The long-awaited Carter Report was published earlier this year and called on NHS organisations to standardise procedures, increase transparency, and drive innovation by working more closely with neighbouring health trusts. The report also mentions the improvements that can be gained by deploying innovative technology, citing as an example, the systems deployed at the Royal Wolverhampton Hospitals NHS Trust. Here, we speak to Julia Fishman, former NHS paediatric surgeon and vice president of clinical operations at Teletracking Technologies, about the use of technology and what other trusts can learn from the approach of centralising patient placement
“Many of the hospital practices and staffing models across the world, including nursing-to-patient dependency ratios, are largely based on assumptions due to a lack of real-time data.”
This comment from Dr Julia Fishman also resonates strongly within the NHS and is one of the reasons that Lord Carter of Coles, in his review of NHS performance and productivity, called for greater use of innovative technology to better plan services and reduce waste.
“In the NHS we are really good at innovation within the clinical space,” said Dr Fishman. “But outside the clinical space there are silos.”
Technology is helping to overcome this problem and TeleTracking’s system was highlighted by Lord Carter in his report as something that other trusts should look to adopt
“One trust might innovate, but it is often not shared in a timely manner, or there’s no channel for them to do it easily.”
“This is the cause of much exasperation within the health service. But the work of one trust is helping to set a benchmark for the future.”
Several years ago The Royal Wolverhampton NHS Trust won a grant from NHS England to create a hand hygiene tool that would aid infection control measures in hospitals.
Dr Fishman said, “We were asked to innovate and over three years of working with the trust we created our Hand Hygiene tool. Using this innovative piece of software, and leveraging on RFID hardware, the trust went from manually recording between 400- 600 hand hygiene interactions a month to recording over 1.4 million interactions and providing traceability in the case of infectious outbreaks.
“The system doesn’t just capture whether staff have used gel or handwashes, but tells us where they did it and when.”
Following the initial deployment, TeleTracking took the technology even further, using RFID to track patients, assets, staff and equipment across the organisation.
Dr Fishman said: “In terms of asset tracking, we can trace everything from a drip stand to a pressure-relieving mattress. We know whether it’s clean, where it is, and its condition. Often trusts over order or procure more things than they need because they don’t know what they have or where it is located.
Technology should never make your life harder. If the right system is used, it can provide frontline staff with the real-time, actionable data that they need to make the right decisions for their patients and for their trust
“Technology is helping to overcome this problem and TeleTracking’s system was highlighted by Lord Carter in his report as something that other trusts should look to adopt.”
The system can also help to determine optimum staffing levels by collecting data on where staff spend their time. In addition, the software provides the bed management team with real-time data, allowing them to co-ordinate bed allocation and flow of patients entering and exiting the hospital, without having to manually count beds on each ward.
Dr Fishman said: “Currently, hospitals often know a lot about what happened yesterday or this morning, but relatively little about what’s happening at any given moment and we need to rectify that.
“Patients come in from a number of different routes, through A&E or via a transfer, for example, and systems like our Patient Flow Dashboard and Capacity Management Suite help hospitals to keep track of them.
“It’s about centralising patient placement so that we can ensure patients have access to healthcare when they need it and get placed into the right bed first time, every time. And this innovative approach doesn’t have to cost the Earth.
“There are things TeleTracking can help the trusts do better on the IT and technology front,” said Dr Fishman. “Relatively speaking, this is not expensive technology, not in the same way as bigger systems such as electronic patient records (EPR), so it doesn’t have to cost a lot.
But, despite this, and Lord Carter’s praise for the use of IT to drive innovation at The Royal Wolverhampton NHS Trust, some organisations are still not embracing technology.
Dr Fishman said: “This is not just about IT; it’s about transformation - transformation enabled by data.
The potential this system offers is phenomenal and can fundamentally underpin the operating framework of our organisation
“It means changing the way we work and there’s a huge culture shift needed for that. The lack of uptake by some trusts has been largely due to the enormous commitment needed by leadership and staff to embrace this new way of working.
“We always support them with the clinical engagement, but nevertheless that’s what’s scaring them. However, we can’t do what Lord Carter is asking without change. There has to be change underpinning this type of large scale transformation.”
Offering advice to other trusts, she added: “If we were going into an organisation from scratch we would deploy software first to help with things like patient flow, access and capacity, then, if the organisation needs it and has the operational maturity to support it, we would introduce RFID to provide extra data and granularity.
“That’s the model in the US and Canada with over 850 healthcare organisations and that is what will drive change in the UK market, too.
“Technology should never make your life harder. If the right system is used, it can provide frontline staff with the real-time, actionable data that they need to make the right decisions for their patients and for their trust.”
Highlighting the huge impact technology can have, the Royal Wolverhampton project, known as SafeHands, has led to the following improvements:
- 1.4 million automated hand hygiene observations
- Beds are now available to new patients in less than 40 minutes
- It takes 25 second to find a tagged asset
- 75% of discharged patients leave their wrist bands in a drop box before leaving the hospital, triggering housekeeping to clean vacated beds
- In 2014/15, the trust treated 10% more patients, equating to £20.8m in addition revenue opportunity. To achieve this the trust invested only £7.9m of additional nursing resources
Cheryl Etches, chief nurse at the trust, said: “I now have access to so much information about patient safety and experience issues. The potential this system offers is phenomenal and can fundamentally underpin the operating framework of our organisation.”