Digital communication improving efficiency for specialist heart failure care
A case study from University Hospitals Sussex NHS Foundation Trust
Digital messaging reduces telephone calls by 33%
Being able to send a message rather than trying to get through by telephone is certainly quicker. I have been able to manage patients more effectively between appointments – they can message in with blood pressures for instance which can help my decision making. It feels more streamlined rather than disjointed phone messages coming in. It also prevents interruptions in workflow as I can choose to answer PKB messages at a time that suits rather than breaking off to answer a phone call. Overall it has helped us to manage the ever increasing patient demand.
Sarah Young, Nurse Consultant, Cardiology
Problem
Solution
Taking advantage of the Trust’s existing Patient Portal, provided by Patients Know Best and called My Health and Care Record, we set up our team on the portal and developed an implementation strategy to maximise its benefits and achieve our objectives.
A mapping exercise reviewed current practice and opportunities for digital support. We identified that a simple introduction of the messaging functionality would give many patients a more convenient and efficient method to contact us with general queries, alongside access to education materials which would provide further support and information. We created a library resource for patients to access consisting of information on heart failure and cardiomyopathy, supporting patients with psychological support and lifestyle including travel, smoking, hot weather and blue badge applications.
We also introduced a PIFU pathway utilising the messaging functionality. This means that once the patient is optimised and stabilised they can access specialist care directly if their condition deteriorates, rather than being discharged solely to GP care.
Outcome
2-week telephone audit demonstrated a 33% reduction in telephone activity
Since going live the Heart Failure team currently has approximately 588 patients registered on the portal. In the last 52 weeks we have added 115 patients. Since go-live 13,373 messages have been sent. Of these 8,944 were sent by the patient and 4,429 by the professional team. The team responds to over 70% of the messages within 24 hours.
A 2-week telephone audit demonstrated a 33% reduction in telephone activity (from 224 calls at baseline to 151 calls). This equates to a 15% reduction in time spent on calls.
There was also a reduction in telephone calls and a move to messaging patients for routine communication (from 49% of calls to 41%).
Staff feedback has been positive. Of the 8 team members all are inviting patients routinely to register onto the patient portal.
If a patient is not able to use a digital tool then standard care using the telephone is maintained.
75% of the nurses felt the messaging function had helped to manage their caseload and 50% were regularly signposting patients to the resource library. Patient feedback has been positive with comments in a focus group highlighting improved accessibility and convenience for heart failure nurse support through the digital system.
These results demonstrate that digital communication can definitely be used to improve the support of specialist heart failure care. By replacing some telephone activity it can lead to a more efficient use of nursing time with less interruptions for the professional and with more convenience for patients.
It also provides a safer way of communicating medication changes (via messaging within PKB) with less risk of mishearing hearing instructions.
Replacing some telephone activity leads to a more efficient use of nursing time with less interruptions for the professional and with more convenience for patients. It also provides a safer way of communicating medication changes (via messaging within PKB) with less risk of mishearing instructions.
Anecdotally patients get muddled with their tablets as names are often similar. I feel it is safer if there is something written rather than just a quick telephone conversation.
Future developments
Going forward we will promote greater use of the resource library to reduce the need for paper information and postal costs.
Long-term evaluation is required to understand the impact of a growing caseload of heart failure patients able to access specialist support through the digital tool who are on the PIFU pathway, rather than being discharged to general practitioner care.
Sarah reflected by saying: “These patients often require a single specialist intervention when they get back in contact to maintain their stability but our workload has increased as we change the way specialist care is accessed over a longer period of time. PKB has been a useful digital tool to support our specialist heart failure nurse care and has improved efficiency in our ability to deliver care to patients remotely”.
