GB2468125A

GB2468125A - Recording and displaying patient information in a healthcare environment

Info

Publication number: GB2468125A
Application number: GB0903144A
Authority: GB
Inventors: Ian Taylor; Marc Baker
Original assignee: VISUAL HEALTHCARE SOLUTIONS Ltd
Current assignee: VISUAL HEALTHCARE SOLUTIONS Ltd
Priority date: 2009-02-25
Filing date: 2009-02-25
Publication date: 2010-09-01
Also published as: GB0903144D0

Abstract

A patient information recording and display system in a healthcare environment (such as a hospital) having a plurality of spaces (or beds) (5) for accommodating patients. The system comprises first means (1) for receiving first information relating to each patient at a location local to the space (5) occupied by the patient. The system also comprises second means (2) for electronically displaying second information relating to each patient at a location local to the space (5) occupied by the patient, the second information being derived at least in part from the first information. The system also comprises third means (3) for electronically displaying, at a location remote from at least some of the spaces (5), a plurality of visual indications, each visual indication relating to the status of a different respective one of the spaces (5), and the visual indications being derived at least in part from the first information. The system also comprises fourth means (4) for electronically communicating the first information, or information derived therefrom, from the first means (1) to the third means (3) to enable appropriate visual indications to be displayed.

Description

Apparatus and Method for use in a Healthcare Environment The present invention relates to an apparatus and method for use in a healthcare environment such as a hospital.

In a typical hospital environment today, one would typically notice a distinct absence of information, in the immediate vicinity of a patient in a bed or on a trolley, concerning the condition of that patient.

Should there be any patient notes nearby, one would find different sections belonging to: (a) doctors; (b) nurses; and (c) therapists. One would need to consider all three of these sources of information together in order to begin to understand the patient's situation.

One may also interrogate the hospital's electronic systems, if any. For example, one such system may show which bed the patient is in (if it is up-to-date); and another may show results of tests and diagnostics (if available).

One may also ask a nurse. Having found the nurse responsible for the patient in question, the nurse would then produce a handwritten piece of paper from their uniform pocket containing information on patients under their care. This information might then lead one to go to the nurse's notes within the patient's notes.

Now consider the following fictitious example according to the current situation.

Patient X' has been admitted to a medical ward the previous night. The ward round starts at 9.3Oam. The consultant finds out that he has nine patients to see on this round, and he has several junior doctors with him.

They congregate at the trolley with the patient medical records. Patient X is seen first, the medics discuss their symptoms, history, possible diagnoses, and so on, and then agree on the need for some diagnostic tests. Notes are made by the junior doctors and the ward round moves on.

The ward round finishes at 11.l5am. The junior doctors have notes on what the agreed next actions are for each patient seen. For CT scans they may have to fill in a 30553783-1-Ihorlon form template from the radiology department and fax it to the radiology department.

For blood tests they may have to write a request for phlebotomy services to come to the ward and take samples from the patient. This form is placed in a box at the nursing station and the phlebotomy staff pick up the contents of this box and action them on their daily (Monday to Friday) ward visits.

From the above, the present applicant has appreciated that clear and unambiguous plans, status, checks and adjustment processes are absent in today's hospital environment, and has appreciated the desirability to address this issue. Adding to, or integrating with, these current information systems will merely add to the current shortcomings.

According to a first aspect of the present invention there is provided a system for use in a healthcare environment having a plurality of spaces distributed across the healthcare environment, each space being for accommodating a patient within the healthcare environment, and the system comprising: first means for receiving first information relating to each patient at a location local to the space occupied by the patient; second means for electronically displaying second information relating to each patient at a location local to the space occupied by the patient, the second information being derived at least in part from the first information; third means for electronically displaying, at a location remote from at least some of the spaces, a plurality of visual indications, each visual indication relating to the status of a different respective one of the spaces, and the visual indications being derived at least in part from the first information; and fourth means for electronically communicating the first information, or information derived therefrom, from the first means to the third means to enable appropriate visual indications to be displayed.

Figure 7 of the accompanying drawings illustrates a system according to an embodiment of the present invention, comprising a plurality of first means 1, second means 2, and fourth means 4, together with a single third means 3. Figure 7 also shows a plurality of spaces 5, with bounding boxes to illustrate which spaces 5 are served by which first/second/fourth means 1/2/4.

The second information may comprise a plan for the patient. The second means may be arranged to display variance against the plan.

30553783-1-Ihorlon The first information may comprise information entered manually by staff of the healthcare environment.

The first information may comprise information output from clinical equipment. In this way, information may be gathered automatically from clinical recording equipment in real time and fed into the system.

The system may comprise means for maintaining and managing a plurality of buffer spaces.

The first means may comprise a plurality of entry stations, each entry station having a user interface for entering at least part of the first information manually.

At least some of the entry stations may comprise a touchscreen interface.

The second means may comprise a plurality of electronic displays.

At least some of the electronic displays may comprise the touchscreen interface of the first means.

The spaces may be organised into a first plurality of local groupings, with each first grouping comprising one or more spaces, and wherein each of the plurality of entry stations is associated with and located within or nearby a different respective one of the first groupings.

The spaces may be organised into a second plurality of local groupings, with each second grouping comprising one or more spaces, and wherein each of the plurality of electronic displays is associated with and located within or nearby a different respective one of the second groupings.

The first plurality of groupings may be the same as the second plurality of groupings.

At least some of the plurality of groupings may correspond to wards of the healthcare environment.

30553783-1-Ihorlon The fourth means may be arranged to communicate the first information or information derived therefrom to the third means substantially in real time.

The system may comprise means for deriving the second information from the first information, preferably substantially in real time.

The system may comprise means for deriving the visual indications from the first information, preferably substantially in real time.

The third means may be arranged in a plurality of different locations within the healthcare environment.

The third means may be arranged in a central location within the healthcare environment.

The system may comprise means for sending an electronic kanban to a support service so as to make progress towards a desired status for a space or the patient occupying that space. The support service may be selected from the group comprising: imaging; physio; pathology; and pharmacy.

The first and second means may be coterminous (that is, implemented using apparatus that is located in the same general space, albeit with their respective functions being performed by different parts of that apparatus).

The status may be selected from the group comprising: space is empty; space is booked; space is occupied by a patient considered to be medically fit; space is occupied by a patient considered to be not medically fit; space is occupied by a patient requiring specific attention; and space is closed.

The healthcare environment may comprise or be a hospital. It could be multi-site (e.g. across community hospitals and/or general practices).

The system may comprise means for performing a trending analysis of recurring issues.

30553783-1-Ihorlon According to a second aspect of the present invention there is provided a method for use in a healthcare environment having a plurality of spaces distributed across the healthcare environment, each space being for accommodating a patient within the healthcare environment, and the method comprising the steps of: receiving first information relating to each patient at a location local to the space occupied by the patient; electronically displaying second information relating to each patient at a location local to the space occupied by the patient, the second information being derived at least in part from the first information; electronically displaying, at a location remote from at least some of the spaces, a plurality of visual indications, each visual indication relating to the status of a different respective one of the spaces, and the visual indications being derived at least in part from the first information; and electronically communicating the first information, or information derived therefrom, from the first means to the third means to enable appropriate visual indications to be displayed. The accompanying drawings can be considered to comprise a flowchart having four step represented thereon corresponding respectively to the four steps of the second aspect of the present invention.

According to a third aspect of the present invention there is provided a program for controlling an apparatus to perform a method according to the second aspect of the present invention or which, when loaded into a system, causes the system to become a system according to the first aspect of the present invention. The program may be carried on a carrier medium. The carrier medium may be a storage medium. The carrier medium may be a transmission medium.

According to a fourth aspect of the present invention there is provided an apparatus programmed by a program according to the third aspect of the present invention.

According to a fifth aspect of the present invention there is provided a storage medium containing a program according to the third aspect of the present invention.

