Taking images securely to get advice and guidance

Routine methods of referring an NHS hospital inpatient for speciality review previously included bleep/pager, telephone, email, fax and online e-referral. Hospitals are now encouraged to move away from the use of bleep/pagers and fax in particular, and look to more modern methods of communication.

Situation

Review of inpatient dermatology referrals previously took place as a daily ward round over lunchtime between clinic commitments, or at the end of the working day. This frequently meant no breaks during the working day and extended work outside of contractual hours. It also led to potentially long waiting times for patients to be seen and for advice to be actioned, as they often had to wait for hours until clinic commitments were completed, or until the following day for the formal dermatology ward round review.

Aspiration

Streamline inpatient dermatology referrals to reduce the number of in-person reviews required, and expedite advice and guidance for patients to start appropriate treatment faster, rather than waiting for formal in-person review.

Solution and impact

• The solution was to use a smartphone app called Pando to send and receive all referrals, including photos, of the referring complaint. Pando is designed to allow sharing of patient confidential information and photos between healthcare professionals, both on-site and off-site
• Referring clinicians send a referral by using an ‘ask advice’ feature on the app which sends the information and photos to a selected group, for example, ‘dermatology referrals’. Members of the group can range from one individual to a whole department, depending on an individual hospital’s referral process
• Once a referral is received, instant messaging is available between the referrer and actioning clinician to provide appropriate advice and guidance. This allows prompt feedback for patients who can then commence treatment more quickly. Pando says this has expedited discharge from A&E or acute medical units, with patients avoiding long waits for formal in-person review
• The app is not designed to replace all in-person dermatology reviews in cases of uncertain diagnosis, clinical deterioration or serious life-threatening dermatoses; it’s  used as a triage tool which can lead to faster diagnosis and treatment
• It may also help reduce the risks of infectious cross-contamination between patients and staff as it decreases the number of in-person reviews required and allows clinicians who may be working off-site to advise on acute inpatient dermatology
  

Functionality

• Designed for use with smartphones and tablets
• Data, including photos, is securely saved in the app rather than downloaded or saved to the user’s device or in the cloud
• Currently free for NHS staff with a trust or NHS email
• Enables secure messaging, image transfer and sharing of patient lists between individuals or teams
• Available from the NHS Apps library
• Approved supplier on the NHS Transformation Directorate Clinical Communications Framework
  

Capabilities

• Direct instant messaging between healthcare professionals, both on-site and off-site
• Secure photo sharing; NHS email required
• Group messaging platform for teams
• ‘Ask advice’ feature for referrals
• Gallery for saving photos
• Directly linked to nhs.net email to send photos
  

Scope

• The ability to send photos and messages securely from a referrer and between clinicians
• Can be used for advice and guidance, improved referrals and second opinions
• Designed for use in hospital, off-site, or cross-site working

Key figures/quotes 

The KSS AHSN Insights team conducted an in-depth evaluation to assess the impact of Pando in 2019, which found that an acute Trust adopting Pando could save £922k from in-year cash and non-cash savings, rising to £44 million should the application be rolled out across all acute Trusts nationally.Savings are mostly attributed to workforce time (non-cash savings). Less than 2% of overall savings were a result of avoiding potential fines from disciplinary action requirements (non-cash savings) and pager savings (cash-savings).
Source: KSS AHSN

Find out more

Find out more on the Pando website

Key contact

Dr Natalya Fox, Epsom and St Helier Trust Hospitals

Natalya.fox1@nhs.net