videoconferencing in the welsh health service experience of the south west wales cancer network and...
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Videoconferencing in the
Welsh Health Service
Experience of the
South West Wales Cancer Network
and Hywel Dda Health Board
Delyth LewisTelemedicine Service Manager South West Wales Cancer Network
and Hywel Dda Health Board
Introduction
• Requirement to achieve compliance with National Cancer Standards in Wales
• Meet challenges of delivering healthcare in rural Wales
• Response to clinical needs
National Cancer Standards
Calman Hine Report 1995 Cameron Report 1996 (recommendations)
Cancer Centres Cancer Units Multidisciplinary Teams Cancer Networks Minimum Standards
Keeping Care Local (KCL) Feasibility Study, 1998 Reducing unnecessary travelling for patients and staff Forming electronic links with specialist centres and centres of
excellence Creating educational links with others to overcome clinical
isolation
Cancer Unit and Cancer Centre 75 miles apart
Road infrastructure is poor - 4 hours travelling time by car
Long distances for patients/staff to travel
Poor public transport –Limited bus serviceNo rail links
South West Wales Cancer Network covers a large geographical area – combination of inner city, urban and small dispersed rural populations.
Challenges
Aims
Telemedicine in routine use in Ceredigion and South WestWales over last ten years.
Main aims:
• keep care local as much as possible
• reduce travelling for patients and health professionals
• improve the quality of care.
Examples of uses of videoconferencing
• Clinical use - ‘virtual’ meetings between cancer multidisciplinary teams in local hospitals and specialist teams in specialist centre.
• Patient videoconsultations – ‘virtual’ clinics
• Transmission of live images for specialist advice, radiology/ histopathology images and echocardiography ultrasound.
• Educational seminars, lectures and professional sessions.
• Management and staff meetings.
• Interviews (national/international).
• Cross video-network links eg Universities, County Council, English Health Authorities and International sites.
• Multi-site and point to point sessions.
(No dedicated videoconferencing suites at NHS sites)
Virtual Cancer Multidisciplinary Team Meetings
• Improved access to specialist opinion• Improved communication• Improved patient care• Achievement of national cancer standards• Efficient Multidisciplinary Teams • Strengthening of clinical networks
Environmental impact of using videoconferencing(one month - one site)
October 2006
October 2007
October 2008*
People using vc 60 90 72
Meetings held 21 30 25
Hours travelling saved 247 330 215
Miles travelling saved 11,176 12,9930 8,737
Travelling expenses saved £4,470 £5,172 £3,249
Total kg CO2 saved 1696kg 2590kg 2039kg
Number of trees required to absorb total kg CO2
31 48 38
*14 excluded from survey – details of car engine/fuel and/or mileage omitted from questionnaire
Palliative Care Telemedicine
Palliative Care
Resource Centre
Dedicated videoconference
suite
Marie Curie Hospice,
South Wales
• Improved community staff support – access to ad hoc advice – weekly videoconference meetings• Reduced the need for staff to travel for advice/support• Extended to palliative care units at:
Ty Bryngwyn - Llanelli, Ty Olwen -Morriston and Y
Bwthyn - Bridgend
Marie Curie Hospice link enabled: • Joint educational meetings and best practice seminars to Consultant Palliative Care Physician and team in South Wales
40 miles
110 miles
Paediatric Cardiac Telemedicine
Transmission of echocardiography images
Singleton Hospital, Swansea
42 miles
1 day
Welsh Health Video Network
(minutes)
• Quicker diagnosis and implementation of treatment plan agreed by a group of experts.
• More efficient use of specialist staff.• Reduced the need for Consultant Cardiologist’s travel to Singleton
Hospital (especially on call).• Lower cost of service delivery due to reduced travel expenses.• Guidance/supervision of newly qualified staff in echocardiography
ultrasound.
University Hospital Wales, Cardiff
Neurology Telemedicine Clinic
• Improved patient access to neurology services - frequency of clinics increased from once every three months to six weekly.• Waiting list eliminated.• Neurologist travel eliminated• Better use of scare resources, eg clinical time.• Improved educational opportunities for staff at remote site.• Opportunity for local physician to discuss neurological
diagnosis/management of patients requiring local assistance from time to time (eg epilepsy).
• Instigated regional neuroscience videoconference meetings with remote site for consultant and trainee education.
Head and Neck Cancer Speech and Language Therapy
Patient videoconsultations to Speech and Language Therapist in tertiary centre for pre and post laryngectomy management (Aberystwyth – Singleton and Withybush – Singleton)
Patient benefits include:• immediate positive verbal feedback• not having to travel for consultations• specialist services closer to home• more relaxed, no anxieties about travelling, weather, parking etc
Welsh Health Video Network
Clinical Pathology ConferencesClinicians use videoconferencing to link into educational,professional and multidisciplinary meetings, eg Interstitial LungDisease Network, Regional Stroke Meetings, Welsh PaediatricNetwork, Nutritional multidisciplinary meetings)
Benefits:• Enables clinicians’ participation in clinical discussion on complex or
interesting cases
• Opportunity to present own patients, share radiology and discuss management with colleagues across Wales (eg Regional Stroke Meetings, Interstitial Lung Disease Network)
• Reduced travelling expenses and clinicians’ time travelling
Need for sites hosting conferences/educational sessions to make videoconferencing available
Management/Educational Use• Multi-site management meetings between health board managers and
locality staff, clinical team leaders and staff working across different sites.
• Cancer Network board meetings.
• Consultants and trainees linking into Paediatric Academic Programme – weekly sessions.
• Tele-lecture between Physician at Bronglais and Swansea medical students.
• Tele-lectures to students on BSc Medical Sciences and Humanities,- Module PM102 Delivering Healthcare at Swansea University and MSc Health Informatics Module at Swansea.
• Nursing staff linking into PGCE lectures at Newport University.
• Nursing students linking into lectures with Carmarthen Trinity College and Swansea University.
Lessons for Universities
• Training for users (including etiquette) to be confident and competent in use.
• Promote potential of videoconferencing. • Introduce videoconferencing techniques into curriculum
of future workforce.• Reliability - network and equipment.• Robust helpdesk support.• Establish easier inter-organisational/network connectivity• Encourage use of videoconferencing for lectures.