Telecardiac Investigations - Part one - video transcript

Megan 00:06
I don't know if, if it's a suitable phrase, 'suitable' rural healthcare, because healthcare should be suitable across the whole board. Yes, we choose to live here. But where else would we be? This is home and health care should be available to everybody no matter where you live.

Tiarne 00:33
Hi, I'm Tiarne. I live in Barcaldine and I have two kids; Paisley she's two and a half and Percy, he's one. So I have a heart disease called SVT. I have some PVCs also, which another type of extra beat. It's not really common in young people, so mostly elderly people do have what I have. I'm just the lucky one. I have had three surgeries in the past, I think I was 18 or 19 when my first one and then I had another one the next year and then I had one just this August gone which was nine hours, very painful. Yes, they hate when we go to the city because they don't have this area to play in. He's got the biggest smile, hey, he gets it off his dad. Yeah, well Percy is still breastfed and I've never left Paisley unless I was in hospital. My family are on a property out of town so I don't really have anyone in town that I can just say here can you have my kids I have to go somewhere you know they have to come we can't just leave them. Being rural, they can't do a lot here so I can have appointments with the GP and for my appointments I have to usually go all the way to Brisbane sometimes I can wait in hospital for two and a half hours and I see them for 10 minutes and then I'm out and I have to get a plane home. It's pretty crazy that we live here. In the past I would have to drive either to Longreach or Emerald, so an hour or three hours to get a holter monitor put on for 24 hours and then have to get it off again the next day. So now that they have the telehealth here, I can just go up to the hospital here which is two streets away and I can get it put on it and they can check it all through the telehealth and they can read it straight away from down there when the machines here.

Tiffany Roberts
Hello, my name is Tiffany Roberts and I'm the consultant Cardiac Scientist for the Telecardiac Investigations Program. Telecardiac investigations is using telehealth to be able to perform cardiac investigations to all Queenslanders, regardless of the geographical location. So it doesn't matter whether you live in Mt Isa, Longreach, Mornington Island, they're getting the exact same care, for holter monitoring and exercise stress testing as patients living in Brisbane would. So we're able to use telehealth and video in using high definition camera and microphone, we're able to see the patient as they're having the tests performed so we're virtually in the room with the patient at the time of testing, which is awesome. It allows us to communicate to the treating team, to the local nursing staff and the doctors and basically provide the best possible care for those patients living in rural and remote locations in Queensland. Pre-telehealth and what we were finding is we were getting the reports emailed to us, the cardiology registrar here would have a look through the report and it was difficult for them to actually do a full comprehensive analysis because they weren't there and they couldn't judge certain aspects. So for example, if a patient had a drop in blood pressure during the test, and they were using an automatic blood pressure machine, it became difficult for the cardiology registered to know if that was a proper significant drop, or whether it was just a fault in machinery. And by allowing the cardiology registrar and the cardiology team to be there at the time it does allow them context and a bit more information. And at the time if there is anything that's picked up significantly, they can address it straightaway with the team. It is really a no brainer. Why should one person have one level of care if they're living in Brisbane and another person have a another level of care living in Barcaldine; it should be the exact same and we should be trying to strive to provide the best possible care

Tiarne 04:46
It saves me a lot of time and a lot of money. I don't have to drive an hour or three hours to get a holter monitor put on or fly three hours with two kids to Brisbane. To live out here, people might say it's our choice - and it is our choice, it's a lifestyle we love - but if they want to have a steak on their plate, someone's got to do it. So next time they eat a steak, I hope they remember where it's come from when they say that, if we have illnesses we live here. Yeah, it is tough. When you do have a medical history or any conditions. Obviously, I can't go down by myself with the kids, especially with COVID, I can't take them into the hospital, o someone has to look after them. So this is Megan, this is my mom. She gets dragged along to the Brisbane trips.

Megan 05:43
That's a big thing. Support is, plays a major role in healthcare, and recovery and treatments. Because without your, without your family support, you struggle. It's, you need your family there. And there were times where I couldn't go. And so hubby would have to take time off work or her mother-in-law would take time off work. But someone would always have to travel with her because she's not allowed to travel alone. So family plays a huge role in the healthcare and you need to have telehealth. It's something she can do on her own. And if she does need someone else there, there's someone only a few minutes away. It's hard. It's really hard. You know, you'd never call it a burden, because it's just what you do. And I've been told I just, take it in my stride, and you just take, excuse me, you just take every moment as it comes. Yeah. Sorry. It gets a bit hard, bit much at times. But you wouldn't not do it. You're there to support your family all the time. Hey, miss!

