Having immediate and remote access to a patient’s electrocardiogram (ECG) within a single integrated digital record allows clinicians to treat patients quicker, thereby improving outcomes. This helps to save time, improve flow and provide a positive patient experience.
Calderdale and Huddersfield NHS Foundation Trust (CHFT) perform around 7,635 ECGs every month1 across their two main sites, Huddersfield Royal Infirmary and Calderdale Royal Hospital. Digitising and integrating the process within their Cerner Millennium® electronic patient record (EPR) was an obvious step on their digital transformation journey.
To aid pressures within the Trust, especially during winter and all the demand that entails, CHFT were looking to deploy an integrated cardiology management system that would rapidly improve decision making in the accident and emergency department, flow within the organisation and support effective admission avoidance strategies to support the delivery of emergency care.
This was a key next step for ambulatory services across the Calderdale and Huddersfield footprint. The other areas of impact would be around the cardiology department and technicians that work across the hospital everyday visiting wards to perform ECGs. The new system would drive down inefficiencies, improve patient care, improve pathway processes for the staff throughout the Trust and allow cash-releasing benefits. The elimination of paper tracings in departments would mean that clinicians were no longer physically sought to view an ECG for their interpretation or to request a repeat when the paper ECG was unavailable, which was often the case.
To make this change project even more challenging, as a condition of funding from NHS Improvement, the Trust were challenged to implement within three months – an ambitious goal for such a major transformation project on this scale.
The Trust installed 30 new Welch Allyn ECG machines that integrate seamlessly into the Trust’s Millennium EPR, ensuring that results automatically populate patients’ record.
As a result, the end-to-end process and workflows now allow staff to quickly order ECGs on patient arrival, transmit them, and immediately view electronic ECGs from within the EPR for interpretation, from anywhere.
The Trust, and Cerner experts, worked closely with frontline staff in cardiology, the emergency department, and both inpatient and outpatient departments to develop the best new processes that supported a new digitally enhanced way of working. Training the workforce was also a key part of the project success with 90 percent of staff trained on the new process and tools. Education is ongoing, to continually improve and ensure maximum value is realised for clinicians, patients, and the organisation.
Associate director for digital health operations, Maureen Overton, recalled the real and immediate impact of digital ECGs on go-live day.
“A patient in A&E had an acute cardiac problem. Before, the ECG would have to be reviewed in the department before a decision was made. In this case, the cardiologist reviewed the ECG remotely, contacted the department directly and instigated tertiary treatment immediately.
“Whilst this patient would have received the appropriate treatment, the implementation of digital ECG enabled the process to be expedited in a much timelier manner.”
While major benefits include improved care quality, speed to treatment, and patient outcomes, the project also provides significant time savings for clinicians.
Removing time-intensive steps such as downloading data from the cart, entering patient demographics, manually matching records to the master index, and entering activity on other Trust systems now saves clinicians around 200 hours each week, the equivalent of five full-time equivalent staff (FTE).
Cardiologists can now review the results instantly in the EPR, and often remotely, which speeds up diagnosis in what is often a crucial time for treatment. Consultant and chief clinical information officer Graham Walsh said:
When you compare us to other sites, who have not achieved that number after a few years, let alone weeks, it’s a great achievement, made more impressive as we launched across all departments at once”.
Clinicians can review ECGs remotely, which has proved a massive benefit for all staff and a huge safety feature. Chief nurse information officer Carol Gregson said: “whilst reviewing the benefits of the implementation of digital ECG, a junior doctor working in ED was asked what her opinion of ECG digital was. She was incredibly sincere in her response when explaining that on her last night call, she had been unsure as to the plan of care for her patient who had an abnormal ECG, she contacted her superior who was able to remotely view the ECG whilst on a ward in a different part of the hospital and instigate preliminary care without the need to rush to ED unnecessarily. The benefit to patient and both clinicians were realised.”
Integrated digital ECGs:
The Trust have also seen a significant reduction in triage turnaround time by having the ECG immediately and remotely viewed, rather than requiring having to physically locate a doctor to review the ECG, with a clear audit trail as to which clinician signed off the ECG and at what time.
In the Trust’s cardiology outpatients clinic, they have seen an improvement in the patient flow whereby specialist nurses order ECGs as part of their clinic preparation – patients attend and have their ECG performed prior to their clinical review making the outpatient experience a smoother one.
As previously stated, the Trust is committed to becoming paperless and reducing its carbon footprint and as Graham Walsh has stated: "We are excited that we have got rid of another piece of paper in our journey to a paper-free Trust.”
The project involved collaborative working between colleagues within CHFT, the EPR ‘business as usual’ team, The Health Informatics Service (THIS) training and technical teams, as well as the suppliers, Cerner and Welch Allyn.
The Trust continue to share their learnings, challenges and successes with other peers and NHS organisations.
1. Cerner Lights On Network®, average ECG procedures from Jan – June 2019 = 7,635/month