Design, development and implementation of the virtual, coordination, access, referral and escalation service in western New South Wales.

PROBLEM

People in rural and remote New South Wales experience avoidable admissions, limited access to skilled clinicians and commonly travel >400 km to access specialist services within the district and >700 km for tertiary services outside.

DESIGN

Iterative use of New South Wales Health redesign methodology in the period 2015-2020.

SETTING

Western New South Wales Local Health District is geographically the largest Health District within New South Wales and includes disadvantaged communities. Virtual Coordination Access Referral Escalation is an audio-visually enabled transport, patient flow and clinical advice unit established in 2006 to support patients and clinicians at 35 small, rural and remote hospitals.

KEY MEASURES FOR IMPROVEMENT

Right care, right place and right time by the right team the first time. Care delivery close to home and 'on country'. Safe and cost-effective transport. Performance measures to support quality, safety and clinical outcomes. Improving the human experience.

STRATEGIES FOR CHANGE

Cycles of strategic planning, innovation, productive partnerships, change management and human systems development.

EFFECTS OF CHANGE

Virtual Coordination Access Referral Escalation critical care telehealth more effectively supports rural and remote health care across large distances.

LESSONS LEARNT

Improvements include expanded/redefined management and nursing roles, integration of dedicated critical care emergency medicine specialists within the service, delegated authority to accept transfers, upgraded technology, 24-hour service provision and a central 'Virtual Support' proactive outreach model.