Wilhelmina Hospital Assen (WZA) now has more than half a year of experience with the Luscii app, and enthusiasm levels are high. Evaluations show that patients feel safer, the cooperation between professionals is running smoothly and Luscii is easy to use. Therefore, the hospital has decided to expand. Initially, within the heart failure department, but with ambitions to extend even further.
It was back in April 2019 that the first patients at WZA’s heart failure clinic were introduced to the Luscii app. Since then, patients measure their own pulse, blood pressure and weight at home, which means they no longer need to visit the hospital for check-ups. The measurement data is then sent via the Luscii app to the Medical Service Centre NAAST. Is there a rise in weight or blood pressure? If so, NAAST informs the heart failure nurse in the WZA immediately. With a razor-sharp video connection, the nurse can make direct contact with the patient to assess the situation.
Nurse takes the lead
Stoer, a heart failure nurse in training, is one of the initiators. ‘At the outpatient clinic, I often see people returning for check-ups. And yet, agendas are bulging. I asked myself: could we not do something differently? We already had a vision document on remote guidance in the WZA, so I started to look for suitable systems. Then I came across Luscii. Coincidentally, our board was already in contact with Luscii’. A meeting was then arranged between cardiologist Richard de Jong, WZA director Suzanne Kruizinga and Daan Dohmen, the founder of Luscii. And Erica Stoer? She joined too. ‘We are a relatively small hospital with more direct lines. Everybody knows each other. The fact that I was a part of such a conversation as a nurse fits in with that philosophy. Ultimately, I’m the one who has to work with the system’.
About thirty patients with heart failure are now connected to the Luscii app, and enthusiasm levels are high. Evaluations show that patients feel safer. The collaboration between professionals is also going well and the Luscii technology is easy to use. That’s why the decision was made to continue to expand. Initially to fifty patients, but the ambitions of the hospital extend even further.
Step by step
‘The growth from thirty to fifty patients is an intermediate step’, according to cardiologist Richard de Jong. ‘We need to gain experience and adjust the organisation where necessary. Of course, I would prefer to supervise all my heart failure patients remotely. It is still too early for foregone conclusions, but several studies have since shown that remote guidance stimulates a patient’s insight into their own illness and encourages self-management. We even expect that the number of acute admissions will decrease in the long term because we can spot deterioration earlier. Growth in the number of patients does mean a shift in outpatient work. Nurses are now in charge of remote guidance. They are doing a great job, but they must be facilitated in that responsibility. For them, I am merely a supervisor and a back-up’.
The right care in the right place
Director Suzanne Kruizinga, formerly a doctor in emergency care, thinks it is a wonderful development. ‘We are eager to scale up extensively with Luscii. I would prefer to include all patients who need care for a longer period of time in the home measurement program today. The aging population is increasing the number of patients while specialist nurses are becoming scarcer. The right care in the right place offers a solution and Luscii’s technology helps to implement it safely. In addition, we desperately need to involve patients more in their treatment. Research shows that telemonitoring offers a starting point to achieve this goal’.
Sometimes, Kruizinga experiences some opposition within the organisation. ‘Healthcare professionals have to let go of their patients and that is not always easy. But’, she puts the resistance into perspective, ‘it is, above all, a challenge to steer the enthusiasm about remote guidance in the right direction. Every week, I have a medical specialist at my desk who has big plans for home measurement. And we had to stop recruiting patients because we couldn’t handle the influx. I want to scale up as quickly as possible, but carefully, too. Remote guidance means adjusting processes. I prefer to do that without overhauling the entire organisation. Learn, grow and consolidate, that is the goal. There must be room to try new things and make mistakes. And the revenue model must also be right. But I am confident that, together, we can make the transition a success’.
Health care insurer happy with safe care at home
Many people like being treated at home’, says Rutger de Vries, senior buyer at health care insurer Zilveren Kruis. ‘They feel that this type of care gives them more control over their lives, flexibility and comfort. So, we are happy with the upscaling within the WZA. The hospital puts innovation to the fore. Periodic check-ups for chronically ill seniors have long been the rule, but home measurement offers many benefits. It leads to customisation and prevents patients and their loved ones from having to travel unnecessarily. Hospitals see that. However, it requires a change in organisation and different ways of working. For example, nurses need support in their new role. We continue to actively look for options to organise healthcare in a smarter manner and are subsequently following developments in the WZA with more interest than usual’.
De Vries agrees with Suzanne Kruizinga that the revenue model of the WZA needs attention. ‘When hospitals are successful with telemonitoring, this leads to fewer visits to the outpatient clinic and emergency department. That is good for the patient and healthcare costs, but not for the income of the hospital. We are currently in discussions with the WZA about compensating for such a loss of income. After all, money cannot put the brakes on this great development. We will look together at which type of contract offers the best solution’.
In the meantime, the WZA has not been idle. With the publication of this article, the upscaling to fifty patients has long been achieved and there are concrete plans to use the Luscii app in other specialties, including oncology and surgery.