ReferBack: Electronic Emergency Referral System (#3060)

Creation
Draft
Initial
Detailed
Accepted
Adoption
Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
ReferBack™ is a secure electronic specialist referral system that standardises the referral process, improves patient care, helps clinicians avoid unnecessary risk, interfaces with the BSR and saves time and money for the clinician and the NHS.
Overview of Innovation:
ReferBack™ provides a simple and secure electronic referral platform that allows medical teams to connect to specialists to assess conditions; refer critical patients and gain advice on treatment options for urgent cases.
ReferBack™ has been developed by Amplitude in conjunction with leading spine surgeons in the UK; is endorsed by the British Association of Spine Surgeons and links directly to The British Spine Registry.

Developed specifically for urgent spine and neuro referrals, the system is pre-populated with precise clinical questions and options that specialists require to make their assessment.

Information is requested in structured forms and clinical questionnaires, relevant to the patients presenting problems. This allows a speedier in-put and selection of symptoms, co-morbidities, test results and observations, needed to gain a whole picture view. This process ensures thorough and consistent patient evaluations.
Patients and hospitals are no longer exposed to the consequences of unstructured and untraceable communications. All communications are tracked and traceable, so patients are not "lost" in the referral process.

ReferBack™ automatically notifies clinicians when a new referral has been received and when advice has been returned via text message, so that "downtime" between teams during any on-going communications is minimised. Communication continues until patient management decisions are agreed.

Clinical administration is simplified and reduced. Additionally, the system interfaces with the British Spine Registry (BSR), reducing the need for duplicate data entry, as the patient is on-boarded directly to the BSR. The use of an electronic emergency referral system and contribution to the BSR was highlighted as best practice recommendations in the 2019 Spinal Services GIRFT Programme National Specialty Report.

In 2016/17 the cost of medical negligence claims against spinal surgery was £135.1 million. Over 75% of these claims were due to ‘judgement / timing’ (512 claims, 52.35%), ‘interpretation of results / clinical picture’ (255 claims, 26.07%). All communications in ReferBack™ are tracked and traceable and can be used in any future litigation queries made about the quality of care received.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
Similar Content3
Innovation 'Elevator Pitch':
Reviewing the causes and treatments of spinal pain
Overview of Innovation:
A one-day course at the Robert Jones & Agnes Hunt Orthopaedic Hospital focusing on spine pain and spinal pain treatments.  It will also focus on possible complications of these treatments.  There will be particular emphasis on audience participation and discussion. 
Topics include: Spine pain (a neurologist's view), Spine pain (a spine surgeon's view), spine interventions (a physiotherapist's view), image guided spinal intervention - what can go wrong (a spinal injuries consultant's view), facet joint treatment, vertebroplasty.
Target Audience: Consultant in Raiology and Orthopaedics/Spinal Surgery, Physicians in Pain Medicine, Anaesthetists, Anaesthetic, Orthopaedic and Radiology Registrars, Allied Health Professionals
Registration Fee:
£100
For information: sian.jones36@nhs.net
To book: www.orthopaedic-institute.org/courses
 
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Education, training and future workforce
Benefit to NHS:
Increases understanding and treatment of spinal pain
Benefit to WM population:
Increases understanding and treatment of spinal pain
Current and planned activity: 
This course is run at the Robert Jones & Agnes Hunt Orthopaedic Hospital, the largest centre of orthopaedic excellence in the country.  The Orthopaedic Insitute, who runs this course, is a charity providing funds for research and education within the hospital.  This is ongoing and is one of the many reasons the hospital has the pre-eminent reputation it does in terms of patient care.
What is the intellectual property status of your innovation?:
Confirmed
Return on Investment (£ Value): 
N/A
Return on Investment (Timescale): 
N/A
Ease of scalability: 
Simple
Rejection Reason:
Unsuitable for Campaign
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Innovation 'Elevator Pitch':
The TUC Safety Valve eliminates risk associated in treating patients requiring TUC by preventing inadvertent balloon inflation in the urethra thus preventing traumatic injuries which prove costly to both patient safety and health system expenditure.
Overview of Innovation:
Urinary catheter related injuries typically occur in patients when the catheter’s anchoring balloon is inadvertently inflated in the urethra instead of correct inflation in the urinary bladder. Approximately 1.3%-7% of patients receiving an indwelling catheter will sustain iatrogenic urethral trauma during the insertion process through inadvertent balloon inflation whilst misplaced in the urethra. Many more patients outside of the hospital setting (ie. community care) rely on TUC as part of their daily lives, thus the scale of the issue at large is under reported. Injuries are more common in vulnerable patient groups such as spinal cord injury patients, pregnant females with distorted urethral anatomy and elderly men dependent on long-term urinary catheters or supra-pubic catheters.
 
