Remote monitoring service to be expanded in Norfolk following success

Norfolk Community Health and Care NHS Trust (NCH&C) is expanding a successful remote monitoring service to help increase life expectancy and improve quality of life for patients diagnosed with heart failure. Lead heart failure nurse at the trust, Rhona Macpherson, spoke exclusively to Digital Health News about the impact of the services on patients and nurses and what the future holds.
At Norfolk Community Health and Care, it is using a remote monitoring service from Inhealthcare which allows patients to monitor their vital signs at home and relay readings via a choice of communication channels to clinicians who monitor trends and intervene if readings provide any cause for concern.
Analysis of the six months before and after introduction showed a significant reduction in hospital bed days, A&E attendances, GP visits and out-of-hours appointments.
For Macpherson, the service has helped promote self-management.
“We give each of the patients a set of scales, blood pressure monitor and pulse oximeter and we get them to do their observations,” she said.
āSo weāre promoting self-management and looking at things but also it means that we can get accurate information on whatās happening with their observations.
āWe then set parameters to alert if they go outside of the parameters, and it just means we can intervene much more quickly than we would do, and we can see whatās going on between our visits as well as whatās happening when weāre actually there.ā
The trust launched the service in Norwich and, after resounding success, plans to expand it to South, West and North Norfolk with funding from the Norfolk and Waveney Integrated Care System (ICS).
An evaluation of the expanded service will be evaluated, looking at quality of life, health improvement scores and hospital admissions among heart failure patients.
A transformation for nurses and patients
The service has transformed working practices for nurses, increasing efficiency and saving valuable time.
Macpherson said: āWeāre using the technology to try and make ourselves a little bit more efficient, so itās saving on the travel time and face to face visits.
āWe can do a lot more with telephone. Weāve got the option of using video, but telephone is actually quite useful. So itās less face to face visits, less travel and also, weāre trying to empower the patients to do their own observations and monitor themselves, rather than us just doing it for them.ā
The outcomes for the patients on the audits that NCH&C has done with it, as Macpherson explains, āshow a reduction in face to face visits with us, face to face visits with a GP, A&E attendances and hospital admissionsā.
āSo itās really keeping the patients more stable, keeping them out of hospital and giving them that independence to sort of monitor their own conditionā, she added.
Encouraging feedback
Feedback from heart failure patients has been generally positive, although Macpherson made clear that not all patients are initially excited by the idea of a remote monitoring service.
āSometimes weāll offer it to patients and theyāre not confident with it. With some patients, you potentially could be making them more anxious by a lot of monitoring that they sort of overdo itā, she said.
āBut for the patients who have used it, the feedback weāve had is that they feel very safe and very secure with it. It gives them confidence in monitoring themselves and they know that weāre there in the background keeping an eye on whatās going on.
āItās important they know that itās not for an emergency, itās for monitoring longer term, and that in between appointments, if they are unwell, then they need to go through appropriate services.
āWeāre a Monday to Friday service so no oneās looking at the results over the weekend. Weāre giving guidance that weāre there and weāre looking for the alerts, but weāre not watching it 24/7 for whatās going on,ā Macpherson explained.
The service is hugely popular among nurses, whose feedback has been overwhelmingly positive once they have familiarised themselves with the technology.
Macpherson said: āIāve always been quite an advocate for it, I find it very useful. I think thereās an initial sort of āhow does that workā, and then a bit of an initial āoh but I want to go and see themā, so itās building that trust with the technology and how to use it with the patients using it.
āWeāre about to expand it into South Norfolk and West Norfolk and the nurses there are really looking forward to it, particularly in South Norfolk because itās such a big area, such a lot of driving to get from patient to patient if theyāre not coming into clinic.
āI think itās going to really save a lot of time and at the same time empower the patients.ā
The future of heart failure care
Macpherson stressed that the picture that heart failure care paints is a big contrast to a couple of decades ago, with positive strides made and more to come.
āThe future of care for heart failure is so different now to where we were 20 years ago, itās very much a long term condition now, whereas 20 years ago the prognosis was very poor, they had a very limited lifespan,ā she said.
āBut weāre now really looking at it as a long term condition in the same way as we do with diabetes and COPD [chronic obstructive pulmonary disease]Ā and the numbers are on the increase, so I think this service is a very good way of getting patients into self-management and recognising symptoms.ā
The future of heart failure care looks bright, particularly following the news last month that NHS England has launched a new initiative called āManaging Heart Failure @ Homeā to support heart failure patients with the tools and expertise they need to remotely monitor their condition at home.