The assay from global health technology provider Mindray allows clinical teams to measure cardiac troponin I proteins that are released into the blood during heart attacks, and when the heart is damaged.

Found to be highly precise and sensitive for both men and women, the cardiac troponin I assay has been the focus of a new study carried out by world-renowned cardiac biomarker specialists at Hennepin Healthcare’s Hennepin County Medical Center in Minneapolis, Minnesota. Early evidence has shown significant potential for clinical applications in helping to reduce pressure on busy emergency departments.

Opportunity for Clinical Diagnosis of Heart Attack Risk

Researchers found that the test not only performed as well, if not better, than those already available in the market, but that it also had the potential to help clinical teams rule out many patients with symptoms suggestive of a heart attack at an early stage.

Focussing on more than 1,500 patients who presented to the inner-city hospital’s emergency department with symptoms such as chest pain, arm pain, or jaw pain, the study found that 15% of early presenters could be ruled out for a heart attack based on a single blood test on arrival at hospital.

Typically for most assays of this kind, an initial blood examination would serve as a baseline measurement for early presenters, with a further test required to detect cardiac troponin I two hours later.

Combining this approach and applying a second blood sample to the Mindray assay after two hours, researchers also found that an additional 30-40% of remaining participants could also be safely ruled out with less than a 1% probability of an adverse event within 30 days.

Unusually precise measurements of cardiac troponin I made possible using the Mindray assay, meant additional individuals could also be ruled out. In total, across all cardiac troponin I measures, researchers were able to identify 60% of patients presenting to the emergency department with heart attack like symptoms, who could be safely sent home.

Opportunities for Cardiac Troponin Assay

Professor Fred Apple, the study’s principal investigator, a medical director in laboratory medicine at Hennepin Healthcare, professor at the University of Minnesota, and a former committee chair of the International Federation of Clinical Chemistry and Laboratory Medicine Committee on Clinical Application of Cardiac Bio-markers, said: “Patients who comes in to an emergency department with chest pain or arm pain, symptoms suggestive of a heart attack, would rather spend the night at their home with a surety that they aren’t going to have a heart attack, versus a bed in the hospital. But sometimes it can be difficult for a clinician to determine whether or not that pain is related to the heart.

“Our preliminary findings around Mindray’s high-sensitivity troponin I test are exciting for emergency medicine – with multiple ways this could be built into algorithmic clinical practice to help avoid overcrowding and enhance triage safety.

“Cardiac troponin alone doesn’t determine if you have had a heart attack, but it can tell the clinician if the heart has been injured, and when measurements are normal that it is safe to send a patient home.

“In 40 years of cardiac biomarker research, this assay is as good, if not better than any cardiac troponin assay I’ve worked with in my career. That it is so incredibly precise and analytically very sensitive to measure low cardiac troponin concentrations, opens new and unique possibilities when patients present early to an emergency department, so that clinicians can make informed decisions to send people home, without concern.”

In addition to ruling individuals out, findings also demonstrate that the assay can help to determine with high probability when patients are having a heart attack, with a high positive predictive value of approximately 70%. Researchers believe this could assist clinical decisions to immediately admit patients.

The Institutional Review Board approved study (MERITnI) was conducted alongside existing tests as patients presented to the hospital. Standard hospital procedures were used in the triage and care of patients, and the same blood samples drawn for routine clinical practice were also applied to the Mindray high sensitivity cardiac troponin I assay for research purposes, in order to evaluate the assay. The Mindray assay used in research was not used for patient care decisions during the study.

The assays were produced by Mindray after it acquired the Finnish company HyTest in 2021, where Professor Apple previously served on the board.

Preliminary findings are now undergoing peer review, but already additional possibilities are being explored. Future work in examining high sensitivity cardiac troponin I and high sensitivity cardiac troponin T assays are expected to inform applications that might help clinicians to better understand if myocardial injuries are chronic or acute – and help them to determine the best treatments and therapies for patients.

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Smart Triage, an AI-powered autonomous patient triage system developed by health technology company Rapid Health, was implemented at The Groves Medical Centre in October 2023. The system has transformed patient access, enabling equitable and safe care based on clinical need rather than on a first-come-first-served basis.

An independent real-world evaluation, funded by Health Innovation Kent Surrey Sussex, one of 15 health innovation networks across England, and conducted by Unity Insights, has measured the impact of autonomous patient triage between October 2023 and February 2024. The evaluation assessed the system’s acceptability, implementation, effectiveness, and impact on health inequalities.

Key findings of the evaluation include:

• Patient waiting times reduced by 73%, from 11 to 3 days, for pre-bookable appointments
• The practice had 47% fewer phone calls at peak hours, with a 58% reduction in the maximum number of calls, all but eliminating the “8am rush”
• Same-day appointment requests fell from over 62% to 19%, significantly expanding the capacity for pre-bookable appointments
• 70% fewer patients needed a repeat appointment, having received the right care on their first visit
• 85% of appointments booked via the new system were delivered face-to-face, a 60% increase compared to the pre-implementation period
• Only 18% of all patient requests were initiated over the phone after the system was implemented versus 88% prior to it being implemented
• 91% of appointments were automatically allocated without staff or clinical intervention.

These changes have culminated in a better overall experience for patients at The Groves Medical Centre. GPs now spend 50% more time with each patient by moving from 10 to 15-minute appointments.

Dr Andrea Fensom, GP Partner at Groves Medical Centre, remarked: “Smart Triage has completely changed how we work. It has not only optimised our resources but increased patient access. Feedback shows that patients find it easy to use our online tool and it’s convenient for them, giving them multiple options for appointments where safe to do so and booking them with the most appropriate clinician for their problem. We are all very proud of these results”

Increase in Appointment Availability

Additionally, the practice has achieved an 8% increase in the number of appointments delivered per working day without hiring additional staff. Patients now have a wider selection of appointment slots to choose from, with an average of 61 slots available per patient appointment request. This has resulted in a 14% reduction in patient no-shows, despite the practice already maintaining low DNA (did not attend) rates.

Jake Kennerson, Group Manager at Groves Medical Centre, added, “The positive outcomes we’ve seen in such a short period are a testament to the effectiveness of this innovative system. There’s been a significant decrease in the number of patients requiring same-day appointments and wait times have been drastically reduced. All of this change was achieved during the peak winter months and without any additional staff. If others were to adopt a similar approach, it could lead to transformative results for patients and the NHS as a whole.

AI Delivers Autonomous Triage Process

In contrast to traditional online consultation and triage tools that only collect information, Smart Triage fully automates the patient navigation process from the initial contact with their GP practice. Whether requesting care online, by phone, or in person, patients are guided through a series of questions based on their concerns. The system then assesses their symptoms and directs the patient to the most suitable care, even enabling immediate self-booking into the right appointments. This streamlined process empowers patients to access care at their convenience while relieving the practice from direct involvement in each request. This is the first time a study has proven an autonomous clinical system is safe and effective in doing this process end to end.

Expressing his pride in the system’s success, Carmelo Insalaco, CEO of Rapid Health, said, “We’re really proud to see the extraordinary impact of autonomous patient triage at The Groves Medical Centre. These results reflect what we consistently observe with our customers across the country – the remarkable potential for Smart Triage to dramatically enhance patient access and choice, while solving the persistent challenges of lengthy waiting lists and disruptive morning bottlenecks. We look forward to further collaboration and expansion across the wider NHS to benefit more patients and healthcare providers”.

By implementing the autonomous patient triage software, GP practices and Primary Care Networks (PCNs) can improve patient access, reduce workload, unlock capacity and manage patient demand more effectively. With better access for patients online, call volumes are reduced and peaks in demand can be smoothed out, eventually eliminating the ‘8am rush’. This ultimately enhances and automates the Modern General Practice Access Model which was introduced by NHS England last year.

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Data from December 2023 to May 2024 shows the practice has experienced substantial improvements. During winter, typically the busiest period for primary care, phone queues were significantly reduced, dropping from up to an hour to just a few minutes. While call volumes have decreased from over 200 calls by 8am on Mondays to an average of 80.

The system has now processed over 20,000 patient medical requests, with 82% of appointments booked via Smart Triage being scheduled straight after completing the online assessment by the system. This capability eliminates delays for patients and the need for staff involvement in booking a high proportion of appointments. The unique clinical assessment and autonomous navigation features ensure patients can be directed to appropriate care without needing staff input, enhancing the overall patient experience, reducing waiting times and workload for the practice.

By automating the triage and navigation process, the system frees up valuable time for clinicians and administrative staff, allowing them to focus more time on delivering quality care.  Additionally, the practice now has a clearer understanding of true patient demand, enabling targeted staff recruitment.

Feedback from both patients and staff has been overwhelmingly positive.

Morag Dugas, GP Partner at Sutton Coldfield Group Practice, said “Rapid Health has helped us to deliver improved services to patients.  We value our partnership and welcome the opportunity to continue to develop the system’s capabilities.”

Chief Operating Officer, Deb Sutton, added “Rapid Health has undoubtedly improved our services to patients. Our telephone response times are much improved and the 8 o’clock reception queue has diminished. While we still have progress to make, Rapid Health is helping us transform our services to patients”

Carmelo Insalaco, CEO and Co-Founder of Rapid Health said: “When you create a system that benefits both patients and practice staff, change can happen very quickly, as we’ve seen with Sutton Coldfield.  Using a system that gives patients the autonomy to book clinically appropriate appointments not only improves patient satisfaction, but also helps to positively influence patient demand and behaviours, eventually eliminating the 8am rush.”

