The Emergency Telehealth Service – an innovative service delivery model for rural and remote EDs using telehealth technology and a specialist emergency medicine workforce. ETS empowers nurses to deliver timely, quality emergency care with the support of specialist doctors and a comprehensive education program within a supportive teamwork environment.

Mrs Yvonne Zardins, Melanie Goode1

1WA Country Health Service, Perth, Australia

 

The purpose of this presentation is to illustrate how technology and innovative service delivery can empower rural and remote nurses to deliver timely emergency care with the support of specialist emergency physicians via telehealth.

The Emergency Telehealth Service (ETS) aims to deliver accessible, quality emergency medicine (EM) to country patients.  High definition video conferencing equipment, installed in participating EDs enables ETS to deliver accountable, timely EM – supporting patient management in 76 rural EDs seven days a week. ETS doctors activate and control the equipment in response to a call for assistance ensuring local clinicians are hands-free to care for their patients.

  • An innovative model of care places specialist Emergency Physicians ‘in the room’ with rural clinicians and patients.
  • ETS has demonstrated the capacity to deliver improved access and outcomes for rural emergency patients.
  • Enhances local clinician learning and capacity, enabling better management of high acuity patients, supporting professional development and reducing professional isolation.
  • Enhanced community confidence, reinforced by positive nursing and patient feedback.
  • ETS has delivered over 46,000 consults with 75% of patients treated and discharged home, demonstrating the ability to manage a variety of clinical cases.
  • Provision of high quality education by specialists directly into remote sites both through dedicated program with flexible learning framework and real time learning.

Effectively pioneering a new service delivery model for emergency medicine, ETS has raised the clinical standard of patient care in rural hospitals empowering nurses to deliver immediate care. ETS has introduced improved emergency medicine clinical governance, leadership, support and educational and learning opportunities that is generally only available in metropolitan EDs.  ETS is repeatedly and positively referenced by local communities, clinicians, and health consumers as a valuable addition to the local hospital.

 


 

Biography

Melanie is a graduate of the University of the West of England in Bristol UK and has long had a passion for Emergency Nursing.  In 1999 she completed a Post Graduate in Accident and Emergency Nursing and in 2001 a second degree in Paediatric Nursing.  Melanie has worked in large tertiary EDs in the UK and WA, but has most enjoyed her time working in rural and remote WA.  Roebourne was her first experience in 2008/9, followed by Onslow, Mulan and more recently Three Springs in the Midwest.  Her interests have diversified into education, learning and development.  With moving to Perth she has become part of the Emergency Telehealth Service clinical team which allows her to continue to support her passion for quality emergency care and education for rural and remote patients whilst living in the metropolitan area.

Yvonne Zardins is an experienced healthcare professional having combined clinical, management and project roles across metropolitan and country health services in Western Australia. As a Registered Nurse with a Bachelor of Business and a Master of Health Service Management, Yvonne has been well placed to manage both clinical service reform and development within her healthcare management roles. Most recently Yvonne has been responsible for the establishment and development of the WA Country Health Service Emergency Telehealth Service (ETS), a dedicated consultant-led emergency medicine service using video conferencing technology to deliver medicine to regional and remote Emergency Departments in WA.

Practical Examples of Point-of-Care Testing Technology Use in Rural and Remote Australia

Mrs Brooke Spaeth1

1Flinders University International Centre For Point-of-care Testing, Bedford Park, Australia

 

Introduction:Pathology services are generally situated in large urban or metropolitan centres with turnaround time for pathology results to a rural or remote health services taking 24 hours up to 2 weeks. This delay causes issues with loss-to-follow-up for chronic and infectious disease management and is impractical for acute care. Patients requiring regular pathology testing are sometime forced to move closer to pathology services.

Point-of-Care Pathology Testing (POCT) technology offers practical advantages in rural in remote locations through providing immediate pathology results at the time of patient care.

What is happening in your project(s):

The Flinders University International Centre for POCT manages a range of POCT networks in rural and remote Australia covering chronic, acute and infectious disease testing.

Quality Assurance in Aboriginal & Torres Strait Islander Medical Services (QAAMS) Program: National chronic disease management and screening program using POCT to test for HbA1c for diabetes management and urine ACR to screen for early kidney disease.

Northern Territory POCT Program: Territory wide acute care testing program using a POCT device to test for a range of acute care markers such as troponin I, blood gases, electrolytes, lactate, creatinine and haemoglobin. The benefits of this program include, increased patient safety and significant cost savings through preventing uncessessay medical evacuations.

Infectious disease programs: Sexually transmitted infections program testing for chlamydia, gonorrhoea and trichomonas, providing a reduced time to treat for patients with these transmissible diseases.  Program testing for total white cell and 5-part differential white cell count, providing immediate results for a range of chronic and acute conditions such as sepsis, respiratory tract infections, appendicitis and parasitic infections.

Conclusion: These programs to provide practical examples of the use of POCT and its clinical applications and benefits to remotely located patients.

 


 

Biography

Brooke joined the International Centre for Point-of-Care Testing in February 2010 as a Research Assistant after completing an honours project with the Centre evaluating the implementation and effectiveness of POCT in remote health centres of Northern Territory.

Brooke is now the Point-of-Care Coordinator for the Northern Territory POCT Program.

In 2015, Brooke was successful in her first grant from the Emergency Medicine Foundation to evaluate the cost effectiveness of the Northern Territory POCT Program. Results from the grant research were positive, indicating potential cost savings to the Northern Territory health system were in excess of $20 million per annum.

Evaluating Organisational Cultural Competence in Maternity Care for Aboriginal and Torres Strait Islander women

A/Prof Robyn Aitken1, Associate Professor  Virginia  Skinner2, Ms Louise Clark1

1Menzies School Of Health Research and Top End Health Service, Charles Darwin University, Australia, 2Office of the Chief Nursing and Midwifery Officer Northern Territory Department of Health

Reducing health inequalities experienced by Aboriginal and Torres Strait Islander women and babies compared to non-Indigenous Australians is essential to the closing the gap strategy (COAG 2011), and a core component of CRANAplus member’s work. This AHMAC funded research assessed the progress of Australian publicly funded maternity services in achieving the goal of organisational culturally competent maternity care. Technology was used to measure the degree to which these services have incorporated identified characteristics into the fabric of their organisation, producing an evidence based validated on-line tool.

Results demonstrated that actions to integrate women’s health care records across the continuum of care have occurred nationally. Correlational analyses identified that organisations who provided documentation from antenatal records through to discharge summaries to all relevant stakeholders including Aboriginal and / or Torres Strait Islander women had a statistically significant relationship with encouraging family members to accompany and support Aboriginal women during their pregnancy. Similarly, organisations employing Aboriginal and Torres Strait Islander Health Practitioners had a statistically significant relationship with providing such continuity of care.

This research provides a benchmark for organisational cultural competency performance. The technology used will facilitate ongoing cyclic use of the validated tool. The results reinforce the value of Aboriginal workforce in maternity settings regardless of location, and the benefits of investing in integrated records. It is of relevance to rural and remote health professionals for guiding activities to improve the maternity experiences of Aboriginal women whether cared for in the bush, or transferred to a regional or metropolitan centre.

Simulation assist nurses working in Rural Australia complete their continuing professional development

Judith Brown1

1Qld Health, Richmond, Australia

 

Through the innovation of a nursing staff member at Richmond Multipurpose Health service. The facility is able to promote ongoing learning, onsite for nursing staff through Simulation-Based Education (SBE), It can be problematic when living and working in rural and remote areas to complete the mandatory Compulsory Professional Development (CPD) hours due to the tyranny of distance. The pocket is supported locally by nursing and medical staff.  Additionally, the Clinical Simulation Centre at The Townsville Hospital (TTH) and the Clinical Skills Development Service (CSDS) in Brisbane provide support through provision of manikins and delivery. The pocket is in its infancy, with the local Simulation coordinators being trained at CSDS, Brisbane, in November 2016 and the SBE program beginning in February 2017. There are two Simulation Coordinators trained to use the high fidelity equipment, with the provision of training for an additional staff member each year funded through CSDS. CSDS supply the Simulation equipment including manikins and part-task trainers enabling diversity in delivery.  The equipment is freighted by CSDS to Richmond at no cost to the facility.   Lauren Camilleri, Nurse Manager, Clinical Simulation Centre at TTH has been instrumental in assisting us with a site visit and arranging expired stock to be sent to Richmond.  The high fidelity manikin being utilised to run clinical scenarios is a Laerdal Megacode Kelly.  The manikin is operated through the use of a SimPad and monitor.  Other part-task trainers such as QCPR and Airway heads support clinical education and assist in the evaluation of staff maintaining their competency in the Recognition and Management of the Deteriorating Patient. It is envisioned that in the future Simulation Coordinators will be able to facilitate external courses such as Recognition of the Deteriorating Paediatric Patient (RMDPP) and provide support in the delivery of Imminent Birthing for Non-Midwife Training.

 

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Biography 

Judith Brown is a Rural and Isolated Practise Endorsed Registered Nurse and Child Health Nurse with over 20 years of experience working in Rural Queensland. She is currently working as a Clinical Nurse at the Richmond Multipurpose Health Service.She is currently completing a Graduate Certificate in Clinical Education and is also studying a Master of Nursing (Nurse Practitioner). She enjoys working in rural environments as she feels part of the community. When not working, Judith resides on a cattle station 100km from Richmond. She has two Children who are both at boarding school.

