Download - Innovation in community nursing
Rachel Binks
Nurse Consultant – Digital & Acute Care
Airedale NHS Foundation Trust
Telehealth,
e health,
digital health…..
Telecare
Telemonitoring
Teleconsultation
Tele care
Tele monitoring
tele medicine
tele coaching
Tele coaching
tele medicine
Tele medicine
a system designed by default
some people seem to do
quite well without
waiting for healthcare
support……
Telehealth Hub
• 24/7 working
• Experienced nurses
• 2nd tier - physician
• Shared Electronic
health records
• Resilient infrastructure
• Opened September 2011 – now
supports >3000 people
• www.immedicare.co.uk
The Aim of the Service
• Provide, safe, effective high standards of care
• To support residents to stay at home
• Support residents/nurses/carers in the planning, and
delivery of care
• Escalate to community teams out of hours
providing remote consultant opinion to the
English prison service
supporting elderly patients with long term
conditions in their own homes, nursing and
residential care homes via Telehealth HUB
developing the support of rural communities with
community based remote outpatient
consultations and remote out patient care for
patients in residential and care homes
Bringing healthcare home
Providing Telemedicine To:
•3000 Patients
•200 Care homes in:
Airedale, Wharfedale, Craven,
Bradford
Calderdale & Huddersfield
Cumbria
East Lancashire
Dartford & Gravesham
Coventry
•70 Patients with long term diseases in own home
Nothing is ever new…
• Custodial health care
8 year programme
Live in 20 prisons
Significant change in patient flow
735 consultations past 12 months
Teleconsultation at Airedale
Applications
Case studies
• Chronic chest disease
patient at their own home
– “frequent flyer”
• Care home resident – fall
• COPD patient – acutely ill
Case Studies
• Stroke
• CPR
• Head injury
• Unwitnessed fall nose & lip laceration
• Unwitnessed fall (shoulder injury)
Technical infrastructure?
Information Governance?
Clinical Governance?
Medico-Legal?
SystmOne, EMIS?
Prescribing? Consent?
SystmOne – Shared Record
• Shared record between the hub, and other services
involved in the residents care
• Consent obtained from resident/best interest
decision form
• Consultation flagged to GP, and other services
When Admission to Hospital is Required
• Streamlined process
• Avoiding A&E where ever possible
• Supporting the resident, and their carer until the
ambulance arrives, via the video link
Care homes – summary results (2011-2012)
(n=17)
Care Homes (continued 2013-2014)
-53%
-59%
-35%
Call outcomes
Call outcomes
Results: 24 hr teleconsults to 26 patients
with COPD (at home) – 1 year pre/post
Video system displays via home TV
Patients measure their Oxygen / Peak
Flow
Typically have “rescue” meds at home
-45%
Call numbers 2012 „v‟ 2013
Nurse led triage is the norm
Feedback
“Definitely has reduced
admission rates. Telemedicine
is an asset to the home with
benefits Out Of Hours and
weekends”
“Telemedicine became our lifeline – what a
wonderful piece of equipment!
“At the press of a button we could have face-to-face contact with a
medical team, which is so important for both a patient and carer, and
that helped to keep Geoff’s spirits high…”
“The Doctor was fantastic when one of our
dementia patients fell and hurt herself. I would
have called an ambulance and she would have
endured an A&E visit which would have terrified
her. Your consultant saved her from this and
reassured me that the cut was superficial and she
was fine...”
“The Telehealth Hub came into its own last winter when snow and ice
brought traffic to a halt. My Husband’s condition deteriorated suddenly,
and having visual, instant contact with the team was very reassuring. A
wonderful service.”
GP Triage Calls
• Clinical assessment by Hub nurse
• Onward refer if required to HCP for home visit
• Request prescription
• GP surgery informed by NHS secure mail
Remember - we are transforming healthcare
for our children…. So “design for tomorrow,
not today”
What Are We Waiting For?
“Jeremy Hunt @Jeremy_Hunt 3h Just been 2 Airedale hosp & seen
some of best tech anywhere in NHS including digital patient records
shared with GPs - and gr8 patient care”
Questions?