TECHNOLOGY
District nursing in the digital era Rachel Binks
Nurse Consultant, Digital and Acute Care; Clinical Lead, East Lancs Care Homes Vanguard, Airedale NHS Foundation Trust, Airedale General Hospital [email protected]
become a routine part of the care delivered to this cohort of patients, where the practitioners provide immediate clinical consultation rather than an algorithm-based approach such as that delivered by 111. The hub, based at Airedale Hospital, is staffed 24/7 by a team of senior nurses and therapists and also delivers triage and assessment of all requests for GP visits in hours (GP Triage) and a telephone service to patients in their last year of life who are on the Gold Standards Framework (www. goldstandardsframework.org.uk/) (Goldline, www.airedaledigitalcare.nhs.uk/our-services/goldline/). The care homes telemedicine service is a joint venture between a technical provider, Involve VC, and the trust, which provides a fully managed technical service using bespoke laptops with HD cameras and 4G SIM or broadband connectivity.
The role of technology in health care
Telemonitoring
The use of devices to remotely collect and send data from the patient’s home to a central monitoring service. Alerts are managed, triage (clinical and technical) is carried out and where necessary referrals are made
Although a number of terms are frequently considered, they are often confused when discussed and it is important to understand the similarities and differences between each of the services (see Box 1). In 2005 a remote outpatient service was launched with prisons (Careline, www.airedaledigitalcare.nhs.uk/our-services/careline/) to reduce the need for inmates to be moved into hospital settings. This improved safety for the public as high security prisoner movement was reduced and the service was proven to be economically viable, as travel and escorts were not often necessary. As this became more successful, remote emergency department (ED) consultations began and 31 prisons across the country are now supported with a variety of 20 different specialist services, from dermatology to endocrinology and speech and language therapy (SALT) – see case studies at www.airedaledigitalcare.nhs.uk/ case-studies/careline---weighing-in-with-health-advice/.
Telecoaching
A telephone-based health coaching service, delivered by nurse care navigators who have had additional training in motivational interviewing and behaviour change techniques
Why technology benefits community care
Telemedicine
The provision of remote video consultations (in patient’s own home, nursing homes or other community settings) between clinicians and patients to enable clinical review and interventions to minimise the severity of the condition and its potential deterioration
Box 1. Definition of regularly used terms Telehealth
478
Services that use various point-of-care technologies to monitor a patient's physiological status and health conditions. When combined with personalised health education within a chronic disease management programme, it can significantly improve an individual's health and quality of life
In 2011, the telemedicine service expanded to patients with long-term conditions and those residing in nursing and residential homes. Patients with chronic obstructive pulmonary disease (COPD), chronic heart failure, diabetes and those at the end of their lives
© 2017 MA Healthcare Ltd
T
he use of telemedicine in primary care settings will be seen as quaint when looked back upon a few years from now, in the way we might now discuss whether practitioners should ever talk to their patients on the telephone.The idea behind telemedicine is that patients do not always have to be physically in front of practitioners to receive care.The appeal is obvious: travel costs are largely eliminated; care can reach areas without nearby clinicians; for services that can often be delivered asynchronously, such as dermatology, scheduling hassles are reduced. These efficiencies have already been realised in most other settings where we accomplish all kinds of business without face-toface encounters (Asch, 2015). In November 2015, David Asch from the Center for Health Care Innovation at the University of Pennsylvania wrote an editorial in the Annals of Internal Medicine, which stated that ‘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’ (Asch, 2015). In a small district general hospital in West Yorkshire, tele-consultation by secure video link between nursing and residential homes and the Airedale Digital Care Hub has
British Journal of Community Nursing October 2017 Vol 22, No 10 © MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 154.059.124.102 on October 3, 2017. Use for licensed purposes only. No other uses without permission. All rights reserved.
