Medipex NHS Innovation Awards 2010
More than 170 people from Industry and the regional NHS gathered at Weetwood Hall on Wednesday April 21st for Medipex’s 2010 NHS Innovation Awards evening.
The sponsors of this year’s Innovation Awards and Showcase 2010 were NHS Yorkshire and the Humber, Skills for Health, UDL, Yorkshire Forward, Medilink Yorkshire and Humber , South Yorkshire CLAHRC, South and West Yorkshire CLRN and CPD4 Health Innovation.
£10,000 in total prize money was awarded to the winners in the 4 categories; Medical Devices and Diagnostics, Software and ICT, and Publications, Publications and Training Materials and Innovation Adoption and Diffusion.
Category includes (but is not limited to) improvements to existing medical devices or new ideas and would cover every item of equipment likely to be found at ward level, operating theatre, A&E, diagnostics, imaging and in the community.
New obstetrics forceps for assisted vaginal delivery
Alexander Oboh, Hull and East Yorkshire Hospitals NHS Trust
Alex’s innovative idea is to produce a new obstetric forceps for assisted vaginal delivery (AVD) to reduce the risk of trauma to the baby and mother during childbirth. Globally 10-15% of births are AVD with either the forceps or vacuum devices. The forceps device has a higher success rate for AVD. The major drawbacks of the current forceps device are; the risk of trauma to the perineum of the mother and baby due to use of excessive traction force, the device being made of steel and its success being dependent on the operator’s skill and experience. Whilst the vacuum device been improved over time, there has been no innovative improvement to the forceps devices.
The new obstetric forceps have been designed with an in-built safety device to regulate the amount of traction force that can be applied to achieve a vaginal delivery. The operator is simultaneously able to see the amount of force being applied (from a traction force indicator built into the device) and get additional auditory and tactile feedback once the maximum traction force is exceeded. This removes individual variations in the maximum amount of force used and the risk of use excessive traction force. The new device will be single use and made of lightweight recyclable non-steel materials. This has environmental benefits and in low-resourced countries reduces the risk of cross infection and the cost of sterilisation.
NHS at Home: 21st Century Community Matron’s bag
David Swan, University of Huddersfield
The devolution of healthcare treatments into the community continues to gain momentum (DoH, 2010-2015: from good to great; CBI, Best of Health, 2010; Burham, NHS Care at Home, Feb 2010).To support this paradigm shift, a dedicated community matron's bag is desirable to meet rising patient expectations, enable service consistency and quality and to ensure patient safety, as well as, enhancing a clinicians' productivity, efficiency and effectiveness.
Present community services are characterised by improvisation and inconsistency, as no dedicated products exist to support clinicians working in this challenging environment. Evidence suggests that these practices are widespread (validated by data gathered from community matrons from NHS Cornwall & Scilly Isles). Furthermore, the common practice of using sterile wound dressing packs to establish an aseptic field in the home contributes significantly to the NHS's carbon footprint related to procurement.
The government has a strategic aim to deliver world-class public services through transformation change and for our experience of public services to match the very best delivered in the private sector. This product contributes to this ambition. This product has been designed by the primary applicant and is the culmination of an exhaustive and inclusive innovation process that has yielded an unique and much needed healthcare product.
Development of computer technology to assist children with cerebral palsy to undertake arm exercises within their own home
Bipin Bhakta, Leeds Teaching Hospitals NHS Trust
The system (HB-RES) assists children with cerebral palsy (CP) to participate in independent fun home arm exercises through an engaging exercise environment and physical guidance we developed the system with the help of disabled children. It has three aspects (a) exercises are presented through engaging computer games to aid motivation; (b) provision of robotic assistance via the powered joystick, which enables children with greater levels of disability to participate in arm exercise without the physical assistance of a therapist; (c) affordable design, enabling the system to be used widely within health, school and home settings.
