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Te Whatu Ora - Nelson Marlborough

How digitising deteriorating patient information, clinical communications and task management has revolutionised quality care delivery

About Te Whatu Ora – Nelson Marlborough

Te Whatu Ora – Nelson Marlborough was originally established as Nelson Marlborough District Health Board in 2001, providing and funding health services in the Nelson, Tasman and Marlborough regions on the South Island of New Zealand.

In 2022, Te Whatu Ora – Health New Zealand and Te Aka Whai Ora – Māori Health Authority became Aotearoa’s new national health authorities. Nelson Marlborough District Health Board (trading as Nelson Marlborough Health) became part of Te Whatu Ora – Health New Zealand.

Getting smart with clinical communications

Miya Observations & Assessments (formerly Patientrack) was already improving care delivery at Te Whatu Ora – Nelson Marlborough, giving clinical staff a transparent view of where and when a patient is deteriorating, with data available at the bedside or in a clinic room for senior clinicians.

On the back of seeing the benefits for clinicians and patients, clinicians turned their attention to procuring an electronic communication / task management solution that would improve communication between departments as well as provide transparency of information; which in turn would assist with clinical decision making.

Smartpage Clinical was chosen to replace existing paging systems and facilitate communication and notification. Users found interface intuitive – presenting relevant information face-up to streamline engagement and provide the user with easy access to all actions and updates supporting their work. Messages provide the full patient context, with integrated patient identification, vital signs, early warning scores, read-receipts and instant two-way replies that improve patient care and clinical collaboration.

With the implementation of Smartpage Clinical, clinicians at NMH have been able to save time with routine task management and improve communication. With group messaging providing security around how teams communicate and move communications off unsecure sites.

A staff survey following the implementation of Smartpage Clinical (which included medical, nursing and allied health staff) revealed that 22% stated Smartpage had saved them time.

A Ward Nurse said, “It’s better than phone calls because it doesn’t matter if I’m busy or on the phone, I still get the message and can respond more usefully due to the information they send in the Smartpage message (rather than having to pick up phone messages or notice that a text has come through).” with a colleague stating, “Its brilliant – keep it up! This is a rapid and highly efficient tool for communication”.

A House Officer in the survey noted “I actually really like Smartpage. I prefer a Smartpage chat about charting regular meds, or paracetamol etc. rather than a phone call. And I like the fact that you can leave the page sitting there until you’ve done the job so that you don’t need to write anything down (like you would if you got a call)”. Another stated “When the whole ISBAR and patient observations are filled out on job requests it is great and makes jobs a lot easier. Is also great being able to deal with things through Smartpage when you are free, instead of constantly getting called and interrupted.”

Since the introduction of Smartpage Clinical, the uptake of ward to ward information around patient flow and handover of information is now completed more efficiently. Where there would have previously been a phone call, Smartpage allows staff to respond when they are ready and not take them away from clinical workloads. Deteriorating patient alerts can be automatically escalated via Smartpage. The solution has been embraced by the Allied teams who use it as their main referral tool from Emergency and HDU in the Wairau Hospital.

The success of the Smartpage Clinical implementation in 2022 inspired system leaders to roll out the solution to other non-clinical departments, with the aim of further improving the flow of information and reducing delays in each patient’s journey.

Effective, intuitive task management for Orderlies

To kick start the Smartpage Non-Clinical project, Alcidion, the Nelson Marlborough Orderlies and Digital team came together to understand Orderlies’ workflow and requirements, and map out how Smartpage could help. Initially Orderlies were concerned about the technology not being easy to use as they felt “technologically challenged”. However, they found the user interface so intuitive that this concern never eventuated.

The trust that had built up through previous implementation projects was strengthened during the Smartpage Non-Clinical roll out, with the organisation’s teams appreciating Alcidion’s responsiveness to their needs and requirements.

Smartpage Non-Clinical was implemented in early 2023 and has been well received by users who can now order patient transfers and issue tasks with immediate dispatching to orderly staff via smartphones. Smartpage delivers benefits from requesting, co-ordination and individual perspectives. Each staff member has visibility of task status across the organisation. The use of real-time information, electronic requests, instant dispatching and self-allocation creates efficient workflows and improves team productivity. Patient journeys are streamlined, service delivery is more efficient and patient satisfaction is increased.

Following the Smartpage Orderlies implementation, the Orderly team have seen huge improvements in team productivity, with better visibility of all the orderly requests which has facilitated better management and execution of tasks.

An Orderly Team Leader said, “Smartpage is an easy to use, handy tool. The messages are very clear, so we know where to go and what to do”, with an Orderly also commenting, “I love it! I loved it as soon as I saw it! It’s easy to use and if you are already in a ward [doing a job] you can see what else needs doing and do it while you are there”.

Clinical users also liked that they can see which tasks have been activated and actioned provided by the feedback loop function, which was not transparent before. A Charge Nurse Manager said, “We are loving Smartpage. We also like knowing the job has been viewed by the Orderly team”.

Ward Clerks have also been impressed by the reduction in queries from Orderlies on the tasks allocated since the implementation of Smartpage Orderlies, with a member of the clerical support team saying, “I love it! Love the ease of it and it’s so quick!”.

Using Smartpage data to plan for the future is a big benefit for the teams. For example, being able to see that 32% of urgent requests are for equipment; such as blood tubes, culture bottles, IV lines, specimen bags, IDCs, and nasogastric tubes provides the opportunity to improve the restocking process and re-evaluate baseline ward stock levels. Small changes in the way wards are restocked have the potential to free up clinician and orderly time. Visibility of bottlenecks means staff can be redeployed to alleviate pressure points. All of which releases time to provide quality care for patients.

The future

Te Whatu Ora – Nelson Marlborough aims to work across the whole health system, potentially expanding the use of Smartpage to other teams such as Radiology and Household Services.

Te Whatu Ora Health New Zealand’s vision is to achieve a vision of Pae Ora, healthy futures for all New Zealanders by creating an equitable, integrated and sustainable health service, which is not determined by who the patient is or where they live.

All New Zealanders deserve access to consistent quality care when they need it, to live longer in good health and have the best quality of life. Te Whatu Ora works to increase collaboration, strengthen leadership and accountability, and improve equity of access and outcomes across the health service, providing a national health system that is:

People-centred – a system that brings together the voice of all communities
Equitable – a system that focusses on working in partnership with Māori and honouring Te Tiriti o Waitangi
Accessible – a system that offers more equitable, convenient access to services for all New Zealanders
Cohesive – a national health system that delivers locally supported by co-ordinated planning and oversight

  • Area covered: 22,700 square kilometres
  • Population: 160,000
  • Healthcare staff: 3,022
  • Venues: Two hospitals, two public health services and many community services
  • Beds: 211
  • Admissions: Average of 388 per month across all sites
  • ED attendances: Average of 4,000 per month across the district
  • Ambulatory attendances: Average of 17,000 per month across the district

22% of staff stated that Smartpage Clinical has saved them time.

It’s better than phone calls because it doesn’t matter if I’m busy or on the phone, I still get the message and can respond more usefully due to the information in the Smartpage message (rather than having to pick up phone messages or notice that a text has come through).”

32% of urgent requests are for equipment – data that wasn’t visible before Smartpage Non-Clinical implementation.

Smartpage is an easy to use, handy tool. The messages are very clear, so we know where to go and what to do