What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

Working in collaboration with Dorset Clinical Commissioning Group (CCG) and Baywater Healthcare, our acute oncology service (AOS) has adapted a telehealth system to monitor chemotherapy side effects and observations remotely using patient-use tablet device and observations equipment from home. Patients input obs and complete set questions and are either reassured or prompted to follow home-care advice or seek urgent medical advice from the hotline service.

During the pandemic, the AOS expanded telehealth to support more patients, with the aim of reducing hospital assessments and admissions due to cancer treatment toxicities and to identify patients before they became critically unwell. Clinical feedback is good. We have had no patients admitted to hospital with side effects in crisis.

We wish to embed telehealth within the AOS so it becomes standard to offer it to patients, requiring less co-ordination, promotion and hands on management as the clinical teams become more accustomed to it.

What does your project aim to achieve?

To provide better clinical outcomes for patients by identifying clinical problems early, reducing admissions and improving patient safety by minimising hospital footfall and face to face contact whilst ensuring the sickest patients are reviewed earlier.

Telehealth reduces health inequities by encouraging patients who might not otherwise contact the hotline about their symptoms to do so early, thus ensuring the right care at the right time. Equipment provided free-of-charge means that patients who might not otherwise purchase a digital thermometer, or home BP monitor are able to access this equipment.

Our pre-pandemic pilot project (limited to patients with colorectal cancer) established the safety and acceptability of telehealth to patients and led to numerous individual anecdotal cases of clinical benefit.

The service is no longer restricted to patients on chemotherapy for colorectal cancer but is now available to any patient on cancer drug-treatment and could be expanded to include patients undergoing radiotherapy.

How will the project be delivered?

Telehealth, at its current level, is funded by the CCG. The project is managed by a Cancer Prescribing Pharmacist and Lead Clinician for AOS. There is regular liaison with the CCG team.

We hope to offer telehealth to more patients, bringing an oncology nurse in to provide additional out of hospital clinical support and liaison and promotion across primary/secondary care boundaries. We hope to extend telehealth to include patients undergoing (chemo)radiotherapy treatment going forward.

The impact of the service will be assessed using patient satisfaction surveys, hospital assessment and admission data. Audit of clinical events relating to patients using the service will be mandated.

This bid is therefore to expand our clinical support team in order to support a greater number of patients. Subsequently, further funding will be required to continue longer term. More recently the CCG have indicated that funding may be required for equipment as the service expands.

How is your project going to share learning?

The benefits of telehealth have already been established in many clinical settings.

Audit data relating to key clinical outcomes such as the number of assessments, face to face contacts, length of stay, severity of symptoms and patient satisfaction can be presented at our weekly departmental meetings. We would also be keen to share our data at hospital-wide clinical meetings to describe its wider applications for patients undergoing more complex treatment.

The Wessex Acute Oncology Group bi-annual meetings will also provide the ideal forum for our data to be presented and learning shared with trusts in Dorset and the wider region.

Nationally, our project data could be shared with oncology teams across the UK via conference abstracts and networking events. This could inform national debates relating to increase community delivery of complex care.

The telehealth team remains extremely motivated to participate in educational and clinical meetings to share its data.