#HandoverProject - Automated Ward Round & Handover System

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Case Study Summary
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Overview summary:
Dr Sarah Steadman from Birmingham Women’s Hospital (BWH) developed and implemented an electronic ward round and handover system, which has proven to be an effective streamlined process with numerous benefits, helping the NHS work towards a paperless future.

The system is a unified electronic handover and ward round tool that has been applied to the neonatal ward. The system has demonstrated that it is a viable solution, has significantly saved time and has potential to be adapted for other inpatient units where ward rounds are conducted.
Challenge identified and actions taken :
Most UK hospital teams verbally handover patient information with a hand written or typed list, containing basic demographic information, clinical information such as reason for admission, current treatments and a job list for each patient. These sheets are then used throughout the shifts, with additional information on patients being gathered before the next shift. These sheets also contain clinical information that needs accuracy, legibility and traceability just like patient records, but this is often overlooked.

Ward rounds consist of a team of doctors reviewing each patient’s clinical condition, treatment and future plans regarding management, which is documented in notes. Depending on case load this process can take a considerable portion of the working day (in this case 5 hours).

When ward round notes are handwritten there is the potential for illegibility due to poor handwriting, bad spelling or errors being made when coping information back and forth. The system developed solves these problems by electronically transferring information between a handover sheet and ward round format, updating itself as each process happens.

Furthermore, this software has helped the trust in working towards their goal of becoming paper free, one of the national NHS goals.
Impacts / outcomes:
There are many impacts and outcomes that the software’s system has been shown to achieve, for example it has significantly reduced shift handover and ward round times. During its trial introduction period data showed it to save 24 hours per week.
The system has also enabled staff to have more time to carry out other duties, such as increased time with patients and families and opened up time for teaching students and junior clinicians.

Below are some more of the outcomes that the Handover system has achieved:
  • The electronic solution automatically placed the time, date and patient identifiers on each page and the entries were all typed, which meant that all ward round entries completed using the electronic system that met 100% of NHS Litigation Authority audit standards.
  • Based on the data available from the Handover software, it is estimated that the time of intervention has saved on average 57 minutes per day of time for the members of medical staff involved in the ward round. Based on this alone it can be estimated to save the Trust over 24 hours of staff time each week.
    • As the system has saved time and allowed an earlier completion of ward rounds, it has enabled staff to spend more time with patients and completing routine work during daytime hours.
    • Earlier completion of ward rounds also meant that routine tasks such as placing long lines could now be completed in working hours rather than be handed across to the on-call team.
  • Medical staff were freed from the process of duplicating documentation from one day to the next reducing the risk of errors when transcribing information.
  • The nursing team were pleased with the improved standard of documentation and legibility of the ward entries and have started using the printed sheets as a handover tool for their nursing shift handovers.
Overall, the use of the low cost, unified electronic ward round and handover solution has demonstrated a significant reduction in average ward rounds and handovers whilst simultaneously improving documentation standards.
Supporting quote for the innovation from key stakeholders:
Below are some supporting quotes from the media that covered our project:

Herald Scotland News: “Using laptops or tablets instead of paper for hospital rounds could save each doctor an hour a day, research suggest”http://www.heraldscotland.com/news/13154481.Laptops__can_save_doctors_hour_a_day_/

ITV News: “Laptops or tablets could save doctors up to an hour a day…. Medics spend around 56% of ward tome filling out paperwork, but this could be reduced to around 41% if doctors made use of technology…” http://www.itv.com/news/update/2014-04-08/laptops-or-tablets-could-save-doctors-an-hour-a-day/

CBR (Computer Business Review): “Switching to an electronic system would also allow doctors to read and share records with colleagues much more easily, instead of having to rely on the famed unreadable scrawl of many medical professionals...”
“…eight months after the trial, the hospital unit is still using the electronic system, which has saved an estimated 24 hours of doctor time per week.”
https://www.cbronline.com/news/tech/hardware/desktops/doctors-could-save-an-hour-a-day-by-using-laptops-on-ward-rounds-study-claims-4212058

Mark O’Herlihy, director of Healthcare, EMEA, at Perceptive Software said "A paper-based approach has been relied on for all too long and has often resulted in misplaced medical records, operational inefficiencies, and delays to patient care…Faster and secure access to the correct and relevant data at the right time could see a real benefit to patient care and confidence in the NHS as we go forward."https://www.cbronline.com/news/tech/hardware/desktops/doctors-could-save-an-hour-a-day-by-using-laptops-on-ward-rounds-study-claims-4212058

Hit consultancy: “Historical data also showed that only 68 percent of the doctor’s paper entries into medical notes are legible, but an electronic system boosts this to 100 percent.”
“8 months after the trail, Birmingham Women’s Hospital’s neonatal unit is still using the electronic system improving handover and documentation standards.”
https://hitconsultant.net/2014/04/09/doctors-saved-1-hour-daily-using-laptopstablets-for-hospital-rounds/
Which local or national clinical or policy priorities does this innovation address:
• The software developed is being used at Birmingham Women’s Hospital NHS Foundation Trust. • Other local neonatal units in the region have approached the team to see if the system can be adapted or have developed their own similar concept. • It addresses how ward rounds and handover can be done in a time saving, efficient, safe manner which fits in with the NHSLA record keeping standards.
Plans for the future:
Due to the software’s success it is still being used by the department neonatal at the Birmingham Women’s hospital as a solution while the team investigates the potential for developing a custom system which has a potential link to other hospital systems.

Moreover, the team are taking this project to commercial partners, which has the potential to provide the NHS with a step towards paperless working. This can also help the NHS make considerable efficiency improvement, while maintaining quality.

In addition having heard about the success of the project other local neonatal units in the region have approached the team to see if the system can be adapted to run on their machines. Expanding our software for others NHS Trusts to use is another future plan.
Tips for adoption:
This system was designed and programmed by 2 NHS junior doctors using readily available Microsoft based software. It is proof that even simple IT solutions can save the NHS money and time and that junior doctors are a valuable resource for the NHS in terms of Quality Improvement.

We hope to take #HandoverProject to a commercial partner to help us combine the concept into a wider electronic solution to link into systems for bed management, electronic prescribing and test results.

If you would like additional information on how our software could be adapted at your Trust please don’t hesitate to contact us: sarahlouise.steadman@nhs.net

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