The province of BC is in the grips of dual public health emergencies: COVID-19 and the escalating crisis of overdoses from a poisoned and toxic drug supply. As a result of the current opioid crisis, healthcare workers in multiple disciplines are finding themselves facing life and death situations they never imagined they would encounter. Furthermore, not all of them have been able to access evidence-based training and information to best support their patients or clients in crisis.
Expert guidance is a phone call away – precisely when it’s needed.
In June 2020, in response to BC’s public health threats of toxic drug poisonings and COVID-19, the BCCSU (British Columbia Centre on Substance Use) launched the 24/7 Addiction Medicine Clinician Support Line. The line is staffed by leading experts who provide clinical advice around the clock to physicians, nurses, nurse practitioners, pharmacists, midwives, and healthcare workers in Indigenous communities.
Dr. Paxton Bach, Co-Medical Director for the BCCSU and the physician lead for the 24/7 line, says there is a great need for a reliable clinician support service to fill in the gaps when other resources may not be available.
“The line was created to support those healthcare workers on the ground who are faced with a situation they may not know how to deal with. We field questions about unusual substances they might encounter, whether someone needs to be admitted to hospital, or how to safely manage a patient who has overdosed. The 24/7 line helps to make sure education and advice is available to practitioners who need it – when they need it.”
Customizable TELUS Collaborative Health Record is made to measure.
“We have a unique documentation need for the 24/7 line”, says Amanda Giesler, Clinical and Internal Engagement Lead at the BCCSU, who led the development of the 24/7 Addiction Medicine Clinician Support Line.
“We’re not providing direct patient care – we provide consultative advice to other clinicians, which is quite different from the typical care delivery services that EMRs generally support.” When searching for an EMR platform, Amanda said TELUS Collaborative Health Record (previously Input Health) was flagged immediately. “It was already being utilized by a provincial partner that does similar work to the BCCSU – so it made sense for us to use it too.”
Adding to the attraction was the malleable nature of the Collaborative Health Record (CHR). “The fact that it could be customized for our needs was a big selling point,” says Amanda. “A technician worked with us to make sure it functioned exactly the way we needed it to.”
“We have a call centre that initiates the EMR record. When a clinician calls the centre, the clinician answers a series of triage questions, which are entered into the CHR. The clinician is then connected to the expert on call. During the consultation, the expert is able to add details to the EMR record created by the call centre. This process helps eliminate extra administrative burden on our experts and ensures that their time is spent wisely.”
“The CHR helps us to catalogue and categorize the encounter just like we would any other medical visit so that we can go back to it for medical or legal reasons,” adds Dr. Bach. “It’s all part of meeting the standard of care.”
The 24/7 line is staffed by approximately 30 experts from across BC – each taking a 24-hour shift per month. Because the CHR is cloud-based, experts can access it from home or the office on demand.
Data helps build the case for a sustainable 24/7 line.
Provincial funding for the 24/7 line expires in August 2022. “We are currently exploring opportunities to extend it to a long-term sustainable service,” says Amanda. “The robust analytics platform of the Collaborative Health Record will help demonstrate how this service is supporting clinicians in providing complex care to their patients.”
The 24/7 line has responded to well over 1,000 calls from clinicians in various healthcare settings (community, acute and emergency) across the province. The majority of the callers were physicians, followed by nurse practitioners, nurses and pharmacists. It is an invaluable resource to clinicians working evenings, nights and weekends as 35 per cent of the calls were received outside of normal business hours.
“The analytics show us the type of calls – whether it’s COVID or related to substance use, the common scenarios and questions requiring support, if they contributed to a reduced number of ER visits or specialist referrals, or the initiation of treatment that otherwise might have been delayed,” says Amanda.
Dr. Bach adds, “We hope to be able to demonstrate the benefits of the 24/7 line and hold it up as a model for how we can innovate elsewhere – not only in the context of a provincial health crisis, but on an on-going basis to provide an essential service that is accessible, cost-effective and has a direct impact on patient care.”
For the on-call experts, the 24/7 line is about more than the numbers. “I get goosebumps when I hear members of our physician team tell me they feel like they are making a difference on these calls,” says Amanda. “It’s wonderful to hear that our service is so valuable and important to everyone involved.”