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:
The Safer Provision and Caring Excellence (SPACE) Programme has been developed by the West Midlands Patient Safety Collaborative (WMPSC), and is being designed and delivered in collaboration with Walsall Clinical Commissioning Group (CCG) and Wolverhampton CCG. It will run in 35 care homes across Walsall and Wolverhampton (all of which provide both residential services and nursing care) over 24 months.  The programme is being evaluated by the NIHR Collaboration for leadership in applied health research and care (NIHR CLAHRC).  
Challenge identified and actions taken :
Improving safety in care homes is becoming increasingly important. Care home residents typically have multiple physical and/or cognitive impairments, and adverse events like falls often lead to hospital attendance or admission. Developing a safety culture is associated with beneficial impacts on safety outcomes, but the complex needs of care home residents, coupled with staffing pressures in the sector, pose challenges for positive safety practices to become embedded at the individual and organisational levels. Staff training and education can positively enforce safety culture and reduce the incidence of harms, but improvement initiatives are often short lived and thorough evaluation is uncommon. The programme will train staff and managers in service improvement techniques, with the aim of strengthening safety culture and reducing adverse
safety event rates. The evaluation will use a pre-post design with mixed methods. Quantitative data will focus on:care home manager and staff surveys administered at several time points and analysis of adverse event rates. Data
on hospital activity by residents at participating care homes will be compared to matched controls. 
Impacts / outcomes: 
This mixed methods evaluation of a large-scale care home improvement programme will allow a substantial amount of qualitative and quantitative data to be collected. This will enable an assessment of the extent to which care home staff training can effectively improve safety culture, lower the incidence of adverse safety.
events such as falls and pressure ulcers, and potentially reduce care home resident’s use of acute services.
Which local or national clinical or policy priorities does this innovation address:
Patient Safety, Improved Quality of care, Prevention of adverse events, Improved staff morale, Improved Dementia Care
Supporting quote for the innovation from key stakeholders:
"Giving the Care Sector a voice"
"supporting each other to provide a positive safety culture"
Plans for the future:
Evaluation to be published in 15 months time 
Regional Care Home Conference in October 17 in the north of the Midlands 
Contact for further information:
Helen Hunt 
Assistant Programme Manager - PSC 
0121 371 8057
Helen.Hunt@wmahsn.org
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Helen Hunt 02/06/2017 - 10:15 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:
"Let's talk about anticoagulation" video gives information that can be shared with patients who need to consider having anticoagulation therapy.
 
Challenge identified and actions taken :
To support a consultation with a clinician.  The video shows the reasons for anticoagulation therapy, the choices available, including the risks and benefits of the different types.
Impacts / outcomes: 
Gives a simple clear understanding of anticoagulation options for patients and their carers.
Which local or national clinical or policy priorities does this innovation address:
WMAHSN reducing unwarranted clinical variation in AF
Plans for the future:
This video will be included as part of the toolkit of resources the WMAHSN is producing to support AF detection and treatment,
Tips for adoption:
To be used as part of a consultation.
Contact for further information:
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Karen Morrey 03/05/2017 - 13:50 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:
The film was developed by Wessex AHSN and will support practitioners with discussions with patients on anticoagulation but also be a tool that patients can return to after discussions in clinics. 

Anticoagulants are prescribed to prevent harmful blood clots that can lead to stroke.  They are designed to prevent or treat clots, but can increase the risk of bleeding. Patients and carers need advice and information about how these medicines work, and their potential side effects. To view the film in full please click here
Challenge identified and actions taken :
Many people taking anticoagulants don't fully understand what side effects to look out for, or when to seek help.  Starting Anticoagulation with Jack has been created to prevent people becoming unwell while on anticoagulant medicines, and avoid unnecessary admissions to hospital.
Impacts / outcomes: 
Anticoagulants are prescribed to prevent harmful blood clots that can lead to stroke.  They are designed to prevent or treat clots, but can increase the risk of bleeding. Patients and carers need advice and information about how these medicines work, and their potential side effects and to help them to improve adherence to prescribed medication.
Which local or national clinical or policy priorities does this innovation address:
Reduction of unwarranted clinical variation in Atrial Fibrillation
Supporting quote for the innovation from key stakeholders:
We’d like to share our new anticoagulation film with you and ask you to share it with your networks.
 
It would be really helpful if you could consider how it can be made easily accessible to patients to support them with anticoagulation treatment.
Plans for the future:
The West Midlands AHSN is working on an Atrial Fibrillation, (AF), programme to support clinicians, patients and their carers in the detection and treatment of AF.  We have an Advisory Group and plan to launch the first part of our project in May.  We will be developing a toolkit to support clinicians, patients and their carers.
Tips for adoption:
This film has been developed after significant research into what patients and their carers want to see.  It can be used to support clinicians explaining about the treatmen they are prescribing.
Contact for further information:
For information about our West Midlands programme contact:
Karen.Morrey@wmahsn.org
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Karen Morrey 29/03/2017 - 12:39 Approved
Overview summary:
Diabetes is a major health challenge in the UK with a rapidly increasing number of people affected. Active disease of the foot is a crisis situation for a patient with diabetes & requires timely referral & management. A new solution for reliable & remote monitoring of diabetes foot ulcers, Silhouette, was implemented as part of an integrated primary & secondary care pathway. This initiative is supported by EMAHSN.

Who’s involved? 
  • Entec Health Ltd
  • Aranz Medical Ltd
  • Derby Teaching Hospitals NHS FT
  • Derbyshire Community Healthcare Services NHS FT
  • EMAHSN
Challenge identified and actions taken :
The challenge:
  • > 61,000 people with a Diabetic Foot Ulcer (DFU) at any given time
  • 6,000 people with diabetes have leg, foot or toe amputations each year in England - many avoidable
  • Improving DFU outcomes can avoid amputations, improve quality of life & mortality
  • Total NHS spending on ulceration & amputation estimated at £651m
  • 50% of foot care expenditure in diabetes is for primary, community & outpatient care
Innovation deployed:
  • Technology-enabled new model of care: 3D wound imaging & information system - Silhouette®. Enabling routine DFU treatment to be delivered in the community
  • SilhouetteStar camera uses laser-assisted 3D measurement technology to accurately map wound size, enabling clinicians to assess wound progress & response to treatment with objective data
  • Supports reliable, reproducible & remote monitoring & management of patients with active DFU & chronic complex wounds
How?
  • The partners have collaborated to implement the Silhouette® 3D wound imaging system as part of an integrated pathway across both primary & secondary care
  • EMAHSN assisted with the procurement of the system & worked with all partners to get the new pathway implemented in four settings
  • EMAHSN is providing support with the implementation, communications, patient & public involvement, planning & procurement for wide adoption & spread
Impacts / outcomes: 
Impacts to date:
  • Moving 35% treatment sessions to community clinics forecast to reduce DFU service costs by 15- 20%
  • Patient feedback very positive
  • Quality of treatment maintained with opportunities for improvements
  • Secondary applications of digital wound imaging system being explored
  • Projected savings if deployed across the East Midlands: £0.9m-£1.8m per annum


Nigel Baggaley - Podiatrist at Ripley Community Clinic


SilhouetteStar Camera


Dr Bruce Davey - CEO ARANZ Medical with SilhouetteStar Camera

        
Which local or national clinical or policy priorities does this innovation address:
Long term conditions: a whole system, person-centred approach
Supporting quote for the innovation from key stakeholders:
Clinical Champion:
Professor Fran Game, Consultant Diabetologist, Derby Teaching Hospitals NHS Foundation Trust said; “This innovative service means patients can be seen and monitored much closer to home, outside of the often busy hospital environment. This is better for the patients and is also easing the pressure on our foot clinic at the hospital."

Service User, Patient Experience: 
Albert Sutton from Kilburn said; “We only live just down the road from the clinic and it saves so much time for us, it is much closer to home than the hospital is, which means we are not spending so much time getting to and from appointments.”
Plans for the future:
Next steps:
The project is being evaluated to confirm the health economic model and business case for spread of the innovation to other locations within and outside the East Midlands.
Tips for adoption:
  • Develop good relationships with all the key stakeholders.
  • Fully define the challenges experienced first, then consider if this is the right solution.
  • Ensure there is a clinical champion.
Contact for further information:
Achala Patel, Managing Director – achala.patel@entechealth.com
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Achala Patel 02/03/2017 - 11:43 Approved
Overview summary:
Four years ago Wandsworth CCG embarked on their Referral Management Programme and chose Kinesis as one of the core elements supporting it.
In 2015 Kinesis was used to seek advice on 3639 patients by GPs from across the CCG. The advice they received from specialists at their providers resulted in 1700 of these patients avoiding an outpatient referral & receiving faster access to appropriate treatment. They also saved over £300,000 in referral costs. Since then 6 further CCGs to adopt Kinesis and are beginning to see the same benefits.
Challenge identified and actions taken :
The average cost of an outpatient clinic referral is around £204.
In 2009 the problem associated with increasing referrals was reported by NHS Institute for Innovation & Improvement (Delivering Quality and Value - Focus on: Productivity and Efficiency. April 2009); evidence presented showed that “up to 65% of patients attending outpatient specialty clinics are discharged with no significant pathology being detected”.
NHS Midlands & East reported (Confer: End of Pilot Report 2012) “marked and ongoing increases in outpatient referrals” (13% during 2008/09 HES online) and discussed the demand management challenge for primary care commissioners and acute trusts. The trend has continued with 13.6m GP referrals in 2015, a 5% rise on the previous year.
Continued pressure on outpatient clinics due to increased demand, and the necessity of decreasing the time to appropriate treatment in order to minimise health costs and maximise clinical outcomes lead some organisations to wonder if there were better ways of supporting GPs when making referral decisions.
 