TECHNOLOGY (www.airedaledigitalcare.nhs.uk/case-studies/) had the telemedicine service installed to support them through their illness in their usual place of residence. Evaluation of the intervention demonstrated patients much preferred to be provided with a specialist service remotely, rather than having to make the journey to hospital (Middleton-Green et al, 2016). Community teams, particularly district nurses, were essential in supporting the patient’s management plan if hands-on care was required (Box 2). Digital technology is used to enhance care, not to replace it, and it is therefore essential that the people, systems and process are considered and in place before the addition of technology. During the day the hub team, together with hospital consultants, GPs and community nursing teams, manage the calls to keep people out of hospital and reduce inappropriate attendance at ED. In nursing and residential homes, a laptop is provided which links directly through to the hub and staff can speak to the nurses 24 hours a day. Digital services are expanding NHS Providers, 2015) and telemedicine installations can be a useful addition in many settings: to support busy GP surgeries to enable remote consultations; with hospital specialists to help them decide on the best course of action without the need for the patient to attend hospital; mental health services where patients live in rural locations and specialist nurses can’t always visit as often as they would like; with patients in their own homes where they used to frequent the ED or who have numerous admissions but can be safely cared for at home with remote support; for SALT appointments for patients who need voice coaching and also physiotherapy sessions which can be carried out via the remote link. Care homes (www.airedaledigitalcare.nhs.uk/our-services/immedicare/) across the country, particularly at Vanguard sites (www.england.nhs.uk/ourwork/new-care-models/
Box 2. Evaluation of the digital hub ‘The Telehealth Hub came into its own last winter when snow and ice brought traffic to a halt. My relative’s condition deteriorated suddenly, and having visual, instant contact with the team was very reassuring. A wonderful service.’ ‘I only have one word to describe telehealth – excellent.’ ‘A very good service. It made me feel confident within my job so I could do the best I can for our residents. This service takes the pressure off us as we have access quickly to a health professional…’ ‘The doctor was fantastic when one of our dementia patients fell and hurt herself. I would have called an ambulance and she would have endured an A&E visit which would have terrified her. Our consultant saved her from this and reassured me that the cut was superficial and she was fine...’ ‘Telemedicine became our lifeline – what a wonderful piece of equipment! At the press of a button we could have face-to-face contact with a medical team, which is so important for both a patient and carer, and that helped to keep Geoff’s spirits high…’ Healthwatch Evaluation, Hewitt, 2016
vanguards/care-models/care-homes-sites/) are developing a remote service through telemedicine as distance is no object and the hub can link to the local community teams, GPs and out-of-hours medical services to support these vulnerable patients. The hub uses an electronic records system (TPP SystmOne) which is available across the country and enables access to GP records with patient consent. During a remote assessment, the hub team can be in contact with the patient, carers, community service and ambulance, guaranteeing a robust handover and ensuring all involved are aware of the full history as they attend. Telemedicine is set to revolutionise the services provided to patients in their place of residence, bringing specialist help and advice to their living rooms. As acute hospitals try to reduce bed numbers, prevent unnecessary ED attendances
Before and after pathway review BEFORE
Call for ambulance service
Ambulance staff and equipment is cleared at prison
Escort arranged
Patient escorted to hospital A&E department
Patient seen and treated in A&E under escort
Patient is admitted and bedwatched
Patient returns to prison
© 2017 MA Healthcare Ltd
AFTER Patient taken to telemedicine suite in prison
Online consulation
Treatment decision
Figure 1. Prison pathway, before and after telemedicine
British Journal of Community Nursing October 2017 Vol 22, No 10
479
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 154.059.124.102 on October 3, 2017. Use for licensed purposes only. No other uses without permission. All rights reserved.
and hospital admissions, timely intervention from a senior clinical team prevents deterioration, enables early intervention and allows sensible decisions on future management to be made by the patient and their health care teams.
How district nurses can use technology in their practice As the role of the district nurse becomes ever more complex and demanding, enabling patients to maintain their independence by supporting them to manage long-term conditions and treating acute illnesses will be key to the success of policies that aim to provide more care closer to home. A King’s Fund report (Maybin et al, 2016) investigated what ‘good’ district nursing care looks like from the perspective of people receiving this care, unpaid carers and district nursing staff.They put forward a framework (King’s Fund, 2017) for understanding the components involved, much of which can be supported by the use of technology. The report also looked at the growing demand and the capacity gap in district nursing which needs to be addressed. However, with a reducing available nursing workforce and challenges across the whole system, technology must be better embraced to support patients out of hospital and keep them safely in their place of residence. In terms of the policy ambition to offer ‘more care close to home’, resources, monitoring and oversight have not yet been aligned with the technological advances available and being used by other sectors. The health sector needs to address the lack of engagement with and low uptake of digital technology and focus on innovative ways of plugging these gaps. It is important that the system recognises the vital strategic importance of community health services in realising ambitions for the transformation of the health and social care system. Community services must be involved in, and central to, the development of new care models and sustainability and transformation plans. Pressures are not limited to district nursing; general practice, social care and the voluntary sector also face significant challenges of rising demand at a time of constrained resourcing and capacity. To address such wide-reaching problems, it will be necessary to look beyond each service in isolation and respond in the round, using all aspects of technological innovation to support patients remotely, ensuring only patients who require hands-on care from registered practitioners use that resource and all other support is delivered remotely or by non-registered practitioners supervised remotely.
