Optimising Telemedicine for Critically Ill Rural Patients Requiring Retrieval to Tertiary Hospitals in South Australia
Date
2025
Authors
Fudge, Melanie Jane
Editors
Advisors
Foley, David
Stuart, Peter (SA Health)
Zeitz, Kathryn
Stuart, Peter (SA Health)
Zeitz, Kathryn
Journal Title
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Thesis
Citation
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Abstract
Providing specialist care for critically ill patients in rural South Australia is challenging due to the state’s vast geography and widely dispersed population. Rural clinicians often make critical clinical decisions and decisions around patients transfer in professional isolation, which can impact patient outcomes. Telemedicine presents a promising solution by enabling real time support. However, its utilisation in rural emergency settings remains limited despite widespread availability since 2016. This study employs a Participatory Action Research (PAR) methodology to explore the barriers to telemedicine use and co-develop strategies to optimise its integration into rural emergency and retrieval practice. Through in-depth interviews and focus groups with rural and retrieval clinicians, key themes emerged, including human factors, workplace culture, the need for clearly defined pathways and targeted education. A pilot intervention was developed with key clinicians in which telemedicine would become standard practice for critically ill patients in the rural sites included in the study. This was implemented and evaluated over three months in 2023. Key findings reveal telemedicine’s benefits including improving patient assessment and care, clinician teamwork and accuracy of logistics. However, barriers still existed, with telemedicine uptake only improving from 6% in 2022 to 20% in 2023. Additionally, the uptake was different between sites. Notably acceptance of telemedicine was greater in paediatric care. The study identifies five crucial factors for optimising telemedicine use: addressing human factors, improving workplace culture, establishing routine pathways, leveraging the success seen in paediatrics and implementing targeted education and change management strategies. Rural emergency departments can enhance care delivery and outcomes for critically ill patients across South Australia by fostering clinician confidence and embedding telemedicine into existing workflows. This research offers actionable recommendations for optimising telemedicine adoption, by boosting clinician confidence and integrating telemedicine into existing workflows, rural emergency departments can improve care delivery and outcomes for critically ill patients, ultimately reducing the disparities in healthcare access between rural and urban settings.
School/Discipline
School of Nursing
Dissertation Note
Thesis (MClin.Sci.) -- University of Adelaide, School of Nursing, 2025
Provenance
This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legals