Using SBAR for Nursing Homes (#2468)

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Idea Description
Overview of Innovation:
SBAR is a structured method for communicating critical information that requires immediate attention and action.

SBAR improve communication, effective escalation and increased safety.

Its use is well established in many settings including the military, aviation and some acute medical environments.

SBAR has 4 steps
– Situation
– Background
– Assessment
– Recommendation
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Innovation 'Elevator Pitch':
We have successfully designed, implemented and evaluated a standardised triage system for use within maternity care.  It is currently used in eight maternity units, with more planned.
Overview of Innovation:
Triage systems are designed to ensure the patient receives the level and quality of care appropriate to their clinical needs and resources available. Triage involves establishing the presenting problem, undertaking a standardised physiological assessment including vital signs and results in a score being assigned based on predictors of urgency which determines the priority of on-going care.
The physiological changes associated with pregnancy mean the standard triage tools may not be applicable. In addition, the underlying good health of the maternity population, which may mask the severity of maternal illness, and no assessment of the condition of the unborn baby reinforce the need for a specific maternity tool. While some informal triaging takes place within maternity care, a national survey showed that women currently wait to be seen in the order in which they arrive and that current prioritisation systems do not use clinical determinants.
 
Birmingham Symptom specific Obstetric Triage System (BSOTS)
The system was co-produced by clinicians and researchers in Birmingham to prioritise care for women presenting with pregnancy related complications or concerns.  
The BSOTS bundle includes:
  • Completion of a standard clinical triage assessment by a midwife within 15 minutes of the woman’s attendance.  This includes taking a brief maternal history, completion of baseline maternal observations, assessment of pain levels, abdominal palpation and auscultation of the fetal heart rate .
  • This assessment is used to define a category of clinical urgency using a 4-category scale, which guides timing of subsequent assessment and immediate care (by an obstetrician if required) using algorithms.
 
  • Standardised symptom-specific algorithms are used for allocation of clinical priority and the immediate care and further investigations of the eight commonest reasons for attendance (abdominal pain, antenatal bleeding, hypertension, suspected labour, ruptured membranes, reduced foetal movements, unwell/other, and postnatal concerns). 
 
  • Documentation is provided to support and standardise completion of the clinical tasks required.
 
Implementation of BSOTS requires multidisciplinary training of clinicians which takes approximately three hours. The BSOTS training has also been developed and elevated by the team
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: 
Innovation and adoption
Benefit to NHS:
The benefits to the NHS of a dedicated maternity triage system are centred on improving safety for women and their babies by reducing the interval from their attendance to their initial review by a midwife and prioritising urgent care. BSOTS is supported by Royal College of Obstetrics and Gynaecology and Royal College of Midwives for national implementation.
Implementation of BSOTS as the system improves management of the triage department by enabling staff to:
  • See how many women are waiting who have not yet had their initial triage assessment to determine level of clinical urgency
  • See how many women who have had the initial assessment and the level of clinical urgency is known for each women
  • Know when further assessments are due for women in the Department
  • In circumstances where women attend who require urgent treatment it allows women with less clinical urgency to be safely moved out to the waiting area and escalation to occur
  • Facilitate easy handover of the department between shifts using SBAR
  • Use a shared language between clinicians to communicate clinical priority
BSOTS  provides a standardised process to manage emergency attendances and reduces staff safety concerns in maternity triage whilst increasing their resilience and improving handover and communication.
 
