eDischarge Helps Cornish Hospitals Tackle Annual Influx of Children's Summer Holiday Accidents and Illnesses

The system speeds up administration so discharges can be handled far more quickly, as secretaries and clerks do not have to be available to deal with notes and letters. This means that the turnover of beds has been accelerated – which is especially important as around 70% of patients need to be in hospital for less than 24 hours. A complete discharge summary is also given to the family, detailing the reason for admission and all treatment and medication, before they leave. If further help is required, perhaps from an out-of-hours GP service, the family can give clinicians the information they need to provide safe and effective care.

Dr Yadlapalli Kumar, consultant paediatrician at the Truro hospital, said: "Before I came to Cornwall 10 years ago, I had no idea of how many children would be admitted due to accidents whilst on holiday. We see lots of incidents including head injuries and broken bones. The population here doubles during the holiday period, and in some areas it can triple, so while other hospitals can see a fall in demand it remains just as high for us. In fact, during the holiday season a majority of our patients are from outside the area.

"What's great about the eDischarge system is that it cuts administration and improves bed management. The time it takes for case notes to be fully dealt with has been cut by days - and now they are ready before the patient leaves."

Copies of the discharge summary are posted off to the family’s GP, if they come from outside the county. If the child lives locally then the system is even quicker as discharge summaries are emailed to the area’s 70 practices after being turned into PDFs to allow for electronic storage. This means that practices know straight away regarding any hospital intervention so are therefore able to provide seamless care. In the past it could be several days before the notes were sent and received.

Up to 20 inpatients a day tend to be discharged by the hospital's paediatrics department and Dr Kumar estimates that its eDischarge handled around 4500 cases since its introduction. It is now also being used in gastroenterology, endocrinology and nephrology meaning the total number of eDischarges will exceed 5,750 by the end of June. It is hoped that the system will be used for all the RCHT inpatient activity over the next 12 months.

All the information in the eDischarge summary document is stored in a database, which is invaluable if the patient returns. At another level it will permit the trust, and its clinicians, to mine the data to identify patterns in demand.

Dr Kumar said: "As the database builds up we can begin to analyse the information in all sorts of ways so we can understand exactly what sort of cases we get, when they tend to occur and also look at the outcomes. This is very valuable for planning patient services and for identifying the best care pathways."

The IMS MAXIMS eDischarge solution is highly interoperable and integrates with the trust's ePharmacy system which is supplied by JAC. This means the discharge summary shows what medicines the patient has been given to take away and lets the clinician handling the discharge to check that the correct drugs, quantities and doses have been supplied.

Shane Tickell, IMS MAXIMS CEO, said: "The size and rural character of Cornwall, combined with the huge number of holidaymakers, presents the RCHT with very specific challenges. The flexibility and interoperability of our eDischarge solution makes it ideal for the trust’s needs. One of the key advantages is that it accelerates the discharge process, so patients can go home sooner and beds can be freed up more quickly. Most importantly it means that GPs are informed as fast as possible about any hospital treatment their patients have had.

"eDischarge is already helping the trust deal very effectively with the demands faced by its paediatric, gastroenterology, endocrinology and nephrology services. The benefits will continue to grow as the system is rolled out further and as the data it yields can increasingly be used for analysing and planning services," Tickell continued.

The eDischarge solution is based round the MAXIMS electronic Discharge Documents (eDD) product and an electronic pharmacy system from JAC Medicines Management. It provides details of the patient's condition, their treatment while in hospital, their discharge medication and any future care plan.

About Royal Cornwall Hospitals NHS Trust and eDischarge

• Completed eDischarges from time of introduction (in brackets) to June 2011
  Paediatrics: 4,481 (Jul 2010)
  Gastroenterology: 432 (Dec 2010)
  General Medicine: 641 (Nov 2010)
  Endocrinology: 149 (Dec 2010)
  Renal: 53 (Apr 2011)
• The RCHT provides acute services for Cornwall and the Isles of Scilly (1,369 square miles). It serves a resident population of around 500,000, a figure often doubled by summer holidaymakers. The population is thinly dispersed and the entire urban area for the cathedral city of Truro has around 21,000 residents.
• The trust provides services for around 645,000 patients a year, including more than 70,000 A&E attenders, 52,500 emergency admissions, 14,000 elective admissions and 49,000 elective day cases.
• The RCHT has three sites, with around 750 beds in total. These are the Royal Cornwall Hospital, Treliske, Truro, the West Cornwall Hospital, Penzance and St Michael's Hospital, Hayle. It employs approximately 5,000 staff and currently has a budget of around £290 million.
• Cornwall's eDischarge solution was piloted in the paediatrics department in the summer of 2010. The number of GP discharge notifications made within a day (in line with government targets) went from 16% to 66% in a month and continued to grow. This high level of compliance was achieved even though a substantial proportion of patients are from outside Cornwall, so their GPs are not linked to the system.
• Paediatrics was chosen for the trial because it is concentrated on three wards, with 27 junior doctors and a dozen consultants, so progress was easy to monitor. Training was quick, using the trust's own eLearning package, with staff having to score 100% in order to get a user name and password.
• The flexibility of the system made it possible to tailor it to local requirements - for example access privileges were adjusted to allow consultants' secretaries to make late additions to the record rather than having to create another document.
• The discharge summary document was designed according to best-practice guidelines set out by the Royal College of Physicians which described what information should be included. Specialist areas within the trust make their own additions as necessary by using forms developed by trust staff which integrates with the Maxims product. GPs value having discharge information in a standardised format.
• Errors are reduced as the eDischarge system has extra safety checks built in, highlighting areas where more information is needed, and because information is in type rather than handwritten. As the system is web-based it can be accessed anywhere at any time, using a secure browser. The RCHT use of computers on wheels (CoWs) on the paediatric wards allowed information to be input at the bedside.
• From a trust-wide perspective the eDischarge and JAC data will be valuable for stock control and service planning as it will provide a clear picture of peaks and troughs in admissions for specific conditions and the staff and medicines needed to treat them. It provides an excellent audit trail so actions can be traced to their source, but simultaneously reduces time spent on administration.

About IMS MAXIMS
IMS MAXIMS specialises in developing clinical and administrative software solutions and currently supports more than 100 organisations and 10,000 users of IMS MAXIMS products. To find out more about IMS MAXIMS and its products visit www.imsmaxims.com.