The Health Call Undernutrition Service

The Health Call Undernutrition Service

Undernutrition

The hidden problem of undernutrition 3 million people in the UK affected at anyone time 93% of people with undernutrition live in the community Costs the UK 13 billion pounds per year An undernourished older person has triple the risk of dying in hospital or post discharge Identification and treatment of undernutrition can: reduce complications by 70% reduced hospital length of stay and readmissions reduce mortality by 40% If reduced costs by 1%, save over 130 million per year

Nutrition and hydration is everyone's responsibility

Care homes for older people Medical practices Hospitals NHS Community Services Health Call Undernutrition Service

Present challenges Improve quality of service delivered Increase the capacity of services Reduce the cost of the service

What is your dream? Regularly monitor every adult who is prescribed an oral nutritional supplement Regularly monitor every adult who is identified at risk of undernutrition

Partnership using digital health Innovation and developed by dietitians Clinical leadership

What is Health Call? Automated telephone call 1. Nutritional supplement monitoring 2. Undernutrition monitoring 3. Multi user online Health Call monitoring

How Health Call works Patient weighs themselves Automated phone call received every week. Questions answered using keypad Changes in weight determined Risk of undernutrition determined using MUST Phone calls continue next week Compliance in drinking nutritional supplement determined Patient contacted and treatment recommendations discussed Health care professional emailed alert if responses outside pre-determined parameters. Reviews information online. Health Call automatically analyses responses Appetite response determined

Evaluation Patient quality of care Patient experience Service user feedback Cost effective Capacity/ workload

Number of patients Reason Number % Patient died / too ill 25 34% ONS stopped 23 32% No longer suitable 7 10% Patient non-compliant 7 10% Patient requested to stop 5 7% Reason not provided 5 7% Total 72 100%

Is Health Call accurate? We have to rely that information provided by the patient/carer is correct, similar to a clinic or telephone review 10% patients completed dietetic clinical reviews comparing results with Health Call 100% agreement with MUST 100% agreement with weight (type 3 scales vs patient s scales) 83% agreement with nutritional supplement compliance

Dietitian feedback The proactive identification of potential concerns, dietitians quickly adapting prescriptions, resulting in reduced prescribing Reduced waiting times, as not bringing patients into clinic appointments More efficient use of dietitian time Improved quality of service provided, due to better monitoring and quicker responsiveness to issues Increased service capacity to review more patients Believe it has improved patient compliance in taking supplements

Patient feedback Easy and quick to use Prompts me to take my nutritional supplements Provided reassurance and confidence that they are being monitored and given support Feel more involved in their care Saves time, much preferred than having to attend a clinic appointment Would recommend Health Call to others patients

Patient stories Simple & easy to use, even mum can do it and she is deaf I feel more confident knowing someone is looking at the information and within hours I have contact from the dietitian if there is a problem Feel more in control and involved Dad feels as though he has a voice and is involved in his care Able to see Dad s progress My weight increased from 5 1/2 stone to 8 1/2 stone Life changing Whole family involved

One care homes results 11 patients on ONS, transferred onto health call for monitoring February July 2013 High agreements between clinical dietetic review and health call Positive staff feedback on using health call Area Staff travel time 31.86 Mileage 34.2 Staff consultation Time 189.04 Supplements 3000 Total savings 3255.10 Cost of Health Call 836 Overall cost savings 2,419.10

Cost savings 100 patients over 10 months Dietetic service impact: 180 clinic appoints (20 mins) 61 hours dietetic time 2,050 staff time Nutritional supplement prescribing impact: 19,500 Total: 21,550

Better data when reviewing patients (quality care, patient safety) Patient self management, improved treatment compliance, improved outcomes (patient empowerment) Improved patient monitoring (quality care, patient safety) More appropriate use ONS (Cost effective) More efficient use of dietetic time (capacity/ workload) Increase number patients N&D review (service improvement, quality care, patient safety, capacity/ workload) Proactive identification of problems (quality care, patient safety, cost savings)

Multi User Online Health Call

Nationally Available to use in other organisations by license

BE THE CHANGE YOU WANT TO SEE IN THE WORLD LET S BE THE GENERATION THAT ELIMINATE UNECESSARY MALNUTRITION Alisha Brotherton, (BAPEN)

Nutrition and Hydration Week Webinar Thurs 20 March 2014 9am-10am http://nutritionandhydrationweek.co.uk/webinars/

Any questions

www.focusonundernutrition.co.uk Info@focusonundernutrition.co.uk 01388 452330 Focus on Undernutrition, County Durham and Darlington Foundation Trust, Henson Close, South Church Enterprise Park, Bishop Auckland, Co Durham, DL14 6WA