The success of this project is attributed not only to Rapid Health’s innovative technology, but also to the critical feedback and collaborative partnership with Sutton Coldfield Group Practice. This collaboration has been essential in fine-tuning Smart Triage to meet the specific needs of the practice and its patients.

Due to the positive outcomes, Sutton Coldfield Group Practice has renewed its partnership with Rapid Health and plans to integrate the system with additional care services, such as pharmacy, further enhancing efficiency and patient care.

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Effective management of a patient’s journey requires a systemwide approach, from specialist referrals to inpatient admissions through to discharge. Key to this improvement is making data easily accessible and mobile, engaging clinicians, and predicting bottlenecks in the system.

Patient flow management

The strategic partnership between Alcidion and Novari enhances the opportunity for our customers to liberate data, drive operational efficiencies, improve patient flow, and reduce waiting times across the care continuum.

Novari Health designs, builds, and implements award-winning enterprise scale solutions that improve access to care, coordination of care, and the delivery of healthcare services. The Novari Access to Care Platform includes a series of integrated software modules providing surgical wait list management, referral management, central intake, and care coordination. Health systems, hospitals, regional health authorities, and governments leverage its cloud-based technologies to drive down wait times and ensure that the right patients get treated at the right time and by the right provider.

Alcidion’s platform, Miya Precision, delivers real-time interoperable data to support digitally enabled care. Miya Precision delivers efficiencies in clinical decision making, and real-time health informatics which contributes directly to the safer delivery of healthcare.

In acute care settings, Alcidion’s electronic patient journey boards present real-time information, creating a comprehensive view of patient, ward, site, and health service capacity and demand.

Together, Novari and Alcidion offer a rich blend of technology and expertise that supports the efficient and effective delivery of care and improvements to patient safety. This partnership is driven by a shared commitment to addressing the critical challenges healthcare systems face in managing patient flow and patient access to care. Inefficient processes, administrative bottlenecks, and fragmented data often lead to delayed care, frustrated patients, and strained resources.

Improving patient experiences

“At Alcidion, our commitment has always been to enhance hospital operations, and our collaboration with Novari allows us to amplify our impact throughout the entire patient experience.” – Kate Quirke, Alcidion CEO

“The combined Alcidion and Novari capabilities address common challenges experienced by healthcare systems in Australia, Canada, New Zealand, United Kingdom, and beyond. Together, we can help our clients to deliver efficient and timely patient care.” – John Sinclair, CPHIMS, President & CEO, Novari Health.

Since listing on the ASX in 2011, Alcidion has acquired multiple healthcare IT companies and expanded its foothold in the UK, Australia, and New Zealand to now service over 400 hospitals and 85 healthcare organisations, with further geographical expansion planned.

As the partnership continues to evolve, Alcidion and Novari Health remain dedicated to advancing patient-centred care, fostering innovation, and contributing to the ongoing improvement of healthcare systems globally.

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To tackle patient waiting times, the healthcare system must strategise around the root cause of the issue. Long waits in the patient journey are not a resource problem; they are a flow issue. Therefore, methods that can improve patient and workflow across a hospital through efficiency and optimisation are necessary.

Reverse Bed Chain is a strategy that is fast growing as a solution to inefficient patient flow. Its central function is to change patient movement from a ‘pull’ to a ‘push’ process, grouping patient moves as a ‘single task’ and synchronising journeys to create continuous flow. Key to this approach is also the ability to allocate staff and equipment in the most optimal way.

If adopted widely, Reverse Bed Chain could transform the patient experience within the NHS – here are four ways it can do this.

1. It improves patient flow

Throughout the patient journey, there are a series of ‘pull’ movements that take them through each ward, from when they enter the Emergency Department (ED) to the assessment ward to the base ward and, finally, to the discharge lounge. During this process, the discharge of one patient triggers a pull through each ward of the next patient.

However, traditional movement approaches can be inefficient and lead to delays. Often, logistics staff have to move patients individually, working their way back across the hospital to move each patient to the relevant ward.

A ‘push’ process, on the other hand, optimises efficiency by moving multiple patients in a single group. This helps to save time and reduce the ED backlog, thereby creating more capacity. However, the movement of multiple patients at the same time to relevant locations is a complex statistical process with many variables.

It is possible to map it out on paper or spreadsheets. But this is a slower process, prone to human error. Technology like an intelligence workforce platform can deliver a robust and reliable push process. Not only can it display the priority order in which a group needs to be moved, but this group is then assigned to a porter based on their real-time location in the building.

By efficiently moving patients from ‘start to finish’, Reverse Bed Chain directly reduces patient waiting times. But the movement of patients is just one part of the process.

2. It optimises capacity

As well as patients, Reverse Bed Chain also streamlines the movement of staff, information and equipment between departments and settings – an intelligence workforce platform, delivered via an app, uses real-time location services (RTLS) to improve flow and work experience for all staff.

