Decision Support

A patient-flow system implemented at MidCentral District Health Board (DHB) in New Zealand is helping to streamline patient journeys through Palmerston North Hospital and allowing clinical staff to view important patient information at the bedside. The MIYA patient flow system, from Alcidion, is live in 17 wards and the emergency department at Palmerston North Hospital and one ward at the Horowhenua Health Centre. Alcidion is an Australian-based provider of Clinical Decision Support Systems, including Patient Flow Software, EDIS, Mobile EMR and Outpatient Solutions. MIYA gives real-time updates of bed management and patient flow throughout the hospital and health centre, showing a patient’s progress from the time they arrive to the time they are discharged, as well as an overview of hospital occupancy. Charge nurse Sarah Donnelly says, “The mobile technology is a godsend on ward rounds and has helped improved patient flow in and out of the ward, making discharges more evident and timely. I love it and wouldn’t be without it now”. The system was tested on two wards for three weeks in early November 2018 before being rolled out to all clinical areas later that month. Acute care and hospital operations service manager Carrie Naylor-Williams says the next phase of the implementation involves looking at how to use the data being collected by the system on a day-to-day basis. The hospital also plans to go live with MIYA in theatres before the end of this year. The data can be used to predict future demand, so staff know what to expect on different days and can plan accordingly. It’s also used to forecast operations for surgical patients. “We can see the cohort of patients currently admitted and what their predicted length of stay is and therefore what surgeries we can do. It will give us greater understanding to be able to manage the capacity of the hospital,” says Naylor-Williams. Bed management and capacity planning was previously done on paper and whiteboards and experienced staff getting a “general feel” for how things were looking, she explained. “We want to put be able to put a science to it and not be dependent on someone with experience being able to do it, but anybody can look at the board and see what the day’s like,” says Naylor-Williams. MIYA pulls data from the hospital’s clinical portal, so clinicians can securely view a current patient’s history, including admissions, demographics and results, on mobile devices at the bedside. The software platform has successfully integrated with five clinical information systems at Midcentral DHB, including WebPas, CareStream Radiology, Clinical portal and Pathology to provide clinical staff with detailed patient information displayed on the ward’s journey board. Naylor Williams says this means doctors can discuss results with patients face to face and make immediate decisions while on their ward rounds. They can also quickly view immediate bed availability in suitable wards. A version of this article first appeared on eHealthNews.nz.

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An antibiotic prescribing app developed at Capital and Coast District Health Board (DHB) has improved doctors’ adherence to prescribing guidelines. Developed by the DHB’s Infection Services with computer science students from the Victoria University of Wellington, the Empiric app gives prescribers easy mobile access to antibiotic guidelines and assists with clinical decision making. Empiric prescribing is when a doctor chooses an antibiotic before knowing exactly what micro-organisms are involved, so they prescribe according to the symptoms. Between 35–50 per cent of hospital inpatients are on antibiotics at any one time. Most large DHBs will have their own empiric antibiotic prescribing guidelines, which are often used by the smaller local DHBs. Previously these guidelines were either in a booklet or on a website, which meant doctors had to either carry a paper copy or find a computer terminal to look them up. Infection Services clinical leader Dr Michelle Balm says that while adherence to the guidelines was good, there was room for improvement. “We wanted to make it a lot easier for prescribers to make good clinical decisions about antibiotics use as close to bedside as possible,” Balm said. Empiric is automatically downloaded on to all the DHB smartphones that are given to junior doctors in place of the traditional pager. Figures show all junior doctors are using it weekly and most on a daily basis, and adherence to the guidelines has increased since the app was introduced. Doctors report that it increases confidence around prescribing. The app is also free to download on the Apple and Android app stores and has been downloaded 700 times outside the DHB. Balm says that while there are regional differences, the prescribing guidelines are broadly applicable across New Zealand, and that the DHB made Empiric freely available for anyone to use, “in the interest of transparency and to try and get a national discussion going on this topic”. Empiric takes prescribers through a set of questions to produce a personalised – rather than generic – prescription recommendation. Features include options for when a patient has an allergy and where there is a risk of multi-drug resistant organism. This article first appeared on eHealthNews.nz.