Diabetes care for children is team-based, says Vernon general pediatrician Eiko Waida.
“There are a lot of people involved. We have the patient, the patient’s family, sometimes multiple families, the nurse, the dietician, administration, different pediatricians – industry is the other big thing. We have pump trainers out in the community. It’s a lot of players,” she explained.
As a result, when the team isn’t working in a smooth, cohesive manner, dissatisfaction has a long way to spread. In 2019, Dr Waida recognized that managerial changes, operational barriers to care, and patient and staff departures had left the diabetes team at Vernon Jubilee Hospital – which serves 100 children in the North Okanagan – disturbingly fractured. “So I just thought, ‘I need to learn some tools to see whether or not I can re-engage the whole team again.’ Perhaps, with different techniques, I could bring the clinic back to a more functional program.”
Dr Waida became the medical lead of a Physician Quality Improvement (PQI) project that reunited the whole team – plus patient partners – to achieve this goal. They began with patient journey-mapping to identify the key components required for timely delivery of excellent care. The team established priorities and potential pathways, and created smaller working groups. But just as it began to click, the COVID-19 pandemic descended, forcing its members to shift their focus to the virtual provision of pediatric diabetes consultation.
The move increased workloads and highlighted gaps in the clinic’s technology and processes, but newly re-engaged team members found themselves more willing to overcome these obstacles than they might have been previously.
The Specialist Services Committee (SSC) and PQI were integral to the success of the transition, promoting the concept of the medical/operational dyad, a critical partnership for delivering patient-centered, cost-effective care; PQI continues to provide administrative, project and networking support. Dr Waida credits Operational Dyad Yvonne Taylor – Director, Primary Care, North Okanagan – with facilitating her work with members of the Interior Health (IH), IT and chronic disease management departments to change the clinic’s structure and improve its efficiency.
Meanwhile, clinic staff who had departed got back on board to finesse the virtual version, and families that had decided to step away from the hospital’s live diabetes clinic became re-engaged with it online.
Now the clinic’s elective appointments are conducted virtually with all team members – pediatrician, dietician, RN, family, patient, pump trainer – while sharing the patient's electronic data. This process has received positive feedback from families, some of whom want to continue visiting virtually in the future. One parent of a child with diabetes expressed delight after she realized that with this new system, she could make an appointment within the hour with Dr Waida and easily share the necessary information.
Going forward, the clinic plans to provide intensive diabetes education in the outpatient setting for newly diagnosed, medically stable Type I diabetic patients. The team is also looking critically at its clinic software platform to enable the collection of de-identified population-based data to optimize care.
Dr Waida hopes that by making visits/interactions easy for families, patient engagement will increase and, ultimately, improve glycemic control. The clinic is also piloting a secured email app to use with patients in order to improve their access to timely care.
All in all, she said, “I would say that we are probably more accessible as a team with virtual care than we ever were in person.”