Technology


and provision of critical care expertise delayed, including admission to critical care areas.7 Periodic monitoring of patient vital signs is


the backbone of “track and trigger systems”, such as the NEWS2 (National Early Warning Score), which use multiple-parameter or aggregate weighted scoring systems, allowing for a graded response. These systems work as a continuous loop that starts with measuring the patient’s vital signs, documenting them in the patient record, possibly an electronic patient record, and potentially communicating alerts or alarms triggering further actions by clinicians, such as increasing the frequency of observations, ordering additional tests, urgent response, or emergency response. Each of these further actions require communication and collaboration in a time-constrained manner. Consistent execution of this process is


challenging at each step. Measuring a patient’s vital signs contributes significantly to routine nursing workload on general hospital wards,8 when healthcare is facing one of the biggest staff shortages we have ever experienced.9 When staffing is lower, more observations are missed.10


Methods known to reduce the time


taken to document vital signs in the patient’s record (e.g., mobile devices) might be expected to free up clinical time, making it possible for staff to document more observations.8,11,12 The Imperial College Healthcare NHS Trust


deployed a connected vital signs monitor device to connect wirelessly to their electronic patient record system. The monitoring devices capture and record patient vital signs seamlessly at the bedside, while also providing caregivers with NEWS2 early warnings scores and escalation instructions automatically on screen.13


The mean time to take and record vitals was reduced from 2 minutes 35 seconds to 1 minute 12 seconds with the digital solution. By using bedside devices, 600 hours of nursing time was released from routine documentation and that time could be used in direct patient care.


be used in direct patient care. A saving of 30 hours per month of audit time was also achieved. Together, this was projected as 323,500 hours a year across the Trust.14 Improving the efficiency of vital sign


measurement has significant operational value for the hospital; however, recent studies have shown that this first step of “track and trigger” – tracking and storing vital signs data in an electronic system – may not in itself be enough to ensure early intervention and improve patient outcomes. Early warning score may not be as important as the clinical workflow and to whom the warning alerts are directed.15 It may be that not enough attention has been paid to how clinicians communicate and collaborate once a warning alert has been sent.16


Studies have documented the challenges


when trying to escalate care in response to early warning scores, with nurses commenting on their frustration, be it in accessing a doctor on the phone or in them attending to review the patient.17


“You are often ringing and ringing


them to come up…. The other day, I spent an hour trying to get a doctor to review a patient because of their early warning score,”18


The mean


time to take and record vitals was reduced from 2 minutes 35 seconds to 1 minute 12 seconds with the digital solution. By using bedside devices, 600 hours of nursing time was released from routine documentation and that time could


reported


one nurse at a large regional hospital in Ireland. One way to address this could be


interoperability between connected vital signs monitors, clinical surveillance software (which receives data from disparate systems and creates meaningful alerts to drive proactive interventions), and a unified clinical care communication system that connects care teams to improve care coordination and keep caregivers informed. The Gartner technology market research firm defines unified clinical care communication systems as IT systems deployed by healthcare providers, and used by clinicians and support staff, to communicate and collaborate on patient-related activities. They are used to share patient information, alarms and notifications, and optimise care transitions and patient throughput.19


It has been estimated that ~35% of


US hospitals have some form of unified clinical care communication solution.20


The relative


market shares of unified clinical communication technology suggest that, in Europe, the


deployment of such solutions has so far been less extensive than in the US.21 According to CWD, a leading multi-brand


provider of information technology solutions, key features of unified clinical care communications include:22 l Dynamic directory: Dynamic directory, or dynamic call routing, is essential for clinical collaboration. This feature uses answering rules to automatically direct a call to the correct care provider for a specific patient, based on on-call scheduling, answering service hours or other factors.


l Role-based calling: This capability aligns with the shift-based nature of healthcare work by directing communications to the correct caregiver, based on roles rather than individuals. Users no longer need to look at a list of names and scroll through to find the correct person to handle a specific need at a specific moment.


l Active response: In emergency situations, unified clinical care communication systems can send alerts directly to recipients, eliminating the need for overhead paging. This alternative reduces noise and stress in the already hectic care environment.


In addition to patient vital signs from a connected vital signs monitor, clinical surveillance software can also receive and alert to pathology lab data, including organ function data such as kidneys and liver. This data can provide insights about patient risk of deterioration. As this data is repeatedly captured over time, trends might emerge to give further insight to caregivers. A recent publication from Dorset County Hospital NHS Foundation Trust summarised the benefits of clinical surveillance software: l Uses real-time data from various clinical information systems across a facility, such as patient administration systems (PAS) and laboratory information management systems (LIMS) and applies advanced analytics to provide meaningful information to the users for clinical decision-making.


l User-defined alerts bring immediate attention to lab results, patient exposures


June 2023 I www.clinicalservicesjournal.com 49


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