Note from Michael May 12 2023 | PCH Internal Medicine Coverage Plan

From the desk of Dr. Michael Gardam, Health PEI CEO

 

Notes from MichaelHi everyone, 
 

I want to inform you of the latest plans to address the challenges presented by the PCH Internal Medicine shortage. 


The recent departure of two internal medicine specialists has required dedicated planning efforts to ensure we can continue to offer services for all Islanders to meet critical care needs and to support critical care at the PCH. Despite ongoing efforts to attract short and long-term locums as well as permanent Internists to PCH, we must make changes to how the services are offered in order provide safe care for Islanders. 

I don’t need to tell anyone at Health PEI how important this is, as these plans affect our most acutely ill patients.

Our integrated provincial planning teams, which include representation from front-line health care workers, administrators, physicians and medical leaders for PCH and QEH as well as provincial leads, have reviewed staffing models and patient demographics to design a safe and viable option for a provincial response to critical care needs on PEI.

I want to be clear that the plans we have are what we need in place now. These will be frequently revisited as we recruit Internal Medicine physicians to PCH, based on how many people we can recruit, and the population needs. 

Plan details

Effective May 14, 2023 the PCH critical care services will become a Progressive Care Unit (PCU), like the PCU at QEH. 

This is the level of care necessary for most patients who have historically been cared for on this unit, and as such, the majority of patients will see no change in service.

This unit will be staffed by Family Physicians and Hospitalists and nursing staff. The change will allow us to increase the beds from 6 to 8 as fewer nurses will be required for the level of care offered. 

Patients who need ICU services will be stabilized and transferred to the QEH. An additional two beds will be staffed to accommodate these patients, increasing the ICU beds at QEH up to as many as 10. 

Emergency patients will continue to be seen and assessed at PCH before transfers. EMS is aware of the changes in our system and discussions are occurring about what is needed to support this work.

When locums are available to work at PCH, there will be 24/7 Internal Medicine support at PCH (“on call” available for in-person support when needed).  Recruitment to increase the number of internists at PCH will continue as a priority for the health system.

In order to do this, our teams have implemented training and tools to help with the transition, including:

  • Enhancement of the scope and education of Family Physicians and Hospitalist physicians to enable them to support PCU level care patients at PCH with back up support from Internal Medicine.
  • Exploring potential virtual critical care supports (i.e. Criticall, etc). 
  • With the support of a skilled retired flight nurse (Karen Webb-Anderson) from Nova Scotia, we are developing tools to support this transition for physicians and staff such as transfer guidelines, transfer checklists, and stabilization and transfer education.
  • High Fidelity Simulation education is being organized for staff involved in the stabilization and transfer of critically ill patients to ensure the highest level of safety.
  • A tabletop exercise completed with key team members to discuss scenarios and identify gaps in planning that require immediate attention. Further tabletops are planned.
  • Collaborating with iEMS staff and Health PEI leadership regarding ICU level transfers to the QEH 
  • Ongoing evaluation and monitoring of critical care delivery across the Province will be a priority for HPEI with a goal of recruiting a full complement of Internal Medicine Physicians at PCH.


This is a big change, and one that required the support and input from Health PEI team members at PCH, QEH, community hospitals, partners with IEMS and the Department of Health and Wellness, and leaders across our system. Our planning groups brought together cross sections of experts and leaders from across the system to develop this plan. 

While I appreciate not everyone will agree with this plan, we must make decisions based on the resources we have available and, ultimately, the offering the safest and highest-quality care for Islanders.

I want to sincerely thank all of you who have stepped up to support our system with this approach. As difficult as this is, the way we are facing this challenge shows how much our Health PEI team has come together and how strong we are as one provincial system. 

Updates will be provided as things change and senior executive, as well as planning teams, will continue to meet and monitor this situation in the weeks to come.

Thank you,

Michael

 

Please send questions, comments, or submissions for these notes to emclean@gov.pe.ca, subject line “Notes for Michael”.

 

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