A nurse-led remote surveillance programme for vascular patients, has boosted patient participation to 100 per cent, saved hundreds of hours of clinician and patient time, and over $1.5 million of healthcare costs.
The program is the first of its kind in Australia and allows patients who need ongoing surveillance of vascular conditions to visit their local medical imaging facility instead of travelling to the central site each time.
Results are then reviewed by a vascular surveillance clinical nurse at the Royal Adelaide Hospital (RAH) with vascular consultant oversight.
No patient left behind
Vascular patients require close ongoing surveillance to detect early changes in disease progression, or to monitor vascular interventions. This monitoring period typically requires retesting every 6 to 12 months and lasts from a few years to lifelong surveillance.
For a variety of factors including a large travel burden for patients located outside of Adelaide and duration of follow up, loss to follow-up rates following vascular surgery remain high.
“Loss to follow-up after vascular surgery really impacts on the quality of care we are able to provide and can have serious consequences for the patient,” said Marianne Lupson, Vascular Surveillance Clinical Nurse at the RAH.
A central solution
In 2014 the RAH Department of Vascular Surgery introduced the centralised remote surveillance programme where suitable patients could attend one of 25 local imaging locations across the one million square kilometres of South Australia.
Vascular surveillance clinical nurses and vascular consultants at the RAH could then review the results and determine if patients needed in-person follow-up or further remote surveillance.
“Patients are more likely to continue to attend their follow-up imaging appointments if it’s located close to home. Factors such as being able to attend whilst working, organising transport and even easily accessible parking play a large part in compliance of long-term follow-up,” said Ms Lupson.
Good for patients, hospitals, and the environment
In the five years following establishment, loss to follow-up dropped to zero.
The avoided outpatient appointments saved approximately 930 hours of clinic and consultant time as well as a subsequent $1.5 million.
“Our outpatient clinics are limited in the number of people they can see, so the remote surveillance program frees up appointments for new patients to be seen in a timely manner and helps to keep our outpatient clinics manageable,” said Ms Lupson.
For every outpatient appointment avoided each patient saved 197 km travel and $87 in fuel costs. This was associated with a saving of 30 tonnes of CO2 vehicle emissions each year.
“We analysed our data just before the pandemic, and before the recent rises in fuel prices and cost of living. So for patients, these savings have only become more relevant since then,” said Ms Lupson.
The study team also found that patients who required emergency interventions resulted in hospital admissions that were four-times longer and three-times more expensive than those triggered due to surveillance.
The findings paint a clear picture that shows that remote vascular surveillance has clear financial, clinical, patient and environmental benefits.
For 74-year-old vascular patient, Donald, who has benefitted from RAH’s vascular service for 11 years, the surveillance program is “invaluable for me and my family.”
“Marianne arranges all my scans ultrasounds and tests which is local and efficient. She is my one stop shop and knowing that these people keep tabs on me is very reassuring as I don’t like to worry my wife or son unnecessarily as he lives in Melbourne. Every 3 months I have a check-in which helps to alleviate some of my worry. The updates give me confidence to go on holidays seeing friends and family interstate.”