Papworth Hospital decided to implement the Academy of Medical Royal Colleges (AoMRC) headings into their eDischarge summaries to:
ensure consistent recording of information
improve the quality of information shared with GPs
enhance audit data
The pilot started in September 2016 to coincide with the 2016/17 NHS Standard Contract deadline to implement the AoMRC headings in eDischarge summaries by 1 December 2016. The success of the rollout was largely due to nursing engagement and support from Chief Clinical Information Officer (CCIO), Chief Information Officer (CIO), Patient Services and IT.
About the organisation
Papworth Hospital is the UK's leading heart and lung hospital, treating over 100,000 patients each year from across the UK. The hospital includes the country's largest heart and lung transplant centre, the only national centre for pulmonary endarterectomy and it's a national centre for a range of other specialist services.
Since carrying out the UK's first successful heart transplant in 1979, Papworth has established an international reputation for excellence in research and innovation, top surgical results and the very best in patient care. Papworth Hospital carries out more major heart operations than any other hospital in the UK (more than 2,500 per year). With regular scrutiny from robust quality performance monitoring systems, the survival rates and outcomes of these operations are among the best in the world.
The national requirement to implement the AoMRC headings in eDischarge summaries by 1 December 2016 was behind Papworth's project. A task and finish group was set up, led by the Deputy Director of Nursing, with members including a senior nurse, the IT department, the Health Records department and Pharmacy, as well as engaging with the Medical Lead for IT in the hospital.
The group developed a plan, which included time to build the eDischarge summary form according to the Academy of Medical Royal Colleges (AoMRC) headings and training for all staff. The plan also included going live with one ward per week from the end of September 2016, so that all wards were live by December 2016. The organisation comprises of 7 inpatient wards, 2 day wards and an admission and discharge lounge with the ward areas consisting of between 12 to 38 beds.
The benefits of using the AoMRC headings in the eDischarge summaries include:
reduces the time taken to produce eDischarge summaries
improves patient safety by reducing the risk of omitting vital information
reduces GP's time spent chasing up for missing information and interpreting different eDischarge summary layouts
Before the introduction of the AoMRC headings The content of eDischarge summaries was thought to be consistent across the organisation, but in reality there was a huge variation in the content and layout, with different headings being used by different departments. This made it difficult for staff to complete eDischarge summaries when moving between wards.
After the introduction of the AoMRC headings Introducing the AoMRC mandatory headings has ensured eDischarge summaries are now structured consistently throughout the organisation. There was also consultation with GPs. Based on this feedback and local business needs, some departments chose to add the AoMRC optional headings, so that the eDischarge summaries contained the additional information required by GPs.
The task and finish group worked with key stakeholders, including input from GP's, to ensure the information received was relevant and linked to requested actions about what was expected of the GP. The engagement also included testing the eDischarge summaries to ensure that GP's were able to receive them.
A project plan was developed which included building the eDischarge summary form using the AoMRC headings in the electronic medical record. All the current forms, whether paper or electronic, were replaced with the new headings. There were adjustments made to the optional headings to fulfil requirements for specific needs and specialties.
Rollout of the program was scheduled from September to December 2016, spanning all the inpatient and day wards. On average, each inpatient ward has between 5 to 10 discharges per day, day wards have up to 20 or more discharges and the new discharge lounge has between 5 to 8 discharges per day. During the rollout, weekly reviews were carried out before moving onto the next ward.
The benefits include:
standardising the implementation of AoMRC headings across the organisation has reduced the time spent producing the final eDischarge summary by approximately 50% in some areas
from a safety point of view, using the AoMRC headings means less opportunity for the omission of key information
reduces time spent by GPs contacting the Trust to ask for potential missing information - this will be monitored by the Trust
collaboration with GPs in the design of the form and order of the AoMRC headings to ensure they are receiving the information they require in the order they want it
meeting a national and local requirement to provide information to GPs on agreed CQUINS - the fact that these are now electronic saves time and is better for auditing purposes
Challenges and lessons learned
To ensure as little resistance as possible, all communications focused on the benefits for staff and patients of moving to an eDischarge summary with AoMRC headings, with the full support of the CCIO and CIO.
One of the challenges faced was the availability of desktop computers, but this was addressed prior to the introduction of the eDischarge summary with support from the IT department.
The variation in practice of the different specialties was initially a challenge, but this was resolved by using the AoMRC's optional headings.
During the rollout, which was one ward at a time, it was important to make sure that all staff were supported and comfortable using the new headings, including working with night staff.
The rollout was successful due to the structured project plan, gradual rollout and consistent daily support for staff, addressing and actioning any problems encountered at the time. This gave staff reassurance and confidence that the change was being managed and monitored, thereby keeping them engaged in the project.
During the rollout there was dedicated support for each area to ensure that any problems or challenges encountered by staff were addressed at the time.
Training on the use of the headings was provided on a one to one basis on the ward by actually producing a discharge summary. Training on the EMR was done a short time prior to the roll out for those that required it and it also ensured that everyone had the correct rights and editing access. In total, 500 nurses and a number of medical staff, from junior doctors to consultants, across the wards and departments were trained.
After the rollout on each ward was complete, a letter was sent thanking them for their contribution and value in the successful delivery of the project.
Papworth will soon implement Lorenzo EPR and introducing eDischarge has been a useful step in terms of organisational readiness for the change.