In 2016, a prospective study in two hospitals from Republic of Ireland over 6 months highlighted that 37 urethral injuries occurred across the two hospitals during the placement of 2,750 catheters resulting in a healthcare cost of €335,377 exclusive of long-term complications, outpatient care and medico-legal costs. There were an additional 330 bed days and 17 ICU days required as a direct result of these injuries. This resulted in a cost in excess of €122 per catheter placed in these hospitals to cover the costs of iatrogenic injuries caused during the procedures. In 2019, a follow up study from the 37 patients who received urethral injuries highlighted 2 patients died as a result of urethral trauma related to TUC.

The patent protected TUC Safety Valve, is a novel, innovative, clinically proven technology preventing the risk of inadvertent inflation of the Foley catheter retention balloon in a patient's urethra instead of the bladder, as intended. It uses a safety pressure relief valve to indicate misplacement of the retention balloon during catheterisation, eliminating urethral damage. Once the valve has “popped” it will automatically deactivate once the user ceases depressing the syringe plunger so that it functions effectively throughout the procedure. The flow restrictor prevents rapid inflation of the retention balloon (an act which has the potential to allow a portion of the fluid to bypass the pressure valve and cause partial inflation of the balloon even when mispositioned) in the urethra.

View articles:
https://doi.org/10.1007/s11845-014-1120-5
https://doi.org/10.1016/j.juro.2016.05.114
https://doi.org/10.1016/j.urology.2018.02.026
https://doi.org/10.1007/s00345-019-02775-x

 
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Innovation and adoption / Patient and medicines safety
Benefit to NHS:
Urinary catheterisation yields significant volume of iatrogenic injuries with serious short & long-term patient complications that have substantial financial, resource, and medico-legal implications. Such injuries lead to an increased burden on resources, inpatient/ICU beds and workforce in the NHS.

Up to 25% of all hospitalised patients undergo routine Trans-Urethral Catheterisation (TUC) during their stay. Many more patients outside of the hospital setting (ie. community care) rely on TUC as part of their daily lives, thus the scale of the issue at large is under reported. TUC is more challenging in male patients due to the tortuous anatomy of the male urethra and due to prostatic hyperplasia however this risk is not limited to male patients nor solely adult patients.
Another cost measurement to consider is medico-legal claims against health organisations. In a 2011 British Journal Urology International publication, between 1995 to 2009 in the NHS 493 urology related claims were closed with indemnity payment with an average of 35 successful claims per year. In all, £20,508,686 was paid out, averaging £41,599 per claim.

Assuming a conservative 0.55% incidence rate (lower than the studied incidence rate), using the example of an 1,800 bed capacity NHS Trust:
  • 21,600 catheterisations per annum @ £10 per catheter kit = £216,000
  • 118 urethral traumas per annum (21,600 catheterisations * 0.55% incidence rate)
  • (1053 additional bed days, 54.5 additional ICU bed days)
  • £948,542 in complication costs + £216,000 total catheter spend = £1,164,542
  • 21,600 TUC Safety Valve @ £15 = £324,000
  • Net Yearly Cost Reduced from £1,164,542 to £540,000 (catheter kit + TUC Safety Valve)
Complication costs relate directly to immediate care required to manage urethral injury complications ie. additional bed days and ICU days incurred.

Using a reference of 142,000 in the NHS, assuming the above 0.55% incidence rate:
  • 1,704,000 catheterisations per annum @ £10 per catheter kit = £17,040,000
  • 9,372 urethral traumas per annum (1,704,000 catheterisations * 0.55% incidence rate)
  • Average 35 medico-legal claims @ £41,599 = £1,455,965
  • £75,336,742 in complication costs (83,627 additional bed days, 4,325.5 ICU bed days)
  • + £17,040,000 total catheter spend
  • + £1,455,965 total medico-legal claim
  • = £93,832,707 total NHS catheter care spend per annum
  • 1,704,000 TUC Safety Valve @ £15 = £25,560,000
  • Net Yearly Cost Reduced from £93,832,707 to £42,600,000 (catheter kit + TUC Safety Valve)
 
Initial Review Rating
4.60 (2 ratings)
Benefit to WM population:
As the manufacturing organisation (Class Medical Ltd) aspires to grow and develop an organisational structure in the UK to further promote and enable adoption of the TUC Safety Valve in the UK and Internationally, there is potential for an office base to be located in the UK with recruitment of a sales/clinical engagement team, marketing persons and a small administration and logistics team. This could benefit the WM region should the company decide to locate their office base in the UK as WM is a central location with access to a good logistical network and access to a skilled workforce.

