Scottish NHS achieves first in early warning and response for sickest patients

Frontline clinicians in Fife have achieved a major impact on patient safety following Scotland’s first-ever go-live of a comprehensive electronic clinical observation and early warning system.

NHS Fife became the first health board in Scotland to deploy a full-scale electronic track and trigger system, after going live with Patientrack at Victoria Hospital.

For the first time the technology has given healthcare professionals real-time visibility of the sickest patients on individual wards across the hospital, and has allowed a rapid improvement in the way staff monitor vital signs and respond to deteriorating patients.

We are the only hospital in Scotland with the ability to identify in real-time all of our sickest patients and have a meaningful clinical discussion about patient care

Cardiac arrests have fallen by as much as two thirds in one of the busiest hospital areas after only six months of using the technology. Doctors expect that the technology will impact in other ways and that it offers significant potential for hospitals throughout Scotland.

Dr Gavin Simpson, consultant critical care and anaesthetics at NHS Fife, who led the clinical deployment of Patientrack at NHS Fife, said: “Any clinician can now instantly see the profiles of the sickest patients in the hospital. Patientrack has helped us introduce some of the biggest and most-immediate changes in clinical practice I have ever seen.

“There are warning signs before cardiac arrests. The key is to pick them up quickly - that is what Patientrack allows. Patientrack has helped us achieve an immediate and significant reduction in cardiac arrests in one of the busiest areas of the hospital, by up to two thirds.

“Moving forward, Patientrack has the potential to address a range of clinical problems faced by hospitals across Scotland.”

The technology works by ensuring that crucial observations are not missed and allows nurses to capture vital signs digitally at the bedside. Patientrack then accurately calculates the patient’s early warning score and automatically calls doctors when signs of deterioration are present. The system continues to escalate calls until patients receive an appropriate response. This has already meant that nurses using the system at Victoria Hospital in Fife no longer need to manually phone for doctors to attend, and can more effectively prioritise patients.

Marie Paterson, senior charge nurse on the cardiac care unit and cardiology ward at NHS Fife, said: “Patientrack is a really-useful tool and assists us to keep patients safe. It helps the nurse in charge to see where the deteriorating patients are being nursed, which is really helpful when organising teams. It allows the nurse in charge to check that these patients are receiving the appropriate care and to give advice and support to junior colleagues who may be caring for these patients.”

Moving forward, Patientrack has the potential to address a range of clinical problems faced by hospitals across Scotland

The technology has also had an impact on NHS Fife’s safety huddles, where clinical teams meet daily to review clinical and operational safety issues and are made more effective by the use of Patientrack.

Dr Rob Cargill, associate medical director at NHS Fife, said: “We are the only hospital in Scotland with the ability to identify in real-time all of our sickest patients and have a meaningful clinical discussion about patient care.

“Our safety huddle prioritises clinical issues and allows a multi-professional team to discuss individual patients at risk and ensure there is a management plan in place. It is enormously powerful to be able to view a live summary of where the sickest patients in our hospital are so we can respond appropriately.”

Encouraged by Scottish ministers, safety huddles are designed to ensure patients at risk are identified and managed collaboratively. In NHS Fife, live data, shown through the Patientrack system during the safety huddle meeting, ensures that every area of the hospital is aware of priority patients and that wards are properly equipped to care for them.

Val Hatch, divisional general manager for emergency services in NHS Fife, said: “Our safety huddle has developed over time to have less discussion around bed management to become a conversation about supporting appropriate clinical decisions. This has been enabled by having real-time information on the whereabouts and status of every patient across the hospital and encourages high levels of clinical engagement.”

Healthcare professionals now believe the technology has significant potential for other hospitals in Scotland, with the technology supporting the objectives of the Scottish Patient Safety Programme to reduce hospital mortality, to better identify deteriorating patients, to reduce cardiac arrests, and to target serious conditions like sepsis. The track-and-trigger system also offers Scotland’s hospitals an opportunity to meet the ambitions of Scotland’s Healthcare Quality Strategy by reducing avoidable harm as well as progressing the 2020 vision of Scotland’s eHealth strategy to electronically record and share findings in order to quickly and easily initiate care processes.

William Edwards, general manager for eHealth and IM&T at NHS Fife, said: “This is a prime example of eHealth at its best: clinical teams collaborating with technology specialists to deliver better, safer care for patients.

“Healthcare professionals in Fife have taken the lead and worked in partnership with IT teams to respond to real clinical priorities and make technology work for the good of the patients we serve.”

This is a prime example of eHealth at its best: clinical teams collaborating with technology specialists to deliver better, safer care for patients

Dr Grant Forrest, eHealth clinical lead at NHS Fife, added: “It is great to see a project where eHealth has made a significant difference to frontline care, helping staff to swiftly communicate crucial information needed to keep patients safe. IT can bring the most value when clinicians and technology specialists get together to understand and address real challenges.”

And Donald Kennedy, managing director of Patientrack, said: “NHS Fife has become a Scottish pioneer in using its information to quickly understand where it’s most-unwell patients are, so that it can immediately prioritise resources and alert clinicians to intervene. This is a fantastic move for better, safer care in Scotland and we look forward to spreading the benefits across the country.”