This case study was published prior to the NHS Listening Exercise. The outcomes of this exercise have led to some changes to the policy, and this case study may not reflect the current policy position. More information can be found in our detailed response to the NHS Future Forum.
Acute care work utilising iTracker
Bassetlaw Commissioning Organisation (BCO) has been working in partnership with Doncaster and Bassetlaw Hospitals Foundation Trust (DBHFT) to improve acute care processes and discharge systems.
This case study provides an example of how joint working, and use of technology can improve patient care. Development of the iTracker is ongoing, and the case study provides an overview of the work so far.
- Summary of the iTracker
- Description of the system
- Benefits of the iTracker
- Progress report from DBHFT
- Future development
Summary of the iTracker
DBHFT have developed a system called iTracker, which is central to a joint plan to improve patient pathways. iTracker is a real-time web based information system. It has significant potential to:
- reduce length of stay
- identify delayed discharges and reasons
- improve the number of patients who have an Expected Date of Discharge (EDD) set within 36 hours
- improve social care pathways by rapid identification of patients requiring assessment
- identify patients readmitted within 30 days
- encourage joint working across primary, secondary and social care to improve outcomes.
Description of the system
The iTracker system can be accessed securely via the web. At present two GP surgeries are trialling this access and all medical inpatients have data available. The system will be expanded to all surgeries soon and will include all inpatients. There is therefore some development and refining of the system at present.
The system provides information regarding:
- patient details, ward and bed number
- consultant responsible
- reason for admission
- expected date of discharge, and date this was set
- any delays to the EDD, and reasons
- date of social care forms being completed and assessment dates
- dates investigations ordered and performed
- date TTOs (drugs that a patient goes home from hospital with) and transport ordered
- audit/reports for commissioners and providers regarding performance.
The system has already increased the number of patients having an EDD set within 36 hours from 60% to 80% within 3 months and further training is being provided to improve data input.
Benefits of iTracker
- patient involvement: Patients have information regarding the discharge planning process and the EDD is known to staff and patients.
- co-ordinated discharge planning: The system allows social, primary and secondary care to be involved in the patient’s pathway and identifies blocks within the current pathways.
- audit: The system provides reports which can be used within secondary care meetings and facilitate bed management.
The system provides an overview of the patient’s entire pathway.
Progress report from DBHFT
‘Development of the i-tracker began in May 2010, with implementation commencing in June 2010. The system has subsequently been reviewed and version 2 was released in October 2010. Version 2 now incorporates increased functionality from a primary care perspective and has been developed with input from GPs and Social Services.
‘The iTracker is now fully embedded on all Medical Wards at Doncaster & Bassetlaw Hospitals NHS Foundation Trust. A roll out plan for the remaining specialities has been agreed and it is anticipated that full implementation will be achieved by August 2011. Ongoing work will still be required to ensure that the system is operational across all community services and stakeholders.
‘It is essential that a whole system approach is adopted when considering roll out and we are therefore currently working with partnership organisations in both health and social care to develop the roll out plan.
‘The consultants and ward staff have played a key part in the successful implementation of the iTtracker and continue to support development . Dr Tim Noble, Clinical Director of Acute Medicine, states
‘The i-Tracker helps to clarify what is happening and where the delays are causing the most difficulty. This allows you to target your input and audit your service.’
‘Dr Noble’s quote encapsulates the benefits achievable through the significant adoption of the i-Tracker. The system enables the organisation to prioritise providing the best and safest care to patients whilst not losing sight of the key performance and quality targets which are associated with the delivery of acute hospital care. It also provides a platform upon which to improve partnership working between the different services within Health and Social Care and the development of integrated pathways across these areas.’
It is important that the system is seen as an enabler to improve patient care rather than as an isolated system.
BCO is currently working with DBHFT to produce a co-ordinated acute care vision with will also involve joint working with social care.
This vision aims to ensure that primary, secondary, community and social care work together and communicate effectively before, during and after a patient’s admission.
The systems being developed would enable commissioners and providers to work together to reduce length of stay, reduce inefficiencies and remove blocks to effective patient pathways. Working jointly ensures performance can be monitored and improved, and planning is as effective as possible. There is significant pressure upon social care which is likely to increase, and it is vital that we work together to make sure social care can keep people out of hospital where appropriate, and can work efficiently when people are admitted.
It is the intention of BCO to utilise a co-ordinator to oversee inpatient care. This may be a joint initiative with secondary care and will enable us to potentially contact patients on discharge, ensuring they have appropriate advice, follow up and medication. It is hoped this input into the entire pathway will reduce readmissions to hospitals, ensure patients get appropriate follow up from community teams/primary care or secondary care, and will provide patients with the reassurance that clinicians are working together to provide the best care possible.