Dr Richard Johnson1, Dr Deborah Russell2, Dr Michelle Fitts2, Dr Supriya Mathew2, Ms Zania Liddle2, Mr David Reeve3, Dr Yuejen Zhao4, Dr Danielle Green4, Dr Bridget Honan1, Dr Petra Niclasen1, Prof John Wakerman2
1Northern Territory Health, Central Australian Health Service, Alice Springs, Australia, 2Menzies School of Health Research, Charles Darwin University, Darwin, Australia, 3Northern Territory Health, Central Australian Health Service, Alice Springs, Australia, 4Northern Territory Health, Top End Health Service, Darwin, Australia
Background: In 2018 the remote consultation and retrieval model of care in Central Australia changed. Previously, remote GPs managed all patients with onward referral to ED and retrieval as required. Now acute presentations are managed by Medical Retrieval Consultants and primary care presentations by GPs.
Aims: To evaluate the timeliness, efficiency, cost-effectiveness and impact on health outcomes of a new remote retrieval and consultation model.
Methods: before and after surveys of health professionals; NT Health and RFDS administrative data descriptive analysis including for cost-effectiveness; and thematic analysis of qualitative interviews with health professionals.
Results: Clinicians perceived that the new model improved: work efficiency (p<0.001); timeliness of critical care (p<0.001) and primary care (p<0.001) advice; timeliness of retrievals (p<0.001); quality of clinical assessments (p<0.001) and health outcomes for acutely unwell patients (p<0.001). Quality of care (p=0.002) and health outcomes (p=0.013) in remote primary care were also perceived to have improved.
There were 10% (n=282) fewer retrievals/year under the new model, or 0.77 fewer/day (p<0.001), a corresponding 10% reduction in total hospital admissions and 22% reduction in potentially preventable hospital admissions from 0.68 to 0.52/day (p<0.001). Mean length of hospital stay reduced from 5.0 (95%CI 4.6-5.4) days/admission to 4.3 (95%CI 4.0-4.5) under the new model (p=0.012). ICU utilisation by patients presenting to hospital within three days reduced by 23% (p<0.001).While the overall hazard of dying within one year was non-significant, survival probabilities were significantly higher from 100 days following retrieval.
Excluding ICU and hospitalisation related savings it costs $377 (95%CI $179, $496,) per year of life saved, which is highly cost-effective at the current Australian willingness-to-pay threshold ($202,942).
Conclusion: This critical care physician-led retrieval consultation service is more efficient and highly cost-effective. Primary care telemedicine consultations are also more accessible. These results are informing further translational research to strengthen remote retrieval systems.
Biography:
Richard is a UK and Australian trained emergency physician with a long relationship with prehospital care. He cut his teeth with Mountain Rescue in the North of England and worked for UK HEMS (GNAAS) before moving to Australia in 2012 to take on the opportunities and challenges of being Director of Retrieval in Alice Springs. This research presents the culmination of 7 years of vision, determination and hard work. He no longer heads up the retrieval service and is working to develop research capacity within Alice Springs