RACE in a Box

“The service is available for all Physicians, Medical Residents, Nurse Practitioners and Midwives across the region, Monday to Friday from 0800-1700.”

The Rapid Access to Consultative Expertise (RACE) advice line was launched at Providence Health Care/Vancouver Coastal Health on June 21, 2010. The RACE model allows Physicians (SPs and FPs), Medical Residents (MRes), Nurse Practitioners (NPs) and Midwives to go to one online application or call one number and speak directly to specialists.

The service is available for primary care providers and specialists across British Columbia (BC), Monday to Friday from 0800-1700. The RACE online application and phone line provides structure through an organized specialist coverage rotation, timely call back and specialists who will provide an educational experience for primary care providers to enhance the care of their patients. RACE was launched with 5 specialty services. As of 2022, there are 80+ services available through RACE and plans to increase.

Provincial Specialties:

• Addictions Medicine (RACEapp+ only)
• Addiction Perinatal
• Allergy (RACEapp+ only)
• Cardiac Transplant (Telephone only)
• Cardiology – Heart Rhythm (RACEapp+ only)
• Cardiovascular Risk & Lipid Management (RACEapp+ only)
• General Internal Medicine – COVID-19 Long-Term Sequelae (RACEapp+ only)
• General Internal Medicine – Obesity (RACEapp+ only)
• HIV Care, Treatment and Prophylaxis
• Infectious Diseases – Acute COVID-19 Infection & Treatment (RACEapp+ only)
• Infectious Diseases – Tropical Medicine and Parasitology (RACEapp+ only)
• Medical Assistance in Dying Advice
• Medical Refugee Health
• Medical Termination of Pregnancy Advice
• Palliative Care (see below for details)*
• Parkinson’s Disease and Other Movement Disorders
• Physical Medicine and Rehabilitation (RACEapp+ only)
• Psychiatry – Adult Eating Disorders
• Psychiatry – Child & Adolescent (see below for details)**
• Psychiatry – Geriatric
• Psychiatry – Perinatal
• Rheumatology – Pediatric
• Sexual Assault Service (RACEapp+ only)
• Sexually Transmitted Infection Service (Telephone only)
• Sleep Disorders Service
• Thrombosis
• Trans Gender Care
• Vascular Surgery (RACEapp+ only)
• Work Safe BC †

Vancouver Specialties:

• Cardiology (RACEapp+ only)
• Emergency Medicine
• Endocrinology (RACEapp+ only)
• General Internal Medicine (RACEapp+ only)
• General Pediatrics (RACEapp+ only)
• General Surgery
• Geriatrics (RACEapp+ only)
• Heart Failure
• Hypertension (RACEapp+ only)
• Infectious Diseases – Adult (RACEapp+ only)
• Medical Assistance in Dying Advice
• Nephrology (Telephone only)
• Neurology (RACEapp+ only)
• Obstetrics and Gynecology (RACEapp+ only)
• Ophthalmology (RACEapp+ only)
• Orthopedic Conditions – Hand & Upper Limb
• Orthopedic Conditions – Leg, Foot and Ankle
• Otolaryngology/ENT (RACEapp+ only)
• Psychiatry – Adult (RACEapp+ only)
• Radiology (RACEapp+ only)
• Respirology
• Rheumatology (RACEapp+ only)
• Tuberculosis

Fraser Valley Region Specialties (RACEapp+ only for all specialties listed below):

• Cardiology
• Emergency Medicine
• Endocrinology (09:00-17:00)
• Geriatrics
• Infectious Diseases – Adult
• Liver/Pancreas Surgery
• Nephrology
• Neurology
• Psychiatry – Adult
• Rheumatology

Vancouver Island Specialties (RACEapp+ only for all specialties listed below):

• Cardiology
• Gastroenterology
• General Internal Medicine
• Geriatrics
• Gynecology
• Hematology
• Infectious Diseases – Adult
• Palliative
• Plastic Surgery
• Psychiatry – Adult
• Psychiatry – Geriatric
• Psychiatry – Sexual Medicine (09:00-17:00)
• Rheumatology

Northern Specialties (RACEapp+ only for all specialties listed below):

