Case Study
Case Study

Hull & East Yorkshire NHS Hospitals Trust

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Background
Hull & East Yorkshire NHS Hospitals Trust has completely revolutionised the way it manages patient flow improving patient safety and experience, as well as boosting staff morale, since starting their technology enabled journey in 2011. Through a cycle of continuous improvement and innovation they have extended the patient flow solution to encompass an ever widening footprint that now includes infection control, pharmacy, repatriation and even the chaplain's service.
Hull & East Yorkshire Hospitals NHS Trust is split over two sites, making communication and patient placement extremely challenging. The trust had used a variety of manual processes and systems to capture patient information and had to record bed availability 6 times a day in a spreadsheet but there was no live system. The Trust's initial requirement was to provide real-time secure information on patient status and location, supporting improved patient flow and bed management across the two sites.

Following an initial deployment in the care of the elderly wards and the 72 hour assessment unit the conclusion of the Nursing Director was that the product was 'Extremely successful in improving the flow of information and in turn the flow of patients across the organisation.'

This led to the Trust placing orders for the deployment of the solution across all wards and locations with the requirements covering:

Planned and unplanned admissions
Improvements to ward rounds and shift hand-overs
Bi-directional interfacing with the Patient Administration System (PAS)
The ability to perform discharge and transfer activity in real-time from within the patient flow solution
Interactive real-time dashboards for management oversight of activity and status

Views of the data relevant to specific clinical (such as Diabetic Monitoring, Pharmacy, Therapies) and non-clinical (such as the Discharge Hub, Social Services and Chaplaincy) teams, or to specific processes (such as Outliers, 'Transfer to' and Repatriation)

An essential requirement was to allow teams to be able to, quickly identify the priority actions/patients to facilitate timely intervention for both patient care and achievement of targets.
"We have to find ways of using technology, which is evolving really quickly, to benefit our patients. It's a no-brainer."
The technology works on a both touchscreens and electronic white boards and these will be installed on each ward for use by clinical staff.
Using colour coding and a locally designed user interface, the screens show whether patients are male or female, where they are with regard to their care pathway, when they are ready for discharge and which medical staff they need to be seen by, such as a diabetic nurse or a physiotherapist.
The system also helps both clinical staff and administrators to more quickly identify which beds are available in the hospitals and where they are located, enabling patients to be moved to the correct bed on the correct ward as soon as possible. The system can also be used to manage bed cleaning, reminders for repetitive treatments e.g. catheter changes, as well as tracking the preparation of medicines etc.
The Chief Executive went on to say: "This is about trying to get the patients to the right place first time, with minimum patient movement."
Phil Morley
Trust's Chief Executive
The Project
Mandy French, Senior Registered Nurse on ward eight at Hull Royal Infirmary.
By adopting Cayder's preferred agile methodology across all phases of the project the Trust were able to move at pace in identifying the data sets and underlying business rules already embedded in its manual patient flow processes. The key was to identify the relevant information already being used to run the wards, meaning the transition to a technology enabled flow environment required little or no training and blended seamlessly in working practice.

During this activity the Trust uncovered many different ways of working across the wards, for example, different colours or symbols being used to mean the same thing, something they standardised in the technology enabled solution. Cayder's process ensured that within days of completing a design session, working test systems were available for staff to try with feedback incorporated in an iterative approach which Cayder extended for a period of 4 to 6 weeks after live usage had commenced. These iterations created high levels of engagement as staff saw the technology could easily adapt to their precise needs.

The Trust used this crossover stage to implement appropriate standardisation; thereby improving patient safety and reducing complexity for staff working across wards and directorates.

Post implementation reviews confirmed that the ease of deployment was a direct consequence of the views reflecting the current ways of working, combined with the intuitive technology interface found in the Cayder PFM solution.
Benefits of using Cayder PFM

  • Actual transfer times - reduced from 22 to 5 minutes (patients can be transferred electronically across wards with information flowing seamlessly between teams)
  • Electronic transfers - at least an hour of clinical time is saved on each and every ward in the organisation every time a patient is transferred. Key patient safety information being available instantly to the receiving ward team
  • Clinical handovers - 15 minute reduction per patient
  • Discharge times - are halved and completed in real-time at the touch of a button
  • Non-ward efficiencies – the creation of virtual wards mean patients are discharged quicker (i.e. medicine reconciliation can be done quickly as the pharmacy can prioritise it's workload by knowing which patients are likely to be discharged)
  • Response rates – the diabetic virtual ward allows the diabetic in-reach team to manage care and referrals faster than previous manual processes, improving patient care and reducing costs associated with unnecessary tests.
  • Patient safety and overall patient experience - staff have more time to spend on clinical actions, direct care time has increased and information being readily to hand and not buried in notes mean patients' feel the difference
  • Transparency of movement – patients are more often in the right bed at the right time
The Future for Hull
Looking forward from 2016 the Trust are now using Cayder PFM, to manage patient repatriation to surrounding Trusts as well as linkages to their community provider partners to ensure effective flow across organisational boundaries.

The trust also uses best practice as a way of keeping abreast of how they can make continual improvement. Cayder Patient Flow Conferences are one of the ways allowing them to meet with other flow users like South Eastern Health and Social Care Trust and Lincoln Community Health Services NHS Team to share knowledge and ideas.

This continual approach to improvement and benefit realisation shows no signs of stopping and Cayder's technology is designed to allow rapid change and improvement to occur without requiring system downtime or outages.