R. binks implementation of ict telemedicine-experiences of yorkshire

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R. binks implementation of ict telemedicine-experiences of yorkshire

  1. 1. Implementation of ICT/Telemedicine: Experiences of Yorkshire Rachel Binks Nurse Consultant, Critical and Acute Care Airedale NHS Foundation Trust
  2. 2. Tele care
  3. 3. Tele monitoring
  4. 4. Tele coaching tele medicinetele coaching
  5. 5. Tele medicine tele medicine
  6. 6. The Airedale journey new ways to deliver early specialist opinion
  7. 7. Using technology to work differently
  8. 8. Development into the Mainstream NHS Market Received grant from the Technology Strategy Board Development of telemedicine solutions for the home Worked with local company to develop video capability for the patients’ own home Pilot for 28 Diabetes patients to receive outpatient appointments via telemedicine
  9. 9. Regional TelehealthHub Partners Airedale NHS Foundation Trust -Telemedicine Regional Telehealth Programme and Hub Hull University and Barnsley PCT Hull and East - Telehealth and Yorkshire NHS telecoaching Trust - Telemonitoring
  10. 10. Home teleconsultation2008 - ALIP programmeTSB funding, 4 partnersAims:-develop product for home useTV as the display devicestandard broadband linkcarry out plannedteleconsultations usingdiabetes as the exemplar
  11. 11. Hub at Airedale Dedicated facility opened September 2011 24/7 telemedicine service Acute care nurses Consultant physicians
  12. 12. Bringing healthcare homeproviding remote consultant opinion to theEnglish prison servicesupporting elderly patients with long termconditions in their own homes, nursing andresidential care homes via Telehealth HUBsupporting children with diabetes to managetheir condition at home via Telehealth HUBsupporting rural communities with communitybased remote outpatient consultationsenhancing recovery for stroke patients throughstroke telemedicine service
  13. 13. Telemedicine Deployments Hospice  1 Hospice  5 end of life pathway patients Integrated Pilot  6 GP surgeries  7 residential home  2 COPD patient
  14. 14. Telemedicine Deployments Patients’ own homes  42 COPD patients  30 Heart Failure patients  25 Diabetes patients Nursing and Residential Homes  29 Care Homes + 33 this month
  15. 15. Evidence Base to December 2012578 Clinical Consultations  357 primary consultations  221 follow up consultations  198 admissions avoided  52 admissions
  16. 16. The big questionDoes it Work?Feedback• from patients in their own homes• Nursing and residential home patients• And carers• And clinicians• And nurses
  17. 17. Patient feedback “…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…” Gillian, Diabetes Patient, talking about her home based telemedicine servicehttp://www.airedaledigitalhealthcarecentre.nhs.uk/Videos/
  18. 18. Care Home feedback“Very good service, made me feel confidant within my job role so I could do the best I can for our residents. So often we are left in confusion whether we should call a doctor or an ambulance. This service takes the pressure off us as we have access quickly to a health professional who can advise us the best route to follow. Dr Pope was fantastic when one of our dementia patients fell and bashed her nose. I would have called an ambulance and she would have endured an A&E visit which would have terrified her. Dr Pope saved her from this and reassured me that the cut was superficial, which was true - and she was fine.” Residential Home Care Worker
  19. 19. Nursing Home staff• ‘made me feel confident in my job role’• ‘quick, helpful and much easier than going through telephone triage as (I was) recognised as a professional, with knowledge, rather than a complete lay person as often occurs via telephone’
  20. 20. Does it work?“It’s a brilliant concept”“ [the telemedicine system]…has been a Godsend to me. Thank youfor getting me one”“came into its own 4th Feb when snow and ice brought traffic to a halt.Geoff’s condition deteriorated suddenly and having visual, instantcontact with the team was very reassuring. A wonderful service”“I’m only sorry it wasn’t out years ago”“All the people in my block came round for coffee and saw it working –they are all quite envious of it now!”“The best thing about it is knowing I am not alone”“the picture is faint and the sound keeps coming and going”http://www.airedaledigitalhealthcarecentre.nhs.uk/Videos/
