Title

Business Case: Real time patient observation and escalation system (Safer Hospitals, Safer Wards Technology Fund)

Sponsoring Director Chief Operating Officer Author(s) IM&T Project Manager Report Purpose For approval Previously considered by N/A

Executive Summary: The Trust has been approved funding by the Safer Hospitals Safer Wards Technology Fund to implement a Real Time Patient Observation and Escalation System.

Related Trust Vision 1. Drive forward improvements in the

quality of services to improve patient safety, outcomes and experience for people who use our services.

Yes

2. Work with our partners to develop and implement the joint service strategy across the health communities we serve.

N/A

3. Develop more integrated community based services, enabling people who use our services to be treated closer to home, or at home.

N/A

4. Continue to expand our secondary care services into Leeds and maximise income.

N/A

Risk and Assurance

Ensure services are as efficient and effective as possible whilst ensuring good information governance is maintained

Legal implications/ Regulatory Requirements

There are no legal implications

Report to the Trust Board of Directors: Date 23 April 2014

Paper number 13.1

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Action Required by the Board of Directors Request permission of the Board of Directors to delegate authority to the Trust Chair and Chief Executive to sign contracts with a provider to the maximum value stated within the case

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A Business Case for the implementation of a

Real Time Patient Observation and Escalation

System

Version Date Purpose of Issue/Description of Change Review Date

3 April 2014

Trust Board of Directors approval required

Scope Trust-wide

Authors: IM&T Project Manager: Mr G Flavell

Approved by Chief Operating Officer: Mr R Harrison Finance Director: Mr J Coulter

Date: 17/04/2014

CONTENTS

1. INTRODUCTION ............................................................................................ 5

2. MANAGEMENT SUMMARY .......................................................................... 6

3. BACKGROUND ............................................................................................. 7

4. STRATEGIC CONTEXT................................................................................. 8

5. INVESTMENT APPRAISAL ........................................................................... 9

6. BUSINESS OBJECTIVES AND BENEFIT CRITERIA .................................. 9

7. COSTS ......................................................................................................... 10

8. RISK MANAGEMENT .................................................................................. 12

9. PROJECT MANAGEMENT ......................................................................... 14

Request for Approval ....................................................................................... 17

Appendix A ........................................................................................................ 17

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1. INTRODUCTION

1.1 The Trust has been approved funding by the Safer Hospitals Safer Wards Technology Fund to implement a Real Time Patient Observation and Escalation System.

1.2 The system will enable nursing and medical staff to use handheld mobile devices to record patient observations in real time at the patient bedside. The system will use the data recorded to calculate the national early warning score (NEWS), using these scores to alert relevant staff to patients who may be deteriorating as well as recording when the next observations should be taken. Clinicians will be able to review the data on a handheld device from anywhere with access to the hospital network and take appropriate action if needed.

1.3 This project is to implement a real time patient observation and escalation software and hardware solution. The project will address staff training and change management for working procedures and audit/reporting procedures.

1.4 This business case sets out the scope and expected benefits of this project together with the costs, options and quantifiable benefits.

1.5 The purpose of this business case is to:

• Appraise the Board of Directors of the project to implement a Real Time Patient Observation and Escalation solution within the organisation.

• Progress the project to enable a preferred supplier to be appointed

• Request permission of the Board of Directors to delegate authority to the Trust Chair and Chief Executive to sign contracts with a provider to the maximum value stated within the case

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2. MANAGEMENT SUMMARY

2.1 The trust is reviewing real time observation and escalation systems that enable nursing and medical staff to use handheld mobile devices to record patient observations in real time at the patient bedside. This software would use this data to calculate the national early warning score (NEWS), using these scores to alert relevant staff to patients who may be deteriorating as well as recording when the next observations should be taken. Clinicians will be able to review the data on a handheld device from anywhere with access to the hospital network and take appropriate action if needed.

