WaitLess - An App for Minor Emergencies (#2837)

Creation
Draft
Closed
Idea Description
Overview of Innovation:
WaitLess is a free to download App which allows people with minor injuries to select the location which will get them access the quickest treatment facility. It combines live feeds from A&E departments and all types of Urgent Treatment Centres showing the number of people waiting and waiting time in the department. The App combines this with travel time to the location and expresses both wait and travel as a single figure. It draws on live feeds from A&E departments and all types of Urgent Treatment Centres
It has reduced attendances at A&E departments in the pilot area by 5% and transferred 11% of minor injury attendances to MIUs, which typically have significantly shorter waiting times.
Waitless was designed as part of the Vanguard New Care Model and adopted by the National Inovation Accelerator programme for 2018 as best practice nationally.
Most A&E attendances are from self-presenting patients, attending A&E with conditions that are associated with minor injuries, ailments and minor emergencies which can be seen in other departments like the Minor Injuries Unit or the Urgent Care Centre. Various studies, undertaken both locally and nationally recognise that many patients could be treated more quickly closer to home.
It is designed by patients, for patients. It removes facilities that are closed, or that will be closed before you can reach them.
Since its launch in east Kent, Transforming Systems have tracked a significant reduction in minor A&E activity. Our observations have been confirmed as statistically significant by the University of Greenwich and the Behavioural Insights Team.
Benefits
Reduction in “A&E minors” attendances by 11% against an end of year target of 5%. On days where there is significant pressure on majors, it is common for waiting times in minors to increase. As waiting times increase in one facility, patients choose other locations with lower waits. This spreads activity more proportionately across the system, giving pressured A&Es much needed time to recover. Studies show patients commit quickly in an emergency to a venue of care. Providing information that is easy for patients to access and understand at the point of decision enables them to make an informed decision about the best place to access care. In most cases, patients access care closer to home with lower waiting times.
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Overview of Innovation:


WaitLess is a free to download App which allows  people with minor injuries to select the location which will get them access the quickest treatment facility. It combines live feeds from A&E departments and all types of Urgent Treatment Centres showing the number of people waiting and waiting time in the department. The App combines this with travel time to the location and expresses both wait and travel as a single figure. It draws on live feeds from A&E departments and all types of Urgent Treatment Centres
It has reduced attendances at A&E departments in the pilot area by 5% and transferred 11% of minor injury attendances to MIUs, which typically have significantly shorter waiting times.
Waitless was designed as part of the Vanguard New Care Model and adopted by the National Inovation Accelerator programme for 2018 as best practice nationally.
Most A&E attendances are from self-presenting patients, attending A&E with conditions that are associated with minor injuries, ailments and minor emergencies which can be seen in other departments like the Minor Injuries Unit or the Urgent Care Centre. Various studies, undertaken both locally and nationally recognise that many patients could be treated more quickly closer to home.
It is designed by patients, for patients. It removes facilities that are closed, or that will be closed before you can reach them.
Since its launch in east Kent, Transforming Systems have tracked a significant reduction in minor A&E activity. Our observations have been confirmed as statistically significant by the University of Greenwich and the Behavioural Insights Team.
 Benefits
Reduction in “A&E minors” attendances by 11% against an end of year target of 5%. On days where there is significant pressure on majors, it is common for waiting times in minors to increase. As waiting times increase in one facility, patients choose other locations with lower waits. This spreads activity more proportionately across the system, giving pressured A&Es much needed time to recover. Studies show patients commit quickly in an emergency to a venue of care. Providing information that is easy for patients to access and understand at the point of decision enables them to make an informed decision about the best place to access care. In most cases, patients access care closer to home with lower waiting times.
Initial Review Rating
3.50 (1 ratings)
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Innovation 'Elevator Pitch':
WaitLess is an app for patients, combining A&E & MIU real-time waiting times, numbers waiting, traffic & routing helping patients make better decisions about where to go for minor emergencies. In east Kent, it reduced minor A&E attenders by 11%.
Overview of Innovation:
WaitLess is an innovative new app for patients. This reduces A&E attendances during busiy times by showing patients the quickest place to be seen, simply. It proves patients can be treated faster and closer to home by highlighting alternative services, driving activity away from busy A&Es. It's free for patients to download and was designed by patients for patients, funded by CCGs and STPs. Our charging model is 25,000 per CCG, or 3p per person based on population.

