HealthLink 811

Report 20112012
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Table of Contents

Letter to Minister from Executive Director............................................................. 1

Healthlink 811 Objectives..................................................................................... 2

Overview.............................................................................................................. 3

Services................................................................................................................ 4

Caller Satisfaction and Quality Assurance............................................................. 5

System Stakeholder Satisfaction............................................................................ 8

Community Responsiveness................................................................................. 9

Teletriage Phone Services.................................................................................... 9

811 Demographic Information............................................................................ 11

District Health Authorities................................................................................... 16

Healthlink 811 Registered Nurses....................................................................... 17

Medical Oversight and Clinical Advisory Committee......................................... 17

Language Services.............................................................................................. 18

Successes............................................................................................................ 19

Future Opportunities........................................................................................... 20

Financing............................................................................................................ 21

Future Reports.................................................................................................... 21

Contacts ............................................................................................................. 22

811.novascotia.ca
 Crown copyright, Province of Nova Scotia
2013
ISBN: 978-1-55457-539-8
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Letter to Minister from Executive Director
Dear Minister of Health and Wellness,

It is a pleasure to present our 811 system report for the fiscal year 20112012. This
report provides an overview of the HealthLink 811 program and the successes and
challenges that continue to inform the delivery of safe, quality health-care services
to Nova Scotians.

811 registered nurses and the rest of the HealthLink 811 team have worked hard
over the past year to provide safe and effective health care, resulting in peace of
mind surrounding health issues affecting individuals, families, and communities.
Confidence in this service has been maintained through the expertise, competence,
and commitment to quality health-care delivery that the HealthLink 811 team
provides every day.

Work has been completed over the reporting period to identify 811 system data
that will contribute to health-care planning and program development across the
province. As a result, District Health Authorities now have a new source of data to
support the identification of health-care priorities in their respective jurisdictions.

Other developments include work to ensure that Sable Island occupants

have access to 811 services in the absence of medical personnel on site, and
collaboration with our addictions partners to support individuals and families
impacted by mixing prescription drugs and alcohol.

We are excited about the year ahead as we continue to work with health-system
stakeholders to ensure the quality of the service and to identify evolution opportunities
that will support the ever-changing needs of our populations and communities.

Sincerely,

Ian Bower
Executive Director
Primary Health Care & EHS

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HealthLink 811 Objectives
HealthLink 811 is a program of the Nova Scotia Department of Health and Wellness.
HealthLink 811 provides Nova Scotians with trusted health information and advice
by experienced registered nurses.

The objectives of the program are:

to promote self-care

to provide a reliable source of health-related information

to reduce the need for travel for basic primary health-care advice

to increase capacity to respond to critical health-related events across

the province (such as H1N1 and fires)

to help Nova Scotians access the right health-care services when

they need them

Peace of mind!

2 HealthLink 811 Report 20112012

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Overview
Since Nova Scotia launched its Telecare service on July 29, 2009, Nova Scotians
have been calling 811 and receiving reliable health information and advice from
registered nurses 24 hours a day, 7 days a week. We now have more experience
with the delivery of Telecare services in the province. Over the course of this
reporting period, 811 helped thousands of Nova Scotians with health-related
symptoms and questions.

The Department of Health and Wellness launched a promotions campaign that

resulted in a notable increase in call volumes. Approximately 137,000 Nova Scotians
received health information and advice over the phone from registered nurses during
the fiscal year 20112012. This is an increase of 48,000 from the previous fiscal year.

Nova Scotians calling 811 during this reporting period most frequently sought advice
on the following:

abdominal pain/discomfort

medication questions (adult no triage)

chest pain/discomfort

cough (pediatric)

fever 3 months or older (pediatric)

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Services
Telecare is a broad concept reflecting the use of electronic media in the provision of
health care. Through a team of experienced and knowledgeable registered nurses,
HealthLink 811

enhances access to care advice by reducing or eliminating barriers of

geography, mobility, culture, language, and cost

provides recommendations and knowledge to patients so they will seek

services that meet their health-care needs

delivers health-care advice to the population so that individuals and families

have the tools and knowledge for effective self-care

The following are key attributes of HealthLink 811:

assessment of the urgency of a callers symptom(s)

provision of health advice and information by experienced registered nurses

24 hours per day, 7 days per week operation

TTY service for the hard of hearing

service in over 120 different languages (third-party

language-interpretation service)

the website trusted health information in both English and French

delivery of culturally competent care

an ability to increase capacity to respond to significant events (such as

H1N1) affecting the health of communities

4 HealthLink 811 Report 20112012

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Caller Satisfaction and Quality Assurance
The delivery of safe and effective health-care services provided by HealthLink 811
remains a key priority, and our quality assurance framework is part of ensuring that
we meet this objective.

