Improving Patient Care with Technology Debbie Guy Clinical Director

How Are we using IT to Improve Good Patient Care Clinically Driven The right tools for the right person Improve information flow and sharing Reduce duplication Remove unnecessary Delays A number of external publications, studies and Awards NICE Validated QIPP case study 2 ACCA Studies on H@N and Mobile Handover Royal College of Physicians Future Hospital Case Study BMJ Healthcare Awards 2011-Transforming Patient Care by using Technology HSJ Awards 2013 – Enhancing Care by Sharing Data

Mobile Clinical Workflow for Doctors and Nurses Fully integrated with Clinical Systems PAS, Clinical Portals, Order Comms, Pathology Clinical Systems Observations, Handover, H@N, Assessments Collaboration and escalation enabled Clinical Workflow Tasks, alerts and notifications Daytime, OOH, cascading escalations, business rules Task Management Presence and Collaboration Presence, Location, Role, Workload, Availability, relationship to patient User Management Native Apps for Mobile Devices Apple, Android, Blackberry, Cisco

Agenda Task Management Observations Handover Clinical Assessments

Task Management Recording and management of all hospital activities Escalations – cascading and presence enabled Applications include: Hospital at Night Day-time wards ED Specialist Referrals Alerts e.g. AKI Porter Management

Cascading Escalations Nervecentre tracks who is present in the hospital Job title Location Workload Status And relationship to patient Driving accountability And applies business rules based on time of day In Hours / OOH / Weekends Dr Smith F1 Nurse Wallis Outreach Nurse Moss NIC Patient Dr Smith Registrar Dr Jones F1

Hospital at Night Benefits ACCA May 2011, BMJ Study March 2012 70% Reduction in Clinical Incidents Average Length of Stay Down 12% (Bed costs are ~ £400 / day) 8,000 Hours pa of Senior Clinical Time Released back into Patient Care £100k pa Cash Releasing benefits through improved staffing information

H@N Bleep Volumes by Shift Source: Collaboration and Communication Technology at the Heart of good clinical governance, ACCA, May 2011

An example process

Agenda Task Management Observations Handover Clinical Assessments

e- Portfolio Evidence

Configurable Observations Models Patients are assigned a default observation model based on age, specialty, ward, that defines valid ranges, frequency and escalation pathways Spot checks allow nurses to measure and record interim or additional observations such as lying/standing BP, epilepsy Doctors can set special circumstances for a patient, changing observation frequency, triggering ranges for chronic conditions, or escalation pathways A full set of standard and advanced observations are supported including GCS, Pain, Nausea, Blood sugar, lying/standing BP, Posture

Observation Frequency Obs due timers Frequency set by policy based upon EWS and patient circumstances Strict enforcement or ward round based Alerts or list-based approach Obs overdue timers Informs NIC in real-time to allow immediate response to policy breaches Reporting Reports on ward compliance with observation policies

Simple Collection Previous values are displayed automatically Automated insertion of ‘/’ and ‘.’ in BP and temperature Prevents entry of invalid or out of range values O2 auto-sets litres and % Contribution to EWS is shown beside the observation Immediate alerts based upon policy, e.g. Temp > 40 ”Consider sepsis”

Collection and Escalation Flow

Observation Charts

Agenda Task Management Observations Handover Clinical Assessments

Mobile Handover Reduce handover related incidents Record key patient information as it happens ACCA report into deployment at Leicester report 30 mins saving per doctor per day Fully integrated with H@N Task Management Morning Ward round No 5pm Peak Handover of care is one of the most perilous procedures in medicine. Safe Handover, Safe Patients Professor Sir John Lilleyman Medical Director, NPSA

Agenda Task Management Observations Handover Clinical Assessments

Clinical Assessments A framework for providing standard or Trust defined assessments VTE Dementia MUST Relevant to many CQUIN targets, which are typically focused upon assurance of process

Summary A whole hospital workflow capability Can improve any aspect of hospital process where communication introduces risks and delays Some very impactful and cost effective quick wins e.g. H@N