ISQUA16-2493CARE IN THE ETHER - DEVELOPING A ROBUST CLINICAL REVIEW METHOD FOR TELEHEALTH

Abstract

Objectives: The quality of Healthdirect Australia's telehealth services underpins the contribution of its services to the Australian healthcare system. There is a high community expectation that telephone-based health consultation should be as safe as face-to-face consultation. Telephone-based health assessment and advice to an unseen and unknown patient carries potential risks. Over assessment of the acuity of the patient's condition can lead to costly and unnecessary service utilisation. Of more concern, under assessment of a condition may result in delayed commencement of treatment, longer or more intensive treatment and poorer health outcomes. The principal objective of this project was to develop a reliable and evidence-based clinical evaluation model that can be used to periodically review the appropriateness, effectiveness and safety of healthdirect nurse triage and the after hours GP helpline. Methods: The method used to determine the most effective evaluation model involved a scoping study of quality standards and auditing approaches that might be adopted to systematically review the service provider's fulfilment of contractual clinical obligations to provide high quality services. The development method also involved a comprehensive literature review that was undertaken to specifically focus on the use of simulated patients to assess quality and safety in delivery of telephone triage and health advice. A multidisciplinary Clinical Advisory Panel was established to advise on selection of scenarios and importantly, to reach clinical consensus on the appropriate disposition or outcome that should be applied to a given scenario. Logistical and statistical issues were addressed and resolved and assessment and recording instruments were developed, adapted from a previous evaluation and validated clinical communication assessment tools identified in the clinical literature. Results: The review model developed has two component parts. The first is a method for auditing and reviewing the service provider's clinical policy, processes and structures that are required for effective clinical governance of the services that ensures good clinical practice. Examples of these are; credentialing policy and process; encounter documentation, both nursing and medical, including accuracy and completeness; incident review process and documentation The second component is the use of clinical scenarios. The literature review provided international evidence on the use of this form of clinical review in other healthcare systems. Specific characteristics of the method include the number and type of scenarios presented, the number of "mystery shopper" calls to be made; the professional background and number of simulated patients participating in clinical review, the professional background and number of assessors of the simulated patient calls and methods used to test and confirm the reliability of those assessments. Conclusion: The Clinical Review Model, using a clinical audit and the simulated patient method, developed for Healthdirect Australia is based on five key steps: identification of common case scenarios with an uncommon level of acuity presented in some scenarios; an annual series of simulated patient calls using trained medical actors; robust clinical and communications assessment of the calls; rapid feedback to the service provider, and provision of targeted professional development to address identified risks to patient safety and service quality. Implementation of the model, in accord with Healthdirect Australia's Clinical Governance Framework, will strengthen risk management and quality improvement and enhance the quality of health assessment and advice services offered to Australian consumers.