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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 YorkshireRachel BinksNurse Consultant, Critical and Acute CareAiredale NHS Foundation Trust
  2. 2. Tele care
  3. 3. Tele monitoring
  4. 4. tele medicinetele coachingTele coaching
  5. 5. tele medicineTele medicine
  6. 6. The Airedale journeynew ways to deliver early specialist opinion
  7. 7. Using technology to work differently
  8. 8. Development into theMainstream NHSMarket Received grant from the Technology Strategy Board Development of telemedicine solutions for the home Worked with local company to develop video capability for thepatients’ own home Pilot for 28 Diabetes patients to receive outpatient appointments viatelemedicine
  9. 9. Regional TelehealthHub PartnersAiredale NHSFoundation Trust-TelemedicineHull University andHull and EastYorkshire NHSTrust- TelemonitoringBarnsley PCT- Telehealth andtelecoachingRegionalTelehealthProgramme and Hub
  10. 10. 2008 - ALIP programmeTSB funding, 4 partnersAims:-develop product for home useTV as the display devicestandard broadband linkcarry out plannedteleconsultations usingdiabetes as the exemplarHome teleconsultation
  11. 11. Hub at Airedale Dedicated facility opened September 2011 24/7 telemedicine service Acute care nurses Consultant physicians
  12. 12. providing 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 serviceBringing healthcarehome
  13. 13. TelemedicineDeployments Hospice 1 Hospice 5 end of life pathway patients Integrated Pilot 6 GP surgeries 7 residential home 2 COPD patient
  14. 14. TelemedicineDeployments Patients’ own homes 42 COPD patients 30 Heart Failurepatients 25 Diabetes patients Nursing and ResidentialHomes 29 Care Homes + 33this month
  15. 15. Evidence Base toDecember 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 ownhomes• Nursing and residentialhome 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 thenspend time sitting around in waiting rooms……simply a live link up where I can talk freely and wecan swap ideas as to how to improve my life…”Gillian, Diabetes Patient,talking about her home based telemedicine service
  18. 18. Care Home feedback“Very good service, made me feel confidant within my jobrole so I could do the best I can for our residents. Sooften we are left in confusion whether we should call adoctor or an ambulance. This service takes the pressureoff us as we have access quickly to a health professionalwho can advise us the best route to follow. Dr Pope wasfantastic when one of our dementia patients fell andbashed her nose. I would have called an ambulance andshe would have endured an A&E visit which would haveterrified her. Dr Pope saved her from this and reassuredme that the cut was superficial, which was true - and shewas fine.”Residential Home Care Worker
  19. 19. Nursing Home staff• ‘made me feel confident in my job role’• ‘quick, helpful and much easier than goingthrough telephone triage as (I was)recognised as a professional, withknowledge, rather than a complete layperson 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”
  21. 21. Overall level ofsatisfaction95% patients and 90% of clinicians described themselves as being “very satisfied”or “satisfied”.
  22. 22. • Several patients have mentioned the positive benefit of includingfamily 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”Level of satisfaction –ability to communicate issues andconcerns during the Teleconsultation
  23. 23. When to use?numerous potential usecases:• long term conditions• outpatients• nursing homes• employee health & wellbeing• early supported discharge• admission avoidance• dementia – carer support• social care• purely social calling• specialist networks
  24. 24. Deploying at scaleJust imagine….…the number of patients livesthat could be enhanced…the number of carers andfamilies that could besupported…the amount of time releasedto care…the resources released forbetter 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 developingbusiness 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 tocommunicate your issues andconcerns 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/admissionsince Telemedicine enabled
  28. 28. Admissions from September 2011 – August 2012Timeof AttendanceinED010203040506070809012:00-12:59AM01:00-01:59AM02:00-02:59AM03:00-03:59AM04:00-04:59AM05:00-05:59AM06:00-06:59AM07:00-07:59AM08:00-08:59AM09:00-09:59AM10:00-10:59AM11:00-11:59AM12:00-12:59PM01:00-01:59PM02:00-02:59PM03:00-03:59PM04:00-04:59PM05:00-05:59PM06:00-06:59PM07:00-07:59PM08:00-08:59PM09:00-09:59PM10.00-10:59PM11:00-11:59PMNo of Patients
  29. 29. Admissions from September 2011 – August 20126(0.98%)612(53.5%)11440200400600800100012001400Emergency Department Attendances forNursing/Residential HomeResidentsNumber Admitted Number Deceased within 24 HoursNumbers of admissions
  30. 30. Admissions from September 2011 – August 2012LENGTH OF STAY0 10 20 30 40 50 60 70 80 90 1000123456789101112131415161718192021222324252627282930313233343536373839404142434445464749505253545559>NumberofDaysNumber of Patients
  31. 31. Admissions from September 2011 – August 20120 10 20 30 40 50 60Cerebral infarction, unspecifiedLobar pneumonia, unspecifiedPneumonia, unspecifiedUnspecified acutelower respiratory infectionChronic obstructpulmonary dis with acutelower resp infecConstipationUrinary tractinfection, sitenotspecifiedSyncopeand collapseFractureof neck of femur ClosedPertrochanteric fractureClosedTop 10Admission Reasons
  32. 32. Admissions from NonTelemedicine EnabledHomes• 43 Homes with data from 2011 and 2012• 34 had a reduction in admissions in 2012• Overall the reduction in admissions was31%
  33. 33. Admissions from Non TM Homes0246810121416181 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 42HomeAdmissions2012 - Blue2011 - RedOverall Reduction inAdmissions = 31%
  34. 34. Admissions fromTelemedicine EnabledHomes• 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 Homes0510152025301 2 3 4 5 6 7 8 9 10 11 12 13 14HomeAdmissions2012 - Blue2011 - RedOverall Reduction inAdmissions = 46%
  36. 36. 1 year results – 24 hrteleconsultations at homeYear pre postYear pre post-29.5% -36.5%
  37. 37. Quotes from patients• “The telemed literally brought tomorrow’s technology into my livingroom today; without any need to travel I can talk to a specialist!. Thesystem puts me in control of my diabetes care instead of my illnessgoverning or interfering with my lifestyle.”• “There is no expensive journey to and from hospital (2 bus journeyseach way), no reorganising of work commitments to then spend timesitting around in waiting rooms: simply a live link up where I can talkfreely and we can swap ideas as to how to improve my life”• “The consultation is an active two way process…it makes a hugedifference to how I feel about my diabetes and therefore aboutmyself”
  38. 38. What more could we want?Any Questions?