Authors (including presenting author) :
V TANG(1), M CHENG, E WONG, J LIU, YC KOK, WH LI, N LUI, SC LEE, F HUI, FK CHOW, C KAN
Affiliation :
(1) Community Nursing Service, Kowloon Hospital, (2) Rehabilitation Department, Kowloon
Introduction :
Telehealth in Hospital Authority (HA) Go first launched in 2021. It provides not only convenience to patients but also saves patients’ waiting and transportation time. Virtual Ward (VW) aims at providing a holistic approach to end-of-life (EOL) patients in the community. With the progress of the disease, patients will become more symptomatic and the burden to the family members is increased. Frequent medical attendance and repeated hospitalization are common phenomena. In this case, VW (doctor, VW community nurses, VW clinic and EOL ward) with the patient and caregiver adopted a transdisciplinary approach by using telehealth for disease monitoring and consultation at home.
Objectives :
Virtual Ward by using telehealth to support an advanced heart failure patient and her family members at home for consultation, disease monitoring, titration of medications and medical advice. The transportation burden and the cost of attending the clinic are minimized by telehealth.
Methodology :
Patient Journey 1. A 90 years old lady with advanced congestive heart failure (CHF) due to severe mitral regurgitation (refused operation), with 2 episodes of hospitalization over the past 6 months due to CHF, mobility problem, renal failure, overweighed and recently undiagnosed blisters disease on both lower limbs that had difficulty attending SOPC was referred to VW. 2. Discussion with case doctor, VW community nurse, caregiver, VW clinic and EOL ward, to conduct telehealth consultations at home instead of physical consultation in the hospital 3. Workflow – 3.1 The caregiver agreed to telehealth and stayed with the patient for HA Go technology support. 3.2 Telehealth appointment and technical support was arranged by VW Clinic. 3.3 During the VW community nurse home visit for wound care, the nurse stayed for a short extended period with the tele consultation together. 3.4 VW community nurses support physical examination and transdisciplinary care during the doctor consultation such as pitted oedema, skin and wound condition review, vital sign monitoring, body weight and oral intake record and blood taking. 3.5 The case doctor reviewed the patient’s condition and adjusted the medication and treatment plan. 3.6 The caregiver collected the medication after the consultation. 3.7 On-going case monitoring by VW community nurse and regular consultation by case doctors will be continued.
Result & Outcome :
Advantages 1. Perform home-based medical consultation through telehealth in managing heart failure symptoms and the blister illness. 2. Reduced the transportation burden to the patients and caregivers. 3. The caregiver can voluntarily participate in the caring process and the discussion. 4. The patient can enjoy the precious moment with the family and feel more comfortable at home. 5. Reduced hospital cost of VW Clinic appointment. 6. Reduced the risk of hospital-acquired infection. Result - The patient was followed up by virtual ward for 10 months. - During this period, she had 2 VW Clinic attendances, the first visit (including Advanced Directive discussion & documentation) and a regular visit (more than 6 months & review the Advanced Health Care Planning) & 11 telehealth consultations. - The patient looked happy and showed gratitude during the consultation. - The relative felt being support. She can attend the consultation and maintain her job. - No hospitalization nor AED attendance was noted until the terminal admission. - The terminal admission was a direct admission to the KH EOL ward. - The patient stayed in the EOL ward for 1 day and succumbed peacefully with relatives around her. Conclusion Stable patients are the usual targets of telehealth consultations. For selected cases and with appropriate nursing support, telehealth may have a role in managing the changing medical condition.
