E TAN 1,2, T JENNINGS 2. K RABINDRANATH 1,2
1Regional Renal Unit, Waikato Hospital, Hamilton, New Zealand), 2Whakatane Hospital, Bay of Plenty DHB, New Zealand
Aim: To describe how telehealth impacted on renal healthcare delivery
Background: The Waikato renal unit uses the hub-and-spoke model to cover vast catchment areas. Both staff and patients regularly travel huge distances for clinics, meetings and education. This is time-consuming, expensive and unsustainable. With an ever-growing renal service, innovative and cost-effective solutions are necessary.
Methods: Telehealth was phased-in gradually, using secure, encrypted electronic platforms: Cisco-Jabber (facilitates virtual hospital-to-hospital video clinics, with outreach nurse acting as physician’s proxy in examining patients) and SmartHealth (HealthTap: facilitates video consultations with patients at home). These expanded to monthly results review, telephone clinics, virtual dialysis ward rounds, impromptu consults and urgent patient-family meetings. The whole renal department rapidly adopted telehealth (dietitians, transplant co-ordinators, pre-dialysis nurses, social workers and dialysis technicians) for many activities (consults, education, departmental meetings, virtual home visits, home assessments and problem-solving). Feedback questionnaires were also sent out.
Results: There were huge time-savings and cost-savings, with minimal carbon footprint impact; Cisco-Jabber increased outreach clinic capacity whilst SmartHealth allowed home consultations. Travel was reduced, including unnecessary physical home visits. The video facility flexibly enabled impromptu consultations, meetings (including palliative end-of-life discussions with dialysis patients) and problem-solving (particularly with dialysis equipment malfunction). Another unexpected benefit is the clinical upskilling of satellite-based nurses. Patient and staff feedback was excellent.
Conclusions: Renal telehealth is phenomenally successful and has revolutionised renal healthcare delivery. Improved access to physicians reduced satellite units’ vulnerability. Telehealth improved patient care (improved all-round communications led to better care continuity) and improved work efficiency and environment for staff.
Discussion: Future plans include increasing virtual renal outpatients to 30%. New technological advancements include: mobile Cisco-Jabber, electronic prescribing and electronic pathology-investigations ordering.