It's priced delibarately low to make WaitLess accessable to all, and can be deployed in less than two weeks. WaitLess was independently evaluated by the University of Greenwich and the Behavioural Insights Team and found to achieve an 11% reduction in minor attendances. 

Various studies undertaken since 2009 have found A&E attendance reduction schemes to be difficult to achieve. This is thought to be due to a number of factors incuding that patients find urgent care pathways confusing and hard to navigate. Various studies have identified that patients make a relatively quick decision about where to access treatment minor injuries. Once patients have arrived in A&E, evidence shows that they are committed to waiting to be seen and often reluctant to move. WaitLess applies an effective three second nudge to patients, by showing the quickest place to go and using real time routing options to help avoid traffic and overcrowding busy units during peak times. 

A reiew undertaken by encompass MCP found the following observations, which were confirmed as statistically significiant by the behavioural insights team and the University of Greenwich:
  1. Improved patient experience as patients are signposted to units with the lowest wiaiting times
  2. Reduction in A&E minors attendances by 11%
  3. An overall reduction of 5% in attendances across A&E and minors as more patients choose primary care.
  4. Quick and responsive, nudging patientstowards facilities with lowest waiting times.
  5. Takes pressure away from A&E and flattens activity
  6. Quick to deploy
Business cases for WaitLess are currently being considered across a broad range of regions, inclduing the South West, Greater Manchester, Yorkshire and the Humber, Surrey and Sussex. Given the benefits to the NHS, we are seeking to significantly accelerate this rollout across the NHS and to explore alternative uses for WaitLess (such as Primary Care). As a proven autonomous decision aid, WaitLess is a key pillar to any urgent care strategy.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Wealth creation / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
WaitLess has been independently evaluated by the University of Greenwich and the Behavioural Insights Team and found to deliver reduced activity, waiting times and save money for the NHS. The headline benefits are:
  1. Reduced minor injury attendance profile across the whole health economy. The total number ofcases (including A&E and MIU) shows a significant decrease (5% less, p=0.024).
  2. The total number of A&E cases shows a significant decrease (11% decrease, p<0.001).
  3. The proportion of cases (MIU out of (MIU+A&E) shows a significant decrease (the effect size varies by day of the week, but is approximately 3-4%, p<0.001)
  4. Reduction in A&E minors attendances by 11% within six months against an end of year target of 5%.
On days where there is significiant pressure on majors, it is  common for waiting times in minors to increase. As waiting times increase in one facility, patients choose alternative locations where waiting times are improved.  This has the net effect of spreading activity across A&E and UTC settings much more effectively.

As patients choose A&E because they are unaware of level 3 & 4  A&E units (UTC), nationally Hospitals are facing an increase of circa 5% year on year in A&E attendances. Peak attendances are predictable, occuring in the early evening and at weekends. WaitLess acts as an autonomous patient decision aid, helping to reduce pressure without impacting on surrounding UTCs. In addition to the benefits to patients, operational and performance benefits, WaitLess also saves money for Commissioners.

It is common for Urgent Care Centres to have much ower waiting times than A&E departments. By using real time data, WaitLess influences patients to choose the facility that willsee them fastest, giving improved overallexperiencefor patients and encouraging more competition among providers of urgent treatment services.