Initial evaluation at BWCNFT demonstrated  that the use of BSOTS increased the numbers of women seen within 15minutes of attendance from 39% to 54% [Relative risk (RR) 1.4 (1.2, 1.7 (95% confidence interval (CI)] and reduced the time to medical review for those who require it. Thus providing a robust pathway for rapid assessment and urgent medical care if required, improving outcomes for mothers and their babies.
Good reliability and validity of the BSOTS bundle were found on the basis of the numbers of women who re-attended and investigation of predefined maternal and neonatal morbidities.  All the midwives reported that BSOTS training had improved their knowledge and confidence and that implementation of the system improved safety for mothers and babies and reduced stress amongst the clinicians.
Intra-rator reliability was excellent both at BWCNFT initially with an Intracluster Correlation Coefficient (ICC) of 0.961 (95% CI 0.91-0.99), and in the additional maternity units where the ICC was 0.971 (0.915-0.996). There was no apparent difference between midwifery band level and amount of triage experience. Showing that the BSOTS tools are reliable and consistent for use amongst varied midwifery staff.
Initial Review Rating
4.60 (2 ratings)
Benefit to WM population:
The West Midlands remains a national outlier for poor rates of perinatal and infant mortality and is committed to the national ambition to halve the number of stillbirths, neonatal and maternal deaths and brain injuries by 2025.
 
In line with the National Maternity Review (published in February 2016) which set out a clear vision for maternity services across England to become safer and to promote good practice for safer care; the Birmingham Symptom specific Obstetric Triage System (BSOTs) improves the process and clinical prioritisation of care for women presenting with pregnancy related complications or concerns. BSOTs has also been shown to prioritise urgent care for those women who are most unwell or requiring more rapid access to obstetric intervention and emergency treatment.
 
With increasing use of the Birmingham Symptom specific Obstetric Triage System (BSOTs) across the maternity units within the West Midlands region, women can expect continuity of process and care when they present to units with urgent concerns and that care is standardised across the region. Standardisation of the maternity triage pathway also provides an opportunity to ensure that the midwifery and medical workforce in maternity are able to be trained with the right skills to implement appropriately timed and clinically relevant prioritised of care within all maternity triage departments in which they may work.
Current and planned activity: 
The Birmingham Symptom specific Obstetric Triage System (BSOTs) is currently used in seven units nationally; including half of all maternity units within West Midlands.
A further twelve maternity units have received training for their implementation teams and are due to launch the BSOTs programme in the next six months.
Bespoke training courses for maternity teams are held in Birmingham every two months. This training includes specific training the trainers materials, the BSOTS© maternity algorithms, Triage Assessment Cards and Patient information posters and tips for implementation from other units.

Further development of the Birmingham Symptom specific Obstetric Triage System (BSOTs) with Clevemed systems to transfer the paper based system into an electronic tool with contemporaneous patient record is on-going; due to complete by May 2019. This will enable maternity units currently using the Badgernet Maternity electronic system to use BSOTs digitally and further improve availability.
What is the intellectual property status of your innovation?:
Use is currently protected by signing a Licensing agreement provided by UoB and MidTech.
 
The schedule within the licensing agreement includes the Birmingham Symptom specific Obstetric Triage System (BSOTs) package for Training and Implementation and is intended to ensure the package is used as intended and that training has been given before implementation
The package is intended to support local training, implementation and on-going use of the (BSOTs) system, in the maternity unit assessing women who attend with unscheduled pregnancy related concerns. This package is set out during the face to face training course, it includes specific training the trainers materials, local training materials, the BSOTS© maternity algorithms, BSOTS© Triage Assessment Cards and BSOTS© Patient information posters. The components of the triage system should be adopted in its entirety, rather than separately.
Return on Investment (£ Value): 
N/A
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
Co-Authors:
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Overview of Innovation:
Background
Anaesthetists are renowned as effective communicators.This skill underpins every working day. From handovers , to ITU referrals, pre-assessment of patients , managing anaesthetic emergencies to calling the consultant for advice in the middle of the night. Tools for communication have evolved and these integral systems vary within hospitals. The last decade has seen widespread use of mobile phones with touch screen technology allowing further access to quick communication.  We have looked at the tools commonly used by trainees to enhance communication.
 
Materials and Methods
Prospective snap shot questionnaire using ‘Survey Monkey’ looking at methods of communication amongst anaesthetic trainees within London hospitals.
 
Results
The majority of trainees found face to face communication the best tool to communicate. WhatsApp and personal mobile phones were deemed an important application in daily communication. Trainees percieved WhastApp use as positive, however some thought being contacted out of hours made it difficult to switch off from work.
 
