Collaborative Practice in a

1
Collaborative Practicein a

• Pediatric Consultative Clinic

at the Burntwood Regional Health Authority
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Current Pediatric Situation in the BRHA

• No full time pediatrician- 3 vacant positions
• Pediatric services are carried out by the NP and
  a locum pediatrician.
• One full time NP
• 13 different locum pediatricians in the last year
• Varied time periods they stay (days to a month at
  a time)

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Pediatric Practice

• In-patients
• Ward
• Level 2 nursery
• Consultative Clinic
• On call for Thompson and surrounding Aboriginal
  Communities
• Teaching center

4
Practice Similarities

• Brenda (NP) Andrew (MD)
• Hospital admission privileges
• Ward rounds (done together)
• Clinic
• no difference in the types patients booked
• Travel to outreach clinics
• Attend C-sections for high risk deliveries

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Practice Differences

• Brenda (NP)
• Not on call
• No prescriptive authority for narcotics /or
  stimulant meds
• Andrew (MD)
• On call
• Has prescriptive authority for narcotics /or
  stimulant meds

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Elements of Success

• Get along
• Mutual respect
• Mutual recognition of limitations
• Common goals

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Elements of Success

• Unique experience of northern medicine and
  culture is shared with visiting MD.
• NP has an expertise in conditions not often seen
  in the urban centers.
• Expand my experience and knowledge base, i.e.
  what was old hat to Brenda was new to me.

8
Elements of Success

• Brenda provides a vital continuity of care to
  patients and as well a comprehensive follow up.
• Providing unique insight and experience that
  majority dont get.

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Elements of Success

• Brenda has a more practical/holistic approach vs.
  theoretical approach.
• Our styles complement nicely and in the end
  provides the patients with better care.
• Always good to have second opinions and a person
  to bounce ideas off.

10
Practice Impact

• Patient satisfaction
• 2 complementary approaches to one patient
• Job satisfaction
• High satisfaction

11
Practice Impact

• Patient outcomes
• Quality improvements in patient care

12
Barriers for Us!

• Thompson vs. Hamilton

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Although proven to work together
14
Modern Technology
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Email

• Title SOS
• Hi Andrew, looking for some help.remember our
  patient Ally, 18 months old with WBC of 45 and a
  sky high alk phosshe is back.her LDH is high
  now.CBC has settled somewhat, her MRI indicates
  subcorticol white matter atrophy bifrontally 
• Re-admitted her and working her up more..
• What have you got to say todaycome on give me
  some more differentials

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Why it works in general

• Addresses shortage of physicians
• As double the number of pts can be seen with
• Short reviews with MD
• Majority of cases do not need exhaustive work ups
  and can comprehensively be done by NP

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Why it works in general

• Short reviews with collaborating physician for
  exhaustive work-ups
• Difference in training complements each other
• Examples health promotion and disease
  prevention, patient advocacy

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Questions

• Thank you for the opportunity to share our
  collaborative practice with you.
• Happy to answer any questions