Orthopaedic Telehealth – Specialist care closer to home

Christina McInally 1

Telehealth Coordinator, Rockhampton Hospital, North Rockhampton, QLD, Australia

 

Background

The Orthopaedic Outpatient Telehealth Service in the Central Queensland Hospital and Health Service (CQHHS) provides specialist orthopaedic care to patients throughout Central Queensland and Central West areas. The Orthopaedic Outpatient Telehealth Service has shown innovation and determination to meet the ever increasing patient demand by providing Telehealth to orthopaedic patients. Orthopaedic Medical and Nursing staff identified there are patients from outlying areas requiring ongoing access to Specialist Orthopaedic care and the distance patients were travelling for this service was immense.

Methods

The Orthopaedic team commenced a Telehealth model of care to ensure equitable access to specialist care for patients in rural and remote areas of Central Queensland and Central West. The Orthopaedic Outpatient Telehealth Clinic with Rockhampton Hospital as the provider uses large wall hung screens, which provide a high definition view of the patient and their fracture or wound. With the recipient sites having similar equipment, this then enables the Orthopaedic Medical Officer and nurse in Rockhampton to control the camera at the recipient site to view the wound, sutures or functionality of the patient’s body.

The clinic can see patients who are review postoperative fractures, postoperative joint replacements, external fixations, ongoing rehabilitation assessment and range of movement checks.

Results

The number of patients seen through the Orthopaedic Outpatient Telehealth Service in 2015/16 has grown to a phenomenal 3437 patients. The service has established a positive reputation within the communities so much so that patients contact the department directly to see if their appointment can be performed through telehealth. Many of the reasons for their request include work restrictions, inability to drive due to type of injury, too much time off school for the child and children who suffer from travel sickness or too much expense purchasing fuel for such a long distance drive.  We have had a significant impact on the cost savings through patient travel subsidies, which has shown a $2 million worth of savings across the CQHHS for 2015/16 financial year.

Orthopaedic patients can experience pain and discomfort because of their injury, which can be very distressing if the patient needs to travel in a car for up to 4 to 5 hours. Telehealth is one of the options available to these patients when travelling long distances is very challenging and expensive for the patient.

Discussion

The Telehealth Service of Central Queensland is striving for excellence through effective and sustainable delivery of Telehealth services to patients throughout Central Queensland and surrounding districts. This presentation will explore how the service was initially set up, the requirements of clinical/non-clinical staff involved in the clinic, equipment required, the referral process, types of patients clinically appropriate for Orthopaedic Telehealth, why the clinic is so successful and ongoing maintenance required ensuring the Orthopaedic Telehealth Clinic is run in accordance to policy and procedures.

neoRehab service delivery trial within TCP Toowoomba

Samantha Donohoe1, Brioh Guffin2

 

1 Transition Care Program, Baillie Henderson Hospital, Browne House, Level 1 PO BOX  Toowoomba, QLD, 4610, samantha.donohoe@health.qld.gov.au

2 Transition Care Program, Baillie Henderson Hospital, Browne House, Level 1 PO BOX  Toowoomba, QLD, 4610, brioh.guffin@health.qld.gov.au

 

Background:

Within the Toowoomba Transition Care Program (TCP), the use of neoRehab clinically validated videoconference software is enabling real time service delivery via iPads. Within this model, the multidisciplinary community-based rehabilitation team of allied health professionals, nursing, case management staff, and allied health assistants, are alternating weekly home visits with videoconference consults, for appropriate clients. A staff member sits with the client and operates the neoRehab software on the TCP iPad in the client’s home, whilst the clinician is able to provide his/her review consult from the team office, with purpose-designed clinical measurement tools on-screen to assist in monitoring progress.

A three month pilot study was undertaken to review and update the existing Toowoomba TCP neoRehab service delivery resources (user guide and clinical guidelines) and review the implementation and service delivery of neoRehab within Toowoomba TCP. This innovative change to service delivery for clients in Toowoomba and surrounds has, in its initial stages, demonstrated time, resource and cost effectiveness.

