Birmingham Women’s and Children’s NHS Foundation Trust Use Case Study
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Within the NHS it is widely recognised that approaches to healthcare need to change. Technology is playing a key role in the redesign of services. Within this environment of change, the Patient Status Engine can enable a suite of healthcare solutions which will lead to improved clinical outcomes, reduced overall cost and increased revenues.
No matter which care model you’re focused on and where you’re located, the PSE can support your requirements.
The current challenge Of the 1.5 million children admitted to UK hospitals every year; 650 suffer cardiac arrests and 3,000 die. Most have signs that indicate deterioration before the life-threatening event, however, these deteriorations can often be missed. Birmingham Women’s and Children’s NHS Foundation Trust wanted to use the Patient Status Engine to take wireless continuous observations from patients and use this data to understand, in real-time, what is normal for each patient and to detect the changing patterns in their physiology. This continuous monitoring allows deterioration to be recognised, triggering an alert and provoking timely intervention to prevent patients suffering further deterioration and death. This is the first time this technology has been used in this way, anywhere in the world.
1.5 million children admitted to UK hospitals every year
650 suffer cardiac arrests
3,000 die
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The Patient Status Engine Isansys largest study to date has been the RAPID (Real-time Adaptive and Predictive Indicator of Deterioration) project at the Birmingham Women’s and Children’s NHS Foundation Trust. The three-year project was started in 2014 and was funded by a £1.8m grant from the Welcome Trust, Innovate UK and SBRI Healthcare. So far, more than 1,300 pediatrics (from neonates to 16 years) have been monitored for an average period of 75 hours. Isansys worked with Birmingham Women’s and Children’s NHS Foundation Trust on the RAPID project to show the feasibility of the Patient Status Engine and the new data analytical techniques running on the platform. The project focused on the development of the new personalised selflearning early warning score – the RAPID Index.
The Patient Status Engine enables clinicians to collect patient’s physiological data including heart rate, pulse rate and respiratory rate and offers remote access to the data collected. All of this is done without wires or cables. Instead patients wear tiny wireless smart patches also designed and manufactured by Isansys allowing them to move around more freely, all the while being monitored as if they were in a high dependency unit. Predictive algorithms created by the Birmingham Women’s and Children’s NHS Foundation Trust and Aston University for the project which interface with the PSE are individualised for each child, and analyse large amounts of physiologic data in realtime to monitor and identify patients whose health status is trending towards deterioration. The University of Birmingham is providing insight into the Health Economic benefits of translating the monitoring device into standard care.
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Significant results to date
Proactive approach By analysing and modelling large amounts of data in real-time this allows for a more proactive approach to monitoring patients.
1,300 paediatric patients A secure system for collecting continuous wireless vital signs ensures that more data is available than from routine observations, data is stored for review so clinicians can look at each patient’s vital signs and see how they change over a longer period of time and in response to interventions.
1,300 pediatric patients have been monitored for an average of 75 hours.
Collecting data efficiently An Android tablet has been repurposed as a much cheaper way of collecting data than expensive monitors. The team have solved difficult power management issues and steadfastly eliminated sources of data loss.
Waste is reduced The Lifetouch wireless wearable sensors are fully recyclable so waste is reduced; this is the first monitoring sensor to be recycled. Doctors and nurses can easily access up-to-date patient information, enabling faster treatment decisions, resulting in improved outcomes for the patient. Processes are being streamlined, allowing each nurse to efficiently monitor and take care of a greater number of patients with better access to quality data. The automatic nature of the PSE saves nursing time, increases productivity and allows for better patient care.
Detect deterioration faster The RAPID Index enables the clinical teams to see those more subtle and slower changes in a patient’s condition and, with the use of early warning scores, staff are able to detect deterioration faster.
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Potential benefits include Increased hospital capacity to meet growing demand for specialised pediatric care. Reduced waiting lists for planned interventions as a result of increased patient throughput. Possible financial saving for hospital to adopt PSE based vital sign monitoring for at-risk patients. Immeasurable benefit to quality of life for those patients and families where the PSE averted an adverse event. Increased monitoring information: More frequent data from continuous monitoring and early warning provides deeper insight into what a patients’ physiology has been since monitoring commenced and an indication of when patients are at high risk of deterioration. Early calls for expertise to bedside or/and early intervention will lead to subsequent reduction in morbidity and mortality.
Parents prefer the freedom wireless monitoring offers them so they can pick up and cuddle their children more easily and move about with getting tangled in wires. Patients prefer to be mobile and not wired to a bed so they can eat, interact, or go for a shower whilst being monitored. Increased hospital capacity to meet growing demand for specialised pediatric care. Reduced waiting lists for planned interventions as a result of increased patient throughout. Possible financial saving for hospital to adopt PSE based vital sign monitoring for at-risk patients. Immeasurable benefit to quality of life for those patients and families where the PSE averted an adverse event.