2.2 Use of this software would significantly reduce the potential for nursing and clinical staff to fail to recognise and respond to patient deterioration, having a significant positive impact on patient safety and mortality. This would ensure that appropriate care is provided in a timely manner, assisting clinicians and specialist teams to proactively identify patients needing attention / intervention.

2.3 Users of the system will include nursing and medical staff on the patient ward, as well as specialist clinical teams such as Intensive Care Outreach. Early studies indicate significant improvements in a number of areas, including patient safety, mortality and ITU/ HDU occupancy. Outputs include:

• Significant improvement in number of completed observations

• Increase in appropriate observations for more complex patients

• Improvement in compliance regarding timeliness of observations completed

• Significant improvement in accuracy of NEWS calculation

• Improvement in escalation and response times

• Reductions in ITU/HDU occupancy as patients are identified earlier for transfer.

The project includes integrating data recorded in the system into the Trust data warehouse, enabling development of reporting suites, automating report generation, further improving information analysis and audit.

2.4 The successful bid under the Safer Hospitals, Safer Wards Technology Fund means that this work can start immediately

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2.5 This Business Case sets out the cost and expected benefits.

2.6 A project organisation structure has been defined and is documented in Appendix A

3. BACKGROUND

3.1 Currently patient observations are captured, analysed and stored using a paper based process on the acute wards at Harrogate and District NHS Foundation Trust. Escalation for deteriorating patients is done using telephone and bleep technology.

3.2 Escalating deteriorating patients to the necessary clinical staff is often time consuming and requires nursing staff to call pagers without the communication loop being closed. A nurse may not know if the recipient of the escalation has received the information or if they intend to do anything with the escalation.

It is intended that this paper recording and bleep based process will be converted into a digital solution utilising touch screen mobile devices and automatic escalation technology.

3.3 Implementation of a Real time observation and escalation system will enable nursing and medical staff to use handheld mobile devices to record patient observations in real time at the patient bedside. The software used will allow observation data to calculate the national early warning score (NEWS), using these scores to alert relevant clinical staff to patients who may be deteriorating, as well as recording when the next observation should be taken.

Clinicians will have the ability to review the data from anywhere with access to the hospital IT network, taking appropriate action where needed.

3.4 Use of this solution will significantly reduce the potential for nursing and clinical staff to fail to recognise and respond to patient deterioration, having a significant positive impact on patient safety and mortality. This will ensure that appropriate care is provided in a timely manner, assisting clinicians and specialist teams to proactively identify patients needing attention / intervention.

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3.5 Users affected by the implementation of this system will include nursing and medical staff on patient wards, as well as specialist clinical teams such as Intensive Care Outreach.

4. STRATEGIC CONTEXT

4.1 The project has been identified for inclusion in the 2014/15 Business Plan.

4.2 The introduction of a Real time patient observation and escalation system is consistent with the IM&T Strategy, in that:

“The Trust’s business plan explicitly identifies the importance of

technology in clinical and management contexts, as well as for the general public. The need to support ongoing service improvement; leading to improved patient experiences and outcomes …”

4.3 The objectives of this business case are:

• To set out the costs and benefits of the project

• To highlight the risks

• To detail the project control

• Confirm agreement to the Trust Chair and Chief Executive having delegated authority to enter into a contract with a preferred supplier following a mini competition supplier selection process.

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5. INVESTMENT APPRAISAL

5.1 The Trust was successful under the Safer Hospitals, Safer Wards Technology Fund in obtaining “match funding” to implement the rollout of a Real time patient observation and escalation system. The Trust has set aside funding to meet its commitment under this project and are in the process of identifying a preferred supplier through a mini competition process.

6. BUSINESS OBJECTIVES AND BENEFIT CRITERIA

6.1 Real time patient observations and escalation has a number of benefits ranging from:

• Significant improvement in timeliness of completed observations

• Reduction in missed observations

• Increase in frequency of observations for deteriorating patients

• Significant improvement in accuracy of NEWS calculation

• Improvement in frequency of necessary escalations & recording of decisions made

• Improved escalation awareness response

• Sustained high levels of compliance with hospital protocols

• Continuously updated and accurate record of patient location

• Continuously updated and accurate record of patient condition

• Faster response rate from doctors and faster escalation process by nursing staff.

