Discussion
Mixed reality shows great potential for solo clinicians to work autonomously in the community, however, the success of its use was hindered by poor internet connectivity in RACFs despite using a 5G modem. Since the Royal Commission into Aged Care and Quality report highlighted a lack of progress in the application of communication technology in RACFs there has been greater investment in telehealth enabling residents to be assessed online to avoid potential transfers to hospital [13]. Despite advancements, challenges related to inadequate information technology infrastructure to support telehealth have been reported [14]. Further work is needed to explore reliable and higher quality videoconference connections such as utilisation of Wi-Fi through local RACFs to facilitate telehealth consultations.
Advanced telehealth using MR is a cost-efficient way to expand the capacity of the AO OPEN model while also empowering nurses to broaden their skillset and work to their full scope of practice with support and guidance from a senior clinician. Nurses and midwives represent over 50% of all registered health professionals in Australia [15], yet over a third of all primary health nurses report they are under-utilised often or most of the time [16]. Empowering nurses to work to the full extent of their scope of practice not only improves health outcomes as service delivery is optimised it also increases nurses job satisfaction and retention in the workforce [17]. It is important however that healthcare organisations provide the necessary education, training and support to equip nurses with the skills and knowledge to competently and confidently provide quality care in the community [18].
There are several limitations that need to be considered. This was a QI project with a small sample size and caution should be exercised when generalising these findings to other healthcare settings. It is also important to consider the potential effect of selection bias associated with using a convenience sampling design. Further rigorous testing with larger numbers is required to test the technology in similar healthcare settings to inform wider adoption.
The world has an ageing population and innovative, cost-effective strategies are urgently needed to ensure older persons receive the right care in the right place at the right time. The use of MR in emergency outreach teams shows great potential to increase capacity and capability in healthcare services. While there is a long history of MR use in simulated real-world environments further research is needed to understand the clinical and cost effectiveness of its use in real-life settings to inform wider adoption of the technology. Furthermore, with the rapid pace of technological innovation it is important to ascertain the longevity of manufacturer support before investing in long term integration of the technology. Collaborative research between industry partners and healthcare services could assist with the development of fit for purpose technology to optimise service delivery and outcomes for patients.
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