Temporary model of healthcare proposed for Canso: Meeting outlines plan, hears feedback

·6 min read

GUYSBOROUGH – “With this model we have to make the best of our available resources, expand roles, and cooperate to expand service to areas such as Canso,” Andrew Heighton, Nova Scotia Health’s director of Integrated Rural Health, Eastern Zone told The Journal last week following a public meeting in Canso on the proposed temporary model of care for the area on Aug. 23.

For more than two years, Eastern Memorial Hospital (EMH) in Canso has faced frequent emergency department closures due to lack of physician and/or nursing coverage.

Over the summer, that situation has become more dire as one of the three remaining doctors working the one-week-on/three-week-off rotational coverage model in the community retired.

The temporary care model put forward Aug. 23 relies on three measures to increase healthcare coverage in the area while physician recruitment continues. The first step is the creation of a collaborative care clinic made up of a team of allied health professionals such as a physician, nurse practitioner and family practice nurse who will work together to support patient care.

The second piece of the plan is the establishment of an urgent /emergent treatment clinic which would support emergent and unscheduled needs that cannot be met in the collaborative care clinic setting (such as bloodwork, X-rays), and would be supported by a physician or nurse practitioner, an assessment nurse and members of the collaborative care clinic.

The Journal asked Heighton to explain how an urgent/emergent care clinic would differ from what was already available in Canso. He said this would provide coverage by physicians who don’t have emergency department credentials or a nurse practicioner. “They’d be able to cover emergent or urgent care. That would be things that are little outside of primary healthcare working with the emergency trained nurse. So, it would be able to provide a high level of coverage for the community. But, again, without the credentials for the emergency department coverage such as doing intubations or those types of things which is where we partner with EHS, and that’s part of the proposal.”

The third prong of the temporary care model would increase the role of Emergency Health Services (EHS) when the urgent/emergent treatment clinic is not open.

According to the Canso Stakeholder’s Working Group Facebook page, a family practice nurse has already been hired and job postings are up on the Nova Scotia Health website for physicians specifically for EMH, while nurse practitioner employment vacancies are advertised for sites across the province.

The model relies on support from EHS, which has been experiencing its own staffing and coverage shortages, to help fill the gap in healthcare coverage in Canso. The Journal asked Heighton how EHS could be expected to fulfill this new obligation in the area when, in the past, this newspaper has reported their staffing challenges, including an eight-hour delay in ambulance service to EMH.

Heighton said EHS has made a lot of changes and infused a lot of resources into their system over the last year, one of them being medical transport units which provide transportation of patients that don’t require a paramedic, “That in itself does allow for EHS, the paramedics, to be freed up for acute transfers…These things are being put in place by EHS [and] are going to free up and leave the EHS in the community more often, providing more care for the community.”

One point in the Aug. 23 presentation referred to the support of physicians on staff. Asked to elaborate on that point, Heighton said, “It’s looking at how do we utilize the limited resources and expand on that to provide support for the physicians and the nurses that are on site. One thing that we are looking at in addition to this is providing increased education for nurses, bringing the education to community so the nurses don’t have to leave the community all the time for education. Working with our interprofessional practice and learning team to provide education that will then transfer into further confidence and further resources for the nurses as well as utilizing our simulation team to provide on-site simulated training for the nurses and the physicians. That will further provide that confidence and support to the whole healthcare team for situations that they would not see on a regular basis that could present such as heart attacks, motor vehicle accidents, situations like that that we can simulate with the team and provide them more education and experience.”

Rural physician recruitment is ongoing, but has had limited success in recent years. When asked to comment on what efforts are being made, Heighton said NSH needed to focus on getting medical residents into rural communities as that would increase the chances that they would choose to stay. He added that working with local residents, including high school students who had plans to enter the field of medicine, was another strategy because, “The likelihood of them coming back is much higher than recruiting someone who is not from the community.”

Municipality of the District of Guysborough’s Deputy Warden Janet Peitzsche attended the meeting on Aug. 23 and sent The Journal the following comments via email: “The meeting was a good meeting, Minister Michelle Thompson, MLA Greg Morrow, Nova Scotia Health professionals, EHS staff, Eastern Memorial staff, members of the Stakeholders group, and the community, attended, discussion centred around what can we do for days that there is no doctor available. Solutions included EHS, Virtual Access to a Doctor, a full time Nurse Practitioner etc.

“Nova Scotia Health will continue to work on recruiting doctors to our area, both fulltime and locums. There was a good prestation and discussion from the community. One of the concerns was the EHS component and how that would work,” wrote Peitzsche, adding the NSH would try to incorporate what they heard from the community into the final plan.

Susan O'Handley, co-chair of the Canso Stakeholder Working Group, told The Journal in an email that the meeting was meant to inform, “the public of the temporary plan to put a Family Practice Nurse and/or Nurse Practitioner in place. We have about 10 days in a month with no physician in the community. We had some focus group time to discuss what we liked, or didn’t like about the proposed model, recruitment, communication and to offer suggestions.”

O’Handley added, “It was short notice for a public meeting, so the attendance wasn’t great. A Tuesday in August with a couple days’ notice; I don’t feel the community had enough notice. However, those in attendance asked lots of questions.”

The Journal asked Heighton what the reasoning was behind the timing of the meeting, from 2 to 4 p.m. on a workday. He replied, “We worked with the Canso and Area Working Group to find a date and time that would work for that group as well as well for the majority of EHS and Nova Scotia Health representatives to get people to the community, understanding that this was our first meeting and we are committed to having more consultations at different times that work for the community at large so we can get a better overall perspective from the community.”

Lois Ann Dort, Local Journalism Initiative Reporter, Guysborough Journal