So my name’s Jamie Munro, I work for Pentland Medical. Joining me on the stage if Markku Viherlaiho. I’ve pronounced that right. Markku is a nurse with 35 years’ experience working in the NHS. We’re here today to talk about our experiences working with remote monitoring technology as a healthcare supplier in the UK. Our particular solution allows the status of multiple IV infusions to be monitored from a central point or a mobile device. But this talk is designed as an educational review of remote monitoring in its various forms, relating it to the state of healthcare in the UK, and showing how it can be beneficial.

Remote monitoring is a bit of a buzz term in healthcare at the moment. And the pandemic has demonstrated solutions that can reduce routine checking can be particularly beneficial in terms of crisis when the hospitals get so busy, overloaded with patients, and nursing shortages become an even bigger problem than they already are. Additionally in these times of reduced human contact and social distancing, remote monitoring does have the potential to limit the spread of infectious diseases; however, the NHS is still a long way off from digital transformation.

So I’m going to hand over now to Markku, who’s going to give a bit of an overview on the nursing shortage problem faced with the UK at the moment and describe how remote monitoring can be of some benefit. So, Markku, over to you.

MARKKU

Thank you Jamie, so that’s enough of my introduction, but you know that change, we’re always faced with change. And the NHS definitely, it’s not just the health secretaries that change, but everything changes around us. And today is your change, because my name should have not appeared there. There should have been somebody called [Niko Savola? 0:05:02] who is the monitor company’s CEO. And also because of COVID he could not travel here. He would have been much more flamboyant presenter than me, so you’re going to get the boring me instead of Niko. But I do well it’s my name, if I do badly it’s Niko, so the usual thing that people say. So thank you Jamie by the way, asking me to do this. That was very kind of you. At least I’ve got the same accent as Niko has.

There has recently been a lot of interest about nursing shortages. Those of you working in hospitals are all too aware of the problems. Nursing shortages are real and nurses are overloaded. I have had my team members in this sort of state, and you’ve probably seen the same. Who wants to work as a nurse if your working conditions are as bad as reported in some cases, the quality of care can suffer. But how can more nurses be recruited with poor working conditions, and if the available technology is not implemented to stress. Having said that, it’s not an easy problem to fix, and therefore there is an urgent need for new innovations to help our frontline healthcare workers.

In Southampton University research from 2020 to 2021, very recent indeed, on COVID and nursing shortages, found that when staffing levels were lower nurses in England were more likely to report that necessary care was left undone, not surprising. And Nuffield Trust data from 2018 showed a staffing shortfall of 8%. There has been nursing crisis in NHS ever decade since the ‘50s, and currently stands at approximately 40,000 nurses according to Royal College of Nursing. The NHS has tried everything to remedy this by offering university bursaries for nursing students. When the dreaded austerity hit us the government removed the bursaries and student numbers really did plummet. However in 2020 this has been overturned and the government hopes that 50,000 a year bursary will bring the crowds of 50,000 men and women back into nurse education. And actually the recent figures show that there has been a dramatic increase, about 5,000 new students. So hopefully that continues.

If it doesn’t continue we are going to be in trouble. But NHS staff shortage is not just about nurses, as we don’t have enough doctors, paramedics, radiographers, therapeutic and technical staff, and the list goes on. And I’m sure you have found as well to find a good quality candidate is not always easy. All this amounts to approximately 98,000 vacancies altogether. It is scary to investigate estimated staff shortage figures by 2030. Actually it is estimated that the gap has increased to 250,000 vacancies. Now that’s scary under any viral attack, and I’m getting old so not good.

COVID also highlighted a lack of not just ICU trained nurses, but also physical beds. The NHS has only seven ICU beds per 100,000 people, three times fewer than our European leader, Germany, which has 24.6. And you might have seen some other figures, but these were from NHS website I just took them. So according to NHS data the numbers have increased, and in April 2020 they had 4,119 ITU beds or ICU beds. So last figures I show was about 3,600 patient increase is great. In addition we must get rid of our corridor care - my pet hate - as it’s unsafe, undignified and unacceptable. The long-term aim is to increase the number of patient beds from 2.5 to 4.7 per 1,000 people. It would be then in line with OECD average.

