Innovation Warehouse - Stories - Innovation (Approved)

Creating a Blueprint for STP Digital Strategy and Investment

Overview summary:

ETL has worked with SEL STP to refresh their Digital Strategy. The HSLI in Provider Digitisation provided the funding stream to deliver the priority changes. ETL facilitated the creation of the HSLI case over three years and the development of the PIDs Business Cases and Value for Money analysis for the initiatives. We are now supporting the delivery of priority FY18/19 projects, updating the digital strategy reflecting the ICS and NHS 10-year plans and prioritising initiatives for FY19/20.

Challenge identified and actions taken :

The existing SEL Digital Strategy was over 70 pages long, had not been updated for a while, and was not understood. The challenge was to update the strategy so that it reflected the latest thinking in the NHS and STP plans. We delivered a strategy that was a few pages long, easily understood, achievable and had STP-wide consensus.

In addition, there was a need to draft an investment case to secure 3-year HSLI in PD funding within a fixed deadline. The challenge was to get agreement on a set of initiatives that could be delivered in FY18/19 with robust benefits and outline proposals for FY19/20. These needed to be aligned to the criteria set out by NHSE as well as the STP and provider priorities.

Having secured HSLI in PD approval, we drafted quality PIDs, Business Cases and VfM analysis documents for FY18/19 and within tight deadlines. We worked closely with NHSE Chief Digital Officer to ensure that our proposed initiatives would meet expected criteria.

With key lessons learned we have an equally challenging task to refresh the STP digital strategy so that it is aligned to the ICS and NHS 10-year plans. We need to deliver the projects that we have committed to in FY18/19, whilst also getting priority FY19/20 initiatives. Finally, we need to draft quality submissions with robust business cases by Spring 2019.

Impacts / outcomes:

We now have a STP digital strategy that is agreed across the STP and can be communicated easily and understood by all stakeholders. It is also a strong reference point for measuring the alignment of the initiatives that the STP is pursuing to the strategy.

We have a robust HSLI in Provider Digitisation investment proposal that is agreed across the SEL STP and provider organisations. It has been approved in principle by NHSE and hailed as the standard for the whole of London to follow.

We have a set of documents - PIDs, Business Cases and Value for Money Analysis - for the initiatives that we are progressing and delivering in FY18/19. In addition, we have a template for future initiatives and lessons have been learned on how best to implement new and similar work. These lessons and good practices can now be shared readily with other STPs.

Which local or national clinical or policy priorities does this innovation address:

This innovation addresses the proposals set out by NHS Five Year Forward View, NHS Digital Priorities, Matt Hancock’s HSLI in Provider Digitisation initiatives and SEL ICS ambitions and NHS 10-year plan. It also helps significantly to improve and deliver the digital maturity in the NHS.

Supporting quote for the innovation from key stakeholders:

Quote from John-Jo Campbell the SEL CIO.

“I understand that ETL may have opportunities to undertake STP Digital work in other parts of the country. I am happy to confirm the excellent work ETL have undertaken in supporting SE London STP in updating and refreshing the Digital Strategy and roadmap in 2018 and more latterly driving the process of developing and submitting cases for HSLI digital funding.

As discussed, please share this as you see fit, I am happy to be contacted for further information or references for ETL.”

Plans for the future:

The next phase of the project includes:

Delivering the projects that we have committed to in FY18/19
Refreshing the STP digital strategy so that it is aligned with the SEL ICS ambitions and NHS 10-year plan
Securing SEL ICS wide consensus to priority HSLI in PD FY19/20 initiatives
Drafting quality submissions with robust business cases for NHSE to approve by the end of Spring 2019.

Tips for adoption:

The right type of leadership, governance and collaboration at STP and provider level are key to success. What this means is all the key stakeholders at the STP and Provider level recognising the importance of these initiatives, the commitment, collaboration and leadership that is required and the time that needs to be allocated to discuss, agree and stick to the priorities. Without that and the underpinning governance and decision-making forum would lead to initiatives that are not fully thought through and tax-payers money wasted. We have seen this first hand and recognise the true significance of this.

It is also very important that the leadership team engage the right type of expertise to drive this requirement at the STP and ICS level. Without that it will be very challenging to secure the funding and deliver the much-needed changes underpinned by digital solutions in the NHS.

Contact for further information:

John-Jo Campbell – CIO SEL STP
E: john-jo.campbell@nhs.net

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Tas Hind 22/01/2019 - 20:10 Approved

Royal Stoke Pharmacy Workforce Calculator (RSPWC)

Overview summary:

The Royal Stoke Pharmacy Workforce Calculator (RSPWC) was developed at University Hospitals North Midlands NHS Trust (UHNM). It was developed to determine local clinical pharmacy staffing levels required to deliver pharmaceutical care to specific patient cohorts. Its algorithm is based on ‘activity standards’ for tasks and ‘unavailable’ staff time, which generates a resource to deliver services sustainably across a full year. It has been utilised by UHNM for a number of years as a method of responding to business case plans.

Challenge identified and actions taken :

Challenges began for the pharmacy workforce at UHNM when there was an increase bed numbers and patient cohort changes, increasing the number of patients requiring pharmaceutical services. This had a clear impact on the pharmacy team’s ability to deliver the pharmaceutical care requirements for patients. Securing adequate resources for pharmacy service delivery was challenging. Often the pharmacy was not considered in financial calculations of associated business cases and when it was, an arbitrary value, insufficient for service needs, was allocated.

This led to the development of the RSPWC as a method to objectively identify and calculate the necessary resources to ensure adequate staffing. The calculator is now a validated tool that identifies the staffing resources required to deliver clinical pharmacy services to in-patients in acute hospital settings. It does this by using the mean time the pharmacy workforce takes to complete patient related clinical pharmacy tasks (the ‘activity standard’) and extrapolating this for a specific cohort of in-patients, using number of beds and average length of stay. This determines workforce staff and resources needed, taking into consideration the ‘unavailable time’ (annual leave, sickness, training etc.) to ensure that the service is sustainable 24/7/365.

Impacts / outcomes:

There are many positive outcomes that have come from the RSPWC. These are discussed below:

The RSPWC provides an objective calculation of pharmacy staff resource, to ensure that adequate staffing in a changing health service is provided.
The system requires minimal data collection by users as data is readily available from the ward demographic data, which completes the process. The resources that are needed by the pharmacy workforce are then identified and are broken down into staff groups to allow skill mixed opportunities to be identified.
The RSPWC has been validated through a process that included a Delphi study with a panel of national experts for application to pharmaceutical care services for acute hospital in-patients, both in general medicine and surgery
For the first time, a consensus on required service components for the delivery of pharmaceutical care, across multiple hospital sites nationally in the UK has been established. .
Through the application of the calculator to business cases the pharmacy establishment has grown over a number of years. It has increased staff numbers across all grades and staff groups. This has allowed improved patient care e.g. staffing to RSPWC levels an increased number of patients can be discharged directly from the ward area (the surgical team deliver around 85% of discharges in this way. This has reduced turnaround time for medicines required for discharge from 3 hours to 30 minutes.
Furthermore, there is evidence from other sites that suggests that staffing to levels suggested by the calculator has had an impact in reducing length of stay and readmission rates of patients.

Which local or national clinical or policy priorities does this innovation address:

With the increased focus on pharmacy workforce following the Carter Report 2016, many hospitals are looking at utilisation of pharmacy staff in much greater detail. The need to expand pharmacist roles beyond the traditional ward service is increasing and the RSPWC allows pharmacy managers to understand baseline staffing requirements before addressing changes of role or scope of practice. The RSPWC has been used by other Trusts to support responses to business cases and guide service development eg. Coventry and Warwickshire NHS Trust, East Kent NHS Trust.

Supporting quote for the innovation from key stakeholders:

“In this era of standardisation, rationalisation, benchmarking and Carter it [the RSPWC] will support some agreed standardisation of pharmacy so it fits nicely in the political context.”

“I think historically capacity and demand planning have been very much feeling based, but it’s nice to have something that either backs up that feeling or completely challenges it I guess.”

“I did try it just for a ward we’ve got at the moment and one that I thought was reasonably functional and it came out with roughly what we’ve got.”

“I put some figures through it last week due to the Trust opening more beds and have so far got a positive response from finance which has led to getting in two locums based on the figures."

Plans for the future:

Future development plans include:

Developing and validating versions of the calculator for application to specialist areas. At UHNM we have started developing a Renal version of the tool. This speciality has long had a n accepted patient/pharmacist ratio for guiding staffing however the advantage of the RSPWC is the inclusion of technician and non-registered workforce staff groups, essential for service delivery but not included in the national benchmark. Early approaches have been made for developing a mental health version of the tool, but this will require substantial research in-put and would be available as an MSc project for an interested candidate.
Generating outcome data to demonstrate the patient care benefits that staffing to this level will deliver – it is hoped to pilot this through the winter of 18/19.
Reviewing the model to consider the impact of pharmacist prescribing on the activity standard – this is an additional role but there will be some overlap of activity and this is not yet understood, but will have implications for staffing levels and skill mix.

Tips for adoption:

If your NHS Trust would like to adopt the RSPWC we have developed, it has been shared on the NHS platform “Kahootz” which is accessible to Chief Pharmacists. All the information you need on how to adopt the system is available on there.

Contact for further information:

If you would like more information on the Pharmacy Workforce Calculator then contact Ruth Bednall via email: ruth.bednall@uhnm.nhs.uk

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Ruth Bednall 19/12/2018 - 17:18 Approved

Study- Step Right Buddy

Overview summary:

Carole Owen of Birmingham Community Healthcare NHS Foundation Trust (BCHC) has been collaborating with Dr Sarahjane Jones from Birmingham City University to explore the potential clinical benefits of a device called ‘Step Right ’, which aims to reduce the risk of falls in walking frame users.
The original idea for the Step Right Buddy device came from rehabilitation assistant, Carole Owen, at BCHC, who recognised the need to address the issue of poor posture, falls and the poor technique used by patients when using their walking frames.

Challenge identified and actions taken :

Falls are prevalent in older adults, one third of adults over 65 fall each year. A walking frame is a common device given to older adults whose poor mobility or balance places them at risk of falls.
Incorrect use of the walking frame is common practice, which in itself presents a risk of falls. Patients often step too far into the frame, making the frame unstable and likely to tip, leading to falls.
This led to the invention of the Step Right buddy – an attachment to a standard walking frame, aiming to teach correct use of the frame. It is an elasticated band secured across the top of the back legs of the walking frame, designed to make patients aware that they have stepped far enough into the frame, to stop them stepping any further. It also prevents patients from falling backwards due to holding the frame too close. The device is designed to provide walking frame users with sensory and visual feedback on how far to step into the frame thus lessening risk of falls.
The research team which included Carole Owen, Sarahjane Jones, Faye Dimmock and Helen McEwan undertook a pilot study of the device. The aim of the study was to gain insight into the user’s experience of using the device after trialling it for one week. The study was also used to identify whether any new risks were introduced with use of the device.

