3_White Paper EPFM

The Economic and Wider Benefits of ExtraMed
Emergency Patient Flow Manager from Hospedia
This White Paper draws on substantive analysis, performed by Deloitte, of the ExtraMed Emergency
Patient Flow Manager from Hospedia, alongside recent industry commentary, to assist hospitals in
creating an evidence base and business case for using the service to improve patient care while
supporting Cost Improvement Programmes (CIPs)
3
Based on economic
assessment by
The Economic impact of Hospedia
Emergency Patient Flow Manager
Contents
Executive Summary............................................................................................................................................. 3
Introducing the Need for Patient Flow Management in Emergency Care......................... 3
The Quantitative Benefits of Emergency Patient Flow Manager............................................. 5
The Qualitative Benefits of Emergency Patient Flow Manager................................................ 6
How Emergency Patient Flow Manager Works................................................................................... 7
Implementation - Process and Support from Hospedia............................................................... 8
How Emergency Patient Flow Manager is Being Used Today.................................................. 9
Conclusion................................................................................................................................................................. 11

The Economic and Wider Benefits of Emergency Patient Flow Manager from Hospedia
Page 3 ©Hospedia Ltd 2014 November 2014
1
Source: Deloitte Report “The Economic impact of Hospedia. Emergency Patient Flow Manager”
2
Source: Kings Fund Quarterly Report February 2013
3
http://www.england.nhs.uk/2013/05/09/sup-plan/
Executive Summary
The growing pressures on Accident and Emergency departments in the NHS Acute sector, and the subsequent
release of the NHS A&E Improvement plan to respond to the issues that are arising, indicate a serious need for
Trusts to develop a proactive approach to patient flow management.
Investing in Emergency Patient Flow Manager from Hospedia has been validated by Deloitte to deliver financial
benefits in excess of £1.3m per annum in a typical hospital, supporting not only Cost Improvement Programmes but
also delivering considerable process and productivity improvements.
This paper draws on substantive analysis performed by Deloitte, as well as recent industry commentary, to provide
an independent evidence base for the use of ExtraMed Emergency Patient Flow Manager from Hospedia in your
hospital.
Introducing the Need for Patient Flow Management in
Emergency Care
There are over 20 million attendances at Accident and Emergency (A&E) departments each year across the NHS
in England1
and, with pressure on NHS resources rapidly increasing, manual methods of managing patient flows
are time consuming and inefficient. Going digital can resolve these issues and generate significant operational
efficiencies.
Within the unscheduled care environment, IT solutions can deliver significant benefits to patients and clinicians,
from improved patient throughput to clinical efficiencies and streamlined workflows. Frequently these benefits go
unrealised, ultimately resulting in clinical staff duplicating effort and working inefficiently.
Meeting financial targets and ensuring financial balance are key objectives for healthcare providers, underpinned
by a driving ambition to improve services to patients.2
Although 90% of A&E patients in England are seen within
four hours, concern has been growing about the trend of increasing numbers of patients waiting longer3
. Against
a backdrop of the NHS needing to find billions of pounds worth of savings across the entire healthcare economy,
considering how existing infrastructure can be better leveraged to support increased productivity, and reduce
patient waiting times, is critical.
Emergency Patient Flow Manager (EPFM) is a software-based system designed to replace the traditional whiteboard
method of tracking patient flow from A&E through to admission or discharge. By integrating with existing IT systems,
such as the hospital Patient Administration System (PAS), the system records and tracks the status of each patient,
sharing this data in real time and avoiding the need to locate available beds by telephoning individual wards.
Staff can update and share information regarding the location of the patient, their needs, referrals and discharge status,
at any time, in real time. EPFM saves time and improves accuracy; optimising patient journeys through integrating and
sharing patient data instantaneously; delivering cost savings, time savings and patient experience improvements.

