While experiencing relentless demand and having limited capacity, NHS hospitals are constantly under pressure to keep a steady throughput, or ‘flow’, of patients through their services. Two NHS Trusts in particular have taken action to tackle their patient flow and are already seeing the positive impact of their efforts.
Managing flow is a complex business – the Nuffield Trust highlight that ‘flow needs space’¹, while NHS Improvement, among others, advocate that to efficiently admit patients from the Emergency Department (ED) to Acute Medical Unit (AMU), the AMU should run at between 85-to-90% bed occupancy.²
Keeping any level of spare capacity in itself is a challenge for Trusts while they cope with huge demand, and digital care tools are able to support them to better manage their resources and operate efficiently.
In fact, the NHS highlights that the mismatch between capacity and demand is one of the main reasons why waiting lists or backlogs develop and waiting lists and waiting times increase.³
Patient flow is an integral part of a positive patient and staff experience. Ensuring that patients are moved to the most appropriate place when required, discharge is planned from arrival, so that staff can treat patients at the right time, and blockages that can delay essential care for incoming patients are predicted and avoided.
Manually, it is difficult to coordinate all of the right teams at the right time to streamline the complex flow process. Staff, wards and services, portering and transport teams, and cleaning teams must be able to see ahead of time when action is due, to help patients who are ready to be moved, to do so at the right time, to free up resources for incoming patients in need of attention. Back-up on the wards can lead to back-ups on ED and medical assessment units, where patients await the next appropriate and available bed.
If not addressed, poor flow can impact patient wait times and slow bed turnover. In short, it’s frustrating for everyone.
Taking action The NHS Foundation Trusts of Calderdale and Huddersfield, and Bradford Teaching Hospitals, are optimising their bed management with Cerner’s CareAware Patient Flow® solution, built into their Millennium® electronic patient record (EPR), to help bring these elements together and digitise the experience - helping the Trusts improve communication, visibility and flow, and get patients where they need to be, sooner.
This digital functionality delivers reliable real-time information to staff across multiple wards and departments; they are able to request appropriate services at the right time, supported by automated job assignments and notifications within the EPR. Through collaborative working with technology, they are able to confidently identify potential bottlenecks and improve the flow of patients through the admission, transfer and discharge process. They can also use this information to redesign processes to optimise and streamline patient, staff and equipment workflows.
At Calderdale and Huddersfield NHS Foundation Trust, ED matron Louise Croxall is realising the benefits of the EPR system: “as matron for ED, you have a greater confidence in your co-ordinators’ ability to be able to manage your patients better as they know exactly where their patients are, and the stage of care that they are at, including what they are waiting for in terms of treatment.”
The two Trusts are also realising value across the healthcare journey and are seeing a range of benefits across several areas⁴. With Patient Flow, they:
Have more visibility of patients:
Using Patient Flow’s integrated registration and portering function, staff have increased visibility of each patient’s location at any time, even when they are away from their bed for a procedure or surgery appointment.
Know where to clean to keep ward beds available:
Bed managers are now able to use the live bed board to see and chase a ward’s dirty beds that are long overdue for cleaning. The availability of real-time information has empowered the team to drive higher utilisation and occupancy of beds and reduce costs.
Can avoid unnecessary cleans:
Using Patient Flow to log infectious cleaning requirements, staff are able to determine circumstances where infectious level cleaning is not required. This has reduced the workload for the infection cleaning team by 40%⁵. Not only does this have an impact on cost savings, but the team is able to turn around beds to the ward for the next patient at a faster rate, increasing throughput.
Improve communication and reduce wasted time:
Patient Flow’s real-time bed board means bed managers have reduced the amount of time spent walking between wards and departments. With the time that they have saved, they have more capacity to spend time actioning transfers, focusing on preventing bottlenecks, and coordinating discharges.
Heather Cording, one of Calderdale and Huddersfield’s lead nurses for central operations, reported that “we have a better overview of where patients are and can track them much easier… I can order equipment, such as mattresses and document that in the patient’s notes, keeping documentation clear and up-to-date, thereby reducing risk to patients and improving patient experience.”
This positive experience is also reflected over at Bradford. Janette Reynolds, clinical lead for patient flow explains that “in conjunction with some targeted transformation work related to patient placement, the system has enabled the clinical site team to spend less time collating information manually, contacting wards for bed states and SitReps resulting in the team being able to focus on patient discharge, transfer and movement to manage flow from the Emergency Department and admission units”.
Transfer patients faster:
The amount of transfers that breached four hours from request to complete dropped by 45% while using Patient Flow⁶. Faster transfers lead to an improved care experience for patients and satisfaction for clinicians, as patients arrive faster in the place most appropriate for their treatment.
Bradford’s clinical site managers identify that the use of transfer lists has revolutionised the Trust’s approach to patient allocation and prioritisation of patient movement. They commented that:
Help porters to engage their patients:
Using Patient Flow Mobile on their mobile device, as well as being able to improve efficiency by having complete visibility and notifications of requests, porters have also improved patients’ experience of care through an improved bedside manner. Porters are now able to address patients by name and know their specific requirements automatically from the job details.
Andrew Donegan, facilities manager at Calderdale and Huddersfield, said:
“Requests are generated through the EPR that previously were taken during office hours on the telephone to send to the porter and out of hours was a bleep system. Once the porter has completed their task, they become available for the next task. Their device then indicates where the next task is for them to accept.
“It is a much fairer and equitable system in terms of issuing of jobs. Management are aware of the status of the portering task and can send messages as required and the business intelligence is very good.”
Remove reliance on the telephone:
Before using Patient Flow, porters would be managed via a number of phone calls. Patient Flow Mobile’s auto-assignment of jobs and automatic job details has enabled porter management to reduce the frequency of calls and time spent on the phone, helping the porters to respond and act more quickly and effectively – resulting in an improved staff experience.
The Trusts are seeing a range of benefits, including:
The Trusts continue to explore new functionality within the EPR system with the help of their own digital teams and Cerner. Their aims are to continue to enhance care that patients receive, improve outcomes and enable staff to be able to utilise new functionality within the system. Two years on from their EPR go-live, staff are now realising the potential the system can give them and they are eager to take this forward with the support offered from the Trust’s senior team.
1. www.nuffieldtrust.org.uk/files/2017-01/understanding-patient-flow-in-hospitals-web-final.pdf
2. improvement.nhs.uk/documents/1426/Patient_Flow_Guidance_2017___13_July_2017.pdf
3. www.england.nhs.uk/ourwork/demand-and-capacity/about
4. Calderdale Royal Hospital and Huddersfield Royal Infirmary, since May 17, Bradford Royal Infirmary, since Sept 17
5. As of February 2018, based on August 2017 levels
6. Transfers breaching 4 hours: June 2017 = 373; Jan 2018 = 204
Client outcomes were achieved in respective settings and are not representative of benefits realised by all clients due to many variables, including solution scope, client capabilities and business and implementation models.