Evaluating the scalability of Melo: a new digital health technology for supporting ABI Patients with challenging behaviours across the Brain Injury Care Pathway - following a successful first NHS pilot.

Within the UK, 1.3m people live with the effects of an Acquired Brain Injury (ABI) at a cost of £15bn per annum to the UK economy1. Up to 70% of ABI admissions display challenging to manage behaviours (CtMB)2, which include verbal and physical aggression, wandering, and other disruptive actions3,4. These behaviours are associated with longer hospital stays, reduced engagement in rehabilitation, and poorer functional outcomes5,6,7. CtMBs negatively impact families, carers, and healthcare staff8,9,10. Early assessment and intervention for CtMB is crucial. However, current paper-based assessment methods are time-consuming, inconsistent, and fail to capture these behaviours' complexities. This hinders timely and effective interventions across the care pathway resulting in potentially adverse incidents and worsened patient outcomes. MeloTM, a new digital health platform developed by Decently, addresses the challenges of assessing and managing CtMB in patients with ABI, particularly in neurorehabilitation settings. The platform includes a web application for patient assessments via mobile devices and real-time clinical dashboards for sharing information across teams. It streamlines behavioural assessments, improves communication, and enhances patient care by: Replacing paper-based assessments with digital tools Presenting real-time data visually Improving hand-over between healthcare professionals Facilitating evidence-based decisions and personalised care plans Melo aligns with the NIHR i4i FAST call by developing a digital healthcare technology designed specifically to improve ABI patient outcomes and drive healthcare efficiencies. Melo is currently at TRL-6 and classified as Tier C innovation on the NICE ESF. It is not classed as a medical device as it focuses on "informing clinical decision making". Melo was awarded the Innovation of Year (2023/4) award from the UK Acquired Brain Injury Forum. A 15-month pilot at Salford Royal Hospital was undertaken to "demonstrate Melo in a relevant environment". The pilot saw Melo deployed across two inpatient neurorehabilitation wards, where it was used over 300 times to assess 103 patients by a range of staff members from across the clinical team. 50+ members of staff participated in workshops and focus groups. The pilot was evaluated by the research team at Salford, with promising results when compared to current standard of care: 466% increase in assessment data collection in ABI patients 8.6/10 average user rating - demonstrating acceptability to staff 80% of users reported improved behavioural analysis 89% reduction in assessment completion time These findings highlight Melo's potential to improve healthcare efficiency and patient outcomes. However, further research is required around broader benefits such as reduced length of stay and patient incidents - which in turn will help build a strong value proposition and health economic model. We have a PPI group of ABI patients, carers/family members and 100+ clinicians across which we run regular stakeholder sessions to help continue to shape the platform. We recently conducted an online focus group with the NIHR Brain Injury MedTech Co-operative, involving 10 ABI survivors and 2 family members. Feedback on topics like current clinical assessment limitations, CtMB understanding, and data privacy led to several Melo improvements. These include a new family report currently in development.