integrating telemedicine into mental health care and rachel... · complex care team other services...

E n h a n c e d h e a l t h i n c a r e h o m e s

Airedale and Partners

Enhanced Health in Care Homes Vanguard

Integrating Telemedicine into mental Health Care– learning from a Care Homes Vanguard

Rachel BinksNurse Consultant – Digital & Acute CareAiredale NHS Foundation Trust

Martin FordVanguard Programme ManagerAiredale & Partners




Telecare

Telecoaching

Telemonitoring

Teleconsultation

Digital Health




A system designed by default

Some people seem to do quite well without waiting for healthcare support…




Teleconsultation Prison health care

Care at home

Nursing & residential care

Supporting end of life patients

24/7 clinical hub

improving patient experience

changing patient flow

reducing costs

Electronic shared recordconnecting primary & secondary care now

connecting whole health & social care economy tomorrow

right care today




right time – care anywhere




right place - replicable model

475 Nursing/Residential Care Homes + 50 in implementation

Supporting > 14,000 residents

NEWCASTLE

LEEDS

MANCHESTER

BIRMINGHAM

LONDON




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

Aims of the service




Gold Line

GP Triage

Intermediate Care Hub

Acute Care Team

Single Point of Access

Complex Care Team

Other services delivered from the digital care hub

Shared record

Registered practitioners

Visual contact




Clinical assessment by Hub nurse

Onward refer if required to HCP for home visit

Request prescription

GP surgery informed by NHS secure mail

GP triage




http://www.health.org.uk/gold-line

http://www.airedale-trust.nhs.uk/services/telemedicine/

Video insight into our telemedicine and Gold Line Service

http://www.health.org.uk/gold-line

http://www.airedale-trust.nhs.uk/services/telemedicine/




Data from End of Life Care Profiles PHE and district wide reporting (CSU)