 

Method:

Data focussed on capturing occasions of service (OOS) and additional parameters to identify the overall clinical service advantages of the integration of neoRehab into our existing service delivery model has been collected and analysed from a period including March, May and June, 2016. In addition, we have obtained staff feedback during informal interviews within the TCP team.

 

Data collection results (summary):

  • 23 of 26 sessions in three months substituted face-to-face consultations (~88.46%)
  • In 12 weeks, TCP saved approximately $1,574.35 using neoRehab as an alternate to face-to-face consultations
  • In 12 weeks, Toowoomba TCP completed 26 neoRehab sessions which saved an overall amount of $1,893.41
  • Overall, TCP saved $735.05 in staff costs
  • Overall, TCP saved $1,158.36 in car travel costs
  • In 12 weeks, the overall saving per OOS was approx. $69.43, with an average of 58.58km saved per OOS
  • 16 out of 26 neoRehab sessions had no episodes of disconnection or disruptions

 

Aspects that made the TCP team less inclined to use neoRehab included; technical difficulties, reception black spots particularly in the rural areas. Further, neoRehab isn’t as hands on as regular service delivery, and the poor sound quality at times when full reception isn’t available has been a barrier to use with our older clients at times.

All staff members were able to identify how neoRehab is useful in their area of practice and identified that it saves both staff and client time, and reduces the travel time, thus making the service more efficient and more responsive. Additionally staff indicated that neoRehab was beneficial for building teamwork by being a useful learning tool for both clients and staff. The team has identified that they would like to know more about the application of features of neoRehab.

 

Future Direction/consideration:

Please note: due to the preliminary nature of our data, we are aware that the following is representative of data collected as part of a series of first steps in a longer-term plan to integrate neoRehab into our team’s service delivery model. In future, we hope to conduct formal research to obtain reliable evidence in support of the feasibility of neoRehab within a community-based rehabilitation setting. We anticipate this data will be applicable to health services beyond our own, across our district, and further afield.

 

Conclusion

NeoRehab is showing promising potential as a feasible, cost effective advancement with further integration into our existing model of service delivery. Further scope for formal research over a six months period exists to quantify the feasibility, cost and clinical effectiveness of this service model within our team.

Telehealth parent counselling trial and research project

Nicole Owen BSW MSW1, Stephanie Golden Roser BSW2,

 

1 Child & Youth Community Health, Children’s Health Qld, Qld Health, C/O PO Box 1060 Noosa Heads 4567. nicole.owen@health.qld.gov.au

2 Child & Youth Community Health, Children’s Health Qld, Qld Health, Locked Bag 1 Caboolture 4510. Stephanie.goldenroser@health.qld.gov.au

 

This trial supported 12 Early Intervention Parenting Clinicians (EIPC/EIC) (social workers and psychologists) located at 9 child health services to set up video conference capability and deliver video conferencing (VC) counselling sessions to caregivers in rural and remote communities or those who cannot access a centre. It evaluated the set up and deployment, functionality and sustainability of VC counselling in the trial sites, including the clinician and client experience and satisfaction of VC delivery of parent counselling. The research component of the project is ongoing and will formally evaluate the parent’s and clinician’s experience of using VC and clinical outcomes.

The trial encouraged partnerships in the trial sites between the clinicians, the Telehealth Support Unit (who sponsored the trial) and local telehealth coordinators.   We run monthly VC training sessions with clinicians and telehealth colleagues and this was successful in enhancing VC skill level, confidence and clinician engagement. In the trial phase, 42 clients were told about the trial and 4 families utilised the VC sessions through local health centres or hospitals and all were satisfied with this mode of service delivery. There were minimal technical difficulties and additional clients are now engaged in ongoing VC service delivery in these sites.  The trial highlighted technical barriers such as lack of  internet access to rural/remote communities which affected the delivery of VC parent counselling services.  Data was collected on reasons why parents did and did not want counselling delivered through telehealth.  Main reasons for wanting VC parent counselling is that no service available in their area or large travel distance to access face-to-face service.  The research component has commenced VC into clients’ homes using the new Qld Health Telehealth Portal link generator.  One client’s feedback:

“Love being able to do this in my own home.  More flexible” (Working mum of young children).