We need to reverse the many decades reduction in hospital beds. So hopefully the government’s ambitious plan to build 40 new hospitals will happen. I’m not sure that that’s going to happen, or have you heard anything, I haven’t, and during this COVID crisis things have been a bit different; however, the question is where does the staff come from and is there enough money to equip them, especially with this fantastic equipment we see here; especially now that the government needs to also direct funds into elective surgery and cancer treatment and care.

The COVID pandemic saw the urgent need for more bed capacity so that the patients are treated in an appropriate facility, while the elective surgery continues so that we don’t end up again with five million patients on a waiting list. Infection control is another aspect that needs to be taken into consideration. It will affect the technologies that we need to implement. It is not only about saving on PPE, we also need to investigate what environmental effects the continuous use of PPE causes, especially if COVID crisis or similar becomes the norm. So if we can manage patients by observing them remotely, sorry I went a bit far. Sorry, next slide yeah. Thanks Jamie.

So how can we plug the hole of staff shortages in the short term? Before this [unclear 0:11:36] so people have been trained, NHS will have to spend money on international recruitment, I’ve done that a lot, agency and temporary staff, and unqualified staff. Again this puts the strain on in-house training. The question is are temporary and unqualified staff well enough trained in using modern technology, or do we need simple and safe technological solutions to make the care safer? Digital transformation is not just about putting your patient notes on a computer or making a video call say Senate Gilmore, the Chair of the RCNE Health Forum. Digital transformation is about thinking differently, and if continued. If new technologies and systems are going to be successful, they must meet the needs of the nursing staff, and to be intuitive and easy to use. It’s really important that the nurses understand how they can use that technology more effectively for patient care.

If the shortage of nurses in the hospital is the problem, the question is how to reduce their workload? It’s the routine work that could be automated. And how do we measure the impact of this automations, and the difference they make in real world scenarios, which are often in high dependency or high pressure environments. Innovation is at its core about solving problems. As the remote monitoring sector continues to grow, companies working in remote patient monitoring will face several key tests. Can the technologies improve patient outcomes or meet the same standard as traditional care at a lower cost? And next slide.

Using our experience working with our solution, we have identified three key areas to address with remote monitoring. First of all patient safety, this can be improved by shorter response times. The benefit of remote monitoring in this regard is being able to spot when the patient becomes ill, or when something has gone wrong with their treatment, and intervene professionally at an earlier stage. Next is time saving, this can be achieved by reduced extra steps and routine checking. Using remote monitoring and technology to automate some of the routine tasks helps the carer’s daily workload. That currently creates pressure and takes a lot of time. Finally the workflow can be improved with the vital information automatically stored in a digital space, information that you could easily miss if done manually. There are many more benefits to be realised with less routine work and more time for personalised patient care, and now back to Jamie.

JAMIE MUNRO

Thanks Markku. So now that we’ve identified the three areas that we look to address with our remote monitoring solution, and the perceived benefits, we now have to prove the impact that it’s having in the real world, and that can be positive, neutral or negative. And it depends what aspect we’re looking at, be that patient safety or time savings for example. There are several vastly different types of remote monitoring solution. For example some of them are like patient facing apps that they use on their mobile phone to collect and store data on their own health. As I touched on earlier our particular solution is a tool designed for healthcare professionals, and the purpose of that is to enable quicker professional intervention. So what impact does this have in the real world?

To give an example we’re currently doing a trial of a remote monitoring solution at a community nursing facility in the UK. What they do at this particular facility is they work from a base, but they go out to the homes of patients living in the community to administer a range of IV therapies and hydration fluids. So concentrating on hydration fluids specifically, these infusions tend to run over 12 hours. So the nurse would go and set the infusion up, and then they need to leave to get on with the day. The problem when we’re talking about infusion therapy outside of the hospital when they don’t have a pump is the gravity flow infusions, they can fluctuate, the flow rate can fluctuate quite a lot in that time, and that can potentially lead to a lot of complications.

