Illawarra Shoalhaven Local Health District (ISLHD) is working to reduce carbon emissions and improve service efficiency within its rehabilitation and medical psychology services, by transitioning to online neuropsychological assessments.
The project aimed to reduce patient travel by offering telehealth assessments and feedback sessions; and minimise paper usage by implementing digital questionnaires and testing tools.
The project achieved significant environmental outcomes, including a 70% reduction in carbon emissions per patient, primarily through decreased travel and paper consumption. Clinically, the average time required for a full neuropsychological assessment dropped by 67%, enabling faster diagnosis and treatment access. Staff were able to see more patients, reducing waitlists and improving service delivery, with patient feedback being overwhelmingly positive.
Addressing reliance on paper-based assessments
Traditionally, neuropsychology services rely heavily on in-person appointments and paper-based assessments. In 2019, patients attending ISLHD Rehabilitation and Medical Psychology services for a neuropsychological assessment typically attended 4 separate face-to-face sessions, resulting in high travel demands and substantial paper usage.
To address these inefficiencies, the service first adopted the Specific Timely Appointments for Triage (STAT) model of care, which introduced triage phone appointments to reduce the number of in-person visits. STAT is a healthcare service redesign approach aimed at reducing waiting times and improving access to outpatient services. Building on this foundation, the current project expanded the use of telehealth and digital tools to further reduce environmental impact and improve patient and staff experiences.
Adopting telehealth assessments and online questionnaires
The project team began with a 4-week baseline audit in September 2024, recording patient travel distances and paper usage across ISLHD Rehabilitation and Medical Psychology services.
The project team commence implementation in October 2024, with the adoption of:
- telehealth assessments
- feedback sessions
- online questionnaires.
Additional measures included using iPads for in-person testing, sending reports digitally via Kiteworks, and conducting questionnaires electronically or via email, where possible.
Barriers included:
- technical difficulties during some telehealth sessions (21.4% of patients experienced issues)
- limited availability of cost-effective online executive functioning assessments
- patient preferences for some in-person materials.
Strategies to address these included increasing access to iPads, exploring more online tools and supporting patient confidence in digital formats.
Assessment time reduced by 67%
The project has delivered clear clinical, environmental and financial outcomes, with a follow-up audit in February 2025 showing major improvements.
While maintaining consistent patient numbers, the average time required for a full neuropsychological assessment reduced by 67%, from approximately 12 hours pre-audit (September 2024) to less than 4 hours in February 2025.
This meant that patients received their results and access to treatment more quickly. Staff benefited from spending less time scoring assessments, allowing them to see more patients and reduce waiting lists.
Patient feedback confirmed the benefits of the new approach. The Virtual Care PREM survey (Jan–Mar 2025) included 14 respondents. Of these, 78.6% rated their virtual care as 'very good' and 21.4% as 'good'. All felt the service was either better (64.3%) or the same (35.7%) as in-person care.
In the neuropsychology outpatient clinic, paper use decreased by 86% (from 1244 pages to 175 pages). Across all Rehabilitation and Medical Psychology services (including Clinical Psychology Outpatient services and ISLHD inpatients services across the region), this reduced by 79% (from 1594 pages to 333 pages). This equated to savings of over 11kg of CO2e from reduced printing alone. Patient travel also decreased significantly, with distance halved and travel-related emissions cut by 48% (from 1538km to 794km). Combined, these changes resulted in a 50% reduction in carbon emissions per patient.
Financial outcomes were equally significant. Replacing paper forms and purchased questionnaires with online versions reduced costs by 84%, saving nearly $500 in the audit period. These changes also contributed to a 15% increase in service events and a 7% rise in activity-based funding, with the largest gains in telehealth services.
Together, the results show that online neuropsychological assessments can deliver high-quality patient care while reducing environmental impact, cutting costs and improving efficiency.
