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Vital Virtual Interactive Telehealth Assistance Links How did Vital originate?
In the spring of 1997 under the new Program Management model with Atlantic Health Sciences
Corporation (AHSC), the Program Manager of the New Brunswick Heart Centre (NBHC) identified
a number of clinical/process issues that needed to be improved. Recognized the potential for
growth within the Telehealth environment, AHSC investigated the possibility of establishing
a partnership with the local Telecommunications Company.
A project plan was formulated; AHSC team selected and a partnership cemented. From there a proposal for participation and funding was put forward to key players and stakeholders provincially. Thus, the Virtual Interactive Telehealth Assistance Links project had begun. What were the 4 clinical issues we addressed and how?
Since the Heart Centre opened in 1991, there had been no real systematic approach to the tiaging of patients from around the province (or Quebec, Nova Scotia, Prince Edward Island and Maine) who needed to come here for assessment and, often, subsequent treatment. Physicians would send referrals by mail, fax them to inappropriate numbers, play telephone tag with physicians here, send the patients to our front door or emergency department or just put them in an ambulance and transfer them sometimes unannounced. Bottom line, there were 11 different ways that patients could enter the Heart Centre. This meant we were not always dealing with the most ill patient in as timely a fashion as was necessary. The idea behind Vital was to develop a method of ensuring the right patient wasin the right place at the right time. Vital AHSC's clinical team developed a set of minimal clinical criteria absolutely required to accurately triage and rank patients from around the province and interprovincially for transfer to the NBHC. A software plugin was developed based on this and currently within NB we have close to 30 sites on line. The remainder of hospitals within NB and those from PEI, NS and Maine fax us the hard copies of the software screens and we enter them at this site. This gives us one method of non-emergent referral to the Heart Centre as opposed to 11. We do all our teaching on line to use the software via the use of desktop videoconferencing and the software allows us to do real time interactive clinical imagery consulting. Provincially, this has been a hit with clinicians as it virtually eliminates the need to call to find out where patients sit on the waiting list or to make a referral. Each site has access on line to their wait list and patient priority. We have had over 3000 patients triaged and transferred in this manner since December 28, 1998. An estimated ¼ of a million dollars has been potentially saved in clinician time, non-repeat diagnostic testing (blood work, chest x-ray, ECG), inappropriate referral transfer costs, faxing, and telephone calls. The bilingual windows based software allows us to capture high-resolution color or gray scale images, measure and interactively annotate them on line with remote sites. This is all done on the wellness network. It can be done simply point to point as well. This process has begun with two referral centres in Prince Edward Island. The encryption in the software allows us to transmit the same data/images via e-mail solution over a DSL.
For both of these outpatient clinics, patients must travel miles and sometimes hours in inclement weather to reach the specialists at the NBHC. Family members most times accompany them, taking time off work. Gas, mileage, over night accomomdations perhaps, meals - it all adds up. The Heart Centre wanted to eliminate the geography in these instances. Vital Each regional hospital corporation in NB has had a Healthcare System installed via our telephone initiative. Now patients book their clinic appointments at the Heart Centre as usual but show up at their local regional hospital. From there a specially trained RN readies the patient for their telehealth (on line) assessment. The cardiac surgeon is in the Saint John Regional Hospital at NBHC, and can perform a fully interactive, real time assessment. The physician at NBHC, using an electronic stethoscope, accurately auscultates heart and lung sounds. High power zoom cameras allow them also to view the patient from head to toe, read EKG's and chest X-rays. Taped echocardiograms may be viewed on line and recorded at the NBHC at the same time for future reference as necessary. We have successfully switched from the cost prohibitive ATM model to more flexible, portable and affordable ISDN infrastructure province wide.
NBHC boasts one of the lowest lengths of stay in Canada for cardiac surgery patients. Barring complications, patients are discharged on their fifth day postoperatively. One of the cardiac surgeons did some research and was dismayed to find that 32.3% of those discharged reaccessed their local emergency departments within the first nine days following discharge. Of that same number, 54% were readmitted. The cardiac surgeon would be totally unaware of this useless transferred to his care at the Heart Centre. Otherwise, he would not see the patient until their sixweek post surgery checkup. Vital In an attempt to decrease these readmissions, the clinicians stepped up to the plate with an innovative idea. The patients would now be sent home following surgery with what has become known as the "Home Unit". Patients are called daily for seven days by an NBHC telehealth RN. During the 30 - 45 minute interactive real time, audio and video call, she not only assesses their physical progress by means of a clinical questionnaire, but receives a live ECG, blood pressure reading and oxygen saturation measurement. Patient's wounds are also monitored. Depending upon the patient's condition; referrals to family physicians, emergency departments or the NB extramural progrma are made. Thus, enabling the patient's problem to be addressed immediately upon detection preventing a potential emergency visit. Patients have 24 hour access to the NBHC by just picking up the phone. Maintaining a video phone and fax machine in their homes, an RN is on call to provide this 7 x 24 service. The RN from her bedside can "virtually" visit the patient. Their readings are sent as usual to the hospital base station and stored then automatically faxed to the RN on call's home using a "Virtual Attendant" modality. All this is done over the plain old telephone system (POTS). This solution was developed specifically for NBHC and is duplicated nowhere in Canada or internationally as far as we are aware. (Though one other Canadian hospital is investigating the use of what we have developed on a trial basis.) To date, November 2002, 1157 patients have been discharged with on this program since its implementation December 06th, 1998. We are currently looking at adding a stethoscope peripheral to enhance the care and add on other specialties. Bottom line...what did we accomplish? We have improved the access, continuity and timeliness of care within the NBHC. Geography has been eliminated provincially. Dollars and lives have definitely been saved. The NBHC now has the right patient in the right place at the right time. |
Pre Cardiac Catheterization Assessment Clinics