1 Stroke Telemedicine Services: A Guide to the Commissioning and Provision Author: Professor Tony Rudd, National Clinical Director for Stroke Date: December 2014
2 First produced in August 2010 by Dr Damian Jenkinson Clinical Lead for Stroke Improvement Programme. Revised July 2014 by Tony Rudd and the Strategic Stroke Clinical Leads Group This document represents a summary of accumulated knowledge, experience and documentation relating to Governance Issues for Telemedicine in Acute Stroke from stroke care networks and sites in England. Summary of the Minimum Standards for an Acute Stroke Service using Telemedicine Telemedicine can be used to assess acute stroke patients although it must be recognised that there are compromises that have to be made. It is unlikely that the quality of the assessment will be as good, in all cases, as a service where the equivalent level of clinical expertise is at the patient s bedside. Nevertheless it offers the possibility of providing expert stroke opinions to services that do not have sufficient local expertise to provide a 7 day, 24 hour service or in remote areas where it is not feasible to transport a patient to a comprehensive stroke centre. It is essential that acute stroke services are not two tier. Patients being considered for thrombolysis and patients unsuitable for thrombolysis should receive the same level of attention and care and therefore if patients are being managed through a remote consultant this needs to be performed for all patients and not just those that are deemed potentially suitable for thrombolysis Telemedicine is only able to replace the expert opinion on diagnosis and immediate management. It cannot replace the need for high quality stroke unit facilities, well trained stroke nurses on site and access to on-going specialist medical opinion that will be needed repeatedly during the course of an average stroke admission. All the standards defined in the National Clinical Guidelines for Stroke 4 th edition (2012) need to be met regardless of the way that the hyperacute assessment is made. A telemedicine consultation does not remove the need to provide specialist bedside assessment of the patient on a daily basis. It is unacceptable to provide an acute assessment using telemedicine on a Friday evening and then not provide a specialist bedside opinion until the Monday. There have been no studies evaluating the effectiveness or feasibility of conducting telemedicine ward rounds There must always be the option of a bedside assessment of a patient where telemedicine is insufficient to address the patient s needs. This document sets out the governance issues that need to be addressed for any stroke service that is establishing a telemedicine service.
3 1 Introduction 1.1 Purpose of document The purpose of this document is to help teams develop a governance framework to support the implementation and delivery of a telemedicine system in acute stroke, primarily to enable assessment of people presenting with acute stroke by a remote specialist in stroke care, to determine eligibility for thrombolysis with alteplase (recombinant tissue plasminogen activator; rtpa). Telemedicine in acute stroke may be used to provide effective 24 hour stroke specialist advice either at single sites, or across networked sites working in collaboration, within or across trusts. Many of the governance principles apply to both settings but there are special considerations for clinicians giving and receiving opinions between trusts. These distinctions are emphasised in this document. Guidance provided in this document represents accumulated current practice across a number of networks and clinical sites across England. The guidance must be considered as recommendation only and any governance framework established within a trust, or between trusts, for the use of telemedicine in acute stroke, must be fully endorsed by local risk management and governance committees. Attached to this document is a set of minimum standards for an acute stroke service that uses telemedicine to assess patients acutely either for the evaluation of patients suitability for thrombolysis or as part of a more general acute assessment service. 1.2 Strategic context Telemedicine is a real-time audiovisual conferencing system that allows specialists in stroke care to remotely assess patients and to view their brain imaging. This enables the remote stroke clinician to advise the local team on the patient s suitability for thrombolysis and other management. The implementation of a telemedicine system in acute stroke is supportive of a range of standards and quality markers contained in recent policy and guideline publications. The National Stroke Strategy (2007) contains quality markers which require patients with a suspected stroke to be transferred to, and assessed at, a hyper acute stroke service, available 24 hours a day. NICE Clinical Guideline 68; Acute Stroke and Transient Ischaemic Attack (2008) recommends thrombolysis and some other acute interventions (e.g. hemicraniectomy for malignant MCA syndrome) as a clinically and cost effective treatment for acute stroke. RCP National Clinical Guidelines for Stroke (2012) which supports the use of telemedicine but says that the evidence base supporting its effectiveness and safety is limited and that at present it is not possible to say definitively that it is as good as a specialist bedside assessment. Direct delivery of acute stroke care by specialists cannot always be achieved in every hospital because of geographical issues or staffing shortages. Telemedicine, allowing a stroke physician to talk to the patient and/ or carer, watch a clinical examination and view the imaging can be used
