Tackling the rising number of attendances for heart failure patients
To combat the rising number of emergency A&E attendances and unnecessary hospital and GP visits for patients with heart failure, patients need to be given more control to monitor their own health, knowing they have the support and information at the touch of a button. Here is how one Trust approached this and is now seeing more informed patients managing their health, tracking their symptoms and improved communication between them and their clinicians, which in turn is reducing DNAs and improving patient outcomes and efficiencies.
Heart failure is a common chronic condition that is a significant burden on NHS resources. Patients diagnosed with heart failure often attend multiple hospital and GP appointments in addition to requiring hospital admission. The National Institute for Clinical Excellence (NICE) published a report in 2018 stating that it is estimated that heart failure accounts for a total of 1 million inpatient bed days (approximately 2% of all NHS inpatient bed days, 5% of all hospital medical emergency admissions).
Evidence shows patients often exhibit deteriorating symptoms over a period of days or weeks prior to presenting to emergency departments in crisis. The West Middlesex area was starting to see numbers of this situation rising and needed to implement new ways of working to help support patients much earlier on.
Chelsea and Westminster Hospital NHS Foundation Trust’s Heart Failure Team, who care for patients in this region, wanted to simplify the complex navigation of healthcare services for patients with heart failure, and to ensure they had access to the relevant education and support material they needed to manage their condition. The team also wanted to reduce the number of unnecessary visits to hospital or GPs and reduce DNA’s. If more patients were in control of their health and monitoring it more regularly, they believed this could reduce the amount of people who presented as emergencies in A&E.
Finding the right solution
PKB was the ideal solution for this programme of work as the infrastructure was already in place as it was already being used under the name of the Care Information Exchange (CIE). Across North West London, the CIE provided the ability to link hospital data systems for the patient. CIE was also embedded to enable connection with the regional Trusts across North West London. Through the previous work with Imperial College Healthcare NHS Trust in particular we were able to use a lot of their learning as well as align our requirements and roadmap goals with them. PKB worked closely with the North West London Information Governance group and so there was a strong internal knowledge of Information Governance (IG) and data security requirements e.g. regular penetration testing, clinical safety case, and regional information sharing agreements. This all meant that Chelsea and Westminster were able to set realistic timelines and goals with PKB as many key requirements had already been demonstrated.
CIE is the cornerstone of the NWL digital strategy, it was already in use as a patient tool and we wanted to build on that to evolve its use as a clinician tool.
Building the right processes
The Project Team ran several sessions with the involved suppliers, the clinical leads, and patient leads to review workflow and functionality options before the core scope was agreed upon. There was a reiterative approach to try and streamline the patient and clinician flows as much as possible. A lot of work was put into rating what functionality was essential, high value, or just nice to have. This did evolve post-go-live as well because of user feedback and subsequently resulted in the delivered functionality.
As a result of the work undertaken to engage at all levels and get their clinical teams on board the project team ended up with a pathway that allowed them to support their patients in a more dynamic way. Providing them with comprehensive and interactive care plans and the ability for patients and clinicians to communicate in a secure and faster route via CIE.
This resulted in better informed patients, a holistic understanding of their care and what was expected of them.
From the clinical teams point of view not only did they have more informed and engaged patients but this also resulted in less DNA’s for clinic appointments, fewer phone calls to Healthcare Professionals (HCP) and more effective use of messaging, plus the ability to ask questions which enabled fewer mistakes and misconceptions.
With patients having the ability to monitor their symptoms and observations they were also recorded in a clear way for their HCP to view, this significantly enabled them to optimise medical therapy for their patients more effectively.
Patients continue to be encouraged to register on the Care Information Exchange. Where possible, the Heart Failure team will communicate with patients via CIE and tell them to input their symptoms, measurements and other supporting health information to help all concerned in their care to see a holistic view of their health record. The keys benefits patients are feeding back to the team are :-
- Having better contact with their clinician
- Receiving confirmation of appointments
- Having access to the right information regarding their health condition via the library
- The feeling of empowerment for the patient to self monitor
Going forward, the team feel patients will gain confidence in using the portal for communicating with clinicians, managing appointments and their health in general.
Chelsea and Westminster Hospital NHS Foundation Trust is one of the top ranked and top performing hospital trusts in the UK. They employ more than 6,000 staff over two main hospital sites, Chelsea and Westminster Hospital and West Middlesex University Hospital, and across 12 community-based clinics within North West London for over 1.5 million people