Portsmouth Hospitals NHS Trust has announced it has implemented an XML-based clinical workflow system, which it anticipates will help support early discharges, reduce the average length patient stays in hospital and deliver cost savings.

Clinical IT solutions provider, Graphnet, has developed and implemented the new clinical workflow system in the Medical Assessment Unit (MAU) at Queen Alexandra Hospital in Portsmouth. It is the first implementation of its kind in the UK, and went live in December.

The trust believes that the new clinical workflow system has the potential to deliver significant cost savings – up to £230,000 a year – by replacing paper-based discharge forms and making more effective use of staff time.

Even greater savings may be possible through more appropriate bed allocation, and better planning and coordination of patient discharges. Saving half an occupied bed day per patient at Portsmouth due to better organisation would equate to releasing 20,000 occupied bed days. At a cost of £250 per day such savings could potentially equate to as much as £5 million annually.

Audit work carried out at the trust in 2001 highlighted that significant delays in internal patient care processes and clinical workflow increased the number of days patients stayed in hospital. The trust identified lack of co-ordination in the discharge process as the most important factors in delays to patient discharges from acute beds.

The new clinical workflow solution is designed to enable better co-ordination of the admission process through the MAE; to enable real-time bed management; and support clinical decision making about the most appropriate environment for patients. A key objective is to help identify patients who have recovered from acute illness and can be more appropriately managed outside an acute hospital setting.

The Graphnet solution will enable real-time bed allocation and bed management and allow clinicians and nurses to see the beds that will become available throughout the day at the press of a button. At the same time, the system provides clinicians with a complete view of the patient, from before admission, until after they are discharged.

Dr Paul Schmidt, from MAU at Portsmouth NHS Trust commented: “Hospital information systems never link ward moves of patients to the clinical process, as this system does. It will enable us to co-ordinate the movement of patients through the hospital, linking it to the clinical decisions that health care professionals make while updating a single care plan that starts on admission and ends at discharge.”

He added: “Being at the interface of primary and secondary care, the MAU is a particularly fast-paced environment where such an innovative approach is needed to respond efficiently to demands for rapidly available information when the patient moves elsewhere.

The clinical workflow system is designed to reflect the multidisciplinary nature of most health care processes in modern hospitals, and allow nurses and doctors to contribute to the final plan for the patient. Clinicians can then use this electronic clinical plan to generate an electronic transfer or discharge documents that can be viewed by the clinicians who will receive the patient and take over the care for the patient.

Dr Schmidt said the new system developed by Graphnet was user-friendly and easily mastered by staff with different levels of IT skills. “When fully implemented, it should allow nurses and doctors to dispense with the pockets and clipboards full of paper lists that they use to keep track of the plan for each patient. Graphnet demonstrated that its XML solutions could deliver on this objective."

As part of the system provided to Portsmouth Graphnet incorporated a clinical audit tool for this called the Appropriateness Evaluation Protocol (AEP). The system uses XML documents to notify the Medical Assessment Unit of GP referrals and A&E transfers before the patient actually arrives at the Unit. An analysis tool then enables clinicians and nurses to refer patients to the correct place – such as whether they need an acute hospital bed, a referral to a specialist clinic or their GP.

Dr Peter Featherstone from Portsmouth hospital’s MAU unit explained: “One particular need was to incorporate a way of safely defining when patients were over the acute illness that brought them into hospital and ready to move on to the rehabilitation or post-acute phase of their treatment.”

He described the incorporation of the AEP tool – which has been used and validated in other countries – as a genuine NHS first: “It will be the first time in the UK that the tool is used in routine clinical care, rather than for audit or research purposes."

Commenting on Portsmouth’s clinical workflow solution Tony Sharer, Operations Director at Graphnet added: "This is an exciting project and one that truly illustrates that cost-effective technology can be harnessed to deliver true benefits, both on a clinical and a financial level. XML represents the future for the NHS. Not only does it enable organisations to protect their existing investments in IT by integrating information from disparate applications, it also enables them to view information in a meaningful way that adds real clinical and audit value.”