So, with the use of our solution, the entire nursing team can now monitor the status of each infusion they’re doing in the community offsite, and any problems can be identified and corrected either by sending a nurse out to the patient’s home, or in some cases they can even train the patient to adjust the given set themselves, and they could just give that patient a phone call. So initial results from this trial not only show the improved patient safety of being able to identify and correct these poor infusion rates, but according to direct feedback, even from the patients, they feel more confident, and they feel safer knowing that somebody’s looking after them even if they’re not physically present.

So, staying with a similar theme for this slide, this is the same solution that we’re doing a trial, but this time the results are from a hospital ward. So just from the slide there we saved 25 hours of nursing time per month. We saved 34 visits to isolation rooms, which highlights another benefit of reducing exposure to infectious diseases for the healthcare staff, given that these isolation rooms are often infection control wards. We saved 129 visits to other patient rooms. We noticed 13 cannula occlusions before they became a problem, and nurses were alerted to empty infusion bags earlier than they normally would have. Additional feedback from this showed the benefits of having a remote monitoring solution at night-time on a ward, where there’s typically less staff on shift. The patients are obviously sleeping. So it can reduce some unnecessary checks, they could just monitor it offsite, and they don’t have to disturb the sleeping patient. Overall improved patient safety and nursing efficiency is an obvious benefit from all of these metrics.

So, what are the barriers that we face as a healthcare supplier? Well the UK healthcare system does continue to adopt and embrace new technologies, but I think it’s fair to say we lag some way behind a lot of other industries. The NHS in particular we find is it’s very slow at adopting new technologies in a general sense. To give an example, as recently as 2018 when former Health Secretary, I had to change that at the last minute, former Health Secretary Matt Hancock started in his role, he banned further purchases of fax machines, because he identified that the NHS worldwide was the biggest purchaser of fax machines, and subsequently banned further orders of fax machines. So Mr Hancock’s obviously moved onto pastures new, but I think this example demonstrates just how far behind the NHS is in adopting new technologies in a general sense, and digital solutions such as remote monitoring, even though there is a lot of publicity around NHSX, which I’m sure you’ll now the digital arm of the NHS.

Another point, it’s always useful to recognise that when it comes to introducing, using or even considering a new technology, everyone comes with their own set of preconceptions, attitudes and experiences. People will have different levels of knowledge, motivation and enthusiasm, and that’s what makes them the most important factor in any major improvement programme. Most recent research done by the NHS Leadership Centre categorised NHS staff into three different groups, and that was early adopters and enthusiasts were in a minority, around 20%. Pragmatists, so those who will support but only, support change but only after they see that it works, only after they see evidence, that was the majority, around 50%. And then we have the sceptics, traditionalists, or laggards as they’re sometimes known, and that was around 30%.

And our experiences as a supplier doing these trials, we could have two very similar hospital wards trialling the exact same system, but the net results are completely different: different staff, different results, different patients in a certain period, different results, COVID or no COVID different results. Getting people to understand the problems that are out there, ensuring that technology can at least partially address them, that’s our challenge. And that’s I guess where we bring those of you working in EBME, our experiences as a healthcare supplier, we always put a huge value on the relationships we build with you. Our relationships with you are always generally very positive, although there’s often no direct involvement with software solutions or even doing the trials on the frontline. I think the influence that you can have to educate your peers, and just make things happen, that’s invaluable, and it’s all about just showing them that new technologies can address some of these problems that are out there. And as Markku was discussing earlier in our talk, nursing shortages is a problem that’s worsening, not improving. So I think it’s important that we’re all able to educate each other on technological advances that can at least partially address these issues.

So that’s it. Thanks for listening to our presentation. It’s been an absolute pleasure. Markku and I are now happy to answer any questions you might have. Additionally Pentland Medical do have a booth, a bit of a shameless plug but come and have a chat with us on stand C30 if you want to have a chat in private. So thanks again, thanks for listening, any questions.

Jamie Munro's presentation at the EBME Expo: Advances in Remote Monitoring Systems