The Wirral Improvement Team sought to address the issue of people with Learning Disabilities experiencing far worse health outcomes and has introduced the Docobo remote monitoring solution with positive results.

People with a learning disability can experience far worse health outcomes compared with people without a learning disability. The Wirral Improvement Team, based at the Wirral Community Foundation Trust, wanted to address this situation by introducing remote monitoring to tackle health inequalities for this community of people.

The team explored options and decided to introduce remote patient monitoring in order to prevent avoidable health issues, and by providing remote consultations, to reduce stress for patients who may find visiting GP surgeries challenging. The Wirral Improvement Team and Graphnet worked together to create a successful pilot which aims to reduce attendance and admission at hospital for avoidable events.

Mark Evans, Project Manager and Lead on Remote Monitoring for the Wirral Improvement Team, Learning Disabilities says:

We wanted to improve experience and outcomes for people with Learning Disabilities and reduce disturbance and distress to patients who don’t like being in GP surgeries, and also to ensure that people are not left out of vital health checks. Patient observations for people with learning disabilities are usually only carried out once a year at an annual review, and the team wanted to improve this, as well as enable better diagnosis with daily readings.

We introduced remote monitoring as we wanted to tackle entrenched health inequalities for people with learning disabilities.  Remote monitoring is improving healthcare outcomes and we think this will also tackle the incidence of avoidable and premature deaths.

Solution: Using remote monitoring to improve healthcare outcomes

The Wirral Improvement team decided to introduce a remote monitoring solution to begin to tackle health inequalities for this community of people in Moreton and Meols. They chose to work with Graphnet who had been working with Mersey Care Foundation Trust since 2017 on remote monitoring and had demonstrated proven success with remote monitoring for people with learning disabilities.

Remote monitoring works by submitting regular readings of, for example, blood pressure, weight, etc and these readings are automatically submitted to a clinical hub where any alerts are picked up by clinicians and acted upon in a swift and effective manner.

Mark Evans says:

We believed that introducing remote monitoring was the best way to tackle poor outcomes. With more regular readings and checking of observations – and by also providing remote consultations – we would have a have a better chance of picking up on conditions for people with learning disabilities such as such as constipation and UTIs.

How the team implemented remote monitoring to improve healthcare outcomes for people with Learning Disabilities

The team worked together to identify 154 patients across several Primary Care Networks (PCNs) for the pilot and started by engaging with nine different care providers at just over 30 different sites. Once the care providers were on board, the team then supplied remote monitoring devices, including blood pressure monitors and the Docobo app so people could carry out daily readings at care homes and in supported living services.

With a high turnover staff, the team decided to take a ‘train the trainer’ approach. Care home and supported living service staff were trained to take daily observations, which gives a baseline of measurements for each individual, meaning that if anything is out of the ordinary, an alert is triggered.

Mark says:

This was a new way of working for primary care. When introducing remote monitoring to GPs, some had concerns about the time required to monitor the alerts and started to see it as a risk. However, the team recommended using a PCN hub which is monitored by Physician Associates, Learning Disability Nurses and administrators. This negates the need for a practice nurse to constantly monitor the alerts as these are triaged by healthcare associates.

Benefits of remote monitoring for the project

The introduction of remote monitoring and increased monitoring of wellbeing observations has led to early detection of changing health patterns and proven evidence of early intervention and prevention.

Mark says:

Patients are really seeing the benefit from remote consultations in care homes and support living settings, as there is no travel and reduced stress for people with learning disabilities.

There have been 800 episodes of intervention in 12 months, including triggers for blood pressure higher than baseline reading.  Physician Associates pick this up in the system and get in touch and arrange for an appointment. Changes in medication or prescribed medication or a GP phone call can also be booked for people.

Remote monitoring provides improved quality of information for primary care colleagues to undertake a clinical assessment. A lot more information about the patient is accessible through the Docobo system for GPs to use in their decision-making processes.  There is also faster access to primary care for patient and community health services.

We have seen a vast increase in improved patient experience and peace of mind care providers. People who are using remote monitoring are happier and healthier and know that patients are actively being monitored by physician associates and alerts are being followed up with GPs.  We have evidence that the digitising of care providers’ observations brings up issues they didn’t think about before. Previously, care providers had paper-based processes in place, now it is digitised they are able to work more efficiently, reduce paper costs, as well as improving healthcare outcomes for people with learning disabilities.

We believe that remote monitoring is vital in bridging the gap in care and allows patients and loved ones to have the peace of mind that they are being actively monitored on a regular basis, safe in the knowledge that an alert will be triggered and acted upon if there are any changes to their health and wellbeing.

A representative from Wirral Mind says: 

Remote monitoring stops us worrying about our tenants so much as health professionals are monitoring on regular manager.

Abi, House Manager, Wirral Mind, says:

Our staff feel they are doing more about their tenants’ health and it is reassuring for staff as they get phone calls when there is something wrong with the observation submitted.

Linda, LD Coordinator, Moreton Group Practice, says:

From my perspective we have a couple of poorly patients that would not be monitored as closely if it wasn’t for Graphnet. We are not just relying on different members of care staff for their opinions/observations on vital signs and a lot of other pertinent information we receive via remote monitoring. This can then aid diagnosis in patients with communications issues. What is unique with Docobo remote monitoring is we can closely monitor individuals and take more frequent readings when they become more ill.

Angie, Business Development Manager, Autism Together says:

Digitising paper-based process is saving significant time for care providers, allowing them more times for other tasks. The ease of use of Docobo for staff and the quick oversight for the managers makes addressing individuals’ health needs quick and efficient.