Improving patient and staff experience and safety with queue management software in the emergency department

Visible queuing: a game changer in hospital emergency departments

HIN Innovation Grants will fund an innovative project to improve patient experience in the Emergency Department at St George’s University Hospitals NHS Foundation Trust.

This project will pilot a visible electronic queue management system so that patients can see where they are in the queue to be seen at any time. The team is understood to be among the first in the UK to introduce this.

The new system aims to improve patient experience and reduce the time receptionists in the Emergency Department at St George’s spend dealing with waiting time or queue position queries. Staff in Emergency Departments around the country deal with a high volume of these questions which can have a knock-on delay in booking-in new patients.

The idea for the new system came from junior doctor Dr Lindsey Bezzina who worked in the Emergency Department for a year and witnessed the problems reception teams and other staff encounter first-hand when it comes to waiting times queries. Currently, a whiteboard behind the reception desk is used to display general waiting times and updated every hour. Lack of visibility of individual positions in the queue can cause concern for patients, who can worry that they have been forgotten, passed over or missed their call to see the emergency team. This leads to repeated queries to reception staff about the waiting time and these queries are not always easy to answer due to the complexity of queues. As well as frustration for patients, these queries can occasionally result in aggressive and abusive behaviours which put additional pressure on staff.

The new system will offer people a code when they first arrive and register their details. This code will correspond with a number shown on an electronic screen, showing where the number is in the queue. The display will be visible from all parts of the waiting room and will make clear that there are multiple queues at any one time and that if someone arrives who needs more urgent care, the queue positions will move accordingly.

This means patients will be able to monitor their own position and progress in the queue, which provides assurance that they have not been missed or forgotten, reducing anxiety as well as the likelihood of aggression directed towards other patients or staff. The transparency the system will offer has the potential to educate people waiting about the multiple queues in operation at any one time, aiding understanding about the way Emergency Departments operate and why some people are seen more quickly.

The grant awarded will be used toward developing and implementing the queue management software in the Emergency Departments department. If this innovative pilot is successful and adopted as business as ususal, the software can be spread and adopted by other NHS emergency departments. There is also an opportunity for use of this system in outpatient departments at a later stage.

Find out more about our work in patient experience

Innovator Spotlight

Dr Lindsey Bezzina, Junior Clinical Fellow, Emergency Medicine, St George’s University Hospitals NHS Foundation Trust said:

“We are passionate about trying new ways to improve patient experience and safety and we believe better queue visibility will give patients reassurance and free up reception team time.

“Emergency departments are pressured and all you want is to do the best for patients. It’s difficult at the moment when we can’t easily answer their top question: when will I be seen? With relatively simple technology we believe we can make a huge difference to their experience and support staff at the same time by reducing interruptions. Greater transparency over the complex queues we operate will help everyone gain a greater understanding of how teams are working to help people.”

Virtual reality relaxation and coping skills for reducing stress and challenging behaviour on acute psychiatric wards

Published on September 23, 2019 and last updated on February 24, 2020 by Rita Mogaiji

Virtual reality relaxation and coping skills for reducing stress and challenging behaviour on acute psychiatric wards

Virtual reality on the wards at-a-glance

• Reduced anxiety and stress, helping people to manage their mental health conditions.
• Reduced levels of stress and challenging behaviour on wards.
• Better environment for both service users and staff.
• Fewer incidents of challenging behaviour and a positive effect on reducing staff stress and burn-out.
• Reduction in the need for seclusion.
• Parity of esteem, ensuring that mental health service users benefit from the latest technology.

Virtual reality on acute wards to help people with complex mental health conditions

Service users on psychiatric wards often report high levels of stress and difficulties regulating emotions, which can lead to violence and aggression toward staff and others. A team at South London and Maudsley (SLaM) NHS Foundation Trust plans to address this through pioneering use of virtual reality.

