The team at Tees Esk and Wear Valley NHS Foundation Trust involving Dr M Santhana Krishnan, Consultant in Old Age Psychiatry/ Senior Clinical Director and Lauren Bennett, Innovations Coordinator, identified that the six lead Alivecor device could be used to monitor patients in the community during the COVID-19 pandemic.
Their patients include those who are on or to be started on psychiatric medication and need carefully monitored for detection of potentially dangerous QT prolongation. A prolonged QTc can lead to a potentially fatal effect, called drug-induced sudden cardiac death (DI-SCD).
Monitoring is ordinarily done by a twelve-lead ECG connected to the patient who is required to be undressed, have their skin prepared and ten separate leads attached. Staff and patients have found the sixlead device less intrusive, as no clothing needs to be removed and patients can use the device themselves. The whole process lasts five minutes and the ECG can be sent instantly to a clinician who can measure and report on the QTc straight away.
The team produced a local standard operating procedure and procured 30 devices for use in a real-world evaluation for antipsychotic monitoring and initiating therapy. Dr Krishnan ran webinars for staff and recorded a step-by-step video guide on how to operate, record and transmit the ECG safely following all the NHS Trust guidelines. The AHSN NENC assisted throughout the project offering advice and funding to test, roll out and scale up the pathway.
Initially the team implemented the pathway to support staff and provide continuity of care for patients during the Covid-19 pandemic by ensuring new and existing patients could receive their ECG remotely. The benefits and evaluation results from patients and staff during this pilot was overwhelmingly positive.
As a result, TEWV took the decision to use these devices on a permanent basis, procuring and distributing over 100 devices across 100 community teams with support from NHSX, NHSE and the Academic Health Science Network for the North East and North Cumbria (AHSN NENC). A further 40 devices were rolled out across Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) with support from the AHSN NENC.
To support the spread and adoption, the AHSN NENC worked with the team at TEWV to develop a suite of resources to support implementation including staff training videos, how to guides and videos, a resource hub, case studies and blogs. All resources can be found on the AHSN NENC website. https://ahsn-nenc.org.uk/
5,814 ECGS have been conducted over the course of the project, 100% of patients surveyed said they preferred the new technology to the old approach.
The success of the project resulted in the nomination and shortlisting for two awards at the 2021 Dynamo Awards and two awards at the 2021 Royal College of Psychiatry Awards.