As part of our latest HTN Now event series, we were joined by a team from Hampshire Hospitals NHS Foundation Trust, who shared learnings and experiences from their digital journey, which included the implementation of virtual wards and new digital systems for their maternity and ITU [Intensive Therapy Unit] wards.
The panel – which encompassed a number of clinicians – was comprised of: John Duffy, Consultant Physician; Naomi Ratcliffe, Associate Director for Clinical Integration; James Coakes, Consultant Intensivist; George Goumalatsos, Consultant Obstetrician; Diane Whittle, Midwife; Tamara Everington, Consultant Haematologist and Chief Clinical Information Officer (CCIO).
After introducing the team, Tamara asked, “why are we talking to you today? Well, we’ve come on a considerable clinical journey in the last four years.”
“Four years ago we were largely paper-based – we had electronic prescribing and we had an electronic handover tool – but everything else was largely on paper. We then joined the GDE [Global Digital Exemplar] programme as fast followers to Southampton Hospital, and this programme came to an end after three years, in April of this year,” Tamara explained.
“During that time we made a considerable advance into a largely digital environment. Now, going forward as part of the National Hospitals Programme, we’re trying to deliver a whole new approach to care across north and mid-Hampshire, within our ICS [Integrated Care System],” she said.
Naomi then took over the session to talk about the trust’s Virtual Health Hub, specifically focusing on its virtual wards and telemedicine service for care homes, as well as its Clinical Communications Centre, which she noted has become integral.
“The telemedicine for care homes is very much what it says on the tin,” explained Naomi, “it is a service for sudden and acute deterioration of care home residents within either the residential or nursing home environment, and we’ve actually also rolled out to learning disability and mental health homes.”
The service was created to deliver high-quality and rapid access to care, while minimising unnecessary hospital visits. “We’ve looked at this in terms of an ICS solution, so trying to work at scale, and making the most of the opportunities that we can benefit from in this regard…trying to develop a service that is very much co-designed and in collaboration with system partners,” Naomi stated.
On the virtual wards – which were set up at pace due to the COVID-19 pandemic – she added: “This is very much around empowering patients with clinically-supported self-management…the difference, really, around virtual wards, is that we have looked at that from a ‘step up’ and a ‘step down’ perspective, and tried to integrate that pathway across primary and secondary care, recognising the importance of the community care services and other parts of the pathway.”
The Clinical Communications Centre, meanwhile, is set up as a single point of access for healthcare professionals to provide, “advice or direct admissions into the hospital from ambulances, colleges, GPs, and through 111.”
“This has really helped us reduce duplication and unnecessary touch points,” she noted, adding that, “creating a safe space between acute trusts and community services,” was the goal. This was part of a short-term solution for patients, and complemented the trust’s key messages and aims around developing an agile leadership approach, building alignment behind a common narrative, and utilising technology.
“The co-design has been the important key to moving forwards with this,” she said, before discussing how it was important to be mindful that we need to use technology to, “help us solve clinical problems that are presented to us, rather than a solution that we can implement retrospectively and hope that it’s going to do the trick”. She also added that the key learning was, “more around understanding the interaction with human behaviour.”
James then stepped in to talk about the ITU system, explaining: “The digital project has been a massive piece of work for us over the last three years, at Hampshire Hospitals…our critical care service – which is both intensive care and high dependency beds – is split across two sites. Prior to our digital project, we were essentially using paper charts for our bedside observation and all our chartings.”
“The issues for us were,” he added, “[that] clearly we needed to go paperless, we wanted to have our full integration and interfacing with the other digital systems already in place, and we also wanted to make sure we had the right governance and assurance processes in place for the support.”
On the solutions used, James said, “it was great being part of the Digital Exemplar programme – not just for the funding but to draw on the experience and the expertise of Southampton…it was really useful to know the processes and path they’d been on. In terms of putting a team together, we were able to draw on their experience about who they had on their team and how they had worked together, and the amount of work which was needed to develop and deliver the system.”
Hampshire’s team, therefore, consisted of members of its clinical team, procurement and IT, a project manager, and the trust’s digital transformation team. “For me,” James said, “I’d really like to emphasise how important that was having all those people involved right from the start.”
James then went on to share his key learnings. “The go-live with the system was a key moment and needed a lot of planning. Because of our two sites, we had to work out whether we wanted to do it all in one go or do it in a staged approach. There are pros and cons of both ways [but] in the end we did it in a staged approach. I think that was the right thing to do because we had an expert team but we wanted them to be able to focus on each individual site, when they were going live,” he said.
