Feasibility and cost of telehealth in respiratory nursing

ABSTRACT

Introduction/Aim: The Respiratory Nursing Service (RNS) at The Queen Elizabeth Hospital (TQEH) uses various review modes including telephone, home or outpatient visits to provide support with disease and exacerbation management. Sars-COV-2 has seen telehealth access fast tracked to provided alternatives to face to face review for continuation of personalized management. Aim: To assess the feasibility and cost of using telehealth in a respiratory outreach nursing program as an alternative to home visiting for face to face patient review for disease management and support during exacerbation. Methods: Respiratory Chronic Disease clients of the TQEH RNS were invited to participate. Requiring an electronic device and internet connection, participants were supported in downloading and testing the telehealth platform. An oximeter and thermometer were provided if participants did not already have at home to enable an objective vital sign assessment of exacerbation should they become unwell. Service utilization, patient satisfaction and staff reported practicality of using telehealth were assessed. Results: Nineteen participants were enrolled, four failed to complete the 6-month study (2-withdrew and 2-died). A total of 51 telehealth episodes occurred with 21 patientreported exacerbations, 76% of these were managed at home. Projected savings on bed days, admission costs and service utilization timings for varying review modes were reported. Eighty percent of patients reported that telehealth provided the same standard of care as face to face. Sixty-seven percent said technology was easy to use, 80% would use telehealth again. Staff reported issues included variable sound and video quality, timeliness of patient to call in and technical issues resulting in platform failure. Conclusion: Telehealth presents opportunities for efficiencies in time and potential cost savings from hospital avoidance strategies for managing exacerbations in the community. Reliability of the platform and the confidence of patients using technology are challenges.