There is an incredible passion for the patients at the Transplant Centre at Sahlgrenska University Hospital. By introducing digital healthcare meetings, the practice has managed to increase the quality of care, has made it easier for patients, and given the keywords person-centred care a whole new meaning.
The Transplant Centre peaked in 2019 with 202 kidney transplants, with a third being donated from living donors. Of four centres in Sweden; Malmö, Gothenburg, Uppsala and Stockholm, Gothenburg performs about half of the kidney transplants in Sweden. This means that they have a large catchment area covering, among others, Norrland, Östergötland, Västra Götaland, Småland, northern Halland and Iceland.
Digital healthcare meetings have been worth their weight in gold for long-distance patients. Ingrid Petersson and Ulla-Maj Andersson, patient coordinators at the Transplant Centre at Sahlgrenska University Hospital, explain how it worked previously when patients had to come to the hospital:
The patient travelled 200 km alone by car to their flight, had never sat on a plane before, had to change flights in Stockholm and endure delays. He was visited by doctors and patient coordinators for information and assessment and then had to make the same journey back home again. All this made for a very stressed patient, which made it difficult for them to assimilate important information and kidney transplantation is a major life event.
In many cases, the patient does not need to be examined at the Transplant Centre and can be offered a digital healthcare meeting, which, for that particular patient would have been of great benefit.
Relatives can attend via secure video meetings
Referrals for kidney transplantation and live kidney donation are sent to the Transplant Centre. Most patients are not called to the Transplant Centre during the assessment. Those who have illnesses or other circumstances that entail clearly increased risk of complication are called to attend the Transplant Unit in person for assessment and information, preferably in the company of a relative. Since the pandemic started, visiting restrictions have been in place and many people have had to visit the hospital alone without their relatives or with only one relative. This is where secure video calls have really been of help and more relatives have been able to be present.
Important face-to-face information
When patients were approved for kidney transplantation, a letter was previously sent to patients with information about the waiting list and the upcoming kidney transplant. Conditions for processing this information can vary according to education level, ethnicity, functional capacity and whether are Swedish speaking or not. According to the Health Care Act, patients have the right to receive important information in a way that is understood. Everyone who previously received a letter, now has a digital appointment and an interpreter is used if necessary. This has proven to be very valuable for both the patient and the healthcare professional. Ingrid explains;
“During a digital healthcare meeting, the patient has the chance to ask questions and you get very close to them. We get to put a face to a name so that it doesn’t feel so alien when they arrive at Gothenburg.”
Risk of infection affects meetings
In some ways, a digital meeting can be better than a physical one, especially for infection-sensitive patients. Ingrid clarifies;
“When we physically meet patients now during the pandemic, we always wear face masks due to patients’ compromised immune systems. During a digital healthcare meeting, it’s great not to have to wear a mask and be able to see each other’s facial expressions.”
Digital healthcare meetings changed the way of working for the better
At the Transplant centre, it is not just about replacing physical meetings with long-distance patients with digital meetings, but it is also about adding a extra dimension to the phone calls. Ingrid and Ulla-Maj tell us that after the introduction of video calls, they experienced longer, and more information-rich conversations with the patients compared to just a phone call. Previously, all those people who had been approved to donate kidneys to a loved one were called, as well as the recipient, with information about the operation time and actual operation. But now only one phone call is made to make an appointment for a digital meeting and more information is provided and questions answered at that meeting.
“The only time we make a phone call nowadays is usually to make an appointment for a digital meeting. The patient then gets to book an appointment that suits them, has time to prepare any questions and the chance to be in a calm and safe environment. For example, at home, instead of in a supermarket. Which makes for a completely different conversation. There is also an opportunity for relatives to participate.”
Although it meant a little more work for the nurses, they think it is a small price to pay compared to the benefits and great value for the patient. Hopefully, more information-rich conversations provide more informed and safe patients, which also helps the care providers. Ulla-Maj explains;
“It has now become part of the working day and makes things less urgent, we can wait two weeks if it suits the patient better. We can adapt to them and that is our whole way of working – person-centred care.”
By being able to see the patient during the conversation, the nurses feel that they have experienced much more informed conversations and formed a closer relationship with the patient. Ingrid tells us about a particular case she remembers;
“There was a patient who had been very sick and scared, where we had a video meeting with him, his wife, two children and even the dog and they had set up for coffee. A home environment makes you feel safe and allows more people to participate, making for a more tranquil conversation. I believe this gives you a better ability to process information. The patient needed their relatives in that situation, something we were unable to offer in the hospital at the time, due to the pandemic.”
Many people were sceptical about the change.
Initially, many healthcare professionals were critical of starting to work with digital healthcare meetings. The practice had already made an attempt with another supplier, which never took off. Was this really in the interests of patients? Ingrid and Ulla-Maj, who have been internal ambassadors for the introduction of digital meetings, were also doubtful at first before Visiba Care came into the picture.
"The support we received in the beginning was fantastic. We could always contact our Customer Success Manager Lovisa Dombrowe and her team at Visiba Care and Gisela Fridstedt, development manager at VGR. Without that support, it would have been difficult!”
Ingrid and Ulla-Maj could always count on support from Operations Manager Per Lindnér and Care Unit Manager Ulrika Nordell and that was important when introducing the new way of working. When the pandemic hit, physical meetings quickly changed to digital, as the habit of having digital healthcare meetings already existed. It also facilitated the fact that they could present an evaluation from the patients’ perspective.
“There were a lot of doubts from different directions, but after we gave a presentation about how satisfied the patients were with the digital conversations, a lot of them changed their minds.”
Initially, all patients were asked to anonymously respond to a digital survey about how they preferred to receive information, and 41 out of 47 people preferred a video call to a physical meeting or phone call. Quotes from the survey;
“Its good to see the person you’re talking to and nice to avoid a long journey, especially during the pandemic.”
“Very good and pleasant meeting, with a lot of information. It was a great way to have a meeting and it saved me a lot of time. Thank you!”
“The meeting gave me a lot of hope for life. Thank you!”
Ingrid and Ulla-Maj’s top tips for getting started
Lower the threshold by making sure everyone has login details, access to the help centre, and can easily book their digital healthcare meetings themselves.
It was important in the beginning to get a good camera and a headset. The importance of the equipment to the quality of the call cannot be emphasised enough.
- Technical support
Take advantage of the support! It is reassuring to know that there is someone to contact in case of problems and to get feedback.
- Support each other!
Supporting each other at the practice has always been hugely important. Some employees received close guidance during the first meetings, to feel safe and manage it independently.