How we improved urgent and emergency care with a digital solution that could benefit health trusts everywhere
Same day emergency care, known as SDEC, is a facility within a hospital to assess and diagnose patients referred from their GP or a hospital’s A&E department.
It aims to benefit both patients and the hospital by reducing waiting times and hospital admissions as patients with relevant conditions can be quickly assessed, diagnosed and treated without being admitted, and if it is clinically safe to do so, they will be able to go home the same day.
The Health Informatics Service (THIS) has worked with its host trust, Calderdale and Huddersfield Foundation Trust (CHFT) and a third-party supplier, a firm of digital transformation experts called SmartCo, to create a software model that smooths the workflow between CHFT’s two A&Es and relevant SDECs by modernising the pre-existing digital solution for processing patients.
Giving A&E staff the right tool to do their job
Patients presenting at A&E who need to be admitted to hospital create a labour intensive workflow. To avoid this for patients who do not need to be admitted, CHFT has been using the SDEC digital solution introduced when the SDEC concept was in its infancy.
The rationale was to take the existing solution and a later updated model created by Oracle Cerner – whose Millennium EPR is used in both CHFT hospitals, one in Huddersfield and the other in Halifax - and fashion a localised version, which we have called SDECModule, that gives our A&E staff the right tool to do their job as part of Oracle Cerner’s FirstNet® patient tracking system.
SDECModule provides A&E staff with a much higher level overview of all the SDEC departments, enabling them to easier see who can be sent to which SDEC, of which we have three at Huddersfield – one in the medical directorate, one in surgical and one for frailty.
It also provides SDEC staff visibility of the patients in A&E who can easily be transferred from there, thus reducing congestion and pressure within A&E.
Louise Croxall, CHFT’s Chief Nurse Information Officer, says:
“The whole aim of this project was to give back time to nursing care while making sure the right patients are in the right place at the right time. We did this by removing the duplication of information as SDECModule uses the same documentation for A&E and the SDEC, which reduces the need for staff to ask patients the same questions over and over again.”
Additionally, the improved visibility of patient status allows for better reporting metrics, especially meeting the new standard for emergency care summaries (ECS), illustrating how long someone has been in the SDEC.
Louise Croxall:
“As this is a staff-facing initiative, the main impact is on them to work differently albeit as part of the SDEC solution they’re already well accustomed to. Essentially, the SDECModule enhancement is allowing them ‘to see the wood for the trees’.
“The benefit for patients referred to a SDEC is a better experience thanks to a smoother journey, waiting to be seen in a more appropriate, less pressurised environment, and even shorter waiting times, we hope. And by using SDECs for inpatients waiting to be discharged, we free up bed space for those in A&E who need to be admitted and reduce risk if A&E is congested by creating more time for staff to focus on the sickest patients.”
Collaborating for a totally seamless transition
Whilst THIS had the resource in-house, it did not have the capacity, so we collaborated with a firm of digital transformation experts called SmartCo to help us develop, deploy and configure our model content in CHFT’s Oracle/Cerner server domain.
SmartCo worked with a wide range of stakeholders and the PMO team from THIS throughout the project’s lifecycle to create a clinically designed, operationally delivered solution.
The resulting model was launched at CHFT’s Huddersfield Royal Infirmary site, going live for all three SDECs (medical, surgical and frailty) at the same time, and we then repeated the roll out at Calderdale Royal Hospital in Halifax.
Neil Staniforth, THIS’ Director of Digital Ops and Delivery, says:
“By concentrating on the Huddersfield site first, we could focus all of our training and change management resources on the one site to ensure a smooth transition, particularly as the pre-existing and the new models were dual running. Once we’d made sure there was no impact on Huddersfield Royal Infirmary staff, we started the roll out at Calderdale Royal Hospital.
“We made sure there was enough ‘at the elbow’ support by employing the relevant technical team to work alongside the operational team working with the clinical end-users to achieve a seamless transition.”
Within this three-tiered approach, four FTE change facilitators from THIS’ digital team worked with our training team to provide hands-on help during the roll-out.
Any technical issues were picked up by our Silver Service team, a proactive technical team within THIS, who then liaised directly with technical support and CHFT’s EPR teams, thus avoiding any job queues sitting with our service desk, to expedite a remedy.
Although the system is still very new, initial data shows that the transition time from A&E to SDEC, to being discharged is making a positive difference.
