Digital Remote monitoring in care homes

Mark Needham, Programme Director, Digital First and Digital Pioneer Fellow.

Overview of project:

NHS and Councils in Kent and Medway aimed to reach isolated care homes during the pandemic in 2020 and Mark’s team scaled this work to provide digital remote monitoring in 2021.

Winning funding from NHSx, Mark as Programme Director led a health and care team to build a digital bridge to connect 195 GP Practices with 500 care homes.

• This includes delivery of:
  • 415 digital literacy sessions to care home staff
  • 509 iPads with support and apps
  • KARA tablets for families to contact their loved ones and prevent social isolation
  • Rapid growth in use of digital applications amongst care home staff
  • Digital dashboard with data insights and an evaluation framework
  • National blueprint for other systems to use

During 2021, they have used the learning from the digital care homes project to rapidly scale digital remote monitoring for Blood pressure monitoring, diabetes, COVID Oximetry and respiratory pathway for acute breathing difficulties in adults and children.

They expect to save around 7400 bed days this winter – the equivalent of providing 243 virtual beds in the community through digital remote monitoring.

We would like to thank Kent & Medway for the loan of the iPad. It is very easy to use – we can now email GPs and use it to take pictures to send securely to nurses and GPs for virtual consultations. Being a small care home we only had a PC in the office. The iPad means that staff can now take part in training without having to use their own smart phones. The training app on the iPad has already been really helpful. We are now also able to use video conferencing so families can have more face to face contact with loved ones.

– The Willows, Willows Residential Home

Impact of project:

Expected improvements of the project are across two phases:

• Digital access to GP Practices and care services
  • Promote digital literacy across social care
  • Access to technology for care homes such as MS Teams, NHS mail, using iPads, online consultations, video and messaging.
  • The AHSN independent evaluation evidenced the project investment of £500K as cost neutral to the system.
• Digital monitoring of care home residents including:
  • To prevent silent hypoxia for residents with COVID through digital pulse oximetry monitoring
  • Acting to prevent deterioration of patents using digital system -NEWS2 clinical score

As their GP I know them well and their families too. Online consultations mean that I was still able to have those difficult end of life discussions from home. Honestly without Laptops and Video Consultations our patient care delivery would have been put in very challenging situations.

– Dr Ash Peshen, GP, Margate

Statistics:

Phase 1 – Digital literacy in care homes

The estimated number of NHS/social care staff to have benefited is 500 homes with 25,000 workforce who support 12,000 residents.

Phase 2 – Digital remote monitoring

In winter 2020, 1000 people have been supported by digital monitoring. Based on the national evaluation, this prevents deterioration (silent hypoxia) and saves lives. Working with the national team early results show this:

• Reduced LoS with Covid-19 by half
• Reduced risk of admission to ITU by half
• Reduced risk of death to a quarter

In summer of 2021, the team developed digital NEWS 2 score. This enables care home staff to digitally notify GPs to act on and provider an appropriate response to prevent deterioration of residents. Testing completed in two care homes shows improved communication – on average 22 urgent alerts sent to GPs for 86 residents, replacing hundreds of phone calls.

Going into the Autumn of 2021, the project is half-way to its target of digitally monitoring 6000 patients. With the expansion of digital remote monitoring to COVID Oximetry and Respiratory pathways for Adults and Children with acute breathing difficulties we are intending to save over 7000 bed days – the equivalent of providing 243 virtual beds in the community.

Key to our success was engagement and communications with all of our practices. We got this right and were able to engage with each practice on their terms and at the right time to digitally enable the practice.

Bill Millar, Director of Primary Care

Key learnings from the project delivery to date:

• Success in relationships and health and care partnerships – identify common problems and work through challenges together
• Win hearts and minds – to address the wide variation in care homes digital literacy and infrastructure
• People want both digital and face to face health and care services – digital only solutions can exclude
• Benefits are difficult to evidence – our evaluation has shown it can be cost neutral and we are working to evidence further benefits
• All projects require phasing and can grow if they continue to solve relevant problems
• NHS and Councils started by building a digital bridge to promote digital literacy and accessible tech for care home staff and GP Practices. (Phase 1 – winter 2020)
• This has provided a platform to support digital remote monitoring over two winters. (phase 2 – winter 2020 and forthcoming winter of 2021)
• Digital monitoring can create capacity in health and care services – preventing avoidable admissions to hospital, earlier discharge and bed capacity in the community through virtual wards
• Where next in winter 2021/22? Phase 3 – Further developing COVID oximetry and respiratory services for children and adults with acute breathing difficulties this winter!