Doing Crisis response digitally: developing new modalities of care in Ireland

Background: The Response for Vulnerable People (RVP) team evolved to support new migrants to ROI initially in the National Transit Centre and subsequently across over 70 geographic locations in Ireland aside from homeless settings. Supporting thousands of distributed migrants that are new to the country with limited access to primary care required a change of approach. Through remote working a small clinical workforce is supported by a larger social care team who act as the eye’s ears and hands of the clinicians. This clinical team delivers healthcare and support directly to clients on site via video and phone call and responds to clinical complexity, outbreaks and other escalations across three counties of Ireland including the populous south inner city of Dublin. Methods: Training social care workers as community health workers (CHW) and embedding them as a support to a clinical team broadens the reach and capacity of that team in a context of clinical skills scarcity. Using an electronic medical records in supported by secure threaded team electronic communications platforms allows dynamic and efficient utilisation of clinical time. A single clinician can remotely consult using video calls and instant messaging across the entire region, support numerous CHW and advise as many as 45 different patients and interface with multiple agencies in one day. There would not be recourse to efficient and appropriate care without this system which is safe and highly effective. Results: Using digital communications (Slack) and data recording technologies (KOBO toolbox) and an Electronic Health Record (Open EMR) across the Response for Vulnerable People service has both increased the accessibility of clinical expertise and support available to non-clinically qualified teams of health care support workers and allowed the limited clinical resources to be optimally directed. We upscaled our utilisation of a combination of secure messaging technology (Slack) during the development of our Migrant Health teams. We utilise distinct live channels that allow text, phone and video communication across our team of over 45 staff for both care planning and assessment. This team is clinically led and supported by 5 nurses and one GP in total. We provides advice, signposting and in limited circumstances urgent care and health promotion as well as primary care to a fluctuating population of approximately ten thousand migrants new to Ireland and 150 Roma families and complex homeless clients needing support. Discussion: This communications approach is much more flexible than telephone or traditional communications technologies and allows non-qualified health care support staff much greater support from a small core of highly skilled clinical resource across diverse settings. This provides improved patient outcomes and reduces acute presentations. It also allows a level of service that would not be deliverable using traditional communication methods.