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Pathway redesign - The Acute Hospital AIREDALE NHS FOUNDATION TRUST 28 th June 2011. No longer fit for purpose….. AIREDALE NHS FOUNDATION TRUST 28 th June 2011. How to change? - challenge everything. Notes: Shared electronic patient records – John Parry TPP SystmOne
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Pathway redesign - The Acute HospitalAIREDALE NHS FOUNDATION TRUST 28th June 2011
No longer fit for purpose….. 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 PopeExemplars Diabetes Renal Medicine Palliative CareToday’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
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
Implementation Challenges faced: 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
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 consultation90% 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…”
When to use? • Numerous potential use cases: • 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
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 • 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