As part of the guidance from the British Geriatrics Society in relation to managing patients with or suspected to have COVID -19 in a care home setting, care home staff should be trained to check the temperature of residents displaying possible signs of COVID-19 using a tympanic thermometer. The guidance states that care home staff, where possible, should also be trained to measure other vital signs including blood pressure, heart rate, pulse oximetry and respiratory rate. This information can then be used by external healthcare practitioners such as GPs during virtual ward rounds and will help to triage and prioritise support of the care home residents and their care staff according to patient need.
Telemedicine is not new and back in 2015 the University of York undertook a study in Airedale, Wharfedale and Craven to analyse the effect telemedicine in a care home setting and the impact of its use on the local acute hospital. From the study, a 39% reduction in the cost of emergency admissions and a 45% reduction in Emergency Department attendances were recorded. A clear benefit in the use of telemedicine in a care home setting both through health benefit to the residents and financially for the wider NHS was therefore shown.
In late April 2020 a partnership was agreed between Feebris, who specialise in artificial intelligence and City Care whose aim is to improve the delivery of health and social care in East London to provide a digital solution to healthcare within the care setting to help those isolated as a result of COVID-19. This will be in the form of an app which is being provided to some East London care homes. From reports on the partnership, the idea behind the app is to enable residents who are socially isolated to gain access to care during the COVID-19 pandemic. The app is reported to guide the carer through a 10 minute patient check up which includes the service user’s vital signs using a digital stethoscope and pulse oximeter. The information obtained through the 10 minute check up is then shared with the resident’s GP and the app is intended to be used as an adjunct to the GP ward round which is likely to be less frequent at present as a result of the COVID19 restrictions on movement.
On 21 May 2020 together with the North and West Hampshire CCGs and other local organisations, the Hampshire Hospitals NHS Foundation Trust launched a telemedicine service for its care home residents with the aim to help prevent unnecessary admissions to hospital. The service was planned to be launched later in 2020 but the pandemic has expedited its roll out to over 80 care homes in that area of the country.
The Hampshire Hospitals’ service enables care homes to speak to a specialist clinical team at the Hospital in Winchester should a resident’s condition deteriorate or if they fall, experience trauma, have a new presentation of confusion or need assistance with pain management, breathlessness or a suspected infection.
The role of a care worker has changed significantly in recent years to include more nursing style tasks which include taking basic medical observations. Care home staff usually hold a diploma or NVQ in health and social care but since the onset of the COVID-19 crisis there have been calls to develop the careers of carers into a standardised training programme to help staff to recognise deterioration, common medical problems and end of life care amongst other things. With more formalised training and qualifications brings a number of other questions about regulation and liability of those care home staff. The discussion of those questions are best addressed in a future article.
With COVID-19 symptoms developing quickly, telemedicine is being seen as a good way to take care home residents’ vital signs and to enable care home staff in isolating care homes gain access to an external healthcare practitioner to assist with swifter symptom management. It also will help with documentation of presenting symptoms for continuity of care or should complaints or claims be brought in the future about a resident’s clinical presentation or the care they have received.
The use of telemedicine will, in turn, have a beneficial impact on maintaining social distancing during the COVID-19 restrictions on movement, potentially reducing the need for paramedic assessment or emergency department transfer and in turn reduce contact between healthcare staff and a cohort of people who are at particular risk of contracting and succumbing to COVID19.
Written by Chris Dexter at BLM