NHS England (NHSE) has released a case study which shares the challenges, results and learnings from the implementation of video consultations in the North Tyneside Integrated Musculoskeletal Service (NTIMS).
Part of the Northumbria Healthcare NHS Foundation Trust, the NTIMS delivers physiotherapy rehabilitation and advanced musculoskeletal (MSK) practitioner clinics, acting as a ‘conduit between primary and secondary care’, with North Tyneside General Hospital acting as the ‘hub’.
The service previously offered a mix of face-to-face consultations and telephone appointments, which the case study said sometimes led to difficulties for patients around journeys, parking space, and cost, or being available to answer the phone.
Following the outbreak of the COVID-19 pandemic, NTIMS also faced additional issues around providing its regular services, and in dealing with a backlog of cancelled appointments.
The service sought a ‘timely, safe and effective’ solution to the challenges. As Northumbria was already part of an NHS England and NHS Improvement video consultation pilot, it had access to the video consultation platform, Attend Anywhere and – following the announcement of a lockdown in March 2020 – it took action.
The trust ‘fitted all of the Outpatient Department consultation rooms with hardware capable of facilitating video calls’ and included its MSK Hub into the supply to ensure they had the equipment needed.
The Video Consultation Project Lead and the trust’s video conferencing team then set up a waiting room and ‘registered all the members of the team within the space of a few hours’.
According to the case study, ‘following a number of trial calls between team members’, the team went live with video consultations ‘that same afternoon’, with one staff member even trying the software out on a selection of patients from their clinical list. Administrative staff also offered patients a choice and explained how the video consultation platform worked.
Challenges that the NTIMS team encountered were:
- The learning curve for all staff as they transitioned from running a traditional service in the morning to offering video consultations in the afternoon.
- A lack process templates to refer to, leading to the creation of a ‘whole new process and patient flow’.
- Fine tuning as clinicians became more familiar with the platform, from ‘the allocation of calls to the consultation process itself’.
- The principles of lighting – challenges around consultation rooms windows leading to partial silhouettes of clinicians, and interfering with patients’ view.
- Some technical difficulties, mainly with patients’ connections.
The results from the case study were varied and include: workflows for both administrative and clinical staff, and ad-hoc live calls with patients by the end of day one; a general feeling that ‘all of the clinicians could see the value of video consultations, both from a responsiveness to need basis and for the additional visual cues that a video consultation can give’; and ‘helpful, enlightening and often amusing visual assessments over the video consultations’ which have ‘added a new layer of depth to remote consultation’.
Approximately 40 per cent of the service’s patients have now accepted a video consultation over other methods to date, and with responses described ‘very positive’, with ‘many patients’ having said they ‘prefer having a video consultation over a telephone call’. The use of video has also supported the team to ‘all but clear’ its backlog of patients who had either had an appointment cancelled or who were waiting to be seen.
Other learnings from the case study include that it’s important to:
- Have a team that is ‘committed to providing the best service they can in challenging circumstances’.
- Have an IT team that can be ‘responsive to the needs of the service’.
- ‘Identify and utilise’ the ‘extended skillset of team members to work on all facets of the change’.
- Have a team member to ‘co-ordinate the collective efforts into a standard operating procedure as a baseline and template for ongoing improvements’.
- Nurture an ‘environment where positive change can happen quickly’.
In terms of their next steps, NTIMS now intends to use ‘digital-first’ as its default method of contact, with the aim of reducing ‘physical attendances at the hospital’ and address some of the ‘longstanding issues’ relating to patient travel and parking. This, it says, will ‘dovetail’ into the trust’s plan of achieving ‘Miles Less Travelled’ targets for patients.
The in-team lead has also created a user support group so that established services and ‘those keen to come on board’ can co-ordinate, share good practice, learn from challenges, and share resources and documents to drive ‘consistency of application’.
Find out more about the case study, here.