• Cardiology
• Chronic Pain
• Gastroenterology
• Infectious Diseases – Adult
• Nephrology
• Orthopaedics (Limited Availability)
• Psychiatry – Adult
• Radiology
• Rheumatology

† Physicians & Nurse Practitioners can only bill if they have a patient with a claim

*BC Provincial Palliative Care Consultation Line (Toll free, 24/7) 1-877-711-5757

• For those who do not have access to a local palliative care service, for advice or support, call 1-877-711-5757. In ongoing partnership with the Doctors of BC, the toll-free Provincial Palliative Care Consultation Phone Line is staffed by Vancouver Home Hospice Palliative Care physicians 24 hours per day, 7 days per week to assist physicians and nurse practitioners with advice about symptom management, psychosocial issues, or difficult end-of-life decision making.

**Psychiatry – Child & Adolescent: Call Compass Mental Health (Toll free, 9am-5pm) 1-855-702-7272

• Compass is a consultative service available to providers across BC working with children and youth with mental health and substance use concerns. The Compass multidisciplinary team can help with diagnostic clarification, medication recommendations, and treatment planning. Calls to Compass are answered by an experienced clinician and take approximately 15-20 minutes. The clinician will triage the call and determine whether Compass can provide day-of support from a Compass child and adolescent psychiatrist. Providers can learn more about Compass and access resources, toolkits, and upcoming webinars at compassbc.ca

Family Physicians
Hold focus groups with family practitioners to determine what the need is:

• Are there pre-existing established patterns of communication?
• Are there specialty areas that are hard to gain access to?

Specialists

• Hold focus groups with specialists to determine usual patterns of communication, availability, interest and need for structure.

Setting up a phone line

Contact your health region telecommunications representative.
Contact your provincial telephone provider.

You can set up a simple telephone line with telephone trees.

• Local line
• 1-800 line if you are expecting long distance calls
• Telephone tree structure
• Monthly reports – the telecommunication company can provide some information on calls. Inquire what information is available
• Consider other alternatives like an online application. Contact the RACE team at RACE@providencehealth.bc.ca for more information.

Provider Expectations – Appendix B

• Timeliness – Call back within two hours, preferably as soon as possible
• Collegiality – Respectful interaction
• Educational – Increase the capacity of primary care

User Expectations – Appendix C

• Consider using a structured communication approach such as SBAR:
  (Situation, Background, Assessments and Recommendation)
• Be aware of and what RACE is and what RACE is not – see Appendix C
• Provide a direct cell number for callback (not a clinic number)
• Ensure profile information, including billing number, is accurate and up-to-date
• If a patient is already under the care of a specialist, consult them first
• If local specialists are available in your region, consult them first

Administrative Support for RACE

• At least one central person is needed
  • to create, organize, and upload schedules into the online application
  • to re-route the telephone numbers weekly or as necessary when there is a change
  • to oversee the schedule and ensure there are no gaps in coverage – manage the spread sheet for the rotations
  • to follow up on unanswered calls
  • to follow up on difficult to answer calls

Bringing on a New Service

• Engage there is a “physician lead” for each specialty to answer group questions and help with scheduling gaps
• Each specialty should have greater than three physicians providing advice to ensure consistent and sustainable coverage
• Each specialty area identifies an administration assistant or specialist who
  organizes the RACE coverage schedule for their area and communicates the
  schedule and any changes to the central administrative support person
• Scheduling of the line should be shared with the central administrative person or team at least 1-2 months in advance
• Coverage of the line is suggested for 1 week blocks

Advantages of Using an Online Application

• Specialists can use email, cell phone or pager number to receive notifications about requests for advice
• Primary care providers are able to enter patient information in the app to support billing requirements
• Specialists are able to access patient and billing information when they receive a request for advice

User Onboarding and Registration

• All users should be aware of documentation requirements as outlined by their professional college
• All users should record any RACE-related “note to file”
• Users are responsible for their own billing processes

Issues and Concerns to Address
It is important to consider the needs of the areas and respect existing, well established communication patterns. RACE is meant to fill a gap and not interfere with existing communication patterns