Examples of technology being used in the community In January 2012,Airedale NHS Foundation Trust (ANHSFT) was successful in a bid to the Health Foundation’s Shared Purpose programme.The bid outlined a project to ‘improve the safety and quality of care for patients undergoing cancer treatment or in the last year of life by providing them with dedicated clinical support in their own home, nursing home, hospice or community hub via telemedicine’.
482
The aim of the project was to deliver a hospital at home service for the most vulnerable patients by delivering clinical care through telemedicine. The bid illustrated 24-hour video links between the patient and clinical or care teams, which enabled patients and families to get the right support while remaining at home. The project also aimed to build greater coordination between corporate and clinical teams and to enhance patient experience with the rationale that health care services need to be more resilient to pressures from rising demand and financial constraints. The project intended to achieve this by delivering more efficient, highquality care to patients and developing more integrated models of care. The Health Foundation provided funding and technical support for three-and-a-half years into 2015 and the main interventions provided through the project were: ww The introduction of an Electronic Palliative Care Coordination System to improve the recording of appropriate information to enhance the care of patients who are in their last year of life ww Training to improve communication skills for clinicians who may care for patients on the end-of-life register ww The introduction of the Gold Line as a single point of contact for patients and carers with the Telehealth Hub at Airedale Hospital In an economic evaluation of the Goldline (Hex and Wright, 2016), it was shown that there was a reduction in the number of hospital bed days used by end-of-life patients as a result of the project interventions and an increased number of patients who were supported to die in their preferred place of death. Airedale continues to have the lowest number of end of life patients die in hospital of any trust in the UK. A number of other enhancements to primary care are being tested using the available technology at Airedale NHSFT.The GP Triage service is being rolled out to enable care homes to only request GP visits following an assessment and triage by a registered practitioner via a video call to the digital hub, to prevent inappropriate visits. GPs and hospital discharge teams are enabled to have video access to care homes via an app on their own device (extensive trial commencing in East Lancashire Care Home Vanguard from August 2017) to encourage video consultation and supported discharge home with remote access to practitioners. Multidisciplinary team conferencing with community nurses, GPs, digital hub and care homes is available and virtual training to care home staff is being evaluated as part of the Enhanced Health in Care Homes Vanguard programme led by East Lancashire clinical commissioning group. Provision in patient’s own home is beginning with the identification of patients at high risk of hospital admission or readmission followed by proactive digital hub care management via care plans which are linked to community nursing and GP care. A pilot has also begun where non-emergency calls from care homes are intercepted by NHS 111 and 999 and are diverted to the hub for assessment and management. All these interventions support the RCN ‘every nurse an
© 2017 MA Healthcare Ltd
TECHNOLOGY
British Journal of Community Nursing October 2017 Vol 22, No 10 © MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 154.059.124.102 on October 3, 2017. Use for licensed purposes only. No other uses without permission. All rights reserved.
