Routine satellite teledialysis service exists between Tromsø's University of North Norway (UNN) renal unit and 6 remote sites (distance from Tromsø):
- Kirkenes og Vadsø (900 km)
- Hammerfest (550 km)
- Alta (400 km)
- Narvik (240 km)
- Finnsnes (160 km)
There are currently 24 patients using the service.
Through ITTS, a new home dialysis service has been expanded and is now implemented in the homes of 2 Peritoneal Dialysis (PD) patients in Brøstadbotn and Tana (northern Norway). Through the use of videoconference (VC) technology, nurses at Tromsø's University Hospital are giving guidance to community care nurses and patients in their own homes. Benefits of the remote service include:
- help to control the set up from the dialysis machine
- help in case of alarms and troubleshooting
- help if suspicion of infection (assessment of color of the fluid)
- guidance in case of catheter problems
- assessment of general conditions, fluid balance, depression etc
Training of nurses is ongoing and currently looking for new patients to grow the service.
In Scotland, NHS Highland have developed significant expertise in the use of videoconferencing (VC) within their Renal Services. This was first established in February 2010 between 2 renal centres and has received positive endorsement from staff and patients. Significantly fewer outpatients now travel the 165km to Inverness as capacity in Wick clinics has increased without incurring additional travel for consultants.
VC is used in the current renal service for:
- Weekly staff meetings between Caithness Hospital, Wick and Dunbar Hospital, Fort William dialysis units and the main Inverness unit in Raigmore Hospital.
- Weekly staff education and training via VC to the peripheral units
- Bi-monthly haemodialysis reviews with Wick dialysis unit by doctors
- Ad hoc consultations with haemodialysis (HD) patients by doctors and allied health professionals
- Ad hoc use for local and national meeting video conferencing
The renal service will build on the success of this VC link to cover other areas across Highland, out to the Western Isles and, ultimately, into patients' homes. The ITTS project will expand the use of VC in NHS Highland renal service to:
- Caithness General Hospital for out-patient (OP) work
- Portree Hospital, Isle of Skye for OP work
- Kyle of Lochalsh Health Centre
- Western Isles Hospital for HD patient review plus or minus clinics
- Western Isles Hospital for weekly staff updates and education
- Expand the use of VC to allied health professionals (AHPs) - especially pharmacist, dieticians and physiotherapist in consulting with haemodialysis patients
- Patients home for peritoneal and home haemodialysis
ITTS has focused on 3 areas of implementation:
- Patient reviews via VC – service running
- Outpatient clinics at remote sites delivered via VC
- VC in homes of home dialysis patients
*The home-based VC strand of the project has been delayed until the national home VC strategy for Scotland is finalised. There have also been difficulties establishing outpatient clinics via VC - this element of the project is still planned but is unlikely to be achieved in the ITTS timescale for evaluation.
Similar to the model in Scotland, ITTS Sweden are developing VC links for renal consultations between the three hospitals in Västerbotten: 1 University hospital (Umeå) and 2 local hospitals. The service is intended for patients with ongoing dialysis (both HD and PD).
Starting in November 2012, the new service is perceived as a positive breakthrough for telemedicine in northern Sweden. The number of consultations/rounds have increased and travel has been significantly reduced for both staff and patients.
The VC equipment has added value as connections are made for team meetings, medical education (both staff development and information sessions for new/existing patients) and administrative meetings.
In Northern Ireland, the ITTS team are working to develop the practice of using VC links to support patients requiring dialysis in their own homes.
Having overcome a number of technical barriers, in September 2013 the new service began using a simple desktop/webcam set-up at the clinician's workplace. To date, 3 HD patients have been selected to use the service with positive feedback from all involved.
Work is continuing to develop increased patient numbers and explore wider application of the service as a support tool during home haemodialysis training.