23 May 2020
Dr Peter McIlroy, lead paediatrician at Nelson Hospital, says a swift expansion of equipment enabled a range of clinical services to be carried out during lockdown via Zoom – cloud-based video-conferencing technology – such as assessments, consultations and clinical meetings. Nelson Marlborough DHB went from an average of 13 telehealth consultations per week, to 766.
One of the many successful services included a virtual paediatric diabetes multi-disciplinary clinic, he says. “We linked with a dietician who was based at home, as well as a diabetes nurse educator and myself in separate rooms at the hospital, connecting with multiple families in their home environment. The ease of use and the experience of all being in a virtual room together worked very well. While we couldn’t carry out finger-prick tests, we could do everything else, as well as use ‘screen sharing’ to provide relevant information. The families could show us their child’s results, which we then discussed in real-time. The experience exceeded my expectations.”
However, to ensure ease of access and a consistent, seamless process for both staff and families, Dr McIlroy says more work needs to be done. “It wasn’t always smooth sailing, as it also highlighted the digital divide – some vulnerable families may have less access to technology and data requirements, and there also needs to be a good process of teaching them how to use it. It has significantly increased the workload for clerical staff as the administration software is not currently designed to fully support virtual appointments – but that can change.”
Smart device technology was already being used across a wide range of services in the South Island and a new strategy to improve and expand telehealth services was agreed upon by the five South Island DHBs in 2019. As part of the strategy, recruitment is underway for a telehealth regional programme facilitator.
The advantages of telehealth are encouraging, says Dr McIlroy, such as less travel time, less stress of dealing with traffic and finding a car park, and it also provides more flexibility to find a suitable appointment time, outside of the clinical structure. “Children are a lot more relaxed when they’re at home, especially those with behavioural difficulties who find it stressful coming into hospital. The downsides are, it’s harder to observe the child, how they interact, and of course you can’t physically examine them. I do feel it’s more suited to follow-up appointments rather than the first, because you’ve already built that trusting therapeutic relationship. But going forward, we’ll definitely be offering all families the option of either an in-person or a telehealth appointment.”
Canterbury DHB clinical manager Bronwyn Suzana says while some clinicians had trialled the use of telehealth with clients who live outside of Christchurch, COVID-19 prompted a huge upskill amongst staff. “Prior to COVID-19, we had been looking at different ways we could provide expertise around stroke rehabilitation. So, this situation really made things happen faster and enabled us to increase our skills very quickly. Now, 100 percent of our staff are competent and confident in using telehealth.”
The Community Stroke Rehab Service moved to providing most of their assessment and intervention via telehealth during lockdown. The team also trialled new initiatives and developed several online stroke rehabilitation groups. One of the staff physiotherapists has been leading virtual Pilates classes from home. “It was an option to get everyone together at the same time,” says Bronwyn. “Travelling can be quite difficult for people who have had recent strokes, and meeting virtually also provided opportunities for interaction with others.”
She says while telehealth has its limitations, it provides a convenient option, especially those who live rurally. “It could also help increase the potential frequency of visits. It doesn’t replace meeting in-person, but it could change how often you see your clients and provide choices as to how they receive rehabilitation. And we were pleasantly surprised at the number of people who were happy to use telehealth, across all ages and stages. They were really positive about interacting in that way during lockdown. As community teams, we are exploring the learning we’ve had during this time and what could work in the future.”
See more info about the telehealth regional programme facilitator role.