Special Report: Mobile on the wards


Vital intelligence

The technology funds encouraged trusts to bid for systems that can be used to record vital signs and calculate early warning scores. While they get to grips with their implementations, Fiona Barr discovers that early adopters are starting to extend the use of their devices; and to gain some unexpected benefits.

In the fourth biggest hospital in England, every doctor and nurse has a mobile device in their pocket and uses it throughout their working day.

The IT used by staff at Nottingham University Hospitals NHS Trust is not part of an electronic patient record deployment, but a vital signs project that has made iPods and iPhones as ubiquitous on the ward as they are at home.

The Nottingham project was one of many vital signs projects partly paid for by the government’s health technology funds, which helped to kick-start substantial growth in the vital signs’ market a year ago.

Twelve months on, the second round of the Nursing Tech Fund has supported 24 more projects and the momentum is continuing as trusts start to self-fund the schemes and add more functionality.

Paul Volkaerts, managing director of the NerveCentre, describes Nottingham as “the boldest hospital in the country” for its decision to give a device to every one of its 4,000 doctors, nurses and health care assistants – instead of asking them to share devices, as other trusts have chosen to do.

Each nurse has an iPod Touch which they use to collect around 7,000 sets of observations a day and each doctor an iPhone with which they can receive and respond to alerts about deteriorating patients. The system aims to remove the human error involving in doing observations on time, collecting a full set, calculating scores and bleeping doctors.

Dr Mark Simmonds, acute and critical care consultant and clinical lead for the project, says the project has run as a close collaboration between IT and clinicians and that the usability of the system has been the key to its success.

“There is an intrinsic apathy about the expectations of NHS IT because a lot of things have not gone well but this is a really useful tool that just works,” he adds.

New ways of using new kit

While the tech funds have encouraged new projects, hospitals that began with e-observations have started to extend their systems to add elements such as electronic handover, infection control and monitoring of indwelling devices.

For example, Sandwell and West Birmingham Hospitals NHS Trust rolled out the Learning Clinic’s VitalPac to 29 wards across two hospitals with the support of nursing technology funding. They are now working with the Learning Clinic on developments including VitalPac Doctor, which supports handover, and a module to support the management of sepsis.

Other trusts, such as Imperial College Healthcare NHS Trust, have taken a slightly different route, and used the second round of the nursing tech fund to add vital signs monitoring to their existing electronic patent record.

For instance, Imperial won funding for Cerner CareAware VitalsLinks which connects mobile vital signs monitors to the EPR.

Gerry Bolger, nursing informatics lead for clinical systems at the trust, says: “Integrating bedside monitoring devices means that up to date clinical information will be added to patient records seamlessly, and this is particularly important for individuals whose condition is at risk of deterioration.

“There will also be benefits in removing risk of transcription error and releasing staff time for patient care.” The data gathered by the mobile devices is proving to be a massive secondary benefit for trusts, providing governance as well as invaluable operational information.

Nick Elliott, client engagement director with the Learning Clinic, is a former NHS chief operating officer and has first-hand experience of battling with incomplete datasets.

He adds: “You rely on administrative staff to keep the system up to date and after a weekend it might be Tuesday lunchtime before you have caught up. This system (VitalPac) gives such amazing data that you can leverage it to for tasks such as placing patients in the right ward first time which is really important for their care.”

Both Elliott and Dr Roger Stedman, medical director at Sandwell and Walsall NHS Foundation Trust say vital signs systems provide much better insight into what each individual and team is doing and proof to regulators such as CQC.

Dr Stedman adds: “You can create all the forms you like on paper but it doesn’t tell you how well you are doing.” Elliott believes this aspect will be a further driver for growth in the vital signs market, increasing uptake from what he estimates is about 40% today to nearer 100% coverage.

Out of the acutes

Vital signs systems suppliers are also moving into the community. IT supplier Civica has partnered with health technology firm Medepad , using its vital signs system MedeTrax. This is deployed on Windows 8 tablets in the acute sector at The Isle of Wight NHS Trust.

ivica is using MedeTrax as the basis for ParisObservations, a new product for its clinical information system Paris. David Roots, Civica’s managing director of health and social care, says it will allow patients to record their own clinical observations and report them to community support teams, reducing the number of necessary visits.

He adds: “You can get the tablets patients would need to do this for about £70 each so I think the return on investment on this type of technology is going to be very attractive.”

Another new development is the introduction of more hi-tech monitoring systems. Last year Sensium Healthcare trialled its wearable vital signs monitor at a private hospital in Brighton and Medepad is also working on a wearable sensor for measuring vital signs.

John Hopkins, chief executive officer of Medepad, says the company won a Small Business Research Initiative contract to look at how sensors might be used to monitor vital signs as well as bio-chemical markers in the blood.

He says the company is working with Alder Hey Children’s NHS Foundation Trust on the project. Hopkins adds: “It’s particularly relevant for neonates where you are taking a significant amount of blood volume if you are monitoring them four times a day.

Tools not tribulations

Technology’s role in supporting patient monitoring tasks has helped to refocus attention on this vital work according to clinicians. Dr Stedman says: “For me it’s one of the most important safety systems that you can put in after e-prescribing.”

And for Dr Simmonds the reports from the frontline of the impact of instant messaging of alerts has been impressive. “We have had one story of our critical care outreach team arriving before the nurse had left the bedside.”

Volkaerts says the real legacy of the technology funds’ support for vital signs systems runs much deeper. “In five years’ time people will look back and they won’t say it’s really good that we have addressed the vital signs problem. E-observations are a really good excuse to give everyone a mobile device.”