For example, the app enables the smart assignment of responsibilities based on the location of people and equipment physically closest to relevant locations. So, as patients are moved, so too are staff, information and equipment. This creates a continuous flow of patients and optimises the allocation of staff and resources, with the result reducing delays in the patient chain, easing staff workloads and, ultimately, improving overall capacity for patient care.

This approach has been tried and tested, working within a five-hospital system managing nearly 700,000 people. By employing Reverse Bed Chain, the system was able to customise operational processes and oversee group training in line with each department’s individual needs. Tasks were quickly and efficiently assigned to staff (in priority order), handled and completed.

The overall result saw response times improved by almost 30%, which consequently shortened patient stays.

3. It transforms overall efficiency

This process delivers a holistic enhancement of patient flow, staff flow and overall operations. By bringing together every aspect of the patient flow experience, hospitals are seeing real-world improvements in overall efficiency and the optimal delegation of resources.

It has worked within a 760-bed hospital that adopted indoor location technology to improve movement efficiency. The AI-led platform allowed them to better align resources to demand and, as a result, gain additional resources by using this data as evidence for stakeholders. Now, the platform can inform data-driven decision-making for management and create daily improvements by guiding practice changes across departments.

In another example, by using smartphone sensors and AI-powered scheduling, a 23-hospital healthcare system could schedule tasks throughout the day, disperse information to multiple help desks, and allow staff to use their phones to report any equipment shortages, faulty equipment, or an increase in wait times.

The holistic restructuring of patient flow can improve satisfaction for every clinician, staff member and patient.

4. It empowers clinical staff to drive the process, improving patient care and satisfaction 

The surge in treatment waiting times is adding uncharted levels of stress on staff. In particular, this strain is being felt by the nurses who are on the front line. Reverse Bed Chain gives agency to these staff by giving them the time and space to provide compassionate and quality care to patients. Clinical staff can focus their efforts on patient care while other team members are distributed to departments where they are most suited and are needed at that moment in time.

As well as providing this immediate benefit, this approach also has the potential to tackle longer-term workforce issues. It can improve overall job satisfaction by easing workloads and allowing nurses to prioritise the essential work they want to do. More time for patient care means a better patient experience.

Reverse bed chain transforming the patient experience

With an election due this year, reducing the NHS waiting list is sure to be a battleground strongly fought over by politicians. However, the healthcare system is in no position to wait for broader policy changes to take effect. Reverse Bed Chain is a revolutionary strategy that has the potential to transform the entire patient experience within the NHS.

Using innovative intelligent workforce technology, hospitals can synchronise patient movements and, through RTLS, optimise the deployment of staff, equipment and task allocation. This reduces the ED backlog, improves operational efficiency and achieves a continuous flow of patients, staff and resources that prioritises patient care and staff wellbeing.

With Reverse Bed Chain, being the right person in the right place at the right time is not left to chance.

By Connie Moser, CEO, Navenio

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Wound care is no exception; many patients living with chronic wounds, such as venous leg ulcers (VLUs), struggle to adhere to treatment. Hard-to-heal and recurring wounds cause a significant negative impact on a patient’s quality of life and contribute to billions in healthcare costs. In the UK, there have been few improvements over the last 30 years in the levels of adherence to wound care, with leg ulcers costing the NHS almost £2 billion to treat every year.

This was significantly exacerbated by Covid-19 where wound clinics were closed and scaled back to stop the spread of the virus, leaving patients to manage their ulcers independently at home. Tackling adherence to wound care can improve patient outcomes, relieve pressures on healthcare systems and reduce treatment costs.

A silent epidemic

VLUs are the most prevalent type of leg ulcer, making up approximately 90 percent of all cases and affecting one in 500 adults in the UK. Although VLUs typically heal within three to four months, some take years while others never heal at all. Recurrence is also common, affecting up to 70 percent of patients and leaving many suffering with VLUs on an ongoing basis, requiring frequent care from wound specialists.

The current standard of care for VLU treatment recommends compression therapy, involving medically prescribed compression bandaging or stockings applied by a clinically trained wound specialist. This reduces vein distension, activating the calf muscles to pump blood back to the heart and reduce oedema. Compression bandaging comes in various forms, including two- and four-layer, hosiery and wraps and will depend on what is required for optimal healing as well as the patients’ preferences for comfort.

However, it is estimated that adherence to VLU standard of care ranges between 12 and 52 percent, indicating that many patients are unable to reap the benefits of treatment.

Identifying the causes

There are many factors that affect adherence and make healing extremely difficult. A study by Weller et al (2021) highlighted the most common contributors to non-adherence, including: compression-related body image issues; lack of patient understanding of their treatment plan and the consequences of non-adherence; and cognitive issues limiting the ability of patients to understand and implement self-care instructions, amongst others.

