Using technology to meet the Working Time Directive

In our second issue of Calling Time we featured an article (Technology with the personal touch, Spring 2006) on the iBleep Rapid Response system in operation at James Cook University Hospital.

iBleep is a piece of software that enables staff to generate, accept and interact with calls generated from the wards, it utilises wireless technology on personal digital assistants (PDAs). Calling Time met with Dr Brendan McCarron, consultant in infectious disease and senior project manager at South Tees Hospitals NHS Trust to find out why the project, which won the HSJ ‘Improving care with e-technology’ award, will soon be freely available for use in your own trusts.

CT: Could you tell us a bit about iBleep?

BM: Absolutely, the system we use at James Cook utilises

e-technology to contact on call teams at night rather than the traditional inefficient and often frustrating paging system. If a ward requires medical help the ward staff enter demographic and clinical early warning score system (EWSS) data on the ward desk computer and send this information to the call coordinator (night sister).

The coordinator assesses the call and transfers it to an available doctor, competent to perform that task. The urgency of calls are weighted using a traffic light colour coding system with red calls (eg chest pain, neutropenic sepsis, GI bleed) being attended to immediately; amber coloured calls (acute confusion, abdominal pain etc) should be attended to within 30 minutes and less urgent calls (venepuncture, death certification etc) within one hour. A free text facility allows for further communication and the ability to request more specific help. The recording of EWSS data allows further prioritisation of calls.

When the call is passed to the appropriate medical staff, the information, patient’s demographics, ward and bed, and clinical data including EWSS recording will appear on their PDA. The doctor will record when on their way to a call, arrival at bedside and completion of every individual call by activating icons on the PDA. This data is stored and an audit trail created on every part of the call ‘journey’. It is also possible to calculate the number of specific incidents by ward, doctor, patient, response times and time to call completion.

The PDA, via the wireless network also allow access to reference information such as local derived protocols and text books such as BNF (British National Formulary), which complements cross cover of specialities.

CT: How does the system aid Working Time Directive 2009 compliance?

BM: Much of 2009 compliance will be achieved by directing medical staff into day time working, with improved training opportunities, as well as reducing hours. Our iBleep system collects activity data as part of service delivery. Therefore, we are aware of doctor activity, not only the number of calls, but also the nature and time to completion of calls. This data can be used to redefine the number of staff on call and to identify tasks, presently performed by doctors, but which could be performed by non medical personnel.

CT: How transferable is the system to organisations that may be split site?

BM: The system has been designed to cope with split sites and during the initial setup of the system, the number and names of sites can be entered.

CT: Skills for Health - Workforce Projects Team and South Tees Hospitals NHS Trust have formed a partnership - what will this partnership mean for other NHS organisations?

BM: The partnership with Skills for Health - Workforce Projects Team is to provide the iBleep system (Rapid Response) to the whole of the NHS in England as a completely free downloadable system.

Hospitals will still need to provide the infrastructure, ie the server to house the system, the wireless network, appropriate devices (wired and wireless). Hospitals will also be responsible for training users, managing the implementation of the system, the change management issues etc. However guides will be available, including all the training guides. Free telephone support will be available for the initial implementation and free email support will be offered for ongoing issues etc. This free support is available until 31st March 2008.

CT: What advice would you give to a Working Time Directive lead who wants to implement the system in their organisation? What do they need to consider and what steps should they take?

BM: It is important to have conversations between clinical leads and IT leads to ensure both are onboard with what is required.

Although this is an IT implementation that relies on new and some leading edge technology, as with most IT implementations, it is the people involved, the changes to processes and the acceptance of the system that needs to be carefully managed. If you already have a WTD or Hospital at Night project, invite an IT representative on to the group and include IT as a core agenda item. In terms of IT, talk to IT leads about the infrastructure already in place within the hospital. Does the hospital have the wireless network infrastructure; does every ward have access to a PC to raise calls? Is there a suitable server where the system can be housed? Training is also important as every ward needs to be trained to use the system to raise calls, all junior doctors need to be trained and the night sisters who coordinate the team need to be trained. Consider how training is delivered, will there be classroom training, drop in sessions, or will users be trained at their work place? Is there enough training resource to handle initial training and ongoing training particularly at each junior doctor intake?

The system is due to be available in April 2007. There is work that can be done in the meantime preparing the IT and the organisation. Consider presentations, road shows and posters.

CT: Were there any other messages that you would like to put across to Calling Time readers?

BM: 2009 is getting closer and as organisations we all have to look at our working practices. It is important that we all share our innovative ideas to improve patient care and improve training opportunities for staff. Data collection on our present ways of working helps identify area in need of change, even though the change seems obvious to some, data convinces!

For further information or to register your interest in implementing iBleep contact Dan Hughes, portfolio project manager at Skills for Health - Workforce Projects Team at dan.hughes@skillsforhealth.org.uk