The Countess of Chester Hospital Foundation Trust has created a digital coordination centre to manage nursing rotas according to patient acuity and streamline bed allocations. This initiative won the Technology and Data in Nursing category in the 2018 Nursing Times Awards
In 2016, the Countess of Chester Hospital Foundation Trust decided to develop an automated coordination centre that would help it improve its management of staff allocation and patient flow. Operational since October 2017, this digital coordination centre works in real time using both an acuity-based rostering tool and a bed management tool. Its implementation required an overhaul of work practices and culture, which was achieved by engaging with staff. The new system gives a better visibility of bed occupancy and patient flow, which allows delays in care and discharge to be reduced, thereby improving the patient journey. It also means nursing staff have more time for patient care and nurse managers have more time for clinical leadership.
Citation: Bett I (2019) Using digital tools to improve staff rostering and patient flow. Nursing Times [online]; 115: 7, 56-57.
Author: Ian Bett is director of planning and partnerships, Countess of Chester Hospital Foundation Trust.
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- Award category sponsored by Vocera
At the Countess of Chester Hospital Foundation Trust, we have set ourselves the goal of becoming a more transparent organisation with more-visible operational processes, including workforce planning and patient flow. The trust comprises a 600-bed district general hospital in Chester and a 64-bed intermediate care service at Ellesmere Port Hospital. It employs almost 4,000 staff and, every year, provides services to more than 445,000 patients from an area covering Western Cheshire, Ellesmere Port, Neston and North Wales.
Like many trusts, we face the challenge of delivering high-quality nursing care against a backdrop of bed moves, outliers, delayed discharges, gaps in nurse staffing and difficulties in recruiting nurses who have the appropriate training. As a result, in late 2016 we decided to create an automated coordination centre that would allow us to:
- Manage nursing rotas according to patient acuity (how ill patients are);
- Streamline bed allocations so patients would access the right bed at the right time more often.
We were experiencing delays in discharges and sharing information about bed occupancy, partly due to old processes relying on telephone calls and paperwork. These delays had a negative effect on how quickly new patients arriving in the emergency department could be allocated an inpatient bed, and whether they could be admitted directly to the right ward. As a consequence, patient flow and the patient journey were too slow, arduous and complicated.
At that time, for example, it was taking over 4.5 hours from the moment a patient was discharged until another patient could access the available bed. Reducing that time would allow us to speed up patients’ admission to the wards and maximise the use of our beds at a time when demand for urgent care services was increasing. In the face of these delays, our aims were to:
- Ease patient flow and get patients in the right bed the first time round;
- Improve the patient journey from admission to discharge;
- Have the right nursing staff on site to address patients’ needs;
- Streamline processes to release time so nurses could focus on patient care.
To achieve these overarching aims, we wanted to:
- Improve the sharing of information about bed availability across the trust;
- Increase the number of discharges occurring at the right time;
- Improve the efficiency of our portering services.
Our solution was to develop a digital coordination centre (which involved working with external partners to develop the right IT solutions) and create a ‘bed turnaround’ team covering the inpatient wards at Countess of Chester Hospital. Composed of 10 healthcare assistants, the bed turnaround team helps streamline patient flow by cleaning beds quickly and efficiently, which releases time for nursing staff to focus on patient care.
The coordination centre works in real time using two separate IT solutions: an acuity-based rostering tool (Allocate) and a bed management tool (Teletracking). It:
- Helps us manage staff allocation and patient flow – and, therefore, the trust as a whole – more effectively;
- Gives an accurate view of available beds;
- Reduces the time senior nurses spend on rostering and managing annual leave, sickness absences and enhancement payments, freeing up their time so they can concentrate on providing leadership to their teams.
The coordination centre helps us make better use of our nursing resources by:
- Publishing all nurse rotas six weeks in advance;
- Matching nursing care hours per patient day (CHPPD) to patient acuity;
- Allocating the right level and number of nursing staff needed to look after patients based on acuity.
Adapting to change
Work on the coordination centre started in early 2017 and the new system went live in October of the same year. On the technical side, the project required extensive installation of hardware and software: around 4,000 sensors were integrated in the walls, equipment such as pumps and monitors were tagged so they could be located, new interactive patient wristbands were issued, along with new staff badges.
It also required an overhaul of trust-wide work practices, habits and culture, which created a few challenges. There were concerns, for example, about adopting new technologies, needing to work more flexibly, metrics use and data confidentiality.
Our role was to inspire staff to embrace change via the use of new technologies. An implementation team was set up and we engaged with staff across the trust through a series of events, workshops and forums, including a ‘model hospital’ showcase event. A positive culture around change was disseminated at team meetings. We listened to staff concerns and addressed them as they arose. ‘Superusers’ were trained so they could train all other staff to use the new system. Staff were kept informed of developments, and, as each area implemented the new system, they were encouraged to share their experience via blogs.
The project was driven by a collaborative approach, led by the director of nursing and quality, the director of people and organisational development, and the director of planning, with the support of senior nurses, HR business partners, senior executives and divisional directors.
There have been several positive outcomes – first and foremost, better visibility of bed occupancy and patient flow. This allows us to address delays in care and discharge in a timely manner, thereby improving the patient journey. New patients are admitted more quickly, as the time between one patient being discharged and another accessing the bed has been reduced from 4.5 hours (before the system went live) to 2 hours 10 minutes (March 2019), with room for further improvement. The length of stay for urgent non-elective patients has fallen by 0.5 days compared with the same period the year before. Portering services have amended their rotas and are much more reactive to urgent requests.
The new system:
- Issues real-time data, allowing us to adapt our operational processes;
- Increases our organisational transparency;
- Improves governance, reporting and decision making;
- Gives us better control of nurse staffing.
A system driven by patient acuity improves the visibility of the level of illness on a given ward, which allows staff to be allocated in a more timely and reliable way to meet patient needs and manage potential risks. Most importantly, these new ways of working mean nursing staff have more time to provide patient care and nurse managers have more time to provide clinical leadership.
“A gold standard example of how to do nurse-led technology in healthcare” (Judges’ feedback)
As this is about modernising our culture and practices and adopting innovative ways of working, it is an ongoing endeavour. We will continue to analyse the data generated to improve our services and adapt them to the needs of our local health economy. We aim to extend the new system to the community setting and hope GP services will soon be able to refer patients, and monitor their journey, electronically.
We will review existing nursing establishments based on acuity data to refine our new model of workforce deployment. Other staff in the organisation, such as therapy groups, are now managed using the same system. Ultimately, our goal is to progress towards an entirely integrated system in which CHPPD drives our workforce in line with operational demands and patient flow.
Advice for setting up similar projects
- Secure your organisation’s engagement from the beginning
- Plan carefully and gain insight from other organisations to determine potential risks
- Ensure there is strong senior leadership that has links with unions and other professional bodies
- Develop a robust governance and reporting structure
- Involve all members of the multidisciplinary team
- Share your vision and purpose with all involved
- Communicate clearly, concisely and regularly about your project
- Give staff at all levels the opportunity to express their concerns and fears
- Set up working groups to engage staff in your project
- Delivering high-quality nursing care against a backdrop of bed moves, delayed discharges and gaps in staffing is a challenge
- Digital tools for rostering and bed management can improve staff allocation and patient flow
- A staff allocation system that is driven by patient acuity can help meet patients’ needs
- A digital rostering tool can free up time for senior nurses to focus on leadership
- Changing practices and adopting new technologies successfully requires engaging with staff