Given the opportunity to work on a hospital-wide project, Sue Clarke, clinical applications specialist, jumped at the chance. Not least because this innovative change programme would significantly contribute to improving patient outcomes while transforming staff’s efficiency and working lives.

Apple iPads, iPhones and iPod touch devices were chosen on which to run a Nervecentre app to put patient observations online and help eliminate delays and human errors. Speed of response to deteriorating patients is just one of its major benefits. Continuity of care is another. A BT team worked with Sue to assure the rollout’s speed and integrity.

Real-time online observations revolutionise clinical practice.

Case study - Nottingham University Hospitals NHS Trust.

A couple of months ago I was in a meeting and I glanced at my screen. I could see immediately there were three patients that had all escalated within 15 minutes of each other. I’d have been oblivious to that before.

Rachel BarkerWard Sister, Children’s Assessment UnitNottingham University Hospitals NHS Trust

Out-of-hours Nervecentre pilot using iOS devices was so successful that hospital-wide rollout rapidly followed.

Case Study - Nottingham University Hospitals NHS Trust.

Successful pilot leads to transformed patient pathwaysWhen Nottingham University Hospitals NHS Trust introduced the Nervecentre electronic workflow platform its initial focus was out-of-hours care. At such times, while clinical resources are lower, the demands of seriously-ill patients are undiminished. That programme highlighted the potential benefits of mobile working, which led on to a far more ambitious plan.

By focusing on solutions to the known clinical risks of physiological observations and staff handover, the team began creating a mobile platform with Nervecentre to meet those clinical needs.

Mark Simmonds, lead consultant at Nottingham University Hospitals NHS Trust, says: “Scaled across a 24-hour day the potential was enormous in terms of transforming patient pathways and improving productivity. So it was decided to extend the system to 4,000 of our key clinical staff.”

However, the scale of the planned project required a co-ordinated effort from ICT, software developers and device deployment partners. “Without confidence that device procurement would be reliable, keeping the pressure on the rollout programme would not have been possible,” adds Mark.

Apple iOS chosen for risk mitigation and securityWith Nervecentre, critical capabilities are available to nurses and doctors at the patient’s bedside or anywhere in the hospital. The benefits are multiplied when everyone’s equipped with the right mobile devices.

“One of the intrinsic advantages of choosing Apple is that they’re well known to be intuitive and easy to use,” says Mark. “We also wanted something that was going to be reliable and secure.” With an average of 2,000 calls for assistance every week, the intent was to combat a failing mix of pagers, fixed telephones and static PCs.

Sue Clarke, clinical applications specialist, who led the rollout, says: “The old way of doing observations was on a paper chart. You had to calculate the patient’s early warning score. We would have to bleep doctors, who could often get ten bleeps in a row. They wouldn’t have any way of prioritising who they needed to see and no way of knowing which was the most urgent.”

Worse, half-an-hour could elapse between a nurse asking for help and a doctor getting the bleep. Ensuring a rapid response to deteriorating patients, the inbuilt Nervecentre escalation function means a nurse’s request goes straight to the appropriate doctor, who can see at a glance the nature of the problem and prioritise it accordingly.

Rapid BT Advise rollout speeds time-to-benefitThe hospital selected a mixture of iPod touches for nurses, iPhones for doctors and iPads for general use. The turnkey rollout project was managed by BT Advise professional services consultants. As well as technical compatibility testing of the devices and the intended apps, specialised cases were sourced for the iPhones that would enable compliance with infection control requirements.

“The involvement of BT was crucial,” says Sue. “Its expertise and resources meant we could get the mobile devices into our people’s hands at pace and with no technical hiccups.”

All devices were configured in a BT workshop and delivered ward-by-ward over a six-month period at around 150 per week. Mark Simmonds says: “BT provided over 4,000 devices that were ready for use. The Nervecentre software was on there and personal email addresses were already loaded. All people needed to do was turn on and get on with their work.”

Moving forward, BT will be managing things using the Apple Device Enrolment Program (DEP). This automates setup for every device so when activated they’re immediately configured with account settings, apps, and access to corporate services. Users are guided through activation with the built-in DEP Setup Assistant.

With the results we’re seeing, the use of iOS devices is expected to massively expand across the hospital.

Mark SimmondsLead ConsultantNottingham University Hospitals NHS Trust

Multiple apps running on iPhones, iPads and iPods include cancer patients’ holistic needs assessment, NUH guidelines, anti-microbial prescribing and blood tracking. The effect is transformational.

Sue ClarkeClinical Applications SpecialistNottingham University Hospitals NHS Trust

Case Study - Nottingham University Hospitals NHS Trust.

The solution also features mobile device management. “If an iOS device is misplaced it can be wiped remotely, augmenting the existing information governance systems the trust has in place,” says Sue.

Bringing expert, morale-lifting care in an instant Fittingly, enabling patient observations to be captured electronically at the bedside in real time, one part of the Nervecentre solution has been named eObs, which is short for electronic observation. Meanwhile, when shifts change, eHandover ensures accuracy of briefing and continuity of care.

Rachel Barker, ward sister on the children’s assessment unit, is one of many keen to bring the effect to life. “A couple of months ago I was in a meeting and I glanced at my screen,” she says. “I could see immediately there were three patients that had all escalated within 15 minutes of each other. I’d have been oblivious to that before.”

The BT-supplied iOS devices have transformed efficiency and patient care. Paper observation charts have been eliminated, with observations transmitted and recorded over the wireless network. Patients’ vital signs are available to all who need them.

“In the past, you never really knew when you were looking at observations what time they were done,” Rachel adds. “Now the observations are done in real time so you know exactly what time they’re taken.” One centralised record of observations means better governance, reduction in human error, and improved patient safety.

Transformational iOS take-up throughout the hospitalWard managers and co-ordinators can conduct their roles in a more agile way. “With everything available on the iOS device, they can spend more of their time with patients rather than tied to a desk,” says Sue. Coupled with such flexible and efficient working practices, the eObs and eHandover apps have lifted morale.

The flexibility of iOS means multiple apps run side-by-side on devices elsewhere in the hospital. Sue says: “Multiple apps running on iPhones, iPads and iPods include cancer patients’ holistic needs assessment, NUH guidelines, anti-microbial prescribing and blood tracking.”

With the prospect of planned electronic patient record systems using the same devices in 2015 the utility of mobile working will continue to grow. Even greater efficiencies are thus in reach. Mark Simmonds sums up: “With the results we’re seeing, the use of iOS devices is expected to massively expand across the hospital.”

Offices worldwideThe telecommunications services described in this publication are subject to availability and may be modified from time to time. Services and equipment are provided subject to British Telecommunications plc’s respective standard conditions of contract. Nothing in this publication forms any part of any contract. © British Telecommunications plc 2015. Registered office: 81 Newgate Street, London EC1A 7AJ. Registered in England No: 1800000

Core services.• BT-supplied iOS devices as a managed service

• BT Advise professional services covering mobility testing, configuration, compliance and security

November 2015

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