Group abc visits to ward and voice recognition quest day 11 07 2018
1. Introduction to ward and
clinical area visits
Dr Deblina Dasgupta, Medical Director designate
Anita Ghosh, Programme Manager
Dan Clifford, EPR Development Manager
2. Our patient stories: Bill
Aged 84 years old
Lives alone with family support from
daughter Debbie who lives in Hackney and
son who lives in Essex
TDS – Carers assist with personal care
Multiple chronic conditions:
Diabetes
Osteoporosis
Prostate Cancer
Has experienced recurrent short admissions
following falls and frailty
Transfer to ECU for return to baseline and
discharge to increased support e.g.
Integrated Independence Team,
reablement support or nursing Home (Mary
Seacole Nursing Home)
3. Our patient stories: Debbie
Aged 55 years old
Supports her father, Bill
Lives with her husband and helps
out with her grandchildren
Ex-smoker
Has COPD – managed in the
community by the ACERS team
BiPAP – managed at home/ in the
community setting
Admitted to Lamb ward (for 48
hours) with chest infection since
needs i.v. anti-biotics four times/day
7. Why change?
• Previous mean letter turnaround time of 17.7 days with
minimum turnaround time of 5+ days
• Letters not stored in our core EPR – difficult to find in our
document management system
• Letters not following Trust standard
• Paying large amounts of money for letters to be typed (in
many cases outsourced) which then needed to be
reviewed
• Part of a flow to incorporate electronic outcomes,
procedures, acute chronic problem recording in
Outpatients
8. What did we do?
• Full scoping and process-mapping of old
flows and ideal flows (cutting out the
unnecessary)
• Clinically led change to workflows
• Collaborative working between our CIS team,
clinicians and managers
9. How did we manage the
secretarial changes?
• Involved secretaries in the project from the
beginning
• Changed the job description with their
involvement
• Advertised other suitable roles across the
Trust from 1 year out
• Held all vacancies with bank and agency
• No redundancies
10. Where are we now?
• Now rolled out to all adult services using
our core electronic patient record (some in
the transition phase)
• Paediatrics and Neonates coming next
• Fertility, HANS, Sexual Health (not using
core system) will move over in the autumn
• Benefits for community services to be
scoped
11. What has happened - benefits?
• Letter turnaround time down to less than 2
days
• Only 600 out of 8,000 letters were not sent
out in first 24 hours
• 300+ clinicians and 40 secretaries using
new flow
• All outsourcing now stopped
• Increased coding in OPD
12. Financial Benefits?
• Secretariat to be reduced = 61.5 w.t.e plus 4
audio typists. Currently reduced to 44 w.t.e.
and no audio typists – aim is further reduction
to 40 w.t.e.
• All outsourcing stopped (cost of £160,000 pa)
• Contributing towards the reduction of medical
records prep – already reduced medical
records staffing by 8 with a further reduction
of 20 posts planned
• COST of licences approximately £120,000 pa
13. What does it mean for our
patients?
• Ali – son-in-law of Bill and Edna
• Seen in Outpatients - gastroenterology
• Copies of scope and report instantly
available in the patient record as are
previous appointment letters
• Ali diagnosed with Cancer
• Referrals to tertiary centre and
information sent to GP and other support
services within 24hours
• Patient letter sent with written information
either within 24 hours (or can be given
then and there in clinic)
Editor's Notes
Short presentation to :
Provide more detail about our 2 patient stories:- Bill and his daughter, Debbie
Show you some information on electronic systems – EPR, HIE and CMC
Previously we’ve used patient stories based on Bill and Edna – well known statues in a Hackney park.
You may have seen ‘Debbie’ = artwork on the Homerton site.
We are using Bill and Debbie as examples of our patients’ journeys.
Here is Bill – he lives on his own now that Edna has passed away:
We will follow his journey from Emergency Department – staff use HIE which can show them care at Royal London and his GP, they can use CMC to check the care plan developed in primary care, they can use EPR to see the care provided at previous admissions
In ECU – staff will use EPR to see the assessment made in ED and on ACU. Patients risk assessments are documented on EPR too e.g. falls assessment. Adult Community Nursing team take part in the MDT. Our IIT would provide support and the discharge summary would be sent electronically to Bill’s Hackney GP
Debbie is Bill’s daughter
Today we will follow Debbie in reverse - from Lamb ward to ED.
You will meet staff from the ACERS team who support Debbie to manage her COPD in the community.
BiPAP – Bilevel Positive Airway Pressure – non-invasive ventilation to support airway via face mask
Explain why patients come in to hospital for anti-biotics and how the ACERS team know that Debbie has been admitted.
On Lamb ward staff would be able to access EPR – to see assessments in ED and previous care at Homerton
In ED, staff can see HIE and also EPR
Hand over to Dan and Anita to log into systems