Feedback on the service is one of many ways that the quality assurance process is
initiated. Feedback is obtained through an online approach that provides a feedback
form that may be completed and submitted via e-mail, fax, or mail. In addition,
consent is requested from callers for a call-back to conduct satisfaction surveys
that provide an opportunity for callers to share their experience with the program.
Other sources of feedback include verbal comments provided to 811 staff and the
Department of Health and Wellness.

I called 811 and received very helpful advice, which was reassuring when I didnt know what to
do next . . . I have called on behalf of myself, my mother and my granddaughter . . . In one
instance, a visit to the ED was required and the Registered Nurse faxed my information to the
hospital to support staff in their efforts to care for me. In another situation, the Registered Nurse
had to call me back and returned my call sooner than they thought possible . . . This is a
great service!
Glenda Marie Cole

20112012 caller satisfaction survey data confirms that 811 continues to provide the
services and level of quality that Nova Scotians have come to know and trust in the
short time since implementation of the program. During the reporting period, 2052
Nova Scotians were surveyed regarding their satisfaction with the service.

Caller satisfaction survey data demonstrates that Nova Scotians experience a

significant level of satisfaction with the quality of services provided by 811 registered
nurses. Combined, 98 per cent of callers surveyed were satisfied, mostly satisfied,
or very satisfied with the quality of services provided by 811 registered nurses during
the reporting period.

811.novascotia.ca 5
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Quality of Service from Registered Nurse

2%
Very satisfied
10%
Mostly satisfied
6% Satisfied

Somewhat/
very dissatisfied

82%
from Caller Satisfaction Survey

Callers reported 99 per cent satisfaction with the attentiveness of 811 registered
nurses to patient concerns. This data reflects a callers perception that the registered
nurse respected and paid attention to the callers concerns. This component of
the satisfaction survey is critical to the health systems confidence in the quality of
services delivered by 811 and is a key factor in the analysis of repeat caller data.

Attentiveness of Nurse to Patient Concern(s)

1%
Very satisfied

3% 8% Mostly satisfied

Satisfied

Somewhat/
very dissatisfied

88%

from Caller Satisfaction Survey

6 HealthLink 811 Report 20112012

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The delivery of quality and timely 811 services requires a team-based approach.
Other members of the 811 team include Telehealth associates (TAs). TAs are trained
staff who support the call-handling process when all registered nurses are busy
handling other calls. The role of the TA is often critical to ensuring that a caller
receives timely access to a registered nurse. During the reporting period, 98 per
cent of callers were satisfied or very satisfied with the quality of service from the
Telehealth associate.

Quality of Service From Telehealth Associate

1%
Very satisfied

13% Mostly satisfied

7% Satisfied

Somewhat/
very dissatisfied

79%

from Caller Satisfaction Survey

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System Stakeholder Satisfaction
Health-care providers and other health-system stakeholders are invited to share
their experience with the program, including any feedback received from their
patients and colleagues. Feedback from the health system is integral to the quality
of the 811 service. In addition, feedback and collaboration on the program promotes
opportunities for integration with other areas of the health system. This feedback
is collected and analyzed to identify trends, program effectiveness, and quality-
improvement opportunities. Examples of stakeholder feedback received during the
reporting period included the following:

A patient and her physician were pleased with the service provided by the
811 nurse, and the referral resulted in a fax to the emergency department,
which made the situation much better for the patient.

A challenge associated with accessing 811 from a callers cell phone

was reported by a service provider, and the situation was addressed through
the programs quality assurance process.

