For patients with long term conditions, discharging and monitoring them from home frees up vital bed space and improves the patient experience, says Linda Milburn
According to a 2012 report issued by the NHS Confederation, the number of patients who are unnecessarily retained in hospital is placing a huge strain on health services. It is estimated that delayed discharge, also known as “bed blocking”, is costing the NHS £545,000 per day, equating to just under £200m per year.
The report also says that 92 per cent of hospital chief executives, chairmen and other senior managers believed the problem has worsened since 2011.
Aside from the economic impact, bed blocking can also prevent hospitals from admitting new patients quickly, which can have a knock-on effect in delaying waiting times for pre-planned operations. The confederation called for urgent steps to be taken.
That’s why we in Harrogate wanted to take action to address this issue. The use of telehealth has been shown to reduce hospital bed days for people with long term conditions. In 2012 results from the Whole System Demonstrator programme trial showed that it enabled a 14 per cent reduction in bed days.
‘Being able to monitor people from home offers a “safety net” that allows potentially vulnerable patients to be discharged earlier without detriment to their care’
In January, we decided to offer telehealth as a means of supporting the discharge of patients admitted with symptoms not generally associated with long term conditions, becoming the first trust in the UK to do so. A new telehealth nurse post is funded by Harrogate and Rural District Clinical Commissioning Group.
The implementation of a telehealth system in a hospital setting goes some way towards meeting the government’s objective to greatly increase the administration of care closer to home, and reduce the strain on secondary care.
Harrogate District Hospital currently offers telehealth support to patients that have been admitted with six key conditions: pulmonary embolism, atrial fibrillation, headache, hypertension, pneumonia and urinary tract infection. These particular conditions were highlighted as being those that are most consistent with patient admissions and readmissions.
‘The majority of individuals have welcomed the opportunity to try telehealth’
Following initial tests and diagnosis by a consultant, suitable patients are referred to me as the telehealth nurse, at which point I introduce them to telehealth. This is offered for the duration of the seven to 30 day “risk period”; the timescale for which the hospital has responsibility for the patient following discharge. On the whole, the majority of individuals have welcomed the opportunity to try telehealth, and we expect to have 100 patients using telehealth over 12 months.
For patients who wish to proceed with telehealth, the process for installing the home monitoring system is surprisingly simple. Many patients are able to set up the equipment themselves, referring to our self-installation booklet. For more complex cases, engineers are on hand to install the system into the patient’s home. This is a particularly useful option in cases where we need to provide an electrocardiogram reader, as the equipment is more complicated.
Once installed and fully operational, the system feeds any alerts back to the response centre where they are picked up by the telehealth nurse or the medical registrar, allowing us to take appropriate action. Since implementing the scheme, we have had very few alerts.
Being able to monitor people from home offers a “safety net” that allows potentially vulnerable patients to be discharged earlier without detriment to their care and if any change or deterioration in condition is detected, I can contact the patient straight away to initiate medication or arrange a medical review. Crucially, telehealth enables patients’ medication to be titrated within a couple of weeks, eliminating the need for lengthy periods of checks, scans and blood tests, ensuring substantial savings in time and money for health care providers.
‘We are looking to open up the channels of communication between GPs and clinicians working in secondary care’
Telehealth has proved particularly useful in the treatment of patients suffering from hypertension. Under traditional circumstances, GPs would have to arrange frequent appointments for patients to undergo blood tests and blood pressure monitoring, which then leads to follow-up appointments to monitor the progress of medications.
Through telehealth, these patients can be monitored, their medication optimised and be reassured that their conditions will continue to be managed and controlled without the need for regular GP intervention. When patients eventually return to the care of the GP, they are in a much better, stable and optimum health.
In a recent case, a patient using telehealth yielded readings that suggested he needed increased medication. We were able to adjust his medication twice in the space of a week. So with telehealth, the patient’s medication was optimised at a far quicker rate at home, as opposed to the three or four weeks it may have taken under different circumstances. Telehealth also saved him any further anxiety and the inconvenience of travelling to and from hospital.
Since its deployment earlier this year, the use of telehealth at Harrogate District Hospital has provided some very encouraging results. We are committed to further improvement and development, and we are looking to open up the channels of communication between GPs and clinicians working in secondary care.
‘Aftercare through telehealth is hugely beneficial for the patients, as it empowers individuals to self-manage their conditions’
For example, GPs using a particular system can download data to see what has been happening with their patients that are using telehealth. We’re also currently sending electronic discharge letters to ensure GPs are aware of the fact patients are being discharged with telehealth.
For those currently on the telehealth programme at Harrogate District Hospital, we are working on a patient survey that we will use to gain an insight into telehealth successes and areas that could be improved. Ultimately, we envisage extending the use of the system to the treatment of additional acute medical conditions, diabetes and chronic heart disease.
Not only does telehealth enable patients to be discharged earlier, allowing them to be monitored from home during the “risk period”, but it also greatly reduces the workload for local GPs, helping to cut time and costs.
In addition, aftercare through telehealth is hugely beneficial for the patients, as it empowers individuals to self-manage their conditions and eliminates the distress associated with unnecessary hospital stays and lengthy follow-up appointments. Although hospital treatment is sometimes necessary, home is where the best care is.
Linda Milburn is telehealth nurse at Harrogate and District Foundation Trust