Task Manager is a digital application developed at Middlemore Hospital to improve communication between nurses and resident medical officers (RMOs) after hours. It allows nurses to create tasks and have them viewed, prioritized and accepted by RMOs from any computer. This provides visibility of workload and streamlines communication compared to pagers. Since implementing Task Manager, pager volumes have decreased and end-user surveys found it easy to use and improved communication. The application was inspired by another DHB's system but redeveloped internally to better integrate within their systems and support ongoing customization.

1. Task Manager – an innovative approach to improving hospital communication after hours Dr. Mary Seddon Dr. David Hay

2. Task Manager: Aim Improve after hours communication between nurses and RMOs: - Mixture of text pagers and numeric pagers - RMOs unable to prioritize calls - Nurses unable to see RMO workload/response Decrease interruption from pagers: - Frequent pagers (bleeping up to once every 7 minutes) - Distraction a factor in errors Understand after hours workload.

3. Task Manager “ after hours” 1600 -0800 weeknights and all weekend Task Manager - an application that records after hours ward tasks, colour-codes them for urgency and allows tasks to be viewed, and accepted from any computer Accessed from Concerto (added security and utility) Inspired by the Hutt Valley DHB ‘SPADE’ (Simply Prioritise and Distribute Electronically) project

4. Colour – coded Sort by location NHI is a hyperlink to e-labs/radiology etc Early warning score Sort by service Nurses know that Dr. has accepted task Indicates comment Can accept and complete tasks from front page

6. Accepting and completing a task

7. Information on workload Most common tasks: 30% blood tests or inserting cannula Most tasks generic in nature (did not require specialist skills) Tasks completed by: 30% phlebotomists 30% medical house officers 30% surgical house officers Tasks very unevenly distributed

8. TM Reports: Who is doing what?

9. Information on workload

10. Results: Decreasing pager numbers

11. End-user acceptability: RMOs

12. TM: Acceptability “ Not constantly being interrupted. Task Manager - nurses are required to state what the job/concern is and then you can prioritise; paging - they often just leave an extension number to call back and then when you call the number, you often wait for them to find the person who paged and found what the job is - lot of time wasted.”

13. End-user acceptability: Nurses 89% thought that it was easy to use 68% thought that it had improved communication with doctors "We are now sure that our tasks will be acknowledged and actioned" "Don't have to sit near the phone and wait for the doctors or phlebotomists to respond"

14. Final Thoughts from clinical perspective Value in exposing the amount of work undertaken afterhours (~140/evening & night) Successful in decreasing page rage and improving communication Very little training required for end users If had time again, would not have had a label for “urgent” tasks (would have 3 gradations of routine)

15. The Architects perspective…

16. Key Scenarios Ward create a task for a service integration with PAS (Patient Administration System) Display all tasks - multiple sorting/filtering User (RMO) accept task Can display clinical data for that patient (via Concerto) When finished, task marked as completed Reporting functions Clinical hand over Administrative (‘pain points’, staff loading)

17. Architecture

18. Why didn’t you use Hutt’s application (SPADE)? Well, actually we did. The User Design is the hardest part, and Hutt did all of that We absolutely acknowledge that We re-developed the application because: Hutt DHB is not set up as a vendor (they were happy to give us the code) We wanted to be able to integrate into our environment We do have different requirements (more teams, services, locations, different workflows) We wanted to be able to extend and customize easily Application support is critical

19. Road Map Use by other clinical services on-going deployment Extended to Orderly (non-clinical) users (deployed last week) required new workflow model - dispatcher assigns a task rather than user accepting one more sophisticated reporting use throughout whole of Middlemore hospital on a 24/7 basis Part of ‘Middlemore Central’ an enterprise wide initiative to identify and better manage ‘vulnerable patients

20. Final Thoughts Great example of the Business and IS working together to achieve a goal Absolutely acknowledge the input and value of the Hutt solution Success is gratifying, but did expose some weaknesses in the support model (change management is critical!) Decision to develop it ourselves was the right one, as users continue to request enhancements and further integration with existing systems