Smarter access to healthcare Telehealth and Paediatrics

1. Smarter access to healthcareTelehealth and Paediatrics Sharon Levy Lorraine Clydesdale Telehealth nurse specialist

2. Once upon a time…. Leanna Three-year-old Leanna has leukaemia and geographical constraints mean that her treatment involves a great deal of travel and separation for her and her family. How could readily available technologies have helped? http://www.patientvoices.org.uk/flv/0109pv384.htm

3. Tele- WHAT????

4. Context: NHS24 Paediatrics LTC Education Stroke SCTT Telecare Infrastructure Mental Health

5. What do we do We are focused on : • promoting, delivering and supporting innovative practice in Paediatric Healthcare, aided by advanced communication technologies • Our live projects include: • Unscheduled Care/ Critical Decision Support • Care at Home • CAMHS • Child Protection • Maternity Telehealth Services • Telehealth for Children – Think Tank

6. Unscheduled Care / Critical Decision Support • Using Telehealth to support Rural Hospitals with Paediatric decision support • Delivering training and raising the profile of Telehealth • Ensuring the transfer of patients happens only when necessary • Investigating the use of Single Point of Contact for Paediatric Support

7. Children with palliative / complex care needs “Caring for children with life limiting or terminal illness in their own home is cheaper and less emotionally stressful for family members than caring for them in hospital” Anne Harris – director of care services at the children’s charity Rainbow Trust Nursing Times 107(18) p7

8. “Telehealth is gaining wide spread acceptance and is perceived to be both usable and acceptable to patients and professionals in palliative care settings” Kidd L, et al., Telehealth in palliative care in the UK: a review of the evidence. Journal of telemedicine and telecare, 2010. 16(7): p. 394 - 402.

9. Yet… Place of death for children with: Neurodisability, Cancer, Neonates, Metabolic, Cardiac, Other Palliative Care Statistics for Children and Young Adults. Department of Health, 2007

10. Care at home To pilot a technology solution that provides a potential for enhanced healthcare communications for patients, parents or carers in their own home To test the infrastructure for supporting video conferencing access from patients' home, or a home like environment, to a suitable service provider To evaluate the benefits obtained and challenges encountered during the pilot and to assess the feasibility of a wider national rollout of a care at home

11. Evaluation: clinicians at Tayside Guy’s Communication Questionnaire (GCQ) • Did you achieve your aims during the consultation? Yes * 8 • In your session, could you see everything you needed to see? Yes * 8 • Could you hear all you needed to hear? Yes * 7 • Would you like to have another session like this again? Yes * 8 • How close did you feel to the person you were talking? Just right * 8 • Comments? Plenty!

12. Benefits • Early benefits included increased parental satisfaction with the service and establishing the cost effectiveness of the intervention. • Parents valued the enhanced support during the difficult end-of-life phase. • The option of accessing the expertise of the clinical team, from home, improved the therapeutic interaction and the sense of ‘partnership’ with the family. • Innovative practice significantly reduced the need for the patient to attend hospital visits and prevented possible admission to the ward. • When the planned care was going well there was less need for home visits and the family experienced an increased sense of being ‘in control’. • The team in Tayside suggest that there were at least 3 occasions where an admission to the ward was averted – one day admission £450 total savings = £1350

13. “… there was a marked deterioration in the condition of the child during a week of extreme weather, were everywhere was covered in snow. The Telemedicine link proved extremely valuable then. Swift and appropriate action was taken following the virtual visit. The team could determine the care and treatment requirements prior to setting off on urgent home visits. Drugs, equipment and appropriate support were provided ‘just in time’ and the impact of such action on the child’s quality of life was remarkable…” Lead consultant NHS Tayside

14. Care at home – complex needs • A number of families were identified by the Scottish Spina Bifida Association and regular remote interactions were progressed: e.g A new born discharged home to Dumfries needing to attend an outpatient clinic in Glasgow some 140 miles away. Four virtual sessions scheduled with parents (and local Health Visitor) where the surgeon was able to: • monitor surgical wound healing and developmental growth, • offer parental education and reassurance, • support local health care providers and ensure continuity of care, and • demonstrate innovative practice to accompanying medical students.

15. Care at home – Being part of the group A number of teenagers in the Grampian area were able to participate remotely with the SSBA Youth club: “ There are no other young people with this condition locally and going to Cumbernauld means a 4 hours drive… so its really good to be able to take part. They are all really friendly and you were able to say anything – it was great!” M age 13

16. Complex needs – returning home The discharge back home ,to remote and rural location, was only considered by J’s family after assurances were given that his wound site will be monitored, remotely, by the surgical team at Royal Aberdeen Children Hospital. For the lively 3 year old that meant going home to familiar surrounding and to be with the people who he loves most. For the parents that meant less time off work and less reliance on informal carer to look after their other 3 children. It also meant far less travelling from the island to hospital for overnight visits. For the NHS the calculated savings, in terms of reduced bed occupancy as an inpatient, is estimated as 1000s of pounds. Real benefits noted by the surgeon and the mother included • Better patient experience • Better coordinated care with local healthcare providers and • Reduction in risks of hospital acquired infection

17. What else??? • NICU • Maternity service • BabyCam • CAMHS • MCN/MSN • Child Protection /Peer Review • Incontinence nurse led tele service • Education and training • Knowledge sharing and transfer • ….

18. Telehealth for Children – Think Tank • Skilled group of clinicians and telehealth specialists • Tasked with identifying solutions which will tackle growing challenges to the Scottish Health Economy • Challenged to identify funding opportunities for new projects

19. Challenges • eHealth and SCTT silo working • National V Local agendas and priorities • Standard setting and governance • Leadership • Change management and transition • Education & training competencies • Risk management and evidence based practice

20. Questions? Sharon Levy S.levy@nhs.net