Reducing inpatient bed days by moving pre and postoperative orthopaedic care to the home

Medway NHS Foundation Trust’s surgical medical acute response team (SMART) and trauma team introduced a care pathway. The pathway is for patients in A&E with broken lower legs.

Situation

Patients who come to A&E with broken lower legs are admitted under the care of the trauma team.

They are managed as an inpatient until the swelling reduces and an operation slot is available.

Patients can be hospitalised for up to 8 days before surgery. After surgery, patients can remain in hospital for another 2 days.

Aspiration

The Trust wanted to safely monitor and manage orthopaedic patients at home before and after their surgery. This would keep hospital beds free for patients who need acute hospital care.

Solution

Medway’s SMART service uses Current Health’s care-at-home platform. This delivers safe and effective care to orthopaedic patients at home before and after surgery.

When a patient comes to A&E:

• the fracture is stabilised
• medication is prescribed to prevent deep vein thrombosis
• the case is referred to the surgical repair waiting list

The patient is then referred to the SMART service and a nurse initiates remote care.

The SMART nurse does daily virtual visits using Current Health’s platform.

Nurses monitor the patient’s continuous vital signs for signs of thrombotic complications or infection. Vital signs are captured by a wearable sensor.

Swelling is expected to subside within 5 to 7 days after the injury. At this point, the SMART and trauma teams can finalise a time for surgery.

1 day before surgery, a SMART nurse arranges a home visit to complete:

• blood tests
• a final evaluation of the fracture

Patients are discharged after surgery on the same day.

They are remotely monitored for another 24 hours.

Impact

Patients now only need 1 day of inpatient care. This saves the hospital 9 bed days.

Functionality

Through a wearable sensor worn on the upper arm, the platform continuously captures patients’:

• respiration rate
• oxygen saturation
• heart rate
• body temperature
• movement data

Patients have video consultations using a tablet device which is provided as part of the Current Health kit.

Capabilities

Current Health’s care-at-home platform:

• enables patients to be monitored at home
• enables the SMART team to complete video patient assessments on the patient’s tablet
• helps the SMART team see both real-time and trend health data through a centralised dashboard
• has alarm notifications to alert the team to the early signs of deteriorating health, enabling them to deliver treatment

Scope

Healthcare providers use Current Health’s platform to deliver clinical care to patients at home.

Key quotes

“[There is a] better patient experience when care is given by acute specialist nurses in [the] patient's own home.

With experience, patients control their pain and general symptoms better when they are participating in their care.”

Jackie Hammond, Clinical Nurse Lead, SMART

“Being monitored daily whilst maintaining my standard of living at home is important for me to maintain my independence. I feel comfortable receiving hospital treatment in a familiar environment and in my own bed.”

Anne Sands, Clinical Sister

Key contacts

Jackie Hammond, SMART Manager, Medway NHS Foundation Trust

jacqueline.hammond1@nhs.net