Innovation Warehouse - Stories
Meridian is a resource for you to be able to share the changes that you have made to the way that you do things that have resulted in improved health outcomes for patients, a more effective way of delivering more for less, an increase in the productivity or just a different way of doing things.  Please use this space to upload the innovations that you wish to share and that others can benefit from.
Thank you.
You are welcome to submit new stories or comment on existing ones

Innovation (Approved)

Overview summary:
This tool has been developed by a team at UHCW, headed up by Professor Meghana Pandit, Chief Medical Officer & Deputy CEO.

This is a digital tool that will enable tracking of all post-surgical complications / morbidity by surgeon for each patient. It will enable learning and help reduce complication rates and identify trends in complications and morbidity.
Challenge identified and actions taken :
This innovation is a surgical morbidity scorecard developed at UHCW. It allows capture of theatre details and complications from two different systems onto a scorecard. The idea being that each month, surgical teams can review their performance as a team or as individual suegons and analyse the data. The indicators include generic surgical morbidity measures such as length of stay, readmissions, heamorrhage, DVT, PE, wound infection, return to theatre and unexpected admission to ITU. With this data available for each surgeon and each patient, surgeons will be able to iddentify need for change in practice and equally will be able to counsel / consent patients before surgery with their own morbidity / complication rates. 
 

This information is sufficiently robust to enable identification of trends in morbidity, allow in depth review when concerns are highlighted.  Such morbidity data, when appropriately actioned can be utilised to improve quality of patient care. 

The morbidity scorecard demonstrates that it is possible to establish an automated system capable of identifying trends in outcome. Accurate recording and reporting of surgical outcomes, in particular morbidity figures, is important in maintaining and improving surgical practice and perioperative care.
Impacts / outcomes: 
This innovation has a clear benefit to patient care and to the NHS. It will improve an understanding of surgical morbidity prospectively enabling surgeons to change practice when rquired. It also enables reduction of complications through learning therby reducing cost to the NHS. Furthermore, patients will benefit from improved counselling and consenting process.
Which local or national clinical or policy priorities does this innovation address:
NHS England guidance on the review and monitoring or morbidity rates.
Supporting quote for the innovation from key stakeholders:
In Healthy Measures: A UK gynaecologist’s plan to improve hysterectomy outcomes led her to develop a Surgical Scorecard that can be used in all surgical specialties. 
Plans for the future:
In terms of the development of the system itself, we plan to increase the number of indicators on the scorecard. These will be speciality specific bespoke indicators.

We are also hoping that this may be taken up throughout the region and the wider NHS and would welcome enquiries about assisting other organisations in doing so, either licensing the materials that we have develoed here at UHCW, or passing on knowledge to enable similar systems to be developed in-house elsewhere.
Tips for adoption:
As above, we would be happy to have a discussion with you regarding implementing this in your organisation. Please see the contact details below.
Contact for further information:
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Meghana Pandit 15/07/2017 - 14:13 Approved
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 - 11:17 Approved
Overview summary:
The project used existing pharmacy interventions, New Medicine Service (NMS) and Medicines Use Reviews (MURs) to improve knowledge and confidence in using the correct injectable therapies for both community pharmacy and patients. Pharmacists attended 2 training events focused on improving knowledge and consultation skills with patients with diabetes who were using injectable therapies. Pharmacists were also introduced to a consultation framework, the Five Star Diabetes Consultation, which became the framework for future patient consultations.  
Challenge identified and actions taken :
It was intended that the project would:
  • Develop an education framework for a community pharmacy consultation on injectable therapies in diabetes  
  • Develop a community pharmacy consultation framework for injectable diabetes therapies
  • Enable community pharmacists in the pilot to deliver patient support for injectable therapies for diabetes via a consultation
  • Measure outcomes to show the value of interventions  
  • Increase confidence of pharmacists in conducting consultations and improve the competence of patients using injectable therapies
  • Foster closer relationships between community pharmacy and general practice
27 community pharmacies and eight general practice surgeries in the Coventry and Rugby CCG participated in the project around the following areas: 

Pharmacy education: An initial engagement meeting was held ito communicate the project. This also provided an insight into the training needs for community pharmacy. Two pharmacy training events were delivered. 

Framework for pharmacy consultation: The project team developed a pharmacy consultation framework, the Five Star Consultation, which provides a guide to pharmacy on how to deliver a patient consultation.

Development of an education framework: A declaration of competence was produced in order to provide a framework for pharmacists to develop and maintain skills.
Impacts / outcomes: 
Project outcomes include: 
  • A pharmacy consultation and education framework was written
  • Pharmacists who attended the training reported an increase in confidence pre- to post-training as a consequence of the training, with 77% likely to complete and NMS/MUR consultation as a result of the training.  
  • During May and June 2017, 50 consultations on injectable therapy were completed as a result of the training.
  • An improvement in pharmacists’ ability to deliver consultations for diabetes injectable medication.  
  • Pharmacist reported a significant increase in their confidence to deliver consultation for patients taking injectable diabetes therapies. Figure 1: illustrates the impact which the project has had on improving the ability of community pharmacy to deliver NMS/MUR.
  • Pharmacists felt the face to face training was excellent, ‘the best’ one the pharmacist had ever attended. 
Videos of the 2 start and 5 star consultation along with an engagement video are available upon request. 
Which local or national clinical or policy priorities does this innovation address:
Five Year Forward View and providing support to long term conditions
Supporting quote for the innovation from key stakeholders:
“As barriers are broken down across the NHS and boundaries become blurred, patient pathways for injecting become all the more important and this needs to begin with better support for Advanced people to manage their own health. 

“Much greater pharmacist support to people with long-term conditions should be the ultimate aim, but only as one element of a patient’s care and alongside measures to improve public health. It needs to be delivered in a way that is integrated both in terms of NHS and public health systems.”

Community Pharmacy Clinical Review The Kings Fund 

"Diabetes is a fast growing health threat facing our nation.  Over 3 million people are living with diabetes in England.  If their condition is managed they can live longer and fuller lives. The cost of diabetes to the NHS will continue to rise.  In order to ontrol these costs, the Department and the NHS must take significant action to improve prevention and treatment for diabetes in the next couple of years"

Diabetes United Kingdom - State of the Nation 2016
 
Plans for the future:
This programme highlighted the benefits of involving Community Pharmacists in supporting people with long term conditions and the future could involve a much wider cohort of conditions to support.  The Health Living Pharmacies start to underpin this approach and are evolving across the region at pace and scale. 
Tips for adoption:
Conclusions and lessons learned:
  • The project identified a lack of integration between general practice and community pharmacy, with little or no incentive to integrate community pharmacy into general practice. Figure 2 within the case study attached illustrates the current interface between general practice and community pharmacy and an envisioned process.
  • The project team had not anticipated the lack of awareness from primary care of pharmacy NMS and MUR
  • When engaging with general practice it is essential to secure a CCG sponsor who will facilitate engagement from general practice
  • Education and consultation frameworks were developed and can be used for future projects
  • Completing the data recording paperwork by pharmacists was a barrier to data collection owing to other data collection work happening at the same time. This resulted in a lower than expected data return. 
Contact for further information:
NHS England’s (NHSE) West Midlands Pharmacy Local Professional Network, the West Midlands Academic Health Science Network, Coventry and Rugby Clinical Commissioning Group (CCG) and Coventry Local Pharmaceutical Committee, Lilly UK and Novo Nordisk Limited completed a joint working project aimed at improving the outcomes of patients with diabetes who were taking injectable therapies. 

More information can be found in the attached document or by contacting: 

Lucy Chatwin 
lucy.chatwin@wmahsn.org 
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West Midlands Academic Health Scien... 18/01/2018 - 10:34 Approved
Overview summary:
Working in collaboration with TeleHealth platform developer Dignio, Sykehuset Østfold Hospital in Norway began the pilot project in January 2017.
 
This ground-breaking cancer care pilot project has produced significant results. This is the first trial in the world where patients were empowered to measure their own white blood cells in the comfort of their own home. A small-scale trial has been completed which has shown positive feedback from patients, clinicians and carers. And now the hospital is funding a larger scale clinical trial.
Challenge identified and actions taken :
The side effects of chemotherapy seriously impact cancer patients’ daily lives. Managing them effectively is a long-time concern for doctors and clinicians.
 
