Canterbury District Health Board (CDHB) is responsible for the healthcare of approximately 12% of the population of New Zealand – an estimated 558,000 people. It is the second largest DHB in New Zealand in terms of both population and area. Their ability to maintain service delivery is critical to the functioning and sustainability of the whole New Zealand health system. The population of CDHB has the fastest-growing Māori population, the sixth largest in New Zealand and has the largest population aged over 75.
The DHB has five major hospital facilities in Christchurch and Ashburton and roughly 30 smaller rural hospitals and community bases across the region.
The DHB is strongly committed to providing high quality health care services across its population by providing the right care and support, by the right person, at the right place, at the right time and in the right way, striving for a patient safety vision of ‘zero harm’.
CDHB is the main planner and funder of health services in Canterbury; a tertiary provider of hospital and specialist services; a promoter of the population’s health and wellbeing; and the largest employer in the South Island – employing over 9,400 people across their services.
CDHB provides a significant load of regional and national services and their ability to maintain service delivery is critical to the functioning and sustainability of the whole New Zealand health system. In all, CDHB provides over $1.6b worth of services to the populations of other DHBs around New Zealand and delivers half of all the surgical services provided in the South Island.
CDHB initially wanted to address the deteriorating patient to reduce morality rates and avoidable ICU admissions, as well as improve the patient experience. In response to recommendations from the Health and Disability Commissioner and to reduce approximately 40 different patient observation and assessment forms, CDHB proposed that the use of an electronic system to enable better clinical protocols would improve patient outcomes.
Routine measurement of basic observations to assist in the assessment of patients and clinical progress has been a foundation of medical and nursing practice for decades. CDHB had already implemented a standardised Early Warning Score (EWS) in 2007 on the paper observations chart to better recognise deteriorating patients to ensure the most effective clinical response. However, CDHB soon acknowledged that replacing a paper-based EWS with a broader suite of automated real-time assessment and communication tools, would improve work flows, allow clinicians to dedicate more quality time with patients and ultimately reduce the number of adverse events.
CDHB engaged Alcidion to implement Miya for the electronic capture of physiological and clinical observations, early identification of deteriorating patients and alerting of clinicians. In addition to their standard physiological observations chart, they also required tracking of IV line insertions, removals and the regular reviews of these lines for infection, daily weight, pain, fluid balance, bowel chart and neurological observations.
To improve the staff workflow, Miya was integrated with the Patient Administration System (PAS) and Clinical Portal.
Before Miya, nurses recorded all observations on one or more paper charts. Patients often required a variety of observations to be taken at different times and different intervals, as some would require physical observations every couple of hours to ensure they were not deteriorating; while others would only require observations once a shift. Additionally, some patients also required neurological observations and others had IV lines that required regular review.
Having only one physical source of information on what observations were required and when, could often lead to problems when the chart was unavailable. CDHB found that paper-based charts created risk, as clinical staff were not always aware or alerted to an increasingly sick patient. The critical patient information only existed in hard copy, could not be easily accessed by staff working remotely and could be easily misplaced or might not be available if the patient suddenly deteriorated.
In progressing the vision of a patient centric digital health environment, CDHB agreed that by error proofing their systems and integrating their processes, they could achieve great improvements in patient care and safety. Using electronic systems would enable better adherence to clinical protocols, assist in real-time management of the standard of care and significantly improve the patient experience with better and more favourable outcomes.
The expected results from adopting the technology included:
- 100% EWS calculation accuracy
- Increased timely clinical attendance to the deteriorating patient
- Reduction in unexpected cardiac arrests and reduction in mortality
- Improved patient journey
- Reduction in avoidable ICU admissions
- Reduction in patient ICU days by more timely admission
- Better access to information for planning, collaboration and research
- The system will be extensible to the Southern Region and beyond
Alcidion’s solution was chosen by CDHB through a rigorous procurement process. A complete digital and mobile bedside solution, Miya is proven through clinical trials to improve patient safety, quality and efficiency of care in one easy-to-use application.
Miya is a clinically proven ‘track and trigger’ system that utilises the latest in mobile technologies to deliver measurable improvements to the quality of patient care and patient outcomes while also supporting more efficient processes of acute care delivery generating substantial savings and improvements to patient throughput.
For CDHB, one of the benefits of the Alcidion solution is that it can easily be configured to their specifications based on their policies. This included the electronic capture of a large variety of observations such as standard adult observations, pain, neurological observations, cannula insertions, removal and reviews, fluid balance, as well as weight and bowel charts. Miya uses this information to calculate risk indexes in order to indicate patients at risk of deterioration. In addition to data capture, it also schedules when each type of observation needs to be taken, allowing a continuation of care across single and multiple shifts.
Capturing observations electronically means the patient chart is also electronic; allowing it to be accessed in multiple locations across the hospital, resulting in no more missing charts or having to hunt for the patients’ paper chart.
Since the first pilot ward, CDHB have successfully rolled out the solution across their facilities and more broadly to West Coast DHB.
“Our surgical teams who have been using the solution this year report that it’s easy to use and provides accurate/real-time information that is helping us improve patient care.”
– David Meates, Chief Executive, Canterbury and West Coast District Health Boards
CDHB conducted an audit of the results, comparing the pre and post implementation records based on an analysis of 8,700 observation sets. Only three months after initial go-live the following benefits were being achieved:
- Prior to the implementation of Miya there were 71.3% EWS completed and this moved to 100% post implementation
- Prior to the implementation of Miya the EWS was accurately calculated 67.1% of the time and this moved to 100% post implementation
- Recording each set of observations now takes a minute less for each patient
The improvement in accuracy and completion of EWS in turn leads to better detection of patients at risk of deterioration and helps to reduce length of stay and unplanned admissions to ICU, or the need for interventions by ICU Outreach. This ultimately improves patient outcomes, patient experience and patient flow. Over time Miya will reduce demand on expensive ICU resources and provide for a less stressful and more efficient ward environment.
The reduction in time spent looking for charts now frees up time for nurses to care for patients, which again improves the patient experience, staff satisfaction and reduces costs over time.
Alcidion and CDHB continue to expand the use of this clinical documentation capability.