Innovative Cardiac Remote Monitoring Technology Improves Patient Pathway in Value Based Procurement Pilot
To meet the changing needs of patients, the NHS must adopt innovative technologies at pace. This pilot demonstrates the benefit of looking beyond unit cost and adopting a patient pathway improvement approach to procurement. As a result, Leicester’s cardiac patients are benefitting from improved outcomes and the trust itself is freeing up capacity to care for more patients.Ben Shaw, Director of Productivity, University Hospitals of Leicester NHS Trust
With more than 17,000 members of staff, University Hospitals Leicester (UHL) is one of the UK’s largest providers of acute and specialist services for the one million residents of Leicestershire, Rutland, and the surrounding area.
UHL, like so many other trusts, face significant pressure on its cardiac services and sought an innovative solution to free up clinical capacity and reduce hospitalisations. The aim was to also drive increased social value from the battery-driven Cardiac Rhythm Devices – which are Implantable Cardioverter-Defibrillator (ICD) and Pacemakers. Activation of the ‘remote monitoring’ function in these devices’ costs around £500 – £600 per patient, and historically at Leicester not all devices have had their remote monitoring functionality activated. Therefore, an opportunity was identified to align to chapter 5 of the NHS’s long-term plan on using digital technology to support patient care, by increasing utilisation of remote monitoring for UHL’s cardiac patients.
The principle of remote monitoring involves the collection and transmission of clinical data between a patient and the clinician. Using sophisticated technology across mobile and wireless networks enables the implanted devices to be checked regularly, without a patient needing to attend the clinic. Remote monitoring is proven to free up clinical capacity, keep patients out of hospital settings, and helps to identify symptoms faster – streamlining the patient pathway.
The aim of this Value Based Procurement (VBP) approach was to identify opportunities to increase the levels of activation for existing UHL cardiac device patients, and benefit from the following advantages of remote monitoring:
- Reduce hospitalisation rates
- Reduce length of stay for hospitalised cardiac patients
- Free up clinical capacity
- Improve patient experience.
The estimated number of patients in scope to receive remote monitoring was 3,800.
UHL and NHS Supply Chain worked together to understand and quantify the opportunity to increase the activation of remote monitoring. Ensuring clinical alignment to this change was key, and together we were able to demonstrate tangible benefits to seek and gain board approval from the trust for the investment into widescale activation of remote monitoring.
The Forecasted Results and Financial Benefits
reduction in rates of hospitalisations
reduction in length
efficiency benefit in the
first 12 months
- 43% reduction in rates of hospitalisations – due to early symptom detection.
- 34% reduction in length of stay for patients who are hospitalised.
- Reduced clinical follow up time, freeing up clinician’s capacity to treat more patients.
- Social Value – reassurance of continual monitoring and reduced patient appointments.
- 14.4kg annual reduced C02 emissions per patient through reduced patient journeys.
This VBP pilot project aimed to generate efficiency benefits by using remote device monitoring. This innovative technology can identify and treat patient symptoms far sooner – allowing the trust and patient to benefit from all the associated advantages that early detection brings.
The activation of over 3,800 patients’ devices is a significant undertaking and will be delivered over an 18 month roll out period. The efficiency benefits recognised by the trust in the first 12 months are £994,000 with a £424 per patient net efficiency improvement identified through the increased levels of remote monitoring on cardiac devices.
The pilot clearly demonstrated how the adoption of new technology and working in partnership with industry to support the required changes in clinical practice has enabled the trust to recognise opportunities to release capacity, improve patient flow and patient experience.
There is the potential for wider adoption across Integrated Care Systems. It is suggested that if the introduction of increased levels of remote monitoring was aligned to a process of service redesign across an ICS footprint, this could optimise productivity even further.
Is the procedure NICE approved?
Yes, NICE support the use or remote monitoring of implanted cardiac devices.
Do we have to buy capital?
Depending on the manufacturer, some devices require a bedside communicator to be purchased, whilst some remote monitoring solutions use mobile phone Bluetooth apps to communicate device data to the hospital.
Is remote monitoring compatible with equipment we have?
Most new ICD’s and pacemakers have remote monitoring capability, however some older generations currently implanted within some patients may not be compatible with remote monitoring.
Is there substantial training required?
No, most cardiac centres already use remote monitoring to a degree, increased usage of remote monitoring does not require additional training.
For more information on this product and pilot project please contact:
Programme Lead, NHS Supply Chain: Cardio-vascular, Radiology, Endoscopy, Audiology and Pain Management