One of the big challenges providing quality healthcare in a country the size of Australia is balancing the vast disparity in human and other resources available in metropolitan versus regional and rural areas with the specific needs and desires and patients.

For many years, Sydney’s Royal Prince Alfred Hospital (RPAH) has been providing critical clinical and other support to Broken Hill Base Hospital in the far west of NSW, often facilitating care and/or transportation of more complex cases to Sydney.

However, while doctors and nurses at Broken Hill would often seek to transport critically ill patients to Sydney for better care, they would often express a preference to remain ‘on country’, closer to home and their families.

Rising to this challenge, which was especially acute for indigenous patients and communities, the tech team at Sydney Local Health District (SLHD) – in partnership with Far West Local Health District ICU – created Virtual ICU (vICU) which has transformed care and meant patients needn’t be transported the more than 1,100 km East to Sydney.

The first service of its kind to ever be offered by NSW Health, the vICU now connects clinicians, patients and carers from Broken Hill Base Hospital in real time with nursing and medical staff at Royal Prince Alfred Intensive Care Service (ICS).

“It provides 24/7 virtual care advice and education via video conferencing and remote monitoring to support clinical services provided by Broken Hill Base Hospital for critically unwell patients, avoiding transfer to other facilities like the Royal Adelaide Hospital (RAH),” SLHD tells CIO Australia.

The service also incorporates Retrieval Services (Air Ambulance Control Centre – Royal Flying Doctors Service) as part of the clinical consultation process.

How it works is that clinicians at Broken Hill ICU initiate a video conference call (utilising MS Teams) with clinicians at RPA ICU for clinical advice, education and patient escalation.

RPA clinicians in Sydney are able to view patients via an over-bed camera and a camera located on the Broken Hill ICU Workstation-on-wheels (WOW) computer.

This enables them to provide 24/7 real time emergency response to ‘deteriorating’ patients, with immediate access to Far West electronic Medical Record (eMR) to view patient clinical notes and results, and view live telemetry feeds allowing for real time assessment.

RPA clinicians are also able to add – via teams – Royal Adelaide Hospital and Retrieval Services for earlier clinical engagement to make more informed decisions.

“The innovative new approach is based on a specific ICU model of care to support clinical decision making and was developed to meet the changing needs of our remote communities and promote the best possible health outcomes for all patients through integrated care,” SLHD explains, adding that its vision is:

“To deliver high quality consultation and timely care, harnessing resources through virtual care and avoidance of unnecessary hospital and district transfers for critically unwell patients."

Clinical autonomy

In a recent vICU evaluation and patient scenario meeting discussion turned to a patient who was critically unwell and required transfer to another larger hospital for urgent care. The patient however did not want to be transferred to another hospital and wanted to stay on country where their family was nearby.

The staff at Broken Hill ICU, mindful of cultural needs, endeavoured to prevent patient transfer, with the vICU service accessed for advice and support.

The clinicians at RPA ICS and Broken Hill ICU worked with each other to help stabilise the patient so that they did not need to be transferred and could remain in Broken Hill ICU.

This is a powerful example of how the vICU can help significantly improve patient outcomes.

Providing proper care in rural and/or remote hospitals if often tough, especially when there are complex critical needs. Not only are there typically fewer staff, but staff turnover tends to be greater when compared with metropolitan hospitals, while there’s less access to resources for making optimal decisions.

Now with the vICU in place, SLDH reports overwhelmingly positive results for patients that have come into contact with the service, 6.5% of whom are indigenous.

SLHD says that the project has promoted “clinical autonomy” and “patient advocacy” with a general improvement in patient care.

Managing the transfer of knowledge has been key to success, with clinicians at RPA ICU sharing their regular in-service education with the Broken Hill critical care team. Meanwhile, four members of the Broken Hill ICU staff recently spent two weeks each at RPAH to upskill in the management of the critically ill patient referenced above.

From go-live in April 2022 to July, vICU managed 70 service encounters in relation to patient care or escalation with 30+ patients benefiting from the vICU service.

More than 70% of patients remained successfully within Broken Hill Base Hospital, eventually stepping down from ICU to general wards, avoiding transfer to other facilities. A quarter of patients were transferred to Royal Adelaide Hospital with RPA ICU Staff Specialist support and consult.

“Using MS Teams as the videoconferencing platform leveraged off existing licensing capability and support agreements at both Districts and minimised ongoing additional licensing and support costs for other platforms,” SLHD says.

Sizable cohort

Standing up such a complex and untested healthcare solution demanded input from across the board, spanning SLHD, FWLHD, eHealth, NSW Ambulance – ‘Retrieval Services’ – The Royal Flying Doctor Service and the Royal Adelaide Hospital.

And bringing all of these groups together to achieve consensus wasn’t always easy.

“To facilitate continued momentum, executive engagement was utilised to manage multiple stakeholders ensuring alignment of end deliverables and project go live date,” SLHD notes.

Collaboration with Aboriginal communities and clinicians from remote areas was another essential part of the vICU project, ensuring specific concerns and issues experienced by these communities were properly understood, while also helping to form and maintain long-term partnerships.

“The service has been successful assisting staff in keeping Aboriginal and non-Aboriginal patients of Broken Hill on country, closer to their homes; helping to avoid unnecessary hospital transfers, upskilling clinical staff through educational activities, and providing support in the assessment and management of critically unwell patients,” SLDH says.

David Binning