Establishing the business case for electronic patient flow systems, alongside credible ROI calculations, can be an
issue in the strategic decision making process for Healthcare providers concerned with the initial investment and
on-going costs associated with technology solutions. We are therefore delighted to be able to provide independently
produced business case support for EPFM, detailing not only the estimated financial savings but also the indirect
benefits to patients and staff, based on a number of case studies produced by Deloitte detailing the quantitative and
qualitative benefits arising from Hospedia’s products and services.
Using the Treasury Green Book Methodology, including in person interviews and deriving calculations from real
world examples, Deloitte evaluated the economic impact of using Hospedia’s EPFM service to provide patient flow
improvements in the emergency environment.
6
http://www.pickereurope.org/assets/content/pdf/Frequent%20Feedback/Bedside%20TVs%20survey%20pilot%20report_LD_SS_v2%200%20(2).pdf
7
Source: Deloitte Report “The Economic benefits of Hospedia. Supporting hospitals and patients”
Figure 1: Methodology Diagram5
Indentify
Benefits
Conduct
Interviews with
Hospitals
Primary
Analysis
Secondary
Literature
Finalisation of
Benefits

6
Source: Deloitte Report “The Economic impact of Hospedia. Emergency Patient Flow Manager”
7
Source: Deloitte analysis
8
Stakeholders interviewed by Deloitte quantified 4 full time members of staff typically employed to undertake this function manually
9
Deloitte estimate an 11% reduction in average length of stay based on analysis of lengths of stay before and after implementation of EPFM
10
http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/cancelled_operations.html
11
Calculation based on analysis of surgery cancellations before and after implementation of EPFM, controlling for the trend rate of improvements
The Quantitative Benefits of EPFM
Operational savings represent the savings
associated with freeing up staff time as a result of
the software-based management of patient flow in
an A&E department,8
and the value associated with
optimising the production of discharge summaries.
Hospitals can achieve significant cost savings and
productivity improvements through reducing patient
length of stay. EPFM can support more timely
admission and discharge through shared real-time
access to patient information, helping to reduce
the length of patient stays within the emergency
environment9
and generate annual cost savings of
£950k.
Cancelled operations waste time and resources and place a significant burden on hospital administration. The
effective management of patient flow can help to reduce elective surgery cancellations, alleviating ward bed
unavailability, one of the causes of surgery cancellations.10
As around a quarter of patients attending emergency
care are subsequently admitted to hospital, tracking the status of these patients is fundamental in managing bed
availability throughout the hospital. The value of reducing surgical cancellations, estimated at a 17% reduction11
,
represents a benefit of £137k per annum.
Benefits Hospitals p.a
Operational savings £237k
Reduction length of stay £950k
Fewer surgery cancellations £137k
Total benefits £1.3m
Figure 2: Economic Benefits of EPFM7
“In a typical hospital, EPFM is estimated to deliver savings of £1.2m per annum
and additional benefits of £137k per annum”6

12
Source: Deloitte Report “The Economic Impact of Hospedia. Emergency Patient Flow Manager”
13
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4118689.pdf
14
15
Source: White paper: “Patient flow in the NHS: The efficiency, cost and clinical gains of Patient Flow Management”. 2012
16
Source: National Audit Office
17
Source: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4118689.pdf
18
The Qualitative Benefits of EPFM
Replacing manually updated ward whiteboards with a software-based system designed to optimise patient journeys
can provide benefits far in excess of the pure financial gains.
Patient Experience
Through reducing length of stay, EPFM helps to improve patient experience; thereby releasing income from the
CQUIN payment framework targeting improved patient experience13
. The associated benefit of reducing the
burden on staff spending time tracking available beds also improves staff workload, further contributing to patient
experience and enhancing the overall environment in A&E.14
Staff Safety
A negative patient waiting experience can be correlated to violence and aggression towards frontline staff.15
Violence
and aggression towards frontline hospital staff is estimated to cost the NHS at least £69 million a year in staff
absence, loss of productivity and additional security measures.16
By streamlining the patient journey and reducing
length of stay, EPFM contributes to improvements in patient waiting experiences.
A&E Targets
A&E departments are subject to a variety of targets set by the Department of Health, with potential fines being
imposed if targets are not met. One of the priorities of emergency care, aligned closely to the primary concerns of
patients, is the reduction of waiting times.17
By tracking patient journeys in real-time, EPFM can not only monitor
performance against the targets but also generate alerts to highlight potential breaches, reducing the risk of fines.
Enhanced Information and Operational Insights
EPFM records every patient attendance at A&E, minimising not only lost revenue from unrecorded attendances but
also mitigating the associated clinical governance risk.
Users of EPFM also report that the collection of data can be used to optimise hospital processes. Due to the range
of data that can be recorded, hospitals can track activity and manage individual staff performance and realise
operational efficiencies.18
“EPFM can improve patient experience and help monitor A&E targets, while the quality
of data collected supports further service improvements”12

