Using digital, data and technology to improve the outcomes of patient care in North West London
Imperial College Healthcare NHS Trust provides acute and specialist healthcare in North West London for around a million people every year. It is one of the largest NHS trusts in the country with five hospitals and over 13,000 staff. With its partners, the trust forms the Imperial College Academic Health Science Centre working to ensure the rapid translation of research for better patient care and excellence in education. And working with the National Institute for Health Research, the trust hosts a biomedical research centre with Imperial College London, and is a part of the Health Informatics Collaborative to enable new insights into care and treatment through research.
What was the aim?
The trust’s goal through the Global Digital Exemplar (GDE) programme was to use digital, data and technology to improve the outcomes of patient care, give patients and staff better experience of care, and deliver financial savings.
What were the solutions and impact?
Shared electronic patient record system
The drive to introduce a shared Electronic Patient Record (EPR) system for Imperial College Healthcare and its fast follower partner, Chelsea and Westminster Hospital NHS Foundation Trust, was at the heart of the trust’s approach to the GDE programme.
Chelsea and Westminster Hospital was one of the first sites to introduce an EPR system in 1999. By 2016, the system was starting to show its age and the trust needed a plan for replacing it. They found the answer a few miles away at Imperial College Healthcare. The two trusts now use a single shared system across seven hospitals with 20,000 staff and over two million patient contacts a year.
There are significant benefits for both trusts, including:
- reduced payments to the supplier
- improved staff experience for those who work at both trusts
- patient safety benefits with information available to clinicians regardless of which hospital administered the treatment
The two trusts work together to continuously develop and improve care delivery.
Wireless entry of patient vital signs
Nursing staff routinely take observations like blood pressure, heart rate, temperature and oxygen saturation using mobile bedside monitoring devices. Previously these observations had to be entered manually into the EPR. Now the information goes directly into the patient record over wifi. This reduces the risk of error, increases patient safety by triggering alerts for deteriorating patients, and saves time. It’s available on wards across the trust and releases 23,000 hours of nursing time for care every year.
Digital monitoring of foetal and maternal vital signs
Around 10,000 babies are born at Imperial College Healthcare every year. Contractions and foetal and maternal heart rates from cardiotocograph (CTG) devices were previously printed out on rolls of paper and midwives added handwritten clinical observations. These records were hard to share quickly for a second opinion.
The solution was to connect the CTG machines to the EPR system. Maternity staff can now view electronic, graphical displays of heart rates and contractions for all mums and babies on trust labour wards. They can spot signs of distress and take action quickly, improving patient safety. The data is recorded in the electronic patient record.
Paper free outpatients
When adult patients visit the trust’s hospitals for outpatient appointments, all of the records held by the trust relating to the patient are now available to clinicians from their computers.
This has the following benefits for patient safety:
- Clinical decision making can always be supported by all the information available to the trust.
- The reliance on having the right paper records in the right place at the right time is removed.
- Historical records have been scanned and there is no longer a need for paper records to be stored on site.
- A total of 1,680 square metres of space used by health records libraries has been released for clinical and operational use.
- In the first two years of the project there was a £2.25 million cumulative reduction in the health records budget.
- Between 2016 and 2020 external printing costs came down by £310,000
- Many of the staff in the health records team have gone on to other roles in the Trust, in some cases more senior roles with greater responsibility
Digital patient identification
Digital positive identification of patients, medications, blood and human milk is making our patients safer. Safe administration of medications depends on the five rights:
- right patient
- right drug
- right dose
- right route
- right time
Positive patient identification using bar code scanning linked to the EPR verifies all five. The clinician scans the patient and the medications, and an alert is raised if anything is wrong. For example, on a drug round when the clinician scans the patient, the system will recognise if the patient record the clinician has opened is not for that patient. This has been successfully piloted and the trust-wide rollout is underway.
The same technology is allowing:
- phlebotomists to print labels at the patient bedside reducing the risk of error in labelling tubes
- operating theatre staff doing blood transfusions to scan the blood and the patient to ensure that the right blood is going to the right patient
- neonatal intensive care units to make sure the right human milk is given to the right babies
Using data to improve care
Clinical data analytics is enabling improvements in clinical practice and better outcomes for patients. Digital sepsis alerts, test bundles and treatment plans were central to an improvement initiative that led to:
- 71% increase in the likelihood of patients receiving timely antibiotics
- 7% reduction in the chances of a patient experiencing a long hospital stay
- 24% reduction in the risk of death from sepsis
Analysis of the effectiveness of risk assessments for venous thromboembolism (VTE) demonstrated a clear benefit to patient care from timely risk assessments and preventive treatment where needed.
During the GDE programme the trust built capacity in clinical analytics, enabling a quick response to the need for data during the pandemic. For example, the trust used digital solutions to report on COVID-19-positive patients in its hospitals, and to identify patients in its care who needed to shield.
Over the next two years two more acute trusts will begin sharing Imperial College Healthcare’s EPR system. This will have significant benefits for patient care and collaborative working across the North West London Integrated Care System (ICS).
Imperial College Healthcare has led the work on the Care Information Exchange on behalf of North West London to provide patients and service users with access to their health and care records. With over 150,000 registered patients it is already the largest personal health record system in the country and that number is expected to double over the next two years.
The trust is playing a key role in the development and delivery of the digital, data and technology transformation plan for the North West London ICS.
“Imperial College Healthcare completed its Cerner EPR implementation journey in a series of go-lives over eight years between 2011 and 2019. The Global Digital Exemplar programme allowed us to work in partnership with our Fast Follower to launch the same system at Chelsea and Westminster in one weekend in 2019.
“Collaborating on digital transformation to deliver better care and better staff and patient experience is the essence of what the GDE programme was all about. And the journey has not stopped there. By 2024 we will have four acute trusts sharing a single EPR system in North West London.”
Kevin Jarrold, Joint Chief Information Officer, North West London Health and Care Partnership, Imperial College Healthcare NHS Trust and Chelsea and Westminster Hospital NHS Foundation Trust
“The Global Digital Exemplar programme significantly increased our clinical engagement with digital, data and technology and enabled us to deliver real benefits including cost savings. The momentum has carried over into our Digital by Design programme, which is supporting the Trust and the wider ICS to exploit Digital Data and Technology and embed a digital culture to deliver better health for life.”
Linda Watts Associate Director of Digital Transformation & General Manager Outpatients & Patient Access, Imperial College Healthcare NHS Trust
“The Global Digital Exemplar programme accelerated our progress with digital transformation. And when COVID hit we were in a much stronger position to enable the response at both a Trust and an ICS level. So much of that response had a digital foundation from helping patients to communicate with their families and increasing our capacity to care for COVID patients through to providing the ICS and NHSEI with the data needed to manage resources.”
Dr Sanjay Gautama Consultant anaesthetist, CCIO and Caldicott Guardian - Imperial College Hospitals NHS Trust, CCIO and IG co-chair NW London Integrated Care System, London regional clinical informatics lead
“Digital, data and technology are allowing the nursing community to drive improvements in practice and increase patient safety. One of the keys to success is making sure that new digital solutions are always within the context of the EPR system that nurses are using every day.”
James Bird Chief Nursing Information Officer, Imperial College Healthcare NHS Trust
“The digital patient record and real-time operational data are now as essential to the frontline clinician and operational teams as the oxygen supply. They are mission critical systems. One example of this is the role of digital and data in our work to improve the speed and effectiveness of our response to suspected sepsis when a digital sepsis alert is triggered. This led to a 24% reduction in the risk of death from sepsis.”
Dr Anne Kinderlerer, Consultant rheumatologist and Acute Physician Associate Medical Director