Adding value to outpatient heart failure services and the patient journey through digital transformation of services

Abstract

Introduction Heart failure (HF) is a chronic condition affecting over 900,000 people in the UK. The management of patients with HF frequently involves regular face-to-face appointments. Digital transformation of care with telemedicine, remote monitoring and mobile applications (Apps) may help improve patient experience and relieve demand on services. The Covid-19 pandemic resulted in an acceleration in telemedicine. This thesis evaluates pre-pandemic HF services at the Royal Brompton Hospital (RBH), identifying potential areas for improving patient journeys.

Methods Retrospective cohort studies including over 200 patients were used to analyse the activities and actions resulting from HF clinic appointments over 3 years. Time-and-motion studies were conducted for each of the 4 consultant-led HF clinics at RBH, where flow through hospital was analysed for 58 patients. Eight clinicians and 8 patients who had undergone telemedicine consultations were interviewed about their experiences and perceptions, with narrative data thematically analysed. Focus groups and existing educational material were used to design an educational App for HF.

Results Most HF patients under long-term follow-up were followed up twice yearly. At clinic visit, worsening HF symptoms and therapy change by clinicians were uncommon (21% and 36% of appointments respectively). Patients spent a median of 103 minutes in hospital on the day of an appointment for a median 20-minute consultation. The majority of consultations ran late. Clinicians and patients found telemedicine consultations generally acceptable, but both groups identified changes in time utilisation, clinical assessment, communication, and technology. Telemedicine appointments were shorter and involved less time waiting and travelling for patients. Patients and clinicians agreed that when patients are “stable”, telemedicine is preferred. A prototype HF educational “Avatar”-based App was produced.

Conclusion Digital transformation of outpatient services, including telemedicine can improve patient and clinician experience, efficiency and rationalise limited resources, thus adding value to outpatient HF care.