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Digital hub cuts care home referrals to GPs by more than a third

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6287 (Published 22 November 2016) Cite this as: BMJ 2016;355:i6287
  1. Nigel Hawkes
  1. London

A telemedicine service run by a Yorkshire NHS trust has reduced care home referrals to GPs by 40% and ambulance calls by almost 30%.

Staff in more than 200 care homes across England are linked to a digital hub at Airedale NHS Foundation Trust in Keighley and can seek advice 24 hours a day about the health of any of their residents. The service is run by a team of senior nurses who have online access to GP patient records and can consult doctors at the trust if they need to.

The aim is to improve care and to make best use of GP and emergency facilities by reducing needless referrals. “We started off with the local population, and then on the back of evidence that it worked, we went national,” said Justin Tuggey, consultant in respiratory and general medicine and clinical director of digital care and telemedicine at Airedale. “We now look after care homes from northern England to the Isle of Wight.”

The hospital has run a telemedicine service for prison inmates for 10 years, gaining experience on which to build its care home initiative, recently described by the Care Quality Commission as outstanding and selected by NHS England as a vanguard site for new care models.

The service now covers 217 care homes and around 7500 residents. Between April and August this year it dealt with 3754 calls. Had it not been there, two thirds of the homes said that they would have called the patient’s GP, in or out of hours, and 8% would have called an ambulance. The advice provided eliminated 40% of the calls to GPs and 29% of the calls to the ambulance service.

Tuggey told The BMJ that telemedicine adds incremental value to existing efforts to reduce referrals in conventional ways. A formal audit of local care homes showed referrals falling generally, but falling faster in those covered by the service, generating an 8% reduction in costs of emergency admissions over a 20 month period and a 14% faster decline in emergency department attendances.1

A typical case might be an old lady who falls out of bed. “A member of staff would normally have to accompany her to the emergency department and wait four hours while she was seen,” Tuggey said. “Now she can be assessed by a senior nurse with access to her record, and guidance can be given to staff on what to do. She can be called back an hour later to see how she is getting on.

“Lots of care home residents with diarrhoea and vomiting are admitted to hospital, which is the worst place for them to be. Now a nurse can talk to them, make sure they have a glass of water at their bedside, and say ‘I want you to drink half of that by the time I ring you back.’ The eye to eye contact is vital.”

The service has found uses that weren’t originally intended. Christine Dennis, who cared for her husband Stuart until he was admitted to a hospice, was distraught when she herself was admitted to Airedale Hospital with pneumonia and could no longer visit him. With the aid of an iPad and the telemedicine system, an online meeting was arranged.

“I didn’t know what to expect but he was so clear on the screen and looked so well,” she said. “We had a chat and it was really lovely. That connection I had with Stuart was the most important one that I ever had. It was as near as it could have been to being with him in person, which was wonderful for us both.”

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