National data England 2013

AWC 2013 Bradford District 2013

Bradford City 2013

GSF/Gold LineYear 2013/14

All deaths in hospital

48.3 36.0 45.9 50.4 14%

All deaths at home

22.4 20.1 24.5 23.1 41%

All deaths in care homes

21.6 33.2 19.0 19.7 22%

All deaths in hospice

5.5% 8.8 8.3 4.6 23%




Call sheet




ReportingNursing Homes

Residential Homes

Day Current Month

Last Month

% Variance

YTD Day Current Month

Last Month

% Variance

YTD

Monday 128 85 51% ↑ 213 Monday 194 153 27% ↑ 347

Tuesday 117 74 58% ↑ 191 Tuesday 174 121 44% ↑ 295

Wednesday 83 83 0 ↔ 166 Wednesday 152 121 26% ↑ 273

Thursday 76 79 4% ↓ 155 Thursday 128 104 23% ↑ 232

Friday 88 108 19% ↓ 196 Friday 145 160 9% ↓ 305

Saturday 106 107 1% ↓ 213 Saturday 153 174 12% ↓ 327

Sunday 110 76 45% ↑ 186 Sunday 197 108 82% ↑ 305 Time Current

MonthLast

Month%

VarianceYTD Time Current

MonthLast

Month%

VarianceYTD

Morning 295 255 16% ↑ 550 Morning 456 379 20% ↑ 835

Afternoon 413 357 16% ↑ 770 Afternoon 687 562 22% ↑ 1,249

Hours Current Month

Last Month

% Variance

YTD Hours Current Month

Last Month

% Variance

YTD

In Hours 344 329 5% ↑ 673 In Hours 466 419 11% ↑ 885

Out Of Hours 364 283 29% ↑ 647 Out Of Hours 677 522 30% ↑ 1,199

Total 708 612 1143 941




Reason for callNursing Homes Residential Home

Purpose Current Last % Variance YTD Current Last % Variance YTD

Advance Plan/DNAR 0 0 0 ↔ 0 0 0 0 ↔ 0

Agitation/Confusion 0 0 0 ↔ 0 0 0 0 ↔ 0

Anxiety 1 4 75% ↓ 5 8 11 27% ↓ 19

Bowel concerns 0 0 0 ↔ 0 1 0 100% ↑ 1

Breathing difficulties 18 14 29% ↑ 32 31 17 82% ↑ 48

Catheter concern 12 10 20% ↑ 22 26 22 18% ↑ 48

Cerebral event 1 0 100% ↑ 1 0 0 0 ↔ 0

Chest infection 75 65 15% ↑ 140 68 46 48% ↑ 114

Chest pain 2 0 100% ↑ 2 7 9 22% ↓ 16

Death 0 0 0 ↔ 0 0 0 0 ↔ 0

Dehydration 12 6 100% ↑ 18 24 7 243% ↑ 31

Emotional distress 7 4 75% ↑ 11 6 8 25% ↓ 14

EOL Symptoms 0 0 0 ↔ 0 0 0 0 ↔ 0

Eye Infection (eye) 8 9 11% ↓ 17 21 7 200% ↑ 28

Falls 49 31 58% ↑ 80 119 91 31% ↑ 210

General Deterioration 0 0 0 ↔ 0 0 0 0 ↔ 0

Head Injury 0 0 0 ↔ 0 0 0 0 ↔ 0

Medication issue 0 0 0 ↔ 0 1 0 100% ↑ 1

Nausea 4 1 300% ↑ 5 6 5 20% ↑ 11

Other 239 197 21% ↑ 436 398 251 59% ↑ 649

Pain Management 39 24 63% ↑ 63 68 50 36% ↑ 118

Seizure 5 5 0 ↔ 10 10 3 233% ↑ 13

Skin complaints 86 25 244% ↑ 111 106 86 23% ↑ 192

UTI (suspected) 68 41 66% ↑ 109 109 76 43% ↑ 185

Vomiting 13 10 30% ↑ 23 18 10 80% ↑ 28

Wound care 11 5 120% ↑ 16 17 30 43% ↓ 47




Outcome of calls

Nursing Homes Residential Homes

Referral Current Month

Last Month

% Variance YTDCurrent Month

Last Month

% Variance YTD

collaborative care team 0 1 100% ↓ 1 0 3 100% ↓ 3

community matron 2 3 33% ↓ 5 4 12 67% ↓ 16

district nurse 12 5 140% ↑ 17 60 72 17% ↓ 132

palliative care service 0 1 100% ↓ 1 0 0 0 ↔ 0

palliative care physician 0 0 0 ↔ 0 0 1 100% ↓ 1

Referral to social services 0 1 100% ↓ 1 0 0 0 ↔ 0

Referral to GP 224 204 10% ↑ 428 258 223 16% ↑ 481

GP out of hours service 170 115 48% ↑ 285 209 152 38% ↑ 361

Intention (would have) Current Month

Last Month


Last Month

% Variance YTD

called their GP 509 342 49% ↑ 851 721 509 42% ↑ 1,230

attended A&E or called an ambulance 56 38 47% ↑ 94 85 68 25% ↑ 153

contacted community nursing 8 9 11% ↓ 17 69 58 19% ↑ 127

Not have contacted an alternative healthcare provider

20 6 233% ↑ 26 32 18 78% ↑ 50

Not applicable 57 56 2% ↑ 113 137 76 80% ↑ 213

Outcome Current Month

Last Month


Last Month

% Variance YTD

Patient remained in place of residence 618 527 17% ↑ 1,145 1,018 779 31% ↑ 1,797

Ambulance request for patient 83 65 28% ↑ 148 123 110 12% ↑ 233

Hospital notified of death 7 2 250% ↑ 9 9 9 0 ↔ 18




What would you have done?




