Case Study
Case Study

Chesterfield Case Study

Subscribe for regular updates
Technology is often lauded as the key to transforming the way hospitals operate to improve patient outcomes, but is this really accurate in the eyes of frontline staff? One Trust is proving that with the right IT in place, nurses can streamline processes creating more time for patient care.
It's adding value because our nurses are using it, and if they didn't appreciate its worth they wouldn't. It's made a tangible difference to nurses and therefore a real improvement to the care and attention we can give to our patients."
A first-class mission
In 2010, Chesterfield Royal Hospital NHS Foundation Trust, that serves a catchment population of around 400,000, identified the improvements it needed to make in managing the progress of patients through treatment – from referral to inpatient stay and back into the community – as part of its mission to become a first-class district general hospital.

Tracking patients through their hospital stay; and managing the subsequent ancillary activities such as bed management and cleaning, was proving problematic. For example, the trust was experiencing issues such as copious phone calls to organise bed cleaning and multiple team meetings to discuss bed allocation for patients. The result was an inefficient use of nurses' time, and potentially increased length of stay for patients.
"One objective was to reduce the reliance on a manual bed management process across the organisation; another focused on implementing the Department of Health's 'Productive Ward' principles; and we also wanted to be able to locate patients across the hospital, particularly for improving our night handover procedure."
Dr Maxine Simmons
Senior Matron for Practice and Professional Development
The Solution
To meet these objectives, the trust selected Cayder's Patient Flow Management (PFM) solution. Its aim was to support nursing staff in managing their patients' progression in the hospital by providing them with up-to-date, real-time information which could be viewed at a glance and involved minimal interaction with IT. The system was deployed hospital-wide across all 15 of its wards including surgical, orthopaedic, paediatrics, neo-natal and general medicine, as well as key departments including pharmacy and domestic services.

With just one or two touches on an electronic whiteboard, the PFM solution now provides nursing staff with a quick and highly intuitive way of realising efficiency benefits immediately. To deliver this solution, a series of 55" inch, wall-mounted touchscreens, replacing the traditional whiteboard, were situated on each ward and relevant departments, with bi-directional links to the hospital's patient administration system (PAS) ensuring both systems remain completely in line and up to date.

Today, this solution is helping to reduce administration around the admission, transfer and discharge of patients. In addition, it is making it easier for nurses to schedule and track routine activities and drive discharge planning, including tracking TTOs (medicines to take out).

Adding Value
The Trust was keen to ensure that the solution added value to their nurses' daily routines, as well as improving the patient journey, Dr Simmons explains: "Nurses have traditionally been suspicious of technology with a fear that IT systems take them away from dealing directly with their patients. So this project has helped them to understand and appreciate the benefits IT can really deliver – and effectively help them to spend more time caring for patients."

Prior to implementing the solution, nurses working out-of-hours, without the support of a ward clerk, were finding it difficult to keep patient records up-to-date. By integrating the PFM system with the Trust's existing PAS, the result is minimal administration for nurses, by reducing repetitive data entry behind a desk - as this has been replaced with quick 'on-the-fly' touchscreen updates. The result provides staff with instant information regarding patient status and an updated PAS.

Dr Simmons says: "Linking the two systems together means that when we discharge a patient via the PFM solution, it automatically updates the PAS. This has made it very easy for the nurses, because they just click on the patient name and click on discharge. When the patient has left, the bed is empty, ready to be cleaned – quickly enabling them to care for the next patient requiring critical emergency care."

More time to care
The PFM technology is ultimately about reducing the burden of unnecessary administration and organisation for frontline carers. Providing instant access to information about a patient's status has empowered ward teams and healthcare staff in other departments to make better, informed decisions quickly and effectively - both clinical or operational.

One example of this is when nurses are regularly interrupted during shifts by requests for information from colleagues and visitors about the location and status of patients, therefore reducing the time they spend on caring. The bed management function of the PFM solution helps to streamline this communication process. Take, for example, dealing with domestic services. This process is now quick and simple as domestic supervisors are automatically alerted when a bed requires cleaning after a nurse has updated the PFM regarding a patient being discharged.

Dr Simmons explains: "If a nurse on the ward is trying to get a bed cleaned, they used to have to bleep one person who would then bleep another person who would then arrange for the cleaning to be done. Often the nurse back on the ward would be unaware as to the status of the bed cleaning priority list. Now if there is a bed crisis, the nurse can request specific beds are prioritised for cleaning."

Keeping it simple
Engagement with frontline staff is key to any successful deployment, and the introduction of any new IT system often requires time-consuming training sessions, especially for those who are unsure of the benefits technology can bring to healthcare. The Cayder software deployed at the Trust takes a different approach as it puts the healthcare professional in control of the technology, allowing teams on the wards to decide how they want to use the system, and then develop their own processes around it.

Dr Simmons explains that the ability to 'own' the technology has played an important role in boosting the confidence of nurses using IT: "We wanted the nurses to deploy the initial roll out instead of the IT department. We were challenged by some nurses who had concerns around using technology, however they soon realised it was achievable. So I think it has helped to build confidence for staff in their own skills as well."

Taking control
Another key feature of the PFM software is the visual communication element. Boxes represent beds on a ward on the electronic whiteboard and then symbols and colour-coding are used, which are fully customisable to the ward's specific requirements. This allows a range of information to be displayed and digested quickly by nurses.

Dr Simmons explains: "Initially when looking at the range of symbols and colours it can look quite busy, but actually once you learn that a triangle always relates to nutrition and that different colours of the triangle mean a particular nutritional indicator for that patient, it probably takes around 10 minutes to learn. Because the symbols are intuitive, it makes it easy to understand."

The solution provides the current location and status of patients under a nurse's care, which has allowed quick identification of potential risks, Dr Simmons continues: "What it enables us to do, for example, is clearly identify all the patients on the ward that are at risk of falls, that then automatically transfers onto the nurses handover sheets and therefore everybody can see what risks are present."

Changing attitudes
Dr Simmons explains that the current culture amongst the nursing profession means that introducing new technology will need to demonstrate immediate, tangible benefits: "Tasks that take nurses away from delivering direct patient care are resisted, but updating a patient record can save them more time later on in the day because, for example, it means other staff have no need to keep asking for information."

Ultimately, the deployment of the Cayder PFM solution at the trust was to reduce the administrative burden on nurses, something that has previously not been particularly successful: "It is used on a daily basis, it is kept up-to-date and it is helping to keep our PAS current. It's adding value because our nurses are using it, and if they didn't appreciate its worth they wouldn't. It's made a tangible difference to nurses and therefore a real improvement to the care and attention we can give to our patients."