Successes and Failures in Telehealth 2017

Transcription

1 Emergency Telehealth Service (ETS) an Essential service for rural Western Australia funded through Royalties for Regions WA 500,000+ people - dispersed over 2.55 million km 2 Melissa Vernon Executive Lead Telehealth COO Strategy & Reform 5.5 hours flying time ED-CO (WACHS) 7 distinct & diverse regions 6 regional hospitals 15 district hospitals 47 small hospitals 50 nursing posts/health centres 24 community mental health services 4 inpatient mental health units 175 population health facilities Resident FACEM s Visiting FACEM s What is Telehealth? Nothing New 1954 the use of Information and Communication Technology applications to provide health and long-term care services over a distance (WHO, 2010) Used in: Education and training Store and Forward Applications Home Monitoring August 2012 Peter was sceptical about Telehealth this is all about getting rid of doctors in the bush, next it will be the hospitals Bob (FACEM) was sceptical of the telehealth technology how am I to give proper medical care What about GPs? Mixed proof in the pudding and majority are on board National Rural Health Alliance

2 EQUITY ETS commenced August 2012 = 8 pilot sites Early observations: accessibility/availability education dedicated team governance clinical standards October 2017 Nearly OOS 57,000 since hospitals 7 regions Service development principles ETS Flowchart Consultant-led safe, consistent, quality, effective emergency medicine. Equity & Advocacy best possible outcome for country patients. Governance and operational management Country health led, compliance with WACHS clinical governance pathways/policies = consist quality of service in a country context. Collaborative regional engagement Regional decision making and local protocols guide intra-regional transfers with appropriate guidance and negotiation from the ETS physician. Site receives ED patient and assesses need for ETS specialist clinical support High acuity ATS 1 & 2 has specific pathway -- usual immediate VC ATS 3,4,5 may be desktop /phone or VC with a wait Nurse Co-ordinator ETS - Virtual Service Delivery & Virtual conversations 2

3 Bob (FACEM) I have the capacity to deliver quality, effective clinical care, perhaps even at 80% capacity Critical Success Factors BURNING PLATFORM NEED Identified need with mostly rapid uptake by WACHS staff. QUALITY PRODUCT Standardised product FACEMs and ED Generalists. DEFINED MODEL Well defined service delivery model that aligned easily with existing systems. LEADERSHIP & FOCUS Executive support and leadership. Client focus patients AND local ED nurses and doctors. POSITIVE OUTCOME FOR PATIENTS + POSITIVE FEEDBACK ~75% of all consultations - patients go home. Collaborative Development of ETS EDUCATION- Flexible (Blended) Learning Framework Importance of relationships Nurses and ETS doctors Trust in the clinical setting Opportunities for hands-on learning and skill development Real time education Facilitated consistency in terms of governance and clinical practice Advanced practice development Consultant level advice and leadership Introduced Consultant - FACEM ownership of patient transfers Improved clinical preparation for retrieval Improved communication and handover Strong advocacy for patients and local clinicians with RFDS Collaboration MORE THAN SERVICE ACCESS ETS opened up opportunities for: Improved governance Consolidation of clinical standards Dedicated ETS education program Need to empower local nurses to work with FACEMS at new level of expertise, yet within scope of practice Local nursing staff hungry for education Successful education program Real Time Capacity Building Videoconferencing Practical Theory Simulation elearning Program ETS HELP Face to face Education ETS Staff Clinical specialties From didactic, information rich sessions...to practical, skill based sessions.. 3

4 ETS- Emergency Medicine Education Program Number of Participants ETS Practical Skills Sessions extended further to simulation 20 0 Consistently positive evaluations Session Title Total Sessions: 15 Total No of participants: 556 LED TO = ETS HELP (Health Emergency Learning Program) Packaged Practical Skills, Lectures, Videos & Useful links, recorded education sessions Located on the WACHS LMS Access whenever, wherever ETS Education Coordinator maintains HELP Addressing shortfall of doctors in emergency settings in rural and remote Building strong clinical relationships with metropolitan based EM specialists and rural clinicians Improved access to timely medical care This with other access improvements decreased clinical incidents Overall Impact of ETS Rural and remote patients now have access to an emergency doctor that was previously accepted as unlikely & acceptable ETS has contributed to increased numbers of medical consultations in WACHS small hospitals ETS Regression trend ETS: Top 10 referring sites 2016/17 Dongara Roebourne Jurien Bay Onslow York Kalbarri Boddington Coral Bay Cunderdin Pingelly 1691 (10%) 1446 (8.6%) 1013 (6%) 925 (5.5%) 919 (5.4%) 622 (3.7%) 593 (3.5%) 515 (3.1%) 453 (2.7%) 450 (2.7%) 4

