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Hospital deaths fall 'with use of handheld technology by nurses'


Death rates at two large hospitals fell by more than 15% after nurses started using handheld computers instead of paper charts to record patients’ vital signs, according to new research.

The drop in mortality represented more than 750 lives saved in a single year across the two sites, the paper published online in journal BMJ Quality & Safety found.

Nurses record patients’ blood pressure, pulse, oxygen levels and other indicators on the handheld devices.

“We believed traditional paper charts were not doing the job well enough”

Paul Schmidt

Specialist software, called VitalPAC, automatically calculates if the patient is deteriorating.

If so, the nurse is warned to increase the frequency of their monitoring of the patient and, in some cases, to alert a doctor or a rapid response team.

The introduction of the new system was followed by a fall of almost 400 deaths among patients in one year at Queen Alexandra Hospital, Portsmouth, and a drop of more than 370 in the same period at University Hospital, Coventry, according to the research.

An accompanying editorial in the journal described the research as “an important milestone” in improving patient safety, and said the lowering of mortality at these two hospitals “represents a truly dramatic improvement”.

The system was developed by doctors and nurses at Portsmouth working together with health improvement company The Learning Clinic.

Dr Paul Schmidt, of Portsmouth Hospitals Trust, one of the leaders of the project, said: “Observing patients and making accurate records provides a safety net to guard against their deterioration.

“We believed traditional paper charts were not doing the job well enough so we designed an electronic system to support staff,” he said. “This study shows its introduction was followed by a significant drop in deaths.”

The VitalPAC software uses the information entered by the nurse to calculate a patient’s Early Warning Score, which provides an indication of the severity of the patient’s condition.

A high EWS triggers an alert. But calculating the EWS requires time and accuracy, and too often busy nurses using paper and pen make a mistake.

By speeding up the process, the VitalPAC system gives nurses more time for other tasks.

Dr Duncan Watson, from University Hospital Coventry, who also worked on the project, said: “This technology improves the performance of routine but important tasks and frees up clinical staff to do what only human beings can do – care for patients.”

Portsmouth Hospitals NHS Trust

Source: The Learning Clinic

Nurses input patient data to device which calculates early warning score

Information recorded on the handheld devices is automatically uploaded to a hospital-wide system allowing nurses, doctors and managers to monitor the health of patients across all wards. Staff on ward rounds have instant access to information from any device connected to the hospital network.

VitalPAC was introduced in Portsmouth in 2005 and in Coventry two years’ later. Researchers compared the actual number of deaths in each hospital following deployment of the system with estimates based on the number dying in the year before roll-out.

In 2010, 397 fewer patients than expected died at Portsmouth. At Coventry, the figure was 372 patients.

Roger Killen, chief executive of The Learning Clinic, said: “This is a great example of a collaboration between front-line clinicians, engineers and software designers to create a system which brings clear benefits to patients and staff.”

But a nursing academic cautioned against encouraging nurses to rely solely on technological devices.

“The key issue is the fact that the devices are helping nurses recognise deterioration – this is the key factor in preventing people becoming sicker. As a profession we have to raise the importance of spotting early deterioration in patients and acting” said Michael Adams, associate head of the School of Nursing, Midwifery and Social Work at Birmingham City University.

“I find it slightly depressing that nurses need a phone (or other electrical device) to tell them to call a doctor,” he said. “On our programme here we absolutely focus on spotting physiological signs that someone is becoming ill – and acting on it.”



Readers' comments (7)

  • I applaud the fact that the hand held computers are helping to save patients lives, but I am seriously concerned that nurses need a computer to inform them that a patient's condition is deteriorating.
    The comment that mistakes are made on the paper charts, cannot the same mistakes be made on the hand held computer?(garbage in garbage out)
    I appreciate that nurses are short staffed and extremely busy surely we should be improving staff numbers and training especially when funding is at a premium.

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  • Initially dubious as I always thought hands on care was best, having almost lost my sister recently due to her not being observed in A&E for six hours (she had a ruptured ectopic) and had been an inpatient, a handheld device would have recorded when any obs entries were made and we could have proved she was not monitored whilst she nearly bled to death. Paper records can be added later to falsify accounts whereas computers are much harder to fake so I welcome this whole heartedly.

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  • I am not an expert on the use of these devices, however I am open to the concept of technology to assist in decision making processes. Perhaps the issue is not that nurses do not "need" a computer to assist them because the nurse is lacking in knowledge etc but more that computer has a system that works better than a human when it comes to recongnizing suttle changes in a patien's condition. We use computers because they often do certain jobs better than humans, so why not in this context. Any technology that assists health professionals and results in better patient outcomes is to be welcomed. My question is, do they paediatric and neonatal versions?

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  • What concerns me is that this technology will be used to replace an RGN.
    What scares me is the reason why the technology was developed!

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  • These devices are only as good as the staff who input my area HCA's who whilst excellent in following vital pack prompts, don't feel a pulse or manually record blood pressure meaning that RN's are reliant on 2D technology when making decisions.

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  • Very well done Portsmouth and Coventry!

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  • No RN works 24/7 365 days per yer. Yes, charts exist, but I'm all for having a computer constantly monitoring the patients.
    Is Mrs. Smith declining? The nurse that is just starting her week's shift 20 minutes ago can't necessarily say (especially since she has not only Mrs. Smith, but also Mrs. Jones, Mr. Jackson, Mr. Simpson, Ms Watson, and maybe 8 others to also take care of).

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