Successful implementation of remote video consultations for patients receiving home parenteral nutrition

Even though type III intestinal failure (IF) is a relatively rare disease with an estimated prevalence of 5-80 cases per million population, these numbers are growing in the UK and elsewhere. Between 2011 and 2015 a 102% increase in adults dependent on home parenteral nutrition (HPN) was noted.

International guidance for the management of IF dictates that such patients are cared for in dedicated specialist units, which are only available in a few locations.

Situation

Salford Royal NHS Foundation Trust’s intestinal failure unit (IFU), provides care to patients from an extensive range of localities. This presents both economical and geographical barriers to patients using the service.

Between March 2008 and 2015 the trust noted a significant rise in the number of patients using the service, with an associated 51% increase in clinic appointments.

Aspiration

To evaluate whether telemedicine would provide a strategy to reduce patients’ need to travel for review, while maintaining safe clinical standards.

Solution and impact

The implementation of remote reviews of patients dependent on HPN began in December 2015.

Remote video consultation discussions were carried out through an internet video call service (Skype).

Patients’ blood tests were checked by their GP after the telemedicine consultation and forwarded to the IF team.

Patients could use remote reviews for HPN management and for additional support such as psychological follow up and intervention.

Impact

Patients using the remote service for psychology appointments were very satisfied since they could not have accessed this specialist care closer to home.

Saved patients the time and cost of travel.

Doctors rated more than 94% of the consultations successful.

Functionality

  • Web-based service (Skype)

Capabilities

  • Web-hosted video calls and phone calls

Scope

Can be used at home by patients and in a clinical setting by clinical staff members.

Key learning points

Telemedicine is not suitable for every patient.

Access and ability to use an electronic device are a prerequisite.

Notably, clinician satisfaction with the telemedicine consultation was somewhat higher than that of patients, but it is difficult to identify the exact reason for this discrepancy. In future the service will use a qualitative research approach to explore patients’ and clinicians’ attitudes to the remote service in greater detail.

Key figures/quotes

During the study period, patients receiving HPN rose by 18% to 288.

25 patients used telemedicine for HPN follow up, 3 of these for follow up with the psychologist.

63% of patients rated their satisfaction with the system at ≥90%, with a mean satisfaction of 85%.

8% of the telemedicine cohort was admitted with an HPN complication, compared with an admission rate of 24% for the whole HPN cohort. One emergency admission was avoided.

Find out more

Read about the implementation of remote video consultations for patients receiving HPN (PDF, 566KB)

Key contact

Professor Simon Lal, consultant gastroenterologist and clinical director of the IF unit at Salford Royal and University of Manchester

simon.lal@srft.nhs.uk