How virtual services are reshaping the regional care landscape

A new project, coordinated by the Digital Health Cooperative Research Centre (DHCRC), is set to evaluate how virtual care is supporting regional and rural patients.

The project, in partnership with the University of Sydney’s School of Rural Health and Menzies Centre for Health Policy and Economics, will evaluate the Western NSW Local Health District’s (WNSWLHD) vCare Virtual Support model of care as a safety net for patients in rural and remote hospitals.

Timely management of clinical deterioration

The WNSWLHD introduced the Virtual Support model of care in 2019, an additional function within the existing vCare service. The project was specifically designed to provide an additional safety net for patients in 35 WNSWLHD rural and remote hospitals where from 2016–2019, failure to recognise and manage clinical deterioration in a timely way was deemed to be a contributing factor to several serious incidents.

The Virtual Support model of care allows remote clinicians to recognise clinical deterioration and guide management as an extension of rural/remote clinical teams.

Prior to the introduction of the vCare Virtual Support service, rural clinicians relied solely on a one-way self-referral to the vCare service to escalate or refer those of their patients requiring a higher level of care than the health resources locally available, which could mean delayed referrals, delayed transfers or missed treatment opportunities to provide the right care at the right time and avoid unnecessary patient harm.

Keeping patients safe

Delays or failure in recognising clinical deterioration and providing a timely response as per the ‘Between the Flags’ system, and delayed referrals to vCare for transfer to a higher level of care of critically ill patients were key reasons for introducing vCare Virtual Support service, said Amanda Hunter, General Manager of vCare in WNSWLHD.

The WNSWLHD in New South Wales covers some 250,000 km² and is home to a population of approximately 276,000 people. The virtual service aims to overcome this tyranny of distance by incorporating improved clinical escalation and communication pathways, and advanced remote monitoring using alerts and algorithms for clinical decision support by the team of dedicated virtual care clinicians.

“With a 24/7 dedicated team, the virtual care model allows us to have an additional set of eyes and ears supporting patients with advanced virtual care and remote monitoring technology across rural and remote facilities,” Hunter said.

Experiences and outcomes

The project seeks to generate new evidence on remote monitoring systems in rural and remote healthcare settings by evaluating the patient, family and carer expectations with virtual care, as well as clinician experiences and the impact on patient outcomes. The project will also evaluate the economic implications of the service including utilisation and sustainability of resources, compared to traditional care.

DHCRC CEO Annette Schmiede said understanding the benefits, and challenges, of the virtual support service had significant repercussions for rural and remote health care.

“This research will help us to understand both patient and clinician experiences of this new model of care and how virtual care programs, such as this one, can contribute to a more equitable and sustainable healthcare system, potentially, enhancing statewide rapid response systems and ultimately advancing the quality of care delivered in rural and remote settings,” Schmiede said.

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