Using Assistive Technology to Deliver Long-Term Care what

Using Assistive Technology to Deliver Long-Term Care  what

Using Assistive Technology to Deliver Long-Term Care what would help our patients? Dr Allison Graham, Consultant in Spinal Cord Injuries National Spinal Injuries Centre (NSIC) Stoke Mandeville Hospital History of Spinal Injuries Centre Established in 1944 Largest and longest established spinal injury centre in Europe , now 125 beds

Covers mainly south and East of England Paediatric/child referrals from all 4 home countries 5000 active caseload Remit Provide life long care therefore have developed an extensive database of patients as patients living longer Patients travel to us for care and treatment can be long distances

We do have Outreach services for acute and ongoing care, but these are currently physical face to face. What is spinal cord injury? Tetraplegia or quadriplegia. This means your arms, hands, trunk, legs and pelvic organs are all affected by your spinal cord injury. Paraplegia. This paralysis affects all or part of the trunk, legs and pelvic organs.

Where our patients live LONDON Admissions 0 1 to 2 3 to 13 14 to 30 34 to 201 SCI Patient

Population density mapping for the National Spinal Injuries Centre Who are our Patients? The acute patients Now in an Intensive Therapy Unit, or Major Trauma Centre What do we need? Early information about the patient

The ability to talk to treating clinicians in other hospitals the doctors, nurses, physiotherapists etc What does the patient need? Input of a specialist spinal cord injury clinician to prevent complications occurring and review current complications Information about what the treatment at the NSIC is likely to entail

Psychological support for self and family Encouragement that there is life after paralysis The Rehabilitation Process Patients admitted to Stoke Mandeville as in patient for 6-9 months Need to be able to keep in touch with family and friends Need to learn a lot of information- need to be able to access this at later date- try use of

patient specific education on website accessible by our patients Families need to access this information Use this as a back up to what information staff give face to face over lifetime Spinal in-house Services! Adaptive equipment training (voice-activated computer, environmental control, emergency call systems, etc.) Personal carer training Patient education

Community re-entry classes Driver's training, adaptation, car and van clinics General health promotion Hand surgeries and bracing Home modification consultation Neurophysiology laboratory Neurosurgical consultations on-site continued

Orthopaedic clinic Orthotics clinic Pain clinic Rehab engineering workshop Seating and posture clinic Sexual health programs Skin clinic Spasticity clinic Stress management

Swimming pool therapy Education for school-age patients Wellness promotion programme Wireless high speed internet service and e-mail access Women's health services and information Follow up for life Patients attend for review- physically come here- could this be altered? Patient contacted by skype etc to have consultation on well being and prevention matters and investigations and

examinations arranged after this initial discussion Some conditions such as pressure ulcers can be seen on screen with patients and community team in patients home and recommendations for treatment made. Reduces travel for patient which could compromise skin further. Outreach clinic- therapists and nurses can contact doctor in Centre at distance- improve throughput of service Currently very traditional approach

Extending follow up for life Complications of spinal cord injury General health and well being assessment Pressure ulcers Bladder problems bowel disorders Chest complications Patients with mechanical ventilators Intrathecal drug delivery systems- programmer by computercan this be done on line

More patients can be seen with centralised staff and easier access to these staff Ageing with spinal cord injury Challenges for future working The chasm of where we are and where we want to be Having faith in making the changes Ensure it is functional

and fit for purpose Telemedicine for us How do we extend the continuum of care into home and community for a complex, expensive specialised service? How does the newly injured person integrate back into their real world? What services can we as the NSIC offer in the persons home? What do we want to use, information, education,

communication, rehabilitation, wellbeing? Some problems-Getting to hospital How difficult is it to get these people to hospital? Why travel? Stay at home but be treated by your own medical team

Studies at NSIC have shown that mobile phone technology taken at patients home can be diagnostic when sent into clinicians at the centre Prevention Identify those at risk after discharge and do virtual home visits via skype. Current system is for a senior nurse to visit- due to widespread patient catchment area and southeast traffic- rare to see more than 2 patients per day! Telephone calls too impersonal- need to see

what is happening! Going Forward How can we best utilise telemedicine and telehealth for the benefit of all of our patients? Why is the NHS on the ward not keeping up with commercially available systems? Telerehabilitation Most people with SCI can benefit from

telerehabilitation as a tool to support assistive technology interventions. The choice of technology has to fit the needs of the person served rather than the availability of new tech. Needs to aim to promote personal responsibility for wellness and improvement- again the right person to be chosen Long distance rehab Hand function rehabilitation scarce in community

Therapist sits in clinic with several patients on line adjusting treatment Keeping well and improving What do patients have that can be used alreadyapps for treatment as well as information Barriers- users In the healthcare sector, there are very specific barriers to adoption of innovations with regards to

those in telehealth and telecare. Older adults strongly prefer continuing care with an individual physician (Thorpe et al. 2011). So the challenge would be to strike the right balance between traditional human contact and technologically advanced but seemingly impersonal practices. . Thorpe et al. 2011. Patterns of perceived barriers to medical care in older adults: a latent class analysis. BMC Health Services Research. Available online at

http://www.biomedcentral.com/1472-6963/11/181 Face-to-face appointments Central to healthcare, but are not necessary in every case, can often be inconvenient for patients, carers and families. the ability to use email for non-confidential communications or to have a remote consultation with a doctor using the telephone or online technology, would often be a more convenient way to access NHS services.

90% of all interactions in healthcare are faceto-face and that every 1% reduction in face-toface contact could save up to 200m? 2012 Why technology Appointments for people who really need them. Fitting in with peoples lives and delivering faster and more convenient services. Improving patient choice and satisfaction levels and enhancing quality of care. Helping to deliver efficiency gains by reducing face-toface interaction. Empowering patients to take control of their own

healthcare needs and promoting self-care. Improving collaboration across healthcare, social care and industry. Cut carbon emissions by reducing unnecessary travel to appointments. Too good to be true? Whole System Demonstrator (WSD) The early headline findings from this study show that if used correctly telehealth can deliver the

following Reduction in mortality rates 45% Reduction in emergency admissions 20% Reduction in A&E visits 15%

Reduction in elective admissions 14% Reduction in bed days 14% Reduction in tariff costs 8% Big problems Can hospital IT departments cope with challengebroadband speed, confidentiality, exchange of information? Who is involved- is this a tele-technician/teletherapist role rather than IT for patient admin systems? Cost- who pays- hospital or home?

What do patients have that can be used alreadyapps for treatment as well as information What to do? Joined up thinking Technology exists but people need to be brave to step outside existing walls of care Review human factors Review appropriate technology Embed change in whole care pathway Remember how far we have come?

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