The COVID-19 pandemic accelerated plans for digitalisation at Wolverhampton Royal NHS Trust, with its use now being adopted in increasing areas of frontline healthcare. Health Tech World learns more
Initially a project to support patients with COVID-19 symptoms, struggling with respiratory problems, the use of remote monitoring is now being rolled out in other parts of patient care.
Wolverhampton Royal NHS Trust adopted the use of digital to help support patients virtually in January 2021, freeing up vital primary and inpatient resource to be redirected elsewhere while also maintaining the independence of patients to remain out of hospital.
In April last year, when the COVID-19 pandemic was at its height, the Trust became one of the first to implement significant transition to remote assessment through the creation of its Care Co-Ordination Hub, which offers a single point of access and clinical triage to all community services to determine which care pathway and intervention was best for each patient based on meeting patient need.
To compliment this development, the ‘virtual ward concept’ was developed and its adoption of the Luscii platform took that to the next level. This enabled clinicians to remotely monitor patients in their own homes, empowering them to submit their own readings and offering the chance to interact with clinical team via messaging and video calling. If anything causes concern in the remote readings or information from patients, clinical teams can intervene immediately.
Having introduced the Luscii app – supported by NHSX funding – initially for use among COVID patients to help monitor their respiratory symptoms, the Trust has already identified the potential for use among other aspects of its care by rolling it out into its COPD patients in May this year.
“We knew we wanted to support people remotely, but at first it looked like we’d be using bits of paper and explaining things to people by phone multiple times a day,” says Rachael Brown, group manager primary care and adult community services at the Trust.
“While we started it as a ‘manual’ service, a move into digital quickly followed. We went from paper-based to digital really quickly once the decision was made.
“We could support people with oximetry at home who were well enough to stay at home. These were mainly patients who were accessing primary care red sites or 111 services with respiratory problems who were COVID positive. We later went on to further develop the virtual ward to enable early supportive discharge of COVID positive patients, freeing up inpatient beds. Again we were able to monitor these patients post-discharge using Luscii.
“We were testing the water, we’d never done anything like this before, but thought let’s run with it and see what it looks like.”
The use of remote monitoring was deemed to be such a success that once COVID admissions and cases started to fall, the Trust decided to adopt it in other aspects of its respiratory work and, as of May 24, rolled it out to its COPD patients.
“We worked really closely with two of our respiratory consultants, who were involved in the co-design of the pathway, and they saw the potential for COPD,” says Rachael.
“We had a cohort of patients who would go to ED (emergency department) for treatment, be seen and treatment given, then go back home, only to re-attend ED again at day 6 or 7 with similar symptoms, and the continuous cycle would start again. Therefore this felt like a great place to start to use Luscii to support this group of patients differently.
“Through using the virtual ward and Luscii, we wanted to try and prevent that readmission / attendance, and looked at how these symptoms could be managed in a different way to improve outcomes for patients.
“We can use remote monitoring to see trends in patients conditions, even if they don’t submit information every day we can see a decline and rather than wait until the point where they’re so unwell they require a hospital stay, we can intervene earlier and prevent further deconditioning.
“The consultants are able to review all the patients on a virtual MDT meeting to see if there’s anything we need to do or tweak for each patient, equally whether there is any other diagnostics they need to undergo which could add value to that patient; this enables us to decide things quickly and then take immediate action.
“Already, its use in COPD is looking to be working well, and we’re working on some education tools regarding lifestyle, such as whether people are smokers and adding links to the Luscii platform regarding self-care for help to quit service; advice on how breathing positions and the effective management of anxiety and what relaxation techniques they could use. This means that patients have everything in one place on their phones or tablets.”
The move to virtual monitoring has been welcomed by patients, many of whom have become more accomplished with using technology over the past year and welcome the opportunity to use it as part of their NHS care.
“Patients really love it, they can be at home but we can support them. Previously if they’ve been quite anxious or breathless they’d panic and go to ED or phone the GP, but now they can just tell us via the app,” says Rachael.
“We have regular contact with patients and the fact they have direct access is a massive thing. We can message backwards and forwards and have a video chat if we need to and reassure them or take action if we need to. It’s not different care, but it’s done in a different and almost better way.
“We can sustain patients for a longer time at home, they like the knowledge that we’re keeping an eye on them and feel secure. Even when they’re discharged, they can tap back into us whenever they need it.”
For the NHS, whose move into digitalisation has largely been made in the past few months, with the seismic pressures created by the pandemic leading to new ways of thinking in how support could be given to patients remotely. The change, although welcome, is still proving very different for many medical staff.
“I’ve been really keen on using virtual for a while but it was a really slow process. With COVID, it gave us the opportunity to do something really different. Things we thought might happen two or three years down the line were all of a sudden accelerated,” says Rachael.
“From a nursing point of view, caring for patients in a digital way it’s a confidence thing. Clinicians have the skillset and that will be the same whether it’s virtual or face-to-face, but in the work we do the fact you may need to touch patients, or hold their hand, is something that you don’t get virtually.
“But by using virtual, you can still pick up the non-verbal cues, you can still tell if they’re breathless whether it’s over the phone or on video, and if anything, it really improves the sharpness of skills if you’re assessing someone virtually.
“We’ve probably got a larger caseload now than we’ve ever had, but through using virtual, we can have more time to engage with patients. It would take a lot of time to send a community nurse to someone’s house three times a day, but to check in on a patient three times a day using Luscii is a win-win for us both.”
Using the Luscii platform, and building a close relationship with the team, has enabled the Trust to learn quickly in how to transition from manual to digital.
“It has been really great. With COPD, we knew what we wanted it to look like, but didn’t know how to do it, or whether it would even work,” says Rachael.
“There is more we can be doing and we’re talking about whether we can do YouTube clips of things like breathing techniques using our clinicians, people the patients have probably seen before at some point, and that in itself will give greater reassurance.
“With COPD we’re still testing it out and there looks like there are loads of opportunities in how it can be developed not just for respiratory but other conditions too.”
*Article written by Deborah Johnson and originally published in Health Tech World, July 29th 2021.