1. Impact is Key – AHPUSC19!
1 Essential Group Supporting 6 Essential Actions!
10th October 2019
Digital Solutions
Demonstrating impact of the NMAHP Digital Health and Care Leadership
Programme
Ann Rae, Principal Educator – NHS Education for Scotland
#AHPUSC19 #AHPsday2019 #AHPsDAYSCOT
2. Digital Solutions
AHPUSC19!
Demonstrating the Impact of the
NMAHP Digital Health and Care
Leadership Programme
Ann Rae
Principal Educator
NHS Education for Scotland
10th October 2019
3. NHS Education for Scotland
• > 200 NMAHP/Tec Lead participants
• Blended learning over 8/9 months
• Great speakers covering
– Leadership, Knowledge into Action,
– Data for Improvement, Digital applications,
– Information Governance, Social Media
• Leading an improvement project
Programme outline
7. NHS Education for Scotland
• Maximise Digital use
• Access the Community of Practice
• Connect with participants
• Follow #dnmahp on Twitter
• Consider applying for Cohort 14
So what?
8. NHS Education for Scotland
Thank you
ann.rae@nes.scot.nhs.uk
enmahp@nes.scot.nhs.uk
@AnnRae
10. Impact is Key – AHPUSC19!
1 Essential Group Supporting 6 Essential Actions!
10th October 2019
Digital Solutions
Attend Anywhere with COPD in NHSGGC
Pamela Vaughn, Advanced Specialist Physiotherapist in Respiratory Care
Glasgow Royal Infirmary
#AHPUSC19 #AHPsday2019 #AHPsDAYSCOT
11. The Reality of a Virtual
Respiratory Outpatient
Service
PamelaVaughn – Advanced Specialist Physiotherapist
Lorraine Wishart - Specialist Physiotherapist
NHS Greater Glasgow & Clyde
October 2019
13. Corporate Objectives
Better Health
Better Care
Better Workforce
Better Values
Moving Forward Together principles
HSCP Integration
Modern Outpatient Approach
Realistic Medicine.
14. Integrating the Digital Vision
“The issue is not whether
digital technology has a role
to play in addressing the
challenges we face in health
and social care and in
improving health and
wellbeing:
the issue is that it must be
central, integral and underpin
the necessary
transformational change in
services in order to improve
outcomes for citizens”
National Digital H&SC Strategy
January 2019 – Delay, equipment, IT
DNAs Jan – March 2019
First remote consultation – Feb 2019
Recruitment drive in increase throughput of
remote consultations – April 2019
Steady increase to uptake of remote
consultations for returning patients – ongoing
The ideal patient.......
15. Remote Consultations
Respiratory Physiotherapy Outpatient Appointments
(Jan-June 2019)
Attended Cancelled
Did Not
Attend (DNA)
All
446 91 70
Face to face
in clinic 427 83 58
Remote
consultation
by video call
19 8 12
Shortest
7min 37s
Longest
27min 52s
Average
12min 5s
Duration of video
consultations
50% of DNAs did not attend subsequent F2F
16. The Experience
I was comfortable at
home and not anxious
about attending a
hospital appointment
I would have
preferred a
hospital
appointment
I couldn’t hear
any sound
The system was easy
to use
I did not have to
take time off
work
It took less
time
It was more
convenient for me
It saved me
having to
travel
Shorter appointments
could increase clinic
capacity
Ease of follow up for trial of
treatments
Monitor long
term conditions
Infection control
Cautious uptake
/ Higher DNA
rate
No appointment
reminders
17. Patient Digital Resources
Video series for patients with
diagnosis of bronchiectasis
Animated film - Introduction to
Bronchiectasis
Patient demonstrations of airway
clearance
Self management
Enables easy and repeated viewing
18. The Digital Future …
Alternative format for patient / clinician contact
Opportunity for better contact between primary
and secondary care
Limit need for unplanned care
“Drop in” remote clinics
Changing services and access to health
professionals
Do patients place same value on remote consultations ?
Promote active self management
Value for money?
Redistributing pressures in system?
