North Bristol NHS Trust (NBT) successfully fast-tracked the roll-out of a Trust-wide care coordination system to clinicians in March 2020 to both help in the response to Covid-19 and support their overarching goal to implement an electronic patient record.

Over 3,500 clinicians went live with the CareFlow Connect clinical communications and care coordination platform to aid collaboration in and between teams.  The system is facilitating electronic handovers, clinical tagging, patient lists, referrals and task management, and the ability to share clinical photos and messages.  All this information is automatically captured in real time as part of the electronic record, providing rich clinical information for patient care in one place to improve decision making.

The system has been well received, with positive feedback from clinicians, and has become the Trust’s springboard for digital transformation. It has also played a valuable role in the response to the pandemic.  Staff in the Intensive Care Unit are better supported with instant messaging and pictures for faster care of Covid-19 patients. Handovers are digital, rapid, comprehensive, and collaborative. 

The success of the project saw NBT emerge as regional winners/national finalists in the ‘Future NHS’ category at the NHS Parliamentary Awards 2020.

Rationale

NBT wanted to improve its digital maturity and set about by developing a strategy[1] to integrate digital solutions into every patient interaction for improved patient care and experience, and provide clinicians with a single view of patient information to support decision making.

The Trust chose System C as a technology partner, using the company’s CareFlow Electronic Patient Record (EPR). A key piece of functionality within this is CareFlow Connect - a secure and mobile instant messaging and collaboration app designed to facilitate faster and safer care coordination.

While deploying CareFlow Connect was part of North Bristol’s long-term digital transformation strategy, a decision was made at the outset of the Covid-19 outbreak to fast-track the roll-out as part of the Trust’s broader pandemic response.

Solution

CareFlow Connect is optimising key clinical workflows at NBT with features such as electronic handovers, patient identified messaging and photo sharing, patient lists and updates, clinical tagging, referrals and task management, accessed through desktop and mobile devices.

Staff distributed 900+ iPads making the mobile system available to staff at a patient’s bedside.

CareFlow Connect is now used by over 5,450 clinicians, has enabled approximately 683,000 handovers, and been used to send 97,000 care coordination messages and tasks amongst teams.

Improvements and Benefits

A Valuable Tool During Covid-19

Adoption of the new system in the Trust’s Intensive Care Unit has made a big difference during the pandemic. The team can review the latest clinical information and communicate with colleagues away from the bedside to minimise contact with patients. For example, a staff member can send instant messages and images regarding a patient’s care avoiding the need for colleagues to unnecessarily put on new PPE and also be at bedside. This change in working practice is helping to speed up patient care and reduce costs. 

Connect is facilitating digital handovers with real-time clinical summaries which is saving time and increasing efficiency at a point when admissions have been higher and demands on staff greater. The care coordination app is also encouraging colleagues of multiple disciplines to contribute to the handover, rather than being limited to doctors alone, which is improving effectiveness. 

Integration with the CareFlow e-observations module (Vitals) means that patient observations data is feeding through to the information in CareFlow Connect. This is supporting handover, enabling all team members involved in a particular patient’s care to work from the same up-to-date information irrespective of their location.

Hospital at Home

The Hospital at Home (H@H) team is using the system for patients who are well enough to leave the hospital (and free up bed capacity) but still require clinical monitoring. Before adopting the system, the H@H team would visit or call the patients at their homes to monitor progress and record their observations – as they would in a hospital setting – until formal discharge. The Trust has created virtual wards for each community team, and patients are transferred to these virtual wards once they are well enough to leave hospital. This setup also gives NBT visibility of the caseload/workload for each team. 

The H@H team is also making use of picture messages to allow swift intervention from senior clinicians to help reduce readmission rates. A benefits study will be published later this year. 

Improved Efficiency and Patient Care

CareFlow Connect has replaced paper processes with faster digital processes and handwritten information with clearer electronic text which avoids ambiguity and delays that could put a patient at risk. 

Handovers are faster which is helping during challenging times with increased Covid admissions and subsequent pressure on staff.

A fuller picture of the patient is aiding clinical assessments and decision making.

The app is supporting current ways of working, with up-to-date consolidated information at a clinician’s finger tips. Doctors can arrive in the morning and review their patient’s information prior to rounds by looking at observations, notes and pictures together rather than reading through a set of notes and having to gather further information from other sources.

Vascular surgeons are using the picture messaging capability to provide an easily accessible record of the wound for post-surgical care so that the patient is spared unnecessary discomfort during dressing removal whether in hospital, at home or in the community.

User Feedback

The programme team and its clinical leadership have captured staff feedback on the system to inform future plans. From the 151 clinicians who responded, the majority felt that CareFlow Connect had a positive impact on their workload, improving not just communication with other staff but also patient care they could provide.

“It’s really encouraging that North Bristol and System C have successfully deployed CareFlow Connect in exceptional circumstances, with minimal disruption and high uptake. The system has played a significant part in the Trust’s Covid-19 response and helped create a more digitally-aware organisation, which has created the foundations on which we can deliver further change.”

- Dr David Mitchell, chief clinical information officer, North Bristol NHS Trust

Parliamentary Recognition

The rapid deployment of CareFlow Connect as part of NBT’s Covid-19 response was nominated for the 2020 NHS Parliamentary Awards. The Trust went on to win the (south west) regional ‘Future NHS’ category.

The awards are designed to recognise NHS staff, volunteers and carers that go above and beyond the call of duty to make the NHS a better service – with hard work, exciting new ideas and putting patients first. They generated more than 700 entries in 2020 which puts NBT’s achievement into broader context.

“This achievement was a team effort across the Trust. The success of our roll-out can be attributed to many teams and individuals, the partnership with System C, and also the working relationship with our clinical and patient-facing colleagues who fully embraced this change – particularly in challenging circumstances that none of us could have predicted. It has been a watershed moment in terms of how our Trust colleagues see the value of technology to their work and patient care.”

- Neil Darvill, director of IM&T, North Bristol NHS Trust

Winning the regional award means that the Trust is automatically shortlisted as a national finalist in the Parliamentary Awards Future NHS category. The outright winner will be announced in July 2021.

Next Steps

Next step plans include refining emergency department referral processes with CareFlow’s referral feature.

[1] North Bristol NHS Trust, One NBT Digital Vision (2018), Four-year view ending in 2022.