Wye Valley NHS Trust is the provider of healthcare services at Hereford County Hospital and several community hospitals in the area, along with providing healthcare services in the community for Herefordshire and its borders. They also provide healthcare services at community hospitals in the market towns of Ross-on-Wye, Leominster and Bromyard.

Wye Valley NHS Trust and IMS MAXIMS have worked together since 2015 going live with PAS as the first phase of partnership in 2017. Since then there has been a planned and continual roll-out of additional clinical solutions including Electronic Whiteboards (eWhiteboards).

Before going live with eWhiteboards in July 2020 on Arrow Ward, the Trust had many challenges in that every ward used manual write-on wipe-off boards to summarise clinical information and tasks for admitted patients. eWhiteboards not only replace the physical whiteboards but make this information available to users on mobile devices at the point of care. The interactive features of eWhiteboards help streamline the workflow and encourage best practice.

Sam Cattermole, EPR Clinical Workstream Lead, explained through observing working practice they found that 90% of the time all staff only used the whiteboards to locate the patients, however eWhiteboards now offer a more standardised view of patients status and planned activity, supporting safe and timely discharge.  In addition, eWhiteboards allow for more information to be shared remotely to support better care planning

Like all Trusts, there are times when the hospital is working at full capacity and there is a need to optimise patient flow, this has historically been done by bed managers who manage patient admissions, discharges and transfers, needing to attend the wards during busy periods to support workflow. With eWhiteboards installed, it’s possible to view discharge planning and outstanding actions from anywhere in the hospital or even remotely.

Teams can now remotely view the bed management information, knowing it’s up to date allowing decisions to be made quickly and confidently.  Increasing adoption of digital solutions will become part of the wider digital cultural change for staff resulting in better patient care and outcomes.

eWhiteboards is a helpful tool accessible by clinical teams, such as the complex discharge team, anywhere across the hospital or even remotely.  The available information can help to support early discharge when the hospital is at escalation level 4 when it is important to have an overview of beds available.  The use of eWhiteboards supports the Trust to identify which patients can be discharged, assessed for discharge, or discharged to services or other care outside of the hospital.

THE WYE VALLEY APPROACH

Digitising their whiteboards enabled the Trust to provide each ward and/or bay with an efficient, comprehensive, integrated view of all information (administration, patient data, clinical data) relating to each patient’s care. The solution’s flexibility provides every ward and/or bay with the ability to configure their eWhiteboard to reflect their own needs.  Therefore, the content was reviewed carefully for each care setting before the Trust commenced the project. The Trust EPR team and Estates Management department worked closely with IMS MAXIMS to ensure the screens and hardware were set up and working correctly before commencing roll-out.

Demonstrating the flexibility of the solution the Trust has added VTE status and results and NEWS2 scores to the eWhiteboards.  The information viewed on the eWhiteboards is supplemented by a detailed patient summary view containing all administrative events relating the admission, clinical summary and discharge plan. Early analysis of the use of eWhiteboards, has identified different elements used by wards, and ongoing refinement will enhance patient care and clinical decision support.

The Trust had applied the same roll-out blueprint for eWhiteboards as per the MAXIMS Electronic Observations (eOBS) deployment.  This was determined by wards that already had implemented MAXIMS Mobile Suite (mHealth) and were thereby familiar with the functionality. This made it easier to introduce the eWhiteboards as the ward staff were already familiar with interacting with the electronic patient record, and thereby supported a smooth transition to interacting with eWhiteboards. This approach was key to the successful roll-out and well received and adopted by each ward into their daily tasks and routines.

Feedback from ward staff is that eWhiteboards are really easy to use and it only takes 10 minutes to train each person. The training course is as simple as observing the display layout, source of the data, and how it supports other clinical teams.

Like many other Trusts, Wye Valley currently rely on the use of agency staff especially during the Covid-19 pandemic.  The agency staff picked up the use of mobile devices and the eWhiteboards very easily reducing the amount of time training and ensuring continuity of patient care.

THE OUTCOME

When the patient is admitted on MAXIMS, the ward clerk or nurses can then add to the electronic patient record, using mHealth applications.  Mobile devices, such as iPads, are used both to enter data and display information on the eWhiteboards at the point of care.  Information can be updated from a mobile device without leaving the patient’s bedside to find an available workstation.

All wards are now live across the hospital, providing real-time, standardised and accurate patient information, giving hospital teams such as;

• Complex discharge team

• Site team

• Senior managers

• Bed managers 

• Control room

the ability to seamlessly manage patient flow and benefit from eWhiteboards.

BENEFITS

The benefits, and the quick wins, that will be realised through this project are clear to see:

• Real-time information supports clinicians in ensuring that patients are receiving timely and correct clinical treatment

• Improved patient flow including the timely transfer and discharge of patients

• A real-time site overview allows multiple teams to view and manage the bed state

• Providing teams real-time insights across the Trust via mobile devices without having to visit any wards

• Supporting quicker clinical decision making, which saves staff time and improves patient care

• Ward visitors and clinical staff can find the patient quickly and easily

• It is configurable and very flexible in that we can change columns/headers to adapt to situations for example:  we now have a COVID-19 patient management column as one of the headers that will specifically support appropriate patient care

• User-friendly design making it easy for nursing staff to navigate around

• Outstanding patient tasks are easily identified alerting clinical staff to take the necessary action

• Provides patient information at a glance which can be used to manage and improve efficiency of ward rounds

 WHAT NEXT

The Trust are already considering more options for tailoring information, by looking at how they may add other clinical services such as Dietetics and Speech and Language Therapy (SALT). Also, how information can be further consolidated in enhancing the content and display on the eWhiteboards.