Salford Royal NHS Foundation Trust National Intestinal Failure Unit (IFU) provides care for patients from across the UK and beyond. Type 3 IF patients are routinely reviewed at 3–6 month intervals. Between March 2007–2017 there was a 90% increase in type 3 patients attending our outpatient. Coping with the increasing demand whilst maintaining outpatient capacity and standards is a key component of IF care. Telemedicine provides a strategy for achieving this. Moreover, whilst doing so, such approaches can save patients’ time, cost, lengthy and difficult journeys to the outpatient clinic.Thereby improving the patient experience.Method
Quality Improvement (QI) methodology was used to implement and evaluate remote video consultations. Implementation began Dec 2015 via patient consultation and small tests of change. All protocols and information sheets were approved through clinical governance and trust policy. Clinical data was obtained from a prospectively maintained database forming part of ESPEN audit standards.Method
A virtual clinic allows the clinician and the patient to see each other, holding a face to face discussion via the internet using the video call service Skype. An anonymous qualitative satisfaction questionnaire was subsequently completed by participating patients.Results
At the end of 2015, 246 patients were receiving HPN, this figure rose by 13.7% by 2017 to 285. Twenty-one patients used our telemedicine service, with a total of 55 contacts. Mean potential distance travelled by telemedicine cohort was 118.6 miles (range 10–441.8), mean cumulative miles saved since telemedicine initiated 8600 miles. Twelve patients used the service on multiple occasions. Seventy percentage of patients rated their satisfaction with the system at 90% and above, with the mean satisfaction of 83%. Despite the increase in number of HPN patients, the mean duration between outpatient appointment offered reduced from 103.7 days before telemedicine to 100.4 days in 2017, for the whole HPN cohort. One patient had a CRBSI following commencement of telemedicine. 9.5% of the telemedicine cohort were admitted with a HPN complication. This compares to an admission rate of 23.5% for the whole HPN cohort over the two years since telemedicine was initiated.Conclusion
The introduction of telemedicine can release some HPN clinic capacity and help reduce the increasing pressure for patient access to HPN services. Importantly, compliance with NICE and ESPEN guidelines can be maintained.Whilst maintaining patient satisfaction and patient safety.