During the pandemic, reduced oxygen saturation levels have been shown to be a key identifier of deterioration in patients with confirmed or suspected COVID-19. COVID Oximetry @home uses pulse oximeters for patients to safely self-monitor their condition at home, providing an opportunity to detect a decline in their condition that might require hospital review and admission.
The programme is managed by NHS England and NHS Improvement, in partnership with NHSX and NHS Digital.
From a starting point of 20% of Clinical Commissioning Groups in November 2020, 100% of CCGs had established a fully operational COVID Oximetry @home pathway by early February.
Patient Safety Collaboratives (hosted by Academic Health Science Networks) supported this rapid spread by working closely with CCGs in their region to offer quality improvement expertise, access to training and resources, data collection and evaluation, and by facilitating a national learning network.
The COVID virtual ward model is a secondary-care-led initiative, using remote pulse oximetry monitoring to support early and safe discharge from hospital (step-down care) for COVID patients. 94% of acute trusts now have access to a COVID virtual ward, an increase of 69% since the beginning of the year.
Natasha Swinscoe, national patient safety lead for the AHSN Network and Chief Executive Officer of the West of England AHSN, said:
‘We have learned so much during this pandemic, and this impressive uptake in the use of pulse oximetry has undoubtedly saved lives. It has also allowed us to ensure, where appropriate, we can provide safe care for vulnerable people shielding at home through simple, remote monitoring.
‘I’m proud of the role Patient Safety Collaboratives have taken, providing support and assistance ‘on the ground’ to establish completely new ways of working in such a short space of time.’
This intensive PSC support to implement these pathways is due to wind down at the end of March 2021, with AHSNs continuing to support systems to embed @home models in the long-term.
A year on since the start of the pandemic, Consultant Acute Physician, Matt Inada Kim, reflects on the simple device (a pulse oximeter) that has been a lifeline for thousands of COVID patients & transformed the way the NHS delivers care.
The West of England Academy are hosting a new series of five interactive online workshops each Wednesday morning from 28 April focusing on the successful adoption and spread of healthcare innovation, best practice or products.
Free to attend, and for any healthcare project team member or innovator based in the West of England, each two-hour session is standalone so you can choose individual workshops or sign up for the series.
Ideally attendees will be working on a live project and come with an improvement idea they have tested at small scale in an NHS organisation and who want to learn how to think about the skills and capabilities needed for adoption and spread.
Attendees can be in any role and level within their organisation, for example from clinical, administration or facilities.
Our academy works hard to welcome attendees from a broad range of backgrounds creating a safe and open environment for learning and sharing ideas.
Since mid-November, the West of England AHSN has been supporting our three STP systems with the rapid implementation of the COVID Oximetry @home service (a step up pathway) to help detect the early signs of deterioration in patients with confirmed or suspected COVID-19. More recently, since mid-January, COVID Virtual Wards (‘step-down’ pathways to help enable people in hospital with Covid-related illness to return home safely as soon as possible) are also being rolled out across the region.
By working collaboratively, over 1,600 patients have now been supported by these programmes across the region.
Both of the pathways feature enhanced monitoring for patients with a confirmed COVID case – pulse oximeters are used by the patient to identify ‘silent hypoxia’ (a reduction in oxygen levels in the blood with no other obvious clinical signs). These services built on learning from the first wave of the COVID-19 pandemic and make use of clear escalation pathways based on the person’s oxygen saturation levels in the blood (which are known as sats).
The West of England AHSN has provided a supportive role to our three STP systems, helping drive collaboration within, and across, each region with over 1500 patients having been supported across the step up service (COVID Oximetry @home) and over 100 patients on the step down service (COVID Virtual Ward) thus far.
Crucially for patient safety, these services were demonstrated to reduce mortality, reduce inappropriate hospital admissions (findings also suggest monitoring sats allows patients to be admitted to hospital before they have severely deteriorated), reduce the length of hospital admissions and escalation to intensive care wards.
Hein Le Roux, Joint Clinical Lead for Gloucestershire CO@H, also Clinical Lead West of England AHSN, and GP at Churchdown, said:
“The COVID Oximetry @Home service has had a real impact on my patients who have developed COVID. In Gloucestershire, over 1100 patients have been referred to the service and for the majority it has provided reassurance that they have not developed the potentially fatal silent hypoxia. For the few people who did deteriorate, we were able to identify them early and prioritise their care with steroids and oxygen in the hospital setting.
