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Not going with the flow: Why we need to redesign clinical flow around patient needs using real-time information

6 June 2018

Take any successful manufacturing company, engineering firm or airport operator, they will have got their business and operational flow completely sussed. They will be using technology to give them visibility of what is happening at any stage in their business, and will use those insights to support real-time interventions and decision-making.  Why isn’t this happening yet in health? 

To say this is a wasted opportunity is an understatement.  The flow of patients into, within, and out of the hospital is the biggest single headache facing the NHS today. 

The fact the NHS is lagging behind other industries is not because all health professionals are Luddites. Simply tagging airline bags and scanning them periodically as they move through the airport can provide a wealth of operational information. Finding an efficient and effective way to collect and view reliable information about what is happening to patients in real-time as they move about a healthcare system is a whole different order of complexity.  

In order to understand and manage flow in a hospital you need to access to real-time operational information such as where a patient is, what their current clinical status is and what they need as part of their care or ongoing support. Employing staff to collect and input all this information into a single dedicated system is clearly a non-starter, not least because it is resource-intensive and untimely.  But by layering and integrating information collected by various different applications which are already in use, it should be possible to create a web of useful information which can be interrogated and analysed. The fact that clinicians are starting to use mobile technology as an intrinsic part of performing their core clinical duties, and are therefore routinely collecting important operational information and insights, is a game-changer. 

As a base layer of information, take the patient data collected through a mobile e-observations system. The primary function of this information is to allow clinicians to get to deteriorating patients quickly. But as by-product, it also gives a highly accurate, up to date, picture of patient location, bed occupancy and use, as well as the clinical condition of the patient. Linked with a hospital PAS, you can bring in waiting list information, people waiting in ED and links to social care.

Then integrate this with a secure, mobile clinical communications and workflow solution.  Anyone involved in the care of a particular patient can collaborate.  Alerts can be set up (admissions, discharges, bed states for example, as well as EWS, Sepsis or abnormal results) to trigger speedy responses in reaction to events and ultimately predicted events.  Team-based task management and handover means that we can understand at a glance what a particular patient is waiting for and where they are on their pathway.  

This is a long way from the monolithic healthcare solutions of old.   Our own CareFlow solution, which integrates e-obs, communication and workflow, not only allows us to do this within an organisation, but across a health and social care system. Instead of communicating by fax, a social worker can receive an electronic alert that someone is ready for discharge.  A community provider could see at a glance that a piece of equipment they are providing is all that stands before a patient getting home.  Our early examples have delivered as much as a 20% reduction in length of stay.

What we are working on now is applying simple algorithms and BI techniques to surface and interrogate the data to enable operational staff to take a grandstand view, looking across a whole health system to understand properly where the blocks lie and target the resources to unblock them.

What this all adds up to is that the rise of integrated, mobile clinical systems is bringing the NHS manager’s holy grail to reality – effective clinical flow where the patient’s needs are driving the placement and actions of the operational teams, and where all staff - from the ward to the board - are making decisions on the basis of real-time clinical data captured by care teams. This will be the key to unlocking transformation across health communities. 

Beverley Bryant

Beverley Bryant is chief operating officer of the System C & Graphnet Care Alliance

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