5 Game Changer Proof Medical response October 2012 multiple casualties benefit from ETS coordination Keeping patients closer to home sounds simple, but for the patient located 500km from Perth. 34 year old female Afternoon BBQ - piece of meat lodged in oesophagus Trip to local hospital ETS presents at local Emerency Department ETS called, specialist treatment initiated NO ETS presents at local Emergency Department no local medical staff, ambulance transferred to regional centre Multiple casualties Small Hospital Delayed retrieval & coordinated Critical care, timely communication Efficient co-ordination treatment successful discharged home - same day scope required, not available - transfer to Perth overnight stay in Perth for Endoscopy List discharged home - day 3 from Perth You met Peter Earlier - Farmer - December 2012 life saving benefits of ETS Chloe and Mum July 2017 benefits of early intervention by Specialist Physician... no previous December heart troubles 2012 Unexpectedly Chest Pain chasing sheep on a hot day Heart Attack ETS diagnosed called Cardiac Arrest x 2 Peter I wouldn t be alive today if it wasn t for the ETS doctor and the nursing staff at Cunderdin Hospital Baby had 30km from nearest difficulty hospital breathing 5 week old baby Respiratory distress ETS Early diagnosis - Doctor Brochiolitis Successful resuscitation treatment - life saving time critical Transfer to Perth full recovery life changing event Potentially life threatening for 5 week old treatment time crucial RFDS & NETS Transfer to Perth PMH - ICU full recovery 5 months on Future State (an integrated approach) Patient Clinician Partner (NGO, Private etc) WA Health User Training / Education Manager Future State Integrated Solutions Patient Clinician Partner (NGO, Private etc) WA Health User Training / Education Manager WA Health Telehealth Portal TELEHEALTH SERVICE DELIVERY MODES WA Health Telehealth Portal Telehealth Portal TELEHEALTH SERVICE DELIVERY MODES WA Telehealth Strategy and Implementation Framework ICU/HDU ACUTE INPATIENTS OUTPATIENTS Before SIHI Virtual Acute Service TELEHEALTH CLINICAL SERVICES Emergency Mental Health Presentation Inpatient Consultation Emergency Telehealth Service SIHI SIHI Hyperacute Consultation Outpatients Stroke Cancer Outpatient Appointment Eye, Ear and Oral OUTPATIENTS IN-HOME CHRONIC CONDITIONS Home Support Follow-up Appointment Chronic Conditions Video Conferencing Core Infrastructure Healthier country (could communities be a mix of hardware, through software, partnerships on premise, off premise) and innovation MDT MDT BROADCAST INTERACTIVE Service EDUCATION & EDUCATION & TRAINING Introduction TRAINING TELEHEALTH NON CLINICAL SERVICES Education & and Training Family Meeting CLASS 1 CLASS 2 CLASS 3 CLASS 4 CLASS 5 MEETINGS Business Meetings Co-ordinate Activity Technology WA Telehealth Strategy and Information Implementation Framework Systems BROADCAST INTERACTIVE OUTPATIENTS CHRONIC ICU/HDU ACUTE INPATIENTS OUTPATIENTS MDT EDUCATION & EDUCATION & MEETINGS IN-HOME CONDITIONS TRAINING TRAINING SIHI 2 SIHI Before SIHI TELEHEALTH CLINICAL SERVICES TELEHEALTH NON CLINICAL SERVICES Telehealth Meeting Room Outpatients Education & Training Business Mental Health MDT Telehealth Waiting Room Meetings Emergency Telehealth Service Supporting Applications (e.g. scheduling, mobile applications, secure store & forward etc.) Stroke Cancer Business Intelligence Chronic Conditions Eye, Ear and Oral Service Management Virtual Acute Service CLASS 1 CLASS 2 CLASS 3 CLASS 4 Non-clinical CLASS 5 Clinical Infrastructure Infrastructure Video Conferencing Core Infrastructure Healthier country (could communities be a mix of hardware, through software, partnerships on premise, off premise) and innovation 5

6 Success R4R government funding We tell the stories multi media Celebrate & promote success Patient stories & quotes Telehealth Awareness Week Annual November: Attach Acute Inpatient Service for 1. Deteriorating patient 2.Dr not available short term Thank you & we welcome you 6