how technology is helping to shape the future of maternity ... · clear strategy to embed tec as...
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How technology is helping to shape the future of maternity servicesLearning WebEx May 28th 2020
Improvement Hub
Enabling health and social care improvement
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Recorded WebEx
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Jacqueline Lambert Professional Advisor, Midwifery & Perinatal Care, Scottish Government
Geraldine JordanPortfolio Lead for Acute Care Portfolio, Healthcare Improvement Scotland
How technology is helping to shape the future of maternity services
• Understanding the opportunity that Near Me offers to improve access for women across Scotland
• Sharing enablers, challenges and top tips from NHS boards who have used Near Me in maternity and mental health services
Why is Healthcare Improvement Scotland (HIS) supporting the implementation of Near Me?
• We signpost people to existing guidance or help based on their situation and queries
• We escalate issues that stop Near Me implementationto local and national Near Me Leads
Technical Set up
• We signpost services to existing local and national training and resources based on their situation and queries
Training
We have targeted conversations with services to highlight the key things they need to consider to set up processes for this new way of working.
1. We discuss whether the pre-requirements are in place (technical set up, completion of Near Me training)
2. We help services to consider how the normal processes will be replicated virtually (for example appointment booking processes, communication with patients, waiting area management, follow-up processes such as prescriptions, escalation and contingency plans)
3. We signpost to national guidance or information available (such as clinical criteria for using Near Me, updates on procurement plans)
4. We share the learning from working with other boards, organisations and settings
Service/Practice Processes
Maternity Policy Context Pre-COVID
Policy Context pre-Covid-19
Best Start recommendation 62:
• “A working group should be set up to explore the potential for enhanced use of telemedicine in maternity and neonatal services”
• Aims:
• Consider gaps in service provision as well as low uptake of technology enabled care initiatives for maternity and neonatal services
• Consider which recommendations that TEC could facilitate in implementing
Findings
• The group also identified that the following gaps exist within Technology Enabled Care (TEC) in boards:
• Consistent approach across boards
• Clear strategy to embed TEC as standard work to facilitate care provision
• Appropriate support
Best Start Recommendation 14:
• “NHS boards should redesign maternity services with a focus on local care, built around the concept of community based hubs, with the majority of women being offered routine care and services through these hubs...”
Maternity and neonates –Why focus on this area?
• Covid-19 social distancing requirements:– All pregnant women to self isolate
– Pregnant women with underlying medical conditions
– Reduce numbers of women coming to clinical settings for appointments
• Workforce pressures relating to Covid-19
• Maintain good quality maternity services
• Support for all women but especially those with additional health needs
• Neonatal outreach/contact
Which groups to focus on now and for future
1. Complex medical – women with pre-existing medical conditions – heart, lung,
diabetic type 1 – that attend medical clinics and home monitoring essential &
specific shielded group
2. Planned obstetric outpatient – questions to resolve locally – how to undertake
observations e.g. midwife with woman or woman have kit or monitoring pod
3. Unplanned obstetric review or consultation/triage
4. Regular midwife to woman appointments – questions as above
5. Neonatal review to prevent admission support early discharge or to maintain
contact (link perinatal network)
6. Diagnosed perinatal mental health (link perinatal mental health network)
Sustain and build for future maternity care
Clare Morrison
National Near Me Programme Lead,
Technology Enabled Care Programme
Scottish Government
Near Me: enabling consultations by video
Clare Morrison, National Near Me Lead, TEC Programme
What is Near Me?
March 2020
“Suddenly the relative advantage of virtual consultations has changed dramatically.”
Professor Trisha Greenhalgh
(March 2020)
Covid response: rapid scale up
February300 calls/week
w/c 17 May14,090 calls/week
Technical set up
Service processes
Individual training
0
2000
4000
6000
8000
10000
12000
14000
16000
Week 0 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week10
Week11
Near Me Consultations from 1 March
Accident & Emergency, Addiction Services, Advice Services, Anaesthetics, Art Therapies, Cardiology, Cardiothoracic Surgery, Chemical Pathology,
Child & Adolescent Psychiatry, Chiropody/Podiatry, Chronic Pain, Clinical Genetics, Clinical Neurophysiology, Clinical Oncology, Clinical Psychology,
Clinical Radiology, Community Mental Health, Community Nursing & Health Visiting, Counselling, Dental, Dermatology, Dietetics, Ear, Nose & Throat, Endocrinology & Diabetes, Forensic Psychiatry, Gastroenterology, General Medicine, General Practice, General Psychiatry, General Surgery, Geriatric Medicine, Haematology, Health Visiting, Immunology, Infectious
Disease, Integrated Care, Intensive Care Medicine, Learning Disability, Link Workers, Medical Oncology, Mental Health Nursing, Midwifery, Neurology, Neurosurgery, Obstetrics & Gynaecology, Occupational
Medicine, Occupational Therapy, Ophthalmology, Paediatric Surgery, Paediatrics, Palliative Medicine, Pharmacy, Physiotherapy, Plastic Surgery, Prosthetics/Orthotics, Psychiatry & Old Age, Psychotherapy, Public Health,
Rehabilitation Medicine, Renal Medicine, Respiratory Medicine, Rheumatology, Sexual & Reproductive Health, Sleep Therapy, Social Work,
Speech & Language Therapy, Trauma & Orthopaedic Surgery, Urology
Primary care, Outpatient, Inpatient & Community services
Patient survey:Would you use Near Me video again?
