Some 1,049 clinicians at one of the country’s biggest NHS acute Trusts are using a mobile care-coordination app to communicate and share tasks between teams and out into the community.
Clinicians at University Hospitals Bristol NHS Foundation Trust (UH Bristol) are using the CareFlow Connect app to send instant messages and images, in patient context, between themselves. It is helping them to do away with paper, respond to the needs of patients, and deliver co-ordinated services from nine different sites to a population of 350,000.
But the impact of the app has already extended way beyond these anticipated benefits as usage continues its rapid growth. Unexpected examples of how doctors are using CareFlow Connect include: helping provide emergency advice and collaboration with paediatric cardiology colleagues across South West England; locating patients and recovering operationally within hours after a major incident; improving patient recruitment to research studies.
Chris Bourdeaux, consultant anaethestist and Chief Clinical Information Officer (CCIO) at UH Bristol, said:
The ability to self-organise and communicate as a team wherever you are, using your own phone, and to know when information has been received and read – these are powerful benefits for clinicians and care professionals. We are all delighted to reduce reliance on pagers and email, with all the inefficiencies they have involved. However, we continue to be surprised by the wealth of benefits and uses our colleagues are finding for the app. It really has been revolutionary.
Examples of how the app is being used include:
The Trust’s ICU has gone paperless for handover after introducing CareFlow Connect. Previously, handovers were done on paper, increasing the risk of information getting lost or miscommunicated. Now both nurses and doctors use CareFlow for a multi-disciplinary electronic handover, speeding up the process and introducing a standardised format to improve consistency and patient safety.
Dr Scott Grier, senior registrar on ICU, said:
It has transformed the way we handover. CareFlow Connect gives us a contemporaneous record of what we do. It’s always accessible; in your pocket on your phone or on the iPad. We can all access the same thing and maintain the consistency and quality of a handover.
He said the secure group messaging function enabled staff to easily reach those off site.
It’s efficient and has improved patient safety along with communication between day and night shift staff. It also means you can keep an eye on where a patient is on the unit even when you are not physically here. As a system, it’s essential to the function and continuity of our handovers now. The learning curve has been short and very achievable so you can just pick it up and go with it.
The general surgery on-call team creates ‘smart lists’ of patients to improve co-ordination about the surgical needs for each patient, identifying ‘take’ patients, for example, and which patients need to be reviewed by the consultant. This has helped speed up the flow of the patient through the ward, as clinicians triage and create a package of care.
Similarly, the Trust’s paediatric cardiology teams are using CareFlow Connect to tag patients from out of area and into Wales, supporting improved discharge planning and handover. Clinical colleagues from as far away as Cornwall and Cardiff are also using the app to send ECG images to the Trust for discussion and advice.
The thoracic surgery team share images before, during and after surgery for clinical recommendations and second opinions from their colleagues. These can also be used for teaching. Updates with patient context provide a contemporaneous record of care for others within their team to see, and also for other clinical teams who may also be managing the same patient (the pre-op team, for example).
The Trust recently declared a major incident following an electrical fire in its oncology centre. All patients were evacuated at 2.00am and cared for in other part of the hospital run by the Trust. The oncology centre was not yet using CareFlow Connect. Within an hour or two, teams were up and running with CareFlow on phones, iPads and on the desktop. Adam Dangoor, CCIO and medical oncologist, explained: “By the time I did my ward round, I could tell where my patients were, and what the junior doctors were handing over about their care; I could join in and update the handover or message my team. All of this could happen from anywhere. So it was a fantastic example of how quickly CareFlow can be rolled out and how it can be really useful.”
Crucially, the CareFlow Connect app is integrated with UH Bristol’s operational and clinical systems. Conversations automatically become part of each patient’s wider electronic record, providing a single, contemporaneous source of patient information, available for all to see and with a clear audit trail of actions.
The key focus for us in developing CareFlow has been clinical usability and creating something which is genuinely useful for clinicians and helps with patient care,
said Dr Jon Shaw, System C’s director of clinical strategy and design.
It is very gratifying to see this level and speed of take-up.
CareFlow Connect is a integral part of System C’s blueprint for digital excellence. This blueprint covers all clinical and operational IT within a hospital and across the care community, in a single solution-set.
The blueprint can be adopted in its entirety, as UH Bristol and ‘fast follower’ Whittington Health are doing under the Global Digital Exemplar programme, or built incrementally.