Comment: Surviving the worst winter the NHS has ever seen

Published: 17-Feb-2014

How Hull and East Yorkshire Hospitals NHS Trust is benefitting from the deployment of e-whiteboards

As NHS organisations across the country are feeling winter pressures, Hull and East Yorkshire Hospitals NHS Trust is managing to deal with a huge influx of patients thanks to technology that is helping address patient flow, improve safety, join up care and save many hours of time for clinical staff. In this article, the trust’s chief nursing information officer, Steve Jessop, explains the impact it has had on services

Think back to winter two years ago. One of the largest acute trusts in England was facing a 25% surge in patients coming through the door. As the only A&E for 60 miles, turning patients away and diverting activity was simply not an option for Hull and East Yorkshire.

But at this extremely busy time a very real clinical risk emerged: patients can be missed through the system.

The flow of patients was managed in a relatively basic way back in 2011. In the acute assessment unit (AAU) alone we admitted 100 patients every day during the winter, turning over each bed at least twice, with referrals from GPs, ambulatory care, walk-in patients, and patients admitted from the A&E department. We averaged at least 400 attendances per day.

Patient movements were made even more complicated by the fact that the acute trust is split over two sites, with Hull Royal Infirmary located six miles from Castle Hill Hospital, making communication even more challenging. But, despite this complex situation, medical staff in the AAU wrote with coloured pens on a large whiteboard to record patient names and other details. Doctors were writing on the board to prioritise patients, having to tick a box to indicate a patient had been seen and they were then forced to telephone around to find bed availability for patients.

The e-whiteboards have been so successful in taking away the high-intensity pressure often associated with managing patient flow that if we tried to take away the technology now, there would probably be a mini-revolution from staff

A spreadsheet did exist in which all wards would record bed availability six times per day. But there was no live system. Medical staff were running around, collecting lists of jobs, tasks and patient numbers.

Something had to be done differently for the next winter to ensure patient safety – and we made sure it happened.

One year later and the winter of 2012-13 was the worst on record for the majority of NHS organisations when it came to the number of patients requiring help and the severity of their conditions. But, despite last winter’s pressures, Hull and East Yorkshire succeeded and managed extremely well as it was able to map through and manage patient flow effectively. The reason: the introduction of new technology that is providing a clear view of where patients are in the system and that is saving medical staff huge amounts of time.

Two Cayder boards were deployed in the AAU to replace the physical whiteboard. The 55-inch electronic whiteboards provide the ability to immediately manage patients coming onto the ward safely – removing the risk of patients being lost in the system. The boards in the AAU provide a complete overview and a ward view of beds, allowing staff to instantly see tasks and manage patients. And the technology is being rolled out across the trust and beyond, starting a journey that is transforming how patients are managed from pre-admission to discharge.

Following the early successes in the AAU, local commissioners have now funded the rollout of the technology to numerous other parts of the trust. To date 39 wards have the technology in place and it is being applied in ways that are freeing up huge amounts of time for frontline clinical staff to focus their efforts on patients.

The boards have now been deployed in medical, surgical, oncology and haematology wards and in our surgical assessment lounge. And all 45 electronic whiteboards are connected on a patient flow module, showing a live bed state across the organisation. In every instance of deployment, department staff have led the design of their board configuration.

Getting senior doctors, nurses and therapy staff to decide what information the boards need to collect and how they wanted to use the technology has been crucial. The process as a consequence is not only about replicating what sat on a physical whiteboard, but has led to other add-ons that benefit both patients and staff. Patients can now be transferred electronically across wards – reducing transfer times dramatically to less than five minutes down from 22.

Patients can now be transferred electronically across wards – reducing transfer times dramatically to less than five minutes down from 22

Now a short conversation takes place and staff on the receiving ward are able to glance at the e-whiteboard to find the clinical information they need about the patient. Electronic transfers mean that at least an hour of clinical time is saved on each and every ward in the organisation every time a patient is transferred. A nurse can also now discharge a patient at the touch of button, or by just marking their finger across a screen to place a patient into a discharge box – much more quickly than the five or 10 minutes that the paper-based system used to take. Virtual wards created through the boards have also allowed for discharging patients in a far timelier manner.

Our chief pharmacist is now doing things that they would have never before dreamed they could do with existing resources. Now with two Cayder boards medicine reconciliation can be done quickly and the pharmacy can prioritise its workload by knowing which patients are likely to be discharged. A virtual ward has also been created for patients across the trust who have diabetes, allowing the diabetic inreach team to manage care and referrals and to give advice and support much faster than the previous manual referral processes allowed. From dementia to fall risks – knowledge of the patient at handStaff now have far better visibility of the issues individual patients face.

The boards are used every morning for safety briefings. All staff, including doctors and nurses now congregate for two to three minutes around the board for a safety briefing in which the boards show who is being discharged, as well as safety information. Then a formal ward round can take place to obtain more-detailed clinical information. Treating patients with dementia is also now far more effective. The boards display a butterfly symbol next to patients with dementia, allowing anyone working on the ward to instantly know which patients have dementia and need to be supported accordingly. But there is an argument that patients with dementia should not be managed in an acute hospital setting – an environment which could make their condition worse. And so the Cayder boards are now helping to integrate care with community so that we can ensure we release patients from hospital to a setting where their care can be monitored.

Our local authority partners now have a real appetite to procure their own electronic boards, which will integrate with the trust’s, allowing patients to be transferred more effectively and information to be shared much more readily. Information from social care will appear on the ward’s e-whiteboard, which will allow staff to inform patients precisely where they are in discharge planning.

This collaborative way of working will be crucial when community hospitals come under winter pressures. There are many more plans for the technology going forward both in and beyond the trust. By 2018 we want a paperless system across the NHS and this kind of technology allows us to get one step further to that. But as far as Hull and East Yorkshire is concerned, the e-whiteboards have been so successful in taking away the high-intensity pressure often associated with managing patient flow that if we tried to take away the technology now, there would probably be a mini-revolution from staff.

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