Secondary Care

Electronic observations at Central Manchester: The nursing view

testHospitals throughout central Manchester are delivering numerous patient safety benefits as a result of nurse-led technology-enabled care using Patientrack. Lead nurses from Central Manchester University Hospitals NHS Foundation Trust reveal how the trust took forward pioneering electronic observations work.


Key outcomes

  • Patientrack flags patients at risk of deteriorating, and automatically alerts medical staff
  • With significant acute care initiatives, the trust has seen a 50% reduction in cardiac arrests, reduced risk of mortality for out of hours’ admissions, and reduced critical care length of stay.
  • Patients benefit from improved observations accuracy, early warning scores’ response rates and faster clinical attendance

Challenge: Improving care for deteriorating patients

Central Manchester University Hospitals NHS Foundation Trust (CMFT) is passionate about patient safety, and it knew that providing better care for the deteriorating patient was central to enhancing care.

The trust recognised that staff sometimes lacked confidence in dealing with sick patients, and that difficulties were being encountered in passing information to senior colleagues when patients were in urgent need of escalation.

Sarah Ingleby, lead nurse for the Acute Care Team and hospital at night, said: “We have worked closely with Patientrack to support our clinical processes using technology. This did not come without its challenges. However, by working together with the company and our dedicated staff, we have developed the system to ensure that we can meet all their needs and ensure safer patient care.”

CMFT is a teaching trust, with new staff coming through on a regular basis. This means that new members of the team need to get up to speed quickly on applying the protocols used to care for the sickest patients. The trust implemented early warning scores in 2000 to identify deteriorating patients in many areas, however there were occasions when the policy did not achieve 100% compliance and the supporting technology has gone a significant way to improve this.

The organisation also wanted to take an approach that could work across all of its hospitals, which meant that information needed to be available to healthcare professionals across the patient pathway.

Solution: E-observations technology

CMFT became an early adopter of electronic observations with Patientrack in 2009, and worked with Patientrack and the trust’s informatics team to apply ‘track and trigger’ technology across all its wards.

“We combined the technology with acute care education to engage all staff, encouraging colleagues to follow established protocols,” said matron Richard Cox from the Acute Care Team. “We also worked with informatics staff to show the difference they can make at the frontline of patient care, through patient stories that illustrate how technology can make a real difference to individual patients.”

Ingleby added: “By working closely with clinical and informatics staff, and with the help of the Patientrack team, we have subsequently designed assessments and have configured the system to meet local needs and priorities. This, together with a concerted effort to promote the benefits of the technology, has helped us fully embed the system throughout all in-patient areas in 55 wards in adult and children’s hospitals across Manchester, as was highlighted in our latest CQC report.

“For the more recent development of the assessments, we have worked closely with ward staff and our specialist teams. We have held meetings and workshops to understand the needs of the clinicians and patients and understand how they might want to adapt the system to meet their individual requirements. This has helped encourage them to get on board with using technology as part of care.”

Informatics staff also carried out integration work to ensure that the patient observation process continued seamlessly across CMFT sites, and a single attendance and patient record is maintained in Patientrack. This benefits the patient, as all their sets of observations are maintained for the duration of their care with the trust.

Results: Halved cardiac arrests, reduced critical care length of stay  

“Our approach has delivered clinical benefits such as more rapid clinical attendance for patients most in need, which has helped alongside other acute care initiatives to achieve a 50% reduction in cardiac arrests. We have improved the accuracy of observations, reduced the risk of mortality for out of hours’ admissions, and reduced critical care length of stay,” said Cox.

“We have already seen dramatic improvements in VTE re-assessment; from 41% to 90% compliance in three weeks of the implementation of the assessment, along with the support of the medical teams. Infection control and diabetes and acute kidney injury specialist nurses are excited that they will soon be reaping the benefits as well, as they have technology that is helping them to do their jobs.”

Ingleby added: “Six months ago we reviewed our mortality over the seven-day week. There is no difference between weekdays and weekends, and we believe that this is due to Patientrack. We have systems working 24/7 to pull nurses and doctors to patients’ bedsides when needed.

“The development and trial of the Patientrack system has been an exciting, interesting and sometimes challenging experience – in particular changing the culture and ways of working within our organisation.”

Concerns over alert fatigue have not come to fruition, particularly where in areas of the trust Early Warning Scores were embedded. Data is also being collected from several thousands of observations every day, which helps CMFT see how different wards are responding to patient needs, and identify how it may improve. There’s a real sense of healthy competition between wards in making sure that patients get the best care possible.

“We are continually feeding in our ideas into how Patientrack can develop the system, helping to ensure that it adapts to our changing clinical needs. The software, and the approach to care it helps deliver, are becoming much more integrated with our clinical systems and practice. We can now see nurses of all technical abilities use technology to realise benefits for their patients. It is something that I am proud to be working on, as it makes such a huge difference to the care we can deliver to our patients,” ended Cox.