The present applicant has appreciated the following problems with current approaches to management within a hospital environment, the current approaches having been described above. Firstly, there is a lack of accurate status' information for patients currently in system. Secondly, the system is updated in batch' mode by staff. The outcomes of this are excessive waits for the patient and increased length of stay for the hospital. No one person can determine what is going on for each individual patient.

30553783-1-Ihorlon Therefore, patient management decisions are sub optimal; one cannot manage what one cannot see.

Should an embodiment of the present invention be implemented in place of the current approaches, it is considered that the impact would be colossal (transformational).

A system embodying the present invention will provide at least one of the following advantages: * Complete visibility at ward level: a real-time visible plan for every patient from admission to discharge (and variance against plan enabling catchback').

* Complete visibility of demand and required activity: real-time visibility of demand for diagnostics, specialist treatment or therapies and where safe to do so the precise nature of a requirement along with co-ordinates (e.g. physiotherapy required for patient Mr X in bed Y on ward Z).

* Complete visibility between departments: real-time visible status of buffers (enabling pre-defined reaction plans and escalation processes to be enacted).

* Centralised visual status of every patient in the hospital displaying whether for

example they are:

* In the wrong speciality ward (enabling transfer to the correct ward) * Not medically fit * Medically fit enough for immediate safe discharge/transfer * Medically fit enough for immediate safe discharge/transfer but delayed due to a constraint beyond the hospital's and/or patient's control (complex) * Or any combination of the above.

This would be the case both within and between departments and across the entire hospital.

Reference will now be made, by way of example, to the accompanying drawings, in which: Figure 1 shows an electronic visual plan for every patient display on the wards, how the plan is entered and how variance to plan is recorded; 30553783-1-Ihorlon Figure 2 shows a touchpad that feeds the plan for every patient display; Figure 3 shows a mechanism for sending orders' or demand data to diagnostics, specialist treatment or therapies from the wards; Figure 4 shows a central visual hospital display; Figure 5 shows icons employed on the central visual hospital display; Figure 6 shows a visual buffer status, its impact on the entire system and an example escalation process; and Figure 7 is a schematic illustration of a system embodying the present invention.

An embodiment of the present invention addresses the above issues based on the concept of a lean thinking', using an integrated user-friendly (e.g. keyboard-less, touch screens employing coloured icons) electronic system that will provide complete visibility within and throughout the hospital.

The concept of lean thinking' in the context of an embodiment of the present invention can ensure that services are planned/measured and managed from patient(s) perspective first rather than for organisation efficiency. It allows a hospital to change the service provision models to allow flow' of patients, with no waiting anywhere. To complement the flow change one should remove push' planning where local schedules are made by individual groups, services and departments independently, and instead to pull' work orders generated by patient demand for specific activities and services: when demand wants a service, one should provide. It allows a hospital to plan and execute continuous improvement activities with staff, and to focus these activities using feedback from data and controlled in the same way as previous. The concept of lean thinking is closely associated with and can be considered herein to be intercahngebale with the concepts of kanban' and just in time' production planning.

Figure 6 illustrates these points for a whole hospital following emergency (unplanned) patient demand. It shows how a single point in the system can be used to control the whole system (master patient scheduling process).

30553783-1-Ihorlon This single process releases work orders to the discharge processes (frontline and support) to help patients, who are medically fit enough to do so safely, leave the hospital without unnecessary delays or waits.

This activity in turn creates space for the new patients identified by the front door services as requiring a space.

There are normally enough spaces that can be created to cope with all incoming demand; however sometimes due to variation in demand there are not. To cope with these situations, buffers of empty spaces are built in to the system to provide appropriate places for these patients to go to. Known status of these buffers enable pre-defined reaction plans and escalation processes.

Lean thinking, however, can only achieve this in a complex system such as a hospital if there is complete visibility, for example: * A visible plan for every patient (and variance against plan) at ward level * Visibility of demand for diagnostics, specialist treatment or therapies * Visible status of buffers * Centralised visual status of every patient in the hospital whether for example they are: * In the wrong speciality ward (due to pressure to find the patient a bed, anywhere) * Not medically fit * Medically fit enough for immediate safe discharge/transfer * Medically fit enough for immediate safe discharge/transfer but delayed due to a constraint beyond the hospital's and/or patient's control (complex) * Or some combination of the above.

