Mr James FergusonConsultant in Emergency Medicine and Clinical Lead, The Scottish Centre for Telehealth

www.sct.scot.nhs.uk

FROM MINORS TO MAJORSFROM 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.

ED Department, Aberdeen Royal Infirmary.

Scottish Executive

• 14 Community A&E Units

• >1600 A&E consultations in 1 year

• Increasing rate of usage with time

Pre-Hospital thrombolysis

A&E Department, Aberdeen Royal Infirmary.

Benefit of hospital thrombolysis by time

1.4Boersma et al. Lancet 1996; 348: 771-75.

0

20

40

60

80

0 3 6 9 12 15 18 21 24

Treatment delay (h)

Live

s sa

ved

per 1

000

patie

nts

trea

ted

ED Department, Aberdeen Royal Infirmary.

Teleconsultation

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

Hospital >200 bedsHospital >200 bedsPCI centrePCI centre

Hospital <200 bedsHospital <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, •• RescueRescue

• 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

A&E Department, Aberdeen Royal Infirmary.

Transfers Avoided By Telemedicine Consultation

Transfer Avoided

ImmediateTransferTransfer Delayed

CURRENT DATA

COMMUNITY HOSPITAL A

COMMUNITY HOSPITAL B

COMMUNITY HOSPITAL C

JAN 06

JULY 06

JAN 06

JULY 06

JAN 06

JULY 06

% That could have been seen

on TM 55% 64% 80% 85% 0 2%

MINOR INJURY % 14% 19% 58% 67% 0 2%