Stuart Iglesias1, George Carson2, C Ruth Wilson3, Beverley A Orser4, David R Urbach5, Ryan Falk6, Douglas Hedden7, Victor Ng8, Roy Wyman9, Mark Walsh10, Nancy Humber11, Peter Miles12, Jennifer Blake13. 1. Retired rural family physician with anesthesia and surgical skills in Bella Bella, BC. siglesias64@gmail.com. 2. Clinical Professor of Obstetrics and Gynecology at the University of Saskatchewan in Saskatoon. 3. Professor Emerita in the Department of Family Medicine at Queen's University in Kingston, Ont, and a family physician practising in Yellowknife, NWT. 4. Chair and Professor in the Department of Anesthesiology and Pain Medicine in the Temerty Faculty of Medicine at the University of Toronto in Ontario and the Department of Anesthesia at Sunnybrook Health Sciences Centre in Toronto. 5. Professor of Surgery and Health Policy, Management and Evaluation at the University of Toronto, and Head of the Department of Surgery at Women's College Hospital in Toronto. 6. Clinical Instructor in Rural Family Medicine and Adjunct Professor in the Branch for Global Surgical Care at the University of British Columbia in Chilliwack. 7. Professor Emeritus at the University of Alberta in Edmonton. 8. Assistant Professor in the Division of Emergency Medicine of the Schulich School of Medicine and Dentistry at Western University in London, Ont, and Associate Director of Programs and Practice Support for the College of Family Physicians of Canada. 9. Assistant Professor at the University of Toronto and Director of Certificates of Added Competence at the College of Family Physicians of Canada. 10. Assistant Professor of Surgery at Dalhousie University in Halifax, NS, and President of the Canadian Association of General Surgeons. 11. Rural family physician in Lillooet, BC, and Clinical Assistant Professor at the University of British Columbia. 12. Assistant Clinical Professor at the University of Alberta in Grande Prairie and Chair of the Canadian Association of General Surgeons Rural Surgery Committee. 13. Past Chief Executive Officer of the Society of Obstetricians and Gynaecologists of Canada; and Adjunct Professor of Obstetrics and Gynecology at the University of Ottawa in Ontario, at the University of Toronto, and at McMaster University in Hamilton, Ont.
Abstract
OBJECTIVE: To describe the essential components of well-resourced and high-functioning multidisciplinary networks that support high-quality anesthesia, surgery, and maternity care for rural Canadians, delivered as close to home as possible. COMPOSITION OF THE COMMITTEE: A volunteer Writers' Group was drawn from the Society of Obstetricians and Gynaecologists of Canada, the Society of Rural Physicians of Canada, the Royal College of Physicians and Surgeons of Canada, the Canadian Association of General Surgeons, the College of Family Physicians of Canada, and the Association of Canadian University Departments of Anesthesia. METHODS: A collaborative effort over the past several years among the professional stakeholders has culminated in this consensus statement on networked care designed to integrate and support a specialist and non-specialist, urban and rural, anesthesia, surgery, and maternity work force into high-functioning networks based on the best available evidence. REPORT: Surgical and maternity triage needs to be embedded within networks to address the tensions between sustainable regional programs and local access to care. Safety and quality must be demonstrated to be equivalent across similar patients and procedures, regardless of network site. Triage of patients across multiple sites is a quality outcome metric requiring continuous iterative scrutiny. Clinical coaching between rural and regional centres can be helpful in building and sustaining high-functioning networks. Maintenance of quality and the provision of continuing professional development in low-volume settings represent a mutual value proposition. CONCLUSION: The trusting relationships that are foundational to successful networks are built through clinical coaching, continuing professional development, and quality improvement. Currently, a collaborative effort in British Columbia is delivering a provincial program-Rural Surgical Obstetrical Networks-built on the principles and supporting evidence described in this consensus statement.
OBJECTIVE: To describe the essential components of well-resourced and high-functioning multidisciplinary networks that support high-quality anesthesia, surgery, and maternity care for rural Canadians, delivered as close to home as possible. COMPOSITION OF THE COMMITTEE: A volunteer Writers' Group was drawn from the Society of Obstetricians and Gynaecologists of Canada, the Society of Rural Physicians of Canada, the Royal College of Physicians and Surgeons of Canada, the Canadian Association of General Surgeons, the College of Family Physicians of Canada, and the Association of Canadian University Departments of Anesthesia. METHODS: A collaborative effort over the past several years among the professional stakeholders has culminated in this consensus statement on networked care designed to integrate and support a specialist and non-specialist, urban and rural, anesthesia, surgery, and maternity work force into high-functioning networks based on the best available evidence. REPORT: Surgical and maternity triage needs to be embedded within networks to address the tensions between sustainable regional programs and local access to care. Safety and quality must be demonstrated to be equivalent across similar patients and procedures, regardless of network site. Triage of patients across multiple sites is a quality outcome metric requiring continuous iterative scrutiny. Clinical coaching between rural and regional centres can be helpful in building and sustaining high-functioning networks. Maintenance of quality and the provision of continuing professional development in low-volume settings represent a mutual value proposition. CONCLUSION: The trusting relationships that are foundational to successful networks are built through clinical coaching, continuing professional development, and quality improvement. Currently, a collaborative effort in British Columbia is delivering a provincial program-Rural Surgical Obstetrical Networks-built on the principles and supporting evidence described in this consensus statement.
Authors: Stuart Iglesias; Jude Kornelsen; Robert Woollard; Nadine Caron; Garth Warnock; Randall Friesen; Peter Miles; Victoria Vogt Haines; Bret Batchelor; Jenny Blake; Garey Mazowita; Roy Wyman; Brian Geller; Braam de Klerk Journal: Can J Rural Med Date: 2015
Authors: Katherine J Miller; Carol Couchie; William Ehman; Lisa Graves; Stefan Grzybowski; Jennifer Medves Journal: J Obstet Gynaecol Can Date: 2012-10