• No disruption to preexisting referral patterns
• Ensure capacity of specialist to cover the calls
• Protocols for managing volume increases
• Ensure alignment with other adjacent, regional, provincial structured
  telephone advice (both existing or other who wish to expand)
• Protocols for managing quality

Recommendations

• Keep it simple – you want it to be easy for the user
• Be responsive – follow up on all unanswered calls
• Gain feedback from the providers and users

Supplementary Questions for RACE Implementation Decision Tree

1. What is your catchment area – hospital based, regional based?
2. How many family practice physicians are within your catchment area or area based on normal GP/Specialists referral patterns?
3. Do FPs encounter difficulty accessing specialists?
4. Are there particular specialists groups that have been identified as challenging to access?
5. Do FPs have an informal list of specialists they can easily access?
6. When FPs call specialists do they get a timely response?
7. Do conversations currently take place that support the FP (education, or confirmation of treatment plan) to avoid a face to face consult?
8. Do FPs normally consult with specialists outside your catchment area? If so which specialists where? Do they do this even when there is a specialist within? Why?
9. What are the number and mix of specialists within your catchment area?
10. Do you have a critical mass of specialists that are willing to support this?
11. What is the long-term vision? How do you see it evolving?
12. Specialists are requested to meet quality standards developed to ensure uptake (e.g.: timely return of calls within ~15 minutes, time spent on the call, ~ 10 min, willingness to have a collegial, educational discussion, call schedule availability)
13. Who will “own” the service? Recruitment, invitations, adding new specialties, usage statistics / evaluation, quality assurance, issues management, etc.?
14. Do you have a dedicated person that will be responsible for the administering the online application and telephone system?
15. Do you have funds to support an advice line?

Specialists provide timely telephone advice to Physicians, Medical Residents, Nurse Practitioners, Midwives, Monday to Friday, 0800 – 1700.

What RACE provides:

• Timely guidance and advice regarding assessment, management and treatment of patients
• Assistance with plan of care
• Teaching opportunities — educational and practical advice
• Enhanced ability for FPs to manage patients in their offices
• Calls returned within 2 hours and commonly within an hour

What RACE DOES NOT provide:

• Appointment booking
• Results of diagnostic investigations to the referring physician
• Arrangement of:
  • Transfers within 24 hours
  • Laboratory or diagnostic investigations
  • A hospital bed

Answering a call:

• The goal is to answer the call as close to “real time” as possible, with a maximum response time of 2 hours
• Use the opportunity for teaching
• Facilitate a collegial interaction
• Length of call usually varies between 5 – 15 minutes

Unable to answer calls?
If you are not able to get through to the primary care provider’s number, please email RACE@providencehealth.bc.ca. The RACE administration team will follow up with the user.

Billing Information:
Billing code G10001 — $60.00 — for calls returned within 2 hours
For questions or feedback related to RACE, call 604-806-8558 or email RACE@providencehealth.bc.ca

RACE means timely telephone advice from specialist for Physicians, Medical Residents, Nurse Practitioners, Midwives, all in one phone call.

Monday to Friday 0800 – 1700

Online at www.raceapp.ca or though Apple or Android mobile device. For more information on how to download RACE mobile applications, please visit www.raceconnect.ca/race-app/
Local Calls: 604–696–2131 | Toll Free: 1–877–696–2131

For a complete list of current specialty services visit the Specialty Areas page.

What RACE provides:

• Timely guidance and advice regarding assessment, management and treatment of patients
• Assistance with plan of care
• Learning opportunities — educational and practical advice
• Enhanced ability to manage the patient in your office
• Calls returned within 2 hours and commonly within an hour
• CME credit through “Linking Learning to Practice http://www.cfpc.ca/Linking_Learning_to_Practice/

What RACE DOES NOT provide:

• Appointment booking
• Arranging transfer
• Arranging for laboratory or diagnostic investigations
• Arranging a hospital bed
• Informing the referring physician of results of diagnostic investigations

Unanswered Calls?
If you call the RACE line and do not receive a call, please email RACE@providencehealth.bc.ca or call 604-696-2131 (press 0). All unanswered calls will be followed up on.

Billing Information:
All with a specialist fee – $40.00

For questions or feedback related to RACE, call 604-696-2131 (Press 0) or email RACE@providencehealth.bc.ca

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