3 March 2023
The children we support are extremely vulnerable, and any delay or interruption to the treatment they receive could have serious implications for their recovery. Being able to deploy a solution so rapidly enabling us to continue helping them has been a real relief - Michele Boyce, Service Lead Nurse, Kernow Health
Children with eating disorders would normally receive clinic-based care, but this is not possible during the COVID-19 pandemic.
How has Cornwall Partnership NHS Foundation Trust adapted its service to support this cohort of patients?
What we did:
Since 2017 Kernow Health CIC has delivered the Children’s Eating Disorder Service (CEDS) Physical Monitoring Service on behalf of Cornwall Partnership NHS Foundation Trust (CPFT) CAMHS as a sub-contractor. The Physical Monitoring Service team offers physical monitoring to children (8-18) with a range of restrictive eating disorders including Anorexia Nervosa. Children attending face to face clinics for monitoring of their vital signs and symptoms.
The demand on the CEDS Physical Monitoring Team has grown from a case load of 36 patients in 2017 to one of 161 in February 2022 (home and Face to Face monitoring). This increased demand is reflective of the national trajectory, “the number of young people completing an urgent pathway for eating disorders has increased by 141 per cent between quarter four in 2019/20 and quarter one in 2021/22” (Mental Health Network, 2021) due to the impact of the Covid-19 pandemic on children and young people’s mental health, and is expected to continue.
In November 2020 the NHS committed to investing into early intervention services to support young people in the early stages of eating disorders – First Episode Rapid Early Intervention for Eating Disorders (FREED), as part of the NHS Long term plan. With eating disorders causing serious physical and mental health problems which can last decades, the NHS expanded service will target care to those who have been living with a condition for fewer than three years, to tackle problems before they escalate.
In 2020, due to restrictions in place during the pandemic, risks to patients and practitioners, and a reduction in the use of onsite premises, it was essential for the CEDS Physical Monitoring Service team to find alternative ways to engage with their cohort of patients. Working with Tunstall, who had a well-established programme working alongside Cornwall Foundation Trust providing Digital Health Service remote monitoring by nurses for patients with Respiratory and Cardiac Conditions, Kernow Health and Tunstall were able to introduce remote health monitoring for patients.
About remote health monitoring:
Patients use Tunstall’s myMobile app and peripheral medical devices (e.g. blood pressure monitor, thermometer and scales) in their own homes. They also access a special health interview that was developed based on the Junior MaRSiPAN (Management of Really Sick Patients with Anorexia Nervosa) risk assessment framework.
Depending on the child’s assessed physical risk monitoring ranged from daily to monthly, patients use devices to take their vital signs:
They then answer the following symptom related questions:
All the information is collected via the myMobile app on the patient’s smart device, and is automatically uploaded to ICP triagemanager, where any breaches of parameters set for individual patients will raise an alert on the system.
Clinicians can log in to a secure portal to view a colour
coded dashboard which prioritises patients according to
the need for intervention. Individual patient’s readings can
also be viewed over time to monitor their progress.
Home monitoring was easy to setup and use, and meant no issues with missing school. Feedback was quick by text and ensured the team had up to date readings to hand and could communicate any concerns. Our daughter was able to use the monitoring equipment herself and this helped empower her in her recovery from her eating disorder. I believe the home monitoring contributed to a faster recovery time. - Patient's Family Member
Feedback from patients, families and clinicians involved in the service is very positive. Benefits include:
A total of £81,000 costs were avoided (FY 2021/22) as a result of the remote monitoring service due to reduced inpatient stays, Emergency Department stays, and use of the community clinic room, as well as reduced environmental impact, with the service saving: