How an experiment in Nova Scotia helped rural doctors get more sleep

Nova Scotia Health is reporting success with a small-scale experiment to help rural emergency doctors get more sleep while working alone.

For three weeks this spring, emergency rooms in Neils Harbour and Canso were staffed by only one doctor on call 24 hours a day. 

Nova Scotia Health asked ambulance provider EHS to let its overnight emergency doctor assist by phone with minor health matters.  

"We're looking at innovative ways to better support these rural sites," said Angela MacArthur, director of integrated health for the rural sites in the province's eastern health zone.

Normally a doctor at a rural emergency room sees every patient in person, day and night.

But Dr. Andrew Travers, the EHS medical director, said this can lead to days of working around the clock.

"It's really important for those docs to get some rest, particularly at night, so they can be fresh in case they get called in, or be available to take care of patients the next day. So that's where we came in as EHS," Travers said. 

Travers, an emergency doctor at the QEII Health Sciences Centre in Halifax, he works in-person at the EHS's ambulance command centre in Dartmouth.

In a normal shift, he advises paramedics on their treatments in the field. 

But for three weeks this spring, he was on standby to take phone calls from nurses working overnight at rural emergency departments. 

Travers said he took a handful of calls giving advice to patients with minor complaints.

Minor complaints

"They have sore throats, or they have rashes, or urinary tract infections or sprains. Simple kinds of things," he said. 

This allowed the on-call doctors to stay at home in bed.

Travers said he can even phone in prescriptions to a patient's pharmacy. 

But he said he only gets involved in non-urgent cases. Nurses call the doctor in for everything else. 

"If patients are unwell, and they're having the worrisome symptoms, then normal things happen. They call in the doc, and the doc on site arrives there and helps manage the case," Travers said. 

MacArthur said the overnight support was appreciated by both doctors who spent up to two weeks covering ERs alone. 

Positive feedback

"It was two physicians, one at each site. And … we've had positive feedback from both of them," she said. 

MacArthur said the system needs more study to see if it's sustainable at a larger scale. 

But she hopes it could eventually be introduced at other emergency sites in her health zone. 

"We don't have the number of resources that larger facilities have, right? So we depend on a smaller number of people to provide that service," she said.