RPA ramps up virtual hospital service for COVID-19

Sydney Local Health District has massively ramped up its Royal Prince Alfred Virtual Hospital (rpavirtual) since the coronavirus pandemic began, rapidly redesigning its service to help manage 446 COVID-19 positive patients either at home or in special accommodation hotels since March.

rpavirtual has also seen a big increase in nursing and medical staff deployed to the service and a reconfiguration of its electronic medical record (eMR) to handle the crisis, while also capturing real-time data from wearable devices provided to patients.

rpavirtual was established earlier this year as a proof-of-concept trial involving palliative care patients, adult patients with cystic fibrosis and patients with chronic conditions such as lower leg ulcers, originally for 12 to 18 months.

A 24/7 Virtual Care Centre was set up staffed by nurses, with Sydney Local Health District community nurses also visiting patients in their homes.

According to rpavirtual health information manager Eleni Efthymiou, when the pandemic struck, the service saw an increase in staff and a change in focus to patients testing positive to the virus and others coming into Australia from overseas who were in quarantine at special health accommodation hotels.

“There was a rapid redesign to provide virtual healthcare to patients with COVID-19 managed in the community,” Ms Efthymiou said. “This is for patients who were stable enough to be monitored at home and includes clear escalation processes.

“The model is based on early detection of deterioration and managed care escalation so the service was redesigned to cater for that and also for the different volume of COVID-19 positive patients being monitored.”

From an initial two FTE nurses the staffing numbers grew quickly to over 35 nursing staff now. There is also a team of medical officers, one of whom is a GP.

“The clinicians are all delivering the care to patients isolating both at home and in the special accommodation hotels,” she said. “This is a large group especially of nursing staff who have joined rpavirtual and we've had to create a process of on boarding, including not just their access to the eMR but very specific training tailored to virtual care.”

The original trial used a remote monitoring platform for its palliative care patients called CarePro, and rpavirtual is working with the vendor to explore its use it in the response to COVID as well, Ms Efthymiou said.

For the COVID-19 patients however, rpavirtual is using an enterprise Zoom solution for video conferencing or the eHealth NSW-supported Pexip platform for patients. Patients are also equipped with the iHealth pulse oximeter and the TempTraq wearable thermometer, which involves a disposable patch with a sensor embedded inside that is placed in the patient's armpit.

An app installed on a patient’s smartphone records the data collected by the sensor, which is then able to be accessed by nurses at the rpavirtual Care Centre.

“TempTraq displays temperatire results on a dashboard on the nurses screen ,” Ms Efthymiou said. “With some other observations they ask the patient and then write it into the Between The Flags observation chart within the eMR. The registered nurses have all of the patients' temperatures on screen with colour coded built-in alerts.”

In addition to the 446 COVID-19 positive patients admitted – 384 of whom have since recovered, leaving 62 who are currently being treated by rpavirtual – the service is also treating patients who have tested negative but are in quarantine. There have been 156 patients admitted as COVID-19 negative, 109 of whom have been discharged and returned home.

“People who have been coming in from overseas have had to quarantine for that period of time and they find themselves in the special health accommodation hotels,” Ms Efthymiou said. “They may have clinical needs that require nursing care, medical care or even allied health care including mental health. We receive and accept referrals for these patients as well.”

Health information management

The experience of a rapidly expanding virtual health service has been eyeopening for many, including for rpavirtual's team of health information managers.

From dealing with new registration codes and clinical eForms creation to onboarding clinical staff to the eMR, the HIM team has been intimately involved in ramping up the service, Ms Efthymiou said.

Training clinical staff in using virtual care and the reconfigured eMR has been the biggest challenge, she said.

“The nursing and administration staff have come from other services that may not necessarily have similar workflows to rpavirtual,” she said. “It is dealing with the people part of this as well and explaining the whole concept and what we are trying to achieve.

“As a HIM I was heavily involved in training in the eMR processes, especially the way patients are registered to the service and then educating the clinical staff on the importance of the quality of the data entered into the eMR, from clinical documentation and progress notes all the way to documenting discharge summaries and sending them off for ongoing care.

“Essentially I am supporting the end-to-end use of the eMR to support the clinical workflow.”

HIMs have also been integral to the capture of data and the quality of that data, Ms Efthymiou said.

“As HIMs we understand how the capture of the data and the quality of the data heavily impacts in all of the other aspects in healthcare reporting. I have been working closely with the data analyst to ensure the way it is collected is accurate, but also taking it back and then aiding in minimising the errors through training and communication.”

The HIMs were also involved in the design of new clinical forms for COVID-19, such as the new COVID screening tool and the criteria-led discharge form, as well as activity-based funding requirements.

“We also had to introduce about a week into the pandemic the scheduling and appointment functions so we could organise when these calls to patients were going to happen and assist staff in planning the different appointment types and duration. There was a lot of creation of quick reference guides around all of that.”

It has been a big challenge but also a fascinating experience for Ms Efthymiou. “It happened very quickly and as a health information manager I never would have thought that I'd be able to have the opportunity to be involved with something so innovative.

“Coming from a background of medico-legal and coding and traditional health information management, it's definitely great to see this with my own eyes.”

Posted in Australian eHealth

Tags: Telehealth, remote monitoring, COVID-19, rpavirtual

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