There’s nothing we love more than sharing a great case study. Full of learnings, challenges, benefits, tips and insight – the below submissions to our Health Tech Case Study of the Year award are chock full of useful information.
Enjoy reading the examples below and tune in to the HTN Now Awards evening at 7pm, on 20 January 2022, to find out who has taken the top ‘prize’. Whoever wins on the big night, we think they’re all brilliant.
Barts Health NHS Trust
Barts Health was selected to be Lead Provider for London’s COVID-19 Mass Vaccination Centres at ExCeL London, Westfield Stratford and other hospital hubs. The trust developed the Class Attendance Tracker QR (CATQR) solution in conjunction with a Microsoft Gold Partner to efficiently monitor workforce attendance and competence in real-time.
The trust’s Education Academy was tasked to induct, train and competency assess a workforce able to deliver up to 10,000 vaccinations a day whilst working to extremely tight deadlines.
They decided to use their existing real time solution for training attendance and compliance, Class Attendance Tracker QR (CATQR), co-developed CATQR with Microsoft Gold Partner, Shinetech Software, and previously used at NHS Nightingale Hospital London. The technology uses QR codes and people’s own mobile phones to effectively ‘sign in’ to education and training sessions, providing accurate real-time data for both learners and the trust.
CATQR was used in a variety of ways: to track people’s attendance at group training sessions; to check the signing in and signing out of staff and volunteers into the centre, as a record of who was in the building for safety; to track the successful competency assessment of all staff through daily supervision; to track the lateral flow testing results of all staff and volunteers; to monitor clinical competency in real time within the pods.
CATQR effectively replaced around 25,000 individual paper signatures from the workforce and provided a system that not only eliminated the errors that creep in with manual systems but also enabled real time data reporting.
The trust delivered over 180,000 vaccinations and says CATQR addresses a ‘long-standing problem that has simply never been tackled – how to accurately and efficiently track face-to-face training and competency assessment.’
Discover more through the video below:
Darent Valley Hospital, a member of the Dartford and Gravesham NHS Trust, has pioneered the use of Antser Virtual Reality (VR) for its safeguarding training, with the aim of increasing empathy, changing attitudes and modifying behaviour to enable positive change by immersing users into ‘real’ scenarios.
Overseen by the Safeguarding Children’s Team since October 2020, Antser VR has been used as a training and development resource for the hospital workforce. The safeguarding team is responsible for the training and development of over 3,000 staff, and has recently developed the ‘Think Family’ training approach. The model approach recognises how mental health issues can affect family life and have an adverse effect on children and young people.
The VR training programme fits well within the aims and objective of the Think Family model and complements the training for the workforce. It is used at the beginning of the training and is a stark reminder of the experiences of abused children. Thinking of the bigger picture, in A&E and many other clinical settings, the workforce can witness a range and number of family scenarios – all of which would have an impact on a child. When the workforce is armed with the knowledge and experience to recognise these situations, the right referrals to social care can be made, at the right time.
Antser has worked closely with the hospital, training 10 of its staff members, including midwives, to deliver the VR programme. These 10 staff members are now able to deliver the VR training programme throughout the organisation. This will be mainly aimed at all clinical staff who attend Safeguarding Level 3 training which includes A&E, paediatrics and maternity. 164 staff members have now completed the training programme.
Sonya Stocker, Senior Sister for Safeguarding, came across the innovative VR technology at a NSPCC conference. She said: “I could quickly see how powerful the VR was and how the immersive experience would help staff understand and recognise certain situations with more empathy.”
There are also other potential opportunities where VR could be used, including a stop smoking initiative and working with other health partners to provide trauma informed training.
A Women’s Health Physiotherapy team (WHPT) have improved their service using digital self-referral through MyPathway, a secure, digital clinical management platform connecting patients to clinicians, and empowering and engaging patients in their own healthcare journey.
