Rural Surgical and Obstetrical Network

2020–2021 has been another highly successful year for RSON, with substantial lateral and horizontal network development, as demonstrated by the relationship building that occurred between similar communities, shared disciplines, local teams, and provincial pillar activities. In addition, RSON’s ongoing work with health authority partners resulted in numerous steering committee activities and integration into other provincial and health authority programming, such as operational capacity and quality initiatives.

The Remote Presence Technology pillar made great strides advancing its work throughout the year. In addition to implementing remote-presence coaching of adductor canal blocks between specialists in Vancouver and family practice anesthetists in Revelstoke, RSON teams implemented simulations for maternity, emergency, anesthesia, and critical care. The Smithers team was able to offer virtual pre-surgical screening to patients in surrounding communities. Throughout the year, tremendous collaboration also occurred between RSON sites and the Real-Time Virtual Support program, with sites connecting to RTVS pathways for remote facilitation during neonatal resuscitation simulations.

In the year ahead, the Remote Presence Technology pillar will continue integrating technology within RSON sites, both for critical care support and coaching activities.

Meanwhile, despite the numerous challenges presented by COVID-19, the Continuous Quality Improvement pillar progressed its work throughout the year. Quality nurses were hired in all eight RSON sites, and monthly quality dialogue sessions were held to connect teams around the province. Other quality improvement highlights included:

• Implementation of the 30-day Patient Reported Outcomes and Experiences Survey at seven RSON sites, receiving more than 400 responses to date. This survey data will inform local quality improvement initiatives.
• Activation of Salus Global’s more^EXProgram in the Northern and Interior Health regions, providing quality infrastructure and tracking tools for local teams.
• Collaborative development of quality metrics and reports with Interior Health, which will continue to support rural sites into the future.
• Development of a local tracking tool for process and outcome data for specific surgical procedures.

In the coming year, the Continuous Quality Improvement pillar will continue exploring new data sharing agreements in order to provide local sites with access to their quality data. Ongoing network development with local quality teams around the province will continue.

Clinical Coaching, the first step in network formation, has also had a highly productive year. To date, the pillar boasts 57 registered coaches, 106 coachees, and 1125 coaching hours. Many of these coaching activities occurred with maternity nurses, which is not supported by other programming. Highlights for the Clinical Coaching pillar from the past year included:

• Implementation of the Call-a-Coach maternity nurse program in Smithers.
• Midwife-led interdisciplinary coaching for maternity team members in Hazelton.
• Maternity and neonatal intensive care unit nurse coaching at regional centres.
• Ongoing coaching with visiting specialties, including plastic surgery, in Vanderhoof.

In the coming months, the Clinical Coaching pillar will continue improving general practitioner-specialist coaching activities. It will also progress the formalization of maternity and neonatal coaching within regional centres and the coordination of maternity activities with the Rural Obstetrics and Maternity Sustainability Program.

Finally, RSON’s Operational Capacity robustly responded to ministerial priorities this past year, including dental surgeries, and endoscopy waitlists. It was also able to reduce the impact of COVID-19 and integrate into ongoing ministerial funding sources and surgical recovery funding. Throughout the year, RSON sites reduced surgical waitlists to pre-COVID states, and continued working with COVID precautions. RSON funding has allowed teams additional capacity to prepare for new surgical workflow by simulations, quality activities, and team meetings to prepare sites for COVID and, in some areas, led the province in COVID surgical workflow.

Looking ahead, Operational Capacity aims to coordinate RSON operational capacity funding with ongoing ministerial funding that is formalized through health authority structures.

Other tasks on RSON’s agenda in the coming months include formalizing data sharing and acquisition to review and share evaluation of the model, as well as onboarding new RSON sites in Vancouver Coastal Health. Transition planning for RSON legacies will also be explored, along with expanding the impact of technology within networks. Quality networks between sites and local quality teams networked with like sites and regional/provincial structure will be further developed. And an evaluation for available data to understand outcomes within networked models, including out-of-pocket costs to patients and holistic risk and costs of travel for out-of-community maternity and surgical care, will occur.