Background
Epsom and St Helier University Hospitals NHS Trust (ESTH) serves a diverse population, with 36% of patients from global majority backgrounds, including significant Arabic and Tamil-speaking communities, and a higher rate of assisted conception patients. Communication barriers, particularly for the 233 women (0.5% of 4,300 annual antenatal bookings in 2024) who do not speak English as their first language, pose significant challenges. These barriers contribute to health inequities, with the MBRRACE-UK report (December 2024) indicating that Black women are three times and Asian women twice as likely to die compared to White women, underscoring the need for effective communication solutions.
The Challenge
A clinical audit identified key communication challenges in maternity services:
- Timely access to interpreters, especially for Tamil-speaking patients, is difficult with 52% of staff reporting delays and 34% noting increased difficulty out-of-hours (2024 staff survey).
- Busy clinics face prolonged waits for traditional interpretation services, impacting patient flow.
- 17.3% (642 women) of the maternity cohort have High Gestational Diabetes Mellitus (GDM) Rates, requiring complex communication to manage effectively, particularly for Asian patients.
- Non-English-speaking patients face a higher risk of readmissions (7.79% in 2023/24, 7.17% in 2024/25) due to misunderstandings about infant feeding and hypoglycaemia prevention, costing the NHS £1.6 billion annually.
- 18% of staff reported complaints or litigation linked to poor translation, highlighting patient safety concerns.
These challenges increase the risk of complications, such as neonatal hypoglycaemia (20% higher NICU admission risk with poorly managed GDM, per NICE guidelines) and stillbirths (55% linked to unreported reduced foetal movements).
The Solution
ESTH implemented CardMedic as part of its digital transformation strategy to address communication barriers, ensuring non-English-speaking patients receive critical information in their preferred language before discharge.
Targeted workstreams were developed to deliver consistent information on GDM, infant feeding, and antenatal screening across hospital and community settings. This improved patient understanding of care pathways, with 50% of staff surveyed in Q4 2024 reporting CardMedic’s usefulness in conveying information to patients and families. Patients arrived better prepared for consultations, enhancing informed decision-making.
CardMedic’s digital flashcards were tailored for maternity needs, particularly GDM management (e.g., diabetes education, blood testing protocols) and antenatal screening (e.g., blood tests, scans). Content in 50+ languages, including Arabic and Tamil, and formats like EasyRead and British Sign Language (BSL), aligns with NHS England’s equality and diversity standards. For example, CardMedic enabled urgent communication for a Tamil-speaking patient with reduced foetal movements, facilitating timely CTG and induction to prevent potential stillbirth.
Using the BadgerNet maternity system, ESTH identified non-English-speaking patients to deliver relevant CardMedic content. Data analysis showed a potential reduction in neonatal readmissions (from 7.79% to 7.17%), with specific cases (3 in Q2, 2 in Q3) linked to improved understanding of infant feeding and jaundice.
iPads on wards and smartphones for community staff enabled on-the-go access, complementing traditional interpretation services by reducing reliance on time-consuming phone-based systems (e.g., 35-minute delays reported for the contracted language service provider) and enhancing efficiency in urgent scenarios.
Implementation Strategy
To ensure the successful integration of CardMedic into maternity services at ESTH, a comprehensive implementation strategy was developed. Initial and ongoing staff training programmes were prioritised to boost awareness and adoption, as only 30% of staff were familiar with CardMedic prior to its implementation, according to a 2024 baseline survey. This training addressed translation challenges, such as the 61% of staff who relied on Google Translate, which risks errors in clinical communication.
In collaboration with clinical leads, specialised content was created for critical areas like gestational diabetes mellitus (GDM) management and safe sleep education, which demonstrated CardMedic’s role in reducing risks associated with sudden infant death syndrome (SIDS), with 189 cases reported annually in the UK.
The initiative was seamlessly integrated with ESTH’s maternity cultural transformation efforts and aligned with NHS standards, including Martha’s Rule, to enhance patient safety and engagement.
Regular content updates were implemented based on national requirements and patient feedback, ensuring relevance and cultural sensitivity. Additionally, baseline and follow-up staff surveys were conducted to monitor progress, identify ongoing challenges, and refine the use of CardMedic, fostering a more equitable and effective communication framework for non-English-speaking patients and those with diverse needs.
The Impact
CardMedic’s implementation has delivered significant improvements in maternity services:
- Non-English-speaking patients, particularly those with GDM (17.3% of the cohort), receive comprehensive pre-appointment information, improving engagement and reducing complications like neonatal hypoglycaemia (20% NICU risk reduction potential). CardMedic ensured timely antenatal screening discussions for a Tamil-speaking patient, meeting Public Health England deadlines.
- Neonatal readmission rates dropped from 7.79% to 7.17%, with potential savings of £30,000 - £50,000 annually. Improved communication on infant feeding and hypoglycaemia prevention directly contributed (e.g. 5 cases in Q2/Q3).
- CardMedic complemented traditional interpretation services by reducing delays associated with telephone systems (e.g. 35-minute delays with the contracted language service provider avoided) and minimising unnecessary costs, such as late cancellation fees for pre-booked face-to-face interpreters. 50% of staff rated it beneficial, with community midwives noting its value in home settings.
- CardMedic supports NHS Accessible Information Standard and Martha’s Rule, reducing litigation risks (18% of staff reported related complaints). CardMedic has played a role in urgent scenarios, preventing stillbirths (55% linked to unreported foetal movements).
- By addressing communication barriers for 36% of patients from global majority backgrounds, CardMedic aligns with MBRRACE-UK goals to reduce maternal mortality disparities.
- Enhanced understanding of screening and procedures - CardMedic facilitated time-sensitive booking discussions without relying on family interpreters, against Trust guidelines.
"CardMedic has transformed our ability to communicate complex topics like gestational diabetes and safe sleep. It’s reduced interpreter delays, empowered patients and improved our efficiency, allowing more time for care."– Louise Emmett, Consultant Midwife, Epsom & St Helier University NHS Trust
Despite these gains, only 30% of staff were aware of CardMedic initially, indicating potential for greater impact with increased adoption.
Next Steps
ESTH is committed to expanding CardMedic’s impact through:
- Incorporating Friends and Family Test data to refine content and delivery.
- Developing cards for vaccination information (e.g. RSV) and procedure-specific content for the South West London Elective Orthopaedic Centre, enhancing trust-wide applicability.
- Continued evaluation to confirm statistical significance of readmission reductions (current data limited by small cohort size) and GDM management improvements.
- Collaborating with partners to optimise pre-operative checklists and explore system-wide adoption across South West London ICS.
- Scaling CardMedic to enhance efficiency in interpretation services, such as reducing DNA penalties and optimising the use of on-demand telephone interpretation where appropriate, to complement face-to-face services while maintaining high-quality patient care.
By using CardMedic’s digital flashcards, ESTH aims to further reduce health inequities, enhance patient safety and achieve cost-effective, high-quality care for its diverse population.
For further information please contact Louise Emmett Consultant Midwife [email protected]