A new digital platform for managing behavioural assessments in neurorehabilitation is aiming to improve the lives of up to 10 million patients, clinicians and carers over the next 10 years. NR Times finds out more.
Inadequate understanding of behavioural risks among brain injury patients is estimated to cost the NHS £2.5 billion a year through adverse incidents and staff turnover.
Current behavioural risk assessments are typically carried out on paper, but wards and staff are extremely busy and this data collection is often slow and inconsistent.
To tackle this, award-winning health tech company, Decently, has developed a new platform which aims to streamline and simplify these assessments, using data to support clinicians in making evidence-based care decisions and ultimately, reduce the impact and number of incidents of challenging to manage behaviour.
Over the last 15 months, MeloTM, has been developed and rolled out among clinicians at Salford Royal Hospital, to help facilitate better decisions around behavioural management through intuitive data collection, visualisation and advanced analytics.
Following a successful pilot programme, the company is now looking to expand into a number of NHS trusts and private healthcare organisations across the UK. Co-founder of Decently, James Burch, and Dr Alistair Teager, consultant clinical neuropsychologist at Salford Royal, tell us more.
James Burch, co-founder, Decently.
At Decently you are passionate about improving lives through digital solutions, can you tell us how the idea for your first product, Melo, came about?
James: A couple of reasons, back in the autumn of 2021 we had someone reach out from The Walton Centre in Liverpool, who knew about our previous work within the space of digital risk assessments. They had a challenge around behavioural management and the behavioural assessments that relate to that, particularly among those recovering from brain injury and what they refer to as ‘challenging to manage behaviours’. But also at a similar time my co-founder, James Chapman, had a close friend going through neuro rehab as a result of a traumatic brain injury resulting from a fall. James saw first hand the impact on his friend and loved ones.
These events started an 18 month period of discovery across a number of trusts. In that time we spoke with 300+ individuals from across various in-patient settings to better understand both the challenges and the opportunity to make a difference. In 2022, we were introduced to Dr Teager and started some discovery sessions with clinical teams to understand more around the status quo currently of behavioural assessments, which was largely very slow, inconsistent and less data-driven decisions were being made because there was no bringing together of that data into a place that was helpful for teams looking after patients. These initial meetings led to a 15 month project where we were able to take all of this thinking, designs and prototypes and create what is now Melo™— a digital platform that begins by bringing online some of their existing paper-based processes with a long-term view that through the use of AI it can really start to make a difference as we build up a data-set in neurorehab inpatient settings.
What do we know about how much of an issue challenging behaviour is in brain injury healthcare settings?
James: We looked at it from a global perspective in terms of traumatic brain injuries, all the way down to specific issues at Salford, and we’ve done some work looking more broadly into other neurological conditions where behavioural management and assessments of some kind take place, whether it be dementia or more complex mental health. But certainly within traumatic brain injury, we know that somewhere in excess of 50 million people a year globally experience some sort of TBI and 40-60% of those will develop challenging to manage behaviours, either in the early part of their rehab or for many of them it can be something that they live with as a lifelong challenge.
What about the cost implications on the NHS?
James: Salford Royal knows that on their inpatient wards, a patient that is displaying challenging to manage behaviours will have an extended stay of approximately 19 days, which can amount to approximately £9,000-£10,000 per patient. So there’s an immediate, obvious cost there because there’s not only the management of the patient on the ward for that extended period of time, but also the need for ongoing assessment of where they should go next in their care pathway.
If members of staff are absent through stress or get injured in the course of managing a challenging patient, we know (from NHS England) that litigation can be £20,000-£30,000 per case. Then there’s obviously the operational impact of staff having to take time off, people leaving the profession as well as a not insignificant cost of the paper-based process at the moment and the insights that are missed because of the fact that it’s not a joined up process. If we can make a positive impact on some or all of these costs through the use of Melo on top of improved patient and staff wellbeing then that would be fantastic.
Is the aim for Melo to be rolled out more widely in the NHS?
James: Certainly within the NHS, but also in private settings. We’re aiming to bring on board probably another four or five NHS trusts this year, but we’re also in advanced discussions across quite a few large private providers. We are also exploring the potential for Melo to roll-out further through a patient and family version – however, this is still in the early days right now.
Can you explain how the platform is used in real-terms, as part of clinical practice?
Alistair: We have been evaluating the Melo platform in the Northern Care Alliance to see if we can improve the way we assess and understand challenging to manage behaviours in neurorehabilitation services. This has included running focus groups with MDT members, stakeholders, and users in order to help develop the platform, and using digitised versions of common tools for assessing challenging to manage behaviours, such as the Agitated Behaviour Scale (ABS) and Antecedent Behaviour Consequence (ABC) charts. In turn, these have helped inform MDT work and behavioural support plans.
Photo supplied by Melo.
What impact, if any, did you notice it had in terms of helping staff better understand the challenging behaviour of patients?
Alistair: By gathering more routine data on challenging to manage behaviour, we have been able to build closer working relationships with MDT members. We feel that we have helped staff better understand what challenging to manage behaviour might look like, and ways in which challenging to manage behaviour can be assessed. We also feel that the Melo project has opened up more conversations and discussions about challenging to manage behaviours, and the data we have been able to gather has improved a number of behavioural support plans for patients on the wards.
How do you envision that the platform will utilise AI to help prevent or reduce incidents?
James: To begin with, Integration is going to be a vital part of Melo’s ongoing proposition. We want this data to be joined up and working alongside an existing electronic patient record system. I think when you are specifically looking at a patient group or from a ward point of view, staffing levels and how you workout the best use of your resources, then Melo would have a lot of that data all in one place.
The exciting bit then is if we can get to that point of having a big data set, what are the clinical insights that can be gained when we’ve then got hundreds, thousands of datapoints within Melo? We would bring it into our AI model in an anonymised data set with the aim to move to predicting spikes in patient behaviour and informing learning and best practice. We’re working hard to build that community where clinical and data science come together to see what insights can be made.
We’re working closely with the Hartree Centre in Cheshire, a supercomputing centre that’s linked into the UK Government’s Science and Technology Facilities Council and is giving great insights into the potential AI roadmap for health tech organisations.
What about your aims in terms of improving patient outcomes?
James: Our aspirational vision is to positively impact the lives of 10 million patients, clinicians and family members over the next 10 years. We know that the impact of challenging behaviour first and foremost, of course, impacts the patient, but there is also the impact on family members when they move back home and the staff that care for them.
Both myself and my co-founder have friends who have been impacted through brain injury and in many cases people aren’t the same as they were prior to the injury.
Melo is a clinical-facing tool at this stage and it’s got a heavy amount of input from clinical neuropsychologists and other staff across the multi-disciplinary team, but also we would want to see how it can be used by the patients and family members themselves as part of their ongoing recovery.
The patient through no fault of their own is experiencing these challenges and if we can improve the understanding of those behaviours and triggers related to their environment, medication, times of day or certain interactions, then I think that can really impact a lot of people.
Alistair: We felt that we were able to gather and analyse behavioural data more quickly and in a standardised way, and that this improved our ability to support patients and staff struggling with challenging to manage behaviours. We also felt that we were able to identify potential challenges to manage patients earlier, and that the quality of information being gathered improved. By getting quicker, richer data on challenging to manage behaviours, we felt that we were able to provide more timely, person-centred support for the patient, family, and staff.
Find out more about Melo here including a Salford Case study video and coming soon, the full evaluation report from the Salford project