This has meant they were less unwell prior to receiving treatment and have thus recovered more quickly. It has also shown that by working together as a care system between primary care, the COVID Oximetry @Home service, South Western Ambulance Service NHS Foundation Trust and our acute colleagues, we have improved patient care”.
Michelle Reader, Chief Operating Officer from Medvivo said:
“The Medvivo-provided oximetry monitoring services are a testament to the collaborative and system-wide approach that was taken across BaNES, Swindon and Wiltshire (BSW). Once we’d offered to provide the service for the region we felt really supported by colleagues in commissioning, primary care, secondary care, community services and the AHSN. This allowed these services to be established very quickly, enabling us to provide valuable supportive services to the people of BSW.
The sharing of learning from other areas was really important. I’ve never been part of such a rapid system-wide collaboration, and there was a real ‘can do attitude’ from all involved. It’s been a learning process and we continue to learn and develop the service. The feedback from the patients has been fantastic – this makes all the efforts worthwhile.”
The below case study demonstrates the impact of the COVID Oximetry @home pathway through the story of one patient who we will call John*:
Day 1 – John is a 57 year old gentlemen who has developed cough and fever.
Day 2 – John takes a COVID test
Day 3 – John receives a positive COVID test result. John’s GP contacts him and he is placed in ‘at risk group’ for silent hypoxia & deterioration. John is referred to the COVID Oximetry @Home (step up care pathway) and provided with pulse oximeter.
Day 4 – John receives advice on how to use the service for daily monitoring of blood oxygen saturations through a digital monitoring platform. John’s sats are recorded at 95%.
Day 7 – John’s sats are now 91% (this is now in the parameter of silent hypoxia). John is contacted by the service provider where he advises he is feeling ‘okay’. John’s advised to call 999 urgently for hospital assessment and possible treatment.
Day 7 to 10 – John is admitted to hospital and given dexamethasone and oxygen. John’s sats gradually improve over the next three days.
Day 10 – John is discharged home after four days in hospital. John is now monitored on the COVID Virtual Ward (step down pathway).
Day 13 – John has made steady progress and is discharged from the COVID Virtual Ward service and sign posted to Long-COVID pathway & given safety netting information.
Without the COVID Oximetry @home service and use of a pulse oximeter, John may not have known he was significantly unwell and could have required more extensive hospital treatment, or potentially even died. These services have not only a positive impact for the patient but the positive impacts are seen across primary and secondary care.
The West of England AHSN is proud to announce diversity and cohesion specialists BCohCo, have been appointed to support our diversity and inclusion programme.
Following a successful tender process, BCohCo will be working across the AHSN to review how we ensure diversity, inclusion, cohesion and equality are embedded as core values across our organisation and work programmes. Innovation, quality improvement and collaboration will remain core commitments as we explore and progress on this journey.
This exciting next step builds on our existing equality, diversity and inclusivity commitments which include a series of Diversity Pledges agreed across the AHSN Network (which is made up of the 15 AHSNs across England, of which the West of England is one). We will now be working with BCohCo to co-develop an action plan setting out how we achieve these pledges.
To continue to celebrate the diversity of the region in which we live and work, and ensure inclusive work programmes that have equality as a core value, we also signed the Bristol Equality Charter in September 2020.
Chief Executive, and chair of the Diversity and Inclusivity Group, Natasha Swinscoe said:
“As an AHSN, we have a leadership role in championing and developing diversity within our NHS innovation pipeline, our organisation and across the West of England region. Our Diversity and Inclusivity Group, and the broader organisation, are committed to learning and making real progress on this important journey.
We look forward to working with BCohCo to ensure equality, diversity, cohesion and inclusivity is embedded in what we do, how we work together and the decisions we make”.
Katie Donovan-Adekanmbi, Inclusion and Cohesion Specialist from BCohCo Ltd said:
“‘Given the events of 2020 we have been left with a lot of questions about difference, fairness and belonging. By bringing BCohCo (Building Cohesive Communities) on board, the West of England AHSN have demonstrated their commitment to starting these conversations honestly, openly and authentically.