The system is not intended as a substitute for conventional therapy, rather to supplement exiting treatments, by enabling therapist to prescribe individualised game-exercises between formal therapy sessions. My role was supervision/project management and original device idea from seeing children in the paediatric mobility clinic
A feasibility study to evaluate HB-RES has been undertaken with 18 children with CP (medial age 7.5 years, range 6-15) being recruited to the study from local hospitals. This study suggested that the device could be used to augment home-based arm exercise in an engaging way for children with Cerebral Palsy. (COREC 06/01205/84 NIHR NEAT-G006).
Clinical waste-streaming at point-of-use – a new machine; a new system; a new psychology
Jonathan Ross, Sheffield Teaching Hospitals NHS Foundation Trust
Clinical waste (some extremely hazardous e.g. Hepatitis C virus contaminated) is generated in unergonomic and time-pressured areas, and therefore fairly difficult to differentiate and dispose of. Currently, the mess is loosely bundled up and stuffed in one bin as there are no convenient waste streaming facilities. It consists of admixed paper, cardboard and plastics; blood and human tissue/ waste. Sharps, metals and waste pharmaceuticals are put in sharps bins. As a rule, waste is disposed of in the ‘safest’ (most expensive) route possible, for safety purposes. That’s incineration, then autoclaving, then household.
‘Household waste’ is disposed of at around £100 per tonne, bagged; ‘Clinical waste’ is disposed of at £350 per tonne; ‘Sharps bins’ cost an eye-watering incineration price of £1100+ per tonne.
The team members have researched and designed a new cost-effective compacting and streaming trolley system to segregate waste efficiently at point-of-use by the operator. The device is robust, unpowered, portable, easily emptied, hygienic and cleanable. It utilises current waste bags; adds very little extra waste to that generated; complies with H&SE guidelines; is engineered to be psychologically conducive to adoption and use; is lightweight and ergonomic to use and has been hazard-engineered to reduce maximally any potential harm. It’s been developed with Developing World healthcare systems in mind also. The operator-segregated, compacted waste is taken from the trolley to a central collection point for processing.
SPECS – Speech-Driven Environmental Control System
Zoë Robertson, Barnsley Hospital NHS Foundation Trust
SPECS is specifically designed for individuals with severe physical disability and dysarthric (highly variable disordered) speech. Environmental control systems enable people with physical disabilities to access things in their immediate environment, for example controlling their television, answering the phone etc. The effect on independence provided by such systems can be profound.
The majority of current environmental control systems are controlled via a single switch. Although this provides a way for people to access these devices it can be slow, tiring and frustrating for the user. With SPECS the input method is speech and so this provides a potentially quicker, less frustrating access method for some people with severe physical disabilities. Speech-driven environmental control systems do exist, however they are not widely prescribed and we investigated reasons for this when undertaking the initial development work for SPECS. A key reason identified was reliability and in developing SPECS we have focused on high reliability. Furthermore a high proportion of people who use environmental control systems have dysarthric (disordered) speech. Therefore in developing SPECS emphasis has been put on the speech recognition being able to cope with highly variable dysarthric speech. The techniques we have developed have proved very successful and have produced better recognition rates for severely dysarthric speech than any previously published in the international research literature. The joint team from Barnsley Hospital and University of Sheffield came up with the initial idea, developed new speech recognition methods and developed the software for the SPECS device. Our industrial collaborators, Toby Churchill Ltd and Elpedium Technologies developed the hardware platform and peripherals. We have heavily involved potential users of the device throughout this user-centred research, design and development process to produce a device that is acceptable to, and usable by disabled people.
Category includes (but is not limited to) novel uses of databases, improvements to clinical outcomes, document management and hospital management systems, patient records, LIMS and patient booking and information systems.