Historically, antenatal women accessed WHPT via a paper referral from either a midwife, GP or Obstetric Consultant for antenatal pregnancy-related pelvic girdle pain, low back pain, rectus diastasis, carpal tunnel syndrome and pelvic floor dysfunction. However, the team found that the problem with manual referral was that patients were not always seen in a timely manner
WHPT wanted to test the feasibility of implementing a digital self-referral pathway, with the intention to improve accessibility. They wanted patients to refer themselves to the service when they felt they needed to access women’s health antenatal physiotherapy support, from the start of their pregnancy through to their due date. They also wanted a digital pathway to help monitor the DNA rate and improve quality of data on the referral.
MyPathway allowed patients to register and complete a questionnaire, providing the WHPT with the relevant information about the patient’s condition. The WHPT can then ‘assign’ the type of appointment needed. The patient is offered either a video package, replicating the antenatal group session, or a 60-minute face to face appointment. Patients also have access to resources regarding pregnancy-related conditions within the app. The patient is also invited to choose and book their own appointment at a time convenient to them, and are able to tell the physiotherapists themselves about their problems and the impact it is having on their lives.
After four months of live data, 179 referrals were completed and triaged. Results included:
- 4.5 per cent of patients were triaged to telephone consultations, 87.5 per cent of which attended.
- 45.2 per cent of patients were triaged to a video package, of which there was a 1.2 per cent DNA rate, below the trusts expected level.
- 50.3 per cent of patients were triaged to 1:1 appointment, 87.8 per cent attended their appointment.
Moving forward with MyPathway, the WHPT want to gain more feedback from their patients to further improve the service as well as reintroduce the group sessions that is currently on hold due to COVID-19 restrictions. Now that the team have the technology in place, there is also the possibility of extending this pathway to post-natal women.
Real World Health
RwHealth, with Derbyshire Healthcare NHS Foundation Trust, completed a Multi-Agency Discharge Event (MADE). Over the course of a week they brought together colleagues from RwHealth with operational, clinical, and transformational teams within Derbyshire, and surrounding system partners, to support accelerated and safe discharge of patients in the hospital with the aim of supporting enhanced overall patient flow.
The decision to hold the MADE event, and the challenge at hand, was largely in response to a number of systemic issues at the trust, which resulted in trust-wide caseloads in excess of the national average. With a need to ensure patients with long lengths of stay (LoS) and that those who do not need to be in hospital were appropriately discharged, the central focuses of the MADE were two-fold:
1. Discharge of as many clinically optimised patients as possible from hospital, and,
2. Capture of key learnings to inform the focus of flow improvement initiatives with system partners going forward.
Combining both the necessary technology and data solutions, alongside support on the ground by the very people at the frontline of delivering healthcare, is essential to improving patient flow. To achieve this at Derbyshire Healthcare NHS Foundation Trust, RwHealth combined its Data Science Platform (DSP) and Mental Health Flow Tool (MHFT) within the structure of a Multi-Agency Discharge Event.
The event took place over the course of a week, during which time the MADE team examined progression along agreed care pathways, down to an individual patient level: highlighting, documenting, and tackling identified blockages to flow. Each stage of the patient’s journey was reviewed in detail, ensuring any necessary interventions were undertaken and any escalations could be actioned. By pinpointing and documenting any challenges or delays, they curated a daily source of information for the central team, with particular focus on stranded patients. Analyses by RwHealth were conducted through deployment of the Mental Health Flow Tool (MHFT) in advance of and during the session.
Analytics conducted in advance of the session were used to identify key flow issues at the trust in preparation for the event, utilising the MHFT’s service user tracking capabilities to drill down into issues and ensure teams were supported in discharge decision-making both during the MADE and into the future. Analytics were also conducted on the day to identify key trends, interrogate them, and identify opportunities, with testing of key flow improvement hypotheses identifying marked differences between sites, wards, and community teams.
These analyses highlighted a number of processes that warrant changes in the way in which services are delivered, supporting clinical and operational leads who were keen to build upon pockets of good practice and take forward proven hypotheses to extend the MADE process to CMHT teams. Key clinical model changes emphasised by senior clinicians include:
1. ‘Beds’ — neighbourhoods to work more closely across wards and community teams to lower occupancy.
2. ‘Home First’ — setting clear expectations from admission outset regarding the aim and shared drive to support return to a home environment.