From a patient perspective, through delivering upon the NHS ethos ‘Do No Harm’ by preventing: unnecessary adverse events, short and long-terms complications, unplanned care episodes, avoidable trauma, inpatient admissions, referrals to A&E and morbidity, the health and safety of the overall WM population (whom require TUC as part of their care) enables a better health economy whilst also reducing the strain on services in the region allowing a more efficient service to be provided. This in turn aids the local economy and resources can be allocated more efficiently and effectively to better support the needs of the population.
 
Current and planned activity: 
The TUC Safety Valve is pending CE and FDA Approval, both of which are on schedule for December 2019 as the final benchmark testing of sterility (shelf life) is finalised.

Commercial launch will take place internationally in January 2020. In the meantime, MedTech Connect Ltd are acting on behalf of Class Medical Ltd in the UK and internationally in engaging with KOL's, regulatory bodies, healthcare organisations and health innovation partners to identify pathway to adoption.

In the UK, we are identifying with AHSN partners regional sites for clinical evaluation and engaging discussions with community healthcare providers highlighting the safety and cost burden Urethral Trauma secondary to TUC in order for the TUC Safety Valve to be considered as part of the catheterisation pathway for patients and an effective value proposition to be delivered. NICE have also selected the TUC Safety Valve for selection by the selection committee to move forward with relevant guidance.
 
What is the intellectual property status of your innovation?:
Class Medical has a strong IP position, and no other syringe or catheter exists in the EU for TUC that has any safety features. The IP currently resides with the University of Limerick. The TUC Safety Valve was granted patents in the USA in October 2016 and the EU in January 2018. The simplicity of the design makes it very difficult to replicate. Importantly, the IP covers the device interface parameters with the human body and rate of inflation preventing a false positive signal. Parameters patented make it extremely difficult for other syringe or catheter designs to operate in the design window.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
3
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Innovation 'Elevator Pitch':
Amplitude pro enterprise™ uses simple technology to capture clinical and outcome data for specific diseases, diagnosis, interventions and care pathways. Data is retained locally and available for immediate reporting and analysis.
Overview of Innovation:
The Amplitude pro enterprise™ software is a simple, tailored online platform centred around two crucial elements:
A user-friendly electronic patient portal which gives patients the freedom of completing their scores online at home, on site and via various devices and a consultant dashboard giving the clinician(s) the ability to input patient specific complexity factors and procedure data quickly and easily.

The result is representative, accurate and meaningful data that paints a clearer picture of each patient’s level of health and expected recovery. Clinicians are engaged with the clinical outcomes processes at your hospital, you get the insight required to innovate your clinical services and patients get a consistently high standard of care.

pro enterprise™ is simple, cost effective and delivers precise and accurate data, selecting scores that are identified as important to you.

The data you collect in pro enterprise™ will allow you to monitor your service delivery, identify quality issues and demonstrate levels of care. Your hospital can be confidently transparent about its activities, resulting in reassurance to your peers that you are offering the best care possible.

Amplitude specialises in the collection of electronic PROMs and clinical outcomes and we are the leading supplier of electronic PROMs to the NHS. We are accredited by NHS Digital for the electronic capture and upload of National PROMs and our platforms have achieved the highest levels of IG compliance, using data centres that are ISO27001 certified. 

Amplitude's unique data exchange tool means that you enter and retain your data locally in your pro enterprise™ platform and the necessary data for clinical registries, National PROMs and NJR can be  pushed to the relevant databases on your behalf.

Our systems are designed to empower clinicians in adding value to their data e.g. proper case mix adjustment, log-book, revalidation report and easy analysis and self-monitoring tools. The system automates the process of data collection via a series of reminders sent to patients via email and SMS. These reminders are triggered from the intervention data which at minimum includes procedure/intervention description and diagnosis. 

Amplitude pro enterprise™ is customised and tailored to suit specific department requirements and objectives including virtual clinics, clinical outcomes and PROMs. pro enterprise™ is currently being used in T&O, Rheumatology, Urology, Cardiology and Mental Health departments.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Advanced diagnostics, genomics and precision medicine / Wellness and prevention of illness / Education, training and future workforce / Clinical trials and evidence / Digital health / Innovation and adoption
Benefit to NHS:
The Amplitude pro enterprise™ system captures and manages clinical and PROM’s outcome data with the key focus to improve overall quality of patient care.
NHS healthcare professionals are required in many specialist areas, to monitor the long-term effects of treatments.  Historically, these were captured on a macro level and this mass gathering of non-specific data, results in outcomes data that is non-meaningful and without sufficient detail or context, preventing its use in making effective, informed clinical and management decisions.
In addition, due to the paper-based nature of how PROM’s and clinical outcomes were historically gathered, often, data would only be made available months after being gathered and in an aggregated and anonymised format, rendering it out of date and of little value.

