by Rob Halhead, Docobo

There’s been a lot of talk about patient monitoring particularly during the COVID-19 pandemic. Rob is going to be telling us about Docobo’s patient monitoring activities both during the pandemic, and in the years before: 

‘Since the first wave of COVID-19 in March 2020, we’ve introduced telehealth in many parts of the country to help the health system cope with the demands of the pandemic.  On a positive note, the crisis has removed any remaining barriers to adoption of digital patient monitoring. As COVID, thankfully, starts to recede from crisis level, we can begin to look forward to the wider adoption of patient monitoring to help patients enjoy a better quality of life and clinicians to cope with demand.

Technology enables the NHS to introduce new ways of delivering care and make care more pro-active, while the fundamental challenge for the NHS is that demand exceeds supply.  This problem has been exacerbated, of course, by COVID, while the back-log of treatment and procedures continues to mount.

The economic effect of patient monitoring is to transform capacity. In Liverpool, during the pandemic, Mersey Care increased the ratio of monitoring nurses to patients from over 1:300 people  to  1: 500. In reality, this means that one nurse can observe the continuing health of 500 patients per day.

Engaging in a trial in the North West, a GP said that by using remote monitoring, he could monitor 120 of his most poorly patients within two hours (the monitoring nurses were not available on one occasion).   This is effectively one patient per minute!  At the beginning of the trial, the GP concerned had started out as a digital health sceptic, whereas he is now, and remains, an enthusiast, and why wouldn’t he? When his normal capacity at full pace is 6 patients per hour.

The pro-active nature of patient monitoring enables doctors and nurses to spend more time face-to-face with the patients who benefit most.

Similarly, monitoring leads to early intervention and preventing emergency events.  Preventing admissions to hospital is a gain for the whole system; patients avoid the experience, the ambulance or paramedic isn’t called, capacity is not consumed and the need for any post-discharge care is avoided.   Thus, the NHS is ‘increasing capacity’ by reducing emergencies and keeping people at home.  As we live longer, we stay out of hospital for longer and we enjoy a better quality of life. It’s cheaper and it reduces clinician workload.  Surely, a no-brainer.

Moving on to community nursing: conventional care means that patients who can stay at home are often visited by district nurses and community matrons. In the absence of any insight into that patients’ condition, those visits are carried out on a scheduled basis. With digital health providing the insight about a patient’s condition every day, those home visits only need to take place when they need to – thus increasing the capacity of community nursing.

In care homes we now have the Enhanced Health in Care Homes Framework – part of the NHS Long Term Plan – which means that GPs and nurses are often nominated to a particular care home. Patient monitoring technology supports clinicians and substantially reduces the workload of care homes and carers, enabling the GP to deliver better care and reduce the number of visits made to the care homes. In one particular trial in London (Bexley), the GP recording the outcomes over nine months, measured a two hour saving per week in visits avoided to just one care home.

Patient monitoring is also applied to supporting discharge from hospitals and out of hospital care, helping to release hospital beds as soon as possible.  Elderly patients are discharged and supported at home as soon as it’s safe, helping to limit deterioration associated with being in hospital for any longer than necessary. Most of us recover better at home and prefer to sleep in our own beds.

With ‘supported discharge’, patients are physically discharged to go back home with monitoring equipment but remain under the care and responsibility of the hospital.  Clinical discharge, back to primary care/GP, happens when the hospital consultant is confident. Discharge back to primary care may mean that the patient continues to be monitored. Recently, COVID Virtual Wards were an example of supported discharge.  In Liverpool, Mersey Care provided a monitoring service for the University Hospitals; measurements included ketones and breathing rate and the nurse monitoring was delivered with a higher level of intensity.

Patient monitoring technology enables the heavyweight transformation of out of hospital care.

In our experience (we celebrate our 20^th year in September) success demands a change management approach. The key ingredient is, of course, having the right people involved in the programme.   Successful change leads to better processes and pathways.  The outcome is better quality of life for patients, help for clinicians, a ‘virtual’ step-change in capacity and improved economics.’