Hospitals in England have a total bed capacity of approximately 141,000 beds, which is a reduction of 8.3% since 2010, according to the BMA. This reduction would not be a problem if patients were able to move through the care system easily and efficiently to a place that is more appropriate for their care, such as their own homes, with or without community nursing or regular social care support.
Unfortunately, issues of delayed transfer of care and poor patient flow are a reality for every hospital. It isn’t just a hospital challenge, it is an ICS-wide issue that must be tackled at the root cause of the bottlenecks that negatively affect patient safety, experience and outcomes can be alleviated.
As a junior doctor, I have witnessed first-hand the variety of issues that hinder patient flow, and many of them are a result of inefficient processes often exacerbated by out-of-date and unfit-for-purpose technology.
In my view, poor patient flow and transfer of care is as much about “lost tech days” as it is “lost bed days.” The challenges we doctors face every day leave us utterly exasperated and contribute to delays in the delivery of care. Many of these are widely documented, such as difficulties accessing patient information, old and decrepit computer hardware (some computers even with missing keys) and repetitive paper-based administration. These slow down the patient journey.
Thankfully these experiences are becoming less frequent as trusts push to meet government deadlines to introduce EPRs, EPMA systems and shared care records. However, my plea, as a doctor, is that as we move towards a new era of digital maturity and integrated care, we must ensure these fundamental systems support a proactive approach to patient flow.
This couldn’t be more critical. The issue has hit the headlines due to the number of trusts experiencing queuing ambulances waiting to transfer patients into Emergency Departments (ED). Paramedics are spending entire shifts waiting to unload patients. However, this is just the tip of the iceberg. Within every hospital, there will be patients waiting longer than necessary—for X-rays, for test results, for a bed on a medically fit ward, for a bed in the community or to be discharged home—because there has been a breakdown or inefficiency associated with patient flow. Technology can, and is, helping with this transfer of care. It is fairly common now for test results to be displayed in real-time through an EPR and for discharge papers to be generated automatically. However, other areas of patient flow are disjointed and slow. One area that is almost universally overlooked is the communication with ancillary staff.
For example, if I need a porter, I have to ring the switchboard to alert them that I need a patient taken to X-ray. However, if the X-ray department is busy, they may not be able to see the patient straight away. This may lead to the porter undertaking other jobs and risks the patient being forgotten about. If this request can be issued via an app, which also enables the X-ray department to indicate when they are ready for the patient, the porter can instantly be alerted making it easier to visualise and prioritise and to eliminate delays.
Similarly, transfer of care delays can occur at the point in which a bed becomes available on a ward. If housekeeping isn’t notified in a timely manner that a bed needs to be changed and cleaned, then the bed will stay vacant, delaying the care of the next patient. Yet, through the introduction of digital technology, this process can be streamlined significantly, and patient flow expedited. Altera Digital Health’s Patient Flow™ with Census Logic Solution does exactly this.
Any solution that provides a dashboard that clearly displays where patients are, how to move them on and can contact porters, housekeepers and other ancillary staff can only be a good thing. It’s not just about efficiencies and reducing frustrations for clinical staff, it has a direct impact on patient safety and outcomes. Longer stays are associated with higher incidences of secondary infection and increased mortality rates. Patients can experience loss of mobility due to inactivity and bed rest that could have long-term consequences on their ability to maintain independence and improve their overall outcomes. The faster we can move a patient through the care pathway the better the outcome for the patient (in terms of care and satisfaction), for the clinician (in terms of reduced frustration and stress) and for the NHS (in terms of cost savings due to a more efficient system).
As mentioned above, patient flow is an ICS-wide issue. Discharge from secondary care to the home or a community setting will require coordination across multiple settings involving different partners. There is immense value in patient flow dashboards in supporting these discussions. They can provide real-time predictive analytics and real-time data, to help make informed decisions and facilitate preparation for high-demand periods. For example, staffing-level decisions can be made based on history and predicted demand and, when necessary, data can trigger multi-agency discharge events to free capacity.
I would strongly urge trusts to consider how their existing systems support patient flow, including their EPRs, paying particular attention to the positive effect technology can have when non-clinical roles are also digitised. The greatest benefits can only be realised through full integration inside and outside the hospital, with consideration of bed-management tools, clinical decision support features and predictive analytics. Only when this is optimised will we truly be able to consistently deliver the highest quality care, which is what all patients need.
By Ed Hutchison, Doctor at University Hospitals Bristol and Western NHS Foundation Trust and Senior Solutions Specialist at Altera Digital Health