Any concern received about 811 services results in a comprehensive quality review.
This ensures that the call-handling process and clinical guidelines are applied
appropriately. Quality-improvement opportunities are identified and implemented to
improve the service for Nova Scotians.

Community Responsiveness
Two important aspects of HealthLink 811 are its service inquiry process and
community outreach activities. They help ensure that the 811 service is responsive
to the needs of the public.

Service Inquiry Process

The 811 service relies on caller and stakeholder feedback to inform and improve
the quality of patient care and service delivery. Through the service inquiry process,
the public and providers are able to identify concerns about an 811 call-handling
process, guideline, response time, nursing interaction, or any other issue that, for the
caller or stakeholder, is unclear or is considered unsatisfactory. The service inquiry
process is open to all residents of Nova Scotia and health-system stakeholders.

For more information, you may visit the 811 website: 811.novascotia.ca

8 HealthLink 811 Report 20112012

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Outreach
Outreach activities are undertaken to promote the service to system stakeholders
such as District Health Authorities and health-care providers. Other related
opportunities include participation in the 50+ and Family Expos. A major focus of
these outreach activities is to address integration opportunities wherever possible
with other services and organizations.

The Telecare operator engages system stakeholders and interested parties on a

number of key aspects of the program. Active health-system engagement supports
local adaptation and acceptance of Teletriage guidelines and the development
of health information topics that are consistent with provincial standards and
approaches to health care in Nova Scotia.

Teletriage Phone Service

A person who dials 811 from any phone registered in Nova Scotia has access to an
experienced registered nurse, who will ask the caller to share their health-related
question or describe the symptom(s) they or a family member are experiencing.
The registered nurse will then assess the urgency of the symptom(s) described and
provide advice and education about what the caller should do next. Advice ranges
from self-care to see your health-care provider to visit the local Emergency
Department; or 811 may transfer the caller directly to Poison Control or 911.

Total Number of Patients

16,000

14,000

12,000

10,000

8,000

6,000

4,000

2,000

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811.novascotia.ca 9
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Experience in other jurisdictions suggests that promotion of Telecare services is
the most significant driver of call volume. During 20112012, an 811 promotions
plan was developed and implemented; it included television, radio, and a
provincial mailer for Better Care Sooner, which identified 811 as a key component
of Nova Scotias health system. Public promotion of the 811 service during the
20112012 fiscal year resulted in an increase in the total number of patients cared
for by the 811 service.

HealthLink 811 Patient Advice

2% 2% 911 Hot Patch

ED Immediately
1%
11% Poison Control

PHC provider
31% (within 48 hours)

PHC provider
26% (over 48 hours)

Self-care triage only

19% 8% Self-care no triage

Other

Anecdotally, Nova Scotians demonstrate a significant openness to self-care

involving health advice and information that support the management of their
symptoms independently and safely in the comfort of their own homes.

811 Dispositions A Description

The following are brief descriptions of each respective disposition that may result
from symptom-based calls:

Self-care Health information and advice that support an individual in the

management of their symptom(s) at home, without further clinical intervention.

PHC (primary health care) provider (over 48 hours) See your family doctor
or nurse practitioner after 48 hours; represents multiple dispositions, such as
within 72 hours or within 7 days.

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PHC (primary health care) provider (within 48 hours) See your family doctor
or nurse practitioner within 48 hours; represents multiple dispositions, such as
as soon as possible or within 24 hours.

Poison Control Direct transfer to the Regional Poison Centre if a potential or

actual exposure to poison is suspected.

ED (Emergency Department) immediately Go to the nearest Emergency

Department immediately.

911 Hot Patch Direct transfer to 911 in an emergency situation; the 811 staff
will remain on the line until the caller is safely transferred to 911 services.

811 Demographic Information

811 caller and patient gender data are significant sources of information to
support public awareness and promotion of the 811 service. In addition, this
information helps us understand gender differences in how Nova Scotians
access and receive health care across the province. Caller gender data
demonstrates the level of awareness across genders and supports planning of
811 promotions to ensure that both males and females access this service.

Caller gender is defined as the gender of the person calling the service. A caller
may be calling on behalf of oneself and/or one or more others including, but
not limited to, children, parents, and friends. Meanwhile, patient gender data
represents the gender of individuals who receive health advice and information
from a registered nurse.

