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www.england.nhs.uk
Innovative IT
Solutions for
7 Day
Services
8th November 2016
Welcome
We will begin at 13:00
www.england.nhs.uk
Welcome Marie Tarplee, Programme Lead - Seven Day Services, Midlands and East
NHS England Sustainable Improvement Team
Safe Hands: Using real-time locating to improve patient safety and support seven day service delivery
Clare Nash, Senior Nurse Procurement and Safe Hands,
The Royal Wolverhampton NHS Trust
Using nerve centre to support seven day services John Jameson, Deputy Medical Director
Julia Ball, Assistant Chief Nurse
University Hospitals of Leicester NHS Trust
Questions and discussion
Summary
Agenda
Safe & Effective | Kind & Caring | Exceeding Expectation
Safe Hands
Using real-time locating to
improve patient safety and
support 7DS delivery
Clare Nash RGN
Senior Nurse Procurement and SafeHands
RWT Faced Significant Challenges
• Lack of organisation-wide visibility
into status and location of bed,
patient, staff, and equipment
causing efficiency challenges and
posing safety risk
• Bed Managers walking the floors to
find beds
• Poor patient flow leading to:
– ED breaches
– Same day cancelled electives
– Multiple ward moves and outlier
bed days high
• Challenges to track and manage
infection outbreaks
10,288 9,788
10,220 10,332
10,992 10,796 11,403 11,308
10,939
11,686
12,551 12,049
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Emergency Admissions
Emergency Admissions
Infra-red and radio-frequency RTLS
Real –Time mapping
Patient flow & safety together
• Source: Sample Text
Transport Tracking
Patient / staff / asset
tracking
Real time alarms
& Info at a glance
“Last Seen” Indicator
Bed Tracking and cleaning
Centralised Patient
Placement and discharge management
Custom reporting
Centralised Patient Placement
Central Control
External bed requests
IHTs
ED
Direct Emergency Admissions
Internal Transfers
Electives
Right patient to right bed at the right time
Place patients if bed empty
Pre-book beds based on EDDs
Target beds coming up
% of 4 hr ED breaches with Reason
“No Bed Available”
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
2012 2013 2014 2015 2016
Medical Outliers
Analysis of General Medical Outliers total bed days / Number of ward stays
(2016 annualized)
0
1,000
2,000
3,000
4,000
5,000
6,000
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
2016/2017 2014/2015 2015/2016
Total Bed days No of patient outlied
Cancelled Ops Due to Lack of Beds
Cancelled Operations (on the day) by month
0
10
20
30
40
50
60
70
80
90
100
Dec
Sep
Aug
Sep
Nov
Jun
Aug
May
Apr
Mar
Nov
Oct
Jun
May
May
Mar
Feb
Jan
Dec
Jan
Feb
Dec
Jan
Aug
Jun
Sep
Feb
Nov
Mar
May
Mar
Apr
Apr
Apr
Oct
Nov
Oct
Jan
Feb
Dec
2012 2013 2014 2015 2016
Bed Shortages – Exc. Ortho Bed Shortages
Improved Theatre
performance
during winter
months
7DS - Improving Discharge patterns
7DS Patient / Dr
Interaction Durations and outcomes
The Patient Flow Bundle - SAFER S - Senior Review. All patients will have a Consultant Review before midday.
A - All patients will have an Expected Discharge Date
F - Flow of patients will commence at the earlier opportunity (by 10am) from assessment units to inpatient wards.
E – Early discharge, 33% of our patients will be discharged from base inpatient wards before midday.
R – Review, a weekly systematic review of patients with extended lengths of stay ( > 14 days)
https://improvement.nhs.uk/resources/safer-patient-flow-bundle/
S – Senior review before midday Location Durations in Minutes Where Entry Time is before 12pm (Consultant Only)
Period: 26/09/2016 - 02/10/2016
Mon Tue Wed Thu Fri Sat Sun
Ward Name 26
/09
/20
16
27
/09
/20
16
28
/09
/20
16
29
/09
/20
16
30
/09
/20
16
01
/10
/20
16
02
/10
/20
16
1 0.0 6.1 1.0 0.0 0.6 0.0 0.0
2 0.0 0.0 28.5 0.0 0.0 14.7 0.0
3 0.0 0.0 110.7 0.0 3.3 5.0 0.0
4 87.2 31.9 52.9 25.0 109.6 58.7 74.4
5 0.0 0.0 0.0 155.9 51.1 9.9 1.3
6 0.0 0.0 3.8 0.0 0.0 37.9 51.4
7 18.9 0.0 7.8 2.0 0.0 0.0 0.0
8 0.0 0.0 0.0 0.0 0.0 0.0 6.7
9 0.0 0.0 0.0 0.0 4.4 132.2 139.2
10 0.0 0.0 9.7 0.0 0.0 120.6 7.0
11 168.5 160.0 149.3 110.1 135.4 43.5 0.0
274.6 198.0 363.5 293.0 304.2 422.5 279.8
Average Nursing contact hours /patient (1 week snapshot)
28
23
26
32 31
30
22 23
18
27
22
20
14
18
10 9
7 8
4
7
4
0
5
10
15
20
25
30
35
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Co
un
t (P
ati
en
t &
Sta
ff)
Av
era
ge C
on
tact
tim
e (
Ho
urs
)
Number of Patients Qualified Staff Unqualified Staff Average Time per patient (Qualified) Average Time per patient Contact Time (Unqualified)
Data to be interpreted with caution:
Interaction = patient and staff member in same small defined space at same time
Patient in bed, nurse at end of bed will not count towards contact
Not all of the nurses captured here are ward based staff eg Cardiac Rehab, TVNs, Palliative care and Infection
Prevention
Next Steps for the care interaction data
Comparing CHPPD with Actual HPPD
Interaction times vs. patient outcomes (the “So What” factor!)
Setting the national benchmark on what “good” looks like
Questions
Contact Information
[email protected] for SafeHands queries
[email protected] for 7DS queries
www.england.nhs.uk
Using nerve centre to support seven
day services John Jameson, Deputy Medical Director
Julia Ball, Assistant Chief Nurse
University Hospitals of Leicester NHS Trust
© 2015 Nervecentre Software Ltd. 20
Whole Hospital Mobile Platform
BED MANAGEMENT*
HANDOVER OBSERVATIONS
HOSPITAL AT NIGHT
CLINICAL ASSESSMENTS
TASK MANAGEMENT
Clinical Applications
ACTING UPON RESULTS*
SEPSIS AND AKI*
INSTANT MESSAGING
PATIENT STATUS AT A GLANCE
EMERGENCY DEPARTMENT*
PORTERING ACUITY AND SAFER
STAFFING*
Communication Operational Improvement
© 2015 Nervecentre Software Ltd. 21
HANDOVER
Work at UHL
Reduces unplanned admissions to ICU by 16%, 10% total nursing time released to patient care
Handover
• Constant communication of patient status
• Provides continuity of care
• Increases patient safety
CASE STUDY: Leicester Hospital (1,600 beds, 4,000 clinical staff)
• 30 minutes saving per doctor per day • 100% compliance with Hospital policy • 2m sets handover, discharge and step-
down notes
www.england.nhs.uk
Questions for all participants: • Are others using nerve centre, how are you using it to
support 7 days?
• How are others using IT solutions to support the
delivery of 7 days?
Questions and
discussion
www.england.nhs.uk
“Measurement for improvement” • Tuesday 6th December 2016
• To register interest email:
Let us know if:
• If you have work you would like to share
• There are other topics you are interested in
email: [email protected]
Next 7 day services enabling
webinar:
