Technology
There is no longer a need to take a printed document, write a name, or manually record data - reducing inaccuracies and errors in patient care, and risks of records going missing or being misfiled.
Carbon, cost, and clinical impact Significant impact is being realised. The Trust now prints far fewer ECGs. This is saving thousands of pounds in printing costs alone, and we require fewer physical machines, having reduced our reliance on printing carts. This is in turn beneficial to the Trust’s environmental impact. Although we are still to quantify many clinical benefits, impact has been very significant. Inappropriate admissions are not happening anymore. Delayed treatment of patients is now being prevented, and savings can be made on avoided inappropriate tests such as angiograms and angioplasty. Clinical risks are also being mitigated – for example, the risks of inappropriate procedures that we are now better positioned to prevent through informed decisions.
Additional blood tests for troponin that might be carried out in the absence of information, are being avoided. These can lead to longer hospital stays as patients wait for results. If taken during the weekend, a patient might have been required to remain in hospital for the remainder of weekend as they wait to be reviewed by a specialist on a Monday, and might have been sent for a CT scan, or for review by other specialists – all of which can now be more easily avoided when not required. Better compliance with national guidelines
around the timeliness of key interventions, and ‘door to balloon’ times, has also been supported. Patients with some of the most severe heart attacks can require their artery to be opened within 90 minutes. At Barts Health we aim to do this in 60 minutes. Our compliance has improved to approximately 95% in the last year, as part of a package of measures that includes more easily comparable digital ECGs. In so many ways, availability of information means that we are releasing scarce healthcare resource for those in greatest need, reducing cost, improving safety of patients, and rapidly putting the patients on the right pathway.
Patient satisfaction Patients have remarked on their satisfaction with our new approach. Paper-based ECGs, that have the potential to go missing, can frustrate patients if delays ensue in recognising when they have not had a heart attack. But now, with access to ECGs from different sites, we can confidently examine a dozen or more ECGs that all look the same, and advise the patient they don’t need further tests for a heart attack, within seconds of accessing their record. There has been a noticeable difference in
the way we treat patients, and the way they feel about treatment, with many saying how impressed they are that we can make such determinations so quickly.
Analogue to digital: An opportunity to scale? We have now carried out some 200,000 digital ECGs. If there is one negative – patients sometimes question why this isn’t available everywhere. My aim is to promote this digital initiative, so that as many hospitals as possible can consider incorporating similar approaches. The opportunity is to scale this beyond Barts Health. We are living in a world of AI, and of exciting emerging technologies. The fact that ECGs remain on paper seems strange, and might be described as an example of Lord Darzi’s description of an NHS in the “foothills” of digital transformation. Opportunities to unleash raw data that exists in ECGs, and to potentially leverage AI to predict what might happen to patients demonstrates that more could be done to realise even further benefits from work we have started, a conversation I am beginning to explore. More immediately, this is an affordable and
straightforward aspect of digitisation to deliver – one which utilises relatively inexpensive ECG
machines that may already be in place for many hospitals. Efficiency, high-impact possibilities, and the potential for better outcomes, might make this attractive to others. As the NHS continues to deliver large scale digitisation programmes against a policy backdrop to shift from ‘analogue to digital’, this initiative merits attention from boards to wards.
CSJ
About the author
Dr. Krishnaraj Sinhji Rathod is an Interventional Cardiology Consultant at Barts Heart Centre in London, UK and a Senior Clinical Lecturer at The William Harvey Research Institute at Queen Mary University of London (UK). His clinical interests are within complex coronary intervention, particularly CHIP cases. He has an academic interest in observational studies and outcomes following percutaneous coronary intervention and has over 130 peer reviewed publications and has over 250 abstracts. He has also presented at over 50 International Cardiology conferences. Other research interests include conducting interventional clinical trials. He completed a PhD in translational medicine at Queen Mary University of London funded via a prestigious NIHR doctoral research fellowship.
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