Patient Centred
Community Designed
Team Delivered
Success stories from Saskatchewan’s new framework for primary health care
Retaining physicians in rural
areas can be a challenge,
particularly because
doctors are required to be
on call 24/7. The CEC has
great potential to stabilize
Maidstone’s emergency
services in the long-term
and give doctors a better
work-life balance.
Maidstone CEC proving beneficial
The new Collaborative Emergency Centre (CEC) in Maidstone has only been open since September, but is
already getting positive reviews. The CEC provides the community with access to primary health care during the day and urgent care after hours. Several months in, it is benefitting both patients and physicians.
“In terms of continuity of care, physicians can give a complete assessment rather than dealing with things in
isolation,” said Dr. Sherwyn Roman of the Maidstone CEC. “It really allows you to get to know your patient,
do an overall assessment and prioritize, and discuss with your patient what really needs to be done. I think
that with the experience and the feedback we’ve received so far, it has been really well received by the
community.”
Physicians were a driving force behind the CEC. Retaining physicians in rural areas can be a challenge,
particularly because doctors are required to be on call 24/7, which leaves them little or no personal time.
The CEC has great potential to stabilize Maidstone’s emergency services in the long-term and give doctors a
better work-life balance.
Success stories for primary health care
The model is not only a winner from the health care providers’ perspective – residents
seem to agree it works for them as well. A town hall meeting was held in October 2013 to
get feedback on the CEC; feedback indicated that the health region was on the right track.
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Prairie North Health Region says before the CEC,
service was disrupted anytime a physician left the
community. Maidstone had been experiencing service
interruptions for about two years when the CEC concept was considered. This circumstance contributed to
strong public support for the new model.
“For many years, we had been operating a 24/7 facility, so there was always a physician available to support
health care. What we were proposing was something
different than that,” said Neal Sylvestre, Director of Rural Health Facilities for the Prairie North Health Region
and Maidstone Health Complex. “The CEC wouldn’t
have an on-site physician during the night time, and
some people didn’t think that was a very good idea.
The CEC needed to provide a good alternate level of
night time care to be successful.”
Residents still receive care outside regular clinic hours through the CEC night time team.
The night time team includes a registered nurse (RN), a primary care paramedic, a licensed
practical nurse and other staff. Physician care is provided through an arrangement with
STARS (Shock Trauma Air Rescue Society).
Patients are treated and discharged, treated and given an appointment for follow-up at the
clinic the next day, or transferred to a larger centre for care, such as Lloydminster or North
Battleford. While the STARS physician handles night time cases, the model still requires a
local physician to be on call for the facility to retain hospital status. The four local physicians follow an on-call schedule to provide 24/7 service to long term care residents and
acute care inpatients. However, the incidence of those late night calls are less frequent
since the CEC began operating, said Sylvestre.
“The RN and a primary care paramedic contact an offsite STARS physician for every patient
that comes into our facility, and the three of them have a discussion about what the patient presentation is, and what they need to do in terms of patient follow up,” said Sylvestre.
He added that the health region ensured that the team had up-to-date triage training and
advanced cardiac life support, and introduced basic intermediate trauma life support and
pediatric advanced life support training. Since urgent cases are not seen often, the team
keeps their skills sharp by running a scenario of a potential emergency every night.
Success stories for primary health care
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Charlotte Hamilton, Regional Director of Primary Health Care with Prairie North Health
Region said it was important for the region to ensure that staff understood why expanded
hours were necessary in the community and obtain their support. One benefit of this approach was allowing physicians and the clinic manager to plan schedules, rather than the
health region.
“As soon as we changed the schedule to provide more hours, we were able to offer same
day or next day appointments. We didn’t increase physician hours at all. We flexed the
time to increase access over a longer period of time, and that seemed to be what the public needed – access to primary health care services. We want our doctors to focus on the
best practice guidelines in managing chronic conditions, so people with heart conditions,
diabetes, coronary artery disease, or other conditions can access their physicians and get
support in self-management, and perhaps prevent some hospitalizations and emergencies,” said Hamilton.
The Maidstone CEC has been attracting interest provincially. Representatives from other
health regions have taken tours, and a group of 55 first and second year medical students
recently toured the facility. Following the opening of a second CEC in Shaunavon in late
2013, more health regions are proceeding with plans to introduce CECs in the coming
months.