Professor Janice Sigsworth, Chief Nurse, Imperial University Hospital Gerry Bolger, Chief Clinical Information Officer, Imperial University Hospital

1. Humanising care in a digital
world
Professor Janice Sigsworth
Chief Nurse
Gerry Bolger RN, MHM
Nursing Informatics Lead/CCIO
20th April 2014 – eHealth Nursing Plenary

2. Creative Commons Licence

3. Agenda
• About Imperial
• Why the digital agenda is important to nursing
• Changing landscape of IT
• What this means practice of care
• Role of CCIO-Nursing
• Safer Care project
• Making tech the enabler in the therapeutic relationship

5. St Mary’s Hospital, founded 1845
St Mary’s Hospital is a major acute teaching hospital that diagnoses and treats a broad range of adult
and child conditions. The hospital also provides maternity services and hosts one of the four major
trauma centres in London.
Hammersmith Hospital, founded 1902
Hammersmith is a specialist teaching hospital and hosts the heart attack and arrhythmia centre for
north west London. It is well known for its research achievements; hosting a large community of
Imperial College London researchers.
Charing Cross Hospital, founded 1818
Charing Cross is an acute teaching hospital providing a range of adult clinical services. It hosts one of
eight hyper acute stroke units in London.
Queen Charlotte’s & Chelsea Hospital, founded 1739
Queen Charlotte’s & Chelsea Hospital provides maternity and women’s and neonatal services. It cares
for women with high risk pregnancies through to those choosing midwife-led deliveries in the birth
centre.
Western Eye Hospital, Marylebone, founded 1856
Western Eye Hospital is a specialist ophthalmology hospital. It offers the only 24-hour emergency eye
care service in west London.
Our hospitals and their services

6. Why IT is important to nursing
• Releasing time to care
– Audits / gathering data
• Improving the patient
experience
• Decision support
• Improves nurse/care team
experience
– Access to the same information
• Assurance across the
continuum of care
Source: Dan Piaro
http://www.icecreamnation.org/wp-content/uploads/2012/05/hunter-gatherer-cartoon-by-Bizarro.gif

7. E-health policy perspective
System
Information
Data for
Transparent
Performance
Quality of care
transparent
Standards for
'meaningful use'
Digital
Enablers
Electronic Patient
Records (EPR)
Trust & Value
eRostering / EPR /
ePrescribing &
information
Impact to
Professionals
Interoperable
paperless records
Access to info &
knowledge &
CCIOs
e-catalogue &
costing to deliver
care
Benefit to
Patients
Patient access
EPR, use of Apps
& make
appointments
Enabled choices
EPR &
ePrescribing
Five Year
Forward
View
Personal
Health &
Care 2020
Carter
Review
Gerry Bolger

8. Changing digital landscape
Moving From Moving To
Reactive Care Proactive health
Perceived difficult patient Empowered user
Recipients of care Co-producers of own care
Problem focus Solution orientated
Limited data Evidence with Information
Opaque overview Transparent reality

9. What this means - Challenges
• Change to practice
• Need for standardised
working approaches
• Workforce
– Transition challenges
• IT enabled / informed
patients
• Impact of technology in
the therapeutic
relationship

10. Digital direction

11. Role of Nurse CCIO
Strategic
analysis
Transformation
Patients &
Practice
Information
for
assurance
Personal Health &
Care 2020 set this
as a
recommendation

12. Why the - Safer Care Project
Identify
patients at risk
Rapid
intervention
Release time
to care

13. How?
Bid to the Nurse Technology Fund
• Bedside monitoring
• Supported by Dashboard for Patients at Risk
• Releasing time to care
• Introduce Sepsis alerting FY 2016/17

14. How we did it
• Led by Nurse Directors
identified pilot & rollout
areas
• 70 Bedside spot monitors
for general wards areas
• Integrating existing bedside
monitors for ED / Recovery /
High Dependency areas
(150 devices)
• Pilot in Nov
• Rollout end of Jan
• 50% complete end of March

15. What we learnt
Baseline
• Completing NEWS on
paper 2.5 – 3.5 mins / a
patient
• Manually record on EPR
took 20 seconds longer
Since starting to implement
• 209,750 data points
entered
• 8179 sets of NEWS scores
• Reduction 1:10 sec in
recording time
• Releasing time to care =
167 nursing hours
• NEWS visible on
Handover screen

16. Breakdown of NEWS
•
37%
27%
19%
9%
4%2%1%0%1%
% of NEWS Observation
0 1 2 3 4 5 6 7 8+
94%
4% 2%
NEWS Score by Risk
Low score 1-4 Medium score 5 & 6 High score 7+

17. 0
500
1000
1500
2000
2500
3000
3500
0 1 2 3 4 5 6 7 8+
Number of NEWS observations

18. Feedback from staff

19. What next
• Finish rollout
– Integration devices
– End user feedback – what could be improved.
• Analysis of SBAR
• Introduce Sepsis Alerting & Management

20. Making tech the enabler
• Bedside care
documentation
• Nursing routine care build
into software
• Involve the patient – it’s
their clinical information
• Team boards/handover
• Use graphs – especially to
show improvements
• Make the use of IT in care a
positive impression

21. I*LEVELS model
I* – Introduce
yourself / patient
sees you
L – Let the patient
look & involve
them
E – Eye contact
with patient
V – value the
contribution of the
computer
E – Explain what
you are doing
L – log off
Source - Kaiser Permanente
& *Virginia Mason