The ‘e’ revolution that continues to sweep healthcare across the UK shows no sign of diminishing following the completion of the latest Working Time Directive 2009 pilot project.
Since October 2007, Imperial College Healthcare NHS Trust’s Acute Medicine Ward, based at Charing Cross Hospital, have trialled the Streamlined Ward Working programme. It aimed to improve patient care, safety and ward based clinical processes, whilst reducing the administrative burden on clinical staff.
The organisation used a number of high tech systems to run the programme, including VitalPAC data recording software. They also use iWard, a real time bed management system which populates an up to the minute electronic board (to replace the traditional ward whiteboard) and an electronic handover system. The latter is designed to be used by all members of the multidisciplinary team involved in a patient’s care. In addition this data is designed to follow a patient around the hospital to different departments.
The VitalPAC system uses a network of handheld PDAs and tablet PCs, as well as traditional desktop computers in other parts of the hospital to view patients’ observations remotely. The iWard software also allows for remote access to the ward information, giving hospital staff real time bed states and access to patients conditions for clinicians, helping them judge any need for intervention. iWard provides an integrated doctor/nurse handover, reduction in repetition and error, improved use of junior doctors and nurses time and improved quality of information between groups of staff on a particular ward and between wards. This in turn will help to eliminate potential errors when passing information to colleagues, either verbally or through individual interpretation.
Dr Graeme Wilson, consultant respiratory physician and clinical lead for the project said: “The iWard project allows the nursing staff to record observations that will assign each patient a modified early warning score (MEWS). This in turn will trigger a need for intervention if pre-set physiological limits are reached.”
The system is not intended to replace the traditional relationship between patients and doctors but to add an extra layer of care that allows the patient’s condition to be better monitored. It also has the potential to improve WTD compliance as it helps junior doctors to have a good standard of patient information when covering wards that are new to them. It also reduces the amount of time spent on entering patient information.
However, Dr Wilson advises that if other trusts consider implementing a similar system, they should make sure they use the right equipment, he said: “Getting the right PDAs and tablet PCs is very important as they are worked extremely hard, with very little rest time. We are already considering replacing the PDAs we used in the pilot as they have not performed to the standard we’d expected. The trust is implementing wireless network coverage throughout the hospital to facilitate the expansion of the pilot scheme to cover the whole hospital.”
Unlike some pilots, where there have been elements of resistance to the proposed changes from staff and the executive board, the project has been supported at all levels. Dr Wilson believes the key has been involving people in the programme from the beginning, he said: “We put on a variety of demonstrations to the frontline staff. These focused on the benefits of the scheme from both a clinical and administrative task perspective. We have also shown the project to senior members of the trust executive. We have received plenty of support from our IT staff, who have spent time on the wards to see the systems in action and talk to the junior medical staff and ward nursing staff to ensure that they get firsthand feedback.”
Whilst the pilot has officially ended, project staff have continued to develop the scheme and are now working on a business case for a full hospital roll out.
Dr Wilson said: “I’m sure the hospital would benefit from a full roll out, however it would be wrong to pretend there weren’t problems during the programme, but when they surfaced we dealt with them quickly.
“One of the most interesting things that happened during the pilot took place over a weekend when the network server went down. The nursing staff were forced to go back to the old methods of recording observations, and without exception, when asked, they all agreed that the new ways of working were much, much better.
“It is also worth noting that full trust rollout will provide additional benefits not realised in the pilot, in particular inter-ward and consultant information transfer and the tracking of patients via MEWS, especially beneficial for hospital at night and critical care outreach teams.
“Even allowing for the problems we faced, the best part is that the staff can see the benefits of what we’re trying to do and want it to work.”
Working Time Directive 2009 