Computerised, self-learning, autonomous control of Automated drug-infusions to support the Cardiovascular System in patients post Cardio Pulmonary Bypass
Jonathan Rossm Sheffield Teaching Hospitals NHS Foundation Trust
Circulatory failure, ‘shock’, displays wide variation in severity and rate of progression, and often is fatal. Management involves co-ordinating multiple drug infusions to maintain multiple cardiovascular variables within accepted bounds. Computer control of this therapy is notoriously difficult as every patient is unique, with infinitely variable presentations of myriad illnesses and widely varying responses to diseases and therapies. Patients’ responses in time and magnitude are notoriously non-linear; there is inter- and intra- patient parameter variability as well as outcome uncertainties, so the management of the multi-input, multi-output system is challenging. Conventional computer programming with all the necessary rules to achieve this successfully would take infinite time. No-one has managed to automate this treatment.
Automation is a ‘Holy Grail’ of ITU as many of the features of computerisation/ automation are highly prized in the clinical setting, including accurate control of target values through 24 hours of the day; no variability on expertise of the treating staff; their reliability and dependability. An automated system would allow less highly-trained staff to care safely for patients, thereby reducing staffing costs.
Following an extremely successful project funded by the Engineering and Physical Sciences Research Council between 2005 and 2008, myself and two Control Engineer colleagues from the Automated Systems and Control Engineering Department at the University of Sheffield achieved a ‘world-first’, demonstrating truly autonomous computer control in a clinical trial of three different Intensive Care patients’ cardiovascular systems. We published a series of breakthrough papers and abstracts demonstrating that a computer could control therapeutic drug infusions to precise target values demanded by a senior clinician without prior knowledge of the patient, or the possible responses to therapy. I developed the novel, hierarchical system of control rules from scratch. No pre-existing research work stratified the cardiovascular system, or the predicted responses in this novel manner.
Integrated Haemato-Oncology Diagnostic Software
Danny Pearson, Sheffield Teaching Hospitals NHS Foundation Trust
In order to link the HODS network of referring hospitals, HODS has developed a centralised, bespoke, secure, internet based software solution to provide booking, tracking, reporting and integration of laboratory reports for cancer diagnosis and monitoring, producing one integrated report per patient. The software was developed in partnership with an external Information Technology provider and allows patient samples to be booked into the HODS software at source and sent to the central laboratory from any hospital within the North Trent Network. In addition the software sends an e-mail alert to the referring haemato-oncologist on sample receipt. Once received, the patient sample(s) are dispatched to the relevant diagnostic HODS team for investigation, the HODS software uploads authorised reports produced by the HODS pathologist to a diagnostic review list. Once all the necessary HODS investigations have been completed on the patient's samples the HODS software produces a worksheet that can be used by the HODS pathologists to formulate a final, all encompassing integrated diagnosis based upon World Health Organisation diagnostic coding criteria for haematological cancers. This is made possible by using the HODS software 'reporting' function. Once this is done, the integrated HODS report is immediately available to view by the patient's consultant on a secure web-based browser through the software, which also alerts the consultant, via an automatic e-mail when their patient's integrated report is ready for viewing. The software has built in audit functions to monitor turnaround times and displays 'real time' case report progress. It has an e-learning repository that can be accessed via the web by members of the HODS team and any haemato-oncologists in the network providing access to educational presentations, audit data, quality control reports and network guidelines.
Planning Workflow Manage
Sandhya Pisharody, Hull and East Yorkshire Hospitals NHS Trust
Developed in conjunction with the treatment planning staff at the Queen's Centre for Oncology & Haematology at Castle Hill Hospital , the Planning Workflow Manager helps to organize and manage the patient radiotherapy treatment planning process. PWM is a bespoke tool to streamline the multi-stage planning process. Designed to seamlessly interact with the existing Radiation Oncology software suite, PWM integrates the planning process with the overall radiotherapy care stream to ensure early patient treatment delivery. Filtered views of the planning list based on process stage and task assignment aids monitoring & management of individual staff and overall workloads. Quick-glance graphical outputs help to identify bottlenecks and provide an opportunity to follow up as soon as possible. Planners and clinicians can also add comments to individual patient cases to inform other staff of any issues affecting planning or treatment as well as flag up non-conformance to processes or protocols. Radiotherapy treatment staff and booking office staff can track the planning status of patients scheduled for treatment by name, Patient ID or treatment date, ensuring a synchronized patient care process. A bespoke reporting module provides easy access to the collected data for workflow and performance analysis for users with administrative privileges. My role in this project started from requirements gathering and analysis to define the functional specifications for the system, to designing and developing the entire software and associated database, and finally implementation and user training. I am responsible for ongoing support for this system and have implemented a controlled Software Change Request process to manage bug reporting as well as requirements and/or design change requests.
