AVH Presentation re Annapolis CEC

August 22, 2012
Revision by OCECC of Transcription of notes taken by Dave Tinker.

First the good news: 3 new consulting rooms have been opened to house Specialists in onsite clinics (ObGyn, Urology, Internal Medicine, and in the fall, Pediatrics).

The In-Patient beds and Palliative beds will remain.

Regular bloodwork collection is still available from 8am to 9.30am

X-Ray services are still available, from 8am to 4pm, at present 7 days a week

Urgent bloodwork for ER patients is now being obtained through Point-of-Care blood analysis, which provides prompt bedside test results. ACHC has always sent some blood test to SMH and VRH for analysis. Now some additional tests also have to be sent out for processing.

The new X-Ray table and 6 new hospital beds have arrived or are arriving and installed. In addition one new Family Physician and two Family Practice Residents are already on staff, and there is to be another Resident on staff coming next July.  (Residents are fully qualified MDs getting advanced training)

At this time these additional Doctors will not be taking on new patients.

The CEC “target” implementation date is Sept. 17.  There will be a community meeting on Monday Sept. 10 at 6:30 PM in King’s Theatre to brief the public, and we anticipate that a brochure (which we have discussed) may be available by then.

Walk-in Emergency Care will continue to be provided by the On-Call Doctor to anyone who presents to ACHC CEC from wherever, as it is at present.

The big surprise: there will be enhanced Primary Health care access with a Physician or Nurse Practitioner, through the Annapolis CEC, aimed at the people who live in the “Defined Population” area, basically the western slice of Annapolis County plus the village of Bear River.  Folks in Clarence or Digby, for example, are excluded from that area. People who live outside the boundary, unless they already have a family doctor here (i.e. Collaborative Family Practice or  Dr. Buchholz) should be seeking Primary Health care from their local Doctor or Hospital, i.e. Middleton, Digby or Liverpool etc.

When a patient presents to ACHC CEC, they will be triaged by a Nurse, as at present. If they have an urgent medical need they will be seen promptly by the on-call CEC physician, as at present, regardless of where they live.

If their need is less urgent and the patient lives within the local defined population, and/or are on the list of a local Physician, they will be directed to their Doctor’s Office where they should be offered a same day or next day appointment. The Collaborative Practice will have a Duty Clinician each day, whose appointments will not be pre booked, but will be available for same day or next day appointments. Dr Buchholz runs his Office with flexible scheduling to accommodate demand day by day. This will be an improvement in access to Primary Care for this group of patients.

If their need is less urgent and the patient lives within the local defined population and have no local physician, they will able to be offered a same day or next day appointment with the CEC Duty Doctor – this will be a huge improvement in access to Primary Care for this population who currently have little or no access to a Doctor other than through the ER.

If their need is less urgent and the patient lives outside the local defined population and are not on the list of an Annapolis Physician, then they will be invited to sit and wait to be seen in turn, as at present. There will be no decrease in health care access for this population. This would be the case for “an American tourist who develops a sore throat” or a hiker from Keji.

ACHC Catchment Area Map

The prioritisation for the CEC Duty Doctor’s time will be:

  1. urgent clinical cases
  2. same day or next day appointments
  3. non-pre-booked patients

EHS will not bring acute care or emergency patients to ACHC, rather the patients will be taken directly to the nearest adequately equipped and resourced ER at Middleton, Kentville or Digby. This has been decided so as to provide dedicated timeslots for same day or next day appointments with the CEC Duty Doctor.

When Digby or Middleton ERs are known in advance to be closed, ACHC CEC will not be able to offer same day or next day appointments due to the additional workload that inevitably arrives. However, DHW plans are expected to mean that these closures will not be continuing to occur.

The night time emergency service will be staffed by an RN, an LPN and an on site paramedic with Primary Care Level training (this is the most basic of the three levels of Paramedic training), with access by telephone to an on-call EHS physician.  If you call 911, ambulance will take you to the most appropriate hospital, which will be direct to Kentville if it is something life threatening like heart attack or stroke, as at present.  If you present yourself at ACHC, the team (nurse, paramedic, and on-telephone EHS doctor) will decide whether or not to transport you to Kentville, keep you till morning, or send you home.

In the long run, many aspects of primary care should improve a lot.  For example, an up to date and comprehensive online medical records system has already been implemented, probably the best in the province.  This will ensure that wherever we need care, our information on illnesses, prescription status etc. will be available to the caregiver.  This will also allow the team to collect accurate statistics on what care is actually needed in our area, something which is only guesswork now.  And there are plans to implement much improved follow-up care and home care, making it possible for people to remain in their own homes as long as possible.  All these things should make for better and more efficient medical care.


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