4 safely for evaluation of the appropriateness of thrombolysis and other acute treatments, as an alternative to face to face in a specialist stroke centre. Various forms of telemedicine (using telephone consultation, video camera linkage with or without remote access to the radiology) have therefore been tested in a number of settings over recent years. The literature consists of one underpowered randomised controlled trial: STRokEDOC (Meyer et al. 2008) of telemedicine for thrombolysis decision-making and many observational studies. The STRokEDOC trial compared telephone consultation to video link and found that correct treatment decisions were made significantly more often in the video link arm than the telephone consultation arm. However, there was no statistically significant difference in functional outcomes at 90 days (Meyer et al. 2008). From the evidence available it is not yet possible to firmly conclude that any form of telemedicine for acute decision making is as good as a standard bedside assessment or whether telephone consultation is better or worse than video link telemedicine services; however the consensus of the Intercollegiate Stroke Working Party developing the 4 th edition of the National Clinical Guidelines was that video-linked telemedicine is preferable to telephone only consultations. All telemedicine services should have immediate access to Information Technology (IT) support to ensure that the service is available whenever needed. 2 Definitions 2.1 Telemedicine Telemedicine systems consist of a digital network including a two-way video and audio conference facility, plus brain scan image transfer using a high speed data transmission. In acute stroke, the video camera captures real-time clinical signs from the patient, enabling a consultant to receive images remotely and hence undertake a remote presence consultation. In addition, brain scan image transfer, typically via Picture Archive and Communication System (PACS) and broadband technology, enables the remote consultant to assess images. Local medical teams and clinicians with the patient employ specialised mobile telecarts, typically provided in A&E or acute stroke units. 2.2 Remote telemedicine consultant For the purpose of this document considering telemedicine in acute stroke, a remote telemedicine consultant is defined as a consultant with experience of acute stroke, who has demonstrable training, skills and experience in the procedures used to diagnose, treat and oversee patients who will benefit from thrombolysis as well as giving more general advice on the diagnosis and management of patients not suitable for thrombolysis. The competences necessary to support this have been described by national consensus the Interprofessional Thrombolysis Framework. Clinicians with appropriate competences may include, but is not limited to, stroke physicians, emergency medicine physicians, neurologists and specialist practitioners. 3 Clinical Quality Requirements 3.1 Service requirements
5 The specification and scope of any telemedicine system for use in acute stroke firstly needs to be defined and agreed. Consideration needs to be given to: If the service will be solely delivered by consultant physicians, or if other appropriately-trained and experienced grades will use the system to provide a remote opinion. Operational hours, and if the service is to be used both in-hours and out-of-hours. If the service is to be used solely for patients presenting at the same trust as that employing, or holding an honorary contract with, the consultant providing the remote opinion. If the service will enable remote opinions to be sought and given between different trusts. If the service is going to be used solely for the assessment of patients with acute stroke to determine their eligibility for thrombolysis, or if it will be used for other related purposes (e.g. TIA/post acute stroke care). Where different trusts are collaborating to provide a network of telemedicine to support acute stroke care across a range of clinical sites, it is recommended that a lead trust should be designated to take responsibility for all governance issues: including clinical, information, and technological. The outline of the service to be provided should be determined, referenced as much as possible to existing national guidelines and standards, such as the National Stroke Strategy, the NICE Clinical Guidelines and the RCP Clinical Guidelines (see section on standards below). The service requirements should be defined. As an example: The service must provide the following: Coordination of a rota of identified on-call remote telemedicine consultants available at all specified operational hours. Technical capability to carry out audiovisual teleconferencing and remote access to CT brain scan images during operational hours. Access to specialist advice following the initial consultation, within operational hours, for the management of complications or other queries relating to treated patients. A framework to monitor the quality of both the clinical and technical services, to include patient experiences and opinions, and to generate regular performance reports. An administrator facility to coordinate the rota, produce activity, performance and patient experience reports, and coordinate regular multidisciplinary outcome meetings and teaching updates. A mechanism, with clear and documented lines of accountability and timing, for the handover of information regarding patients treated via telemedicine from the remote stroke specialist to local stroke consultant and team. 3.2 Patient pathways
