Smarter access to healthcare
Telehealth and Paediatrics
• Sharon Levy
• Lorraine Clydesdale
Telehealth nurse specialist
Once upon a time….
Leanna
Three-year-old Leanna has leukaemia and
geographical constraints mean that her treatment
involves a great deal of travel and separation for
her and her family. How could readily available
technologies have helped?
http://www.patientvoices.org.uk/flv/0109pv
384.htm
Tele- WHAT????
Context:
NHS24
Paediatrics
LTC
Education
Stroke
SCTT
Telecare
Infrastructure
Mental Health
What do we do
We are focused on :
• promoting, delivering and supporting innovative
practice in Paediatric Healthcare, aided by advanced
communication technologies
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Our live projects include:
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Unscheduled Care/ Critical Decision Support
Care at Home
CAMHS
Child Protection
Maternity Telehealth Services
Telehealth for Children – Think Tank
Unscheduled Care / Critical Decision Support
• Using Telehealth to support Rural Hospitals with Paediatric
decision support
• Delivering training and raising the profile of Telehealth
• Ensuring the transfer of patients happens only when
necessary
• Investigating the use of Single Point of Contact for Paediatric
Support
Children with palliative / complex care needs
“Caring for children with life limiting or
terminal illness in their own home is
cheaper and less emotionally stressful for
family members than caring for them in
hospital”
Anne Harris – director of care services at the children’s charity
Rainbow Trust
Nursing Times 107(18) p7
“Telehealth is gaining wide spread
acceptance and is perceived to be both
usable and acceptable to patients and
professionals in palliative care settings”
Kidd L, et al., Telehealth in palliative care in the UK: a review of the evidence. Journal
of telemedicine and telecare, 2010. 16(7): p. 394 - 402.
Yet…
Place of death for
children with:
Neurodisability,
Cancer,
Neonates,
Metabolic,
Cardiac,
Other
Palliative Care Statistics for Children and Young Adults. Department of Health, 2007
Care at home
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To pilot a technology solution that provides a
potential for enhanced healthcare
communications for patients, parents or
carers in their own home
To test the infrastructure for supporting video
conferencing access from patients' home, or a
home like environment, to a suitable service
provider
To evaluate the benefits obtained and
challenges encountered during the pilot and
to assess the feasibility of a wider national
rollout of a care at home
Evaluation: clinicians at Tayside
Guy’s Communication Questionnaire (GCQ)
• Did you achieve your aims during the consultation? Yes * 8
• In your session, could you see everything you needed to
see? Yes * 8
• Could you hear all you needed to hear? Yes * 7
• Would you like to have another session like this again? Yes *
8
• How close did you feel to the person you were talking? Just
right * 8
• Comments? Plenty!
Benefits
• Early benefits included increased parental satisfaction with the
service and establishing the cost effectiveness of the intervention.
• Parents valued the enhanced support during the difficult end-oflife phase.
• The option of accessing the expertise of the clinical team, from
home, improved the therapeutic interaction and the sense of
‘partnership’ with the family.
• Innovative practice significantly reduced the need for the patient
to attend hospital visits and prevented possible admission to the
ward.
• When the planned care was going well there was less need for
home visits and the family experienced an increased sense of
being ‘in control’.
• The team in Tayside suggest that there were at least 3 occasions
where an admission to the ward was averted – one day admission
• “… there was a marked deterioration in the condition
of the child during a week of extreme weather, were
everywhere was covered in snow. The Telemedicine
link proved extremely valuable then. Swift and
appropriate action was taken following the virtual
visit. The team could determine the care and
treatment requirements prior to setting off on urgent
home visits. Drugs, equipment and appropriate
support were provided ‘just in time’ and the impact
of such action on the child’s quality of life was
remarkable…”
Care at home – complex needs
• A number of families were identified by the Scottish Spina
Bifida Association and regular remote interactions were
progressed:
e.g
A new born discharged home to Dumfries needing to attend an
outpatient clinic in Glasgow some 140 miles away. Four virtual
sessions scheduled with parents (and local Health Visitor)
where the surgeon was able to:
• monitor surgical wound healing and developmental growth,
• offer parental education and reassurance,
• support local health care providers and ensure continuity of
care, and
• demonstrate innovative practice to accompanying medical
students.
Care at home – Being part of the group
A number of teenagers in
the Grampian area were
able to participate
remotely with the SSBA
Youth club:
“ There are no other young
people with this condition
locally and going to
Cumbernauld means a 4
hours drive… so its really
good to be able to take part.
They are all really friendly
and you were able to say
anything – it was great!”
Complex needs – returning home
The discharge back home ,to remote and rural location, was only considered by J’s
family after assurances were given that his wound site will be monitored, remotely,
by the surgical team at Royal Aberdeen Children Hospital.
For the lively 3 year old that meant going home to familiar surrounding and to be
with the people who he loves most.
For the parents that meant less time off work and less reliance on informal carer to
look after their other 3 children.
It also meant far less travelling from the island to hospital for overnight visits.
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For the NHS the calculated savings, in terms of reduced bed occupancy as an
inpatient, is estimated as 1000s of pounds.
Real benefits noted by the surgeon and the mother included
Better patient experience
Better coordinated care with local healthcare providers and
Reduction in risks of hospital acquired infection
What else???
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NICU
Maternity service
BabyCam
CAMHS
MCN/MSN
Child Protection /Peer Review
Incontinence nurse led tele service
Education and training
Knowledge sharing and transfer
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Telehealth for Children – Think Tank
• Skilled group of clinicians and telehealth
specialists
• Tasked with identifying solutions which will
tackle growing challenges to the Scottish
Health Economy
• Challenged to identify funding opportunities
for new projects
Challenges
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eHealth and SCTT silo working
National V Local agendas and priorities
Standard setting and governance
Leadership
Change management and transition
Education & training competencies
Risk management and evidence based practice
Questions?
Sharon Levy
S.levy@nhs.net