The key here is the nurses/paramedics - if they can do all that it would
be possible and the remote GP would manage the communication etc. Are
there such people in Apollo Bay?
(Nice place for a locum tho)
Without skilled assessors on the ground it would be impossible. I dont
think IT can make up the whole gap. The other issue would be indemnity -
the state would have to assume this for the special situation as it
would be a higher than average risk
R
John Mackenzie wrote:
Gentlemen,
I have just returned from a short locum at Apollo Bay
where there is a problem common to rural general
practice ... After hours cover.
AB has a small hospital with 4 acute medical beds,
residential aged care, and a small A+E.
In one general practice there are 2 GPs (husband
and wife) aged in their 70s, and who do NO after
hours cover or any hospital work (viz: no A+E or
acute medical).
The other general practice has a female GP doing
about 6 sessions and NO after hours cover. This
practice tries to supply 2 additional GPs who need
to provide ALL the after hours cover. These GPs
soon burn out, and there have been *28* GPs
come and go over the past 2-3 years. It is also
difficult to keep the "temporary" GPs busy in hours
and well remunerated.
There is no circuit breaker foreseeable in the next 5
years, with the permanent GPs "standing their ground".
Solution: Remote on call GP.
I would estimate that 9/10ths of after hours disturbances
could be managed remotely by an experienced GP
with the right IT setup. The remote on call GP could
then be 1st on call whilst the local GP is "2nd" on call.
The rural hospital would need to have electronic health
records, with VPN access by the remote on call GP.
Maybe a web cam, also.
Obviously most of the crap such as inpatients needing
medications/IV fluids ordered/recorded/signed during
the night could be easily looked after remotely. But a lot
of major emergencies could similarly be managed.
Eg. patient presents to A+E with crushing chest pain, ECG
shows acute AMI changes ... Nurses/paramedics insert IV,
remote GP orders further investigations and meds (as
per usual protocol), rings referral hospital, and ambulance
transfers - all while the 2nd on call local GP sleeps.
Comments ?
John Mac
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