6 Patient pathways will vary between sites but for the successful use of telemedicine at both single sites, and especially between networked sites, it is essential to ensure that all relevant national, local and network standards (see below) are embedded within services and adhered to. All contributors to the clinical pathway need to fully understand what should happen, where and when. The most effective way to accomplish this, and ensure genuine engagement of all relevant stakeholders along the care pathway relevant to the use of telemedicine, is to undertake thorough process mapping and action planning exercises involving all of the specialties, departments and organisations contributing to the care pathway. 3.3 Quality Standards Thrombolysis in acute ischaemic stroke must be delivered without delay, and telemedicine must safely and effectively support a time-constrained service. Recent trial data demonstrate efficacy of alteplase for up to 4.5 hours after stroke onset. Telemedicine services should adhere to national quality standards. The National Stroke Strategy Quality Marker 7 states that all patients with suspected acute stroke are immediately transferred by ambulance to a receiving hospital providing hyper-acute stroke services (where a stroke triage system, expert clinical assessment, timely imaging and the ability to deliver intravenous thrombolysis are available throughout the 24-hour period). The National Stroke Strategy Quality Marker 8 states that patients with suspected stroke receive an immediate structured clinical assessment from the right people. Patients requiring brain imaging are scanned in the next available scan slot within usual working hours, and within 60 minutes of request out of-hours with skilled radiological and clinical interpretation being available 24 hours a day. The National Stroke Strategy Quality Marker 9 states that Hyper-acute stroke services provide as a minimum, 24 h access to brain imaging, expert interpretation and the opinion of a consultant stroke specialist and thrombolysis is given to those that would benefit. The telemedicine service must adhere to, or exceed accepted guidelines for best practice, and have been developed in line with the following: NICE Clinical Guideline 68 Stroke (2008) state: Access (within a specified maximum time frame) to a remote specialist in acute stroke care who is trained and experienced in the management of acute stroke via a telemedicine service. An assessment of the patient by the remote stroke consultant specialist using agreed documentation, protocols and policies. Real-time audiovisual conferencing, plus remote access to CT brain images, to enable the stroke specialist, working with other clinical practitioners local to the patient, to determine eligibility for thrombolysis. Local staff who are trained and experienced in both acute stroke care, and in the use of telemedicine. Assurance that the telemedicine facility, and its usage in the delivery of thrombolysis for eligible patients, is fully integrated within a comprehensive, effective and safe stroke service.
7 RCP National Clinical Guidelines for Stroke (2012) is broadly similar but says A telemedicine service in an acute stroke unit should consist of: a video link which enables the stroke physician to observe a clinical examination and/or-telephone which enables the stroke physician to discuss the case with a trained assessing clinician and talk to the patient and carer directly. All telemedicine services should have a link which enables the stroke physician to review radiological investigations remotely. An acute stroke unit using a telemedicine service should still include specialist stroke nurses at the admitting hospital. Staff providing care through telemedicine (at both ends of the system) should be specifically trained in: - the use of the technology - assessment of acute stroke patients, delivery of thrombolysis and other acute interventions in the context of the remote system being used. The quality of decisions made through telemedicine should be regularly audited Administration standards Records made by the remote stroke specialist during the telemedicine consultation must be entered into the patient s health care records within a specified interval (e.g. less than 15 hours after consultation). One practical method to accomplish this is through an electronic workbook and checklist shared between the remote consultant and the clinicians at the local site. This can then be ed to the hospital site and bound in the patient notes Monitoring process and outcomes The treatment of people with thrombolysis should be evaluated and audited by entering data on the Sentinel Stroke National Audit Programme (SSNAP). A framework for the recording of the performance of the telemedicine technology should be made, to include a record of any episodes of technical failure of audiovisual connection or loss of digital brain image data. The outcome of cases should be reported back to appropriate divisional and/or trust clinical governance committees on a regular basis. Any major complications or serious adverse incidents should be reported to the divisional director and trust clinical governance committee. Clinical teams should meet at regular intervals to review all cases treated through the telemedicine system, including those who are ultimately deemed to be ineligible for thrombolysis. 4 Clinical Governance Issues 4.1 Patient consultation via telemedicine The telemedicine consultation should take place under the same GMC guidance as if the remote telemedicine consultant was face-to face with the patient. The patient s privacy and dignity needs to be ensured. Confidentiality of the consultation must be maintained. The consultation should be inline with GMC guidance in Good Medical Practice: Duties of a Doctor (2006).
