Transcript The Virtual Clinic: Alternative ways of accessing a specialist opinion Dr. Khalid Khan

The Virtual Clinic:
Alternative ways of accessing a
specialist opinion
Dr. Khalid Khan
Consultant Cardiologist
Betsi Cadwaladr University Health
Board (East)
Betsi Cadwaladr University
Health Board
The Triple Challenge
Increasing
Demand
Reducing
Treatment
Times
Reduced Resources
Demand > Capacity
30% growth in
referrals to
Cardiology in 2yrs
Reducing Treatment Times
Referral
26 week
pathway
Referral
Reduced Resources
Underfunded &
savings expected
Understaffed &
block recruitment
Changing Our Perspective
Traditionally
Patient sees GP
Any Problem
One Solution
(refer to OPD)
Classical Patient Pathway
ENTRY
• Inappropriate/unnecessary referrals & admissions
• Only 2 options: OPD or Admit as emergency
• Often non-specialist intermediaries/services
DURING
• Slow progress: multiple appointments & serial tests
• Multiple (junior) doctors: ‘treading water’
• Poor communication with patient & GPs
AFTER
• ‘Consultant knows best’: annual MOT
• Interminable FU: no plan, no exit strategy
• Lack resolution of original diagnosis/management
Different People Different Needs
Review
Urgent review
or admission
Advice
Reassurance
Referrers Requirements
Spectrum of Needs
Usual OP
appointment
Advice
Simple
Complex
Patient Complexity
What Should a Consultant Do?
A Consultant
should
consult more
See less of
everything
slowly
More of
some things
quickly
Embracing Advancements
Technology &
Communication
• Moving beyond letters & fax
• Email & web
• Mobile technology
Roles &
Responsibilities
• GP manage much more
• Nurse-led clinics
• Consultants should consult more
Medical
Developments
• New modes investigation
• Sub-specialty clinics
• Novel drugs & procedures
A Tailored Cardiology Service
Built around the needs of the
• Patient
• GP
Integrated & flexible
• With other cardiology clinics
• Across primary / secondary care
Deliver more for less
• Time, money & people
• Quicker, quality care
Adaptable to other services
The Virtual Clinic Pathway
50 GP Practices
275,000 patients
Patient Problem, Query, or Concern
Telephone
Email
Letter
Fax
Single Point Entry & Signposting
One-Stop
Cardiology
Clinic
Possible Testing
Specialist
Cardiology
Clinics
Virtual Diagnosis, decision or plan by Cardiology Consultant
Communicated by telephone, email and/or letter
Nurse-Led Triage Referrals
• Cardiology services
complex
• Need for clear
signposting & tracking
• Single point entry for all
referrals
• Speed passage & exit of
patients through ‘maze’
Referral
Treatment
1-STOP Cardiology Clinic
Echo
New
Patients
Bloods
ETT
Tilt Test
24hr BP
Holter
Lung
Novacor
Cardiorespiratory Department
Initial Results from Pilot Study
> 200 new patients dealt with ‘virtually’
Equates to
• 25% of all new patients seen by Consultant
• One new clinic per Consultant per week
Patient Outcomes
• 95% discharged back to GP (not seen in clinic)
• 70% underwent one or more tests
GPs love it!
Virtual Clinic: Email Component
• [email protected]
• Secure
– Patient Name
– NHS Number +/- Hospital number
– Question/Query
– Attachments ECGs etc
• Comprehensive response usually within a
couple of hours (but officially 5 days)
• PAS altered to count this activity including RTT
CURRENT OVERVIEW
CHRONIC
ACUTE
Rhythm
Disorders
Valve
Low risk CP
Paramedic
Cath lab
ACU & CCU (new)
MPI & Stress echo / CT
Chest pain nurses
Heart Assessment
HF team
Palliative HF
AF Primary care
SCD & ICC service
VIRTUAL CLINIC
Heart
Failure
ONE-STOP CLINIC
IHD
SINGLE POINT NURSE TRAIGE
RACPC (nurse)
EMERGENCY
Rapid FU
Saving 1000 lives
HF Team
IP HF service
Palliative HF
Device therapy
2 BHF Arrhythmia Nurses
Nurse led cardioversion
Arrhythmia/AF clinic
Pacing care pathway
Syncope/TLOC clinic
Syncope guidelines
Valve Clinic
?Too late
Cardiologist Of Week
GROUP
Health Foundation - SHINE Award
Proposal November 2009
(Karen Keating)
Interviews & award £75,000
December 2009
Facilitate 1 year project
from April 2010
Implement & study in detail
impact, benefits and
applicability elsewhere
(cardiology vs. other
specialities, England vs.
Wales)
Broad representation on
project board
Measurement domains
quality & efficiency
England vs. Wales
Primary Care
Trust
(QOF)
Secondary Care
Trust (PBR)
Health Board
Purchases & Provides Services
Primary Care (QOF)
Hospitals
(No PBR)
Tertiary Care
Trust
(PBR)
Key Challenges
•
•
•
•
•
•
Consultant time & job planning
Robust tracking of patient outcomes
Recognition of virtual activity
Quality care & patient ‘safety’ & satisfaction
Security & recording of electronic activity
Demonstration savings in time, money &
resources (dark green vs. light green)
Measures of Success
Safety
Savings
Satisfaction
Speed
The End – Questions…