97.8%
2.2%0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Yes No
Per
cen
t
Patient feedback from survey
Near Me is the new norm?
Clear rationale
For 3 reasons…
All health and care consultations are provided by Near Me whenever it is clinically appropriate
1. Enables continued physical distancing
2. Person-centred care & meets demand
3. Environmental imperatives
Primary care
Secondary care
Community based
services
Wider public sector*
Third sector
Social care
Where
Place of Near Me
Telephone
• First line to reduce infection spread
Near Me
• Video provides additional clinical information e.g. pallor, rash, respiratory rate
• And greater reassurance e.g. anxiety
Face to Face
• For when video is insufficient
Technical set up
Service processes
Individual training
Setting up Near Me
Technical set up
Service processes
Individual training
Setting up Near Me
Technical requirements
Both patients and clinicians need:
1. A reliable internet connection
2. A device for making a video call
3. Chrome or Safari browser
There is no App to download or log-in for patients
Technical set up
Service processes
Individual training
Setting up Near Me
Process
Appointment booking process
Patient entry: website link
Appointment letter with patient information
Forms and follow up
How will Near Me be embedded in existing system?
Technical set up
Service processes
Individual training
Setting up Near Me
Training
https://learn.nes.nhs.scot/28943/coronavirus-covid-19/remote-consulting
• Technical skills (how to use Near Me)
• Video consulting skills (for clinicians)
• Practices processes and other resources
Technical set up – video consulting equipment
Technical set up – Near Me system
Processes:
Appointment process
Patient entry process
Forms and follow up
Contingency plan
Training
Next steps
NHS Grampian
Morag Ogston, Badgernet Support Midwife
NHS Grampian
What have been the enablers?• National guidance & local support for teams to make the
changes to pathways – been the driver• Already in place for Best Start Teams, Bereavement Support
Midwife and Infant Feeding Team• Access to a considerable amount of IT equipment already
We overcame our challenge by:• Collaborative & inclusive approach to rapid roll • Strong local connections within eHealth• Support & direction from midwifery leadership team• Willingness of the teams to embrace change
What’s worked well?• Midwives have embraced virtual consultations • Reduced unnecessary travel for midwives & women• Enabled flexibility in delivering care• Facilitated antenatal education & staying in touch• Good feedback from women – acceptable method for consultations• Accelerated roll out possible – good infrastructure
What have been the challenges?• Suitably of equipment currently available i.e. Microsoft surfaces• Accessibility in some GP settings• Low utilisation by obstetricians – different ways of providing
outpatient care• Confidence to try digital approaches & solutions• Lots of rapid change – ability to keep up
Any top tips?
• Access to local data – helpful to understand where you are & supports rapid feedback to teams• Digital champions within teams – supports confidence building• Practical demos of realistic clinical situations
NHS Highland
Catriona Dreghorn, Acting Lead Midwife
NHS Highland
What have been the enablers?Best Start Implementation & being an Early Adopter Board introduction of BadgerNet (all midwives have devices with cameras and Google Chrome)Buy in from Midwives & Near Me ease of use
We overcame our challenges by: Having a Project Midwife Working with Service Improvement and Planning teamEngaging with HIS to share learning and address implementation challenges across boards
• PDSA• “Spread the word” – travel cost saved, journey time reduced/nil, survey women, Care opinion feedback, interagency
use• Make Near Me (not phone) the default• Share learning• Set up meeting rooms for staff to get used to using. Can be used for Clinical Supervision, team meetings etc
What’s worked well?Starting small initially and gathering feedbackSetting each team up with a ClinicSupport from Project Midwife and Tech teamMidwife being with woman for clinic and can join remotely during current pandemic
What have been the challenges? Setting up clinic structure cross boundaryWiFi can still be patchy in remote/rural areasSome teams slower to adoptConsistent use of Team shared electronic calendar
Any top tips?
