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Nursing Times Awards 2010

Nursing and Technology Award

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WINNER: RAPA - Recurring Admission Patient Alert, Sheran Oke, Megan Stowe and Sinead Kenny, Imperial College Healthcare Trust

Background

Recurring Admission Patient Alert (RAPA) is an automated alert system which sends an email when a known cancer patient registers in A&E. Before its introduction it was common for cancer patients to be admitted without any of the cancer team knowing. This can lead to a poor experience for the patient and their family, as well as unnecessary tests being ordered and patients not receiving the right care at the right time.

With RAPA, when a patient with cancer registers in A&E, an email is instantly sent to their clinical nurse specialist providing the opportunity for them to see the patient, inform A&E staff of the patient’s care plan and to support previously made decisions about the patient’s plan of care. In its first 16 weeks RAPA demonstrated a decrease in the length of stay for our patients. We have also utilised the technology in new ways to provide alerts for a number of professionals tailoring it to their individual patient needs.

The process

The project manager and clinical nurse specialists worked closely to assess and determine opportunities for RAPA within cancer. We decided initially to offer alerts to each tumour site. All participating clinical nurse specialists received an email as soon as one of their patients was registered in A&E.

Nurses were encouraged to consider what type of intervention they could make, for example, visiting the department to support the patient, notifying members of their multidisciplinary team or following up with the patient at a later time.

A key facet of introducing RAPA is to develop the alert response with the clinical nurse specialists. We have held two focus groups and also provided a great deal of one-to-one support to enable and support development of ways to use RAPA.

Advice to other organisations

It is essential to include stakeholders, the clinical nurse specialists, from the beginning in this sort of project. Collaboration and clear communication created support for and membership of the RAPA initiative and created a momentum for change. As RAPA transcends various departments within the organisation (such as information and communication technology, A&E, nursing and management) a strong project board with full representation is essential.

Benefits of the initiative

There are numerous benefits associated with using RAPA. Ultimately patients have a better experience when visiting A&E as they see a familiar face. Care plans and clinical decisions are maintained by bringing the clinical nurse specialist to the department, while unnecessary admissions are avoided, decreasing non-elective length of stay.

Though 75% of cancer attendances at A&E are not emergencies, those patients who do attend with a true oncological emergency benefit. For example, a patient with neutropenic sepsis will benefit from their clinical nurse specialist advising A&E staff of current treatment protocols.

Financial implications

By reducing length of stay through use of RAPA, we have an estimated saving of £28,600 in bed days alone just for non-elective lung cancer patients over one year (130 days saved charged at £220/day). It is difficult to quantify the savings associated with the unnecessary tests such as X-rays and blood profiles that have been avoided by having clinical nurse specialists attending the department when their patients are admitted.

Future plans

There is great opportunity to further develop RAPA, for example to create a neutropenic sepsis alert for patients currently receiving or just finishing chemotherapy who attend A&E. Generating an alert to a specific nurse would mean these patients could have instant access to the appropriate care.

In addition, an extension could be built on the RAPA software to enable clinical nurse specialists to measure and demonstrate how their time has been spent supporting patients. This could be audited to justify their use of time. Furthermore, by providing the opportunity for other professionals such as allied health professionals to receive RAPA alerts, patients with complex needs could be better supported when seeking support in A&E.

We hope to disseminate RAPA to all long-term conditions within our trust, and to provide infection control alerts to the bed manager (for example, a known patient with MRSA creates an alert). With prospective charging for readmissions, there is also the potential to have all discharged patients creating an alert if visiting A&E within 30 days of discharge.

We would also like to provide RAPA support for initiatives like enhanced recovery to enable us to track readmitted patients, giving us the opportunity to intervene with the appropriate care for those in A&E.

* This project was also highly commended in the Innovation in your specialty category.

Contact

For more information on this initiative please contact Megan Stowe: megan.stowe@imperial.nhs.uk

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