Another way to prioritise the sickest patients: new digital routes to decision-making

Kathy Adams is the Transformation Manager at Homerton University Hospital NHS Foundation Trust. She has a clinical background as an Emergency Department Senior Sister, but over the last four years has been transforming systems and managing digital change across the whole of this acute Trust.

As part of her NHS Digital Pioneer Fellowship at DigitalHealth.London, Kathy is currently working on outpatients transformation, looking at all parts of the outpatient journey in the Trust from referral to discharge. Here, she shares what she has so far learnt through the Fellowship.

As an Emergency Department Sister, and former Trust Deteriorating Patient QI Lead, my passion is early recognition and treatment of unwell patients, and supporting staff to do this even better. This saves lives and can prevent complications and long-term harm.

We have just had our second full day of our NHS Digital Pioneer Fellowship. On both days we have been introduced to and challenged by different ways of thinking, especially in the field of design thinking. The days have been long, but hopefully nothing that those of us from clinical fields can’t handle!

Topics have already been as varied as patient involvement and digital evaluation frameworks. As a cohort we have shared progress on our projects and begun to properly network. We have also been introduced to the technique of “Action Learning Sets.” These create a more in-depth relationship with a smaller group of colleagues aiming to support and provide challenge by listening to each other and ask questions to encourage different perspectives.

How is all of this supporting me with my project?

The Trust I work for already uses Electronic Patient Records (EPR) to document patient notes and observations, prescribe and administer medications, order lab tests, and manage extra patient flow, amongst other things.

Also, as a Trust (just like many others), we have done a lot of work on improving the care and early recognition of deteriorating patients. We have all seen and heard the stories in the press of patients with sepsis having long term complications or even not surviving because they were not recognised or treated in time.

At present, if a patient is on one of the wards overnight or at the weekend where there is no full-time doctor cover, the on-call / critical care outreach teams rely on receiving a bleep from the wards (either that or constantly scrolling through each ward-based view on our systems) to identify any deteriorating patients. This leads to delays in escalation of patients, and also the fact that the right member of the team (a senior decision maker) is not always aware of what is going on until later in the pathway. Does this sound familiar?

What if there could be better tools to support this? What if we could have an overview that showed the sickest patients in the Trust? What if this could also identify key results, and if there was already a clinician allocated? This would mean that there was an alternative, there would not be a total reliance on a bleep from a ward on the other side of the hospital, and the senior clinician managing the on-call work-load could allocate the team more effectively. At present, we are in the scoping and design phase to create something like this.

We could be further forward, but there are many conflicting priorities for our in-house technical team who will be building this. However, in the mean-time, the NHS Digital Pioneer Fellowship has helped me ensure that I have the problem statement and aims for my project refined. My action learning set group has suggested other ways to approach unlocking progress, and design thinking has given new perspectives on what should and could be achieved.

It also has been made even clearer to me that, as a Trust, we need to understand our current metrics to be able to track improvements once the new view is implemented. Therefore, while I wait I for progress in one area, I will ensure that easy metrics are all established. In addition to the above, for the last two months, I have also been supporting other digital projects, the first being a “Homerton App,” co-designed by clinical staff, to provide guidelines/ action cards (such as sepsis protocols), SOPs, and links to other useful sites such as medusa and toxbase. I have also been scoping out digital automated registration and initial assessment in the Emergency Department amongst other things.

All of these projects are at different phases but all support clinical decision making and the early identification of the deteriorating patient.

I have used the skills and knowledge learnt so far in the Fellowship to help re-frame aim statements, and to evaluate phases of the project, as well as to look at design in a different way. I will be using the next action earning set to help me progress, and I look forward to supporting our group with their projects equally.

In summary, the most useful thing so far about this Fellowship has been the headspace to think differently. To have time to think away from the work environment, and to listen to and be challenged by experts and my peers who are facing some of same challenges in getting their projects off the ground.