In Saguenay and Quebec, hospitals have adopted a new emergency pre-triage mode. The first contact is now made virtually, with a nurse who is on the screen.
The newspaper The Daily recounted this week the surprise of a patient who suffered a head trauma who, on arriving at the emergency room of the Chicoutimi hospital, first found herself faced with a virtual “pre-triage” by Teams. An initiative to reduce waiting, explains the CIUSSS du Saguenay–Lac-Saint-Jean in the article.
At present, two emergency rooms at the university hospital center (CHU) in Quebec City are doing the same and those of the three other hospitals in this network will follow shortly.
Mylène Ferrand, who is the emergency critical care coordinator there, was at the forefront of the implementation of this way of doing things.
Where is the virtual nurse located? A little apart, in an office. If someone collapses in front of the screen, it will not be her who will rush to help the patient. A code will be triggered immediately so that the staff next door can take charge.
Because the nurse who is placed in the pre-triage, at the CHU, is pregnant or immunosuppressed.
One of the benefits of this initiative, says Mr.me Ferrand, it is precisely the contribution of this nurse “who cannot do the groundwork”, but who can nevertheless make her contribution.
“That makes us one more nurse in the emergency room,” continues Mme Ferrand.
This pre-triage nurse asks summary questions, asks the patient what brings him to the hospital and assesses how quickly his condition requires him to be seen at triage, where a nurse, among other things, takes vital signs and assigns a priority code (from 1 to 5).
Since a virtual nurse is doing the pre-triage, Mme Ferrand ensures that the wait to be seen at the next stage, at the triage, never exceeds an hour, “while in rush hour, it could go up to three or four hours”.
Aware that not everyone is comfortable with first seeing a nurse on a screen, patients have the option of seeing a professional in person when they arrive, says Ms.me Ferrand.
Since it still takes several hours to see a doctor, a nurse must, at repeated intervals, reassess patients. This task is now also assigned to the virtual nurse, who also keeps an eye on the waiting room at all times.
Quebec welcomes this project which has also been implemented in vaccination centers, says Antoine de la Durantaye, press secretary for Christian Dubé, Minister of Health.
This is a concrete example of what can be achieved with new technologies to ensure greater accessibility based on patient needs, as is done in particular with telemedicine.
Antoine de la Durantaye, press attaché to the Minister of Health, Christian Dubé
In Montreal, no hospital contacted said they had a virtual pre-triage project in the pipeline.
The FIQ is in favor
Julie Bouchard, president of the Fédération interprofessionnelle de la santé du Québec (FIQ), says her union will have “an eye open to current experiences [pour] see if it would not be worth exporting the practice to other emergencies”.
The DD Judy Morris, president of the Association of Emergency Physicians of Quebec, finds the idea “super interesting”, in particular because it allows a member of staff to contribute even if their state of health does not allow him punctually to be on the ground.
She stresses, however, that the virtual nurse must remain an “additional help” and that this must never result in the withdrawal of a person from the field, because all hands are necessary, among other things when someone a bit aggressive shows up at the hospital.
The DD Morris adds that the pre-triage must be done by an experienced nurse who knows the environment well, this task requiring great skills.
The Dr Alain Vadeboncœur, emergency physician at the Montreal Heart Institute who participated in the late 1990s in the development of an emergency triage scale, does not see any problem with the new practice in place in certain establishments either.
In the emergency room, people often expect to “feel cared for”, so it is important to assess whether patients are comfortable with the concept. But a priori, that the first basic questions are asked by a nurse who is at a screen rather than behind glass as is currently the case, this is the same logic, according to Dr Vadeboncoeur.