As part of the University Hospitals of Morecambe Bay NHS Foundation Trust’s (UHMBT) Electronic Patient Record (EPR) Optimisation Programme, the Emergency Departments (ED) have just taken a major step towards becoming ‘Paperlite’ by removing the paper CAS Card that is currently used in ED and replacing it with an Electronic CAS Chart available within the Electronic Patient Record.
In addition to the removal of the paper CAS Card, phase 1 also sees the digitisation of the core ED triage and assessment processes, including diagnosis, treatment and patient discharge. The digitisation once completed will remove over 60 existing pieces of paper that either start and remain in ED or start in ED and follow the patient into the hospital. This content will now be collected within the EPR.
These changes will significantly reduce the amount of paper form-filling that doctors, nurses and other healthcare professionals need to complete. It is accepted that initially this will take longer than the current process to record while staff adapt to the new way of working. However, benefits such as legible writing, the fact that patient information is always available for ED staff and the amount of time saved for audit purposes outweigh this.
These changes also provide staff in ED with instant access to key information about their patients that multiple staff can all access at the same time – which is impossible with a paper record. Appropriate staff will be able to access key information about their patients in an instant, without the need to wait for paper forms to be delivered from one area to another.
For the few paper forms that will still remain within the department at the end of phase 1, a scanning solution has been developed as part of the EPR Optimisation that means that staff can scan the paper form for a particular patient directly into the EPR so that it appears as part of the patients electronic record.
In addition, the current status board within ED will be expanded to take into account statuses and clinical indicators recorded in the system so that ED staff have a better overview of the ED Department and so can see at a glance what has happened to the patient and where they are on their journey as they progress through the department.
Phase 2 of the Optimisation Programme is scheduled to take place in September. This second phase comprises ‘Lorenzo on the Wall’ which is an interactive touch screen that presents an overview of the physical location of each patient within the department which enables real-time patient location tracking and treatment status.
The third and final phase of Optimisation within ED when Drug Prescribing and Medicines Administration (including medicines given to patient on discharge from ED) that are currently recorded on paper will now also start to be recorded electronically within the EPR.
Luca Pensabene, Associate Specialist Doctor at RLI ED, UHMBT, who has been a key participant in the EPR Optimisation Programme in ED, said: “This is a very exciting development with the potential to transform the way we work, providing clinicians with instant access to much better information that will help us provide the very best care for our patients.
When complete, the project will permit instant access to patients’ records, improving the quality of decision-making and patient safety and enabling more time for caring for patients.”
Dr Colin Read, Lead Consultant in Emergency Medicine at RLI ED, UHMBT, said: “It may not be possible to get rid of paper altogether as part of phase 1 but this is a major step towards our ambition of becoming truly ‘Paper-Lite’ with electronic systems that are fully integrated with each other and provide authorised members of staff with relevant information such as a patient’s medical history, allergies, test results, and so on.”
Paul Grout, Deputy Medical Director, Emergency Medicine, FGH, UHMBT, said: “During the run up to go-live, we were able to adapt the ED Medical Assessment Form during the testing session, resulting in a format that will significantly improve the governance of note keeping. The visible time and date stamp for actions/plans will act as a tool to aid flow within the department”.
Judith Walmsley, Sister in the Emergency Department at Furness General Hospital, UHMBT, said: “I have worked here for years – it will be a massive help not having to print out the CAS Card and Labels. This functionality will improve patient flow & I loved the new triage process. The new electronic CDC forms are absolutely brilliant especially when they calculate scores automatically. I realise it will take longer initially but it is worth it for the benefits this brings.”
Aaron Cummins, Director of Finance and Deputy Chief Executive, UHMBT, said: “This is a fantastic new way of working which will benefit our staff and patients in ED for well into the future. Well done to the team for all of their hard work.”