Funded by the HIN Innovation Grants, this project aims to evaluate the implementation of a new virtual reality (VR) technology, VRelax, to reduce stress and arousal in service users with complex mental health conditions. The VR headsets allow people to experience calming and relaxing environments. Previously, the NHS typically asked people to think of positive mental imagery, which requires more concentration and imagination and can be challenging to sustain. Virtual reality will give people the chance to feel immersed in a more calming environment.

The team will introduce 12 new VRelax headsets and assess their effectiveness in reducing service user stress and associated risks (violence, aggression and seclusion) on six acute psychiatric wards within SLaM. VRelax consists of 360 degree videos of calm, natural environments. This includes a scuba diving experience with wild dolphins, a sunny meadow in the Alps, a coral reef, a drone flight, a sunny mountain meadow with animals, a guided mindfulness meditation on the beach or a wide range of other options, all shown in a VR headset. The team will train the nursing staff on the software and nurses will then be able to decide how and when to offer this to their patients, as an additional option that complements existing relaxation techniques.

Heightened stress reactivity is not good for individuals: it’s related to recurrence of mood, anxiety as well as psychotic disorders and it’s not good for staff or ward environments: difficulties regulating emotions can increase risk of violence and aggression, which put both service users and staff at risk. This can result in seclusion being necessary, with isolation potentially increasing service user stress and costs. A previous randomised cross-over trial of VRelax with 50 psychiatric outpatients showed strong immediate effects on stress level, and on negative and positive mood states. The team at SLaM wants to bring these promising findings to service users on acute wards in the UK.

In addition to improving care for service users, VR has the potential to have a real impact on the overall ward environment. By reducing stress and anxiety, the project hopes to reduce violence and aggression. This will create a better environment for both staff and service users.
The project has collaboration at its heart. The team will link three main institutions – SLaM, University Hospital Lewisham, King’s College London and University Medical Center Groningen, in the Netherlands.

Find out more about our work in mental health

Innovator Spotlight

Dr Simon Riches, Highly Specialist Clinical Psychologist, South London and Maudsley NHS Foundation Trust said:

“At a relatively low cost, this technology could have a major impact on the ward environment and the people in our care. Service users will have the chance to feel immersed in a more calming environment, meaning that both staff and service users can benefit from reduced levels of stress and challenging behaviour.

“We’ve brought a lot of people together for the project who are very passionate about digital health, including international colleagues. It’s still very new and the opportunity to collaborate on this emerging area of research is exciting.”

Dr Freya Rumball, Clinical Psychologist, South London and Maudsley NHS Foundation Trust, said:

“There is strong evidence that relaxation and grounding techniques can have a positive impact on stress and anxiety, and we will be among the first teams to test this exciting new technology on acute wards in SLaM. Our pilot will advance the evidence base and we are keen to disseminate our findings as widely as possible.

“Innovating in the NHS can be challenging, as it can be hard to find the time to think about things from a fresh perspective. However, we’re really passionate about bringing new technology to the forefront of our clinical work and are actively supported in this by our management and leadership.”

Simulation Lab for Health Technology Development and Adoption: Discovery project

Published on September 23, 2019 and last updated on February 24, 2020 by Rita Mogaiji

Simulation lab for health technology development and adoption

Tech simulation labs at-a-glance

Mobile simulation labs for health technology

A new type of simulation lab aimed for the NHS to test and develop digital health technology is being designed by NHS teams. The HIN Innovation Grants have funded a new discovery project aiming to bring the benefits of hi fidelity simulation to health technology procurement and implementation in the NHS.

The NHS has used hi fidelity patient simulation for high pressure clinical scenarios for many years, where either actors or sophisticated dummies act as patients and scenarios are played out and recorded. This gives NHS staff a learning environment that is safe and controlled so that the participants are able to make mistakes, correct those mistakes in real time and learn from them, without fear of compromising patient safety. It also allows for changes in process and workflows to be identified and tested, to improve ways of working.

