Much has been said about what is needed to address the challenges that are contributing to rising waits, including helping the least digitally mature trusts to accelerate the roll out of technology that can streamline the patient journey, and free up hospital beds.
Fifteen trusts have been earmarked for funding based on their performance on A&E waits and transfers. Six trusts have been identified that require entirely new systems, six have systems that require further investment to optimise, and three require additional real-time location system functionality adding to their current system.
At the time of writing, the funding details are still to be released by NHS England.
Anticipating their imminent release, in this blog Dr Jonathan Bloor, Medical Director at System C, gives his opinion on what the trusts targeted for the investment should consider.
Worrying trends persist
A lot of work has been done over recent years by trusts to improve flow. As a result, length of stay for many elective procedures has dropped dramatically and the introduction of virtual wards is starting to have an impact on earlier discharge for some cohorts of patients.
However, hospital A&E activity data released by NHS England reveals an unsustainable trend in prolonged wait times for patients waiting over 12 hours for admission over the last decade.
As outlined by Digital Health Intelligence in its October report on electronic bed and capacity management, the rapidly increasing numbers suggest significant capacity issues across health and care. This highlights the need for effective electronic bed capacity management systems (eBCMS), and I’m sure the funding will be welcomed by trusts currently struggling to manage without an effective digital solution.
However, while these figures paint a picture of heightened clinical safety risk, and poor patient experience in acute settings, it’s important potential solutions are assessed at a system level and by their potential to provide valuable data about the whole patient journey.
Bed management vs. patient flow systems
When applying for funding to invest in new or optimise existing systems, NHS trusts must consider the difference between bed management and patient flow systems, and how digital solutions can improve the discharge process to community health and social care.
Bed management systems help identify available beds, streamline admissions, and facilitate the movement of patients within the hospital. These systems primarily address in-house bed allocation and utilisation.
Patient flow systems are broader in scope and consider the entire patient journey within the hospital. They encompass bed management but also include discharge planning, outpatient scheduling, and coordination with community health and social care providers. These systems should be fully integrated with the electronic patient record (EPR) system and its components, including the patient administration system (PAS), care planning, real time bedside capture of vital signs and patient assessments and hospital wide communication, handover and task management.
A whole system approach
When hospitals are permanently at almost full capacity, a more holistic approach to the problem, and not just an acute hospital-centric one, is needed.
Ensuring that the chosen solution can seamlessly integrate and share data with other systems in your hospital and other settings such as social care case management, or shared care record systems is important. A patient flow system should provide operational views of data collected as part of routine clinical and operational practice to improve the speed at which patients transition through the hospital with no additional hardware requirements.
The right digital solution can play a pivotal role in this process by:
Coordinating discharge planning
Patient flow systems should provide real-time data on patient status and treatment progress, allowing for efficient discharge planning. Integration with GP, community health and social care systems enables a smoother transition for patients once they leave the hospital.
Reducing delay and readmissions
Effective patient flow systems help minimise delays in discharge, reducing the risk of readmissions. By ensuring that patients receive necessary care outside the hospital, NHS trusts can enhance patient outcomes and optimise bed utilisation.
Data-driven decision making
Digital solutions offer valuable insights through data analytics. NHS trusts can identify trends, bottlenecks, and areas for improvement in patient flow, ultimately leading to better decision-making and patient outcomes.
Accelerating benefits realisation and value for money
To accelerate benefits realisation and speed to value from investment in a bed management and patient flow system, NHS trusts should consider:
Reviewing existing process to leverage full capability of existing technology
Often systems are deployed without ever being fully utilised because existing processes are not modified. For example, it’s not uncommon for trusts to deploy flow systems and not replace old fashioned whiteboards, so the transition to the digital solution takes longer.
Ensure electronic patient record (EPR) and patient administration system (PAS) data is seamlessly integrated with the patient flow system. Data integrity is vital for accurate bed capacity management.
Keep the patient at the centre of your planning. Patient experience and therefore satisfaction is closely tied to efficient patient flow and discharge processes.
Targeted benefits will differ from trust-to-trust, and system-to-system. However, from System C’s experience working with a significant number of different trusts to deploy our Flow system, consistent requirements include:
• Visibility of early warning scores, providing clear real-time clinical status
• Visibility of expected discharge date (EDD) and information required to achieve made available from any location, positively impacting length of stay
• Ability to update EDD via bidirectional integration with PAS, helping to meet the national requirement for every patient to have an EDD within 24 hours of being admitted
• Visibility of tasks for each patient available from any location for any clinician requiring input into each patient’s treatment, saving significant time walking between physical boards and visiting wards
• Visibility of the prescription status of the patient including to take out (TTO) medication from anywhere in the hospital speeds up the discharge readiness process
• Ability to update consultant and specialty using a front end interface, increasing accuracy of information and ensuring any attendance or treatment is recorded against the correct consultant
• Ability to audit historical information for quality improvement
• Enable operational teams to see the status of each ward remotely, in real time without having to interrupt clinical colleagues
• Special information feeds for different operational teams, e.g., kitchens which prepare meals that require mixing with supplements
• Enhanced sitrep information regarding live bed states and visibility regarding how long beds are taking to prepare or are unusable for
• Improved communication for nurse-led discharge pathways
To ensure the benefits of any investment ultimately translate into better patient outcomes and more efficient use of scarce resources, an holistic approach is required.
The benefits of an integrated patient flow system go beyond the immediate care of the patient when in hospital. They should help improve and speed up discharge processes, which in turn helps reduce the chance of future emergency admission.