daniel kesik - west gippsland healthcare group warragul - teleconferencing using skype
DESCRIPTION
Daniel Kesik delivered the presentation at 2014 Hospital in the Home Conference. The 2014 Hospital in the Home Conference included practical presentations such as Medico Legal Issues, Public Private Partnership Driving HITH Growth, HITH implementation, Clinical Redesign and Impact on Clinical Governance & Performance, Advanced Care Planning and more. For more information about the event, please visit: http://www.informa.com.au/HITHconference14TRANSCRIPT
Teleconferencing Patients Reviews
Daniel Kesik HITH Team Leader
Barb Milner District Nursing Unit Manager
Daniel Stefanski Infectious Disease Physician
Background:
LOCATION:
West Gippsland
Healthcare Group
Warragul(WGHG)
100 kms from
Melbourne
1-2 hours drive
BACKGROUND
WGHG Hospital in the Home(HITH)Commenced in 1996
2014 workload is manage by 2 nurse Co-ordinators, with
District nursing providing the HITH patient care.
A steady increase in demand for HITH admissions, which
has lead to a greater demand on medical and surgical units to
review and support admitted HITH clients.
ISSUES RECOGNIZED
Increased demands on HITH have lead to:
Pharmaceutical supplies
Wound consumables
Allocation of resources, Nursing, Medical and Allied Health.
A recent review of clients admitted under HITH at WGHG
found of those admissions for iv antibiotics in 2013 - 15.5%
where deemed inappropriate by our ID Physician.
Number of HITH admissions deemed
inappropriate, by specialty.
Antibiotic Stewardship
Support introduction of the antibiotic
stewardship- to comply with National
Standards for accreditation
As antimicrobial resistance increases and
development of new antimicrobial agents
declines, it is critical that antimicrobials are
used wisely and judiciously.
Antibiotic Stewardship
Antimicrobial Stewardship is an unmet need
in many rural hospitals. West Gippsland
Hospital(WGH) provides intravenous (iv
antibiotics) for approx 100 patients per
Annum through their Hospital in the Home
Program.
The process a patient
needed to go through
prior to Introduction of
Telehealth!
Melbourne Review Early morning clinic appointment for treatment
Travel down to Melbourne
Arrange transport if unable to drive.( this could become a
hospital cost)
Need to leave early to beat the traffic
Work out where they are going
Find a car park
Pay for the car park
Wait in waiting room for doctor to review( no set time)
Melbourne Review
Medical Review
Trip back home
Find out what happened at the medical review.(Not all
Doctors write in the HITH notes)
The HITH Team Leader to organise any changes , such as
blood test and medication supplies– (need to find registrar
willing to complete documentation.)
Arrange for it all to happen again in a week .
AIM Offer Infectious diseases specialist care in a rural setting.
Under guidance of Antibiotic Stewardship.
Improving access for patients.
Developing a program that provides correct treatment for
correct diagnosis.
Being able to provide regular review of Clients admitted to
HITH program to meet Australian Standards.
Good Clinical Governance of HITH Patients leads to better
health outcomes with better use of resources.
Equipment
Old Lap Top - Toshiba
ClearOne Chat 50 personal speaker phone.
Logitech webcam
COST approx $350.
(not including lap top
- hand me down).
HITH Review!
ID Physician
HITH nurse
Patient
Medical Registrar
REVIEW USING SKYPE
Skype review with Physician, HITH Team
Leader and Registrar
All documentation completed by Registrar.
Patients gets seen in a reasonable time in
clinic and return back home to convalesce.
REVIEW USING SKYPE
discharge/Care plan discussed with patient
and HITH team
Adjustments of medication or d/c scripts can
be attended by registrar.
Any further tests can be ordered and be
reviewed by registrar prior to next telemed
review.
Benefits from audio visual reviews
Allows for a Multidisciplinary consult
Patient involvement
Patients can talk to the doctor directly with Visual contact
Patient centred care
Discussion is open
Privacy is maintained
Benefits from audio visual reviews Meeting National Standards
Changes to Pharmacy service
Less wastage of medications
Arrange medication in a timely manner
ID Physician
pick up on diagnosis/changes
Complicated assessment which is virtual supervised.
Telehealth Antimicrobial
Stewardship Telehealth has allowed our health service an
acceptable way to measure/monitor and
provide oversight of IV antibiotic
management of Clients in our Rural
Community.
Bridges to cross! Patient right to refuse
consent for SKYPE
Increased work load on
HITH Team Leader
Utilisation of available
resources.
Compliments
Quick review without
waiting around.
Supportive HITH
team.
They knew what was
being said and it was
explained to them
Patient Survey Results
Complaints
.
It was hard to hear –
we now have a speaker
system that has
improved this
The computer screen
too small, and we need
to look at other options
The review room is too
small – with a lot of
people in our review
area.
Developing technology- what is the best option in technology.
software
price
portability
confidentiality
A SATISFIED CONSUMER:
Acknowledgements:
• The HITH clients who helped us by giving honest opinions
• Dr .Daniel Stefanski (The patient used in this photo has given consent)