Actual GP referrals




Random 30 cases audit for GP Triage Homes in September

• 53% for GP Visit

• 20% Medication review

• 20% Prescription

• 2% Advanced Care Planning

• 5% other

Reason for Hub on-referral to GP




Impact …



Enhanced Health in Care Homes VanguardCare Homes in Bradford and Airedalecirca 130 homes Impact Warning data not yet validated

Demonstrates circa 33% reduction in A&E attendances 12 months after installation

A wide range of home installation dates are all aligned as month 0



Enhanced Health in Care Homes VanguardCare Homes in Bradford and Airedalecirca 130 homes Impact Warning data not yet validated

A wide range of home installation dates are all aligned as month 0

Demonstrates circa 25% reduction in admissions via A&E 12 months after installation




Forecast impact of Full GP Triage Telemedicine Service to 70 Care Homes in Anytown CCG

Savings Area Impact Saving FYE

AMBULANCE CALL OUTS

(Calculation based on NW

Ambulance Data

comparing 50 homes with

Telemedicine and 50 without)

1 fewer ambulance calls outs per care home per month based on typical 83% conveyance rate @ £230 journey

£ 200k

A&E ATTENDS(on forecast ambulance data)

1 fewer A&E attends per care home per month @ £126

£ 10k

NON ELECTIVE

ADMISSIONS(on forecast ambulance data)

0.67 fewer admissions per care home per month based on typical 67% admission rate@ £2,258 per admission

£1,271

GP VISITS

(Digital Hub Counterfactual Vanguard Homes)

3,760 GP visit requests annually @ £40 unit cost

£ 150k

Illustrative Business Case

not all cash releasing

Total Saving

Service cost

Net Saving

£1,630k£ 504k£1,126k




Organisation Date Title

Healthwatch 2016 Telemedicine in Care Homes: A Qualitative Evaluation

NHS England 2016 Top 100 Care Homes Ambulance Conveyance

SS CCG 2016 Care Home Innovation Programme (CHIP)

Lancashire County Council

2016 Analysis of NWAS call outs to care homes – older people service user category

East Lancashire District North West Ambulance Service

2015 NWAS Cost savings per care home data

Airedale Digital Hub 2016 Audit of 30 GP referrals for Pendle Care Homes

Bain & Co 2016 Detail to support development of Vanguard Hypothesis Generation

Airedale Vanguard 2016 Value Proposition

AWC CCG/ANHSFT 2015 AWC Review of case notes to assess effectiveness of TM

Airedale Digital Hub 2016 Telehealth Jan 2016 current awareness

Airedale 2016 Bringing Healthcare Home. Final Report. Health Foundation. Shared Purpose

YHEC 201520152016

Telemedicine Service Evaluation and Economic Modelling Telemedicine in care homes in AWC. Clinical GovernanceEvauation of a Pilot project for the implementation of TM in CH in Bradford

Airedale Telemedicine Studies & Reports(Report used in impact forecast highlighted)




"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 feedback




“The innovation that telemedicine promises is not just doing the same thing remotely that used to be done face to face, but awakening us to the many things that we thought required face to face contact, but actually do not.”

David D Asch MD, MBA, Perelman School of Medicine, University of Pennsylvania

Innovation potential




• Link to the Mental Health Trust

• Advise for physical health issues

• Advice for mental health issues

• Access to experts

• Visual contact for both teams

Potential Outcomes

• Reduced attendance to ED

• Reduced admissions

• Clinical Support and Advise for both teams to enable immediate robust assessment and care

Mental Health First Response




• Team can access hub

• Team can access each other

• Access to First Response hub

• Access to Digital Care Hub

• Remote consultation and

appointments

Potential Outcomes

• Reduced travel

• Immediate response

• Reduction in crisis calls

Care Home Liaison Project




Support for care home staff using the VTR

Support for DNs and community teams – do they need to attend?

Overview and clinical support of care home staff developing enhanced roles

Remote outpatient clinics

Remote training and clinical support




Technology Enabled Health – the art of the possible…

Questions

integrating telemedicine into mental health care and rachel... · complex care team other services...

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