VC use in Haemophilia Network
The Inherited Bleeding Disorder Service supports over 1,000 known patients, the vast majority from birth to death. The patients are monitored regularly but many do not require intensive clinical input – only when trauma occurs or they have surgery. Patients are spread throughout south Wales, with many having a long journey to their nearest clinic.
To support the smaller Swansea site, the project explored if video consulting (VC) could be used to establish VC MDT’s or could provide a platform for staff groups to communicate together across the Inherited Bleeding Disorder Network. Ways that VC could be used to support the Network included providing a platform for nurses to shares processes and policies, new staff could be hired from outside of the current sites and VC could help new staff avoid travelling as they started their role.
The project also wanted to test using VC to hold clinic appointments with patients, saving their travel time as patients are across Wales and often hours from a Network site. In addition, if a patient experiences a bleed, then additional treatment is needed however there is variance between each patient that can lead to sub optimal treatment (both by over treating or under treating). The correct management of these bleeds however leads to improved outcomes for patients as well as reduced cost. VC clinic appointments were seen as an opportunity to improve patient adherence to prophylaxis and bleed treatment, improving their long term outcomes and reducing additional treatment and surgical interventions.
This project initially aimed to trial for a year and, if successful, would be made permanent. The business case for this project outlined the establishment of outreach clinics in Carmarthen, Aberystwyth and at a later date include Betsi Cadwaladr sites.
At the time, no other Inherited Bleeding Disorder Service in the UK used VC appointments.
- Reduce number of patients needing to attend the centre in person
- Reduce travel time for patients
- Improve MDT (multidisciplinary team) experience for clinicians
- Increase support for potentially isolated colleagues in the Inherited Bleeding Disorder Network
- Potentially create improved outcomes and cost savings if bleeds can be treated more appropriately
- Assist in facilitating the growth of the Network
- Reduce travel time and costs for staff
- Enable management of an increased number of patients efficiently
- All Health Boards
Inherited Bleeding Disorder Network (spanning all Welsh health boards apart from Betsi Cadwaladr UHB) made up of:
- Network team based in the Haemophilia Centre in UHW Cardiff and Singleton Hospital in Swansea
- Satellite clinics in Abergavenny, provided by consultants based in Cardiff
- Welsh Health Specialised Services Committee provided the funding
- Lessons learnt
There were several challenges and lessons learnt during this project, including:
- A change in practice is required for the centre to engage with patients using this technology
- It will require educating and training for patients and clinicians as well as monitoring processes to be put in place to identify patients that require VC support
- Network Manager and admin staff need to be responsible for providing local IT solutions and support to patients when first using the system.
This project looked at a number of different data in order to measure the impact:
- Number of miles saved for patients
- Number of bleed treatments used per bleed before VC support versus during VC support
- Bleed rate of patients before VC support versus during VC support
- Joint scores of patients before VC support versus during VC support
- Number of successful MDTs held on VC
- Number of travel hours and costs saved by staff