Aptean Medworxx partners with the NNUH to develop a world-class Integrated Care System (ICS)
The Norfolk and Norwich University Hospital Foundation Trust (NNUH) is responsible for providing a broad range of acute clinical services to a population of around 900,000. The hospital provides secondary acute care and some specialist tertiary services, and is a centre for professional education, training and healthcare research for the East of England.
The Trust employs approximately 7000 staff, on two sites, and provides a total of 1200 beds. Like most large acute teaching Trusts the NNUH has to balance the combined impact of financial and staffing demands with the provision of high quality care and efficient patient flow. Demand for healthcare services is also increasing year on year, and Norfolk has a population with the oldest average age in the UK.
NNUH has sought to deploy innovation and new technologies in order to achieve improved and more rapid patient flow. The Trust has piloted a number of new operational initiatives in the last 12 months including the expansion of ambulatory emergency care services. This reduces the time patients wait to move to a nursing home or long term residential care by the deployment of individual care coordinators.
The Trust has also developed the UK’s first Older People’s Emergency Department which is dedicated to patients over 80 years old. The Trust’s main aim is to deliver continuous service improvement by monitoring and reviewing the efficiency of each step in the patient’s acute hospital journey, and delivering solutions to problems which may retard optimum patient flow.
From the ‘front door’ in the Emergency Department, and the delivery of the NHS 4 hour quality standard, to the improved Discharge Service - which aims to discharge as many patients as possible in less than seven days - the NNUH is committed to achieving and maintaining consistent results.
As with most acute hospital systems, winter pressures on the service of increased admissions and higher rates of respiratory exacerbations and infectious illnesses such as flu and Norovirus, mean that, from time to time, short-term additional bed capacity is required. This additional capacity tests the whole health system as it very often results in sluggish patient flow and increased pressure on the already limited workforce.
Prompted by the long-term NHS plan for greater integration of health and social care services, and the development of Integrated Care Systems (ICS), NNUH Deputy Chief Operating Officer, Roberta Fuller explains the NNUH strategy:
“We have been challenged by a number of problems in recent years including rising demand for acute admissions, a growing elderly population and slower patient flow. All these exert operational pressure on our bed capacity which has reduced over the past two years due to reduced staffing levels and the need to develop a higher ratio of high dependency beds within the hospital.
“Our commitment to service improvement involves trialling an extensive range of measures, each of which are a contribution to achieving optimum patient flow. We review the impact of each initiative and continue the projects which have worked well and had positive impact, whilst decommissioning the projects which do not deliver.
“We have focused on a number of projects aimed at improving internal patient flow within the hospital – such as the Red to Green campaign – and we have realised that the regular and automated reporting of information to inform the development and delivery of operational processes on the wards and departments is of vital importance.
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“As well as a focus on process improvement we have also sought to secure the ‘hearts and minds’ of our staff in the delivery of improved care. The ‘Last 1000 days’ campaign, which promotes the value of the patient’s time and their experience as the most important currency in healthcare, reminds health professionals of the importance of improving service efficiency as part of the overall care of their patients.
“We know that longer lengths of stay in hospital, especially for elderly patients, contribute to deconditioning and worse clinical outcomes. By working to improve patient flow all health professionals contribute to “giving back to the patient some of the precious last days of life”.
Medworxx CUR was implemented in the NNUH in September 2016. Full roll out was achieved by March 2017 and was the largest and fastest roll out in the UK. This achievement was recognised by NHS England. The system is live on 964 beds across the hospital, including the Acute Medical Unit (74 beds), the Surgical Assessment Unit (33 beds) and Paediatrics (33 beds). Data input is completed daily by Ward Sisters, and overall compliance ranges from 77% to 83%.
As well as clearly identifying the top five reasons for delay, early data analysis has highlighted the shortfalls in integrated Community Services such as Outpatient IV Antibiotic Therapy (OPAT) and the management of VAC dressings. Combined potential annual bed day savings have been estimated at approximately £289,000.
Despite limited resources to support the project management of some of the new initiatives, the gradual application of faster and safer discharge processes, particularly for vulnerable and frail patients, has started to deliver a more efficient hospital and local health system. Other local health system partners have been inspired by the use of the Medworxx system to understand better their patient flow dynamics.
Better partnership working and information sharing has paved the way for easier integration of services across the acute, community and social care sectors. Medworxx has enabled NNUH to improve compliance with clinical information recording to 85%, reduce ‘ready for discharge’ patients by 18% and reduce ‘avoidable admissions’ by a further 5%.
Roberta Fuller confirms: “Medworxx helps to provide clarity at all levels of the patient journey through the acute hospital, and potentially beyond, if our local health system partners decide to adopt the Medworxx product. Effective use of the Medworxx system enables us to identify blockages to efficient patient flow and gives us a focus around which to design solutions.
“We are working with our clinical teams to empower medical and nursing staff to understand the impact of their daily work processes and decisions, and to design improved services for patients which can minimise harm and support more rapid recovery. Regular Medworxx reports have been designed at NNUH to answer the questions most frequently asked.
“The Trust is currently in the process of embedding the use of this data as part of business as usual. We have high hopes for the continued use of Medworxx to support the ongoing delivery of service improvements as we explore the use of new technologies and techniques to manage the optimum flow of patients from arrival to discharge.”
How healthcare can safeguard itself against cyberthreats
One of the most fundamental lessons from the COVID crisis is that health should always be a priority. In a similar fashion to the human body that frequently fights off viruses and foreign invaders that intend to cause it harm, the sector itself is now a prime target for another type of external threat: cyberattacks.
The figures speak for themselves: between December and January this year, hospitals in the UK were at 89% capacity, with 7,000 fewer available beds than there usually are. As the pandemic increased pressure on hospitals, clinics, and research facilities to create a treatment for patients globally, it has left the sector exposed to hackers who, like a virus, have been targeting it relentlessly and evolving their tactics.
From patient records being held ransom, to fake emails claiming to originate from the UN WHO, the NHS, or vaccine centres, through to attacks on the cold supply chain to find out the secret formula of the COVID vaccine, the healthcare industry is facing constant cyberattacks and struggling to cope. This threat is unlikely to go away anytime soon – and as such, the industry needs to take a proactive, preventative stance to stay safe in a dynamic digital world.
The responsive nature of healthcare – particularly of hospitals – means that efficiency is crucial to the industry’s standard operations. To support this, the sector has been embracing technological advancements that can improve the quality of work, enabling staff to meet pressing deadlines, and enhancing patient care. For example, the industry has been digitising records and improving its ways of working through digital means over the past few years.
This shift is critical to offer high quality patient care; yet, it also means the sector has become more dependent on IT, which can come with a risk if cybersecurity processes employed are deemed as inadequate.
Without the correct security measures in place, the desired efficiency gains realised, can be easily lost in a heartbeat. Simply put, an elementary glitch in the system can have a tremendous ripple effect on many areas, from accessing patient records and conducting scans, to maintaining physical security and protecting the intellectual property of experimental treatment development.
To prevent this, healthcare organisations need to ensure they’re considering cybersecurity as part of their overall digital transformation strategy – and setting the right foundations to create a culture where safety goes hand in hand with patient care.
Before implementing cybersecurity process, healthcare organisations need to assess the potential risks they face. Depending on how much confidential data the trust has, where it is stored, who has access to it and via which means, the cybersecurity strategy and associated solutions will change.
It’s fair to say that a medical device start-up where all employees have a corporate-sanctioned laptop and access data via a VPN will have radically different needs to a large hospital with hundreds of frontline workers connecting to the hospital’s Wi-Fi using their personal device.
These requirements will pale by comparison to a global pharmaceutical giant with offices in multiple locations, a large R&D department researching new treatments for complex diseases and a fully integrated supply chain. Considering the existing setup and what the organisations is looking to achieve with its digital transformation strategy will therefore have an immediate impact on the cybersecurity strategy.
Despite this, there are fundamentals that any organisation should implement:
Review and test your back-up policy to ensure it is thorough and sufficient – By checking that the organisation’s back-up is running smoothly, IT teams can limit any risks of disruption in the midst of an incident and of losing data permanently.
In our recent State of Email Security report, we found that six out of ten organisations have been victims of ransomware in 2020. As a result, afflicted organisations have lost an average of six days to downtime. One third of organisations even admitted that they failed to get their data back, despite paying the ransom. In the healthcare industry, this could mean losing valuable patient records or data related to new treatments – two areas the sector cannot afford to be cavalier about.
Conduct due diligence across the organisation’s supply chain – Healthcare organisations should review their ways of working with partners, providers and regulatory institutions they work with in order to prevent any weak link in their cybersecurity chain. Without this due diligence, organisations leave themselves exposed to the risks of third party-led incidents.
Roll out mandatory cybersecurity awareness training - Healthcare organisations shouldn’t neglect the training and awareness of their entire staff – including frontline workers who may not access the corporate network on a regular basis. According to our State of Email Security report, only one fifth of organisations carry out ongoing cyber awareness training.
This suggests it is not widely considered as a fundamental part of most organisations cyber-resilience strategy, despite the fact many employees rely on their organisation’s corporate network to work. By providing systematic training, healthcare organisations can help workers at all levels better understand the current cyberthreats they face, how they could impact their organisation, the role they play in defending the networks, and develop consistent, good cybersecurity hygiene habits to limit the risks of incidents.
Consider a degree of separation – Information and Operational Technology (IT and OT) networks should be separated.
Although mutually supported and reliance on each other, employees shouldn’t be accessing one via the other. This should be complemented by a considered tried and tested contingency and resiliency plan that allows crucial services to function unabated should there be a compromise. Similarly, admin terminals should not have internet access to afford a degree of hardening and protection for these critical accounts.
As the sector becomes a common target for fraudulent and malicious activity, putting cybersecurity at the core of the organisation’s operations is critical. It will help limit the risks of disruption due to cyberattacks, reduce time spent by the cybersecurity team to resolve easily avoidable errors, and ensure that institutions can deliver patient care, safe in the knowledge that their networks are safe.
Fighting future threats
With technology continuing to change the face of healthcare, the surface area and vectors available for attacks by malicious actors is constantly increasing. With the introduction of apps, networked monitoring devices, and a need for communication, the attack vector is ever expanding, a trend that needs to be monitored and secured against.
To prevent any damage to patients, staff, or the organisation they are responsible for, healthcare leaders must put security front and centre of their digital transformation strategy. Only then can the sector harness the full benefits of technology. Doing this should include implementing cybersecurity awareness training to challenge misconceptions around security, encourage conversation, and to ensure employee knowledge of the security basics and threats faced.
This ultimately allows healthcare organisations to do what they do best: provide the highest standard of patient care, safe in the knowledge that their operations, patients, and data are safe.