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Telemedical solution for pregnancy complications

Distance monitoring Denmark
Pregnant women experiencing complications are offered home-monitoring options. Home monitoring is offered to pregnant women with preeclampsia, premature drainage or other complications or medical conditions. Admitted pregnant women make self-monitoring today as well using the same technology. The solution will replace many hospitalisations and hospital visits, benefitting pregnant woman and hospital staff.
Many hospitalizations for women with premature drainage before week 37 of the pregnancy can be avoided because pregnant women will be able to self-monitor their pregnancies. Some of the usual outpatient visits are replaced 1:1 by telemedicine. For such complications there is an estimated potential of reducing hospitalizations by 5,850 days across Denmark.
Users of the solution are pregnant women experiencing at least one of the following complications; increased complicated blood pressure, preeclampsia with chronic hypertension, mild to moderate preeclampsia, premature drainage before the 37th week of pregnancy without regular contractions, previous severe preeclampsia. These pregnant women would otherwise often be hospitalized. It is estimated that there are 2,600 women with these five types of complications at a national level.
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Quotes/testimonials

“This is my first child so it was devastated when it went wrong in week 28 and I really think that being able to stay at home made a difference. I had premature drainage and would normally have had to be hospitalized or visit the hospital on a daily basis in order to take measurements. I have been able to take my measurements at home in the morning, finish within an hour and then do the things I needed to do. I have always had a lifeline to the hospital so taking the measurements at home hasn’t made me feel insecure. I don’t know if it’s because Lone (midwife) explained so much to me at the start, including how to take measurements, and that I had a direct phone number for the hospital. I have never felt worried about taking the measurements at home”.

- User

Elaboration

Needs and challenges

Women with pregnancy complications must visit a hospital for a check-up. These check-ups are often time consuming for both the patient and healthcare staff.

This solution enables women to take the measurements themselves at home and hospital staff can then focus on the patients that need a physical meeting.

Solution and function

Pregnant women take their measurements at home before 09.00 and the midwife or nurse at the hospital examines the data. Measurement discrepancies will be discussed with the obstetrician.

The telemedical equipment package comprises:

  • A tablet
  • A blood pressure device
  • Test strips for measuring protein in urine
  • CTG device for measuring contraction activity and foetal heart sound
  • Pregnant women with premature drainage before week 37 of pregnancy also receive a CRP meter for measuring infection parameters particularly relevant to this target group
  • Scales

Implementation

The workflow in the hospital department has been redesigned so that telemedicine services replace hospital visits, rather than telemedicine services being added to the existing set-up.

Nurses and midwifes have been trained in the use of telemedical equipment and pass on their knowledge to pregnant women. The staff already know which results they must be aware of and will therefore not require any further training in terms of treatment.

Economy

Costs are primarily driven by costs for healthcare professionals in connection with the coordination and control of the telemedicine being performed.

There are also costs related to training pregnant women with complications in the use of telemedical equipment, as well as costs related to running and maintaining telemedicine.

Cost in terms of implementation relate to project management and the training of health professionals.

Investment costs amount to around 25% of all costs over a 5-year period. The business case estimates a net savings potential of DKK 18 million over five years.

Process

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Communication

Pregnant women and health professionals communicate through mandatory follow-up meetings and via phone if any of the results give cause for concern.

In the event of undesirable results, the woman in question will be told to visit her midwife/obstetrician at the hospital.

More about effects

During the implementation phase, the organization successfully reduced the number of hospital beds for pregnant women with complications by 44%.

The introduction of telemedical home monitoring for pregnant women with premature drainage before week 37 of pregnancy enables an average reduction in hospitalization time of 22 days of admission per procedure.

For the other sub-target groups, the introduction of telemedical home monitoring enables a cost reduction of 45% per outpatient control as a result of less time spent per individual control.

Pregnant women with complications are satisfied with the telemedical solution as it contributes to a greater level of safety and flexibility in the process. In addition to a greater degree of safety and flexibility, the telemedicine solution also requires greater skills and the opportunity for pregnant women to assume greater responsibility for their own treatment.

Learnings

Do you want to know more about the solution?

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Users will need to be trained in how to take measurements, all of which are fairly basic. The health care already know what results is alarming and can act on the basis of this knowledge.  

The solution can be used for all pregnant women who have at least one of the five complications mentioned in order to reduce the number of visits to the hospital and the number of hospitalizations.

It can be used in any setting, as long as pregnant women have access to the necessary equipment, which will be provided by the hospital. 

Lone Holst, Aarhus University Hospital

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