Sandwell and West Birmingham hospitals NHS trust: technology innovation award runner-up

Dr Matthew Lewis (far right) takes part in an electronic board round with his team.

Sandwell and West Birmingham hospitals NHS trust's established electronic bed management system (eBMS), which runs across its three acute hospitals, was expanded to help reduce bed-blocking and improve the quality of patient care.

The system can track a patient from admission to an acute medical unit until they are discharged to go home and keeps a log of the care they receive along the way.

Dr Matthew Lewis is the trust's group director for medicine and emergency care and a consultant in gastroenterology. He says: "At an individual patient level it's a single tool which enables us to co-ordinate the care we provide in different teams both inside and outside the hospital."

The eBMS, says Lewis, has become "the centrepiece of an electronic board round", where every day a ward's multi-disciplinary team will refer to the system to discuss a patient's progress and his or her readiness to go home.

The eBMS has other benefits too. "On a different level, it is also used as a way for us to look at the [bed] capacity issue. It means at any one time we can see whether we are on track or not," he says.

The eBMS has real-time operational dashboards, which track variations in patient flow, showing any reduction in length of stay, bed turnover intervals and delayed discharge. "The dashboards allow key staff to monitor at ward level any specific area of patient care during the inpatient stay which will cause a queue," says Lewis.

eBMS also includes 44 manual flags that can be applied to highlight a clinical patient alert and another 37 clinical alert flags are automatically triggered via electronic messaging from the hospital's other IT systems. These alerts are passed on to doctors via text, email, dashboard or bleep.

Lewis adds: "The combined functionality of patient-flow tracking, coupled with the many alerts and flags, enables the clinicians to have up-to-date information in real time to enable them to make informed clinical decisions quickly, that not only saves lives but improves the overall experience of patients during their inpatient stay."

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Portsmouth hospitals NHS trust: hospital admissions award runner-up

An initiative by the diabetes inpatient team has cut hypoglycaemic episode admissions by nearly 20%. Photograph: Portsmouth hospitals NHS trust

A hospital has seen a 33% drop in the number of diabetes patients calling 999 or turning up at A&E following a hypoglycaemic episode, while admissions fell by nearly 20% following an initiative that helps patients manage their care better and educates GPs about best practice.

The diabetes inpatient team at Portsmouth hospitals NHS trust wanted to tackle the recurring number of diabetes patients being admitted to hospital following a hypoglycaemic event.

It decided that a diabetes consultant and specialist nurse would visit every GP practice in the district twice a year to discuss diabetes management and spread best practice. Educational events were also held at local nursing and residential homes to help improve diabetes management.

A new telephone hotline was set up with South Central Ambulance Service for paramedics to call the hospital inpatient team if they had treated a hypoglycaemic patient. That patient would then be contacted by the team within 24 hours.

Any diabetic patient admitted to hospital following a hypoglycaemic event was given advice about managing their care to prevent another attack.

After the project was launched, the number of hypoglycaemic people arriving at A&E or being seen by a paramedic between November 2011 and November 2012 was 83 – a drop of 33% compared to the previous 12 months. During the same period the number of hospital admissions fell by nearly 20% from 85 to 63.

Dr Partha Kar, the trust's diabetes clinical director, says: "As far as we are aware our pathway is the first to show discernible benefits of hypoglycaemic admissions thereby showcasing how a simple innovative approach can help patient care. The pathway can achieve little unless dovetailed with educational support for primary care which has formed the crux of the local model of diabetes care."

The initiative is part of the trust's Super Six Diabetes model of care designed to move more care away from hospital into the community.

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National blood service, Oxford University hospitals NHS trust: technology innovation award runner-up

Oxford University hospitals NHS trust uses handheld computers at the bedside to scan the identity barcode on a patient's wrist band.

Introducing an identity barcode on a patient's wrist band, using handheld computers at the bedside, electronically controlling the temperature of blood fridges and tracking stock have improved patient safety Oxford University hospitals NHS trust's national blood trust and saved £528,000.

The trust wanted to reorganise its bedside and laboratory transfusion service in order to reduce the number of deaths from "wrong transfusion" – the second most frequent cause of death from transfusion reported to the UK's serious hazards transfusions scheme. In the past 15 years, errors in the UK transfusion service were responsible for 27 deaths and 120 cases of major morbidity.

Oxford hoped that by using technology it would also reduce the amount of time staff spent checking blood, reduce blood wastage and the inappropriate use of supplies, as well as speed up the supply of blood in emergencies.

Consultant haematologist professor Michael Murphy says: "For many members of the public or patients to think a process that is so important is relying on bits of paper and people looking at long numbers, is just unbelievable."

Today transfusion patients are identified by a barcode on their wrist band, which is scanned by a nurse at the bedside using a handheld computer. The nurse also scans his or her own barcode before following the transfusion process written on the computer screen.

There is now a complete electronic audit trail of blood supplies after the blood bank IT system was linked to others in the trust, which has led to significant improvements in blood sample collection, the collection of supplies from fridges and the transfusion-related admin.

Paperwork has been cut by 52 minutes per patient and the bedside transfusion process now requires one nurse instead of two. The initiative is recognised as an exemplar NHS evidence, quality, innovation, prevention and productivity project. The Oxford team wrote a national specification for the electronic transfusion service for the former National Patient Safety Agency.

