great to some more positive outcomes
Early warning system helps Basildon and Thurrock University Hospitals NHS Foundation Trust reduce cardiac arrests and identify and respond to other potentially fatal conditions such as sepsis and AKI.
This Trust has reduced cardiac arrests by more than three quarters since it went live with early warning system called Patientrack. The trust is now redesigning clinical pathways using the same solution to spot potentially fatal conditions including acute kidney injury (AKI) and sepsis.
Challenge
When Basildon and Thurrock University Hospitals NHS Foundation Trust started to deploy Alcidion’s early warning solution, Patientrack, in April 2016, as part of its deteriorating patient programme, it had big ambitions to make a significant difference to patient safety and the working lives of nurses, doctors and other healthcare professionals.
With rapid impact already seen in other hospitals from the use of Patientrack, the trust’s team was keen to deploy quickly.
Before Patientrack, nurses had to manually write measurements of key physiological parameters, and manually calculate the national early warning score, otherwise known as NEWS2, a crucial indicator of whether a patient’s condition is deteriorating.
Solution
Patientrack has replaced the paper charts traditionally used to capture bedside observations with iPads, so that nurses can digitally record their patients’ vital signs directly into Patientrack. It also automatically calculates the NEWS2 score.
“This has helped to improve the accuracy of observations. Staff have loved the Patientrack system which they can access regardless of location, something that hasn’t been possible with paper charts.”
– Chief nursing information officer, Sam Neville, Mid and South Essex University Hospital
A further integration is also starting to allow Patientrack to take readings directly from the trust’s Welch Allyn monitors – used by nurses to capture several observations, including blood pressure. This is reducing the need to manually enter readings, and the associated risk of data entry error.
Result
The impact the programme has achieved has been tremendous – from a major reduction in cardiac arrests, through to hours of time saved for nurses every day, and a great deal more still to come. The project is empowering nurses on the ground to call for help sooner when patients need it, and it has also meant that the Mid and South Essex University Hospital group has now created its first chief nursing information officer, Sam Neville, who holds the responsibility for embedding digital technology, innovation and forward thinking throughout the trust’s clinical services.
“The outcomes of this project have shown nurses just what they can do with technology, with nurses now influencing and delivering digital leadership.”
– Chief Nursing Information Officer, Sam Neville, Mid and South Essex University Hospital
“Electronic observations functionality was rolled out in nine months to all inpatient wards,” says Neville. “That’s pretty good going – 25 wards all live within nine months, with a small deployment team of four.”
Going digital with observations – hours saved for nurses every day
The use of Patientrack is having a big impact on releasing nurses’ time. A baseline audit with electronic observations and paper revealed that the time taken to complete a set of observations reduced from two minutes and 30 seconds to just one minute and 30 seconds after going digital.
“That’s a minute saved per set of observations, per patient. A nurse saves 28 minutes per round, four rounds per day. As many as 13 hours of time are now saved for a nurse in a single week. It means staff can spend more time with the patient. One of the comments we had back was that ‘I’ve actually had time to wash a patient’s hair today’. So, this is helping us to improve the quality of care.”
– Director of Nursing, Dawn Patience, Basildon and Thurrock University Hospitals NHS Foundation Trust
Cardiac arrests fall dramatically, pressure relieved on staff
The introduction of Patientrack has also had a big impact on patient outcomes. Cardiac arrests went from 2.20 per thousand admissions to 1.26 in October 2016, and now it is as low as 0.46. That’s a drop of more than 75% on the ultimate measure we use to assess our management of patient deterioration. Electronic observations have undoubtedly been an important contributing factor to this improvement.
“Patientrack is a vital part of a suite of measures that we introduced alongside new medical emergency teams, revised escalation policies and an active education and training programme. Being able to make emergency calls at the point the patient is deteriorating, means nurses don’t need to wait for the patient to start arresting to call for help. We use observations as our evidence. For scores of 4 or 5 or more on NEWS2, staff can call for help straight away. Visibility that a patient is deteriorating means we can get someone to help before the patient has a cardiac arrest.”
– Chief Nursing Information Officer, Sam Neville, Mid and South Essex University Hospital
This proactive process is helping to reduce pressure on nurses and gives them confidence to trigger interventions. They know they can activate sooner. It has taken away an insecurity. Nurses are empowered to act on the information they have. Because that information is more visible, it is easier for anyone to act. Anyone can now access observations wherever they are on PCs and iPads, rather than a nurse relaying over the phone.
Patience added that better and earlier visibility of patient deterioration has led to important clinical decisions being made earlier. Ward level views on an electronic whiteboard tell the nurse in charge where the sickest patients are and their status and trust level views of the same information inform critical care outreach whilst helping the trust’s dedicated deteriorating patient nurse to identify who they need to see.
“This means we are not doing things to patients that we don’t need to do. There is a review of a patient’s treatment plan earlier and we are getting the right patients into intensive care sooner, rather than ‘let’s wait and see’.”
– Director of Nursing, Dawn Patience, Basildon and Thurrock University Hospitals NHS Foundation Trust
The Basildon pathway – redesigning the approach for everything from sepsis to AKI
The trust has moved a significant range of assessments into the Alcidion Patientrack solution. This includes VTE, nutrition scoring, food charts, fluid charts, stool charts, infection control screening and monitoring, neuro obs, as well as smoking and alcohol screening. All of this has had a big impact on reducing paper – with expected savings on paper alone of £60,000 per year.
But the biggest benefit is expected from the development of the Basildon Deteriorating Patient Pathway – a holistic approach to identifying and responding to serious conditions linked with tens of thousands of deaths in the NHS every year – including sepsis and AKI.
“Rather than looking at this as a sepsis problem, or an AKI problem, through our pathway nurses are looking at the patient as a whole. There are commonalities in the triggers for these conditions and others around bleeding and airways, for example. Our approach in Basildon has been to develop an exclusion approach, where we exclude possibilities rather than starting with a diagnosis.
“If you focus only on looking for sepsis you are likely to miss a GI bleed. Some of the symptoms are very, very similar. Our approach doesn’t just put the patient on a single sepsis pathway to determine if they have sepsis but assesses the patient as a whole so we can get them the right response and help ensure something serious isn’t missed.
“At the end of the day this is all about improving the care that we provide for patients, and the more efficient, effective use of technology will enable us to do just that.”
– Director of Nursing, Dawn Patience, Basildon and Thurrock University Hospitals NHS Foundation Trust
This project is part of the trust’s wider commitment to develop its digital agenda and to work in partnership with industry to innovate and advance the use of digitally-enabled care. It is also part of a clinically-led patient safety programme that aims to empower frontline staff with new tools and methods to help measure improvements in patient care.