Sheffield in-vivo Dosimetry Database (SiDD)
Jonathan Hughes, Sheffield Teaching Hospitals NHS Foundation Trust
Part of the quality assurance process in radiotherapy is the verification of the radiation doses individual patients receive. The 2009 DH Manual for cancer services: draft radiotherapy measures seeks to make a verification technique called in vivo dosimetry (IVD) a requirement for certain treatments. This technique involves a radiation detector being placed in or on the patient to sample the dose of radiation received during a treatment; the reading from the detector is compared to the dose expected from the treatment plan to verify the treatment is being delivered correctly. IVD has the ability to detect and prevent serious radiotherapy errors. WPH have previously purchased several sets of semiconductor diode radiation detectors for use in an IVD programme.
Quality Control Monitoring Software
Nuthar Jassam, Leeds Teaching Hospitals NHS Trust
Transferability of patients and patient data cannot be achieved unless analytical variability is detected at an early stage i.e. before it impacts on patient results. The previous quality control system had been designed for single, rather than networked laboratories. The change from a single laboratory to network of laboratories has not been accompanied by a change in the quality system. The quality of the analytical process was usually assessed by visually examining data from internal quality control (IQC) and external quality assurance schemes (EQA). Over a one month period, our laboratories produce over a million data points of IQC and at least 427 reports from EQA. Each laboratory reviewed their own data and no access to each others data was possible. Therefore continuous monitoring of the quality data for analysers that are geographically distant by using paper based quality systems is impossible.
The previous system has been replaced by an electronic quality system; Following collaborative work with the analysers manufacturer (Siemens), the IQC data is captured on a regular basis from all 16 analysers in the core biochemistry laboratories. This data is then automatically imported into a data-base.
Following collaborative work with UK External Assurance Scheme Organisers across the country, agreement was reached for them to deliver our EQA data electronically in a pre-agreed format compatible with our database. However, there is a lack of defined quality specifications for quality control at a local/national level. The author has derived a unique form of quality specifications for every test in core biochemistry. These quality specifications relate the analytical performance to the clinical use of a test. This data is fed into the data-base. Mathematical formulae relate the analytical variation to the clinical aspect have been applied to compare results from different sites and to present the data graphically in a single monthly report.
Category includes (but is not limited to) books, DVD, CD’s, pamphlets, information packs, videos and educational resources.
Working together to help children with developmental coordination disorder in Wakefield
Heather Angilley, Mid Yorkshire Hospitals NHS Trust
The idea is to develop a pathway for early identification of children with this condition, involving both the health and education services. Following on from this, to develop a treatment programme that is easy to use, requires minimal preparation and uses existing resources in schools.
Teaching and Education staff are trained to recognise movement disorders, with a particular emphasis on DCD which affects approx 6% of the population. Teaching staff identify children who require intervention and the pathway guides them through the various stages. Most children can be helped in school using the programme described below; only the more intractable conditions require formal referral to the NHS.
The intervention programme is set out in a loose-leaf folder. This has 10 sections covering areas such as ball skills, scissor skills and visual tracking. It has received positive feedback from schools, who find it easy to use and popular with the children. The therapy takes place in small groups within school. Educational Support Assistants screen each child using an assessment tool included in the programme. If a child is making measurable progress they continue with the programme. If they are not, they can then be referred for NHS therapy via the school health service. Early identification forms part of the SEN code of practice, and the programme provides the child with earlier access to targeted support while reducing the number of referrals to NHS therapy.