Impacts / outcomes:

The pilot study assessed the acceptability and safety of the device on 17 walking frame users who had been identified as using the frame incorrectly.
- Users reported positive experiences from using the device
- Users reported the Step Right Buddy corrected their posture and that the concept has great potential.
- No serious adverse events occurred, however two incidents of unsafe and incorrect use of the device were identified.
- Alongside the research project, the university also provided training and development opportunities for staff at the Trust, in the design, development and delivery of research.
- Wider patient and public involvement was sought in both design and analysis of the study using an afternoon tea party group discussion format.
- The study has highlighted that the Step Right Buddy is acceptable for patient use and the need for further research.
An application for funding from the Health Foundation is being considered and manufacturing sought.
The Step Right Buddy was also awarded a cash fund after being shortlisted for the MidTECH prize for best NHS-developed Medical Technology Innovation at the annual West Midlands Academic Health Science Network Awards.

Which local or national clinical or policy priorities does this innovation address:

The Step Right Buddy is a simple accessory that can be added to a walking frame to guide patients who have experienced difficulties using a frame. This device’s priority therefore is to help prevent patient falls when using a walking frame.

Supporting quote for the innovation from key stakeholders:

Rehabilitation assistant at Birmingham Community Healthcare NHS Foundation Trust Carole Owen:
“It was a ‘light bulb’ moment and initially, I just used a pair of tights… then I went home and ran up a simple flexible strap for 40p. I never imagined at that stage that it would develop the way it has.”
Senior research fellow at Birmingham City University Dr Sarahjane Jones:
“It’s a brilliantly simple concept because it acts as both sensory and visual aid”
“We’ve been very pleased to partner with BCHC on this and support Carole. This funding will help us develop and produce a batch of up to around 200 Buddies, taking forward the concept into a larger trial.”
The project was also aided by the feedback of former physiotherapy service patient John Fancote:
“I’d had such wonderful support from the physios so I said I’d like to give something back and I was very pleased to be able to offer a patient’s view and support the development of such a simple but effective idea.”
Innovation Manager at of Birmingham Community Healthcare NHS Foundation Trust Hamid Zolfagharinia:
“Carole is a shining example of what we can achieve by working with colleagues to take their great ideas from clinical practice and develop them.”

Plans for the future:

Funding awarded from MidTECH will help the team further develop the device Step Right Buddy and will aid to produce a batch of 200 buddies, which will take the concept forward into larger trials. A larger scale study will aim to identify the effectiveness of the device on frame users who are fallers and those at risk of falls. The team are currently in the consultation phase with a designer to formulate a design specification of the device in readiness of getting the product to a manufacture.

Tips for adoption:

At this time, the Step Right Buddy isn’t available for adoption into practice, however, if organisations would like to learn more, or be a partner site in the recruitment of patients to a larger trial, please do get in touch.

Contact for further information:

If you like more information on Step Right Buddy contact Carole Owen: Carole.Owen@bhamcommunity.nhs.uk

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Hamid Zolfagharinia 13/11/2018 - 13:54 Approved

The use of the geko™ device to serve an unmet VTE prevention need in acute stroke patients

Overview summary:

NICE recommend Intermittent Pneumatic Compression (IPC) to reduce Venous Thromboembolism (VTE) risk in acute stroke patients. However around 30% of patients cannot be prescribed this modality. To serve this unmet need The Royal Stoke University Hospital has introduced a new VTE pathway which included neuromuscular electrical stimulation of the peroneal nerve using the NICE approved geko™ device (Firstkind Ltd UK). This pathway change also increased patient surveillance of both IPC & the geko™ device so to maximise the anti-stasis intervention.

Challenge identified and actions taken :

VTE prevention strategies available to high risk stroke patients are limited. NICE recommend IPC as the primary method of VTE prevention because the risk of symptomatic intracerebral haemorrhage with routine anticoagulation (including low molecular weight heparin) outweighs any potential benefit. Furthermore anti-embolism stockings are not recommended.

IPC reduces VTE risk by increasing venous return and preventing venous stasis in the veins of the calf. This modality, alongside standard measures of hydration, mobilisation and aspirin represents standard UK VTE prevention for high risk immobile acute stroke patients. The VTE consequence of no IPC intervention in this cohort was recorded in the CLOTS-3 study which showed a high resulting VTE incidence rate of 8.69%.

The geko™ device is an alternative anti-stasis device for use on patients who cannot be prescribed or tolerate IPC. The Royal Stoke University Hospital has recently introduced the device into the stroke pathway for patients who were either contraindicated or became intolerant to IPC and would otherwise have had no anti-stasis intervention.

Furthermore, nursing practice was amended to increase patient surveillance and maximise compliance for both IPC and the geko™ device. The objective was to maximise the anti-stasis intervention in this population.

Impacts / outcomes:

Blood clots, or venous thromboembolism (VTE), are a major risk to hospitalised patients. VTE leads to pain, swelling and potential death. While the full scale of the problem is not known, it is estimated that hospital-associated VTE leads to about 40,000 deaths in England per year, 25,000 of which may be preventable through proper risk management and care. This is about five times as many healthcare-associated deaths as from methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile combined. There is a strong quality and financial imperative for hospitals to prioritise VTE prevention.

National Institute for Health and Clinical Excellence (NICE) guidelines set out the preventative measures that should be implemented to reduce this risk. In 2014, new guidelines recommended the use of the geko™ device for use in people who have a high risk of venous thromboembolism and for whom other mechanical and pharmacological methods of prophylaxis are impractical or contraindicated.

The size of a wrist watch and worn at the knee, the easy-to-use geko™ device is a neuromuscular electro-stimulation (NMES) medical device that gently stimulates the common peroneal nerve (a nerve adjacent to the knee) activating the calf and foot muscle pumps. The device creates a painless contraction of these muscles every second resulting in the prevention of “venous stasis” or static blood in the deep veins of the calf.

The risk of venous thromboembolism (VTE) after stroke is increased in patients with restricted mobility and associated increase in venous stasis. The alteration in blood flow in weakened limbs may lead to vessel wall injury, whilst there is also an abnormal tendency for the blood to clot more after stroke. The results from the Royal Stoke University Hospital show that introducing the geko™ device into this pathway lowered the overall incidence rate of symptomatic VTE. The geko™ is as effective as IPC at reducing DVT, the device was well tolerated and offered an alternative prophylaxis strategy to IPC, ensuring that all patients received VTE prophylaxis, where previously no prophylaxis could be given.

A clinical audit reviewed 1,000 patients admitted to the acute stroke unit at Royal Stoke University Hospital between 1st Nov 2016 and 3rd March 2018.

Key impacts:

188 patients were sufficiently mobile and did not require any form of VTE prophylaxis.
125 were assessed and deemed suitable for anti-coagulant drug to reduce VTE risk
687 patients were assessed as immobile and at high risk of VTE, were unsuitable for drug and required an anti-stasis intervention.
21/687 patients refused any kind of anti-stasis VTE preventative treatment
Therefore 666 patients received an anti-stasis intervention in addition to standard measures.

544/666 were initially prescribed IPC to reduce their VTE risk
122/666 patients were immediately contraindicated to IPC and were prescribed the geko™ device.
81 patients who were initially prescribed IPC but became intolerant to it and were switched to the geko™ device.

Accordingly, 203/687 or 29.5% of patients represented the unmet need as described above and required an alternative anti-stasis and were therefore served by the geko™ device.
The geko™ was used for a mean of 9 days/patient.
The geko™ device was well tolerated by patients.

Key outcomes:

This audit also reviewed the VTE (DVT or PE) incidence at 90 days post discharge for the 687 patients who needed an anti-stasis intervention.

11 VTE occurred in patients treated with IPC
1 VTE occurred in the group who were initially prescribed IPC but who were switched to the geko™ device.
1 VTE occurred in the group who refused any form of anti-stasis intervention
There was no incidence of VTE in patients prescribed the geko™ device.

The above new VTE pathway in acute stroke patients, which increased patient surveillance and included IPC and the geko™ device to maximise the prescribed anti-stasis intervention, resulted in a low overall incidence of symptomatic VTE. The incidence in high risk immobile patients requiring an anti-stasis intervention was 1.9% (13/687), which is lower than the 6.6% in a comparable patient population in the CLOTS-3 study.

Which local or national clinical or policy priorities does this innovation address:

National Institute for Health and Clinical Excellence (NICE) guidelines set out the preventative measures that should be implemented to reduce the risk of blood clots, or venous thromboembolism (VTE). In 2014, new guidelines recommended the use of the geko™ device for use in people who have a high risk of venous thromboembolism and for whom other mechanical and pharmacological methods of prophylaxis are impractical or contraindicated.

Supporting quote for the innovation from key stakeholders:

‘Following the positive results of our clinical audit within our acute stroke unit, the geko™ device is now in routine use and has marked a significant change to our nursing practice. The audit has shown a need to use the geko™ when other VTE prophylaxis strategies are contraindicated or impractical. This pathway enhancement ensures that all acute stroke patients now have another VTE prophylactic intervention option where previously patients would have had no other intervention available to them’.

Dr. Indira Natarajan FRCP (UK)
Consultant Stroke Physician
Clinical Director Neurosciences
The Royal Stoke University Hospital

Plans for the future:

Whilst the above data has proven sufficient for the geko™ device to be adopted specifically to meet this unmet need, this audit will be extended as will the ongoing collation of associated quantitative & qualitative data.

Further support will be given to multiple trusts to further validate the use of the geko™ device to serve this large and meaningful unmet need in acute stroke patients

A publication strategy will also be formulated with the aim to present this data as appropriate.

Tips for adoption:

Firstkind are determined to remove any administration obstacles to accelerate the adoption process whilst fully respecting due process. We can assist the adoption process by offering the following:

The team at Royal Stoke Hospital are receptive to assist where possible in terms of process and sharing of experience
The sharing of all the relevant “committee” forms that allow for a new device to be considered and used within a trust. This common approach has created efficiency.
In terms of any device audit that has been conducted to quantify the size of any unmet need the audit collection forms have been shared between trusts to the reduce administrative burden.
Created a cross trust partnership approach to delivering patient benefit.

