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What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

Covid-19 has made healthcare workers completely rethink how to communicate with patients. This is particularly true for families of the one in ten newborn infants who require some form of intensive care. With Covid-19 necessitating the need to isolate symptomatic mothers from their sick baby, the use of secure virtual contact has proved to be an extremely effective tool for communication.

In the East of England around 70 infants each year are born suffering from neonatal encephalopathy caused by lack of oxygen to the brain during birth. These babies are transferred away from their mothers to regional neonatal units for specialised cooling treatment to protect the brain (neuroprotection). Communication with families has always been challenging, particularly if it involved breaking bad news. The virtual communication revolution we have seen during Covid-19 offers a unique opportunity to bring parents to the centre of the decision making and management of their baby.

What does your project aim to achieve?

The aim is to bring parents into the heart of their baby’s management during the critical first few days of life, even if they are in separate hospitals. Parents have expressed the feeling that their baby was ‘taken away from them’, and that they ‘didn’t know what was going on’ (see video). In any event this is traumatic, but in situations where the baby may have lifelong brain injury or worse, poor communication only exacerbates an already horrendous situation. Poor communication is often sited in medico-legal cases (which from maternity cases alone costs the NHS £1 billion/year).

By embedding secure virtual communication tools, we will enable parents to have access to their baby at all times and ensure appropriate and timely communication with the doctors and nurses. Empowering parents in this way will mark a change from a ‘paternalistic’ style of medical management to a more collaborative approach.

How will the project be delivered?

This project brings together healthcare professionals working across 17 network hospitals, the Paediatric and Neonatal Decision and Retrieval service (PaNDR) and families of critically ill newborn infants. We will work closely both with family advocate groups as well as parents who have experienced birth of a critically ill baby requiring transfer for neuroprotection. This will enable us to identify the gaps in communication which this project aims to address.

With a large number of stakeholders across a wide geographical area we will appoint a project administrator to ensure effective operation and communication throughout the project.

We will develop a structured operating procedure and to mitigate risk ensure information governance sign-off from all relevant parties before commencement.

We will enrol clinical champions in each Trust to support the project, working closely with the parent partners. Rolling feedback will be instrumental in measuring and defining impact and developing resources further.

How is your project going to share learning?

UK neonatal services benefit from a regional network-based system of care. The East of England has already developed an award-winning neonatal neuroprotection service set up with funding from the Health Foundation, which will allow this project to be embedded in all 17 neonatal units. The project is scalable across networks throughout the UK through national organisations such as British Association of Perinatal Medicine (BAPM) and BLISS charity. Learning from this project can be shared with both service providers and family groups, through the QI story board, IHI websites, social media platforms, presentations and publications.

Significantly the learning from this project can be translated to other critical care situations involving the transfer of critically ill patients (e.g. trauma networks) where communication with relatives is essential if the patient is incapacitated. The landscape of virtual communication tools is complex and ever-changing and our learning will therefore be valuable to any healthcare provider.

How you can contribute

  • Experience - Many Q members have experience of Virtual Communication Environments: developing secure communication tools in the NHS environment is a non-trivial endeavour to ensure appropriate security and governance. Therefore, learning from others experience and sharing our knowledge is fundamental to the success of this project e.g. initial feedback from Q has signposted us towards Mircosoft Teams.
  • Sharing - We passionately believe that improving communication with families and relatives is fundamental in improving trust in professionals and developing a collaborative approach to healthcare, so will be excited to help share and support other teams wanting to use this virtual approach.
  • Learning - Critical and constructive feedback from Q members will help us develop and think outside the box.
  • Support - with QI methodology and implementation science will be vital and will ensure timely rollout.
  • Dissemination - The Q community will enable our learning to be spread to other areas of healthcare outside our own specialty.

Plan timeline

1 Apr 2021 Develop feedback form with input from parents, BLISS and charities
1 May 2021 Engage local units, operational delivery network and parents
1 Jul 2021 Finalise the digital platform to be used
1 Jul 2021 Information governance support will be sought from the EoE ODN/PaNDR
1 Jul 2021 SOP: communication
1 Aug 2021 Pilot phase
1 Nov 2021 3- month interim results
1 Feb 2022 6-month results and feedback for analysis
1 Mar 2022 Dissemination

Comments

  1. HI, this feels like a very relevant project and is already suggesting lots of transferable learning opportunities both into and out of your project. If you need any help with using QI to define and test your ideas I am happy to help.

    1. definitely would be interested to touch base re testing our ideas using QI methodology

  2. Hi Nazakat - you may find it helpful to reach out to members of the SiG about video consultations, as they may have expertise to share about the different platforms available, and pros and cons. Many of the people in that group would have been involved in implementing video consultations rapidly in response to COVID-19 so may also have useful learning about security and governance, and the specific QI approaches that were useful for them https://q.health.org.uk/community/groups/video-consultations-how-to-set-them-up-well-fast/

    1. Thank you

      I have become a member of the group and hoping to get some good ideas to use in our PDSA cycles

  3. Hi Nazakat,

    Myself and my colleague Emma Adams (Health Transformation Partnership) are supporting the Health Foundation this year by fostering conversations between Q members and encouraging collaboration. We were Exchange applicants last year, so we’re hoping that our experience will help us to help others, as their ideas take shape.

    Having read through your idea (which I found very compelling, by the way. The litigation costs quoted alone are eye-watering!), I was struck that there are a number of project ideas seeking to deliver a high quality digital services, post-COVID. They address different services, but have some similar challenges e.g. the choice of the best virtual platform. I have picked out a few projects which I think it would be beneficial to link with (perhaps comment on their idea pages?): "Embedding video consultation services inclusive of non-English-speaking communities", "Using Telehealth to support patients on chemotherapy at home" and "Supporting frail patients with diabetes in a virtual clinic age". If I can help you make further connections I will and in the meantime I wish the best of luck with your idea.

    Pete

    1. Hi Pete

      Sorry for the late reply (busy clinically- its the season!)

      Yes please any help would be great.

      Thanks

      naaz

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