Savience CareExpress

With Accident and Emergency Departments (A&E) facing unrelenting pressure, a fundamental redesign of NHS urgent care is long overdue.

Dubbed by some as the ‘urgent care spaghetti’, the current system is far too confusing for patients with too many people turning up at A&E, despite more appropriate options being available.

This is the agenda which CareExpress, the ED streaming solution, from Savience sets out to address.

Following implementations in Hull Royal Infirmary, Warrington Hospitals, Altnagelvin, Londonderry and the Ulster, in Belfast, Savience is leading the way in unravelling patient journeys through A&E.

How it works

Every patient who arrives at A&E follows the same procedure. They use a touch screen kiosk to register and then go through a streaming process based on the nature and severity of their condition. Patients’ information is completely secure and provides greater privacy than reporting their condition to a member of the reception team.

CareExpress uses one-touch technology combined with user-friendly instructions and easy-to-follow graphics. Patients simply enter their information, which matches the unique record already held on the Patient Administration System (PAS), and follow a short screen dialogue to establish a fuller picture of their health issue. If a unique match is not found in the PAS, the patient is directed to reception where A&E staff will be able to confirm the patient’s PAS record from a list of possible matches. When the self-streaming process is complete, a unique Emergency Department (ED) number is generated.

A call number allows the patient to be called by staff, via audio and LCD screens.

The screens can also be used by Emergency Department staff to help minimise stress for patients during their visit by displaying information such as average waiting times and additional hospital services. This multimedia system can also be used to offer supplementary information, such as the availability of out-of-hours GP services, 24-hour pharmacies, and NHS helpline numbers.

How it works for clinicians

The Savience CareExpress self-streaming system is an ideal solution for meeting NHS guidelines on patient admission/discharge. Self-service technology enables patients to stream their condition rather than waiting for a nurse for an initial assessment. This significantly enhances the efficiency and effectiveness of the department by freeing nurses’ to spend more time with patients. Because CareExpress provides essential, at-a-glance information on each patient’s condition, the process of prioritising treatment is faster. The result is a more streamlined passage through ED, from admission to discharge, and a reduction in the number of patients whose admittance/discharge time exceeds the 4-hour target.

The CareExpress streaming process is governed by clinically defined triage parameters, set by the hospital. These determine the flow of queries presented to the patient; the responses are relayed in real-time.

For example, a patient responds to a query regarding the affected body part and selects face/head/neck. The patient is then prompted to provide further information, specifying which part of the face, head or neck is affected – in this case, scalp, face, eyes and so on. Patients can go back to their responses at any time if they make a mistake or need to double-check the accuracy of their replies.

Throughout the process, CareExpress calculates the severity and priority of the patient’s condition. These calculations are configured by the hospital to produce a simplified priority system: Red, Amber and Green, enabling nurses and clinicians to focus on those patients presenting with severe conditions and in need of urgent intervention. The calculation process uses factors such as the length of time the patient has had the condition, level of pain experienced and the patient response to specific conditions such as chest pain, heavy bleeding, dizziness and shortness of breath.

Fully flexible and client specific, these factors are configured by a Savience account manager and trained hospital staff. Different triage processes can be allocated according to both the age and gender of the patient. The results are available on-the-move, ideal for busy departments using mobile technology such as tablets or where fixed locations for IT systems aren’t the most effective.

When a user hovers over the Notes field, the priority of the patient can be reviewed immediately.

The benefits – for clinicians

For clinicians, it’s simple. In the fluid Emergency Department environment, time is of the essence.

In many A&E departments the conventional process of patient registration and then assessment by a triage nurse leads to pinch points in service delivery – because their role extends towards simple interventions such as first-aid treatments and analgesia. This linear approach introduces a dual pinch point and creates queues. CareExpress relieves the pressure and workload on ED staff by reducing the need for clinicians to assess every patient immediately, in turn giving staff more time to provide patient care and cope with increasing demand without the need for staff expansion.

Overall the reduction in the total time spent in the ED by ensuring direct flow of ambulatory patients to the appropriate clinical teams has been shown to improve performance against the key performance indicators.

The system also adds an extra safeguard against missing patients in need of urgent and ambulatory care; CareExpress quick views highlight urgent cases for priority treatment. For example, patients with an urgent need for analgesia.

It all means less time processing. More time treating. A win-win for ED staff.

For Patients

A visit to ED is an anxious time. CareExpress helps remove the stress of emergency wards through a user-friendly interface that is both secure and private, and communicates their condition to clinical staff quickly. Because a well-informed patient is a less stressed patient, CareExpress provides real-time information on waiting times. Supplementary information can be provided too, showing how best to access hospital services and other facilities available nearby, empowering patients to make choices even before they are seen.

For Management

ED departments are monitored on the time taken to undertake initial triage assessments. While patients interact with the self-streaming kiosk, the clinical team is alerted to patients who need to be seen quickly displaying the reason they are presenting in ED. This removes the need for traditional nurse-led triage, enabling A&E departments to organize more effective models of care. It reduces the time for triage assessments and ensures patients receive the very best healthcare service while reaching performance levels.

Another key performance parameter is the capturing of accurate patient demographic information – data quality targets are significant with the potential for penalties to be imposed on organizations for discrepancies in postcodes, invalid NHS codes, GP Practice codes and also GPs assigned to the wrong commissioner. CareExpress offers patients a simple secure private and confidential method of updating sensitive information which is otherwise difficult to obtain.

CareExpress will help put an end to the urgent care spaghetti paradigm.

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