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Primary care can ease pressure on hospitals

Primary care should be recognised as critical to finding a solution, rather than part of the problem, say James Kingsland and Graham Roberts. Photograph: Getty

Inadequate staffing levels and limited provision during the weekend are thought to have led to a rise in mortality rates in hospitals across the country. As a result, we need to refocus on the role that primary care can play in relieving the pressure on secondary care. It may be over-simplifying, but improved access to GP and other services in the community will reduce the burden on hospitals, particularly if there is an increased focus on preventative care. Primary care should be recognised as critical to rectifying this situation as opposed to being part of the problem.

We are seeing an ever-increasing demand on public services, with an expectation for immediate access to everything from our bank balance to consumer goods and not least to healthcare. Waiting lists and pre-booking appointments do not fit well with improving response times and rapid access. Too many people now prefer to seek help for a range of non-urgent health needs from an accident and emergency (A&E) department. While they can at least guarantee that they will be seen on the day, they can wait for up to four hours (or more, when the national waiting time target is breached) for what may not be the right care.

This means that the distinction between serious illnesses requiring urgent attention and those that would be better scheduled through an appointment system are blurred, and hospital staff are put under a greater strain than is necessary.

Many blame this "crisis" on poor access to general practice and the consequences of the 2004 GP contract, which saw most GPs opt out of out-of-hours care. However, this only identifies one small part of the bigger picture of increasing demand but poorer management of this, demographic changes, societal expectation and technological advances (to name but a few). Since 2004 there has been an eight-fold increase in out-of-hours activity in some areas, which suggests that there are other issues that need to be addressed aside from an alteration in working hours.

A significant problem is that many GPs do not have the facilities to enable them to increase provision and extend care facilities. Too many practices are still based in cramped converted dwellings, and while often in residential areas this actually adds to the restriction on the extension of services.

Expanding and equipping our GP surgeries to provide services that may have traditionally rested within hospitals is a major step in solving the current plight of the NHS. Integrated primary, community and social care centres with room for third-sector services and which also house diagnostic facilities and minor surgery suites, that serve a registered population, must be the future of primary care if we are to continue to enjoy an NHS free at the point of delivery. International evidence consistently demonstrates that a strong, well-resourced system of primary care reduces the risk of hospitalisation. The good news is that this vision already exists, but still reflects a minority of general practices.

The NHS, now 65 years old, is continuing to develop and grow. We would be naïve not to build on the best of what we have already. The less well-informed response to the healthcare crisis is to create alternative, poorly evaluated services. This is not the answer, as was the case with the walk-in centres and NHS 111, which have risked fragmenting precious available resources and often provide questionable value for money.

Ultimately, in order to increase efficiency in the NHS and meet the public's top priorities of waiting and access, GPs need to be resourced and equipped to do more. They also need to build teams to perform and complete more episodes of care in their primary care setting in modern, purpose-built 21st-century facilities. It is extremely difficult to change the expectations of the general population, but what we can do is ensure that healthcare practitioners are working in the right environment to respond to the demands effectively.

Dr James Kingsland is national clinical lead for NHS clinical commissioning and Graham Roberts is chief executive of Assura Group

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Home improvement for those with poor health saves hospitals money

Adapting the homes of wheelchair users saved a London borough £30,000 per client. Photograph: Janine Wiedel Photolibrary / Ala/Alamy

Countless reports have called for greater collaborative working between the housing sector and health care providers, specifically with the view of creating lasting homes where care and support can be given to help those with poor health, as well as those recovering from long-term illnesses.

Looking at the connection between health and housing is a logical starting point, but how does it work in practice?

Part of my frontline role for a home improvement agency in the east of England is to promote the services we provide. We target GPs and hospitals, as our services could benefit their patients – specifically those who can not be discharged from hospital due to their housing conditions – but getting a foot in the door is often the biggest obstacle.

I have arranged meetings with surgery managers to discuss how we can work in partnership but arrive to find they are too busy to see me. However, when I chat with others about the services we provide, they can see how the work we docan prevent hospital admission. The housing sector needs to get to those involved in the decision making.

Perhaps the biggest barrier to overcome is funding. Last year, the Department of Health allocated an additional £20m for disabled facility grant funding, the finance mechanism for disability aids and adaptations. Typically, local authorities would have to pay for 40% of the grant but this has now changed and councils are no longer required to top up or match government funding.

Adaptations effectively pay for themselves while taking pressure off our already stretched health service. A report published last year by the London School of Economics highlighted an example of one London borough that had two wheelchair users in residential care due to the condition of their homes. Adapting the properties and making them fit for purpose saved £30,000 per client. Another local authority reported reductions in care costs of almost £2m over a five-year period as a direct result of investing £110,000 in 20 shower adaptations. These cost savings could be replicated by a consistent, collaborative working approach.

We do have a positive working relationship with Norwich city council and the Suffolk district councils who understand what we are trying to achieve. The councils recognise the link between housing and health and boast impressive turnaround times for their adaptations. The average wait in Norwich for an adaptation is between four and six months, compared to up to three years in some parts of the country. It is this forward thinking that we need to make a positive impact on what we and the health services provide.

Alan Sharman is casework team leader at Orbit Care and Repair

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