Teamwork drives triage by telehealth

A consultant physician from Tasmania is using telehealth to in effect triage patients during video consultations with their general practitioners, having conducted well over 80 such video consults since he began using the technology.

Jorge do Campo, an acute medicine specialist at Launceston General Hospital, first discussed using telehealth with a GP at the Devonport GP Superclinic in late 2011. Dr do Campo provides visiting services once a month to Devonport, an hour's drive from Launceston, and to Scottsdale, which is about 70km to the north-east.

While triage is not the aim of the consult itself, it does tend to happen spontaneously, Dr do Campo said.

“If you are seeing the patient for the first time and the GP has requested a consult as soon as possible, depending on the information you have you can see whether the patient needs to come to hospital,” he said.

“I use it as a tool to triage patients that the GPs think is necessary or as follow-up for patients that I already know or have seen before when I visit the practice or when they have been inpatients under us.

“It doesn't replace my normal practice – the patients are going to be seen by me on a personal basis – but the telehealth works as a triage and I can anticipate investigations and give directions to the GP of what to do for the patient before I see them in person.”

If he judges that the patient should come into hospital soon he can arrange the transfer without having to wait for a letter of referral, or he can recommend that the patient remain under the GP's supervision. If the patient needs to see another specialist, he can write the referral himself.

“We can start moving investigations in the same day, in real time,” he said. “In the interview, the GP takes notes on directions and they can start the investigations. Sometimes I see that the patient needs to be referred on so I do the letter of referral. It doesn't matter if I haven't seen the patient yet – I have enough information to refer them to another specialist so I generate the letter of referral from the telehealth consult.”

Dr do Campo and the GPs he works with all use Skype for the video consultation, which he conducts through his iPad in his consulting rooms. He uses his desktop PC to access the hospital's portals to pathology or radiology results and his email system.

The time of the consult is booked by phone, and the GP emails Dr do Campo the patient's details, medications and area of concern, he said.

“In general I try to use mobile devices, so I use my iPad or my iPhone and I can Skype with any of them. I combine the use of my iPad for image contact with the GP and the patient and the laptop to check email and the information the GP has sent to me.”

Technical problems do occur, such as the time that he was consulting with a GP through Skype and the audio link died. Video was still working so Dr do Campo waved his mobile at the GP and they finished the consult on the phone.

“You can always have technical issues and technical problems, but it's more important to create the network itself for teamwork,” he said.

“When you really need an image, you can ask the GP to take some photos and email them. You can still use the standard technology and do things around it that will help you be effective.”

Teamwork is one of the great benefits of telehealth, he believes. While the initial motivation to begin providing telehealth consults was to reduce the amount of travel patients needed to do, the improved collaboration between the specialist and the GP is one of the great benefits of the technology, he said.

Dr do Campo claims the MBS telehealth item number through his private practice and the GP does the same.

“The motivation was to try to use the new system to avoid people having to travel and at the same time … they didn't have to pay for the consult as we have Medicare support to do it,” he said. “We also abbreviate the time needed to have input from the specialist when the GP needs the consult.”

He believes almost any discipline can use telehealth to improve patient care, including patients in aged care facilities and at home. “I haven't done [aged care consults] so far, but I can see telehealth as a tool for communication in any discipline and from any environment,” he said.

“Nursing homes, home care, hospital in the home – any system you want to organise the telehealth consult with is ideal. It reinforces the concept of teamwork and you can incorporate more people in your network by utilising this sort of technology.

“The important thing is time waiting for a consult and getting sicker – that's a benefit to the patient. For the GP, it's a very interesting new way of practicing ... [We] are together looking after the patient and interacting with the patient. The patient is in an environment they are comfortable with – their regular GP – so they are friendlier.

“On that basis I think we are supporting the GP in a nice way. I am representing the Launceston General Hospital when I go out to see patients, and this way we are telling the GP that the hospital is here with you taking care of the patient. It is a new type of way to practice.”

The University of Tasmania has recorded an interview with Dr do Campo talking about his telehealth work which can be viewed here.

Posted in Australian eHealth

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