Three years ago, if you had cancer and were admitted to hospital as an emergency at Sandwell and West Birmingham Hospitals NHS Trust, the chances are that you wouldn’t have seen a clinical nurse specialist during your stay.
Yet, strikingly, the chances are that you would have stayed in hospital for around 20 days. These statistics frustrated clinical nurse specialists.
They believed if they had known about these patients’ admissions they could have improved their journey through the hospital system.
A collection of baseline data over a two-year period confirmed what they suspected. Patients were not receiving the best possible care and staff were not being used as well as they could be to support that care.
Light bulb moments
In partnership with the Pan Birmingham Cancer Network, Sandwell and West Birmingham decided things needed to change.
“We were asked to look at changing patient outcomes, as they were faced with emergency admissions where length of stay was around three weeks,” says Adrian Kearns, service improvement facilitator for the Cancer Network. “We had to change this.”
He says the “light bulb moment” came when it was suggested that keyworkers should be alerted to the emergency admission of known cancer patients to hospital, so they could get a supported discharge plan in place.
“Only 50% of patients by discharge received a visit by a cancer specialist and we decided we needed to change that,” Kearns adds. “And we decided to that by setting up a simple email alert.”
Simple and developed in house
The keyworker alert was developed in-house by the hospital’s IM&T and electronic patient record implementation teams.
It was based on the “simple” idea of using the trust’s IT system, Lorenzo, to flag a patient once they were under the care of the cancer team. If a patient with a flag is admitted, an email is sent to the relevant keyworker. These can be accessed via a computer or a smartphone.
The alerts have been used for colorectal cancer patients and for those diagnosed with upper gastrointestinal cancers since May 2010. Urology and lung cancer patients have been flagged since April 2011.
Once they have received the alert, the keyworkers can attend A&E or the ward onto which the patient has been admitted, and get a supported discharge plan in place.
“I believe there has been something similar at other trusts in England, but we have adapted and improved it to suit our needs and show the change in healthcare with the increased focus on integrated care,” Kearns says.
“We have looked to use the local healthcare economy as we were keen to emphasise that this wasn’t just a system for the benefit of the hospital.
“The problem with the NHS is that it’s often very hard to get any momentum going but this project has snowballed and we have been absolutely staggered by the results.”
The results achieved and benefits realised since implementation have certainly been impressive – two years of admissions data demonstrate that length of stay has reduced from 20 days to four days.
And across two tumour sites running the alert system for eight months, the reduction in length of stay associated with emergency admissions has released in excess of 3,700 bed days, creating a saving of over £900,000.
The reduction in bed days has released extra capacity throughout the trust, as patients are not receiving diagnosis or undergoing tests which would then require laboratory work.
Patient benefits have also been significant. Patients no longer have repeat batteries of tests and they receive a more “robust” emergency inpatient experience, reassured that someone who knows about their condition can attend and offer support.
“At Sandwell and West Birmingham, the system has had an impact on nearly 12,000 patients. It has simply allowed us to deliver integrated care for patients,” says Kearns.
The work won the ‘IT-enabled change’ category of the EHI Awards 2011 in association with BT. Kearns says this was a boost for the team, and has made it easier to extend the project.
“We were delighted to win the EHI award,” he says. “The cancer team felt like it had been rewarded for embracing change and it provided us with significant national recognition.
“Since then, we’ve had no problem in rolling out the alerts across the area. We have been helped by the award because it acted as a kind of quality assurance mark, encouraging other hospitals and trusts to implement the system.”
Since the award, the concept has been rolled out at the Heart of England NHS Foundation Trust and Walsall Healthcare NHS Trust, while University Hospitals Birmingham NHS Foundation Trust has begun the implementation of a similar system.
Kearns adds that the rapid adoption of keyworker alerts also owes a lot to the IM&T team who produced the cost neutral project, and the clinicians who have been particularly keen to endorse the system.
“It has been a lot easier to roll out this system when clinicians are telling other clinicians that the system works, rather than being approached by project or IT leads. When their peers tell them they tend to listen,” he says.
With the system now area-wide, Kearns believes the concept could and should be adopted in other long-term conditions.
“We have had contact from various organisations and trusts such as Glasgow who are all looking to do the same thing. So without a doubt the message has got out there.”