Case studies

SuperFit for purpose

Remote monitoring: a significant opportunity to improve the experience of prostate cancer patients at University Hospitals of Leicester NHS Trust.

The InfoFlex Remote Monitoring system has enabled the Urology department at Leicester’s hospitals to go a significant way towards providing the care closer to home that was envisioned in the NHS Five Year Forward View (2014). About 400 prostate cancer patients in a stable phase have already been registered on the system since December 2016. It is estimated that at least 2,000 patients will be registered for remote monitoring within 3 years.

Benefits

Quality of life

  • Relief from anxiety as patients are notified of results more speedily
  • Patients are saved the stress and inconvenience of unnecessary hospital appointments

Improvements to the service

  • Valuable clinic capacity is freed for patients needing to see the consultant urgently
  • Robust and secure electronic system ensures that no patient “slips through the net”

Ease of use

  • Supportive and responsive service during and after the design phase
  • The system design can be easily tailored to meet local needs
  • Alerts, flags, automatic letters and so on can be set up to respond to results more efficiently and to relieve administrative pressure on staff
  • Registering is a simple one-step process
Drivers

“Patient representatives made it very clear that they were big supporters of a remote monitoring solution.”

The improvement of prostate cancer patients’ pathway experience was the key driver for making the business case to set up prostate cancer remote monitoring.

At an initial meeting, also attended by clinicians, nurses, management and GP representatives, patient representatives made it clear that they were very much in favour of a remote monitoring solution. Simon Jones, Macmillan Cancer Pathway lead said, “We heard from patient reps that they were big supporters of it because of their experience of anxiety… the difficulties of coming to hospital, waiting around and then being told everything is OK.” He explained that the majority of stable patients will have a blood test showing PSA (prostate specific antigen) levels within acceptable parameters, so that repeat visits to their consultant are unwarranted and a waste of their time.

The unlikely but potential risk of cancer patients “slipping through the net” while being followed up was unacceptable. An electronic remote monitoring system could be designed to assist with patient management and ensure a speedier and more responsive service.

With an ageing population leading to rapidly increasing demand for prostate cancer care, Leicester’s Hospitals also needed to find the means of creating greater capacity. By reducing a large number of unnecessary appointments, capacity in Urology clinics could be freed up for those patients needing to be seen urgently.

The InfoFlex solution

“…the use of the InfoFlex Remote Monitoring System was ‘like a natural progression.’”

Simon described the search for a solution: “I spoke to a number of organisations who were doing different things. One of the organisations I spoke to was the Royal Devon and Exeter NHS Foundation Trust who use InfoFlex to do remote monitoring.  Their experience showed that InfoFlex already had a module that was working and very impressive patient experience results as well.”

Furthermore, the use of the InfoFlex remote monitoring system was “like a natural progression” because Leicester’s Hospitals’ Cancer Services were already using the InfoFlex Cancer System and there was a clear advantage in terms of having the patients’ information held electronically in the system, with the potential for an interface with Leicester’s Hospitals’ Pathology department. Clinical Nurse Specialists had become accustomed to using InfoFlex and Simon, the project lead, had built a good working relationship with the responsive and supportive InfoFlex team.

Maximising the use of the existing system and developing its potential for the remote monitoring of other blood test-based pathways, such as for thyroid cancer, also made financial sense.

Designing the system

Once the business case was accepted, the task of designing the system and interfacing with Leicester’s Hospitals’ Pathology system began. Taking the Royal Devon and Exeter design as a starting point, Simon worked with Clinical Nurse Specialists, patient representatives and InfoFlex to design a system fit to meet the requirements at Leicester.

Simon explained that his experience of having worked with InfoFlex previously made the design process easier. He said, “I always liked the idea that you could bounce your ideas off the team, get their opinion and in terms of setting up the interface (with pathology) it was a very responsive service.”

Challenges included designing and testing the remote monitoring system’s ability to respond to a range of results; to flag up anomalies, raise alerts about impending dates, and reduce the reliance on manual interventions.

Remote monitoring in action

‘The patients are very happy with it.’

Joanne Wortley, Clinical Nurse Specialist in Urology/Oncology at Leicester’s Hospitals, is now responsible for the day to day running of the prostate remote monitoring system.

Suitable patients are referred to the remote monitoring system by their consultant via a simple letter and a form. The consultant specifies the grading stage of the tumour and the patient is entered on the system by an administrative assistant. As most patients are already on the InfoFlex Cancer System this is a simple one-step process.

If patients are not already on InfoFlex because they started treatment before it was introduced or because their results do not come through Leicester’s Hospitals’ pathology system, their data has to be entered on InfoFlex first. The alert level for PSA is set according to the treatment the patient has had and the stage of their cancer. An introductory letter generated by InfoFlex is sent to the patient with an explanatory leaflet and a blood test form which specifies when they should have their first PSA test done. Blood tests can be carried out at the patient’s local surgery or at Leicester’s Hospitals.

Joanne explained that her contact details are also supplied and that patients appreciate the “safety net” of being able to call their Clinical Nurse Specialist, who, by this stage, many patients know personally.

Blood test results are monitored regularly by the administrative assistant. If the result is within normal limits a letter is sent to the patient and their GP automatically, stating that their PSA level is satisfactory and a hospital appointment is not needed, as well as another test-form with the date for their next blood test. If an abnormal result is flagged up, the Clinical Nurse Specialist will take action according to the level reported, ranging from a phone call to suggest doing a 3-month monitoring instead of a 6-month monitoring or contacting the consultant for advice or to arrange a clinic visit.

Joanne said: “We’ve probably only done that (the latter) for two patients and we’ve had somewhere in the region of 400 referrals so far. So it’s working really really well and the patients are very happy with it. Obviously it’s early days yet but I think it will increase. I suspect we will be getting busier and busier. The system works very well for the purpose.”

She added: “It’s freeing space in Urology and Oncology. It’s going to be saving lots of money in the long run. Data is collected from InfoFlex every 3 months and the figures which are coming through are being reported back to CCGs.”

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