Problem Statement

Traditionally, collection of patient information in the hospital has been paper-based and manual. This has resulted in variations in care processes and staff inefficiencies. On average, there would be more than 40 paper-based forms stored in two or more folders, which clinicians would need to access in order to collate patient information, making it difficult to gain an overall picture of a patient’s care.

What are we trying to achieve?

Our goals are to:

  • increase patient safety through the timely collection and monitoring of patient’s physiological data (including identifying risk for falls, risk of pressure injuries and potential for delirium)
  • use the information collected to continuously improve patient care
  • educate and train staff based on organisational policy and guidelines
  • improve workforce satisfaction by engagement and improvement planning
  • reduce duplication and increase the efficiency of workflows to enable better care at the patient’s bedside.

What have we done?

eVitals is an electronic solution for collecting patient observations and assessments. eVitals has moved CM Health away from paper and manual processes by enabling staff to obtain and monitor patient information, both at the bedside and from a distance, using specifically designed software on tablet devices.

Ensuring that patients who are deteriorating receive appropriate and timely care is a key quality and safety challenge. eVitals standardises care by automatically calculating the early warning score, and automating the process of alerting clinical staff based on the score and clinical judgement. It also prompts staff when observations and assessments are due or incomplete, including daily or weekly scheduled activities.

What did we find?

Patient safety has improved with eVitals through earlier identification of deteriorating patients, and prompts for necessary assessments.

eVitals is also providing a hospital-wide and ward view of patients who are at risk of deteriorating.

eVitals has improved visibility around adherence to clinical policy and allowed a baseline clinical indicator for assessments to be established. At present, the timeliness of observations is sitting at 83% (taken from a snapshot of one week).

In addition, the automated calculation of patents’ early warning scores has reduced variation in care for deteriorating patients.

How did we make a difference?

Differences are being made as a result of the increased visibility of clinical information and the data being produced in reports.

For example, ward practices have changed. Historically, observation rounds occurred to suit the nursing staff, i.e. at the change of shift or bundled together at specific times. Now, nurses are actively recording vital signs, based on individual patient need and hospital policy.

Reports are also making a difference, due to observations, vital signs and risk assessment reports being emailed daily to senior nursing staff. These reports show that there has been a general increase in compliance in recording information at predetermined times since their inception. Reports include whether vital signs were taken on time or late, and assessments completed within specific timeframes based on inpatient admission times.

In addition, data about a patient’s body mass index is now available, as a result of it being captured when the patient is assessed for their pressure injury risk. This has made a difference for the Health Intelligence Team and clinicians, who can now look at how obesity impacts on a patient’s length of stay and theatre times.

Other differences made are:

  • reduced Intensive Care Unit presentations and average length of stay, through earlier preventative care and an improved patient experience
  • improved staff satisfaction
  • reduced house officer and nursing time spent looking for patient charts and patient information
  • reduced nurse time in handover and shift planning
  • reduced nurse time documenting, calculating and recalling observations
  • reduced nurse time recording admission forms
  • improved timeliness of early warning score observations and calculation accuracy.

Where to from here?

During 2019/2020, eVitals will be upgraded to a more recent version, providing enhanced features and functionality, for ward use and background system administration. The upgrade is planned for July to October 2019.

Additional eForms are in the development phase. These forms will help reduce duplication of processes and increase visibility of patient care.

A solution is also being sought to provide an automated alert notification function within the application. The function will generate automated alerts, based on the early warning score calculated. At present, escalation requires the responsible clinician to be phoned or paged in order to escalate care, and dialling the hospital operator to raise a medical emergency (777) call.

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