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

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care homes – onward referrals

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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