Hospital taps into new online service for neurosurgical consultations

Supports Strategic Aim to "Save 1,000,000 hours of time patients spend in Central East LHIN Emergency Departments by 2013."

Since Monday,January 24th, patients brought to the Northumberland Hills Hospital (NHH) Emergency Department (ED) with a head injury have had a new system of electronic and human supports waiting at the ready to get them the care they need as quickly as possible. 

The Emergency Neurosurgery Image Transfer System (ENITS) is a welcome complement to the top-of-the-line digital CT scanner installed at NHH in 2009 thanks to community donations. A province-wide system designed to link Ontario hospitals with the neurosurgeons and critical care beds necessary to assess and care for patients coping with head injuries or neurological disturbances, ENITS promises to offer a measurable change for patients and care providers in situations where a quick response is often key to a positive outcome.

Here’s how it will work.

As in the past, patient John Doe arrives at NHH by ambulance, unconscious with visible head trauma and suspected brain injury following a car accident on the near-by 401. The ED physician orders a CT scan to assess the extent of the damage and the CT, in turn, is performed by the NHH radiologist on site or, if it’s after hours, on call.

In the past, John Doe’s results would then be read by the NHH physician and radiologist and a determination would be made as to whether he was stable enough to be transferred to a larger centre for further assessment, or admitted, possibly to the Intensive Care Unit, for observation. NHH does not have a neurosurgeon on staff.

Under the new system, NHH’s Diagnostic Imaging department will automatically upload John Doe’s completed CT head images onto the ENITS provincial data centre using a secure web-based network.

If John Doe’s condition is found to be serious, and he is a candidate for surgery, the physician in the NHH ED can now request an immediate on-line consultation with a neurosurgeon assigned to the ENITS system from CritiCall Ontario.

Funded by the Ministry of Health and Long-Term Care, CritiCall (www.criticall.org) is a vital link in the health care chain--a 24-hour-a-day medical 9-1-1 emergency referral service for hospital-based Ontario physicians. Initially designed to offer capacity management to Ontario’s acute care beds, the system has been expanded to offer supports for specialty care such as neurosurgery.

In the case of NHH’s John Doe, the CritiCall neurosurgeon identifies a bleed in John’s brain as a result of the accident trauma and, rather than be admitted to NHH, he is promptly put on stand-by for an urgent air-ambulance transfer to a specialty centre for emergency surgery. The next steps in John’s timely care are assumed by the coordinators at CritiCall Ontario in conjunction with NHH ED staff. The NHH physician does not need to call centres in search of a bed and returns, instead, to his other patients in the ED while John Doe is transported to a suitable specialized centre in Ontario where, within hours of his injury, surgery is performed.

For Elaine Burr, Program Director for NHH’s ED, the system is a win-win for the hospital and for patients. “Ideal for smaller centres such as our own,” notes Ms. Burr, “this new, almost instant access to neurosurgery expertise is fantastic. It’s technology at its best and for patients, it can mean the difference between life and death. First, it will shorten the time it can take to identify the problem and set a plan in motion to address it. Second, it eliminates unnecessary hospital-to-hospital transfers. CritiCall will determine if a patient requires surgery and transfer and, then, which neurological centre has bed availability. We no longer have to call hospital after hospital to see if they will accept our patient on transfer.”

A third benefit is also anticipated by the NHH ED team. All ED and Intensive Care Unit patients given a head CT at NHH will now have their scans uploaded automatically into the provincial system. “In this way,” explains Ms. Burr, “if a patient deteriorates over time, the images will be in the system, eliminating the need to find someone (for example, in the middle of the night) to push them out for an urgent consult. While our volumes of head trauma are not large, our team is very excited about gaining access to this system. It speeds up the process considerably, and if it helps even one individual, that’s good news. We look forward to additional consultation access coming on stream in the future.”

Dr. Carson Kwok, Interim ED Chief at NHH, agrees: “We strongly support this new initiative and anticipate improved patient care as a result of the collaborative program.”

Submitted by Jennifer Gillard, Northumberland Hills Hospital