Telehealth Helps Close Gaps
6 November, 2019
Northland DHB has developed a new acute care telehealth network linking all of its rural Hospitals’, Kaitaia, Bay of Islands, Dargaville, and in 2020, Rawene, to the Intensive Care Unit at Whangarei Hospital.
The Northland Telehealth and Mobility team developed this network in conjunction with Northland DHB intensive care physicians, Connect NZ, healthAlliance and the University of Queensland Centre for Online Health.
The technology is a mix of static room setups and mobile carts which allow remote patient assessment and management in an acute clinical setting. It enhances assistance and decision making for acute retrieval requests from the rural hospitals and provides Whangarei Hospital with an after-hours telestroke service.
The Rapid Information Telehealth Assessment (RITA) uses Zoom videoconferencing from a computer workstation, tablet or cell phone to enable a much broader and more integrated communication network than previously.
RITA enhances Whangarei ICU’s remote acute assessment capabilities to rural Hospital Emergency Departments and wards for patient safety through direct rapid patient assessment of acutely unwell patients. This includes assisting with decision-making in determining the safest way to transport the patient.
The new setup in the Acute Assessment Unit (AAU) at Dargaville Hospital supersedes the community purchased mobile videoconferencing unit which is still in use in other parts of the hospital. It has a ceiling mounted camera with a powerful zoom that is controlled remotely and wall mounted TV screen. All functionality can be controlled at the ICU end, so the Dargaville team can be hands off with the technology and concentrate on their patient.
RITA proved its worth in Dargaville when a child started bleeding from a wound three days after a tonsillectomy. Doctors at the hospital were able to Telehealth to ICU for assistance from the Ear Nose and Throat surgeon to manage the patient. The bleeding was controlled and terminated before the retrieval of the child by helicopter.
There have also been other incidences where ambulance transfers were requested, and there was no ambulance available. The Dargaville team were able to liaise with ICU via Telehealth to manage those patients requiring transfer until an ambulance became available, avoiding the need for helicopter retrieval.
RITA is a truly integrated acute clinical telehealth network. The remote access capability allows for multiple clinicians in different locations to assess patients together in a multidisciplinary approach.
Whangarei ICU triaged 532 retrieval requests in 2018, of which 226 were allocated as Category 1, and 306 as category 2. Category 1 flights are crewed by an ICU doctor, an ICU retrieval nurse and a paramedic, while category 2 flights are crewed by a paramedic only.
The forerunner to RITA was installed in Kaitaia Hospital’s Accident & Medical Department in 2013, named NEMO (Neo-Natal Examination Management Online). It was part of a research collaboration with the University of Queensland and was a significant contributor to the design and capability of RITA. It also prepared clinical teams for how they use RITA now.
Our evaluation data shows that:
• 72 percent of clinicians recorded that using the
device added to the advice that they were able to
• 32 percent of cases showed a change in acute management
• Changes in transfer category occurred in 16 percent of cases.
Overall, this Telehealth system leads to enhanced patient safety, increased support to Senior Medical Officer’s (SMO) in the rural Hospitals, Northland’s Flight team and registrars once onsite, adequate resource allocation, and a reduction in unnecessary flights.
The introduction the RITA network and NEMO before that has repeatedly shown that Telehealth eases the communication between different health care providers, improves the care for the acutely ill patients, and closes the gap between the rural hospitals and the referral centre.
Image: RITA in action at Dargaville Hospital