Increased time to care: Nursing time spent on response to false alarms can be diverted towards patient care. Continuous wireless monitoring of physiologic data that does not require active input will help reduce nursing time required to actively input all required physiologic data. This saving in time, as a result of smarter working, can also be diverted to provide good quality care to increasing patient populations.
Parents prefer the freedom wireless monitoring offers them so they can pick up and cuddle their children more easily and move about with getting tangled in wires. Patients prefer to be mobile and not wired to a bed so they can eat, interact, or go for a shower whilst being monitored.
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Expected outcomes include The benefits of increased time to care and efficacy at the Birmingham Women’s and Children’s NHS Foundation Trust will be assessed at the end of Phase 2 of the project. Cost effectiveness of the Patient Status Engine, the translation to practice, and clinical/ health economic evaluation will be evaluated at the end of Phase 3 in 2018. This programme of work will assess the actual impact on improving clinical outcomes, reducing overall cost and increased revenue.
5% reduction At least 5% reduction in average length of stay in PIC as a result of early detection of deterioration and timely intervention.
160 children Currently 160 children per year are admitted urgently to PIC at BCH, from the cardiac wards, with an average length of stay of 4.5 days.
£108k saving Improved quality of care as a result of increased nursing time to care, without increasing staffing.
At least a 5% reduction in average length of stay in ward beds through early warning of children at risk and hence more timely escalation of acute care.
£50k saving
At an average cost of care of £13,500 per child (£2,500/day) this equates to a potential saving of about £108K per year on these admissions.
25 PIC admissions Improved efficiency would permit an extra 25 PIC admissions per year without increasing staffing. This equates to half the patients on the cardiac surgery waiting list.
This will save 100 bed days (£250/day), with a projected saving of about £25k per year. We also expect to catch at least 1 preventable cardiac arrest per year, representing a saving of £50k.
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Feedback from Birmingham Women’s and Children’s NHS Foundation Trust
“The Patient Status Engine is assisting us in decision making and helping us to provide the right care at the right time for the patient.” “With the PSE, the data is stored and we can look back at that patient history. We can then use this data to be able to identify patterns or trends which allow us to look at how to treat patients in the future.” “Now, for the first time, doctors can access a lot more information about their patient’s health status and because of that they have a clearer idea about what they’re looking for.”
“The PSE enables a fast, efficient handover. This makes processes much more efficient and reduces transcription errors.” “Alarms at the bedside increase parent anxiety and means nurses have to constantly reassure the parents. This takes a lot of time when it’s not actually a real alarm. The PSE reduces these false alarms and frees up time to care - allowing nurses to spend more time caring for their patients.” “It’s phenomenal what we’ve learnt from the data collected by the PSE. It’s going to revolutionize the way we monitor patients.” Research Nurses at Birmingham Women’s and Children’s NHS Foundation Trust
Feedback from Birmingham Women’s and Children’s NHS Foundation Trust
“This technology is truly transformational. It allows us to analyse many more patients’ data in realtime for the first time in the same way that various other high-risk industries have done for years. The ability to track and identify deterioration towards a cardiac arrest will give doctors the chance to save the patient’s life. I genuinely believe that this will change the way we care for patients in hospital forever.”
“The PSE allows us to get a sense of the patient’s specific ‘normal’ and determine what their early warning thresholds should be. We can now know the status of a patient’s health at all times and be alerted to deterioration within minutes. This makes for a very powerful tool.” “This new wireless technology is usable and reliable. It’s better at reducing false alarms. This technology essentially allows us to have fewer expensive monitors and at the same time monitor a lot of patients, generating a lot of data.” Dr Heather Duncan Principal Investigator And Clinical Lead For The RAPID Project At The Birmingham Women’s and Children’s NHS Foundation Trust
Feedback from patients
Gulshaz, Nusaybah’s mum: “The Isansys Lifetouch has allowed me to cuddle her, lift her and care for her in the way I want to. It’s given me peace of mind and a sense of norm.”
Noreen Akhtar, mother to Anayah: “The Patient Status Engine has made things a lot easier; especially when it comes to creating that bond between a mother and her daughter, which is really important. When Anayah was monitored using wires it was difficult to hold her and pick her up. The wireless monitoring means I can do this and move around. It makes the bond more special.”
Shaun Lewis, the father of Kaleb: “Kaleb’s been through a lot and having the Lifetouch on him means there are less wires around him, so we can actually be a parent to him”
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