19
http://www.england.nhs.uk/2015/05/09/sup-plan/
20
Source: Hospedia
How Emergency Patient Flow Manager Works
EPFM replaces standard, traditional A&E whiteboards with interactive digital screens that can easily share
information between departments and receiving wards. Staff can update and share information about patient
locations, needs, referrals and discharge status, view information in a variety of formats and follow patient journeys
in real time, at a glance.
The interactive screen displays not only the patient status but also allows users to view bed status information,
including cleaning and isolation details. The maximum four-hour wait in A&E remains a key NHS commitment to the
public, set out in the NHS Constitution19
. Patients are entered into the system on arrival, beginning the tracking of
their journey, and indicators alert staff to patients at risk of breaching any of the targets.
Fully customisable handover notes, alongside discharge and referral activities, provide full service management of
the patient journey from pre-admission. GP letters can be sent directly through the solution, either within a specific
module or via email, allowing Trusts to hit targets affecting this area of communication. EPFM also provides bi-
directional integration with existing clinical systems, such as PAS, order comms and infection control, supporting HL7
among many healthcare standards. Clinical coding functionality allows Trusts to save money through accurately
integrating ICD10 and OPCS4 codes directly in the solution.
Operations Centre
◼ Patient flow in real-time
◼ Hospital/patient monitoring
and compliance
Emergency Teams
◼ Whiteboards - Patient
status at a glance
◼ A&E Targets
◼ Discharge summaries
Admission Units
◼ Whiteboards - Patient
status at a glance
◼ View demand in real-time
◼ Escalations
Specialist Teams
◼ Real time patient list
whiteboards
◼ Compliance monitoring
EXTRAMED - EPFM
PAS ORDER
COMMS
OTHER DEPT
SYSTEMS
HL7HL7HL7
INTERACTIVE WHITEBOARD
Figure 3: Network Connectivity Diagram20

21
Source: Hospedia
Implementation - Process and Support from Hospedia
Hospedia have a dedicated team with experience of successfully and rapidly rolling out patient flow solutions to
more than 20 hospitals and service providers across the NHS.
Working to PRINCE2 and observing best practice in risk management, Hospedia ensure that customers get an
effective patient flow solution up and running quickly - making a positive impact on patient flow from day one with
screens that are intuitive for clinical staff and managers.
Our consultative approach during project initiation allows the project team to identify and focus on the key areas of
strategic importance to the Trust and translate these requirements into practical improvements on the ground. Close
collaboration with and understanding of operational staff ensures that the deployment phase is rapid and effective
with clear goal setting and staged delivery.
With the solution installed we continue to work with the Trust to make sure that the system becomes embedded
in operational processes and remains relevant to managers and front line staff in a changing NHS. Regular update
meetings with the Trust and the availability of upgrade assurance means that EPFM remains current with the Trust
and NHS requirements.
Ongoing support, including engagement in Hospedia User Groups to
enable Trust contributions to the product roadmap
Staged rollout to wards with Hospedia and Trust support teams
Trial in single area to embed awareness and enable Train the Trainer approach
Prepare system for live trial testing based on UAT signoff and clinical input
Engage IT and clinical teams in User Acceptance Testing (UAT) and feedback sessions
Joint working between NHS and Hospedia teams to establish
Connectivity and Test environment
Project Kick-off meeting to agree goal milestones and resources
2
3
3
5
6
7
1
Figure 4: Implementation Process21

How Emergency Patient Flow is Being Used Today
Hospedia’s ExtraMed EPFM solution is in use across the NHS, supporting thousands of users in over 10 hospitals, 24
hours a day. The system has such a wide range of features; it supports hospitals in achieving different aims. Just a
few of the myriad ways in which Trusts are using the system are detailed below.
University Hospital Coventry & Warwickshire
University Hospital Coventry & Warwickshire implemented EPFM in 2008, to manage increasing demands in an
emergency department catering to over 160,000 attendances each year.
EPFM provides the department with a single shared view of activity and the ability to deliver real time analytics
on key performance indicators. The A&E Breach report gives the department information, in real-time, to help staff
identify where and why breaches occur.
EPFM has also provided the Trust with the opportunity to integrate Clinical Decision Units and Admission Units into
emergency patient flow, further increasing the availability of patient information across the hospital.
East Lancashire Hospitals NHS trust
East Lancashire NHS Trust uses EPFM to manage A&E Departments and Minor Injury Units across 5 hospitals within
the Trust. The system provides the Trust with a valuable, real-time overview of patient flow in and out of A&E, as well
as departmental activity affecting admission gateways. Users can access the information from anywhere within the
organisation, sharing data to support patient care and improve patient experience.
Allowing key users to access the information they need enables informed decision making, EPFM ensures patients
access the right level and type of bed in the right timeframe, and helps initiate escalation processes when
appropriate.
“In building the Electronic Discharge Whiteboard, the Hospedia team has demonstrated a real
understanding of clinicians’ needs and they have used that knowledge to produce a system that
presents the relevant information in a clear and concise way”
Nick Elliott – Chief Technology Officer, University Hospitals Coventry & Warwick
“In a nutshell, it provides strategic and operational clarity with regard to
patient flow and departmental activity”
John Goodenough – Deputy Director of Nursing, East Lancashire Hospitals NHS Trust

