the medicine and someone helping to coordinate at the same time so that the patient is getting what they need and being triaged and set up for medi-vac in an efficient way.”

The best thing to happen to rural medicine

Dr. Jodie Graham, chief of staff at the Chetwynd Hospital, said having RTVS was the best thing to happen to rural medicine.

She has trained and worked in rural medicine for over a decade, including in rural Alberta, Northwest Territories and Yukon.

She said she would not want to work in an urban centre but was also very aware of the challenges of rural and remote medicine.

“You don’t get less scared the more you do it,” she explained.

“But now [with RTVS] I feel like, going into it, I have this extra support. You’re going to get really good support. It makes it more doable and less scary.”

The help with patient transfer has definitely removed stress, she said.

“It just takes one thing off your shoulders and makes you feel so much better that someone is doing it. Someone is advocating for you too. I know a lot of people could phone PTN but to have that RTVS physician who understands the medical side as well as that rural piece. They know you can’t keep them for 24 hours; you have one doc and two nurses and a full hospital and if you keep that patient the hospital is going to go on diversion and then you have nothing for this whole area. The group that’s there really understand the need for efficient and timely transfer which is very helpful.”

Dr. Matt Petrie, an RTVS physician who has helped to coordinate patient transfer for the Chetwynd team, said it was sometimes difficult for doctors at urban centres to understand the situation on the ground in a rural centre.

As a member of the RUDi (Emergency) team on RTVS he understands that part of his job is to advocate for rural providers who may not be able to advocate for themselves and their community during a stressful situation.  “Sometimes you have to have an educational conversation about managing the impact of a critically ill patient with one physician and two nurses in addition to other patients – that situation would close the Chetwynd hospital and would exceed the capabilities of the nearest city, Fort St. John.”

Call early and call often

Dr. Finkelstein urged other healthcare providers to call RTVS early – before they get too busy to call – and to call often. “Use it every opportunity you get. Whenever you have a significant case, a challenging case, a case where you just wish you had a second opinion, you actually can have a second opinion. I’ve never encountered someone who was unwilling or unhappy to talk to you. …. The more you use it, the more you want to keep using it. If you’re unsure, use it the first time and, you’ll be sure.”

Dr. John Pawlovich, the Rural Coordination Centre of BC’s virtual health lead, who was instrumental in establishing RTVS, said he urged other providers in the province to reach out for support.

“Our team is here for you. It doesn’t matter how big or how small the problem is, if you need someone to talk to, we are just a Zoom call or a phone call away,” he said.

For more information on how to get started with RTVS, visit the RTVS Getting Started page.