811 put my mind at ease. I didnt know whether I should seek medical attention or
emergency care and 811 was there . . . the registered nurse provided me with the advice I
needed to manage my situation until I could see my family physician. Just to be able to
talk to a registered nurse over the phone made the situation that much better.
Glenn Wilson

Caller Gender
Analysis of early call data following the launch of 811 services revealed a low
ratio of male to female callers. Reasons for calls by male callers during the
reporting period included the following:

Do I apply a hot or cold compress?

Im a new dad, my baby has a rash, and I am not sure what to do!

811.novascotia.ca 11
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1% Caller Gender

21% Female

Male

Unknown

78%

Callers by Age Range

Callers between the ages of 21 and 45 are the most predominant in other jurisdictions
across the country. Consistent with other jurisdictions, 811 received the highest
number of calls from this age group (67,810 calls) during the reporting period.

According to Statistics Canadas 2011 census data, Nova Scotia (16.5%) had the
highest proportion of the population aged66or older.1 With a rapidly growing
population of seniors, analysis of callers by age range contributes significantly to

Callers by Age Range

67,810

29,418

7,404

4,033
3,725

1,197
284

12-16 17-20 21-45 46-65 66-75 76+ N/A

12 HealthLink 811 Report 20112012

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understanding the level of awareness of the program within this age group and
informs future promotion and evolution of the service. 40,855 callers were over the
age of 45, with 11,437 callers over the age of 65. This suggests that while awareness
among seniors is significant, more work is required to promote the service with this
population as it continues to grow.

Consistent with other jurisdictions across North America and Europe, age and
gender combined influence the key target market for the use of Telecare services.
Women between the ages of 21 and 45 represent the dominant 811 caller profile,
with 55,729 calls from this group during the reporting period. While the total number
of male callers (24,057) increased during the reporting period, female callers across
all age ranges made 64,720 more calls to the service than male callers did.

Callers by Age Range & Gender

76+
Male

66-75 Female

Unknown

46-65

21-45

17-20

12-16

0 10,000 20,000 30,000 40,000 50,000 60,000

Patient Gender
The total number of female patients who received care from a registered nurse
was 89,469, which is almost double the number of male patients (46,304).

An 811 call may include more than one patient in a situation where the caller
is calling on behalf of oneself or one or more family members. Female callers
represent the majority of callers and frequently call on behalf of male patients,
resulting in a significantly higher number of male patients relative to male callers.

811.novascotia.ca 13
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Caller & Patient Gender

Female Callers

Female Patients

Male Callers

Male Patients

0 20,000 40,000 60,000 80,000 100,000

Patients by Age Range

During the reporting period, 136,974 patients of all ages infants, youth, young adults,
adults, and seniors received health information and advice from HealthLink 811.
Patients including infants, pre-school, and elementary school-aged children (011
years) totalled 33,343, compared to 27,737 patients between the ages of 46 and 65.

Patients aged 66 years and older totalled 15,060, compared to the 11,437 seniors
who called 811. This suggests that family members and caregivers are also calling on
behalf of patients 66 years and older.

Patients by Age Range

51,326

27,737
21,329

8,227
6,745

6,833
5,269

4,958
3,128

1,422

0-3 4-5 6-11 12-16 17-20 21-45 46-65 66-75 76+ N/A

14 HealthLink 811 Report 20112012

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Of all patients served by 811, 11 per cent were over 65 years of age. Conversely,
patients between the ages of 21 and 45 represented 37 per cent of all patients
served by 811.

Age Ranges as Percentage of Patients Served

37%

20%
16%

5%

4%

6%

5%
4%

2%

1%
0-3 4-5 6-11 12-16 17-20 21-45 46-65 66-75 76+ N/A

811.novascotia.ca 15
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District Health Authorities
HealthLink 811 supports enhanced access to health services across the province.
As the service matures and we gain more experience with Telecare in Nova Scotia,
trends are beginning to emerge regarding the needs and behaviours of callers. As in
other jurisdictions, serviced call volumes vary across the province from one region to
another. Factors that affect call volumes from various parts of the province include
barriers to accessing health-care services in the geographic area, services available
in communities and surrounding areas, and population numbers within a District
Health Authority (DHA). The number of serviced callers is the number of 811 callers
who received services from a registered nurse. Because callers may be calling for
themselves or on behalf of one or more others, the number of serviced patients
reflects the actual number of Nova Scotians who received services from an 811 nurse.