8 4.2 Patient confidentiality As with conventional consultations and examinations, how and where a teleconference takes place will be an important consideration for clinical teams to ensure confidentiality of the consultation and examination. Local guidance should be developed and issued that sets out the appropriate use of telemedicine. This will include measures to ensure confidentiality of consultation. Although most telemedicine videoconferencing facilities do not record the images and sound, consideration should be given to ensuring that the patient has access to any records kept about themselves generated as a result of the teleconsultation. If recordings of the teleconference, data, or images are made and transferred as part of the teleconsultation and subsequently stored, they should remain protected and secure. 4.3 Patient consent Informed consent for the use of telemedicine in acute stroke should be sought and documented by the attending practitioner in each case. In particular, the patient and family/carers should be made clearly aware that a remote telemedicine consultant will be consulted. If the remote telemedicine consultant is not employed by the trust where the patient is located, this should also be made clear. Signed consent from the patient for the use of telemedicine is not required where the videoconsultation is not recorded. Ideally, summary written information, in addition to verbal explanation, should be made available to patients and/or their families/carers, (see Appendix 1) who should then be asked for consent. An assessment checklist should require the practitioner to document if verbal consent has been obtained. Many patients with acute stroke have a communication impairment, or cognitive or attention deficits, which render fully informed consent difficult to obtain. In such a situation, capacity should be assumed, and individuals should be given the opportunity to make those decisions that they have the competence to. Family and carer involvement is important where an individual cannot provide consent. In the absence of capacity to provide consent, the local physician may make the decision to employ telemedicine in the best interests of the patient, but should ensure full documentation of this. If the video-consultation is recorded for the purposes of audit, training and research, then patients should be asked for their written consent for the digital information to be retained as soon as practicable following the stroke. The GMC guidance for making and using video and audio recording for patients is contained in Guidance for Doctors (2002). 4.4 Responsibilities of relevant staff groups It is essential to have considered and clarified the roles and responsibilities, and required training, of all relevant staff along the acute stroke care pathway in relation to telemedicine. The precise pathway, and hence the groups of staff involved, will vary from site to site. The following is provided as an illustration of the relevant stages at one site (see also Appendix 2):
9 4.5 Roles and responsibilities of consultants giving remote opinion via telemedicine on patients within their own trust The role of the remote telemedicine consultant is to advise the local team in their trust on the best management of the patient, when their advice is sought. The remote telemedicine consultant is accountable for the advice that is given. Responsibility for the care of the patient remains that of the on-call medical team, or other designated specialist team (e.g. acute stroke unit staff), at the same hospital trust. A remote telemedicine consultant who is giving an opinion for a patient within their trust should be able to provide evidence to demonstrate that they: Are trained in stroke thrombolysis, and receive training updates. Are regularly involved in the provision of both day-time and out-of hours thrombolysis for acute stroke (consideration will be needed to locally determine minimal levels of activity to maintain skills). Are trained in the use of the telemedicine equipment. Are able to perform an NIHSS stroke assessment. Attend regular multidisciplinary thrombolysis outcome review meetings. Attended a stroke thrombolysis masterclass (or approved equivalent). Attended training in interpretation of CT head scans. A remote telemedicine consultant should possess the skills to undertake the following tasks: Reviewing clinical information provided on the patient. Reviewing time of onset/time last seen well. Assessing and conversing with patient via video-link. Reviewing physiological parameters. Reviewing inclusion and exclusion criteria. Reviewing medication. Reviewing brain imaging. Explaining to patient and/or family the risks and benefits of thrombolysis if appropriate. Advising the local team as to whether thrombolysis is appropriate or not. Providing guidance on any other issue relevant to care of the person with acute stroke.
10 Additional work undertaken by consultants in providing a remote opinion via telemedicine should be reflected in their job plan. This will need to be negotiated within the trust. Additional remuneration for out of hours on-call work should be calculated on the basis of frequency, intensity and actual work (see BMA and GMC guidance). 4.6 Roles and responsibilities of consultants giving remote opinion via telemedicine on patients between trusts The role of the remote telemedicine consultant is to advise the local team in another trust on the best management of the patient, when their advice is sought. The remote telemedicine consultant is accountable for the advice that is given. The remote telemedicine consultant will hold a full or honorary contract with one of the trusts participating in the telemedicine network, but is not required to hold an honorary contract with each of the participating trusts. Responsibility for the care of the patient remains that of the on-call medical team, or other designated specialist team (e.g. acute stroke unit staff), at the hospital trust where the patient is receiving treatment. 4.7 Roles and responsibilities of clinicians seeking remote opinion The clinician (doctor/nurse/physician assistant/therapist) seeking advice from the remote telemedicine consultant has the responsibility of having demonstrable appropriate training and skills, and a requirement to adhere to guidelines and protocols. As an example, they should: Have completed and be certified in NIHSS scoring. Have completed an approved thrombolysis training course. Follow the procedure for contacting the remote stroke specialist. Ensure that the appropriate diagnostic scan is acquired speedily, usually within 30 minutes of the patient s arrival. Assess the patient as per protocol. Provide the remote telemedicine consultant with a detailed assessment of the patient in order to enable both clinicians to complete the approved checklist. Enable a clearly auditable process for making the decision to thrombolyse or not. Ensure that the thrombolysed patient is transferred to a bed within the hospital with the capacity to provide appropriate care for a patient with acute stroke. Ensure a thorough handover of the details of patient treatment and condition takes place. 4.8 Responsibilities of organisations providing care for people with acute stroke Each organisation, whether a single site or part of a network of trusts, must have organised hyperacute stroke care on a unit designated for hyper-acute stroke.
