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Five ways to improve patient care in the emergency department

The emergency department (ED) is designed for rapid patient care, quickly prioritising and responding to each emergency case arriving at the hospital. But many emergency departments in the United Kingdom, Australia and New Zealand (and other parts of the world) are stretched with limited staff and growing demands.

A major opportunity exists to enhance technology in the hands of doctors to make the flow of information faster and a lot simpler for busy hospital staff. Mobile devices, apps and faster scalable backends have untapped potential to lift the burden on doctors.

There are five key ways that this “tech upgrade” is improving patient care in EDs. Our experience implementing Miya Memory, our recently released iOS app for Miya Precision is a great example. Miya Memory is giving doctors a whole new experience, easing the clinical burden with the latest technology and it works hand-in-hand with the existing hospital software ecosystem (e.g. Electronic Medical Record (EMR), Patient Administration System (PAS), Radiology Information System (RIS), Picture Archiving and Communication System (PACS), etc.). Based on our experience, we can distil the following high level improvements:

1. The Handheld EMR

The smartphone is used extensively for communication by doctors; however, without the full patient context (and data security) these communications are error prone and cumbersome. When the clinician receives a notification, to get all the information they need to take action, they have to find a computer, log in, navigate to the patient record and hunt for the specific information needed. Doctors, wherever they happen to be, need access to the full patient record including results and past medical notes to respond to a call or bleep.

This information is also incredibly valuable at the bedside. The full patient clinical record available at the point of care on a mobile device has several advantages over computers on wheels or other shared workstations. Doctors are able to move around freely and refer without a moment’s notice to notes, results and observations at the point of care.  Doctors are also suddenly able communicate more freely with patients. One doctor noted the benefit of now being able to show images from their phone with patients.

Doctors in-charge also gain better oversight of junior medical staff. As emergency patients arrive in ED, doctors are assisted by quicker access to the patient’s relevant past admission history. The Miya Memory app is also greatly appreciated during handover, allowing doctors to easily follow along independently from their own devices.

2. Design Matters

Outdated software design lacks the usability that smartphone users have come to expect. The usability issues hamper access, slowing down the provision of care and this is especially important when time is scarce. Good design acknowledges that “every click is stretching the friendship” with a clinical user. So when accessing patient data for the ED, or other areas of the hospital, the app needs to be designed to surface the data to the user with minimum effort.

Attention to design is often undervalued but has a very significant impact. Our experience is that when doctors view the records of their own patients in the Miya Memory app there is immediate engagement. Modern Design should provide a rich, elegant and intuitive experience that doesn’t get in the way of the analysis and decision making required to provide patient care.

We have seen these improvements catch on quickly with medical staff. Engagement rates are very high. And even Senior staff who wouldn’t normally access a hospital workstation have asked for access on their phone.

3. Smart notifications improve communication 

There are obvious and immediate benefits to improving the communication process in ED. Much time is wasted chasing around the ward to find a staff member to confirm a critical result. Notifications provide assurance that messages are delivered and tracks when the message is seen. This reduces the response time for results and streamlines the process of acknowledgement. However the notification system needs to be smart.

Miya Precision manages notifications carefully to prevent over-alerting. Miya Precision is sensitive to the relative weight of potential notifications, preventing un-necessary noise. Throughout the Miya Memory app information is stratified by risk and urgency. This is a key user interface (UI) design feature that aids usability and makes the system more intuitive for medical staff.

4. Reduce the cognitive load with clinical decision support (CDS)

There is an enormous cognitive load on doctors to remember and track activity. CDS systems help to reduce distractions and allow doctors to focus on patient care.

The clinical decision support engine in Miya Precision is called Miya Logic. Miya Logic makes life easier for clinical decision makers. It does this by using information from the entire EMR to provide context for intelligent decision support. It provides various safety checks to ensure staff consider harmful drug interactions, medical conditions and other detected issues for the patient. It also provides a mechanism to improve compliance with best safety practices in the hospital.

Miya Logic is highly configurable and that gives hospitals the tools to make continuous improvements. Building on the Miya Platform’s real-time data stream, the notification system and Miya Memory app at the point of care, many innovations in care are suddenly within reach. We have implemented (explainable) algorithms to estimate discharge dates and the risk of readmission. Research initiatives, such as these, with Artificial Intelligence (AI) algorithms are much more cost effective, transferable and reliable when you have the platform to support it.

5. Real-time Clinical Infrastructure

There are many and various methods offered to provide operational reports and performance dashboards. This data provides valuable insights about the recent performance of the ED. However these insights are often available too late for staff to respond in meaningful ways.

Real-time information is required to intercept and action issues as they arise. Without improved backend infrastructure it is not possible (or very difficult) to provide insights about events happening real-time. Our customers are seeing great benefits from the switch to a real-time event based data platform. Miya Precision is built from the ground up to provide the real-time data required at the point of care. With better backend support its much simpler to intercept issues as they arise.

Conclusion

Better care and improved clinical safety doesn’t have to be at the expense of productivity. The combination of these improvements allows greater ease of use while adding better safety checks. Making the best thing to do is also the easiest thing to do for the medical team.

As outlined above, Miya Precision is the missing layer of real-time, smart infrastructure on top of transactional systems that makes all this possible.

  • Mobile access to all relevant patient information
  • Modern and highly refined UI design
  • Real-time event based data subsystem
  • Smart notifications, actions and acknowledgements
  • And effective clinical decision support

 

Ben Thow is a Product Manager at Alcidion