Using the emojis to address language barriers with an App supporting chronic disease self-management

Isabelle Skinner1

1Charles Darwin University, Darwin, Australia, 2Decision Support Analytics Pty Ltd, Darwin, Australia

Introduction: This presentation will describe the process of developing a library of emojis to communicate the complex health and lifestyle issues associated with self-management for people with Type 2 Diabetes.

Background: Globally, more than 415 million people have Type 2 Diabetes. With effective lifestyle interventions these people can significantly reduce their risk of complications. Diabetes affects people from all language groups and in all regions of the world. However, many of the people affected have poor access to diabetes educators to support goal setting and provide follow up education, motivation and support services for lifestyle change. Yet, the technology to reach people in even the most remote parts of the world is available using the mobile phone.

Project: A team from Charles Darwin University, Decision Support Analytics, Diabetes WA and Healthy Living NT have used the available evidence of effective goal setting and diabetes self-management to inform the development of an App for people with Type 2 Diabetes. To make the App universally accessible, language differences were addressed by the innovative emoji pictorial library designed for the project. In the first 3 weeks of release the App emojifitDiabetes has seen exponential growth and has been downloaded by people in 24 countries.

Conclusions: The language to communicate cross culturally exists with emojis, Harnessing them and developing a new library to serve the needs of health has made diabetes education accessible to people all over the world.

 


 

Biography

Isabelle Skinner is a Fellow of CRANAplus, she is a Registered Nurse and Midwife. Isabelle’s research and development work has involved using the Internet to overcome the tyranny of distance for health care delivery since 2000 when she was the first Telehealth co-ordinator for the Kimberley region.  Isabelle worked on the Kimberley Telehealth woundcare project for her PhD. Her current work is in the development of Apps to address chronic disease self-management.

The Impact of a Trauma Board in a small rural Hospital and Multiple Purpose Health Service Emergency Department

Kylie Ludwick1

1Queensland Health, Winton, Australia

Problem: Perception of team confidence and function in a small rural facility emergency department in response to unprecedented increase in critically unwell patients requiring advanced level intervention in particular Rapid Sequence Intubation (RSI)

Design: Post debrief feedback, implement strategies to resolve issues identified

Setting: Small rural Hospital and Multiple Purpose Health Service (MPHS), with high prevalence of agency nursing staff, junior substantive nursing pool and wide range of clinical experience that were not necessarily Emergency Department orientated

Key Measures for Improvement: Ease of use, team confidence, team function, and improved documentation from using the Trauma Board

Strategies for Change: Implement a custom designed Trauma Board to facilitate communication, documentation and team functionality during resuscitation

Effects of Change: Improved team communication, confidence and functionality during emergency presentations when utilising the Trauma Board.

Lesson Learnt: Staff validated perception of team performance by measuring human factors such as communication and team function, not by patient outcome

Key words: team function, team confidence, communication, documentation tool

 


 

 

Biography 

Nurse Practitioner, Pre Hospital Trauma Life Support (PHTLS) InstructorBip

How Clinical Information Systems Can Improve Management of a Neglected Tropical Disease, Crusted Scabies.

Michelle Dowden1

1One Disease, Darwin, Australia

In January 2016 Crusted Scabies was made a Notifiable Disease in the Northern Territory (NT) under the Notifiable Diseases Act NT. Crusted Scabies is notifiable by laboratory on detection of scabies mites. The Centre for Disease Control (CDC) NT is responsible for the public health response.

An essential component of the public health response for Crusted Scabies is CDC informing local health service staff who the clients are with Crusted Scabies and what is required for management including household contacts. Most importantly people who have had Crusted Scabies must have life long follow-up which includes regular skin checks and live in a ‘scabies free zone” to prevent reinfection.

An audit of 488 flies within Clinical Information Systems (CIS) was undertaken. The purpose of the clinical audit was to determine the number of clients with a definite diagnosis of Crusted Scabies (CS) according the CDC case definition. The audit also determined if Crusted Scabies clients had flags and reminders in place for long term follow up and care.

Results. The findings of the audit revealed 85 clients had a definitive diagnosis of Crusted Scabies.

More education is needed around detection, diagnosis and long-term management of Crusted Scabies. The inclusion of electronic prompts within Clinical Information Systems will assist health service staff to provide appropriate, comprehensive and timely of care. In the same way a disease register is able to maintain records of a specific disease or condition for a population.


Biography

Michelle is currently the NT Program Director for One Disease.

Michelle is a Registered Nurse Midwife with 25 years experience conducting health programs that focus on good clinical outcomes and the social determinants of health. The main focus of her work has been with remote indigenous communities and other large indigenous health services throughout Australia both in research and service delivery.

Michelle has a strong background and understanding of Continuous Quality Improvement in Indigenous Primary Healthcare both in research and service delivery. She continues to be involved with research and contributes to peer reviewed publications.

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