Conclusion
The messenging application 'WhatsApp' is the most popular tool used for communication. In view of recent cyber attacks within uk hospitals, this tool of communication requires back up when wifi systems fail. Most hospitals offer landlines, deck phones and bleeps but personal phones are deemed quicker and more effective in contacting colleagues. 


What does the future hold: 
- Confidential medical applications offering confidential means of communicating effectively. 
- Widespread use of work mobile phones for means of communication 

Future areas of interest: 
- Encourage WhatsApp as a means of quick effective communication during working hours. 
-Educate trainees on the flaws of communication with regard to confidentiality and professionalism 
- Suggest muting or archiving work groups during periods of leave to avoid constant work connection
 
 
Discover:
I chose the project as I feel strongly about trainee communication. It promoted positive discussions about communication tools amongst trainee colleagues. 
Dream:
I would like to further increase awareness amongst trainees on the importance of the correct tools for the correct forms of communication and also the importance of switching off from work.
Destiny: Promote awareness through education and discussion.
Initial Review Rating
0.75 (1 ratings)
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Innovation 'Elevator Pitch':
Aurora Innovation Logo
The teleQ communication solution enables healthcare facilities to save money, drive productivity & increase patient care & satisfaction. Dynamic, inbuilt decision software mini-triages calls & contacts to the right person/service/department 1st time.
Overview of Innovation:
Aurora teleQ (TQ) is an advanced cloud-based communication solution for health care providers that need to stay available with high inbound call volumes.
 
In a busy department or clinic phones can ring continuously causing patients and staff unnecessary stress. TQ helps to address those areas that have limited resources, ensuring efficiency is maintained by getting callers directly to the person that can address their needs first time. Whether that is connecting a patient to a doctor, a ward nurse or a specialist.  
 
One of the key advantages of TQ’s dynamic, inbuilt decision software is that it can reroute calls to the most appropriate or next on duty person (e.g. locum doctor) without requesting the user (patient/carer) dial a new number. Therefore, reducing time and stress for caller, especially if they require emergency advice for themselves or a loved one. It can equally be used by staff needing to access consultants or specialist when there is a crisis or need. This reduces stress for clinical staff using the system.
 
The statistics in TQ are presented with easily accessible diagrams and provide snapshots of a department/unit’s availability and contact patterns. Based on the statistics, the department/unit can optimise its resources, so the right number of staff handle the right number of contacts at the right time. The statistics can highlight pressure points / areas where efficiencies need to be created.
 
The system can be integrated with electronic patient record systems and other systems gathering crucial patient info (ex. APPs), to immediately bring up patient details thus saving time and ensuring calls and contacts are structured.
 
TQ integrates with analogue and digital infrastructures but takes full advantage of digital and mobile communications. The importance of varied channels of communication is growing. Therefor it is essential to have a tool that brings points of communication together as more channels of communication are added to the legacy points of contact
 
The solution is made up of several modules, all in one interface. Provides a scalable & tailored, system for your requirements; you pay for the modules you need.
 
Main Modules in Aurora teleQ
  • Call back
  • Call queue
  • Duo – call back and queue
  • Response groups
  • Interactive voice menu
  • Interactive voice menu messages / extra message
  • Video
  • Chat
  • SMS
  • Email
  • Voicemail plus
Our aim is to allow you to spend more time with patients as you remove communication roadblocks.
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: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Wealth creation / Digital health / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
The NHS is facing tough challenges, dealing with an increasing volume of patients and an ageing population that will lead to ques on calls and communication. A structured and automated way to manage the volume of contacts is needed. This both for patient, carer and internal contacts.
 
Ineffective communications leave patients and staff feeling frustrated and can create a long lasting negative perception. Communication solutions need to focus on your patient’s needs and can adapt to changes within the healthcare provider, easily and efficiently.
 
The TQ platform helps a caregiver to efficiently gather information from a variety of sources at the point of contact. With the on slew of self-monitoring and APPs collecting data from patients with long-term or multiple illness, an easy consolidator is needed. TQ has several solutions that are integrated and used on a daily basis, such as; fully automated patient triage, lung capacity monitoring etc.
 
