Remote Consultation to Kaikoura
December 2017
A video link between Christchurch and Kaikoura enabled Cathy Hammond to conduct remote patient consultations with patients, their families and local nurse. The long drive from Kaikoura to Christchurch is especially difficult for some older patients and there are a limited number of clinics in Kaikoura so the trial assessed if more regular consultations could be conducted remotely.
“Two similar wounds may require quite different treatments depending on the underlying cause of the wound, and the individual patient's health status” says Cathy Hammond. “It can be a very specialised decision, something that is very hard for a rural or remote GP or nurse to make as they may have limited experience in some problems. An incorrect treatment plan is not only difficult and frustrating for the patient, but can make the problem worse, as well as wasting expensive medication and treatments“. Cathy Hammond was able to review, monitor and adjust treatment plans for a number of patients. Treating a persistent skin condition is a team effort so having the family and district nursing teams involved in the reviews actually produced a better clinical outcome for the patient than an in-person appointment which does not involve the wider clinical team.
For the patient the remote consultation removed the need for travel. One of the patients stated “For my wife it was a lot easier popping into the local hospital for the consultation rather than her having to drive me to Christchurch. Now with the ease of the video I hope we can have more regular reviews so we can get on top of the problem”
Overall, the pilot demonstrated that telemedicine is a valuable resource to rural clinics. It improves access to specialist services, improves communication and has the potential to increase compliance. It appears it could be a cost effective method to deliver care, although the funding of future clinics was not considered in this pilot and needs further exploration. The technology was wonderful, the challenge now is having it more easily accessible for patients and health professionals.
EVALUATION NOTES
- Picture quality excellent, able to zoom to assess wound without losing quality of the picture
- Sound clear - "slight time lapse but we all quickly became used to this and made allowances during consultation"
- Patients, relatives and clinicians seemed very comfortable using the technology
- Patients appeared at ease and comfortable in the familiar setting with their regular nurse - "my view is that compliance improved, more so with one of the patients in particular and their relatives"
- Patients said they felt there was better communication between the clinicians - other district nurses were able to join the clinic to see a particular patient
- The teleconsultation saved each patient a five hour round trip
- "I could observe the nurse's technique and provide guidance and teaching"
- Saved on clinician time spent travelling
THE TECHNOLOGY
In Kaikoura a VC unit (Cisco SX20) and a high definition pan, tilt and zoom camera (12x zoom) was used so Cathy could move the camera around the room and zoom in on the patients’ wounds as required.
In Christchurch a large, high resolution screen was used to ensure larger than life clear view. Both locations were equipped with sensitive microphones capable of picking up the speakers’ voices regardless of if they moved about or not.