2 page Case Study
Posted: 12/10/2012
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Barking, Havering and Redbridge University Hospitals NHS Trust Hospital Achieves #1 Rating Due to Improvements in Patient Safety and Staff Productivity

Core Benefits
Benefits of the e-Handover solution
Barking, Havering and Redbridge University Hospitals NHS Trust wanted to improve patient safety and productivity across the hospital teams. The Business-Critical SharePoint solution, Ascribe eHandover connects Microsoft® SharePoint® 2010 Enterprise with their line-of-business systems, improving efficiency, transparency, and reputation. Now they are using SharePoint for a lot more than just managing documents, they are managing patients and improving patient safety.

Business Needs

Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) provides care for two main hospitals in the United Kingdom with over 1,400 beds, serving a population of around 700,000 people. They have been facing challenges with clinical handover for years.

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* The eHandover solution is the first to identify and successfully manage the shift gap issue which results in significant communication failure and patient risk during nights and weekends. *

Dr Aklak Choudhury
Clinical Lead for Ambulatory Care
Barking, Havering and Redbridge University Hospitals NHS Trust

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In 2009, 850,000 incidents and 3,500 deaths were reported in the United Kingdom due to poor clinical handover*. Clinical handover is a term which describes the transfer of patients’ care between shifts and specialties. Guidance for handover typically recommend that:

• The patient’s new team should have immediate access to all necessary clinical information

• After hours, doctors should be aware of the patients under their care who are particularly unwell

• Doctors should have sufficient protected time for patient handover

• Each clinical action and annotation in patient notes should be traceable to the doctor concerned

• A patient’s resuscitation status must be stored sensitively, but also accessible immediately

• Doctors should know the outcome of their decisions

Very few organisations follow these guidelines, and even if protected time is given for handover, the meetings tend to be chaotic, unstructured and long. This typically means that handovers are combinations of verbal, personal, unstructured, unverifiable; therefore, interventions and actions are missed. Furthermore, many handovers span multiple shift gaps. Transfer of responsibility was not documented either. Teams and individuals were working in silos with no interaction between disciplines or medical specialities.

While patient safety is undoubtedly the main driver in the need for a Handover solution, many healthcare organisations are being fined for the discovery of patient sensitive information outside the trust (in the form of paper handover notes), and are also increasingly facing litigation when incidents have occurred. For the latter there is no secure audit trail of handover activities that have taken place for the patient.

While some EPR systems claim to have handover modules, they are cumbersome and inflexible and do not get used. The main patient administration IT system provided no such functionality that would facilitate handover. The trust had SharePoint in place but they were only using it for document management.

*Source: The National Reporting and Learning System for England & Wales

Solution

Dr Aklak Choudhury at BHRUT wanted to do something about this, so he designed a process that would provide a structure and facilitate some of the key elements of handover. With the support of Ascribe, a Business-Critical SharePoint partner they started mapping out their clinical workflow to facilitate the key elements of handover. The workflow was expanded across disciplines and specialities.

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* It provides the user with the functionality to complete their handover tasks safely, efficiently and without duplication. *

Dr Aklak Choudhury
Clinical Lead for Ambulatory Care
Barking, Havering and Redbridge University Hospitals NHS Trust

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They decided to implement a SharePoint based solution, called eHandover that connects SharePoint with their line-of-business (LOB) systems, including the emergency pathway system as well as their patient administration system. SharePoint provided the in-built security and scalability for the organization and crucially had an in-built audit trail and allowed secure permission level access to patient information.

The goal was to improve handover processes and patient safety across the organization and to fill as many gaps as possible that their backend systems did not cover. Since SharePoint and the LOB systems were already in place, they were able to get more value out of their existing systems and improve ROI without rip and replace.

Benefits

The Ascribe eHandover solution improves business-critical processes and provides a list of patients and their applicable locations (wards, beds and specialties) within the hospital. From these patient lists, clinicians are able to create handover records at any point during their shift. A handover list is therefore effectively built for each shift. In the first 14 months of its operation, 21,500 handover records were logged and actioned in the system by 332 separate clinicians, this was a remarkable testament to the success of the solution give that it was adopted organically.

The business-critical SharePoint solution, has driven four main areas of benefit:

Patient Safety, Security, and Satisfaction

With Ascribe eHandover, clinicians and staff all have the up-to-date patient information at their fingertips. The communication gap has been bridged between teams working on different shifts, with different IT systems, and on different locations. For the first time tasks can be set on a Friday and be allocated to be completed up to 4 days. These tasks still had an impressive completion rate of 98%. Sensitive patient information, such as the patient’s resuscitation status is now stored securely but can be accessed immediately by the authorized person when needed in case of emergency.

Improved Productivity Among Teams

The solution helped with more educated and collaborative decision-making, as several people can contribute to each handover decision real-time and in a collaborative manner. Now doctors are aware of the outcomes of their decisions. As part of the newly designed process, the handover list is projected on to the wall in each handover meeting, and the solution is updated with additional notes and guidance during the meeting. As well as discussion of the clinical case, other data items that were typically reviewed at the meeting included who and what grade of doctor will complete the handover tasks, setting the patient priority for review and discussion of the resuscitation. A wealth of clinical data is displayed in these lists in a user-friendly SharePoint handover board – presented and managed in a way that doctors and nurses understand. The list of handover activities is then used as a task list for the clinicians.The speed of the handover meeting fell from 45 minutes down to 20 minutes

Transparency and Audit Trail

Now activities are recorded and structured. There is a safe audit trail of handover activities in case of litigation. Each clinical action is traceable to the doctor concerned. Functionality such as, procedure pathways, nurse task allocation, and portfolio aggregation for junior doctors all contribute toward transparency and closing the communication gap among different teams. As all the patient lists were centralized on SharePoint, doctors were able to run their handover work completely electronically without the need to print out lists. This led to safer information governance for the hospital.

Improved Reputation

The Ascribe eHandover system led to better reputation internally and externally. The solution centres around improvements in patient safety. The hospital has experienced a falling patient mortality on weekends over the last two years. Secondly, based on an Ascribe eHandover implementation survey, the doctors showed greater than 35% point rises in satisfaction for production of handover lists, identification of sick patients in the hospital, and clarity of handover task status. In fact, the doctors in General Medicine ranked BHRUT as #1 out of 34 hospital trusts in London, versus the year before when BHRUT ranked in the lowest third. Finally, BHRUT has gained reputation in the industry as a beacon site for medical handover and is now working with Medical Education England to potentially set the processes as a “standard” for all health organisations in the UK. The solution has also won the EHI 2011 Award for “Best use of IT to promote patient safety” and the Microsoft Partner of the Year for Health awards.

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Solution Overview



Organization Size: 6000 employees

Organization Profile

Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) provides care for two main hospitals in the United Kingdom with over 1,400 beds, serving a population of around 700,000 people.


Third Party Software
Ascribe eHandover

Software and Services
Microsoft Sharepoint Server 2010 Enterprise CAL

Vertical Industries
Public Health & Social Services

Country/Region
United Kingdom

Business Need
  • Business Critical
  • Business Productivity
  • Sharepoint Business Critical

IT Issue
  • Document and Records Management
  • Regulatory Compliance and Controls

Languages
English

Partner(s)
Ascribe Ltd.

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