PCN Impact Stories - COVID-19

RN in Practice

With the launch of PCNs in the Fraser Northwest Region last spring, one of the initiatives that have been developed is currently in the implementation process is the Registered Nurse in Practice (RN in Practice). This initiative has played an integral role in our local response to COVID-19. The Registered Nurses (RNs) that were placed into practices prior to the pandemic have been supporting the Patient Medical Homes (PMH) in such a positive way during this time. A couple of the biggest ways the RNs have impacted the workflow in practices are by triaging and screening COVID-19 calls and doing proactive phone calls to those patient populations that have been identified with additional risk to COVID-19.

The work that has been in place surrounding this initiative over the last year has also played a crucial role in our Division’s ability to respond to the need for a COVID-19 testing centre within our community. We launched the COVID-19 & Influenza-Like Assessment Clinic on March 16th and the RNs have been critical in daily operations. There are multiple RNs practicing at the clinic each day, they are working side by side with the physicians assessing and swabbing patients. Without the RNs at the clinic, the Division would not have been able to respond as quickly or have capacity for a higher patient volume.

Long Term Care Initiative

Prompt action in regards to electronic communication between Care Homes and practitioners occurred in the FNW due to the relationships and network of the FNW LTCI. Virtual health was made readily available to all sites as iPads were distributed and a website was created to become a long term care hub.  All practitioners were able to obtain virtual health platforms and could connect with their medical teams, as the health authority’s recommendation was to limit their onsite visits. 

The coordination of practitioner scheduling and shift rostering for the COVID-19 clinics, both virtual and onsite, was easily set up due to the pre-existing scheduler that was used for our LTC on-call network. Having this easily accessible sign up method ready, those members who wished to support the COVID-19 clinic did so quickly.

MHSU Supports for Patients

With the implementation of PCNs in our communities, rapid access to mental health supports for patients was one area that our members told us consistently was a priority. We have worked with our partners to ensure there is a network of mental health supports available to patients. 

As a result of that work over the last year, our community has 5 Clinical Counsellors and 4 Mental Health Clinicians. These providers are now seeing patients virtually which is ensuring that - especially during this challenging and stressful time - patients are still able to receive the mental health support needed.

Physician Community Engagement

As part of the FNW PCN work, physician engagement has expanded since the program’ implementation.  Building on that, with the current COVID-19 outbreak, physicians’ peer support has rapidly expanded resulting in a strengthened and unified network of Family Physicians across the FNW.  Since launching the COVID-19 & Influenza-Like Assessment Clinics (both virtual and in-person) there was an immediate response of community support from physicians not only within the FNW, but across the province offering to help provide immediate access to patients both in-person and virtually.  

Additionally, two virtual community events have been held (March 17th and 31st) where community Family Physicians were joined by a regional Medical Health Officer, representatives from GPSC, the president of Doctors of BC, Hospitalists as well as local Family Physicians sharing how they’ve adjusted to practicing during these unprecedented times.  These two events were attended by over 200 Family Physicians with many of them engaging in both sessions.  When Family Physicians were asked what positive impact they’ve experienced throughout this current landscape, the responses were amazing (see word bubble).  Additionally, engagement on FNW Slack channels increased by 420% in the last month by Family Physicians.  This platform enables physicians to communicate with each other, share new and/or updated information, celebrate each other’s work as well as ask questions to peers in a generative, organic and real-time format.  In the last month, there have been over 6600 posts with an average of 238 posts/day by members. 

Panel Management

Part of the PCN work that was implemented in the FNW focused around patient panel management. Those Patient Medical Homes (PMH's) who had completed panel clean up had a good grasp of patients who may require serious illness conversations. Resources from the local palliative care teams and health authority were shared and members were about to reach their patients to have these conversations and could update MOST designations. 

This was especially made urgent within our Long Term Care Homes as our practitioners pro-actively reached out to families and residents regarding impacts of COVID-19. 