TECHNOLOGY e-nurse’ campaign, which aligns closely with the national framework for nursing, midwifery and care staff, Leading Change, Adding Value (NHS England, 2016), and particularly commitment 10: ‘championing the use of technology and informatics to improve practice, address unwarranted variation and enhance outcomes’. Nurses must continue to understand and be part of the transformational benefits of technology and remember the key role of nursing, midwifery and care staff, leading, developing and using technology in all care settings (NHS England, 2016). Challenges of interoperability remain, especially in relation to community services, as do digital and data literacy, the need for a common nursing language, and checking that local information governance rules are regularly reviewed to avoid any unnecessary obstruction to the implementation and use of technology. The need to ensure that nursing, midwifery and care staff are involved from an early stage in ensuring that digital applications provide the relevant and appropriate pathways of care for individuals is paramount. BJCN Acknowledgment:Thanks always to the hard-working and dedicated team who staff the digital care hub at Airedale Hospital
Conflict of interest: Airedale NHSFT is in a joint venture with Involve VC, known as ‘Immedicare’ and delivers a managed telemedicine service to more than 500 care homes in the UK Asch DA. The hidden economics of telemedicine. Ann Intern Med. 2015;163(10):801-802. https://doi.org/10.7326/M15-1416 Hewitt R. Airedale and Partners (Vanguard) Telemedicine in Care Homes Service: A Qualitative Evaluation. 2016. http://www.healthwatchbradford. co.uk/sites/default/files/healthwatch_-_telemedicine_in_care_homes_vanguard_qualitative_evaluation_report_final.pdf (accessed 7 September 2017) Hex N, Wright D. Economic Evaluation of the Gold Line: Health Foundation Shared Pur pose Project. 2016. www.airedaledig italcare.nhs.uk/ seecmsfile/?id=36 (accessed 1 September 2017) King’s Fund. A quality framework for district nursing. 2017. https://www. kingsfund.org.uk/sites/default/files/media/District_Nursing_Quality_ Framework_Slides.pdf (accessed 1 September 2017) Middleton-Green L, Gadoud A, Norris B, et al.‘A Friend in the Corner’: supporting people at home in the last year of life via telephone and video consultation – an evaluation. BMJ Support Palliat Care. 2016. https://doi.org/10.1136/ bmjspcare-2015-001016 Maybin J, Charles A, Honeyman M. Understanding quality in district nursing services: Learning from patients, carers and staff. 2016. https://www.kingsfund. org.uk/sites/default/files/field/field_publication_file/quality_district_nursing_aug_2016.pdf (accessed 1 September 2017) NHS England. Leading Change, Adding Value. 2016. https://www.england. nhs.uk/wp-content/uploads/2016/05/nursing-framework.pdf (accessed 1 September 2017) NHS Providers.Telemedicine at Airedale NHS Foundation Trust: Better Care in the Community for Elderly Patients: NHS Providers Summary. 2015. www. airedaledigitalcare.nhs.uk/seecmsfile/?id=33 (accessed 1 September 2017)
Choose the right subscription for you Volume 20 Number 11
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November 2015
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British Journal of Community Nursing October 2017 Vol 22, No 10
483
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 154.059.124.102 on October 3, 2017. Use for licensed purposes only. No other uses without permission. All rights reserved.
District nursing in the digital era Rachel Binks
Nurse Consultant, Digital and Acute Care; Clinical Lead, East Lancs Care Homes Vanguard, Airedale NHS Foundation Trust, Airedale General Hospital [email protected]
become a routine part of the care delivered to this cohort of patients, where the practitioners provide immediate clinical consultation rather than an algorithm-based approach such as that delivered by 111. The hub, based at Airedale Hospital, is staffed 24/7 by a team of senior nurses and therapists and also delivers triage and assessment of all requests for GP visits in hours (GP Triage) and a telephone service to patients in their last year of life who are on the Gold Standards Framework (www. goldstandardsframework.org.uk/) (Goldline, www.airedaledigitalcare.nhs.uk/our-services/goldline/). The care homes telemedicine service is a joint venture between a technical provider, Involve VC, and the trust, which provides a fully managed technical service using bespoke laptops with HD cameras and 4G SIM or broadband connectivity.
The role of technology in health care
Telemonitoring
The use of devices to remotely collect and send data from the patient’s home to a central monitoring service. Alerts are managed, triage (clinical and technical) is carried out and where necessary referrals are made
Although a number of terms are frequently considered, they are often confused when discussed and it is important to understand the similarities and differences between each of the services (see Box 1). In 2005 a remote outpatient service was launched with prisons (Careline, www.airedaledigitalcare.nhs.uk/our-services/careline/) to reduce the need for inmates to be moved into hospital settings. This improved safety for the public as high security prisoner movement was reduced and the service was proven to be economically viable, as travel and escorts were not often necessary. As this became more successful, remote emergency department (ED) consultations began and 31 prisons across the country are now supported with a variety of 20 different specialist services, from dermatology to endocrinology and speech and language therapy (SALT) – see case studies at www.airedaledigitalcare.nhs.uk/ case-studies/careline---weighing-in-with-health-advice/.
