Clinical dashboards and ‘at-a-glance’ information boards to improve inpatient care
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) implemented a solution to improve upon established tools for data view, and to completely digitise the manner in which clinical information is viewed and tasks updated by inpatient staff.
A transformation project on inpatient wards introduced handwritten white boards. These were successful and well-received by ward staff. However, the information was easy to rub off and the transportation of the board for multidisciplinary (MDT) meetings meant ward staff were left without the board for periods of time. Before implementing the solution, clinical information was recorded in both electronic and manual systems, supplemented with handover sheets and a ward diary.
The ‘At A Glance’ (AAG) boards aimed to replace the written whiteboard used in inpatient settings to provide healthcare professionals with an immediate summary of information to aid treatment and communication with patients and their carers.
Solution and impact
Developed in-house, the AAG boards take information directly from the Trust electronic patient record (EPR) and remain always on and visible to ward staff. The summaries provided by the AAG boards mean staff can immediately begin to deliver appropriate care and treatment without the need to seek out agreed actions and tasks from the electronic patient record (EPR) or other notes. Additional boards for the bed management team show a summary of bed states for Trust mainstream services, as well as supporting management of requests for admission, transfer and discharge.
Benefits and outcomes include:
- improvement in clinical recording on the EPR. Missing and out-of-date information is immediately apparent to ward staff
- improvement in timeliness of clinical recording, as staff have an immediate view of the status of patient records and are able to update contemporaneously
- reduced duplication of information.Staff previously updated the EPR and also a number of manual systems at MDT and handover
- reduced administrative time, as all information can be recorded in the EPR
- increased time to care. Staff working on the ward are able to view an up-to-date summary of patient care and tasks agreed at ward MDT. There is no need to seek out information from multiple sources
- increased time for ward management staff, as previously completed manual tasks are now audited electronically. Ward managers are able to focus on quality of record keeping and care, rather than timeliness of data
Certain technical systems needed to be in place prior to implementation and:
- trusts should work with inpatient staff to understand what data items are critical for the AAG board - requirements may vary depending on care settings
- an EPR, including detailed clinical records, is required in order to feed the AAG board
- real-time access to the EPR database, with tools and ability to develop reports, is required
- a reporting solution able to collate information from the EPR and display complex reports is required
- clinical and managerial support and commitment to affect change is required
The solution is a software application that can be run on a PC and projected on TV screens.
- Transfers of care: information regarding incoming requests for beds and bed transfers are recorded as part of the clinical record and shared with all applicable Trust staff
- Decision support: improved ability to manage patients through the use of information in the clinical record
- Clinical and business management: out-of-date or missing information is clearly visible, so ward staff are able to update information in a more timely manner
- Record, assessment and plans: improved ability to access and update service user information at the point of care
- Asset and resources optimisation: visibility of, and enhancements to, the patient's record to include more effective discharge planning
The approach is intended for use in inpatient clinical settings. However, the reports are available directly through the EPR, so can be accessed regardless of location and setting. Similar reports are now also available for crisis and home-based treatment teams. Community boards are being enhanced also.
Key learning points
- Patient identifiable data: The Trust information governance team was central to ensuring that patient identifiable data was kept secure. Patient names were displayed as initials in order to protect privacy. The location of the board is also considered in order to protect data
- GDPR considerations: during initiation, a data privacy impact assessment was completed
Service user involvement in design and usability work
- The project team worked with clinical staff to agree a process for data entry. This process detailed timescales and expectations for key documentation on the EPR to be completed. This was important, as the data in the EPR is increasingly essential for real time bed management. The training for the project focused as much on data timeliness as quality
- System performance: the boards were initially configured to update information every 2 minutes. Concerns were raised by the infrastructure teams that this placed a burden on the system and could impact performance of the EPR. With clinical agreement, the refresh time for boards was changed to 5 minutes
- Common language: the collective team agreed on a common language to allow for clearer communication
Through implementation of AAG boards, the Trust recorded a 47% improvement in data quality for inpatient settings. Wards were more easily able to see data items that are due to be updated or are out of date.
Find out more
Dr Jonathan Richardson, Chief Clinical Information Officer, Consultant Old Age Psychiatrist, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
Mike Jones, Associate Chief Clinical Information Officer, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
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