Friday, March 5, 2010

Exciting New Health Services Overseas

Megan Cahill, Executive Director Government Planning and Development, ACT Health spoke to HCCA members about the Ministerial Study Tour of United Kingdom and Scandinavia in August 2009.

Megan spoke about four sites they visited, gave an overview of the services and shared the key learnings from each of the sites. In this post we share three of the sites, the Telemedicine Clinic in Aberdeen Scotland, Hillingdon Hospital (London) Bevan Ward and the Great Ormond St Hospital (GOSH) in London.

Telemedicine Aberdeen, Scotland
Nurses in outlying Shetland and Orkney Islands would beam into ED of hospital nurse make preliminary diagnosis and then use telemedicine to present the person and seek advice about treatment on site or transport to the mainland for care. This system has been operating for 2 years, and they have had the opportunity to test and bed down any problems, refine and improve system.

The Orkney TIA tele-clinic won the Improvement and Innovation Award at the Scottish Health Awards in November 2008 and is a service with the potential for replication in other NHS board areas

Benefits include:

  • technology enhanced timely access to care
  •  useful for triage and management
  • record all the tele-med consults and use this as a teaching tool nursing, allied health and medicine
This requires heavy bandwidth, which is an issue for infrastructure.

From the Annual Report of the Scottish Centre for Telehealth:

In July 2008, the new telemedicine service for patients in Orkney suffering a transient ischaemic attack (TIA) began. Current evidence suggests, and recent guidelines recommend, that patients should be seen by a specialist within 24 hours of a TIA so that secondary prevention treatment can start. Using videoconferencing, patients in Orkney can now see the on-call specialist in Aberdeen within that time because they do not have to travel to the mainland or wait for a visiting specialist.

By the end of March 2009, the Orkney TIA teleclinic had seen a total of 16 patients.

Following their telemedicine consultation, all 16 patients were able to begin the relevant treatment. Thirteen later travelled to Aberdeen for further investigations, treatment or management while three were able to remain in Orkney.

During the year, ENT tele-endoscopy became a routine part of healthcare services in Shetland. A dermatology service in Forth Valley which uses digital photography to triage patients is providing a model example of how telehealth can deliver service redesign.

Hillingdon Hospital (London) Bevan Ward
The Bevan Ward which has been operating since June 2009 and has 24 single rooms designed in three different layouts.

UK have moved to 100% single bed wards with positive implications for cleaning, heating, and implications for clinical outcomes for consumers.

This Ward is a good demonstration on how to achieve the single beds. The critical issues in terms of layout is the placement of ensuite. There are 3 configurations of single bed wards with inboard, outboard, nested layouts.

In developing this staff were given the opportunity to provide input into the design of the hospital and about placement of nurses stations and bed pan room and equipment and will evaluate at 6 months and 12 months.

The participants in the study tour were particular impressed with the touchdown stations staff could do observations on patients in an unobtrusive way. They were also impressed with the absolute commitment to infection control, bare from elbows down, wash hands before and after seeing patients, cleaning devices are placed to follow people's work flow. Each room has a clinical wash hand basin.

They achieved a significant reduction in infection rates.
There is a video online that provides a tour of the ward. It was taken by a consumer organisation that monitors NHS services in the Hillingdon area. It shows the room layout and ensuites, touch-down bases for nurses, infection control strategies, nurse call system, ward kitchen for patients and family, clean utility room and a an enthusiastic opera singer.
The video is available on the Community Voice website at or for the direct link, follow this link Bevan Ward tour.

Great Ormond St Hospital (GOSH), London
This site is under going a number of phased redevelopments similar to the Canberra Hospital. The hospital is located in Bloomsbury in the middle of London (adjacent to the British Museum and Russell Square) and has considerable physical constraints. The project period will cover Phase 2 of a planned 4 phase re-development of the complex hospital site and Phase 2 needs to be completed by 2011. One of the project objectives is to provide an exemplar sustainable hospital design to influence the future UK hospital build programme estimated to cost $50bn.

The Morgan Stanley Clinical Building is due to open in 2012 at a cost of $520m.

This will include:

· new kidney, neurosciences and heart and lung centres.
· Seven floors of modern inpatient wards for children with acute conditions and chronic illnesses;
· state-of-the-art operating theatres enabling us to carry out more operations on children with complex conditions; and
· enhanced diagnostic and treatment facilities offering faster and more accurate services for patients
· Tele-medicine and tele-education facilities will be installed, enabling peer practitioners around the world to observe surgical interventions and other treatments via video linkup.

Once the Morgan Stanley Clinical Building has been completed they will redevelop and refurbish the Cardiac Wing, aiming for completion by 2014/15.

They are working to replace the inconvenient, cramped, outdated wards with new facilities where parents will have adequate space to sleep alongside their child in comfort, with parent break out spaces. They are also designing the hospital so that children can decide to leave their beds to eat their lunch in a separate room, visit the playroom or a computer.

They demolished an old building using a new implosion technique that meant that doctors conducting neurosurgery 10m away experienced no noticeable vibration.

The website has a video that shows the demolition processes in progress using large technology including track saws, excavators and pulverisers. The demolition focused on minimising disruption to patients, families and staff as well as minimising dust.

They have a focus on prefabricated components as they don't have space to bring in raw materials, assemble on site and then install, so, for example, ensuites were prefabricated and installed.

They have a webcam on the roof and part of patient entertainment system they could go to the webcam and get a panoramic view of London.

The participants in the study tour were particular impressed with the emphasis on the need for strong leadership in developing new models of care and change management process.

The Great Ormond Street Hospital were joint winners of the award for 'Best Environmental Strategy' in the Estates and Facilities Management Class of the Better Building Healthcare Awards last year. More details of how they achieve a reduction in carbon dioxide emissions, use of bio fuels and increasing the use of renewable materials is available online.

A transcript of an interview with Dr Ken Yeang, (Director of Architects Llewelyn Davies Yeang) is also available on the GOSH website.

The are also excellent photo galleries online at the Build Health website.

We are hopeful that ACT Health will embrace similar websites to share the redevelopment process with the Canberra community.
Megan also spoke about the Akershus University Hosptial.  We are currently writing a blog post on this and will post next week.  In the mean time  I can recommend the blog post by Microsoft's health senior director Bill Crounse, MD, on how information technology can improve healthcare delivery and services around the world.  He vistied Noraway in June 08.

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