Pathway redesign - The Acute Hospital
AIREDALE NHS FOUNDATION TRUST
28th June 2011
How to change? - challenge everything
• Notes: Shared electronic patient records – John Parry TPP
SystmOne
• Opinion: e-consultation – John Stoves / John Connolley
• Who is in charge?: Care Planning – Shahid Ali / R Pope
Exemplars Diabetes
Renal Medicine
Palliative Care
Today’s focus: Telemedicine….
Prison Healthcare - the start line
Patient Care
• UK Prison population - guaranteed the same access to healthcare as
the general population
• Prison population 82,000 - challenging health requirements
Security and Costs
• Inmates escape from hospitals, not from prisons
• Escort and bed watch costs >£25M/year
(This does not includes consultation, hospitalisation and treatment)
• Public prisons - healthcare costs with PCTs
Could telemedicine help?
Prisons supported (5yr
programme):
• Wide geographical area
• 20 prisons, including: Acklington
(Northumberland) down to The
Verne, YOI Portland (Dorset)
• 21 outpatient specialties offering
elective services via telemedicine
link, e.g. orthopaedics,
dermatology, neurology, dietetics
and physiotherapy
• A&E urgent care service available
• Effective
Revised Pathway
Where it is safe and effective to do so Patients are treated in the Prison, not Hospital
Cost savings:
Reduce acute and elective transfers out by
~50%
Average cost per escort episode: £425
Average cost per bed watch episode: £3,731
Savings at least £400/transfer avoided
Other Benefits:
Patient and Staff satisfaction
Empowering Prison clinical staff
Less disruption to NHS Acute Trusts
Improved patient privacy and dignity
Improved response times
Reduced prison lockdowns
Challenges faced:
Implementation
Technology
• Existing technology – highly reliable
• Installing / maintaining in prisons…
Culture
RED TAPE……
• Clinical acceptance – initially sceptical
but now well supported
• Clinical capacity - job plans
• Critical mass crucial to success
Governance
• Strong clinical governance
• Contemporaneous record
• Consultant delivered service
Implementation
• Clear processes agreed
• Go live planned carefully
• Funding arrangements
• Security arrangements
Care close to Home
Care in the Home
Question 1: Overall level of satisfaction with completed Telemedicine
Consultations
95% patients and 90% of clinicians described themselves as being “very satisfied” or
“satisfied”.
Question 2: Level of satisfaction – ability to communicate issues and concerns
during the Telemedicine consultation
90% of users described themselves as “satisfied” or “very satisfied”.
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”
Patient quote
“…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…”
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
NHS Yorkshire and the Humber
Hospital:Hospital telemedicine
“Distributed Specialist Networks”
• Telestroke tender won
• Infrastructure located at Airedale
Mobile telemedicine carts in every Yorks+Humber ED
VC-enabled laptops with on call consultant
• Intention that this would act as a common platform
…….??
Conclusion
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Very strong future for digital healthcare (telemedicine)
Transforming the Acute Hospital’s role and reach
Hub approach key to get to scale
Much to learn, but
No more pilots – time to commit
richard.pope@anhst.nhs.uk