Nurses and midwives within West Suffolk NHS Foundation Trust led key elements of the implementation of a smartphone communication app, which has significantly improved the efficiency of communication, patient experience and safety of their services, releasing staff resources to spend more time with patients.
Where to look
The Trust previously used a pager system to alert staff and to escalate concerns. This communication was one-way with the recipient being unaware of who was bleeping and why, or the level of urgency and there was variation in its use across individuals, specialist teams and wards. With the previous system staff noted that work was interrupted, time was not used as efficiently as it could be, prioritisation was difficult and the evidence trail was limited. Nurses spent a large amount of time using the pager system, for example finding the correct pager number, ensuring that a message had been received or waiting/following up a response. With this in mind, the team were concerned that they were at risk of lapses in the care they could give patients, hence the need for change. The research supported this as there are many examples that have outlined the use of mobile telecommunication devices and their importance in hospital workflows (Prgomet et al 2009 and Banitsas et al 2004)
The team recognised that Information and Communication Technology (ICT), has revolutionised the landscape of healthcare in many areas and felt digitally upgrading would be key to reducing the unwarranted variation in practice. Studies suggest that traditional pager-based interpersonal communication may contribute to inefficient communication practices and lapses in care when compared with use of digital technology (Agarwal et al 2010). Effective communication between caregivers is a key objective in the pursuit of safe and efficient care delivery. Staff at the Trust saw an opportunity to optimise resources, using an app-based approach, in order reduce the unwarranted variation the nurses were seeing in practice as well as improve efficiency of communication.
What to change
The team explored whether there was a different option that could improve the communication within teams in the hospital, as well as with primary and community care partners. A communication app was considered the best option and commissioned as a replacement to the non-cardiac pager. Features built into the app included individual and group text and audio messaging, audio calls, image and file sharing, viewing when a message is sent, delivered and received, viewing role, availability and on-call status of colleagues and pin/fingerprint protected login.
How to change
A pilot was conducted in the trauma and orthopaedic ward and maternity ward, led as a team effort by the Chief Nurse, Matron of Surgery, Matron of Midwifery, nurses and midwives on ward and in the community. Each clinical area had a week to adjust their communication workflows to the app and a week to use it solely for their communications. Nursing and midwifery ‘champions’ encouraged, trained and supported colleagues to use the app. Patient etiquette training was also delivered to staff by the Matron of Orthopaedics in order to make sure that the smartphone use was understood by the patients or relatives using the service and that the patient felt involved in their care.
The Trust conducted a time and motion study in order to monitor and evaluate the app and the tasks and communications times within it, in comparison to the old pager system. It also monitored the number of interruptions seen in practice so this could be analysed further. Two days of nurse pre-pilot time motion studies and pre-pilot qualitative questionnaires were completed. Nurses and midwives fed back what was working well and what could be improved in their communication workflows.
The Chief Nurse played a key role in changing the culture around the use of mobile phones on the ward especially in supporting staff in overcoming any initial concern they may have had. The nursing leads engaged with staff to find out their understanding of the app, any issues they had and talked through the practical application of the app.
Patients were spoken with to ensure their perspectives and needs were taken into account for the pilot.
Better outcomes – Patient safety has improved as staff can communicate in real-time for quicker and informed collaboration, with clear written instructions and clarifications. There is better recall with an audit trail and the technology enables having the skills and input from the right staff at the right time, with earlier escalation of care.
The app has significantly improved the efficiency of communication within and between teams in the hospital and primary and community care, leading to an improved service for patients. In a qualitative questionnaire, staff reported a significant improvement on response time. In response to the question, ‘On average how long do you wait for a response in your base ward before you can complete your patient’s management discharge plan?’ there was an improvement from 44% to 80% for replies within 5 minutes.
Better experience – The pilot went well with teams reporting that they would be very likely to recommend the digital app, and patients when involved were keen advocates of the technology. Patients, relatives and carers are in favour of the technology as their care can be delivered quicker and more effectively. Patients have given positive feedback to being shown the app and messages about their own care.
Better use of resources – The digital app has freed up nursing capacity by 2,536 twelve-hour shifts per annum. On average the app has saved nurses ten minutes per take-home medication prescription and eleven minutes per patient review, equating to a saving of twenty one minutes per shift. The app has also demonstrated a reduction in workflow disruption compared to the old pager system which is positive. Savings of approximately £4.5 million per annum are projected to be achieved by the Trust which include, but are not limited to, freeing up clinical capacity by the equivalent of eighteen full-time nurses and eighteen full-time junior doctors per annum, and improving general communications between services.
Challenges and lessons learnt for implementation
- Daily scheduled catch ups with the wider team are important to understand if anyone is having any issues or challenges, which helped shape the Standard Operating Procedures for the ‘go live’ period when the technology was embedded.
- Infrastructure is key here as this technology is heavily reliant on hospital Wi-Fi so ensuring this is in place is important.
- The right training, adoption and embedding a solution takes time and effort but is invaluable.
The Trust has been selected as a Global Digital Exemplar. These are internationally recognised NHS providers delivering exceptional care, efficiently, through the use of world-class digital technology and information.
Find out more
For more information contact:
- Rowan Procter, Executive Chief Nurse, Rowan.Procter@wsh.nhs.uk