1. The Learning Clinic using research in practice A vision of the doctors desktop Presentation to SIHI Conference, Portsmouth 1 st October 2004 Roger Killen Managing Director The Learning Clinic Ltd

2. The Learning Clinic using research in practice Clinical information supports Clinical decision making Identification of best practice Review of performance trends Patient history review

3. The Learning Clinic using research in practice Clinical decision making There are a number of scoring systems which support clinical decision making including: MEWS (modified early warning score) MTS (manchester triage score) P-POSSUM (surgical outcome predictor) APACHE II (ITU outcome predictor) For each score, theres a trade-off between quality of the predictor and ease of data collection

4. The Learning Clinic using research in practice Identification of best practice National and peer benchmarking (e.g. Dr Foster, CHKS) compares: Mortality rates Length of stay Day case rates Readmission rates Time to operation Suffer from limited case mix adjustment. Good at early warning of performance outliers for review

5. The Learning Clinic using research in practice Review of performance trends Compare current outcomes to local history – some NHS trusts do it, some dont Can be variously adjusted for case mix factors depending on time and will Can be updated in very timely fashion to promote improvement Often burdensome on data collection and analysis

6. The Learning Clinic using research in practice Patient history NPfIT – electronic patient record Accessible patient specific information accessible to responsible clinicians

7. The Learning Clinic using research in practice What is the vision? An information system that combines: Highest quality clinical outcome predictions (case mix adjusted, etc.) Zero additional burden on the workforce (only use routine data) Instant updates as patient condition measures become available (electronic data entry on the ward) Accessible formats – the clinician gets the picture at a glance – informs appropriate intervention

8. The Learning Clinic using research in practice Is this realistic? The technologies to deliver to this vision are here: Wireless LAN on various wards means instant updates Hand held computing power means electronic data capture on the ward is a reality Research evidence shows that linking administrative and clinical databases provides reliable outcome prediction Accessible formats created by DK team (expertise in intuitive computing for the user)

9. The Learning Clinic using research in practice Summary The vision: Real time view of patient progress via intranet Robust prediction of outcomes Suggested intervention supported by research based protocols – ie. who should attend the patient and when, NOT what should the clinician do! When can I see this? Book early for the next SIHI conference – a work in progress