  21. 21. Overall level of satisfaction95% patients and 90% of clinicians described themselves as being “very satisfied”or “satisfied”.
  22. 22. Level of satisfaction – ability to communicate issues and concerns during the Teleconsultation• 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”
  23. 23. numerous potential use cases:When to use? • 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
  24. 24. Deploying at scale Just imagine…. …the number of patients lives that could be enhanced …the number of carers and families that could be supported …the amount of time released to care …the resources released for better utilisation/reinvestment..if we maximised the potential of telehealth at scale
  25. 25. Future Developments 3 year end of life project- Telephone and telemedicine North Yorkshire commissioners developing business case for 40 care homes Enable telemedicine site wide across Airedale
  26. 26. Does it work?Patient survey – on goingHow satisfied were you with:- Ave Score (0-10 scale) (a) the teleconsultation 8.7 (b) the video quality 8.5 (c) your ability to use the link to communicate your issues and concerns 9.0 (d) the advice you received 8.7
  27. 27. Useful data• A&E admissions/attendances• How many admitted• Length of stay• Reasons for admission• Examples of TH Hub support• Any change in attendance/admission since Telemedicine enabled
  28. 28. 12 : 0001 -12: 0 10 20 30 40 50 60 70 80 90 : 00 5902 -01: AM : 00 5903 -02: AM : 00 5904 -03: AM : 00 5905 -04: AM : 00 5906 -05 AM : 00 :5907 -06 AM : 00 :5908 -07: AM : 00 5909 -08: AM : 00 5910 -09: AM : 00 5911 -10: AM :0 5912 0-11 AM : 00 :5901 -12: AM : 00 5902 -01: PM : 00 5903 -02: PM : 00 5904 -03: PM : 00 5905 -04: PM : 00 5906 -05 PM : 00 :5907 -06: PM : 00 59 Time of Attendance in ED08 -07: PM Admissions from September 2011 – August 2012 : 00 5909 -08: PM : 00 5910 -09 PM .00 :5911 -10: PM : 00 59 -11 PM :59 PM No of Patients
  29. 29. Numbers of admissions1400 Admissions from September 2011 – August 20121200 11441000 800 612 (53.5%) 600 400 200 6 (0.98%) 0 Emergency Department Attendances for Number Admitted Number Deceased within 24 Hours Nursing/Residential Home Residents
  30. 30. LENGTH OF STAY Admissions from September 2011 – August 2012 > 59 55 54 53 52 50 49 47 46 45 44 43 42 41 40 39 38 37 36 35 34 33Number of Days 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 0 10 20 30 40 50 60 70 80 90 100 Number of Patients
  31. 31. Admissions from September 2011 – August 2012 Top 10 Admission Reasons Pertrochanteric fracture Closed Fracture of neck of femur Closed Syncope and collapse Urinary tract infection, site not specified ConstipationChronic obstruct pulmonary dis with acute lower resp infec Unspecified acute lower respiratory infection Pneumonia, unspecified Lobar pneumonia, unspecified Cerebral infarction, unspecified 0 10 20 30 40 50 60
  32. 32. Admissions from Non Telemedicine Enabled Homes• 43 Homes with data from 2011 and 2012• 34 had a reduction in admissions in 2012• Overall the reduction in admissions was 31%
  33. 33. Admissions from Non TM Homes 18 Overall Reduction in Admissions = 31% 16 14 2011 - Red 12Admissions 10 8 6 4 2 2012 - Blue 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 Home
  34. 34. Admissions from Telemedicine Enabled Homes• 14 Homes with data from 2011 and 2012• 12 had a reduction in admissions in 2012• Overall the reduction was 46%
  35. 35. Admissions in TM Enabled Homes 30 Overall Reduction in Admissions = 46% 25 2011 - Red 20Admissions 15 10 5 2012 - Blue 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Home
  36. 36. 1 year results – 24 hr teleconsultations at home -29.5% -36.5% Year pre postYear pre post
  37. 37. Quotes from patients• “The telemed literally brought tomorrow’s technology into my living room today; without any need to travel I can talk to a specialist!. The system puts me in control of my diabetes care instead of my illness governing or interfering with my lifestyle.”• “There is no expensive journey to and from hospital (2 bus journeys each way), no reorganising 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”• “The consultation is an active two way process…it makes a huge difference to how I feel about my diabetes and therefore about myself”
  38. 38. What more could we want? Any Questions?

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