Change management was another area considered, with James admitting, “there was clearly an understanding of the support that was going to be needed, and the training programme that was needed. But, I think, on reflection, we probably could have spent more time in terms of preparing everybody for the massive change that was coming.”
“We’re already seeing huge benefits from the system – the safety alerts are now built into the system…the other big benefit is having the checklist and protocols all embedded with the system and easily accessible. For the future, it’s going to be the ability to pull out bespoke reports, for us to review the quality of care and pull into and use [this] for service development and quality improvement projects,” he concluded.
George and Diane took their turns to share learnings next, explaining how they worked to digitalise obstetric care.
“It was so nice hearing from Naomi and James because the only thing that’s changed is the name of the software. The love of technology, the use of technology, the implementation and clinical practice is literally, from what I’ve heard, ‘copy paste’,” George stated.
In his illustration of their digitisation work, George explained that the team – containing clinicians, midwives, nurses and administrators – worked to add BadgerNet software to laptops, iPads, and mobile work stations, to replace paper notes.
“Overall, we are happy. It gives us a nice overall care, it improves communication between the different departments [and] the neonatal unit, it’s accessible on Windows and Apple platforms…obviously, I am heavily biased when I say that, hands down, we have the best IT team in the NHS…none of this would have been possible without our IT team,” he said.
George Illustrated the difference in the way information is now presented in the delivery suite, saying, “all the information, all the data, from all the teams collected and combined into two screens. How it helped us….[was it] improved the links with the neonatal unit – when we transfer a baby we just need to transfer the baby [now], the information is imported and the neonatal team finds them in their computers, laptops and iPads before the baby even arrives.”
“Our midwives can document the patients’ progress and me, being in my office, I can update and see what’s going on with the patient without the need for someone to call me. I can have access to updates from everywhere – I don’t even have to be in my office, I can be at home when I am on call and have access to the monitoring of the baby, and give advice online safely,” George commented.
Other areas of improvement covered in George’s presentation included handovers, updates on labour progress and easy communication between antenatal, labour and postnatal wards. “With digitalisation, all that information lands into the coordinators’ iPad,” he explained.
He also added that different care pathways across different sites could lead to duplicated work in antenatal but that, through digitisation, the care pathways are easier to share and the booking process is more streamlined.
Inpatient wards rounds, George noted, had also been boosted by better data protection and communication with other data management software. He showcased the benefits through ‘before’ and ‘after’ photos of staff assessing patients at their bedsides with notes, versus a laptop or a smart tablet.
He said: “This is what we are aiming at, we look like George Clooney, we look smart, we look cool, and…nobody can see what we have on our iPads. The documentation is sometimes is easier and faster than actual writing…it doesn’t require touch typing because the method we use is sliding the finger to the letters and the software brings up the words really quickly. So, data protection-wise, we are much safer.”
On how these advancements can improve care for women in other hospitals, George added: “The software that we use communicates with other data management software…if we receive a patient in labour who has booked in at Southampton, Portsmouth or the Isle of Wight, I have access to her notes [from] wherever she had her investigations. Because it’s the same platform, it’s as if she had the tests in our hospital – this is phenomenal, it’s so easy.”
Later, Tamara quizzed Diane on how it feels working with patients across the community and their reactions to the digital developments. “I think it’s been a massive change for them, as well, because they are used to having their handheld notes…now they don’t and they’ve got it all on an app. Sometimes you have to say to them, ‘it’s on your app, so you can have a look’, they’re getting used to it and learning how to do it, a lot more,” she said.
“From a midwifery point of view, it’s fantastic to be able to sit in a clinic and say, ‘I’ve plotted this on my growth chart, do I need to refer them for a scan? I’m not really sure’. In days gone by, you would have to describe the chart over the phone…now you can just say ‘this is the lady, can you look at her record?’, they can look at her growth chart, they can look at her history, they can look at her obs and say ‘yes, I want to see her’…that exchange is absolutely amazing,” Diane said.
To conclude, Tamara than returned to lead the chat and ask her team questions about keeping the digitisation programme “on the road” in the face of COVID-19, their lessons learnt and challenges, and their thoughts on patient feedback about the new digital solutions.
To find out their answers, and watch the session in full, view the video below: