Transcript The Virtual Night Hospital - UK Imaging Informatics Group

The Virtual Night Hospital
Dr Philip Shorvon
Central Middlesex Hospital
London
FACTORS
PROFESSIONAL
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SHORTAGE RADIOLOGISTS
INCREASING WORKLOAD
HEAVY CONSULTANT ON- ALL COMMITMENT
PARTICULARLY IN NON-TEACHING HOSPITALS
INCREASING COMPLEXITY OF WORK
LESS EXPERIENCE OF JUNIOR CONSULTANTS
FACTORS
ORGANISATIONAL
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NETWORKED SERVICES- ORTHOPAEDICS/
NEUROSCIENCES/ VASCULAR /ONCOLOGY
EUROPEAN WORKING TIME DIRECTIVE
NIGHT HOSPITAL
‘SMALL DGH’ MODEL
FACTORS
IMAGING AND IT
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INCREASING USE OF IMAGING OUT OF HOURS
FOR TRIAGE
NICE GUIDELINES FOR HEAD CT
INCREASE USE OF EMERGENCY CT IN
ABDOMINAL AND CHEST CONDITIONS
RAPID INCREASE IN PACS SYSTEMS
IT ADVANCES ( NHS NET/BROADBAND ETC)
NIGHT HOSPITAL CONCEPT
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INCREASING USE OF EXTENDED ROLES
REDUCED NUMBER OF MEDICAL
PERSONNEL ON SITE
MORE CONSULTANT LED SERVICES
CENTRAL MIDDLESEX HOSPITAL
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Innovation to survive
2nd hospital to get trust status
Lead patient focussed concept
One of first PFI type deals for MRI (1993)
First DTC to be built (ACAD in 1999)
New build underway (BECaD)
Now merged with Northwick Park Hospital
(NorthWest London Hospitals NHS Trust)
CENTRAL MIDDLESEX HOSPITAL
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250K catchment area
Highly disadvantaged population ( 40K
refugees and > 50% population English
not first language)
80K A and E attendances / year
10K emergency admissions / year
Bedbase 250 approx
CMH- BECAD
(Brent Emergency Care and Diagnostic Centre)
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DOH model of the “small district general
hospital- (www.dh.gov.uk/policyand
guidance/organisationpolicy/configuringhospitals)
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Innovations over staffing/hospital at night
Filmless environment
THE VIRTUAL NIGHT HOSPITAL
? THE SOLUTION
• Several hospitals link their PACS
systems to a central reporting site
• Portable video conferencing to referring
hospitals (discussions with radiographers/
referring clinicians/ even patients?)
• Consultant opinions at central reporting
site - Radiology, A and E , ? Cardiology?
others
Virtual Night Hospital
Work-Flow
Hospital A
Image Repository
& PACS Gateway
n
Hospital B
Hospital A
Examinations for
Reporting are sent to the
VNH Image Repository &
PACS Gateway
(DICOM “processed” to
support multiple PACS
Vendors)
Hospital B
Hospital A
Examinations reported
directly into the On-Call
Worksation and sent back
to the Repository
On-Call Workstation
Hospital B
Hospital A
Teleconference Facilities
make it possible to
communicate between
sites in real-time.
This may also include
streaming images such as
Ultrasound.
Hospital B
Hospital A
Examinations reported
directly into the On-Call
Worksation and sent back
to the Repository
On-Call Workstation
Hospital B
Hospital A
Images and Report made
immediately available via
Web Based Viewer to
referring site.
On-Call Workstation
Hospital B
Report may also be
exported into RIS system.
Hospital A
Fully Reciprocal Arrangement
Hospital B
Highly Scalable
Hospital C
Hospital E
Hospital A
Image Repository
& PACS Gateway
Hospital B
Hospital F
Hospital D
THE VIRTUAL NIGHT HOSPITAL
RADIOLOGY
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ALL OUT OF HOURS PLAIN FILM AND CT
REPORTING PERFORMED AT THE TIME
VIDEO CONFERENCING ALLOW CLINICAL
DISCUSSIONS/ PROTOCOL MANAGEMENT
FOR CT
THE VIRTUAL NIGHT HOSPITAL
RADIOLOGY PROBLEMS
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INTERVENTIONAL ?- will require separate
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ULTRASOUND?- X training nurse practioners
interventional rotas. If organised regionally,
interventionalists could cover several hospitals
(already beginning with vascular networks
(gynae), A and E – FAST. Videostreaming and
remote robotic ultrasound possible
THE VIRTUAL NIGHT HOSPITAL
RADIOLOGY INDIRECT ADVANTAGES
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Radiologist- Much reduced on-call
commitment. Busy when on call but following
day off
A and E films reported on time- less returns/
misses
Good acute training opportunities
Patients- 24 hour access to consultant
opinion
THE VIRTUAL NIGHT HOSPITAL
WHEN?
Need working model by
early 2006commissioning of BECaD
THE VIRTUAL NIGHT HOSPITAL
WHERE ARE WE NOW?
3.
Gaining political support
Identifying funding
Investigating technology
4.
Looking for partners
1.
2.
THE VIRTUAL NIGHT HOSPITAL
WHERE ARE WE NOW?
Technology
PACS-Workstation which can receive different PACS
company data/ PACS to PACS translation (Insignia)
WEB based return of reports
Portable video conferencing- on 3G
networks or via broadband- liaising with Kingston
University
Robotic Ultrasound - assessment
THE VIRTUAL NIGHT HOSPITAL
WAY FORWARD
IF ANY HOSPITALS WITH PACS ARE
INTERESTED IN CONTRIBUTING TO A
PILOT STUDY OF THIS CONCEPTPLEASE CONTACT MYSELF OR DAVID
POWELL (PROJECT LEADER FOR THE
BECaD)
[email protected]
[email protected]
Or Mary McKenna on 02084532270