Meet the team
This member's profile is private - please log in to view all the information.
The Royal Bournemouth & Christchurch Hospital NHS Foundation Trust
- England - Wessex
- Sally Munden, Oncology Prescribing Pharmacist
- Dr Amelie Harle, Consultant Medical Oncologist
- Prof Tamas Hickish, Consultant Medical Oncologist
- Joanna Hack, Oncology Specialist Registrar
- Elaine Higgins, Dorset CCG
- Christopher Senior, OAU Lead
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.
How you can contribute
- We would seek advice from healthcare professionals with experience of community healthcare projects.
- We will need advice regarding budgeting of this project in order to assure that it can be delivered within budget.
|21 Sep 2020||Expanded access available during covid pandemic.|
|19 Oct 2020||Community Oncology Nurse Team agree to support project bid|
|21 Jan 2021||Agree job description for Nurse secondment to Telehealth|
|1 Apr 2021||Advertise Band 7 Nurse 0.3WTE 20month secondment if successful|
|1 Jun 2021||Telehealth Project Nurse secondment in place|
|1 Jul 2021||Telehealth management algorithms revised to include oncology project nurse involvement|
|5 Jul 2021||Trust acute oncology services accessing telehealth online for patient assessment|
|26 Jul 2021||Present audit of experience during expanded access period 2020|
|23 Aug 2021||10 new regimen specific questionnaires written for prioritised treatments|
|19 Sep 2021||Engagement with radiotherapy teams on how to best incorporate telehealth|
|4 Oct 2021||Explore expansion of service to 3rd Hospital in Dorset|
|25 Oct 2021||Commence pilot of service for patients on (chemo)radiotherapy|
|4 Apr 2022||Present audit of telehealth for (chemo)radiotherapy patients|
|1 Aug 2022||Business case written and submitted for ongoing telehealth service needs|
1 Oct 2021
This project has been run by Dr Amélie Harle and Oncology Pharmacist Sally Munden based at Dorset Cancer Centre at University Hospitals Dorset with support from Sarah Chessell (QExchange member within our trust). Over the last few months, our involvement with the QExchange workshops has enabled clear outcome measures to be defined for our project’s evaluation. These outcome measures reflect how remote monitoring of patients can influence patient safety (identify toxicities of cancer treatment earlier), health care utilisation (such a length of stay, need for admission) and patient satisfaction. These are now well defined and ready to be used once the project starts.
Discussion with the wider QExchange faculty on a number of occasions and wider reading of the literature has demonstrated that this project is a service evaluation project rather than a research project. We already provide remote monitoring of cancer patients within our service but wish to demonstrate to the wider team and trust that it can improve outcomes to widen patient access in the future.
We have also engaged with other members of the QExchange workshop teams, learning from their experience running their respective projects and shared expertise across our different professions and sectors. This has proved invaluable as we identified the key outcomes. Understanding some of the key concepts of Quality Improvement projects has been fundamental to our design to ensure a robust project.
During attendance at one of the QExchange workshops, it became clear that we felt relatively isolated within the trust. We were encouraged to identify other stakeholders in our region and organisation who may be able to promote and support the success of this project. As a result of this, it became clear that the CCG is due to end its current contract with the providers of our existing remote monitoring service and that this naturally, will require us to adapt the project significantly as a new remote monitoring service is funded and put into place.
We have since met with the CCG digital team applying for funding for the new remote monitoring service and have been able to explain the needs of oncology patients to them so that any new digital platform that is chosen across the trust can meet the requirements of our patients. Whilst it is frustrating to have to temporarily put on QExchange project on hold, we believe that the outcome of the project may be far better now that we will be working with a more modern digital platform and can influence the choice of this platform.
Over the coming weeks and months, we will continue to engage with the digital team such that the remote monitoring platform can be instituted by next spring. The timelines remain uncertain but we hope that with time, more robust timelines will be identified. The funding of the project naturally is on hold until this is established. We would hope to be able to restart QExchange workshops once the new platform is established.
The community can get involved with our project by contacting us directly to discuss involvement. We are particularly keen to learn from other members who have direct experience of remote monitoring of patients within the community to share good practice and learn from potential pitfalls they may have encountered.