The use of Integrated Operations in order to improve quality of health care and medical evacuations from offshore installations

Abstract

Abstract Since the early 1970s, thousands of patients offshore have been treated on board by our medical staff, in cooperation with our on-call onshore doctors. Several hundred patients have been evacuated to hospitals due to acute illness and serious injuries. Our present standards will be described, as will our perspectives on the future treatment of, for instance, acute cardiac disease and pre-hospital diagnosis through the transfer of electrocardiograms (ECG) and the use of telemedicine to obtain a medical diagnosis directly from the receiving hospital's emergency care unit. Norwegian regulations require nurses to be present on all installations, with doctors available on call onshore. Compared with ordinary nurses onshore, offshore nurses have wider responsibilities in normal diagnostic consultations and in emergency situations. Today, doctors and nurses discuss specific patients and cases by telephone, and they exchange photos. We wanted to use our experiences from integrated operations (IO) and from telemedicine to improve the offshore health care services, in order to provide better quality and integration of the people and organisations involved. Together with the NST (Norwegian Centre for Telemedicine), we studied the possibility of providing medical advice and support through the use of Telemedicine. Valuable experiences from Telemedicine projects, such as expert opinions in training and diagnosis, and follow-up of patients in rural areas and surgery, were collected. The use of IO for training, diagnostics and emergency situations will improve communication and cooperation between nurses offshore and doctors onshore. It may also enable advice to be given through video conferencing. The NST conducted a risk assessment of these new work processes, with special attention being devoted to the electronic transfer of sensitive information (photos/videos and other personal health data). Thirty threats were identified. None of them had an unacceptable risk level given the recommended solutions and the information management system applied. No corrective actions need to be taken, but some small changes in the procedures were suggested in order to reduce risks related to confidentiality, integrity and availability. We have recently started pilot projects on several platforms involving the extensive use of videoconferencing and sharing of real-time data. The equipment supports direct communication between the patient and nurse on the offshore installation and the doctor or hospital onshore. The results of the pilot tests will be presented, as will perspectives on future development and the relevance of the risk assessment. Introduction and historical background Since the start of petroleum exploration and production on the Norwegian Continental Shelf (NCS), medical health care has been provided on offshore installations. Offshore operations are associated with high risk, and, despite safety precautions, injuries do occur (Evensen and Brattebø 2006). With more than five thousand employees working offshore at any given time, illnesses of different degrees of seriousness are also inevitable. Pursuant to national regulations, all permanent installations on the NCS are required to have a nurse available for reactive and proactive health care of offshore personnel. To limit the resources required to operate a proper health service, it has not been required to have a doctor on board each installation. However, an onshore on-duty doctor is required to be available at all times to assist the nurses when necessary. In addition, a doctor has the chief medical responsibility.