Following an overseas tour of virtual hospitals in the USA and Canada, the RPA Virtual Hospital (rpavirtual) was established in February 2020, becoming Australia's first virtual hospital. Its launch coincided with the beginning of the COVID-19 pandemic, prompting rapid adoption of remote patient monitoring. Since it's inception, and particularly during the pandemic, it has grown significantly to enhance service provision and access to care for consumers in the comfort of their homes.
The Virtual Care Centre, a pivotal part of rpavirtual, operates with a team of doctors, nurses and allied health professionals who provide care through Pods that are fitted out with videoconferencing technology and the ability to remotely monitor patients with wearable devices. The multidisciplinary virtual care team are enabled by a range of digital solutions that meet clinical requirements and support patient needs 24 hours a day, seven days a week. rpavirtual also ensures cultural support is available for all Aboriginal and/or Torres Strait Islander patients and interpreters are available for patients with low English proficiency. rpavirtual also includes the long-standing community nursing service, Sydney District Nursing, and Integrated Chronic Care Services, which provide hospital level care and chronic disease management to patients in their homes or in community-based settings.
Strong evidence in support for telemonitoring
Detailed planning for the introduction of the rpavirtual began in December 2019, with the appointment of an acting General Manager and Clinical Director. Initial priorities included, coordinating district-wide consultation, designing an organisational structure and governance arrangements, and defining the infrastructure requirements for a new Virtual Care Centre.
The Sax Institute was commissioned to conduct a rapid evidence scan focused on components of virtual hospital care including direct treatment or care including active treatment, rehabilitation or education (‘tele-healthcare’) or the transmission of data from the home to a provider (‘remote telemonitoring’), or on models which delivered both. The report found the strongest evidence for telemonitoring for cardiac failure patients and those with coronary artery disease, for people with diabetes and for stroke rehabilitation.
Extensive consultation and story gathering
Internal consultation with clinical directors, clinical managers and operational managers informed the virtual hospital model of care. Key discussion points included conditions and patient cohorts that presented opportunities for virtual care and collaboration between rpavirtual, clinical specialties and primary care. Governance committees were convened and met at least once prior to launch, except the Evaluation Committee which met for the first time in February 2020. The rpavirtual Clinical Advisory Council has been an important source of regular feedback and input into model of care planning. External stakeholder meetings were held with the Central and Eastern Sydney Primary Health Network, NSW Agency for Clinical Innovation and eHealth NSW. Extensive consultation and story gathering was undertaken with consumer groups, patients and their carers including a presentation to the district’s Consumer Council in November 2019. A service model and implementation plan for rpavirtual was submitted to the Chief Executive on 20 December 2019 and included details of the:
- governance and organisational structure
- committee governance structure and draft terms of reference
- proposed and potential patient cohorts for phase one of implementation
- proposed priorities for phase two of implementation
- infrastructure and technology requirements
- initial budget estimate
- implementation timeframes and proposed evaluation measures.
An initial model of care was Chief Executive approved on 24 January 2020, and updated in March, April and June 2020, as new patient cohorts were introduced. Implementation updates were provided monthly to the Clinical Advisory Council, Steering Committee and Evaluation Committee. Two internal planning workshops were run in September and October 2020 which included critical reflection, a SWOT analysis and mapping of priorities for the remainder of the pilot period in action plan format.
Excellence in service delivery
Sydney Local Health District engaged the Menzies Centre for Health Policy and Economics to lead the evaluation of rpavirtual. Two annual reports have been published to date and are available on the University of Sydney website. The evaluations concluded that rpavirtual is able to deliver safe high-quality care that is efficient and acceptable to patients as an alternative to in-hospital care, including to Aboriginal patients and patients with low English proficiency. Over 6,000 patient experience surveys have been gathered to date, with excellence in service delivery and a positive patient experience sustained. Ongoing evaluation is complemented by an extensive research agenda including projects in partnership with the Institute for Musculoskeletal Health, the RPA Green Light Institute and the RPA Institute for Academic Surgery.
In 2020, rpavirtual received a NSW Premier’s Award for Excellence in Digital Innovation and in 2023, rpavirtual was accredited (against the National Safety and Quality Health Service Standards) as a stand-alone facility. rpavirtual is also accredited under the Royal Australian College of General Practitioners as a vocational training site and the Australasian College of Emergency Medicine as a virtual care site.
Today, rpavirtual has advanced, providing over fifteen virtual care clinics and extending service provision beyond the district borders to the Far West region of New South Wales. In September 2023, the Secretary for Health launched the rpavirtual Wound Care Command Centre and in November 2023, the Minister for Health launched the rpavirtual Emergency Department collaboration with Broken Hill Hospital.
