01.10.12
Sharing patients' stories
Source: National Health Executive Sept/Oct 2012
A shift to paperless working at the clinical haematology unit at Barts Health NHS Trust is helping to improve patient safety, consultant haematologist Dr Dan Hart tells NHE.
The implementation of Cerner Millennium at Barts Health NHS Trust’s clinical haematology unit has forced new ways of working as a necessary response to actual and potential patient safety incidents.
Dr Dan Hart, who helped lead the implementation, said the way the unit is using the software, especially its clinical as opposed to patient administration functionality, has been very much a “grassroots up rather than by managerial top-down diktat”.
Patient safety
The unit’s patients with severe blood disorders are particularly vulnerable to complications.
But some of them were coming into A&E and not communicating the nature of their blood disorder well – this has especially been the case with some patients from the Bangladeshi community, Dr Hart said, who may experience language and cultural barriers about challenging doctors and advocating on behalf of their own healthcare.
He explained: “We had a couple of near misses where they didn’t communicate they had a serious bleeding disorder and it wasn’t clear to the doctors looking after them: there were potential problems that could have ensued as a result.
“We felt we could use electronic note-keeping to make it clear, as every doctor opens up the same interface for each patient wherever they are in the hospital. If it was flagged up on the front page with a diagnostic label that there was a significant bleeding disorder, that was a way of changing the pathway of care potentially in an attempt to try to avert problems, make communication clearer and obviously improve safety.
“That went very well, so we then started adding in people’s diagnosis so that it’s clear to everybody who looks after them what’s wrong with them – not only what their bleeding disorder is, but if they’ve got other complications, such as heart disease, cancer or other issues.”
Continuity of care
The unit is now almost entirely paperless – except for cases where the law, regulations, data protection and privacy require things to be written down on paper. Paper note-keeping in the unit meant far too many things were written down but never actually seen by other people who might benefit from that information, or married up properly with records kept in the hospital.
Dr Hart said: “If we discharged someone at 2.30pm and there was a complication and they bounced back into A&E at 7 or 8pm, no-one would know or be able to see what happened at 2.30pm. Whereas now, you write down what’s happened and if someone else gets involved in their care later, it’s very clear what’s happened earlier in the day. There had to be buy-in from everyone, not just a few people having a go and others sticking to paper. We’re a very outpatientbased speciality, with a lot of ad hoc emergencies. Sickle cell anaemia, thallassemia, haemophilia – they’re chronic patients so we see them a lot and there are lots of people involved in their care. So in terms of continuity of care, particularly with junior doctors handing over rotas and people going off and on shifts, it’s been a good way of piecing together what’s going on with the patients.”
Dr Hart said as well as the patient safety benefits, there were also benefits for the patient experience and communication: “We’re starting to capture some detail of activity that was never previously recorded.
“It has changed my relationship with the patients in a way. I had a patient who had crashed his cab – relatively minor but he’d been through A&E. I hadn’t been involved in that clinical episode. He came back to the clinic three months later, and as he walked in and sat down, instead of me just sitting there smiling saying ‘how are you doing’, I could actually start by saying, ‘I’m really sorry to hear about the accident, is the cab back on the road?’”
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