Northland hospitals use telehealth system for rural patients needing specialist care

Dr Michael Kalkoff, left, and Telehealth service specialist Dean Oldham talking to Kaitaia SMO Dr Damien Marsh via new telehealth technology. Photo / Tania Whyte

New video technology in Northland hospitals is bringing specialist health care closer to far-flung patients.

Northland hospitals are the first in the country to get the new technology. It has been brought into Kaitaia, Bay of Islands and Dargaville hospitals, with Rawene to get the system over the next few months.

The telemedicine system has been greeted as a aide for a region short on senior medical staff.

A new report from the Association of Salaried Medical Specialists this week showed Northland had the greatest number of shortages of senior medical officers in the country - 36 per cent short, well ahead of Waikato at 24 per cent.

The system also helps free up air and road ambulance transport by allowing remote specialist diagnosis of patients to decide whether they are fit for transport.

It has been used in cases where specialists have been able to stave off transport and treat patients too sick to be moved.

In another case, it saw specialists able to tell a family the patient was terminally ill and rapid transport to Whangarei or other hospitals would make no difference.

In that case, it allowed the patient to pass in comfort, surrounded by whanau, rather than be separated in a pointless dash for more sophisticated emergency care.

Whangārei-based intensive care consultant Dr Michael Kalkoff said the Rapid Information Telehealth Assessment - dubbed RITA - allowed better treatment to start earlier than was usually possible in distant parts of Northland.

Dr Michael Kalkoff assesses and approves transfer requests for DHB patients. Photo / Tania Whyte

Part of Kalkoff's role is assessing and approving transfer requests for acute patients from peripheral hospitals to Whangārei.

Northland DHB organises about 450 flight transfers a year – either from rural hospitals to Whangārei or from Whangārei to Auckland.

"Approving patient transfer means a helicopter will be blocked for at least an hour or two, blocking the service for another acute patient who might need it," Kalkoff said.

Traditionally, emergency department doctors would call Kalkoff on the phone to evaluate whether Whangārei needs to dispatch a helicopter or an ambulance to transfer a patient to the Whangārei Intensive Care Unit.

"Because the patients in the ED are really sick, it's a five-minute call maximum," Kalkoff said.

"That means you'll need to make all these decisions within a few seconds from a telephone call."

That protocol changed since Kalkoff started using RITA last year. The system is a mobile cart with a wide-angle and a zoomable camera, a microphone and a screen which can be moved anywhere in the ED.

Through video conference, Kalkoff and his team can virtually examine a patient in Kaitaia or Dargaville while the local doctors can continue to work on the patient.

"Face-to-face interaction with patients in an urgent and acute setting is extremely important," Kalkoff said.

Dr Michael Kalkoff from the Whangārei ICU discussing a case with Kaitaia Hospital senior medical officer Dr Damian Marsh and registered nurse John Walker via RITA.

The new system is a leap forward from a previous telehealth link between Whangārei and Kaitaia.

"It worked so well that we got hooked, so the IT team came up with an updated version."

The video conference connection also allows families to ask questions and build a connection to the Whangārei specialists.

"I have seen ICU consults done via RITA where the outcome is that the patient is too unwell for transfer and needs to be kept comfortable," Kaitaia Rural Hospital senior medical officer Dr Joel Pirini said.

"The whanau have been able to hear directly from the ICU team that there is nothing else that they can do to help the patient and it would not be appropriate to transfer, and rather than have the patient pass away in Whangārei with no whanau at their bedside."

In another case, RITA helped save an acutely sick renal patient from Kaitaia who required urgent management in Whangārei.

Due to poor weather, the helicopter was unable to fly, and the patient was not safe to transfer without a fully trained escort, intubation and sedation.

RITA was used by the ICU team and remote on-call renal specialist linking into the Kaitaia clinical team who were then able to treat the patient appropriately.

The patient was later flown to Whangārei for further treatment and made a good recovery.

While RITA provides medical support and facilitates work for ED doctors, many rural hospitals struggle with specialist shortages.

Kalkoff said RITA didn't replace specialists but was a way of reducing the gap and breaking barriers that rural hospitals face.

"I believe, even if we had plenty of specialists, RITA would still have a role because patients would still need to be transferred," Kalkoff said.

Dr Shane Reti, MP for Whangārei, welcomed the use of RITA as a way of tackling the shortage:

"We know that we have limited resources, particularly workforce resources. The teleconferencing network helps you address that limited resource," Reti said.

"It's particularly well geared for remoteness which is Northland.

"Telemedicine is a good way of taking services further out to the client."

Reti also pointed towards the fibre broadband in Northland, which makes the region suitable for teleconferencing.