The project was initiated and managed by Sykehuset Østfold Hospital’s cancer specialists Elisabet Nilsen Holm and Andreas Stensvold. Working in collaboration with Norway based TeleHealth platform provider Dignio A/S, Sykehuset Østfold Hospital began the project in January 2017.
 
Dignio Prevent is a secure, off-the-shelf, cloud based device agnostic Remote Patient Monitoring and Telehealth Solution. Dignio can be deployed very quickly with no input from, or impact on, current IT structures, software or licensing services. For the project with Sykehuset Østfold Hospital Dignio provided a complete remote patient vital signs monitoring solution which included an innovative, Bluetooth enabled, home based, white blood cell monitoring device.
 
By combining daily Remote Patient Monitoring of vital signs with CBT and frequent home based white blood cell measurement, healthcare providers can follow the patient in real-time and quickly catch any deterioration in the patient’s health and decrease the chance of hospital re-admission. Analysis of the data improves patient outcomes, reduces treatment costs and decreases re-admissions.
Impacts / outcomes: 
“It’s clear from the pilot project that patients are happy to be monitored and managed in this way. They prefer to be at home, they feed more secure, more in control and less stressed. They begin to learn about and understand how they are responding to chemotherapy and begin to manage themselves.”
Elisabet Nilsen Holm, Cancer Specialist, Sykehuset Østfold Hospital
 
“I hadn’t used a tablet before, I don’t even have a smartphone, but the software is very easy to learn and use. When I was asked to join the trial I didn’t have to think twice. It’s interesting and exciting and has reassured me throughout the entire post chemotherapy period.”
Betty Helen Kristiansen, Cancer Patient
 
Combining Remote Patient Monitoring with CBT and home based white blood cell analysis improves patient outcomes, reduces treatment costs and decreases hospital re-admissions.

Our results which have been independently validated by the City of Oslo.
There is an English language version of their report into the effectiveness of Dignio at:
https://www.dignio.com/s/Telehealth-in-Norway-March-2017.pdf
 
As you will see in the report the outcome of using Dignio was:
32% Less hospital admissions
42% Less outpatient consultations
39% Less hospital bed days
59% Less home nursing
Which local or national clinical or policy priorities does this innovation address:
Cancer - increasing diagnostic capacity
Supporting quote for the innovation from key stakeholders:
“The side effects of chemotherapy seriously impact cancer patients’ daily lives. Managing them effectively is a long-time concern for doctors and clinicians.
 
By combining daily remote monitoring of vital signs combined with frequent white blood cell measurement we can follow the patient almost in real-time and quickly catch any deterioration in the patients’ health and decrease the chance of hospital re-admission.”
 
Elisabet Nilsen Holm, Cancer Specialist, Sykehuset Østfold Hospital
Plans for the future:
Sykehuset Østfold Hospital is currently funding a larger scale clinical trial of Dignio Prevent for home based white blood cell monitoring for patients undergoing chemotherapy.
 
This chemotherapy remote patient monitoring solution is now available in the UK via the UK subsidiary Dignio Ltd.
 