Telecoaching
A telephone-based health coaching service, delivered by nurse care navigators who have had additional training in motivational interviewing and behaviour change techniques
Why technology benefits community care
Telemedicine
The provision of remote video consultations (in patient’s own home, nursing homes or other community settings) between clinicians and patients to enable clinical review and interventions to minimise the severity of the condition and its potential deterioration
Box 1. Definition of regularly used terms Telehealth
478
Services that use various point-of-care technologies to monitor a patient's physiological status and health conditions. When combined with personalised health education within a chronic disease management programme, it can significantly improve an individual's health and quality of life
In 2011, the telemedicine service expanded to patients with long-term conditions and those residing in nursing and residential homes. Patients with chronic obstructive pulmonary disease (COPD), chronic heart failure, diabetes and those at the end of their lives
© 2017 MA Healthcare Ltd
T
he use of telemedicine in primary care settings will be seen as quaint when looked back upon a few years from now, in the way we might now discuss whether practitioners should ever talk to their patients on the telephone.The idea behind telemedicine is that patients do not always have to be physically in front of practitioners to receive care.The appeal is obvious: travel costs are largely eliminated; care can reach areas without nearby clinicians; for services that can often be delivered asynchronously, such as dermatology, scheduling hassles are reduced. These efficiencies have already been realised in most other settings where we accomplish all kinds of business without face-toface encounters (Asch, 2015). In November 2015, David Asch from the Center for Health Care Innovation at the University of Pennsylvania wrote an editorial in the Annals of Internal Medicine, which stated that ‘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’ (Asch, 2015). In a small district general hospital in West Yorkshire, tele-consultation by secure video link between nursing and residential homes and the Airedale Digital Care Hub has
British Journal of Community Nursing October 2017 Vol 22, No 10 © MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 154.059.124.102 on October 3, 2017. Use for licensed purposes only. No other uses without permission. All rights reserved.
TECHNOLOGY (www.airedaledigitalcare.nhs.uk/case-studies/) had the telemedicine service installed to support them through their illness in their usual place of residence. Evaluation of the intervention demonstrated patients much preferred to be provided with a specialist service remotely, rather than having to make the journey to hospital (Middleton-Green et al, 2016). Community teams, particularly district nurses, were essential in supporting the patient’s management plan if hands-on care was required (Box 2). Digital technology is used to enhance care, not to replace it, and it is therefore essential that the people, systems and process are considered and in place before the addition of technology. During the day the hub team, together with hospital consultants, GPs and community nursing teams, manage the calls to keep people out of hospital and reduce inappropriate attendance at ED. In nursing and residential homes, a laptop is provided which links directly through to the hub and staff can speak to the nurses 24 hours a day. Digital services are expanding NHS Providers, 2015) and telemedicine installations can be a useful addition in many settings: to support busy GP surgeries to enable remote consultations; with hospital specialists to help them decide on the best course of action without the need for the patient to attend hospital; mental health services where patients live in rural locations and specialist nurses can’t always visit as often as they would like; with patients in their own homes where they used to frequent the ED or who have numerous admissions but can be safely cared for at home with remote support; for SALT appointments for patients who need voice coaching and also physiotherapy sessions which can be carried out via the remote link. Care homes (www.airedaledigitalcare.nhs.uk/our-services/immedicare/) across the country, particularly at Vanguard sites (www.england.nhs.uk/ourwork/new-care-models/
Box 2. Evaluation of the digital hub ‘The Telehealth Hub came into its own last winter when snow and ice brought traffic to a halt. My relative’s condition deteriorated suddenly, and having visual, instant contact with the team was very reassuring. A wonderful service.’ ‘I only have one word to describe telehealth – excellent.’ ‘A very good service. It made me feel confident within my job so I could do the best I can for our residents. This service takes the pressure off us as we have access quickly to a health professional…’ ‘The doctor was fantastic when one of our dementia patients fell and hurt herself. I would have called an ambulance and she would have endured an A&E visit which would have terrified her. Our consultant saved her from this and reassured me that the cut was superficial and she was fine...’ ‘Telemedicine became our lifeline – what a wonderful piece of equipment! At the press of a button we could have face-to-face contact with a medical team, which is so important for both a patient and carer, and that helped to keep Geoff’s spirits high…’ Healthwatch Evaluation, Hewitt, 2016
vanguards/care-models/care-homes-sites/) are developing a remote service through telemedicine as distance is no object and the hub can link to the local community teams, GPs and out-of-hours medical services to support these vulnerable patients. The hub uses an electronic records system (TPP SystmOne) which is available across the country and enables access to GP records with patient consent. During a remote assessment, the hub team can be in contact with the patient, carers, community service and ambulance, guaranteeing a robust handover and ensuring all involved are aware of the full history as they attend. Telemedicine is set to revolutionise the services provided to patients in their place of residence, bringing specialist help and advice to their living rooms. As acute hospitals try to reduce bed numbers, prevent unnecessary ED attendances
Before and after pathway review BEFORE
Call for ambulance service
Ambulance staff and equipment is cleared at prison
Escort arranged
Patient escorted to hospital A&E department
Patient seen and treated in A&E under escort
Patient is admitted and bedwatched
Patient returns to prison
© 2017 MA Healthcare Ltd
AFTER Patient taken to telemedicine suite in prison
Online consulation
Treatment decision
Figure 1. Prison pathway, before and after telemedicine
British Journal of Community Nursing October 2017 Vol 22, No 10
479
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 154.059.124.102 on October 3, 2017. Use for licensed purposes only. No other uses without permission. All rights reserved.
