Enhancing recovery and addressing the theatre backlog with the help of virtual wards

The Hertfordshire Community Trust (HCT) has an integrated Care Co-ordination Centre (central referral hub) that manages a range of health services in Hertfordshire.

They first launched virtual wards for respiratory patients, in response to Covid-19. Since then, their virtual ward service has grown to include patients with a wide range of conditions, including heart failure and urinary tract infections. These services are known locally as Hospital at Home (HAH). They have learned valuable lessons about implementation and the benefits of virtual wards.

In July 2022, HCT and its technology partner saw the opportunity for virtual wards to help manage the surgical waiting list. They launched the postoperative HAH service in September 2022.

Situation

At the end of August 2022, close to 800,000 people in the UK were waiting for specialist orthopaedic hospital treatment. 42% of these patients had waited longer than 18 weeks (NHS England, 2022).

The number of postoperative beds can limit how many operations are able to be performed each day. Therefore, finding ways to safely reduce length of stay is one step to addressing the backlog.

Aspiration

The objectives of the service are to:

• support patients to better manage their recovery following discharge.
• allow patients to recover from their operation safely and conveniently at home.
• free up bed spaces so that other patients can get their joint replacement surgery sooner.

Solution

The postoperative HAH service is being trialled by HCT and East and North Hertfordshire NHS Trust (ENHT). It is being run in partnership with Doccla.

Patients who consent to HAH receive a Doccla box, containing all the equipment, three days before their operation. Doccla's customer service team calls the patient and explains how to use the equipment. This is called the 'onboarding call'.

The patient starts using HAH when they are discharged from hospital, after their operation. They use the service for seven days, or longer if needed.

The patient opens a pre-installed app on their Doccla supplied smart phone. The app prompts the patient to use the monitoring equipment to record their vital signs (such as their blood pressure and oxygen level) and enter the measurements in the app. The app also asks patients to answer a short questionnaire about how they are feeling and whether they are in pain.

The nurses at the HCT Hub then log into Doccla's clinician dashboard to view each patient’s vital signs and completed questionnaires. They decide how often patients need to enter their readings and decide when they can be discharged.

The Doccla customer service agents also monitor the dashboard and contact patients who have not entered their measurements. This allows the team to identify patients who are having difficulty using the equipment and ensure that clinicians have access to accurate, up-to-date information.

Impact

The first 10 patients have been admitted to the postoperative HAH service. Of these patients, eight have completed their monitoring and have been discharged from the service.

Patient compliance has been high, with 100% of patients submitting their information at the agreed times.

The average stay on the postoperative HAH service is 7.25 days; no patients have required re-admission.

The Academic Health Science Network is currently evaluating the impact of the service on patients' quality and experience of care and length of stay in hospital.

Functionality

Doccla supplies all the monitoring equipment (including software and hardware) and provides a technical support helpline for patients, carers and clinicians.

The Doccla box contains:

• a patient information leaflet.
• a smart mobile phone.
• blood pressure monitor.
• pulse oximeter.
• thermometer.
• haemoglobin and blood glucose metre.

In addition to sending their vital signs, patients can use the mobile phone to take and send photos of their surgical wounds. They can also send messages to the nurses at the HCT Hub and receive video calls.

Capabilities

The postoperative HAH service enables patients to be safely discharged earlier by making it possible for clinicians to monitor their patients' observations from home.

The web-based clinician dashboard allows the nurse to view trends in vital signs using the graph function. There are also alerts that make it easy for clinicians to quickly identify patients whose measurements are outside predetermined thresholds.

Scope

Screening for the service begins before the patient has their operation. Suitable patients must:

• be able to give informed consent.
• be able to use the monitoring equipment or have someone who can help them use the monitoring equipment.

Suitable patients are onboarded before their operation, to give them time to become familiar with the equipment. It also means that they can give consent and be onboarded before they have sedation for their operation.

Key learning points

As the virtual ward is a new concept for most patients and using the equipment can feel daunting, patients can feel overwhelmed by the information, especially when they are in pain. Therefore, clear patient information about what to expect from the service, given at the right time, is essential to a positive patient experience.

Digital equalities

Doccla's helpline is available from 8am to 9pm everyday to support all patients and carers to use the equipment.

For patients whose first language is not English, patient information can be easily translated to the patient or carer’s preferred language.

For patients who have difficulty seeing the mobile phone screen, talkback and voice control are enabled on Doccla mobile phones.

As part of a patient-centred approach, the customer service team can also manually enter the readings on behalf of patients who have difficulty using the mobile phone.

Key figures

Seven patients have provided their feedback so far. 71% reported being 'satisfied' or 'very satisfied' with the service (n=5) and 86% of patients (n=6) reported that the service helped them to manage their health after they were discharged.

Find out more

NHS England, 2022. Consultant-led Referral to Treatment Waiting Times Data 2022-23

Key contact

Judith Cannon, HCT, Hertfordshire Community NHS Trust

Judith.Cannon@nhs.net

Louise Taylor, Doccla Ltd

hello@doccla.com