Simulation labs are well evidenced and used in contexts such as medical training (for example crash calls or trauma) but their application in a digital health context has not previously been systematically researched and tested in the UK. Given the abundance of new technology that NHS teams are now using, ranging from apps to new handheld devices to multi-million pound electronic record systems and equipment, this project aims to test the benefits of simulation for digital health.

At its most basic, simulation requires a screen and camera set-up, typically with cameras in the room that can show the action in real time. The simulation can use a mix of clinicians, staff and actors. Recording the action is crucial so that reflection and learning can take place effectively.

This project aims to show that simulation can be done in a cost effective, mobile way. For example, it will explore whether Trusts could create their own simulations by putting their own screens up and using in-house cameras and laptops at relatively low cost. If this is achieved it could help the NHS make better technology procurement decisions, help staff feel confident in stressful scenarios that involve multiple combinations of technologies and identify design improvements more quickly.

Technology simulation is the norm in many industries. NASA simulates its technology in the closest possible conditions to space using a neutral buoyancy lab. In healthcare, many American hospitals simulate technology on a regular basis. By contrast, while the NHS uses simulation for many traditional clinical scenarios it rarely tests new technologies in a genuinely live environment before they are procured.

The NHS invests millions in new technology every year. Roll outs of technology are complex and it can take many years for the full benefits of new technology to be realised. User testing of digital technologies at the development stage often take place separate to the clinical setting because tech companies struggle to access real-world practice settings as a result of governance, safety and capacity in teams. As a result it is not possible to identify, mitigate and manage problems faced by real users in the context of clinical care.

The team will be focusing on mental health contexts and will start with digital apps, aiming to create a simulation environment that is mobile so it can be easily repeated by other trusts without the need for an expensive standalone simulation lab. The pilot simulation model will be developed drawing on simulation theory and research, user-centred design, agile and implementation methodologies and technology engineering. The final result from this pilot project will be a powerful resource that supports adoption of digital technologies in practice and promotes a technology simulation culture within the NHS.

Find out more about our work in mental health

Innovator Spotlight

Dr James Woollard, Chief Clinical Information Officer, Consultant Child and Adolescent Psychiatrist, Oxleas NHS Foundation Trust

“The amount of technology we procure is only set to increase and often as clinicians, we find ourselves needing to use multiple new pieces of technology simultaneously to care for patients. The NHS has used clinical simulation for years and it’s time we applied this same theory to digital technology. At the moment, we’re asking our staff to use equipment that has very rarely been tested live in the kind of high pressure scenarios they face.

“Our focus is on developing cost-effective mobile simulation labs that will help us all learn, build confidence and make roll outs much faster. If technology companies can rapidly find and address real world problems associated with using their technology before they are rolled out to staff, we’ll see better product design, ease of use and faster adoption.”

‘Mass screening!’ – an innovative healthcare delivery approach to stroke prevention in Wandsworth

Published on September 23, 2019 and last updated on February 24, 2020 by Rita Mogaiji

Mass screening! – an innovative healthcare delivery approach to stroke prevention in Wandsworth

Stroke-busting health checks at-a-glance

• In Wandsworth, nearly 2000 people have undiagnosed atrial fibrillation (one of the main risk factors for stroke) and 35,000 people have undiagnosed hypertension.
• Detection of AF through health checks will prevent strokes, helping communities live longer, healthier and happier lives.
• If you are Black and of African or Caribbean origin you are twice as likely to have a stroke, and at a younger age, than the Caucasian population. This project aims to reduce inequalities by making sure everyone has access to the care they need.
• It’s a better experience – tailored to what people actually want and need.
• Trains people who are embedded in their communities to do new roles that can support the health service and introduces new models of care for people by working closely with community groups and faith leaders to target at-risk communities.

Stroke-busting health checks for Wandsworth

To increase detection of the main cardiovascular risk factors across the most deprived areas of the borough, HIN Innovation Grants will fund a new project to offer ‘Stroke Busting Health Checks’ to 1,000 people at greatest risk of stroke in Wandsworth.

