consultations in in Queensland: : benefits, challenges and cri - - PowerPoint PPT Presentation

Telehealth portal use for pre-admission consultations in in Queensland: : benefits, challenges and cri ritical enablers

Amina TARIQa , Bernd PLODERERb, Michelle GRANT-IRAMUc, Linda CUSKELLYc, Elizabeth Ann DAVISc

a School of Public Health and Social Work, Faculty of Heath, Queensland University of Technology b Faculty of Science and Engineering, Queensland University of Technology c Clinical Operations Strategy Implementation (COSI), Metro North Hospital and Health Service,

Queensland

Clinical Operations Strategy Implementation (COSI) MNHHS

Health Informatics Conference 2018, Sydney, Australia

Tele lehealt lth in in Queensla land

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Queensland Health have taken a strategic whole state approach to Telehealth

Telehealth Support Unit provides support, technical expertise and funds to purchase equipment

Telehealth Incentive payments on top of existing ABF funding

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Centrally funded Telehealth Coordinators and Medical Leads in each Hospital and Health Service So Telehealth staffing and equipment infrastructure at each HHS. In 2016 introduced the Telehealth Portal

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QHealth’s Telehealth Portal…

Android Apple Pexip Infinity Connect

Chrome Firefox Safari Opera

Easy, safe and secure way to videoconference with

• ur patients & external healthcare partners from any

location using PC, MAC, laptop, tablet or smart device as long as they have adequate internet…

How the Telehealth Portal works…

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Andro id

Step 1 MNHHS staff contact patient and provide them with information on how to download the Telehealth Portal as well as a Virtual Meeting Room (VMR) number Step 2 Patient is asked to do a test call to a designated test site the day before their Telehealth appointment Step 3 On the day of the Telehealth appointment everyone dials the same VMR number at the same time to connect (external dial number + address) …

Patient dials

400500@telehealth.health.qld.gov.au

GP dials

400500@telehealth.health.qld.gov.au

Patient family member if not in same location as patient dials

400500@telehealth.health.qld.gov.au

QHealth clinician dials

400500

Metro North HHS

• Population over 900,000, from north of the Brisbane River to north of
• Kilcoy. Population expected to reach over 1.1 million people by 2026
• Over 15,000 staff and a budget over $2.4 billion. Over 250,000 patients

admitted to its facilities in the 2016-2017 financial year, Over 52,000 OPD Occasions of service per month

• All major health specialties and more than 30 sub-specialties.
• Five hospitals – Royal Brisbane and Women’s, The Prince Charles,

Redcliffe, Caboolture and Kilcoy Hospital

• Large community and mental health services
• RBWH and TPCH both tertiary and quaternary services as well as

secondary services for the local population. Some statewide services as well as tertiary services up to Central Queensland

• Queensland Health has a major focus on reduction of OPD long waits.

MNHHS long wait OPD’s have reduced by over 75% since 2014

Clinical Operations Strategy Implementation (COSI) MNHHS

Tele elehealth th Occ ccasions of f Ser ervi vice have explo loded in in MNHHS in in th the e la last t th three ee yea ears

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10,136

2000 4000 6000 8000 10000 12000 14000 2015/2016 2016/2017 2017/2018

14,818 8,055

Why use the Telehealth Portal

Newly available

Visualisation (complements

existing service)

Enables Telehealth (mostly

where usual telehealth delivery in hospitals was difficult to

• rganise)

At home/Aged Care facility

and phone service

wasn’t appropriate Visualisation plus at home plus Flexible timing

• Replaces existing

scheduled phone service – post discharge pharmacy clinics

• Replaces/ Complements

existing local home visit – rehab, palliative care, Complex Chronic Disease Team

• Peri procedural Support

Unit – pre op clinics

• Tertiary services for

patients across Queensland – adult Cystic Fibrosis, Genetics, complex sleep patients.

• Also opportunity to provide
• nline group patient

education/liaison that can be difficult for this cohort with rarer conditions and wide geographical split.

