The latest update on Derby’s progress from a workshop run by Kevin Downs, Director of Finance and Performance, and Keith Jones, Clinical Director of Surgery at Derby Teaching Hospitals NHS Foundation Trust
Kevin Downs, Director of Finance and Performance, opened this case study session on one of the most significant and successful implementations of GS1 standards in an Acute Trust to date. As part of Scan4Safety, GS1 standards have now become just what they do, but it also stems from before the programme when they needed to be able to use their theatres as efficiently as possible to meet growing demand. That started in 2013 and this session was about giving an idea of how they’ve got to where they are now, and hopefully to help others accelerate that journey.
So how did it begin?
Derby’s GS1 standards implementation began with the need for a system that’d allow them to improve stock control – they started by looking for a system that would act as the front end for their existing catalogue system, so they could scan at point of care. Driven by the retail model, this would mean that they only use what they scan against a patient and it’d give them the costs of what they’re spending on that patient and who’s doing it. That’s what now drives all the information that utilised through the system itself.
For Keith Jones, Clinical Director of Surgery at Derby, it was important to start in one small area and then roll it out, so people could see exactly what was going on and didn’t feel threatened by the new system. They started in general theatres, in head and neck, and went from there. And it wasn’t positioned as a stock control system to clinicians, it was sold on the basis of improving patient safety – that they could track and trace implants, screws etc and they could automatically and electronically update external records. They also knew it’d provide opportunities to look more deeply at the costing of what they were doing and help them better understand their mortality rates. Clinicians had the opportunity to own their own data, because this was being done live in their theatres, where they were in charge.
Derby started their catalogue management automation in 2010, with their first point of care business case submitted in November 2013. They rolled out within five months to go live on 1st April 2014, and were revisiting the business case within three months as they realised there was a lot more potential in the new system than they’d first thought, as a result of feedback from clinical staff. After being live in general theatres for nine months, they then went live in radiology theatres. In that time, they changed the system to take into account what they should scan and how they should scan it – and then add it onto what they’d initially specified for the system to do. And the lessons they’d learned in general theatres allowed them to accelerate their rollouts in other areas so they were down to three/four months at a time for implementation. By the time they successfully applied to join the Scan4Safety programme in January 2016, they were able to use the money they received to accelerate the speed of that rollout and development even further. Derby became the first fully accredited Scan4Safety site in 2017.
An area that was extremely motivational for their surgeons and clinicians was their need to improve their coding. When they’d introduced HRG4 it had affected their level of income and that was all about comorbidities and not recording them correctly. The gap was somewhere between £10 – £12m so it was a big opportunity that they were missing. They were also losing out through the Flex and Freeze system, where if you’ve not got the patient records with the coders within two to four weeks of the patient being discharged, and they’ve not coded that patient and invoiced the CCG, you miss the deadline and then you don’t get paid. In July 2014 when they started scanning OPCS codes they saw an immediate change. They uplifted to the national average within the first quarter and they’ve improved their coding by just under £1m, by making sure they code the patients they’re treating. And by allocating GS1 barcodes to each comorbidity, they’re also keeping track of those by scanning them as part of the pre-operating procedure.
For Keith, that data means that for any procedure he can see all the consumables that have been used, all the individuals that were involved, where they were and what they were doing. They even record when a product was opened but not used. So for the first time in his experience of over 20 years as a consultant in the NHS, they now have the ability to accurately cost a procedure.
It also means staff can go back to their day jobs which is treating patients. In their cardio cath labs, for example, they had three band seven nurses working half a day to a day a week actually managing stock. That time’s now been freed up and returned to care, and they’re able to see more people as a result.
Some of the other things they’ve done is make up standard kits and allocate them a barcode. One example of this is where they’ve worked with anaesthetists to develop a standard general anaesthetic kit, so that it’s ready to go in the theatre and gets scanned at the beginning of the procedure. All ordering is done electronically overnight, so in the mornings everything in theatre is ready to go – it’s had a massive improvement for their early starts. Initially, this was difficult with manufacturers and suppliers who couldn’t cope with an electronic download overnight that said we needed 60 screws the following day. Derby had talks with them to emphasise that they wanted to keep working with them but that they needed to be able to get products when they wanted them. It’s reduced consumption in theatre, with an inventory reduction on top of that, that’s delivered £1.2m of savings. They’re treating the same number of patients, if not more, for less cost.
For their trials in wards, Derby used similar principles to their implementation in theatres – they locate the staff, identify the procedure, which ward and what devices are used. And they engaged clinical staff about what they wanted to capture about the treatment of patients, asking them what notifications would be useful and what would aid patient safety and nurse efficiency, and identifying where there might be a training need. As a result, at the touch of a button, they have now have the history of the patient pathway. So a clinician can look at it and identify what may have caused a patient, for example, had to go back into surgery.
They’re continuing to drive their rollout across wards, with the aim to be across all wards by the end of the next financial year. They’re looking at how they can use GS1 standards in pathology, to allocate samples taken on a ward directly to a patient, that would then feed seamlessly into their pathology checking system and then back onto the ward. They’re also looking at using RFID to track both staff and patients, as well as assets, around the hospital. From a safety point of view for mental health patients, for example, they want to be able to close a door if a mental health patient is trying to leave in an unauthorised way, which is an increasing problem. As with everything else they’re doing, it all comes down to patient safety.
Hear from Kevin and Keith talking about their progress implementing GS1 standards at Derby Teaching Hospitals NHS Foundation Trust at the GS1 UK industry conference in 2017