Adopting this approach has fast-tracked the implementation of this new technology into the stroke pathway in several centres across the U.K.

Contact for further information:

Firstkind Ltd
Hawk House
Peregrine Business Park
Gomm Road
High Wycombe
Bucks
HP13 7DL

E: geko.support@firstkindmedical.com
W: www.gekodevices.com

T: +44 (0)845 2222 920 (Orders)
T: +44 (0)845 2222 921 (Enquiries)
F: +44 (0)845 2222 820

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Tony Humphrey 31/10/2018 - 12:52 Approved

'Holding Time' - opening conversations around breastfeeding.

Overview summary:

There is a wide disparity between the emphasis on breastfeeding in culture and the support for mothers attempting to breastfeed for the first time.

Funding for Health Visitor run baby groups & drop-ins throughout the UK have been cut in past 2 years due to budget constraints, leading to increasing social isolation of new mothers.

Young mothers in particular may not have ever encountered another breastfeeding mother, given that the last generation was largely encouraged to bottle-feed.

Challenge identified and actions taken :

Our target - Mothers who may not have access to current research and/or may be unduly influenced by cultural barriers to breastfeeding.

c 700,000 newborn babies born in UK each year. A high proportion will be to new mothers with no experience or understanding of breastfeeding.

Funded by ACE from 2017-18, ‘Holding Time’ a series of photographic portraits of mothers breastfeeding was shown at Fabrica Gallery, ONCA Gallery and Royal Brompton Hospital in London, in print, video and installation formats, accompanied by talks and workshops. ONCA featured a Breastfeeding Hub where comfortable seating encouraged mothers to stay longer and talk with other mothers.

A project website ( www.holdingtime.org), and YouTube channel promoted 5 min Podcast interviews with participating mothers from the photographic series. A BLOG written by Dr Newell explored issues surrounding the cultural barriers to breastfeeding. Facebook promotions and postcard campaigns at GP surgeries drew visitors to the website and exhibitions.

Impacts / outcomes:

Findings / Outcomes:

Exhibition audience was more mixed in gender and age than anticipated
Workshops and talks were attended by many academic, medical and health researchers/practitioners
The ‘Holding Time’ slideshow drew audience to the Youtube channel
YouTube recommendations helped to attract many thousands of visitors to the channel.
The Breastfeeding Hub resulted in longer visits to exhibition
Interviews/talks/workshops revealed structural barriers within health practice where policy and practice are not meeting.

Exhibitions x 10 days/ 435 visitors
Website: 1,000 users/ +67%
Talks x 2: 70 attendees
Facebook fans 303 posts/+91 fans/ +695 engagement
YouTube Analytics: 36,400 Views/ +6,710/60 Likes/+179 Subscribers

Which local or national clinical or policy priorities does this innovation address:

Public Health England - Health matters: giving every child the best start in life; Public Health England Commissioning Infant Feeding Guidance; NHS Start4Life; UNICEF; Every child matters

Supporting quote for the innovation from key stakeholders:

National Strategy:
Include actions to promote, protect and support breastfeeding in all policy areas where breastfeeding has an impact. This includes: obesity, diabetes and cancer reduction; emotional attachment and subsequent school readiness; improved maternal and child mental health; wellbeing in the workplace; and environmental sustainability.

Priorities
Good practice guidance identifies that breast milk is considered the physiological norm of nutrition for infants and can provide wider benefits to further promote the bond between mother and baby. Some of the key evidence based benefits of breastfeeding are summarised below:

Baby
• Children who are breastfed for longer periods have lower infectious morbidity (including diarrhoea and vomiting) and lower risk of infant mortality
• Less risk of constipation
• Reduced likelihood of becoming obese or developing type 2 diabetes or other obesity related conditions later in life

Mother
• Reduced risk of developing breast and ovarian cancer
• Reduced risk of diabetes
• Develops stronger relationship bonds through skin touch between mother and baby
• It is a free resource and readily available
To gain the maximum benefits of breastfeeding the World Health Organization recommends an exclusive breastfeeding period for the first six months of life and continuing to breastfeed for at least two years.

West Midlands
• Breastfeeding initiation is significantly lower in the West Midlands compared to the England averages between 2010 and 2015
• Initiation rates between Local Authorities within West Midlands range from 48% to 77% out of all maternities during 2014/15

Key risks of lower breastfeeding uptake:
• Younger age of mother with those aged under 20 years the least likely to breastfeed.
• Mothers who are from a white ethnic background.
• Mothers who have never worked or employed in a routine or manual occupation (classified as lower socio-economic status).
• Younger age left full time education with mothers who left at or before 16 years least likely to breastfeed.
• Mothers in the most deprived quintile of society (classified as being in quintile 1 of the Index of Multiple Deprivation IMD calculation).

Patterns and associations of breastfeeding prevalence:
• Breastfeeding prevalence rates in England in 2010 were higher for each risk factor group compared to 2005 data for each reported period from time of birth to nine months.
• Breastfeeding prevalence dropped at an increased rate after two weeks from birth for all key risk indicator groups. At six months, roughly one third of mothers were still breastfeeding.
• The largest difference in breastfeeding prevalence is associated with age of the mother followed by age the mother left full time education and then socio-economic status and deprivation respectively.

Awareness of health benefits of breastfeeding:
• An inverse association is demonstrated between awareness of the health benefits of breastfeeding and younger age of mother, mothers classified as Asian or black, those in a lower socio-economic status and mothers who were intending to only formula feed or who had not yet made a decision.
• Mothers from a white ethnic background reported the most awareness but are the highest ethnic risk group to not breastfeed.

Information sharing:
• The groups least likely to receive information about the health benefits of breastfeeding include mothers aged under 20 years and those who have never worked.
• There is no significant difference between ethnicity and receipt of breastfeeding information.
• For all groups there are a low proportion of women who reported attending antenatal classes where infant feeding was discussed.

Please see https://www.youtube.com/watch?v=DjCeenfwBxQ
A film made by rb&hArts – the Charitable trust an partner at Royal Brompton Hospital.

Plans for the future:

Proposal:
A three year campaign of exhibitions/web content creation/printed book to stimulate and curate conversations around breastfeeding between the public and medical professions addressing the discrepancy between research and practice in order to inform research communities and the general public.

Outputs:

10 new exhibitions of Holding Time at community, health and art centres, birthing units and hospitals across the country.
10 x Postcard campaigns of 1000- 1500 (e.g. 25 cards x 50 surgeries per exhibition) leading public to online content
20 mother stories Podcasts
Expansion of Mother Stories section of website
Transcripts/closed caption subtitles for all Podcasts
20 guest BLOG posts: Academics/medical researchers to write on subjects raised by women in workshops and interviews e.g. the struggle to feed in the early stages, the establishment of lactation, post partum care, expressing, breastfeeding in public, looking at how current research can help parents make informed choices in these areas.
10 Podcasts with Academics/medical researchers/health professionals
Facebook Q&A sessions with guest researchers/practitioners and participating mothers

Breastfeeding Hubs/workshops/talks where possible/appropriate delivered by Dr Lucila Newell and Lisa Creagh

Facebook/Instagram channels to promote the above.

A limited edition book featuring Holding Time with an introduction by Dr Debra Bick, essay by Ruth Stirton/Lucila Newell/Erin Barnett. Schilt publishers have confirmed they will produce and distribute this book across Europe and North America using their existing channels.

Tips for adoption:

Any Community health space can host the exhibition, promote the exhibition using the tested method of GPs surgeries locally and linking to the online content. They can also suggest researchers and mothers to interview or write BLOG posts. I have applied to Wellcome for a budget to cover ten exhibitions in areas with low breastfeeding rates nationally.

Contact for further information:

For more information please contact Lisa Creagh
Project Web: www.h oldingtime.org
Artist site: www.lisacreagh.com
Email: lccreagh@icloud.com
Tel: 07816 577140
See additional 'Links' document attached

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Lisa Creagh 13/09/2018 - 09:00 Approved

Enabling Self-management and Coping with Arthritic Pain using Exercise - a group rehabilitation programme

Overview summary:

ESCAPE-pain is an evidence-based, NICE-recommended group rehabilitation programme appropriate for people with osteoarthritis, commonly called chronic joint pain, in their knee and/or hip.

Challenge identified and actions taken :

The probability of having hip replacement is 2.87 times higher in people receiving usual care (for e.g. GP care) compared to those who have participated in individually tailored exercise programmes such as ESCAPE-pain.

What is ESCAPE-pain?

ESCAPE-pain is a group rehabilitation programme for people with chronic joint pain in their knee and/or hip. Participants attend facilitated sessions twice a week for 6 weeks. Each session involves education and exercise components which are individualised for each patient. The Programme is both clinically and cost effective, producing measurable improvements in physical and mental health. It delivers the core NICE recommendations for the management of osteoarthritis in adults.

Research papers show it has wide health benefits and reduces healthcare utilisation. It is cited as a case study in the NHS /Rightcare QIPPseries.

Delivering ESCAPE-pain typically involves implementing changes to current service provision coupled with a commitment from the CCG and Provider organisation to ‘invest to save,’ using the ‘evidence-base’ of ESCAPE-pain to ensure that a minimum of 10 (and ideally 12 sessions) are offered to participants, for longer-term benefit.

