Telehealth – Everyday Business

Alison Loudon

District Manager,

Maternity & Children’s Strategies

Acknowledgement

• IT and telehealth support and expertise

• Aboriginal and Torres Strait Islander Community Elder’s for their guidance, consultation and support for videoconferencing.

Western NSW Local Health District

Everyday Business

Clinical Settings

• Critical Care Advisory Service

• Mobile Videoconference Reviews

• Antenatal Video consultations

• Multidisciplinary Case Conferences

• Escalation of Care

Management Settings

• Team Meetings

• Education

• Individual Accountability Meetings

• Clinical Supervision

• Community Consultations

• Focus Groups

• Award Ceremonies

Critical Care Advisory Service

Acute Telehealth Service

Emergency Birthing Support MODELS OF CARE | Obstetrics Emergency Birthing Model

Model of Care

Governance Technology Outcomes & Benefits Support

Consumers Clinicians WNSW Admin. Tech. Training

• Patient Flow unit co-ordinates Specialist consultation to support Emergency birth and transfer from facility if required

• VC via accessible platform e.g. WebRTC

• LHD to 3rd Party access requirement

• Uses CA700 cameras located in small facilities enabling birthing to occur away from the Emergency Department

• safety for Emergency Delivery by increased access to specialistconsultation

• Improved experience b not having to Birth in the Emergency Department

• Virtual meeting room access enables multiple clinicians to be involved if required.

• Improved support for GP’s, Nurse and Midwives in smaller facilities

• Improved support for communities

Key admin = GP Clinic, or other facility based clerical staff• LHD Obstetrician

roster could be Dubbo or multi-site based

• Desktop support

• Vendor SW –e.g. WebRTC solution

• virtual scenario based training for GP’s and Sitebased Staff

• Training on the use of Emergency Birthing packs

Business Model

DescriptionLate presentation and Emergency Birthing support from WNSW Specialists to GP and Midwives and Nursing Staff in Non Birthing facilities or MPSs; • WebRTC software licensing

and support enables multi-device access to virtual room environment. Mother

Virtual Room

Platform

Obstetrician

Target PopulationMothers who present in Labour can not be transferred .

Remote

Facility or

MPS

Major Rural

Referral Hospitals

NETS

Remote site Midwifery

and Nursing staff

GP

Patient

Flow

Doctor

RFDS

midwives

Perinatal

Advice

Line

• Uses established CA700 and Desktop Videoconferencing internally to LHD

• HD & Pan, Tilt, Zoom (PTZ) VC equipment + remote control software

LHD Midwife

‘Wally’

Mobile Videoconferencing at the bedside

Postnatal Care• Diagnosis• Management Plan• Virtual Rounding• Medical and Midwifery Reviews

Inpatient / Outpatient

Post Natal Remote Support

MODELS OF CARE | Obstetrics and Midwifery Specialist – GP Access

Model of Care

Governance Technology Outcomes & Benefits Support

Consumers Clinicians WNSW Admin. Tech. Training

• GP = primary Medical carer

• Specialist provides patient consultationand GP support

• VC via accessible platform e.g. WebRTC

• LHD to 3rd Party access requirement

• support enabling care to be closer to home

• personal travel costs and expenses

• Improved communication and planningbetween providers ( efficiency)

• Improved Primary –Sub-acute integration

Key admin = GP Clinic, or other facility based clerical staff

• Desktop support

• Vendor SW –e.g. WebRTC solution

• Identification of Lactation support within LHD

Business Model

DescriptionPost natal Video Conferences (VCs) Midwifery / Lactation specialist , and Obstetricians as required supporting mothers on return to small facilities

• Decreased LOS in Rural Referral Hospitals

• Non-Inpatient there are Medicare incentives for outpatient telehealth consultations of 50%. For Specialist , GP’s and AHWs

• Opportunity to improve Lactation Consultancy throughout LHD

• Desktop / Laptop with camera, speakers, mic.

Costs & Revenues

• Saving on travel and accommodation

Mother

GP

VC Platform

Specialist

Midwifery

and

Lactation

Support

Target PopulationPatients who return to small facilities and communities .

GP / VMO

Clinics

HealthOne

Facilities or

MPSs

Major Rural

Referral Hospitals

or Consultant

Rooms

ObstetricianMidwife, CAFHN,

AHW , AMIS

GP

Postnatal Step Down Care

Postnatal Care for well women and their babies in their local facility

• Virtual Rounding

• Upskilling of local staff

• Discharge on Country

• Welcome to the family

• Hospital to Hospital transfer

• High risk

• Vulnerable

• Isolated

• Escalation of

Care

Antenatal Videoconferencing

Travel Time Saved

10 antenatal videoconferences.

Living 408 kms from service specialist service provider.

816 km return trip or a minimum 9 hrs drive.

Total of 8160 kms

90 hrs saved by the clients

• By attending First comprehensive /eMaternity remotely & in the women’s community.

• Face to Face average 90 minutes

Travelling from Lightning Ridge to Dubbo is 708 kms round trip , or 8 hours driving time.

10 visits equals 7080 kms

80 hours by the clients

Travel Time Saved

• Obstetrician, Midwives, Aboriginal Health Workers, Allied Health, GP’s.

• Electronic Medical Record

• Access to Investigation results

• Develop management plans

Multidisciplinary Case Conference

GP Shared Care Guidelines• Enabling Rural and Remote GP’s to provide

shared antenatal care with Midwives & Obstetricians

• Case Conferencing

• Case Reviews

• Webinars

Clinical Videoconferencing Support

• Obstetrician, GP O&G &/or Midwife outreach

• Antenatal care in local community

– LHD or Aboriginal Medical Service

• Shared Care Arrangements

• Care Navigation

Everyday Business

Management Settings

Team Meetings

• Increased ‘connection’

• Decisions as a team

• Work as a team

• Improved engagement, especially over long distances

• Enhance an ‘honest’ conversation

Clinical Stream

• Across many sites over 350kms• Presentation with in the meeting• Increased participation• Interactive meeting• Increased engagement

Joining Face to Face and Virtual Education

• Presenting to 30 participants face to face and 20 virtually.

• Interactive

• Reduces travel

• Increased participation

Individual Meetings

• Increased ‘connection’

• Shared document review

• Improved engagement, especially over long distances

• Enhance an ‘honest’ conversation

Clinical Supervision

• Group or individual

• Utilise appropriate tools (unable to do this over phone)

• Read body language

• Improved understanding of clinicians situation

• Minimises travel, that would otherwise be required

Ministry of Health Consultation

• Presentation • Focus Groups• Consumers, volunteers, clinicians included• Geographical area – 1/3rd NSW

Don’t stop being Innovative!

• Nursing and Midwifery Team of the Year, Western NSW LHD. 2019

• Midwife providing a clinical service in Lightning Ridge No videoconferencing facilities………

Joined in using a Tablet

Thank You