19. Impact is Key – AHPUSC19!
1 Essential Group Supporting 6 Essential Actions!
10th October 2019
Digital Solutions
Ophthalmology with the remote video consultations in NHS Forth Valley
Iain Livingston, Consultant Ophthalmologist – NHS Forth Valley
Dr Mario Giardini, Senior Lecturer in Digital Health – University of Strathclyde
#AHPUSC19 #AHPsday2019 #AHPsDAYSCOT
20. Impact is Key – AHPUSC19!
1 Essential Group Supporting 6 Essential Actions!
10th October 2019
Digital Solutions
Use of digital technology for automated referral for hypoglycaemia
Neil Gillies, Area Service Manager - SAS
#AHPUSC19 #AHPsday2019 #AHPsDAYSCOT
21. Use of digital technology -
automated referral for
hypoglycaemia
Neil Gillies
Area Service Manager, Fife
21
22. Declaration of Interests
• Work done as part of Joint Working
between NHS Fife, Scottish
Ambulance Service and Merck Sharp
& Dohme
• Project Management
– Natalie Shering, Market Access Manager
– North and Scotland
– Neil MacDonald, Area Health Lead – East
Scotland
22
23. Costs of hypoglycaemia?
• Poor glycaemic control
• Driving/Employment
• Morbidity/Mortality
2016 Data 23
Patient Health Service
• Ambulance Service Callouts
• Prolonged visit
• A&E attendances
• Admissions
• NHS Fife 999 callouts
• 632 conveyed to A&E
• Total Cost ~£800K
• Scotland ~£12.3M
25. Call Handling Process –
Hypoglycaemic Event
• 999 call routed via BT to SAS Ambulance
Control Centre
• Medical Priority Dispatch System (MPDS)
triage’s the call
• Call Coded (E-PRF starts to populate)
• Ambulance Service resource dispatched
• Crew provides care to patient
• Electronic Patient Report Form (E-PRF)
completed
• Discharge at Scene (DVLA Impact?)
25
26. Project Objectives
• Gather info via SAS command &
control system (Data Warehouse) and
SCI-Diabetes – Share with NHS Fife
• Improve quality of Patient Data –
Name/Address/CHI Number
• Improve SAS staff understanding
• Engagement with Diabetes Group
• Direct referral during business hours
26
27. Data Matching
27
– ISD clean data prior to transmission to SCI-
Diabetes. Steps:
– Receive Electronic Patient Report Form
(ePRF)
– Identify reports with blood glucose recording
– Check Emergency Care Summary records to
identify CHI
– Add GP practice code to determine relevant
health board
– Transmit to SCI-Diabetes
28. Process
• Patients matched appear
on SCI-Diabetes
• Contact with patients by
IP DSNs
• Advice given
– Change dose of
insulin
– Stop sulfonylurea
• Update of worksheet on
SCI-Diabetes
28
Identification of patients with
Hypoglycaemia
Increased awareness of issues
with hypoglycaemia for SAS
• Education
• Train the trainers
• 15 station champions
• Hypoglycaemia/Leadership
skills for PDP
• Questionnaire
• Ambulance crews
30. Progress - Issues Identified
• Change of SAS reporting system
• Governance Issues
• Changes within SAS management
locally
• Matching problems: Only 50%
matched?
– Not CHI based
• Variable numbers of patients identified
– 1-2/week
30
32. Future steps – Completed
• Continued education to SAS Staff
• Analyse questionnaire
• Improve matching
– ?CHI capture on ePRF
• Analysis after one year of project live
32
Brief overview of the programme - For NMAHPs in all sectors plus tec leads 9 months, blended with virtual and in person learning, service improvement project presented at the end, 200 participants since 2014- relative greater %ahps Oversubscribed Great speakers - and interesting content eg NMAHPs at the forefront, leadership, knowledge /point of care, social media, information governance, data for improvement, Impact
3 areas impact - on peoples experience, on teams and on individual participants
On people experience - video consultation - reducing travel time, ease of access, fits into busy life styles, Bette access to information (add in George) Patient information systems - improved information, reduced duplication, easier sharing, translating into Better health and social care, Improving self care - access to apps and webages, wearables to improve fitness On teams - meeting and learning applications e.g zoom, gotomeeting, webinars, near me, save time, save energy, reduce travel, On individuals - using social media, using technology, building networks, involved in interesting work and many have developed their role in current post or secured new post, joining the national NMAHP steering group for digital health and care,
So what ? Apply for cohort 14 (April ) we advertise on Twitter. Expand your own use of digital to benefit yourself, your team, people you support, invest in your leadership and digital capability
Applications open - January early email us if you want to be informed when enmahp@nes.scot.nhs.uk
CoP has lots of resources free for you to access Find out people you can connect with who are involved or been on the prog - names and contact details are on the CoP Follow #dnmahp on twitter for lots of great resources and finding out new ideas
Lack of investment into Physiotherapy Outpatient service
Consultants increased >200%, 0% increase in physiotherapists.
Service not sustainable with only 1 WTE Advanced Specialist
Unachievable demand on WL - increase in wait time – 18-20w at worst
Not meeting national guidelines for bronchiectasis patients
Patients returning to consultant clinics without first line management
Reducing time to first physiotherapy contact
Lack of physiotherapy succession planning
DRIVERS for this....
Strategic Drivers
Corporate Objectives
Better Health
Better Care
Better Workforce
Better Value
Moving Forward Together Principles
HSCP Integration
Self Care & Remote Care
Health & Social Care Patient Portal
Technology enabled care
Use of digital to enable self-care
Advice referrals and dialogue
Virtual consultations
VCs shorter than standard clinic appointments
Clinic appointments range 20-30min
Longest call is an outlier and skewed average duration
Most calls in region of 7-15mins
Treatment include AD demonstration of chest clearance and breathing techniques, medication reviews, sharing of test results, monitoring of LTAC.
All patients in 6 week period were considered for VC follow up.
Patients deemed not appropriate- required closer exam or physical input, face to face follow up or due for discharge on day of appointment.
Patient reasons for declining VC follow up –most cited being uncomfortable with technology or preferring face to face appointments