Dignio Ltd are actively looking for opportunities to replicate, in the UK, the successful pilot project that has been completed in Norway.
Tips for adoption:
The minimum pilot size to produce meaningful results is 20 patients. The patients have to be trained (it takes about 1 hour) and the nurses have also to be trained on how to care for patients remotely and how to interpret the results. This normally takes around 1 day with ongoing support from our team in Norway (they all speak perfect English). The trial in Norway comprised of patients with the most aggressive cancers where any contra-indication or exascerbation needed very speedy detection and diagnosis.
Contact for further information:
Ken Garner
Director of Business Development
Dignio Ltd
0203 371 9358
Ken.garner@dignio.com
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Ken Garner 08/01/2018 - 15:05 Approved
Overview summary:
The Long Term Conditions (LTC) Network has delivered a stream of programmes to encourage uptake of remote delivery of care for LTCs and adverse lifestyle habits. These include options for delivery of care such as Flo simple telehealth, video consultation, Closed Facebook Groups, apps and aid to diagnosis.
Challenge identified and actions taken :
Lack of clinicians’ awareness of viable options for TEC; competence and confidence in their usage:
  • good practical examples described and signposted in LTC Network bulletin to clinicians
  • publications in national journals
  • support for development & launch of national training module 
Lack of patients’ awareness of viable options for TEC;competence and confidence in their usage
  • good practical examples described for patients 
  • pilot upskilling course for patients 
  • support set up and usage of health professional supervised Closed Facebook Groups by three specialties in acute healthcare settings (and a few local Patient Participation Groups (PPGs) in practices
  • support medical students Year 5 to encourage patients to sign up to Patient Online to access their own records 
  • write article for citizen readership in the North Staffordshire Sentinel newspaper 
Confusion about universal approach to shared management of care of LTCs between providers of care and different modes of remote delivery of care:
  • Create LTC shared management website, with clinician and patient sections; 
Lack of leadership across health economies in relation to synchrony/sharing of remoted modes of delivery of care
  • create example interaction across Staffordshire in relation to videoconsultation for clinical consultations
  • shared learning of usage of TECs 
Impacts / outcomes: 
Facebook:
UHNM closed Facebook groups – a total of 354 members, MS (168), AF (91) and cardiac rehab (95)
Public pages – AF – 895 reach per month/498 post engagements per month; Cardiac rehab – 2099 reach per month/791 post engagements per month
 
Twitter: Over 97,000 accounts reached from tweets
 
Manage your Health App: 330 users
 
Flo Simple Telehealth: 652 protocols registered across the West Midlands region
 
Telehealth E-learning course: Since December 2016 when the RCGP CPD course went live there has been 236 registrations with 42 people having completed the course.  Users have rated the course 4.3 out of 5 stars.
 
Publications:
‘Digital Healthcare: The essential guide’, (Authors: Chambers R, Schmid M, Birch-Jones J), 2016
http://www.otmoorpublishing.com/publications/digitalhealthcare
‘Clinicians rise to the social media challenge’ – Primary Care Commissioning CIC
https://www.pcc-cic.org.uk/sites/default/files/comm_excellence_june_2016_aw_web.pdf
‘How video consultations can benefit patients’ – GP Online
http://www.gponline.com/video-consultations-benefit-patients-nhs/article/1401346
‘How to set up a Skype consultation service’ – Medeconomics
http://www.medeconomics.co.uk/article/1401405/set-skype-consultation-service
‘GPs launch Skype to care homes project in Staffordshire’ – Fabsnhsstuff
http://fabnhsstuff.net/2016/06/26/gps-launch-skype-care-home-project-staffordshire/
‘How should we respond to negative comments on social media’ (Authors: Ruth Chambers, Marc Schmid):
http://www.pulsetoday.co.uk/your-practice/dilemmas/how-should-we-respond-to-negative-comments-on-social-media/20032472.article
‘How a Skype trolley saves GP time’ (Authors: Ruth Chambers, Marc Schmid)
http://www.pulsetoday.co.uk/your-practice/focus-on/how-a-skype-trolley-saves-gp-time/20032834.article
Evaluation report, Autographer plus Flo (Authors: Sue Molesworth, Lisa Sharrock)
http://www.simple.uk.net/home/casestudies/casestudiescontent/mental-health-memory-support-for-mild-cognitive-impairment-or-mild-to-moderate-dementia
Stoke and North Staffordshire leading the way in hi-tech help for patients:
http://www.leek-news.co.uk/8203-stoke-and-north-staffordshire-leading-the-way-in-hi-tech-help- for-patients/story-29733613-detail/story.html
‘Revamp your website to reduce demand’ (Authors: Ruth Chambers, Marc Schmid)
http://pulse-learning.co.uk/practice-business-finance-modules/practice-business-finance/revamp-website-reduce-demand
‘Helping the elderly take tablets’ (Authors: John Marszal, Aoife Donnelly, Ruth Chambers)
http://www.health21.org.uk/2016/11/01/old-people-will-use-tech-if-clinicians-let-them/ 
‘Promoting best practice in COPD management’ (Authors: Rosie Piggott, Elaine Cook, Faye Foster, Alwyn Ralphs, Lucy Teece, Roger Beech)
https://www.bjpcn.com/browse/editorial/item/1943-promoting-best-practice-in-copd-management.html
Video: ‘COPD patient avoids A&E and acute admissions through self-management with Flo’ (Author: Ann Hughes)
https://sites.google.com/a/simple.uk.net/community/home/casestudies/casestudiescontent/copd-patient-avoids-a-e-and-acute-admissions-through-self-management-with-flo
The Health Foundation - The Power of People
Video: Introducing Flo: Telehealth with a human touch
http://healthfdn.org.uk/4Y2-4MPPC-35ITUGKE86/cr.aspx
E-Learning: Telehealth, telemedicine and telecare: an introduction to “TECS” (Technology Enabled Care Services)
http://elearning.rcgp.org.uk/mod/page/view.php?id=4117#register
BMJ – Link to back pain article (STarT Back Tool)
http://www.bmj.com/content/356/bmj.i6748
Year 5 Medical Students x 4 Patient Online Initiative – North Staffordshire & Stoke-on-Trent CCG newsletter publication –
www.stokeccg.nhs.uk/news/staffordshire-students-help-patients-to-log-on-to-gp-services-online-4028/<http://nhs.us6.list-manage.com/track/click?u=ef12432f7b285a04d0bfe1494&id=21f44def52&e=33cdefcc95>
Video: https://vimeo.com/206196885/4a38152bac
WMAHSN LTC Network Newsletter – Publication commenced in January 2017 to 500+, the database has now increased to c.750.
Staffordshire Sentinel – weekly ‘Ask the Doctor’ health articles:
http://www.stokesentinel.co.uk/search/search.html?searchType=&searchPhrase=Ruth+Chambers&where=
‘GP praises Endoscope-i’: https://vimeo.com/191810628?ref=em-share
 