NHS Orkney
Michelle Mackie, Head of Midwifery
Pamela Halliday, Senior Charge Midwife
NHS Orkney
What have been the enablers?• Getting second screen and ensuring laptops set up, including camera function•Local Near Me support team very responsive to (regular!) requests for assistance•Patients willing to embrace change •Enthusiastic admin support to book appointments – get the appointments booked and email links to the women - if it’s already set up, set up takes a lot of the anxiety away• Web links now in place as additional route into the waiting areas
Implemented Near Me in Maternity, but also Health Visiting, Paediatric Occupational Health, Paediatric Physiotherapy, School Nursing, Speech and Language Therapy, all of which can be accessed via our website under Maternity and Children’s Health Services
We overcame our challenges by• Admin, admin, admin.........• Determined leadership and buy-in, proactive positive reinforcement and role modelling of Near Me • Making a decision and sticking to it. Good natured encouragement and chivvying them along•Support officer providing encouragement and appropriate support to users of Near Me prior to and during use.•Showing the run charts at regular meetings to reinforce how well they are doing – tap into their competitive natures
What’s worked well?•Bookings can be done anywhere (trains and taxis!) the midwife was very impressed•Convenience for women – welcome feedback from mums who can’t access childcare due to Covid•Partner can still be involved - especially if isolating in different locations (e.g. off shore workers)•Island based women don’t need to travel•Appropriate local consultant obstetric clinics are by Near Me•Relationship building easier when the women can see you – a known face when attending in person•One of the midwives has continued with hypno-birthing sessions by Near Me•Exploring and testing for specialist clinics locally and NHS Grampian e.g. fertility, diabetes, twins etc•Near Me is the default method for remote contacts•Dedicated space time and location to allow privacy•Postnatal follow up and breast feeding support
What have been the challenges?•Laptops and single screens – couldn't use Badgernet at same time as Near Me•Winning hearts and minds for those not as IT savvy ”it’s easier to phone”•Perception that it would take too much time with everything else going on•Some phones/devices not as compatible (Samsung Browser issues)•Connectivity in some areas
Any top tips?•Make the decision and go for it! •Have the Near Me support person available to troubleshoot especially for the first few times used.
• Get all the equipment in place to make using the system /process is as easy as a phone call – no excuses left
• Suggestion for future being able to send the Near Me link via Badgernet app
NHS Lothian
Dr Rob Waller, Consultant Psychiatrist
NHS Lothian
What have been the enablers?Support from Senior Managers
Digital Mental Health Team & Intranet
We have set up Near Me waiting areas for each of the main mental health specialitiesThe next stage is integration with TRAK for ongoing scheduled care [letters, clinics]
We overcame our challenge by:Video is better than phone
Video is a patient choice
Any top tips?: Champions, Junior Doctors, Teams Tutorials, Piggy-back Digitisation
What’s worked well?Unscheduled Care [IHTT, Assessments]
National Deaf MH Service and Art Therapy
What have been the challenges?Hardware and BandwidthDifferent way of working
Panel Q&A
Critical elements for successful implementation
Knowing appropriate
patient groups
Support from
others Someone to support the
patient
Covid-19
Practice setup before
Covid-19
Enablers• video consulting
experience• previous near me training• equipment availabilityCommon
benefits for patients and
clinicians
• decreased Covid-19 exposure• reduced travel
Having go-to people
Data source: Information was collected from practice managers and GPs w/c 20 April 2020. Nine practices are represented across six NHS Boards with a combined total of 361 Near Me consultations during the previous three weeks.
Barriers
Learning from GP practices in Scotland following successful Near Me implementation
• to demonstrate the system• to fix technical issues• to lead efforts (an
enthusiast)
• knowledgeable admin staff• help from family members
Supportive processes
Promoting Near Me
for patients
• signs and leaflets• telephone message• information on website
Patient processes
• initial telephone triage• care navigation (video
arranged if necessary)
Patient groups well-suited for Near Me
Clinical practice barriers
IT issues
Touch, feel, and smell
sometimes required
Time available for
setup
Poor connection
Reluctance to use new technology
• pixilation• loss of
sound
Patient challenges
• digital exclusion• experience survey causes
issues when reconnecting• patients don’t always
know to use Google Chrome
Straight-forward technical
setup
All practices planned to use Near Me beyond Covid-19
Sustainability
• Equipment provision (e.g. webcams)• Guidance for Near Me post-Covid-19• GP endorsement to increase adoption
Additional support required
• Children and babies • Shielded patients• Those with skin conditions
• Care home residents• Those requiring house calls• Those requiring reassurance
• Those where ‘eyeballing’ supportsdiagnosis (e.g., in the case of frailty, mental health)
Equipment availability
Discussion
• Which enablers do you have in place and which ones do you need to develop?
• What barriers have you come across and how are you tackling them?
• https://tec.scot/digital-health-and-care-in-scotland/video-enabled-health-and-care/covid-19-implementing-near-me/
• https://www.perinatalnetwork.scot/maternity/maternitynearme/
• TURAS guidance on remote consultations:
https://learn.nes.nhs.scot/28943/coronavirus-covid-19/remote-consulting-and-recruitment
Near Me - clinical guidance summaries
Thank you!
That is the end of the webinar, thank you for your attendance and participation.
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