Innovation Insight: Matneo outpatients

Sarah - the midwife's current perspective

Sarah is a midwife. She loves her job, but she has felt for a long time that staffing levels are too low, her workload too high and she is unable to give the level of care she would like. She would recommend midwifery as a career, but she knows she is in a minority among her colleagues in doing so.

The focus of Sarah’s concerns is the outpatient clinic which is noisy and often chaotic – in fact, it sometimes feels on the point of falling apart. Consultations often overrun because women with complicated pregnancies are accommodated in routine slots. There are regularly two or three more women than there are slots available. This means Sarah cannot devote as much time to expectant mothers as she would like, although she has a large number of consultations every day. She rarely leaves work on time at the end of the day.

Sarah reviews the tests she has asked for at the end of the clinic, then she must contact her women to offer advice and support – what keeps her awake at night is the fear she has missed an important detail because of the pressure on her time.

She finds that record keeping is old-fashioned and cumbersome. Some records are on paper and she finds that records across different organisations do not have a common ‘handshake’. It is difficult to find patient records all in one place.

With such a heavy workload, Sarah would welcome some support in keeping in touch with her women because much of her time is taken up with check-ups. A system that would allow mums-to-be to record their relevant data – their blood pressure, for instance – would ease the pressure on her.

She does her banking and shopping on her phone and wonders why more of her work cannot be simplified with new technology. But she doesn’t have the time to consider how the system could be improved – she feels she’s on a treadmill and if she doesn’t keep going she’ll fall over.

Vicky - the patient's current perspective

Vicky, aged 28, is pregnant with her second child. She already has a five-year-old daughter who has just started primary school.

During an antenatal appointment Vicky was told she had gestational diabetes and that, while the condition can be managed very well, she would have to make frequent visits to the maternity clinic for checks.

This presents Vicky with a number of difficulties. The clinic she needs to attend is four miles from her home. She doesn’t drive and has to depend on an unreliable bus service, which is not cheap. She works part-time in a shop and her employer takes an unsympathetic view of her missing work to attend the clinic: she does not benefit from a flexible hours arrangement.

In addition, Vicky collects her daughter from school and arranges her work hours to fit around this commitment. However, her clinic appointments often prevent her collecting her daughter and she has to depend on a friend to take her daughter home to look after her until Vicky gets back from the hospital.

At the clinic, Vicky receives a great deal of information and doesn’t recall all the advice. She sometimes feels she is not in control of her own pregnancy and is unable to discuss her problems because she doesn’t always see the same midwife.

The clinic often runs late and Vicky struggles to get home in time to collect her daughter.

She also smokes the occasional ‘social’ cigarette. She knows she should stop for her own and her baby’s health but finds that smoking eases her stress.

And while she generally handles stress quite well, she admits she sometimes finds her circumstances overwhelming and would welcome some support. She would particularly appreciate the chance to chat with other local mothers-to-be.

After the birth of her son, Vicky experienced some further emotional problems. Her midwife was sympathetic but wasn’t able to give very much guidance about potential emotional changes and Vicky was not signposted to very much support.

Like many new parents, Vicky quickly became concerned if her baby showed any signs of being unwell. But while she wanted the best treatment for her son, she was reluctant to trouble her local surgery for fear of wasting people’s time. Sometimes this means that she is panicking when her husband gets home, so they end up taking their son to A&E for advice – but he has never been admitted.

Vicky - the patient's future perspective

Vicky, now aged 32, is pregnant with her third child. She already has a nine-year-old daughter and a son, aged four.

Her GP has asked her to download an app, Swiftqueue, that helped her book into her first antenatal appointment at a time that suited her. She was able to attend because her daughter was at school and her son at nursery. She checked in through a patient portal when she arrived and waited only a short time for her appointment.

Another app, DrDoctor, found her an empty clinic slot a few weeks later when another expectant mother cancelled an appointment at short notice.

Vicky had continued to smoke the occasional cigarette until she became pregnant for the third time. She mentioned this to her doctor who recommended Inhealthcare, an app that features a library of health services including smoking cessation advice.

Vicky managed to quit smoking. When her midwife encouraged Vicky to have a carbon monoxide test at her first antenatal clinic appointment to test for smoking she did so, and was found to be a non-smoker.

A mother-to-be Vicky met at her antenatal clinic recommended she use the Mush app which connects women with other expectant mothers and helps them form support networks.

Throughout her pregnancy, Vicky has benefited from a number of home monitoring services. An innovative app called HaMpton alerts her if she needs to go to hospital with hypertension, which can be a symptom of pre-eclampsia. The device links her with her local hospital’s computer system.

Vicky had gestational diabetes during her previous pregnancy and her GP, as part of a routine follow-up, recommended she use the GDm-Health app which has successfully controlled her condition.

Vicky also uses the Lincus app. This allows her to record her experience of a number of interventions and describe how she feels, information she can share with her maternity team. This has helped her enjoy much better wellbeing than during her previous pregnancy.

When her son was born, Vicky – like most parents – became very concerned at the first sign of her baby being unwell. She was able to use the CATCH (Common Approach to Children’s Health) app that gave her information about her baby’s condition, as well as guidance and reassurance to provide care at home without having to go to hospital.

Sarah - the midwife's future perspective

Sarah the midwife is finding that her old love for her job – which had abated in recent years – has been rekindled. A number of new digital systems have come on stream that make the clinic a more ordered and peaceful place to work.

In particular, her trust now uses Intouch with Health, a software package that helps her better manage patient flows. The system uses a touch-screen check-in system that seems to put women at ease and helps Sarah’s colleagues work more efficiently. Sarah finds she is able to devote more time to her women and can review the tests she has asked for at the end of the day and contact individuals if needs be. She is now able to leave work on time, most days.

Vicky and her team benefit from a shared record-keeping system in Lancashire, known as LPRES, which has integrated a number of information systems and created a secure digital space where each member of the team can update data about patients. This has helped enormously in contributing to continuity of care. There are similar systems in Cheshire and Merseyside.

A plethora of smartphone apps has eased the burden on Sarah who can now direct her women to a great number of digital resources. She is even able to help women, such as Vicky, who have experienced mental health problems in the past: an app such as Verti, for instance, offers mental health support and keeps users in touch with health professionals.

Self-management apps such as Dip.io are invaluable to maternity services. This app is a smartphone-based urinalysis device, comprising a dipstick and test kit, that can be used in hypertensive pregnancies and for urinary tract infections and considerably ease the pressure on hospitals.

Sarah is also aware of other devices that have improved the care of pregnant women. One such is RespiraSense that helps identify deteriorating patients. This is a patient safety tool that uses a sensor to help clinicians identify a deteriorating patient up to 12 hours earlier than the standard of care.

Meanwhile, Sarah is able to offer support to her women by directing them to the CATCH app after they have given birth which gives them greater confidence in deciding whether, when their child falls ill, they should be cared for at home or in hospital.