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Rural Innovations Changing Healthcare 2016

A one day ‘virtual’ forum linking 18 satellite hubs via videoconference across rural NSW to showcase and share rural models of care which:

Oral presentations

Keynote speakers

My journey from coma: Mary-Louise Clifford

Mary-Louise is a Child Care Centre Director and Early Childhood Teacher who went to work for a very normal day on the 6th February 2013 and had a small accident in the workplace. Mary-Louise sustained a sprained ankle and torn calf muscle when she slipped on a piece of tomato one of the children had thrown on the floor at lunch time in the toddler’s room. This set in place a chain of catastrophic events that were very nearly fatal. She suffered an asytolic out of hospital cardiac arrest caused by a deep vein thrombosis and massive pulmonary embolus, endured life sustaining CPR for 19 minutes, fractured ribs, multi-organ failure and her outcome prognosis was grave to say the least. Her care was nothing short of amazing, and Mary-Louise is here to share her story and provide some insights into how primary, community, and acute care providers can work together to improve communication and support service change to be patient journey centric rather than system processes. She believes she is able to make a difference in the way in which clinicians approach patients and their families in the most catastrophic time of their lives; a time where the emotional and mental impact is devastating.

Kelly Foran, founder and CEO of the Friendly Faces Helping Hands Foundation is an enthusiastic businesswoman but above all she is human. From firsthand experience she knows the frailty of life and of the often overwhelming challenges faced when country people become ill or injured. For several years from 2002 Kelly and her young son endured a harrowing list of illnesses, which saw her family leaving their home in rural New South Wales and spending large amounts of time in hospitals in Sydney and Brisbane. The logistics of handling not only operations and depleted funds, but of finding basic services in a strange environment led Kelly to form Friendly Faces Helping Hands, a foundation which links country people to major hospitals and invaluable health services. In the five years since the Foundation’s inception over 50,000 people have been assisted by sourcing information on hospitals and health facilities on the website and by ringing a hotline, which Kelly answers herself. Kelly regularly does presentations and speaking engagements, which rarely leave a dry eye in the audience, and she co-ordinates all fund-raising for the Foundation.

Patient stories

Orthogeriatric inpatient specialist distance reviews: Tracey Drabsch
Senior Physiotherapist Orange, WNSWLHD

Orthogeriatric inpatients often require orthopaedic follow up at rural referral hospitals requiring the patient to travel for an xray and specialist appointment. For inpatients only requiring a decision regarding weight bearing status the specialist appointment is unnecessary. Collaborative care by the sub-acute care team Physiotherapist has enabled distance orthopaedic follow up to be co-ordinated. The multidisciplinary sub-acute care team now participate in fracture clinic follow up distance reviews when the Physiotherapist is unavailable, co-ordinating care with the local treating teams. An estimated $27k has been saved in Patient Transport use, and 115 hours of travel time eliminated during 2015.

Improving access and reducing inequality: Jane Conway
Disadvantaged Clinics, North Coast Primary Health Network

Northern Rivers and Tweed Heads have a high proportion of homeless people who experience detrimental effects on physical and mental wellbeing and a diminished capacity to access health services. Clinics have been systematically established to provide clinic services for homeless people in Soup Kitchen environments familiar to them. Soup Kitchens provide a safe and welcoming environment for people experiencing disadvantage, and therefore a perfect location for an outreach clinic. During 2015, 172 GP and 128 Community Nurse occasions of service were provided; bringing medical and nursing care to homeless clients at the Winsome and Lismore Soup Kitchen; the majority of whom were male, and 23% of those identified as Aboriginal.

Building partnerships category

Drain the pain: Sarah Lawty
Acting Quality Manager, Lismore, NNSWLHD

This project developed a flexible admission process for end stage liver disease patients requiring regular large volume paracentesis. Admission is initiated by the patient and avoids the Emergency Department, reducing length of stay and improving end of life care. A Clinical Practice Guideline was developed, with a standardised approach to streamline bed management, chronic disease management, paracentesis management and end of life planning. Length of stay for this regular Palliative Procedure has been reduced by 66% from 4 days to 24 hours; with a reduction in overall bed days equalling cost savings of $210,000 in 12 months.

Narrabri venous thromboembolism (VTE) prevention project: Jocelyn Palmer
CNE Narrabri, HNELHD

A pre-audit at Narrabri Health Service undertaken in 2015 revealed that 0% of adult admissions had a VTE risk assessment documented, and 8% had prophylaxis which was not distinguished as being appropriate. Following Clinical Leadership Program methodology, a VTE team was developed, VTE Prevention education was planned and implemented, and community engagement was actively sought and obtained. Post implementation, 95% adult admissions have received VTE risk assessment with 33% receiving appropriate prophylaxis, with plans to expand education and events throughout the Mehi Cluster in pursuing  ‘VTE prevention - every patient, every time’. “Community involvement was a key to the success of the project”.

