The first in a series of stories focusing on partnerships between Memorial University and the province’s communities. Next up: Ocean Safety
While Canadians regularly boast about free health care, equal access to health care remains an issue for people living in rural communities.
Many of us can’t imagine not having a hospital to rush to during a heart attack, stroke or complicated pregnancy, but 47.2 per cent of Newfoundlanders and Labradorians live in rural municipalities where, on average, it takes residents 1.5 hours to access a medical care facility.
The ramifications are severe: Statistics Canada reports that mortality rates get higher the further one lives from a city with a hospital. Without innovation, rural residents will continue to receive unequal access to health care.
That’s why Memorial University researchers have been collaborating with communities throughout the university’s history to find solutions for local health-care challenges Read on to learn about just a few of these collaborations.
First of its kind robot doctor for Nain
In 2010, Dr. Michael Jong did something straight out of a sci-fi movie.
From a hospital in Happy Valley-Goose Bay, he piloted a remote-controlled robotic “doctor” named Rosie to deliver lifesaving health care to 1,500 people in Nain — the most northerly community in our province.
Dr. Jong worked in collaboration with the Nunatsiavut Government between January 2010 to March 2011 to determine if Rosie could be a long-term solution for residents of Nain.
Rosie was the same shape and height as a human, with a computer screen for a head, which allowed Dr. Jong to see, hear and interact with patients. Rosie could also transmit diagnostic materials, like ultrasound scans, and facilitate life-saving resuscitation on patients who had experienced major trauma, cardiac issues, septic shock or severe hypothermia.
“[Patients] received treatment earlier and without the need to travel.”
Before Rosie, a doctor would have to fly 350 kilometres to Nain to see a patient, at a significant cost to the province’s health-care system. The trip between Happy Valley-Goose Bay and Nain can take up to four hours — critical time a patient doesn’t always have.
Furthermore, Nain is the only community in Labrador where a medevac flight can’t fly in after dark, or during fog and bad weather, on account of its location among treacherous mountains.
At the end of the pilot project, Dr. Jong said patients reported improved access to physicians and felt more in control of their own health care.
“They received treatment earlier and without the need to travel,” he said. “Patients also reported more ease and comfort with medical care because their family members or interpreters could also be present in the session.”
In a 2012 address to members of Parliament in Ottawa, Gail Turner, with the Nunatsiavut Government’s Department of Health and Social Development, credited the success of the pilot project to its collaborative nature, and emphasized the value Inuit communities place in not having to travel and leave their families to receive medical care.
“[Nurses] now feel that they have a physician beside them.”
Prior to Rosie, patients had to spend between $1,000-$2,000 to fly to a hospital, take several days off work and incur hotel costs. This simply was not an option for all of Nain’s residents, who felt grateful that Rosie’s presence resulted in only 40 per cent of medical emergencies needing costly air transport.
Ms. Turner also stated that Rosie helped with the retention of nurses in Nain, which helped make the case for keeping Rosie on staff.
“[She] created a whole different working environment for our nurses,” she said. “They now feel that they have a physician beside them. [Rosie] became an integral part of health delivery in Nain, so much so that the Nunatsiavut Government has purchased Rosie Two, which has even greater capacity for the community of Nain.”
Rosie 1.0 and 2.0 paid for themselves in the money saved on flying from Happy Valley to Nain.
Dr. Yong’s robotic telehealth pilot project was the first rural health care solution of its kind in the Canadian North. Former Federal Minister of Health Leona Aglukkaq said this pilot project, specifically, could make health care more accessible to people living in rural areas all over Canada.
In 2016, the project was recognized with a Government of Canada Public Service Award of Excellence.
Cutting congestion in Carbonear’s ER
The shortage of family doctors and primary care in rural Newfoundland and Labrador means a hospital emergency room (ER) is often the only place for a community to receive care.
That puts extra pressure on staff to manage sudden influxes of patients that can overwhelm an ER.
In 2013, upon hearing evidence that their hospital had high rates of patients leaving without being seen, Carbonear General Hospital wanted to do better for the community.
Memorial University’s Dr. Christopher Patey partnered with registered nurse Paul Norman to see if they could improve patient flow and mitigate patient surges in their emergency room.