TQ provides integration into patient facing APPs, for easy communication with patients.


Aurora teleQ (TQ) is an innovative communications solution that is designed to maximise resources, provide more efficient collaboration and decision making. Thereby providing real benefits in patient care and staff efficiencies whilst reducing operating costs and stress.
 
The statistics in Aurora TQ are shown as easily accessible diagrams that provide snapshots of the unit’s availability and communication patterns. Based on the statistics, the unit can optimise its resources, so the right number of staff is assigned to handle tasks. TQ provides several management reports that provide direct decision support. Providing clear information on patient communication efficiency, staffing and competency. The statistics allow for simulation of how the unit can best plan staffing and inbound and outbound call and communication times to meet variety of availability needs and measurements.

 
In addition to the statistics, that are integrated in to the report function, a large volume of data points can be integrated into big data decision tools. This provides an overview of point of contact in relations to the rest of the organisation, allowing for better decisions. TQ builds a model that will provide more accurate decision support over time.
 
Aurora TeleQ will help NHS to enhance patient care, reduce operational costs and increase staff productivity whilst reducing stress.
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
Healthcare organisations are facing increasing financial and patient care level pressures. They require improved communications to provide exceptional service and best value to patients. Patients expect to be involved in decisions and kept informed.
 
Care Giver
Your telephone and text system are the gateway to your service. Staff members shouldn’t be spending time on administrative patient work, answering inappropriate calls and redirecting them than on actual patients. Aurora TeleQ (TQ) ensures a timely patient contact whilst delegating work to the contact most suited for the work. This could even mean an electronic contact for information seekers.  those who need to make contact can get through and are able to access the right help when it is needed most. TQ provides a unified communication solution that improves patient care, lowers costs and frees up the time of healthcare professionals.
 
Patient
Patients and relations will find communications more efficient and to the point. Less time spent trying to find information or getting to the correct contact. When communication with the Care Giver the communication will be more to the point and more informed. The quality will be perceived to be better & more efficient.
 
Decision support
Proficient call and communication logging enables analyses of data & provide meaningful reports about support, usage, costs, capacity & quality of service. By having these statistics at hand, you can react in real-time or identify trends, letting you make informed decisions about future resourcing & commercial needs.
 
Consultancy
Aurora consultants have a 20 years of experience in Patient communication. The intricacies of communication dynamics are part of the Aurora delivery.
 
Benefits
The Aurora TeleQ system will provide time and cost saving. How much and how is dependent on what you want to achieve. If you are focusing on internal time saving you will find that TQ will provide a time saving of some, 1 to 15+ minutes per transaction. In addition to the time saved you will experiens a more harmonious & structured work environment that will be less stressful. Do not hesitate to see what VUmc in Netherlands has experienced https://aurorainnovation.com/en/case/vumc/
 
For other customer presentations please see https://aurorainnovation.com/en/case/

Collaboration
To assist us brining our technology to the UK we are looking for a NHS partner (more details below) we would look to them to assist and support us with validation studies and trials.
Current and planned activity: 
Aurora has 20 years of expertise in patient contact and communication. Aurora consultants work closely with health & care providers to optimize the patient flow and journey. The result is a highly satisfied patient and an effective and low stress communication strategy.
 
Aurora, requires a NHS developmental partner to collaborate with us to run a test installation/Pilot (free of charge). The aim is to customise the solution to match the needs of UK healthcare and the needs of the NHS Trust or partner/s.

The NHS organisation would gain the improvments in efficiency & cost savings along with increased satisfaction of patients and Staff. The pilot process would demonstate the benefits gained in Sweden & Spain whilst helping the company uncover what adaptation & modifications are needed to the system, protocols and API’s to match UK healthcare needs as well as our legal and regulatory requirements.

NHS Partner will have the opportunity to customise a solution for their specific requirements.
 
What is the intellectual property status of your innovation?:
All IP belongs to Aurora Innovation
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
2
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