With many UTCs commissioned on block arrangements, overheads are already paid for. In these scenarios, each A&E attendance saved is equivalent to 85.00 per episode saved. Where UTCs are commissioned on PbR, the standard tariff is 65.00 per episode. in thesecases, WaitLess saves 20.00 per episode. The PbR savings alone equate to 100,000.00 per CCG. 
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
Activity analysis has highlighted over the years that A&E is seen as a  trust brand by patients. Commissioning of alternative facilities with different names, such as MIU / UTC / Minor Injury Cinic / MIIU has created a significant confusion among patients about which services are  available and what they offer. A number of self help apps have been developed to support patients, however these have nationally had a limited impact on emergency attendances to A&E. Since 2004, the UK has seen A&E attendances grow by 5% year on year. A&E Departments are now widely reported to suffer from overcrowding, leading to sub-optimal conditions both for clinicians and patients. The majority of A&E attendances are from patients who choose to self present to Hospital, most with Ambulatory and more minor conditions. As an ex Urgent Care Commisisoner and General Manager for A&E and Acute Medicine, I knew prior to the build of an app that patients make a quick decision about where to access urgent care services, which was recognised by the behavioural insights team in 2015. In many other parts of healthcare planning, autonomous patient decision aids have been found to be highly effective in terms of both influencing behaviour and flattening demand. This can be seen in the NHS rightcare guides. WaitLess provides this for Urgent Care services. It helps the local population in the following ways:
  1. Encouraging people to access care services closer to home
  2. Reducing avoidable A&E attendances
  3. Improving the patient experience
  4. Empowering patients to mae a better decision about where to go to be seen
  5. Reducing pressure on overstretched A&E departments
  6. Savng money for the local health economy to re-invest in pathway changes that are sorely needed to improve urgent care flow.
Current and planned activity: 
We are currently enagaged in discussions around WaitLess with Nene and Corby CCGs, Yorkshire and the Humber and Greater Manachester. As part of the National Innovation Accelerator, we have ensured WaitLess is built on a platform that is simply scaled. Patient feedback has highlighted a need to provide WaitLess at scaleas patients commute for work and leisure and come to rely on the information. Our diffusion plan is outlined in a 12 week programme per CCG which can run in parralel with up to 26 CCGs per cycle. As WaitLess technology is bespoke, it has been built with scaling in mind. Our 12 week programme can be accelerated to 2 weeks, depending on each health economies informtion capabilities and appetite.
What is the intellectual property status of your innovation?:
As a developed and deployed product, we have IP rights  to our innovation
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
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Innovation 'Elevator Pitch':