A Kings Fund Report concluded that supporting GPs in their practice to make better referral decisions was the best way forward (Referral Management – Lessons for Success. Candace Imison and Chris Naylor, Kings Fund 2010).
Introduction of Kinesis has begun to adress this
Impacts / outcomes: 
Since adopting the programme was a CCG now have 5 providers supporting over 40 specialties. All GPs in the area are able to request advice about a patient using a secure but simple browser-based application and expect to receive a reply within a day.
Wandsworth are on target to make over 4000 requests for advice this year with 58% of these resulting in a permanently avoided outpatient appointment.
6 further CCGs have adopted the same approach and are beginning to see equally positive results.
Where patients do need to be referred, this is often to the correct clinic with the right information and tests having been completed and, in some cases, an expedited referral since a specialist has effectively triaged the referral and is expecting this particular patient.
The benefits are not restricted to time-saving and cost saving. Patients benefit from greater reduced waiting times for appointments and treatment, and mostly benefit from continuing to be treated in primary care without a burdensome trip to hospital. GPs have responded I favourably to the system and report significantly improve care and treatment options for patients as well as being able to build relationships with their secondary care colleagues. They also report increased knowledge and confidence in their referral practice and this is reflected in the referral data. Meanwhile the specialists avoid their clinics being burdened with unnecessary referrals, ensuring they can spend more time with patients with greater needs; they also report enhanced relationships with their primary care colleagues and the ability to pass on their knowledge and expertise.

The experience at Wandsworth CCG is a sustained 5 to 1 ROI can be achieved within two years, based on avoidance of referral tariffs alone. It is believed (as suggested by the CCGs) an equal amount of savings are experienced across the health economy in terms of improved clinical outcomes, but this is not be objectively measured.
Which local or national clinical or policy priorities does this innovation address:
Referral management and reducing time to treatment
Supporting quote for the innovation from key stakeholders:
  • and there’s now an opportunity for us ALL to benefit from the recent progress
"It's a very well designed and easy to use system that bears no relationship to typical NHS IT"
Sarah Thurlbeck, Consultant Paediatrician, St Georges Hospital
 
"I think you have an impressive system in Kinesis. It's simple and intuitive and  really makes a difference."
Mike Conlon, Service Redesign Manager, Sutton CCG
 
"the issue isn't really about these savings, it's about the improved patient care…"
Dr Nicola Jones, chair Wandsworth CCG
 
Plans for the future:
We are in ongoing discussions with eRS to integrate Kinesis once they have released the APIs that will allow this. We are also aiming to integrate directly with the main primary care systems to make it even easier for GPs to request advice when required.
In the longer term we are looking at using machine learning to provide even quicker suggestions based on the responses from specialists.
However our main goal is to drive up the number of CCGs and GPs using the system and to increase the number of times they seek a conferral rather than a referral.
Tips for adoption:
  • Ensure that you have a dedicated programme manager - change management is harder than technology.
  • Get the support of your local seconary providers - the CEO is good to have on board, but equally find some individual specialist who really want this to work
  • Chase down any requests for advice that take longer than a couple of days to receive a reply - GPs need to have faith in the process.
  • Feedback to users on how much good it is delivering
Contact for further information:
info@kinesisgp.co.uk
or call Simon Hudson on  0773505295
 
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Simon Hudson 25/10/2016 - 16:15 Approved
Overview summary:
Move it or Lose it! supplied instructors to deliver FABS exercise classes to patients with COPD within Birmingham CrossCity CCG. Classes took place in the GP surgeries once per week, for 12 weeks. Physical and psychosocial wellbeing was monitored throughout. The results have shown incredible improvements in physical capacity including a reduced frailty, enhanced mental state following classes and high levels of enjoyment. Patients have reported reduced medication use showing potential for impact for wealth as well as health for the region. 
Challenge identified and actions taken :
There are currently 1 million diagnosed cases of COPD in the UK, and 2 million undiagnosed cases. It is the fifth biggest killer disease in the UK and costs the NHS an estimated £1.2 billion per annum. It is the second largest cause of emergency admissions accounting for one million bed day per year. 
Not only does COPD impact on the health of those with the condition, but it also places huge economical burdens on the NHS. 
Move it or Lose it! supplied instructors to deliver FABS exercise classes to patients with COPD within Birmingham CrossCity CCG. Classes took place in the GP surgeries once per week, for 12 weeks. Physical and psychosocial wellbeing was monitored throughout.
Impacts / outcomes: 
Following the 12 weeks of FABS exercise classes: 
  • 30s sit to stand scores increased by 120%
  • Timed Up and Go times improved by 27% to within the normal age-related range
  • Patient use of medication reduced, including steroids, antibiotics and COPD exacerbation pack 
  • Physical frailty reduced from 'mildly frail' to 'managing well' 
  • Patients reported high levels of enjoyment and social interaction 
Which local or national clinical or policy priorities does this innovation address:
Long-term health conditions
Supporting quote for the innovation from key stakeholders:
Patient quotes:
"I have really enjoyed the classes. This has changed my life!"
"Breathing is easier to control."