Adherence to treatment is therefore multidimensional and impacted by various demographic, socio-economic, financial, and climatic factors. Like other chronic conditions, wound care requires patients to play a vital role in their own recovery. Without the right environment and support, patients will struggle to adequately treat their wounds – as was largely the case during Covid-19.

Treatment insights: a case study

A recent insights survey conducted by Sky Medical Technology explored the emotional impact of VLUs, adherence to standard of care (compression therapy), and alterations in the level of care as a result of the pandemic.

Using qualitative insight from vascular surgeons, tissue viability nurses (TVNs), community nurses (CNs), and VLU patients across the UK, the survey was able to examine the impact of Covid-19 on wound care delivery, the current extent and success of self-care, and any barriers that exist to introducing MedTech innovation into the healthcare network.

Common themes and findings

1. Health delivery during Covid-19

A stand-out finding, in context to the pandemic, was the re-deployment of wound specialists, such as TVNs, to the hospital setting to support the delivery of Covid-19 critical care. Whilst completely understandable, this refocus of a critical resource was to the detriment of wound patients suffering with acute and chronic conditions.

Most wound clinics were also suspended. All CNs reported the rapid creation of materials to support patient self-care, in the home setting – with most utilizing materials created by the National Wound Care Strategy Programme (NWCSP) in written and video format to help instruct patients on how to wash legs, care for wounds and apply compression correctly.  Importantly, all CNs agreed that embracing VLU self-care is needed in the future – especially with many wound care professionals leaving the health service.

2. Telemedicine

With fewer face-to-face visits, all CNs also reported some use of telephone triage but felt it to be less effective, particularly for patients who struggle with phone/internet access, internet literacy or have cognitive impairments. All CNs were open minded to the role of tele-triage but expressed a common concern that self-care and/or shared care first requires a holistic assessment and the development of a care plan that both a patient and carer can adhere to. Particularly as many patients find the correct level of compression hard to tolerate – causing low adherence to standard of care.

3. Healthcare resources

All TVNs interviewed expressed the concern that generalists within the community nurse teams, prior, during and since Covid-19, are continuously asked to work with fewer resources. Vacant posts are currently unfilled and however good-willed the generalists are, there comes a time where they struggle to find the time to dress wounds as part of ‘basic nursing care’.

Wound care is increasingly delegated to Healthcare Assistants within primary care and the role of the TVN is in educating and training colleagues, as well as supporting generalists in recognising their accountability. They also expressed the need to address comorbidities, such as obesity management and exercise with patient healthcare coaching.

4. Embracing innovation

Vascular surgeons expressed not having a positive perception of the standard of wound care in the community, in respect to timely expertise to diagnose and refer leg ulcer patients to vascular teams. On the question of championing MedTech innovation to improve VLU healing, the majority expressed they are motivated to embrace innovation but would require robust clinical evidence. Many also highlighted the lack of a robust framework between secondary and primary care to achieve full adoption within local networks.

5. Emotional impact

Unsurprisingly, all patients reported experiencing pain, discomfort, social isolation, malodour, exudate leakage, and reduced mobility – expressing that VLUs stop them living their lives and robs them of hope.  Those with long-term unhealed VLUs also expressed feelings of anger, denial, guilt, aggression, depression, grief, anxiety and worthlessness.

The way forward

The pandemic necessitated delivering care differently, and many services rose to the challenge. Many more patients have been supported to self-care, requiring fewer face-to-face visits. Having lifted the barriers to support self-care and telemedicine, it is also recognised that these modes of care delivery will not suit all patients.  Self-care cannot mean support and good shared-care systems are no longer needed.

There is some evidence that areas that have adapted best are those with well-resourced tissue viability and community care services that are already offering advanced care. However, the need to do things differently has led to a broader cultural shift, with more tele-medicine assessments and consultations and more patients supported to self-care. These changes are likely to endure and grow well after the pandemic and will accelerate the redesign of services.

About the author

Bernard Ross is CEO and founder of Sky Medical Technology (Sky). Sky’s multi-award-winning device – the geko device – is a wristwatch-sized wearable applied to the knee delivering painless electrical impulses to stimulate blood flow, without the patient having to move. It has been globally adopted into healthcare systems to treat a range of medical conditions such as the prevention of blood clots.

Bernard is a serial entrepreneur with more than 20 years’ senior experience at private and public board level across multiple industries including pharmaceutical, technology development and FMCG. Bernard is a former Head of International Development at CMI plc, Senior Vice President, Cardiovascular of Bioaccelerate Inc. (BACL) and former CEO of Innacardio Inc.

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I was among the first generation of digital midwives and was recruited into my role five years ago, initially as a six-month secondment. Since then, I’ve joined a huge online community of digital midwives and today I’m part of a team of seven.

My role has evolved hugely over the years and I’m keen to highlight not only its unique importance, but – also – how much it resembles the work of digital nurses and chief clinical information officers (CCIO).

