Pathway redesign - The Acute Hospital

AIREDALE NHS FOUNDATION TRUST 28th June 2011

No longer fit for purpose…..

AIREDALE NHS FOUNDATION TRUST

28 th June 2011

How to change? - challenge everything

• Notes: Shared electronic patient records – John Parry TPP SystmOne

• Opinion: e-consultation – John Stoves / John Connolley• Who is in charge?: Care Planning – Shahid Ali / R Pope

Exemplars Diabetes

Renal MedicinePalliative Care

Today’s focus: Telemedicine….

Prison Healthcare - the start line

Patient Care• UK Prison population - guaranteed the same access to healthcare as

the general population• Prison population 82,000 - challenging health requirements

Security and Costs• Inmates escape from hospitals, not from prisons• Escort and bed watch costs >£25M/year

(This does not includes consultation, hospitalisation and treatment)• Public prisons - healthcare costs with PCTs

Could telemedicine help?

Prisons supported (5yr programme):

• Wide geographical area • 20 prisons, including: Acklington

(Northumberland) down to The Verne, YOI Portland (Dorset)

• 21 outpatient specialties offering elective services via telemedicine link, e.g. orthopaedics, dermatology, neurology, dietetics and physiotherapy

• A&E urgent care service available• Effective

Where it is safe and effective to do so Patients are treated in the Prison, not Hospital

Cost savings: Reduce acute and elective transfers out by ~50% Average cost per escort episode: £425Average cost per bed watch episode: £3,731Savings at least £400/transfer avoided

Revised Pathway

Other Benefits:Patient and Staff satisfactionEmpowering Prison clinical staffLess disruption to NHS Acute TrustsImproved patient privacy and dignityImproved response timesReduced prison lockdowns

ImplementationImplementationChallenges faced:

Technology• Existing technology – highly reliable• Installing / maintaining in prisons…

CultureRED TAPE……

• Clinical acceptance – initially sceptical but now well supported

• Clinical capacity - job plans• Critical mass crucial to success

Governance• Strong clinical governance• Contemporaneous record• Consultant delivered service

Implementation• Clear processes agreed • Go live planned carefully• Funding arrangements• Security arrangements

Care close to Home

Care in the Home

Question 1: Overall level of satisfaction with completed Telemedicine Consultations

95% patients and 90% of clinicians described themselves as being “very satisfied” or “satisfied”.

Question 2: Level of satisfaction – ability to communicate issues and concerns during the Telemedicine consultation

90% of users described themselves as “satisfied” or “very satisfied”.

Several patients have mentioned the positive benefit of including family members in the consultation:-

“It was good how we can all have input; Dr. Pope, Jackie [DSN], myself and my wife all round the TV”

Patient quote

“…There is no expensive journey to and from hospital. No re-organising of work commitments to then spend time sitting around in waiting rooms… simply a live link up where I can talk freely and we can swap ideas as to how to improve my life…”

When to use?

Numerous potential use cases:

• Long Term Conditions

• Outpatients

• Nursing Homes

• Employee Health & Well being

• Early supported discharge admission avoidance

• Dementia – carer support

• Social Care

• Purely Social calling

• Specialist Networks

NHS Yorkshire and the Humber

Hospital:Hospital telemedicine“Distributed Specialist Networks”

• Telestroke tender won • Infrastructure located at Airedale

Mobile telemedicine carts in every Yorks+Humber EDVC-enabled laptops with on call consultant

• Intention that this would act as a common platform

…….??

Conclusion

• Very strong future for digital healthcare (telemedicine) • Transforming the Acute Hospital’s role and reach• Hub approach key to get to scale• Much to learn, but• No more pilots – time to commit

richard.pope@anhst.nhs.uk