At ward level the responsible nurse and doctor touches the relevant patient's name on plan for every patient display (Figure 1) and then adds the plan for the patient, from admission to discharge, by touching the relevant requirements screen (Figure 2).

30553783-1-Ihorlon This in turn sends electronically either demand information or precise orders (depending on safety) to the relevant party (Figure 3); these are referred to as electronic kanbans (or ebans), in reference to the kanban concept mentioned above.

The ward manager, every day, in conjunction with relevant staff, checks that the plan is being adhered to and updates (again by touching the relevant requirements screen) to highlight any variance enabling local catch back' to the plan.

All hospital variances against plan are sent to a central database to enable longer term trending enabling actions to eliminate common constraints to treatment or discharge plans.

There are two distinct demands placed upon hospitals: (1) demand for admission; and (2) demand for discharge.

At any point in time in acute hospitals, it is commonplace to find that between 20% and 25% of the total number of beds are occupied by patients who should have already been either discharged or transferred to their next planned destination (patient demand for discharge) There will also be a large number of patients who have been placed onto the wrong ward for their condition (e.g. medical patients on surgical wards or cardiology patients on a respiratory ward), which both compromises their effective treatment and extends their length of stay in the hospital.

The central visual hospital display (Figure 4) employing simple icons (Figure 5) makes these scenarios completely visible to all, and being able to see the situation at a glance enables effective management of the situation. For example, any green icon represents patients who should be discharged or transferred, thereby enabling space to be created for patients represented by a red icon with a black line to be moved to the correct ward.

Should demand for beds (demand for admission) exceed the number of beds currently empty, buffers are employed to accommodate these patients until a bed has been made available. These buffers are empty spaces (trolleys or beds) to accommodate sudden surges (variations) in demand. The quantity of spaces can be scientifically 30553783-1-Ihorlon calculated and is based on historical (or predicted) demand data. Any patient occupation (or changes in occupation) in the buffer must be known and communicated as soon as they occur enabling a pre-defined, well practiced and well known escalation process to react when certain quantities of these spaces are occupied, the aim being to empty these spaces within a defined period of time.

The central visual hospital display also shows the real time status of these buffers (Figure 5).

This will enable the timely enactment of these pre-defined escalation processes (also see Figure 6) should certain trigger points be met, to respond quicker to meet demand for discharge creating space to accommodate the demand for admission. Figure 6 shows an example within a medical setting whereby under normal conditions the patient will move directly from the Emergency Department (ED) to the Medical assessment Unit (MAU) as there is space within MAU to accommodate them. If however there is no space within available in MAU (fully occupied) the patient will enter a six trolley buffer. In this buffer, the first two spaces represent code green' triggering a low level escalation. Should the third (and fourth) spaces be occupied this represents code yellow' triggering a medium level escalation. Occupation of the fourth (and fifth) space represents code red' triggering a high level escalation. This example is applicable to all other patient types e.g. surgical patients.

It will be appreciated that operation of one or more of the above-described components can be controlled by a program operating on the device or apparatus. Such an operating program can be stored on a computer-readable medium, or could, for example, be embodied in a signal such as a downloadable data signal provided from an Internet website. The appended claims are to be interpreted as covering an operating program by itself, or as a record on a carrier, or as a signal, or in any other form.

