Implementation of iBleep within HaN Royal Bournemouth and Christchurch NHS Trust
The benefits of iBleep were showcased by Royal Bournemouth and Christchurch NHS Trust during their workshop at the Hospital at Night conference.
Judy Blake and Troy Welch discussed how the system has been introduced as part of their trust’s Hospital at Night programme.
The trust decided to implement iBleep as a way of improving Hospital at Night in the organisation, that would also help filter and prioritise calls to on call staff, provide a better measure of workload and provide a timely response to patient needs.
They faced some difficulties along the way, including problems with the speed of the PDAs used to deliver the system degrading over time, requiring them to be reformatted and return them to their original condition. Other issues included the engagement of staff and training.
Despite this, the benefits of using iBleep have meant the resource is now used trust-wide at night, with staff reviewing options of extending this to daytime use also.
Troy said: “As one of the first sites to implement iBleep it was difficult to get feedback and find out how others were using it, but we were determined to implement the system to improve patient safety. It’s important to ensure you have a strong steering group in place to guide you through, as well as IT support.”
Infoflex - Hospital at Day South Devon Healthcare NHS Foundation Trust
South Devon NHS Trust are using a tailor made solution to implement their Hospital at Night/Hospital at Day programme.
As an alternative to iBleep, Infoflex is a bespoke system designed to meet the specific needs of clients. It is capable of handling the modelling of information and workflow processes across departments and organisations.
Adel Jones, head of workforce and OD at the trust said they required a system that could collect task information electronically, is accessible throughout the hospital, can manage beds and improve teamworking among other specific requirements.
South Devon’s Infoflex system was developed to meet these bespoke requirements and replace their Medical Data Index systems, helping to move information closer to the point of care. Adel said: “We chose not to use PDAs as we don’t have wireless networking throughout the hospital, plus we found they aren’t easy to use. We decided to use Infoflex over set computer terminals across the hospital as we found clinicians tend to drift to their front desk.”
The Infoflex system is updated with tasks daily between 5pm and 9am, which are then checked off as they are completed by healthcare staff. All of this is monitored by a programme coordinator, which helps with task management. The system also generates an electronic care planning summary for each patient who leaves the trust, which in turn emails both their GP and consultant.
Adel said: “We previously had no audit information. A big benefit of Infoflex is that it helps us understand exactly what our requirements are to helping us plan for the future. It’s helped us create a better handover system, as well as linking into our pharmacy.
“The next steps include getting our accident and emergency unit linked in.”
Rural HaN Welsh Assembly Government
The specialist challenge of applying Hospital at Night to a predominantly rural setting has been a task led by the Welsh Assembly Government (WAG).
Wales’ population of just over 3 million people is served by 10 recently reorganised NHS trusts, the majority of which are classed as ‘rural’ (having fewer than 150 people per square km).
Wales’ unique geography, with a natural north/south divide created by the Cambrian Mountain range means the main populations are split between the main industrial areas around the north east and south.
Consequently for the Welsh Assembly Government’s Hospital at Night team, encouraging implementation across the country’s healthcare sites presents unique challenges at each location.
Linda Ware, EWTD and New Deal project manager for WAG, together with her colleague Delyth Jones, Hospital at Night project manager, said they faced a challenge of providing services that are acceptable to each individual trust area.
They said that the majority of trusts across Wales were progressing with Hospital at Night which has supported a 49% EWTD compliance, but this was set to grow as different trusts were at different stages of their implementation, whilst some were still to begin.
Delyth said: “To apply Hospital at Night rurally and indeed any setting, it is important to fully understand the clinical workload. It is also vital that support is obtained from your executive team, as very often junior project managers struggle to implement Hospital at Night without the support of senior management, in particular, a designated clinical lead. On top of this you must always consider both Working Time Directive and New Deal.”
The Welsh Assembly Government team will continue to search for further solutions for Hospital at Night implementation and share good practice and ideas.
