Enabling Integrated Care – Telehealth facilitating care closer to home

Introduction: For many families caring for children with complex and chronic conditions, accessing health services is a considerable challenge. To attend regular follow up appointments at the hospital can mean repeated time off work and school; finding alternative care for siblings; and long periods of waiting in clinic for an appointment that may only take fifteen minutes. This challenge is exacerbated in rural and regional areas, where families can incur costs for overnight travel, and experience significant disruption to their work and family life. Practice change: Sydney Children’s Hospitals Network (SCHN) has implemented a Network-wide Telehealth strategy that provides the capability to deliver consultations remotely – to children in their homes, with their GPs and at their local hospital. Aim: To provide patient-centred care closer to home by adopting and promoting Telehealth across SCHN. Targeted population: Families caring for children with complex and chronic conditions. Timeline: January 2018–June 2019 Innovation: Technological innovation, such as the use of technology to deliver health services remotely (Telehealth), is seen by SCHN as a key enabler for the delivery of patient-centred care. Telehealth is delivered through a web-based video-consultation platform accessible to all clinicians across the Network in a ‘business as usual’ model recommended under the NSW Health Telehealth Strategy. It’s been adopted by diverse services across SCHN, including physiotherapists who are even using it to deliver guided physio sessions for cystic fibrosis patients at home. Impact/Outcomes: The widespread adoption of Telehealth across the Network is benefiting children and families in reducing the cost and inconvenience of travel, and the disruption to work, school and family life. Over 40 services across SCHN are utilising Telehealth with a total of 959 telehealth sessions conducted in 2018, resulting in SCHN being the top Telehealth user in NSW. The Hospital in the Home service have had a total of 43 patients with multiple appointments seen via Telehealth which resulted in 39,249kms of travel and 605 hours saved. An unanticipated benefit has been the development of capacity in local GPs and the medical and allied health staff at secondary hospitals, who ‘host’ Telehealth sessions with the patient close to home. Host clinicians who regularly take part in sessions express more confidence in their ability to manage the child’s condition locally. Sustainability: It’s a cost-effective program which has benefits for clinicians and patients. It’s easy to use with few upfront costs for clinicians apart from headsets and cameras. Cost analysis data indicates significant income and cost savings to the Network. Families can access their Telehealth consultation via their smart phone, and are not required to purchase expensive equipment. Transferability: Telehealth has continued to be rolled out across the Network with over 40 services now using this method of patient consultation. Conclusions: Telehealth has resulted in improved access to SCHN services with a significant reduction in travel time and associated costs for families, enabling care closer to home. Lessons learned: Implementation of Telehealth is strengthened by having dedicated Telehealth staff and identifying champions; strong sponsorship, IT support and infrastructure.