Nottingham University Hospital is the fourth largest hospital in the UK, but until its recent investment in tablets and a mobile app it was still relying on PCs, Excel spreadsheets, pagers and phone calls to coordinate staff assignments.
Nottingham's after-hours service, called [email protected], is made up of a skeleton crew of health care professionals, many of them junior doctors in training, who handle a variety of patient needs across 40 of the hospital's wards.
Because the [email protected] staff has to cover so much ground, patient assignments and staff communication is essential. However, its archaic system was hampering that communication. A [email protected] coordinator would sit in an office receiving pages and calling the hospital wards to determine the issue. They would then page or call a junior doctor, who would go take care of the patient.
"It was just lots of calling, paging and waiting," says Andrew Fearn, Nottingham's director of ICT Services. "And assignments were logged on a dodgy Excel spreadsheet. The whole process was limited to one room, on one PC, and only one person could see it."
Eventually, the inferior technology took its toll. Assignments were missed due to sloppy record keeping and busy junior doctors were getting interrupted by pages with no idea which page was a priority.
"It was an inadequate process," says Fearn.
Mobile technology needed, stat
About a year ago, pushed to the brink of inefficiency, Nottingham decided it must invest in modern technology, and fast. The hospital's IT group implemented Cisco's end-to-end network. It then purchased Cisco Cius tablets for nurses and doctors and worked with a third-party app developer called NerveCenter to build an Android app (also called NerveCenter) that works as a task-assignment workflow tool.
After patient information and doctor and nurse assignments are entered into the PC system, the [email protected] coordinator can allocate tasks via the NerveCenter app on a Cisco Cius tablet. The junior doctors receive assignments on their mobile devices be it a Cius tablet or a BlackBerry device, which NerveCenter also supports.
The doctor accepts the assignment using the NerveCenter app and it is logged. The whole staff can see if the task is being done, who the patient is and which doctor or nurse is assigned to that patient.
"Coordinators are not duplicating requests by paging and disrupting a doctor," says Fearn. "We know that every job is being done or is assigned. There's an audit trail."
The NerveCenter app can also automate basic jobs to go directly to doctors with the right skillset. Also, many of the hospital's junior doctors are in training and have to accomplish a certain number of tasks as part of their training.
"They used to carry scraps of paper," says Fearn. "Now with NerveCenter they have a logged history of tasks they've done for training."
The app can also direct tasks to junior doctors who are lacking certain skills and need improvement.
"They can't hide," says Fearn, with a laugh.
Unchained from the desktop, securely
The use of NerveCenter on Cius tablets and BlackBerry smartphones has liberated the Nottingham staff to be more mobile. Before the adoption of the NerveCenter app, coordinators and nurses spent 97 percent of their time in ward offices using the phones and computers.
Now they spend only 40 percent of their time in offices, and the rest of the time they are moving around the hospital with tablet or smartphone in hand, checking on patients.
"By using this app, so much clinical time has been put back into the organisation," says Fearn. "We've got massive patient safety benefits but also it changes the way we work -- there is more time to look after patients."
Fearn said the hospital chose the Cius devices because they best meet security and information governance requirements, and they connect directly and securely to the Cisco network. It didn't hurt, he adds, that the Cius tablets "fit perfectly in the nurses' and doctors' uniform pockets."
NerveCenter on the iPad? Not yet
Although Nottingham does allow the use of Android tablets and iPads for email access, the NerveCenter app does not work on the iOS platform or any Android device other than the Cius tablets. Why not? Security is not there yet, says Fearn.
"From an information security point of view, we absolutely need to keep devices secure, so the NerveCenter app is only used on Cius tablets and BlackBerry devices," he says. "iPads and iPhones are issued but they do not run NerveCenter at this time."
However, in an effort to be device agnostic, Fearn hopes to soon give staffers access to NerveCenter via Apple devices and more Android devices.
Nottingham is also hoping to make more use of a key feature of the Cisco Cius tablets and the Cisco IP network: video. "We're looking at ways to use the video functionality with Cius for the staff," he says.
Improving morale and saving money
In the end, Nottingham's investment in Cisco's network and tablets and the adoption of the NerveCenter app fixed a flawed workflow process that relied on landline phones, pagers and desktop PCs.
Supplying enough Cius tablets for the Hospital @ Night staff and deploying of the NerveCenter app cost the hospital £133,000 (€162,000).
In the process, it has increased patient safety, used resources more effectively and improved morale for staffers who had felt detached and isolated by poor communication.
An ROI study conducted by the hospital estimates that the use of collaboration technologies within mobile devices will result in "an additional 8,000 hours of clinical care annually at no extra cost."
A summary of the report also lists savings of £109,000 (€133,000) per year due to more efficient use of staff members' time and £329,000 (€401,000) per year from reductions in patients' length of stay.
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