South Western Ambulance Service moves to electronic patient care records

This spring, the South Western Ambulance Service (SWASFT) launched a new electronic Patient Care Record (ePCR) with  Weston Area Health NHS Trust – an electronic solution designed by paramedics for paramedics.

19 emergency vehicles have been fitted with the ePCR device and 14 clinical workstations have been installed at five receiving units at Weston General Hospital. 98 SWASFT clinicians have been trained in using the new kit.

This is an exciting development for our ‘Safer Care through Early Warning Scores’ as NEWS (National Early Warning Score) will be automatically calculated, recorded and communicated for all patients using the portable monitoring equipment.

Led by Francis Gillen, Executive Director of IM&T, and clinically managed throughout by Dave Partlow,  East Division Clinical Development Manager, SWASFT has over the last three years, worked tirelessly on the development of an Electronic Care System finally fit for a modern 21st century ambulance service.

The ePCR will enhance patient experience, support the decision-making process of frontline clinicians and open up opportunities for the transmission of data being captured to help improve SWASFT’s overall operations.

Background

The ECS has been created in partnership with Ortivus, a leading supplier of mobile solutions for modern emergency medical care. The solution aims to eradicate paper-based data collection, enhance the clinical decision making process and support the provision of ‘right care in the right place at the right time’.

The project was initially part of four work programmes led by Connecting for Health and aimed to provide an electronic solution across the South of England. Although looking in particular at an ambulance based solution, functionality to support further integration at a later stage has been a consideration throughout.

David Partlow says, “We wanted to find a system that is highly configurable by the ambulance service and a solution that is focused on the needs of a modern 21st century ambulance service. We wanted a service driven by the provision of high quality care and the desire to ensure that the patient outcome meets the needs of the individual patient, but is also focused on supporting the clinician in determining the most appropriate pathway and providing care that meets the objectives of the wider urgent care agenda.

How the ePCR was designed

The ePCR has been configured by a small but very dedicated project team in SWASFT. Using a structured model of examination and assessment, the software is configured so as to take the clinician through a structured process, capturing any and all clinical interventions and where possible and appropriate incorporating validated assessment tools to enhance the clinical decision making process. This in turn allows the clinician to use the solution to support
their clinical assessment and ensure that patients are conveyed or signposted to the most appropriate service.

The solution offers full connectivity at a clinical workstation, connecting the individual end user device via the 3G network. This allows the acute trust and other clinical partners to view the appropriate record and provide early indication of potential patients with regards levels of acuity and likely interventions. The solution is expected to provide for full NHS Spine connectivity and therefore supports the Summary Care Record.

Information Governance requirements feature heavily in SWASFTs requirements and there was a clear need for patient identifiable data to be held securely and only made available to those with a clinical need to see it. Data is only held on the end user device during the patient engagement; once closed and signed the data is held securely on a hosted server and cannot be accessed by anyone unauthorized to do so.

The capture and controlled transmission of patient data is available in the form of highly configurable output forms. This can be created and auto populated from data already entered, to enable Falls Referrals, TIA Clinic Referrals, Safeguarding Referrals and other suitable clinical outputs which further enhance the patient outcome and patient
experience.

The device incorporates a web browser, enabling the clinician to view a selection of approved websites such as toxbase, Athens and NICE. The device also holds a number of hard file documents, such as JRCALC, other national and local guidelines, Patient Group Directions and Operational Instructions.

The solution can and will also enable access via web links to the Directory of Services. Crews are often unaware of the options available to them to enhance the appropriateness of conveyance and this will greatly enhance the ability of SWASFT to build on its Right Care agenda, increasing the appropriateness of conveyance and decreasing the numbers inappropriately conveyed to the emergency departments.

What the future holds

The benefits of the device relate to enhancing the patient experience, supporting the decision making process and opening up real opportunities for the transmission of data. But equally important is the data that will be captured by SWASFT in relation to its operations. Such data will enable real opportunities in terms of research in to pre hospital care, research that up to this point has been incredibly onerous and reliant on review of paper based systems.

Emergency Department Safety Checklist rolled out to Weston, North Bristol and Gloucestershire

This month sees the first wave of early adopters of the Emergency Department (ED) Safety Checklist in the West of England, with Weston, North Bristol and Gloucestershire following University Hospitals Bristol’s lead.

The ED Safety Checklist was piloted at University Hospitals Bristol NHS Foundation Trust (UHB) and supported as a SHINE research project by the Health Foundation. The Checklist systematises the observations, tests and treatments in a time-based sequence for all patients other than those with minor complaints.

In its first year the Checklist has had an extremely positive and demonstrable impact on patient safety in ED.  Since its introduction in the UHB ED, there have been no clinical incidents relating to a failure in recognising deteriorating patients or delays in care delivery. (During the winter of 2013/4 there had been five serious incidents of which three occurred in the ambulance queue.)  Mean proportions in Key Performance Indicators (KPI) taken before and after the introduction of the Checklist improved by 5% – 25% in most cases.

Commenting on the pilot, Dr Emma Redfern, Consultant in Emergency Medicine at UHB and Associate Clinical Director for Patient Safety at the West of England AHSN, said: “All key performance indicators have improved since we implemented the Safety Checklist: things like vital sign measurements, pain scoring and administration of pain relief.

“We feel that a well-designed Safety Checklist can improve the quality of care delivered to our patients during periods of crowding.”

Due to the pressures on local urgent care systems, the West of England AHSN is now supporting three other EDs to implement the Checklist, through the development of an easy-to-use Toolkit and a financial award.

Weston Area Health NHS Trust is our first early adopter, while North Bristol NHS Trust plans to implement the Checklist by the end of December.  Gloucestershire Hospitals NHS Foundation Trust will be our next early adopter in early 2016.

With support from the West of England AHSN, UHB have applied for Scaling Up funding from the Health Foundation to roll out the ED Safety Checklist across the whole of the South West, and we will hear if we are being invited for an interview in January.

For more information on the ED Safety Checklist, contact:

Emma Redfern
Associate Clinical Director for Patient Safety
emma.redfern@UHBristol.nhs.uk

Joanna Garrett
Patient Safety Improvement Lead
Joanna.Garrett@weahsn.net

You can watch a short video here about the ED Safety Checklist pilot at UHB. You’ll need the password ‘shine’.