When I left the hospital after my initial Afib episode, I had a referral to the AFQCP, the Atrial Fibrillation Quality Care Program at Women’s College Hospital for Wednesday of last week. Women’s College has been rebuilt in recent years as an outpatient medical centre. It is a beautiful new building, upbeat and efficient. I had no idea what superb care I would get there.
When I arrived at the Ambulatory Acute Care Centre, I was shown to a room where a nurse practitioner took my blood pressure, gave me an ECG and took my weight. She was a charming young woman who has been trained as a personal support worker and works during the week in Women’s College and also on call during weekends at the Michael Garron Hospital (the former Toronto East General). She told me how PSWs can train in hospitals and, using their formal training and their work-day experience, follow a path into second year Nursing studies.
I then met the Internal Medicine doctor. She had at her fingertips all the medical records created by the Toronto Western Hospital the previous week. Apparently, all medical records created in GTA hospitals are stored electronically and accessible according to privacy protocols. She reviewed my medical history and my medications, explained the nature of the condition, and the pros and cons of the medications I would need to take in the future. Apart from the regular blood-thinners, she also gave me a prescription for a medication that would settle any future Afib incidents. She ordered an echocardiogram and a Holter test.
Then, the unit pharmacist came into my room. This was a totally novel experience. She explained how the medications worked. She confirmed that taking Tylenol for my arthritis (which I have been hesitant to do) would not conflict with any of the other pills. And we had a discussion about expiry dates on medications. She said that I should gather up all the expired pills (both prescribed and over-the-counter) in my household and take them to my local pharmacy for disposal in their program. Throwing pills away in the garbage or the toilet contaminates the environment and the water system.
A doctor who specializes in respirology then arrived. He had a lovely accent and, in response to my question, told me that he had come from southern Ireland nine years before. He is conducting research into the relationship between sleep apnea and Afib. He questioned me at length on my sleep patterns and suggested that I might benefit from an overnight sleep test in a sleep lab. He then explained that his team was testing a new apparatus for “sleep tests” that patients could do at home. He showed me how it worked and asked me to take it home to use for one night. Once I’d done it, I was to return the memory card to him in a self-addressed, stamped envelope. Why not? He told me to expect a call offering me convenient dates for the Lab Sleep Test. That will be interesting.
I was then sent upstairs for the echocardiogram. This ultrasound of the heart is the basic tool used by cardiologists to assess the working of the heart. I had scarcely sat down in the waiting room when I was called to the technician. After I had climbed up on the table and moved into the appropriate position, she set to work: “Breathe in, breathe out, hold it, breathe in a little, hold it, a little more, hold it, breathe out.” The procedure went on for quite some time. The swirling forms and colours on the screen of the machine were mesmerizing. I occurred to me that this is the raw data that my nephew must work with every day. The technologist knew what it was all about. She told me that she has been doing this work for twenty years and that she came from Moscow. I reflected how lucky we are in Canada to have the benefit of so many skilled immigrants.
When it was over, I left the hospital with an After Visit Summary which included my health data accumulated that day, the changes in my medications, instructions for the two further tests, the date I am to return for the followup appointment, the names of the people who had met me that morning, and all the relevant contact information.
What an amazing morning. In less than four hours, I had seen a nurse practitioner, an internist, a respirologist, a pharmacist, had an echocardiogram, and was set up for two further procedures that would complete the workup. What in the past would have taken several months of visiting various doctors’ offices and labs was done in a morning. And I had all the relevant information at my fingertips. An example of one-stop patient-centred service, clearly Cadillac service in a Cadillac facility. Thanks to all the warm and wonderful people who staff the program.