Unique SFMH program helps outpatients with heart and lung issues

The Cardiopulmonary Rehabilitation Program at St. Francis Memorial Hospital (SFMH) helps people living with heart and lung conditions. This satellite program of the Ottawa Heart Institute (OHI) is delivered in Barry’s Bay via telemedicine under close supervision by local healthcare personnel. Shown above with some of their equipment are team members (from left) Anne Burns (Cardiac Rehab Nurse), Lindsey Stamplecoskie (Physiotherapy Assistant), Nadine Utronkie (Respiratory Therapist).

The team uses a live two-way video link with OHI, follows OHI protocols and meets with their supervisor regularly. SFMH administration worked closely with OHI and other sites like Hawkesbury & District General Hospital to develop satellite rehab programs which are especially important in isolated rural areas. The SFMH Cardiac Rehab program began in 2013 and has permanent funding thanks to a successful proposal to the Champlain Local Health Integrated Network in 2014. In 2018 SFMH was the first satellite program to add the pulmonary rehab component when Utronkie (of the Lanark Renfrew Lung Health Program) joined the team.

Patients in the Cardiopulmonary Rehab program

Burns and Utronkie told The Current that if people have a history of heart disease or breathing problems, the rehab program is a local resource to help them get strong in conjunction with their medications. It is secondary prevention – an adjunct to medical care. Their catchment area is bounded by Whitney to Golden Lake and Round Lake, and south to Palmer Rapids and Quadeville. The program is covered by OHIP and all patients must be referred by a physician who certifies they are clinically strong enough for rehab. Referral reasons vary:

• Most patients come directly from OHI following a recent heart event, surgery or procedure.
• Family doctors refer patients with a history of heart disease when they have become de-conditioned.
• Patients with a history of lung disease, e.g. Chronic Obstructive Pulmonary Disease (COPD) that affects their ability to live well are referred for pulmonary rehab.
• Some people have both cardio and pulmonary issues. Very often they have become de-conditioned.

In general, if people with a history of heart disease find they become tired easily and can’t get their breath, they should speak to their GP about a referral to the program. It is particularly beneficial to catch COPD early, but Utronkie says that working people have difficulty getting time to attend the program and the elderly often experience transportation issues.

How the rehab program works

Each one-hour session is linked via live telemedicine with the OHI rehab program (big screen TV shown above in education area). There is an initial nurse assessment. Patients receive constant monitoring for heart rate (unique to SFMH) and oxygen saturation, and specific readings are taken at ten minutes. After a five to ten minute warm-up, they do two fifteen minute exercise sessions on machines with a rest and time for a drink of water between. The cool-down period (equally important) is also monitored. Two members of the team are always present during the session to teach patients how to monitor themselves for safe exercise at home.

The ten to twelve week program offers a staggered entry so patients join as they are referred or when a space opens up. There is a maximum of eight people per session – all at different stages of rehab. The team refers patients to the Senior Fitness exercise programs at the Opeongo Senior Centre in Barry’s Bay after they have completed the rehab program. (A similar program is starting soon in Palmer Rapids.)  Patients who could self-monitor were referred to the Madawaska Valley Fitness Centre at the high school before it closed. The team maintains close links with the specially trained and qualified leaders of the Senior Fitness exercise programs. A team member calls every rehab patient on a six-month follow-up to check on progress and to offer refresher courses as needed.

Demonstrating equipment: Nadine Utronkie (left) and Anne Burns; Lindsey Stamplecoskie

How patients are referred

It is not only OHI or their GP who refers a patient to the cardiopulmonary rehab program. Utronkie spends two and a half days per week at the Madawaska Valley Family Health Team (MV FHT), providing respiratory therapy and education to patients. Also if she sees patients in SFMH Emergency Department who could benefit from the rehab program, she will contact their family doctor for a referral.

No family doctor?

The rehab team works closely with Ontario Telemedicine Network and with Renfrew County Community Paramedics to provide family practice-level medical care under OHIP for orphan patients with cardiopulmonary issues. Burns says that out of the 1300 “orphaned” patients on the MV FHT’s consolidated waiting list, an estimated 400 to 500 have chronic conditions. So six months ago SFMH began offering a secondary prevention orphan clinic focussing only on cardiopulmonary conditions. The Cardiopulmonary Rehab team at SFMH has specialist equipment and training. The nurses can listen to heart tones and breath sounds, and their telemedicine physician (who has 25 years family practice experience) on the other line can hear directly. The orphan clinic establishes a good history and sees patients regularly to monitor their bloodwork and medications. The Community Paramedics can visit patients without transportation to take blood samples so that when the patients do come to SFMH for their telemedicine consultation, the doctor has already seen their test results.

Mary-Ellen Harris, CNE and Director of Patient Care Services at SFMH, says, “Anne, Lindsey and Nadine continue to deliver world class treatment right here at home.  We continue to develop innovative ways to ensure the best quality care can reach those who need it.”

Burns says anyone with questions about the program can leave a message at the rehab clinic. She works three days a week and will call them back as soon as possible to discuss whether the rehab program (or the orphan clinic) is suitable for them. 613.756.3044 Ext. 366.