Early warning system helps clinicians reduce cardiac arrests and identify and respond to other potentially fatal conditions

Our client

Basildon and Thurrock University Hospitals (BTUH) NHS Foundation Trust primarily serves the 405,000 population of Basildon and Thurrock in South West Essex, as well as residents of the neighbouring districts of Billericay, Brentwood and Castle Point.

BTUH provides an extensive range of acute healthcare services at Basildon and Orsett Hospitals, including diagnostic (x-ray and phlebotomy testing) at the St Andrews Centre in Billericay.

The Essex Cardiothoracic Centre is also part of the Trust, based at Basildon University Hospital, and provides a full range of specialist cardiothoracic services for the county of Essex and further afield.

The situation

When BTUH began its deployment of Alcidion’s early warning solution in April 2016 as part of its deteriorating patient programme, it had big ambitions to make a significant difference to patient safety and the working lives of nurses, doctors and other healthcare professionals.

In their current system, the nurses had to manually write measurements of key physiological parameters and manually calculate the national early warning score, otherwise known as NEWS2, a crucial indicator of whether a patient’s condition was deteriorating.

After seeing the immediate impact of Miya Assessments and Miya Observations (formerly known as Patientrack) in other hospitals, the Trust’s team was keen to implement the solution quickly.

The solution

Miya replaced the paper charts traditionally used to capture bedside observations with iPads, so nurses are able to digitally record their patients’ vital signs directly into Miya. It also automatically calculates the NEWS2 score.

“This has helped to improve the accuracy of observations. Staff have loved the system which they can access regardless of location, something that hasn’t been possible with paper charts.”

– Chief nursing information officer, Sam Neville, Mid and South Essex University Hospital

A follow-on project will allow Miya to take readings directly from the trust’s Welch Allyn monitors. This will be used by nurses to capture several observations, including blood pressure. It will reduce the need to manually enter readings and the associated risk of data entry error.

The result

The impact of the programme has been tremendous, from a major reduction in cardiac arrests to significant hours of time saved for nurses every day. The project is empowering nurses on the ground to call for help sooner when patients need it. It has also led to the appointment of Mid and South Essex University Hospital Group’s first Chief Nursing Information Officer, Sam Neville, who holds the responsibility for embedding digital technology, innovation and forward thinking throughout the Trust’s clinical services.

“The outcomes of this project have shown nurses just what they can do with technology, with nurses now influencing and delivering digital leadership. Electronic observations functionality was rolled out in nine months to all inpatient wards. That’s pretty good going – 25 wards all live within nine months, with a small deployment team of four.”

– Chief Nursing Information Officer, Sam Neville, Mid and South Essex University Hospital

Going digital with observations – hours saved for nurses every day

The use of Miya has had a major impact on releasing nurses’ time. A baseline audit with electronic observations and paper revealed that the time taken to complete a set of observations has reduced from two minutes and 30 seconds to just one minute and 30 seconds after going digital.

“That’s a minute saved per set of observations, per patient. A nurse saves 28 minutes per round, four rounds per day. As many as 13 hours of time are now saved for a nurse in a single week. It means staff can spend more time with the patient. One of the comments we had back was that ‘I’ve actually had time to wash a patient’s hair today’. So, this is helping us to improve the quality of care.”

– Director of Nursing, Dawn Patience, Basildon and Thurrock University Hospitals NHS Foundation Trust

Cardiac arrests fall dramatically, pressure relieved on staff 

The introduction of Miya has also improved patient outcomes. Cardiac arrests went from 2.20 per thousand admissions to 1.26 in October 2016 and now are as low as 0.46. That’s a drop of more than 75% on the ultimate measure BTUH uses to assess their management of patient deterioration. Electronic observations have been an important contributing factor to this improvement.

“The product is a vital part of a suite of measures that we introduced alongside new medical emergency teams, revised escalation policies and an active education and training programme. Being able to make emergency calls at the point the patient is deteriorating, means nurses don’t need to wait for the patient to start arresting to call for help. We use observations as our evidence.  For scores of 4 or 5 or more on NEWS2, staff can call for help straight away. Visibility that a patient is deteriorating means we can get someone to help before the patient has a cardiac arrest.”

– Chief Nursing Information Officer, Sam Neville, Mid and South Essex University Hospital

This proactive process has helped to reduce pressure on nurses and gives them confidence to trigger interventions. As the information is now visible, making it easier to act on, nurses are empowered use the information in a more immediate manner. Everyone can now access observations, whether they are on PCs or iPads, rather than a nurse relaying over the phone.

Better and earlier visibility of patient deterioration has led to important clinical decisions being made earlier. Ward level views on an electronic whiteboard tell the nurse in charge where the sickest patients are and their status. Trust level views of the same information inform critical care outreach, while also helping the Trust’s dedicated deteriorating patient nurse to identify who they need to see.

“This means we are not doing things to patients that we don’t need to do. There is a review of a patient’s treatment plan earlier and we are getting the right patients into intensive care sooner, rather than ‘let’s wait and see’.”

– Director of Nursing, Dawn Patience, Basildon and Thurrock University Hospitals NHS Foundation Trust

The Basildon pathway – redesigning the approach for everything from sepsis to AKI

The Trust has moved a significant range of assessments into the Alcidion solution. These include VTE, nutrition scoring, food charts, fluid charts, stool charts, infection control screening and monitoring and neuro obs, as well as smoking and alcohol screening. The Trust has seen a significant reduction in paper, with expected savings of £60,000 on paper per year.

The biggest benefit is expected from the development of the Basildon Deteriorating Patient Pathway – a holistic approach to identifying and responding to serious conditions linked with tens of thousands of deaths in the NHS every year, including sepsis and AKI.

“Rather than looking at this as a sepsis problem, or an AKI problem, through our pathway nurses are looking at the patient as a whole. There are commonalities in the triggers for these conditions and others around bleeding and airways, for example. Our approach in Basildon has been to develop an exclusion approach, where we exclude possibilities rather than starting with a diagnosis.

“If you focus only on looking for sepsis you are likely to miss a GI bleed. Some of the symptoms are very, very similar. Our approach doesn’t just put the patient on a single sepsis pathway to determine if they have sepsis but assesses the patient as a whole so we can get them the right response and help ensure something serious isn’t missed.

“At the end of the day this is all about improving the care that we provide for patients, and the more efficient, effective use of technology will enable us to do just that.”

– Director of Nursing, Dawn Patience, Basildon and Thurrock University Hospitals NHS Foundation Trust

The future

This project is part of the Trust’s wider commitment to develop its digital agenda and to work in partnership with industry to innovate and advance the use of digitally-enabled care. It is also part of a clinically-led patient safety programme that aims to empower frontline staff with new tools and methods to help measure improvements in patient care.