Here are some videos that demonstrate the benefits:
https://www.youtube.com/watch?v=lWFBTQGrILY
 https://player.vimeo.com/external/214476540.hd.mp4?s=efd5a41e987f6998e458bfa9f7089f750f605af7&profile_id=119
Plans for the future:
Scale the programme nationally and adopt for other long term health conditions such as diabetes, frailty.
Tips for adoption:
This programme can be delivered in GP surgeries where room allows, or in local community centres which are easily accessible.
Contact for further information:
Joe Robinson 
0800 612 7785
joe@moveitorloseit.co.uk
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Joe Robinson 19/10/2016 - 17:39 Approved
Overview summary:
The review of mortality within health care settings is a long established tool for quality improvement. There is no agreed methodology or standardised measure and no national mortality measures for community hospitals.
Challenge identified and actions taken :
In 2015 I set the task for all deaths in community hospitals will be reviewed to learn about the quality of care provided to patients and in year added for all unexpected deaths for patients outside of community hospitals will be reported and reviewed by our Mortality Review Group (MRG).
Impacts / outcomes: 
Our team have developed a mortality trigger tool that allows a review of any death and then grades it according to NCEPOD style grading. The tool has been refined over the past 12 months by front line clinicians and allows us to analyse our mortality data as well as use the tool as part of MDT case reviews. We have gone from reviewing 48% of deaths by a labourious paper based system in 2013-14 to 98% for 2015-16 with the current version of the the tool. The CCGs and Trust Board are much more assured about the quality of care and analysis of our mortality data. 
Which local or national clinical or policy priorities does this innovation address:
Reducing avoidable harm
Supporting quote for the innovation from key stakeholders:
To be added - we have just had a review of our mortlaity processes from the CQC and await their assessment which will be added to this page in due course
Plans for the future:
We are looking to develop a mortality tool for use in community non-bed based settings. 

If anybody is interested in using the tool then please contact myself, the WMAHSN or James Turner at MidTECH innovations (www.midtech.org.uk).

 
Tips for adoption:
This requires a sense of purpose, a defined end point, a vision and people committed to learn from mortality and quality improvement.
Contact for further information:
Dr James Shipman, Medical Director SSOTP
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James Shipman 11/08/2016 - 16:25 Approved
Overview summary:
Brush DJ is an app designed to motivate children to have an effective oral hygiene routine by making tooth-brushing fun! The main feature of the app is a timer, which plays 2 minutes of music taken at random from the user’s device or cloud. The app also contains the evidence-based oral health information given in the Public Health England document ‘Delivering Better Oral Health’.  Reminders can be set to prompt at least twice a day brushing, when to change toothbrushes and visit the dentist.   
Challenge identified and actions taken :
Approx 26,000 children are admitted to hospital each year (England) to have decayed teeth extracted under general anaesthetic, the most common reason for children between 5 & 9 to be admitted to hospital. At least 50% of NHS dental budget is spent on treatment of preventable disease c.£1-1.5bn p.a. (England) with £30m spent on hospital tooth extraction for children aged under 18, these costs don’t include loss of income/productivity for parents/carers & lost school hours or the psychological cost of treatment to all involved.
 
The Brush DJ app is free (no in-app purchases or adverts). Videos showing how to effectively use a manual toothbrush, floss & interdental brush can be watched for free on YouTube. Using an app to raise awareness of evidence-based oral health information has financial advantages over methods such as leaflets as there is no printing, storage, distribution cost associated with an app. Apps are instantly scalable & updatable with the cost of producing one app being the same as any multiple, unlike a physical product. Because an app can use local reminders generated by the app itself they have an advantage over text message reminders, which have been used to motivate better oral health.  
Impacts / outcomes: 
The Brush DJ app has been already been downloaded in 193 countries on to 246,000 devices and received mainly 5 star reviews in the app stores https://itunes.apple.com/us/app/brush-dj/id475739913?mt=8 https://play.google.com/store/apps/details?id=uk.co.appware.brushdj&hl=en .  Diffusion of the app can be measured by the number of downloads it achieves.

The main measure of success of the Brush DJ app at a population level will be if there is a fall in the number of decayed, missing or filled teeth reported in the Nation Dental Epidemiology Programme for England, oral health survey of five-year-old children and a reduction in the number of children attending hospital for tooth extraction under general anaesthesia.

The information given in the app comes from the Public Health England document ‘Delivering Better Oral Health – an evidence-based toolkit for prevention’ https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention . PHE have reviewed the app and have no concerns.

The next step in the development of the app will be to include software to measure when users open the app, how long they stay on each screen and if they uninstall the app. The data obtained from this would be used to improve the user experience.

