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Feature: How is patient flow changing for the NHS?

Responsibility for patient flow is no longer just a nursing task – it is everyone’s responsibility. Katy Cain, clinical consultant for smart health technology provider Alcidion, explores changes in the way patient flow is being managed to respond to NHS pressures, maximise capacity and improve patient outcomes. As a senior nurse, she examines how technology plays an important role in helping to ensure professionals across multi-disciplinary teams, hospitals and integrated care systems can move patients forward in their care.

I have worked in nursing for more than 20 years in the NHS. During that time, I’ve seen a lot of positive change in the way patients are managed within hospitals, and in the way services are configured and delivered.

I’ve also seen pressures continue to rise, pressures which have been magnified by the pandemic.

Winter pressures have become an all-year-round pressure, with little chance for busy hospitals to recover during the spring and summer months.

Patients presenting to hospital have an increasing range of complex needs and comorbidities. And patients, who might have waited longer to seek medical help during lockdowns, are now often starting their pathways more unwell or at a later stage of deterioration. This, in itself, is a trigger for increased acute activity and results in longer lengths of stay.

Bed availability and NHS waiting times have also continued to hit headlines. A growing elective backlog of more than 6 million people waiting for treatment, means that the pressure to maximise capacity and efficiency, whilst ensuring patients are treated in the right place and discharged safely and appropriately, is greater than ever.

These are some of the challenges that are leading more and more healthcare providers, and integrated care systems, to turn to technology to help modernise and improve patient flow across hospitals and into the community.

Flow is everyone’s responsibility

Patient flow is so important that it has become everyone’s responsibility. For the majority of my career, patient flow has, to a large extent, been managed by nurses and bed managers. Now, everyone working across the multi-disciplinary environment, within and beyond the hospital, has a role to play in ensuring patients move forward in their care journey safely, appropriately and as efficiently as possible – and with the needs and wishes of the patient and their family respected.

This is important for the patient. Effective flow can help to minimise deconditioning and other risks associated with being in hospital longer than is necessary. It can help ensure they are discharged with the right arrangements to aid their recouperation. And prior to discharge it can play an important role in ensuring patients receive the most appropriate care in the hospital.

Patients who are not allocated the right bed can have longer lengths of stay and other complications and create challenges for care teams. For example, a stroke patient who has been admitted to hospital is likely to have a much better prognosis if they are treated on a stroke ward – and effective flow management can help to ensure that happens.

Effective flow is also important for the health service as it seeks to recover from some of the challenges outlined above. Effective discharge management is a big part of this. New government guidance that became effective from April 2022, makes clear that no patient should be discharged from hospital until it is safe to do so and that patients should not be routinely discharged to a community setting “simply to free a hospital bed”.

The importance placed on discharge is such that the guidance document recommends planning should start at the point of admission, or pre-admission for elective procedures, with the involvement of multi-disciplinary teams across hospital and community settings, focussed on supporting the needs of the individual.

Flow systems can support effective discharge planning, and ensure that patients aren’t kept in hospital unnecessarily for another day when something hasn’t been actioned. In other words, this is about ensuring discharge is never a surprise. Unnecessary discharge delays can lead to knock-on effects in other parts of the hospital and the broader healthcare system. For example, it might be that patients in the busy emergency department are waiting to move to the ward.

Making it easy for staff – technology adding value

Technology is really starting to make a difference, making it easy for healthcare professionals to know what needs to be done to ensure patients move forward in their care.

Miya Flow – Alcidion’s patient flow management solution – provides bespoke dashboards, also known as journey boards, that consolidate real-time pertinent information, so that different clinical specialties and departments can see at-a-glance all the patients in their care.

Ward staff, junior doctors, dieticians, therapists, pharmacists, and a whole range of specialist clinical teams can see which patients they need to attend to, as well as relevant real-time clinical information, so they can plan their activity and ensure patients receive care and treatment in a timely manner.

Over-arching hospital views are also supporting bed managers in planning and getting patients to the right beds, with easy visibility of estimated discharge dates for patients already in the hospital, and access to important information on which patients are incoming and their requirements.

Modernising flow technology

Patient flow functionality continues to evolve too, moving away from manual processes associated with early flow systems, to modern technologies that automate processes, and make use of natural language processing and clinical decision support.

For example, if a patient presents with a heart attack, systems like Miya Flow can be configured to proactively suggest actions around protocols and pathways, so that clinicians are not forced to remember every process. This might include suggesting referrals and actions for the cardiac cath lab, or cardiac rehabilitation, or prompts to clinical teams to refer patients for an echocardiogram or other tests and procedures.

Flow technology is also becoming increasingly integral to digital strategy – integrating and even providing an orchestration layer for e-noting, electronic e-observations, electronic patient records and an array of other systems. Hospitals that work with Alcidion are in some instances exploring flow as the first stepping stone of wider digital transformation programmes, and in some cases have been looking to Miya Flow as the system that clinical teams use to context launch into other applications, avoiding the need to continually log-in and out of dozens of systems. This is helping to add clinical value to the flow process, as it means that clinical teams can fulfil their flow responsibilities, make informed decisions more easily and save valuable time.

Professionals are freeing up time and resources for more meaningful tasks. One of our NHS customers recently observed that a bed manager had previously spent more than 80 hours in a week phoning wards to find availability and to update patient status. And for each those calls, nurses on the ward spent time answering. That time is now being saved and reinvested into clinical care. Hospitals are also automating the capture of sit-rep data required on a daily basis nationally, freeing up senior clinicians who would otherwise capture that information.

Supporting the future: Regionally integrated care

Flow technology is about more than efficiencies in the acute hospital. Alcidion is already working with community trusts to ensure effective patient and client flow across multiple and geographically dispersed community sites, to help to enhance rehabilitation processes, and to move away from a situation where staff populate isolated systems and spreadsheets.

It is also now spanning far beyond individual organisations. The future of service design is more dependent on collaboration across providers than ever. Command and control functionality within systems like Miya Flow provides a tool for integrated care systems to plan resources, flow and discharge processes across their footprint.

As the NHS looks to tackle the national backlog, capabilities like this can provide an important tool to help get patients treatment sooner, to optimise regional capacity, and to potentially deliver more accessible and equitable care in a location that could be more appropriate for that patient.

Technology has the potential to be transformative when it comes to patient flow. But making flow technology really successful rests on technology providers being responsive to the priorities of the organisations deploying it, and to the needs of users. Alcidion is committed to that collaborative approach.