This presentation will outline the findings of the trial and the initial data from the research project.  There will be a discussion of the implications for the future of telehealth in child health and similar services, and strategies for ongoing promotion and development of telehealth, and clinician and client engagement.

Tele-fracture Clinic

Gemma Model1, Elizabeth Wellard2, Dr Robin Diebold3, Dr Neil Ferguson4

1 Hunter New England Health, Armidale Rural Referral Hospital, Rusden Street, Armidale, NSW, gemma.model@hnehealth.nsw.gov.au

2 Hunter New England Health, Inverell Hospital, Inverell, NSW, 2360, Elizabeth.Wellard@hnehealth.nsw.gov.au

3 Hunter New England Health, Armidale Rural Referral Hospital, Rusden Street, Armidale, NSW, 2350, rdiebold@neortho.com.au

4 Hunter New England Health, Armidale Rural Referral Hospital, Rusden Street, Armidale, NSW, 2350, neil.ferguson@hnehealth.nsw.gov.au

 

Background

Improving access for fracture clinic patients from Inverell and surroundings areas was the catalyst for the implementation of telehealth to promote service delivery that is equitable, patient focused and utilises available technology. The key objectives were to decrease unnecessary patient travel over great distances and increase attendance rates optimizing patient outcomes. This project supported some of the most disadvantaged and remote communities in our state (NSW).

Avoidable outcomes that supported the decision for change was highlighted by a patient who failed to attend four consecutive appointments resulting in poor functional outcomes impeding his quality of life and ability to return to work. Many patients spent hours in a car for a simple treatment plan that could have been managed locally.

 

Methods

Data was collected to determine which areas had the greatest patient need and difficulty with access to services which indicated the Inverell area. This required upskilling local staff in clinical management and technology usage. Opportunistic attainment of equipment and support was acquired with engagement from a Hunter New England Local Health District( HNELHD) telehealth consultant  to support the strategy. Patient screening and processes needed development and implementation with  pre planning of appointments including imaging and cast removal, an important consideration to ensure success.

 

Results

  • Establishment of an award winning telehealth model that is simple, sustainable and efficient
  • Improvement in Did Not Attend ( DNA) rates for Inverell patients
  • Total savings for Inverell residents is estimated at $73,917, and some 84,266km of travel since the service began.
  • Increased reliance on telehealth as an acceptable means of patient review
  • 61 per cent of appointments for 0-10 year olds at Inverell used Telehealth
  • Of patients aged older than 80 years, 80 per cent of appointments were by telehealth
  • Patient surveys articulated travel cost savings and reduced time off work and school, as key benefits.

 

Discussion

The use of telehealth as a means of patient review for fracture management is an excellent option in regional and remote areas .The telehealth model implemented by the Armidale hospital is embedded and has now expanded to Glen Innes and Tenterfield. It is requested by many patients and General Practitioners.

Not all patients can use telehealth but often after their initial assessment it may be a viable option.

When using telehealth costs are reduced for the facility, an interfacililty transfer can cost $1600 per patient.  Patients benefit from reduced travel costs and less time away from work and school.

Workload has increased for administrative staff and enhancements need to be considered with the implementation of telehealth.

An incidental benefit of the telehealth process was the ability to access senior staff at a larger facility for sole therapists. This gives an opportunity for follow up and case management.

OOTS – Orthopaedic Outpatient Telehealth Service

Christina McInally1

1 Rockhampton Hospital, Rockhampton, QLD, Australia

 

Background

The Orthopaedic Outpatient Telehealth Service in the Central Queensland Hospital and Health Service (CQHHS) provides specialist orthopaedic care to patients throughout Central Queensland and Central West areas. The Orthopaedic Outpatient Telehealth Service has shown innovation and determination to meet the ever increasing patient demand by providing Telehealth to orthopaedic patients. Orthopaedic Medical and Nursing staff identified there are patients from outlying areas requiring ongoing access to Specialist Orthopaedic care and the distance patients were travelling for this service was immense.

Methods

The Orthopaedic team commenced a Telehealth model of care to ensure equitable access to specialist care for patients in rural and remote areas of Central Queensland and Central West. The Orthopaedic Outpatient Telehealth Clinic with Rockhampton Hospital as the provider uses large wall hung screens, which provide a high definition view of the patient and their fracture or wound. With the recipient sites having similar equipment, this then enables the Orthopaedic Medical Officer and nurse in Rockhampton to control the camera at the recipient site to view the wound, sutures or functionality of the patient’s body.

The clinic can see patients who are review postoperative fractures, postoperative joint replacements, external fixations, ongoing rehabilitation assessment and range of movement checks.

Results

The number of patients seen through the Orthopaedic Outpatient Telehealth Service in 2015/16 has grown to a phenomenal 3437 patients. The service has established a positive reputation within the communities so much so that patients contact the department directly to see if their appointment can be performed through telehealth. Many of the reasons for their request include work restrictions, inability to drive due to type of injury, too much time off school for the child and children who suffer from travel sickness or too much expense purchasing fuel for such a long distance drive.  We have had a significant impact on the cost savings through patient travel subsidies, which has shown a $2 million worth of savings across the CQHHS for 2015/16 financial year.

Orthopaedic patients can experience pain and discomfort because of their injury, which can be very distressing if the patient needs to travel in a car for up to 4 to 5 hours. Telehealth is one of the options available to these patients when travelling long distances is very challenging and expensive for the patient.

Discussion

The Telehealth Service of Central Queensland is striving for excellence through effective and sustainable delivery of Telehealth services to patients throughout Central Queensland and surrounding districts. This presentation will explore how the service was initially set up, the requirements of clinical/non-clinical staff involved in the clinic, equipment required, the referral process, types of patients clinically appropriate for Orthopaedic Telehealth, why the clinic is so successful and ongoing maintenance required ensuring the Orthopaedic Telehealth Clinic is run in accordance to policy and procedures.

Pre-implementation phase: podiatry trial of store & forward technology

Sarah Jensen1

1 Metro North Hospital & Health Service CISS, 490 Hamilton Road Chermside, Queensland, 4032, sarah.jensen2@health.qld.gov.au

 

Background

The Queensland Hospital and Health Service (HHS) podiatry network is a small, mobile profession, delivering care in a variety of clinical settings. Clinical photography is recognised as a standard tool utilised by the profession predominately in the area of wound management. As HHSs become more technologically advanced, the current inefficient process of clinical photography is limiting collaborative care and underutilising this effective clinical tool. Store and forward telemedicine is a recognised form of asynchronous telehealth that can facilitate the access and sharing of clinical images. The pre-implementation phase of this project aims to establish current uses of technology and clinical photography practices amongst Queensland HHS podiatrists, with the intention of investigating the applicability of trialling store and forward technology in clinical photography, using a Smartphone and app.

Methods

All Queensland HHS podiatrists were invited to participate in a scoping survey regarding the objectives of this project.

Results

From the current 66 HHS podiatrists in Queensland, 54 responded to the survey with 45 completing it in its entirety. The survey drew responses from all HHSs excluding Wide Bay, Mackay and Children’s Health Queensland. Of respondents who treat foot ulceration, 95% capture clinical images. HHS supplied digital cameras were the current choice of technology for clinical photography with 82% usage. Interestingly, 38% of respondents have used a personal device (mobile phone, tablet, digital device) to take clinical photographs. The most commonly reported clinical reasons for taking clinical images was to discuss a clinical presentation with a colleague (64%), routine practice (53%) and patient engagement (53%). Of all clinical images taken by respondents in their current practice, 77% were made available to be accessed by other practitioners involved in the patient’s care. However 48.5% of this shared access is limited to a patient’s paper-based chart. Time restraints (58%) were recognised as the main personal barrier to taking clinical images with a third of respondents highlighting a current inefficient process to capturing, storing and sharing photographs.

Discussion

The use of clinical photography within HHS podiatry is a valuable tool used in the provision of patient care. The cohort has demonstrated an already established practice of taking clinical images and a willingness to integrate portable technology into their clinical practice with the expectation of improving collaborative care and clinical photography processes. The varied scope of practice and clinical settings within HHS podiatry will test the capability of store and forward technology using a Smartphone device and will provide clinical applications to a broad range of other services wanting to adopt this technology. Although there are potential risks to privacy breaches, this can be mitigated through clear protocols and consultation with clinicians. It is hypothesised that a successful trial of a Smartphone and app device utilising store and forward technology will result in a self-sustainable model. In addition, the hypothetical scenario of future incentive payments to HHSs for the utilisation of store and forward technology will be invaluable in establishing this application into clinical practice.

