Not too long ago, emergency room physicians in Ontario who required a consultation with a specialist or the transfer of a critically ill patient to a better equipped hospital could spend hours on the phone calling around for help.

The establishment in 1995 of CritiCall Ontario revolutionized emergency care by replacing a time-consuming, inefficient process with a centralized, province-wide 911 service for hospital-based physicians. Now in its 14th year, CritiCall Ontario has raised the bar once again, having relocated to a stand-alone call centre facility equipped with state-of-the-art telecommunication and computer technology.

CritiCall agents are now a few clicks away from all of the information they require to connect an emergency room physician with a specialist or to transfer a patient to another hospital.

Instead of flipping through binders, agents are able to search a database of 7,500 physicians by specialty, access their on-call schedules and place calls to their cell phone, pager or office numbers right from their computer. If a decision is made to transfer a patient, the call agent can quickly access real time data on intensive care unit capacity at hospitals across the province, and conference in ambulance service dispatchers and physicians from the receiving hospital to sort out the logistics.

CritiCall’s new call centre technology now allows it to record all calls for quality improvement, training and legal reasons.

Of the 14,246 calls handled by CritCall in the year ending March 2008, 751 came from the Northeast LHIN and 426 came from northwestern Ontario.

CritiCall attempts to link emergency room physicians with specialists as close to the caller’s site as possible and to transfer patients to hospitals close to home, but will search province-wide if necessary.

“We’re also fortunate to have some very high-quality institutions in neighbourin g jurisdictions that have the capacity to help,” said CritiCall executive director Kris Bailey, referring to hospitals in border cities such as Buffalo, Detroit, Duluth and Sault, Michigan. Patient transfers to Winnipeg can also be arranged for patients from Kenora, Rainy River and other northwestern Ontario communities.

Unique service

According to Bailey, CritiCall Ontario is unique in North America in terms of its scope. The only jurisdictions with similar services that she’s aware of are British Columbia, which has a system for locating hospital beds, and Seattle, Washington, which offers a citywide service.

Based in Hamilton, CritiCall operates on a 24/7 schedule with 19 call agents. There are also seven field staff, who market CritiCall, help with issues and liaise with hospitals and physicians across the province.

Physicians requiring a consultation with a specialist can try to call around themselves, said Bailey. “If they’re lucky enough to get someone right away, fine, but, if not, it’s a poor use of their time because they’re doing the same thing we’re doing. If they call us, they don’t have to sit on the phone and negotiate to have a patient transferred.”

Physicians participating in a recent survey made it clear how little they enjoy sitting on the phone, persuading CritiCall management to reverse a long-standing policy preventing them from delegating the job to nurses.

“If you’re the only physician in the emergency department and you have more than one patient, it’s understandable,” said Bailey.

CritiCall recently rolled out a neurosurgical referral service and has launched extramural paediatric critical care response teams. Through the latter, any physician in any Ontario hospital caring for a critically ill child can access a paediatric intensivist at one of the four paediatric academic centres.

Another recent enhancement is an emergency neurosurgical imaging transfer system that will make CT images available through CritiCall. This service is currently being piloted in London and Windsor.

The call agent’s job can be “extremely stressful,” said Bailey. “You can get specialists yelling at you, or run into problems with a patient transfer because everyone’s full. You feel you’re to blame. In the year ending March 2008, CritiCall arranged for the transfer of 8,897 patients. The average time for first physician response was 13.8 minutes and the average time to patient acceptance was 55.4 minutes.

www.criticall.org