Skip to content

Q logo

What is the challenge your project is going to address and how does it connect to your chosen theme?

Demand across acute outpatient services is increasing which can impact the length of time patients are waiting to access traditional outpatient appointments. Currently patients with gestational diabetes (average 668 attendances per annum 2016-18) are attending for fortnightly face to face follow-up appointments over a 3 month period. An estimated 50% of these patients could be suitable for remote monitoring which in turn would release capacity for more clinically complex cases.

The challenge for the NHS is to provide greater digital choice for patients, providing alternative solutions whilst providing better health and wellbeing outcomes. The app has been evaluated and found to provide the same level of care, to be safe and convenient particularly for women who may also find it difficult to travel in and out of hospital regularly during this time. This solution also facilitates more effective and efficient team based care with automated alerts and electronic capture of data for audit.

What does your project aim to achieve?

The aims of the project are to:

  • Reduce the number of traditional face to face follow-up appointments by 50%
  • Reduce unwarranted clinic visits by 26%, providing women the opportunity to conduct their lives as normal.
  • Reduce the number pre-term births and C-sections
  • Release capacity for clinically complex cases
  • Reduce waiting times
  • Improve clinical pathways and patient experience
  • Provide greater digital choice for patients

Licence purchase will cover the initial year.  Over this 12 months we will evaluate progress each quarter using a PDSA approach, to ensure we close the loop on learning.

The realisation of hospital and patient benefits will be monitored via a set of agreed KPIs during year one.  To ensure we capture the patient perspective, a robust feedback form will be developed:-

  • The number of face to face appointments
  • The number of telephone consultations
  • The number of complex births
  • The number of compliments and complaints
  • DNA rates
  • The number of attendances per patient
  • Patient time and expense

How will the project be delivered?

Initial feedback from similar remote surveillance programmes, supporting cancer patients within the Trust has been positive, and uptake has been higher than expected.  Current feedback indicates patients are expecting and wanting digital solutions as a standard option.  The project will liaise with other providers and Q memners who have previously implemented similar projects.

The project will be delivered and monitored through improvement based methodology.  An initial pilot phase will enable the project to review patient and clinical feedback to evaluate the use of technology from both patient and clinical perspectives.

The project will be managed via an agreed governance process to ensure quality, patient safety and executive sponsorship:-

  • Quality and Safety Committee
  • Transformation Group
  • Clinical Leaders Group

Executive sponsorship and leadership will enable the operational and clinical team to implement the pilot by facilitating change, removing barriers and assist whole system change.

What and how is your project going to share learning throughout?

The use of the mobile app is a scalable project for gestational diabetic patients who are being managed by any NHS organisation within the UK.  Regular monitoring and feedback will enable the local team to generate reports to provide feedback to the QExhange Community, Clinical Leaders Group, and NHSe Transforming Outpatients National Programme (CoCH participant in tranche 2 of the Transforming Outpatients Workstream).

How you can contribute

  • 1. Has any developed a similar project with a successful outcome and is willing to share documentation / information?
  • 2. What measures could be used to understand success across the following themes:
  • - Patient experience
  • - Financial
  • - Capacity
  • 3. What are peoples initial thoughts regarding the project (particularly diabetic mothers)?

Comments

  1. Hi Michaela,

    I agree, we are hopeful that a pilot will demonstrate that remote surveillance will be able to support and benefit both patients and professionals.

    We have been using My Medical Record (MMR) to support cancer surveillance over the last 12 months and we have been pleasantly surprised by the up-take and willingness of our clinical teams to be involved.

    Jackie

     

  2. Outcomes should be number of face-to-face appointments, over-the-phone consultations, complications, how many women were put on metformin, insulin, gestational weight gain, birth weight, apgar score.

     

    I think it is important to incorporate within the app information about diet and physical activity to lower the risks associated with GDM in pregnancy.

    1. Hello Michaela,

      I think the inclusion of data in relation to, reducing risk factors would be very useful and provide some interesting analysis.

      Thank you for your help.

      Hollie

       

  3. When I recruited pregnant, obese women to an intervention I witnessed how labour-intensive it is to monitor women with GDM, especially when done over the phone etc. I think an app would help.  I think the challenge is in implementation and uptake.

  4. There is a team at Oxford who did a similar thing.

    https://oxfordbrc.nihr.ac.uk/gestational-diabetes-app-study-show-positive-results/

     

    They published their findings. The app is now with the company.

    1. I will look into connecting with the Oxford team as it will be useful to see what challenges / benefits they have encountered adn if these were the same as the Swindon team?

      Many thanks

      Jackie

  5. Dear Hollie,

    it’s great to see your idea. The maternity team at great western hospital in Swindon used FLO telehealthcare to help with their outpatients. They may be a really good team to connect with. I haven’t caught up with them in a while, but they were testing this approach using a PDSA framework. They measured a range of outcomes and one of the most popular from a patient perspective was the reduction in time and expense taken to travel and park and to have to find child care when comparing telehealth vs a traditional outpatient appointment.

    good luck 😊

    warm wishes

    Anna

     

     

    1. Hello Anna,

      Thank you for your input and comments.

      I will look into connecting with the Great Western Hospital in Swindon as it will be useful to see what challenges / benefits they have encountered.

      The patient measure perspective will also be a good quality measure.

      Many thanks

      Hollie

Leave a comment

If you have a Q account please log in before posting your comment.

Read our comments policy before posting your comment.

This will not be publicly visible

Please note that you won't be able to edit or delete comments once posted.