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The Virtual Night Hospital

The Virtual Night Hospital. Dr Philip Shorvon Central Middlesex Hospital London. FACTORS PROFESSIONAL. SHORTAGE RADIOLOGISTS INCREASING WORKLOAD HEAVY CONSULTANT ON- ALL COMMITMENT PARTICULARLY IN NON-TEACHING HOSPITALS INCREASING COMPLEXITY OF WORK LESS EXPERIENCE OF JUNIOR CONSULTANTS.

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The Virtual Night Hospital

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  1. The Virtual Night Hospital Dr Philip Shorvon Central Middlesex Hospital London

  2. FACTORSPROFESSIONAL • SHORTAGE RADIOLOGISTS • INCREASING WORKLOAD • HEAVY CONSULTANT ON- ALL COMMITMENT PARTICULARLY IN NON-TEACHING HOSPITALS • INCREASING COMPLEXITY OF WORK • LESS EXPERIENCE OF JUNIOR CONSULTANTS

  3. FACTORSORGANISATIONAL • NETWORKED SERVICES- ORTHOPAEDICS/ NEUROSCIENCES/ VASCULAR /ONCOLOGY • EUROPEAN WORKING TIME DIRECTIVE • NIGHT HOSPITAL • ‘SMALL DGH’ MODEL

  4. FACTORS IMAGING AND IT • INCREASING USE OF IMAGING OUT OF HOURS FOR TRIAGE • NICE GUIDELINES FOR HEAD CT • INCREASE USE OF EMERGENCY CT IN ABDOMINAL AND CHEST CONDITIONS • RAPID INCREASE IN PACS SYSTEMS • IT ADVANCES ( NHS NET/BROADBAND ETC)

  5. NIGHT HOSPITAL CONCEPT • INCREASING USE OF EXTENDED ROLES • REDUCED NUMBER OF MEDICAL PERSONNEL ON SITE • MORE CONSULTANT LED SERVICES

  6. CENTRAL MIDDLESEX HOSPITAL • Innovation to survive • 2nd hospital to get trust status • Lead patient focussed concept • One of first PFI type deals for MRI (1993) • First DTC to be built (ACAD in 1999) • New build underway (BECaD) • Now merged with Northwick Park Hospital (NorthWest London Hospitals NHS Trust)

  7. CENTRAL MIDDLESEX HOSPITAL • 250K catchment area • Highly disadvantaged population ( 40K refugees and > 50% population English not first language) • 80K A and E attendances / year • 10K emergency admissions / year • Bedbase 250 approx

  8. CMH- BECAD(Brent Emergency Care and Diagnostic Centre) • DOH model of the “small district general hospital- (www.dh.gov.uk/policyand guidance/organisationpolicy/configuringhospitals) • Innovations over staffing/hospital at night • Filmless environment

  9. THE VIRTUAL NIGHT HOSPITAL? THE SOLUTION • Several hospitals link their PACS systems to a central reporting site • Portable video conferencing to referring hospitals (discussions with radiographers/ referring clinicians/ even patients?) • Consultant opinions at central reporting site - Radiology, A and E , ? Cardiology? others

  10. Virtual Night HospitalWork-Flow

  11. Hospital A n Image Repository & PACS Gateway Hospital B

  12. Hospital A Examinations for Reporting are sent to the VNH Image Repository & PACS Gateway (DICOM “processed” to support multiple PACS Vendors) Hospital B

  13. Hospital A Examinations reported directly into the On-Call Worksation and sent back to the Repository On-Call Workstation Hospital B

  14. Hospital A Teleconference Facilities make it possible to communicate between sites in real-time. This may also include streaming images such as Ultrasound. Hospital B

  15. Hospital A Examinations reported directly into the On-Call Worksation and sent back to the Repository On-Call Workstation Hospital B

  16. Hospital A Images and Report made immediately available via Web Based Viewer to referring site. Report may also be exported into RIS system. On-Call Workstation Hospital B

  17. Hospital A Fully Reciprocal Arrangement Hospital B

  18. Hospital C Highly Scalable Hospital E Hospital A Image Repository & PACS Gateway Hospital B Hospital F Hospital D

  19. THE VIRTUAL NIGHT HOSPITAL RADIOLOGY • ALL OUT OF HOURS PLAIN FILM AND CT REPORTING PERFORMED AT THE TIME • VIDEO CONFERENCING ALLOW CLINICAL DISCUSSIONS/ PROTOCOL MANAGEMENT FOR CT

  20. THE VIRTUAL NIGHT HOSPITAL RADIOLOGY PROBLEMS • INTERVENTIONAL ?- will require separate interventional rotas. If organised regionally, interventionalists could cover several hospitals (already beginning with vascular networks • ULTRASOUND?- X training nurse practioners (gynae), A and E – FAST. Videostreaming and remote robotic ultrasound possible

  21. THE VIRTUAL NIGHT HOSPITAL RADIOLOGY INDIRECT ADVANTAGES • Radiologist- Much reduced on-call commitment. Busy when on call but following day off • A and E films reported on time- less returns/ misses • Good acute training opportunities • Patients- 24 hour access to consultant opinion

  22. THE VIRTUAL NIGHT HOSPITALWHEN? Need working model by early 2006- commissioning of BECaD

  23. THE VIRTUAL NIGHT HOSPITALWHERE ARE WE NOW? • Gaining political support • Identifying funding • Investigating technology • Looking for partners

  24. THE VIRTUAL NIGHT HOSPITALWHERE ARE WE NOW? Technology PACS-Workstation which can receive different PACS company data/ PACS to PACS translation (Insignia) WEBbased return of reports Portable video conferencing- on 3G networks or via broadband- liaising with Kingston University Robotic Ultrasound - assessment

  25. THE VIRTUAL NIGHT HOSPITALWAY FORWARD IF ANY HOSPITALS WITH PACS ARE INTERESTED IN CONTRIBUTING TO A PILOT STUDY OF THIS CONCEPT- PLEASE CONTACT MYSELF OR DAVID POWELL (PROJECT LEADER FOR THE BECaD) philip.shorvon@nwlh.nhs.uk david.powell@nwlh.nhs.uk Or Mary McKenna on 02084532270

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