and hospital admissions, timely intervention from a senior clinical team prevents deterioration, enables early intervention and allows sensible decisions on future management to be made by the patient and their health care teams.
How district nurses can use technology in their practice As the role of the district nurse becomes ever more complex and demanding, enabling patients to maintain their independence by supporting them to manage long-term conditions and treating acute illnesses will be key to the success of policies that aim to provide more care closer to home. A King’s Fund report (Maybin et al, 2016) investigated what ‘good’ district nursing care looks like from the perspective of people receiving this care, unpaid carers and district nursing staff.They put forward a framework (King’s Fund, 2017) for understanding the components involved, much of which can be supported by the use of technology. The report also looked at the growing demand and the capacity gap in district nursing which needs to be addressed. However, with a reducing available nursing workforce and challenges across the whole system, technology must be better embraced to support patients out of hospital and keep them safely in their place of residence. In terms of the policy ambition to offer ‘more care close to home’, resources, monitoring and oversight have not yet been aligned with the technological advances available and being used by other sectors. The health sector needs to address the lack of engagement with and low uptake of digital technology and focus on innovative ways of plugging these gaps. It is important that the system recognises the vital strategic importance of community health services in realising ambitions for the transformation of the health and social care system. Community services must be involved in, and central to, the development of new care models and sustainability and transformation plans. Pressures are not limited to district nursing; general practice, social care and the voluntary sector also face significant challenges of rising demand at a time of constrained resourcing and capacity. To address such wide-reaching problems, it will be necessary to look beyond each service in isolation and respond in the round, using all aspects of technological innovation to support patients remotely, ensuring only patients who require hands-on care from registered practitioners use that resource and all other support is delivered remotely or by non-registered practitioners supervised remotely.
Examples of technology being used in the community In January 2012,Airedale NHS Foundation Trust (ANHSFT) was successful in a bid to the Health Foundation’s Shared Purpose programme.The bid outlined a project to ‘improve the safety and quality of care for patients undergoing cancer treatment or in the last year of life by providing them with dedicated clinical support in their own home, nursing home, hospice or community hub via telemedicine’.
