1. Application of enhanced communication techniques (Telemedicine) to the development of the Paediatric Intensive Care advice line in the North West of England. Royal Manchester Children’s Hospital

2. Background PETS & Advice line since Nov 96 –(full service April 97) Audit data Compatible with ICNARC Response times (mean to bedside 90 mins)

3. How do we spend £19,000? Investigation of possible systems Memo of understanding Installation of lines Coordination of billing Installation of equipment Identification of stakeholders and their objectives for the project Steering group

4. Progress Sites chosen Partnership Equipment enhancements MSc student(s) First consultation!

5. Project – what do you measure? Outcome measures Feasibility (how to identify levels of infrastructure needed) Training issues Medicolegal issues Comparative audit (response times, referrals, severity of illness) Acceptability to users

6. How did it work? Initial telephone call /Computers on line Video & telemetric link and initial data Contact with Consultant Advice/ retrieval offered PETS team set off Ongoing advice (SpR, Senior Nursing staff) Collection/ fax questionnaire and retrieval form

7. Time scale Funding Nov 98 MSc research Nurse Feb 99 ISDN 2 positive April 99 All equipment functional May 99 Training/ operational policy May 99 Live June 99 Study ended June 2000

9. Telemedicine usage in brackets

14. Phase 2 - a wireless solution? NHS Exec Northwest -- IM & T Collaborative project £80 000 New equipment (Kerridge) Aims –Review of referral/ retrieval rates –Ease of use –Remote role assistance –Establishment of remote scenario training

15. Remote Consultant ISDN Transmitter/ receiver Image capture Self view monitor Visual presenter Specialist Camera Wireless transmission

20. Future & funding Echocardiography/ other tertiary specialists Next step? wider cover within each site more sites mobile communications integrate with NHS net / web based

21. Phase 3 IP based solution Monitor streaming across Hospital Network NHS Net Videoconferencing £30 000 (Regional Support and Review Group)

22. 100 MB triangulated LAN between RMCH, Central and BHCH Link between Regional Burns Centre, Remote HDU and PICU Remote End Motion Media 745 units Eyesite 6 input box PTZ camera Handheld digital camcorder Plantronic wireless headsets Sony digital visual presenter Connections from HP monitors to the LAN Equipment

23. Medical student project 1)Attitudes before and after by questionnaire 16 questions 2) Quality of referral between TM and Telephone Each doctor referred two similar cases Each case had a story, CXR, ECG, ventilation settings, biochemistry

27. Results TelephoneTelemedicine Mean Score (46 total) 35.0 45.9 95% Confidence Intervals 31.2 - 38.8 45.6 - 46.0 Correlation between scores 0.2 (Low) 0.8 (High) Mean difference between scores 10.4 (95% CI 12.5-8.4)

28. Conclusions TM improves information flow Healthcare opinions shifted in favour of TM after using the equipment

29. In the real world.. Impossible to use clinically without major IT & Network commitment If it works to their advantage people will use it Keep it simple!