Innovating through decentralized Teledialysis care
University of North Norway and Tromsø University Hostpital, Norway
Dialysis and transplantation are the two treatment forms when kidneys are failing. Dialysis must be used when the kidneys are no longer able to excrete waste products and regulate fluid balance in the body. There are two main types of dialysis: haemodialysis (blood or machine dialysis) or peritoneal dialysis (abdominal or dialysis bag).
Haemodialysis is the most used dialysis form in Norway and is mainly provided in hospitals. This type of haemodialysis “binds” the patients three times a week for five hours to the hospital, in addition to the travel time needed. Some patients receive treatment at so-called satellites, which are smaller hospitals and other health institutions with no formally recognized specialist in kidney diseases. The administrative and professional responsibility for patients receiving haemodialysis in satellites is placed in a cooperating hospital with nephrologists.
An effective manner for hospitals without specialists in kidney diseases (nephrologists) to gain access to specialist expertise is through what is known as teledialysis. The service provides better health care in rural areas by giving professional support to health workers on site. In Norway, haemodialysis is mainly performed in hospitals with nephrologists. Each of these hospitals has at least one satellite. In total there are 34 satellites in Norway where dialysis is performed. And at each satellite, dialysis is run by specially trained nurse team on site.
The purpose of the teledialysis service is to improve the offer to patients by providing dialysis closer to the patients’ home, and to increase integration of satellite personnel. Teledialysis contributes to ensure implementation of common quality standards at both satellites and their mother unit. Dialysis patients at the satellites did not have the same follow-up as the patients at the hospital. With the possibility of teledialysis the patients benefit from greater continuity and regularity in check-ups and treatment, as well as the opportunity to talk to their kidney specialist directly.
Development of teledialysis
Telemedicine service in nephrology (teledialysis) has been in operation since 2001 in Northern Norway, following a successful pilot project. Satellite dialysis units are situated as far as 900 kilometres from the main university hospital in Tromsø, and during the last few years, teledialysis has been introduced in other health regions in Norway as the demand has increased both nationally and internationally, where the Norwegian solution has also been put into use in Scotland. The aim is to improve the quality of patient care by providing patients and nurses at the satellite units with the same quality of follow-up care and support as that received by patients and health staff at the hospital. To achieve this a videoconference link between the hospital and the satellites was established.
Secure videoconferencing supports the teledialysis treatment
Videoconference can be used for clinical consultations, administrative purposes, rounds, education and staff development. Kidney specialists, like Mark Rumpsfeld at the University Hospital of North Norway (UNN), has his weekly consultation with a patient in Hammerfest, a city almost 550 kilometres north of Tromsø. This is performed by means of telemedicine. “How are you today?” asks Doctor Rumpsfeld at UNN, to the patient who is connected to a dialysis machine at Hammerfest Hospital. The videoconference utilizes a closed network, known as the Norwegian Health Net, which makes it possible for kidney specialists to conduct secure consultations even though the patient is not physically present at UNN. The setup is quite simple. The doctor uses an ordinary television set with a large camera on top. At the same time, the nurse team in Hammerfest, consisting of specially trained personnel, hooks up their system. This all allows the physician and patient to see and hear each other.
Reducing the travelling commitment: benefits for patients and hospitals alike
As administering dialysis can be both time-consuming and fatiguing for the patient, teledialysis has stepped in to help mitigate some of the stress and worry for the patient. There are also increased, added benefits for hospitals facing human resource shortages, in particular specialists. One of the patients in Finnmark County undergoing dialysis supported by telemedicine notes, “Since we do not have a kidney specialist at the hospital in Hammerfest, it is reassuring that the nurses here can quickly get in touch with a specialist in Tromsø if something irregular occurs.” Previously this patient had to travel by plane to Tromsø several times a week for dialysis and consultations with the kidney specialist. The side effects of such treatment were fatiguing: “I’d get very sleepy and tired after dialysis. It’s therefore a relief not having to go by plane, oftentimes with long waiting periods at the airport. Now I can go right back to my couch or bed afterwards,” he explains.
Kidney specialist, Markus Rumpsfeld, sees the value for professionals in rural areas as well. They will have better and closer follow-up through the use of telemedicine. He thinks videoconferencing is important to prevent professional isolation of highly specialised workers outside hospitals. It is the belief among experts in Norway that dialysis treatment given by satellite units and supported by telemedicine is going to rise in the coming years, particularly in response to a large demographic of aging adults suffering from coronary heart disease or diabetes around the world. Decentralized dialysis treatment tailored to the needs of the patient is one option for people depending on dialysis treatment. While not a solution in and of itself, teledialysis is an important tool that supports this overall treatment option.