Mr James Ferguson Consultant in Emergency Medicine and Clinical Lead, The Scottish Centre for Telehealth www.sct.scot.nhs.uk
FROM MINORS TO MAJORS FROM MINORS TO MAJORS Reducing the impact of minor injury/ illness on Unscheduled care
• Clinicians have an ethical duty to deliver high quality care to the patient population they are responsible for. They have a responsibility to ensure that any intervention undertaken on patients has an overall beneficial effect and any harm minimised. However, clinicians are also duty bound to ensure any omission in utilising proven health care interventions is not detrimental to patients under their care.
Scottish Executive • 14 Community A&E Units • >1600 A&E consultations in 1 year • Increasing rate of ED Department, Aberdeen Royal Infirmary. usage with time
Pre-Hospital thrombolysis
Benefit of hospital thrombolysis by time 80 Lives saved per 1000 patients treated 60 40 20 0 0 3 6 9 12 15 18 21 24 Treatment delay (h) 1.4 Boersma et al. Lancet 1996; 348 : 771-75. A&E Department, Aberdeen Royal Infirmary.
Teleconsultation ED Department, Aberdeen Royal Infirmary.
Remote and Rural Area Resource Initiative (RARARI) Pre Hospital Ambulance Service Thrombolysis (PHAST) Project
STEMI Diagnosis to a PCI Centre in 90 Minutes STEMI Diagnosis to a PCI Centre in 90 Minutes PCI centre PCI centre Hospital >200 beds Hospital >200 beds Hospital <200 beds Hospital <200 beds
The Decision Framework… • Builds on the concept of Optimum Reperfusion Pathway , EMJ 2007, encompassing all reperfusion strategies
Scenario 3: Scenario 3: Algorithm Algorithm • PHT, PHT, • • Limited PPCI, Limited PPCI, • • Rescue Rescue •
• Clinicians have an ethical duty to deliver high quality care to the patient population they are responsible for. They have a responsibility to ensure that any intervention undertaken on patients has an overall beneficial effect and any harm minimised. However, clinicians are also duty bound to ensure any omission in utilising proven health care interventions is not detrimental to patients under their care.
WHAT versus HOW
Altruism versus Pragmatism
Patient Centred Care
Patient Centred Care • Unless it involves Health Care Professional changing their practice!
Evidence Based Medicine
Transfers Avoided By Telemedicine Consultation Transfer Avoided Immediate Transfer Transfer Delayed A&E Department, Aberdeen Royal Infirmary.
CURRENT DATA COMMUNITY COMMUNITY COMMUNITY HOSPITAL A HOSPITAL B HOSPITAL C JAN JULY JAN JULY JAN JULY 06 06 06 06 06 06 % That could have 55% 64% 80% 85% 0 2% been seen on TM MINOR 14% 19% 58% 67% 0 2% INJURY %
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