30553783-1-Ihorlon

Claims

CLAIMS: 1. A system for use in a healthcare environment having a plurality of spaces distributed across the healthcare environment, each space being for accommodating a patient within the healthcare environment, and the system comprising: first means for receiving first information relating to each patient at a location local to the space occupied by the patient; second means for electronically displaying second information relating to each patient at a location local to the space occupied by the patient, the second information being derived at least in part from the first information; third means for electronically displaying, at a location remote from at least some of the spaces, a plurality of visual indications, each visual indication relating to the status of a different respective one of the spaces, and the visual indications being derived at least in part from the first information; and fourth means for electronically communicating the first information, or information derived therefrom, from the first means to the third means to enable appropriate visual indications to be displayed.
2. A system as claimed in any preceding claim, wherein the second information comprises a plan for the patient.
3. A system as claimed in claim 2, wherein the second means are arranged to display variance against the plan.
4. A system as claimed in any preceding claim, wherein the first information comprises information entered manually by staff of the healthcare environment.
5. A system as claimed in any preceding claim, wherein the first information comprises information output from clinical equipment.
6. A system as claimed in any preceding claim, comprising means for maintaining and managing a plurality of buffer spaces.
7. A system as claimed in any preceding claim, wherein the first means comprise a plurality of entry stations, each entry station having a user interface for entering at least part of the first information manually.

30553783-1-Ihorlon
8. A system as claimed in claim 7, wherein at least some of the entry stations comprise a touchscreen interface.
9. A system as claimed in any preceding claim, wherein the second means comprise a plurality of electronic displays.
10. A system as claimed in claim 9, when dependent on claim 8, wherein at least some of the electronic displays comprise the touchscreen interface of the first means.
11. A system as claimed in claim 7, wherein the spaces are organised into a first plurality of local groupings, with each first grouping comprising one or more spaces, and wherein each of the plurality of entry stations is associated with and located within or nearby a different respective one of the first groupings.
12. A system as claimed in claim 9, wherein the spaces are organised into a second plurality of local groupings, with each second grouping comprising one or more spaces, and wherein each of the plurality of electronic displays is associated with and located within or nearby a different respective one of the second groupings.
13. A system as claimed in claim 12, when dependent on claim 11, wherein the first plurality of groupings is the same as the second plurality of groupings.
14. A system as claimed in claim 11, 12 or 13, wherein at least some of the plurality of groupings correspond to wards of the healthcare environment.
15. A system as claimed in any preceding claim, wherein the fourth means are arranged to communicate the first information or information derived therefrom to the third means substantially in real time.
16. A system as claimed in any preceding claim, comprising means for deriving the second information from the first information, preferably substantially in real time.
17. A system as claimed in any preceding claim, comprising means for deriving the visual indications from the first information, preferably substantially in real time.

30553783-1-Ihorlon
18. A system as claimed in any preceding claim, wherein the third means are arranged in a plurality of different locations within the healthcare environment.
19. A system as claimed in any preceding claim, wherein the third means are arranged in a central location within the healthcare environment.
20. A system as claimed in any preceding claim, comprising means for sending an electronic kanban to a support service so as to make progress towards a desired status for a space or the patient occupying that space.
21. A system as claimed in claim 20, wherein the support service is selected from the group comprising: imaging; physio; pathology; and pharmacy.
22. A system as claimed in any preceding claim, wherein the first and second means are coterminous.
23. A system as claimed in any preceding claim, wherein the status is selected from the group comprising: space is empty; space is booked; space is occupied by a patient considered to be medically fit; space is occupied by a patient considered to be not medically fit; space is occupied by a patient requiring specific attention; and space is closed.
24. A system as claimed in any preceding claim, wherein the healthcare environment comprises a hospital.
25. A system as claimed in any preceding claim, comprising means for performing a trending analysis of recurring issues.
26. A method for use in a healthcare environment having a plurality of spaces distributed across the healthcare environment, each space being for accommodating a patient within the healthcare environment, and the method comprising the steps of: receiving first information relating to each patient at a location local to the space occupied by the patient; electronically displaying second information relating to each patient at a location local to the space occupied by the patient, the second information being derived at least in part from the first information; electronically displaying, at a location remote from at least some of the spaces, a plurality of visual indications, each 30553783-1-Ihorlon visual indication relating to the status of a different respective one of the spaces, and the visual indications being derived at least in part from the first information; and electronically communicating the first information, or information derived therefrom, from the first means to the third means to enable appropriate visual indications to be displayed.
27. A program for controlling an apparatus to perform a method as claimed in claim 26.
28. A storage medium containing a program as claimed in claim 27.
29. A system or method substantially as hereinbefore described with reference to the accompanying drawings.30553783-1-Ihorlon