The following table represents the number of serviced callers by District Health Authority.

District Health Authority (DHA) Number of Serviced Serviced Regional Regional

serviced callers as callers as population population
calls percentage of percentage of (based on as percentage
total 811 calls total 811 calls 2011 Census of total NS
(adjusted)* of Population) population
(921,727)
DHA 1 8,959 7.9% 8.4% 58,215 6.3%
South Shore Health Authority
DHA 2 5,042 4.4% 4.7% 57,792 6.3%
South West District Health Authority
DHA 3 9,716 8.5% 9.1% 81,338 8.8%
Annapolis Valley District Health Authority
DHA 4 10,030 8.8% 9.4% 71,072 7.7%
Colchester East Hants Health Authority
DHA 5 3,113 2.7% 2.9% 31,370 3.4%
Cumberland Health Authority
DHA 6 5,851 5.1% 5.5% 45,650 5.0%
Pictou County Health Authority
DHA 7 2,777 2.4% 2.6% 43,715 4.7%
Guysborough Antigonish Health Authority
DHA 8 13,668 12.0% 12.7% 119,978 13.0%
Cape Breton District Health Authority
DHA 9 Capital District Health Authority 48,069 42.2% 44.8% 412,518 44.8%
and Izaak Walton Killam Hospital
Unavailable/Anonymous/No address 6,646 5.8%
* Adjusted to reflect number of 811 callers whose district could not be identified

16 HealthLink 811 Report 20112012

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Healthlink 811 Registered Nurses
When Nova Scotians dial 811, they can speak to an experienced registered nurse
with access to a number of tools to support the safe and competent delivery of
Telecare services, including

clinical guidelines

decision-support software

a health information database for health-care providers

a database of community-based health services

online, real-time clinical leadership and support provided by senior clinical

leaders

The response and information provided by a registered nurse is supported by

clinical guidelines, which

guide the assessment of the urgency of a callers symptom(s)

support the registered nurse in recommendations surrounding what the caller

should do next, including identification of the most appropriate source and
time of care (not a medical diagnostic tool)

guide the registered nurse in documenting a detailed record of the call

These clinical guidelines are locally adapted to the Nova Scotia context to ensure
consistency in standards for service delivery and health information provided across
the province.

Medical Oversight and Clinical

Advisory Committee
Clinical advice and support is provided to 811 through a medical director and
Clinical Advisory Committee.

The medical director provides clinical leadership and medical advice regarding
Telecare service delivery and program development. In addition, the medical
director acts in the role of chair, providing leadership and direction to the work of the

811.novascotia.ca 17
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Clinical Advisory Committee. Duties of the medical director also include networking
and outreach with the health-care community throughout Nova Scotia to increase
awareness, understanding, collaboration, and co-operation with the program.

The Clinical Advisory Committee serves as an advisory group to 811 regarding

clinical content and other issues related to the Telecare service. It contributes to and
evaluates the programs quality-improvement initiatives and it networks with health-
system stakeholders to promote a better understanding of the scope and outcomes
of the service. The committee membership is inter-disciplinary and comprises
clinical expertise from across Nova Scotia. The work of this committee continues to
result in an annual update of all clinical guidelines and the addition of a number of
new health topics available to the public on the 811 website.

In 20112012, an annual review of all clinical guidelines was conducted. In addition,

100 new health topics were added to the 811 website in both English and French.
New health topics were identified based on disease prevalence in the province,
analysis of trends surrounding reasons for calling, and a review of existing topics to
identify related gaps.

Language Services
If the individual or a family member calling 811 does not speak English, HealthLink
811 can provide services in more than 120 languages. Bilingual registered nurses
are available to provide services in French. Services in other languages, including
French if a bilingual registered nurse is unavailable, are offered through a third-party
language-interpretation service.

