Digital Transformation in the Emergency Room

Historically, the UK’s healthcare sector has faced challenges in adopting digital technology when compared to other industries. Slow uptake has been influenced by factors such as inadequate infrastructure, limited funding, insufficient quality data and the reluctance to change work practices within an already constrained system. Additionally, concern regarding sensitivity of health information and political context of any proposed strategies have contributed to the stilted progress.

The COVID-19 pandemic has forced the NHS to swiftly adapt under immense pressure, illustrating its capacity to embrace digitally enabled change when provided with adequate support. This period witnessed a transformation in the delivery of both primary and secondary care, with a notable emphasis on the provision of virtual healthcare services. Patients expressed high satisfaction with these services, although some indicated a preference for in-person consultations post-pandemic.

The NHS long-term plan: a digital focus

Recognising the need for change, the NHS Long-Term Plan has highlighted digital transformation as a key future objective. Several successes have already been achieved, including the launch of the e-referral service. The platform is now available across the UK and aims to reduce the rate of missed appointments, saving more than £50m annually. For the future, an ambitious target of 100% of trusts having electronic patient records in frontline services has been set for 2025.

However, disparities in digital utilisation persist across the country. While some hospitals continue to rely on paper-based records and outdated communication systems, others have embraced technology, using individual smartphones for reviewing investigations and consulting with colleagues. Given the unprecedented demand on emergency departments, implementation of digital technologies could offer potential solutions to alleviate staff pressure and enhance the patient experience.

Community care and remote monitoring

A key area for reducing pressure on emergency departments and admission avoidance is the provision of community-based care. Initiatives such as the Remote Access Emergency Coordination Hub (REACH) pilot scheme in East London have given ambulance services and NHS 111 access to virtual consultations with emergency care consultants, often negating the need for hospital visits.

Virtual wards, which gained prominence during the COVID-19 pandemic, have proven effective in reducing pressure on hospital bed capacity. The adoption of these wards has been swift, with nearly 14 new virtual ward beds created per day between March and August of 2023. Patients are equipped with monitoring devices, enabling clinicians to remotely review and provide integrated care within the comfort of their homes. This approach has shown promise in reducing hospital admissions for patients with heart and lung diseases, a group of patients with often complex needs and high burden on acute services.

Funded by a Health Innovation Network grant, St George’s University Hospital has launched a dual check-in and wait time checking app. This innovative solution aims to alleviate patient anxiety and frustration associated with waiting times, as well as save staff time by gathering information which is translated directly into the patient record.

Streamlining documentation with digital scribes

Across healthcare, there is a growing need for the documentation of care encounters, consultations with specialists, and collaboration among colleagues. Administrative tasks can be burdensome and directly affect clinician availability. Trials of digital scribes using automatic speech recognition and natural language processing techniques have shown promise in some contexts, although their applicability in busy emergency departments may be limited.

To address the challenge of communication within and across healthcare organisations, various apps like Pando and Alertive have been developed to facilitate sharing of information and images. These platforms enable secure and efficient communication between healthcare workers, expediting patient care and promoting collaboration between colleagues. However, their use remains uneven across the NHS, with responsibility on individual services identifying their value and choosing to adopt them.

Overcoming digital barriers

While digital technologies hold the potential to alleviate pressure on the NHS, it’s crucial to consider their impact on patient care and address issues related to the digital divide. Ensuring services remain accessible to all, with a focus on those at highest risk of digital exclusion such as the elderly and disabled, is essential.

Implementing digital innovations must prioritise patient safety and ensure continuity in delivery of high-quality care. Most digital technologies will involve a deviation from traditional practice and therefore altered risk profile, meaning engagement with staff, in both design and implementation, is essential to see translation of benefits. Adequate staffing is paramount, especially in the context of an ongoing NHS workforce crisis, which involves recruitment and retention challenges. The NHS Workforce plan has highlighted key target areas to increase training and retaining staff, which is imperative for sustainable healthcare delivery in the future.

By Sophie Lansbury, Healthcare Strategy + Planning Consultant, Lexica

References

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