Tele-fracture Clinic

Gemma Model1, Elizabeth Wellard2, Dr Robin Diebold3, Dr Neil Ferguson4

1 Hunter New England Health, Armidale Rural Referral Hospital, Rusden Street, Armidale, NSW, gemma.model@hnehealth.nsw.gov.au

2 Hunter New England Health, Inverell Hospital, Inverell, NSW, 2360, Elizabeth.Wellard@hnehealth.nsw.gov.au

3 Hunter New England Health, Armidale Rural Referral Hospital, Rusden Street, Armidale, NSW, 2350, rdiebold@neortho.com.au

4 Hunter New England Health, Armidale Rural Referral Hospital, Rusden Street, Armidale, NSW, 2350, neil.ferguson@hnehealth.nsw.gov.au

 

Background

Improving access for fracture clinic patients from Inverell and surroundings areas was the catalyst for the implementation of telehealth to promote service delivery that is equitable, patient focused and utilises available technology. The key objectives were to decrease unnecessary patient travel over great distances and increase attendance rates optimizing patient outcomes. This project supported some of the most disadvantaged and remote communities in our state (NSW).

Avoidable outcomes that supported the decision for change was highlighted by a patient who failed to attend four consecutive appointments resulting in poor functional outcomes impeding his quality of life and ability to return to work. Many patients spent hours in a car for a simple treatment plan that could have been managed locally.

 

Methods

Data was collected to determine which areas had the greatest patient need and difficulty with access to services which indicated the Inverell area. This required upskilling local staff in clinical management and technology usage. Opportunistic attainment of equipment and support was acquired with engagement from a Hunter New England Local Health District( HNELHD) telehealth consultant  to support the strategy. Patient screening and processes needed development and implementation with  pre planning of appointments including imaging and cast removal, an important consideration to ensure success.

 

Results

  • Establishment of an award winning telehealth model that is simple, sustainable and efficient
  • Improvement in Did Not Attend ( DNA) rates for Inverell patients
  • Total savings for Inverell residents is estimated at $73,917, and some 84,266km of travel since the service began.
  • Increased reliance on telehealth as an acceptable means of patient review
  • 61 per cent of appointments for 0-10 year olds at Inverell used Telehealth
  • Of patients aged older than 80 years, 80 per cent of appointments were by telehealth
  • Patient surveys articulated travel cost savings and reduced time off work and school, as key benefits.

 

Discussion

The use of telehealth as a means of patient review for fracture management is an excellent option in regional and remote areas .The telehealth model implemented by the Armidale hospital is embedded and has now expanded to Glen Innes and Tenterfield. It is requested by many patients and General Practitioners.

Not all patients can use telehealth but often after their initial assessment it may be a viable option.

When using telehealth costs are reduced for the facility, an interfacililty transfer can cost $1600 per patient.  Patients benefit from reduced travel costs and less time away from work and school.

Workload has increased for administrative staff and enhancements need to be considered with the implementation of telehealth.

An incidental benefit of the telehealth process was the ability to access senior staff at a larger facility for sole therapists. This gives an opportunity for follow up and case management.