Tiarne 07:17
I always ask when I go to the doctor and they say oh, you need to see the specialist and I say can it be done by telehealth because I don't want to go to Brisbane. I don't want to go to this city. It's too hard. I just want to stay here and they usually say yes. So I've made lots of good use out of telehealth. I will say that, it's been great!

Telecardiac Investigations - Part two - video transcript

Bernie 00:09
Well, it came about that, I was having trouble, pains in the chest and I was getting blue lips. People were telling me my lips were turning blue, that I should go and see a doctor, which I didn't. And I was in the RSL and I said to the manager down there, talking to me and I said I've got some pains in the chest and I don't know what they are. I'm Bernie and I'm in Longreach. Yes, I went up to the, to the doctor at the clinic, one of them one of the doctors, Emily Walpole. And she said, I'll put you in for a stress test. But when the time came, Emily wasn't there, she'd moved on and Dr. Claire Walker linked up with Brisbane and performed the stress test, and I thought there may have been something wrong because the doctor from Brisbane was saying, have a look at this and have a look at that. And that was at spikes on the thing and on Friday, that was a Thursday, then on the Friday, I got a call to be in Brisbane on Monday. Well, what I can gather is I wouldn't be here today. So this is what I've been told. And they got me just in time, and I'm sure, I probably would have been silly enough to put up with the pain, which was not unbearable, but it did hit me in spasms. And I I do think that, I probably wouldn't have been alive today.

Chris Symmons 02:08
You haven't had any chest pain recently?

Tiffany Cover 02:11
So an exercise stress test is a type of investigation that we commonly do in people who are experiencing chest pain in the community and it's usually people who we've risk stratified as being a low-risk chest pain or chest pain that we're less concerned is cardiac. But we need to do sort of the workup to make sure that we don't miss someone who might actually have underlying heart disease. And the purpose of the stress test is that a person actually is attached to an ECG that traces their heart for us. And then we get them to exercise. And when they reach a peak target of exercise, there's now evidence to say that if there's no changes in the tracing, that it's quite reassuring that it's unlikely to be cardiac that's causing their chest pain, so much less likely to be underlying heart disease. It is a risk stratifying tool. So we still tell people that even if this is negative if they continue to have chest pain that they likely will need to go on and have further investigations. So Bernie is one of the first patients in Queensland whose life has likely been significantly impacted by access to a telehealth exercise stress test program and it's through having his exercise stress test performed locally that he was able to be appropriately risk stratified and retrieved to Brisbane for ongoing cardiac intervention and care. Is everybody ready? And are we ready in Brisbane?

Brisbane Team 03:30
Yeah.

Chris Symmons 03:31
Yep. Good to go.

Tiffany Cover 03:33
Alright Bernie, so you've done this before, you already know the drill. So good, we're starting in 3, 2, 1 ...

Chris Symmons 03:44
All, good. Nice, long, slow steps. Try and stay as close up to the front as you as you can. You're doing really well. G'day. My name is Chris Symmons. I'm one of the senior medical officers at Longreach Hospital. I started working in Longreach, about four years ago. And pretty much ever since I started working here, I, I've been involved in the exercise stress test program. My very first stress test was also the very first telehealth stress test. So before, we were faxing or even before that posting the tests down. They were performed with one of our nurses and one of our senior medical officers here and then sent down to the Royal Brisbane Hospital for a report by the cardiologist which happened at a later date. Sometimes in the next couple of days or sometimes even later. Over the last couple of years, it's gone a step further, and the report is signed off by a cardiologist in real time. So the patient finishes the test, one of our cardiology registrar's at the Royal Brisbane reviews the test and signs off, often gives the patient a verbal report at the time of the test before they leave the building. And often, the cardiology team can arrange the investigations themselves. And so it significantly improves patient safety improves the patient outcome. And I think just makes it a much better test.

Alex, Brisbane 05:24
Hi Bernie My name is Alex, one of the cardiology registrar's at the Royal Brisbane Women's Hospital. How did you feel on the treadmill today?

Bernie 05:31
Yeah, quite good. No problems.