Impacts / outcomes:

Clinical outcome measures - KOOS (Knee osteoarthritis outcome score), HOOS (Hip osteoarthritis outcome score) and HADS (Hospital anxiety and depression scale) assess pain, function, activities of daily living and quality of life.
Data from live sites demonstrates improvements in pain, function, and the ability to carry out activities of daily living; as well as improvements in mental health for participants completing the programme.
Staff and participant satisfaction: scores in both domains are consistently very positive.
Capacity benefits: grouping participants into cohorts for ESCAPE-pain reduces wait time for 1:1 physio.
Savings: research evidence showing a reduction in overall healthcare utilisation following the programme can be easily extrapolated to the local MSK prevalence using the MSK calculator (Arthritis Research UK).
From a baseline of 2 sites (2014), ESCAPE-pain is now delivered at >80 sites in England/Wales, including leisure centres as well as clinical departments - over 7000 participants to date.
Physiotherapy savings: extrapolation of research findings suggests physiotherapy savings of £82 per person, i.e. £574,000 total national savings to date. In practice this will have meant capacity release, as disinvestment in physiotherapy services is unlikely to have occurred.
Overall health and social care utilisation per patient: extrapolation of research findings suggests reductions achievement of overall health and social care utilisation of £1,511 per person per programme i.e. £10.6 million total national savings to date

Awards and endorsements

2015 winner of Health and Wellbeing Award from the Royal Society of Public Health
Best Practice Award in Rheumatology and Musculoskeletal Disorders from the British Society for Rheumatology 2016
Endorsed by the Academic Health Science Networks (AHSNs) and listed on the Innovation Exchange website and identified as one of the programmes developed regionally and selected for national adoption and spread across the AHSN Network during 2018-2020.
Recommended by Public Health England (PHE) as a preferred intervention for musculoskeletal management - their report titled, 'Return on Investment Interventions for the Prevention and Treatment of Musculoskeletal Conditions' which shows the programme has a positive financial ROI of £5.20 for every £1 spent.
Accredited by the Chartered Institute for the Management of Sport and Physical Activity (CIMSPA) and now part of their Skills Development Partner network.
Highlighted as a Tier 3 intervention in Arthritis Research UK's 'Providing physical activity interventions for people with musculoskeletal conditions' report and British Journal of General Practice (BJGP) editorial.
Clinical Director, Professor Mike Hurley, was awarded a Fellowship joining the prestigious 2017 NHS Innovation Accelerator (NIA)
Recommended by NHS Staff Health & Wellbeing: Commissioning for Quality and Innovation (CQUIN) as a low intensity therapy for their supplementary guidance
Included in the Richmond Group's 'Doing the Right Thing' report
Highlighted by the British Orthopaedic Association (BOA) in the pre-operative pathway
Awarded a Sport England grant to tackle inactivity in inactive people over 55
Showcased in the NIHR report 'Moving Forward', a summary of the most evidence-based musculoskeletal recommendations. It has been commended for its improvement of patient-care and its encouragement of self-care.
Identified as one of the top 5 case studies in a RAND Europe report commissioned by Public Health England to review the current landscape of health and wellbeing interventions available to employers.

Which local or national clinical or policy priorities does this innovation address:

Health and Wellbeing

Supporting quote for the innovation from key stakeholders:

The ESCAPE-pain website is a project supported by the Health Innovation Network. Founded by NHS England, the Health Innovation Network is the Academic Health Science Network (AHSN) for South London. Their objective is to deliver service improvement and sustainable change, through collaborating with partners from the NHS, universities, local government, industry, the third sector, and prioritising involvement from service users and the public, to drive innovation and best practice across South London.

Plans for the future:

Approximately 1 in 5 of the adult population over the age of 50 have osteoarthritis. Access to ESCAPE-pain need not be limited to clinical environments. ESCAPE-pain is currently being offered in hospitals, physiotherapy departments, gyms, local leisure centres, and community halls etc. One of the aims is to grow the number of leisure sector providers offering the programme and also providers based out in the community.
The programme has been selected by the AHSN Network for national adoption and spread during 2018-2020.
The free ESCAPE-pain app is available on both iOS and Android devices. It contains 16 high-quality exercise videos and engaging animations and videos to help people learn how to manage their condition better and feel more in control of their pain.
An additional digital tool has been launched to further support the ESCAPE-pain programme. ESCAPE-pain Online is a web-based version of the app which replicates the same education and exercise videos. It allows people who don’t have smart phones to continue exercising safely in their own homes. ESCAPE-pain Online has been designed to be accessed from a computer.

Tips for adoption:

Facilitators must attend a one-day training course to become an ESCAPE-pain facilitator covering key areas such as the content of all 12 sessions, the evidence-base, Motivational Interviewing, the importance of collecting the clinical outcomes etc.
Initial support and mentoring to ESCAPE-pain facilitators (typically physiotherapists and fitness instructors) to set up the Programme.
Describing aligned incentives – delivering ESCAPE-pain in groups releases capacity in physiotherapy services, and is cheaper for CCGs, as well as delivering participant benefits.
Influencing commissioners through existing fora/more detailed discussions where CCGs are re-procuring MSK services.
For National Programme spread monthly webinars are scheduled to bring together ESCAPE-pain project/programme managers with those who have experience in delivering the programme. Each webinar covers key topics and provides an opportunity for sharing best practice and discussing challenges. Face-to-face events are planned as well.
Ongoing use and promotion of the ESCAPE-pain website to demonstrate digitally and succinctly how to deliver the Programme; the website also provides research evidence/financial data for commissioners.
Ongoing use and promotion of the free ESCAPE-pain app which is available on iOS and Android devices, and ESCAPE-pain Online.
Distributed leadership: clinical champions and champion sites regularly showcase the Programme.
Annual event to bring together sites delivering the Programme to learn from each other.

www.escape-pain.org gives all the materials required to commission the Programme and provides information on how to access the training.

Contact for further information:

Andrea Carter
E: andrea.carter@nhs.net
www.escape-pain.org: website for healthcare professionals and commissioners, showing videos of the Programme, full evidence-base, educational information for patients etc. Register for free to access the education and exercise videos.
Metrics: outcome data can be provided

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Isabel Rodrigues de Abreu 26/06/2018 - 21:54 Approved

SMARTCARE- The ‘Frailty Passport’ for advance care planning

Overview summary:

Dr Amit Arora at University Hospital of North Midlands (UHNM) has developed a Frailty Passport for frail elderly patients. The Frailty Passport is a patient held diary that holds the patient’s statement of preferences and wishes for the rest of their life.

This project aims to discuss advance care planning with frail elderly patients and as a by-product also reduces unplanned admissions and length of stay by communicating a personalised integrated care plan that is agreed by all parties involved- putting the patient right at the centre of care.

Challenge identified and actions taken :

It has been reported that frail elderly patients often have multiple hospital admissions. They often get readmitted to hospital because they are not always asked what they want when approaching the end of life. These discussions often happen at an inevitable or imminent stage of end of life rather than when approaching end of life. The aim is to issue the Frailty Passport and extend it to those frail patients ‘approaching end of life’ to enable ‘dignity in death’ rather than discussing advance care plans when death is imminent.

Therefore, this project strives to create an intervention service that puts the patient at the centre of their care plan. It aims to reduce unplanned admissions and length of stay, by establishing an integrated personalised care plan- bridging communication and care between all providers. This is done by the passport being completed in conjunction with the patient, their families and the medical teams. A Multi-Disciplinary Meeting (MDT) is organised to create an inclusive environment where all information can be shared regarding the Frailty Passport. The patients GP is also involved and is informed of the passport. It only becomes valid if the GP agrees to the contents after discussions with the patient, or their representative. This then enables patients to spend more time out of hospital.

Impacts / outcomes:

The Frailty Passport is intended to be used by health and social care professionals. The passport incorporates advanced care plans, supporting the patient or a new or revised care plan(s), in relation to the social situation, activities of daily living, crisis management plans, ceiling of care, and end of life plans including DNACPR documentation. Therefore, documenting and respecting patient wishes. This has achieved many positive outcomes which are mentioned below:

By streamlining care and improving communication across the traditional boundaries of primary care, secondary care, ambulance services, social care, housing and care homes it improves the whole experience for both health and social care in later years.
The written information is given to relevant staff in health, social care, carers and care home as guidance about matters that have been discussed in detail with patients (and/or representatives) and their medical records. This improves the quality of life, dignity, choice and autonomy.
As the passport streamlines care it avoids unwarranted hospitalisation, facilitate discharges, readmission and lists patient’s wishes and preferences. It also aims to improve the patients experience across the whole NHS for the rest of their life.
As this written plan is agreed by the MDT it will give enough confidence to health and social care staff to follow patient’s wishes.
The Frailty Passport has been listed as a good practice example by NHS England.

Overall, the Frailty Passport has been effective by clearly communicating the patient’s wishes and putting them at the centre of the care plan. It also gives written information to health and social care staff and provides medico-legal assurance.

Which local or national clinical or policy priorities does this innovation address:

At the moment the Frailty Passport is being used at UHNM and has plans to spread to other Trusts who are interested in the innovation. The priority this innovation addresses is: • To reduce healthcare related harm as complex elderly patients are at risk when admitted as an emergency (NHS England). • Preventing individuals from dying prematurely. • Enhancing the quality of life for individuals with long term conditions. • Helping individuals to recover from episodes of ill health. Furthermore, the Frailty Passport innovation ensures: • Ensures that patients have a positive care experience. • That the treatment and care for patients is in a safe environment, protecting them from avoidable harm.

Supporting quote for the innovation from key stakeholders:

Dr Amit Arora said- Traditionally Health and Social Care professionals are widely acknowledged to use syntactic language, current practice within the project when liaising with patients is to use terminology that can be understood by all involved. Acting as an advocate on behalf of the patient and family ensures that patients were given opportunity and support to discuss their wishes, concerns and suggestions for advance care planning. Also, highlighted was that the Frailty Passport is vital to ensure that patients and family fully grasped what was being communicated. The Frailty Passport also provides the reassurance of a clear documented and agreed written care plan to the care home staff when deciding what to do in the event of clinical deterioration in condition.

Here is some feedback that was given about the Frailty Passport in a few short quotes from individuals who have utilised the Frailty Passport:

“The best service I’ve had.”

“I wish every old person can have one of these”.

“This is the first time I have been asked about such an important issue”.

“This is absolutely fantastic”.

Plans for the future:

The USP of this innovation is that the boundaries between Acute Community, Primary, Social and Mental Health Care are able to successfully align to another. The introduction of the Frailty Passport results strong communications with all parties involved improves hand overs and improves the quality of patient care and satisfaction.

The next step for the Frailty Passport is to work towards the sustainability of the project and possibly modelling and scaling to meet the current demand.
Parameters could also be developed, which will enable identification of groups of high-risk patients at an earlier stage. This will facilitate early intervention and allow a more effective use of resources.
It could be hoped that a predictive model could be introduced in the future.

At present the teams can be alerted about the presence of the Passport by a notice at the back side of front door and is only available in a paper copy but an electronic format is being planned for further roll out. Evidence showed that health and social care can be difficult to understand and navigate as only 55.5% knew how to access further information or support. This will be an area for future improvement.

Tips for adoption:

Adopting the Frailty Passport includes utilising a multi-disciplinary case management approach, which is linked to the management of multi-morbid patients can facilitate a reduction of reliance on acute based care.

Adopting the Frailty Passport enhances communication and has proven to be a valuable tool in enabling all stakeholders to fully understand and comprehend what’s planned how it will be facilitated and who is responsible.

By adopting the Frailty Passport patients, carers and family have been fully involved in the project and always include their own planning and MDTs.

