The Challenges
Southend Hospital National Health Service Trust, treating 70,000 in-patients a year, wanted to improve the patient discharge process with speed and efficiency. When patients leave hospital after treatment their discharge paperwork sometimes goes missing or fails to reach their GP through the post. Whether by human error, or simply pressure on overworked staff, such mishaps can result in serious consequences for post-hospital patient care.
Southend Hospital decided to look for a technology solution to help manage and improve the discharge process, currently taking at least 30 minutes to complete for every patient, absorbing time that doctors or nurses could be caring for other patients or reassuring relatives.
The process to produce a patient discharge form was totally manual and was handled differently by each department. It took two forms. A quick summary note written on the ward and given to the patient to hand to their GP and a more detailed note sent to the GP through the mail. The summary note was also sent to the hospital pharmacy to instruct the pharmacist to issue any drugs patients needed to take at home between leaving hospital and seeing their GP.
This second form outlined diagnosis, patient history, tests undertaken, treatment plan, medication on discharge, and follow up. The more detailed note required the patient case notes file. However, the file was sent for coding immediately after the patient left hospital and it could take up to six weeks before it was returned to the consultant in charge of the treatment. After that it could take a further two weeks for the consultant to prepare the summary and mail it to the GP.
Solution
WCI developed a solution based on Microsoft Office InfoPath® and delivered the solution for the trust in just 20 days, for the first five users.
The InfoPath design mode provides drag-and-drop insertion of controls, data validation, a view of the underlying schema, an interactive preview which demonstrates exactly how the form will behave and look when completed, and a publishing wizard that simplifies form deployment. The forms are automatically populated with information from the trust’s Patient Administration System (PAS). The clinician or nurse logs into the network using their normal Microsoft Windows® login credentials on Tablet PC and accesses the InfoPath form for the patient who is waiting to go home.
If more than one patient matches the details entered, the system pops up a list of matching patients and demographic details for the user to select. After selecting the patient, the nurse can prefill as much of the data as possible prior to the doctor finalising the patient’s release. When the form is complete a hard copy is automatically printed for the case file and the form itself is saved in SQL Server.
Microsoft BizTalk® Server is used to integrate the InfoPath form with the hospital pharmacy to prepare the medicines for the patient to take home. The completed form is automatically sent to the patient’s GP on a secure e-mail solution and at the same time an e-mail goes to the hospital pharmacy to prepare any drugs the patient needs until he or she sees their own doctor. The project was developed using the Microsoft .NET Framework and Microsoft Visual Studio® .
Benefits
The automated patient discharge forms will save Southend Hospital NHS Trust the equivalent of 20,000 working hours a year enabling doctors and nurses to spend more time with patients and fewer working hours on paperwork. Benefits will be primarily experienced by the patients, with paperwork handled electronicaly, nurses and doctors will have more time for the human touch.
The InfoPath forms can be pre-populated with patient data through interfaces with the existing patient data system. This enables doctors to complete the whole process of discharging a patient from hospital in only five minutes, compared to on average half an hour with the old manual system. GPs now have the ability to see a secure electronic copy of the discharge information which eliminates the delay previously experienced. Patients benefit from a greater continuity of care and are more easily reintegrated into the community after a hospital stay.
WCI’s excellence in technology and expertise in implementing lean processes was fundamental to the success of this project. This unique capability is coupled with an 18 year NHS track record, enabling trusts and other healthcare organisations to meet government targets, streamline processes and satisfy local clinical requirements.