Case study – A Digital Triage Solution for the St Helena Government

Case Study - A Digital Triage Solution for the St Helena Government (UK Overseas Territory)

6 weeks

Mobilisation Time

90+ patients

referred to Virtual Lucy

KEY PROJECT GOALS

This project had been designed to deliver the following goals:

Provide advice and guidance to patients that have had a previous MSK condition or treatment within the last 5 years
Identify which patients would require diagnostic investigations or potential further surgery
Highlight a list of patients to the St Helena Clinical board, that require a medicolegal investigation.

AT A GLANCE

Challenges

St Helena is a remote island in the South Atlantic Ocean
Limited Orthopaedic consultant capacity
Limited access to computer devices
Limited internet or telephone communication due to geographical location

Benefits

Provided remote management of patients across a UK overseas territory
Patient assessments completed virtually by UK-based orthopaedic surgeons via the Virtual Lucy® platform.
Advice and guidance provided to St Helena’s clinical board on a cohort of patients on the island

“The general feelings of completing the pre-assessment prior to the consultation were constructive. Patient reviews expressed that there is “time to deliberate” on pervious surgery and by not having this type of appointment before, they felt “the pre-assessment was an icebreaker” of what to follow.”

St Helena Feedback

BACKGROUND

HBSUK were asked to support the Saint Helena Government providing clinical review of a cohort of Orthopaedic (MSK) patients previously treated at Jamestown General Hospital. HBSUK proposed using the Virtual Lucy® platform to provide a specialist remote assessment of a small cohort of patients who potentially required further treatment or surgery.

Saint Helena Island is a remote British overseas territory in the South Atlantic Ocean, to which access is via air travel only, unless travelling to or from the island on a private yacht or the cargo vessel that services the island. The general hospital in Jamestown has been operating with only one Orthopaedic surgeon for the last 5 years, with limited resources such as a lack of on-island MRI scanner or MSK ultrasound facility.

HBSUK’s team of Orthopaedic Surgeons, led by Mr Amol
Chitre, were briefed to triage patients who had pain,
restricted movement, or reduced function from an
Orthopaedic presentation.

After an initial assessment, HSBUK aimed to provide a clinical summary report with recommendations
for the patient’s treatment, if required, as well as highlighting any cases where there could be medicolegal concerns attached, due to previous surgical treatment.

THE PROJECT

The St Helena Government welcomed the opportunity to use Virtual Lucy to triage patients remotely from the Island. The service was deployed to carry-out a review of the Orthopaedic Service to a cohort of patient with previous treatment on the island. This provided an opportunity to showcase that Virtual Lucy could remotely help deliver a safe and accurate assessment to a remote population such as St Helena (including a clinical outcome and advice on treatment).

The project went live 6 weeks after process agreement. The establishment of excellent communication channels and collaboration between the St Helena team and HBSUK, enabled any challenges to be resolved pre-mobilisation or improved during initial mobilisation of the project.

Due to a high percentage of the island being illiterate or having no access to a computer device, HBSUK requested that patients attend a pre-assessment appointment at the hospital (1-2 weeks before clinical review). With the support of St Helena’s trained team, patients felt more comfortable using the service. The appointments were aimed to collect preliminary information to support the subsequent appointment with a consultant, consisting of the patient’s history of their previous orthopaedic surgeries and any problems they are still having, as well as submitting a general health questionnaire.

HSBUK set up roughly 2-3 Clinics per week on Virtual Lucy and a 15-minute appointment slot to complete the assessment. All patients had the assistance from an Orthopaedic Support Officer similar to their pre-assessment appointments. In addition, HBSUK offered follow-up appointments to any patient that required additional scans on island or further clinical information before an accurate outcome could be advised.
Throughout the project HBSUK provided summary reports to St Helena for weekly review meetings. These were an essential part of the project and allowed both teams to gain trust and work collaboratively, which contributed to the overall success of the project.

OUTCOMES

Flexibility and keen willingness to work from both the clinical team on St Helena and within HBSUK, has led to over 90 patients being referred to Virtual Lucy

“This was a great demonstration of how digital services can enhance local healthcare provision in possibly the most extreme circumstances. To be able to provide medical consultation to a remote population over 4000 miles away was amazing, particularly given most of the local population do not have reliable access to the internet. I think we were able to provide a useful service to the patients on the island and answer a number of questions they had as to their orthopaedic care. This project was delivered in possibly the most extreme circumstances that may affect the delivery of digital healthcare and was only achievable by the collaborative work of the local teams, technical and admin support from both ends and the clinical teams working together.”

Amol Chitre

HBSUK MSK Clinical Lead for St Helena Project 2023

Over the past two months, patients were happy with the online Virtual Lucy Platform, and both the care and attentiveness they have received from the Orthopaedic Support Officer and Consultants

Lina Knipe Peters

St Helena Orthopaedic Support Officer & Project Lead