Gloucestershire Hospitals NHS trust, in the UK, has reduced unnecessary referrals to A&E by up to 83% since installing Cinapsis, a digital triage platform that could help UK hospitals tackle the consultation backlog that has built up during the COVID-19 pandemic.

Cinapsis allows GPs to ‘beam in’ consultants via an app, maintaining specialist support while reducing the need for hospital visits, and enabling A&E trips to be triaged in advance.

Beginning with GP practices, the platform has been rolled-out across the One Gloucestershire partnership since December 2018. Seventy per cent of dermatology referrals have been managed without a face-to-face hospital appointment as a result. Since the coronavirus outbreak, 32% of patients with COVID-19 have been cared for safely at home – relieving the pressure on hospitals.

GPs use ‘smart referrals’ via the app to contact consultants who can then offer advice via voice, video, image sharing or messaging – meaning that only patients who need further clinical support are referred for physical appointments.

Founder of Cinapsis, ENT surgeon Dr Owain Rhys Hughes, said the concept of the platform was based on understanding the importance of strengthening existing relationships within the healthcare network.

“GPs want to talk to clinicians in their local hospital,” he said. “They want advice, and advice on how to implement it within their own health system.”

Dr Hughes said enabling easier collaboration between GPs, emergency healthcare workers and specialist means that decisions can be made quickly and seamlessly.

“This is crucial at a time when we run the risk of serious collateral damage in public health post-COVID-19,” he said. “There’s a significant backlog in the system for specialist treatments and appointments, so we’re putting consultants in the hands of GPs to speed up the process, so long waits and longer waiting lists can be completely avoided.”

A number of other trusts are currently in the process of adopting the platform.

WHAT'S THE IMPACT 

Cinapsis is designed to help both GPS and clinicians with their day-to-day work but Dr Hughes acknowledged that acute medical consultants – already under considerable pressure – might initially wonder what’s in it for them.

“We needed to address their pain-points,” he said. “Their unpredictable workload – not knowing when a referred patient might turn up in A&E, but aware that they’d have to leave their own department to see them, perhaps even at the end of a busy shift.

“Cinapsis gives them control of their workload from primary care. They can defer patients who can wait, call in those who need to attend A&E, convert others to planned care so they will be seen in an environment where the patient is expected.”

WHAT'S THE TREND 

Dr Hughes said Cinapsis is a pragmatic solution to many of the problems that are arising from COVID-19. Patients are anxious about attending hospital appointments in person. In the ‘new normal’, hospitals will have to operate with social distancing – reducing capacity and slowing throughput.

“The most important thing in building a technology platform like this is empathy,” he said. “You have to listen to what people are telling you. We sit between organisations and people who work differently within the same network – and we had to listen to both sides to understand what would help them.

“They all really want to do their best for the patient – and they work remarkably well together. This just allows them to do things more efficiently.”

ON THE RECORD 

“Not only are we helping to reassure and better manage our patients by giving them the benefit of specialist advice, we are also reducing demand on busy hospitals by making properly informed decisions,” said Dr Malcolm Gerald, lead GP on the Cinapsis project in Gloucestershire.

“Our data shows that following discussion with a specialist, around a third of COVID-19 patients whose referring clinician had significant concerns about them did not need to be admitted to hospital. This has reduced unnecessary patient, family and staff exposure to the virus, whilst keeping important bed space free for those most in need.”