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e-Observations software improves patient safety at East Sussex

 

Since introducing electronic observations software across the Trust’s two acute hospitals, East Sussex Healthcare Trust (ESHT) has seen marked improvements in patient safety – notably with reduced cardiac arrest rates and improving outcomes for patients.  Other benefits include smarter, more pro-active working and earlier interventions.  The software has also helped the Trust develop a culture of improvement, using real-time data to drive change.    

The Trust’s implementation and use of CareFlow Vitals (formerly Vitalpac) by its Outreach Team is praised by the CQC as an area of excellence.

 

The timeline

It took just over four months for ESHT to go live with Vitals across all 38 wards (781 beds across two sites).  All Trust wards were paper-free within 17 weeks of starting the deployment.   

 

The rationale

ESHT made the introduction of an electronic observations system a priority following a number of patient safety incidents.  Dr Kate Murray, critical care consultant and chair of the urgent care board, said the most serious case was a 40-year old woman with a liver abscess who deteriorated on a medical ward with severe sepsis over the course of a weekend, only to be escalated to intensive care when she was peri-arrest.

“She died of multiple organ failure and I had to explain to her 16-year old son that we had made mistakes. It wasn’t comfortable.  However, we promised to learn from our mistakes and the bid for funding for ward-based electronic observation charts began in earnest.”

 

The solution

ESHT bought System C’s CareFlow Vitals solution in 2014, and nursing teams throughout the Trust are using the software on iPods at the bedside and iPads at ward and Trust level. It provides:

  • Real-time, bedside capture of patient assessments & monitoring
  • Immediate calculation of National Early Warning Score (NEWS)
  • Guidance on next steps - when to repeat observations, when to escalate care
  • A view of data anywhere via hospital intranet, allowing for proactive intervention by specialists and outreach teams

The Trust says the solution’s ease of use and its interoperability have been key to user acceptance and its popularity with nursing staff. The Vitals software has been integrated with ESHT’s own in-house portal, so staff can either enter via the portal using a patient ID and view charts at the patient level, or they can go directly through the front face of the Vitals software and get a different, Trust-wide, view.

Dr Kate Murray, critical care consultant and chair of urgent care board, East Sussex Healthcare Trust : “Vitals has enabled us to embed mobile working and we now feel well-placed to springboard forward in terms of our use of clinical IT.

Next steps include adding System C’s CareFlow Connect (instant messaging) capabilities, which will allow us to develop integrated workflows between teams. As an acute and community Trust, this is particularly exciting for us.”

 

The benefits

  • Observations compliance

Before implementing the Vitals software, ESHT was struggling with incomplete (32%) and delayed (40%) observations.  A massive 50-80% of those that were taken were inaccurate.  And only 5% of observations were taken overnight.   This performance led to a 46% failure to escalate and a 20% failure to respond.

Today the picture is very different.  99.98% of observations across the Trust are complete, 94% of them are done on time and NEWS scores are now 100% accurate.  

Dr Kate Murray: “Many of the errors that led to our failure to rescue that 40-year old lady would now simply not occur.” 

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  • Smarter working and decision making throughout the Trust.

The outreach team is able to work proactively, for example, seeking out deteriorating patients, improving productivity and responding with the right clinical team at the bedside of the patient at the right time.

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The critical care team uses the Vitals software to inform its daily handover meeting, with remote review of patients on the wards to help ensure that patients are admitted to the ITU as soon as they start deteriorating or are monitored following step-down. The result has been improved outcomes for patients admitted from wards.

 

Ward-based teams use the Vitals software on the morning board round. It helps identify who to review first, and the remote review of patient observation charts helps cross-site working and leads to informed discussion when referrals are made or received.

Other teams to benefit include Hospital at Night, physiotherapy teams, speech and language therapy teams and specialist nursing teams. 

 

Establishing a culture of improvement

“One of the biggest benefits is difficult to quantify but should not be underestimated, and that is the impact of the Vitals software on delivering change and establishing a culture of quality improvement,” said Dr Murray.  The Trust has introduced a comprehensive programme to achieve this, including giving feedback to every ward about key metrics, talking and educating all staff about why the Trust is asking for a particular change, sharing good practice, rewarding and motivating in a positive way and introducing an element of competition between teams.

The only way we have been able to do any of this is by having real-time data available to us. This has quite simply been a massive breakthrough for us

Dr Kate Murray

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