Rachel Binks Nurse Consultant Digital & Acute Care Airedale NHS Foundation Trust
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1 Rachel Binks Nurse Consultant Digital & Acute Care Airedale NHS Foundation Trust
2
3 Telehealth, e health, digital health.. Telecare Telemonitoring Teleconsultation
4 Tele care
5 Tele monitoring
6 Tele coaching tele medicine tele coaching
7 Tele medicine tele medicine
8 a system designed by default some people seem to do quite well without waiting for healthcare support
9
10 History Current Approach Activity and Outcomes Future plans
11 History Since 2005 video consultation in prison healthcare Used for: Out Patient referrals and ED referrals
12 What came after Prisons.? Since 2011-Patient consultation in own home
13 Care homes 2012 onwards - Nursing and Residential Care Homes
14 Current approach care homes Nursing/Residential mix Local national model Technology: care home
15 Technology: Airedale Current approach technology Digital Healthcare Centre Shared EHR Internet connectivity Video - via PCs Resilient infrastructure Technology:Clinical partnership
16 Current approach telehealth hub Bespoke centre (small) Operational 24/7 Staffing: Experienced nurses Medical support Administration Technology support Training
17 The Aim of the Service Provide, safe, effective high standards of care To support residents to stay at home Support residents/nurses/carers in the planning, and delivery of care Escalate to community teams out of hours
18 SCENARIO FOR A FRAIL ELDERLY PATIENT TODAY EDNA EDNA IS 79 YEARS OLD, HAS CHRONIC CHEST DISEASE AND LIVES ALONE AT HOME ANNUAL PATIENT JOURNEY COST: 40,500 ANNUAL PATIENT JOURNEY COST: 40,500 EDNA IS ALONE AND DOES NOT KNOW WHO TO CONTACT, SHE CALLS 111 FOLLOWING HER DISCHARGE EDNA IS CONFUSED ABOUT HER MEDICATION AND HER FOLLOW UP CARE PLAN EDNA S CONDITION DETERIORATES 3 AN AMBULANCE IS DESPATCHED AND TAKES EDNA TO THE EMERGENCY DEPARTMENT THE EMERGENCY DEPARTMENT DOES NOT HAVE ACCESS TO EDNA S PRIMARY CARE RECORD. EDNA IS STABILISED AND TRANSFERRED FOR INPATIENT CARE 4 5 DURING EDNA S INPATIENT STAY HER SOCIAL CARE PACKAGE IS PLACED ON HOLD. THIS SUBSEQUENTLY RESULTS IN HER DELAYED DISCHARGE AIREDALE PARTNERS 18
19 SCENARIO FOR A FRAIL ELDERLY PATIENT TOMORROW EDNA IS ENROLLED ONTO THE NEW MODEL BY HER GP 1 EDNA 2 EDNA IS 79 YEARS OLD, HAS CHRONIC CHEST DISEASE AND LIVES ALONE AT HOME ANNUAL PATIENT JOURNEY COST: 26,100 3 EDNA IS SUPPORTED BY AN INTEGRATED, MULTI-PROFESSIONAL TEAM RULES DRIVEN ANALYTICS IDENTIFY EDNA AS SOMEONE WHO SHOULD BE SERVED BY THE NEW MODEL AIREDALE PARTNERS 4 SUPPORTED SELF CARE PATIENTS IN CONTROL REDUCTION IN UNPLANNED HOSPITAL ADMISSIONS PRIMARY CARE CONTACTS MINIMISED BETTER REOURCE UTILISATION & VALUE FOR MONEY IN THE EVENT OF A DISEASE FLARE, EDNA USES TELECONSULTATION TO SEE AND SPEAK WITH HEALTHCARE PROFESSIONALS AND SAFELY DEAL WITH THE ISSUE IN THE COMFORT OF HER OWN HOME EDNA RECEIVES SUPPORT IN SELF MANAGEMENT, INCLUDING PULMONARY PHYSIOTHERAPY 5 EDNA MONITORS HER OWN CONDITION USING GUIDANCE BUILT INTO HER ELECTRONIC WORK SPACE WHICH SHE ACCESSES FROM HOME 6 7 EDNA USES HER WORK SPACE TO COMMUNICATE WITH OTHERS IN A SIMILAR POSITION AS WELL AS HEALTH AND CARE PROFESSIONALS 19
20 HEE Strategic Framework 15 (2014)
21
22 Technical infrastructure? Medico-Legal? Information Governance? Clinical Governance? SystmOne, EMIS? Prescribing? Consent?
23 When Admission to Hospital is Required Streamlined process Avoiding A&E where ever possible Supporting the resident, and their carer until the ambulance arrives, via the video link
24 Results: 24 hr teleconsults to 26 patients with COPD (at home) 1 year pre/post -45% Video system displays via home TV Patients measure their Oxygen / Peak Flow Typically have rescue meds at home
25 Care Homes -53% -35% -59%
26 Current position 147 Care Homes 3853 Residents Cumbria to Kent (majority in Yorkshire/Lancashire) Further 99 care homes in implementation
27 Case studies Falls Laceration Painful shoulder Chest Pain Evolving stroke Drowsy / off legs Medication error with symptoms..positive feedback from users, relatives and staff
28 Feedback Patients/Carers The Telehealth Hub came into its own last winter when snow and ice brought traffic to a halt. My Husband s condition deteriorated suddenly, and having visual, instant contact with the team was very reassuring. A wonderful service. Care homes A very good service. It made me feel confident within my job so I could do the best I can for our residents. This service takes the pressure off us as we have access quickly to a health professional I only have one word to describe [the] Telehealth [Hub] excellent. Telemedicine became our lifeline what a wonderful piece of equipment! At the press of a button we could have face-to-face contact with a medical team, which is so important for both a patient and carer, and that helped to keep Geoff s spirits high The Doctor was fantastic when one of our dementia patients fell and hurt herself. I would have called an ambulance and she would have endured an A&E visit which would have terrified her. Your consultant saved her from this and reassured me that the cut was superficial and she was fine... Definitely has reduced admission rates. Telemedicine is an asset to the home with benefits Out Of Hours and weekends
29 Care Homes activity
30 Care Homes activity
31 Care Homes call activity Calls by time of day (1 month s data) Allow 30 min to: complete call action document
32
33 Care Homes call outcomes April-July 2014
34 Care Homes onward referrals (at place of residence) April-July 2014
35 GP Triage Calls Clinical assessment by Hub nurse Onward refer if required to HCP for home visit Request prescription GP surgery informed by NHS secure mail
36 Remember - we are transforming healthcare for our children. So design for tomorrow, not today
37 What Are We Waiting For? Jeremy 3h Just been 2 Airedale hosp & seen some of best tech anywhere in NHS including digital patient records shared with GPs - and gr8 patient care
38 Questions?
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