Alex, Brisbane 05:34
Perfect. Were you aware of any chest pain or palpitations at all?

Bernie 05:39
No.

Alex, Brisbane 05:40
Great. So you did really well on the treadmill. You reached all the targets we needed to get to. And I can't see any changes on the ECG trace to suggest a problem with blood supply to the heart muscle. A few extra heartbeats here and there through the test, but overall, I'm happy to call the test negative and for you to follow up with your local doctor.

Bernie 06:00
Okay.

Chris Symmons 06:01
So both in the general practice, as well as in the investigations, as well as consultations, I think there is a increasing scope of telehealth and I think as it becomes more accepted, and certainly COVID has helped with that, more places have realised actually I can provide this via telehealth, the systems have been upgraded and, and more familiarity around telehealth has meant hopefully, better care ongoing in rural and particularly remote settings into the future.

Bernie 06:33
I think it's very important. Because there's a lot of people like me, who just say oh, I'm okay. And, and you know you're not okay, but you think you are. And yes, they, it's very... There are a lot of tough men out this way and they say, oh it'll go away.

Bernie's friend 06:56
You were too good for me again, Bernie.

Bernie 06:59
No, you, you just measured it properly.

Bernie's friend 07:05
Yeah, good game anyway mate.

Bernie 07:08
Yeah, good game mate. I live for the grandchildren. I like the people here at the Bowls Club. I have a wonderful time here.

Bernie's friend 07:21
All the best, Bernie Gaylor.

Bernie 07:22
Here's to the good times.

Telecardiac Investigations - Part three - video transcript

Tiffany Roberts 00:00
In Tiarne's case, she's seen multiple cardiologists in Brisbane. And obviously travelling from Barcaldine to Brisbane numerous times, if required, a year is very, It's demanding. And especially when you have children in Tiarne's case. So Tiarne can get the testing done in Barcaldine, she can stay within her community, she can stay with her children, and it's not impeding on her normal day of life,

Tiarne 00:45
I have to have holters every three months. So I would be going every three months to Longreach, Emerald or Brisbane, just to have a little holter monitor put on.

Tiffany Roberts 00:58
A holter moniter is either a 24 or 48 hour device, which is able to detect the electrical activity of a patient's heart. So it's important for symptom correlations of patients experiencing palpitations, or perhaps they're feeling faint or dizzy or even fainting. It allows the doctor to basically have a look at the electrical activity and see if the heart may be responsible for the patient's symptoms. Our G holter monitors, I've got seven leads on them, each specific electrode has got a specific spot that goes on the chest. So with the monitor, it gets connected to a sticker or what we call an electrode. And that's what picks up the electrical activity. So it'd be stuck onto the chest, in specific locations, tape gets put over the top, and then Tiarne would go away and continue her day as per normal. So it's small enough that the patient's able to continue their daily activities, the only thing they can't do is have a shower. And sometimes with the heat of Queensland that can be slightly difficult but it allows us to get a lot of information. So Tiarne would go to her local hospital, which is Barcaldine in her case She's got two appointments, one for the application and one for the removal. So during the application, Tiarne would go in and should have a 12 lead resting ECG and the 12 lead resting ECG gives us a bit more information than what the holter does. So instead of a 12 lead ECG, it gives us three channels. So Tiarne would get that 12 lead ECG taken, we'd have a look at that via telehealth to make sure there's nothing that stands out on that ECG. Once that's completed, that's removed and Tiarne gets a holter applied. Tiarne then goes home for 24 or 48 hours, whichever the doctor requests, she then comes back, we download the monitor, have a look through all the data whilst Tiarne's still at the hospital. Make sure there's nothing significant on there that we need to address straightaway. And that's one of the benefits of telehealth is were able to look at the data whilst the patient's still there without them having to travel hundreds of kilometres home back to their farm or wherever they live before something's picked up. So we have a look at that straightaway and if anything is significant, we're able to alert for and in Tiarne's case, it was definitely alerted to straightaway

Tiarne 03:20
It just saves me so much effort to have something so simple done. Last holter monitor I had before my surgery, I wasn't meant to have surgery until February next year and they logged into my holter and they said you're having surgery in four weeks. We are going to check with the doctors and then the doctors came and spoke to me, right then and there, and just said we're going to book this date. You'll be down here and we'll do it. It was amazing. It was so good. So much easier.