Safe hands 4 kids educational DVD
Alison Thomas, NHS Barnsley
The idea was to produce an innovative, hand hygiene DVD for kids, to help encourage hand washing amongst young people. We researched existing product/training resources. The existing resources did not meet the standards that we required e.g. – wrist watches worn, jewellery, inappropriate dialogue or were poor quality. We took the decision to produce our own hand hygiene DVD, demonstrating evidence based six-step technique, filmed in an appropriate setting. We tailored the script to meet our needs, we recruited local school children, a local drama school (for voice over) and a British sign language champion. The DVD was produced by a local company.
This excellent DVD was distributed to all primary and secondary schools, including special needs school within the borough of Barnsley , to encourage hand washing and help prevent the spread of infection. The DVD has been gratefully received and is being used as part of the school curriculum. It is versatile and can be universally adapted to personalized needs. The DVD can be used as an educational tool by the school nurse and child health.
The DVD has a diverse function in that it can be used by anyone outside of the trust, such as local authorities, private sector, local education authority and other care provider, for pupils and students of all ages. The DVD has sought to reduce communication barriers by including additional function such as subtitles and British sign language (specially adapted for child’s vocabulary) The DVD could be adapted to different languages. The DVD is approximately 5 minutes long and thus provides a contemporary, quick and effective way to deliver an important message.
The Neuro-Logical Game - The fun way to learn about neurological care
Catherine Howes, Sheffield Children’s NHS Foundation Trust
Catherine has devised and produced a board game, to be used by staff and students to learn about the specific knowledge and skills required to care effectively for children with neurological conditions. This game is now used with all new nurses and students who come to the PCCU, and need specialist training on a wide range of subjects which includes neurological care. Catherine has identified that one of the best ways to encourage learning and to reinforce knowledge was through the use of an interactive game. This fun, innovative game replicates real life situations and the management of care in a safe environment.
The S Word. We need to talk about sex.
Melanie Simmonds, NHS Rotherham
The S-Word, We need to talk about sex’ is a sexual health promotion campaign and education/ information resource utilising a movie theme to portray thought-provoking sexual health messages.
Extensive market research identified that movies are a popular past time for most young people and the use of iconic films was appropriate for conveying our key messages. To capture the imaginations and attention of Rotherham ’s young people, films such as The Bourne Trilogy, PS I Love You and Mission Impossible, were altered using allusional imagery and a play on words to create alternative fictional film posters, namely Borne Unintentionally, PS I Infected you and Mission Responsible.
The campaign, which directs young people, parents and professionals to a website where they can get accurate, young people friendly information on sexual health and local services, was launched to professionals in the form of a movie premier which resulted in TV and newspaper coverage. It is also promoted through: Film style posters in buses, bus stops, billboards, phone boxes, locally produced magazines, colleges, schools, youth centres and health organisations.
A viral video is available through YouTube, Twitter and Facebook and was available to large numbers of young people to download onto their mobile phones via Bluetooth; On screen adverts in health centre and at the local bus station; Website promoted via Bluetooth game and radio adverts.
The Sexual Health Team commissioned Hallam fm to produce the promotional materials whilst providing direction on the content and suitability of the final concept. Local young people also assisted with the development of the creative ideas as well as staring in the viral video and radio adverts. The final message within all elements of the campaign is that there is ‘not always a Hollywood ending’ when it comes to sex.
Category includes (but is not limited to) an innovation/service that has improved the delivery of healthcare. Applications MUST show how the innovation/service has been implemented in your Trust, identify any savings made and MUST have the potential for wider adoption in other Trusts.
