Delivering for Remote and Rural Healthcare - One Year On – Sharing and Learning Event

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Delivering for Remote and Rural Healthcare - One
Year On Sharing and Learning Event Care
Pathways Workstream Prof AJW Sim, Workstream
Clinical Lead Mr W McKerrow, RRIG Clinical
Lead Dr C Siderfin, Acute Medicine Lead GP, NHS
Orkney
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Care Pathways

• Recommendation
• Patients should receive the same standards of
  care for common conditions irrespective of where
  they live
• Delivering for Remote and Rural Healthcare
  (2007)
• Implementation
• The North of Scotland Planning Group should
  take a lead role. to facilitate Rural General
  Hospitals to develop care pathways for common
  conditions

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Who are the Acute Hospital Care Pathways for ?

• Scottish Government Health Department
• Health Service Managers
• Trainee Doctors starting new posts
• Other Healthcare Workers starting new posts
• Patients
• Members of the Public
• Do they have a role in helping Community
  Hospitals define what conditions they are able to
  treat locally?

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The Acute Hospital Care Pathways

• Work in Progress
• High Level
• Underpinned by Local Protocols
• 3 Referral Pathway Groups
• Urgent or Non urgent (7 pathways)
• Emergency ( 4 pathways)
• Malignant ( 6 pathways)

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High Level Acute Hospital Care Pathway

• Elements used in the design of High Level Care
  Pathways
• Presenting condition Urgent/Non urgent,
  Emergency and Malignant
• First point of access to healthcare services
  primary care practitioner, NHS 24, 999, AE
• Initial specialist referral Rural General
  Hospital specialist, visiting specialist, another
  specialist
• Subsequent advice/referral visiting
  specialist, another specialist
• Investigation Rural General Hospital or
  Another hospital
• Management Rural General Hospital or Another
  Hospital

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High Level Pathway
Conditions would include Major Multiple
Trauma Extradural Haemorrhage Ruptured Abdominal
Aortic Aneurysm Acute Coronary Syndrome Acute
Respiratory Failure
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More Detailed Pathway of Care Protocols

• Purpose
• Clarity of care pathway between rural hospital
  and tertiary (obligate) centre
• Provide uniformity across RGHs and Community
  Hospitals
• Provide clear guidance to clinicians
• Provide a degree of protection to clinicians
  providing services outside the normal remit of
  their speciality
• A good example would be paediatrics

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Care Pathway for the Managementof the Unwell
Child
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Local detailed clinical protocols

• Purpose
• With regular reviews by specialist consultants in
  the relevant fields they ensure that treatment
  remains up to date with current evidence
• Aide memoir
• Teaching and service delivery by juniors
• Provide guidance and degree of protection to
  clinicians providing care outside the normal
  remit of their speciality
• Clarity of care pathway between rural hospital
  and tertiary (obligate) centre
• To help provide the same standard of care
  irrespective of where patients live
• Protocols modified to reflect local situations
• Do we want to develop a central repository of
  protocols available for adoption and adaptation
  by rural hospitals?

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Acute Coronary Syndrome (NSTEMI)
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Acute Coronary Syndrome (NSTEMI)
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Acute Coronary Syndrome (NSTEMI)
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• Discussion.