Perfect Patient Pathway Test Bed: Digital Care Home Evaluation Report. February 2019.

Emergency admissions from care homes to hospitals in England has been estimated to have increased by around 62% between 2010 and 2016 (Parliament.uk, 2017); suggesting that innovative solutions are required to provide more appropriate and pre-emptive services to this population. Early warning signs have been used in acute settings to detect deteriorating health status. The testing of the usefulness of these signs in pre-hospital settings; to better prioritise allocation and identify the need for further or escalation of care has been suggested (RCP, 2012). However, a systematic review in 2018 (Patel et al, 2018) found evidence of only one study in the care home setting.

This report present the findings from The Digital Care Home (DCH) project, implemented as part of the Sheffield City Region Perfect Patient Pathway Test Bed. It is a preventative intervention, based on the National Early Warning Score (NEWS), and is intended to improve recognition of clinical deterioration. Regular monitoring of physiological measures is relayed to an NHS single point of access (SPA). There are set parameters, which if exceeded, trigger alerts that SPA staff respond to; initially by contacting the care home. Advice is given to care home staff and referrals made to other appropriate services if required.

The evaluation includes the following 4 general approaches: ● Observation and description of the intervention and implementation ● Theory-based understanding of potential benefits, barriers and facilitators ● Design for development and improvement ● Assessment of sustainability and spread

Between June 2017 and October 2018, 139 participants were recruited to the Digital Care Home intervention across 11 care homes. A mean of 12.6 participants were recruited per care home, with a minimum of 5 and a maximum of 21 recruited per care home. All of the care homes taking part in the project were dual-registered; having a mix of both residential and nursing beds. Some of the participants, however, were residential; not receiving routine nursing care.

Overall, there were 5985 recorded events associated with the monitoring system; this equates to a median of 598.5 per care home, with a minimum of 110 events (1.8%) and a maximum of 1122 (18.8%) per care home. The majority of events (3,986; 66.6%) were ‘NEWS task’ related (i.e. instructing care home staff to report physiological measures). The second most common event was a NEWS alert (413; 6.9%), indicating a concern with a resident’s health status.