New adoption and spread guide launched

It is estimated that across the UK, a third of healthcare improvement projects never spread beyond their particular unit, a further third are embedded across their organisation but never spread further than that, and only the final third are spread across their own and other similar organisations. Through the West of England Academy supported by our new guide, we aim to support our member organisations and innovators increase the adoption and spread of successful innovations and improvements in the health and social care sector.

quote from guide

Successfully spreading improvements and ensuring changes are sustained requires overcoming numerous challenges, such as:

  • Creating an awareness of why the change is needed
  • Ensuring those involved have a desire to support and participate in the change
  • Knowledge of how to bring about change
  • The skills and resources to bring about the change
  • Ensuring processes to sustain the change

Our new guide (which you can download here) sets out suggestions to be considered for the successful adoption and spread of innovation and improvement projects. Our Academy will also be hosting a free series of workshops focusing on adoption and spread in spring 2021.

The West of England Academy provides a range of free resources to help you gain knowledge and develop essential skills for innovative thinking and working. We promote the use of quality improvement methodologies to support delivery of better patient care. We also offer a range of resources focused on evidence and evaluation.

If you would like further guidance on this subject, please contact us through Innovation@weahsn.net.

Our Academy also hosts free workshops and learning events. Whether you are looking to learn more about: inventing, innovating, improving or realising impact, and whatever your background or healthcare experience, we hope we’ll have something suitable for you. If you have any suggestions for potential events, or know of any training that we can share then please contact Academy@weahsn.net and let us know.

Calculating early warning scores before they reach hospital can help the sickest patients

Recording National Early Warning Scores (NEWS) when a patient is urgently referred to hospital can improve the process of care for the sickest patients and reduce the time taken to get to hospital, according to a West of England AHSN supported study funded by National Institute for Health Research (NIHR) at the University of Bristol which has been published in the British Journal of General Practice (BJGP) today [7 April].

National Early Warning Scores help clinicians recognise when patients are at risk of deterioration, for example as a result of infection such as sepsis.

The research team, which included our Primary Care Lead Alison TavaréMedical Director Anne Pullyblank and Patient Safety Improvement Lead Hannah Little, was undertaken in collaboration with the NIHR Applied Research Collaboration (ARC) West. The team studied the impact of NEWS scores collected for more than 13,000 urgent GP referrals to hospital. They found that higher scores are associated with patients being taken to hospital by ambulance more quickly. Average transfer time was 94 minutes for patients with the highest scores, compared with 132 minutes for those with the lowest. Patients with high scores were also reviewed more quickly after arriving at hospital.

Patients with higher scores were sicker, with longer hospital stays and more of them being admitted to intensive care. Patients with the highest scores were nearly five times more likely to have sepsis than those with the lowest scores and eight times more likely to die within two days of hospital admission.

Early warning scores (EWS) are designed to help healthcare staff identify patients whose condition is deteriorating, to allow them to get the treatment they need quickly. Higher scores indicate poorer health.

The National Early Warning Score is a simple scoring system of six clinical measurements which are added together to give an overall score, with various thresholds triggering different clinical responses.

National Early Warning Scores are already used in hospitals across England and by ambulance call handlers and paramedics for triage. However, they aren’t consistently used outside hospital and ambulance services, for example in GP surgeries and community settings.

These findings come at a time when the Royal College of General Practitioners (RCGP) is endorsing the use of NEWS in GP surgeries as part of a system-wide response to the COVID-19 pandemic, with new guidance for GPs issued last week in their COVID-19 resource hub.

The researchers also suggest that patients and carers could benefit from education about NEWS to enable the sickest patients to be transferred to hospital quickly.

Dr Alison Tavaré, GP and our Primary Care Clinical Lead, said:

“As a GP I use NEWS alongside clinical judgement when arranging admissions to help secondary care colleagues decide where patients should be seen, by whom, and with what urgency. I feel strongly that NEWS also protects me as a clinician; if a patient unexpectedly has a high NEWS it makes me think ‘have I missed something?”

Alison Tavaré has also written a personal account of contracting sepsis in a Viewpoint article in the same edition of the BJGP. Read more.

Lauren Scott, Senior Research Associate at NIHR ARC West, said:

“We believe calculating NEWS at an earlier point in the patient pathway, in GP surgeries for example, could help the sickest patients receive timely care and therefore save lives. Our findings are particularly relevant in the context of the coronavirus pandemic, as some COVID-19 patients develop sepsis as a result of the infection.

“We found that higher NEWS values recorded at referral into hospital were associated with poorer clinical outcomes, which is to be expected as these patients will usually be the most ill. But we also found that higher NEWS scores meant patients conveyed by ambulance were taken to hospital more quickly, and were assessed more quickly when they got there.”

Association between National Early Warning Scores in primary care and clinical outcomes: an observational study in UK primary and secondary care

Lauren J Scott, Niamh M Redmond, Alison Tavare, Hannah Little, Seema Srivastava and Anne Pullyblank

Published in the British Journal for General Practice (BJGP), April 2020.

Emergency Department Safety Checklist Masterclass

“Checklists are like toothbrushes; everyone wants one, but they don’t want to use anyone else’s!”

On Monday 25 April 2016, the West of England Academic Health Science Network (AHSN) hosted a free masterclass on the Emergency Department (ED) Safety Checklist, piloted at University Hospitals Bristol NHS Foundation Trust (UHB). Delegates were invited from EDs and AHSNs around the country that had expressed an interest in the project.

The masterclass was attended by 22 delegates from 12 different organisations.

Dr Emma Redfern, ED Consultant from UHB, explained why they had developed the ED Safety Checklist: to respond to the challenges of crowding in ED; to be able to quickly assess the sickest patients (by using the National Early Warning Score (NEWS) as an indicator); and to be able to triage according to patient’s needs.

Alex Hastie and Caroline Clark, ED Nurses from UHB, explained how the ED Safety Checklist had been developed. They described the quality improvement methods and the plan-do-study-act (PDSA) cycles employed to test the checklist, and described the benefits they had realised ‘on the shop-floor’:

  • an aide memoire for basic clinical care,
  • NEWScores used to differentiate the sickest patients,
  • a tool for measuring performance in real time
  • a tool to support staff when they are at full capacity
  • a tool to resource plan during periods of crowing
  • a ‘how to’ guide for bank and agency staff unfamiliar with the setting
  • a reduction in free-text writing in notes which has consequently improved patient contact time.

The West of England AHSN presented the implementation toolkit developed to assist adopting Trusts with how they might introduce the principle of the ED Safety Checklist. We also explored the principle of measurement to prove an intervention has an impact, key performance indicators and the ‘Life’ web-based platform to support quality improvement projects.

Dr Phil Cowburn, Acute Care Medical Director at South Western Ambulance Service NHS Foundation Trust (SWASFT) and Consultant in Emergency Medicine at UHB described the challenges of interfacing the ED Safety Checklist with the ambulance trust, particularly where the responsibility of risk sits for patients waiting to off load into ED in the queue.

Feedback from delegates on the day was very positive and the masterclass was well received. Funding, staff capacity and general ‘intervention fatigue’ were seen as challenges. However, the benefits of the ED Safety Checklist, the improvements to patient safety, improved patient triage, improved patient flow through ED, and improved staff resourcing and management were recognised and agreed across the board.

The slide show from the ED Safety Checklist masterclass can be downloaded here.

A full event write up on the ED Safety Checklist masterclass can be found here.

The ED Safety Checklist Toolkit can be downloaded here.

If you’d like any further information on this programme, please contact ellie.wetz@weahsn.net.

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.