The Sydney Children’s Hospital Network has taken a pioneering approach to telehealth for physiotherapy, with the department leading the hospital network in the use of video to improve its patient- and family-centered approach.  
 
By using telehealth in its Hospital in the Home (HITH) specialised service, the department has, by far, provided the most number of telehealth sessions across the whole hospital network, according to its Senior Physiotherapist, Cloe Benz. 
 
HITH is clinical care that reduces the length of stay in hospital or in some instances, avoids an admission altogether.
 
Benz told HITNA that physiotherapy via telehealth, especially in pediatrics, has generally been limited in Australia but that the hospital embarked on a journey to navigate to new borders and demonstrate to other services that big changes can be made and succeeded in within a pediatric physiotherapy population. 
 
“It’s significantly hampered by the fact that physiotherapists, as their name suggests, like to be physically available. That has given a lot of skepticism to the use of telehealth in our line of work,” she said. 
 
“But we have rolled out the program at Randwick and Westmead for a little over a year and have experienced many improvements in our patient- and family-centered approach.”  
 
Through the program, the hospital provides access to specialist care and treatment from home using telehealth, as an alternative to institution-based care. 
 
“Children with chronic respiratory conditions need a very high level of care, in addition to a consistent level of physiotherapy as part of their monitoring and treatment program. So we run a program where kids are admitted to our service and they are seen with what is equivalent to the amount of time they would be seen if they were in hospital.” she said. 
 
This involves physiotherapists setting up a daily timetable with patients’ families. The first daily visit involves a personal visit for observations and checks, while the second daily session is done via video call. 
 
 
“Most chronic respiratory pediatric patients have two physiotherapy sessions that they are meant to do every day of their lives. This is a huge battle for both the children and their parents,” Benz said.  
 
“So, the ability of telehealth is for us to be able to access these patients at home and provide support while they’re trying to do these sessions. It means that patients and their families can have expert advice, support and feedback, while we make sure what they’re doing is done in the most effective and efficient way possible.”
 
Challenges battled through 
 
But rolling out telehealth to a pediatric patient base had its own set of challenges. 
 
“We had to put in a relative age group that we consider is most appropriate for telehealth. We start our telehealth sessions with kids aged between eight and 18 years. We found that children under that age aren't able to engage appropriately with the therapists across a video call,” Benz explained. 
 
Because of the nature of their work, the department also had to put in some risk-related considerations such as the requirement for adult consent to be in the telehealth program and for an adult over the age of 18 to be present with the child during the session. 
 
“Because we were dealing with children, parents initially felt anxious and apprehensive about setting up these programs. We needed to educate them on the safety of using our telehealth solution,” she said. 
 
“We use a program provided by NSW Health called healthdirect, which doesn’t record any of the information from the caller’s side – the only information that the program records is who the therapist is, in addition to what time they entered and ended the call.”
 
Benz added that the caller’s details are initially required to be input into the system at the time of call in order for the therapist to know who’s on the call, but that information is then purged from the system as soon as the call is over in order to keep confidentiality. 
 
Another issue that the department initially faced was delays in engagement as a result of patients and their families joining the program later than expected. 
 
“When we used to schedule a telehealth session, we wouldn’t re-engage with the family until they call in. Because of that, families used to only start the computer at the stipulated session time and by the time they sign in or get out of any technical difficulties, many minutes get wasted,” she said. 
 
“Our families then provided us with feedback that they preferred to get a reminder message a few minutes before their appointment to make sure they’re on time. We rolled that out and now, deliver on a more streamlined process.” 
 
Future potential  
 
According to Benz, the telehealth feature has resulted in better patient engagement and responsibility for their own healthcare.   
 
 
“They engage better than they would stuck in a bed all day if they were in a hospital setting. Telehealth requires a more active engagement, and for them to be more proactive about their health, rather than taking a more traditional, passive approach to recovery,” she said. 
 
“And there are many different areas within acute care that can deliver on potential using telehealth, and I’ll be talking about this at HIMSS19.”
 
Benz also expects more regional reach with the use of telehealth, both in terms of patient care as well as smaller regional healthcare providers following the hospital’s footsteps.   
 
“We expect telehealth to be used on a much bigger scale. Nearly all of the patients that walk through our doors have a smartphone, or at least, one person within a family does. So the access of video, across the world, is huge and health is only just getting on to how much we can do with video to provide a better, more congruous service.” 
 
 
Benz will be speaking about the Sydney Children’s Hospital Network’s telehealth journey and the potential of the technology for other healthcare areas at the upcoming HIMSS19 conference in Orlando. Her session is on February 13,  at 2.30-3.30pm, and is titled Virtual Acute Care: Pediatric Physiotherapy with Telehealth
 

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