In the last of our series of blogs for World Continence Week, a Nurse Consultant details how Cornwall was the first to use telehealth to help patients.
A few years ago I was talking to a colleague who was working as a clinical lead in telehealth.
While she was describing to me how telehealth worked, it occurred to me how I could use it to help patients in my bladder and bowel service. At the time, we were facing a challenge: we had high numbers of patients admitted to hospital or ending up in the emergency department as a result of a urinary tract infection (UTI). A delay in treatment could lead to serious implications.
We are passionate about reducing admissions and improving care for our patients and talking to my colleague it seemed clear to me that telehealth was a simple solution. Surprisingly, when I asked around, we were the first service to use the technology to support the diagnosis and management of UTIs in people’s own homes.
The technology works by patients using the keypad on their phones to answer a set of questions every day that relate to classic and uncharacteristic UTI symptoms. The answers are sent through to our nursing team and if they indicate there may be a problem, we will call the patient back to verify their symptoms and test their urine at home. If there is cause for concern, we will then contact the patient’s GP surgery to start treatment. This is often all on the same day.
Three years on, using telehealth in this way has become mainstream within the organisation. As a result of using telehealth for UTI care, there have been reduced hospital admissions and its associated costs; and improved patient experience. UTIs are now identified earlier and consequently treatment is started promptly: often, we are able to help patients prevent infection before it starts.
In rural areas of Cornwall it also means less travel burden for patients (and their carers) who have transport difficulties, are frail or who have cognitive impairments; and less time travelling for community nurses too, meaning they have more time to spend on patient care.
But there has also been another positive side effect: patients and carers increasing their knowledge and confidence to manage their condition. We have seen a lot of patients – and carers – become aware of the signs and symptoms they need to look for. They will check their urine with the kit they have at home, and because they know what to do, in the evenings and at weekends they will call the out of hours service rather than wait and delay treatment.
One particular case we can recall that demonstrates the difference remote monitoring has made, is that of one of my older patients. At the time she was 78-years-old, living with dementia and cared for by her husband. She had already experienced five hospital admissions for UTI in the previous 12 months. She answered her telehealth questions in the morning and everything was ok. Around lunchtime she was experiencing a burning sensation and a strong urine odour.
Her husband decided to test her urine using the home kit they had been provided as part of the remote monitoring. He then called the telehealth nurse team with the results, which were positive for infection. He asked whether he could start his wife on the emergency medication he already had in their home and the team gave him permission to do so. He expressed his relief that he could now do something about it, saying that if he tried to make an appointment with his GP he would be unlikely to get one until Monday and that this would be too late, which would have resulted in a hospital admission.
By home testing of urine, episodes of infection or no infection enables better informed decision making in the management of this condition.
The next steps include developing localised UTI clinical pathways, informed by best practice and explore ways we can improve diagnostic accuracy and clinical coding to further improve care.
- NHS England’s Excellence in Continence Care is a practical guide for commissioners, providers, health and social care staff to put into effect the best care for patients. It also provides information for the public.
Sharon Eustice is a Nurse Consultant at Cornwall Partnership NHS Foundation Trust’s the Bladder and Bowel Specialist Service. She specialises in the diagnosis and conservative treatment of urinary and bowel continence conditions for all populations.