RealTime Ward View
Reducing Length of Stay is a critical activity for hospitals seeking to reduce costs and improve patient flow. Managing this through clinically driven Estimated Dates of Discharge requires a sophisticated approach.
Cloud2 and our partners provide a sophisticated software tool, RealTime, to support our this, however the key to its effectiveness is the process change and introduction of elements of the Effective Ward.
In addition to the core AvLoS capabilities, this combination of software and services it also addresses infection control, Section 2 and section5 interactions with social services and VTE assessments.
RealTime is a combination of clinical process change and cutting edge software. Unlike conventional bed management systems, RealTime can be inserted easily into existing infrastructure to provide a web-based, point-and-click, simple to use set of graphical tools and views that allow the discharge process to be managed across multiple sites in real time, against agreed key performance indicators.
Financial improvement within hospitals depends on a number of factors, including improvements in the day to day management of hospitalised patients and the development of a clinical culture that is supportive of efficient care delivery representing key leverage points.
Hospitals do not know in real time where their patients are ‘at a glance’, either in terms of their physical location or their position on a care pathway, en route to discharge. Hospitals equally do not know reliably in real time which resources are available by category for new admissions and transfers. This leads to daily confusion that reduces throughput and creates significant inefficiencies in management of the patient journey through the hospital.
RealTime helps hospitals solve three key problems:
- Reducing average length of stay (ALOS)
- Knowing where the patients are
- Reducing and monitoring Healthcare Associated Infections.
For more information on RealTime visit http://www.realtimehealth.net or see the document downloads
Background
Whatever their size, specialities and number of beds, successful hospitals need to minimise patient length of stay (LOS), to increase the number of patients they are able to treat effectively, to enhance patient outcomes, avoid adverse events due to extended stays and to improve productivity across specialties.
Benchmarking against national LOS standards and identifying blockers and hurdles to efficient patient flow are key to this.
Trusts that make improvements in this area achieve multi-million pound savings/efficiency gains, deliver a better patient experience and patient improved health states and have a substantial impact on infection control targets.
The Problem
There are many, interlinked factors that affect the length of stay for a patient. These include the full gamut of patient specific conditions, resource availability, treatment pathways, staffing, logistics and external agency interactions.
With approaches and processes differing from ward to ward and limited visibility of the overall processes it is difficult to make systemic improvements. With limited tools to flag outliers, high risk patients and localised issues it is equally difficult to deal with case by case challenges.
In the absence of planned discharge dates, set at the time of admission, it is impossible to schedule resources and hand over events efficiently.
These issues require a sophisticated resolution, encompassing process change at many levels, effective technology supported reporting and real time insights into bed/patient status across the trust
The solution – Change management + software
Our approach recognises the complexity of the challenge and addresses it using a combination of strong Change Management supported by RealTime software to provide decision support for strategic planning, patient flow and discharge management.
The aim is to ensure pre-emptive discharge planning & reduced Average LOS (AvLOS) are embedded in the organisation, especially at ward level, in order to:
- Save money
- Improve patient flow and capacity
- Increase efficiency
- Allow management reporting for capacity planning
- Expose blockers and inefficiencies
- Improve infection control
This contributes to Quality, Innovation, Productivity and Prevention (QIPP) objectives.
Implementation
Discovery
- Assessment of priority areas
- Agree targets for LOS vs. National Standards
- Analysis of cost drivers
Business Optimisation stage
- Care pathway reconfiguration
- Streamlining services
- Implementation of Business Change
Software Configure (Realtime )
- Build ward specific layout plans and bed models
- Configure care pathways for process and discharge criteria for optimal LOS
- Build interfaces with other systems (PAS etc)
- Data load
Technical Implementation
- Install infrastructure
- Software install
- Integration with legacy systems (PAS etc.)
- Test
Roll out
- Go Live planning (phased vs Big Bang)
- Readiness assessment
- Training
- Technical Go Live
- Business Go Live
Continuity
- Support
- Review – Evaluation and Improvement
- Phase 2 planning – wards, specialties, blockers, further optimisation, Infection control
RealTime Software features
The RealTime application was developed in Oxford and is a browser based server application with a user friendly drag and drop interface. It provides staff with configurable, graphical views of bed occupancy across the Trust. RealTime shows a live view of where the patient is, their current status and what to do to enable a timely discharge. It offers integration with PAS and other systems for exchange of data to ensure all systems are in sync.
The Ward view is anonymised, allowing RealTime to be used, in public, as an electronic whiteboard via a large format display screen. Expected discharge time for each patient is visible and provides a daily count down to planned date of discharge. Views are categorised by condition, diagnosis, infection, consultant, target LOS, etc.
Key Performance Indicators (KPIs) show snapshot and historical performance analysis:
- Patient movement tracking report
- Rolling newly isolated infections immediately assists infection control staff
- Monthly ward and specialty based infection control reports, including graphical representation
- MRSA Screening tracking and reporting
- RealTime promotes protocol-driven Estimated Date of Discharge (EDD) and formalised discharge criteria to promote the clinical tracking of patient care goals , while care pathways are also supported. Easily accessible through a browser, it helps ensure staff can:
- Track patients’ progress towards discharge
- Hold informed discussion with consultants
- View up to date, live progress reports,
- Ensure all services and agencies are ready when the patient is clinically fit for discharge
