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Brighton and Sussex University Hospitals NHS Trust has converted a skunk works-style project created by clinicians into a repeatable IT process for deploying virtual fracture clinics.
The work began four years ago, says Lucy Cassidy, advanced practitioner physiotherapist at the trust.
People who have had a fracture or soft tissue injury often need frequent hospital check-ups and rehabilitation sessions, and the hospital wanted to reduce the number of visits patients needed for physiotherapy treatments.
Rather than book an appointment and attend a clinic, the idea was to use the power of the web to provide patients with training videos to help them recover from their injury.
Cassidy says: “Four years ago, without any budget, we created a virtual clinic model using existing systems with an online web form. We collected data in Excel and directed patients to YouTube and used Survey Monkey for feedback.”
The pioneering work resulted in Brighton and Sussex University Hospitals winning an NHS innovation award in 2015.
But to make the process repeatable so best practices could be used by other NHS trusts, Cassidy said the trust needed to put together a system that could be shared.
The NHS innovation award gave the trust six months’ mentorship from NHS England. This paved the way for it to deploy Microsoft Dynamics 365 to power its virtual clinic, and provide the basis for a template that could potentially be replicated elsewhere in the health service.
“We looked at off-the-shelf orthopaedic software, but what we really wanted was a solution to manage the whole service,” says Cassidy.
Dynamics 365 deployed
The Microsoft Dynamics 365 software was deployed in January this year and now manages the virtual clinic service.
The process begins when the trust receives patient referrals. “An online referral form is completed for the patient, and that is then logged into our dashboard,” says Cassidy. The trust then sends out a welcome email to the patient and login details for the virtual clinic online portal.
The website acts as a patient portal, initially providing patients with some general information and rehabilitation videos. These are still hosted on YouTube, but are now embedded into the patient portal.
“We have 27 rehab videos, mimicking what you have in a face-to-face consultation,” says Cassidy. “It saves patients from having to attend face-to-face consultations. We can review cases remotely and provide patients with self-directed management.”
Patients are sent a number of outcome scores based on their experiences, she says. “If you have injured your elbow, we will ask if you can brush your teeth or open a jar.”
Progress closely monitored
Feedback is tracked so the patient’s rehabilitation progress can be monitored remotely, enabling the clinician to check the patient’s progress after six weeks and then six months.
The system effectively puts the patient back at the centre of care, says Cassidy.
Brighton and Sussex University Hospitals used to need to see all fracture patients, she says, “but now we discharge 57% and it is much more convenient for the patient”.
If a patient needs to return to hospital, the software ensures they go at the right time to see a specialist in the relevant area, improving quality of treatment.
For instance, someone with a foot injury may require a follow-up consultation after six weeks and an X-ray. This can now all be arranged through the new system.
The system currently runs standalone, but Cassidy hopes it will be integrated with the trust’s central IT within the next 12 months.
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The trust ran a conference in January this year, attended by 100 delegates representing 40 hospitals, to talk about its virtual fracture clinic system.
This has resulted in a number of trusts adopting the approach used by Brighton and Sussex University Hospitals. “I developed an adoption pack on our website,” says Cassidy. “Business case and financial models are all available there. We are now supporting 10 trusts directly.”
Some hospitals have been able to take the virtual fracture clinic system on board quickly, but Cassidy thinks it may take others much longer.
The NHS has been looking at ways to reduce hospital visits, which are costly for the health service and inconvenient for patients. The internet of things (IoT) industry is pioneering remote monitoring and fitness devices that could help doctors provide a level of remote patient consultation.
What Brighton and Sussex University Hospitals has shown is that in a digitally enabled world, effective remote monitoring may not necessarily require expensive, high-tech investments.