Research is soon to begin to measure the effectiveness and cost effectiveness of the app in comparison to traditional methods to motivate an evidence-based oral hygiene routine in children. This will involve a randomised control trial comparing the app to traditional methods by monitoring levels of plaque on children’s teeth in the short and long-term.
Which local or national clinical or policy priorities does this innovation address:
Wellness and prevention of illness.
Supporting quote for the innovation from key stakeholders:
The City of York council has started to promote the app in children’s centres and reception classes. http://www.yorkpress.co.uk/news/14306759.Free_dental_packs_for_York_children__as_city_tries_to_tackle_shocking_child_tooth_decay_figures/?ref=fbshr
Plans for the future:
The next step in the development of the app will be to include software to measure when users open the app, how long they stay on each screen and if they uninstall the app. The data obtained from this would be used to improve the user experience.
 
The main barrier to scaling the app is lack of awareness – this could be reduced by all those involved in health in the WMAHSN region actively promoting the app at every contact with patients and the public who would benefit from using it - making every contact count.
 
I have recently been appointed as one of the inaugural NHS Innovation Accelerator fellows http://www.england.nhs.uk/ourwork/innovation/nia/ to try to get the app adopted at a scale and pace in the NHS. With the programme comes a bursary which is being used to improve the app and raise awareness.  To make the app sustainable in the future funding will be needed to cover the cost promoting and maintaining the app.
 
Research is soon to begin to measure the effectiveness and cost effectiveness of the app in comparison to traditional methods to motivate an evidence-based oral hygiene routine in children. This will involve a randomised control trial comparing the app to traditional methods by monitoring levels of plaque on children’s teeth in the short and long-term. 
 
The main measure of success of the Brush DJ app at a population level will be if there is a fall in the number of decayed, missing or filled teeth reported in the Nation Dental Epidemiology Programme for England, oral health survey of five-year-old children and a reduction in the number of children attending hospital for tooth extraction under general anaesthesia.
Tips for adoption:
The City of York council has started to promote the app in children’s centres and reception classes. http://www.yorkpress.co.uk/news/14306759.Free_dental_packs_for_York_children__as_city_tries_to_tackle_shocking_child_tooth_decay_figures/?ref=fbshr
Contact for further information:
Ben Underwood - ben@brushdj.com
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Ben Underwood 19/05/2016 - 09:57 Approved
Overview summary:
WIN is a group of professionals and enthusiasts passionate about utilising digital technology to improve the healthcare. It collates information and provide guidance on health informatics solutions. It facilitates discussion forums through social media, website, workshops and conferences to discuss and disseminate learning around priority areas in health informatics. We will also support educational initiatives to enhance health informatics knowledge and research programmes that will transform the delivery of healthcare services.
Challenge identified and actions taken :
Despite an initial surge in membership of clinicians and academics following the development of the network, growth decreased considerably. In order to address this, steps were taken to ensure that the reach of WIN extended beyond those initially deemed relevant:
 
  • Widened geographic reach to include and individuals / organisations that may wish to do business within the West Midlands
  • Increased industry engagement to include different forms of health provision
  • Increased local authority engagement to address aspects of integrated health and care
  • Development of public sector, industry and academic databases for targeted communications
  • Updated Advisory Group terms of reference to incorporate multi-stakeholder representation
  • Formalised policies and processes, with professional marketing material.
Impacts / outcomes: 
  • A continually growing membership of 644 members as of December 2015
  • A dedicated website with online discussion forums and events
  • Active engagement from the informatics community across healthcare, academia and industry
  • A health informatics educational needs assessment has been undertaken
  • An elected advisory group now established
  • Significant reputational benefits to WMAHSN by successful, well-attended regional events and presentation at national events, including EHI Live
  • Over 250 attendances at WIN events in 2014/15: WIN National Conference in December 2014 with 81 delegates, WIN industry event in January 2015 with 78 delegates and 95-100 attendees at the November 2015 event
  • Raised profile through membership and social media presence (Twitter, LinkedIn).
Which local or national clinical or policy priorities does this innovation address:
Harnessing the Information Revolution
Supporting quote for the innovation from key stakeholders:
Professor Theodoros N. Arvanitis, Head of Research, Institute of Digital Healthcare, WMG, University of Warwick and Co-Director of the Digital Theme, West Midlands Academic Health Science Network: “The West Midlands Health Informatics Network (WIN) is passionate about health service improvement, education and research in the health informatics domain. Our aim is to support the NHS and affiliated healthcare organisations in adopting information technology solutions in order to provide effective, efficient and high quality healthcare for patients/carers. We do this by connecting health informatics experts, professionals and enthusiasts across geographical, organisational and professional boundaries to work towards the goal of achieving in West Midlands and beyond. This is an independent network, with a culture of reciprocity, mutual respect, sharing good practice, support, equal access and shared responsibility.”
Plans for the future:
  • New website to allow members to access knowledge and expertise within the network.
  • Consideration of implications of digital health / justice
  • Increased networking activities to promote best practice and innovation.
Contact for further information:
Theo Arvanitis
t.arvanitis@warwick.ac.uk 
02476 151341
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Sarah Millard 28/01/2016 - 16:42 Approved
Overview summary:
The co-occurrence of mental and physical health problems is common, leading to poorer health outcomes and increased healthcare costs. Birmingham and Solihull Mental Health NHS Foundation Trust developed the RAID model for liaison psychiatry services as a pilot in Birmingham. The RAID multi-disciplinary team assesses A&E attendees/inpatients 24/7 who might have mental health problems, and provides e-training. There is now a RAID service in every hospital in Birmingham and Solihull and 27 organisations nationwide have taken up RAID. 
Challenge identified and actions taken :
The co-occurrence of mental and physical health problems is very common among patients, often leading to poorer health outcomes and increased healthcare costs. People can face lengthy waits before being referred on to the relevant service.
 
