In this blog, Jo Denny, Telehealth Triage Nurse for Tameside and Glossop NHS Foundation Trust, talks about the topical issue of delayed discharge from NHS hospitals and how telehealthcare could be used as part of the solution.
We have seen it in the news recently, NHS hospitals are struggling with delayed transfers of care – a report by the Department of Health earlier this year revealed that around 8,500 patients are remaining in hospital longer than they medically need to, which is costing the NHS around £900 million a year. It’s a staggering figure, which causes not only financial stress but also affects the efficiency of how the hospital is running, delaying waiting times for pre-planned operations, and increasing the risk of hospital acquired infections.
So what can we do to reduce this burden on our health system? Almost half of reported Delayed transfers of care are due to an absence of suitable care support packages to facilitate the patients to safely be discharged back home. A reduction in social care funding alongside an ageing population and declining numbers of hospital beds is creating a growing problem.
The situation is present in hospitals across the UK, such as Addenbrooke’s hospital in Cambridge – one of the UK’s largest hospitals. In 2015 The Guardian posted an article revealing that 87 of their 1,000 beds were occupied with frail, elderly people classed as delayed transfers of care. Almost a quarter of these patients had been ready for discharge for over 3 weeks – the hospital had to declare a major incident, rationing less urgent care to cope with the ongoing demand.
Patients want to return home, doctors want to let them go – but without a guarantee that there is a care package provided, they are duty-bound to keep individuals within the hospital setting.
So how could telehealthcare help?
For some health and care providers, the key to gaining control lies in the integration of telehealthcare technology into the care pathway. Take Tameside Hospital NHS Foundation Trust – we serve a population of 250,000, with a high prevalence of people with long-term conditions. In 2009-2010 we saw 1,024 emergency hospital admissions due to heart failure and Chronic Obstructive Pulmonary Disease (COPD). This alone cost us around £2.7million – predicted to rise to £3.5million annually over the next 10 years.
We needed to do something, so Tameside and Glossop NHS Foundation Trust invested in telehealth to enable care pathways to be redesigned to support more people with long-term conditions in the community, giving them the tools to self-manage their condition.
Showing positive results
Following evaluation of the telehealth integration, it showed to facilitate early discharge and prevent hospital admissions. In 2014, based on 221 telehealth patients over 12 months, hospital admissions reduced from 122 to 75 admissions post telehealth intervention. Of those 75 admissions, 38 weren’t admitted in the first 2 years of installation and all of whom were discharged earlier than the average bed stay for their condition. Only one patient was admitted to hospital in the first year of their telehealth service.
We also saw a reduction in the frequency of some home visits by the Long-Term conditions Management Team (LTCMT), and a reduced number of inappropriate visits which improved effective caseload management. We saw that due to the ability to identify early intervention because of monitoring vital signs and symptoms, we avoided the need for more complex care.
Tom’s story: the impact of telehealth
As well as the financial savings and efficiencies, telehealth has a fantastically positive impact on patients and their families. Take one of our patients Tom. He’s had COPD for five years and has been using telehealth for over a year. He says
“The service is fantastic, I don’t know what we’d do without it. It’s so much better than a hospital. You have specialist treatment in the comfort of your own home. The nurses all know what they’re talking about and they all know me and understand my condition. It’s such a relief for me and for the family, they don’t worry as much about me. It’s so good to know the nurses are there; I take my pressure and things twice a week and within half an hour if there’s anything wrong someone’s in touch with me.
“The service is a fantastic support in all sorts of ways. I was quite depressed for a time, but being able to talk to the nurses really helped; they go above and beyond. I don’t know who invented telehealth but they deserve a medal.”
An opportunity for change
As demonstrated, the implementation of telehealthcare can really go some way towards reducing the strain on our NHS. Bringing care ‘closer to home’ can reduce hospital bed days, free-up in demand resources and ensure that A&E departments and hospital wards are better placed to care for those in need of medical attention.