Proximity Patients uses RTLS & current NHS data feeds to track, inform, guide & notify patients of the nearest non-urgent service required with capacity or the shortest waiting times. It also tracks patients throughout the facility to avoid delays.
Overview of Innovation:
Proximity Patients is a secure solution for hospitals, medical centres and elderly care, amongst others. Whether locating critical staff in A & E, vital ‘missing’ equipment or absent patients across each site, we help optimise staff, patient and provider benefits whilst offering the opportunity to inform and engage with the patient.
Our software can be linked to other systems such as Vital Signs Monitoring or Asset Management software whilst our hardware can be built into the fabric of the building, added at a later date or simply carried by staff and equipment unknowingly using long life power sources.
Real Time Location Services (RTLS) provide up to the minute details of the whereabouts of all entities ensuring efficiencies and care are optimised by the highest utilisation of hospital resources. Recorded information facilitates process improvements based on actual data, not anecdotal evidence. Periodical reviews of this data encourages optimisation and reduces staff transit times between duties; average patient progress throughout their care can be measured and patterns of behaviour established to reduce long term staff and monitoring costs.
Patients are easily located to ensure their operations start on schedule; after a simple electronic registration they are treated as a valued ‘customer’ by all staff who approach them with a smart device, whether previously known or unknown, immediately putting them at ease and reducing anxiety. Patient services can add revenue streams from hospital shops or other pay to use services, via mobile devices.
For added security, the ‘I Need Assistance’ button can be activated by staff or patients to call for help, either from Security or medical staff, without having to clearly identify who and where they are, saving vital seconds in an emergency.
Patients can also use this infrastructure / data for indoor navigation, finding departments or the nearest useable facilities (toilet, shop, car park, etc), communicate with staff.
Stage of Development:
Trial stage - Trial stage to prove that the idea actually works as intended
WMAHSN priorities and themes addressed: 
Education, training and future workforce / Wealth creation / Digital health / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
Scalable roll-out starting with a low investment for single ward / treatment centre.
We do not rely on BLE (Bluetooth Low Energy) beacons but accurate locators working on 2.4GHz can track people, assets, mobile phones and any other Bluetooth enabled devices to with 10cm accuracy. We have 2-way communication with mobile devices and as such can save on the hospital buying multiple solutions. Utilising the same locators for multiple platforms ensures minimal IT installations and maintenance. Studies in airports have shown that BLE beacons cost an average of £220 pa to maintain whereas maintenance for Proxicon locators’ costs less than £30 pa. Less Proxicon locators required to provide a more accurate tracking solution than beacons; this provides the NHS with multiplied savings over other technologies.
No need for additional user hardware if already using other existing NHS systems such as Systems C VitalPacs and Safe Patient Systems; Proximity Patients utilises the same devices. If no other systems are currently in use we need only use a wifi enabled smart device (tablet, smartphone) or a Bluetooth enabled device for lower level functions which can owned by the patient.
Provides simple interrogation of data in 4D; a 3D environment visible in real time replay. This shows hotspots, such as queues waiting for X-Rays or areas where equipment is constantly being used / left unused, optimising the deployment of life saving assets without the unnecessary and labour intensive time studies through manual observation.
Start to build full electronic patient records of essential data across all departments so clinicians can see the full patient picture at a glance.
Enabled ID cards which can also contain a single use panic button function can be traced to anywhere covered by the locators (internally and externally). A discrete emergency signal can be sent with staff ID and location, cutting security response times significantly.
Essential staff can also be located and deployed via a group message, for example in the case of a major incident, staff can be notified that they need to be on standby to report to A&E or go there immediately. All staff communication can be issued irrespective of their location.
Asset tags can be used to track equipment and provide the latest and up to date operating and maintenance instructions to any smart device saving operator and maintenance staff time.
Case studies can show utilised assets and staff during treatment to identify true costs of care.
Initial Review Rating
3.40 (2 ratings)
Benefit to WM population:
Improved customer experience, whether as a patient, visitor or employee:
  • Patients can be prepared for arrival prior to physical presence being observed. Patients can be sent travel plans via SMS, email, push notification. These can include expected travel times and bus routes, for example, to ensure the patient arrives in plenty of time for their operation / appointment reducing anticipation and anxiety.
  • Voice or visual guidance for all patients and visitors to help plan their arrival route and find
    • Wards
    • Departments
    • Parking
    • Shops
  • Patients already familiar with other NHS mobile platforms can be easily tracked and therefore useful location information provided: whether for appointment / health benefits for the patient or for informing accompanying visitors about available facilities. These include the nearest toilets or food outlets; provides wealth generation such as providing hospital shop offers or pre-ordering food from the hospital cafeteria / restaurants.
  • Patients can notify the facility of special dietary and personal requirements (such as an allergy to nuts) prior to arrival and get confirmation that these requirements have been actioned; saving staff time upon arrival. Staff merely confirm the knowledge on arrival that the patient has previously supplied.
  • Patient experiences can be tracked by an ‘opt-in’ to a “Help the NHS to help you survey” built into the platform, making the patient feel part of an inclusive community with their and the NHS interests at heart.
  • Patients can provide their friends and relatives with their unique patient ID to allow them to be located during visiting hours. By using this service, the patient agrees to allow the NHS to post patient specific notifications to those visitors such as:
    • ‘Patient is nil by mouth’
    • ‘Patient may only have 1 visitor at a time’
    • ‘Please use the Hand Sanitizer upon entering and exiting the ward’
  • Patients who are not nil by mouth can order food and drinks from shops for delivery to their ward and pay by mobile platform such as Android Pay, Apple Pay or Paypal. Similarly, they could order books and newspapers from the shops inventory. This provides comfort to the patient and a feeling of some level of self-control boosting their self-esteem.
Current and planned activity: 
We participate in the Serendip programme in iCentrum, run by Innovation Birmingham. We work with the WM Combined Authority on various transportation solutions & have had several discussions with the WMAHSN team there regarding applying our solutions throughout the NHS in the WM region.
As a result, we have made contact with the Local Eye Health Network to expand on our guidance for those with visual impairments from transport into the healthcare environment. We are open to collaborations with other NHS providers and are currently awaiting a couple of introductions to two of those key established providers previously mentioned.
We require assistance to network and find a suitable sponsor to trial the system. We know our technology works in other environments and there are examples where it has been used successfully in healthcare situations in other countries but not attempting to incorporate all the functions we believe should be built into a NHS / patient tracking / engagement system.
What is the intellectual property status of your innovation?:
The IP of the hardware is owned by our Finnish supply partner Quuppa Oy. The IP of the software belongs to Proxicon.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
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