Conferences:
Person Centred Care Conference held in Birmingham on 6th May 2016 – 60 delegates
 
‘Making Change Happen with Simple Telehealth and Florence’ held in Stoke-on-Trent on 25th January 2017 – sharing success and best practice with breakout sessions for Acute, Community and Primary Care – 82 delegates
 
Which local or national clinical or policy priorities does this innovation address:
GP Forward View (New models of care/patient empowerment) Underpin delivery - clinical management of key LTCs: Asthma, COPD, diabetes, hypertension, AF
Supporting quote for the innovation from key stakeholders:
Marc Schmid – Digital Expert, Redmoor Communications:
“The programme has brought patient networks together around MS, cardiac rehab and AF and stroke, providing peer to peer support and regular information from clinicians. The introduction of video consultations has enhanced the care available as well as improving the efficiency of service delivery”.

Luke Bracegirdle – Head of Digital & Business Analytics, Keele University School of Pharmacy:
“West Midlands Academic Science Network part funded a development project to extend work on the Manage Your Health app, to include additional content on long term conditions. Prof Ruth Chambers (Clinical lead Long Term Conditions Network, WMAHSN) has been very supportive and used the network to connect our development team with partners with complementary skills as well as link to further initiatives in the region to promote patient information resources in the area of Atrial Fibrillation”.

Phil O’Connell – Chairman & Chief Innovation Officer, simple.uk.net:
"The WMASHN Long Term Conditions (LTC) Network has provided invaluable support for clinical teams, helping to raise awareness of practical and pragmatic remote delivery of care options.  The LTC Network has worked with us, encouraging evidence based uptake through clinical peer to peer sharing of case studies and evaluation across traditional organisational boundaries of the techniques and methods used by our members to address LTCs and adverse lifestyle habits.
International dissemination of the learning, evaluation and case studies developed through the 'Simple Telehealth' programme of work including Florence in the UK, has been greatly assisted by the practical clinical applications and evaluation made possible by the WMAHSN.  The techniques and methods evaluated have achieved replicable positive clinical and productivity outcomes that are now being studied for implementation in Ireland, USA and Australia."

