Dizziness and vertigo can be caused by extremely serious conditions or benign issues of the inner ear. For rural and remote clinicians, distinguishing the difference without an onsite MRI or access to specialist advice can be challenging. But now thanks to the team at Logan Hospital’s Integrated Specialist Ear Nose and Throat Service and the power of eConsult, they can have rapid specialist advice at their fingertips.
Leia Barnes, Consultant Vestibular Physiotherapist and Team Leader at Logan, updated us on their rollout of the eConsult platform as part of our celebration of Telehealth Awareness Week, on now.
The Complex Vestibular Service within the ENT service at Logan has been using eConsult since the start of the year with Weipa, Cooktown, Longreach and Mount Isa using the service regularly. The new platform came online in August and has further enhanced the communication process. “We use eConsult – what we call Dial-a-Dizzy - for the management of people presenting to an emergency department with acute vertigo and dizziness,” Leia explained. “Dizziness and vertigo can be caused by lots of different things and the tests can be difficult to interpret, so we provide access to specialist advice.”
The team received funding from CEQ to purchase and distribute 5 Vesticam infra-red goggles to five rural sites across Queensland to support clinicians in the early diagnosis of the cause of vertigo, including stroke or vestibular (inner ear) dysfunction. The goggles connect to a smartphone and record a patient’s eye movements. “We use the HINTS+ protocol to see if the cause is a possible stroke, which is best practice because it is better than a diffusion-weighted MRI at identifying stroke as the cause of vertigo in the first 24-48 hours from symptom onset” Leia said.
“Typically, a doctor will call the hotline and say, ‘I think the patient has vertigo, but I don’t know if its cause is the inner ear or the brain.’ The goggles allow us to make on-the-spot recommendations depending on our findings,” she said.
Leia said eConsult was like a one-stop shop. “It has the referral information, digital media, and our findings all in the one platform. It’s excellent! The referrer also knows what’s happening at every step because it’s instant communication in real time, depending on how you use it, so they’ll know someone is reviewing their referral,” she said.
While the use of eConsult helps to quantify how much the team supports their colleagues, it has already helped prevent an unnecessary medivac. “We had a patient who had a suspected brain issue, and they were being prepped for retrieval. But following a Dial-a-Dizzy eConsult, within 30 minutes we were able to confirm their symptoms were not the result of something serious, so the medivac was cancelled. It’s a retrievals and admission avoidance model.” However, Leia said the opposite also occurs. “When we do identify something of concern, we help facilitate the urgent transfer of that patient and often they are streamed straight into a stroke ward.”
“We’re bringing resources to rural and remote sites so they can provide best practice care to their patients regardless of where they are. They might not have equipment to complete an MRI, but they’re still providing best practice care for acute dizziness,” Leia said.
She said the response from clinicians on the ground has been excellent. “I would say they feel grateful and supported, but also remembered. They know someone is there to help them which they said is reassuring.”
Leia said she was ‘blown away’ by the support received from CEQ for their vestibular service, particularly the Healthcare Improvement Unit and Telehealth Support Unit. “I am blown away by the level of support I’ve been given by HIU and the telehealth team. There’s so much more to telehealth than you realise, and different funding options, and I am grateful to the telehealth team for helping me to navigate those processes because as a clinician, we don’t know,” Leia said.
The Dial-a-Dizzy eConsult service at Logan Hospital provides support to the four sites from 8.00 am to 5.00 pm, with the workload shared between three vestibular physiotherapists, who also run Logan’s TRV chair and virtual reality service. Goondiwindi and Beaudesert will be coming online soon.
Following additional funding from Metro South Health and the Department of Health’s Reform Program, Leia said further expansion is on the horizon. “We will be shifting our focus to the local setting to support GPs in Metro South so we can become an ED avoidance model as well. We’d also like to extend eConsult to other sites that have the Vesticam goggles,” she said. “Our other vision is to catalogue our eye videos like you would an MRI so if someone re-presents three years later, you can look and see how things have changed.”
To show your support for Telehealth Awareness Week, head on over to our dedicated campaign website to download and share resources and learn more about how telehealth is expanding our connections.