• Patients who are unable to

travel or for patients who find it difficult to travel– MND patients, OPD appointments for patients in RACF’s

• TPCH Post Children’s ED

attendance clinic

• Involving relatives in

different locations in OPD clinics

• Lactation consultations

when baby ready for a breast feed

• RACF ED avoidance
• Out of town relatives

involved in Inpatient Ward Rounds – Neonatology

• Haemophilia patients

experiencing complications

Clinical Operations Strategy Implementation (COSI) MNHHS

A Formative Evaluation of Queensland Health’s Telehealth Port rtal:

Four unique settings were identified for collecting data - each tested a different context for Telehealth Portal use:

• Periprocedural (PREAC) Support Unit, RBWH
• Patients from across Queensland, all ages, clinical team that were already good users of

telehealth, difficulty accessing hospital based telehealth

• Maternity Outpatients, RBWH
• Young cohort with smart devices, lactation services so would wait until baby was awake for

flexible service

• Motor Neurone Disease Clinic, RBWH
• Cohort of all ages, very difficult for patients to travel to a local hospital or Brisbane to see

their consultant and CNC, benefits of visualisation to the clinical team over phone clinic

• Children’s Emergency Department, TPCH
• Next day post ED attendance for ED staff to assess patient at home – young cohort with

smart devices, flexible timing, much less distress for children to be cared for at home, even small children very familiar with videoconferencing

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Case Study Aim im

• Evaluate the Queensland Health Telehealth Portal use for pre-

admission consultations (PREAC) with state-wide patients that were being admitted for surgical procedures at a metropolitan hospital in Queensland.

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Case Study Context xt: PREAC Unit

• Conducts pre-admission consultations with the patients approximately 2–6 weeks

before the patient is admitted to hospital for a surgical procedure

• Prior to the introduction of the Telehealth Portal, pre-admission consultations

took place either face-to-face, via telephone

• The Telehealth portal allowed patients to join the consultation from their own

homes.

• At the time of this evaluation, the unit had conducted nine Portal consultations.

Eight were consultations with patients in their own homes and one was with a family member who participated in her elderly father’s telehealth consultation by using the Portal

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Methods

• Semi-structured interviews with clinicians (4), administrative staff (1),

and patients (4) using the Telehealth portal.

• Focused on examining the benefits, challenges and key enablers of the

Telehealth Portal as experienced by these principal users of the system.

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Fin indings: Key Setup Success Factors

• A new booking process for the administration team that incorporated

Portal bookings

• Technology readiness (equipment available) and collaboration

readiness by clinicians

• Leadership from the unit director to bring team onboard with Portal

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For me it’s not a waste of time… I didn’t have to take a day or two off my normal schedule. Because obviously travelling from Townsville it depends

• n what the flights

are, and what appointments that you can get at the time (P1) Less stress - mentally and physically, because of travel. I would say that is the biggest hurdle, the stress that’s involved for us, getting down there and then sitting in a hospital for that many hours. I think it’s fantastic. I would think that’s the best thing out of all of it. (P2) It’s one of the criticisms that a lot of the other anesthetists have, that they like to be able to listen to their heart and lungs, so it does turn some of them off. (A) Just that time delay, when the anesthetist spoke or when I spoke but I was a little bit like oh, that would be difficult for a patient that’s hard of hearing. (P3) I think the Portal interview, it always comes down to who the patient is, what the patient looks like and needs (medically) and also how capable are

• they. (RN)

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Key Lessons

This case study highlighted the following best practices: (1) Laying the foundations for successful service through strategic processes and leadership (2) Ensuring ease of access in using the Telehealth Portal (3) Promoting clinician readiness and (4) patient readiness through training and support materials; (4) Promoting awareness about the Telehealth Portal among patients and families.

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Curr rrent sit situatio ion

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Dr Kellie Wren’s and the RBWH Preadmission team are the leaders in delivering telehealth services into patient's homes and to date have delivered over 2,000 telehealth outpatient services all over Queensland. Over 100 of these have used the Telehealth Portal

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