Jodie Williams – Stroke Prevention Clinical Nurse Specialist, University Hospitals of North Midlands NHS Trust:
“The AHSN has widely supported the AF Stroke Prevention Team over the last 2 years.
It has supported the provision for expert advisory for Atrial Fibrillation, its education and management throughout both Primary and Secondary Care.  It has supported the promotion of an online GP Masterclass for Atrial Fibrillation to GPs in Primary Care to continue education and evidence based management for AF patients reducing the risk of AF related stroke. The AHSN has supported the AF stroke prevention team in becoming champions within both Primary and Secondary Care enhancing self care management, reducing major disabling strokes with a positive impact to the Local Health Economy”.
Plans for the future:
  • Continue with pan-Staffordshire rollout of video-consultation option for clinician/patient follow up interaction in all healthcare settings; extend to social care settings as appropriate; share learning and urge adoption across the region
  • Promote the impact/how to overcome inertia to remote options for delivery of care at all levels of NHS across West Midlands and beyond via events, conferences (e.g. focus on CVD and diabetes 10.5.17; quality improvement 13.6.17), publications, LTC Network bulletin, Twitter, etc.
  • Evaluation of Trust-wide rollout of Flo Simple telehealth Sandwell & West Birmingham Trust; county-wide rollout of videoconsultation; use of Facebook in general practices
  • Develop online learning resources and simple course for citizens to use to enhance their confidence and competence in personal use of TEC for their own LTC(s)
  • Promote or develop online learning resources for clinicians to enhance their competence & confidence in adoption of TEC
Tips for adoption:
  1. Inertia is common in the NHS in relation to any new way of working – persist in engaging all those who are vital in making change happen.
  2. Don’t keep what you’ve learnt about the adoption of an innovation to yourself - evaluate, promote, disseminate it. 
Contact for further information:
Ruth Chambers - LTC Network Clinical Lead 
Ruth.Chambers@stoke.nhs.uk

Sue Wood - LTC Network Project Manager 
Sue.wood@wmahsn.org

Marc Schmid - Digital Expert, Redmoor Communications Social Media
Marcgs72@gmail.com

Luke Bracegirdle - Head of Digital & Business Analytics, Keele University School of Pharmacy - Manage Your Health app
l.bracegirdle@keele.ac.uk

Chris Chambers - Telehealthcare Facilitator, Stoke-on-Trent and North Staffordshire CCGs - Flo telehealth
chris.chambers@stoke.nhs.uk
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Sue Wood 23/05/2017 - 08:29 Approved
Overview summary:
Health innovations and ideas frequently require robust research evidence to demonstrate clinical and cost efficiency, or structured real-world trials to support scale and speed of adoption. WFC provide a range of specialist support services in regulatory affairs. 

An example of the services that we can provide is illustrated through the case study of how WFC supported Electromedical Products International, Inc (EPII), to gain real world-data for the adoption of an innovative medical device at scale.
Challenge identified and actions taken :
EPII and the UK distributor The Microcurrent Site (MCS) offer the Alpha-Stim AID medical device. Alpha-Stim AID is proven to be clinically safe and effective in the alleviation of anxiety, insomnia and depression.

To enable EPII and MCS to offer the Alpha-Stim AID to patients in the NHS, research data was required to be submitted to the National Institute for Clinical Excellence (NICE) to evidence the clinical and cost effectiveness of the device when used in an NHS setting. Neither EPII nor MCS had any experience of designing and submitting research studies in the UK.

WFC took a protocol outline and developed it into a full clinical trial protocol with essential documentation following engagement with all stakeholders.

Regulatory submissions were made to the Health Research Authority (HRA) for approval (inclusive of ethical favourable opinion), to the National Institute for Health Research (NIHR) for inclusion onto their portfolio, and to an NHS Improving Access to Psychological Therapies (IAPT) service in the East Midlands.

WFC designed a site initiation training package which was attended by over 60 members of the IAPT team over 2 days to ensure successful and compliant trial delivery.

All aspects of design and delivery were undertaken on behalf of EPII and MCS who were provided with regular progress reports.
Impacts / outcomes: 
The clinical trial, which had been planned for many years, was designed and initiated in just 15 days of WFC consultancy time, enabling EPII and MCS to gather the valuable clinical and cost effectiveness data sooner than expected.

EPII and MCS were able to delegate all aspects of set-up to WFC with confidence, thus reducing the burden upon their teams.

Extensive initiation training ensured a prompt start to recruitment and rapid generation of data.

