17 June 2022
At the height of the pandemic – and more recently, as we have turned our attention to recovery, clearing the backlogs and supporting our exhausted front-line staff, the penny has finally dropped on the benefits of remote patient monitoring.
The System C & Graphnet Care Alliance has been creating virtual wards for nearly twenty years, managing around 50,000 patients, with uptake slowly increasing year on year. Over the last 18 months, demand has soared. NHS England has asked for the equivalent of 5,000 additional hospital beds in its 2022/23 priorities and operational planning guidance. Graphnet/Docobo are targeting over 250,000 remotely monitored patients next year.
In April, NHSE followed up with more detailed guidance, or what it calls “enablers for success.” This document outlines service models and explains how some set-up costs can be met from bids to a temporary Service Development Fund with £200 million to distribute this year and an additional £250 million to distribute in 2023-24.
The biggest challenge the NHS is facing is workforce and remote monitoring offers a vital opportunity by enabling lower qualified professionals to treat large numbers of patients, freeing up the capacity of our most qualified, nurses, allied health professionals and doctors to treat more complex patients. Remote monitoring also enables the NHS and social care to identify patients who are at risk of deteriorating to intervene in the community.
The three main areas of interest are: virtual wards used to accelerate safe discharge, monitor patients prior to admission and reduce length of stay; remote management of patients with long term conditions used to monitor patients at risk of deterioration to intervene in the community reducing admissions and patients facing long spells in an acute setting; and remote management of patients in care homes, which is reducing physical intervention across all care settings.
Much has been learned, helped along by the pioneering efforts of those such as the Frimley Health and Care ICS. They used our population health and shared record solutions to identify patients that would benefit from remote monitoring at home – a technique known as precision cohorting. By using data from all care settings, they were able to improve on more basic selection methods such as national clinically vulnerable lists and they achieved a 42 percent reduction in mortality in shielded, hospitalised patients and a 50 percent reduction in mortality in hospitalised patients who were not shielded.
Liverpool is another region that runs multiple remote monitoring initiatives, and which has seen huge value. In 2021, patients in Merseyside were cared for on their own ‘Covid Virtual Ward’ run by a collaboration of Mersey Care NHS Foundation Trust and Liverpool University Hospitals NHS Foundation Trust (LUHFT).
The wards were used to monitor patients who had been discharged but were still under the care of a hospital. Consultants undertook daily virtual ward rounds assessing patient observations, which included blood oxygen levels, blood sugars, ketones etc. Readings were submitted by patients using a Docobo Careportal® (a tablet-like medical device).
Seher Zaidi, Respiratory Consultant at LUHFT, said:
This helped reduce pressure on hospital beds, and with monitoring of vital signs in the community it was possible for clinicians to remotely observe patients or any clinical deterioration, with the option to review in ambulatory care as necessary. The use of technology and collaboration with Docobo and Mersey Care was the key to safe and effective delivery.
The concept of ‘wards without walls’ is relatively simple. However, the logistics of carrying out remote monitoring, coordinating different specialists, and liaising with others that may be involved (GPs, community care teams, district nurses, mental health, social care) can be more complex.
For virtual wards to work, NHS organisations need:
Remote hospital care on a national scale has been talked about for a long time, but recent progress suggests that it might finally become a reality. I know I’m not the only one feeling positive about that. Who do you know that would rather be in hospital than at home as long as they are safe and have access to good clinical care and the hospital if needed?
Now is the time to build on what we know works, using safe, tried, and tested methods and technology, to take remote monitoring mainstream.
By Markus Bolton, Director, System C & Graphnet Care Alliance
Markus Bolton, Director, System C & Graphnet Care Alliance