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Mr James Ferguson Consultant in Emergency Medicine and Clinical - - PowerPoint PPT Presentation
Mr James Ferguson Consultant in Emergency Medicine and Clinical - - PowerPoint PPT Presentation
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
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FROM MINORS TO MAJORS FROM MINORS TO MAJORS
Reducing the impact of minor injury/ illness on Unscheduled care
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- 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.
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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
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Pre-Hospital thrombolysis
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A&E Department, Aberdeen Royal Infirmary.
Benefit of hospital thrombolysis by time
1.4
Boersma et al. Lancet 1996; 348: 771-75.
20 40 60 80 3 6 9 12 15 18 21 24
Treatment delay (h)
Lives saved per 1000 patients treated
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ED Department, Aberdeen Royal Infirmary.
Teleconsultation
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Remote and Rural Area Resource Initiative (RARARI) Pre Hospital Ambulance Service Thrombolysis (PHAST) Project
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STEMI Diagnosis to a PCI Centre in 90 Minutes STEMI Diagnosis to a PCI Centre in 90 Minutes
Hospital >200 beds Hospital >200 beds PCI centre PCI centre Hospital <200 beds Hospital <200 beds
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The Decision Framework…
- Builds on the concept of
Optimum Reperfusion Pathway, EMJ 2007, encompassing all reperfusion strategies
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Scenario 3: Scenario 3:
Algorithm Algorithm
- PHT,
PHT,
- Limited PPCI,
Limited PPCI,
- Rescue
Rescue
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- 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.
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WHAT versus HOW
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Altruism versus Pragmatism
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Patient Centred Care
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Patient Centred Care
- Unless it involves Health Care Professional
changing their practice!
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Evidence Based Medicine
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A&E Department, Aberdeen Royal Infirmary.
Transfers Avoided By Telemedicine Consultation
Transfer Avoided Immediate Transfer Transfer Delayed
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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
- n TM
55% 64% 80% 85% 2%
MINOR INJURY %
14% 19% 58% 67% 2%
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