With Amplitude pro enterprise™, The NHS benefits from the ability to;
  • Capture the clinical outcomes of patients in larger numbers and in an electronic format,
  • Effectively measure the quality of care provided by clinicians in real-time
  • Measure the efficacy of the treatments being used on a local, national and international level
  • Reduce costs associated with carrying out the required questionnaires in a paper format
  • Use the data gathered to compare treatment plans and ensure that patients are receiving the best possible care available
  • Increase clinical and patient compliance and engagement in outcome data collection
  • Meet the challenge to make the NHS paperless
  • Opportunity to provide multiple language options; allowing the patient to complete their electronic questionnaires in their native language instantly
  • Use Amplitude's unique data exchange tool to automatically upload required registry data when the information is gathered in the Amplitude pro registry™ platforms, thus reducing administration, duplication of effort and importantly, retains the outcomes data at the source pro enterprise™ system, allowing instant insight
  • Access to comprehensive reporting tools, that include templated validation reports for individual clinicians, further reducing resource, time and effort
Amplitude pro enterprise™ provides the NHS with a paperless, streamlined data gathering software, that reduces costs, has real-time results, meaningful insights for clinical and managerial decision makers and ultimately improves the overall quality of patient care.
Initial Review Rating
4.80 (2 ratings)
Benefit to WM population:
The West Midlands AHSN covers 6 regions within the NHS; Birmingham and Solihull, The Black Country, Coventry and Warwickshire, Herefordshire and Worcestershire, Shropshire and Staffordshire.

Within this area, there are 33 NHS Trusts servicing the needs of a population of approximately 7.225 million (ONS 2017). According to the ONS, 18.2% of the population were aged 65 years and over.
It is also documented that over half (54%) of older people have at least two chronic conditions increasing to 69% among those aged 85+ (Kingston, et al., 2018).
Multi-morbidity increases the likelihood of hospital admission, length of stay and likelihood of readmission, raises healthcare costs, reduces quality of life, and  increases dependency. (Kingston et al., 2018).

These are all operational factors being faced in the West Midlands region and the implementation of innovative technologies, to help manage the growing dependency on the NHS, are essential.
The implementation of Amplitude pro enterprise™ will not only allow for monitoring outcomes, it can also use the outcomes data to manage workloads, triage clinics and help to influence operational management. 

Eg; fracture clinics see all patients admitted to A&E with musculoskeletal problems, the system could reduce the number of follow up appointments in Trauma and Orthopaedics clinics by assessing cases in a virtual clinic, prioritising the appointments of patients that require surgery or a clinic appointment and booking those that are less urgent into follow up clinics.

Or: The Amplitude pro enterprise™ platform can provide the method of prioritising more urgent cases in Rheumatology or Cardiology clinics, allowing urgent cases to be seen ahead of patients who are performing well with their current ongoing treatment plan.

Managing the patients according to need and not by pre-set time frames, could help to prevent potential A&E visits by patients who deteriorate or do not respond as expected to their treatment plans.

Administrative workloads can be reduced, and the overall quality of care provided to patients can be dramatically improved, whilst overall cost savings are obtained as a result.

In addition, administrative productivity can be increased with the data exchange tool. For mandated registry data submission such as National PROMs, NJR and now BSR (Apr 2019), data is entered just once and the Amplitude pro enterprise™ platform uploads the relevant information as required, with the data being retained for local analysis.
Current and planned activity: 
With a wealth of NHS experience in the Amplitude team, the products we design and develop have NHS priorities and needs at the heart. When the pro enterprise™ platform is deployed into a hospital or trust, the Amplitude development team continue to improve the system to best service it’s users. Upgrades are released annually, upgrading the functionality on a regular basis.

CCG’s are looking at commissioning based on outcomes and lucrative contracts are sent to the trusts and hospitals with the best results. pro enterprise™ ensures boards can evidence their results to win these contracts, adding funding to budgets.

pro enterprise ™ promotes interoperability. The ability to receive data via exchange from a growing number of PAS’s is a major factor in reducing administrative workload and costs, but when this technology is combined with the ability to also push the data (electronically) to populate the associated registries too, the benefits and cost reductions are multiplied.
What is the intellectual property status of your innovation?:
Amplitude Clinical Outcomes own the intellectual property rights on this platform.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
2 years
Ease of scalability: 
Simple
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