Hospital and community connections get better in Plymouth

Plymouth ICT Shared Service has developed an alerting system that automatically notifies community staff via NHSmail when one of their patients is admitted to hospital. Similarly, it alerts hospital staff when someone being admitted is already a community patient. The result is faster and more efficient information sharing between hospital and community staff, which is key to better planning of patient care and shorter hospital stays.

Andy Blofield, Director of Plymouth ICT Shared Service, said: "New technology solutions that deliver real-time automated text and email alerts can be an extremely effective way of ensuring that important information about a patient gets to the appropriate key workers in a timely way."

Ensuring resources are used efficiently to deliver the best possible patient care can be extremely complex, not least when chronically ill patients under the ongoing care of community staff are unexpectedly admitted to hospital.

"It's at times like this that effective information sharing is paramount to not only ensuring patients get the care they need but that valuable time and resources are not wasted in the process," Andy added.

Such is the situation in Plymouth, where the ICT Shared Service has developed an innovative solution called Risk of Admission Patient Alert (RAPA) based on the NHSmail SMS feature.

Integrated with existing technology and systems used by the PCT, together with NHSmail, RAPA has been configured to automatically send an email or SMS message to key workers in the community whenever one of their patients is admitted to hospital.

The idea for such a solution was first discussed at the beginning of 2010 when the PCT was looking to identify efficiencies and cost savings.  A user group was pulled together comprising all the community matrons across Cornwall and South Devon, together with representatives from the acute GP service and Derriford Hospital.

"The purpose of bringing this multi-disciplinary user group together was to ensure that we could look at issues and needs from all sides, and come up with a solution that worked for all those involved in the care of these patients," said Susan Bracey, Head of Software Development and Integration for the Plymouth ICT Shared Service. 

The key problem to address was unplanned hospital admissions involving community patients. Often when these vulnerable patients are admitted, hospital staff will not immediately know that they are already community patients or, if they do, relevant information about key workers can take time to locate.

Inevitably, this can lead to a patient staying longer in hospital, even though community support and care plans are already in place. Similarly, community staff would go to a patient’s home as planned, unaware that they were in hospital. In some cases, the police have been called out when staff became concerned that a patient wasn’t answering the door.

Initially, the idea was to come up with a solution that would prevent such scenarios by sharing information with key workers faster and more efficiently, focussing on community patients who had more than three unplanned admissions to hospital in the last year. But feedback from the user group made it clear that a simple solution capable of sending alerts about all community patients at risk of admission to hospital would be preferable.

The beauty of RAPA which went live in October 2010 is that it's built on the PCT's existing technology infrastructure. The system is fully integrated with the hospital's Patient Administration System and it makes use of NHSmail to deliver the SMS and email messages automatically.

"The solution centres on a lightweight database," explained Susan. "It's set up so that teams in the community can very easily submit details of their team – names and contact details for key workers – and also the names and NHS or hospital numbers of their patients."

When a patient is admitted to hospital and their information is entered into the hospital's Patient Administration System, RAPA ensures that two things automatically happen.

Firstly, an email or SMS message is sent via NHSmail to the relevant team and key worker looking after the patient in the community. Secondly, a RAPA icon appears on the patient record. Hospital staff can click this icon to find contact information for the relevant community team.

A special code is also provided and Community staff use it when calling the ward, so the hospital can share patient information in confidence.

Further NHSmail messages are issued when a patient is transferred within the hospital and also when they are discharged.

On average, just over a 1000 messages are now being sent via NHSmail every month. With this new system in place, community staff are now alerted that a patient is in hospital within seconds of them being admitted. Seeing the benefits of the system, other teams who look after patients at risk of admission to hospital have now come on board as well, including the renal team and the alcohol abuse team. The cost and efficiency benefits are multiplying as a result.

For instance, when a patient is admitted to hospital, agency care can be cancelled without delay, where previously the agency would turn up at the patient’s house not knowing they weren’t there and so charge the full amount. Length of stay in hospital is also reduced because hospital staff can more quickly find out what community care arrangements are already in place.

Monthly reports are now being issued to GPs as well so they can now see all those patients who have more than three unplanned admissions and assess their care in the community needs accordingly.

"The system is really changing the culture," said one community matron. "Before, nurses on the ward would not give us information when we called about a patient because they couldn't easily verify who we were. I think it's great that we can finally work together."

"The new system saves me a lot of time," added a ward care team leader. "Even if a patient told us they had a community nurse before it could take ages to identify the nurse so we could talk about discharge. Now the information is at my fingertips immediately."