Virtual technology supporting patients and addressing frustration in nurse-led clinics

A discussion at a planning workshop revealed that South Australian regional Nurse-Led Clinic staff were frustrated with referring patients for face-to-face appointments outside their local community.

Patients with wounds, rashes, significant tonsillitis, ear infections, foreign bodies, and eye irritations, were frequently referred to a hospital or medical clinic, however, many of these cases could have been managed locally if an effective virtual option were available.

The South Australian Virtual Care Service (SAVCS) had already been providing medical support for the Nurse-Led Clinics to assist with prescribing and assessment. To address this gap, the SAVCS Living Lab, a department dedicated to testing innovative solutions, explored the possibility of remote assessments for these conditions.

Innovative Solution for Remote Healthcare

A market scan seeking high-resolution, TGA-approved devices that seamlessly integrated with HealthDirect video conferencing and the South Australian Digital Telehealth Network (DTN) was completed. After extensive review, two devices stood out: the Visionflex General Examination Imaging System (GEIS) for viewing wounds, skin irritations, and the patient’s eyes, mouth, and throat, and the Visionflex Otoscope for viewing inside the patient’s ears and nose. Other devices were either low resolution or not TGA-approved.

A technical review in the Nurse-Led Clinic ensured adequate WiFi, access to a workstation on wheels (WOW), and available USB ports to power the video conference and peripheral cameras. This review identified the need for a longer USB cord between the WOW and the camera to enable effective use while maintaining an appropriate view of the patient during the video consultation.

Testing and Staff Feedback

Device testing and familiarisation were completed by the SAVCS team to assess usability and effectiveness. Staff found the GEIS camera provided clear images and was intuitive to use. The otoscope was more challenging to use than traditional devices but was effective in viewing both the ear and nasal cavities using existing consumables.

Hands-on training was provided to clinic nursing staff to ensure confidence in using both devices, especially the otoscope, which required additional skill to operate effectively.

Pilot Results: A Positive Outcome

A three-month pilot between August and November 2024 resulted in 36 calls where the devices were used to complement patient assessment, aligning with the predicted call volume. The results were highly encouraging:

• 79% of patients were treated without leaving their community
• 9% of patients were referred for face-to-face care
• 9% were referred to an Emergency Department for further care

The trial demonstrated a safe, effective, efficient, and patient-centred method for delivering healthcare to regional consumers. Patients received the care they needed without the burden of travelling long distances, incurring travel costs, lost time, and out-of-pocket expenses – unless the absolute need for that travel was confirmed.

Case Study

One patient presented with ear pain and hearing loss on a Saturday morning. During the consultation, clinic staff used the Visionflex Otoscope to examine the patient’s ear. An abnormality was detected by the SAVCS doctor, prompting the need for further investigation.

SAVCS facilitated an on-call ENT specialist’s involvement in the video consultation, allowing for a virtual specialist review in real time. Thanks to this seamless collaboration, the patient remained within their community and commenced initial treatment without needing to travel outside their Local Health Network. A follow-up outpatient appointment was scheduled at a metropolitan centre. The patient and their family were extremely impressed with the service and the level of care available in a regional town.

Enhancing Nurse Confidence and Next Steps

Beyond direct patient benefits, nursing staff at the Gumeracha Nurse-Led Clinic reported a significant boost in their confidence and skills. In a setting where incidental learning opportunities and peer support are often limited, virtual technology has provided invaluable learning experiences. Nurses now have access to expert consultation in real time, improving both patient care and professional development while enhancing job satisfaction.

This story highlights how virtual technology can bridge healthcare gaps where traditional medical workforces are unavailable. The next steps include expanding the use of these devices within the current Nurse-Led Clinics to include children and adolescents while exploring opportunities at additional sites.