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Pathway redesign - The Acute Hospital AIREDALE NHS FOUNDATION TRUST 28 th 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 - PowerPoint PPT Presentation
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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