K PRIYADARSHANA1,3, A ABEYARATNE1, S SIMON1, S CHERIAN1,3, N KANGAHARAN2,3
1 NT Renal Services, Royal Darwin Hospital, Darwin, Northern Territory (NT), Australia; 2Division of Medicine, Royal Darwin Hospital, NT, Australia; 3Flinders University, Adelaide, SA, Australia
Aim: In 2016, the NT renal services (NTRS) redesigned its outpatient model of care. This presentation describes its’ integrated outreach, telehealth and outpatients services.
Background: Before 2015, in the top-end, renal outreach delivered services to 22 communities outside Darwin. This was associated with non-attendance, poor communication among team members, increased patient waiting time and cost of services. In 2016 review, following issues were identified leading to the above: lack of leadership and centralised coordination, ad-hoc referral management, poor activity capture, suboptimal revenue generation and limited surveillance of Chronic Kidney Disease (CKD).
Methods: Strategies for change included; Broad review of the existing services and identification of gaps, stakeholder consultations, recruitment and training of two staff, development of new comprehensive model of care and its implementation.
Results: i) Integration of outpatient and outreach services with introduction of a new telehealth service. ii) Developing a centralised referral management process. iii) Incorporating a new electronic clinic handover process. iv) Multi-disciplinary patient coordination meeting. v) Development of a CKD surveillance program for identifying and tracking at risk remote clients. vi) Development of Key Performance Indicators to monitor processes. vii) In 2016, a total of 1600 and 392 patients were seen in 62 outreach and 49 telehealth clinics respectively. viii) Within this period approximate saving of $1.37 million was achieved on patient travel. ix) Waiting time was reduced from about 6 months to 6 weeks.
Conclusions: This improved model of care delivers savings to the health system and provides improved access to care for remote patients with renal disease. Comprehensive evaluation of program should be undertaken to assess its impact on clinical outcomes and cost effectiveness.