Miniaturisation – unlocking the future
Tabinda Rashid-Fadel
QIPP Clinical Pathways Lead
27th November 2014
Technology
• The last decade has seen tremendous
advancement with technologies
• Communication – mobile phone and intranet
• New technologies allowing near patient testing diagnostics
• Data storage and accessibility – electronic patient
records
• Access to results from central points
• Global reporting
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QIPP and clinical pathways
The use of technology to improve clinical
pathways and quality of services and improving
efficiencies.
• Cardiac physiologist – HCS training – technology
and device based training and role.
• Cardiology- use of technology in diagnostics and
intervention - procurement, introduction and
evaluation of use
• Sharing the learning from cardiology - BHI with
other centres
• Sharing the opportunities from cardiology in other
areas of Specialised commissioning
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ILR project
• This project has taken an introduction of
technology to review the current location of the
service and the change in location was able to
provide key benefits to patients and providers.
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Pilot - BHI experience
• NICE guidance 139 – primary care and
community – infection control
• BHI – outpatients on level 5 -treatment room
Pilot :
• 20 Patients received the LINQ device
• All patients completed a questionnaire
• Review the resources and capacity from the
providers perspective
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Post implant and review
• Very small scar – 1cm
• No wound issues
• Very clean signals
• One patient has already received a PPM following
asystole
• One patient’s device showed tachy arrhythmia
prescribed beta blocker – waiting review
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Remote follow up
• All patients are able to receive a remote follow up
of their device – face to face once a year as per
HRUK guidelines
• Automatic and manual transmissions
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comparative
Wound/scar
Price of device
Staff required
Facilities
efficiency
Follow up
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Reveal
LINQ
Advantage/disadvantage
Larger scar and
implanted device
Cheaper device
Small scar – pre loaded
injectable device
More expensive – new
technology
1x doctor
1x physiologist
1x admin
Reduction in complications
Outpatient treatment
room
6 per session
Advantage to provider and
commissioner
Advantage to provider
remote
Advantage to patient provider
and commissioner
1x doctor
1x physiologist
2x nurse
1x radiographer
Specialist catheter
lab
6 per day (2
sessions)
Face to face
Disadvantage
Advantage to provider
Impact on capacity
Requires catheter lab Allows the procedure to
be undertaken in
outpatients setting
Advantage to patient, provider
and commissioner
tariff
Attracts EA03Z
single chamber
pacemaker or
implantable loop
recorder device
Advantage to the commissioner
?
ILR - BHI experience
• New technology
• Pilot at BHI – within outpatients
• Agree tariff – EA03Z
• Elective activity in OP and community hospital – south Bristol
• Non elective care in MAU/ED – no admission and develop fast
track clinic
• Extended role for physiologist/arrhythmia nurse
• Supported by patient questionnaire findings, and service
redesign
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Project : Optimisation of Devices – maximising benefits
A national project currently reviewing the
purchasing of high cost devices and their use
Main focal points
• Ensuring best value from suppliers – transparency
on pricing
• Ensuring the reimbursement value back to NHS
providers is also transparent and auditable
• Assurance that patients are getting best value
from devices – optimisation
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Cardiac devices – ICD and CRT
• Physiologist programs these devices and follow
up clinics.
• There is a move towards remote follow up of a
number of devices where technology allows this
to happen – huge benefits from capacity and
patient experience
• Devices are optimised for energy conservation
• Devices are optimised for therapy delivery
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Physiology day
• SCN has supported a physiology day for the
south west which has allowed 14 trusts to come
together (27 delegates)
• Reviewed current variation in practice and agreed
to formulate a regional follow up protocol for
device follow up ensuring optimisation
• The physiology services are also in the process of
obtaining accreditation of services through IQIPS
this will ensure quality for future commissioning
models. The region is currently is engaging in this
process
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Next steps
• This work is being presented to and ratified by the
Society for Cardiac Physiology to ensure that best
practice is shared
This is an example where we can start with
cardiology devices and review the services and
practice and share this across other areas e.g.
neuro and renal
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Summary
• Ensuring we review opportunities of new
technological advances
• Support the patients experience and expectations
• Ensure best value for the NHS is effective use of
recourses
• Share best practice through the CRG teams
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