If you would like more information on the Frailty Passport please contact Amit Arora: amit.arora@uhnm.nhs.uk

Contact for further information:

If you would like more information please contact Dr Amit Arora: amit.arora@uhnm.nhs.uk

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Amit Arora 25/05/2018 - 16:37 Approved

National Deconditioning Awareness and Prevention Campaign: ‘Sit Up Get Dressed Keep Moving’

Overview summary:

Dr Amit Arora is a consultant geriatrician at the University Hospital of North Midlands and has served as Chairman of England Council of the British Geriatrics Society. He and his team developed the “National Deconditioning Awareness and Prevention Campaign” that encouraged elderly patients to “Sit up, Get Dressed, Keep Moving”. The campaign aims to stop older patients becoming deconditioned whilst in hospital or care homes. The campaign was initially used locally and then launched nationally on Older People’s Day, 1st October 2016.

Challenge identified and actions taken :

During hospitalisation, older people can spend up to 83% of their time sitting in bed and often a further 12% in a chair, therefore becoming deconditioned. Deconditioning can start as early as the first 24 hours where patients could lose up to 2-5% of muscle mass. It is often said that ten days of bed rest can be considered to be equivalent to ten years of muscle ageing in people over 80 years. Up to 65% of older people can experience decline in functionality during hospitalisation. Moreover, patients may experience:

Reduced mobility and functional ability
Increased dependence
Confusion, loss of self-confidence, depression, and demotivation
Further complications such as falls, delayed recovery, pneumonias and associated complications

These factors can lead to what he describes as ‘Deconditioning Syndrome’. Deconditioning is preventable but requires a strategic approach and awareness. Recovery from deconditioning can take twice as long.

Dr Arora: “Deconditioning is common but it is under-recognized and under-reported. There are many people who may have experienced deconditioning... Across our hospitals and care homes, we need to make healthcare staff and families aware of deconditioning to minimise and prevent it. To create awareness, we’ve developed the ‘National Deconditioning Awareness and Prevention Campaign’.

Impacts / outcomes:

Within the deconditioning campaign there are resources such as banners, posters, screen savers, information leaflets, exercise programs, videos and practical demonstrations to raise awareness.

As older people are the core users of the NHS, they benefit most from this campaign.

Dr Arora says “An appropriate level of exercise, activity and mobility in older people is easily do-able with in the usual surroundings. We are not talking about going to gymnasiums here. It is about doing simple activities of daily living, exercises in bed or chair, walking to toilet, sitting out in chair, standing, walking etc...” Some of the information available includes advice on how people could be supported and encouraged to stay active and independent by performing activities of daily living and movement when in hospitals and care homes. For example staff could ensure that:

Glasses, hearing aids, calendars and clocks are readily available and visible to promote awareness.
Patients are sat up in chairs, rather than remaining stationary in beds.
They should be dressed properly in their own clothes rather than in hospital gowns as it can make people feel better and more able.
Meals are eaten whilst sitting in chairs and not spoon fed in bed unless circumstances dictate so.
Patients should be encouraged to wash and dress independently, walk to the toilet where possible.
- Appropriate mobility aids should be provided earlier on if needed.
- We should ask if the mobility aids are of the right height.
- We should check if the height of the chair for example is not so low that the patient can’t get up.
- Patients should be encouraged to keep their arms and legs moving in their beds or chairs especially if they are unable to mobilize themselves.
Restrictions on visiting hours should be adjusted to encourage normal social interactions, which will also help to maintain functionality, regain independence and reduce loneliness.
Patients should be supported and encouraged to move as quickly as possible, where possible.

All of this support and encouragement movements could help to:

Reduce the risk of harm from falls, infection, thrombosis and delirium.
Reduce length of stay in hospital.
Reduce the likelihood of having an increase in their future care needs.

In addition there are many benefits of staying active in hospital:

Better able to fight infections
Better appetite
Better sleep
Better mood
Better able to cope at home
Lower risk of pressure sores
Less weakness and fatigue
Less dizziness
Lower risk of falls
Less pain
Less confusion

Moreover, this project noted that the biggest change was the individual’s behaviour and organisational culture generated through awareness.

The initial intended outcome was to achieve a 25% increase in the number of patients sat out, dressed and engaging in meaningful activity during their acute illness. However, there was an increase in the number of patients sat out, dressed in their own attire and mobilized by 60%. There was also an increase in therapy review and therapy led plan setting within 24 hours of admission. However, these can be fluctuant and dips were commonly noted so it is important to keep the momentum going.

There was also an enhancement in patient experience and in both staff and relative satisfaction...

Overall, the outcome from the ‘National Deconditioning Awareness and Prevention Campaign’ to get patients to “Sit up, Get Dressed, Keep Moving” has had a positive impact on patients and staff.

Which local or national clinical or policy priorities does this innovation address:

With the support from the British Geriatrics Society and NHS England, within a month there were requests for our material from clinical staff at over 20 hospitals, including hospitals from Australia, New Zealand and Canada and more have joined since. This campaign also received unprecedented support from the #endpjparalysus campaign and Jane Cummings (Chief Nurse, NHS England) and the efforts to prevent deconditioning became popular. Overall, this innovation generates awareness about this common condition in older people especially when they are hospitalized and less active. It also addresses how deconditioning syndrome can be prevented. Furthermore, the campaign’s material was requested by 40 NHS hospitals and more enquires have followed from the UK. The freely available downloadable material has already been requested by 40 hospitals; the team has certainly made an impact.

Supporting quote for the innovation from key stakeholders:

Many people were pleased with the information that was given to them about the ‘Deconditioning Awareness and Prevention Campaign’ and how it can affect a patient’s well-being. Here are a few supporting quotes that showcase how the campaign has been effective and successful, being adopted across different NHS Trusts:

“Hi Amit
This is a great campaign. Thanks for sharing it with us. As Andy said, it should fit well within the Care of the Elderly teaching blocks.”

“Hi Doctor Arora,
I am a physiotherapy student at Keele University and have recently started placement on frail elderly at UHNM. Whilst embarking on pre-placement reading, I came across the deconditioning awareness campaign. I have also highlighted deconditioning and behaviour change as potential topics for my placement presentation.”

“Thank you so much Amit.
I wish there were more stars in the NHS like you. Normally sharing material is not an easy matter & people get protective over their material. I will send you updates when we get them produced.”

“Hi
We love your staying active in hospital patient information and would like to have permission to use in Western Sussex Hospitals NHS Foundation Trust.
Of course credit still going to University Hospitals of North Midlands.”

Here are some supporting quotes from Dr Amit Arora himself on how he came to create the ‘Deconditioning Awareness Campaign’ and how deconditioning can affect a patient’s well-being:

Dr Arora said: “Many years ago I was subject to restricted mobility following an emergency appendicectomy. It took me a surprisingly long time to regain my strengths and abilities. I noted that despite my youth and the will, my muscles would not move. It took a while to recover back to normal.

When I related this to the frail old people that I see in hospitals, I can understand why someone who was able to function well before they came to hospital takes longer to regain their functions. A prolonged hospital stay, bed rest and other risks lead to loss of muscle power, strength and abilities…”

Dr Arora also said: “We should encourage patients to wash and dress independently, walk to the toilet where possible, provide appropriate mobility aids earlier on and encourage patients to keep their arms and legs moving in bed or chair. Even moving arms, legs and sitting up in bed offers a small degree of physiotherapy. It sounds so simple yet very often it just doesn’t happen.”

Amanda Futers, Clinical Nurse Specialist said: “Staff and families have an important role to play in preventing deconditioning. There is sometimes a misconception by families that staff should be doing everything for their loved ones because “they are in hospital”. Educating patients, relatives, carers and staff about the dangers of deconditioning is vital, since bed rest continues to be expected during a hospital stay, despite the considerable evidence showing potential adverse effects from inactivity. Of course there are times and conditions when best rest would be advisable, but more often than not this is not the case.”

Plans for the future:

To continue to build on ward-based exercise groups to maintain muscle tone and abilities.
To launch campaigns and engage influencers at local Older People’s Day events.
Hold national/international conferences at UHNM in 2018.
Continue to speak at national conferences to generate awareness.
Help nurses, therapists and medics conduct further research on methods of effective implementation of such programs.
Continue to roll out locally and nationally via schools, fire service, public, patient and CCG networks.
Engage champions from ward to board and into community.

Overall, we must continue to build on the campaign’s message.

Tips for adoption:

If you would like some tips on how to adopt the ‘Deconditioning Awareness Campaign’, “Sit up, Get Dressed, Keep Moving” then do not hesitate to download our material (This material may be copied without prior permission being sought from the copyright holder provided the purpose of copying is not for commercial gain and due acknowledgement is given):

View 'Poster' here (for hospitals and care homes)
View 'Banner' here
View 'Patient Information Leaflet' here
View Screensavers here

Or contact Dr Amit Arora:
amit.arora@uhns.nhs.uk
@betterageing
www.betterageing.co.uk

Contact for further information:

Contact Dr Amit Arora:
amit.arora@uhns.nhs.uk
@betterageing
www.betterageing.co.uk

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Amit Arora 24/05/2018 - 15:09 Approved

Digital transformation/improvement/quality/performance: Continuing Healthcare service, patients with complex conditions

Overview summary:

Continuing Healthcare is a complex multi stakeholder assessment and funding decision making process. It has been the subject of NHS improvement programmes, National Audit office scrutiny and patient group pressure which led Simon Stevens to make a commitment to Improve the service whilst reducing the cost to the NHS. We focused on developing a solution to improve efficiency and chc2dst was identified as one of ten high impact innovations in 2018. The solution was co-designed with the NHS.

Challenge identified and actions taken :

In late 2016 IEG4 ran an open event for NHS staff to come and discuss where improvements in efficiency through digital could make most impact. Two nurses were very clear that if we tackled the very inefficient process, paper and complex assessments for continuing healthcare we would improve the service for families and patients and dramatically improve the efficiency of the NHS workforce.
Continuing Healthcare improvement is also the focus of the NHS through a strategic improvement programme and a Quality premium payment scheme for CCG’s.

We took on the challenge and with the support of the Cheshire and Wirral Continuing healthcare team developed an end to end digital referral, assessment, workflow and decisions software solution.

Over an 8-month period the software was developed as part of an “agile” project to the stage we had an operational solution which the NHS in Cheshire and Wirral implemented.

Dramatic improvements in quality and performance have shown through with the Cheshire and Wirral CCG’s achieving NHSE targets. The solution is now market ready for rapid adoption across the whole of England to deliver widespread benefits.

Impacts / outcomes:

Tracey Cole - the Head of CHC in Cheshire has presented at events with the NHS England SIP team with the following messages from utilising our solution. These will be presented again at the Kings Fund Digital Health and Care conference in July 2018.

