St Helens and Knowsley Teaching Hospitals NHS Trust (STHK) provides a full range of acute and intermediate healthcare services across three sites at St Helens, Whiston and Newton hospitals, including inpatient, outpatient, intermediate care, maternity and emergency services.
The Trust’s Mersey Regional Burns and Plastic Surgery Unit provides treatment for over four million people across the North West, North Wales and the Isle of Man.
Since its initial success in piloting Refero’s telehealth platform, with partner Cisco’s voice and video communication technology, STHK has extended these services across a multitude of departments. Always been seen as a forward thinking NHS Trust, it is now in a strong position to consult with its patients remotely whenever possible, keeping the footfall into its hospital buildings at a safer minimum.
Eliminating needless travel for
vulnerable stroke and drains patients
Patients attending STHK’s clinics often need to travel many miles for consultations, so the Trust decided to pilot Refero’s telehealth and video consultation services initially with its Cancer Drains Outreach and Stroke Review Services, so that clinicians could assess patients recovering at home remotely via video.
The six-month Stroke Review Service aimed to see more patients in their home or care home, reducing the significant number of travel miles for patients requiring specialist treatment and enable consultations to be delivered remotely via telemedicine. By reducing the travel time by the clinician, it would also give back more time for clinical care. Where a patient’s mobility had been reduced, virtual consultations would avoid the need for a patient having to travel to the Trust for an appointment.
For the Drains Outreach Service, reducing the strain on the Service’s already stretched resources was paramount. The aim was to radically reduce travelling time of specialist nurses, freeing up time that could be utilised in preparing patients for discharge and dramatically improving efficiency. When possible, the Trust initiated virtual consultations for patients needing their wounds and drains reviewing once at home after major cancer reconstruction. Post-surgery, with drains inserted, patients would then be able to return to their homes within days of surgery.
Through Refero’s telehealth platform, patients are digitally connected with the Trust’s clinicians to enable continual engagement via video consultation or messaging through a web portal, smartphone or tablet.
An end to clinician’s six-hour,
single patient journeys
The Trust has seen did not attend (DNA) rates drop from around 25% to just 10% in its Stroke Review Service alone since the introduction of the virtual service.
As well as the predicted cost and logistical benefits, the Trust has additional, less expected insights into patient care. Sometimes the psychological effect of coming into hospital pushes blood pressure artificially high and the Trust’s medical team is far more likely to get a real representation of a patient’s physiology when they are in their own home.
After a stroke, patient will have had their driver’s license taken away, so they become reliant on public transport or family and friends to bring them into hospital for speech therapy or review appointments. Often patients will need to make a five hour return journey from home to the hospital. Connecting a patient via a video consultation is an invaluable way of reducing their travel time, putting less strain on their recovery and helps their clinicians to assess how they are coping in their home environment rather than after a strenuous and tiring journey into the hospital.
As opposed to a telephone call, a virtual consultation also enables clinicians to easily demonstrate new exercises to their patients and see patients in their home environments, invaluable to the overall assessment of a stroke patient’s condition.
Also, the positive psychological benefits of a patient seeing their home environment via video when a physiotherapist visits their home to check it is ready for their return, really encourages them in their path to recovery.
For specialist cancer nurses of the Trust’s Drains Service, travelling time has been greatly reduced. Previously, staff could travel up to six hours a day to review one patient’s drains and wounds.
Dietitians looking after patients with oesophagus and stomach cancer are able to have meaningful discussions with their patients at home and via video are able to look through their kitchen cupboards with them.
The Trust has recorded that 100% of its patients who’ve had virtual appointments have said this method is their preferred choice. Video consultations have helped to determine that 70-80 percent of the time, a hospital visit isn’t required.
Preparing for the Future
STHK wants to empower its patients to take control of their own care and most importantly protect its more vulnerable patients from visiting the hospital for face to face consultations unless absolutely necessary. Telehealth allows the Trust to offer a more innovative and flexible approach ‘post COVID-19’, whereby footfall in its buildings can be minimised and its patients are be both protected and given the best level of care.
The Trust is working closely with Refero and Cisco in its telehealth programme to benefit patients attending its Medicine for Older People Frailty Service; Speech and Language Therapy Service; Burns & Plastics, Breast Reconstruction Service and Gastroenterology and Liver Surveillance Service. It also plans to extend the programme beyond into the community with provision for mental health services in the future.
|We are reaching the point where telehealth is becoming the norm rather than the novel. The huge successes of our pilots in the Stroke Review and Cancer Drains Outreach services have been witnessed by our staff in other departments, who now want to benefit from a telehealth approach.
Most importantly, it’s been the patients’ choice, whereby 100 percent of patients who’ve used video consultations so far, don’t want to revert to coming into the hospital for an outpatients’ appointment.
Telehealth helps us to work smarter. We might get around 100 calls a day from patients worried about their wounds, but video consultations have helped to determine that 70-80 percent of the time, a hospital visit isn’t required.
|Rowan Pritchard Jones