Pivoting, at Pace, to Virtual Patient Management, Communication and Education

Recent weeks have seen massive disruption to healthcare services as we grapple to meet service need in the context of the COVID-19 pandemic.

Over the past six weeks, the SCOPe Directorate* in St. James’s Hospital has pivoted from primarily in person assessment and review to a teleHealth model. This Blog will set out the key enablers that made it possible to achieve this change at pace.

* The SCOPe Directorate is the HSCP clinical structure in St James’s Hospital consisting of the five departments of Medical Social Work, Speech & Language Therapy, Dietetics, Occupational Therapy and Physiotherapy.

Our SCOPe team is no stranger to digital developments having led the digital transition from paper to electronic patient records (EPR) with all documentation transitioned by end of 2016. This improvement project was highly structured and a SCOPe EPR QI team managed implementation and governance.

The vision has always been to progress patient engagement, teleHealth solutions, shared records, patient portal etc. in structured phases.

Looking back, our experience and vision laid the foundation for digital readiness in the HSCP workforce, giving us a big head start when news of COVID-19 emerged.  

Our Journey to a teleHealth Model

In early March, the SCOPe eHealth QI team had a brainstorming session to explore the potential of teleHealth to support patient care as the situation evolved.

Services identified as potentially suitable for transition varied as HSCP staff work across all episodes of care including ED, in-patients and outpatient clinics.

Over the course of the following week, the SCOPe directorate moved to provide urgent assessment and review to all OPD services using a generic teleHealth platform.

Electronic appointments and an EPR are already in situ in St. James’s Hospital so the immediate need was to provide a safe, secure substitute for the face-to-face component of the therapy assessment.

Colleagues in the IMS department provided invaluable support including:

• organising app demonstration
• enabling of infrastructure
• provision of licences for staff

Concurrently, the SCOPe team worked to develop:

• the processes
• clinical guidance
• flow around implementing the teleHealth application
• mechanisms for measuring activity while supporting staff in the introduction of the teleHealth app

Our Learnings So Far …

Feedback has been positive as the teleHealth model allows ongoing contact with patients who require HSCP input.

There is an acknowledgement that it is not ideal for all patients. However, staff report that they are getting better at identifying those patients for whom a virtual teleHealth clinic will work best and at adjusting their communication style to aid rapport development.

In some cases, the teleHealth clinic exists alongside a telephone clinic depending on the patient’s technological abilities.

There have been teething problems with Wifi /4G availability on the patient side and clear instructions are required on how patients can best manage their device for camera visibility.

This use of digital solutions to facilitate ongoing patient management is happening in parallel to the use of virtual tools to facilitate department communication and training.

Where social distancing cannot be observed, significant value is added by the inclusion of virtual video conferencing for education sessions on clinical preparations for the COVID-19 emergency, in-services, journal clubs and meetings.

There is a learning curve with using this technology … a need for collective understanding that technology may fail, cameras may freeze and small visitors may make an appearance in the feed of those working from home!

While it is not always as successful as a group face-to-face meeting, it is a very acceptable alternative when staff can’t all be present in the same room, at this time.  

As well as this, a campus-wide staff communication tool has been implemented in the last two weeks. This has also proven very beneficial for urgent communication from the hospital leadership team and this secure confidential messaging service can also be used to support communication in relation to clinical information.

Most of all, it is clear that the well-plotted transition to EPR created the conditions for readiness amongst the HSCP workforce in the following crucial areas:

Final Thoughts

While teleHealth developments in St. James’s Hospital were already under development, COVID-19 greatly accelerated implementation! By far the greatest asset has been the staff who were required to be ‘early adopters’ of change, learning as part of the doing rather than ahead of implementation.

It has been a huge undertaking and SCOPe HSCP have adapted admirably, motivated by the fact that these changes would lead to effective alternatives to direct patient care for service users.

This Blog was written by Joanne Dowds on behalf of the eHealth HSCP Advisory Group. Joanne is a clinical specialist physiotherapist working in the ICU of St James’s Hospital.