The efficacy of telehealth support for the hospital in the home

McCusker1, E.P. Greenup2

1 Acute Care@Home, Metro South HHS, Melissa.mccusker@health.qld.gov.au

2 Clinical Excellence Division, Queensland Health, Phil.greenup@health.qld.gov.au

 

Hospital in the Home (HITH) provides care in a patient’s residence for conditions requiring clinical governance, monitoring and/or input that would otherwise require treatment in an admitted hospital setting.  Transferring admitted patients early into HITH is popular in many health jurisdictions including Queensland based on evidence that patients have better or equal health outcomes, increased patient and carer satisfaction and reduced expenditure relating to service provision compared to patients remaining in hospital.  Improvements in technology have enabled the provision of treatment in the home at comparable levels of care to those experienced in hospital settings with the promise of increasingly complex and varied cases supported in the home in the future.

Conditions commonly treated by the HITH model include Cellulitis, Pulmonary Embolism, Urinary Tract Infection, Respiratory Infection and Venous Thrombosis.  Patients receive daily contact from registered nurses trained to perform Criteria Led Discharge (CLD) when appropriate for patients with few complications.  Patients unsuited to CLD require the review of a medial officer before being discharged from the program which traditionally involves a doctor visiting the patient’s home or the patient attending hospital a HITH clinic.

An evaluation of equipping nurses with mobile videoconferencing functionality sought to determine if such technology can reduce the frequency in which doctor or patient travel is required prior to discharge from HITH.  Also relevant was whether clinical standards of care can be maintained when doctors provide treatment advice or discharge patients during a video consultation compared the current practice of a physical assessment.  Rates of readmission after 28 days were used as a surrogate measure of clinical appropriateness.  Results of the evaluation indicate doctor travel time and associated costs were reduced while readmission rates between patients discharged in person or via Telehealth remained consistent.

Supporting telehealth delivered allied health services

Melody Shepherd1, Peter Fuelling1, Jayne Kirkpatrick1, Ilsa Nielsen2

1 Cunningham Centre, Darling Downs Hospital and Health Service, PO Box 405, Toowoomba, QLD AHET@health.qld.gov.au

2 Allied Health Professions’ Office of Queensland, Level 6, William McCormack Place (Stage 2), 5B Sheridan Street, Cairns QLD 4870, ilsa.nielsen@health.qld.gov.au

 

Background

Allied health professionals in Queensland health services have identified strong interest in implementing telehealth to improve access for rural and remote consumers and support service efficiency. The Cunningham Centre in partnership with the Allied Health Professions’ Office of Queensland completed an Allied Health Telehealth Capacity Building Scoping Project in 2015. Limited access to examples of telehealth-supported service models specific to the clinical practice of the profession was identified as a barrier to implementation.

Methods

Strategies commencing in 2015 to better meet the information and support needs of allied health professionals wanting to implement telehealth in their service have included:

  • development of training programs/products related to service and clinical redesign for telehealth,
  • initiation of an allied health telehealth collaborative network to support dissemination of information on successful service models, and
  • collation and distribution of resources that assist teams to evaluate telehealth services.

Results

Training products have been drafted that address service redesign and clinical adaptions required for telehealth.  Clinical focus areas of the training program include home assessment, mobility programs, diabetes management, paediatric therapy, hand therapy, burns management and compression garments.  Service redesign topics such as business modelling, scheduling and data collection processes, and host/recipient site collaborative service models have had strong engagement from allied health professionals through the network and the training program development stage.

Sample resources from the training products and their application to clinical practice will be highlighted during the presentation. These products are due for release by the Cunningham Centre in 2017.

Discussion

Allied health workforce telehealth capacity development needs to extend beyond skills training in the use of telehealth device.  Training, resources and collaboration are in demand by health professionals who need practical and clinically-relevant guidance to integrate new technologies into their practice.

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