County Durham and Darlington NHS Foundation Trust use digital health to improve nutritional care
Why did CDDFT see the need to make changes to nutritional care in the region?
With over 12,000 people at risk of undernutrition in the region, County Durham and Darlington Foundation Trust (CDDFT) wanted to look at ways of improving the nutritional wellbeing of patients, increasing the efficiency of the dietitians workload and reducing costs. Working with Inhealthcare, the Trust’s dietetic department is now able to remotely monitor a patient’s weight fluctuations, appetite and intake of oral nutritional supplements (ONS). The team receives daily reports highlighting patients that are at high risk of undernutrition, and lists patients that may no longer need supplements. This service is available for both patients in the community and residents of care homes.
Led by Ian Briggs, Business Development Manager at CDDFT, the service has been used by the dietetic clinics and in 80 care homes for over 2 years. The service has monitored over 700 patients with a further 1,000 planned for next year. “In 2012, we realised we couldn’t achieve the efficiency improvements required through cost cutting alone so with funding from the SHA we launched a digital health programme to improve the efficiency of care delivery,” comments Ian.
Catherine McShane, Lead Dietician for the project has been at the forefront of the initiative. “For patients in their own home, they weigh themselves using a set of bathroom scales. They don’t have to make the inconvenient trip to the clinic and our dietitians no longer have to make frequent visits because if a patient’s weight fluctuates, we’re alerted. They receive an automated telephone call once a week which asks questions around their weight, appetite and how they’re getting on with taking their nutritional supplements. The patient provides the information using the telephone keypad. It’s easy,” comments Catherine. County Durham and Darlington use automated telephone calls because all patients and carers are able to use it, regardless of access to the internet or technical ability. In care homes, the care home manager uses a secure online portal to input resident’s weight, appetite and compliance taking ONS on a weekly basis. Readings are analysed for risk of undernutrition using ‘MUST’ (‘Malnutrition Universal Screening Tool’). The data submitted is also available to the patient’s GP through the integration with SystmOne and EMIS, the two most common GP patient systems.
Over a 10 month period, 58 outpatient visits, 126 home and care home visits and approximately £2,500 in dietetic time were saved. “We’ve also found more time can be spent with patients that need it the most,” comments Ian. “Patients no longer have to attend the clinic as often and our dieticians don’t have to make as many routine visits, creating much more capacity within their workflow"
The service has improved the coordination between the dieticians, the care homes and primary care through better sharing of information. “We’ve all got access to the patient data, meaning we’re much more aligned.” comments Catherine.
The service improves visibility of patients and residents, acting as an early warning system. “The new service highlights changes in health, meaning we can identify if a patient is losing weight early on. Better visibility also makes consultations much more effective,” comments Catherine.
£20,000 of pharmaceutical savings were made by identifying patients prescribed supplements, but who no longer needed to take them because of improved health. Further cost savings of £10,000 were made by highlighting patients prescribed supplements but were not taking them.
We’ve been amazed by the patient feedback so far. Patients have reported that they feel more supported and cared for and they know there’s a dietitian available at the end of the phone if there’s a problem. It really helps patients monitor their own situation and they’re being empowered by that.