Strong working relationships with all stakeholders ensured a well-designed study which quickly processed through regulatory approvals. WFC were also able to facilitate conversations with the relevant Clinical Commissioning Groups (CCGs) and patient advocacy groups, with the result that real-world data collection is near completion and ready for submission for adoption of the device in the NHS. 
Which local or national clinical or policy priorities does this innovation address:
NHS IAPT services are committed to initiating treatment for 75% of people within 6 weeks of referral, and 95% within 18 weeks of referral, a clinical target formalised in policy framework Achieving Better Access to Mental Health Services by 2020. Alpha-Stim AID provides a maintenance therapy for people whilst on the waiting list following referral, thus enabling the target to be achieved. Additionally, a significant proportion of people using Alpha-Stim AID achieve full recovery, and so do not require further individualised treatment from NHS IAPT. This represents a considerable saving, and is in line with the NHS Mandate 2017/18 priority to balance the NHS budget and improve efficiency and productivity. WFC support clients to meet the national requirement for a technology appraisal from NICE, which is based upon clinical and economic data. The NHS is legally obliged to fund and resource treatments recommended by NICE’s technology appraisals within three months, as reflected in the NHS Constitution. As such, WFC are experts in navigating local and national priorities and processes. 
Supporting quote for the innovation from key stakeholders:
“Everything was great and highly professional”: Steve Hutchinson, MCS Managing Director. 
Plans for the future:
EPII and MCS will shortly be submitting the clinical trial data to NICE for technology appraisal. Recommmendation for use in the NHS is anticipated due to the high-quality clinical and economic data gathered, working relationships built with clinicians, NHS IAPT service managers, and Clinical Commissioning Group leads, in addition to support from patient groups.

WFC are ready and available to support other users of the Meridian platform to navigate regulatory affairs issues.
Contact for further information:
Mark Terry, Senior Consultant: mark@wendyfisherconsulting.co.uk
Luke Brewer, Senior Consultant: luke@wendyfisherconsulting.co.uk
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Mark Terry 10/05/2017 - 10:32 Approved
Overview summary:
Birmingham Community Healthcare (BCHC) NHS Foundation Trust have created an interactive PDF version of the Trust Clinical Handbook for use on smart devices.

To save the recurring cost of reprinting to keep the handbook up-to-date, and to keep up with the demand of the digitally enabled workforce, this tool has now been converted to an interactive PDF that can be accessed on smart devices. Examples of procedures included in the handbook are Sepsis screening tool, Resuscitation flow chart, Urine Colour chart, and normal blood values.

Challenge identified and actions taken :
The Clinical Handbook with one-page clinical guidelines on various procedures has historically been printed in a physical hand book.  It was found that there was a large recurring cost associated with this and it was difficult to ensure that clinicians were up to date and has acess to the guidelines in a managable format. 
Impacts / outcomes: 
BCHC has seen a considerable reduction in the printing costs of producing a physical handbook.  The has been estimated in the region of £5-8000.
Which local or national clinical or policy priorities does this innovation address:
Long term sustainability of the NHS - Paperless NHS
Plans for the future:
After a 6-month period of evaluation, the need to create an App with the additional functionalities of user statistics and remote content updating will be considered.

This handbook can be tailored for use in other Trusts and we would like to share this with other organsiations.  Provided that the cost of changing the contents to fit the needs of your Trust are covered and that BCHC copy-rights are mentioned and respected we are willing to openly share this. This means that you will be permitted to use the branding of your own Trust on the handbook, alongside BCHC's logo and branding.
Contact for further information:
Hamid Zolfagharinia, BSc, MSc, MIPEM, CSci
Innovation Manager
Email: hamid.zolfagharinia@bhamcommunity.nhs.uk
web: http://www.bhamcommunity.nhs.uk
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Hamid Zolfagharinia 30/03/2017 - 12:31 Approved
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 - 12:54 Approved
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 - 11:52 Approved
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
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 - 20:54 Approved
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 - 15:37 Approved
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 (fo​r hospitals and care homes​)​​
View 'Bann​er' 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 - 14:09 Approved
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.
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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 - 13:45 Approved
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 - 11:59 Approved
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:
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MidTECH Innovations 05/04/2018 - 12:24 Approved

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