Building Partnerships and Reducing Demand through Telemedicine Alex Blake TANP Digital Care Airedale NHS Foundation Trust
Telemedicine Right care, right place, right time What is telemedicine? How does it work? Aims of telemedicine Benefits Impact Challenges
Telemedicine emerging new care model Technology Enabled Health the art of the possible Teleconsultation by secure video link between nursing and residential homes and senior clinicians at Airedale Digital Hub.
The Five Year Forward View Multispecialty Community Providers - moving specialist care out of hospitals into the community Integrated primary and acute care systems - joining up GP, hospital, community and mental health services Enhanced health in care homes - offering older people better, joined up health, care and rehabilitation services Acute care collaboration - local hospitals working together to enhance clinical and financial viability Urgent and emergency care - new approaches to improve the coordination of services & reduce pressure on A&E departments.
Telemedicine Service Hub based at Airedale Hospital staffed by team of 27 senior clinicians 24/7 NHS England Vanguard site (http://www.england.nhs.uk/2015/03/10/new-eraof-patient-care/) Nurse led Service Triage and clinical assessment to residents in nursing and residential homes country wide. (not a logarithm based approach like 111)
Aims right care, right place right time Improve patient experience Empower care home staff through ongoing programme of education, support Avoid unnecessary secondary care contact Reducing GP burden Reducing costs
Making it work primary & secondary care now, connecting whole health & social care economy tomorrow Fully managed technical service utilizing bespoke lap tops with HD cameras and with 4G SIM or Broadband Clinical examination - effective transfer of skills, close partnership with care home staff Sharing best practice, utilizing support network Promoting clear understanding of service Multidisciplinary collaboration across primary and secondary care Access to electronic medical records / electronic directory of services
right place - replicable model NEWCASTLE LEEDS MANCHESTER 475 Nursing/Residential Care Homes + 50 in implementation Supporting > 18,000 residents 19 CCG contracts YTD 18495 clinical video consultations BIRMINGHAM LONDON
What we do? patient centred care Chest Infection UTI Falls Skin complaints Dehydration Syncope/ TIAs Advance planning Medication advice/ prescription request
Benefits of telemedicine 24/7 immediate access to clinical care and advice from comfort of own home More time to perform consultation than average GP Monitoring and follow up Enables holistic, pro active and preventative approach to care Supporting improved access for elderly to enhanced primary care services Education Changing patient flow Supporting a more sustainable local healthcare system Reducing costs
Impact
Patient Outcomes (April 2017 to July 2017) 924, 10% 8,626, 90% Patient remained in place of residence (incl. reported death) Ambulance request for patient
Care Home Manager Telemedicine is brilliant, the staff are always using it, I hardly get any phone calls during the night, as she used to, staff would be lost without it, you know you are passing the responsibility onto Telemedicine.
Impact on GP Services (Month 10 16/17 YTD) Of those who would have called a GP, what referrals were actually made? 96, 2% 2,420, 41% No referrals were made Caller was referred to general practice 3,404, 57% Caller was not referred to general practice but other referrals were made
GP feedback "Of all the changes in the 15 years I have been working this is the greatest change which has reduced workload I can remember. I don't mind the extra "late" duty doc visit as this is more than made up in the drop in other visits. A big thank you to all involved."
GP Triage Working collaboratively across healthcare boundaries Initial point of contact for triage if GP visit requested Managed by telemedicine with advice, monitoring/ follow up Or onward referral GP, DNs, MM Multidisciplinary approach to care bridging gap between primary and secondary care Prescription request
Medication/Prescriptions Nursing Homes Action Current Month Last Month % Variance YTD Advice given 739 678 9% 6,086 Emotional support 0 0 0 2 Advice about medication 78 51 53% 537 Prescription requested from GP 53 64 17% 566 Residential Homes Action Current Month Last Month % Variance YTD Advice given 1,356 1,230 10% 10,173 Emotional support 0 0 0 1 Advice about medication 122 91 34% 838 Prescription requested from GP 104 104 0 818
Non medical prescribing improving access to medicines Early intervention/ reduce waiting time for prescriptions Potentially reduce inappropriate prescribing Monitor dispensing process Medication review Further reduce GP burden Contractual requirement of role
South Sefton CCG Care Homes Innovation Programme
Care Homes in Bradford and Airedale circa 130 homes Impact A wide range of home installation dates are all aligned as month 0 Demonstrates circa 33% reduction in A&E attendances 12 months after installation
Other services delivered from the digital care hub Prison telemedicine service Gold Line Intermediate Care Hub Complex Care Team Registered practitioners Shared record Visual contact
Setting the scene in EoL care Approx. 1% population die each year We need to identify people who are approaching the end of their lives because. Identification leads to opportunities for care planning and improves outcomes Requires skilled communication Most people would prefer to die at home but many still die in hospital
Place of Death 1700 patients with GL died in the year ending March 2016 1380 had place of death recorded and available to us Place of Death Gold Line England (Dec 2015) Home 34% 23% Care Home 25% 22% Hospice 24% 6% Hospital 14% 48%
Onward Referrals from Gold Line Call managed by hub alone 39% DN 36% From 5100 calls, regarding 1813 patients In hours GP 5% OOH GP 17% Pall care CNS Pall care 2% Consultant 1%
% deaths in hospital AWC compared to England 2012-2015 52 Deaths in hospital in AWC CCG and England Q2-Q1 2012-2015 50 48 England 46 44 42 40 38 Airedale (AWC CCG) 36 34
Growing national media interest in what we do
Challenges solution focused IT platform Staffing model Shared medical record Workforce development Braking down barriers
Building on our innovation What will the future look like? New models of care: in some places the future is already emerging, for example in Airedale
Further potential Primary Care enhancement called GP Triage In hours, care homes are prevented from requesting GP visits direct from GP Practices and must make a video-call to the Digital Hub for patient assessment This service is changed at an additional 2,400 per home/year. Currently provided in circa 100 homes in East Lancashire, Dudley and Aylesbury. GP Video access to care homes (extensive trial commencing in East Lancs April 17) MDT conferencing with Community Nurses, GPs, Digital Hub and Care Homes Virtual Training to Care Home Staff (already available in Bradford and Airedale) Provision in patient s own home Identification of patients at high risk of hospital admission or readmission Proactive Digital Hub care management via care plans Linked to Community Nursing and GP care Move equipment between high risk patients at 6 week intervals to improve cost effectiveness Diversion from NHS 111 and 999 Non emergency calls are intercepted and passed to the Digital Hub for assessment and management
Questions Technology Enabled Health the art of the possible