Telehealth for Acute and Urgent Care
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1 Telehealth for Acute and Urgent Care the Andrew Waring, Consultant, Serengeti Projects Ltd
2 Agenda Individual and workshop introductions and objectives Benefits Chronic Telehealth Benefits Acute and Urgent Telehealth Benefits Requirements Clinical Requirements Monitoring Requirements Timescales and Logistics Challenges, Ambition and Culture Questions
3 Right Right Right Objectives Equipment Place Learning Objectives are: Time Understanding the prize and business case Understanding, recognising and overcoming the barriers to the perfect solution Understanding the level of ambition that is needed
4 Outcomes Able to work with local commissioners to develop the requirements for a Telehealth solution aimed at acute and urgent care requirements Able to work with local commissioners to develop the business case for an acute or urgent care Telehealth solution such as Hospital at Home Understanding of the key change management and transformation challenges and opportunities facing an acute or urgent care Telehealth solution such as Hospital at Home
5 Andrew Waring Benefits-led project and programme delivery in the NHS In conjunction with NHS South, Central and West Commissioning Support Unit, currently delivering three TECS projects for NHS clients: Acute care Hospital at Home Telemonitoring in support of admission avoidance and early discharge associated with an acute spell Urgent care Remote consultations for Care Home patients Strategy development of a strategic plan and blueprint to guide a health and social care economy as it exploits the latest developments in TECS Initial career in engineering Ground breaking care model work led to his involvement in the Whole System Demonstrator (WSD) programme and a contributor to Technology Enabled Care Services (TECS) programmes at scale as well as smaller, specialist deployments Draws upon change, high-tech logistics, clinical and information governance experience to deliver a successful TECS project Contact: andrew.waring@serengetiprojects.net
6 Chronic Telehealth What are the benefits of Telehealth solutions for patients with chronic conditions? What are the requirements that chronic-illness-focussed Telehealth solutions need to meet?
7 Chronic Requirements Benefits Improve clinical safety for patients living at home Reduce provider s block contract costs Reduce costs for commissioners Requirements Remote monitoring Look for trends Communications Education Deployed/installed for months and even years Logistics timescales measured in days
8 Acute and Urgent Telehealth What would be the benefits of Telehealth solutions for patients with: Acute care needs? Urgent care needs? What are the requirements that need to be met by Telehealth solutions: In an acute care setting? In an urgent care setting?
9 The Acute Scenario 30 bed virtual ward: Receiving referrals from medical wards (early supported discharge cases) Receiving referrals from the emergency department and acute medical unit (admission avoidance cases) 1,500 patients per year Patients home within 4 hours of attending ED/AMU Target maximum length of stay 5 days Dedicated nursing resource Consultant led virtual ward rounds Patient participation in ward rounds Medical responsibility remains with Acute Trust
10 The Urgent Scenario Remote consultation for 50 care/nursing homes: Reduces the risk of unnecessary ED attendance and hospital admissions Reduces the time taken for a medical consultation by OOH and by patients own GPs Allows high quality, structured observations to be made available to the medic before visiting patient Can remove the need for a visit by OOH/GP and allow remote consultation instead Allows short term monitoring of vital observations
11 Urgent and Acute Benefits Similar to patients with chronic requirements: Admissions avoided and early discharge Reduced risk of hospital acquired infections Improved patient choice Much better financials Requirements: Improved range of observations Increased frequency and depth of observations
12 The Urgent and Acute Requirements Clinical requirements Acute infections *** Acute pain Cardio-vascular disease Dehydration Delirium (mild) Gastroenteritis Inflammatory disease (acute exacerbations) Respiratory disease (acute exacerbations) Secondary complications
13 Monitoring Requirements Core vital sign observations: Blood Pressure O2 Sats Pulse Respiration rate Temperature Additional observations: Blood glucose Heart rate Peak flow Weight Qualitative ***
14 Qualitative Requirements COPD questionnaire Heart Failure questionnaire Meds compliance Mental health Mobility Pain Urology Wellbeing Unscheduled observations
15 Timescale Requirements Referral timescales measured in hours Deployed for days at a time Logistics timescales measured in hours Implications for stock levels
16 Challenges, Ambition and Culture Usual Telehealth challenges: Cynical view of the benefits of Telehealth Competition for funds Benefits distribution between winners and losers Systems and information integration and governance Additional challenges: Vendors acute capability Staff capability and capacity Logistics capability and capacity Finding appropriate clinical leadership (acute and urgent)
17 Challenges, Ambition and Culture Telehealth is typically seen as technical and therefore much less important than the clinical perspective Telehealth doesn t deliver direct benefits. It s the revised care model that delivers Clinician s need to be prepared to revise the care model to do new things and stop doing the things that are no longer needed Requires cross health economy collaboration Willingness to accept that Telehealth improves patient safety and clinicians efficiency and effectiveness: Often seen as a criticism of clinicians Can result in a refusal to properly debate the options Which undermines the business case
18 Finally Any Questions? As you think of questions in future:
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