So, we need to all work together to deliver digital transformation.

A unique role

Digital Midwives are specialists in delivering digital transformation in maternity services. Whereas a digital nurse will understand bed care plans and the use of digital in nursing wards, the digital midwife focuses specifically on maternity.

There are some differences between digital midwives and other specialities. We have the baby to think about and safeguarding is an issue, especially if the child is fostered or adopted.

Also, one patient enters the maternity episode of care, but (hopefully) two patients leave.

What’s in a title?

But we shouldn’t get bogged down with titles. Most of the work of digital midwives resembles the digital nurse and CCIO roles closely and is equally important. On a day-to-day basis, I spend my time on similar tasks, but in a maternity context.

For example, I engage with suppliers and stakeholders about the scope of digital transformation projects. We work towards national initiatives, maintain computer systems, elicit feedback from service users, and help teach and train clinicians.

Most of my skills are transferrable to other digital roles. For example, data analysis and considering how systems will affect patients. I have project thinking and management skills and have carried out large-scale digital implementations.

I also try to understand how digital change can work in practice. For example, logging in and out of five different systems where half the data is missing is never going to be fit for purpose.

Many of the challenges I face are also common to digital roles in other parts of the hospital. Interoperability is something CCIOs, digital nurses and midwives all think about in our job.

Working in collaboration

As such, it’s essential for digital midwives to avoid working in a silo. We need to work together with CCIOs and digital nurses to ensure seamless data sharing and delivery of digital care.

It’s important to realise that, when a woman or birthing parents’ data is managed through a Maternity Information System (MIS), this is only a single episode in that patient’s journey.

Once the patient (and baby) leaves the maternity services for postnatal care, they are no longer a maternity-specific patient. They move from the maternity ward, and their data also transfers to more general nursing and clinical information systems.

A growing role

Working together has grown more important with the growth of the digital agenda in the last five years. Increasingly NHS trusts are dealing with the introduction of artificial intelligence, for example, and patient expectations are also growing.

Patients today can unlock their car with their mobile phone and even access their bank account, so why do they still have to bring paper notes to their antenatal appointment?

No one wants to travel across Leeds with a paper folder when they could access it, from their phone, at the touch of a button. It’s much easier to transfer a woman or birthing parent to another trust if the clinical record is stored digitally.

IT teams alone are often unable to keep up with demand. Midwives today, for example, are heavily dependent on laptops to do their job. Part of my team’s role is helping ensure midwives have the right hardware whenever they need it.

Pioneering the Future

I’ve been incredibly lucky that my trust pioneered the digital midwife role at a time when it had less recognition. Today I’m one of two digital midwives at the trust, aided by two band 6 support midwives and three band 3s.

I was lucky to have the opportunity to complete a one-year Florence Nightingale Leadership Scholarship, which led me to be mentored by a CIO. Today’s digital midwives have even more opportunities thanks to a PG Cert for Digital Maternity Leaders at Imperial College.

We look forward to being joined by two new digital midwives within the next couple of weeks, who have a great future ahead of them.

About the author

Misbah Mahmood, digital midwife at Leeds Teaching Hospital NHS Trust, will be speaking at the Digital Health Rewired Big Debate: What’s in a name? Titles, Roles and Teams in digital nursing, midwifery, AHP and pharmacy.

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Clinicians at PAHT and local GPs use the module, which has enabled them to remove paper order forms from inpatient wards and the outpatients department.

The clinicians now use the module on iPads to check through patient details and print the labels for the blood tubes that are then sent to the laboratory. For an extra measure of safety, the system has been set up so that phlebotomists can scan patient hospital wristbands before taking a sample, in a process known as positive patient identification.

Within the outpatients department, where patients do not have a hospital wristband, phlebotomists complete a thorough checklist to confirm that the patient’s details are correct.

Nicola Maguire, specialist biomedical scientist at PAHT, said: “We decided to introduce the ICE sample collection module during the COVID-19 pandemic. At the time, there were limited face-to-face GP appointments, which made it difficult to retrieve the paper order forms.

“GPs now order the tests using ICE and patients can book an appointment with the phlebotomist using our online appointment system called Swiftqueue.

“When the patient arrives at their appointment, the phlebotomists can look up and confirm the patient’s details and the required blood tests on their iPad.

“The system has improved the process of collecting blood samples, making it more simple and efficient for our teams to use. The system also helps to enhance patient safety and experiences.”

“We are planning to extend the system into our emergency department and maternity department.”

“A huge thank you to ClinSys for their support with introducing the system, it has made a real difference to our patients and people.”

Glyn Hughes, ICE product manager at CliniSys, said: “This is an exemplary piece of work that demonstrates the benefit of being able to think through the testing process from order to sample collection to processing in the lab.

“We are delighted to have been able to support the pathology service at Princess Alexandra Hospital, in rolling out the ICE sample collection module and integrating it so closely into its processes.