We look forward to working together, in these very unusual times”.
The innovation delivery arm of the NHS, the AHSN Network, has released its Impact Report 2018-2020. The report highlights outstanding impacts achieved by AHSNs, including the West of England, and evidences how they are driving adoption and spread in healthcare innovation, transforming patient outcomes, enabling efficiencies, saving the NHS money, generating economic growth and attracting millions of pounds of investment for the country’s economy.
The report also details how AHSNs have mobilised quickly to COVID-19 to support the NHS and health and social care response.
Key national programme findings from the report show that 13,387 fewer patients are at risk from harm from medication errors as a result of PINCER. The Network’s atrial fibrillation work has helped prevent 11,734 strokes and saved 2,933 lives. Whilst 8,472 people with chronic joint pain have participated in ESCAPE-pain courses.
From 2019-2020, the AHSN Network has generated almost £322.3 million inward investment for our nation, and created and / or protected over 1,000 jobs during this time.
The AHSN Network helps mobilise the value that the NHS can add as an economic asset to the UK economy. AHSNs broker access to a range of expert support and services across the health and care sectors that support NHS innovators and companies to realise the commercial and economic potential of their ideas.
PSCs play an essential role in identifying and spreading safety improvement programmes (SIPs) to create sustainable and continuous improvement in settings such as maternity units, emergency departments, mental health trusts, GP practices and care homes.
Successes include spreading the National Early Warning Score (NEWS2) to 99% of all acute hospital trusts, a 92% uptake of a discharge care bundle for patients with chronic obstructive pulmonary disease (COPD), and more than 120,000 views of a series of training films developed for care home staff.
To support the COVID-19 response AHSNs pivoted their expertise and resources, highlighting their unique ability to be able to work with regional health systems to spread innovation, whilst collaborating across England to drive rapid transformative change across large geographies.
Key examples of AHSNs responding to the pandemic include; providing expertise to NHS regions, by embedding staff in regional COVID-19 response cells, which was equivalent to 157 full time staff. And working with NHSX and NHS Digital, AHSNs help to drive digitisation of primary care, achieving a near-total uptake of video and online consultations in two months across GP practices in England. We also published a rapid-learning report on our patient safety work, ‘Safer care during COVID-19’.
By autumn 2020, AHSNs were continuing to support the COVID-19 response whilst providing expert input to regional NHS planning around the restoration and recovery of services. Nationally, AHSNs have also been leading the NHS ‘Reset’ campaign with NHS Confederation and the Health Foundation and have been playing a key supporting role in the NHS Beneficial Changes Network, focusing on ‘locking in’ learning from the pandemic.
Find out more about how we are working with health and social care colleagues across our region to keep people safe during and after COVID-19.
Piers Ricketts, Chair of the AHSN Network and Chief Executive of Eastern AHSN said:
“We are achieving results that make a real difference for patients and service users, as well as healthcare professionals, innovators and NHS organisations. These strong foundations make us ideally placed to help all those involved in improving and innovating health and care to tackle together the challenges that lie ahead.
The AHSNs’ response to COVID-19 has highlighted how our core strengths and ways of working have proved a valued asset to our partners. AHSNs are agile and well connected organisations, and we were able to mobilise and respond to this new crisis almost overnight, providing additional support and brokering relationships across health and care, research and academia, industry and the voluntary sectors.”
New national programmes
From April 2020, AHSNs are working on three new national programmes;
Focus ADHD; a number of AHSNs are working with mental health trusts and community paediatric services to improve the assessment process for Attention Deficit Hyperactivity Disorder (ADHD) using computer-based tests (measuring attention, impulsivity and activity).
Early Intervention Eating Disorders; a number of AHSNs are supporting mental health teams across England to speed up diagnosis and treatment of eating disorders in young people aged 16 to 25.
Lipid management and FH; AHSNs are scoping a national programme of work around cardiovascular disease (CVD) prevention, which is anticipated to start in autumn 2020.
The West of England Academy are hosting a series of five online workshops each Wednesday from 27 January on quality improvement (QI). Free to attend, and for any innovator or employee within healthcare, each one-hour session is standalone so you can choose individual workshops or sign up for the series.
