EHI Awards 2010: Timely intervention

Central Manchester University Hospitals NHS Foundation Trust won the ‘best use of IT to promote patient safety’ in the E-Health Insider Awards 2010.

It’s been a longstanding concern for hospital trusts that the condition of acutely ill patients can sometimes deteriorate without prior warning.

Indeed for some time now, the National Institute for Health and Clinical Excellence has been advocating ‘track and trigger’ systems aimed at early detection and response in such cases. Alas, most strategies aimed at achieving this have met with limited success.

Wireless connectivity

“In the case of acute emergency admissions and elective patients undergoing planned surgery, it goes without saying that we automatically monitor 24/7 those we’ve already identified as high risk,” says Dr Steve Jones, consultant in adult intensive care at Central Manchester University Hospitals NHS Foundation Trust.

“In the case of all patients, moreover, our nursing teams routinely record observations, such as blood pressures and temperatures.” However, despite constant monitoring, patients can sometimes deteriorate without nursing staff being immediately aware.

“It’s one thing to record observations, but if ward staff aren’t alerted to a sudden change in a patient’s condition, they can’t necessarily be expected to respond immediately,” Jones says. “What they need is a reliable mechanism to draw their attention to adverse events.”

In the absence of a satisfactory solution, Central Manchester decided to conduct a historically controlled trial of Patientrack, an IT application designed to accurately calculate early warning scores (EWS) and alert the appropriate responders.

“The system allows our ward nurses to conduct patient observation rounds as normal, but instead of recording readings on paper charts, they input them onto a wirelessly connected PDA,” says Jones. “The remote software then automatically calculates the ‘track and trigger’ score and advises the nurse of any raised score.

“While there are [other] systems that do this, the difference with Patientrack is that it automatically alerts the appropriate doctor or nurse according to the significance. This alert continues, and indeed escalates, until the patient's condition improves. It effectively closes the loop on any deteriorating patient.”

Sarah Ingleby, lead nurse on the trust’s acute care team, recently arrived on a ward in response to an automatically generated high-level bleep to find critical care staff and the registrar already in attendance.

“One of my nurses was able to remain with the patient throughout the alert because she didn’t need to get to a phone to request assistance,” she says. “Thanks to the instant alerts raised by the system, we were able to put the appropriate treatment in place very quickly and move the patient to a higher level of care.”

Patient safety gains

Jones says that during a 14-month trial of the system - focused initially on a cohort of patients with acute medical conditions - the recording of events was greatly improved by visibly showing nursing staff when to perform observation sets and alerting ward managers to any delays.

“If a patient exhibits abnormal observations, Patientrack automatically schedules the correct timings of observations to drive further clinical reviews,” he says.

“Recognition of abnormalities is dramatically improved as ‘track and trigger’ scores are correctly calculated. Response is also improved by alerting doctors directly and escalating alerts whenever patients fail to improve.”

Since implementing the system, Jones says patients are ‘sicker’ for a shorter period of time and their length of stay is reduced, on average, by 20%. “Fewer patients end up in intensive care and use only half the number of bed days,” he says. “Throughout the trials of the system, no patients suffered cardiac arrests during the intervention phase and the relative risk of death was reduced by 23%. It all adds up to proven patient safety gains and reduced risks to patients.”

At the same time, Ingleby says the system does not purport to replace clinical judgment, but rather to support nursing staff seeking reviews of their patients without wasting time locating doctors and consultants.

“Patientrack allows my staff to quickly identify ‘at risk’ individuals by providing a ward view of patients' track and trigger scores. This and the system’s ability to track EWS, response times and trigger duration means we can closely audit and monitor care in such a way as to allocate the appropriate staffing levels and support in each individual area.”

A replicable advance

The IT patient safety intervention offered by Patientrack is easily transferable to other hospitals, according to Jones. He says the alerting structure can be adopted in its current form or the system configured to reflect any local ‘track and trigger’ policy as recommended by NICE.

“We worked closely with healthcare technology specialists MKM Consulting, who helped us project manage the implementation and map our policy into programming logic so as to maximise the benefits of the system. Written in the Java programming language and running Adobe Flash, the IT infrastructure required is within easy reach of most, if not all trusts.

“Having successfully implemented Patientrack within the department of surgery, we’ve collated ‘lessons learned’ from this initial project and we’re now in the process of rolling it out across four hospitals within our Trust. To avoid duplication of effort, we’re also making our business case and purchasing details available to other trusts via NHS Supplies.

“What’s more, we’ve been successful in a NHS North West funding bid to spread our learning and good practice to other trusts. Those with whom we’ve spoken have similar issues in the recognition and response to critical illness and many are interested in adopting our IT patient safety initiative.”

A finalist in the E-Health Insider Awards 2009 in association with BT, Central Manchester was particularly pleased to win in 2010. “It’s fantastic to have won the award, but the really great thing is that we’ve made an enormous difference to patients,” says Ingleby.

Patientrack

Central Manchester NHS Foundation Trust

The EHI Awards 2011 in association with BT seek out and reward outstanding work within the UK healthcare IT sector. Entries are open now on the dedicated awards website, and will close on 3 June at 4pm.

This year’s awards will be presented on Thursday, 6 October at the Grand Connaught Rooms in Covent Garden, London. For more information or to reserve a table, please visit the awards website.

To find out more about previous winners of the awards, visit our case studies showcase.

View on map