Single point of entry of referrals into the process offers control and transparency over the work load
Improved quality of assessments received – particularly checklists being digital
Reduced volume of cases by better and quicker assessment and education of referrers at the checklist stage
Reduced paper and postage costs
Reduced admin time for the operations team
Reduced admin time spent by clinical team – quicker completion of DST’s
Better allocation of positive checklists to the clinical leads
Automation of communications across stakeholders reduces delay
Improved morale in the team – people doing a better job
Improved delivery of 28-day standard
Digital checklist supporting discharge to assess to achieve the 15% standard
Full transparency of patient progress through the CHC system

Cheshire and Wirral CCG’s performance against an 80% target has improved from 66% to 82% during the period of implementing chc2dst.

Which local or national clinical or policy priorities does this innovation address:

Strategic Improvement Programme for Continuing Healthcare, Paperless 2020 as part of the 5YFV, Quality Premium scheme for CCG’s

Supporting quote for the innovation from key stakeholders:

Reviewers for the NHSE software applications assessment:

“A much-needed system for improving efficiencies in the CHC process”

“A high-scoring, eminently usable system that greatly impressed all three of our assessors in terms especially of clinical efficacy, safety, security and privacy”

Plans for the future:

Collaboration with AHSN’s and STP organisations to deliver the innovation across the NHS and build the digital solution for CHC and Complex care.
.

Tips for adoption:

The adoption process is very straightforward – One demonstration to frontline CHC staff and administrators, arrange a site visit to see the software in action, deploy an “instance” of the software into a test environment, configure the users and release the software to a live environment. Ongoing operational support from a Superuser/admin lead.

Contact for further information:

Charles MacKinnon
Charles.mackinnon@ieg4.com

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Charles MacKinnon 21/05/2018 - 14:45 Approved

Reducing avoidable and unplanned hospital admissions among high users of urgent care

Overview summary:

NHS Vale & York CCG introduced Proactive Health Coaching (PHC), a unique delivery structure bringing together the CCG, private partner, hospital trust, community partners & independent evaluator.

PHC is a telephone-based health management service that improves patient health & quality of life while ensuring healthcare resources are spent as efficiently as possible.

The CCG with partners Health Navigator & York Teaching Hospital delivered a preventative strategy for identified patients delivering better care for patients & reducing stress on A&E.

Challenge identified and actions taken :

NHS Vale of York CCG identified that a large percentage of A&E contact in the area as avoidable. It resolved to tackle the issue head on through work that aligned with local sustainability and transformation plans and its system-wide collaboration with partners.

But the system context in Vale of York is complex. It has three local authorities, an acute and community provider, a mental health trust, a large voluntary sector and alliances of primary care practices working in locality groupings.

Added to that, the clinical commissioning group (CCG) is in special measures due to its challenging financial position and demand is growing across the footprint, with an unsustainable increase in emergency department visits in Vale of York.

To address these challenges, the CCG embarked on a collaborative project with Health Navigator and other partners to see whether it could support patients to self-care better. It also wanted to help patients to navigate the wide variety of care options, to reduce demand on emergency services, so improving patient outcomes and reducing cost to the system.

Impacts / outcomes:

In partnership with Health Navigator and York Teaching Hospital NHS Foundation Trust, the CCG delivered an effective preventative strategy for identified patients that simultaneously provides better care for patients and reduces stress on A&E departments.

Using an algorithm, Proactive Health Coaching identifies patients before they become high users of urgent care services it works by supporting patients with weekly coaching calls in a randomised control trial and facilitates:

putting patients at the centre of care
patients being able to define their own goals so they can take control of their health and care journey, using services other than A&E
a better experience and outcomes for patients
commissioners, acute providers and primary care being able to work together
a reduction of the burden on A&E and inpatient services by reducing unnecessary attendances from some patient cohorts
a more efficient use of healthcare resources.

By supporting patients with weekly coaching calls, the randomised control trial is already showing high levels of improved patient experience, a reduction in attendances at A&E and fewer unplanned admissions to hospital. Patients being supported by the health coaching intervention are also reporting more confidence in the management of their conditions.

Results from an earlier NHS case study collated by York Teaching Hospital NHS Foundation Trust are currently being evaluated and published by the Nuffield Trust, an independent health charity. The patients formally contract with Health Navigator, which at present covers a relatively small patient group of 183 study participants, of which 121 patients have had the support of a health coach. At the time of evaluation, this has yielded savings per patient in the first year of the intervention of £1,034 less than the control group. This means that the service is already close to break-even in its first year, as it costs £1,200 per person for a two-year intervention.

Based on results in Sweden, it is anticipated that those receiving the service will have a further benefit in year two, equating to around 40 per cent further savings. This should mean a total saving of £1,448 per person and a net benefit to the commissioner of £248 per person over the two-year intervention.

Moreover, there are the associated operational benefits from taking activity out of the system. In particular, the intervention group has had 63 per cent fewer non-elective admissions and 60 per cent fewer A&E attendances. The number of bed days was 17 per cent less than the control group.

All of these represent the first year of the intervention only and across a small population group. The CCG recognises that results may change as study numbers increase. It is fully expected that over time, and as a greater number of patients are included within the study, the potential impact is normalised out across the population and the end result may be a slightly lower number, but the trend is clearly a positive one.

These early results mirror the significant impact that has been seen in the much larger trial in Sweden where over 12,000 patients have received similar support. Results from the Swedish trial have been published in the European Journal of Emergency Medicine in 2012 and 2015. The most recent results are showing statistical reductions of 30% in non-electives and 36% in A&E attendances.

The results also provide evidence of relevance, spread and replicability, with the initiative being easy to replicate nationally, even in financially challenged care economies. It also has the ability to be scaled up to cover a wider range of conditions.

Which local or national clinical or policy priorities does this innovation address:

NHS England’s Five Year Forward View - https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf NHS England’s Five Year Forward View states there is a traditional divide between primary care, community services and hospitals, largely unaltered since the birth of the NHS, is increasingly a barrier to the personalised and co-ordinated health services patients need. The NHS will increasingly need to dissolve these traditional boundaries. Long term conditions are now a central task of the NHS; caring for these needs requires a partnership with patients over the long term rather than providing single, unconnected ‘episodes’ of care. Proactive Health Coaching allows for services to be integrated around the patient.

Plans for the future:

This is an exciting time for Health Navigator UK. We are encouraged by the progress we are making and are delighted to have secured a number of significant contracts to deliver new and innovative healthcare services in the UK.

Proactive Health Coaching is being delivered together with various CCG partners in England and will be evaluated by the Nuffield Trust on a yearly basis.

We are at the start of a significant growth phase but acknowledge we cannot do it alone and we are seeking additional sites in the West Midlands to work with.

If you would like to explore this opportunity please get in touch.

Tips for adoption:

Key learning:

Don’t underestimate how important it is to gain buy-in from partners. Time spent working together is key to success at all levels.
Setting up a project to meet research standards and guidelines, and gaining ethics approval, is perhaps the most time consuming part of the project.
It is important to understand the finance and activity relationship between this intervention and any other scheme, coding or change targeting a similar area, as this can skew the results. It is essential to ensure you are looking at like-for-like datasets.
Working with patients to help them understand their conditions and navigate the system effectively has a massive impact on people’s confidence to manage their own conditions. Continuity of support and time spent early on has a lasting impact on health behaviours and use of health and care resources.

Takeaway tips:

Agree the inclusion process and mechanisms for contacting patients as early as you can.
Engage widely, particularly around governance requirements of each partner organisation.
Organisations such as Healthwatch are invaluable in helping to support patients and encourage participation.
Develop appropriate contract risk shares to provide financial incentive to the provider to ensure delivery while protecting the commissioner from exposure to the full impact of any potential non-delivery.

Contact for further information:

Ravinder Sandhu
Managing Director UK
Health Navigator Ltd

T: 07717 412543
E: Ravinder.sandhu@health-navigator.co.uk

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Ravinder Sandhu 21/05/2018 - 12:17 Approved

SCIT App

Overview summary:

The Secure Clinical Image Transfer app (SCIT app) was developed at University Hospitals Birmingham NHS Foundation Trust (UHB), and was officially launched at the Trust in February 2017.

The aim of the project was to create a secure app for use on mobile phones, which allows clinicians to take clinical photos in a secure way. The images taken and some identifiable patient data are then stored off the device into the secure UHB network. Once the image has reached the hospital system it automatically attaches the image to patient’s records.

Challenge identified and actions taken :

In 2013 challenges arose concerning the risks of clinical staff using their own mobile devices to photograph patients during out-of-hours and in emergencies when professional medical photographers were not available.

At the same time a ‘Do It Yourself’ camera, managed by the Medical Illustration department, continued to be returned containing images that could not be matched to a patient as standardised operating processes were not being followed correctly.

SCIT was designed to address the issues outlined above, and continues to provide a simple solution. The secure app available for both Apple and Android allows clinicians to take photos of patients and have them immediately stored off their device in a secure UHB network. Once the image is taken SCIT does not allow the image to be viewed on the mobile device and instead clinicians can view images only once they are passed to the Image Management System (IMS) which is accessible via the electronic patient record. Images are never available on the device even if the device is lost or stolen. As the app does not allow any access to the images on mobile devices or independent cloud systems, it therefore conforms to the NHS governance criteria and data protection.

Impacts / outcomes:

The SCIT app is designed to be simple, straightforward and above all safe, and there are many positive outcomes from its development outlined below:

The app ensures that when the Medical Illustration team are not available, clinical images can still be taken of patients in a secure manner. It allows clinicians to send images to patient records which can be reviewed by other clinicians via the Clinical Portal

The SCIT console gives a real-time view of all user activity, provides a control mechanism to authorise new users, monitors activity, and assesses the quantity of images and data flow
SCIT has allowed for faster patient diagnoses and consequently quicker treatment plans

The SCIT app is unique as it only allows images to be taken and sent to the patient record system without them being accessible on any device
- This also makes it ideal to be developed into a patient app to avoid patients sending on their own clinically sensitive images through insecure and unsuitable electronic routes which is occurring regularly, especially in dermatology
There is no cloud involved, which means that the image is transmitted directly from the device to a Trust server, therefore making it secure enough for the NHS.

There are many other benefits of adopting the SCIT app:

The app can be used on clinicians’ own mobile devices or tablets to securely take and sent clinical images
The app works with iOS, Android and Blackberry
The app is fast and hassle free
The app eliminates the risk of sending un-secured images and protection from large fines for non-compliance on clinical information governance issues
Military level encryption means patients’ images are always secure
The app streamlines diagnosis, improves efficiency and reduces paperwork
The app can be used offline in areas where wifi connectivity is poor
The console monitors all activity and provides robust audit trails every time the app is used.

