Care via video: telemedicine saves money and frees up time
A hospital trust in Yorkshire has expanded its telemedicine service so that outpatient appointments can be conducted with people in a range of settings, from prisons to care homes.
A hospital trust in Yorkshire has expanded its telemedicine service so that outpatient appointments can be conducted with people in a range of settings, from prisons to care homes
More than a decade ago, Airedale NHS Foundation Trust in West Yorkshire began using a video link to deliver consultations to prisoners at a high-security jail.
It meant prisoners no longer had to be escorted to the outpatient department. ‘Being handcuffed to a prison officer was embarrassing and sometimes the outpatient department would have to be closed to the public, so it was very disruptive too,’ says Rachel Binks, nurse consultant for digital and acute care at the trust.
The technology worked so well that hospital staff began to think about whether it could be used to improve care for other groups of patients, particularly those with long-term conditions such as heart failure and diabetes.
‘Patients would often feel frustrated that they had a long drive to hospital, where they had a verbal consultation with a consultant but no physical examination,’ says Ms Binks. ‘Some would question why they’d had to travel all that way when they were managing their condition very well at home.’
‘It works for the vast majority of consultations, unless you need to be hands-on’
The trust began offering telemedicine to people in their own homes, involving a consultation and assessment with clinical staff via video. ‘No one needs to travel anywhere, saving a huge amount of time and money,’ says Ms Binks. ‘It works for the vast majority of consultations, unless you need to be hands-on. But even then, a prior assessment or follow-up appointment can be done remotely.’
In the most recent development, the trust has joined forces with a commercial company, Involve, to provide a range of telemedicine services for more than 500 care homes, as well as to the prison and to people in their own homes.
The services are run from a telemedicine hub based in a refurbished ward at Airedale General Hospital. ‘Nurses come to work here each day as if they were on any other ward,’ says Ms Binks.
It is a 24-hour service, and includes GP triage, with healthcare professionals remotely advising whether a GP visit is necessary. ‘More than half the time we can deal with what’s wrong ourselves, without a GP being needed,’ she says.
Staff also refer patients to other professionals, including practice or palliative care nurses. ‘And we can bring them directly to hospital if they need to come in,’ says Ms Binks.
For overstretched GPs the service has been invaluable, helping them to better manage their workload. ‘Our service aims to enhance what’s already there, not replace it,’ says Ms Binks. ‘But we’re trying to make what’s in place much more efficient, by filtering out inappropriate visits.’
Initially patients had mixed reactions, she admits, with some insisting on seeing their GP. ‘It’s about getting people used to the idea,’ she says. ‘Look back 50 or 60 years ago and people were wary of telephones, but now everyone has them. It’s the same, and this will become normal.’
‘Nurses have to get their heads round it, because even if they’re not using social media themselves, their patients and their families will be’
Other challenges include unreliable technology, especially in rural areas, and the reluctance of some patients to use it. ‘We explain that we can do a much better assessment if we can see them,’ says Ms Binks. ‘In nursing homes, if we can keep the patient in their own bed rather than moving them to a hospital it’s much less stressful.’
Being part of the digital revolution doesn’t have to be about cutting-edge technology. Calvin Moorley, a senior lecturer in adult nursing at London South Bank University (LSBU), says it’s up to every nurse to make the most of social media to enhance their professionalism.
‘Nursing was one of the first professions to begin to lead with social media, adopting it for knowledge exchange and health development,’ says Dr Moorley. ‘But we’re now being overtaken. I think it’s because we tell nurses what they can’t do rather than what they can.’
To bridge the knowledge gap, LSBU provides a two-day social media training course for first-year undergraduate nursing students, which looks at how to use it responsibly. ‘Social media is here. It’s how we use it,’ he says. ‘It’s an easy platform to keep us connected. There’s a huge conversation out there and we can contribute.’
Alongside informing health promotion, social media can also help to identify and share good practice, with nurses playing a key role in ensuring that patients and their loved ones access accurate information.
‘Nurses have to get their heads round it, because even if they’re not using social media themselves, their patients and their families will be,’ says Dr Moorley. ‘They will pick up bits of information from various sources but perhaps not all the facts. That’s where our experience as highly skilled nurses comes in.’
‘One-to-one counselling isn’t the only solution’
Carrying out interviews with young people as part of her postgraduate studies led mental health nurse Emma Selby in a direction she could never have imagined.
‘Long before young people come to our services they search Google for help,’ says Ms Selby, a clinical nurse specialist in the emotional well-being and mental health service at NELFT NHS Foundation Trust in Essex. ‘But what they find is sometimes neither right nor safe.’
Recognising a growing need for better adolescent mental health care, she has been seconded to lead the development of her MyMind app, which launches this autumn alongside a website.
By sign-posting users to thoroughly checked sources of information and support at an early stage, she hopes to increase young people’s resilience and means of self-help, possibly reducing the numbers needing a referral to mental health services.
‘I want young people to become more aware of the online help that’s available,’ says Ms Selby. ‘We need to move away from the idea that if you have a mental health problem one-to-one counselling is the only solution.’ The app also enables service users to manage their recovery, with appointment reminders, access to care plans and video messaging.
Young people have been central to the project throughout, helping to influence the app’s design and the language that is used. ‘For instance, when I would talk about depression, they would say that it means being sad or in a low mood,’ says Ms Selby.
Indeed, finding a common language proved to be one of the biggest challenges, with young people, clinicians and IT specialists working alongside each other to create the end product. ‘Often none of us could understand each other. But the only way it could be clinically effective was if everyone came together,’ she says.
Some were initially critical of her involvement. ‘Nobody quite believed a nurse should be doing this,’ says Ms Selby.
‘I can’t code and I can’t build a website. But if we allow someone who has never worked with patients to design a system for them, then it won’t work. This is not what I imagined I’d be doing when I went to university – but it’s a really interesting place to be.’
How to embrace digital healthcare
- Recognise that digital healthcare is here to stay, so embrace its benefits, advises Ms Binks. ‘You do your Christmas shopping online, and this is no more difficult,’ she says. ‘Support each other to use systems that make our workload lighter, but just as high quality. Lead the change and make it happen.’
- Think of social media as a freely available professional development tool, says Dr Moorley. ‘You can access it wherever you are, sharing experiences and knowledge.’
- Acknowledge that anything new and different can be challenging initially. ‘It’s understandable to be a bit afraid at first,’ says Ms Selby. ‘Remember when you took your first set of bloods how nervous you were.’
Lynne Pearce is a freelance health journalist