3. EUPD pathway — extend and develop areas of good practice to deliver a consistent quality approach, including short, purposeful admissions.
4. Crisis House — expansion as an alternative to informal admission, which audit highlighted were driven by suicide risk concerns, or work to ensure it is used optimally, with consideration of alternatives regarding crisis management of EUPD / suicidal patients.
Trust-wide, the event was highly successful and resulted in a significant improvement, through the engagement of a range of internal and system partners in supporting discharges of patients across the Adult Working Age (AWA) and Older People (OP) wards. Indeed, discharges increased by almost 50 per cent from normal levels, and both staff and system-partner feedback were incredibly positive.
Bolton NHS Foundation Trust
Bolton NHS Foundation Trust designed an Electronic Medical eHandover List which allowed clinicians to add, track and action outstanding clinical tasks and highlight acutely unwell patients throughout the hospital. This resulted in a significant increase in documentation of clinical tasks which were actioned in a timely manner, improving patient safety.
The trust saw an opportunity to implement a Acute Medicine Referral List; to design and implement a Medical eHandover clinical task list. The list would help clinicians add, track, allocate and action outstanding clinical tasks and highlight acutely unwell patients throughout the medical wards, increasing awareness of outstanding tasks and improving visibility of unwell patients throughout the hospital.
Configuration analysts worked with the Allscripts team to identify the best way to pull the data from the system and collated clinical tasks for patients. The clinical handover processes were mapped, with the electronic list automating the majority of the steps and minimising the risk of human error.
The list collates clinical tasks and information on acutely unwell patients from 24 medical wards, releasing time previously spent conducting and transcribing verbal handover to clinical work. It includes useful clinical information such as patient demographics, clinical location, details regarding the outstanding clinical tasks, when they need to be actioned by and the grade of clinician needed to action them. The list can be updated in real-time and viewed by multiple clinicians simultaneously, improving continuity of care.
The list was implemented in September 2021 and, as of three months post implementation, there have been 1,630 entries on the Medical eHandover List. These entries equated to 1,755 clinical tasks for 934 patients, almost one-third of all the medical admissions during this time period.
Compared with pre-implementation data from 2020 and 2021, there has been a 65 per cent increase in the number of recorded clinical tasks, and a ten-fold increase in the number of outstanding investigations. Of the 1,755 clinical tasks that have been entered into the system, almost 85 per cent were to chase outstanding clinical investigations and/or their results. The increased visibility of outstanding tasks has enabled them to be stratified effectively and actioned promptly. The team now intend to share the list more widely so it can be deployed across all specialties.
Barking, Havering and Redbridge University NHS Trust and System C
Barking, Havering and Redbridge University NHS Trust (BHRUT) reported improvements in care and efficiency within days of starting the rollout out of its new care co-ordination and electronic referrals functionality, part of an ongoing digital transformation programme at the trust in partnership with System C.
CareFlow Connect is a secure and mobile clinical communications and collaboration system designed to facilitate faster and safer care co-ordination for clinical teams within a hospital and across a care community. When a junior Tissue Viability nurse was concerned about moisture-related skin damage, she acted swiftly and used CareFlow Connect to take a picture of the injury before attaching it to a referral that asked for expert follow-up advice from Debbie Wickens, the trust’s Lead Tissue Viability Nurse.
Unfortunately, it was later confirmed that the patient had a form of necrotising fasciitis, a rare but serious bacterial infection which can be life threatening if it’s not recognised and treated early on.
Debbie explains: “Detecting the infection led to early intervention. The patient received an urgent surgical review, followed by potentially life-saving surgical intervention. This case really demonstrates the enormous value of CareFlow Connect and we’ve continued to realise the benefits ever since.”
The CareFlow Connect app is helping the Tissue Viability team work more efficiently, reserving initial face-to-face reviews for those who really require them, whilst stepping up activity on supporting ward staff by conducting more follow-up activities on patients. Previously, this had been difficult to achieve as the sheer volume of referrals is so high, making the prioritisation of referrals a challenge.
Photos are of clear value to the team, as they enable the team to triage patients and prioritise their workload by identifying more serious tissue damage quickly, reviewing these patients in priority order and putting in a plan of care. Shortly, the need to include photos for all referrals will be compulsory at the trust.
