We talk to Amanda Ardron, Head of Primary Care, Natalie Marsden, Cardiac Service Co-Ordinator (FCMS) and Rachel Haworth, Project Lead from Blackpool Teaching Hospitals about the ground-breaking cardiac technology service which is bringing benefits for patients across Blackpool, in one of the country’s first digitally enabled cardiac elective surgery backlog monitoring service for patients on the cardiac surgical waiting list. 

Can you tell us a bit about the cardiac elective surgery backlog monitoring service?

Yes of course! Blackpool Teaching hospitals NHS Foundation Trust, FCMS and Lancashire and South Cumbria Integrated Care Board are working on this initiative to provide one of the country’s first elective surgery backlog monitoring service for patients on cardiac surgical waiting lists. This means that patients who are waiting for cardiac surgery at Blackpool Teaching Hospitals are now able to have remote monitoring at home, giving them access to a team of clinicians while allowing them to get on with their lives.

Why was the service set up?

The service was set up to improve patient safety and experience, and to proactively identify deterioration while patients are waiting for their operations. We wanted to provide patients with reassurance that a clinician is continually monitoring them and give real reassurance while identifying any problems. Patients who agree to the remote monitoring service receive patient monitoring equipment, which includes a phone or tablet pre-loaded with software which allows them to send their latest health data digitally and remotely to a clinical team.

Rachel Haworth, Project Lead based at Blackpool Teaching Hospitals said

This service aims to reduce the demand on primary and secondary care, including preventing emergency admission and 999 calls.

How does the service work?

The solution ensures that patients on a waiting list for cardiac surgery can be monitored at home using medical devices to detect any health deteriorations or anomalies. Patients are referred to the FCMS team via their consultant, who will then get in contact with the patients to onboard them and deliver remote monitoring devices. They will then monitor patients’ health while they are waiting for their operations. Any deterioration observed by FCMS’s nursing team leads to a swift intervention and is proving very popular with patients, giving them reassurance and supporting patient safety.

Patients who are on a consultant’s waiting list for cardiac surgery are referred to the FCMS team who contact the patient to explain the service. If the patient decides to receive the service, patient monitoring equipment is delivered, including: a blood pressure monitor, pulse oximeter (blood oxygen), scales, a pedometer and a tablet or phone with Docobo’s remote monitoring software pre-loaded. The software makes the patient device extremely easy-to-use, to optimise inclusion – the screens are all that the patient sees, there is no fiddling with icons, which matters when you’ve never used such devices before. Patients are invited to enter and submit their data twice a week and answer a set of additional questions on their symptoms or whenever they may feel unwell. No Wi-Fi or data connection is required as the solution runs off its own servers.

The data is automatically sent to Docobo’s remote monitoring system and displayed at the FCMS hub, where there is a team of nurses monitoring the patients. If any of the readings are out of the parameters set by the clinician, the system alerts the nurses. The clinicians at FCMS will then call the patient to see how they’re feeling and talk through their symptoms in more detail. That first call from a nurse may be all that is required, or it may lead to the patient receiving help directly from the cardiac specialist team at the hospital.

It sounds really effective – can you tell us about the successes on the project?

The project has been extremely successful so far, with three quarters of referred patients who were eligible for the service having been successfully onboarded. The feedback from patients using the service is very positive and it seems to be making a real difference to our patients.

In Blackpool our nurses have already identified a number of patients who have shown clinical signs of deterioration whilst awaiting a date for their surgery. As a result, they have been escalated to the Trust, with a significant number of these patients then reassessed by their consultant cardiac surgeon and booked in sooner for their cardiac surgery.

As well as this, we have taken a holistic approach, working with GP practices and community services to ensure patients are receiving other forms of appropriate care where necessary. Since the service was launched, we have had lots of positive feedback from patients, especially those who have been moved up the waiting list as a result of our interventions.

There are multiple further benefits of the service:

• Gives patients a direct link to a team of clinicians, while at the same time allowing them to get on with their lives.
• Care can be delivered in the most appropriate place for patients.
• People get to grips with the service really quickly and get comfortable with it
• Remote monitoring at home enables pre-habilitation and optimisation for surgery as well as monitoring.
• FCMS have managed 95% of the total alerts, with only 5% being escalated to the specialist team at the hospital.
• There has been a reduction of patient phone calls since the launch of the service, easing pressure on the hospital.
• Patients can also report if they are unwell and clinical staff are trained to spot any deterioration which will lead to a swift and appropriate intervention.
• The app provides patients with advice as to what to expect in their surgery and how best to prepare for it.
• As part of the service, patients receive a helpline number which means they can call FCMS to speak to a clinician for any non-emergency clinical concerns or an administrator for support with any of their devices if needed.

David Rose, Consultant Cardiothoracic Surgeon said:

For people with complex cardiac conditions, remote monitoring, supplementary to clinical care, can potentially improve health outcomes. Lancashire Cardiac Centre is one of the pioneer units in remote monitoring for patients on the waiting list for cardiac surgery. We have enrolled over 250 patients so far, with great patient satisfaction. Thanks to this technology we are able to have a direct link with the patients and be able to early detect any deterioration in their health condition. Patients showing deterioration will be identified, prioritised, and offered support as appropriate. As the waiting list for life saving cardiac surgery has become increasingly longer, we have to identify those patients who are deteriorating and offer earlier intervention when needed.

It sounds like a real collaborative effort – who’s been working on it?

Blackpool Teaching hospitals NHS Foundation Trust, FCMS and Lancashire and South Cumbria Integrated Care Board are working with the remote monitoring technology provider Docobo on the initiative. The project has been really collaborative.

Natalie says:

We see this as a ‘safety net’ service while patients are waiting for their surgery, and so that patients have that point of contact. Because of the pandemic, a lot of people on cardiac waiting lists may have been deteriorating for some time and have not necessarily gone to the GP. We recently flagged up a patient who had really bad chest pain and shooting pains, we advised him to call 999 and escalated to a consultant. He only went to hospital because we were in touch with him. This was really helpful for the family as they felt reassured that this was followed up and we are there as a service.

What’s the patient feedback?

The project has already onboarded more than 250 patients and is receiving great feedback, which demonstrates the value of monitoring and communicating with patients during their time on a waiting list.

One patient reported:

What a great idea. Felt empowered and reassured taking my own readings and being informed that everything was as it should be.

Another patient reported:

I had been trying to stabilise my blood pressure with the GP, so this allowed me to keep an eye on my own blood pressure from the comfort of my own home, knowing someone was monitoring any changes.

What are your future plans for the service?

Going forward, patients will be given the option to opt into the service at their initial consultation with the BTH cardiac team, where the consultant will explain the benefits of the service to them. If they choose to take part, they are onboarded by the FCMS team on the same day.

We are really pleased that we are achieving the objective of the service, which is to improve patient safety and experience. We can now proactively identify deterioration which can ultimately change a patient’s priority on the waiting list, as well as provide patients with reassurance that a clinician continues to monitor them whilst they are wating for their operation.