11 Each unit must meet the seven acute criteria for units with beds providing care in the first 72 hours: Continuous physiological monitoring (ECG, oximetry, blood pressure) for 24 hours. Immediate access to scanning for urgent stroke patients. Direct admission from A&E/front door. Specialist ward rounds on seven days a week. Acute stroke protocols/guidelines. Nurses trained in swallow screening. Nurses trained in stroke assessment and management. The unit must be staffed to provide specialist 1:2 nursing for the first 72 hours and subsequently for recommended stroke unit intensity. Staff must be trained in the provision of thrombolysis for acute ischaemic stroke. Staff must be trained in the management of complications of thrombolysis. Protocols for stroke thrombolysis and the management of complications must be in place. The unit must be able to provide care to the standards set out in the Royal College of Physicians Intercollegiate Clinical Guidelines for Stroke 4th edition 2012, the NICE guidelines for Acute Stroke and TIA Workforce issues Trusts will be required to provide sufficient qualified and appropriately trained staff to support the use of telemedicine in acute stroke. The competences necessary to support this have been described by national consensus the Interprofessional Thrombolysis Framework Core skills and competences of remote telemedicine consultant For the purpose of this document considering telemedicine in acute stroke, a remote telemedicine consultant is defined as a consultant with experience of acute stroke, who has demonstrable training, skills and experience in the procedures used to diagnose, treat and oversee patients who will benefit from thrombolysis. The competences necessary to support this have been described by national consensus the Interprofessional Thrombolysis Framework. Clinicians with appropriate competences may include, but is not limited to, stroke physicians, emergency medicine physicians, neurologists and specialist practitioners. Those clinicians who do not practice stroke medicine as their major specialty, should deliver their expertise in the context of an integrated comprehensive stroke service. The following core skills and competences are required for such remote telemedicine consultants working in acute stroke: Advanced clinical assessment skills in relation to acute stroke management.
12 In-depth knowledge and understanding of risks and benefits of thrombolysis therapy in acute ischaemic stroke, including having attended a recognised training course (e.g. thrombolysis masterclass or equivalent) and regular (e.g. annual) update courses. A responsibility to deliver care based on current evidence, best practice and, where possible, validated research. A responsibility to work to standards, guidelines and protocols agreed within a trust, between trusts or across a network of trusts Competency assessment An appropriate competency assessment process for all relevant staff who will use the telemedicine system and equipment should be in place. For individual sites, the responsibility for this lies with the provider organisation. For networked sites working in collaboration, the requirement will lie with the network or designated lead provider organisation Contingencies for technical failure Technical failure is the key risk in the usage of telemedicine and remote consultation in the emergency care of people with acute stroke. Contingency plans must be in place both at single sites, and particularly across multiple networked sites, to mitigate risks ensuing from technical failure. Importantly, the remote telemedicine consultant should be provided with a mobile computer with adequate mobile broadband capability, thus enabling rota consultants to provide advice from suitable locations. Whilst achieving the appropriate broadband speed is not problematic in hospital, speeds in a number of home and other settings for both fixed line and mobile broadband can be variable resulting in difficulties in viewing images. Remote access to PACS images is dependent on a minimum requirement for transfer speeds of 1 Mb/s. Should the remote telemedicine consultant be unable to receive and/or transmit audiovisual information during a consultation, then documented contingency procedures should exist. These need to be agreed at a local or network level but may include: The remote telemedicine consultant coming to the site and directly attending the patient. Consultation by telephone only, if both an attendant physician has experience in thrombolysis in acute stroke and an opinion on the scan from a local radiology consultant can be obtained. The technical failure should be clearly recorded in both the patient notes and any remote consultation checklist. 5 Information Governance Issues 5.1 Information management and technology Where trusts are collaborating to provide a network of telemedicine to support acute stroke care, it is recommended that a lead trust should be designated to take responsibility for information governance. Individual trusts, or the designated lead provider trust across a network of trusts, have the responsibility to:
