Can We Make the Hospital a Safer Place at Night?

Opinion Article by Caroline Chapman, Nurse Consultant for Hospital at Night, Portsmouth Hospitals NHS Trust.
In the dead of night, when the rest of the world sleeps, ward nurses up and down the country are calling the Hospital at Night service. They may be looking for a technician to take a blood sample or calling for medical help as one of their patients suddenly deteriorates.

Hospital at Night started in 2005 as a way to address the shortened working week for junior doctors with the European Working Time Directive. Many trusts adopted the system, which involved moving away from every ward for itself to a pooled on call team to be used across the hospital.

At Portsmouth Hospitals NHS Trust we ran ours in a conventional way, relying on highly experienced, senior nurses to run a co-ordination centre. Ward nurses telephoned the co-ordinator who would triage the call and bleep the most relevant person.

It worked reasonably well but there were gaps. If I bleeped a doctor, I had no way of knowing if he or she was already busy. The ward nurses were left hanging on the telephone, waiting for a reply to the bleeps while the on call doctors could not tell whether the next bleep was an emergency or a more routine call so they were constantly interrupted. We felt there was potential for harm.

Common themes
When we looked at our adverse incidents at night we found this impression was true. There were common themes such as errors in communication, patients not being tracked, failure to escalate potentially serious situations and poor record keeping. Senior nurses like myself were largely deskbound by the need to be near a telephone, dealing with hundreds of calls per shift, rather than out and about supporting the wards and giving direct patient care.

We knew safety was high on the agenda - Don Berwick's report on patient safety was fresh in our minds - so we set about modernising our Hospital at Night programme to improve safety and quality of care. Using a grant from NHS England's Nursing Technology Fund, we invested in an electronic task management system with the aim of improving safety.

It works like this. Ward nurses requiring support enter a request onto the online software. Hospital at Night co-ordinator/practitioners receive the request electronically via a PC or tablet, triage for urgency and skill required and assign the task to the relevant on call doctor, nurse or technician with a single click.

As a co-ordinator/practitioner, I can now see in real-time who is on duty, their skill set, where they are and how busy they are. I can allocate the best person to the task and if something urgent comes in, I can divert the most senior and experienced person to deal with it.

Our on call doctors no longer get bleeps but an alert on their mobile device with details of the task. They can see immediately if it is an urgent call and do not need to constantly interrupt their work to answer bleeps.

A safer system
Implementing our new system involved significant change to our processes but even so we found staff adapted quickly and easily.

The nurses were surprised at how quickly they got a response, with a member of the out of hours team on the spot sometimes within as little as five minutes. The doctors were keen on the safety aspects of the system and being able to see a detailed list of patients and how serious the needs are.

Our new Nervecentre Hospital at Night system is very pro-nursing. It puts nurses at the centre of improving patient safety. Our co-ordinators, who are very senior and experienced staff, are no longer tied to a desk answering the phone and chasing bleeps. They are now able to oversee the system while working on the wards. They are out there, seeing patients and leading nursing on the wards and have time to train in advanced skills such as independent prescribing.

In the first year we halved the number of red and amber incidents, in which patients were put at severe or moderate risk of harm, and we have had not a single adverse death at night. This is both because doctors can attend to the most urgent needs first and because ward nurses are no longer waiting by the phone when they need support. Now that nurses can stay with patients we have found there is less risk of falls, for example.

Hard data
With a proper audit trail and aggregated management information, we now know what our on call clinicians are doing at night. We can tell the deanery about the hours junior doctors have worked and the tasks undertaken. We can review incidents in much more detail.

We now know, for example, that technicians and not our on call doctors are inserting cannulas and taking bloods. We have demonstrated to the Trust the level of support required to operate more safely at night and have since employed an additional technician as a result.

We hoped we would improve safety in the hospital at night and we have achieved this. We did not realise just how many other benefits we would see. Now we are keen to make more use of the electronic task management system by extending it to the weekend day time.

This was a clinical transformation, underpinned by information technology. It has taken off so well because it not only improves safety but also it makes clinicians' work easier. Ten years on from the start of Hospital at Night, we have found a safer way to care for our patients. We think there are lessons in our experience for other trusts that agree it's time to modernise hospital at night.

Most Popular Now

SAP IoT Startup Accelerator

The SAP IoT Startup Accelerator is a structured co-innovation program for selected B2B startups focusing on the Internet of Things. The Accelerator helps startups grow and scale their businesses alongside...

Read more

Paving the Way for eHealth Interoperabil…

The EURO-CAS project launched operations today to deliver the eHealth Conformity Assessment Scheme for Europe in 2018. This scheme will help European health systems assess the conformity of eHealth products...

Read more

SkinVision Unveils Breakthrough Algorith…

Dutch mobile health startup SkinVision has revealed its new algorithm that can detect most common forms of deadly skin cancer. Previously focused on detecting melanoma skin cancer, the app can...

Read more

eHealth Hub Solution Match Call: Hospita…

Solution Match is one of the services offered by the EU-funded initiative eHealth Hub, intending to promote and boost up commercialization. The eHealth Hub aims to provide long-term support to...

Read more

Wearable AI System can Detect a Conversa…

It's a fact of nature that a single conversation can be interpreted in very different ways. For people with anxiety or conditions such as Asperger's, this can make social situations...

Read more

Doctrina Raises €1,020,000 of New Capita…

Doctrina, a start-up company transforming the traditional transfer of knowledge between pharmaceutical companies and pharmacies, has raised a total of €1,020,000 in series A funding. The investment will enable Doctrina...

Read more

Biovision World Life Science Forum 2017

4 - 6 April 2017, Lyon, France. Biovision World Life Science Forum is fostering a unique approach to meet, connect and collaborate between international decision-makers from the academic, civil society, policy-making...

Read more

DIY Live Cell Imaging Using a Smartphone

A recent study from Uppsala University shows how smartphones can be used to make movies of living cells, without the need for expensive equipment. The study is published in the...

Read more

Horder Healthcare Uses IMS MAXIMS Electr…

Healthcare provider Horder Healthcare is to deploy an electronic patient record (EPR) from software provider IMS MAXIMS, in order to improve care for thousands of patients and facilitate its digital...

Read more

Brain-Computer Interface Allows Complete…

A brain-computer interface that can decipher the thoughts of people who are unable to communicate could revolutionize the lives of those living with complete locked-in syndrome according to a new...

Read more

Deep Learning in Healthcare Summit

28 - 01 March 2017, London, UK. Discover advances in deep learning tools and techniques from the world's leading innovators across industry, academia and the healthcare sector. Learn from the experts...

Read more

Pitch Your Digital Health Solution at th…

The second eHealth Roadshow, promoted by the new EU-funded eHealth Hub project, will take place on the 6th of April in Stuttgart, Germany, in the frame of the Medtec Europe...

Read more
(HEALTH IT) SPACE - Take a look at who has just Joined