A portable monitoring device that detects heart irregularities in minutes has helped to protect mental health patients during the COVID-19 pandemic and is now due to be rolled out across the North East and North Cumbria.
During the early stages of the pandemic, Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) began using the KardiaMobile 6L portable ECG device within its community teams to monitor patients in their own homes to ensure essential ECGs continued, while also reducing the risk of COVID-19 transmission through the ability to be socially distant during the process.
NHSX has been supporting this work through funding the deployment of remote monitoring technology across the country, including a series of programmes in the North East and North Cumbria, as well connecting people across the country to learn from each other's experience.
Patients using certain antipsychotic medications require regular ECGs due to the possible risk of arrhythmias, which can cause convulsions, dizziness and fainting and, in rare cases, sudden cardiac death.
Traditionally, patients undergo ECGs in a clinical setting using a large twelve-lead ECG connected to the patient who is required to partially undress, have their skin prepared and ten separate leads attached to their chest, legs and arms. The KardiaMobile 6L is a small, wireless device that is quicker and less intrusive providing a reading in 30 seconds.
The team at TEWV, procured 30 devices which were used to track the impact of antipsychotic drugs on a patient’s cardiac health in the comfort of their own home over an initial three-month pilot period.
During that time, more than 300 patients were monitored within the Trust, saving an average of 17.5 minutes per ECG. Staff and patient feedback has been overwhelmingly positive, with 100% of patients surveyed saying they preferred the new technology to the old approach.
Following these initial positive results, NHSX provided implementation support funding and further funding for a further 120 devices to extend the roll-out across TEWV and into a second trust, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) with support from the Academic Health Science Network for the North East and North Cumbria (AHSN NENC).
Tara Donnelly, chief digital officer, NHSX, said: "Through the pandemic at NHSX, we have been helping scale new technology that allows clinicians to monitor and assess patients' conditions remotely. As part of our Innovation Collaborative, NHSX is delighted to be working in partnership with innovators and teams that are transforming care for thousands of people.
"More patients in the North East and North Cumbria requiring antipsychotic medication will now have their ECG recorded in their own homes and assessed remotely by clinicians that ensure their medication can be safely administered."
Once the new monitoring technology is in use across the Trust, 300 hours of clinical time is expected to be saved per month.
It is estimated to save around 255 days of clinical time a year across the 85 teams who will be using the devices, which should deliver annual efficiency savings valued in excess of £300,000.
Dr M Santhana Krishnan, consultant in old age psychiatry/liaison psychiatry at TEWV, said: “It’s very important that people taking antipsychotic medicines have an ECG before initiation and regularly thereafter. This device significantly improved the practical problems we encountered around the COVID-19 pandemic, specifically around clinically vulnerable people who were shielding.
“Monitoring a patient’s health in their own home is a much more comfortable and less intrusive way – and crucially gives us reliable data to keep people safe while they are taking these medications.
“Conducting an ECG as a part of a routine community visit rather than arranging a separate appointment improved efficiency and overall patient experience.”
The AHSN NENC was instrumental in the success of this project by supporting the procurement of ECG devices and assisting with the regional roll out. Following the successful pilot project at TEWV, CNTW has procured 40 devices to use within its Trust.
It’s estimated that 400 mental health patients will be monitored every month within their own home as the project expands across TEWV.
Charlotte Fox, digital transformation lead at the Academic Health Science Network for the North East and North Cumbria, said: “The AHSN NENC is delighted to have supported TEWV on this truly transformative digital innovation which was brought about due to the quick, innovative thinking of Dr Krishnan and his team.
“We believe that the team is the first in the country, possibly the world, to use and evaluate the device for mental health patients in this way, which ultimately helped to keep patients safe and in their homes during the pandemic.”
The KardiaMobile 6L, which is manufactured by AliveCor, is a small wireless device that is placed on the patient’s knee and within 30 seconds remotely records the ECG via Bluetooth onto the professional’s Trust-approved smartphone or tablet. The reading can then be emailed to the patient’s clinical team as a PDF. The whole process takes no more than 10 minutes.
A conventional ECG involves a large 12-lead machine which needs to be administered by trained professional and can be time consuming and intrusive. The process is less comfortable for the patient and the data output from the ECG is paper-based, meaning that analysis and response to the findings take longer.
Sean Warren, AliveCor business director UK/ IRE, added: "NHS trusts have been under immense pressure during the pandemic to enhance quality of care and optimise patient outcomes, AliveCor are proud to support TEWV with their adoption of new innovations like KardiaMobile 6L, facilitating the transformation of clinical practice and optimising patient care with an intuitive digital solution.”
