Embracing digital care can have huge benefits for both healthcare providers and patients. “We have improved patient care through remote monitoring,” says Chief Nurse.
Suzanne Curtis is Chief Nurse at Mastercall Healthcare, an out-of-hospital healthcare provider in the Stockport area in Greater Manchester. Over the past few years, she has overseen the implementation of a new, digital approach to patient care – a project bearing the name “Technology Enhanced Living service” (TEL).
“We believe we can use digital tools to remotely identify illness and deterioration, intervene earlier, prevent unnecessary hospital admissions, and generally improve health and social care outcomes for people,” she states.
The idea of TEL is to monitor and follow up on patients remotely while reducing the need for face-to-face GP check-ups or admissions to emergency services. This involves patients using Bluetooth devices to monitor their health which are sent in real-time data back to a digital solution developed by Dignio. It also involves extensive use of video consultation where possible, and the establishment of a Hospital@Home team that can respond to patient deterioration without admittance to the hospital.
The system relies on Dignio’s digital remote care platform to ensure smooth management of data from the patient. It logs all the patient’s data from the remote devices and allows clinicians to monitor appropriate data which is risk stratified by the platform so they can accurately detect and respond to changes in patients’ conditions, whilst simultaneously reducing strain on GP practices and emergency services.
Curtis explains how it works:
“We can use the Dignio platform to remotely monitor patients’ observations such as blood pressure, oxygen levels, pulse, temperature, and so on. Patients or carers make readings at home with the appropriate equipment, and results are sent to the platform via a Bluetooth device or through an app. In turn, these readings are sent to the clinical hub where clinicians monitor and manage the platform remotely. All this data is rated with a green, yellow and red colour code according to urgency, and a clinician is alerted if any of the observations are outside of the normal thresholds for that individual person.”
“Valuable in preventing deterioration”
Mastercall, which services a total patient population of three million, first rolled out its TEL service to care homes. The primary patient group here is elderly patients who can retain a degree of independence, with limited medical supervision from carers.
Suzanne explains that the challenge for Mastercall was that carers in care homes often rely on the interpretation of vague symptoms in their communication with clinical teams. For example, if carers notice that a patient is not eating, this is not necessarily enough to warrant a visit from a GP or a trip to an emergency room – even though it might be a sign that something might be deteriorating.
“Some of these patients do not need to be seen urgently, but at times when triaging a call it’s difficult to make an accurate assessment without appropriate observations or any baseline.”
This uncertainty has two main effects. Firstly, deterioration can go unnoticed until it becomes an emergency case, with both an increased risk to the patient and higher cost to the healthcare system. Second, it forces carers to utilise emergency services to get appropriate medical intervention which results in increased emergency demand.
“This is where Dignio has enhanced our assessments and allowed us to accurately respond to patients remotely who may have otherwise needed a home visit or a review in ED. Remotely monitoring this vulnerable group has enabled the team to identify changes in a person’s health and prevent deterioration,” Curtis says, adding:
“Another area which has proved valuable is that GP’s can access all the data on their patients through a zone on the platform which allows for them to check their patient’s data prior to an MDT or clinical ward round at the home.”
“Virtual ward” for Covid patients
Mastercall initiated TEL as a pilot in care homes in early 2020. Since then, TEL and the Dignio platform has proved useful across many facets of primary care – especially through the Covid-19 pandemic. “We have provided thermometers and oxygen level monitors to any Covid patient who the clinicians feel would benefit from remote monitoring. Through the Dignio app, clinicians have gained access to vital patient monitoring, without daily, physical contact.”
This way, Mastercall has been able to keep an eye on Covid patients through a “virtual ward”, reducing the need for face-to-face assessments whilst retaining the ability to respond quickly if the patients deteriorate.
“Patient feedback has been positive. People have commented how they “didn’t feel alone”, how they were “scared but knowing they could contact the TEL team made them feel safe”. This was all at a time when accessing health care was difficult and restricted,” Curtis explains.
“The TEL Covid response also supported primary care as these patients would have been contacting their own GP’s at a time when they were struggling to manage the demand. The TEL service was able to safely monitor this vulnerable patient group remotely in the community, “she adds.
Expanding to heart patients
As TEL approaches its one-year anniversary, Suzanne is confident that TEL has been a success.
“There have been many areas where the team can demonstrate how the TEL service has improved patient care through remote monitoring,” she says.
Increased remote monitoring has also yielded some unexpected benefits.
“One unexpected area where we were able to detect and alert was end-of-life care. As well as saving lives, the TEL service has been able to detect and highlight to the GP, care home staff and specialist services that a person may be approaching end of life and initiate end of life discussions or advanced care plans.”
Now, with the experience from care homes and a Covid pandemic, Mastercall is looking to expand the scope of remote care – starting with heart failure patients.
“Many heart failure patients still rely on home visiting, which can be very time-consuming for most clinical teams. Although they often are necessary, they can also be an inefficient way of reviewing patient care. Therefore, we have linked with the heart failure team and the COPD team to offer remote monitoring.”
“We hope that we get to a point where the clinical teams only need to see a patient face to face when necessary and that most monitoring can be done remotely. This is a better use of clinician’s time – and it also empowers their patients to self-care,” Suzanne concludes.