April 2024Feature articles

New alternative to emergency treatment for patients with irregular heartbeat

Clinical Access Service broadens scope to include atrial fibrillation

As soon as Heidy Jampen felt her heart starting to beat rapidly and irregularly, she knew she needed help—a situation that was soon confirmed when she saw her general practitioner.

But where to get the assistance she needed? The Emergency Department seemed like the obvious answer, but this wasn’t exactly an emergency. Although Ms. Jampen’s condition was serious, it was not so urgent that she had to be put on a fast-track for treatment.

Fortunately, a solution was available: The JGH’s Clinical Access Service had just broadened its scope to include patients with atrial fibrillation, the cardiac condition afflicting Ms. Jampen.

Since 2018, the Clinical Access Service, in the Medical Day Hospital in Pavilion K, has served as an alternative to the Emergency Department for patients who need prompt—but not immediate—care for certain types of serious medical conditions. In late January, atrial fibrillation was added to the list.

As a result, the referral from Ms. Jampen’s doctor was received on January 30 and an appointment was arranged for February 1, three days after the Service became available to patients with atrial fibrillation.

Accompanied by her daughter, Ms. Jampen underwent an electrocardiogram and was given a prescription for blood thinner to prevent clots, with additional tests performed later in February.

Where? When?

The Clinical Access Service is located in the Medical Day Hospital on the ground floor of Pavilion K. It sees patients by referral only, from 8:00 a.m. to 4:00 p.m., Monday through Friday.

“I’m so grateful I was seen with so little delay,” Ms. Jampen says. “Am I satisfied? Oh my goodness, yes! Everyone was wonderful.”

In addition to atrial fibrillation, the Clinical Access Service continues to see patients who are suspected of having:

  • Deep vein thrombosis (a blood clot)
  • A mini-stroke (a transient ischemic attack) in the previous two to 14 days

It also sees those who have:

  • Vaginal bleeding in the first trimester of pregnancy
  • Biliary colic and gallstones
  • Lung nodules
  • Painful inflammation of the colon (diverticulitis)

Besides helping to relieve the burden on the JGH’s Emergency Department, the Clinical Access Service conforms closely with the objectives of Care Everywhere, the broad-based, patient-centred approach to care in CIUSSS West-Central Montreal.

In implementing Care Everywhere, the network is striving for the best outcomes by providing patients with the right care at the right time in the location that is the safest, most appropriate and most convenient. In this instance, the Clinical Access Service is the most appropriate location for patients whose pressing needs (but stable condition) fall short of emergency status.

“The whole environment was very warm and very professional.”

Jessica Pinto, Head Nurse of the Service and of the Medical Day Hospital, says atrial fibrillation was added to the list in response to the growing number of cardiac patients who are turning for care to the JGH.

“The launch was a team effort and a major collaboration,” she says. “We worked with the Division of Cardiology, the Pharmacy and the imaging departments to make sure patients can easily get the tests, treatment and information they need.”

In general, Ms. Pinto explains, patients are referred by a family physician or nurse practitioner. However, if a patient happens to go on their own to the Emergency Department, the Emergency physician may decide that this person can best be helped with a referral to the Clinical Access Service.

Ms. Pinto also takes pride in the fact that the clinic is led by nurses “who run the show by using their critical thinking, judgment and experience. Of course, they collaborate with doctors whenever there’s any uncertainty or a need for medical guidance.”

“It’s the nurses who do all of the investigations and treatment,” adds the Service’s Clinical Nurse Specialist, Sorphea Hul. “They also handle the referral process after the patient is done with the Clinical Access Service.”

For Ms. Jampen, a big advantage was being seen in surroundings that are calmer than the Emergency Department, with ample opportunity to speak with members of staff, including a nurse who consulted with Ms. Jampen about her condition.

“The nurse put me at ease and made sure I got what I needed,” she says. “In fact, the whole environment was very warm and very professional.”

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