Project Details
About the Project
The goal of providing equitable access to care for all of Vancouver Island’s residents is frequently challenged by the concentration of medical specialties on the southern tip of the island. Child and Adolescent Psychiatrist Dr. Anna Kalenchuk knows how difficult it can be to provide youth and their families with support for timely psychiatric care, particularly if they are based outside of Greater Victoria. Seeking training from the UBC Sauder Physician Leadership Course and funding from the South Island MSA, Dr. Kalenchuk aimed to support the expansion of the existing child and youth mental health Telehealth Clinic, which was a successful pilot project originally headed by Child and Adolescent Psychiatrist Dr. Giselle Ferguson and the Doctors of BC Joint Collaborative Committee. The expansion of this clinic into a regional service was renamed the “Virtual Psychiatric Consultation Clinic” and was designed to increase access to psychiatric assessment and care for youth and their families across Vancouver Island. Dr. Kalenchuk sought to bring a team-based care model to this clinic during this expansion.
This is not, of course, the first time a virtual clinic model has been used in British Columbia. Dr. Kalenchuk sought advice from other specialists, including Rheumatologist Dr. Michelle Teo from the Interior, about the design of this care model. Called ‘Specialist Team Care,’ this model involves delivering care in a shared care approach, drawing on the respective expertise and skills of a psychiatrist and a psychiatric nurse. In this approach, the nurse does the initial patient/family interview before presenting the patient case to the psychiatrist. The psychiatrist then meets with the patient, gathers further information, shares a diagnostic impression and provides treatment recommendations. The nurse then remains with the patient, continuing to provide further education and follow up. This workflow employs each clinician at the top of their scope, leading to lower wait times for patients and their families. It also provides the patient with three (or more) clinical interactions to share their story, improving their care experience.
Dr. Kalenchuk worked closely with Alexis Gale, her psychiatric nurse colleague at the Virtual Psychiatric Consultation Clinic, to co-design a version of this Specialist Team Care model that would work for their patients and staff. They trialed it with three mock patients to create a workflow and to clarify how information would pass smoothly between members of the team. Cindy Cady, Manager for Child, Youth and Family Mental Health and Substance Use, also provided consultative expertise.
One of the steps undertaken to make the clinic more efficient and effective was to refine the existing screening tool to gather as much collateral information from patients and families before their appointment. This tool allows the patient and family to clarify and communicate their concerns prior to their evaluation, and also improves the accuracy of the evaluation while making it more efficient.
As the clinic began caring for patients, the team wanted to ensure there was a mechanism to continually evaluate the care they were delivering to patients. Working closely with Michelle Riddle, Consultant with Decision Support at Island Health, Dr. Kalenchuk developed a satisfaction survey to gather feedback from patients and families about their experience of care.
Reflecting on this process, Dr. Kalenchuk encourages other physicians to continue to consider how specialist care can be delivered in a way that it reaches patients in a timely manner, enhances the clinical interaction, and draws on the expertise of allied care team members. Dr. Kalenchuk extends deep appreciation to operational leadership for their open-mindedness in piloting this care model and reflects on the importance of this collaboration to ensure that a project aligns with the goals of the division and will have the resources necessary to carry it forward.