Promoting breastfeeding through stopping the free supply of formula milk to newly delivered mothers in Northern Lincolnshire
Debrah Bates, Northern Lincolnshire & Goole Hospitals NHS Foundation Trust
The aim of this innovation was to encourage and support mothers to acknowledge the benefits of breastfeeding for themselves and their infant and to encourage them to initiate breastfeeding at delivery.
In May 2009 the Maternity Services within Northern Lincolnshire & Goole Hospitals Foundation Trust stopped providing women, who had delivered well babies, formula milk with the intention improving breastfeeding rates through the promotion of breastfeeding. This is both a local Public Health Target, a Strategic Health authority CQuINS target and links closely to recommendations of the National Services Framework, Standard 11, Intervention 10.6 – ‘Where women choose to bottle feed, they are encouraged to take into hospital the bottles, teats and formulae feed they plan to use’.
The Trust stopped providing bottles, bottle brushes, teats, formula feed and sterilizing tablets to mothers who delivered well babies and who had made the informed decision to artificially feed their infant.
During the antenatal period midwives discuss feeding options and promote the benefits of breastfeeding. Women are informed at this time that if they choose to bottle feed their babies then they must supply their own formula milk whilst they are in the hospital. At delivery, all women are asked if they would like to put their baby to the breast. It has been noted that on occasion, some women have put baby to the breast rather than prepare the bottle feed that they have brought with them.
It has proven very rare that women do not bring formula feeds with them. Occasionally, partners have had to make a short trip to local supermarkets in the area to buy formula feeds, although the ward does stock a few bottles of artificial milk for emergency purposes only. These are rarely used.
The innovation also provides staff with an opportunity to ensure that those mothers who make the informed decision to artificially feed their baby know or learn how to sterilise equipment and prepare artificial feeds safely prior to being discharged home.
At the time of the innovation I was Head of Midwifery and developed the strategy and led on the implementation.
The Dewsbury Feeding and Swallowing Screen
Mariani Tanton, NHS Kirklees
Mariani designed and developed The Dewsbury Feeding and Swallowing Screen package which comprises two parts:
- The screen: Was designed for early and accurate identification of life-threatening feeding and swallowing problems in patients, whatever the diagnosis, in a variety of locations. It is an observational checklist to capture the patient’s eating and drinking capabilities and safety in as functional setting as possible assessing both fluids (the most likely consistency to cause problems)and diet (which is often overlooked in other screening tools). It is quick, but comprehensive and is easy to use, even for those with little or no experience in this area.
- The Training package takes the place of training and competence checks previously delivered by the author. It comprises a main manual containing information on causes and risk factors in dysphagia, the background of the screen’s development, details about each test item and administration and scoring details; a DVD showing 12 normal and abnormal swallows; a short DVD manual containing 12 completed screening forms relating to those assessments on the DVD.
In practice it has been in use at Dewsbury and District Hospital since 2003. It is used on 5 wards, according to individual remits, at the time of the first food and drink given. Further wards wish to adopt it. It has been adopted, for the Stroke Pathway, by hospitals in Wakefield and Pontefract. The author is to present the Screen within a dysphagia lecture in June, to local Care Homes - many already expressing an interest. Kirklees Independent Sector Workforce Adult Services - Commissioning and Planning have assisted in advertising the Screen locally. A number of other Care Homes throughout the have purchased the package.
Getting Sorted: Our Way
Liz Webster, Leeds Metropolitan University
The ‘Getting Sorted’ Programme for diabetes is a model of self-care that is based on the views of young people with Type 1 diabetes about what impacts on their lives and what they want in a self-care programme. The ethos is to actively engage young people at every stage and for young facilitators with Type 1 diabetes to innovatively deliver 5 workshops and develop the programme within the region. The workshops are unique, active, informative and young person centred. They are aligned to current National Drivers relating to the Expert Patient Programme, the key objective being to enable young people to increase their understanding and self manage their diabetes in ways that suit them, thereby reducing the risk of long term complications. To date, the programme has been delivered in 5 PCTs in Yorkshire and the Humber as part of the SHA Pilot, capturing the views of 100 young people with diabetes. During the SHA pilot workshops were adapted and developed based on feedback from young people.
