Paediatric Unscheduled Care Project
North of Scotland Planning Group
SCTT/NHS24
NHS Highland, NHS Grampian, NHS
Western Isles, NHS Orkney, (NHS
Shetland).
1
Background
• The project led by the Scottish Centre of Telehealth and Telecare (SCTT) and
funded by National Development Plan, began in 2010, intending to provide
Video Conferencing (VC) to reinforce existing paediatric decision pathways
between 6 Rural General Hospitals (RGH), community hospitals (CH)and their
Receiving Centres.
• The original project identified that it is not always likely that Paediatric skill sets
are available in the RGH’s and most likely that paediatric patients will be
considered for Transfer to a specialist centre.
• There was a positive feeling among project stakeholders that if effective
support was easy to access and on-going, then it could lead to an increased
level of confidence at the local RGH and possibly a reduction in the number of
transfers of children to Receiving Centres.
• The proposal to provide 24 hour access to a remote Paediatric Consultant via a
Single Point of Contact (SPoC) using VC was proposed to participating members
2
of the project board. The idea was well met and it was agreed in July 2011.
Is this a new idea??
The Jetsons 1962!
Dr. Zoe Dunhill Report 2011
• NoSPG commissioned a report to look at paediatric services in the
NoS. Titled NoS Paediatric Sustainability review
• The reviewer was asked to review paediatric services across the
five North of Scotland health boards and to report on the current
picture of Paediatric Secondary care in the NOS. She was to
identify where regional collaboration might strengthen future
sustainability of services in the NOS
• 1. An obligate network for Child Health is resourced and put in
place with the utmost urgency in the NOS area
• 2. The unscheduled care initiative (single point of contact) pilot is
afforded prime importance by all NOS paediatric units and RGH
4
partners
Also.......
• Anecdotally, 50% of transferred children are
discharged within 24hrs
• Transfers have a significant impact on rural based
children/families
• Access to OCC could be quicker via VC
• Gather robust transfer data
• Contribute to critical care work
• Transfer learning
• Identify barriers
• Increase use of VC for all situations
• Wider applicability?
The Healthcare Quality Strategy for Scotland:
Effective
The most appropriate treatments,
interventions, support and services
will be provided at the right time
to everyone who will benefit, and
wasteful or harmful variation will
be eradicated
Agreement
• Through general support for trialling a new
model, it was decided that........
• Provide paediatric critical decision support to
Remote General Hospitals and Community
Hospitals from an on call consultant via Video
Conferencing.
7
The Model
•
•
•
•
•
•
•
•
•
12 month trial of concept – commenced July 2013.
Ongoing Evaluation by external evaluator - CRH
24/7 dedicated OCC available
Patient pathways mapped
Close working with PICU’s and SAS
Extensive training and support to HB’s
Clinical lead for the project
Data collection
Learning
8
RGH/CH RGH/CH RGH/CH RGH/CH RGH/CH RGH/CH
1
2
4
Call Handler (NHS24)
3
OCC
8
6
5
Receiving
Centre
Receiving
Centre
Receiving
Centre
Receiving
Centre
7
1
RGH/CH rings Single Point of Contact and speaks to a Call Handler
2
Call Handler, captures essential information.
3
Call Handler, hands over to the OCC and facilitates the VC between them and the RGH/CH.
4
VC to RGH/CH takes place with RGH/Patient/parent and OCC
5
If transfer is required, on call consultant contacts receiving centre
6
If transport is required, on call consultant contacts transport option
7
Transport unit, transports patient to receiving centre
OCC completes patient notes - SBAR, saves record to system, further follow up calls
9
Anticipated Benefits
•
•
•
•
•
•
•
•
•
•
A single number to call
A dedicated OCC to support RGH/CH staff triage, care and support the decisions
which may lead to transfer
The dedicated OCC will provide on going support for patients who are not
transferred, but cared for locally.
The local clinicians dedicate their time to their patient while the OCC facilitates
transport arrangements
An additional set of qualified eyes will be virtually in the room with the staff and
patient providing clinical advice and support
Patient will be ‘seen’ by a paediatric Consultant sooner than current models,
therefore reducing any risk from delay in appropriate care.
There is potential for paediatric skills transfer to local staff in the RGH’s
The collection of data which will inform the Project Board of numbers of transfers,
VC calls and outcomes.
More patients may stay locally reducing their inconvenience and stress and
aligning with the strategic objectives outlines in the NHS Scotland 20:20 Vision.
The dedicated resources will initially have enough flexibility to manage significant
increase in calls, so RGH/CH’s may place multiple calls per patient.
10
Evaluation
CRH provided a mixed method approach of:
• Literature scoping review by NHS Healthcare
Improvement Scotland (HIS) and the Scottish Health
Technologies Group
• Site visits to 6 hospitals and qualitative interviews with 10
OCCs and 17 key stakeholders
• Cost consequence analysis by HIS
• Activity data analysis
11
What Did we find.....
Times of attendance
Daytime
Evening
Night
Not Known
12
Key Findings
Activity
• 98 calls from August 2013 until Jan 2014
approx 4 per week
• Most (60/98) were by VC
• Small majority (53%) met the KPI of VC set up with all attendees within 10
mins
• 9 emergency retrievals and 21 transfers included
• 27 closed calls and follow up in 34 cases (with further 9 transfers)
13
Key Findings (cont.)
Qualitative Positive
• VC support from the OCCs improved the confidence of staff
• OCCs thought calls were appropriate
• Consultant led VC enabled more consistent pattern of support than
previously, particularly to junior staff
• Likely that VC support improved quality of local care
• VC useful for aiding decisions on, and support whist waiting for,
discharge/transfer
• Parents were reassured by the availability
14
of the expert
Key Findings (cont)
Qualitative – negative
• VC not always appropriate, technically or logistically and
telephone used as an alternative.
• Clinical responsibility for the child caused tension in some
cases.
• Some referrers thought PuC jeopardised some pre-established
clinical relationships.
• Some referrers and OCCs thought lack of local knowledge of
geography etc hindered good decision making.
• PuC was bypassed where consultation time thought to be
quicker, problems with VC or appropriateness of VC was
questioned.
15
Technical
Challenges??
16
Current Position – as at May 2014.
•
•
•
•
•
•
•
•
Pilot running for almost 12 months
External evaluation received
Roadmap of engagement post evaluation ongoing
Lessons learnt logged
Future planning in place.
Discussions about future models and geography.
Further trialling.
Widespread buy-in.
17
Thank you for listening
Lynn.garrett@nhs24.scot.nhs.uk
18