Organisation implements an ePortering solution to improve coordination during patient transfers in emergency department, reducing the average time to complete a request by six minutes

Synopsis:

Infinity Health is a team of clinicians, designers and software developers that are addressing workflow and communication challenges across healthcare. Infinity is a secure collaboration and task management solution that transforms the way healthcare professionals coordinate their activity and share critical information. London North West University Healthcare NHS Trust (LNWH) is a large provider with more than 8000 staff, serving a population of over one million people.

Sonia Patel, Chief Information Officer, who has a reputation of innovation and “delivering the best digital healthcare”, selected Infinity Health to transform the coordination of patient transfers to improve clinical efficiency and patient experience. The Infinity ePortering solution was implemented in the Emergency Department at Northwick Park Hospital on October 29th 2018 and is now used to coordinate over 100,000 transfer requests per year.

With Infinity, staff can request a collection or patient transfer using secure mobile devices and porters can accept and share their activity in real-time. It has been a significant improvement for the clinical, operational and facilities teams. The average time to complete a request has been reduced by 6 minutes, which translates to a saving of over 10,000 hours of staff and patients’ time each year.

Ambition:

Over 100,000 porter requests are coordinated every year in the Emergency Department. Previously, staff had to go to a fixed place to handwrite a collection location and a destination for each request. Additional information was rarely communicated, so porters didn’t know who had made the request, the patient’s name or if a chair or bed was required.

Porters had to return to this location to pick up the next job. These factors contributed to delays and ultimately increased waiting times for patients. Clinicians lacked the visibility to track the status of tasks and inconsistent communication between the clinical and operational teams resulted in an inefficient and frustrating process for all.

The use of technology created the opportunity for clinicians, porters and managers to coordinate and share activity in real-time and record audit data that would allow managers to monitor and optimise the service. The key objectives were to: reduce cancellations reduce the time taken per request to improve staff satisfaction.

A multi-disciplinary team provided project management and technical support as well as engagement with frontline staff and patients. All users were provided with training and an opportunity to discuss the current process, the challenges and their perceptions of technology.

Outcome:

Staff can now submit requests from anywhere and reliably escalate urgent tasks. All activity is tracked and shared in real-time. Notifications alert key staff if issues arise, reporting dashboards reveal business insights and a complete audit trail is recorded and archived for all activity, including reasons for cancellations.

The right information is being shared with the right people, at the right time. Porters now know who requested the transfer, the patient’s name and any additional requirements. Clinicians and porters state that they are now working together as a team, connected by technology and report that patients have a far more streamlined and coordinated experience.

The ePortering solution has transformed the manual, paper-based process into a truly digital, Just-in-time (JIT) service. All of these factors have contributed to reducing cancellations by over 80%, resulting in a sustained reduction of 6 minutes per porter request, which translates to a saving of more than 10,000 hours each year, equivalent to five FTEs.

Reducing time to assessment and time to treatment also has a considerable benefit to patient experience and outcomes. Infinity automatically escalates requests for critical patients, expediting diagnosis, treatment and appropriate transfer, which further improves efficiency and patient outcomes.

Spread:

Infinity is being used by over 500 staff (including porters, clinicians and managers) in the Emergency Department. It is well understood that the performance of the Emergency Department has significant consequences on the operational efficiency of the entire hospital. Infinity Health and LNWH are now exploring the use of Infinity in other departments and clinical settings within the Trust.

There are 135 acute non-specialist Trusts in England. Infinity Health has published a case study (please see attached pdf) and is raising awareness of the Infinity ePortering workflow solution to clinical and facilities stakeholders in acute Trusts via emails, social media, conferences and speaking events.

The ePortering solution has been publicised in the Evening Standard and promoted by NHS leaders including Sam Shah (Director of Digital Development at NHS England) and Tara Donnelly (Chief Digital Officer at NHS England), DigitalHealth. London and the Academic Health Science Network, NHS Digital and NHS England are also promoting adoption of the solution by disseminating the case study through their professional networks.

Value:

Using Infinity to coordinate porter requests has directly improved efficiency. There were significant delays with the paper-based process. The percentage of requests being cancelled was substantial at 39% and the reasons were largely unknown. Escalating urgent requests and ensuring that requests were being completed in the correct order were both challenging.

Additionally, it was time-consuming to log activity and reports lacked sufficient detail to optimise the service. A comparison of pre-and post-implementation data demonstrates that the solution has led to a sustained reduction of six minutes per porter request, saving more than 10,000 hours each year and an 80% reduction in cancellations has led to a significant increase in efficiency and value for money, equivalent to five FTEs. Staff experience has been transformed with less time wasted chasing porter requests.

All requests are recorded and archived to provide an audit trail and performance reports, assisting the Trust Facilities team in monitoring the service. Porters can identify patients and clinicians by name, substantially improving morale and team building. The public address system is no longer used to request porters, which disturbed unwell patients and busy clinical staff.

Involvement:

In our experience, the most successful solutions are developed in collaboration with all stakeholders. We began by establishing a detailed understanding of the processes, environment and individuals involved. Appropriate representatives from our team met regularly with porters, the facilities team clinicians, patients and technical stakeholders throughout the prototyping, implementation and evaluation phases.

Workshops were established to train all the different user-groups. These varied from presentations at the end of handover meetings to group training whilst on shifts, to one-to-one instruction in the Emergency Department. Infinity Health worked in partnership with frontline staff, continuously evaluating and integrating feedback to ensure that the solution was easy-to-use and provided measurable benefits.

The positive testimonials that we have received from staff and patients are evidence that all stakeholders were involved. Staff have promoted the ePortering solution on social media, LNWH has been delighted to act as a reference site and is hosting site visits from other Trusts to promote further adoption.

Furthermore, partnering for this HSJ award also demonstrates the strong relationship that Infinity Health and LNWH have established.