The expanded virtual care during COVID-19 at BC Children's has meant Natasha Phillips and her son, Kyle, could celebrate his ninth birthday at home, rather than at BC Children's, like so many years past.
“Virtual health has been such a gift to our Northern family. Our awesome kid has eight - and counting - medical specialists, whose services at BC Children’s are more than 2,500 kilometres away from our home,” says Natasha.
(Right: Kyle's Bhangra dancing birthday party)
Many programs at BC Children’s quickly implemented or expanded virtual care during the first wave of the pandemic as non-urgent hospital appointments and surgeries were postponed. Before the expanded virtual care, Natasha's family spent about $3,000 to travel to BC Children's about four times each year.
“Not having to get on a plane multiple times a year for check-ups, which often require a week’s stay every time, has given us a sense of normalcy – and time for real vacations that we haven’t had in more than eight years. It also means we have actually been able to save money this year and pay down our debt. Rare disease and a pandemic have thrown our world into disarray, but we are so grateful for the changes that can happen when crisis hits.”
Most BC Children’s patients and families, who participated in a survey following a virtual health appointment, reported an overall positive experience with virtual care and 92 per cent would recommend virtual care to others in the future.
Nearly 75 per cent of patients rate virtual care as the same or better than in-person care. Patients surveyed say they found virtual care more convenient and punctual. They said it saved travel time, costs, and sibling childcare.
“One of the silver linings of the COVID-19 pandemic is that it has fast-tracked adoption of virtual care throughout our health system,” says Dr. Jana Davidson, chief medical officer for BC Children's. “This is particularly true at BC Children’s. The speed with which our medical staff transitioned to providing virtual care was remarkable.
Davidson says, BC Children’s is currently determining a triage process to identify which patient visits can be managed virtually and which require an in-person appointment. Virtual care will be used in combination with in-person care to best meet the needs of our patients and their families, while maintaining the high-quality care that they expect from our services.
There were several areas that quickly transitioned to virtual care at BC Children’s Hospital. The
diabetes clinic shifted from about five per cent to 100 per cent virtual visits for routine care
at the onset of the pandemic, and continues to offer virtual care to nearly
all children with diabetes today. At least 72 per cent of patients surveyed in a peer-reviewed study want continued virtual care, even after the pandemic.
“This unusual time, with all its significant challenges, has provided us with a unique opportunity to align our health care with what families clearly want — care that’s closer to home,” says Dr. Brenden Hursh, BC Children’s Pediatric Endocrinologist who led a study on how well remote/virtual visits were working for families of children with diabetes. “A majority of families would like us to provide care in a dramatically different way to how it was provided pre-COVID. Going forward, we need to consider how we can adapt to this new paradigm of care over the long term.”
The Gastroenterology Division has increased virtual visits by nearly 40 per cent. This has resulted in increased efficiency so that the overall patients seen in this clinic is up 26 per cent from the previous year.
The Eating Disorders Program has been providing nearly double the number of outpatient and virtual appointments since the pandemic broke out (1,420 from April to September last year, compared to 717 the same time the year before). With this quick transition, they have been able to ensure children and youth with serious eating disorders can continue to receive timely care during the pandemic.
“Some patients mentioned that it was easier to share and contribute to the group discussion as it felt safer behind a screen,” says Kim Williams, clinical operations manager with Looking Glass Residence in the BC Children’s Eating Disorders Program. “We also found it helpful to use some of the Zoom for Healthcare features, such as ‘hide self’ so patients don’t have to look at themselves onscreen, and ‘breakout rooms’ if we wanted to break the group into smaller group discussions or smaller group meal support.”
Nearly all patients or families surveyed felt their cultural beliefs/traditions were considered in their care and 94 per cent felt their language needs were considered in their care. Virtual care even extends to Remote Interpreters, who are now available in the Emergency Department as well as other acute areas. The service is expanding to sign language translation, as well.
Nearly 60 per cent of BC Children’s patients who require the hospital’s specialized services live outside the Vancouver Coastal Health region. Recognizing that commuting and travel logistics are often a challenge for patients and families, a physician-led group is developing the plan for the future of virtual care at BC Children’s, post-pandemic.
Several programs at BC Children’s are working on virtual health initiatives with Child Health BC (CHBC) and PHSA’s Office of Virtual Health, including in Shapedown, Sunny Hill Health Centre, the Renal program and Kelty Mental Health.
CHBC played a significant role in the BC Children’s virtual education and training at the beginning of the pandemic, developing the education and training curriculum, and training hundreds of BC Children’s health-care providers in less than two months.
“In a matter of just a few weeks last spring, we shifted much of our care to virtual platforms so that we could safely reach our patients during the pandemic,” says Pediatric Dermatologist Dr. Wingfield Rehmus. “Not only was virtual health enormously helpful during the height of the pandemic, but it has also brought us new ways to connect with our patients that we will continue to utilize even after our clinics are fully operational again. It is a tremendous time saver for families who do not live close to the hospital and allows us to connect with them more often and more quickly than we could in person."
While BC Children’s has expanded virtual appointments during the pandemic, it is still safe for patients and their families to seek care at the hospital. Additional safety measures are currently in place, including active screening for COVID-19 symptoms by hospital staff at each entrance, following the provincial mask policy (for care providers, staff, patients, families and visitors), physical distancing on campus, and using personal protective equipment when necessary.
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