13 Lead on asset management and allocations, contract maintenance and system monitoring. Coordinate access to PACS for consultants on the telemedicine rota. Refresh equipment at appropriate intervals. Develop operational and technical handbooks. Provide IT help and service desk requirements. Manage storage of, and appropriate authorised access to, digital information. 5.2 Liability Individual trusts, or a designated lead provider trust across a network of trusts, have the responsibility to ensure that remote stroke specialists, and associated staff using telemedicine in acute stroke, are provided with: Employer s liability Public liability Professional indemnity
The Stroke Strategy confirmed that the Department would commission a short analysis of research evidence in relation to the strategy and the top ten research areas identified in it. We said that we would
S9 Administer thrombolytic treatment in acute ischaemic Screening and initiating treatment, overseeing competency of treatment About this workforce competence This competence is about the emergency administration
SSNAP s Acute Organisational Audit Report 2012: Performance Summary for South London The Sentinel Stroke National Audit Programme (SSNAP) s Acute Organisational Audit looks at how stroke services across
Feedback Report Ambulance Trust Feedback Report Progress in improving stroke care Progress in improving stroke care Ambulance Trust Feedback Report Introduction In February 2010 we published a report on
About public outpatient services Frequently asked questions What are outpatient services? Victoria s public hospitals provide services to patients needing specialist medical, paediatric, obstetric or surgical
Early Supported Discharge (in the context of Stroke Rehabilitation in the Community) Gold Standard Framework This document was produced with reference to national standards for best practice (e.g. NICE
Process for reporting and learning from serious incidents requiring investigation Date: 9 March 2012 NHS South of England Process for reporting and learning from serious incidents requiring investigation
NATIONAL STROKE NURSING FORUM NURSE STAFFING OF STROKE SERVICES POSITION STATEMENT FOR NATIONAL STROKE STRATEGY Preamble The National Stroke Nursing Forum is pleased to be able to contribute to the development
Performance Monitoring for Commissioners: Out-of-hours Service Introduction The detailed specification for the Cumbria and Lancashire out of hours project was to provide a consultant led out of hours Telemedicine
GP workshop Maria Fitzpatrick Nurse Consultant Kings College Stroke Centre Stroke: the Facts Stroke: the Facts Every 5 minutes someone in the UK has a stroke 1 in 4 men and 1 in 5 women will have a stroke
The diagnosis of dementia for people living in care homes Frequently Asked Questions by GPs A discussion document jointly prepared by Maggie Keeble, GP with special interest in palliative care and older
National Sentinel Stroke Audit Phase I (organisational audit) 2006 Phase II (clinical audit) 2006 Report for England, Wales and Northern Ireland Prepared on behalf of the Intercollegiate Stroke Working
Commissioning Policy (EMSCGP005V2) Defining the boundaries between NHS and Private Healthcare Although Primary Care Trusts (PCTs) and East Midlands Specialised Commissioning Group (EMSCG) were abolished
Acute care toolkit 2 High-quality acute care October 2011 Consultant physicians are at the forefront of delivering care to patients presenting to hospital with medical emergencies. Delivering this care
National Clinical Programmes Section 3 Background information on the National Clinical Programmes Mission, Vision and Objectives July 2011 V0. 6_ 4 th July, 2011 1 National Clinical Programmes: Mission
Effective Approaches in Urgent and Emergency Care Paper 1 Priorities within Acute Hospitals When people are taken to hospital as an emergency, they want prompt, safe and effective treatment that alleviates
Bringing Big Data to Quality Improvement in the Sentinel Stroke National Audit Programme (SSNAP) Mark Kavanagh SSNAP Project Manager www.strokeaudit.org 16 June 2015 What is a stroke? A stroke is a serious,
Providence Telemedicine Network Around the clock, around the region, our specialists are with you when every minute counts. Telemedicine brings our specialists to your hospital It is exciting to report
Improving Emergency Care in England REPORT BY THE COMPTROLLER AND AUDITOR GENERAL HC 1075 Session 2003-2004: 13 October 2004 LONDON: The Stationery Office 11.25 Ordered by the House of Commons to be printed
WITHDRAWAL OF LIFE SUPPORT BACKGROUND The complainant s wife was admitted to a public hospital for an operation to secure access for peritoneal renal dialysis. At the time of the patient s admission she
National Early Warning Score National Clinical Guideline No. 1 Summary February 2013 National Clinical Effectiveness Committee (NCEC) The National Clinical Effectiveness Committee (NCEC) was established
Consent for Systemic Anti Cancer Therapy (SACT) Guidance issued by the National Chemotherapy Board May 2016 Supported by: Contents National Chemotherapy Board 1. Introduction 1.1. Purpose of the guidance
ROLES, RESPONSIBILITIES AND DELEGATION OF DUTIES IN CLINICAL TRIALS OF MEDICINAL PRODUCTS STANDARD OPERATING PROCEDURE NO SOP 09 DATE RATIFIED 4/7/13 NEXT REVIEW DATE 4/7/14 POLICY STATEMENT/KEY OBJECTIVES:
What is the Surrey Stroke Services Review? Stroke services in Surrey A stroke is caused when the blood supply to the brain is interrupted, usually because a blood vessel bursts or is blocked by a clot.