482
The aim of the project was to deliver a hospital at home service for the most vulnerable patients by delivering clinical care through telemedicine. The bid illustrated 24-hour video links between the patient and clinical or care teams, which enabled patients and families to get the right support while remaining at home. The project also aimed to build greater coordination between corporate and clinical teams and to enhance patient experience with the rationale that health care services need to be more resilient to pressures from rising demand and financial constraints. The project intended to achieve this by delivering more efficient, highquality care to patients and developing more integrated models of care. The Health Foundation provided funding and technical support for three-and-a-half years into 2015 and the main interventions provided through the project were: ww The introduction of an Electronic Palliative Care Coordination System to improve the recording of appropriate information to enhance the care of patients who are in their last year of life ww Training to improve communication skills for clinicians who may care for patients on the end-of-life register ww The introduction of the Gold Line as a single point of contact for patients and carers with the Telehealth Hub at Airedale Hospital In an economic evaluation of the Goldline (Hex and Wright, 2016), it was shown that there was a reduction in the number of hospital bed days used by end-of-life patients as a result of the project interventions and an increased number of patients who were supported to die in their preferred place of death. Airedale continues to have the lowest number of end of life patients die in hospital of any trust in the UK. A number of other enhancements to primary care are being tested using the available technology at Airedale NHSFT.The GP Triage service is being rolled out to enable care homes to only request GP visits following an assessment and triage by a registered practitioner via a video call to the digital hub, to prevent inappropriate visits. GPs and hospital discharge teams are enabled to have video access to care homes via an app on their own device (extensive trial commencing in East Lancashire Care Home Vanguard from August 2017) to encourage video consultation and supported discharge home with remote access to practitioners. Multidisciplinary team conferencing with community nurses, GPs, digital hub and care homes is available and virtual training to care home staff is being evaluated as part of the Enhanced Health in Care Homes Vanguard programme led by East Lancashire clinical commissioning group. Provision in patient’s own home is beginning with the identification of patients at high risk of hospital admission or readmission followed by proactive digital hub care management via care plans which are linked to community nursing and GP care. A pilot has also begun where non-emergency calls from care homes are intercepted by NHS 111 and 999 and are diverted to the hub for assessment and management. All these interventions support the RCN ‘every nurse an
© 2017 MA Healthcare Ltd
TECHNOLOGY
British Journal of Community Nursing October 2017 Vol 22, No 10 © MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 154.059.124.102 on October 3, 2017. Use for licensed purposes only. No other uses without permission. All rights reserved.
TECHNOLOGY e-nurse’ campaign, which aligns closely with the national framework for nursing, midwifery and care staff, Leading Change, Adding Value (NHS England, 2016), and particularly commitment 10: ‘championing the use of technology and informatics to improve practice, address unwarranted variation and enhance outcomes’. Nurses must continue to understand and be part of the transformational benefits of technology and remember the key role of nursing, midwifery and care staff, leading, developing and using technology in all care settings (NHS England, 2016). Challenges of interoperability remain, especially in relation to community services, as do digital and data literacy, the need for a common nursing language, and checking that local information governance rules are regularly reviewed to avoid any unnecessary obstruction to the implementation and use of technology. The need to ensure that nursing, midwifery and care staff are involved from an early stage in ensuring that digital applications provide the relevant and appropriate pathways of care for individuals is paramount. BJCN Acknowledgment:Thanks always to the hard-working and dedicated team who staff the digital care hub at Airedale Hospital
Conflict of interest: Airedale NHSFT is in a joint venture with Involve VC, known as ‘Immedicare’ and delivers a managed telemedicine service to more than 500 care homes in the UK Asch DA. The hidden economics of telemedicine. Ann Intern Med. 2015;163(10):801-802. https://doi.org/10.7326/M15-1416 Hewitt R. Airedale and Partners (Vanguard) Telemedicine in Care Homes Service: A Qualitative Evaluation. 2016. http://www.healthwatchbradford. co.uk/sites/default/files/healthwatch_-_telemedicine_in_care_homes_vanguard_qualitative_evaluation_report_final.pdf (accessed 7 September 2017) Hex N, Wright D. Economic Evaluation of the Gold Line: Health Foundation Shared Pur pose Project. 2016. www.airedaledig italcare.nhs.uk/ seecmsfile/?id=36 (accessed 1 September 2017) King’s Fund. A quality framework for district nursing. 2017. https://www. kingsfund.org.uk/sites/default/files/media/District_Nursing_Quality_ Framework_Slides.pdf (accessed 1 September 2017) Middleton-Green L, Gadoud A, Norris B, et al.‘A Friend in the Corner’: supporting people at home in the last year of life via telephone and video consultation – an evaluation. BMJ Support Palliat Care. 2016. https://doi.org/10.1136/ bmjspcare-2015-001016 Maybin J, Charles A, Honeyman M. Understanding quality in district nursing services: Learning from patients, carers and staff. 2016. https://www.kingsfund. org.uk/sites/default/files/field/field_publication_file/quality_district_nursing_aug_2016.pdf (accessed 1 September 2017) NHS England. Leading Change, Adding Value. 2016. https://www.england. nhs.uk/wp-content/uploads/2016/05/nursing-framework.pdf (accessed 1 September 2017) NHS Providers.Telemedicine at Airedale NHS Foundation Trust: Better Care in the Community for Elderly Patients: NHS Providers Summary. 2015. www. airedaledigitalcare.nhs.uk/seecmsfile/?id=33 (accessed 1 September 2017)
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