Each workshop will be interactive, so you can apply learning in real-world scenarios. The workshops will be beneficial regardless if you are working on a specific QI project or not. If you encounter challenges in your role (or outside work), and want to consider how these can be tackled through QI, these sessions will help.
Attendees can be in any role or level within their organisation or business; for example clinical, product development, administration or facilities.
Our academy works hard to welcome attendees from a broad range of backgrounds creating a safe and open environment for learning and sharing ideas.
In this Q&A our West of England Academy Project Managers Kate Phillips and Vardeep Deogan share their reflections on the delivery of the Academy’s recent Quality Improvement (QI) Summer Series. They led 10 hours of online interactive workshops and delivery of QI theory by 12 different facilitators to around 60 delegates per session from across the West of England region and beyond. The Academy team have also compiled a series of slides with their top tips on hosting virtual learning.
What did you enjoy about the QI Summer Series?
Vardeep: Every part of our workshops had a purpose, so being creative and thinking outside the box with activities without making them complicated was really important. Supporting our guest facilitators was a pleasure too. After our fifth session, we really felt a sense of achievement, and we cannot wait to deliver future online workshops.
Kate: An unanticipated pleasure was coaching our guest facilitators. Vardeep and I were the main hosts, but wanted the series to reflect the wealth of knowledge and range of experiences of working with QI across the West of England. We also figured that our voices might be a bit dull for two hours straight! Considering that online training was a fairly new concept, this meant that Vardeep and I mentored our guest facilitators to deliver their 25 minute activity. The feedback from the guest facilitators was lovely – they felt challenged by the experience but also supported. I think they were all very proud of themselves which was great to see.
The overwhelmingly positive response to the sessions has also been wonderful. Vardeep and I cooked these sessions up, combining our knowledge and experiences and we seemed to have stumbled upon a winning formula!
“Exceeded my expectations – I learnt so much.”
2. What are the differences between online and face-to-face delivery?
Vardeep: When delivering face to face it’s much easier to ‘read the room’ for non-verbal communication and how people interact with each other, and as a facilitator you respond accordingly. We had to think differently about how to get this feedback during and throughout each workshop. This involved designing activities and including opportunities for feedback using functions like slido, the chat box and voting.
We also considered different learning styles and made certain to include activities that reflected these. Using liberating structures supported this.
Kate: The whole experience is different- quite often I’d be looking at only one or two faces in the corner of my screen, but knowing I was talking to 50+ delegates who had prioritised our training over other work, it’s a bit of a barmy experience really! I think delivering online sessions brings a different type of nervous energy…the adrenaline flows!
3. Can you tell us about your biggest ‘aha’ moment?
Vardeep: As the series progressed, even though we may have been delivering our fourth or fifth session (and at times felt we were repeating ourselves with instructions for activities etc.) we kept in mind that this may be someone’s first experience on zoom or of virtual learning. I realised the value of clear instructions from the positive feedback we received where our clarity was praised. This was a key learning point.
Kate: For me, a lovely moment during our second session was when Vardeep asked a delegate to turn their mic on and share their experiences verbally with the entire group. We regularly asked delegates to share feedback via the Zoom chat box, but giving individuals the platform to voice their thoughts brought the session alive. It did mean having to relinquish some control, but it was worth it every time. Sharing the platform was important.
“I think I’ve learned more in this two-hour online session than any other face-to-face course I’ve attended!”
4. Have you learnt any new skills with online facilitation/delivery?
Vardeep: I’ve learnt you have to be even more adaptable and fluid when delivering online. Anything can happen at any time (tech issues!) and you have to be able to step in and pick up anything, whether this is the delivery of a session or an aspect of facilitation. Every member of the team needs to be able to pick up any role and this really stretched me and took me out of my comfort zone – we survived a few hairy moments.
Kate: I had delivered a few online webinars before, but they were very much ‘chalk and talk’ style. I’ve loved learning about, and using, Liberating Structures to keep delegates engaged and to facilitate interaction between them. I’ve also enjoyed thinking creatively to convert traditional face-to-face QI training for online delivery.
5. Have you learnt anything about yourselves during this project?
Vardeep: Working alongside Kate to plan every session in detail, really enabled me to be fluid and agile to the needs of others, particularly guest facilitators. I’ve learnt that with the right team around you, you can adapt to any last minute change and for it to still feel under control and most importantly – fun.