Birmingham and Solihull Mental Health NHS Foundation Trust developed the RAID (Rapid Assessment, Interface and Discharge) model for liaison psychiatry services in December 2009 as a pilot in City Hospital in Birmingham, with an investment of £0.8 million. The RAID team, comprising nurses, psychiatrists, psychologists and physicians assistants, will promptly assess anyone 24/7 attending A&E or who is a hospital inpatient, who might have mental health problems.
 
The RAID network, which is supported by WMAHSN, was established to strengthen links between RAID services to facilitate collaborative working on research and innovation projects, facilitate adoption of RAID and improve and expand the overall service provided by RAID across the NHS. 
Impacts / outcomes: 
  • Following the success of RAID in City Hospital, the trust now has a RAID service established in every acute hospital in Birmingham
  • 27 organisations nationwide have now taken up RAID
  • In its 2014 document Achieving Better Access to Mental Health Services by 2020, the Department of Health highlighted strong evidence that the RAID model can deliver clinically and cost-effective care to patients with a range of mental health problems
  • A paper published in The Psychiatric Bulletin (2013) uses data from admissions to all 600 beds in City Hospital between December 2008 and July 2010. The paper showed that the main direct effect of the RAID model was on time to readmission:
  • The rate of readmission in the RAID group was four for every 100 patients, while in the pre-RAID group it was 15 for every 100
  • Including the RAID-influence group, the total reduction in readmissions is estimated to be 1,800 over 12 months. This equates to a saving of 8,100 bed-days per year
  • There is also a strong indirect effect resulting from the broader influence on those not referred to the service, in the form of reduced lengths of stay: the RAID-influence group demonstrated an average length of stay 3.2 days shorter than that of the pre-RAID group. This corresponds to a total saving of 13,935 bed-days per year
  • The RAID model is estimated to save between 43 and 64 beds per day, which is equivalent to two-three wards
  • Most of the savings were accrued by geriatric wards
  • The study estimates the potential savings to be £4-6 million per hospital by reducing both admissions and length of stay
  • The service won a prestigious HSJ Award for innovation in mental health in 2010
  • RAID was highlighted in 2011 in an NHS Confederation Mental Health Network briefing paper which documented the benefits of liaison psychiatry
  • An independent economic evaluation of the original RAID service was produced by the London School of Economics and Centre for Mental Health in 2011
  • RAID was cited in an a 2012 HSJ article, “Liaison psychiatry can bridge the gap”
  • An economic evaluation of the RAID roll-out across Birmingham was produced in 2013 by the local Commissioning Support Unit, Midlands and Lancashire CSU
  • Further liaison psychiatry service guidance which discusses the range of potential models was produced for the South West Strategic Clinical Network for Mental Health, Dementia and Neurological Conditions in 2014
  • A RAID review was commissioned from the University of Birmingham’s Health Services Management Centre, with six West Midlands implementation sites involved (2015)
  • Dementia and self-harm e-learning, tailored for acute trust staff, has been delivered to more than 60 staff in each module across two acute trusts
  • A national RAID Network has been established to support organisations and individuals who are using or planning to use Psychiatric Liaison models. To date two meetings have been held, the second of which had Geraldine Strathdee, National Director for Mental Health, as a key speaker. The RAID network’s first event attracted delegates from across the region, along with people from across England and the wider UK. 61 people from 24 organisations attended the first event, and 64 people from 31 organisations registered for the second event. In total, representatives from 41 different organisations registered to attend, with 17 new organisations coming to the second event. This has created a mechanism for sharing best practice for liaison services nationally. In addition, the network’s long term funding has been secured by BSMHFT in partnership with East London NHS Foundation Trust
  • The national RAID Network is supported by a website and newsletters
  • Two academic organisations, two acute trusts, two mental health trusts and three industry bodies were involved in project delivery.
Which local or national clinical or policy priorities does this innovation address:
• This is a priority area for the government, with a £30 million targeted investment in effective models of liaison psychiatry in more hospitals announced in October 2014 as part of its aspiration to put mental health care on an equal footing with physical healthcare • The NHS Five Year Forward View emphasises proper funding and integration of mental health crisis services, including liaison psychiatry.
Supporting quote for the innovation from key stakeholders:
John Short, Chief Executive at Birmingham and Solihull Mental Health NHS Foundation Trust, said: “RAID has a track record of improving quality of care for patients and also saving money and has been independently evaluated and highlighted nationally as a best practice model for liaison psychiatry. We are delighted to host this network in order to bring together teams from across the NHS to share knowledge and learning and further develop and improve the RAID model for the future.”
Plans for the future:
The RAID review will be used to drive consistency and to support the tailoring of RAID services regionally, to local needs and context while remaining true to the core principles which enable successful delivery. 
Tips for adoption:
  • Innovative new approaches can make an important contribution to improving outcomes and relieving pressures on other parts of the health system – but there are unlikely to be ‘magic answers’ or panaceas. Even where a new model appears to have significant early success it is unlikely to be something that can simply be imported/bought in in order to solve all problems locally
  • Many participants felt that RAID had delivered (or had the potential to deliver) real benefits. However, the way in which RAID was planned, resourced, staffed and supported were perceived to be key factors influencing its success
  • New services do better when they receive the support of senior managers and where the service is sufficiently resourced – a number of participants talk of a ‘critical mass’ that was needed to instigate real change
  • RAID was more favourably evaluated by participants when services included a focus on older adults and where the service addressed the needs of inpatients, in addition to having a role in reducing waiting times in A&E
  • The RAID service, designed to operate across a number of different services, could not be sufficiently evaluated by using single outcome measures i.e. reduced waiting times or cost savings
  • New models are designed in a specific way for a reason, and there needs to be a degree of fidelity to the underlying model if the successes of early service models are to be replicated. Only partially implementing a new approach is unlikely to work. Certainly, those Trusts that have taken the RAID model and implemented only a proportion of the new approach shouldn’t be surprised if it doesn’t deliver what a full model might
