The reality for some time in respect to continuing to provide quality health care is “Work smarter not harder”. The health dollar is becoming like a Northern White Rhinoceros, still in existence but rare. There is ever increasing scrutiny about how both of these prized possessions are used and treated. Continued investment is regularly linked to reportable outcomes, whether it be in the case of the Rhinoceros an increase in their numbers or for the health dollar reduced overall cost. You are more likely these days to find the CEO of a hospital having an MBA in hospital administration than being a senior clinician. As this is a reality we need to develop strategies/programmes that do have clinically reportable outcomes that they will comprehend.
Technology provides an excellent opportunity to work smarter not harder and can encourage patients and carers to be involved on a more regular level. I had the great opportunity a few years ago to be involved with a joint project between Flinders University and Southern Adelaide Palliative Services where I am a Clinical Practice Consultant Nurse.
The Project was called Telehealth in the Home: Aged and Palliative Care in SA. The aim of the project was to implement a programme that provided greater support to both the patient and their carer with a focus upon being proactive in respect to managing changes in symptoms encountered by the patient and/ or the support their carer required. Patients were requested to use an iPad (provided by the study) to enter daily scores related to their symptoms, and a weekly assessment of how they saw their functional status AKPS (Australian Karnofsky Performance Status Scale). When there was an increase in a symptom severity an e-mail was automatically generated to the Palliative Care nurse caring for the patient as an alert to change. Patients or their carers were still able to phone if they preferred to alert staff to an increase in symptom severity. Video conferencing was also an integral part of the programme as was a case conference with GP and significant others when AKPS began to decline.
As the Telehealth project began I was to be honest a little apprehensive as the majority of the patients I had in the community were >65 years of age and I had some doubts about how they would accept technology such as an iPad. After all, my early years were with black and white TV and getting up from the chair to change the channel, how will I get my patients to embrace the project? I was blessed with a wonderful project manager Deidre Morgan whom managed this so well and my worries diminished quickly. I would describe myself as a people person and had initial concerns about how I would feel about , talking to patients over the iPad rather than crushing the carpet at their home with a home visit. I did find that nothing replaces an initial home assessment but follow up visits using the iPad were of equal value to the patient and myself, and allowed in many cases a quicker response time when the travel component was able to be removed. Patients and carers also found great reassurance when they saw their GP in direct contact with the specialist team.
Having the iPad with me also allowed me to ‘travel light’ but yet have access to links / Apps on the iPad for PBS (Pharmaceutical Benefits Scheme), Decision assist, MIMMS + a trusty electronic navigation tool. Occupational Health and safety was also enhanced as a simple and free tracking App was able to be loaded. Using the iPad / Telehealth continues to enhance the care patients receive as it can be used to link clinicians to patients removing the travel component. This on many occasions makes a consultation possible and reduces the need for an acute hospital episode of care.
Patrick Cox; RGN, BN, Mng (Palliative Care), Clinical Practice Consultant, Southern Adelaide Palliative Services