Well Connected Care Homes (Sunderland)

A digital tablet intervention to record and communicate data on the health of residents was used in care homes in Sunderland. A small-scale evaluation compared data between 8 of the care homes routinely using the intervention with 8 similar care homes who weren’t between April 2017 and March 2018. It was found in the 8 care homes using the intervention a saving in A&E attendances and ambulance services in this period was estimated at £756,144.

The Academic Health Science Network North East and North Cumbria (AHSN NENC) Well Connected Care Homes Programme commissioned a small-scale evaluation of a new digital health intervention that aims to enhance the appropriateness of healthcare received by care home residents and the skills of care home staff.
The goals were to:

  • support care homes in becoming internally and externally ‘well connected’ in the digital age;
  • enhance the quality of care experienced by care home residents, and by
  • significantly improving communication between care homes and the external health environment.

This will provide better and more efficient cost-effective care. It has two elements:

  • to improve record keeping of care home residents by using tablet-based Apps to allow electronic recording of aspects of care plans
  • to train qualified and unqualified care home staff to make and record relevant clinical records (NEWS scores)
  • to promote use of electronic communication of patient clinical information between care homes and primary care (GP electronic patient records); emergency care (including out of hours) and ambulance services and community services.

This phase of the project is a partnership between AHSN NENC and NHS Sunderland CCG which aims to evaluate the outcomes of its care homes technology project.

 

Learning Points:

The qualitative evaluation identified some ongoing issues:

  • Staff turnover within the care home setting presented a challenge in ensuring that a high number of staff were confident in using the technology.
  • Community specialist nurses considered some care home staff were struggling to master the quite complex intervention.
  • There were some negative views expressed by external (clinical) staff about the capabilities of the (unqualified) care home staff to reliably perform and record the necessary clinical tasks needed. This may have led to a reduction of motivation in some care home staff.
  • Training provided may not have been sensitive enough to the ’real world’ challenges of using the equipment in a care home setting. Attempts to introduce the intervention as widely as possible across care homes in Sunderland probably meant that training in individual care homes was not as robust as it should have been in some cases, and that ongoing support was lacking.
  • The way in which the intervention, particularly the NEWS score designed for a hospital setting, has been implemented may not have fully considered the care home setting.

Contact Details

Project Dates

Project Start 01/05/2017
Project End 01/11/2018

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It is a useful resource, you can look at a resident and think “they’re not quite right, but I don’t know why”. It seems silly phoning a doctor to say … “they’re just not themselves”. But if you’ve done their NEWS and their NEWS is indicating, you can obviously relay that information to the GP and say, “their score is normally this, but it’s gone up to this so there is obviously something going on somewhere”.
Care Home Manager
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There are around 400,000 older adults living in care homes in England, and they are some of the most complex NHS patients. As populations age, older adults are living longer with complex health and social needs. As a result, the needs of care home residents and the challenges faced by care homes, their staff, and NHS and social services that support them, are increasing. Care homes are often perceived to be a burden on primary and acute health care, with the use of services being described as often inappropriate or avoidable. Care home residents experience higher rates of emergency hospital admissions and accident and emergency attendances, compared to the general population aged 75+. Some of this service use is appropriate and driven by the needs of the care home population. However, the quality and nature of primary care for care homes may also influence these hospital admissions, with many services reacting to problems as they arise, rather than adopting a proactive, preventive approach that could avoid escalation. The skills and expertise of care home staff are also influential. Carers who are alert to changes in residents’ health status are well placed to call for help at an early stage, and potentially avoid a hospital transfer. Improving training and increasing the skills of care home staff so that they can effectively care for their residents has been described as an ‘ethical and policy imperative’.

Digital technology was introduced into care homes to support staff in the recording and communication of digital data on the health of residents. The intervention included three measurement tools:

• National Early Warning Score (NEWS);
• Malnutrition Universal Screening Tool (MUST), and
• Abbey Pain Scale.

Technology used included:

• a digital tablet;
• blue tooth blood pressure cuff;
• pulse oximeter,
• thermometer.

Non-qualified staff were trained to use the equipment in providing baseline NEWS scores, repeated when there is a clinical concern for a resident. Data is then shared with attending health care professionals from the NHS to improve triage and decision making.

To date there are 14 care homes in the Sunderland area using the digital tablet following receipt of training and support from the local system. The project is supported by a steering group representing partner organisations which includes North East Commissioning Support, North East Ambulance Service, Newcastle Universities, Tyne and Wear Care Alliance, Sunderland NHS Foundation Trust and the Patient Safety Collaborative.
The steering group developed the correct information governance infrastructure to progress the work. Ongoing support was provided to the delivery team and the focus was on three elements of evaluation:
• an economic evaluation of the impact of the innovation;
• a qualitative evaluation including a number of interviews, and
• a NOMAD survey.

18,000 NEWS scores have been secured which will be analysed in detail in the coming months.

The small-scale evaluation compared data between 8 care homes of a similar size regularly using the digital tablet intervention against data from 8 care homes who were not using the tablet between April 2017 to March 2018. Results demonstrated:
• where the tablet was in full use in 8 care homes there was 192 less non-elective admissions over the year. This resulted in a reduction of £601,920 costings (based on tariff);
• a scatter plot of the counts of A&E attendances showed lower attendances at every time point over the year in ‘in use’ care homes. The total difference was 336 less A&E attendances resulting in a cost saving of £71,232 (A&E attendances) + £82,992 (ambulance services).
This demonstrates an overall approximate cost saving of £756,144 in one year for 8 care homes.

 

A further analysis using a more robust study design using an interrupted time series regression analysis compared the performance of 8 care homes in the year prior to using the digital tablet intervention against a year post implementation of full use. This also included a 13-month intermediate roll out period. In comparing bed days for those admitted to hospital before and after the introduction of the digital tablet intervention it was suggested there was a 49.2% reduction. It was suggested from the 35 months prior to the introduction of the tablet system that if it had not been introduced, the use of emergency bed days would have cost £837,877 in the 25 months after March 2016. However, the actual cost saving was £658,451 which was a saving of £179.426.

Results from a NOMAD questionnaire circulated to 47 Sunderland care homes demonstrated respondents were generally positive about the intervention and the way it had been implemented and believed it could fit with their current work and could become part of the norm.
It is considered that if the results from this small-scale evaluation were extrapolated to more care homes the potential financial savings would be considerable for the health economy, whilst improving quality of care and job satisfaction of staff in the care homes. A further much larger evaluation is underway.
Using lessons learned, the use of tablets to record information on residents is now rolling out as ‘routine use’ in the whole Sunderland health economy.
Four other CCG areas in NENC are now adopting this approach.

Care and Quality

Funding and Efficiency

Health and Wellbeing

Driving Economic Growth

The AHSN NENC Connected Care Homes Programme commissioned the evaluation of this new digital health initiative to inform decisions about the long-term future of the intervention.

AHSN NENC provided programme support to the local delivery team and provided connectivity to the wider system across the region.

A regional event was held to celebrate the uptake of the innovation and to encourage spread.

Video with care home staff speaking about the Well Connected Care Homes (Sunderland) project.  See https://www.youtube.com/watch?v=o_1qmcjQ05c

Shared learning – Sheffield Test Bed also implemented technology and NEWS see https://www.youtube.com/watch?v=8-ZP4Fjurwo .

Sunderland CCG – Care Home Digital Tablet video see https://www.youtube.com/watch?v=YftVRDiDim0