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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