1. Improving Patient Care with Technology
Debbie Guy
Clinical Director

2. 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 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

3. Mobile Clinical Workflow for Doctors and Nurses
Fully integrated with Clinical Systems
PAS, Clinical Portals, Order Comms, Pathology
Clinical Systems
Observations, Handover, 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

4. Agenda
Task Management
Observations
Handover
Clinical Assessments

5. 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

6. 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

7. 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

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

9. An example process

10. Agenda
Task Management
Observations
Handover
Clinical Assessments

11. e- Portfolio Evidence

12. 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

13. 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

14. 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”

15. Collection and Escalation Flow

16. Observation Charts

17. Agenda
Task Management
Observations
Handover
Clinical Assessments

18. 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 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

19. Agenda
Task Management
Observations
Handover
Clinical Assessments

20. 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

21. 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.