Remote Presence Technology enhances relationships that support good rural healthcare delivery

An RSON Series


The InTouch Vantage unit, located in Revelstoke, allows ER physician Dr. Kimberly Veale, FPA Dr. Alex Farrugia, and ESS FP Dr. Dries Mostert to virtually consult with Vancouver General Hospital trauma surgeon Dr. Morad Hameed. All of them are participating in a simulated scenario involving a critically injured patient, and are making management decisions as a team.

REMOTE PRESENCE TECHNOLOGY (RPT) PILLAR

The work of the Rural Surgical and Obstetric Networks (RSON) is split out into five pillars: Clinical Coaching, Continuous Quality Improvement, Remote Presence Technology, Evaluation, and Scope and Volume. In previous issues of BC Rural Update, we examined how the Evaluation Pillar intends to measure the impacts of RSON, how Clinical Coaching is improving both individual and team performances, and how the Continuous Quality Improvement (CQI) Pillar is enabling cultural changes that strengthen teams, safety, and the healthcare system as a whole.

Over the next year, BC Rural Update will be featuring the work of each of these pillars, and will engage the providers leading each pillar to discuss the ongoing work taking place within these networks.

Imagine you are part of a rural healthcare team that is operating in your local OR. You are mid-procedure when you encounter a condition that seems unusual, or maybe you’re seeing something that you’ve never encountered before. There is a trusted colleague that you can consult, but they live in a city that is 25, 50, 100 or more kilometers away. What do you do?

If you’re one of the rural communities participating in the Rural Surgical and Obstetrical Network (RSON) project, in the near future, you’ll be able to contact your trusted colleague using Remote Presence Technology (RPT). This equipment will allow your entire team to converse with your colleague and it will allow that consultant to literally see what you see, enabling them to “virtually operate shoulder-to-shoulder” with your team despite distance, inclement weather, or difficult geography.

The Remote Presence Technology Pillar – currently led by Dr. Bret Batchelor and RN Julia Jeffery – is overseeing the assessment, acquisition, and deployment of RPT equipment into the rural communities participating in RSON. It’s important to note that the RPT Pillar is doing more than selecting and installing the technology, however; the group is working actively to support existing relationships between rural providers and their regional and urban colleagues through the use of this equipment, allowing rural teams to have real-time conversations with peers and/or specialists who understand the local context.

While remote surgical support is one of the most obvious functions for RPT technology, the team supporting the RPT pillar are focused on using the equipment to support local rural teams in other ways. This group is collaborating with other RSON pillar leads and UBC Rural CPD to create processes and approaches that leverage RPT equipment for use in clinical coaching, and quality improvement for providers and teams in RSON communities. One example from the Revelstoke site is that of RPT-enabled team trauma simulations being developed and delivered in collaboration with trauma surgeon coaches from Vancouver General Hospital (VGH). Revelstoke Enhanced Surgical Skills family physician Dr. Vikki Haines has led this work. All of these activities allow rural teams to train, learn, and self-reflect in-community while building strong relationships with regional and/or urban colleagues. Coaching and learning enabled by RPT allows individuals and/or rural healthcare teams to interactively train in a broader range of procedures more frequently than would be possible with traditional face-to-face CME/CPD, leading to greater surgical competence and confidence, and increased local capacity. Simulation training enabled through RPT will allow rural teams to practice and hone essential skills and scenarios that are critical but often less frequently utilized in communities with a smaller volume of patients.

Facilitating coaching, learning, and training in-community not only creates supportive, effective teams, but also reduces the risk to healthcare providers who would otherwise be traveling for their education. Virtual-enabled in-community education also reduces the number of days the provider spends away from the community, which reduces the strain on the remaining provider rota. Additionally, when individuals and healthcare teams are able to work to the full breadth of their skills and practice in a competent and confident manner, their stress is reduced and their job satisfaction increases which enhances recruitment and retention of providers in rural communities. Finally – and most importantly – local patients also benefit when they are able to have surgical and obstetrical procedures performed in-community and/or closer-to-home, minimizing and/or avoiding the risks, expenses, and social-isolation associated with medical travel to an urban centre. 

Beyond the benefits already described, it is anticipated that the installation of RPT equipment in each of the RSON communities will allow local rural health teams to communicate and connect more effectively and securely for knowledge transfer, and will likely simplify the process of looking for alignments between current and future programs. RCCbc Project Coordinator for RSON, Tom Skinner, is actively making connections with health authorities, providers, and diverse teams currently using virtual health technology to deliver other services such as stroke management and paediatrics. By aligning with other virtual health programs, the RPT Pillar team is building strong relationships through RSON which will be facilitated and enhanced through the intentional use of this technology for teaching, learning, and clinical intervention.

RSON BACKGROUNDER

The Rural Surgical and Obstetrics Networks (RSON) is an initiative that seeks to stabilize, support, and enhance the delivery of quality healthcare to vulnerable rural BC rural populations, including Indigenous populations. It provides sustainable local/regional surgery programs “closer-to-home” in geographic areas served by Enhanced Surgical Skills Family Physicians (ESS FPs) or a solo General Surgeon through enhancing existing care networks shared with referral centres. Through this work, these rural surgical and obstetric networks support enhanced critical care, emergency, and trauma services while also supporting closer-to-home maternity care, including vaginal birth and Caesarian section.

The local/regional RSON model seeks to improve both patient and provider experiences of care by:

  • understanding holistic risk and cost associated with travel so mitigation strategies can be put in place;
  • supporting networks of high quality, highly effective maternity and surgical teams to provide the right care at the right time by the right providers
  • supporting rural providers to practice full-scope of rural generalist medicine
  • enhancing and supporting relationships between team members within the geographic network
  • providing a robust evaluative framework for quantitative and qualitative metrics applied to both maternity and surgical care
  • providing culturally and rurally appropriate care closer-to-home

RSON is an initiative supported by the Joint Standing Committee on Rural Issues (JSC) that is operationalized through the Rural Coordination Centre of BC working in collaboration with the health authorities, the Ministry of Health, UBC Rural Continuing Professional Development, and the Centre for Rural Health Research