Telecare
Post-operative telecare of babies a success for Belfast children's
hospital
November 2007
A three-year home-care project by the Paediatric Cardiology Department
of the Royal Belfast Hospital for Sick Children, has shown that
videoconferencing can provide major assistance in the post-operative
care and monitoring of babies and small children with major congenital
heart conditions.
The success of the project has led to a two-year, £130,000 grant from
the UK Department of Health as part of its telecare programme. “This
money will enable us to turn the trial into a fully-funded service
available throughout Northern Ireland,” said Dr Brian McCrossan,
Clinical Research Fellow in Paediatric Cardiology at the hospital.
Eighty patients were included in the trial, twenty-eight with the
videoconferencing support and the rest in a control group or with
telephone support. By placing videoconferencing systems in the patients’
homes, doctors at the hospital were able to monitor those patients
without regular recourse to other medical facilities.
According to Brian McCrossan: “For parents, the most stressful time is
not the diagnosis or surgery, but the first day they take their child
home. Emerging evidence from the trial has proved that patients’ parents
in the videoconferencing support group have suffered less anxiety than
those in the other groups. Hospital re-admissions, A&E attendances, and
GP visits have also been lower amongst this group. While the latter
benefit provides significant cost savings for the Health Service, it is
the re-assurance that videoconferencing gives parents that is the more
important benefit.”
This development is also being encouraged through the use of broadband
internet for linking to the patients’ homes rather than via ISDN. ISDN
is expensive to deploy, whereas many homes will already be
broadband-ready. Experience has shown that the image quality over the
internet is as good as ISDN, although there have been some problems with
the connections. “This seems to be mainly in rural areas and probably
the result of the distance from the local exchange,” says Brian
McCrossan. “Despite this I believe that the internet will become the
solution for a flexible, remote monitoring service.”
Monitoring at home
Patients are monitored for up to six weeks while awaiting or following
surgery; or as part of a course of treatment. A pool of Tandberg 1000
videoconferencing systems has been made available by Questmark Limited
for installation in patients’ homes. These can then connect to the more
sophisticated Tandberg 880 systems installed in the hospital’s
cardiology department via the ISDN links or the internet.
At a set time each week the Clinic's doctors have a videoconference
session with each patient. The quality of resolution is high enough for
them to determine whether their condition is satisfactory or whether
further medical attention is needed. Conversely, should the parents
suspect a problem they can contact the hospital for an immediate
diagnosis, often avoiding an unnecessary journey.
There are a number of determinants that can alert doctors to potential
problems. The colour of babies ie the degree of blueness is a
significant one. A very rapid respiratory rate is another, while the
hospital can also see the patients' general demeanour, such as their
levels of activity, interaction with their parents, and any feeding
difficulties.
Monitoring physical symptoms such as the colour of the children’s lips,
their breathing patterns, and general demeanour and levels of activity,
as well as taking data readings from such items as saturation monitors,
are recognised methods of checking the health of young cardiac patients.
The visual access the videoconference brings allows these remote
assessments to be made regularly and accurately.
The original videoconferencing application was on a hospital-to-hospital
basis, allowing the doctors in Belfast to remotely see and make
diagnoses from echocardiograms from the ultrasound scan taken by the
attending paediatrician at the remote hospital. Again, this saves travel
by patients and medical staff while a faster consultation and diagnosis
can be made.
Viewing an ultrasound scan on a videoconferencing
screen
Foetal scans
The hospital is now extending the use of videoconferencing to foetal
scans for the ante-natal diagnosis of congenital heart conditions. This
comes at a time when the demand for this is outstripping capacity and as
Brian McCrossan points out: “It will have an important role in
increasing access to this precious resource."
Until now all pre-natal scans on babies’ hearts have had to be referred
to Belfast, but now, under a trial between the Children’s Hospital and
Altnagevin Hospital in Derry, radiographers in the latter take the scans
which can be seen simultaneously by consultants in Belfast for a
virtually instant diagnosis.
The pilot service has been ethically
approved and has proved favourable with parents, especially as a journey
to Belfast is saved. So far, over 40 scans have been taken via this
method with a high degree of diagnostic accuracy.
The whole videoconferencing project has been supported by Questmark;
apart from the supply of videoconferencing systems they have also
provided the ISDN connections and training. “Their contribution has been
vital to our success,” says Brian McCrossan. “Indeed, without them it is
doubtful whether we could have proceeded with it.”
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