This co-produced, community-led scheme will see the NHS partner closely with faith and community groups, led by Wandsworth Community Empowerment Network, to use mobile ECG devices to test people for irregular heart rhythms (a warning sign for stroke) and offer wider health advice. The health checks will include Atrial Fibrillation (AF) checks using innovative mobile ECG devices, diabetes testing, blood pressure, cholesterol, and body mass index. They will be an opportunity to talk about the risk of smoking, including the direct link to stroke.

It is widely recognised that hard to reach groups have greater health inequalities and poorer health outcomes, with Black, Asian and minority ethnic (BAME) communities at substantially higher risk of poor health and early death, including due to stroke. Traditional NHS approaches aren’t working well enough – these communities are less likely to attend NHS health checks, despite being the most at risk. Therefore, this team is going to work in an innovative new way to go to these communities and work alongside local leaders to engage people.
In total, the project aims to perform at least 1,000 “Stroke Busting Health Checks” in hard-to-reach communities at high risk of stroke. It will use healthcare assistants from local GP practices to offer regular checks through a hub and spoke model of engagement in high volume places of worship and association, including temples, mosques and churches.
To support the checks and help engage the community in this work, the team will also produce a bespoke film, distributed through social media, featuring local faith and community leaders with a call to action to take part in the checks. This culturally specific content can support other health projects elsewhere in the borough and beyond.

The project is expected to increase awareness of stroke and cardiovascular disease as well as reduce the prevalence of stroke in the Borough. All those identified at risk of stroke through the checks will be supported to attend further tests and commence treatment. Faith and community leaders will trained and upskilled to support and encourage their communities to access additional services where needed, including registering with GPs.

Find out more about our work in stroke prevention

Innovator Spotlight

Dr. Nicola Jones, a GP and Chair of Wandsworth Clinical Commissioning Group said:

“The people of Wandsworth can look forward to a new and innovative local approach to stroke prevention. At the moment, over a third of people invited for a health check do not attend. We’re using this funding to kickstart an innovative new collaboration between Wandsworth community leaders and the health service, working hand-in-hand with local groups to get our services to those who need them most.

By targeting hard-to-reach communities we will reduce health inequalities and we expect this grant to be the first step in developing a new approach to screening that will benefit the communities we serve.”

Malik Gul, Director of Wandsworth Community Empowerment Network, Wandsworth, said:
“Together, we’re bringing health checks into the community in a way that is unique and transformational. The approach unlocks the value and capabilities held in communities – in mosques, churches, temples, as well as in community groups and associations. This is a vital network of microsystems – the project is creating an innovative, emergent system that can offer the NHS new ways to make early health interventions more effective and work towards reducing health inequalities.

“Leadership has been essential – senior people across Wandsworth have been brave enough to say yes, we need change and yes, we’re ready to get behind this. Without strong collaborative and cross-sector leadership, the NHS would not be working in these new ways.”

Lewisham Primary Care Recovery College Pilot Project

Published on September 23, 2019 and last updated on February 24, 2020 by Rita Mogaiji

Lewisham primary care recovery college pilot project

Recovery College Pilot at-a-glance

• Improved and open access for people who need support.
• In South East London, 40 per cent of GP consultations relate to mental health. This could help reduce pressure on primary care at the same time as improving access.
• This is a new way to improve patients’ understanding of conditions, confidence in managing their health independently and personal resilience: and for this to have a measurable impact on their subsequent patterns of contact with a clinician.
• Increases opportunities for patients/service users and carers within primary care to work within a co-production framework, learn together and reduce of mental health stigma within the primary care environment.
• Strong example of care delivered in different settings and opportunities for primary care to offer new services in collaboration with other parts of the system.
• An opportunity to gather evidence and make the case for a sustainable roll-out.
• Recovery colleges quite new so evidence base is still emerging but studies to date show a high return on social investment – up to £10.81 for every £1.

