taking the lead innovation for real ... - ahpnw.nhs.uk...within the blackpool, fylde and wyre nhs...

Taking the lead ... Innovation for real patients

in the real world!

Southern & Roddam, 2011 1

Taking the lead to hunt down funding over the last four years!

Funding worth in excess of £220k:

*£50k Computer Therapy Award – NW Region – including a service evaluation written by Dr Hazel Roddam *funding for LSVT training – to bring NICE quality treatment to Parkinson’s Disease patients *£25k funding from the Cardiac and Stroke Network to bring computer training and software licenses to SLTs in Lancashire and Cumbria *£25k funding for touchscreen computers with software for the Stroke Unit and the Learning Disability Team at the Centre for Independent Living *£12k funding to implement Telehealth *£19k non-recurrent funding organised and secured *£42k NW IT Innovation award to remotely access dysphagic patients in nursing homes – running a research study alongside the project with Dr Liz Boaden from the University of Central Lancashire...£40k further secured to extend the project *£5.5k funding to provide and implement the Malcomess Care Aim training

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Why? ...because of Fred


http://thumbs.dreamstime.com/z/grumpy-old-man-sitting-wheelchair-park-outdoors-39577636.jpg

5

Fred is an elderly gentleman living in a

care home who can only say “wa wa”

and has swallowing difficulties.

He needs intensive communication

therapy (NICE Quality Measure No 7)

He sometimes needs rapid access to a

swallowing assessment to prevent

readmission to hospital

NICE Quality Statement 7

“Patients with stroke are offered a minimum of 45 minutes

of each active therapy that is required, for a minimum of 5 days a week,

at a level that enables the patient to meet their rehabilitation goals

for as long as they are continuing to benefit from the therapy and are able to tolerate it.”

NICE Clinical Guidelines Quality Standards Programme

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He needs a Speech and Language Therapy Service which is rapid, modern and responsive to his needs...do we provide this?


Steve Jobs...

‘...if he saw something that could be made better, smarter or more beautiful, nothing else mattered.’

‘...never did things the way they had already been done. He did things the way they were supposed to be done in a smarter, more advanced fashion.’

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Communication

Computer Therapy service innovation

• Combine traditional SLT + computer therapy as service model

• Increased access/capacity versus traditional therapy

• Computer therapy access for in-patients in acute stroke phase

• Computer therapy access for out-patients – group and home

• Enhanced therapy experience for patients

• Optimising skill mix of therapy team

• Demonstrating value-for-money service

• Using Telehealth to access patients at home and tailor their rehabilitation software remotely

• £50.000 funded by The Regional Innovation Fund

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Patient ID Contact with SLT

in hours and

minutes

“Traditional

therapy”

(March-May

2010)

Contacts

in 1 hour service

innovation

“Computer therapy”

(01.09.10-30.11.10)

Comments regarding attendance at

computer therapy sessions

A 30 mins 6 hours Not attended all sessions due to ill health

B 8 hours 48 mins 15 hours Not attended all sessions due to ill health

and moving house

C 7 hours 24 hours

D 20 hours 20 mins 12 hours Did not complete the full 3 months as had

a home licence installed

E 25 hours 15 mins 25 hours

F 17 hours 20 mins 26 hours

G 0 22 hours Not attended all sessions due to ill health

H 7 hours 20 mins 16 hours Not attended all sessions due to other

health appointments

I 8 hours 45 mins 26 hours

J N/A 26 hours Referred to SLT at end of May

K 0 22 hours

L 4 hours 30 mins 13 hours Attended once a week

Table 3.3: Patient contact time in traditional and computer-based sessions

Swallowing (dysphagia)

Patients who receive formal swallowing assessments and

adequate fluid and nutrition have reduced risk of poor patient

outcome. Prompt assessment can avoid deterioration in health and

subsequent admission to hospital.


Swallowing Assessment and Management via Telemedicine

Service Evaluation Report prepared for Blackpool Teaching Hospitals NHS Foundation Trust Speech and Language Therapy Department Service evaluation report by: Dr Elizabeth Boaden, Fellow RCSLT; PhD; BSc; HPC

Consultant Dysphagia Practitioner Date: April 2014


Aim

The SLT team wanted to deliver -an improved response time to referrals without incurring extra costs in staffing, -with an improvement in the quality of healthcare service currently delivered, -that was acceptable to patients, nursing homes and therapy staff despite the exponential increase in demand on the service. This service development was funded from the North West IT Innovations Programme award scheme.


