New innovations in virtual coaching recently brought University of British Columbia (UBC) anesthesiologists at St. Paul’s Hospital/Providence Health Care in Vancouver directly into the operating room (OR) of Queen Victoria Hospital (QVH) in Revelstoke. Videoconference and ultrasound technology in the OR enabled the specialists to provide e-coaching to four Revelstoke-based family practice anesthetists (FPAs) on adductor canal blocks for patients receiving anterior cruciate ligament (ACL) surgery. The regional anesthesia technique reduces post-operative pain for patients.
Dr. Kirk McCarroll, a Revelstoke-based FPA and FPA Network Lead with the Rural Coordination Centre of BC and FPA Medical Lead for the UBC RCPD Coaching and Mentoring Program, coordinated the e-coaching on behalf of QVH’s Department of Anesthesia. The FPAs began providing adductor canal blocks over a year ago when QVH expanded its surgical service to include ACL surgeries, so the team had a wide range of comfort with the technique. They therefore used the e-coaching to obtain the latest recommendations for the block and develop a safe, standardized approach. The collaborative innovation exemplifies the Rural Surgical and Obstetrics Network (RSON) initiative, bringing together coaching, increased operative capacity, and remote presence technology to improve access to care for rural patients.
“It can be difficult to go back for additional training in regional anesthesia because space is competitive and you often have to go out of town, away from your practice,” said Dr. McCarroll. “E-coaching, like this, brings unique skills and knowledge that you really only find in large centres to the periphery.”
To coordinate the e-coaching, Dr. McCarroll contacted Dr. Steve Petrar, Director of the UBC Regional Anesthesia Fellowship Program. Dr. Petrar then recruited Dr. Justine Denomme, Regional Anesthesia UBC Fellow from St Paul’s Hospital, to provide the Revelstoke FPAs with an hour-long Sunday evening CME presentation on the adductor canal block technique, followed by discussion. For two ACL surgeries that week, Dr. Petrar and Dr. Denomme beamed into the Revelstoke OR via videoconference. Their screen, connected to the ultrasound, allowed them to observe the FPA conducting block—including a perfect view of the needle, the nerve, and the local anesthetic spreading over it. Where necessary, Dr. Petrar and Dr. Denomme provided feedback to the local FPAs.
“Overall, it was an easy educational opportunity that didn’t slow down our days,” says Dr. McCarroll. “The specialists on the other end really want to provide support, are non-judgmental, and like to share their knowledge with us. One-on-one training from the most up-to-date specialists in anesthesia—you really can’t get better than that.”
The benefits to the patients are also enormous. Expanding surgical services in Revelstoke for ACL surgeries means local patients no longer need to travel to larger centres, like Kamloops, Vernon, or even Banff. In fact, patients from larger centres are now traveling to Revelstoke for the procedure. In addition, providing adductor canal blocks reduces the need for patients to take opioid medicines post-op, which can be addictive.
Dr. McCarroll encourages other rural sites to find creative ways to use their technology to incorporate e-coaching into their work to enhance their knowledge and skills. He and his fellow FPAs plan to hold further e-coaching opportunities with Dr. Petrar’s team in February, then expand it to include other block techniques. In time, this work may also be applicable to Real-Time Virtual Supports, with the expansion of Point of Care Ultrasound (POCUS), and the potential to have virtual providers collaborating in real-time.
To learn more about RSON, coaching support or other details about this e-coaching experience, email RCCbc.