Optimising hospital patient flow - a key step towards high quality and sustainable healthcare?
Managing patient flow effectively is fundamental to any hospital’s operational efficiency and sustainability. Maximising finite resources, whilst ensuring safe patient outcomes, is a core objective. A winter bed crisis in the NHS and the risks of a potential flu pandemic have placed the issue into sharp focus.
As the UK population ages, debates have concentrated on how the NHS should adapt. In 2014, the NHS Five Year Forward View (FYFV) called for greater integration of services. Consequently, Sustainability and Transformation Partnerships (STPs) and Accountable Care Systems (ACS) are enabling collaboration. Appropriate patient transitions are a key measurement of joined-up health care.
National and local provider initiatives seek to ensure quality integrated care and eliminate unnecessary waits for patients, while minimising costs. Digital technology advances provide a significant opportunity to achieve this. The NHS will be able to improve understanding of patient needs, tailor services, improve outcomes and deliver efficiencies - freeing up resources for frontline services.
The Clinical Utilisation Review (CUR) offers a scientific and internationally recognised evidence-based approach. Using a web-based software CUR solution automates many time consuming manual processes, delivering in-built admission and discharge criteria which effectively remove subjectivity and reduce the negative effect of people working in isolation. Too often, variances lead to patient delays, or worse - readmission. Information should be easily shared using purpose-built technology driving the redesign and delivery of processes.
CUR identifies patients ready for discharge (RFD), providing insight into systemic bottlenecks. Solutions can be designed to improve patient flow, patient experience and overall service integration with data based on CUR evidence; not a subjective viewpoint. Minimising unnecessary stays is key to managing limited bed capacity and resources. Every day of stay beyond clinical necessity risks the patient’s wellbeing, and costs for the provider.
Hospitals either have a Patient Administration System (PAS) or an Electronic Patient Record (EPR) with an existing flow capability for bed management, or one that at least shows discharge status. Yet, there is no insight into appropriateness of care, avoidable admission or days of stay; nor internationally researched criteria that cover all levels of healthcare.
To overcome this, the NHS SAFER Patient Flow initiative works effectively with CUR. Red to Green Days is a visual management system where a Red Day is a day of no value and a Green Day is when a patient receives acute care only deliverable in hospital, progressing them towards discharge.
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Reducing unnecessary stays is an absolute priority in the NHS. The Last 1,000 Days campaign asks: if you had 1,000 days left to live, how many would you choose to spend in hospital? Patient time is the key metric of performance with quality best measured from a personal perspective.
Achieving good patient flow requires reliable data. An efficient software-based CUR solution will deliver patient assessments that can be conducted daily by nurses in under two minutes. Operational and clinical teams often ask similar questions; however, they aren’t being applied to every patient every day.
CUR also helps introduce standardisation. Using criteria to drive discharge planning empowers staff to make decisions based on proof. A software-based CUR solution enables clinical teams to have a clear picture of discharge blocks - and who needs to take responsibility.
The biggest challenge to adoption is culture change. It’s crucial to gain nurses’ confidence in new technology and show it won’t increase their daily burden. CUR replaces outdated manual practices and this appeals where resources are often stretched.
Introducing ownership and accountability for the patient journey from point of admission requires strong leadership from a trust’s senior team and engagement with partner organisations. All groups in and outside hospitals need to collaborate and act together. Many organisations introduce discharge teams responsible for managing transition, helping to improve integration between services.
To achieve the transformation, trusts need to supplement core capabilities with more advanced solutions, such as, tools identifying patients at high risk of an adverse event and amenable to a particular intervention. They also will need electronic patient records, giving all clinicians the full picture and tools to support the monitoring of wider system programmes. This supplementation of core capabilities should also include enhanced tools that integrate clinical workflow with patient activation data to ensure treatment in the right place at the right time.
Crucially, it will require a fundamental shift in how clinicians, managers and patients use new digital technologies, data and innovations to support delivery of ongoing service improvements to manage flow and deliver positive outcomes for patients each and every time.
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.