Quest to improve patient safety starts with smart technology
Canterbury District Health Board (CDHB) initially wanted to address the deteriorating patient to reduce morality rates and avoidable ICU admissions, as well as the patient experience of the journey. Partly in response to recommendations from the Health and Disability Commissioner, and to reduce approximately 40 different patient observation and assessment forms; CDHB proposed that using an electronic system to enable better clinical protocols would improve patient outcomes.
Routine measurement of basic observations to assist in the assessment of patients and clinical progress has been a foundation of medical and nursing practice for decades. CDHB had already implemented a standardised Early Warning Score (EWS) in 2007 on the observations chart to better recognise deteriorating patients to ensure the most effective clinical response. However, CDHB soon acknowledged that by replacing paper-based EWS with a broader suite of automated assessment and communication tools they could make available to teams in real time would and improve work flows, allow clinicians to dedicate more quality time with patients and ultimately reduce the number of adverse events.
CDHB engaged MKM Health to implement Patientrack for the electronic capture of physiological and clinical observations, early identification of deteriorating patients and alerting of clinicians. In addition to their standard physiological observations chart they required tracking of IV line insertions, removals and the regular reviews of these lines for infection, daily weight, pain, fluid balance, bowel chart and neurological observations. To improve the workflow of staff Patientrack was to be integrated with their existing Patient Administration System (PAS) and with their clinical portal.
Canterbury District Health Board is the main planner and funder of health services in Canterbury; a tertiary provider of hospital and specialist services; a promoter of the population’s health and wellbeing; and the largest employer in the South Island - employing over 9,400 people across their services.
CDHB (the second largest DHB in New Zealand by both geographical area and population size) provides a significant load of regional and national services, and their ability to maintain service delivery is critical to the functioning and sustainability of the whole New Zealand health system. In all, CDHB provides over $1.6b worth of services to the populations of other DHBs around New Zealand and delivers half of all the surgical services provided in the South Island.
Before Patientrack was implemented, nurses were required to record all observations on one or more paper charts. Patients often required a variety of observations to be taken at different times and different intervals, as some would require physical observations every couple of hours to ensure they were not deteriorating; while others would only require observations once a shift. Additionally, some patients also require neurological observations and others had IV lines that required regular review.
Having only one physical source of information on what observations were required and when, could often lead to problems when the chart was unavailable. The DHB found that paper based charts created risk, as clinical staff were not always aware or alerted to an increasingly sick patient. The critical patient information only existed in hard copy, could not be easily accessed by staff working remotely, and could be easily misplaced, or might not be available if the patient suddenly deteriorates.
In moving towards the vision of a patient centric digital health environment, CDHB agreed that by error proofing their systems and integrating their processes, they could achieve great improvements in patient care and safety. Using electronic systems would enable better adherence to clinical protocols, assist in real-time management of the standard of care and significantly improve the patient experience with better and more favourable outcomes.
The expected results from adopting the technology included:
- 100% EWS calculation accuracy
- Increased timely clinical attendance to the deteriorating patient
- Reduction in unexpected cardiac arrests and reduction in mortality
- Improved patient journey
- Reduction in avoidable ICU admissions
- Reduction in patient ICU days by more timely admission
- Better access to information for planning, collaboration and research
- The system will be extensible to the Southern Region and beyond
Patientrack was the system chosen by CDHB through a rigorous procurement process. A complete digital and mobile bedside solution, Patientrack is, proven through clinical trials, to improve patient safety, quality and efficiency of care in one easy-to-use application.
Patientrack is a clinically proven ‘track and trigger’ system that utilises the latest in mobile technologies to deliver measurable improvements to the quality of patient care and patient outcomes while also supporting more efficient processes of acute care delivery generating substantial savings and improvements to patient throughput.
For CDHB one of the benefits of Patientrack is that it can easily be configured to their specifications based on their policies and charts. This included the electronic capture of a large variety of observations such as; standard adult observations, pain, neurological observations, cannula insertions, removal and reviews, fluid balance, as well as weight and bowel charts. Patientrack uses this information to calculate risk indexes to indicate patients at risk of deterioration. In addition to capturing the data, Patientrack schedules when each type of observation needs to be taken, whether it is in 30 minutes or 7 days; allowing a continuation of care across single and multiple shifts.
Having observations captured electronically means the patient chart is also electronic; allowing it to be accessed in multiple locations across the hospital, resulting in no more missing charts or having to go to the ward to hunt for the patients’ chart.
Since going live on the first ward CDHB have successfully rolled the solution out to 27 wards, with additional wards planned across more hospitals, including hospitals over at the West Coast DHB. Over 356,000 sets of EWS and 6.5 million separate data points have been recorded to date.
“Our surgical teams who have been using Patientrack this year report that it’s easy to use and provides accurate/real-time information that is helping us improve patient care.”
David Meates, Chief Executive
MKM Health helped CDHB implement Patientrack on the first ward in November 2015, and in the following February CDHB conducted an audit of the results comparing the pre and post implementation results based on an analysis of 8700 observation sets. Only three months after initial go-live the following benefits were being achieved:
- Prior to the implementation of Patientrack there were 71.3% EWS completed and this moved to 100% post implementation.
- Prior to the implementation of Patientrack the EWS was accurately calculated 67.1% of the time and this moved to 100% post implementation.
- Recording each set of observations now takes a minute less for each patient.
The improvement in accuracy and completion of EWS in turn leads to better detection of patients at risk of deterioration and helps to reduce length of stay and unplanned admissions to ICU or interventions by ICU Outreach. This ultimately improves patient outcomes, patient experience and patient flow. Over time Patientrack will reduce demand on expensive ICU resources and provide for a less stressful and more efficient ward environment.
The reduction in time spent looking for charts now frees up time for nurses to spend on caring for patients, which again improves the patient experience, staff satisfaction and reduces costs over time.
CDHB are continuing to roll out Patientrack to the remainder of their adult hospitals. MKM Health are developing configurations specific for the women’s and children’s hospitals, and working towards automatic alerting for the at-risk patient to the appropriate level.
MKM Health and CDHB are collaborating to identify new areas into which Patientrack can be expanded, including the on-admission nursing assessment and integration with the infection control system used at CDHB.