Task management has proven essential for the Tissue Viability team, too. The team’s workload is allocated via CareFlow Connect’s task management functionality and each task set for general and complex cases is allocated according to the skillset within the team. The ability to schedule tasks will be available soon, which will provide further value.
The team can now view referrals and complete handovers in minutes, while immediate advice and a care management plan is quickly provided to all patients. Debbie says: “Due to social distancing, I’m required to work from home one day a week. However, CareFlow Connect ensures that my clinical effectiveness is maintained, regardless of location.”
Eva’s point-of-care vaccination platform, eVacc, is a rapidly-deployed, cloud-based and interoperable vaccination platform for PCNs (Primary Care Networks) to support vaccination delivery across settings. It has scaled to 60+ PCNs in less than six months and delivered close to 1 million vaccinations. The platform saved also saved its pilot site 20 seconds per jab and continues to experience 0% downtime.
In December 2020, NHS Digital invited Eva Health to tender for a point-of-care vaccination solution to provide an additional option.
Having mobilised the team in just two weeks, Eva pivoted to focus on the vaccination effort to create eVacc. The team went from the first line of code to a fully assured solution, tested to take the full vaccination load of England without crashing, and available for the NHS to use, in less than six months.
Eva Health says it is ‘most proud’ of being able to ‘support the delivery of healthcare services in new, more flexible ways’, across a range of care settings and pop-up locations – from GP surgeries and care homes, to mosques, gyms, nightclubs and even a bus.
Results to date include:
- One-day turnaround, five-minute training
- Fortnightly upgrades, 20 to date
- 0% downtime to-date
- 6x active and assured NHS integrations, ensuring updates of patient records and accurate and timely reimbursements and reporting
- Over 50 PCNs use eVacc and have onboarded in less than six months
- Closing in on 1 million vaccinations
- 3,000+ registered users onboarded and using the platform
- 700+ GP Practices are receiving data from the Eva system
- 500,000+ patient records stored
- +67 net promoter score
- 88% customer satisfaction for implementation, 92% customer satisfaction for training, 94% customer satisfaction for support.
Royal Papworth NHS Foundation Trust and Dedalus
A pre-requisite for Royal Papworth Hospital NHS Foundation Trust when moving to the Cambridge Biomedical Campus was transforming from a paper-driven environment to paper-light . Implementing ePMA (Electronic Prescribing and Medicines Administration) across the trust was essential, from both an efficiency and safety perspective, and has resulted in savings estimated to be £475,606.
The Royal Papworth wanted to roll out a new system, as the foundation for its overall digital transformation and to improve medication safety across the hospital to enhance patient safety, ensuring the right patient gets the right drug in the right dose every time.
Its aim was to entirely eliminate handwritten prescriptions in all settings across the organisation, improving patient safety and patient experience. The trust had three ambitions:
1) Reducing errors and risks of harm
2) Enhancing the patient experience
3) Enhancing the staff experience.
Over a period of a year, a project was delivered to implement EPMA in all areas outside of critical care, which was using a speciality EPR, including all medicines types for inpatient, outpatient and discharge prescribing as part of a wider Dedalus Care Suite EPR project. The core deployment team was seconded from within the organisation in order that there was sufficient knowledge of institution processes and to ensure that learning was retained within the organisation. Focused EPR configuration training was provided by Dedalus and the team was supplemented by business change and training analysts, as well as implementation specialists from Dedalus.
The project rapidly progressed through workflow design and validation, with processes designed collaboratively by the project team and subject matter experts, and validated by clinical users. System configuration was led by clinical staff with experience within the organisation to ensure that drug catalogues and order-sets met the needs of the teams within the trust. Testing involved both project team and clinical users, whilst face to face training was provided for all users.
The clinical cut-over process from paper to the Dedalus Care Suite EPR was carefully planned and piloted prior to the go-live date. Elective activity was reduced, and prescribers and pharmacists were split into teams to visit inpatient areas and transcribe prescriptions and key clinical information into the system. The transcription was a two-step process, with the prescription entry being validated by a pharmacist. Each team was supported by an expert user (project team member or Dedalus product specialist) with second-line input available from configuration specialists. The EPMA system was implemented patient-by-patient over 10 hours after which all inpatients had been transitioned onto the electronic system.
