Cambridge University Hospitals Show How Other NHS Trusts Can Prepare For Second COVID-19 Wave

In this blog Afzal Chaudhry, CMIO of Cambridge University Hospitals (CUH) NHS Foundation Trust and Debbie Pope is the Country Manager (UK & Ireland) for Capsule Technologies discuss CUH digitalisation and medication device integration and how other NHS Trusts can prepare for a second covid-19 wave.

• Introduction
• Efficiency and Automation are key
• A leader in digital adoption
• Lessons for covid-19
• Improved clinical and financial performance

All NHS Trusts and Foundation Trusts are warily eyeing the winter.

More time spent indoors with more people – even if most Britons do not return to workplaces, restaurants, pubs, theaters and other gathering places – still increases their risk of contracting COVID-19.

It appears, however, that more Britons are leaving home to meet family and friends in public spaces. According to an early September survey report from the Office for National Statistics, only 3% of Britons ventured out in public in mid-May, but that figure had already risen to nearly 30% at the end of August. If visiting a restaurant or pub during these outings, the risk of virus exposure is much higher due to face covering removal.

A second surge of COVID-19 cases poses challenges to Trusts that are still reeling from the first wave. A study released in early September shows that up to 10 million people could be on the care waiting list by April 2021 – more than double the number at the start of 2020 – if patients with COVID-19 start filling up the hospitals in the winter as they did earlier this year.

EFFICIENCY AND AUTOMATION ARE KEY

While it is impossible to predict the influx of patients with COVID-19, hospitals can mitigate overcrowding and reduce waiting list times by operating as efficiently as possible and delivering the highest quality care to encourage shorter hospital stays. Helping physicians, nurses and other staff work more efficiently also can help reduce spending and improve the Trusts’ financial performance, which suffered due to the significant decrease in elective care due to the pandemic.

CUH NHS Foundation Trust is an example that other Trusts can follow leading into winter and beyond. CUH’s focus on efficiency and streamlining provider workflows has reduced costs, while also generating additional benefits. Its strategy, which involved a complete transition from a paper to an electronic patient record (EPR) system and a comprehensive medical device integration (MDI) effort, yielded millions of pounds in annual cost savings, increased productivity in its surgical theatres, and improved the experience of providers and patients.

Although CHU’s digitisation and MDI initiative began years before the pandemic, the resulting efficiencies and improved care delivery to patients across a broad range of condition severities can serve as a guide for other NHS Trusts.

A LEADER IN DIGITAL ADOPTION

CUH is one of the most well-known healthcare trusts in the UK. Comprised of Addenbrooke’s Hospital and The Rosie Hospital, CUH’s vision is to improve patients’ quality of life through innovative and sustainable healthcare.

Becoming a completely paperless organization, namely by adopting its EPR, was a major part of that vision. In 2015, CUH was awarded the HIMSS Electronic Medical Record Adoption Model (EMRAM) Stage 6 status, which is one stage below the highest, and was revalidated in 2018. During this advanced EPR adoption, CUH developed electronic early warning alerts to automatically notify clinicians of potential sepsis in their patients, which resulted in a 42% reduction in sepsis mortality.

Alerts are based on data captured from medical devices. To further improve the accuracy and timeliness of the warnings for sepsis and other conditions, CUH wanted to develop a single solution for medical device connectivity and data management to inform clinical decision-making, but not just for critical care patients. Rather, the device data would be culled from surgical theatres, as well as the general ward and post-acute care areas.

Apart from predictive alerts, device data also would need to automate EPR documentation, which whe created manually was time-consuming, distracting for providers, and potentially a source of errors. CUH then wanted to supply device data to clinical research systems and beyond. This required a system that could capture inbound connections, but also parse the outbound data into multiple, customisable feeds to meet the requirements of other systems.

LESSONS FOR COVID-19

In parallel with the EPR implementation, CUH chose a medical device integration platform to capture and standardize its device data and make it actionable for its multiple purposes. This included integrating cardiac monitors, ventilators, anesthetic devices, and carbon dioxide (CO2) monitors into CUH’s EPR.

Data from ventilators, which are not commonly integrated with other medical devices, and CO2 monitors are particularly meaningful in assessing the status and trajectory of patients with COVID-19. The vendorneutral platform CUH chose captures and contextualizes medical device information, providing timely patient updates at the point of care. The expanded and deeper clinical context delivered by the integrated devices speeds provider comprehension, which improves staff communication and decision making.

More than 200 patient beds were connected by the integration. The phased implementation approach began with the intensive care unit and surgical theatres. Phase No. 2 expanded MDI across the remaining high acuity care areas, the A&E department, and additional device types, and then expanded the use of data into clinical research. With the first two phases of the implementation complete, CUH’s future integration plans include the general care wards and the use of data for decision support analytics. MDI was a key factor in CUH’s designation in 2017 as an NHS Global Digital Exemplar.

IMPROVED CLINICAL AND FINANCIAL PERFORMANCE

As a result of the EPR and MDI implementation, CUH is experiencing improvements in operational efficiency, accuracy of captured information, and time reallocation to activities supporting patient care quality and safety.

With automated charting, overall clinical documentation is faster and more accurate. CUH estimates its documentation time savings in Critical Care is equivalent to £2.6 million in annual staff time. Meanwhile, CUH increased the number of anesthesia theatre cases by 225 a year, in part due to the decreased turnaround time by three minutes per case.

The EPS and MDI initiative improved patient safety through a returned clinician focus on direct patient care, not on documentation. With access to a single source of truth, the number of appropriate clinical interventions CUH tracked increased while treatment delays decreased, which is an especially meaningful improvement given an impending increase of patients with COVID-19.

We have learned much about COVID-19 in the months since the pandemic began and we still have much more to learn. Although a vaccine appears to be on the horizon, NHS Trusts should nonetheless prepare for a challenging winter and optimize their facilities’ operations for a potential influx of patients, beyond what they have experienced in previous winters.

As CUH has learned, digitisation and MDI can support in that preparation by eliminating many repetitive and unnecessary data management tasks to enable higher quality care, improve outcomes and shorten both the hospitalisations for patients with COVID-19 and the length of waiting lists for patients seeking other needed care.

Capsule Technologies is a leading global provider of medical device integration, clinical surveillance and patient monitoring for hospitals and healthcare organizations. Our platform captures streaming data from virtually any medical device and transforms that data into context rich information to clinical documentation, alarm management, patient surveillance, decision support and research. Our end-to-end data management and connectivity supports better collaboration and communication, improves patient safety and overall satisfaction.