Application of enhanced communication techniques (Telemedicine) to the

development of the Paediatric Intensive Care advice line in the North West of

England.

Royal Manchester Children’s Hospital

Background

• PETS & Advice line since Nov 96 – (full service April 97)

• Audit data • Compatible with ICNARC• Response times (mean to bedside 90

mins)

How do we spend £19,000?

• Investigation of possible systems• Memo of understanding• Installation of lines• Coordination of billing• Installation of equipment• Identification of stakeholders and their

objectives for the project• Steering group

Progress• Sites chosen• Partnership• Equipment enhancements• MSc student(s)• First consultation!

Project – what do you measure?

• Outcome measures

• Feasibility (how to identify levels of infrastructure needed)

• Training issues

• Medicolegal issues

• Comparative audit (response times, referrals, severity of illness)

• Acceptability to users

How did it work?• Initial telephone call /Computers on line

• Video & telemetric link and initial data

• Contact with Consultant

• Advice/ retrieval offered

• PETS team set off

• Ongoing advice (SpR, Senior Nursing staff)

• Collection/ fax questionnaire and retrieval form

Time scale• Funding Nov 98

• MSc research Nurse Feb 99

• ISDN 2 positive April 99

• All equipment functional May 99

• Training/ operational policy May 99

• Live June 99

• Study ended June 2000

Computer Hardware £ 8060.78P/ T Research Nurse £ 8468Line rental £ 1000Telephone calls £ 1000Travel & sundries £ 384

£18912.78

Additional value of project f rom collaboration

Hewlett Packard Medilink system £ 17000Cable & Wireless f ree installation £ 1200C & W Subsidised line rental £ 240University of Salf ord MSc tuition andfees

£ 2500

GEMI SI S Telemedicine conference £ 320£21260.00

Total project value £40,172.78

Ref er r ed Ret r ieved A dmit t ed

Bolt on 26 (6 ) 19 (5 ) 25 (5 )

Bar r ow 11 (8 ) 10 (6 ) 10 (7 )

Telemedicine usage in brackets

Question 1. “Was the equipment easy to use?”

1 2 3 4 5 6

Easy Hard

Question 2. “Did the Telemedicine link assist youin f ulfi lling your role?”

Yes/ Made no difference/ Made things worse

Why wasn’t the link-up used? Equipment f ailure 1 Staff training 2 Wrong area 21 Barrow SCBU 2 Ward 1 Bolton A & E / CT 9 Ward 5 Theatres 2 SCBU 2

Phase 2 - a wireless solution? • NHS Exec Northwest -- IM & T Collaborative project

• £80 000

• New equipment (Kerridge)

• Aims

– Review of referral/ retrieval rates

– Ease of use

– Remote role assistance

– Establishment of remote scenario training

Remote Consultant

ISDNTransmitter/ receiver

•Image capture•Self view monitor•Visual presenter•Specialist Camera

Wireless transmission

Future & funding • Echocardiography/ other tertiary

specialists• Next step?

• wider cover within each site • more sites• mobile communications• integrate with NHS net / web based

Phase 3

IP based solution

Monitor streaming across Hospital Network

NHS Net

Videoconferencing

£30 000 (Regional Support and Review Group)

100 MB triangulated LAN between RMCH, Central and BHCH

Link between Regional Burns Centre, Remote HDU and PICU

Remote End•Motion Media 745 units •Eyesite 6 input box•PTZ camera•Handheld digital camcorder•Plantronic wireless headsets•Sony digital visual presenter•Connections from HP monitors to the LAN

Equipment

Medical student project

1) Attitudes before and after by questionnaire• 16 questions

2) Quality of referral between TM and Telephone • Each doctor referred two similar cases• Each case had a story, CXR, ECG, ventilation settings, biochemistry

Results   Telephone Telemedicine

Mean Score (46 total)

 35.0

 45.9

95% Confidence

Intervals

 31.2 - 38.8

 45.6 - 46.0

Correlation between scores

 0.2

(Low)

 0.8

(High)

Mean difference between scores

 10.4

 (95% CI 12.5-8.4)

Conclusions

TM improves information flow

Healthcare opinions shifted in favour of TM after using the equipment

In the real world ..

• Impossible to use clinically without

major IT & Network commitment

• If it works to their advantage people will

use it

• Keep it simple!