Virtual clinics make their mark

10 May 2017

Three nurses from diverse specialties share case studies of using telehealth technology to make life simpler for their patients.

Sensitive timing for rural cancer patient (Fiona Sayer, Thames Hospital)

medical touchscreenFiona Sayer got a call this particular day from Waikato Hospital’s oncology department to say that the latest blood test of Julie – a 54-year-old breast cancer patient who had had metastatic disease in her bones – did not look good, with disturbing liver function results. They were requesting a CT scan.

Sayer, the oncology/haematology nurse coordinator of the small rural hospital in Thames, rang Julie, who already knew that something was wrong as new and worrying symptoms had emerged. Julie came into Thames ED, which was very busy that day, and after her scan was transferred with her husband to Sayer’s chemotherapy room to wait for the rushed ED doctor to interpret the result.

However, underway next door was the weekly telehealth clinic run by Julie’s Hamilton-based oncologist and Julie jumped at the opportunity to have her own oncologist deliver – via the TV screen – what she expected could be, and was, devastating news, rather than an ED doctor. With her husband holding her left hand and Sayers her right hand, Julie heard that the cancer was now in her liver, there were no further intervention options and the care plan would be comfort cares and symptom management.

Tough news to receive via a television screen, but Sayer points out that telehealth meant the care outcomes for this patient was a timely prognosis from her own oncologist – a person whom she knew and who knew her – and with whom she was comfortable asking clarification questions. Sayer says it also gave her patient and her husband a chance to thank the oncologist and bid him farewell. And she left the telehealth clinic with a developed care plan, the necessary referrals completed and prescriptions signed for her immediate needs.

Zoom conferences reduce infection risk for CF adults (Robyn Baird, Christchurch Hospital)

Robyn Baird is a clinical nurse specialist working with the about 85 adult clients with cystic fibrosis (CF) spread across the South Island – both urban and rural. New treatments mean that more and more people with CF are surviving into adulthood, with about 50 per cent of the CF population now aged over 16.

The Christchurch Hospital-based nurse says recommended best practice for CF patients is quarterly review by a multidisciplinary team and since 2012 Canterbury’s Adult CF Service has been offering telehealth video conferencing for clients from secure hospital-to-hospital video conferencing facilities. But Baird says not all areas have these facilities; many patients still have to travel and the risk of infection or cross-infection is a major concern for CF adults.

So the service decided to investigate in-home telehealth options and decided on the option of clients downloading the free videoconferencing software Zoom to the clients’ own devices (like laptops, home computers or tablets). Pros included easier access for clients, reduced infection risk and minimal costs. But cons included individuals needing adequate broadband speed, additional equipment to allow videoconferencing (i.e. camera/headphones/laptop), and some clients being unable to upload information to the conference, such as portable spirometry.

After a trial and pilot with suitable patients, the Zoom conferencing is being used successfully to replace the inpatient scheduled review for some rural remote patients, and also for some palliative patients and those awaiting transplant. It has also been used to review patients on home IV treatment and those requiring close follow-up. Baird envisages that future uses could include virtual exercise classes for CF adults to reduce the infection risk of in-person classes.

Virtual vascular clinic gives patient power (Sandra Almeida, Auckland City Hospital)

Sandra Almeida looked to nurse-led virtual clinics by telephone to provide a more timely and convenient service for the abdominal aortic aneurysm (AAA) patients she works with as a clinical speciality nurse (CSN) at Auckland City Hospital’s vascular services.

These clinics are particularly useful for patients needing ongoing surveillance after an endovascular aneurysm repair (EVAR) of an AAA and those undergoing AAA surveillance (EVAR uses stents and has replaced open aortic surgery as the treatment of choice for AAA, but it can have post-op complications years down the track.)

Almeida says normal practice was that patients on surveillance have scans (usually six-monthly) and then wait for a face-to-face appointment with a consultant for the results. The feedback from the often elderly patients was that coming into an outpatient clinic just to be told that their results were okay was seen as a waste of time.

After investigating the evidence for virtual clinics, Almeida proposed and piloted the option of virtual clinic appointments by phone instead. Under the virtual clinic model, Almeida attends the multidisciplinary meeting where the vascular team discusses the scan; she then phones the patient to inform them of the outcomes and any proposed investigations and management, as well as offering them education, answering questions and giving advice on what to do if they get any adverse symptoms – i.e. head to ED straightaway.

Almeida stresses that virtual clinic patients are given the opportunity for a face-to-face appointment to discuss any concerns; patients who are cognitively impaired or mentally ill always have face-to-face appointments. She says telephone consultation requires a significant amount of knowledge, skill and judgement because of the lack of visual interaction and the decreased chances for patients to raise concerns instinctively.

Some elderly patients and cultures also believed they should only see a doctor, but overall the five-month pilot – involving 116 patients in the first half of last year – showed high patient satisfaction and the take-up of clinic offers is still growing. Almeida says the virtual clinic is improving patient satisfaction and is also freeing up outpatient clinic appointments for new referrals and saving the service funding.

HiNZ scholarships

These three stories were case study presentations at the Nursing Informatics arm of the Health Informatics New Zealand (HiNZ) 2016 conference.

Thirty HiNZ conference scholarships are available to nurses and allied health professionals wanting to attend this year’s HiNZ conference in Rotorua from 1–3 November.

For more information on each scholarship package (worth nearly $1,000) go to
www.hinz.org.nz/page/scholarships.

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