Digital transformation continues to be one of the core strategies to improve quality and efficiency in healthcare. Fundamental to the transformation is the evidence that any intervention or change has a positive impact. In this article, we show how one of our customers, County Durham & Darlington NHS Foundation Trust, is using data to monitor performance and support improvements to mobile workflows across a number of key patient safety indicators.
County Durham & Darlington NHS Foundation Trust (CDDFT), a Medanets customer since 2022, are passionate about improving patient safety. They have been leading the way in designing mobile workflows that enable the user to deliver high quality care. Considering some of the topics associated with patient safety incidents such as falls, failure to recognise deterioration and communication, we will look at how monitoring data has supported improvements in their practice.
Reducing in-patient falls
Around 1 in 3 adults over 65, and half of people over 80, will have at least one fall a year. Falls are the most commonly reported patient safety incident occurring in hospitals:
- Over 240,000 in-hospitals falls are reported annually in England and Wales.
- These falls can lead to serious consequences, including 70,000 hip fractures each year, costing the UK £4.4 billion annually.
- The one-year mortality rate for hip fracture patients is between 18 % and 33 %, and 20 % enter long-term care within the first year.
This significant economic, social and patient safety burden has resulted in falls reduction being a key quality area for improvement both nationally and locally across the NHS.
Simple interventions, such as providing a clutter free environment, vision checks, medication reviews, monitoring lying and standing blood pressure, and keeping call bells and walking aids within reach, can all support falls reduction. Yet, understanding what is normal for the individual patient, is critical to consider their individual risk. A comprehensive falls risk assessment can be completed on a mobile device.
CDDFT recognised that improvements to their workflows were needed, particularly in completing and documenting lying and standing blood pressures, and how closer monitoring of patients (through intentional nurse rounding) could be captured more easily. Their basic workflow involved completing a falls assessment within four hours of admission, using the assessment outcome to suggest a falls care plan and further management, and repeating the assessments weekly.
Their optimised workflow, in turn, introduced enhancements to individual care rounding, separate tasking for completing lying and standing blood pressure, and a separate bed rails assessment. As these enhancements were utilising mobile workflows, Medanets worked closely with CDDFT to align these changes. Following these optimisations, CDDFT have witnessed a continued and sustained reduction in falls.
However, it is important to recognise that this reduction in falls is not solely the result of changes made to the workflows, as the reason for improvement is multi factorial. Nevertheless, the timings of the optimisations to bed rails assessments, and intentional rounding particularly, align with a sharp uptake in compliance with this documentation, thus driving safety improvements. the compliance with the process has increased significantly, with assessments completed for 94.5 % of all patients. The current incident of falls is below the national average; though as the trust review this data, they base measures for improvement on benchmarking against their own data.
Improving recognition and response to the deteriorating patient
In 7 % of all national patient safety incidents where the outcome was death or severe harm, failure to recognise deterioration was cited as the reason. Furthermore, research suggests that 26 % of preventable deaths were in relation to failed monitoring. The national early warning score has been pivotal in providing an evidenced based system to monitor and respond to deterioration, and this is now used in every NHS organisation and in many other countries internationally.
CDDFT recognise the importance of monitoring vital signs and responding to deterioration. They have developed workflows within the mobile solution to create real time escalation of deteriorating physiology from the patient’s bedside:
- The creation of mid-flow decision prompts during the EWS process supports more junior staff in interpreting and understanding the vital signs measurements and when to seek further assistance.
- Vital signs tasking and overdue icons on the Medanets Dashboard ensure that vital signs monitoring is completed on time.
CDDFT reported data on compliance with EWS monitoring is impressive, with over 90 % of vital signs completed as per the policy. In addition, they have also seen a further reduction in cardiac arrests per 1000 admissions this year, the current rate being 0.64 per 1000 admissions, reducing year on year since 2012 (when data collection commenced).
Enhancing sepsis treatment
With sepsis deaths being as high as 48.000 annually in the UK, identification and rapid treatment for sepsis has been another patient safety improvement initiative and performance metric. At CDDFT, they have designed a sepsis screening workflow to improve rapid screening and timely diagnosis of sepsis, so that treatments can be prescribed and given as soon as possible:
- Nearly 5,000 sepsis screens are completed every month, with 84 % being completed within 15 minutes of an abnormal EWS value.
- Audit data suggests that 75 % of patients are administered antibiotics within the expected timeframe; a figure which CDDFT are continuously seeking ways to improve.
The ability to monitor data and performance is also helping to improve practice. Through sharing the data across different platforms such as senior nurse meetings, ward performance meetings and alike, the teams can see their own performance and consider what steps are needed to further improve or celebrate excellence. For example, where falls assessment compliance has seen a decrease in compliance in ward B, the ward can review this and understand what they need to do to increase the assessments being completed. The trust have built their own dashboards, so departments can see this data at granular level, as well as a larger organisational oversight.
In summary, CDDFT have seen positive results across several vital patient safety initiatives including falls, vital signs monitoring and sepsis screening. There appears to be strong correlation between the optimisation of mobile workflows on Medanets and the improvements in the data. Whilst the trust is showing as being above average in terms of performance in cardiac arrest per 1000 admissions and incidence of in-patient falls, it is important to recognise that direct comparisons should not be made with other NHS organisations, thus CDDFT continue to monitor improvements by considering their own benchmarks.