“It’s great to hear about the practical efficiency and safety benefits that the trust has achieved, and we look forward to helping other CliniSys customers to realise the same achievements by working in this way.”

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Digitisation in pathology is taking place at an unprecedented pace. Healthcare providers almost everywhere are now progressing their plans for the biggest transformational change that the centuries-old discipline has ever seen.

Such progress is exciting and important – with significant implications for clinical collaboration and enhanced patient care. The UK government has placed such importance on modernising diagnostics, that it is currently investing hundreds of millions of pounds into digitising diagnostics, within the space of a single year. Gone are the days when we can continue to expect pathologists to stand over microscopes, working in relative isolation from each other.

But as necessary as digital pathology is, an inevitable challenge to the longer term sustainability of initiatives has continued to trouble some people – the cost of storage.

How big is the digital pathology storage problem?

It has been a big challenge, from a data generation point of view at least. Pathology is by far the largest consumer of digital storage when compared to other diagnostic disciplines. In radiology, a typical x-ray might consume about 35 megabytes of data. A more complex examination, like a CT scan, might produce images in the region of 300 megabytes. But in pathology, digital images created from the scanned biopsy slides associated with just a single average patient examination generate as much as five gigabytes of data.

Putting the challenge into context, one of the world’s most advanced digital diagnostic initiatives recently reported that it had produced half a petabyte of radiology data over a 10-year period. Having also now digitised pathology, the programme soon expects to produce around three petabytes of data every single year from scanned slides. That’s 3,000 terabytes of data every year, for a relatively modest regional population, and just from digital pathology.

For healthcare organisations with ready access to expansive storage options, this is less of a challenge. But for many others, who might produce several times the data in the above example,  alternative solutions are being sought to ensure the cost of digital pathology storage remains sustainable.

Solving the storage problem

Despite its immense storage footprint, pathology has one very significant advantage. Once digital slides have been reported and the clinical diagnostic cycle is complete, images are relatively less likely to be needed again.

This differs to other diagnostic arenas. In radiology, for example, access to historical imaging is clinically important, allowing healthcare professionals to quickly see what might be historically normal for a patient, or to monitor progression of areas of interest over time. A single x-ray might be looked at many times as a point of reference during a person’s life, especially if it highlights potential areas of concern.

But in the vast majority of pathology cases this isn’t a requirement. Any valuable information is typically extracted at the point of reporting. Once a clinical decision has been made and the patient is on a pathway, biopsies are not usually revisited for ongoing patient care.

Some recent regional digital pathology initiatives I have spoken to are now taking strategic advantage of this situation, coupled with emerging developments in cloud computing. In particular, they are opting to utilise archive storage capabilities that started to emerge a few years ago and which have now become common solutions from major cloud providers.

Retrieving data from such deep layers of archive storage can come with a cost, but overall, it means that vast quantities of data can be stored at scale whilst remaining affordable and sustainable.

Ending the storage of glass slides altogether?

If such images are so infrequently needed, you might legitimately question why they need to be stored in the first place.

Some initiatives have decided to try to manage without storing images in the longer term. They have chosen to purge imaging data from servers, instead opting to spend time retrieving the original physical slide that is kept in storage and to then re-scan that slide at the point the image is needed.

When slides are revisited, it is often for medical-legal reasons. For example, if a cancer has been missed, an inquiry may want to understand if a cancer should have been detected, and to see what was visible to the pathologist at the time of reporting.

One potential challenge with this approach is that the quality of physical slides can degrade over time, meaning that what is visible when that slide is rescanned, might differ to the original image at the time the diagnostic report was made. A high quality digital image, on the other hand, will remain the same indefinitely – providing a highly reliable record that might also provide significant value for research or for the training of AI, for example.

Novel cloud archiving options being put into practice now are likely to defeat the case for data purging strategies. Indeed, they might even raise questions as to whether physical slides should be retained. Current guidance from organisations like the Royal College of Pathologists do for the time being require tissues to be retained and stored. But is the storage of slides an unnecessary cost in itself if a reliable digital image is all that is needed?

Cloud is the way forward

Nearly every digital pathology initiative I have encountered recently is reliant on the cloud, for many reasons. It is a more secure option when it comes to cyber security. Cloud providers invest vast resources into their cyber resilience – whereas an on-premise solution managed by an already busy hospital IT team, can only defend against so much.

Cloud also offers flexibility of scale, and to ‘pay as you go’ rather than investing large amounts of capital into hardware, capital that does not exist for many healthcare providers.

Cloud helps to drive forward consolidation and regional multi-organisation pathology programmes. Utilising the cloud can help to standardise and simplify digital pathology deployments. And it can help to reduce the time to deployment – with projects not dependant on sourcing increasingly scarce hardware that would otherwise dictate timescales.

