When patients are discharged from hospital, it’s hoped their recovery will continue with the help of medical providers in their communities. Unfortunately, when complications arise, some patients end up back in the emergency department. BC has one of the highest readmission rates in Canada. Now, a virtual care platform aims to reduce unnecessary readmissions by providing answers to patient’s health concerns through two-way texting.
Vancouver Coastal Health Research Institute scientist Dr. Richard Lester is spearheading the WelTel pilot project, which will enroll approximately 700 patients at Vancouver General Hospital (VGH). The study will determine if the WelTel virtual care platform reduces readmission rates.
“When patients are discharged the care can be fragmented and difficult to coordinate—they have appointments with GPs and different specialists, and they have a variety of tests that need to be arranged. When unforeseen problems occur, they can be overwhelmed.” Lester says WelTel provides patients with a direct connection to navigate that recovery path. Patients will be able to text a nurse with questions on everything from medication to side-effects. The nurse can quickly answer concerns, head off problems before they get worse and direct patients to the appropriate care provider. All of this could prevent costly and unnecessary hospital readmissions.
“WelTel is all about maintaining a connection between discharged patients and their providers—it’s about ensuring a continuity of care.”
Lester says text-based communication has huge advantages. “People prefer texting to phone calls. Texts can be read at your convenience and there is a visual record of the information provided. For many people, it’s hard to recall details of every phone conversation and keep track of various handouts.”
But the WelTel platform offers patients a lot more than texting. Each enrolled patient will be given their own private portal to store their information. “Patients can log into their portal at any time to see all their discharge instructions, as well as any other links or documents caregivers deem important for them.”
In addition, the platform extends to virtual care. For example, if a patient develops a side-effect like a rash they can request a video chat or send photo to the nurse, who can either diagnose the ailment or determine whether they should seek additional medical care. “A small thing like a rash or a missed medication dose can cause worried patients to return to the ER because they didn’t have a clear channel of communication. If we can answer concerns early on, we can prevent problems from getting worse.”
“Even a small reduction in readmission could lead to large health care savings, meaning more resources for other system needs.”
Getting home sooner
Lester says another potential benefit of the WelTel platform is enabling earlier discharge from hospital, knowing there is a trusted two-way communication system in place for support. “An example of this is patients staying longer because they are on IV antibiotics for something like pneumonia. In many cases we now have an oral antibiotic option, but it requires vigilant dosing times; caregivers can be reluctant to discharge a patient if there is not support in place."
Another feature of the platform is that family members and trusted friends can be granted proxy access to the patient portal and read texted information and instructions, rather than relying on a loved one’s memory of a phone call. They can also text with their own questions.
"There are really only two things that follow patients throughout their transition from hospital to community: themselves and their mobile phone. This virtual platform supports them all the way through."
Lester is quick to point out that WelTel isn’t reinventing the wheel, it just provides a better mode of care. “Hospitals like VGH recognize the need to support transition—they already have a great care management team that makes plans for discharged patients. But it’s being done by phone and fax and paper handouts. The team is excited to take advantage of all that WelTel platform offers.”
Lester says because the platform is patient-centred, it’s been very well-received in earlier trials—with HIV patients in Kenya and with patients in the US. “Patients today expect and even demand better communication. With this kind of platform, they feel heard. Their concerns are answered more quickly and more conveniently.” Lester’s approach has been published in top medical journals such as the New England Journal of Medicine and The Lancet.
Lester’s team hopes to expand the platform to other departments at VGH and serve as a model for other BC hospitals. As a member of the World Health Organization’s taskforce on digital health, Lester says virtual health care platforms are the way of the future.