East Cheshire NHS Trust
East Cheshire NHS Trust turned to EPFM to deliver a solution that would help clinical front line staff to manage the
increasing flows of patients through the emergency department, manage the 4 hour wait-time target and enable
data capture to support payment-by-results income.
Through a close working relationship during the implementation and change management process, EPFM has been
beyond the initial offering, delivering enhanced functionality and increasing staff engagement.
Using the EPFM whiteboard provides the hospital with a clear view of patient waiting times, clinical coding and bed
availability in the wider hospital.
These are just a handful of examples of how the system is being used to support hospitals in making efficiencies,
improving patient experience and supporting CIPs. In addition to its primary function as a patient flow management
tool, EPFM is also being used as part of workflows focusing on Medications Reconciliation, VTE assessments and
Observations, among many other key NHS initiatives.
“The [Digital] Whiteboard is the first time we’ve had a visual clue as to what’s happening in the department.
If you see someone who is starting to near breach point you can follow it up and find out why. Everyone is
really keen to use it, because it’s actually fun and easy to operate.”
Christine Scott, Operational Lead Nurse, East Cheshire NHS Trust
“...The driving ambition underlying the challenge to deliver greater productivity and a stable financial
position is not only to maintain the quality of services to patients, but to improve it.”
The Kings Fund, February 201323
.

Conclusion
The constant increase in patient numbers presenting to emergency departments has led to calls for urgent action to
help reduce the pressure on over-stretched departments. According to Health Minister Anna Soubry, attendances
have risen by a million in just the last year.22
It is evident through the case studies and the reports produced by Deloitte, as well as the NHS priorities identified
throughout this paper, that Emergency Patient Flow Manager is not only economically advantageous, it is also highly
powerful in reducing the pressures on A&E departments through freeing up staff time and reducing patient length of
stay.
Generating direct cost savings of over £1.3m per annum, alongside wider direct and indirect benefits, EPFM puts
intuitive and productive patient flow management at the heart of the emergency care environment, supporting front
line staff in day to day activities while improving the overall A&E experience.
Not only delivering productivity and financial benefits, EPFM helps to reduce length of stay and waiting times,
provides auditable data, and supports infection control standards and overall operational change; improving quality
for patients and staff.
With the Health Secretary’s aim of bringing the NHS paperless by 2018,24
digitising existing processes will be decisive
in the success of hospitals reaching this achievement. Through EPFM, emergency patient flows are managed
digitally, not only saving staff time in tracking down available beds, but also removing the need for paper processes
to be employed.
22
http://www.bbc.co.uk/news/health-22460741
23
http://www.kingsfund.org.uk/publications/how-health-and-social-care-system-performing-february-2013
24
http://www.ehi.co.uk/news/ehi/8315/hunt-wants-paperless-nhs-in-five-years

About Hospedia
Hospedia is the world’s leading provider of point of care systems in healthcare. Hospedia’s Patient Centred Care
Platform provides patient media, patient engagement and clinical workflow solutions that support hospitals, staff,
patients and visitors worldwide, through powerful software, hardware and integration capabilities. The Platform
delivers a range of services that make a real difference to patient care while providing clinical efficiencies and
substantial financial benefits.
If this white paper has been of interest, and you would like more information about how the solution can be
implemented to support your hospital priorities, please contact our team of experts. This paper summarises
the case studies produced by Deloitte; our team can provide the full cases and work with you to help build a
business case for individual circumstances, formulate an implementation plan that works around operational
requirements and assess how to tailor the service to your specific needs.
info@hospedia.com

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