Easing pressures and smoothing the patient journey
The most tangible impact of SDECModule from a staff perspective is that we have improved the visibility of which patients can be transferred to a SDEC area as opposed to waiting in A&E.
Louise Croxall:
“For example, if we have 70 people in the A&E and 10 can be triaged to a SDEC, those we transfer spend their time in a more suitable environment and the hope is this positively impacts on their waiting time.
“And by reducing the numbers waiting in A&E, it has a positive impact on that department too, because patients can be seen sooner, which improves the experience and the journey of both sets of patients and helps the staff because it eases some of the pressures on them.”
The digital element of the new way of working, SDECModule as part of Cerner’s FirstNet® patient tracking system, is a more seamless process than that employed previously. It not only provides clarity of who can be streamed off to a SDEC, but how quickly that is achieved.
Neil Staniforth:
“The improved transparency improves CHFT’s reporting capabilities too, by helping to track waiting times. For example, the trust’s inpatient system might say someone has been in the A&E for 0.7 of a day, which is actually 9 hours, so by displaying the wait in hours as opposed to a fraction, it paints a more realistic picture.”
We think the main value generated by the modernised model is that we have improved the pre-existing solution for every other trust in the country. By sharing what we have achieved we can improve patient tracking for everyone if they follow the roadmap we have created in collaboration with SmartCo.
However, a second, unintended benefit, has emerged within CHFT. Colleagues working in our assessment units have requested to use SDECModule and FirstNet®, as the streamlined process is better suited to their ways of working.
The first roll-out is planned for our Paediatric Assessment Unit at Calderdale Royal Hospital with others to follow, creating a quick, safe solution to increase patient experience and patient safety.
Creating a smooth workflow that can benefit other trusts
SmartCo has an established record of working in and alongside healthcare organisations to create clinically led digital systems, and their staff became part of an agile project process led by CHFT’s Chief Information Officer (CIO) and Chief Nursing Information Officer (CNIO).
It included a wide array of clinical stakeholders ranging from consultants, clinical leads, CHFT’s EPR team, through to junior doctors, nursing staff and operational colleagues - as well as the PMO team from THIS.
SmartCo staff held workshops with stakeholders throughout the project’s lifecycle to develop, deploy and configure our model content in our Cerner/Oracle server domain, mitigating all issues along the way to onboard a clinically designed, operationally delivered solution.
In effect, they worked with us in taking off-the-shelf model content from Cerner and finding innovative ways to embed it in our Oracle/Cerner domain to create a smooth, problem-free workflow that can now benefit other organisations in the future.
Taja Quigley, SmartCo’s Head of Professional Services, says:
“The work with CHFT has been a collaboration of two organisations with a single goal of developing a SDEC content which enables the smooth running of their SDEC units. It has been a long journey with some complex work along the way, but the delivery of this will be scalable to hopefully benefit many more NHS organisations.”
Sharing knowledge and saving time
We now plan to share our learnings and model content on the Cerner Model Village, a well-recognised, transparent and trusted source of intelligence, so that it can be viewed by teams from other trusts.
Neil Staniforth:
“This is knowledge we have acquired from the project’s 12-month lifecycle, but now we’ve completed the ‘hard yards’ it will enable other trusts to realise similar projects in a much shorter timescale - possibly as little as three to four months. We would recommend they do this in conjunction with SmartCo, who proved to be an excellent collaborator.”
Meanwhile, the plan now is to roll out the new solution to nearby trusts sharing the Oracle/Cerner domain over the next 12 months, beginning with the Bradford Teaching Hospitals NHS Foundation Trust, which runs six hospitals, and the Airedale NHS Foundation Trust, which runs Airedale General Hospital. This means it will be deployed in three trusts and four A&E departments, all using the single domain.
Contact THIS
As well as collaborating with our host trust, THIS project managers can work across the entire healthcare sector such as GP practices, laboratories, hospices, care charities and NHS trusts. Our clients include London’s Great Ormond Street Hospital, and hospital trusts in Southampton, Oxford, Cambridge, Nottingham, Derby, Birmingham, Liverpool, Manchester, Middlesbrough, North Tees & Hartlepool, Newcastle Upon Tyne, Edinburgh, Lanarkshire and Glasgow.
If you’d like to collaborate and innovate with THIS on a project in your healthcare organisation, get in touch.