  • At the same time, new ways of working need to be designed and implemented in ways that are appropriate within the context of existing local services, personalities and relationships. This means that models cannot be imported wholesale, but that there is a legitimate process of adaptation (which may take time to plan and implement)
  • Taken together, the two bullet points above suggest a tricky balance between being clear on/remaining true to the key elements of a successful model, whilst also being flexible about how best to implement in different local contexts. Adaption of the model needs to be mindful of existing services that are in operation and of local populations
  • ‘Soft’ outcomes matter too – even if they are harder to measure. It may take time for all outcomes to be produced because of “teething difficulties” as a service establishes itself and because an attitudinal change towards mental health is hard to achieve
  • Paying attention to practicalities is important (for example, access to IT and appropriate accommodation/space near to linked services). In order to have an integrated service, teams need to be physically close to each other and be able to access joint notes
  • Developing new ways of working takes time, and is as much about developing new relationships as anything else. By definition, liaison is a two-way process, and attention needs to focus on the host organisation as well as on the new service
  • Above all, we need to be clear about the outcomes we are trying to achieve by looking to a new service. Improving patient experience is a different type of outcome from trying to hit a 4-hour access target, which is different again from raising awareness of mental health issues amongst hospital staff, facilitating swift discharge, preventing readmissions and/or freeing up staff time to focus on other priorities. While it may be possible for one approach to do a number of these things at once, being clear about what success would look like seems to be an important precursor to knowing whether or not something has actually succeeded in practice.
Contact for further information:
Katie Saunders
katie.saunders@bsmhft.nhs.uk
0121 371 8061
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Sarah Millard 28/01/2016 - 16:36 Approved
Overview summary:
Newcastle upon Tyne Hospitals worked with North of Tyne Local Pharmaceutical Committee (LPT) and Pinnacle Health to develop an electronic referral template using PharmOutcomes. Hospital pharmacy staff used the system successfully in the North of Tyne area to refer patients to their community pharmacist if considered beneficial after leaving hospital. 
Challenge identified and actions taken :
Evidence shows that 5-8% of unplanned admissions are due to medication issues and when patients are prescribed a new medicine, a third are non-adherent after 10 days and 30-50% of medicines are not taken as intended.  However on-going community pharmacist support has been shown to improve medicines adherence. 
In an attempt to improve medicine adherence, improve patient safety and improve patient outcomes, Newcastle upon Tyne Hospitals worked with North of Tyne Local Pharmaceutical Committee (LPT) and Pinnacle Health to develop an electronic referral template using PharmOutcomes. Hospital pharmacy staff used the system successfully in the North of Tyne area to refer patients to their community pharmacist if considered beneficial after leaving hospital. The AHSN NENC supported the development and implementation of this framework across the region. The project is now gaining traction nationally.
Impacts / outcomes: 
Through active communication and participation in the national AHSN Medicines Optimisation network this work has been established as an exemplar model of communication between secondary care and community pharmacy.
  • Seven acute trusts are now making referrals to a potential 504 community pharmacies for follow up support with their medication after discharge from hospital;
  • Over 750 patients have received follow up support since the initiation of this service in July 2014;
  • Community pharmacists have reported nearly 90% of patients had a better understanding of their medicines as a result of their consultation and would be therefore more likely to adhere to their prescribed medicine regimes.
  • The project team have won two prestigious HSJ awards in 2015, in the categories for  ‘Enhancing Care by Sharing Data and Information’ and ' Most effective adoption and diffusion of best practice'
  • The work has directly contributed to the production of a Hospital referral to community pharmacy toolkit, distributed nationally by the Royal Pharmaceutical Society;
  • The Transfer of Care work initiated in the AHSN NENC has attracted national interest and has been adopted in a number of areas throughout the country.  
Which local or national clinical or policy priorities does this innovation address:
Health and well-being; patient experience.
Supporting quote for the innovation from key stakeholders:
At the HSJ Awards the project was described by judges as a "beautiful, simple solution that works...developed by clinical leaders who saw potential in existing functionality". The judges went on to praise how the Trust “genuinely demonstrated adoption and diffusion of innovative practice across the region” and that "Every hospital should be doing this."
Plans for the future:
  • Outcome measures collected through PharmOutcomes will help inform the direction and development of the project.
  • Further rollout of the project nationally will continue
  • The e-referral system is being further developed to involve GPs, doctors and nurses as well as pharmacists.
  • Development of Trust systems will facilitate the auto-population of the referral form, further speeding up the process.
  • The evidence base will be further enhanced through publication to the BMJ of research being undertaken by academics at Durham and Manchester Universities.
Tips for adoption:
Trust staff need the buy-in of community pharmacies.
The NENC region uses PharmOutcomes for E-referral and it helps if systems are complementary across regions but this is not a pre-requisite for the methodology to be adopted across Trusts.
Contact for further information:
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Anonymous 22/01/2016 - 11:52 Approved
Overview summary:
This Programme will support primary care to reduce the burden of AF-related Stroke in our population through achieving the following clinical aims: Where appropriate, to increase rates of anticoagulation use in AF patients identified as high risk of AF-related stroke not currently receiving appropriate anticoagulation; Optimise anticoagulation of AF patients unstable on Warfarin through transfer to NOACs where appropriate.  The programme is funded through a joint working project between Bayer HealthCare and West of England AHSN.
Challenge identified and actions taken :
The UK sees 150,000 strokes per year of which 20% are attributable to AF (Ball 2013) giving a figure of 30,000 AF-related strokes. Extrapolating the results from phase one may result in approximately 15% fewer strokes in high risk patients across the UK.
  • Quality Improvement: Create an approach that will enable clinicians to re-evaluate how identification, diagnosis and treatment occurs and consider NOACs alongside traditional anticoagulants
  • Strategic: Create an approach that will enable a CCG to sustainably drive implementation of the above (including appreciation of risks (financial and otherwise) of implementation).
Impacts / outcomes: 
Phase One: Across eleven partner practices in phase one, 2,688 patients with AF were identified. Of these, 335 patients were rated as being at ‘high risk’ (i.e. had a CHA2DS2Vasc score of greater than one); over a three-month period, 131 patients were reviewed with regard to optimising their management.

