Bringing quality perioperative care to people in rural areas is an important, but challenging, experience.
Rural Australians have statistically poorer health than those that live in major cities, with 20 percent higher rates of chronic disease; and a range of increased risk factors, including smoking, alcohol intake, and malnutrition.
Mortality rates are notably higher among both men and women in rural Australia, with rates of preventable disease and hospitalisation known to rise significantly with geographical remoteness.
Overlaying this, staffing and skilling shortfalls are omnipresent, with practitioners required to be multi-skilled in the absence of larger clinical teams, in which staff members each have a specialisation.
However, for Deborah Burrows, District Clinical Nurse Consultant for Perioperative Services, at Southern NSW LHD, every drawback of delivering perioperative care remotely has a flip side, and presents an opportunity to improve service delivery.
“Recruiting competent professionals that have experience in all aspects of perioperative care has always been a time-consuming process, but we have found that there are many positives that come with this approach,” she said ahead of Operating Theatre Management Conference.
“Whilst it may take longer to find suitably qualified staff, we do find that many candidates welcome the opportunity to become multi-skilled – unlike the experience they often get in metropolitan sites, where perioperative roles are more siloed. It’s a great way for them to build leadership potential.
“Emphasising this selling point in graduate outreach efforts has been really successful and we’ve found that many city dwellers celebrate the opportunity to move to rural NSW and acquire their post-graduate experience here.”
An additional challenge with smaller teams is the perceived lack of career progression, which can undermine recruitment efforts. However, Deb believes smaller teams can also present an advantage.
“With a more intimate working environment, we tend to attract dedicated and loyal staff that we can train up and keep moving forward,” she said.
While opportunities for continuous education can be difficult in rural settings, Deb says collaboration with local partners – and virtual alternatives – provides a strong substitute.
“From a leadership perspective we don’t often have the immediate support layers you would get in a metropolitan unit. On the other hand, we learn to find our own support networks.
“In NSW, the Perioperative Clinical Nurse Consultants across the state of NSW meet on Skype every month and talk about where we are at and what we are doing.”
Complementing these efforts, adaptability and resilience among rural workers is paramount, she says.
“Rural Australians are used to dealing with the tyranny of distance and doing things differently in all aspects of our lives, and it is something we take in our stride. We regularly do meetings and trainings over video conferencing and don’t feel we are lacking because of this.
“If you are not used to learning via a screen, it can feel less adequate than in-person contact, but if you have known little else, it doesn’t feel like a disadvantage and can complement the face to face meetings.
“When it comes to primary healthcare, there is no choice but to make things work, and we find our can-do attitude bridges many of the gaps in resourcing.”
Medical supply sourcing has also failed to present a challenge, with the LHD standardising its procurement efforts.
“We work with our LHD and have a great Clinical Products Manager who works with the stakeholders and oversees procurement around the district, standardising our equipment and consumables to give us economy of scale.
“There will always be some surgeons that prefer one product over another – and they can, by and large, still have what they want. We typically aim for around 80-90 percent standardisation when purchasing new equipment and consumables.”
While the traditional problems of rural healthcare delivery have largely been remedied by the LHD, modern challenges like scaling up virtual care may present a roadblock moving forward.
“As we look to increase the use of telehealth and real time remote patient monitoring, we always need to be careful of mobile and internet blackspots. Usually the hospital site is completely covered by networks, but travelling between sites can cause issues. Additionally, it is common for patient’s homes not to have a suitable connection for telehealth consultations.”
To combat this issue, the LHD keeps tabs on where black-spots exist and ensures it always has a plan B.
“We routinely use down time forms and have procedures in place for when a connection drops out or becomes untenable. For some patients this means continuing to use a paper base, as well as an electronic medium.”
Additionally, Deb is a member of various committee groups, ensuring the rural voice gets heard in the context of healthcare policy.
“A lot of new healthcare policies can be quite metro-centric and it’s my job to ensure rural conditions are taken into consideration. As virtual care becomes more pervasive, I will continue to advocate for equitability,” she concluded.
Deborah Burrows leads perioperative services at the Southern NSW Local Health District. She is due to speak at the Operating Theatre Management Conference – 27 July 2021. This year’s event will be held at the Swissotel Sydney and virtually delivered.