“We were able to treat patients sooner and better.”
What started out as co-written sticky notes on a wall grew into efficient emergency room flow processes that they dubbed “SurgeCon”: a merging of the phrases “patient surge” and “DEFCON.”
Between the years of 2013 and 2017, Dr. Patey and Mr. Norman worked with staff to enact SurgeCon protocols with extraordinary results:
- Average wait times in Carbonear’s ER dropped from 104 minutes to 42 minutes
- Total length of stay decreased by 65 minutes
- The number of patients who left without being seen decreased by 62 (from 12.1 to 4.6 per cent)
Even more impressive, these results were achieved despite an overall 25 per cent increase in patient volume during the timeframe they tested SurgeCon.
One example of action taken was the re-designation of an underused waiting area into a rapid assessment fast-track zone. The extra space is now used for patient assessments, blood tests, electrocardiograms and other minor procedures to maximize patient throughput.
“Every minute SurgeCon gives back to our staff improves the quality of care we can give our patients,” said Mr. Norman. “We were able to treat patients sooner and better. By improving their experience in our ER, they’re more likely to seek medical attention as needed, which improves community health.”
Dr. Patey added that improving efficiencies in rural hospitals is especially important in Newfoundand and Labrador, since a large section of the population lives outside of urban settings.
“Sometimes, they’re the only option people may have for care, so improvements in the ER have an impact on the whole community.”
SurgeCon is now a software any hospital can use. To use it, emergency department staff enter data such as current patient numbers and available staff.
As the emergency room moves from one surge level to the next, the program notifies key personnel and assigns them tasks to maintain order and quality of care.
“We continue to field inquiries from around the globe.”
Having proved that SurgeCon worked in Carbonear, Dr. Patey and his team subsequently received nearly $5 million from the Canadian Institutes of Health Research in 2019 to improve the SurgeCon software and test it in other hospitals.
“We have reviewed and provided training to emergency departments in Nova Scotia, Alberta, PEI, B.C. and New Brunswick,” Dr. Patey said. “Globally, we’ve worked with hospitals in South Africa, Switzerland and the U.S. and we continue to field inquiries from around the globe.”
As well, as technology and artificial intelligence improves, so will SurgeCon, he said.
Memorial’s Centre for Rural Health Studies
Memorial’s Centre for Rural Health Studies helps physicians and researchers address community-specific health-care challenges here at home in Atlantic Canada.
One of the centre’s crown jewels is its 6for6 program: a 15-month research training session tailored specifically to family physicians in rural or remote communities who have noticed an issue impacting the health of residents or in their experiences seeking health care.
As isolated, busy practitioners, it isn’t always clear how to investigate an issue or it can feel daunting to do so alone.
The 6for6 program addresses the issue by partnering doctors with with librarians, doctoral researchers and other professionals at Memorial University to develop and answer their research questions.
Dr. Shabnam Asghari is the research director at Memorial’s Centre for Rural Health Studies.
She says the program provides isolated rural physicians support in tackling their research questions while also teaching them the skills to conduct a successful research project.
“6for6 has empowered 50 rural physicians to conduct research in the communities they serve and more than 100 research projects have been generated.”
Examples of succeses include Dr. Christopher Patey’s SurgeCon project mentioned above and Dr. Yordan Karaivanov’s work in devising a culturally appropriate way to treat high rates of diabetes in the Innu community of Sheshatshiu.
Another example is Dr. Daniel Hewitt’s discovery that a majority of residents in his municipality weren’t testing their well water.
He then led a communications campaign for residents to start testing for arsenic in Gander Bay and Cormack Valley. Arsenic is a cancer-causing agent that occurs naturally in Atlantic bedrock. It can’t be remediated by boiling or filtering.
One of the program’s early participants was Dr. Gabe Woolham, who is now vice-president at Labrador-Grenfell Health.
Writing in the journal Canadian Family Physician, Dr. Woolham said, “In rural and remote places, we can use research as a way to engage people in questions that matter to them and their community. Memorial’s 6for6 program makes this achievable.”
“To date, 6for6 has empowered 50 rural physicians to conduct research in the communities they serve and more than 100 research projects have been generated by 6for6 participants and the Centre for Rural Health Studies team,” said Dr. Asghari.
