March 16, 2016

The proof is in the pudding: NHS Health Call Undernutrition

The pilot of the NHS Health Call Undernutrition service in County Durham and Darlington evidenced great benefits:

  • Reducing travel time and cost
  • Positive patient and carer feedback
  • Increase in clinician capacity
  • Increase in cost efficiencies
  • Improvement in appropriate prescribing of oral nutrition supplements (ONS)

Whilst I have always passionately believed that other organisations could reap the same benefits as we had, we were yet to have the evidence that this was the case. This was until the nutrition and dietetic service of the Southern Health and Social Care Trust, Northern Ireland, conducted a pilot of their own.

Would they gain the same efficiencies? Would they realise similar benefits? Would they recognise the value of remote monitoring for both their patients and their service?

Motivation for the NHS Health Call Undernutrition service in Northern Ireland

Referrals to the service for oral nutrition support and advice in the community/domiciliary setting accounted for a third of all contacts and was increasing, placing additional burdens on an already stretched service. A significant amount of time and expense was spent travelling to assess patients in a large rural geographical area.

Implementation

The NHS Health Call Undernutrition service was implemented in 14 care homes in February 2015 and the pilot ran until September 2015. Support was provided by the Health Call team to develop the care pathways.  Patients in those care homes referred for oral nutritional support were then monitored using the web based portal.

Results

As a result of digital monitoring of patients and adapting pathways, patients who needed a review were able to receive this within 2 weeks rather than 6. They were also on the dietetic pathway for an average of 4 months compared to 6 to 9 months with an average saving of 2 hours per patient in consultation time. In addition, 50% of patients assessed had a reduction in their oral nutritional supplement prescriptions.

Whilst in the current climate it is vital that we are providing a service that is efficient and cost effective, it should not be at the price of the quality of service that our patients or carers receive. The feedback from the care home staff in Northern Ireland has echoed what we found. Overall the portal was found to be easy to use but it also meant that the home did not have to release a member of staff when a dietitian called or visited. Importantly the homes also reported that the use of NHS Health Call Undernutrition drove nutritional care and they appreciated that there was more dietetic input for the patients that needed it and increased the shared care.

There has been a lot of positives seen with the introduction of Health Call Undernutrition with improvements in nutritional care, cost efficiencies and care homes reporting feeling better supported. But what about the dietitians? They would be the first to admit that there was effort needed to implement the service. It represented a new way of working, there was less face to face patient contact and a change in skill mix with more work delegated to dietetic support workers. But they would also admit that going back to how they were working would be a step back. Being able to monitor patients more closely meant that they were able to offer a more responsive proactive role, that there was more focus on a ‘food first’ principle and more confidence in altering nutritional supplements and errors in prescriptions were identified far earlier.

Learning points were that new pathways were needed, and that you can’t implement a new service onto existing creaking pathways. It is time well spent investing in working through these pathways and the support provided from the Health Call team was valuable in this process.

As I said at the beginning I always have passionately believed that Health Call will work in other organisations but there is now proof in the pudding.

We’re at this years BDA Live event, showcasing NHS Health Call’s Undernutrition service, along with others. Come over the the innovation zone to chat to me about our services and find out more.

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