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St Vincent’s University Hospital, Dublin, wanted to create a more modern and efficient way of running its emergency department (ED), to support clinicians in safely and effectively managing patient pathways throughout the department. The hospital partnered with IMS MAXIMS to implement a functionally rich, easy-to-use ED system that fully integrates with other hospital systems and provides a comprehensive suite of analytical reporting tools. The new software, live since November 2015, allows real-time tracking of a patient journey through the department and provides an instant overview of a patient’s status, while improved reporting now measures key performance targets set by the HSE.
As one of the country’s busiest EDs, St Vincent’s identified technology as a key enabler for transforming its care delivery and looked to upgrade its existing IMS MAXIMS ED system, which had been in place for 14 years.
Becoming more efficient would allow clinicians to reduce the time spent on unnecessary administrative tasks and increase contact time with patients. It would also help to facilitate communication between departments and with patients and other healthcare providers, such as GPs, plus reduce bottlenecks.
At the time, the ED was planning to become a much larger department, having experienced significant rises in emergency admissions. It had grown from just over 33,500 attendances back in 2002, when the original IMS MAXIMS system was installed, to around 50,000 for the last two years. This move to a larger location presented an ideal opportunity to change to a more powerful, modern and flexible ED system that could share information across departments and would underpin the department for many years to come.
St Vincent’s worked closely with IMS MAXIMS to install and test the new ED system.
The new system provides:
Real-time, configurable patient tracking, including display of breach time indicators, KPIs, alerts, re-attendance and prioritisation of patients.
Notification of new results and clinical notifications, previous history and incoming arrivals.
Triage work-list and assessment, supporting multiple triage protocols, highlighting urgency levels, allocating nursing staff and providing decision support to define pathways.
Clinician work-list and assessments, supporting the streamlining of patients for clinician intervention.
Discharge summaries that include future care plans, support network, medication, outpatient booking and clinical outcomes.
A multidisciplinary team involving consultants, senior nursing staff and administrative staff ensured the system would meet the hospital’s needs, while dedicated project managers at both St Vincent’s and IMS MAXIMS worked alongside each other to ensure the project met the clinical requirements of users.
Both teams recognised that streamlining and improving pathways could help reduce delays in a patient’s progress through the ED, supporting more timely clinical care. Prof John Ryan, Consultant in Emergency Medicine at the hospital, said: “Access to demographic data on our patients allows us to deliver timely critical care to injured and ill patients that attend our department with emergencies.”
Healthcare professionals (HCPs) were fully engaged with the project, providing support and consultation within their functional area of the ED, so that any potential issues across registration, triage, diagnosis and treatment and discharge could be quickly highlighted and resolved.
Usability was a major requirement and teams focused on reducing clicks and increasing software integration to lower the number of times staff had to log in to disparate systems. In addition, hospital reports, training videos and links to third party systems were integrated into the solution to provide all resources in one place.
By enhancing the previous system’s reporting facilities, St Vincent’s has greater visibility of trends in admissions from the ED, which can produce useful insights into improving areas of the patient experience.
“The tracking system is highly valuable for ourselves and visiting physicians in locating patients in an environment where there can at times be in excess of 100 patients being cared for. In a data-driven department where we place so much emphasis on audit and research, the search facilities and report generation give us comprehensive access to information on our business, allowing us to plan staffing and resources that match the demand,” Prof Ryan said.
Providing patient pathway information is an important function to help measure the ED’s performance. The hospital can now run patient experience times reports for the HSE or reply to ED Task Force requests quicker and more easily, by linking the reporting functionality directly to the discharge process.
The integration and data migration challenge
The hospital chose to upgrade to IMS MAXIMS’ latest ED module and implement what in practice was a completely new application. This involved migrating 16.5 million records from the previous system, creating new interfaces and a large amount of data mapping testing.
The project team built a new bidirectional interface for the ED, to ensure clinical and administrative data could move seamlessly between the hospital’s patient administration system (PAS) and other hospital systems, and be available for clinical use at the point-of-care. In addition to reducing the amount of manual processes performed by administration staff, the interface updates patient master index and admission discharge and transfer activity in real-time, to help co-ordinate care more efficiently and reduce the risk of any unnecessary delays in transfer or medical errors.
More efficient care
Senior consultants remain in control wherever they are in the hospital, accessing the system on iPads to gain an overview of staff movements and using it to deliver care to patients within specific timeframes. This real-time view of the department means issues can be identified quickly and steps taken to avoid them or respond.
“The ED team has an integrated system that has facilitated mapping of the patient journey through the department from start to finish, and give a detailed view of what is happening with patients at any given time,” said Mr Dermot Cullinan, Director of ICT at St Vincent’s.
Reporting on department performance has also been significantly improved – St Vincent’s no longer has to use third-party tools to generate reports and wait weeks for the results. The new system has its own reporting database, which means detailed reports are created within hours. This allows staff to conduct a quick and efficient handover during the morning and evening patient assessments, while externally they allow St Vincent’s to report to the HSE on patient experience targets, including wait time and triage time.
The faster and detailed reporting function means St Vincent’s can predict trends and analyse admissions by the hour, allowing hospital staff to identify areas of improvement for the patient experience, and implement appropriate and rapid changes in hospital practice.
“The new system is the cornerstone of how the ED operates — it has simplified and sped-up many core activities and it would be impossible to manage the department without it,” commented Mr Cullinan. “It’s a powerful tool for making sure we keep on top of what’s happening within the department.”
One example of the streamlined core activity is the generation of discharge notes. “We also welcome the discharge letter facility, which pulls together the presenting complaint, investigations, treatment and diagnosis into a functional letter for patients’ GPs on discharge,” added Prof Ryan.
Reducing clinical risk
St Vincent’s now has a modern and effective solution that enables nurses and clinicians to better manage patient journeys through the ED.
The new software arms clinicians with patient information securely, wherever and whenever it is needed, including the urgency of each case, the length of wait and any risk factors.
The move away from paper-based care has helped eliminate issues created by missing patient notes, mislaid orders or results and unreadable handwriting.
Internally, St Vincent’s plans are to move the ED to a completely electronic patient record in the next 12-18 months and has already started the process.
This move aims to significantly reduce the current clerical workload shared by the ED multidisciplinary team. Physicians will be able to record their notes electronically with tablet devices at the bedside and from these same notes, automatically generate discharge letters and prescriptions — optimising the legibility and quality of medical records in the process.
With a view to integrate care outside the hospital, the new ED module will be extended to St Michael’s Hospital in Dun Laoghaire later in 2016. Beyond this, St Vincent’s plans to generate electronic messaging of discharge summaries and clinical records to allow continuity of care into the primary care sector.