Please let me out - A standardised capacity testing process for confused patients: John Shibu
Social Worker, Coffs Harbour, MNCLHD

The aged demographic of the MNCLHD reflects ever increasing admissions of aged confused patients, yet there was no process for assessing the confused inpatient’s capacity to make independent medical, living or financial decisions resulting in hospitalisation for longer periods than necessary. Process review led by a multidisciplinary team developed and implemented a testing process and procedure with a designated pathway and objective assessment tools. A key aspect of the procedure is a decision-making flow chart. As a result, documentation has improved and the person-centred approach has reduced length of stay for these vulnerable patients with diminished capacity, where there is limited access to geriatricians or psycho-geriatricians.

Integrated healthcare category

Cerebral palsy hip surveillance - A virtual clinic: Karen Height
Service Manager Kaleidescope Paediatric Rehabilitation Service, HNELHD

Children with Cerebral Palsy have a greater risk of hip dislocation and require regular hip surveillance – yet a co-ordinated hip surveillance program was not available in the Northern Child Health Network. A Virtual Clinical Model was developed, whereby xray services are provided in the child’s local community, results are accessible online and reviewed by a Cerebral Palsy Hip Surveillance Service. Follow up processes are determined and only the children with an issue highlighted are required to attend a clinic. This model utilises local resources and limits unnecessary travel and face to face appointments, reducing the costs to families and the health system. Early detection of progressive hip disease has demonstrated that hip salvage surgery and further disability and pain can be prevented.

Cerebral palsy hip surveillance - A virtual clinic: Karen Height
Service Manager Kaleidescope Paediatric Rehabilitation Service, HNELHD

Children with Cerebral Palsy have a greater risk of hip dislocation and require regular hip surveillance – yet a co-ordinated hip surveillance program was not available in the Northern Child Health Network. A Virtual Clinical Model was developed, whereby xray services are provided in the child’s local community, results are accessible online and reviewed by a Cerebral Palsy Hip Surveillance Service. Follow up processes are determined and only the children with an issue highlighted are required to attend a clinic. This model utilises local resources and limits unnecessary travel and face to face appointments, reducing the costs to families and the health system. Early detection of progressive hip disease has demonstrated that hip salvage surgery and further disability and pain can be prevented.

Palliative care partnering with the Cootamundra community
Fiona Grogan Nurse Unit Manager HealthOne
Dr Dan Fry GPVMO /Anaesthetist, Murrumbidgee LHD
Steve Pollard NSW Ambulance, Cootamundra

Palliative Care patients in Cootamundra historically were cared for in an inpatient hospital based service model. Palliative Care providers identified that with changes to after-hours services and improved integration of existing services most of these clients could be cared for within their homes. An integrated Palliative Care service model was developed between NSW Ambulance, General Practitioners, Local Health Advisory Group, community Palliative Care services, the local Nursing home and another local Aged Care facility, as well as the Acute and Community Health Services. Introduced were: multidisciplinary case conferences, joint home visiting with nurse and doctor, increased integration with NSW Ambulance and introduction of ambulance protocols, increased use of advance care directives and improved pain management systems and the opportunity to use the palliative care suite at the local community Nursing Home, as an alternative to hospital admission. The HealthOne Cootamundra Clinical Co-Ordination Palliative Care Group now share resources and have a model which is beneficial to all palliative care clients within the Shire.

Patients as partners

Patient driven radiotherapy movies: David Willis
Chief Radiation Therapist, Tamworth, HNELHD

Radiotherapy patients in Tamworth reported feeling anxious at the start of treatment as they were uncertain about what to expect during the treatment processes. In response, clinical staff collaborated with patients to plan, produce and review a series of information videos. Concepts that could not easily be explained with real footage were described using footage from “PEARLTM” 3D visualisation software. PEARL is typically used for student training as it provides an interactive model of the treatment environment, including the machine, lights, sounds and “virtual patients”. PEARL footage was mixed with real footage of patients who volunteered to have their treatments filmed. Videos now form part of the standard ‘check list’ for individual consultations and information sessions with all new patients. Survey analysis found videos enhanced patient understanding and reduced pre-treatment anxiety. Access to DVD and online versions of the videos allow patients to share the information with loved ones who are unable to attend consultations. This is highly valued by patients who travel to receive care in Tamworth. The patient information videos convey complex concepts simply, are cost neutral and can be replicated or adopted easily by other Radiotherapy Services.

Healthy living

Let’s Look at Lunches: Maxine Molyneux
Health Promotion Officer, NNSWLHD

Childhood obesity is a public health concern as it leads to chronic disease which can mostly be prevented through improved diet. It was identified that providing information to parents regarding packing healthy lunchboxes would lead to behaviour change. Let’s Look at Lunches (LLaL) commenced in February 2015 by developing a subscriber base and commencing a fortnightly e-Newsletter and Instagram profile to increase healthy lunchbox information using Social Media channels which span geographic boundaries. The numbers subscribing, opening e-Newsletters and Instagram posts increase daily indicating that this is an effective and sustainable way to access information. The Let’s Look at Lunchboxes interactive platform enables consumers to engage and also drive change, and the communication strategy is transferable across other health domains.

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