CDHB initially wanted to address the deteriorating patient to reduce morality rates and avoidable ICU admissions, as well as improve 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 to use an electronic system to enable better clinical protocols and 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 and ensure the most effective clinical response. However, CDHB acknowledged that replacing a paper-based EWS with a broader suite of automated 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.
Before working with Alcidion, CDHB 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. 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, could be easily misplaced or might not be available if the patient suddenly deteriorated.
CDHB agreed that by error proofing their systems and integrating their processes electronically, 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.
CDHB engaged Alcidion to implement Patientrack 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 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, Patientrack was integrated with the Patient Administration System (PAS) and Clinical Portal.
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 achieved:
- Prior to the implementation of Patientrack, there were 71.3% EWS completed and this moved to 100% post implementation
- Prior to the implementation of Patientrack, 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. This 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, this will reduce demand on expensive ICU resources and provide for a less stressful and more efficient ward environment.
“Our surgical teams who have been using Patientrack this year report that it’s easy to use and provides accurate/real-time information that is helping us improve patient care.”
– David Meates, CEO, Canterbury District Health Board
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.
Since the first pilot ward, CDHB have successfully rolled out the solution across facilities including West Coast DHB. Alcidion and CDHB are also collaborating to identify new areas into which Patientrack can be expanded.