Manitoba

Peachey pitches regular bedside visits as part of new model of Manitoba patient care

A bedside visit every day from a patient's doctor and nurse might be one solution to what ails health care in Manitoba.

It sounds like 'common sense,' Dr. Ron Taylor says of bringing health-care professionals together in one unit

Teams of medical professionals making daily rounds prevents staff themselves from working in silos, says Dr. Ron Taylor of the accountable care unit model. (Shutterstock / interstid)

A bedside visit every day from a patient's doctor and nurse might be one solution to what ails health care in Manitoba.

Dr. David Peachey — the consultant who recently assessed the progress of Winnipeg's hospital reorganization plan — suggested one improvement to the health-care system would be developing teams of professionals who make daily rounds to their patients.

It is described as an accountable care unit, and the program is reportedly running with great success in Saskatchewan. 

It "sounds a lot like common sense that people who are outside of health-care and haven't had to interact with it, they kind of look at you and say, 'You mean you weren't doing that already?'" said Dr. Ron Taylor, co-lead of Canada's first accountable care unit in Regina.

Daily patient check-ins

Peachey listed the idea as one of 17 recommendations as the ongoing consolidation of emergency care in Winnipeg from six ERs to three takes shape. The full report was made public last week.

The accountable care unit, which started at Regina's Pasqua Hospital in 2016, amounts to a seismic shift in how medical patients are handled.

A physician and nurse manage a team making bedside visits at the same time every day, which can include other professionals like occupational therapists, dietitians and social workers.

Hospital staff speak with the patient, and each other, about the treatment plan in a matter of minutes. They make adjustments on the fly, and with each other's backing.

Dr. David Peachey suggested an accountable care unit be "encouraged across the region," as part of his 17 recommendations in an assessment of Winnipeg's health-care overhaul. (Ian Froese/CBC)

It makes sense, Taylor said, but the scheme goes against traditional practice.

Physicians have long shifted from one hospital unit to the next, driven by need, but he said accountable care units keep doctors in specific areas — which promotes collaboration among colleagues. 

"A lot of the physicians that we have who have come to this and been exposed to it … they realize that patient care is better and they become supportive of the model," he said.

The type of care has increased patient satisfaction in Saskatchewan, and reduced the number of patient advocate complaints, Taylor said.

The program has since expanded to Saskatoon, he said.

The model itself was founded by Dr. Jason Stein, who said accountable care units provide the type of care that patients actually expect.

"In an environment that's not organized like an accountable care unit, if you happen to see your doctor and your nurse at your bedside at the same time, that's just a coincidence and a rare one at that," he said on the phone from Atlanta, Ga.

'Nobody's talking to each other'

Traditionally, patients become unwilling conduits of information. They tell the nurses what the doctor told them first, and vice-versa. 

"You only have to be asked the same question by three different people, three different times, to realize that nobody's talking to each other."

He said the model, which operates in more than 20 American states and Australia, has drawn rave reviews in Saskatchewan, as well as another Canadian hospital in Cambridge, Ont.

In Manitoba, Peachey recommends the accountable care unit "be encouraged across the region," in unison with the expected expansion of My Health Teams — groupings of health-care providers who work in the same offices or virtually to help individual people. His report suggests a two-site pilot project. 

Manitoba Health Minister Cameron Friesen said the idea is being considered. 

Manitoba will mull the merits

"We have committed to implementing Dr. Peachey's key recommendations and, as such, will closely consider the merits of the accountable care unit model," his office said in a statement. 

Peachey's report listed two other lessons from other jurisdictions that Manitoba should consider.

He said a freestanding emergency centre, a facility providing 24-hour emergency care but separate from an acute-care hospital, is worth considering, though he noted the facility's presence in Winnipeg is "neither anticipated or recommended in the short-term, but cannot be ruled out in the longer-term based on need."

Peachey also cited language from the National Health Service in England, which last year updated its protocols whenever there's a shift in the delivery of front-line services.

It notes, for one, the community should be involved continuously whenever service change is implemented — which critics of Winnipeg's health-care reform say has been lacking. 

About the Author

Ian Froese

Reporter

Ian Froese is a reporter with CBC Manitoba. He has previously worked for newspapers in Brandon and Steinbach. Story idea? Email: ian.froese@cbc.ca.

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