Outpatients’ telehealth program is saving time and money

---

Senior Physiotherapist, Stephanie Carroll, walks us through the successful trial of a telehealth program being used in the Post Arthroplasty Review (PAR) clinic at St Vincent’s Hospital Melbourne (SVHM).

---

SVHM is responsible for approximately 700 joint replacements a year with each of these patients requiring routine reviews for up to ten years post surgery. SVHM provides an Elective Surgery Access Service (ESAS) which offers surgery to patients that have endured long wait times elsewhere. Often patients are required to travel long distances to attend their review appointments.
In 2008, a physiotherapy review clinic led by Advanced Musculoskeletal Physiotherapists (AMP) was established to assist with the increasing number of reviews traditionally completed by orthopaedic surgeons.
Our clinic is an advanced musculoskeletal physiotherapist review clinic. So our physios have had some extra training in performing reviews post total joint replacement. Traditionally a patient would see their surgeon for all their post-op reviews starting at 6 weeks after surgery and then at 3, 6 and 12 monthly intervals, following up with reviews at 3, 5 and 10 years.
Physiotherapists have been involved in providing some of these reviews for a number of years now. About 18 months ago, the telehealth element was introduced and this provides another way to provide these reviews for patients finding it difficult to attend a clinic due to location or in some cases, work commitments.
We trialled a telehealth program (Blue Jeans) that Monash Children’s Hospital had used successfully to provide a video link for these appointments as an alternative to a face-to-face appointment. We were very pleased with the results and we are continuing to use it.
Part of the review appointment involves assessing the patient’s movement, for example, their walking, how they stand up from a chair and their standing balance. Video conferencing facilitates this by allowing the physiotherapist to get a good visual of the patient.
The screen sharing function is also valuable. We can bring-up the patient X-ray on our screen and share that with the patient while explaining the findings. This helps the patient understand what is happening and allows them to be more engaged in the care process.
A review appointment takes approximately 10 minutes. So for a patient to be able to have this review done in the comfort of their own home or at work with no travel time or expense is a lot more convenient for them. With eliminating the need for unnecessary travel and time off work for a face to face review, patients reported saving an average of $77 and 5 hours through a telehealth appointment.
Firewall restrictions have been a challenge which requires us to have dedicated computers for the telehealth program. Internet connectivity and patients having access to the necessary hardware can be a problem that we feel will resolve as computers and tablets become commonplace.
We would like to see this technology used more broadly across the hospital and other clinics. We have found from an organisational perspective, this telehealth initiative has increased productivity and has the potential to improve patient outcomes by making review appointments easier and less costly for our patients. It means that we can provide a patient centred service without compromising quality of care.
FAST FACTS

• SVHM perform approx. 700 joint replacements a year with reviews for up to 10 years post surgery.


• The Post Arthroplasty Review (PAR) clinic conducted a telehealth trial for performing reviews.


• Telehealth enables patients to access review appointments remotely, eliminating travel time and cost.


• The trial was a clinical success.


• Patients reported average savings of $77 and 5 hours per telehealth appointment.


• Firewall restrictions and internet connectivity are challenges to overcome.

Steps in a postoperative joint review
(Picture to be inserted.)
Meet the patient.
Subjective questioning. How are you going? Any problems with the new joint such as pain or restricted function?
Conduct an X-ray review with the patient.
Objectively observe the patient’s movement.
Case Study
Mrs Z, is a 69 year old female who lives 213 kms from SVHM. She was due to have her five year review post total hip replacement as per the orthopaedic protocol. Mrs Z was identified as appropriate for telehealth. She was contacted and given this option to which she agreed.
Mrs Z was able to have her X-rays taken at a local radiology service. These were accessed by the Advanced Musculoskeletal Physiotherapist at SVHM via an online account prior to her appointment and then reviewed by an orthopaedic surgeon as per routine for traditional face-to-face reviews.
The telehealth appointment was conducted using Blue Jeans which allowed for Mrs Z to be observed mobilising, performing functional tasks (squatting, getting on and off a chair) and view hip range of movement without any issue. It was possible to easily discuss Mrs Z’s progress and with the share screen function, she could be shown her X-ray and have it explained.
Mrs Z was asked to provide feedback on her experience of using telehealth. She reported being extremely happy with the telehealth service and would use it again in the future. Mrs Z found the program easy to setup and use.
The telehealth appointment took 9 minutes in total, whereas it would have taken her a whole day to come to St Vincent’s with 3 hours of travel to and from Melbourne at cost of approximately $70 in fuel. This was a significantly positive outcome for Mrs Z as she could remain at home and still receive the same standard of care as she would have if attending the appointment in person.
Stephanie Carroll
Stephanie Carroll is a Senior Physiotherapist (orthopaedic team) and Credentialed Advanced Musculoskeletal Physiotherapist (AMP) in the Post Arthroplasty Review (PAR) clinic, St Vincent’s Hospital. Stephanie is also the Project Lead of the telehealth AMP PAR clinic. Stephanie has a particular interest in health promotion, quality improvement and innovative care.