For our thought leadership feature series, we spoke to a selection of people from Altera to get their views on how technology can support patient flow and, ultimately, increase efficiencies for healthcare organisations.
We were joined by Mark Hutchinson, Altera’s vice president of healthcare strategy and transformation for UK, Europe, the Middle East and Africa, and previous chief digital information officer at Gloucester Hospitals; Judy Sealey, expert solutions specialist and nurse; Dr Ed Hutchinson, expert solutions specialist at Altera Digital Health and NHS junior doctor; Eve Olivant, director of system flow at NHS Gloucestershire; and Sarah Walters, associate director for urgent and emergency care and system flow at NHS Gloucestershire.
How technology can improve patient flow, hospital efficiency, early discharge while delivering cost-efficient care
Mark: From a background point of view, the way the NHS and social care are structured means that the responsibility for hospital care sits with one organisation; the responsibility for community care sits with another; and the responsibility for social care sits elsewhere. To be able to successfully discharge patients in a way that prevents readmission, we need coordination between those organisations. On top of this, as we know, the capacity of these organisations is stretched thin across the whole country.
You can achieve that coordination through lots of phone calls, sure, but if we are to deliver this coordination in a meaningful and sensible way that is fit for purpose for 2023, we need to better use technology. We need to share information from our hospital EPR, like Altera’s Sunrise™, with community providers and social care providers, so that they can better prepare for the patients who they will be responsible for upon discharge.
It’s a chain reaction: Enabling that early discharge frees up beds within a hospital, and by freeing up those beds, we’re giving doctors in emergency departments more space to admit patients so that we don’t have queues of ambulances outside the hospital. Every time you take delays out of that system, you drive efficiencies. You slightly relieve the pressure on incredibly hard-pressed staff, and you allow the entire organisation—the NHS and social care in its broadest possible definition—to work as efficiently and smoothly as possible.
Ed: From the discharge point of view in a practical sense, there’s often a challenge that we’re dealing with people from across different geographical groups. You could be looking to discharge three people, but if they are all from different ICS regions, there are different forms to fill out and different people to contact. It can cause delays because someone from a social care organisation in a particular region might come back to you days after you contacted them and say the patient is not in their region, so they can’t take them. Having a digital system in place that increases visibility, prevents duplication of information and enables that swift sharing of information is really key.
With regards to improving efficiencies within hospital, poor patient flow not only risks harm to the patient, it also takes up a lot of staff time. Ultimately, from an efficiency point of view, staff time is money. Anything that enables the process to run more smoothly helps us spend more time with our patients rather than tackling logistical problems.
Tech in planning demand and capacity: How Altera tech has supported patient flow at NHS Gloucestershire
Eve: We have seen the benefits of using Altera’s Sunrise EPR to support patient flow in a number of areas across NHS Gloucestershire. Altera’s modular adaptable approach has enabled community and social care partners to have access to review the EPR so we have been able to establish a ‘patient pull model’ from the acute into community services. This includes reviewing patients waiting in ambulances outside the hospital to assess suitability for redirection to alternative services, patients in the emergency department and patients on wards. This has provided the wider system with flexibility in developing solutions that have been enabled by utilising the product across the system. In our experience, it has been straightforward to enable access for our partners to Sunrise EPR so that we can work in this way, which has previously proved more difficult with other systems.
The ability to use Sunrise EPR system-wide has supported the development of positive cross-system relationships between operational, clinical and digital colleagues. The data and metrics under review in delivering patient flow across health and social care are rigorously scrutinised by our regulators to assess performance delivery, so you need to create a culture where health and social care partners feel safe about sharing their data. There needs to be an understanding that performance reporting is secondary to working to understand the underlying actions and processes which result in the numbers, and secondary to how we can improve the patient journey.
The development of a system-wide patient flow dashboard which all partners contribute to has enabled us to track and monitor our long length of stay and 21-day length of stay patients and reduce them significantly. The real-time feed from Gloucestershire Hospitals Sunrise EPR and the richness of the information we can pull through has been fundamental to its success, and it also helps to drive discussions with other partners regarding their systems and data improvement.
As part of our winter response last year, digital colleagues at the trust were able to work with operational colleagues to set up a real-time discharge tracker. The flexibility of the Sunrise EPR system enabled this to be done extremely quickly – we could utilise and develop existing flow sheets which clinical colleagues were already familiar with using in order to develop a solution. The team were able to build a patient flow whiteboard which shows definite and potential discharges for the next 48 hours, enabling real-time demand and capacity planning across the hospital bed base to manage safe effective patient flow. The information is live on display in the site operations team and is used to support site flow meetings throughout the day.
The ability to develop a digital solution so quickly without requiring a larger scale procurement of a ‘bed management’ module enabled an immediate response to operational pressures and ease of implementation through the existing EPR.
Approaching large-scale transformation in a way that minimises disruption to patient flow
Mark: A key point here is that the NHS is under enormous pressure at the moment, and we need to be able to implement significant change in bite-sized chunks. I think there’s something like 50,000 doctor and nurse vacancies across the country currently. You can’t take people out in big numbers to have them redesign systems or undertake all the training that is necessary if you want to change the way a hospital works. Taking a phased approach to the way that hospitals function and implementing EPRs in a modular way is a really important when delivering change.
I’ve done this three times—in Salford, Wythenshawe and Gloucester—using Altera’s Sunrise EPR to implement in that phased way. I always describe it as eating the elephant one chunk at a time, so you don’t end up with indigestion. You do see hospitals up and down the country suffering that indigestion as a result of trying to change everything in one day, which can cause massive problems.
