How WCH is leveraging virtual care to address COVID-19
The COVID-19 pandemic has forced the entire health system to re-think how we can deliver care. Leveraging our expertise and infrastructure as Canada’s first virtual hospital, Women’s College Hospital (WCH) has quickly adapted to respond to the needs of our community during this public health emergency. Our Women’s Virtual team is working across the organization and with our partners across the health system to accelerate our virtual care capabilities to ensure that we can provide care safely for patients who need it.
Over the past few weeks, we have been able to convert many in-person visits to virtual visits. While all our clinics have shifted a large volume of care to phone visits, our Department of Mental Health, Cardiac Rehab Program and Sexual Assault/Domestic Violence Care Centre (SA/DVCC) are all utilizing video visits to enhance access and continuity of care for patients. “Prior to COVID-19, WCH averaged roughly 20 video visits per month, as it rolled-out this capability to providers. Within the month of March alone, WCH providers completed 240 video visits, a roughly ten-fold increase,” said Laura Pus, administrative director of Women’s Virtual. “The Women’s Virtual team, IM/IT and others have been working tirelessly with providers across the hospital to covert as many visits as possible to virtual,” Pus added. Over the next few weeks, additional WCH care teams will be enabled with video visits.
This shift towards virtual care has been particularly apparent in WCH’s Family Practice Health Centre (FPHC). “In the face of this unprecedented pandemic, we're changing how we deliver our services, to keep our patients and staff as safe as possible - while continuing to provide care to those in need,” explained Dr. Ruth Heisey, chief of family medicine at WCH. Within a two-week period, 80 per cent of patient visits at family practice were conducted virtually. “These changes will be in place for the foreseeable future. But they'll be influencing our models of care long after this pandemic has passed. It's clear we're all going to need to embrace our virtual capabilities, to help optimize care via video and phone consults and other virtual tools - bringing the care and comfort of a family physician's visit into the comfort and safety of a patient's home,” Dr. Heisey said.
In response to COVID-19, we have fast-tracked our Women’s Virtual LTC+ program to support our long-term care (LTC) colleagues who care for many frail older adults in Ontario. In the context of the COVID-19 pandemic, transfers to acute care pose greater risks to seniors living in LTC. LTC+ aims to deliver the best care possible to residents in the LTC setting to avoid unnecessary transfers to hospitals.
LTC+ is a virtual care program that connects LTC nursing staff and physicians with 24/7 virtual consultations with medical specialists for advice and consultation. It also provides the LTC team with access to other services, such as the availability of STAT labs and community paramedicine, that will enable the LTC team to provide high-quality care to residents in the LTC home setting and avoid unnecessary transfers to hospitals.
The program is enabled by cross-sector partnerships that brings together hospital and community based resources to support LTC residents. “As we all now know, seniors and those with compromised immune systems need to be particularly careful during this pandemic. Reducing unnecessary ED transfers is an important step towards protecting their health and reducing the spread of COVID-19,” said Laura Pus. LTC+ is currently live with five long-term care facilities, over the next two weeks, WCH will expand this program to include all 37 LTC homes in the Toronto area.
COVID-19 Virtual Assessment Tool
Recognizing that responsive access to testing is critical during this pandemic, WCH has launched our own virtual assessment tool to support the efforts of our COVID-19 assessment centre. Found on our hospital website, the tool first screens people through a series of questions to determine the most appropriate pathway for patients. Individuals who meet the criteria for an assessment receive a virtual assessment with a WCH physician to determine if they require a nasopharyngeal swab. Patients requiring a swab are fast-tracked allowing them to come into the assessment centre and get swabbed right away. “If people do have COVID-19 symptoms, we want to make the assessment process as quick as possible for them to alleviate any fear or anxiety they may have and get them care as soon as possible,” said Darryl Yates, vice president, patient care and ambulatory innovation. As of April 1, 4798 people have used our virtual assessment tool, 484 have received follow up calls and over 242 have been fast tracked through our assessment centre for care.
As demand on acute care resources including emergency departments and inpatient beds increase, most symptomatic yet stable patients will be required to monitor their COVID-19 symptoms at home. In response, WCH will shortly launch COVIDCare@Home, a virtual care initiative designed to support primary care providers as they care for patients at home with COVID-19. Working with our hospital partners, the Department of Family and Community Medicine at the University of Toronto, the SCOPE program and multiple WCH teams, COVIDCare@Home is building practical digital pathways and tools for primary care providers as they virtually support their patients with COVID-19. “Being able to monitor patients with COVID-19 virtually, not only allows us to ensure that everyone who needs care is receiving it, but should their health deteriorate, we are better positioned to act quickly and escalate their care,” said Dr. Payal Agarwal, WCH family physician and co-process lead of COVIDCare@Home.
A virtual care hub, housed at WCH, COVIDCare@Home will share specific resources with providers enabling them to better address their patient’s medical, mental health and social needs. It will also provide real-time support to primary care providers and patients, as well as enable virtual care through phone or video visits. COVIDCare@Home patients will also have access to the WCH AACU as needed, limiting the burden on acute care hospitals.
Through these multiple virtual care channels and tools, WCH is ensuring on-going care for existing patients, as well as directly responding to the COVID-19 pandemic. “In a relatively short period of time, our teams have quickly utilized digital health tools and new virtual models of care to address this emergency,” said Dr. Danielle Martin, executive vice president and chief medical executive at WCH. “Everyone at WCH is going above and beyond to think outside the box to help care for our community and reduce health system pressure during this important time. It has been an incredible privilege to be a part of,” Dr. Martin added.