Remote Monitoring with step up/down for HITH and Chronic Disease

Evidence has shown that remote patient monitoring (RPM) has greatly enhanced the ability of health services to identify deteriorating patients with chronic conditions in the community. At present, with no remote monitoring available in Chronic Disease Teams, if clinicians identify on a home visit that the patient's condition has deteriorated, the typical escalation is for an ambulance transfer to the Emergency Department. If the community based chronic disease teams had remote monitoring infrastructure available, they could detect clinical deterioration early. Once this deterioration is detected, Chronic Disease clinicians should be able to directly refer to Acute Care@Home (HITH) for more acute care with continued remote monitoring. Once the patient's care has stabilised, they could then be transferred back to the Chronic Disease Team. This process would bypass the need for Emergency Department presentation and admission to an acute hospital.

To implement this plan would require:

  • Access to remote monitoring infrastructure
  • Ability for Chronic Disease Teams to directly refer to HITH when early deterioration is identified

This is a paradigm shift from delivering reactive care to early, proactive intervention to improve patient experience and patient safety outcomes.

Why the contribution is important

The current process increases the risk of communication and care coordination issues because the care for patients with multiple chronic conditions typically involves a greater number of care providers in a range of different care settings and sectors. Each transition across care boundaries presents known risks that arise from poor communication and information sharing between clinicians. Multiple services using one clinical portal for remote monitoring allows for seamless transition of care.

Patients with complex, chronic conditions typically present to the ED with high acuity conditions, are more likely to require admission to hospital and have higher mortality rates. It is very important that the need for hospitalisation be prevented with early identification of deterioration. Once attending the hospital:

  • ED average lengths of stay for the chronic disease cohort are typically 2-3 times longer than the National Emergency Access Target (e.g. ELOS for Heart Failure at Redland Hospital Jan-June 2019 is 12.76 hours)
  • There is a very high conversion rate of Emergency Department presentations to hospital admission - 79 % of patients who present with chronic conditions to Redlands or QEII hospitals are admitted to an inpatient ward from the ED

Through remote monitoring, and a collaborative step up/down approach between Chronic Disease and HITH, patients can remain in their home and receive high quality care.

by Denis on August 20, 2019 at 02:34PM

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