Which local or national clinical or policy priorities does this innovation address:

The SCIT app has been utilised at UHB and other NHS trusts such as Coventry and Warwick NHS Trust, who purchased the SCIT app in 2017 and have adapted it to link with their secure Wi-Fi network, to provide vital evidence at the most appropriate part in the care pathway. It supports safer working practices, telemedicine, teledermatology, remote community- based working and addresses the current data protection and information governance risks. In addition 30 other organisations are also enquiring about SCIT Version 2, ranging from Dermatologists, Trauma specialists, GPs and the Information Governance groups.

Supporting quote for the innovation from key stakeholders:

Jane Tovey UHB Medical Illustration Services Manager: “The SCIT app will enable the NHS to securely capture clinical images and send them direct into the patient’s electronic record. The encrypted data package is monitored to ensure it is delivered to the correct patient notes and all parts of the pathway are safe and auditable.”

Chris Coulson UHB Consultant Ear, Nose and Throat Surgeon: “Whilst we all know that a picture can speak a thousand words, the majority of clinical findings are currently recorded by hand drawn pictures, or by text. The SCIT app will give clinicians the ability to document visual findings using photography, which can then be securely uploaded into the patient records. This will undoubtedly lead to an improvement in patient care, using the cameras on mobile devices most of us carry around every day.”

Plans for the future:

We are already in the planning stages of SCIT Version 3, which will include bar-code scanning to speed up patient data entry, the ability to take small video clips and confirmation emails that will hold direct links to the Trust’s IMS. These can only be opened on a secure networked computer within the Trust but could speed up image sharing.

Tips for adoption:

If you would like to learn more about the SCIT app then visit our website and try out the free demo: www.scit.nhs.uk

Or you can simply contact the SCIT administration team on: SCIT@uhb.nhs.uk

Contact for further information:

Contact the SCIT administration team on: SCIT@uhb.nhs.uk

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Jane Tovey 15/05/2018 - 12:59 Approved

SWITCH Waste initiative - UHNM

Overview summary:

SWITCH Waste is an innovative solution available to the NHS and healthcare sector. It facilitates standardisation in waste management- resulting to cost, carbon and quality benefits.

Our mission: “Deliver sustainable benefits to the healthcare sector, achieving a cleaner, safer, patient environment and experience, along with financial savings associated with the improved segregation of waste”.

It was first adopted by University Hospitals of North Midlands (UHNM) and has resulted in a Waste Management service that is regarded as a national leader.

Challenge identified and actions taken :

The way Waste services are managed has a huge impact upon operational and financial efficiency, as well as environmental sustainability and compliance. UHNM recognises the impact that its operations have on the environment and the link between sustainability, climate change and health. The Trust has implemented a range of measures in order to enhance its responsibility as a waste producer, for example, UHNM strives to achieve high standards for waste management from the point of disposal, and when waste is produced; increasing the amount that is reused, improving waste segregation and giving more presence to recycling and diversion from landfill.

The SWITCH Waste partnership with UHNM, exemplifies all of these principles.

Action:

SWITCH Waste allows pre-sorted, non- hazardous waste (domestic and offensive), to be segregated at wards and department level and then transported internally in separate colour coded 770 litre waste bins. It is then jointly compacted (within the same compactor) for onward disposal at the local waste to energy incineration plant, where the embodied energy within these waste streams is recovered and used to generate electricity and heat.

SWITCH Waste also has an educational program that informs colleagues on the importance of sustainability and encourages them to improve working practises.

Impacts / outcomes:

UHNM has had positive outcomes from facilitating the SWITCH Waste innovation. Firstly, managing their waste has reduced costs and improved the patient environment. The correct segregation of waste has provided UHNM the opportunity to reduce waste costs. For example:

Using Tiger bags (offensive waste) as standard and only using Orange bags if the patient is infectious;
Using clear bags (recycled waste) alongside black bags (domestic waste)

SWITCH Waste achievements made by UHNM:

The safe and compliant declassification and diversion of a significant proportion of waste went into non-hazardous waste streams.
Introducing a culture of staff empowerment and a ‘blended learning’ technique for education which comprises:
- SWITCH Waste e-Learning modules
- Waste Management e-Learning modules for specific staff groups
By improving the quality of waste segregation and declassifying a large proportion of waste to ‘non-hazardous’, UHMN has enabled an opportunity/freedom to transport and dispose waste in a different way by no longer requiring the use of a specialist clinical waste contractor and facility.
With specific waste procedures and staff education in place, the local Waste to Energy facility have deemed the risk of contamination by hazardous waste at a low level and accept UHNM non-hazardous waste as ‘mixed’ waste stream, duel consigned by the European Waste Catalogue (EWC) code.
- This is a first for the NHS and a municipal disposal facility- achieved with engagement by the Environment Agency.
UHNM is a zero waste to landfill Trust.
SWITCH Waste adopted by UHNM has resulted in a Waste Management service that is regarded as a national leader and is currently positioned in the lower quartile for waste costs according to Lord Carter.

Which local or national clinical or policy priorities does this innovation address:

The SWITCH Waste initiative has already been implemented at UHNM and has helped to achieve a more sustainable approach to waste management through facilitating a lean and innovative approach which results in cost, carbon and quality benefits. The SWITCH Waste initiative is fully proven, commercially deployable, market ready and already adopted.

Supporting quote for the innovation from key stakeholders:

Jenny Clarke, Matron, Estates, Facilities and PFI, UHNM:
“The UHNM SWITCH Waste project has been a resounding success and an example of how clinical staff have embraced change. The waste team have given nursing staff the knowledge, information, resources and support to enable them to decide the best way to dispose of waste in their clinical areas. This has been a superb example of how clinical and facilities teams can work together….it has been a “win –win” for all concerned.”

Louise Stockdale, Head of Environmental Sustainability, UHNM:
"The Mixed Waste solution has enabled a huge opportunity with the way we store, transport and dispose of waste –This whole solution is innovative yet simplistic. It is enabling the Trust to receive efficiency, operational and quality benefits whilst also bolstering our local economy by using its services.”

Plans for the future:

UHNM is working with the Staffordshire and Stoke-on-Trent Sustainability and Transformation Plan (STP) in order to roll out SWITCH Waste, thereby standardising efficiency across local NHS Trusts.

Tips for adoption:

For more information contact SWITCH Waste: Email: switch@clinisolutions.co.uk

Contact for further information:

switch@clinisolutions.co.uk

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MidTECH Innovations 05/04/2018 - 13:24 Approved

#HandoverProject - Automated Ward Round & Handover System

Overview summary:

Dr Sarah Steadman from Birmingham Women’s Hospital (BWH) developed and implemented an electronic ward round and handover system, which has proven to be an effective streamlined process with numerous benefits, helping the NHS work towards a paperless future.

The system is a unified electronic handover and ward round tool that has been applied to the neonatal ward. The system has demonstrated that it is a viable solution, has significantly saved time and has potential to be adapted for other inpatient units where ward rounds are conducted.

Challenge identified and actions taken :

Most UK hospital teams verbally handover patient information with a hand written or typed list, containing basic demographic information, clinical information such as reason for admission, current treatments and a job list for each patient. These sheets are then used throughout the shifts, with additional information on patients being gathered before the next shift. These sheets also contain clinical information that needs accuracy, legibility and traceability just like patient records, but this is often overlooked.

Ward rounds consist of a team of doctors reviewing each patient’s clinical condition, treatment and future plans regarding management, which is documented in notes. Depending on case load this process can take a considerable portion of the working day (in this case 5 hours).

When ward round notes are handwritten there is the potential for illegibility due to poor handwriting, bad spelling or errors being made when coping information back and forth. The system developed solves these problems by electronically transferring information between a handover sheet and ward round format, updating itself as each process happens.

Furthermore, this software has helped the trust in working towards their goal of becoming paper free, one of the national NHS goals.

Impacts / outcomes:

There are many impacts and outcomes that the software’s system has been shown to achieve, for example it has significantly reduced shift handover and ward round times. During its trial introduction period data showed it to save 24 hours per week.
The system has also enabled staff to have more time to carry out other duties, such as increased time with patients and families and opened up time for teaching students and junior clinicians.

Below are some more of the outcomes that the Handover system has achieved:

The electronic solution automatically placed the time, date and patient identifiers on each page and the entries were all typed, which meant that all ward round entries completed using the electronic system that met 100% of NHS Litigation Authority audit standards.
Based on the data available from the Handover software, it is estimated that the time of intervention has saved on average 57 minutes per day of time for the members of medical staff involved in the ward round. Based on this alone it can be estimated to save the Trust over 24 hours of staff time each week.
- As the system has saved time and allowed an earlier completion of ward rounds, it has enabled staff to spend more time with patients and completing routine work during daytime hours.
- Earlier completion of ward rounds also meant that routine tasks such as placing long lines could now be completed in working hours rather than be handed across to the on-call team.

Medical staff were freed from the process of duplicating documentation from one day to the next reducing the risk of errors when transcribing information.
The nursing team were pleased with the improved standard of documentation and legibility of the ward entries and have started using the printed sheets as a handover tool for their nursing shift handovers.

Overall, the use of the low cost, unified electronic ward round and handover solution has demonstrated a significant reduction in average ward rounds and handovers whilst simultaneously improving documentation standards.

Which local or national clinical or policy priorities does this innovation address:

• The software developed is being used at Birmingham Women’s Hospital NHS Foundation Trust. • Other local neonatal units in the region have approached the team to see if the system can be adapted or have developed their own similar concept. • It addresses how ward rounds and handover can be done in a time saving, efficient, safe manner which fits in with the NHSLA record keeping standards.

