“I know of specific instances when people’s lives have been saved because of quick access to a physician consultant’s advice,” says Lisa Weir, superintendent of Saskatoon Health Region’s Acute Care Access Line (ACAL), run by M.D. Communications at M.D. Ambulance.

“Let’s say there’s a car accident in North Battleford. Initially, the injured will be taken to the local hospital and assessed by the emergency room doctor,” Weir says.

Lisa Weir, superintendent for M.D. ACAL, facilitating calls between physicians.

Lisa Weir, superintendent for M.D. ACAL, facilitating calls between physicians.

If one or more of the patients requires a higher level of care – for example, surgery – the emergency room doctor in North Battleford will call ACAL.

“We have all the doctors in the province programmed into our electronic system,” Weir says, explaining that when she gets a new call, the first thing she’ll do is take the physician’s name.

“Then, I take the first and last name of the patient, their health services number, gender and date of birth,” she continues. “I’ll mark the patient as critical or non-critical. If the patient can remain stable for 30 minutes, I keep going with the call to get more information.”

If the patient is not stable, Weir will place the emergency room doctor into one of 20 online conference rooms and contact STARS air ambulance. STARS will connect her with their emergency transport physician, who she’ll place in the same virtual conference room as the emergency room doctor.

Next, she’ll contact a physician who specializes in trauma injuries. At the beginning of each shift, Weir receives a list of all the specialists on call for that day at Saskatoon’s three acute care sites (Royal University Hospital, Saskatoon City Hospital and St. Paul’s Hospital).

Weir will contact the specialist either by phone or page, and if unable to connect with them within 10 minutes, an exclamation mark will pop up beside the specialist’s name to alert her to try again.

“Sometimes we have to search for the specialists, because they’re still doing their day-to-day work caring for patients,” she explains.

When all three physicians (the North Battleford emergency room doctor, the STARS emergency transport physician and the trauma specialist) are in the online conference room, they’ll consult with each other by phone to determine the most appropriate mode of emergency medical transportation for the patient. STARS helicopter is not always used to respond to critical incidents, as both the decision to transport and flight times are affected by weather conditions, location of landing sites and availability of resources, in addition to the patient’s condition.

If required, STARS may also call Saskatchewan Air Ambulance, a provincial service that works collaboratively with STARS to determine the best mode of transport for critically ill and injured patients, depending on weather, aircraft availability, patient location and flight times.

“We take notes on the call and provide an overview to anyone on the call who will be directly involved in the patient’s care,” Weir says, adding that she’ll also notify the accepting hospital about the patient’s estimated time of arrival.

The calls can take anywhere from five minutes to an hour and a half, especially if there are multiple requests for consultations with physicians from various specialties.

In addition to calls for urgent or critical patients who require immediate transfers to receive specialized care, Weir receives calls for patients who still require a higher level of care but less urgently. For example, a family physician will call the line for a child with a broken nose who needs reconstructive surgery within 48 hours.

“It’s an efficient, coordinated effort to bring patients into a higher level of care when they need it,” Weir says.

Nurse practitioners from northern Saskatchewan, where physicians are not always present, also use the service.

“But typically, it’s physician to physician,” LeeAnn Osler, Deputy Chief of Communications for M.D. Ambulance and Manager for M.D. ACAL says, adding that she’s amazed at the amount of work the physicians take on when they’re on call, especially cardiologists who often get very high call volumes during their on call week.

“The cardiology physicians easily get 10 to 15 calls from us in a day shift,” Weir explains. “One cardiologist said to us, ‘I’ve never run into an ACAL person who’s having a bad day, who’s angry, who’s grumpy,’ because we aren’t. We’re professionals. We get the job done no matter what the circumstances.”

“On the emergency side of M.D. Communications, we’re an accredited centre of excellence, which means we have very strict guidelines that we follow,” Osler says. “It doesn’t matter whether you call in at three in the morning or three in the afternoon, you’re going to get the same service. We have a saying, ‘All in, all the time.’ This philosophy, along with a quality assurance process, has been incorporated into M.D. ACAL.”

Since it launched in 2011, M.D. ACAL has processed 143,900 patients – an average of 110 patients per day. Each patient call requires an average of four to five phone calls, meaning there are days when staff members like Weir might facilitate discussions among upwards of 100 physician consultants on various different calls.

“Our record is 11 consultants in one room talking together,” Weir says. “There have been times at night when one person is working and they have two phones to their head.”

The ACAS and CPAS connection

The ACAL team also works with ACAS (Acute Care Access Services) and CPAS (Client Patient Access Services).

“We call the ACAS patient care supervisors when we’re transferring a patient back to Saskatoon,” Weir says. “Likewise, the ACAS supervisors or managers will call us if they’re re-directing services from one hospital to another.”

“We’ll also call ACAS’s patient placement clerks when a patient needs an admission,” continues Weir. For example, if a pediatrician calls to inquire about transferring a child to Royal University Hospital from Prince Albert, and the pediatrician knows the child is going to be admitted to hospital, Weir will keep this consultant on the line and transfer him or her through to ACAS, so the patient placement clerks can find a bed for the child.

When a patient needs to be transferred to their home community, CPAS will get involved to help make the transfer possible. For example, if Weir receives a call from a doctor who wants to transfer a patient to their home community of Meadow Lake, she’ll find out which physician in Meadow Lake is responsible for accepting patients and will facilitate a phone conversation between the two physicians. Weir will then provide a form to the CPAS office to inform their staff that a patient has been approved for a transfer.

“It’s a very busy centre,” says Osler. “The feedback we’ve received is that the doctors are happy with the service, and that’s what we strive for – excellent customer service. You let us know what you need, and we’ll help you out.”

This article is part of a three-part series:

Acute Care Access Services: Safely placing patients in the right beds (Part 1 of 3)

Client Patient Access Services: Helping patients navigate the healthcare system (Part 2 of 3).