Primary Care Virtual

Prior to the Assessment sites creation, because many patients weren’t disclosing their symptoms until in the exam rooms with the physician, there were several physicians that fell ill, or were potentially exposed to Covid19. Leaving them at home, quarantined and unable to provide medical care to their patients. This jeopardized their patients' good health from COVID spread, as well as the financial stability of their practice from being closed. The Division’s fast response to get telehealth set-up in each of its member clinics has allowed the physicians to still provide care for their patient panels. With each of the clinics being able to triage their own patient panel virtually, this has allowed the practices to extend their PPE supplies, which are costly for small practices, and on back order from their suppliers. Click here to view all the clinics in our community now offering virtual care for their patients. 

Telehealth for the Vulnerable & Home Insecure

With residents at the Fraser Northwest Shelters facing greater difficulties in accessing healthcare, and being more at-risk because of underlying health issues and other high-risk characteristics that predispose them to visit more often than the general population, an innovative response was the solution.

The innovative solution:

Designate a clinic area in each of the shelters as a virtual health space during the hours of operation of the FNW DoFP’s Virtual Clinic, and have a staff member that could help residents to navigate the care that they need via use of the self-assessment tool at www.covid19tool.com. They could also help the residents to book and logon to the appointments in the clinic room. 

With the generosity from a member’s spouses company, 5 laptops were donated to assist those shelters that needed a computer for their resident’s access. The Divisions IT coordinator has been able to go into those shelters and set up those laptops as virtual clinics, and telehealth in the other shelters who have fitting technology already in place. 

Maternity & Newborn/Well Baby Clinic

In the current Covid-19 crisis, patient medical homes are limiting in-person physical assessments due to a shortage of PPE and concerns around potential exposure, which has many clinics not seeing maternity patients or doing deliveries. FNW has 2 maternity clinics that take on the patient for wellness checks and until delivery, at which point they connect them to their family physicians.

However, 30-40% of babies born at RCH are discharged into the community and are unattached. Most of the babies’ moms are truly unattached. Some have doctors who won’t see the baby within the first week of life or have offices too distant to suit the moms, as 60-70% of attached patients are attached to a family physician/patient medical home outside of the FNW.

The lack of in-person exams has limited well-baby visits, as well as delayed some infant’s vaccination schedules. 

An FNW member offered their clinic space and preceptors to operate a resident-run well-baby clinic. Partnering with the hospital maternity groups, a follow-up with a virtual physician 24 hours after discharge and regular intervals thereafter could be provided.  Physical assessments and immunizations could be completed in a quick, timely, in-person visit at a newborn/well-baby clinic that has the appropriate PPE.

Hospital Follow Up

In order to provide continuous care and follow up following discharge from hospital and prevent readmission, all patients (COVID-19 affected or not) are now being contacted by a family physician within 48 hours of discharge from ERH and RCH. To reduce the risk of exposure to COVID-19, these assessments are being done virtually by either the patient's own family physician or one of the virtual clinic physicians at the COVID-19 and Influenza-like Assessment Site. Community FPs will receive a phone call notifying them of their patient’s recent hospital discharge, and asking if they are willing and able to provide virtual follow-up care. If they are unable to provide this, or the patient is unattached, the patient will be contacted by a virtual clinic physician, who will assess the patient and determine which supports (if any) the patient needs in the community. This may include referrals to Home Health, Mental Health, OAT clinic, or the New Westminster Specialized Seniors Clinic. 

Enhanced Home Health Services

In an effort to support patients who are at higher risk of decompensation or readmission following discharge from hospital, Home Health primary care nursing services have expanded to support those who may require short-term episodic care, and who might not otherwise be followed by a Community Health Nurse.

In addition to regular Home Health referrals, Home Health will respond to referrals from the virtual care physicians at the FNW COVID-19 and Influenza-like Assessment Clinic. All referrals will be prioritized and as required, will be followed either virtual or in-person by a CHN same day or within 24 hours.