Performance Standards Clinical Telemedicine Services Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best
NHS Midlands and East Stroke Services Specification Version Control Version No. Date Authors/ Editors To be reviewed by Status v1.0 01 June 2012 Tim Lawrence, Laura Dendy External Expert Advisory Group
The new Stroke Nurse Practitioner candidate position at Austin Health The new Stroke Nurse Practitioner (NP) candidate position offered by Austin Health provides an exciting opportunity for a senior nurse
National Early Warning Score National Clinical Guideline No. 1 February 2013 The National Early Warning Score and COMPASS Education programme project is a work stream of the National Acute Medicine Programme,
OPERATIONAL GUIDELINES FOR THE ACCESS TO ALLIED PSYCHOLOGICAL SERVICES INITIATIVE (ATAPS) SUICIDE PREVENTION SERVICE JANUARY 2012 Mental Health Services Branch Mental Health and Drug Treatment Division
Future hospital: Caring for medical patients Extract: Recommendations Future hospital: caring for medical patients Achieving the future hospital vision 50 recommendations The recommendations from Future
Guidance on NHS patients who wish to pay for additional private care DH INFORMATION READER BOX Policy HR / Workforce Management Planning / Clinical Document Purpose Gateway Reference Title Author Publication
Skill Levels for Delivering High Quality Asthma and COPD Respiratory Care by Nurses in Primary Care September 2007 Revised December 2009, April 2014 Author: Ruth McArthur In conjunction with the PCRS-UK
Announced Follow-Up Inspection Dignity and Essential Care Cardiff and Vale University Health Board University Hospital of Wales Ward B7 Date of 29 th April 2014 1 HIW Follow-Up Inspection: Ward B7, University
PG Certificate / PG Diploma / MSc in Clinical Pharmacy Programme Information 2010 2011 School of Pharmacy Queen s University Belfast Queen s University Belfast Clinical Pharmacy programme Distance learning
Who? Level III Stroke Center Data Collection Requirements All LERN Level III Stroke Centers. LERN Level I and II Stroke Centers have reporting requirements to The Joint Commission or other Board approved
Emergency Department Planning and Resource Guidelines [Ann Emerg Med. 2014;64:564-572.] The purpose of this policy is to provide an outline of, as well as references concerning, the resources and planning
NHS Grampian Staff Policy For Patients To Receive Aspects Of Their Treatment Through Private Healthcare Providers (Co-Payments) In Respect Of Medicines Co-ordinators: Deputy Director of Pharmacy Consultation
ACCESS TO HEALTH CARE OCTOBER 2005 BriefingPaper Towards faster treatment: reducing attendance and waits at emergency departments Key messages based on a literature review which investigated the organisational
Update on Stroke Reconfiguration Programme Birmingham, Solihull and Black Country Agenda Item no 6 1. Purpose To provide an overview of the Birmingham, Solihull and Black Country Stroke reconfiguration
www.ehealth.acrrm.org.au ACRRM TeleHealth Advisory Committee Standards Framework ATHAC 1 Telehealth Standards Framework Purpose The purpose of the ATHAC Telehealth Standards Framework is to provide health
Contents 1. Scope of These Guidelines... 2 2. What is Telemedicine?... 2 3. Introduction... 3 4. What Are the Benefits of Telemedicine?... 3 5. Frequently Asked Questions Physician Care and Treatment...
Review of compliance Mid Staffordshire NHS Foundation Trust Stafford Hospital Region: Location address: Type of service: Regulated activities provided: Type of review: West Midlands Mid Staffordshire NHS
Training Module: What is Telehealth? Version 2 Updated June 2012 What is Telehealth? The use of video conferencing equipment, software and the internet to provide a real-time audio-visual clinical consultation
June 2013 PATIENT TRANSFERS Principles for the safe transfer and handover of patients from acute medical units By Liz Lees Executive Summary: This document is written for Health Care Assistants (HCA) working
Section 1: The purpose of this document There are three key components to the Healthcare Science workforce in the UK: 1. Healthcare Science Associates and Assistants who perform a diverse range of task
Dear Colleague Arrangements for NHS Patients Receiving Private Healthcare 1. This letter provides revised guidance to NHS Boards covering situations where patients obtain private healthcare in addition
JOB DESCRIPTION: ACCOUNTABLE TO: RESPONSIBLE FOR: Speciality Doctor in Palliative Medicine Medical Director Day to day medical care of patients on the in-patient unit and day hospice. Advice and support
PART 1 Keeping patients safe when they transfer between care providers getting the medicines right Good practice guidance for healthcare professions July 2011 Endorsed by: Foreword Taking a medicine is
Stroke Services: Ensuring the best outcomes for patients and communities in the year ahead Progress and Way Forward Version 3.0, 3 March 2014 Summary The most important message for anyone with a suspected
NHS LANARKSHIRE HEALTH RECORDS POLICY Management and Maintenance, Security, Storage, Distribution and Retention of Health Records Author: Responsible Lead Executive Director: Endorsing Body: Governance
Proposed co-location of stroke services Contents Contents... 2 Executive summary... 3 Introduction... 4 How stroke services are currently provided... 6 The case for change... 8 What is our proposed service
