Articles & white papers

Using IT to improve patient care in Accident & Emergency

Article for HES December issue

Today, as in the rest of the health service, demands on Accident & Emergency Departments are on the increase. Rising crime, an ageing population and A&E being viewed as virtually a 'walk in at any time' service, regardless of the nature of the complaint, are all contributory factors. The community services, including GPs, have little control over these patterns, as most patients are self-referred. However, in spite of this, an A&E department must be capable of running a 24 x 7 service and provide the optimum level of emergency care, in order to ensure maximum health and social gain for all patients who suffer accidents or sudden illness.

Furthermore, as reiterated in the Government's recent National Plan, another issue that A&E Departments must also consider is that of waiting times for patients. In the absence of large injections of cash or extra resource, many A&E departments have been seeking ways of improving current working processes in order to ensure that patients' needs are met fully from their current resources.

Within the modern business environment, technology has been the main driver in changing work practices for the better and improving productivity. The NHS is now being encouraged to learn from commercial businesses in other sectors, and should regard the procurement of modern, integrated IT as an essential ongoing investment in the infrastructure required to improve patient care, by giving staff ready access to the information they need to work more effectively.

Birmingham City Hospital NHS Trust is one hospital which has done just that. By using IT to help it deliver high quality leading edge healthcare services to over half a million patients each year, City Hospital is already reaping the benefits of readily available, fully integrated patient information following the successful implementation of iSOFT's i.Patient Manager.

As one of the largest district general hospitals in the country and situated in the inner city, Birmingham City Hospital has a very large and busy A&E. The department handles over 90,000 cases per annum and anything from 200 to 350 patients in one day.

Since March 1998, both administration and clinical staff in the A&E department alike have embraced i.Patient Manager to help them in their drive to improve patient care.

Mike Barton, Clinical Projects Manager explains, "The functional richness of i.Patient Manager has really helped us to adopt new models of care and more flexible working practices throughout the Trust, including A&E." For example, before i.Patient Manager, A&E relied on a mixture of paper and a standalone, non-integrated IT systems, so it had no easy way of accessing patient information from elsewhere in the Trust or vice versa. Furthermore, the old system was only used by administration staff. With the implementation of i.Patient Manager, both administration and clinical staff alike were able, for the first time, to readily access patient information. In addition, as a modern Windows-based system with open technology i.Patient Manager put a halt to paper chasing, due to the ease with which information could be imported or exported. Being a fully integrated, patient-centred system, i.Patient Manager is not restricted to use within just one department. It can combine information from the entire organisation into one single efficient system, which facilitates the delivery of a better all-round service for patients.

The functionality of the system has truly helped the working practices of clinical staff. "Staff have gained benefits from using i.Patient Manager and we have seen improvements in their working practices," comments Mike Barton. "Staff can find out where their patients are, what is wrong with them and finally how long they have been there. They can prioritise their workload and ensure the best possible outcome for patients."

Pathology tests and clinical alerts are now available for clinicians. Such alerts can instantly flag up and warn of known clinical conditions of a patient, for example if a patient is an epileptic or diabetic. Additionally, the system can display an alert if the patient has previously received certain treatment that could have subsequent implications on the current course of treatment. Non-clinical alerts are also available, such as patients with a record of violence or missing persons. Patient charter triggers are also monitored in the system to alert staff to take action.

"i.Patient Manager also provides comment on what a clinician should do if they are alerted to certain facts, such as rare genetic conditions. We will soon have a web-based departmental home page for A&E with links to useful websites and internal information, as well as access to web browsing technologies to gain useful instruction when in unfamiliar situations," comments Mike Barton. "This new technology has already proved an extremely popular 'Doctors' Handbook' replacement with inpatient doctors."

"We are also using web technology to help GPs. By using web views, GPs can query i.Patient Manager to find out the exact course of treatment for their patients following visits to A&E. There is the potential for A&E discharge letters to be sent directly from i.Patient Manager to the GP via email."

Other healthcare professionals within the organisation are realising the wide range of clinical benefits i.Patient Manager provides. For example, a Sister on the admissions ward can at the touch of a key see how busy A&E is to help her assess subsequent demand for beds. "To help with bed management, an electronic red dot system has been initiated through i.Patient Manager. Traditionally, the triaging nurse within A&E would decide that a patient might potentially need to be admitted and assign a red dot on the patient's notes. However, it was only after the clinician's assessment that the necessity for admission could be confirmed," explains Mike Barton. "Now, by allocating an electronic red dot on i.Patient Manager, it is possible for the admissions sister to produce a live report using web browsing technology to see how many people may potentially require a bed. Previously, it was only possible to assess demand for beds by physically counting patients actually in beds already."

Ambulance control is an important factor within the Birmingham Health Authority and i.Patient Manager also has the potential to manage quota figures electronically. This means that the ambulance control can be alerted in real-time if City Hospital has exceeded its allocated quota of A&E patients and is currently at full capacity. Consequently, emergency patients can be taken to alternative hospitals within the area with the minimum of delay to ensure that they receive the best care possible.

Health Managers are also able to use i.Patient Manager to improve work practices, since i.Patient Manager enables them to extract real-time data for auditing purposes. This allows them to evaluate the effectiveness of the care delivered, in order to ensure optimal use of resources, and identify areas for further improvement and development to ensure best possible practice.

"At City Hospital we have adopted a truly proactive approach to the use of IM&T within a healthcare environment. We see i.Patient Manager as a crucial enabler, helping us to provide new modes of care and new ways of working within A&E, as well as the rest of the Trust, and with other care providers. This is ensuring that we are well ahead of the requirements of any Government initiatives such as Information for Health or the recent National Plan and can guarantee a very healthy service to all patients," concluded Mike Barton.