The project was delivered one day ahead of schedule, with all clinical areas live with electronic prescribing for all prescription and medication types, including outpatients, infusions and day cases. The implementation was considered successful, with few significant issues being raised.
Benefits realisation included: reduction in time spent transcribing; reduction in time taken for medicines reconciliation; improvement in productivity by use of order sets and formulary; reduced expenditure on paper prescription charts; reduced CO2 emissions due to less paper use.
Leeds Teaching Hospitals
Teams at Leeds Teaching Hospitals NHS Trust (LTHT) have worked together to develop and launch a new radiological alerts system which automates the notification of significant findings on radiology imaging examinations. The new system is designed to meet and exceed National Patient Safety Agency (NPSA) and Royal College of Radiologists (RCR) best practice standards, improving governance processes and ensuring a robust audit trail.
There has been increased recognition over the years about the importance of incidental findings on scans and the significant risk posed to patients by inadequate alerting systems. A variety of national organisations, including the Parliamentary and Health Service Ombudsman, National Patient Safety Agency and The Royal College of Radiologists have highlighted these risks and made best practice recommendations to prevent serious patient harm. A common theme in these is to have a robust integrated digital solution to alerting clinicians about significant critical findings on xrays and scans in a timely fashion.
In line with LTHT’s approach to continuous improvement, a review of the unexpected significant findings reporting system in place highlighted that a number of improvements could be made. The driving force behind this change was to improve patient safety as a key priority.
The RCR produces standards documents which are designed to provide guidance to radiologists and others involved in the delivery of radiological services with the aim of defining good practice, advancing the practice of radiology and improving the service for the benefit of patients. Several of these standards are relevant in improving reporting of unexpected significant findings on radiology imaging examinations:
- Standard 6 – Responsibility of the employing organisation to provide IT systems whereby as soon as reports have been created they are available for action by the clinical team, with a permanent audit trail of who has read the report, and who has taken responsibility to act upon it.
- Standard 7 – Efficient and effective electronic means of fail-safe alert notification require investment by trusts, and require tracking within the EPR.
- Standard 8 – Fail safes should be IT based to reduce error and increase efficiency.
Clinical teams led by Radiology worked closely with LTHT’s digital team to specify and develop new functionality in PPM+, LTHT’s electronic health record system, which is developed and managed in house.
The new functionality uses a hashtag alert system which when inserted in radiology reports triggers a task alert in PPM+, automatically notifying the appropriate clinical teams and MDT’s for further action. The hashtags alerts include both cancerous (#alertcancer) and non-cancerous significant findings (#alertsignificant). This hashtag automatically creates a task in PPM+, prompting the clinician to review the findings, ensure all appropriate steps have been followed, and provide any further commentary required. Once the clinical team completes the task, it is marked as concluded and a weekly safety net report generated from PPM+ gives a ‘live’ status update to both radiology and the clinical team on completed and pending tasks. Quarterly performance reports are generated for operational and strategic planning purposes.
Seamless digital integration of radiology alerts into PPM+ ensures this information becomes an integral part of patient’s health records and can be accessed by clinical teams across the trust. The alerts system is also being developed further to notify GP’s throughout the region, enabling patients to discuss findings with their doctor should they wish to do so.
The new system ensures appropriate colleagues are automatically notified of findings, improving the reporting workflow and providing assurance of robust, clear communication with a clear audit trail of when the alert was placed, when the alert was actioned, and an easily searchable resolution within the patient record. The system also reduces manual effort and provides an additional patient safety benefit.
During the pilot period from March to May 2021, 300 alerts were processed, with 100 per cent pulling through to PPM+ without any missed alerts and 100 per cent of alerts actioned appropriately within a short timeframe. Following on from the success of the ED (Emergecy Department) pilot, the system is now being considered for an initial roll out in Cardio-Respiratory Medicine and Surgery for #alertcancer and #alertsignificant.