Teleconferencing Patients Reviews

Daniel Kesik HITH Team Leader

Barb Milner District Nursing Unit Manager

Daniel Stefanski Infectious Disease Physician

Background:

LOCATION:

West Gippsland

Healthcare Group

Warragul(WGHG)

100 kms from

Melbourne

1-2 hours drive

BACKGROUND

WGHG Hospital in the Home(HITH)Commenced in 1996

2014 workload is manage by 2 nurse Co-ordinators, with

District nursing providing the HITH patient care.

A steady increase in demand for HITH admissions, which

has lead to a greater demand on medical and surgical units to

review and support admitted HITH clients.

ISSUES RECOGNIZED

Increased demands on HITH have lead to:

Pharmaceutical supplies

Wound consumables

Allocation of resources, Nursing, Medical and Allied Health.

A recent review of clients admitted under HITH at WGHG

found of those admissions for iv antibiotics in 2013 - 15.5%

where deemed inappropriate by our ID Physician.

Number of HITH admissions deemed

inappropriate, by specialty.

Antibiotic Stewardship

Support introduction of the antibiotic

stewardship- to comply with National

Standards for accreditation

As antimicrobial resistance increases and

development of new antimicrobial agents

declines, it is critical that antimicrobials are

used wisely and judiciously.

Antibiotic Stewardship

Antimicrobial Stewardship is an unmet need

in many rural hospitals. West Gippsland

Hospital(WGH) provides intravenous (iv

antibiotics) for approx 100 patients per

Annum through their Hospital in the Home

Program.

The process a patient

needed to go through

prior to Introduction of

Telehealth!

Melbourne Review Early morning clinic appointment for treatment

Travel down to Melbourne

Arrange transport if unable to drive.( this could become a

hospital cost)

Need to leave early to beat the traffic

Work out where they are going

Find a car park

Pay for the car park

Wait in waiting room for doctor to review( no set time)

Melbourne Review

Medical Review

Trip back home

Find out what happened at the medical review.(Not all

Doctors write in the HITH notes)

The HITH Team Leader to organise any changes , such as

blood test and medication supplies– (need to find registrar

willing to complete documentation.)

Arrange for it all to happen again in a week .

AIM Offer Infectious diseases specialist care in a rural setting.

Under guidance of Antibiotic Stewardship.

Improving access for patients.

Developing a program that provides correct treatment for

correct diagnosis.

Being able to provide regular review of Clients admitted to

HITH program to meet Australian Standards.

Good Clinical Governance of HITH Patients leads to better

health outcomes with better use of resources.

Equipment

Old Lap Top - Toshiba

ClearOne Chat 50 personal speaker phone.

Logitech webcam

COST approx $350.

(not including lap top

- hand me down).

HITH Review!

ID Physician

HITH nurse

Patient

Medical Registrar

REVIEW USING SKYPE

Skype review with Physician, HITH Team

Leader and Registrar

All documentation completed by Registrar.

Patients gets seen in a reasonable time in

clinic and return back home to convalesce.

REVIEW USING SKYPE

discharge/Care plan discussed with patient

and HITH team

Adjustments of medication or d/c scripts can

be attended by registrar.

Any further tests can be ordered and be

reviewed by registrar prior to next telemed

review.

Benefits from audio visual reviews

Allows for a Multidisciplinary consult

Patient involvement

Patients can talk to the doctor directly with Visual contact

Patient centred care

Discussion is open

Privacy is maintained

Benefits from audio visual reviews Meeting National Standards

Changes to Pharmacy service

Less wastage of medications

Arrange medication in a timely manner

ID Physician

pick up on diagnosis/changes

Complicated assessment which is virtual supervised.

Telehealth Antimicrobial

Stewardship Telehealth has allowed our health service an

acceptable way to measure/monitor and

provide oversight of IV antibiotic

management of Clients in our Rural

Community.

Bridges to cross! Patient right to refuse

consent for SKYPE

Increased work load on

HITH Team Leader

Utilisation of available

resources.

Compliments

Quick review without

waiting around.

Supportive HITH

team.

They knew what was

being said and it was

explained to them

Patient Survey Results

Complaints

.

It was hard to hear –

we now have a speaker

system that has

improved this

The computer screen

too small, and we need

to look at other options

The review room is too

small – with a lot of

people in our review

area.

Developing technology- what is the best option in technology.

software

price

portability

confidentiality

A SATISFIED CONSUMER:

Acknowledgements:

• The HITH clients who helped us by giving honest opinions

• Dr .Daniel Stefanski (The patient used in this photo has given consent)