IT HaN solution
highlights clinical champions
Salisbury NHS Foundation Trust
From a position of informal and uncoordinated handovers with the associated risks of failing to pass on vital information and no audit trails, the Salisbury NHS Foundation Trust has moved to a positive position of a formalised framework for handover.
This has come about through trust board leadership, clinical champions, structured induction with an educational DVD, a Hospital at Night handbook and new referral escalation procedures to guide doctors working at night.
These developments have been financially supported by Workforce Projects Team alongside an in-house HaN IT application previously developed and continually improved to meet the needs of many different specialties within an acute hospital.
Medical director, Alistair Flowerdew stated: “We have achieved near trust wide implementation of the system with increasing multiprofessional sharing of information and we now aspire to develop a clinical risk tool for every patient.”
“We have learnt from the project,” said Debbie Dupont, project manager HaN IT Solution. “We’ve seen an overwhelming improvement in handover and an overarching trust handover policy will underpin all departments’ handover processes. The input by the users and drive from the clinical champions at all levels have provided a dynamic project team with a highly rewarding experience coupled with improved safety for patients at night. We now look to phase two. There is a wealth of opportunity for continuing development.”
Taking Hospital at Night forward
Two hospitals which have successfully implemented Hospital at Night are now extending the methodology to 24:7 working.
Homerton
The need for cooperation and crossworking in teams to achieve improved patient care was highlighted by Dr John Coakley, medical director, Homerton Hospital NHS Trust. The Homerton Hospital reached compliance with the 48 hour limit as of August 2007, bringing them well within the WTD 2009 objectives. The hospital was a Workforce Projects Team WTD pilot site in 2007 and a Hospital at Night pilot site in 2004. The compliance was achieved through implementing the HaN method and taking it further to 24:7.
On cross working/multitasking Dr Coakley said: “Hospital doctors who are resident should all at least have the generic skills required to treat hospital inpatients. They can do more specialised things as well but they should not be able to say ‘this is my specialty and that’s all I can do’.”
He suggested that 60% of people in hospital are waiting for something, such as test results, prescriptions, and they don’t need to be in hospital. “It’s about reducing inefficiencies and making sure emergency work gets done properly.”
South Devon
South Devon Healthcare NHS Foundation Trust is a rural trust which has focussed on a health community approach and making ‘the right thing to do the easiest thing to do’. Dr John Lowes, director of education for the Trust endorsed the benefits of IT in capturing data around ward activity thus enabling the trust ‘to put the workforce where the work is currently, not where it was historically.’ The Trust has been using Infoflex to capture activity during the night at first and now during the day.
The Trust wanted to reduce delays and improve efficiency through the implementation of HaN.
Two of the key activities which were implemented were standardising ward management across the hospital and having only one front door - generic assessment model, assessed by one clerking procedure. The standardisation of Warfarin dosing has led to a dramatic decrease in adverse events.
The Trust has achieved reduced length of stay through working with the PCT to use a health community strategy as well as a reduction in healthcare acquired infections.
Consultant job plans were rearranged, including increased consultant input at weekends. There has also been greater use of technology for patient care with electronic care summaries and mobile phones for consultant contact out of hours.
There are, of course, costs involved in getting senior staff to work out of hours and at weekends but South Devon have one of the shortest length of stay in the country.
Leadership
General issues with training doctors for leadership and management were discussed by Dr Patricia Hamilton, chair, Royal College of Paediatrics and Child Health.
She highlighted the added pressure of working at night, in the context of HaN leadership. She discussed the poor incentives for clinicians to become leaders and the longstanding stigma attached to leadership positions by clinical staff. She said that it takes a particular type of person to put themselves forward for these roles.
The need for work based learning for management and leadership skills to encourage team working was emphasised and the Academy of Medical Royal Colleges has developed a leadership competency framework to be incorporated into training and revalidation for all doctors.
Dr Hamilton said: “It’s wrong to think you either have leadership skills or you don’t.
If you have leadership qualities you still require training in leadership.” www.healthcareworkforce.nhs.uk/hanconference2008.
Working Time Directive 2009 