For that and other reasons, cloud is the way forward. But storing petabytes upon petabytes of data in traditional online environments would likely become too expensive, too quickly for most initiatives. Archives might now be the answer many have been searching for.

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MTW is a large hospital trust located across two sites – Maidstone Hospital and Tunbridge Wells Hospital in Kent and Sussex. The Trust serves a population of half a million people, providing a full range of general hospital services and specialist cancer care. As part of a 2020 digital maturity strategy, the Trust partnered with TeleTracking Technologies to improve patient flow and centralise bed management by implementing a Care Co-ordination Centre. Prior to the partnership, MTW relied on manual and paper-based processes to manage capacity within and across the hospital. Like many NHS organisations, the approach involved written notes, hundreds of phone calls, and delays in allocating beds. 

On November 24th, 2020, MTW went live with their Care Co-ordination Centre powered by TeleTracking’s software and managed by MTW staff. Similar to Air Traffic Control Centres at airports, MTW’s Centre is operational 24/7, every day of the year, acting as a centralised hub for capacity management. Now, dedicated professionals have full visibility to MTW’s bed capacity, enabling them to efficiently and effectively manage beds and resources in real-time with the flexibility to transfer patients between sites based on staffing and demand levels. To support the Centre, MTW recruited a Bed Turnaround Team consisting of 10 members of staff based at each site. The Team is responsible for cleaning beds and preparing the space for the next patient. Once the bed is available for use, the team updates the Care Co-ordination Centre from a handheld device and the bed is reallocated to the next ready-to-move patient.  

In light of the technological upgrades implemented by Maidstone and Tunbridge Wells NHS Trust (MTW), it is also worth mentioning the potential benefits of incorporating electric hospital beds into their healthcare strategy. Electric hospital beds, widely used in hospitals and care homes, can greatly enhance patient comfort and quality of sleep, while also making it easier for patients to get in and out of bed. This is particularly beneficial for those struggling with mobility or those at risk of injury due to falls. The range of available electric beds can cater to a multitude of user needs, from low care beds for improved mobility and injury prevention, to deluxe designs for added space and comfort. Such an investment could further contribute to the Trust’s ongoing commitment to improving patient care and operational efficiency, while also aligning with their digital maturity strategy.

Since implementation and go live, MTW has significantly improved efficiency across both sites:

• More elective procedures performed each day: MTW is the only organisation in Kent where no patient waits over 52 weeks for an elective procedure. 

• More digitally advanced with greater access to data: The centralised, electronic system provides a wealth of information on performance, allowing MTW staff to address challenges proactively and in real-time, continually evaluating processes over time to ensure efficiency is maintained. 

• More efficient patient flow: On average, MTW now completes over 3,000 patient transfers per month.

• Increased visibility of patients with Covid-19: Since implementation, staff have benefited from real-time visibility of over 3,000 patients who tested positive for Covid-19, ensuring infected patients are isolated from other wards.

• Reduced ED transfer time by 33 percent: Over 580 hours of bed capacity released from ED patient placements every month through the streamlined Care Co-ordination Centre.

• Thousands of hours given back to nurses and ward staff: Over 4,500 bed cleans, taking 53 minutes on average, have been completed by the Bed Turnaround Team, releasing 2,290 hours back to administer care per month.

• Increase in portering capacity: Over 12,000 dispatcher-less portering jobs completed each month, with each job taking on average 23 minutes to complete. Best practices ensure that portering jobs are prioritised on patient needs and allocated fairly across teams.

• Reductions in bed turnaround time: 40 days of capacity released early over a period of four weeks using automated discharge. All patients are given electronic wristbands which are placed in a dropbox at the point of discharge, immediately alerting the Care Co-ordination Centre and subsequently reducing bed turnaround time.

The introduction of TeleTracking’s patient flow platform has been transformative, according to Nick Sinclair, Director of Operations at MTW NHS Trust: “From admission to discharge, we’ve been able to utilise TeleTracking’s platform to streamline the entire process. It has enabled us to operate more efficiently and effectively than ever, with real-time visibility of capacity and the ability to identify potential issues and adapt accordingly. Crucially, TeleTracking gives staff so much time back to care for patients.” 

Daniel Wadsworth, Account and Optimisation Executive, TeleTracking International, added: “MTW’s Care Co-ordination Centre represents an integrated and sophisticated approach to operational excellence and capacity management. Just 12 months after implementation, the results are outstanding; a testament to the dedication of staff and stakeholders at MTW who have completely embraced the technology.”

As TeleTracking and MTW enter the second year of the partnership, the trust has ambitious plans to continue driving efficiency through data and innovation. The Trust is currently working towards implementing TeleTracking at a system-wide level, creating visibility of beds at community partners and hospices to improve the transfer process and continue reducing patient wait times. MTW has also unveiled plans to redesign the Care Co-ordination Centre, expanding the facility into a standalone building to increase situational awareness and drive performance. 

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