Day two of the conference kicked off with an introduction to Project ECHO by self-proclaimed “enthusiast” Professor Max Watson.
Watson explained how ECHO (Extension of Community Healthcare Outcomes) is about “moving knowledge not people”.
In contrast to telehealth, which is about using technology to connect up healthcare professionals and patients, ECHO is a form of “telementoring” and involves using technology to help share expertise and knowledge among professionals, so that better care can be provided to more people.
With growing demand for specialist palliative care – and specialist healthcare more generally – it is not always practical for everyone to be referred to, and be seen by, the specialist. Patients may end up on long waiting lists and, in more rural communities, travelling to see a specialist may be time consuming, expensive and impractical.
By training up front-line healthcare professionals, many of these patients can be cared for locally, without the need for a referral to a specialist. This is what Project ECHO is all about.
Practically, “ECHOing” uses a system called Zoom, which is similar to Skype but with some extras. A number of “spokes” (community healthcare teams) call into the central “hub” using a computer with a microphone and camera, or from a phone or table.
Sessions – which may be held as frequently as deemed necessary – involve some teaching by the expert team at the hub and then discussion of case studies, which are submitted by the spokes.
Watson explained how the Northern Ireland Hospice has been using ECHO with its community nurses, who are based all over the country.
Through regular ECHO sessions, nurses have increased their knowledge – and feel they are learning very practical things – and report being more confident in the care they provide to their patients. The system also helps foster peer support and encouragement among the community teams.
The sessions also count towards the nurses’ CPD requirements in a time-effective way as no travel is required to access training.
Watson is now working with the HSC (Ireland’s Health Services) to set up five new ECHOs for different groups of specialists, and is also working with other hospices to set up an ECHO for carers to support each other.
Northern Ireland Hospice is also now a “super hub” which means it can train others to set up and manage their own ECHOs.
Let’s face the music and dance
The day’s lunchtime cultural distraction was provided by Maggie’s Choir, which is made up of patients who are currently being supported by Maggie’s and bereaved relatives.
The choir took up position at the heart of the conference centre and soon attracted a large crowd as people were drawn from the various corners of the building to hear the music.
Music continued into the afternoon and the second plenary of the day, which was given by the always energetic and enthusiastic Professor Scott A Murray.
Dancing around the stage, Murray compared different disease trajectories at the end of life. He suggested that cancer is like the Gay Gordons – predictable, guided, we can all do it. Organ failure is more like a tango – not everyone knows the steps, and the music involves a lot of ups and downs. Frailty is maybe more like a slow waltz.
The entertaining comparisons were used by Murray to help explain the findings of his team’s research into these trajectories, using narratives from people with cancer, organ failure and fragility.
He highlighted how, as different disease diagnosis will result is different trajectories, services need to adapt and change how they do things to better support those patients who don’t have cancer.
Murray shared multi-dimensional trajectories, which suggest when patients would most need psychological, social and spiritual support, as well as for their physical needs.
His lecture included examples of how hospices could expand their care, such as through joint clinics (at the hospice or elsewhere) held by palliative care specialists with disease specialists, for people with COPD, dementia etc.
Murray also shared some newer research which found that, over the past three years, there has been an increase in “anticipatory care” across Scotland – likely due to a national drive encouraging GPs to identify people who were at risk of hospital admission.
Murray explained that anticipatory care is similar to palliative care, but seems to be a more acceptable (ie less scary) and this may explain why GPs find it easier to suggest and discuss with patients.
He also highlighted SPICT (Supportive & Palliative Care Indicators Tool), a tool for identifying people who may benefit from a palliative care approach. SPICT has been translated into many other languages for international use and there is also now an app version available.
Murray concluded his plenary by encouraging everyone to “innovate and evaluate”, and called on those in the audience to share some of the innovative things they are already doing to reach more people who can benefit from their support.
The day concluded with the Hospice UK annual meeting, at which chair of trustees Michael Howard took the opportunity to highlight a few of the charity’s achievements this year, and answered questions from members.
Presentations from the conference can be downloaded from the Hospice UK website and you can also follow the action on Twitter using #HUKconf15.
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