Results -The diagnostic accuracy of the system (100% inter-rater reliability for fluid and diet modification) has been demonstrated -with concomitant increased awareness of swallowing difficulties by staff within the nursing homes -and an increase in response time from referral to assessment -Qualitative analysis demonstrated both patient and therapist acceptability in use of the equipment and ability to establish rapport.


-This programme of work has demonstrated a reduction in time taken to undertake a swallowing assessment from ninety minutes for a home visit to thirty minutes for a Teleswallow assessment, -thereby improving productivity and releasing capacity to address waiting lists and other staffing pressures. -As a result of the Teleswallowing system, none of the patients involved in this service development were admitted to hospital nor required a home visit.


The comparative costs (average SLT assessment, travel and location costs only) of i) admission to the acute sector, ii) domiciliary visits and iii) remote assessment and management via Teleswallowing for a single individual are evidenced in the following table:


Admission to acute sector

Home visit by

SLT

Teleswallowing

Therapist specialist assessment cost @ £31.82 per hour

£31.82

(1 hour) £47.73

(1.5 hours) £15.91

(30 mins)

Average of two further review appointments

@ £31.82 per hour

£63.64

(2 hours) £95.46

(3 hours) £31.82

(60 mins)

Average Travel Time

@ £31.82 per hour n/a

£63.64

(3 x 40 minutes) n/a

Transport (return journey)

£422.54

(ambulance)

£26.13

(3 x 13 miles @ 67p per mile)

n/a

Location Cost @ £223.98 medical ward per day

£2748.23

(average 12.27 days) n/a n/a

Total

£3,266.23

£232.96

£47.73

Table 1: Costs of different service delivery models (one patient)


Assessment and 2 reviews

2013-14

Current Service Delivery Models

Teleswallowing Service Delivery

Model

Teleswallow-ing Cost

Efficiency

240 admissions to acute

sector for eating and

drinking difficulties

£783,895.20 £11,455.20 £772,440.00

456 Domiciliary Service referrals

£106,229.76 £21,764.88 £84,464.88

Total £890,124.96 £33,220.08 £856,904.88

Table 2: Annual relative costs of current service delivery models compared to Teleswallowing Service Delivery Model and subsequent cost efficiencies. NB the 456 domiciliary referrals include all domiciliary referrals irrespective of diagnosis as it was not possible to extract dysphagia referrals from the system


Recommendations The Blackpool Speech and Language Therapy Department has demonstrated by their programme of work that Teleswallowing can be delivered to all patients regardless of cognitive state in a UK setting and by NHS therapists.


1. Teleswallowing as an Augmentative Service

Delivery Model

Teleswallowing can be regarded as an augmentative

service delivery model that facilitates the development

of clinical skills, reduces waiting times, improves the

quality of care offered and makes substantial cost efficiencies.


2. Extending Teleswallowing within the local healthcare

economy

Further funding to extend software licence agreements and

purchase hardware (iPad/laptops) is requisite to continue

the current service and allow for expansion of the

Teleswallowing service delivery model to other

establishments.

Teleswallowing training for new staff would be requisite.

Training would also need to be available to nursing homes

already using the Teleswallowing service delivery model

to accommodate staff turnover.


3. Engagement of the Telehealth concept with the wider healthcare community It may be beneficial to extend this project design to collaborate with the wider healthcare community within the Blackpool, Fylde and Wyre NHS locality eg Dieticians, OTs, The Care Home Team (we are bidding for Health Foundation funds to scale up our joint projects, but the HF bid does not include funding for equipment) Utilise the skills and knowledge of the SLT Project Manager to advise further interdisciplinary teams within the Trust to benefit patient care.


4. Professional Engagement

5. National Engagement

Top Tips

• Choose the right innovation – something that is right for the population but also links in with Trust strategic goals

• Involve/speak to the right people – top level sign in, colleague commitment and take up

• Persevere! Keep working towards your goals.

Final words…

• “We don’t get a chance to do that many things” the late Apple chief once said, “and every one should be really excellent. Because this is our life. Life is brief, and then you die, you know? And we’ve all chosen to do this with our lives. So it better be damn good. It better be worth it.” Steve Jobs

• Fred is worth it... 30

•

Veronica Southern MA BSc CertMRCSLT CertMHSC LSVT Certified

Clinical Leader Principal Speech and Language Therapist (Rehabilitation)

Speech and Language Therapy Department Victoria Hospital

Whinney Heys Road Blackpool FY3 8NR

tel 01253 957091 Mon fax 01253 956214 tel 01253 953873 Tues, Wed and Thurs fax 01253 955611

E-mail [email protected]

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mailto:[email protected]

taking the lead innovation for real ... - ahpnw.nhs.uk...within the blackpool, fylde and wyre nhs...

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