Australia introduced widespread telehealth reimbursement into general practice in a series of policy innovations in 2020, in response to the COVID-19 pandemic. This innovation presented an opportunity to study in real time the challenges and strategies used by clinicians and patients to achieve good consultation outcomes as they develop skills and familiarity with telehealth. A particular concern, frequently raised around telehealth, is how safe clinical decision-making and care provision can be ensured in the remote consultation setting.
This interactive roundtable focuses on challenges negotiating availability, accessibility and safety to deliver quality primary care within episodes of patient care. The roundtable aims to sense-check findings from the Australian National University Telehealth in Primary Care study, which includes quantitative analysis of linked administrative data, think aloud interviews with clinicians and deliberative workshops with consumers.
After presentation of findings, participants will engage in a set of facilitated, interactive gamified consultations using simulated patient scenarios that pose quality and safety challenges in the context of remote consultations. Participants will variously take the role of the clinician and the patient, to explore negotiating strategies to support safety, such as safety-netting, distant monitoring and mode-switching, in a range of clinical situations and for clinical conditions. The discussions around these strategies will be used to further clarify and seek consensus on ways to optimise safety-making in telehealth consultations.

1. Telehealth poses particular challenges for safety for both clinicians and patients
2. Both clinicians and patients use a range of safety-making strategies to counter these risks
3. Managing the safety risks of telehealth requires strategies used within the consultation, and strategies used across episodes of care in a series of linked consultations .

Background
Rural regions are particularly challenged by distance and access to care, given the scattered distribution of services. Yet, older and sicker patients experience repeat hospitalisations, which may be prevented by early detection and care. Ararat Health@Home incorporated a telehealth outreach service staffed by local residents into its community program to expand skilled clinicians' outreach. A successful trial of the telehealth program had been conducted in Monash Health previously.

Aims
To describe the telehealth phone calls to high-risk rural patients identified through the Victorian Hospital Readmission Prevention Program screening tool from March 2016 to July 2022 in an Healthy@Home deployment in Ararat, East Grampians Health Service, Victoria.

Methods
Case study of weekly or more frequent outreach telephone calls by 3 part-time local telehealth assistants to 160 patients. Nurse managers supervised the non-clinician telehealth assistants. The telehealth - Patient Journey Record System (PaJR) guided outreach phone calls with a clinical algorithm predicting deterioration.

Findings
8,135 calls out of 10,579 calls recorded no problems; while the remaining 23% of calls flagged that 2% were very high risk of admission and 20% were a moderate-high risk, indicating an 80:20 power-law distribution. COVID exposure was associated with the expansion of total calls and calls reporting health problems from March 2020 to July 2021.

Discussion and Conclusion
The telehealth assistants monitored high-risk patients with low-cost telehealth calls, reducing the need for expensive community nursing welfare checks. Patients reporting health deterioration were rapidly transferred to professional care, while the stable caseload was continually monitored. COVID stimulated a rapid Increase in patient load and calls, which was easily accommodated.

Evaluating the impact of the PaJR calls used ongoing learning, feedback and adaption. This is shaping its further rollout in Beaufort Skipton Health Service, Maryborough District Health Service, East Wimmera Health Service and Grampians Health.

1. Telehealth assistants supported by a well-validated telecare program can substitute for time-consuming welfare checks by highly trained and more expensive nurses in 80% of weekly phone call follow-ups/
2. New models of telehealthcare can enable a new local community workforce to extend care
3. in the revamping of medicare, the scope of practice for a new cohort of workers should be considered