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How one care provider introduced an electronic bed management system

East Lancashire Hospitals NHS Trust has embarked on a scheme to support patient flow. Chief nursing information officer Amanda Claeys brings us up to date

East Lancashire Hospitals NHS Trust has embarked on a scheme to support patient flow. Chief nursing information officer Amanda Claeys brings us up to date

Better use of information and innovative technology helps professionals with decision making (Department of Health 2012, 2013), while bed-management information systems can support flow in acute hospitals with user commitment, mainly clinical ward staff. A common criticism of healthcare, is that it is data rich and information poor (Mettler and Vimarlund 2009) and access to timely and meaningful information can be challenging (Russell at all 2014).


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East Lancashire Hospitals NHS Trust (ELHT) decided to upgrade its bed board system to support patient flow and help ward managers access timely information in ward areas.

The previous system evolved from a pilot and there was limited adoption in some areas of the trust. It was decided that an effective bed management and ward dashboard system would be beneficial to the hospital and the clinical care its staff provides. This article describes implementation of the new system, the progress made at ELHT and future plans.

Two-way data flow

The technical solution was to upgrade the old system to enable use of a bi-directional feed to the patient administration system (PAS) from the bed board system. This two-way data flow would reduce the need for duplicate entries onto two separate systems and was a vital part of the upgrade as it would ensure the hospital had a live bed state and only one version of the situation, which is not always the case with dual entry.

Touchscreen monitors with microcomputers were installed in each ward area to enable staff to enter information swiftly and in real time using a drag and drop interface. The system shows bed status and acts as a dashboard of patient care by displaying icons related to elements of care. These can include, for example, an icon that prompts staff to complete a dementia assessment for all patients over 75 years old.

Clinical engagement

It is vital to engage clinicians in informatics projects to ensure patient safety (Caballero Munoz and Hullin Lucay Cossio 2010) and to lead change effectively (Mayfield 2014). Evidence suggests that around 70% of these changes fail (Kotter 2008, Cinite et al 2009, Wheelan-Berry and Somerville 2010) and the NHS Institute for Innovation and Improvement (2007) states that the most common reason for failure is lack of consideration for the human dimension. Therefore, a multi-professional group of clinical staff was set up to lead and drive the project.

The group met fortnightly with informatics staff to plan the changes and updates required to implement the system. The informatics staff then worked with the solution provider to deliver the enhancements and changes.

Maintaining the momentum of an initiative is important and it was agreed that the clinical group would continue to meet once the system was in place to consider lessons learned, drive further changes and lead on the second phase of the project. Using a simple change model, Plan Do Study Act (Deming 1982), enabled the group to evaluate the effectiveness of the system implementation and consider requests for change throughout the project. The team used various methods of communication including cascade, face to face, email and ‘message of the day’ to inform staff about the plans.

The journey to date

ELHT had a bed management system in place for many years that was used extensively in the emergency department, but less successfully on some of the wards. Providing a system that has a clinical benefit and gives a clear, live-bed state was the driver for change. The touchscreen monitors introduced as part of the system upgrade ensure staff can use the new functionality easily. The change was clinically driven and the enhancements to the system in phase one included the introduction of a standardised, electronic situation, background, assessment and risk approach to handover. Optimal handover can support clinical care and patient flow (Sujan et al 2015) but requires consistent guidelines in place (Poletick and Holly 2010). To support the new handover process, a template highlighting what should be included was developed as an interim measure while waiting for prompts for each section to be added to the system.  

A standard operating procedure was developed by clinical staff with the support of informatics to help managers and matrons implement the change and ensure adoption of the system was standardised.

Challenges since going live

One of the main challenges of change projects is getting staff to move away from old processes, in this case to stop using manual whiteboards. Despite work undertaken before implementation to examine the layout of the manual whiteboards and configuration of the electronic solution, there are some areas that staff feel have not been addressed. To counter this, the system administrator and project manager continue to visit each ward to ensure the system is configured for optimal use. Further change requests have been submitted to the system provider to support ongoing use and workflow on the wards and units.

Developing the bi-directional interface, a two-way connection to feed data, with the PAS was complicated and the system supplier is still working through some of the technical challenges. It is extremely complex to integrate a stand-alone system with a stand-alone PAS but the benefits for the organisation are likely to be such that the trust and the system supplier are committed to delivering this function.

An audit of system use is planned for the near future and findings will support further developments and plans to use the system to full potential. The audit will also help us prioritise ongoing developments.

Future plans

The trust has begun the preparatory work for phase two of the project, which includes development of nursing risk assessments, venous thromboembolism assessments and observations and National Early Warning Scores. The system will highlight when repeat assessments and observations are required. This phase will support staff to provide safe care and help ward leaders manage ward activity with the system acting as a dashboard of elements of patients’ journeys. Dashboards can be used to identify patient acuity and staff allocation, which can support resource management (Alghamdi 2016).

The plan for phase two follows one of the concepts of the NHS Institute for Innovation and Improvement's 'Productive Series', a Patient Status at a Glance (PSAG) board (King's College London and NHS Institute for Innovation and Improvement 2010). Lennard (2012, 2014) suggested that multidisciplinary and ward staff need access to patient status information to allow them to provide effective care, and that PSAG boards can support timely discharge thus improving patient flow.

Conclusion

Having a live-bed state with ‘one version of the truth’ is vital for running a hospital, while a system that allows staff to access data about patients’ needs at a glance will support clinical staff and ward managers to provide effective care. The journey for ELHT is continuing and resolution of the challenges with the bi-directional interface to PAS and implementation of phase two of the project will provide greater benefits in both areas.

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References

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  • Department of Health (2013) A Review of the Potential Benefits from the Better Use of Information and Technology in Health and Social Care. DH, London.
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Amanda Claeys is chief nursing information officer, clinical informatics, East Lancashire Hospitals NHS Trust

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