Recovery College: innovating to improve mental health support in primary care

A new project to take mental health recovery, self-management and wellbeing workshops into GP practices will be funded by the HIN Innovation Grants.

From the team that leads SLaM’s successful Recovery College, this project will take its model to GP practices. Recovery Colleges focus on hope, opportunity and choice/control- co production. They enable the students to become experts in their own self-care, and develop skills they need for living and working.

Students are usually individuals who do not currently need acute mental health services but do need more support than they’re able to get from busy GPs at present. It could be for a very wide range of conditions, for example long term stress or low-level depression and anxiety that affects people’s daily lives but not to the point where it needs acute intervention.

The project will provide free, co-produced self-management, recovery and wellbeing workshops and courses for patients, carers and staff in primary care, using shared perspectives, skills and knowledge to help people recover and live as well as possible. By extending into GP practices for the first care, it aims to reach more people with support and improve access.

The pilot college will be based within a health centre in Lewisham and aimed at service users/patients registered with five GP surgeries at in and around New Cross. A key part of the approach is that the trainers are paired together so that there is one ‘peer recovery trainer’ – someone who has lived experience of mental ill-health or distress as a service user – and a ‘professional trainer’ – someone who has professional experience. This means students get the clinical perspective and a personal narrative so that they can discuss and learn from someone who knows what it can be like, and feel more comfortable to share personal experiences.

Recovery College also helps people to network and meet people who are in a similar circumstance, increasing peer support. Often people are isolated and benefit from social networks. Learning about staying well in addition to having opportunities to stay connected can be very helpful for recovery. The team plans to offer a range of courses over a ten week pilot period. The courses will be co-designed, based on current SLaM Recovery College content, including topics around depression, anxiety, mindfulness, staying well and making plans and wellbeing.

The pilot will accept both referrals from GPs as well as self-referrals, with a maximum of 20 – 25 per workshop. Increasing access and routes to this kind of support will not only support people with their mental health, it aims to reduce the need for these individuals to use GP appointments for support that can be offered through the college.

The use of peer trainers has been very successful at SLaM Recovery College to date. Taking the peer trainer model into primary care is likely to be an extra and impactful support for the current NHS workforce when designing services and an additional forward step to tackle stigma and culture around mental health services.

Find out more about our work in mental health

Innovator Spotlight

Kirsty Giles, Manager (OT), SLaM Recovery College, South London and Maudsley NHS Foundation Trust, said:

“Our hope is that this pilot shows that recovery colleges can become an essential part of the primary care landscape, improving access to support for people with mental health needs while reducing the pressure on traditional GP appointments. Our trainers and our students are really brave, by putting themselves out there and sharing their story to help someone else. The approach is welcoming and effective.

“The college works with a really diverse group of people. As clinicians, we’re always learning from our students’ lived experience and are inspired by how they look after their wellbeing. This is a two-way knowledge exchange.”

Transforming delivery of antenatal care in gestational diabetes

Published on September 23, 2019 and last updated on February 24, 2020 by Rita Mogaiji

Transforming delivery of antenatal care in gestational diabetes

Improving care for women with diabetes in pregnancy at-a-glance

• Potential to reduce deliveries before 36 weeks and caesareans.
• The NHS is working hard to make sure women have consistent midwife contact through their pregnancy by 2021. This could free up to 600 specialist appointments so that women can spend this time with their community team and have familiar faces throughout.
• Focus on education supports faster changes to diet and medication, helping to improve sugar levels more promptly over the course of the pregnancy.
• Values women’s time and creates a space to deliver education around food and exercise alongside specialist one-to one input.
• Gives women more control of their care as well as improving outcomes.

