The recent addition of emergency medicine to the Rapid Access to Consultative Expertise (RACE) Line  is addressing what some might call a typical Canadian problem. Not wanting to be a bother.

In this case, it’s family physicians (FPs) needing to speak with Emergency Department (ED) physicians for advice on how to care for their patients, but worrying their calls might be inconvenient.

“I think some family physicians felt that calling the ED would create an undue extra burden on emergency physicians,” says Dr. Eric Grafstein, VCH-PHC regional head of Emergency Medicine. “With RACE ED, we’ve tried to create an environment where the emergency physician answering the call doesn’t have time constraints.”

Launched as a VCH/PHC pilot in February, RACE ED was inspired in part by frank and open discussion about the need for better communication between acute and community care at a VCH-Vancouver Leadership Team meeting in October 2014.

“We’ve prioritized improving hospital-family physician communication as fundamental work In Vancouver,” says Vivian Eliopoulos, chief operating officer, Vancouver Acute Services. “It’s essential for providing quality patient-centred care, and we’re working in partnership across our community of care, and across the region, with Dr. Grafstein and others to make a difference.”

Enhancing patient care one call at a time

While reducing the number of patients who unnecessarily visit the Emergency Department (ED) is helpful, it was never a priority, says Dr. Grafstein.

“We just felt that we weren’t providing a strong enough service to family physicians in our region, both in terms of getting to the phone quickly and in providing advice,” he explains.

Working closely with Margot Wilson, RACE director and director of Chronic Disease Management Strategy at PHC; Dr. Bob Levy, Specialist Lead for Shared Care; and Dr. Gary Mazowita, PHC Head of Family and Community Medicine, Dr. Grafstein set the goals for the three-month pilot:

• provide a way for FPs to easily access the ED for advice;
• streamline the referral process for patients needing assessment in the ED and/or admission to hospital;
• minimize the disruption to emergency physicians, who can receive two or three outside calls in a short period of time while working a shift;
• strengthen the relationship between emergency and family physicians

From migraines to jaundice

RACE ED operates Mondays through Fridays (except holidays) from 8 am to 5 pm. Since launching, the service averages four calls per day, and as many as eight or nine. The bulk of calls come from FP offices (versus walk-in clinics) and the average call length is roughly 5 minutes.

Presenting complaints have included everything from complex migraines, painless jaundice, chest pain, a fractured elbow, to HIV secretion exposure. The average time per case is about 11 minutes.

“In general, we have a better idea of the kinds of patients being referred to the ED for care, which creates some ability to help patients avoid coming to the ED unnecessarily, or to help navigate them to a less busy ED through the public wait times website,” says Dr. Grafstein.

Results of the trial have also revealed the need for FPs to have access to same-day CT scans and ultrasounds for acute problems.

“The true benefit, however, is in creating a stronger relationship between the ED and family physicians in the community, both to provide faster access to pass on information about a patient they want to send to the ED for possible admission, or for advice about caring for a patient.”

Expanding to Fraser Health in August

Assessing the impact of RACE ED, Dr. Grafstein says: “I think most FPs are pleased with the service, and there’s some ability to help patients avoid coming to an ED.

“But,” he adds, “there aren’t as many calls as I would have hoped for. Getting the message out to busy FPs and walk-in clinics is challenging.”

Still, it’s early days and there’s potential for growth. RACE ED is expanding to serve the Fraser Health Region starting August 4, 2015.

Learn more 

Rapid Access to Consultative Expertise (RACE) Line

RACE gets quality health care to the finish line