Kate: I’ve learnt that my happy place is extremely organised and where I’m in control. Fortunately Vardeep is very good at making me feel safe enough to step outside of that and allow space for spontaneity and discussion, and that’s where the magic happens! On the flip-side, I’ve learnt to value the skill of organisation and I don’t think we could have pulled off this series without it.
“Really good workshop today – best I’ve attended during this whole pandemic, so thanks to you and your colleagues”.
6. What has been the biggest challenge?
Vardeep: You never truly know how you’re being received online until you read the feedback. Over the five sessions I got used to smiling and talking to a camera instead of being able to make eye contact and responding to non-verbal cues. That often felt odd but it’s vital to the person the other side of the screen.
Kate: At the start I was overwhelmed with the task that lay ahead of us, thinking about all the details. Fortunately I work with brilliant colleagues who made this series a true team effort. I was able to focus on planning and delivering the sessions in a step-by-step way, knowing that the event logistics and marketing of the series were being expertly handled. Breaking down the roles, tasks and working as a team was crucial.
7. Do you have any top tips for online delivery?
As a facilitation team agree a way of communicating with each other behind the scenes (such as Whatsapp). This allows you to adapt, adjust or abandon as you go along.
Plan your sessions with timings in mind. This is invaluable and is a skill – things often take longer virtually. This also includes prepping any guests.
Allow time for a team pre-brief and de-brief after each session. Kate, Shomais and I always spent time reflecting on what went well, what didn’t go so well and we also captured new ideas to incorporate for the next session on ideaz boards or jamboards.
Kate: I think one of my favourite phrases from this series was “team work makes the dream work”. We couldn’t have delivered such a slick series without the designated online technical support that our colleague Shomais provided. Having clear roles and responsibilities in the team was important, e.g. being clear on who is responding to questions in the chat box, who is co-ordinating break-out rooms and who is introducing facilitators and welcoming delegates back from breaks. I think the clarity of roles and knowing we could depend on each other, created a safe space to do each of our jobs really well.
Thanks to Kate and Vardeep for sharing their experiences.
Further information about the West of England Academy’s online resources and future events can be found here.
The NHS Innovation Accelerator (NIA) – an NHS England initiative supported by England’s 15 Academic Health Science Networks (AHSNs) and hosted at UCLPartners – has launched its call for applications representing high impact, evidence-based innovations. Successful applicants will become 2021 NIA Fellows.
The call is open to local, national and international healthcare innovations supported by passionate individuals from any background, including SMEs, clinicians, charity/third sector and academics.
In alignment with the current NHS priorities of COVID-19 Reset and Recovery, innovations put forward this year must address at least one of the following themes:
NHS response to COVID-19
Supporting the workforce
The application period is open until 16 October 2020 at midnight.
This list of Frequently Asked Questions explains the NIA in more detail, who can apply, the selection process, what support an NIA Fellow 2021 can expect. We recommend reading this document before applying to the NIA or contacting us about your application.
Interested in applying?
Visit the NIA website to learn more about the application criteria and process, register for informational webinars, and access the online application portal. Webinars will be held on 8, 9, 22 September and 8 October.
On 5 March 2020, the NHS Innovation Accelerator (NIA) announced 11 high impact innovations joining the national accelerator in 2020, including one developed here in the West of England: The WaterDrop. Read more about The WaterDrop and their journey to becoming an NIA 2020 Fellow.
About the NHS Innovation Accelorator (NIA)
The NIA is an NHS England Initiative highlighted in the NHS Long Term Plan. It accelerates uptake of high impact innovations for patient, population and NHS staff benefit, and providing real time practical insights on spread to inform national strategy.
The NIA supports individuals (‘Fellows’) with a set of values and passion for scaling evidence-based innovation to benefit a wider population, with a commitment to share their learnings.
Since launching in July 2015, the NIA has delivered the following (these stats do not include data from the latest rounds of Fellows, unveiled in March 2020):
2,214 additional NHS sites using NIA innovations
£134.8m external funding raised
486 jobs created
113 awards won
45 innovations selling internationally
NIA innovations save the health and social care system £38m per annum, according to conservative figures from independent evaluations by York Health Economic Consortium.
