Virtual Clinics: chronic diseases

Background

The Hospital was looking for a solution to reduce the pressure on their outpatient department in order to free up clinic appointments to promptly see patients with acute flares of their condition.

The traditional process of bringing patients back for routine review meant that clinics were booked up usually months in advance. Patients who needed to be seen urgently, whether new or follow-up, were, as a consequence seldom able to get an acute appointment when they needed it. Whereas routine patients who may have been symptom free would have made unnecessary journeys to clinic and spent their valuable time.

The current system’s efficiency was based on maximising appointment attendance and not focusing on patients needing urgent clinical review. As a result, those patients with acute flares or worsening severity of their chronic condition were unable to access their acute care in a timely fashion and therefore risk poor outcomes.

Thus, the hospital was in need of an effective and trusted method of monitoring and managing patients remotely, so that face to face clinic appointments were available promptly to those who were deviating from the expected response to treatment. This reduction in unnecessary attendances and availability of more clinic slots for urgent reviews paves way for high-quality care with improved cost efficiency.

The objective of procuring a system was to find a platform that could effectively and safely manage the remote monitoring of patients, with minimal administrative or clinical input and which could also assist with the effective prioritisation of patients based on their clinical needs. Those clinical needs were to be monitored via questionnaires and outcomes scores.

The Approach

Amplitude applied its standard approach to the project, early on identifying success criteria with the customer and the clinical requirements to make the project a success. Amplitude Account Managers worked closely with the customer once the system went live, to ensure the continued success of the project.

The new process adopted is such that, once a new patient is referred to the clinic, the intuitive interface automatically creates a new patient in Amplitude and places them onto a pathway that automates the collection of a baseline score.

Patients embark on a digital approach to their care plan, completing questionnaires in a remotely accessed patient portal, at regular intervals. This way any deviation in the severity of the recorded scores, is highlighted when it occurs, flagging up to the clinician those patients that require attention.

The clinician then virtually assesses each patient and assigns them to a more specialised pathway where this is appropriate, depending upon their symptoms and any test results. This means easy retrieval of diagnosis, medication and treatment data going forward.

Where the patient either requests a review or deviates from expected responses to treatment, the clinician can decide to arrange a formal review either via phone call, video conference, or face to face consultations. In addition, Amplitude is now offering an additional Covid-19 assessment questionnaire that will allow the clinical team to assess a patient’s Covid-19 status before they are issued an appointment.

Because of the new approach, anxiety about patients being lost in the system or patients feeling neglected was raised as a risk at the outset. Duplicate effort initially was practised for a period until admin and clinical staff alike were confident in the robust nature of the product. Patients were also furnished with a satisfaction questionnaire about the newly adopted process.

The Result

As patients no longer receive a pre-arranged appointment in a defined time period, time pressure in clinics has been reduced and patients identified by the system as needing urgent review can easily be offered a clinic appointment immediately, as and when they need it.

All patients receive continued interaction from their clinician, with the ability to alert the clinical team to any deterioration in their condition. Most importantly, clinicians will have instant access to a patient’s record of clinical status without waiting for clinic letters being typed with 3-6 week delays. All patients are reviewed and seen by the consultant, but by order of need as opposed to a first come first served appointment basis.

This has resulted in improvement to the care provided to patients, by means of a structured pathway approach to ramping up treatment regimes, based on documented and evidence-based responses to optimise treatment that will be available in real time.

This means fewer missed appointments as those in need of an appointment are less inclined to not make the appointment, an increase in clinic appointment availability and more efficient use of clinical and admin resources, all resulting in significant cost savings and ultimately an improved patient experience.

The dual monitoring process was discarded within the first 2 weeks as users recognised the simplicity and reliability of the process and patients were delighted with the new process, many expressing how pleased they were to reduce the need for unnecessary journeys and time off work, while retaining what they felt was a more open access to their consultants and receiving high quality care from the hospital specialist
teams.