Dr. Jennifer Balfour, Dr. Cullen, and their colleagues wanted to find a better way to care for pediatric patients who came through the emergency room and required further follow up. They also knew that undergraduate and post graduate trainees needed to see patients in an environment where they could learn how to assess and manage common pediatric problems, in order to be ready for practice. Prior to their initiative, patients and their families would come to the ER and get referred either to the on-call pediatrician or the community-based pediatrician’s office. Either option could result in lengthy wait times and significant uncertainty for the family. Families would sometimes return to the ER multiple times rather than risk the wait, resulting in overuse of ER services.
Dr. Balfour wanted to create an Urgent Pediatric Access Clinic (UPAC), a designated facility and staff to address those patients who required follow-up within two weeks. In Dr. Balfour’s words, “the aim was to get the patients to the right specialist in a timely, predictable fashion”. She and her colleagues anticipated that creating this clinic would reduce wait times to see pediatric specialists, lower the strain on the pediatrician on-call, and facilitate an easier discharge from the ER as the patient and their family would anticipate a prompt and predictable follow up.
Drawing on expertise and input from ER physicians, pediatricians, ER nurse clinicians, pediatric nurse clinicians, and family practice physicians and teaching faculty, the group brainstormed what such a service would look like, and engaged with Island Health about logistics for the space and staff required for the clinic. Throughout, Island Health was a real partner in this effort, as all were trying to solve the problem of an overcrowded ER. “We really needed Island Health to share the vision for this clinic and they did”, says Dr. Balfour. So too was the staff of the Island Medical Program, who recognized the need to support learning in an authentic environment, with meaningful patient experiences, where skills in assessment and management could be developed. The support of IMP in advocating for space, and supporting administration and scheduling, was essential and invaluable.
The Urgent Pediatric Access Clinic (UPAC) has been operating since January 2019, seeing an average of 10 – 12 patients a week. The staff have received encouraging feedback from ER and pediatric clinicians, families, and residents. One family practice trainee stated that after two afternoons in the UPAC, “it was the best two days of learning in pediatrics in my life”. Dr. Balfour is very satisfied with the way the UPAC has enabled access to urgent patients: “In our job, we’re just trying to see the right patient at the right time. Sometimes you see a patient and they’ve waited too long to see them because you didn’t have the right information on the referral form to triage them appropriately, or the short notice office time with which to assess them. Sometimes our offices have so many chronic complex patients that the urgent cannot be seen in a timely fashion. With the UPAC clinic, the situation is changed for the better.”
It is also considerably more likely now that a learner can be involved in an appropriate teaching environment where important skills and experience can be gained and taken in to future practice.
Going forward, the group would like to guarantee the use of two rooms with greater overall space capacity, allowing them to assist patients and their families without overcrowding in the exam rooms. They will also continue to engage with family practice physicians to ensure that this effort assists, rather than adds to, or competes with, their work.