Waitemata District Health Board eVitals project
Waitemata District Health Board (WDHB) had a vision for an ‘eVitals’ system. It wanted a system that could provide clinical decision support capabilities, help identify deteriorating patients by automatically calculating an Early Warning Score (EWS), alert appropriate clinicians and provide prompts to the user for follow up actions. This information was required to be available for nurse managers and nurses to identify overdue or incomplete observation sets or assessments; and provide access for other clinicians to view patient status onsite or remotely.
MKM Health was selected to implement the Patientrack solution to be deployed to wards at North Shore Hospital and Waitakere Hospital (825 Beds). Patientrack would replace paper-based observations as well as automating EWS calculations. Patientrack would be delivered on devices for use at the bedside where assessments could be recorded and available to all users anywhere, any time.
The eVitals project is part of the WDHB Leapfrog Program, which is intended to fast track key initiatives that support the organisation’s purpose, values and strategic priorities. The program aims to increase efficiency, provide real-time access to clinical information, better integrate primary and secondary care, and lay the ground work for long-term, intelligent continuous quality improvement across the organisation. The program will help instil the culture of improvement and innovation; demonstrating that WDHB is prepared to lead in these areas, learn from exemplars internationally, and able to rapidly implement.
Waitemata District Health Board serves the largest DHB population in New Zealand - more than 580,000 people. It is also the second fastest growing of New Zealand’s 20 District Health Boards. WDHB employs around 6,800 people in more than 30 different locations, serving residents of Auckland’s North Shore, Waitakere and Rodney districts on New Zealand’s North Island.
WDHB operates North Shore Hospital, on the shores of Lake Pupuke in Takapuna, and Waitakere Hospital in West Auckland. It provides emergency, medical, surgical, maternity, community health and mental health services locally within its district as well as a range of services for the Auckland region, including child rehabilitation and respite at Takapuna’s Wilson Centre, forensic psychiatric services at the Mason Clinic in Point Chevalier, oral health services for children and young people from multiple locations through the Auckland Regional Dental Service and Community Alcohol and Drug Services.
Prior to Patientrack, physiological vital signs and assessments were paper-based and held in patient folders and on charts. EWS calculations were performed manually by nurses who would then follow a written protocol for appropriate response and escalation. This system relied heavily on accurately measuring a full set of vital signs, correctly calculating the EWS, and prompt follow-up actions based on the written protocol. Manual compliance audits showed variations in standards and knowledge across individuals, teams, days of week and time of day.
These patient paper-based records needed to be accessed by various multi-disciplinary team members and were sometimes not returned in a timely fashion. In turn, nurses were unable to record vital signs directly to the patient chart; they did not have access to the EWS protocol; and other relevant documents were not available to record or assess risk. This approach also presented challenges that come with managing multiple folders, and impacted the effectiveness of handovers and ward rounds.
Some of the key drivers for change were to:
- Improve patient outcomes:
- Facilitate early identification of deteriorating patients
- Provide a hospital-wide view of at-risk and deteriorating patients for appropriate responses
- Increase consistency, appropriateness and timeliness of responses to deteriorating patients
- Increase the identification of patients at risk through increased completion of assessments
- Improve productivity and release time to care for patients:
- Reduce time spent looking for paper charts
- Facilitate communication between nurses, doctors and others e.g. outreach teams, allied health
- Provide real-time audit information and reduce nursing time spent conducting and analysing audits
- Improve the experience of patients and families through timely intervention and support
- Improve staff experience with better communication across teams and timely response to support requests
- Improve the assurance of care standards through real-time reporting and improved compliance with reduced variation improved audit capability
“The new real-time system means we will no longer rely on paper charts to search for records and identify patterns, which ultimately means safer care and more clinical time to focus on the patient.”
Jenny Parr, Associate Director of Nursing
Patientrack was the system chosen by WDHB to deliver the eVitals project. Patientrack is a complete digital and mobile bedside solution proven to improve patient safety, quality and efficiency of care in one easy-to-use application.
MKM Health worked closely with the project teams from WDHB and healthAlliance to configure Patientrack in accordance with WDHB policies and clinical protocols. Patientrack was released to an initial ward for assessment, before a progressive roll-out across Waitakere and North Shore as well as training key clinical coaches in both end-user and administrative functions. The configuration and development delivered included:
- A number of observation profiles with defined scheduling for when a patient’s set of observations should be taken
- Calculation of adult EWS scores based on observation data to identify patients at risk of deterioration
- Assessments and related charts to monitor a patient’s condition including; neurological, fluids, stools, weight, PIVC and smoking history
- The ability for WDHB administrators to create additional observation profiles for the hospital due to feedback received from nursing staff
- Flags to support end-of-life care and non-resuscitation identifiers for patients
- Customised views (My Views) based on user needs
- Automated alerts to notify recipients of a patient’s condition as and when required
MKM Health also provided integration services so that Patientrack data could be accessed through other hospital systems including:
- CSC iPM – the existing Patient Administration System (PAS) where HL7 messages are received and processed by Patientrack to maintain key data as well as patient movements within the hospital.
- Orion Health Clinical Portal – the existing medical applications portal. Patient observations and other charts generated by Patientrack are made available to clinicians using the portal.
- Sysmex Éclair – the existing regional document store where discharge charts generated by Patientrack are stored to provide a historical view of patient charts.
The engagement commenced late 2015 and went live on the first ward mid-2016. Since the implementation began, Patientrack has been rolled out across over 400 beds on two acute sites with 70 beds being added every two weeks. Over 800 health professionals are logging in to Patientrack using a variety of devices to access clinical data. iPad minis are being carried by clinical staff and offering mobility for data access and capture.
WDHB is experiencing a 100% completion rate for observations with Patientrack on the ward. Through the use of Patientrack’s My Views the outreach team is more aware of patients’ conditions.
Wards with Patientrack are experiencing consistent improvements on clinical audits such as 100% compliance for cannula and bowel assessments, which had never been achieved before.
“Now, all the doctor needs is access to any computer or one of the tablet devices stationed in the ward and immediately they can read the patient’s chart simultaneously. Also, the outreach nurse can be elsewhere in the hospital and still be aware of who are the sickest patients and re-prioritise their work based on EWS scoring and other observations.”
Peter Groom, eVitals Clinical Lead & Clinical Nurse Specialist
WDHB will continue the roll-out of Patientrack across both hospitals with an aim to have all wards live by 2017. The fast uptake and perceived benefits of Patientrack are already being realised by nursing staff, managers and clinicians; and the project team is receiving numerous suggestions for new assessments and features to help it further streamline processes and enhance workflow. Additional assessments WDHB plans to include are sepsis, glucose, Venous Thromboembolism (VTE), morse falls and Malnutrition Universal Screening Tool (MUST).
Subsequent work will include automating the comprehensive nursing assessment. The aim is to improve the nursing assessment process by offering the potential to screen the ‘well’ patient, reduce the requirement for repeated assessments, save nursing time, and direct nurses to areas of concern.