During July and August 2020 the West of England Academy, aided by guest facilitators and speakers, held weekly Quality Improvement (QI) webinars. This season of learning, known as the QI Summer Series, was fully booked with a lengthy waiting list. We are also delighted to say the series received 100% positive feedback from attendees, no mean feat in a world where virtual fatigue is setting in.
Before and during the series our Academy team compiled their thoughts and tips on hosting learning sessions via webinar: To download the slides as a PowerPoint, please click here.
In the coming weeks, our Academy team will also be sharing a Getting Started with QI Guide alongside a blog about their experiences organising and leading the QI Summer Series.
The West of England Academy will be hosting further QI webinars, alongside other virtual events.
You can browse the full range of AHSN events here.
Upon discharge from hospital, 30-70% of patients experience unintentional changes to their medications or an error is made because of a miscommunication. 37%1 of older patients experience medication related harm within eight weeks of discharge. This was estimated to cost the NHS £396m per year. These errors can also result in patients being readmitted to hospital.
TCAM identifies patients in hospital who need additional support with their medicines, often people using multi-compartmental compliance aids. These patients are referred for pharmacy input in the community.
We know through our recent project work commissioned via the national network of Patient Safety Collaboratives that medication errors in care homes is a significant issue, and that residents medications upon discharge from hospitals are a consistent concern nationally.
The COVID-19 pandemic brought a renewed focus from NHS England and a national call to action for the NHS to support the “provision of pharmacy and medication support to care homes”. Building on the communication system utilised to deliver the TCAM project, our response pivoted to supporting reviews of new care home residents or those recently discharged from hospital by sending messages directly to community based pharmacy teams that support care homes with their medicines management.
Working collaboratively with member organisations and commissioners, the West of England AHSN is testing the hypothesis that utilising the TCAM communication system to refer to pharmacy teams that support care homes will mirror the impact identified in the nationally commissioned programme and reduce medication errors and potentially reduce readmission rates1,2,3,4.
Our medicines optimisation programme benefits from active and experienced colleagues from member organisations who form the Medicines Safety Steering Group. Through this group, experience and understanding was utilised to build on the original TCAM programme for the benefit of care home residents. In responding to our commissioner’s renewed focus, the collaborative and cross-system nature of AHSNs was demonstrated by the implementation of this project at pace in one regional trust.
Chris Learoyd, Project Manager said:
“Listening to our member organisations, care homes and understanding their needs and regional system(s) was crucial. The COVID-19 pandemic has changed many things, but the AHSN’s approach to project delivery has remained. The reactive, adaptive and collaborative practices required in responding to the COVID-19 pandemic have indeed drew-upon the AHSN’s approach: supporting healthcare innovation, quality improvement across the system; generating additional capacity, avoiding unnecessary costs whilst enhancing safety across the health and social care sector”.
Sabir FR, Tomlinson J, Strickland-Hodge B, Smith H. Evaluating the Connect with Pharmacy web‑based intervention to reduce hospital readmission for older people. International Journal of Clinical Pharmacy. https://doi.org/10.1007/s11096-019-00887-3
Nazar H, Brice S, Akhter N, Kasim A, Gunning A, Slight SP, Watson NW. New transfer of care initiative of electronic referral from hospital to community pharmacy in England: a formative service evaluation. BMJ Open. https://doi:10.1136/bmjopen-2016-012532
Mantzourani E, Nazar H, Phibben C, Pang J, John G, Evans A, Thomas H, Way C, Hodson K. Exploring the association of the discharge medicines review with patient hospital readmissions through national routine data linkage in Wales: a retrospective cohort study. BMJ Open. http://dx.doi.org/10.1136/bmjopen-2019-033551
Wilcock M, Sibley A, Blackwell R, Kluettgenas B, Robsen S, Bastian L. Involving community pharmacists in transfer of care from hospital: Indications of reduced 30-day hospital readmission rates for patients in Cornwall. International Journal of Pharmacy Practice. http://doi:10.1111/ijpp.12603
The West of England AHSN is hosted by the Royal United Hospitals Bath Foundation Trust. West of England AHSN is not responsible for the content of external sites. Read about our links to external sites.
West of England Academic Health Science Network Cookies Policy