Telemedicine/video consultation: application and evaluation for end of life care

Categories: Care.

Just days before Airedale NHS Trust learnt that it had been successful in an application to become one of the NHS ‘vanguard’ sites for the New Care Models Programme, members of the team shared their experiences with a multi-professional hospice audience.

The journey they described is one that has taken the team from using telemonitoring and teleconsultation (initially with prisons and subsequently in patients’ own homes or care homes) to establishing a bespoke telehealth hub, operational 24/7 and staffed by experienced nurses from the acute care speciality.

The statistics are impressive; with the hub supporting 13 prisons, 183 care homes, 100 individuals at home with telemedicine and 1,000 patients in the last year of life by telephone.

Coverage of care homes encompasses more than 6,000 residents and an area stretching from Cumbria to Kent.

Although a full economic evaluation has yet to take place, a qualitative evaluation led by Laura Middleton-Green at the University of Bradford has endorsed its value for patients.

In contrast to the more traditional way of working – in what Rachel Binks, nurse consultant for digital and acute care, described as a system ‘designed by default’ – the hub :

  • supports patients and residents to stay at home
  • supports their carers in the planning and delivery of care
  • escalates care, where necessary, to community teams, including GPs and/or to streamlined hospital admissions which typically avoid A&E.   

In describing their own experience of setting up 24/7 helplines, hospice-based attendees acknowledged these have largely been used by people already known to the hospice, however their presence at the master class was prompted by a desire to extend delivery of services by adopting comparable technology.

In contrast, consultant Dr Linda Wilson explained that by enabling all patients thought to be in the last year of life on the Gold Standards Framework to have 24/7 access to the telehub via a GOLDLINE telephone support system, Airedale’s coverage is significantly more extensive.

Success factors   

Dr Richard Pope, who led Airedale’s work on telemedicine and is now clinical director at Dynamic Health Systems, joined a discussion of factors contributing to the success of the service and how these might be replicated elsewhere. These included:

  • Seed corn funding, which Airedale secured via a successful Health Foundation bid, and the opportunity this provided for long-term organisational commitment to the work and to partnering with a research-active organisation.      
  • Common software platforms and the ease of access to medical records which this provides.
  • A shared approach to end of life care achieved by use of the GSF in primary and secondary care combined with an interest in, and willingness on behalf of GPs, to engage with data on ‘Goldline’ patients.
  • Investing in the training and engagement of care home staff.
  • Developments in technology – most significantly the advent of the ipad and its ease of use in contrast to the limitations of set-top boxes.

The human factor 

The quality and commitment of the hub’s staff, and its skill mix, has also been of paramount importance, as has the opportunity for referral to palliative care nurses and consultants.

This was borne out by reflections from one of the nurses who described her experience of working in the hub as being less about a ‘system’ and more about providing ‘care and compassion’, albeit it at a distance and to people who she might never meet other than by phone or video link.

Similarly, a recent letter of thanks to the Goldline team reflected on an “incredible level of service and knowledge” which had dispelled fears of its getting in the way of “real care”.

Powerpoint presentations from this master class are available to download from Hospice UK’s website.

Members of the telemedicine team will be speaking at Hospice UK‘s annual national conference ‘The art and science of hospice care‘ (10 to 12 November 2015)

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