Learnings from FetaLink Implementation at Imperial College Healthcare NHS Trust

Imperial College Healthcare NHS Trust successfully implemented a CTG trace integration system, known as FetaLink in 2017. Using interviews conducted by the Technology Team at the Health Innovation Network with staff directly involved in the implementation, this resource contains condensed lessons and key facts which aim to aid other NHS organisations considering implementing similar solutions.

Imperial’s maternity service delivers c10, 000 babies per annum, providing care throughout pregnancy, labour, and the postnatal period. The primary reason for monitoring a baby’s heart rate during labour is to detect signs of foetal distress, which can suggest that the baby’s supply of oxygen is being compromised in some way. If this is detected early, clinicians can intervene to reduce the incidence of a near-miss or an adverse event, potentially preventing complications.

FetaLink allows for vital signs of the mother and baby to be monitored from any location, such as at the midwives’ desk by the shift co-ordinator or remotely by the consultant in other parts of the hospital, as well as at the bedside. It also enables digital transmission from the CTG monitors into the Electronic Patient Record, which reduces the risk of lost or faded CTGs.

The maternity unit had already gone live with Cerner maternity clinical documentation and electronic prescribing and administration two years prior to introducing FetaLink, and was relatively experienced at managing digital transformation projects as a result.

About the project team

The FetaLink project was led by the ICT project team in conjunction with the pre-existing maternity steering group and a FetaLink working group.

The steering group acted as the project board and consisted of key decision makers across maternity, including a Lead Obstetrician, General Manager, Cerner Project Midwives, Head of Midwifery, ICT Change Lead, Project Lead and the Lead Trainer for maternity.

The working group was smaller and included key stakeholders involved in the FetaLink implementation, including the Lead Obstetrician and leads from each department. Decisions were made in this group and fed back to the steering group.

Insights by theme

Planning

Collaboration between the steering and working groups was imperative.
Clinical champions were key to building commitment pre-implementation.
Gathering information through data collections forms helped us to make good decisions.
Our Change Lead worked hard to unite teams.
Running data correction meetings helped us monitor performance and identify risks.
Conducting risk assessments helped to ensure patient safety.

Software configuration

Upgrading bandwidth capacity and making holes in the firewall was necessary for the project.
Working with the clinical teams and suppliers to specify annotations, display, dropdown menus and other software features allowed us to tailor the software to our needs.

Equipment

We hadn’t factored in the need to test old devices; but doing it was valuable because it showed that some needed replacing or upgrading.
Ensuring all rooms are sufficiently spacious and have enough power sockets saves you time later.
Considering the space when planning for screens was necessary: wall-mounting is better in small rooms and screens on trolleys are the best option for bigger spaces.
And then understanding how this will affect your connectivity is key; screens on trolleys need wiring, wall-mounted screens need telemetry.

Training

The “Train the trainer” programme gave trainers a thorough understanding of the software, equipment connectivity and troubleshooting.
Conducting classroom training that included a click-through demonstration of FetaLink and exercises to complete helped people feel confident.
Creating an e-learning resource based on the classroom training script has been useful for refreshing training or onboarding new staff.
Training the Clinical champions to solve problems such as hardware issues and troubleshooting was helpful.

Support

We needed 24/7 in-person support at go-live. This can be provided by the change lead, the training team, agency floorwalkers and the Cerner technical team.
Having an ongoing support structure in place, such as an ICT project manager, Cerner Project Midwives and an IT helpline helps with day-to-day issues.

Deployment

Staggering deployment between labour wards relieved some of the pressure on go-live.
The support that the Cerner Clinical Team provided after go-live was invaluable, if a little too short.
We realised that the biggest risk was association and disassociation of the patient to the device.

About FetaLink

FetaLink is part of Cerner’s PowerChart Maternity functionality and is compatible with the Trust’s current electronic patient record (EPR) system. It is a maternal and foetal monitoring system that enables digital transmission from the CTG monitors into the electronic patient record in real time, and gives a graphical display of the relationship between foetal heart rate and the mother’s contractions, which can be monitored remotely.

FetaLink implementation has been proven to have significant benefits. Automatic integration of vital sign monitoring into the patient record has led to time savings of thousands of hours annually and up to 1-hour per childbirth in other hospitals (HIMMS, 2019). In addition, it helps circumvent the problems associated with manual data entry, which some studies have shown to have error rates as high as 13.5% (Meccariello et al., 2010; Gearing et al., 2006), thereby improving patient safety. Other benefits include the following – Safer as readings are view-able outside the labour
room to all treating clinicians, action can be taken immediately, interruptions are kept to a minimum, integrated into the patient’s electronic health record, easier monitoring of multiple pregnancies, improved handovers, no photocopying and no lost or faded CTGs.

Alternatives to FetaLink include systems from Clinical Computes Systems, PeriGen, GE Healthcare, EMIS, Huntleigh HealthCare and Philips.

This e-resource

Compiled by the HIN’s Technology Team, this e-resource brings together the challenges faced and lessons learnt throughout Imperial College Healthcare NHS Trust’s (ICHT) implementation of FetaLink. This resource aims to share knowledge in order to aid the successful implementation of a CTG trace integration system by other NHS Trusts in the UK and beyond.

The information found in this e-resource is based primarily on semi-structured interviews conducted by the HIN’s Technology Team with key staff members at St Mary’s and Queen Charlotte’s & Chelsea Hospitals and the ICHT ICT team around their experiences with the planning and implementation of FetaLink in their labour wards.

For further information or to discuss commissioning similar e-resources please email us at hin.southlondon@nhs.net. More information about the HIN’s Technology Team can be found here.