The provision of services in multiple languages is a key component of the Telecare

program. The Province of Nova Scotia is committed to supporting the health of
all of our communities, including new Nova Scotians and immigrants. Work has
been completed during this reporting period to promote the service to populations
who speak languages other than English. Activities included participation at a
multi-cultural health fair, collaboration with organizations that support immigrant
settlement and health care in the province, and the production and distribution
of a poster promoting the service in many different languages. In addition, the
Department of Health and Wellness collaborated with a local university to support
awareness of the program for international students coming to Nova Scotia.

During 20112012, callers most frequently sought services in English and French.
Other languages requested include Spanish, Arabic, Mandarin, Russian, and Korean.

18 HealthLink 811 Report 20112012

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Online Health Resources
HealthLink 811 provides reliable health information in both French and English
on the 811 website (811.novascotia.ca). This information can help Nova Scotians
understand health issues that matter to them, their families, and their community.
The website also highlights and provides information on current health issues
affecting Nova Scotians, including seasonal health issues such as allergies and
sun protection, or information regarding an outbreak affecting communities across
the province. Recent additions include a link to Air Quality and Your Health, and
Publications where the 811 annual reports are available to the public.

HealthLink 811 successfully launched an 811 website in French to support improved

access to 811 and enhanced access to health care for Nova Scotias Acadian and
Francophone communities.

In total, the 811 website was accessed 18,899 times during 20112012.

Successes
While HealthLink 811 is still relatively new, the program demonstrates significant
capacity to support the ever-changing and diverse needs of Nova Scotia
populations.

Since the last report, work was undertaken with our partners at Environment
Canada to implement an approach to ensuring that occupants of Sable Island have
access to HealthLink 811. Sable Island occupants comprise visitors and short-term
residents who do not have access to health-care professionals unless they leave
the island. Now, occupants can contact HealthLink 811 for reassurance and advice
regarding all kinds of health-related questions and concerns.

Other successes include an initiative targeting those at risk of mixing prescription

drugs and alcohol. Currently, too many people in Nova Scotia put themselves
in grave danger when they mix alcohol and prescription drugs. HealthLink 811
partnered with Addictions Services on an initiative to support Nova Scotians facing
these challenges. Components of this initiative included public announcements
encouraging Nova Scotians affected by mixing alcohol and prescription drugs to
call 811 to receive information about resources in their communities who can talk to
them about services and support available to them.

811.novascotia.ca 19
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Future Opportunities
The HealthLink 811 service has been identified as an important aspect of the health
system.

This service presents a broad range of opportunities for future growth. Examples of
opportunities for the further development of Telecare include

integration with electronic health records to improve communication

between care providers and to support continuity of care

the addition of other providers to the service

Promotion of 811 to the public has been integral to helping Nova Scotians
understand how HealthLink 811 can support improved access to health care. How
the public uses the services available to them has a significant impact on the health
of the individual, the health system, and related services when they are needed
most. To better understand how to reach those who may not know about 811, work
is underway to analyze data surrounding how individuals heard about the service.

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Financing
The Nova Scotia Department of Health and Wellness continues to invest in the
HealthLink 811 program to support enhanced access to health-care services for all
Nova Scotians. The total cost of the program for fiscal year 20112012 was $6.1
million. This includes calls to the service for Teletriage and health information and
advice from registered nurses, clinical oversight, infrastructure that supports 24/7
access anywhere in Nova Scotia (with language-interpretation services for over 120
languages), availability of an 811 website in both English and French, and public
promotion of the service.

Future Reports
Future health-system reports on HealthLink 811 will continue to include data
analysis and trends, new components of the program, and future evolution
opportunities.

811.novascotia.ca 21
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Contacts at HealthLink 811

General Address
Department of Health and Wellness
Primary Health Care and Emergency Health Services Branch
Barrington Tower, 5th Floor
1894 Barrington Street
Halifax NS B3J 2A8
Fax: (902) 424-3243

Ian Bower
Executive Director
Tel: (902) 424-4833

Cheryl Purcell-Cotnam
Manager of Operations
Tel: (902) 424-8881

Dana A. Mingo
Telecare Coordinator
Tel: (902) 424-2785

Marty Warren
Health Services Database Coordinator
Tel: (902) 424-6861

22 HealthLink 811 Report 20112012

Peace of mind!

811.novascotia.ca