For BC Children’s Hospital ambulatory clinics, the concept of virtual health – and the barriers to its implementation – had been discussed occasionally and, for the most part, inconclusively for some time before this year. While some areas in the hospital’s medical clinics had begun to implement some form of virtual health visits, it wasn’t widely used before March of 2020.
“When COVID hit,” says Dr. Mumtaz Virji, medical director of Ambulatory Care at BC Children’s Hospital, “it was like all those hurdles just disappeared and everyone was working to see the patients and provide the care needed.”
Now, several divisions have undergone major changes to their care models. The endocrine division, for example, has gone nearly 100 per cent virtual. This division works primarily with children who have recently been diagnosed with diabetes, as well as their families.
“The families usually come to the hospital for a four-day in-person intensive training, now that the family needs to learn about this new normal,” explains Susan Schroeder, senior director of Medical and Surgical Ambulatory Patient Care Services at BC Children’s Hospital. “We would go through a lot of feeding and nutrition and the injection. We’re now doing all of this online, which is quite a change from that in-person care.”
The division has also successfully transitioned much of their follow-up appointments to virtual. “In fact,” says Schroeder, “we’re actually able to check in a little more often than we would have before because we don’t have to arrange for the family to come in for an on-site appointment.”
As for other clinics, the gastroenterology division are conducting about 60 per cent of their appointments virtually, which has shrunk their waitlist, as well as increased the efficiency of their throughput to clinics. The most specialized cases, through the hospital’s Complex Care unit, conduct up to 90 per cent of their appointments virtually so as to keep patients who would be especially vulnerable to severe cases of COVID-19 safe in their homes.
Commuting and related logistics are so often a challenge at BC Children’s Hospital, especially for more specialized patients outside the Lower Mainland, who make up about 20-40 per cent of those treated at the hospital. Tessa Diaczun, a pediatric nurse practitioner within both the Complex Care Program and the Child and Youth Primary Care Clinic, notes that virtual health visits with patients and their families not only allows patients to save the time, money and energy spent on commuting, but it also give clinicians an entirely new perspective of their patients’ family life.
“Virtual health gave me the opportunity to observe the way the child was positioned and supported at home, which is so vastly different than what I see when they’re up in their wheelchair after a two-hour drive to the hospital and they’re tired and grumpy. You just get this very different sense of the child,” Diaczun said. “What we do see in clinics is just very differently orchestrated because everything is attached to the wheelchair and you’ve got all your portable stuff that’s different than the set-up at home. I was really able to appreciate this family’s experience of being home with all the distractions and all the beautiful things too, like the view out the window that the child had and the things the siblings were showing me -- whom I’d never met before because they just don’t come to the appointments.”
This clearer image of a child within their family and in their own home life, is valuable. “I felt I had a different connection with them,” Diaczun says, “and they might have let me in on a few things that were going on in their life that they may not have let me in on had they been in the hospital. Letting clinicians observe families in their home is a whole other level that I think can make a difference to their care.”
Of course, though there are many different benefits to providing care virtually there can be serious drawbacks as well. There are occasionally some technical difficulties around some of the technology. “We’ve had to get good at guiding the patients through what to do,” says Dr. Virji, “You have to be adaptable. Now we’re having fewer issues but in the beginning, we ran into them a lot.” For some, these issues are focused around technology literacy and equal access to tools such as computers and smartphones too, which are often a necessity when using virtual health.
“Some families where access to technology, access to adequate bandwidth, access to a phone or a computer, and virtual health literacy is low, for those families this practice is problematic. I don’t have a lot of teenagers in my primary care practice but those I do see, I’ve noticed this is challenging for them. Where previously I was a physical location and a teenager might be able to connect with me in a safe way, I’ve now lost touch with them... I just worry about being able to provide appropriate, adequate care in an equitable way because the infrastructure isn’t there for some families.”
While there are certainly questions about the future of access and achieving a balance of in-person and virtual health care, the past six months have been full of breakthroughs with regard to providing care to those who have been unable to physically visit the hospital. Virji is most proud of the team’s adaptability and flexibility.
“To be able to work virtually and make sure the patients are provided the care that they deserve is something to be proud of. We have been talking about virtual health and how we can integrate it, but in the end we said ‘Okay, we need to implement it. Let’s do it.’ That’s a very proud moment.”