The integration of Flo into the pathway for pregnancy mothers at City Hospitals Sunderland NHS Foundation Trust in supporting the monitoring of both gestational diabetes and mild pregnancy induced hypertension has been highlighted by the Care Quality Commission as outstanding practice in their recent report.
City Hospitals Sunderland NHS Foundation Trust developed the use of Simple Telehealth in 2012/13 using a multi-matrix, multi-partner model in collaboration with NHS England Northern Senate to support two common pregnancy complications: gestational diabetes (affecting 4.5% of pregnant women) and mild pregnancy induced hypertension (affecting 5-10% of the pregnant population).
The aim of the initial pilot was to determine the practical application of Simple Telehealth, the clinical/non-clinical benefits, how patient safety was managed and patient experience.
Dr Rahul Nayar, Consultant in Diabetes and Endocrinology at the Trust, leads the gestational diabetes implementation where pregnant mothers diagnosed with gestational diabetes are offered Flo to support increasing adherence to their current healthcare regime. This is provided in the form of reminders and encouragement in achieving goals set (for blood glucose assessment, weight targets and adherence to lifestyle modification). Clinical benefits for patients have included;
- Achieving target blood glucose profiles
- Achieving a appropriate weight loss
- Effective titration of therapy
- Where relevant a significant reduction in cigarette consumption in one case from(20/day to 3/day, due to reduced anxiety levels evoked by the knowledge of good foetal wellbeing and safety.
A case study is available highlighting that with the adjustment of oral medication and insulin facilitated outside of the usual clinic environment healthy foetal growth was achieved, providing the woman with reassurance and resulting in four fewer visits to the ante-natal service combined. The case study also demonstrates improved healthcare usage over a 20 week period reducing the routine four appointments to one appointment (e.g. overall cost saving over a 20 week period of £320 based on a single visit cost of £80/pt).
Mr Kim Hinshaw, Consultant in Obstetrics and Gynaecology and Director of Research & Innovation at the Trust leads Flo’s integration into the pathway for pregnant mothers diagnosed with mild pregnancy induced hypertension. Flo provides support to increase the patient’s adherence to their current healthcare regime in undertaking blood pressure readings and highlighting symptoms that would be of concern (e.g.headaches, flashing lights, epigastric pain) with the patient prompted to attend the hospital when systolic BP reaches >150, also upon which the on-call Consultant is contacted via the bleep service.
A case study is available and reveals that Flo resulted in appropriate alerts and prompt admission to hospital, allowing timely induction of labour and safe delivery of mother and baby and highlights the potential that pre-implementation of Flo, that the mother’s escalated BP may have been missed by the standard care system (she was asymptomatic). The Trust found that the patients clearly preferred self-administered home monitoring to midwifery home visits confirming satisfaction with the integrated pathway and higher levels of empowerment.