Irish Heart Foundation Stroke Manifesto One in five people in Ireland will have a stroke at some time in their life. Until recently, many believed stroke was a disease for which little or nothing could
Executive Summary University of Virginia Health System Center for Telehealth Industry: Academic Medical Center Location: Charlottesville, Virginia CHALLENGE Need to increase and support practitioners in
Summary of the role and operation of NHS Research Management Offices in England The purpose of this document is to clearly explain, at the operational level, the activities undertaken by NHS R&D Offices
ST LUKE S HOSPICE JOB DESCRIPTION: DAY HOSPICE LEAD/ CLINICAL NURSE PRACTITIONER DATE: MARCH 2015 WRITER: DEB HICKEY HEAD OF CARE SERVICES SUZANNE SALES CLINICAL NURSING SERVICES MANAGER TOTAL NUMBER 11
A fresh start for the regulation of independent healthcare Working together to change how we regulate independent healthcare The Care Quality Commission is the independent regulator of health and adult
Implementation of the t Protection of Life During Pregnancy Act 2013 Guidance Document for Health Professionals 2014 Table of Contents 1. Introduction... 4 1.1 Background to the Act... 4 1.2 The Protection
CROSS HEALTH CARE BOUNDARIES MATERNITY CLINICAL GUIDELINE Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Obstetric Early Warning Score Guideline Implementation
Guideline Health Service Directive Guideline QH-HSDGDL-025-3:2014 Effective Date: 17 January 2014 Review Date: 17 January 2016 Supersedes: qh-hsdptl-025-3:2012 Patient Access and Flow Health Service Directive
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE DRAFT GUIDELINE Transition between inpatient hospital settings and community or care home settings for adults with social care needs 1 1 Draft for consultation,
Hearing Aid Council and Health Professions Council consultation on standards of proficiency and the threshold level of qualification for entry to the Hearing Aid Audiologists/Dispensers part of the Register.
Information Governance A Clinician s Guide to Record Standards Part 1: Why standardise the structure and content of medical records? Contents Page 3 A guide for clinicians Pages 4 and 5 Why have standards
Guide to the National Safety and Quality Health Service Standards for health service organisation boards April 2015 ISBN Print: 978-1-925224-10-8 Electronic: 978-1-925224-11-5 Suggested citation: Australian
School of Public Health and Preventive Medicine Use of guideline recommendations Anna Barker email@example.com Overview Knowledge translation Objectives Methods The problem of falls Knowledge to action
Community health care services Alternatives to acute admission & Facilitated discharge options Directory Introduction The purpose of this directory is to provide primary and secondary health and social
Insulin Pump Therapy for Type 1 Diabetes Aim(s) and objective(s) This guideline has been developed to describe which patients with Type 1 Diabetes should be referred for assessment for insulin pump therapy
. PATIENT ACCESS POLICY TITLE Patient Access Policy APPLICABLE TO All administrative / clerical / managerial staff involved in the administration of patient pathway. All medical and clinic staff seeing
Review of Stroke Services in Tameside Personal and Health Services Scrutiny Panel July 2012 Contents Paragraph Page No. Introduction by the Chair Summary 1 2 2 4 Membership of the Scrutiny Panel 3 4 Terms
Brain & CNS cancers 2015 Annex B Epidemiology 1. The incidence of brain & CNS tumours in England was reported to be just under 4,000 in 2007. 1 This is expected to increase further with an aging population
Medical Information Systems Introduction The introduction of information systems in hospitals and other medical facilities is not only driven by the wish to improve management of patient-related data for
department of health and mental hygiene maryland medicaid 2014 telemedicine provider manual September 2014 table of contents Introduction and Service Model Description...1 Provider Eligibility...2 Provider
Acutely ill patients in hospital Recognition of and response to acute illness in adults in hospital Issued: July 2007 NICE clinical guideline 50 guidance.nice.org.uk/cg50 NICE 2007 Contents Introduction...
Delivering Local Health Care Accelerating the pace of change Delivering Local Integrated Care Accelerating the Pace of Change WG 17711 Digital ISBN 978 1 0496 0 Crown copyright 2013 2 Contents Joint foreword
A break-even analysis of delivering a memory clinic by videoconferencing Tracy A Comans(1,2), Melinda Martin-Khan(3,4), Leonard C Gray(3,4) and Paul A Scuffham(1,2) 1 Centre for Applied Health Economics,
Quality Assurance of Medical Appraisers Recruitment, training, support and review of medical appraisers in England www.revalidationsupport.nhs.uk Contents 1. Introduction 3 2. Purpose and overview 4 3.
MISSISSIPPI LEGISLATURE REGULAR SESSION 2016 By: Representative Mims To: Public Health and Human Services HOUSE BILL NO. 1187 1 AN ACT TO AMEND SECTION 73-25-34, MISSISSIPPI CODE OF 1972, 2 TO REVISE THE
Appendix 1 Business Case to Support the Relocation of Mental Health Inpatient Services in Manchester (Clinical Foreword and Executive Summary) Together we are better Foreword by the Director of Nursing
Time to Act Urgent Care and A&E: the patient perspective May 2015 Executive Summary The NHS aims to put patients at the centre of everything that it does. Indeed, the NHS Constitution provides rights to