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HTN Festival: Alcidion on balancing patient care and service demand with flow management

For our next live session at HTN Festival, we were joined by Alcidion to discuss the potential for positive impact of flow technology on NHS services.

The session was led by UK Commercial Director Tom Scott, Chief Medical Officer Dr Paul Deffley and Head of Clinical Consulting Katy Cain. The team explored how healthcare organisations can use flow technology to manage patient care and available resources effectively and efficiently, how it enables clinical teams to quickly see and act on what they need to do for patients, how hospitals are tackling national priorities and what integrated care systems (ICSs) stand to gain from using flow technologies.

Tom began the session by providing some background information about Alcidion. “We’re a technology organisation with an exclusive focus on healthcare,” Tom said. “We have extensive experience of complex system integrations across our three core markets in the UK, Australia and New Zealand.” Alcidion entered the UK market in 2018 following the acquisition of Patientrack and currently works with 40 clients here, across 132 hospitals.

Alcidion works to “engineer our solutions to really meet the needs of modern healthcare organisations,” Tom said, “in an innovative and smart way that allows them to address the problems that are impacting clinical workflow and service demand.”

This approach is centred around addressing specific challenges such as patient safety; clinical productivity; patient flow and logistics; virtual and new models; practice variation; and consumer driven care.

“We do this through a highly interoperable solution which is built on open standards,” said Tom. “It’s really engineered to be an active participant in healthcare and not just a passive data store.”

Clinician’s view

Here, Paul took over the discussion, focusing initially on the problem that Alcidion are aiming to solve through application of digital patient flow systems.

“The reality is that we are at a very challenging time for the NHS,” Paul said, “and following on from huge ongoing efforts made by NHS teams to manage the COVID pandemic, the knock-on impact on patient pathways and care pathways been really significant”.

“The key challenges that we are facing are workforce, workload and morale. Digital solutions have got a key role to play in changing that momentum.” Paul added that when it comes to patient flow, the “positive impact and consequential benefit of a digital system is really clearly understood”.

Managing flow, and ensuring that there is a clear system for managing a patient’s journey as soon as they attend a trust or seek help, is “fundamental to how we address the backlog, the workload issue, the staff morale issue,” Paul continued. “If we hit stasis within our organisations, then it starts to create a catalogue of challenges that make it harder and harder to address the things that we’re trying to solve.”

Paul highlighted some of the local challenges faced by organisations, such as manually collected and maintained information that is only available in one place, leading to inefficient patient journeys and unnecessary increases in patient length of stay. “The honest reality is that we need to move away from this established way of working,” he said, “and start understanding how digital tools can improve and change the opportunities that we have.”

The use of old systems and ways of working, Paul noted, “add up to one thing – it’s harder for our teams to do the right thing first time. Understanding what people are waiting for, making sure that they’ve got their planned outpatient appointment whilst they’re still an inpatient, that their take-out medicines have been processed and their transport request hasn’t been lost… it’s so hard to manage each person’s journey smoothly.”

To solve these problems, Paul brought it back to the need for “well-designed, well-implemented digital patient flow systems”.

Paul then provided an overview of what patient flow actually is, that is, moving patients seamlessly around the entire system, not just around the organisation, improving flow through things like length of stay reduction and increased satisfaction, and minimising manual data entry and duplication. A patient flow system will capture automatic updates about key steps in the patient journey and can bring a range of information such as pathology, medication and transport into one place.

It “frees up teams from the manual data entry components of the work and the industry that has developed around managing flow at a site-level” so that they can “spend time on what matters, using skill and knowledge to solve problems as opposed to collating information”. Critically, Paul added, it “reduces the burden on overstretched teams that are in desperate need of support”.

Looking to the future, Paul said: “Any digital system that manages flow has to have a technical architecture that means it’s designed to be able to address the challenges of new models of care. As we move into ICSs and as our organisational boundaries start to get really blurry, and be much more closely correlated with the community, we need to be able to have a technological infrastructure that can manage that transition.”

A key lesson learnt during the COVID-19 pandemic was the importance of making sure that the right digital technology is in place to support new models of care. “There’s no better example of that in my opinion than the virtual ward, where traditional practices and a traditional approach just aren’t fit for purpose,” Paul said, highlighting the roles of new technology like wearable devices to monitor oxygen saturation or patient questionnaire on the severity of symptoms in making it easier for teams to know who to escalate and who to de-escalate. “It makes it far more impactful by having the right technology underpinning it.”

In summary, Paul said, “the NHS is facing challenges at scale that I’ve not seen before in the twenty years I’ve been working in it. I think we are facing a significant period of time in which we need to harness the power of digital technology. By digitising the system, it allows for detailed data collection to drive that quality improvement. So often teams can report anecdotally and have really clear knowledge of where the bottlenecks in their systems lie, but unless you’ve got robust data from a digital system, you can’t furnish a business case with the information it requires, you can’t unlock the investment because you can’t monitor the impact of that funding.”

Matron’s view

At this point, Katy took lead of the conversation. “I’ve got more than 20 years’ experience of working in the NHS as a registered nurse,” Katy began, sharing how she worked as an Acute Cardiology Matron with responsibility for inpatient care, community nursing teams and more.

“During this time I’ve managed patient flow in a wide variety of different settings, using whiteboards and different digital products,” Katy said, noting that she has used manual and digital systems together in her time with the NHS, alongside support from a ward clerk to help her keep track.

“I’ve also seen that pressures have just continued to rise,” she commented, highlighting how existing pressures were magnified by the pandemic alongside the increasing range of complex needs and comorbidities presented by patients.

“As Paul said, patient flow is so important,” Katy said. “It’s become everyone’s responsibility. In my experience, patient flow to a large extent has been managed by nurses and bed managers, and now everyone across the multidisciplinary environment within and beyond the hospital walls is trying to ensure that patients move forward in their care journey safely, appropriately and as efficiently as they possibly can, with the needs and wishes of patients and their families respected within that.”

Patient flow can also help through minimising de-conditioning (generalised loss of fitness through extended hospitalisation), Katy said, and can support patients by providing more streamlined care in an appropriate ward to prevent complications arising through longer lengths of stay. Additionally, patient flow helps patients in being discharged with the right arrangements to aid recuperation and helps to prevent readmissions.

Discharge is an important part of this, Katy noted. “We know that we’ve got lots of things around now… what other care services are available to try and care for patients so that they are not admitted to hospital, so that they are discharged earlier. Even looking at someone attending hospital for an elective total hip replacement, they can be seen and treated and that can be done as a day case. But how do we get those patients optimised before surgery and make sure that they get the necessary care afterwards?

“Technology is really starting to make a difference,” Katy continued. “It’s making it easier for healthcare professionals to know what needs to be done, to ensure that patients do move forward in their care.”

Solution overview

Next, Katy moved on to show how Alcidion’s solution supports patient flow management; to view Katy’s demonstration, go to 24:30 on the video below.

The demonstration provided an insight into the Miya Flow journey board, showing patient information in a ward area with columns including data input from the clinicians looking after the patients, demographics pulled from other EPR systems, safety considerations such as food allergies and isolation requirements, how the board can link into other systems to look into patient results, and more.

Watch the full session here:

Many thanks to Tom, Paul and Katy for their time and thoughts.