The roll-out of e-Obs on mobile devices connected up to 5,500 staff, including doctors, nurses, physiotherapists and dieticians on 76 wards at both the Queen’s Medical Centre and City Hospital.
Prior to the pilot, recording of patient observations and early warning scores (EWS) of acutely ill patients were previously manually calculated and inputted onto a paper chart.
The eObs software, developed by Nervecentre Software Ltd, not only automatically calculates EWS and generates clinical alerts it also provides clinical staff with up-to-the-minute patient information at their fingertips.
Dr Mark Simmonds, Consultant in Acute and Critical Care Medicine and Clinical Lead eObs Programme at NUH, said: “Good clinical care is all about information and communication. eObs has not just revolutionised patient observations but thanks to eHandover, clinical staff now have crucial details about patients in the palm of their hand which is accurate, up-to-date and shared by the whole team.”
The evaluation study was conducted by the Human Factors Research Group & Horizon Digital Economy Research Institute together with ICT Services at NUH.
Lead academic, Dr Alexandra Lang, Human Factors Research Fellow in the Faculty of Engineering, University of Nottingham, said: “After the eObs package was introduced we noted staff spent less time in offices filling out and checking paper notes and talking on the phone to glean or chase patient data from ward colleagues or those in other departments.
“This meant both medical and nursing staff groups spent more time on wards, visible to other staff, patients and visitors. The time spent with patients increased for both nurses and doctors, in the case of doctors that time was doubled.”
The study observed that the accessibility of information provided by eObs on mobile devices appears to have improved communications between clinical staff, patients and relatives.
Similarly using eObs boosted communication within ward teams, meaning clinical staff could fast-track discussions on observation data to address treatment plans for patients.
Caron Swinscoe, Head of Clinical ICT at NUH, said: “More time to spend with their patients is the greatest gift that technology can give to a clinician.
“Our doctors, nurses and midwives now have the technology they need to be able to provide the highest quality care, helping them to prioritise their workload and giving them more time for direct patient care.”
Interview feedback indicated that the shift to eObs facilitated remote decision-making and work allocation for medical staff, for individual and team tasks.
There was also universal praise for the specialist clinical ICT team, trained as ambassadors and technicians who led the deployment, and were cited as a key reason for a successful roll out.
The aims of the evaluation were to:
• capture and evaluate the impact of technology on staff practice and how it is used by staff
• provide guidance for future implementation of technology
• report on staff satisfaction with change in technology and practice
• Provide guidance for future implementation of technology
The evaluation employed two methods: 85 hours of direct observation of staff activity; and 18.5 hours of face-to-face interviews with 40 medical and nursing staff, in various job roles and seniority, on 19 wards. Interviews ranged from 12 to 65 minutes.
Observation sessions, which lasted between 15 minutes and two hours, were carried out before (24 times) and after (65 times) the deployment of handheld technologies to record staff activities, tasks and locations on the ward. This method was selected to quantify changes in the distribution of activities for each staff group.
Observers ‘shadowed’ staff, using a bespoke application running on a tablet computer to record activities and locations from exhaustive lists. Data were collected by human factors researchers at The University of Nottingham and by clinical staff managing the technology rollout.
Semi-structured interviews and focus groups were undertaken to elicit staff experiences of the eObs system deployment and feedback about their use of the software and handheld technologies in clinical practice. All interviews were carried out post-system deployment, with staff experience of the system ranging from one week to five months.
Key learning points for future technology deployments:
• deployment of this technology takes time, must involve working directly with users and must be supported by a specialist clinical deployment team
• junior staff adapt to the technology particularly well and provided informal mentoring
• embedded algorithms must take account of different clinical specialities
• the technology can support clinical and patient communications
• it is vital that there is integration of new IT systems with existing systems
• the technology is only as good as the infrastructure that supports it
• there needs to be feedback mechanisms for staff use and training requirements
To access the full report, click on: Handheld Technologies in the Ward.
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