New innovations to improve care for women with diabetes in pregnancy

A HIN Innovation Grant will go to fund the Kingston Hospital team to introduce innovative approaches to supporting women with diabetes in pregnancy (gestational diabetes). The team plans to introduce a sugar monitoring app (GDM-Health), guided shopping trips and a ‘connected waiting room’ with added benefits.
Currently women are required to prick their fingers four times a day, record this in a book and then have a face-to-face appointment once a fortnight. This new app and the changes that will be made to specialist midwives job plans will mean daily virtual clinics with midwives, run via the app and phone. Every day, midwives will go through all of the information received and contact anyone who needs support to get their blood pressure under control. Too often at present, such regular face-to-face appointments for diabetes in pregnancy can overly medicalise their pregnancy, increase anxiety, result in lots of time spent at the hospital and take away a woman’s feeling of control over their pregnancy as it is closely monitored by medical professionals.

Research has shown that gestational diabetes can be an indicator that a woman is more likely to develop diabetes later in life, and that the children of mothers with gestational diabetes are more likely to be obese and to develop diabetes themselves. Risk factors for this condition include increased body mass index, maternal age and non-caucasian ethnicity, factors which are present in south London’s population. Effective interventions that support education around diet, weight and exercise are essential to try and prevent poor health later in life.

There are three main aspects to the pilot:

• Using a new app, women will upload the sugar measurements they take four times each day so it can be reviewed in real-time by specialist midwives. Work arrangements for the midwives will be redesigned to ensure that there is someone available Monday to Friday to answer queries by phone or email, and proactively monitor results – so that the team can act more quickly with diet advice or medication adjustments to improve sugar control and reduce the risks to mother and baby.
• The team will also seize the opportunities of the waiting room to create a ‘connected waiting room’ that encourages exercise, healthy eating and peer bonding to help women explore ways to maintain good sugar levels alongside a healthy pregnancy. The waiting room is a key opportunity as women will often have appointments with more than one team member in the clinic, meaning that there is time spent in the room between appointments. To maximise the value of that time, the team will bring the room alive and introduce a library of recipe books, posters around diet and exercise in pregnancy and conversation prompts to encourage women to talk to each other. They will also hold drop-in education sessions covering diet tips, breast feeding advice, first aid for newborns and other topics suggested by the women using the service.
• To support the women in their care further, the team plans to pilot guided tours in a local supermarket, where they will guide women through changes they can make to their weekly shopping and hold an education session on healthy eating at the supermarket, suggesting alternatives and exploring barriers to change.

The project aims to reduce caesareans and interventions in birth through more responsive antenatal care as well as increasing the space for education around food and exercise. The plans are also designed to improve continuity of care. Most women with gestational diabetes are diagnosed at around 28 weeks. When their care is transferred to the diabetic clinic it breaks already established relationships with their community midwifery team.

The new app’s ability to monitor sugars more easily and remotely should mean that women need two fewer face-to-face appointments with the diabetic clinic. Instead, women can then make two appointments with their usual community midwifery teams, maintaining consistent contact with the team that will support them when they deliver their baby and in the community after delivery. Continuity of carer is proven to reduce preterm birth and pregnancy loss, as well as increasing maternal satisfaction with the care received. The team predict that if successful, the pilot could move as many as 600 appointments each year back into community settings.

Find out more about our work in diabetes

Innovator Spotlight

Caroline Everden, Consultant Obstetrician and Gynaecologist, Lead for diabetes in pregnancy, Kingston Hospital NHS Foundation Trust, said:

“It’s really exciting when you see something and realise the impact it can have on the women you care for. Women’s time in pregnancy is valuable and we want to use it effectively as we can. Whether it’s through the app to monitor sugars more easily, making the most of the waiting room or by giving them more time back to spend with community midwifery teams, we believe that there is more we can do.

“Our model will hopefully demonstrate that specialist input and education can be delivered in a way that values and supports the relationship established between a woman and her midwife, while also ensuring that expert attention is paid to a potentially very serious condition in pregnancy.”

Diabetes prevention decathlon

Published on September 23, 2019 and last updated on February 24, 2020 by Rita Mogaiji

Diabetes prevention decathlon

Diabetes Decathlon at-a-glance