The other thing that I’ve learnt is organisations really rely on their patient administration systems (PAS) for continuity of patient care and the management of that really big waiting list. Changing those systems can result in organisations losing track of patients and losing accurate waiting list data, which means they can’t submit it nationally. My experience has been that it’s best to focus on the clinical aspects of an EPR first and leave your PAS doing its national reporting. Help your clinical colleagues who are under a lot of pressure by giving them tools that give them the information that they need at the bedside; focus on that, deliver some benefits, and then if you need to change your PAS, do it at a later point so that you don’t lose track of patients and end up causing delays to patient care.
What frontline clinicians need most from tech to support patient flow: A digital nurse perspective
Judy: I have been a nurse for a number of years now, and I previously worked in a team who managed beds within a hospital directory. I know all too well the experience of having all those phone calls trying to establish bed availability, expected discharges for the day and the process of manually updating a clipboard throughout a day. A huge amount of time is spent on that, and a lot of the time, that information is not correct anyway. All that time could be reinvested into clinical care and improving the patient journey.
From that perspective, and from conversations with my nursing colleagues, what we want is a streamlined digital process that actually works. Altera offers patient flow technology that provides a single source of truth and gives you the full picture and clear visibility of the beds that are available in one hospital or across a group of hospitals. Having that information available is so helpful when it comes to decision-making for nurses. It’s the provision of real-time information that allows you to improve your capacity management, and it also allows for better communication within a team too, so everyone feels that they know what is happening.
How can health tech suppliers alleviate patient flow challenges for doctors?
Ed: From the doctor point of view, it’s ultimately about getting patients to the right area to optimise their care. That could mean getting them to a particular specialist ward, or getting them discharged home. Similarly to Judy, for us, digital tools can increase our visibility of those pathways and speed up the process too. Rather than duplication of forms or two people making the same phone call, the information is set out in one place that everyone has oversight of. It’s clearly labelled if a patient needs to be moved to a particular ward, we can see the number of beds that are available in that ward, and we can start to plan that patient’s care ahead of time.
Similarly, within the hospital, digital tools can help us save time in getting patients to scans or treatments—we can send a digital request for transportation, for example, rather than needing a paper form to book that transportation in.
All of this is not only going to help clinicians and make their lives easier, it’s also going to improve patients’ experiences and optimise their outcomes.
How to get patient flow right
Ed: In my current organisation, we’ve had a lot of problems over the past few years with patients getting stuck in the emergency department. You see the impact that delays can have on patients when they need to have a specialist review, and also in terms of patient or relative frustration. It’s distressing being in the wrong place and that affects the patient, their family and staff, too. A lot of time and energy goes into thinking about ways to optimise things like treatments and scans, but arguably, getting a patient to the right place in a timely manner is just as important. Having processes in place that recognise the importance of that is key.
Other than that, I think it’s about keeping it simple—having a clear, concise solution that allows that process to move smoothly. You don’t need to add unnecessary bits that complicate it, you just want to have that visibility and get people to where they need to go.
Also, having the same system across the hospital and the wider trust is so important. Inter-hospital transfers are really common and you can end up with the same problem where you can’t see what’s going on in another hospital. That leads to more phone calls and more delays.
Judy: One of the things I always say is, ‘Why wasn’t something like this available when I was managing beds on the cardiology directorate all those years ago?’ I was pounding the different wards and units trying to get information, even counting up the empty beds myself because I knew that the information I had been given probably wasn’t correct. I wish this technology had been available then.
There’s also something to be said for the way that a solution like this can help the coordination of things like portering services and bed cleaning—other aspects of patient flow that could delay a patient getting into that bed. Being able to streamline all those activities and coordinate that flow within a hospital or a group of hospitals is tremendously helpful.
Mark: Essentially, it boils down to data and the sharing of information, which we typically don’t tend to do very well between NHS organisations. People’s interpretation of information governance rules often makes it harder to access information about patients than it should be. Taking a step back and looking at that to see if it’s been over-complicated can help patient flow.
Also, it’s about people. We’re dealing with really pressured clinicians and managers who are working incredibly hard. How can you help them think differently when they are running so fast, just to do their daily work? Henry Ford said that when he invented the car, if he’d asked people what they wanted, they would have asked for faster horses. It’s really easy for people who are working in a very pressured environment to just want the current process to work faster. We need to find a way to help people find the time to take a step back and imagine new ways of working. If you can do that, you can help them understand how these kinds of technologies can make their lives better. That’s key: It’s about hearts and minds.
Sarah: It is about not seeing digital as an aside, but bringing it into the operational space and building relationships with digital colleagues and not being afraid to use the tools. If there’s an element of hesitancy around digital, and you aren’t willing to test things, then you won’t get ahead with it. We were really brave last winter about stepping some of the digital tools up, and it’s really helped us. It’s definitely given us more confidence for tackling the winter ahead.
Eve: Key takeaways: don’t be afraid of surfacing data that may need work to improve quality and reliability; create a safe culture to work with the information available; if you can’t see the problem, you can’t find a solution for it.
In my experience digital colleagues can design solutions very quickly but it takes much longer to build the relationships, trust and buy in to fully utilise the opportunities available – the sustained effort required by leaders to facilitate this shouldn’t be under appreciated.
Many thanks to Mark, Ed, Judy, Eve and Sarah for joining us.