Remote Monitoring Solution Allows Better Triage of Patients in Real-Time
Spirit Digital’s CliniTouch Vie saves time and healthcare resources at Rushey Mead Health Centre
Dr Amit Rama, GP Clinical Lead at Leicester’s Rushey Mead Health Centre has been using Spirit Digital’s CliniTouch Vie (CTV) remote monitoring solution at two of the practice’s nearby care homes – Rushey Mead Manor Care Home and The New Wycliffe Home, since June 2020.
Over the past five months, around 60 care home residents have been monitored using CliniTouch Vie, through the concept of the ‘virtual ward’.
Introduced to help the NHS manage its COVID-19 response, CliniTouch Vie’s digital remote monitoring technology has enabled the GP teams at Rushey Mead Health Centre to provide continuity of care to their patients remotely, helping to ensure vulnerable patients remain safe and minimise avoidable hospital admissions. Additional benefits have been better use of clinical time and resources; more confident and empowered care home staff; and the ability to capture richer patient data, including dementia reviews, mobility and early warning signs of deterioration.
Traditionally, weekly ward rounds would be completed face-to-face by the allocated GP after reviewing patients’ medical notes from the care home staff. The pandemic and full lockdown introduced on 16th March demanded an immediate reassessment of how these patient reviews could take place, providing continuity of care while minimising unnecessary face-to-face contact.
Using CliniTouch Vie, care home staff take regular vital signs readings and answer patients’ personalised health questions on a smartphone, tablet or computer. These readings are provided directly to Dr. Rama and his team, who can then remotely connect with carers and patients during the scheduled ward round through video link to provide health and wellbeing advice, and intervene where and when more urgent care is needed.
Moreover, CliniTouch Vie allows for more effective triage of patients, when care home staff feel a patient needs clinical intervention outside of the scheduled ward round. By providing clinical staff with real-time insight into a patient’s observations, symptoms and condition – with clinical calculations that automatically generate a Red/Amber/Green risk rating presented via a clinician dashboard, Dr. Rama’s team is better able to prioritise vulnerable or high-risk patients and make an immediate intervention should a patient indicate signs of deterioration.
Dr. Rama explains: “CliniTouch Vie asks the resident all the questions beforehand, which can make the consultation a lot quicker and more effective, giving me time back for care where it’s most needed. I have an average of 3 hours allocated to review patients from both care homes one day a week, and since using CliniTouch Vie, which highlights which patients have an acute problem to review, I am saving an estimated half an hour per care home. With this saved time, I can instead focus on improving the quality of the ward round, such as reviewing two or three patients with no acute concern, but those who haven’t been reviewed for two or three months based on a ‘Care Home Frailty Question Set’, which provides the team with additional information including mood, mobility and nutrition.”
The solution is also minimising call-outs from care home staff to emergency departments. As Dr. Rama says: “Previously, there would be times, if care home staff felt it might take too long for one of the GP team to physically assess and triage a patient, they would bypass our team and call the paramedics instead. This would result in the paramedic team attending the care home, who would then communicate with one of our GP’s about the patient to ask about their care plan when admitting them. However, this inevitably resulted in unnecessary call-outs, as not every patient would need to be admitted. Instead, by having CliniTouch Vie in place, we have real-time remote access to a patient’s status and can triage more quickly and more effectively, while also saving healthcare resources including money, time, staff and equipment. I can confidently say that there has been a significant fall in paramedic call outs since using CliniTouch Vie.”
Following the implementation of CliniTouch Vie in both Rushey Mead Manor Care Home and The New Wycliffe Home, Dr. Rama created two sets of care plans for each individual resident, focusing on clinical observations and overall general health and wellbeing. The clinical observation plan is used for vulnerable residents or patients who are at risk of health deterioration, and need to be reviewed daily or weekly. Temperature, respiratory rates and vital signs including pulse, blood pressure and oxygen saturation levels are recorded.
“The team will monitor key readings – such as the temperature going out of range or the respiratory rate picking up – as triggers for deterioration,” highlights Dr. Rama. This has allowed the team at Rushey Mead to use this information to paint an overall picture of a patient’s health in real-time, in turn, allowing for a quicker triage should the resident become unwell as they have an early warning of deterioration.
Additionally, the general health and wellbeing plan asks questions about the resident’s nutrition, fluid intake, mobility, mental health, memory and overall cognition. Similarly, this plan is used to gain an insight of the general picture of a resident’s health, both short and long term, while also making sure that the GP’s and care home staff are reviewing the patients properly. This can ultimately help to empower both the patient, carer and clinician in the management of their health as all parties can feel confident about an individual’s health status. “It’s taking care provision to a new level of focus on prevention on a personalised level,” Dr. Rama emphasises.
The questionnaire templates also offer a wider scope for healthcare assessment which would have been difficult to achieve previously. “We have been able to introduce questions which we wouldn’t have routinely asked, including questions about deterioration and mobility,” Dr. Rama says. “The system is therefore actually doing a lot of extra work for us by capturing this additional data, again allowing us collectively to focus on preventative care.”
Particularly looking at the Quality and Outcomes Framework (QOF), Rushey Mead Health Centre has been able to conduct a number of dementia reviews and capture blood pressure readings, which is something they were unable to routinely capture before the deployment of CliniTouch Vie.
Expanding on this, Dr. Rama has also developed a new template in the clinical system that automates patient recalls: “Effectively, I made a protocol which adds patients to a recall list, which automatically generates a calendar reminder for a specific period of time – be that two weeks or a month,” he says. “By combining the clinical and wellbeing data and the recall into just one click, we have insight into who needs to be reviewed and when, and are able to do so in an easy and quick way,” Dr. Rama said.
Going forward, Dr. Rama plans to complete an audit to review all incoming calls from the two care homes and compare that with the use of CliniTouch Vie on the day, in order to see what the outcomes were from each phone call and apply further training for care home staff where needed. He also has ambitions to expand on the use of the solution beyond care homes to care for patients who might be in their own home, and continue his collaborative work with Spirit Digital to improve patient quality of care.
He concludes: “There is a huge amount of scope for CliniTouch Vie in the practice and care homes than what we’re using it for currently, but of course, it’s still early days. We aim to continue using this tool as a more efficient method of achieving our QOF targets, whilst improving the quality of patient care. We are completely pro-digital remote monitoring to augment care provision for those who need it most, and I’m really excited to continue progressing and reaping the benefits of this solution.”