• More reliable delivery of care

• Shorter lengths of stay on general wards

• Shorter lengths of stay on critical care units

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• Increase in time spent at patient bedside delivering care rather than carrying out administration tasks

• Reporting and audit requirements easily accessible time saving

• Future projects benefit from readily available data to do pre and post project analysis

• Reductions in ITU/HDU occupancy as patients are identified earlier for transfer

7. Costs

The Trust has received funding from the Safer Hospitals Safer Wards Technology Fund on a ‘matched funding’ basis to support the implementation of this project. The costs are broken down as follows:

2013-14 2014-15 2015-16 2016-17 2017-18 2018-192019-20

Onwards

ROW INITIAL PROJECT COSTS

A1 Capital Expenditure - Centrally Funded Element 605281

A2 Capital Expenditure - Trust Funded (i.e matched funding) 322719

A3 Revenue Expenditure - Trust Funded (i.e. matched funding) 4561 139000 139000

FOLLOW-ON COSTS

B1 Capital Expenditure - Trust Funded 59000

B2 Revenue Expenditure - Trust Funded Other 139000 139000

B3 Revenue Expenditure - Trust Funded Cost of Capital Charge 37355 73580 71321 69062 66803

B4 Revenue Expenditure - Trust Funded Depreciation 64544 64544 64544 64544 64544

Table One: (£ 000's)

8. RISK MANAGEMENT

The following risks have been identified as posing a threat to the success of this project. This risk register will be reviewed and updated on a regular basis throughout the conduct of the project.

8.1 Resource

8.1.1 Project timescales overrun

The project plan details tight timescales and assume all resources are available on time. Other internal or external initiatives may impact on the availability of resources, thus leading to delays in implementing. Any substantial delays could impact the funding of this project.

Management Review the project plan with the supplier to ensure that any potential delays are brought before the Project Board to seek guidance.

8.1.2 Inadequate staff resource to manage and implement project Staff resources from within Informatics and Clinical departments will have to be devoted to the testing and implementation of the system. The requirements of the project will have to compete with both day to day workloads and calls on staff time for initiatives.

Management Ensure the commitment from all members of the Project Board and Team and to highlight any conflicts/difficulties as soon as possible. Additional recurrent and non-recurrent funding for posts to support the implementation has been allocated to the project. Posts include project management, clinical / change management, systems management, systems development and training.

8.1.3 Insufficient supplier support The successful implementation depends heavily on the expertise and support given by the supplier. The supplier will be involved with implementations across a number of trusts as a result of bids to the Technology Fund.

Management Work closely with the supplier to ensure that they understand the requirements of the project.

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8.2 Technical

8.2.1 Insufficient hardware on the wards to meet user requirements

The exact requirements for users on the wards and the most suitable type of device are still being investigated. Failure to supply sufficient quantities of mobile hardware devices will significantly impact on the operational acceptability of the system.

Management A detailed analysis of the hardware requirements is to be undertaken.

8.2.2 Hardware and Software problems Problems with any hardware or software could have a significant impact on the operation of the system and the acceptability from a user’s perspective. It may also lead to the loss of some or all of the data, which could dramatically increase the operational risks associated with the system.

Management Ensure robust hardware and software support specifications are included in requirements.

8.2.3 Network installation problems An inadequate of slow running network could have a significant impact on the performance of the system and thus affect the perception of the adequacy of the system from the user’s perspective.

Management Ensure that the network requirement are detailed in the contract and implemented and tested before go-live.

8.3 Implementation

8.3.1 Pre Implementation planning insufficient

Careful planning will be required to ensure resources are made available as and when required to meet the requirements of the project.

Management To work closely with supplier to fully understand and schedule tasks involved.

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8.3.2 Staff training not sufficient It is proposed that core trainers will be identified from members of IM&T. A full understanding of the new software will have to be gained to undertake a training needs analysis. Adequate time will have to be made available for core trainers to develop appropriate training material.

