By Joshua Rowe
Keeping patients out of hospital benefits everyone. Patients are less stressed and anxious because they can remain in a familiar environment with the assurance that their condition is being managed. The NHS benefits because beds, equipment and resources are freed up. Patients with chronic cardiac conditions traditionally make frequent visits to hospital, so cutting the frequency has a big impact. The author describes how hospital visits are being cut by the use of telemedicine which provides ECG and weight scale readings from home.
One of the biggest pressures on NHS resources and budgets is ‘frequent visitors’ to hospital. Whether for acute cardiac episodes, or chronic cardiac conditions such as congestive heart failure (CHF), the cost of diagnosing, treating and caring for patients with these problems represents an enormous financial burden on the NHS every year.
Managing these patients within hospitals costs the NHS £598 million annually (1). However, the issue isn’t just cost. It’s the fact that in the majority of such cases, the ability to manage these patients’ conditions outside of secondary care is being overlooked.
The idea of diagnosing and treating cardiac symptoms within a primary care or home setting makes sense. Early detection facilitates early action; this allows patients to receive more timely and preventative treatment – reducing the need for hospitalisation.
Keeping patients out of hospital benefits both parties. The patient is less stressed and anxious because they can remain in a familiar environment with the assurance that their condition is being managed, with assistance just a phone call away.
From the hospital’s viewpoint, beds, equipment and resources are freed up, notwithstanding the lower cost of deploying and managing the home monitoring solution.
Let’s take a close look at how a PCT has pioneered the use of telemedicine to help better manage both CHF and acute cardiac symptoms.
Trust put in telemedicine
Southampton City Primary Care Trust (PCT) has over 250,000 registered patients and has been developing community-based cardiac specialist services for some time. It was keen to explore models of care, which were clinically effective and guaranteed quick, reliable results to help reduce the financial and operational burden of cardiac care on its hospitals and acute care providers.
Using an EU grant for the development of telemedicine projects, Southampton PCT opted for a cardiac telemedicine service provided by Manchester-based telemedicine specialist Broomwell Healthwatch.
Broomwell’s 12 lead remote ECG device allows hospital quality ECG readings to be taken (within the GP surgery) for all patients requiring an ECG as part of their clinical assessment. 12-lead ECGs are transmitted as a sound signal by telephone in just seconds to Broomwell’s monitoring centre, where it is displayed on screen for interpretation by trained cardiac clinicians.
Based on a high quality ECG trace staff at the centre provide an immediate verbal interpretation by telephone and also a formal written analysis returned by e-mail or fax for inclusion in the patient’s clinical notes.
The service delivers immediate diagnosis from qualified clinicians at a primary care level, saving time for hospital staff and improving patient care. In effect, the service brings ECG expertise (via the telephone) into every surgery.
The service is growing rapidly and is now in use across Greater Manchester, the North West and a number of other areas.
Home care cardiology
Chronic cardiac conditions such as congestive heart failure (CHF) also represent a substantial drain on NHS resources, with hospital inpatient care for CHF accounting for 60% of the total cost of CHF in the UK (2).
Conventional methods of dealing with CHF patients involve monitoring patients in hospital, (mainly for changes in weight), or sending district nurses to patients’ homes on a frequent basis.
However the ideal would be to deploy a method, which not only monitors and manages the symptoms of CHF but also significantly reduces its cost to the NHS. Adopting a solution which has the ability to move treatment away from hospital care to home care seems the best way to achieve this.
Preceding the ECG service rollout Southampton City PCT introduced Broomwell’s telemedical weight scales to help monitor and diagnose CHF from the patient’s home.
The weight scales detect an early symptom associated with CHF – weight gain through fluid build-up. Typically CHF patients keep a weight diary and visit their GP on a regular basis for an evaluation, but this method relies heavily on the patient remembering to keep an up-to-date and coherent record of information.
The weight scales solution relieves patients of this responsibility whilst giving monitoring clinicians a more reliable and accurate result.
Weight scale readings are taken and interpreted in much the same way as the ECG. Patients use the scales at home (as they would use any normal weight scales) and these transmit the data electronically and automatically, to Broomwell’s monitoring centre, to be evaluated by cardiac clinicians, who then identify any potentially dangerous trends.
If any abnormalities are identified the results are transmitted to district nurses and / or the patient’s physician for early intervention, or in more critical cases the patient is sent for emergency treatment.
Weighing up the benefits
Both services have proven to deliver clear benefits across Southampton City PCT and have helped prevent hospital admissions.
Giving clinicians access to fast expert advice on sometimes complex cardiac issues is an invaluable aid. Cardiac telemedicine reassures the majority of patients that their signs and symptoms are not indicative of an immediate, threatening condition – reducing stress – whilst those in immediate danger are transferred to definitive care.
The telemedicine approach has been used successfully across a number of primary care bodies in the UK. In a major NHS pilot (3) of Broomwell’s technology across Lancashire and South Cumbria, use of the telemedical ECG service avoided referral to A&E and Admissions, demonstrating the potential to save 90,000 A&E visits and 45,000 hospital admissions.
Another major pilot by the Greater Manchester and Cheshire Cardiac Network (4) indicates that, due to the use of the Broomwell service, 64% of patients avoided referrals to Outpatients. The two pilots translate to a cost saving of some £100,000,000 per annum. The service is now deployed across virtually all PCTs in Greater Manchester and in numerous PCTs across the country.
Our own research shows that home monitoring of CHF patients can save the NHS 29% of the £211M spent annually on CHF (over £60M) and save thousands of lives.
With both acute and chronic cardiac “frequent flyer” patients impacting significantly on NHS resources, it makes sense to manage those constantly in and out of hospital with chest-pain symptoms, using telemedicine within primary care or at home as much as possible. As well as delivering financial benefits telemedicine will have a considerable impact on diagnostic efficiency – contributing to achieving a higher level of patient care.
As Southampton PCT’s real-life example has shown cardiac telemedicine is valuable for patients, clinicians and the NHS. By using both devices the PCT has been able to provide a comprehensive model of cardiac care to their patients, which not only helps to manage both chronic and acute cardiac conditions but also helps to optimise NHS resources.
Joshua Rowe is CEO at Broomwell Healthwatch
(1) NHS Institute, ‘Table of Emergency admissions of ambulatory care sensitive conditions’, 2003/04
(2) British Heart Foundation Statistics Database, 2006 http://www.heartstats.org/datapage.asp?id=817
(3) The full report is available from the website of the NHS Lancashire and South Cumbria Cardiac Network, visit http://www.lsccardiacnetwork.nhs.uk
(4) The full report is available from the website of the Greater Manchester and Cheshire Cardiac Network, visit http://www.gmccardiacnetwork.nhs.uk/