How Can Technology Be Used to Improve Patient Flow?
Dr Gareth Lewis is a consultant in acute medicine and nephrology in Antrim Area Hospital and has been with the trust as a consultant for just over four years. His department sees 80 to 100 patients a day and, on top of this, Dr Lewis has responsibility in quality improvement. He is also a junior doctor liaison and is responsible for the Physician Associate programme in the Northern Trust. In short, he is a very busy man.
Dr Lewis feels the healthcare space chose him, not the other way around – with parents in the sector, it simply made sense: ‘for me, medicine integrates all sorts of things, from science to compassionate humanity.’ Compassionate humanity is something we have needed in large quantities as we tackle the challenges created by the pandemic.
Patient Flow Management during COVID-19
The past two years required an all-hands-on-deck approach and came with unique challenges in patient flow management:
‘We’ve been working to protect patients and staff in our trust whilst delivering the best possible care, which has meant reshuffling many wards in our hospital. Because of varying needs our Intensive Care Unit has moved seven or eight times from where it was. That involves relocating everything from staff to equipment, presenting challenges of keeping tabs on where everybody is at one time.’
Despite the stresses of the pandemic, staff worked well together to complete these reshuffles, but morale alone could not fix these huge logistical challenges. Thankfully, the trust had Cambio’s Patient Flow Manager (PFM) in place to make managing this considerably easier.
‘PFM meant it was easy to rename wards – for example when our care of the elderly ward became our ICU – and change patient locations. It was invaluable in containing the chaos and it gave staff and patients confidence that we knew where people were, who needed to be seen, and where they were with their admission. It was always a little bit of light in the darkness.’
The trust has made extensive use of Cambio’s PFM throughout the pandemic, making it easy to adapt to these regular changes and enabling staff to track each patient’s healthcare journey from arrival to discharge. Easily accessible notes on infection risk have been invaluable in the rapid isolation of patients.
Even when wards are not being reshuffled, patients regularly move from one specialty to another in acute medicine. After arriving in an emergency department, patients move through an acute assessment area and then either on to discharge or a further specialty ward such as respiratory or gastroenterology. Sometimes patients move physical spaces two or even three times on day one of their admission, so it’s vital that the nursing staff are able to manage that flow, and to do so in a way that is safe and reliable.
‘As a clinician, I use Cambio constantly. Previously we were using lots of paper to make notes for 50 to 60 patients a day; add to that the old adage about doctor’s handwriting and the potential for information compromise or loss was huge.’
‘PFM has been working 24/7 for three and a half years, being used by doctors, nurse practitioners, and pharmacists. It contains an up to date list of everybody who has been admitted in the past 24 hours, as well as where they are. People can make annotations and see the ones made by everyone else, enabling better coordination and smoother care.’
Without Cambio, members of the team were having to chase each other to get hold of the most recent paper notes and staff were being pulled in all directions. Not only does this risk loss of information, but it also slows down every member of the team involved. Cambio means staff can spend less time chasing each other and more time actively supporting patients.
‘There are a huge number of benefits that we find from using this digital list and we worked with Cambio to create something that very much fitted our purpose. So that’s been my experience with PFM: completely bespoke, and true to our needs.’
Data and analytics in the healthcare space
With his role in quality improvement, Dr Lewis has a strong awareness of how data systems such as Cambio have the potential to improve quality of care in the long term. Cambio enables the creation and measurement of improvement plans on a scale that was simply not possible without it:
‘Unless you are able to measure something, you don’t know where you’re getting better or getting worse, or if a change that you’ve made is leading to an improvement or deterioration. Without data you are kind of flying blind – you only have opinion, feeling and individual experience.’
Dr Lewis and Cambio developed a system aptly titled the Digital Weekend Review list. With this, they can accurately capture how many patients require review and how many patients are discharged on a weekly basis.
It’s anticipated that this rich data can be used to drive improvements in how they allocate staff and how they work with pharmacists, phlebotomists and nursing staff to get patients more safely out of hospital at an earlier stage. Delayed discharge puts great pressure on the trust but because this has not previously been captured in any meaningful numerical sense it has not been open to improvement, analysis or investigation.
The use of this data extends far beyond performance targets; data curated through the use of Cambio’s systems enables hospitals to examine figures and determine the reasons behind them. With this data, hospitals can gain a deeper understanding of how their systems work and how people work within those systems. These insights enable the trust to monitor the impact of changes, gaining better business intelligence and ultimately improving patient care.
The challenges of technology solutions
‘We’re surrounded by technology but I don’t think we’re very good at interfacing with it,’ commented Dr Lewis. ‘Ask any junior or experienced doctor what they think of technology and they will come out with frustration first of all.’ This is a feeling that many health professionals share and it stems from using old inefficient systems and slow devices that can be more of a hindrance than a help. Things as small as computers being tied to printers in specific wards can hinder efficient patient flow, and these small things add up.
‘The challenge is not so much in the implementation of new technologies but the human adoption side – if we can improve how we interface with technology and the digital world, then I think how we use technology will automatically start to improve and we’ll see new areas and new opportunities.’
The transition in Northern Ireland to the Northern Ireland Electronic Care Record has been invaluable in improving patient flow and making the use of Cambio so seamless. To further improve patient flow, Dr Lewis envisions future uses of the technology we already carry in our pockets: our smartphones.
‘Being able to easily capture data moments could really help us to actually see how our patients are improving or deteriorating from day to day. Finding ways to use these things that are information governance friendly could massively improve the agility of our work.’