The originality of the project was based around an idea formulated over 20 years of experience working in practice, through observing the positive benefits of peer support, through working with young people with complex health needs. This was achieved through engaging with 3 young adults with type 1 diabetes, developing their skills as young researchers, who facilitated the ‘talking groups’ (name given by young people for focus groups), analysing data through listening to the development and delivery of the programme. It was found that the emphasis of a self care programme should be designed; created and written ‘by young people for young people.’
The intention now is to roll out the diabetes ‘Getting Sorted’ Programme across more PCTs in the region and embed it as part of mainstream service provision.
Continence Prescription Service
Joanne Mangnall, NHS Rotherham
This service has been established with no increased costs to the PCT. Prescribing responsibility was transferred from GP practices to the continence service along with financial responsibility for the prescribing budget. A centralised telephone contact point was established within the existing nurse led continence service. Patients were given one number to ring to order prescriptions or access help or advice. A triage template was developed to sit within the patient electronic record. The template guides the prescription co-ordinator through a telephone triage consultation. If the patient gives a positive response to any of the questions a referral to the nurse is generated for review before a prescription is issued. Use of the electronic patient record ensures patient safety as real data is collected. This centralised approach has enabled us to achieve more efficient product use which has resulted in cost savings which have been re-invested in two additional continence nurses.
This approach has enabled NHS Rotherham to establish a nurse led continence service which ensures all patients, that use prescribed continence products receive an annual review as outlined in Good Practice in Continence Services (DH 2000). Different team members were responsible for different elements of the project implementation process. Stuart Lakin, Head of Medicines Management took overall responsibility for transferring the prescribing budget from the GPs to the continence service. Kate Midgley, Senior Medicines Management Technician was responsible for identifying over 1,000 patients in GP practices who were prescribed continence products and safely transferring their data to the new service database. Joanne Mangnall, Clinical Nurse Specialist was responsible for ensuring the template within the electronic patient record was clinically effective. The service went live on 1st April 2009. The project team continue to work together to ensure ongoing service developments are effectively implemented.
Electronic consultation (e-consultation) in Bradford and Airedale
John Stoves, Bradford Teaching Hospitals NHS Foundation Trust
Traditionally patients presenting to their GP with symptoms of mild to moderate chronic kidney disease (CKD) are referred to a renal specialist via a paper/telephone referral. This communication process can be lengthy causing delays and inconvenience for patients. Identifying eligible patients who require specialist referral is also a problem. Often patients are inappropriately referred, impacting upon the workload of the renal specialist. These patients could be better managed in primary care.
In collaboration with colleagues from Bradford and Airedale Teaching Primary Care Trust (BAtPCT) I have co-developed a CKD electronic consultation (e-consultation) advisory service using a networked centralised IT system, SystmOne®. The service allows GPs to send electronic referrals and share patient electronic health records (EHRs) with a renal specialist in secondary care after first obtaining verbal patient consent. GPs use locally agreed criteria to ‘request advice’ or ‘question the need for hospital clinic review’. The renal specialist is able to open the patient’s EHR and view important clinical details. A decision is then made as to whether a patient should be referred to clinic, undergo tests or interventions in the primary care setting, or continue to be monitored and treated by the primary care team. Physician time is saved by using pre-set ‘auto-consultation’ responses. Responses are saved in the patient’s EHR and also sent as tasks to alert the referring primary care team.
I have co-led the introduction of e-consultation into 17 general practices across Bradford and Airedale, and respond to GP requests for specialist advice and support. I have worked alongside colleagues to adapt the IT system to meet our requirements, refining it as required. I have co-developed educational materials and conducted educational events in the district to encourage the adoption of this innovation. I have also conducted an evaluation study of this innovative service.