Management Ensure a full understanding of all processes and requirements, and resources are identified and time is made available for training purposes.

8.3.3 Insufficient Go Live Support

Resources will have to be fully committed to supporting go-live and the post go-live perion to ensure that users are supported in the operation of the new software.

Management Ensure that sufficient resources are committed from both the Trust and the supplier over the go-live period.

9. PROJECT MANAGEMENT

9.1 Planning, Organisation and Control 9.1.1 The project will be managed using the application of PRINCE principles

for planning, organisation and control. 9.1.2 The project will be directed by a Project Board and implemented by a

Project Team. 9.1.3 Progress will be reported regularly to the Project Board, and to the Trust.

A monthly highlight report will be produced showing the status of the project.

9.2 Implementation Roles and Accountabilities

9.2.1 Project Board

• The Project Board is responsible to the Trust Board for the overall direction and management of the project. It will do this by approving plans, authorising deviations from plan, authorising start and sign off of project stages.

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• The Project Board represents at managerial level the Business, User, and Supplier interests in the project.

• The Project Board members are the decision makers and responsible for the commitment of resources to the project such as personnel, funds and equipment.

• The Project Board is responsible for ensuring that the project remains on course to deliver products of the required quality as defined in this document and the Full Business Case.

• The Project Board will normally meet at planned sign off milestones.

9.2.2 Project Sponsor

• The Project Sponsor is ultimately responsible for the project.

• The Project Sponsor’s role is to ensure that the project is focussed throughout its lifecycle on achieving its objectives and delivering a product that will achieve the projected benefits within agreed tolerances for budget and schedule.

• The Project Sponsor is the key decision maker, the Project Board is not a democracy controlled by votes.

9.2.3 Senior Clinical User

• The Senior Clinical User is responsible for the specification of the clinical needs of all those who will use the system, for clinical user liaison with the project team and for monitoring that the solution will meet those needs within the known constraints of quality, functionality and ease of use.

9.2.5 Lead Nurse / Change management

• to lead and implement clinically led change management working closely with the clinical departments and project team.

9.2.6 Systems administration

• to manage general system management and administration, upgrades, and provide user support.

9.2.7 Systems development

• to design, develop and maintain reporting and analysis, integrating into data warehouse with other clinical systems.

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9.2.8 Trainer

• to train end users during implementation, rollout and ongoing upgrade / new starter training.

9.2.9 Senior Technical

• The Senior Technical representative is responsible for ensuring the technical infrastructure is adequate to meet the requirements of the solution, including commitment or acquisition of technical resources as required.

9.2.10 Project Manager

• The Project Manager has the authority to run the project on a day-to-day basis on behalf of the Project Board within the constraints laid down by the Board.

• The Project Manager’s prime responsibility is to ensure that the project produces the required products, to the required standard of quality and within the specified constraints of time and cost of the project.

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Appendix A

Project Organisation

Project Chair / Senior User David Leinhardt

Governance Sylvia Wood

Senior User – Nursing Alison Mayfield

Lead Nurse/Change Management Robin Pitts

Patient Systems Manager Jo MacLean

Senior Technical Andy Moore

Project Manager Gary Flavell

Senior Management Paul Nicholas

Patient Safety Nicki West

Critical Care Outreach Sarah Blackburn

Consultant Anaesthetics David Earl

Project Sponsor Robert Harrison

Matron Lesley Danby

System Administration, Training and Support

Maria Macknight/Rachel Knowles

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Request for Approval

• The Board of Directors is asked to approve the business case for the implementation of a Real Time Patient Observation and Escalation solution and the progression of the scheme to enable the appointment of a preferred supplier.

• Request permission of the Board of Directors to delegate authority to the Trust Chair and Chief Executive to sign contracts with a provider to the maximum value stated within the case.

APPROVAL

……………………………… Date ………………….. Chief Operating Officer

………………………………. Date……………………. Finance Director