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Northland DHB paving way for future healthcare

Fuseworks Media
Fuseworks Media

Northland DHB is paving the way for future healthcare by trialling a high-tech, potentially life-saving telemedicine system.

Neonatal Examination and Management Online (NEMO) was developed in Australia to allow remote patient assessment and management. It has been used to provide advice and retrieval management between a tertiary hospital in Brisbane and four regional special care nurseries, winning two Queensland Health Innovation awards.

Northland is the first to use NEMO for both adults and children. The unique tool is enhancing assistance and decision-making for acute care clinical teams by linking Kaitaia Hospital with Whangarei Hospital Intensive Care Unit (ICU) via real-time video.

Northland DHB, in collaboration with the University of Queensland’s Centre for Online Health (COH), have been trialling the system for two months and it has made a promising start, says Northland DHB clinical head of ICU and project clinical lead, Dr Katherine Perry.

"Staff have been able to get familiar with the equipment and, already clinical gains are being observed. The ability for the Intensivist to see the patient, observe real time investigations and see clinical information, have led to rapid assessment, diagnosis and efficient transfer to Whangarei for ongoing care."

NEMO is controlled from a computer workstation located in Whangarei Hospital’s ICU and it links via Northland DHB’s secure computer network to a mobile cart located in the Kaitaia ED. Staff at the ICU end control the call and camera functions and can see and talk with clinicians at Kaitaia using a camera and screen.

The second camera - the clinical camera - is where NEMO comes into its own. Attached on a tall, extended arm, to give the best possible angle for viewing patients, the camera produces excellent quality imagery and has a powerful zoom.

In Northland, NEMO is primarily being used for acute care, particularly in the area of retrieval medicine for both adults and children. It aims to improve: Whangarei Hospital ICU’s remote acute assessment capabilities to the district hospital Emergency Departments (ED) and wards; patient safety through rapid patient assessment in ED and the ward, as well as advising on management of the critically-unwell patient. This includes assisting with decision-making in determining the safest way to transport patients to Whangarei.

Dr Perry explains: "Often transport requires the use of the NEST (Northland Emergency Services Trust) Air Ambulance Retrieval Service. A St John Flight Intensive Care Paramedic will accompany these missions and, when required, a doctor and flight nurse from the Whangarei Intensive Care Unit will be involved in the retrieval of the critically injured or unwell patient.

"Flight nurses and doctors will now be able to use NEMO as a tool to help assess the patient and plan the requirement for the retrieval."

In addition, NEMO is being used as a tool for education and ultimately as a means of providing ICU outreach nursing support. For the last three months, Kaitaia nursing staff have attended several refresher sessions for using specialised breathing circuits via NEMO. The training is being evaluated to gauge its effectiveness.

Kaitaia Hospital clinical leader Dr Sarah Clarke says it is fantastic for Far North clinicians to have the visual support of the ICU specialists.

"We are hoping that it will lead to better decision-making about safe and appropriate mode of transport for our patients transferring to Whangarei. Also there's lots of scope for future use. At the moment, our nurses are using NEMO for education and absolutely loving it."

The research collaboration with University of Queensland’s COH is an important component of the project. Working together over two years, Northland DHB and the COH will evaluate the use of NEMO and share the results both within New Zealand, and internationally.

COH research fellow Dr Nigel Armfield, who is responsible for the development of NEMO, commented that: "this project offers an exciting opportunity to learn from the introduction and use of NEMO in a different setting to that of Queensland, with a wider age group of patients and different health service challenges."

Adds Dr Perry: "The opportunity that this brings is for Northland DHB to understand whether this type of technology can enhance clinical practice and, at the end of the day, save lives. If proven, Northland DHB would look to introduce this type of technology to all Northland’s outlying hospitals."

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