In our latest feature we highlight two case studies that have improved patient safety. The first from Cambridge University Hospitals NHS Foundation Trust and the second from Hill-Rom.
42% reduction in sepsis mortality through the use of digital technology and integrated decision support at CUH
Patients at risk of the ‘silent killer’ sepsis are being identified and treated quicker at Cambridge University Hospitals NHS Foundation Trust (CUH) thanks to an innovative alert and action feature which the Trust’s in-house digital team has created, in collaboration with clinical colleagues, within its electronic patient record system (EPR).
National guidance recommends that patients with sepsis are given antibiotics within an hour of diagnosis to reduce the risk of serious complications – for every hour of antibiotic delay, the risk of mortality increases by around 8%.
In 2016 a Sepsis Action Group was created at CUH – consisting of clinicians from the emergency department, infectious diseases, acute medicine and rapid response, and the Trust’s eHospital digital team. They collaboratively explored how digital technology could be used to better alert clinical colleagues to sepsis patients when they present in the emergency department. They subsequently developed and built an innovative electronic alert and action set within the Trust’s Epic electronic patient record system. Launched within the emergency department in August 2016, this electronic alert brings to the nurses’ and doctors’ attention that sepsis could be a possibility if a patient’s clinical observations (temperature, blood pressure, pulse, respiratory rate) meet sepsis criteria at the point of initial triage. This alert then guides a series of electronic prompts to support clinicians in guiding the actions and tests (linked to national guidance) to effectively diagnose, care for and treat the patient with sepsis. With 99% of all clinical care at CUH documented, ordered and available in its EPR, ED nurses electronically order blood samples, blood cultures and oxygen for potential sepsis patients; typically completed within 30 minutes of receiving the alert. When a doctor arrives to see the patient, blood results are available in the EPR which enables appropriate treatment to be immediately determined. Within the EPR, doctors then select the most appropriate antibiotics to treat the source of the infection, with the EPR supporting clinicians by recommending the correct dose and frequency.
Since implementation there has been a 70% increase in the proportion of patients diagnosed with sepsis receiving antibiotics within the recommended one hour national timeframe when presenting at the Trust’s ED. Following this success, the alert and action set was tailored to suit inpatient environments and rolled out across all adult inpatient wards in June 2017; resulting in a 50% increase in adult inpatients receiving antibiotics within one hour of sepsis diagnosis. This initiative has resulted in a 42% reduction in sepsis mortality across the entire Trust. CUH is now working to implement this initiative in other areas of its hospitals – paediatrics for example – and is working with NHS England to create a national blueprint of this work to support other NHS trusts with the use of digital technology to improve patient safety.
Dr Sian Coggle, Consultant in Acute Medicine and Infectious Diseases, and Sepsis Lead, CUH” Improving prompt identification of sepsis patients and timely access to treatment is vital. The electronic alert and action set, devised with clinicians and created in our electronic patient record by our in-house eHospital digital team, better equips our doctors and nurses to be more aware of the possibility of sepsis and act quickly with appropriate treatment.”
Dr Afzal Chaudhry, Renal Consultant and Chief Clinical Information Officer, CUH. “The vision of our eHospital digital transformation back in 2010 was to use advanced technology to improve patient safety, provide high quality care and contribute to better outcomes. This significant improvement in sepsis care is an excellent example of how we are achieving exactly that by combining clinical and technical expertise, within our hospitals, to tailor and develop the capabilities of the technology that we now have to ultimately benefit our patients.”
Patient Diagnostics in a heartbeat: Using connected electrocardiograms to improve patient safety
According to the Royal College of Nursing an integrated electronic care system can have benefits for both patients and caregivers alike. With a single, comprehensive electronic health record system, patients can be confident that high quality, accurate data is available to their clinician, wherever they access healthcare. Investment in wirelessly connected devices that transmit tests to electronic patient records can improve clinical workflow, reduce admin burdens and enhance accuracy of patient data in order to improve patient safety.
As part of a wider project to replace the ageing technology in the cardiology department at the Antrim Area Hospital, Northern Ireland; investment was made in five Welch-Allyn ELI380 ECG machines that could connect to the hospital’s existing electronic systems. The devices were equipped to wirelessly transfer results to the hospital’s Cardio Vascular Information System (CVIS) and onto the Northern Ireland Electronic Care Record (NIECR).
Data integrity is a key patient safety issue, as possible implications of data inaccuracy can include delayed or missed diagnoses or incorrect treatment, which puts caregivers at risk of patient harm. In a 2015 report of 7,149 cases in which communication failures contributed to patient harm; 12% of these were estimated to be as a result of poor documentation, including breakdowns in documentation timing, accuracy and legibility.
When Welch-Allyn vital signs monitors were introduced at Antrim Hospital, instances of data inaccuracy were significantly reduced. The hospital performs around 200 ECG readings every single day, and results showed that ‘failures’ due to errors made by mistyping were virtually eliminated, reduced from around 30-40 daily to almost nothing (5).Admin burdens were also reduced, with benefits including:
- Utilisation of barcodes on patient’s wristbands, allowing patient demographics to be instantly transferred to the Patient Administration System, preventing mistyping errors.
- Turn-around time between patients was reduced, with a timesaving of around five minutes per patient, allowing staff to meet increasing demands on their service efficiently.
- Wireless data transfer to the electronic care record so consultants can access it from any location, out-of-hours. This enabled staff to seek out more senior involvement and escalate at-risk cases when necessary.
The ultimate goal of the project was to introduce fleet of advanced ECG devices which could wirelessly communicate with the existing hospital patient systems. Interopeability to existing hospital systems is key to the success of these projects, and with the expertise and experience of the Connectivity Project Management team; Hill-Rom has been able to fully connect Trusts in as little as six weeks from start to finish. This creates a platform which caregivers can use confidently from the outset.
Caregivers were keen on the devices’ ease-of-use and wireless ECG patient cable, which eliminated trip hazards from trailing wires and enabled use of the device in space-limited areas.
Sean Armstrong, head of IT networking and security commented, “The device’s use of Linux operating software makes it less susceptible to security attacks, which made connection to the hospital’s wireless network much more straightforward”.
Gavin Richards, Marketing director at Hill-Rom comments; “Hill-Rom is dedicated to developing cardiology solutions that combine Welch-Allyn’s rich heritage of pragmatic knowledge with a visionary spirit of innovation and continuous improvement. Hospitals are under increasing demands; by developing innovative solutions to improve workflow and enhance data accuracy we can ensure healthcare providers get the best value from technology and improve patient outcomes.”