As a consequence, it has been estimated that between five and six strokes were prevented over this period.

Investigations into the potential financial implications of a stroke have suggested an associated cost of £23,315 per stroke (National Audit Office, 2010).  Applying this principle to the findings of the innovator phase could suggest costs between £116,575 and £139,890 may have been avoided.
Which local or national clinical or policy priorities does this innovation address:
Enhancing quality of life for people with long-term conditions
Supporting quote for the innovation from key stakeholders:
The programme is funded through a joint working project between Bayer HealthCare and West of England AHSN.
Plans for the future:
 It is anticipated that accredited online training resources will be available by Q1 16/17.
Tips for adoption:
Project management resource; CCG Leads (clinical; managerial; pharmacist); Other CCG support (comms; finance; project sponsor; primary care team); Resource to deliver training (clinical updates and quality improvement); quality improvement mentoring and coaching; caseload audit resource; availability of practice support pharmacists to work with practices; informatics (to enable quantitative evaluation of impact). Online tools to support patients and practices in shared decision-making, implementing a quality improvement project are already available.
  • Clinical Champions (both at strategic and project level)
  • Modelling of Health Economic impact of adoption
  • Building a community of practice (with regard to both clinical case for change, as well as creating a shared language and experience underpinning the quality improvement element)
  • CCG also included this clinical area in their primary care offer.
It is critical that the health economic impact of the project and associated changes in prescribing costs should be explored with each CCG during initiation. We have a local health economic modelling tool that could be adapted to suit local needs.
Contact for further information:
Anna Burhouse, Director of Quality (anna.burhouse@weahsn.net) Stephen Ray, Programme Manager (stephen.ray@weahsn.net).

www.dontwaittoanticoagulate.com; Phase one evaluation (full version and executive summary) available; Health economic modelling tool.
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Joanne Mewis 20/01/2016 - 12:48 Approved

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