Supporting quote for the innovation from key stakeholders:

Below are some supporting quotes from the media that covered our project:

Herald Scotland News: “Using laptops or tablets instead of paper for hospital rounds could save each doctor an hour a day, research suggest” http://www.heraldscotland.com/news/13154481.Laptops__can_save_doctors_hour_a_day_/

ITV News: “Laptops or tablets could save doctors up to an hour a day…. Medics spend around 56% of ward tome filling out paperwork, but this could be reduced to around 41% if doctors made use of technology…” http://www.itv.com/news/update/2014-04-08/laptops-or-tablets-could-save-doctors-an-hour-a-day/

CBR (Computer Business Review): “Switching to an electronic system would also allow doctors to read and share records with colleagues much more easily, instead of having to rely on the famed unreadable scrawl of many medical professionals...”
“…eight months after the trial, the hospital unit is still using the electronic system, which has saved an estimated 24 hours of doctor time per week.” https://www.cbronline.com/news/tech/hardware/desktops/doctors-could-save-an-hour-a-day-by-using-laptops-on-ward-rounds-study-claims-4212058

Mark O’Herlihy, director of Healthcare, EMEA, at Perceptive Software said "A paper-based approach has been relied on for all too long and has often resulted in misplaced medical records, operational inefficiencies, and delays to patient care…Faster and secure access to the correct and relevant data at the right time could see a real benefit to patient care and confidence in the NHS as we go forward." https://www.cbronline.com/news/tech/hardware/desktops/doctors-could-save-an-hour-a-day-by-using-laptops-on-ward-rounds-study-claims-4212058

Hit consultancy: “Historical data also showed that only 68 percent of the doctor’s paper entries into medical notes are legible, but an electronic system boosts this to 100 percent.”
“8 months after the trail, Birmingham Women’s Hospital’s neonatal unit is still using the electronic system improving handover and documentation standards.” https://hitconsultant.net/2014/04/09/doctors-saved-1-hour-daily-using-laptopstablets-for-hospital-rounds/

Plans for the future:

Due to the software’s success it is still being used by the department neonatal at the Birmingham Women’s hospital as a solution while the team investigates the potential for developing a custom system which has a potential link to other hospital systems.

Moreover, the team are taking this project to commercial partners, which has the potential to provide the NHS with a step towards paperless working. This can also help the NHS make considerable efficiency improvement, while maintaining quality.

In addition having heard about the success of the project other local neonatal units in the region have approached the team to see if the system can be adapted to run on their machines. Expanding our software for others NHS Trusts to use is another future plan.

Tips for adoption:

This system was designed and programmed by 2 NHS junior doctors using readily available Microsoft based software. It is proof that even simple IT solutions can save the NHS money and time and that junior doctors are a valuable resource for the NHS in terms of Quality Improvement.

We hope to take #HandoverProject to a commercial partner to help us combine the concept into a wider electronic solution to link into systems for bed management, electronic prescribing and test results.

If you would like additional information on how our software could be adapted at your Trust please don’t hesitate to contact us: sarahlouise.steadman@nhs.net

Contact for further information:

sarahlouise.steadman@nhs.net

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Sarah Louise Steadman 04/04/2018 - 15:47 Approved

The electronic Adrenal Incidentaloma Management System; “eAIMS”

Overview summary:

Adrenal incidentalomas (AI) are lesions found whilst patients undergo radiological scans for other conditions. Most are benign and hormonally non-functional. However, 20% are malignant and/or produce excess hormones. Malignant lesions require rapid treatment as tumours can be aggressive and life-threatening.

This project based at University Hospitals of North Midlands and University Hospital of South Manchester aimed to establish effective management of patients with AIs, minimising delays in diagnosis/treatment and reducing patient distress.

Challenge identified and actions taken :

We did not develop consensus guidelines - these became redundant following publication of 2016 guidelines.
How to make the system utilisable with different centres IT systems within our pilot work’s limited budget.
We identified the importance of incorporating an MDT outcome letter into eAIMS to save time and reduce errors. Ultimately, this will positively impact on uptake by other centres.

Actions:

The system is aligned with the newly published European Guidelines for AI (2016).
In collaboration with Trust IT, we developed a web-based embedded electronic management system (the electronic Adrenal Incidentaloma Management System; “eAIMS”). Use of a web-based system improves ability of other centres to uptake eAIMS, even if they utilise different IT systems.
The system captures key information on AI cases and generates a pre-populated MDT outcome letter, saving clinical and administrative time whilst ensuring timely management with enhanced safety (reduced need to re-dictate and type results, minimising transcription errors). We also developed a prioritisation strategy, in collaboration with MDT members, which ensured that high risk individuals are prioritised for prompt discussion and decisions.

Impacts / outcomes:

There are many positives outcomes from the eAIMS project. It has made a positive impact within the healthcare industry and helped to improve patient safety, reduced the time from AI identification to MDT decision and much more. The impact that eAIMS has made is discussed in more detail below:

By using the newly published European guidelines, we developed a novel, web-based eAIMS that links the clinical, biochemical and radiological data necessary for assessing and managing AI patients.
Implementation of eAIMS, along with improvements in the prioritisation strategy, resulted in:
- A 78% reduction in the time from AI identification to MDT decision (vs. our original primary objective of 20%). This significantly reduced delay, which will result in less patient anxiety.
- A 49% reduction in staff hands-on time.
- Improved patient safety:
  - A reduction in the risk of transcription errors, given the in-built error validation of entered data and the automatic generation of the MDT outcome letter as opposed to repeated human-instigated steps.
  - Our analysis identified that 70% of AIs were not being followed-up, and hence we are now developing the next stage of the programme to proactively identify all new AI cases, thereby avoiding missing cases (work in progress).
- A 28% reduction in costs (from an independent health economics analysis).
Links outside UHNM: Built-in the project is the partnership with UHSM to explore the generalisability and utility of the system. The system was conceived as web-based from the outset to facilitate wider adoption. We have also established dialogue with the Association of British Clinical Diabetologists to showcase our work.

Which local or national clinical or policy priorities does this innovation address:

Firstly, the eAIMS system has improved the prioritisation strategy of AI patients, which has led to a reduction in the time from AI identification to MDT decisions. It has optimised the likelihood of tumour treatments from earlier identification and enhanced digital health. • The eAIMS system is already in place and has become the default at UHNM (University Hospitals of North Midlands). • The web-based system has also already been adopted by University Hospital of South Manchester and is fully functional. This will demonstrate the adoptability by other Trusts.

Plans for the future:

Our plan for the future is to spread the innovation:

One of the ways we will spread the innovation is by offering the system to selected Trusts across the UK. By doing this we hope that the system will be adopted by other Trusts.
We also would like to further develop the eAIMS system to ensure that it is more user-friendly and less time-consuming (e.g. a paper form to be scanned to allow data entry).
Furthermore, another plan for us is that the data management infra-structure (e.g. system administrator) to manage the core system, ensuring data quality, managing enquires, facilitating audits and more.
Moreover, we would like to explore other options to enhance and evaluate cost-effectiveness, patient benefit (as measured by changes in anxiety levels).

Tips for adoption:

System is web-based making it very easy for other centres to adopt the system. This has already been demonstrated through University Hospital of South Manchester, who operate on a different base IT system to UHNM, and have successfully adopted and utilised the eAIMS system.

Contact for further information:

For more information contact: Simon.Lea@uhnm.nhs.uk

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Dr Simon Lea 08/03/2018 - 12:37 Approved

eConsent; Networks, Partnership and Commercialisation

Overview summary:

Stephen Lake, a consultant at Worcestershire Acute Hospitals NHS Trust, had the idea to create an eConsent software application. There are many factors that could cause problems when clinicians are writing up risk factors for patients, for example paper-based consent forms are open to increasing errors - handwriting may be unreadable, doctors could miss out crucial parts of patient data and patients may not understand abbreviations.
This led to the creation of the eConsent form, which MidTECH supported with its development and commercialisation.

Challenge identified and actions taken :

A consent form fully-informs patients and their agreement to proceed with a surgical intervention. The problem was that these paper-based forms had become complex and open to errors.

Stephen’s vision was of a structured digital version, supporting communication with individual patients. His initial approach was through his Trust’s IT project team, with whom he built a database in Microsoft Access. He and his colleagues used this to select and enter all the necessary fields clearly. The final form was printed out and signed by the patient.

After successful use within the Trust, the idea was ready for further development and commercialisation. This was a challenge that Stephen faced, he was having difficulty finding the right partner.

Action:
MidTECH was approached:

Their experienced consultants were able to call on their contacts in order to understand which firms had the expertise, experience and interest in a product like eConsent that would be able to take it to the next stage.
They also advised both parties on right agreements, from confidentiality agreements through to licence negotiations and contract drafting- striking the best shape for partnership.
Their wide network of clinical and commercial contacts meant that the project was uniquely placed to find the right collaborator, eHealth Innovation.

Impacts / outcomes:

One of the outcomes was that with several years of success within the Trust behind the project (which became a Health Service Journal Award finalist in 2008); it was clear that the idea was ripe for further development and commercialisation.

In less than a year, the contracts were signed. Matthew Smith, Business Strategy Manager for Wellbeing Software Group, believed this process was crucial to successfully taking eConsent to market.

eHealth Innovations had the know-how to take a Microsoft Access database and turn it into something slicker and more intuitive to use. The package now runs off a hospital server and displays in an attractive user interface optimised for mobile devices, such as tablets. The process is fully digital too – the paper form is being finally consigned to history.

MidTECH are continuing to consult with e-Health Innovations and the Worcestershire team, supporting eConsent in its broader adoption. Via its links with the West Midlands Academic Health Science Network, MidTECH has encouraged regional adoption through workshops and launch events.

eConsent is a software application that originated within Worcestershire Acute Hospitals NHS Trust, resulting in a licensed commercial product which is now available on the market.

Such has been the success of the partnership that was facilitated by MidTECH that the adoption of eConsent doesn't stop there. "Only months after the official launch, we were invited to tender for introduction in thirty-eight hospitals in the USA," says Chris. "As of now, we've made it through to the shortlist”.

“We wouldn't have even heard about eConsent without MidTECH – and now we're working to market it the world over. Their networks have helped to make this happen."

Therefore, MidTECH has helped this project take international adoption.

Which local or national clinical or policy priorities does this innovation address:

Issues around the proper consenting of patients.

Supporting quote for the innovation from key stakeholders:

“I didn’t know then that this idea might be considered worthy of a prize, but it did seem an extremely useful time-saving, and quality–improving, concept.”

"What emerged from the MidTECH introduction was a really productive partnership. Both Stephen and the Trust were really keen to get the product out there – and so were we.”

“We wouldn't have even heard about eConsent without MidTECH – and now we're working to market it the world over. Their networks have helped to make this happen."

Plans for the future:

Chris Burdett is the Product Manager at e-Health Innovations and responsible for eConsent: "We're developing new functionality for eConsent all the time. Stephen's original idea has been totally reworked using our expertise into eConsent 2.0. The product emails a link of the form to a patient, so they can review it at their leisure – and they simply sign on the device the next time they're in the hospital. It's a huge move forward for the patient experience."

Tips for adoption:

If this is a system you would like to adopt in your organisation then please contact e-Health Innovations - http://e-healthinnovations.com/

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MidTECH Innovations 21/02/2018 - 14:44 Approved

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