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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
Rachel Binks, Nurse Consultant - Acute and Digital CareAiredale NHSFT
The Art of the Possible - Enabling Care Homes with Technology
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
telehealth, e health,digital health…..
Telecare Telecoaching Telemonitoring
Teleconsultation
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
right care today
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 record connecting primary & secondary care now connecting whole health & social care economy tomorrow
0100
200300
400500
600700
Acute Admissions 1Year Prior toDeployment ofTelemedicine
Acute Admissions 1Year PostDeployment ofTelemedicine
0
200
400
600
800
1000A&E Attendances 1Year Prior toDeployment ofTelemedicine
A&E Attendances 1Year PostDeployment ofTelemedicine
-5%-14%
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
Key
Care HomesHospicesHospitalsMedical CentresOwn HomesPrisons
replicable model
• 361 Nursing/Residential Care Homes+ 113 in implementation
• Supporting > 14,000 residents
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
• 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
aim of the service
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
activity
9/21/2
015
9/25/2
015
9/29/2015
10/3/2015
10/7/2015
10/11/2015
10/15/2015
10/19/2015
10/23/2015
10/27/2015
10/31/2015
11/4/2015
11/8/2015
11/12/2015
11/16/2015
11/20/2015
11/24/2015
11/28/2015
12/2/2015
12/6/2015
12/10/2015
12/14/2015
12/18/2015
12/22/2015
12/26/2015
12/30/2015
1/3/2016
1/7/2016
1/11/2016
1/15/2016
1/19/2
016
1/23/2016
1/27/2
016
1/31/2
016
2/4/2016
2/8/2016
2/12/2
016
2/16/2
016
2/20/2
016
2/24/2
016
2/28/2
016
3/3/2016
3/7/2016
3/11/2
0160
50
100
150
200
250
300
350
400
450Calls Chargeable Calls Total GP Triage Number of homes live
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
what would you have done?W
/C 0
7/12
/201
5
W/C
14/
12/2
015
W/C
21/
12/2
015
W/C
28/
12/2
015
W/C
04/
01/2
016
W/C
11/
01/2
016
W/C
18/
01/2
016
W/C
25/
01/2
016
W/C
01/
02/2
016
W/C
08/
02/2
016
W/C
15/
02/2
016
W/C
22/
02/2
016
W/C
29/
02/2
016
W/C
07/
03/2
016
W/C
14/
03/2
016
0
50
100
150
200
250
300
350
Called an ambulanceContacted a GPContacted a community nurseDone nothingQuestion not asked (follow up etc)
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
512; 9%
3887; 70%
238; 4%
229; 4%
661; 12%
Called an ambulanceContacted a GPContacted a community nurseDone nothingQuestion not asked (follow up etc)
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
actual GP referrals
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb0%
10%
20%
30%
40%
50%
60%
70%
80%
Referred to OOH GP %
Referred to In Hours GP %
Referred GP (both In & Out of Hours ) %
Question response - Would have called a GP (average)
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
actual call outcomes
Admitted to Hospice
Admitted to Hospital
Ambulance Called To Assess
Patient remained in place of res-idence
Referral to A & E Department
Reported Death
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
care homes - call outcomes
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
care homes – onward referrals
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
innovation potential
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
remote training and clinical support?• 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 out patient clinics
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
what is the gold line? 24/7 service for any patient thought to be in the
last year of life - and their carers Linked to entry onto Gold Standards Framework Mostly a telephone service with addition of
video-consultation for a subgroup Designed with and for patients approaching end
of life Developed in partnership Health Foundation shared purpose grant
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
call outcomes
Disposition after call, year ending Oct 20156515 calls, 475 to report death, of the 6040 remaining:
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
Avoidance Outcomes – Oct 2014 – Sept 2015 Totals
Admission Avoided 118
A&E Attendance Avoided 231
GP Visit Avoided 438
Community Nurse Visit Avoided 228
goldline impact
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
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%
data from End of Life Care Profiles PHEand District wide reporting (CSU)
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
patient and carer feedback
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
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
Other services delivered from the digital care hub
• GP Triage• Intermediate Care Hub• Acute Care Team• Single Point of Access• Complex Care Team
Shared record
Registered practitioners
Visual contact