3_White Paper EPFM

The Economic and Wider Benefits of ExtraMed

Emergency Patient Flow Manager from Hospedia

This White Paper draws on substantive analysis, performed by Deloitte, of the ExtraMed Emergency Patient Flow Manager from Hospedia, alongside recent industry commentary, to assist hospitals in creating an evidence base and business case for using the service to improve patient care while supporting Cost Improvement Programmes (CIPs)

3

Based on economic assessment by

The Economic impact of Hospedia

Emergency Patient Flow Manager

Contents

Executive Summary ............................................................................................................................................ 3

Introducing the Need for Patient Flow Management in Emergency Care ........................ 3

The Quantitative Benefits of Emergency Patient Flow Manager ............................................ 5

The Qualitative Benefits of Emergency Patient Flow Manager ............................................... 6

How Emergency Patient Flow Manager Works .................................................................................. 7

Implementation - Process and Support from Hospedia .............................................................. 8

How Emergency Patient Flow Manager is Being Used Today ................................................. 9

Conclusion ................................................................................................................................................................ 11

The Economic and Wider Benefits of Emergency Patient Flow Manager from Hospedia

Page 3 ©Hospedia Ltd 2014 November 2014

1 Source: Deloitte Report “The Economic impact of Hospedia. Emergency Patient Flow Manager”2 Source: Kings Fund Quarterly Report February 20133 http://www.england.nhs.uk/2013/05/09/sup-plan/

Executive Summary

The growing pressures on Accident and Emergency departments in the NHS Acute sector, and the subsequent

release of the NHS A&E Improvement plan to respond to the issues that are arising, indicate a serious need for

Trusts to develop a proactive approach to patient flow management.

Investing in Emergency Patient Flow Manager from Hospedia has been validated by Deloitte to deliver financial

benefits in excess of £1.3m per annum in a typical hospital, supporting not only Cost Improvement Programmes but

also delivering considerable process and productivity improvements.

This paper draws on substantive analysis performed by Deloitte, as well as recent industry commentary, to provide

an independent evidence base for the use of ExtraMed Emergency Patient Flow Manager from Hospedia in your

hospital.

Introducing the Need for Patient Flow Management in Emergency Care

There are over 20 million attendances at Accident and Emergency (A&E) departments each year across the NHS

in England1 and, with pressure on NHS resources rapidly increasing, manual methods of managing patient flows

are time consuming and inefficient. Going digital can resolve these issues and generate significant operational

efficiencies.

Within the unscheduled care environment, IT solutions can deliver significant benefits to patients and clinicians,

from improved patient throughput to clinical efficiencies and streamlined workflows. Frequently these benefits go

unrealised, ultimately resulting in clinical staff duplicating effort and working inefficiently.

Meeting financial targets and ensuring financial balance are key objectives for healthcare providers, underpinned

by a driving ambition to improve services to patients.2 Although 90% of A&E patients in England are seen within

four hours, concern has been growing about the trend of increasing numbers of patients waiting longer3. Against

a backdrop of the NHS needing to find billions of pounds worth of savings across the entire healthcare economy,

considering how existing infrastructure can be better leveraged to support increased productivity, and reduce

patient waiting times, is critical.

Emergency Patient Flow Manager (EPFM) is a software-based system designed to replace the traditional whiteboard

method of tracking patient flow from A&E through to admission or discharge. By integrating with existing IT systems,

such as the hospital Patient Administration System (PAS), the system records and tracks the status of each patient,

sharing this data in real time and avoiding the need to locate available beds by telephoning individual wards.

Staff can update and share information regarding the location of the patient, their needs, referrals and discharge status,

at any time, in real time. EPFM saves time and improves accuracy; optimising patient journeys through integrating and

sharing patient data instantaneously; delivering cost savings, time savings and patient experience improvements.



Establishing the business case for electronic patient flow systems, alongside credible ROI calculations, can be an

issue in the strategic decision making process for Healthcare providers concerned with the initial investment and

on-going costs associated with technology solutions. We are therefore delighted to be able to provide independently

produced business case support for EPFM, detailing not only the estimated financial savings but also the indirect

benefits to patients and staff, based on a number of case studies produced by Deloitte detailing the quantitative and

qualitative benefits arising from Hospedia’s products and services.

Using the Treasury Green Book Methodology, including in person interviews and deriving calculations from real

world examples, Deloitte evaluated the economic impact of using Hospedia’s EPFM service to provide patient flow

improvements in the emergency environment.

6 http://www.pickereurope.org/assets/content/pdf/Frequent%20Feedback/Bedside%20TVs%20survey%20pilot%20report_LD_SS_v2%200%20(2).pdf7 Source: Deloitte Report “The Economic benefits of Hospedia. Supporting hospitals and patients”

Figure 1: Methodology Diagram5

Indentify Benefits

Conduct Interviews with

Hospitals

PrimaryAnalysis

Secondary Literature

Finalisation of Benefits



6 Source: Deloitte Report “The Economic impact of Hospedia. Emergency Patient Flow Manager”7 Source: Deloitte analysis8 Stakeholders interviewed by Deloitte quantified 4 full time members of staff typically employed to undertake this function manually9 Deloitte estimate an 11% reduction in average length of stay based on analysis of lengths of stay before and after implementation of EPFM10 http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/cancelled_operations.html11 Calculation based on analysis of surgery cancellations before and after implementation of EPFM, controlling for the trend rate of improvements

The Quantitative Benefits of EPFM

Operational savings represent the savings

associated with freeing up staff time as a result of

the software-based management of patient flow in

an A&E department,8 and the value associated with

optimising the production of discharge summaries.

Hospitals can achieve significant cost savings and

productivity improvements through reducing patient

length of stay. EPFM can support more timely

admission and discharge through shared real-time

access to patient information, helping to reduce

the length of patient stays within the emergency

environment9 and generate annual cost savings of

£950k.

Cancelled operations waste time and resources and place a significant burden on hospital administration. The

effective management of patient flow can help to reduce elective surgery cancellations, alleviating ward bed

unavailability, one of the causes of surgery cancellations.10 As around a quarter of patients attending emergency

care are subsequently admitted to hospital, tracking the status of these patients is fundamental in managing bed

availability throughout the hospital. The value of reducing surgical cancellations, estimated at a 17% reduction11,

represents a benefit of £137k per annum.

Benefits Hospitals p.a

Operational savings £237k

Reduction length of stay £950k

Fewer surgery cancellations £137k

Total benefits £1.3m

Figure 2: Economic Benefits of EPFM7

“In a typical hospital, EPFM is estimated to deliver savings of £1.2m per annum

and additional benefits of £137k per annum”6



12 Source: Deloitte Report “The Economic Impact of Hospedia. Emergency Patient Flow Manager”13 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4118689.pdf14 Source: Deloitte Report “The Economic Impact of Hospedia. Emergency Patient Flow Manager”15 Source: White paper: “Patient flow in the NHS: The efficiency, cost and clinical gains of Patient Flow Management”. 201216 Source: National Audit Office17 Source: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4118689.pdf18 Source: Deloitte Report “The Economic Impact of Hospedia. Emergency Patient Flow Manager”

The Qualitative Benefits of EPFM

Replacing manually updated ward whiteboards with a software-based system designed to optimise patient journeys

can provide benefits far in excess of the pure financial gains.

Patient Experience

Through reducing length of stay, EPFM helps to improve patient experience; thereby releasing income from the

CQUIN payment framework targeting improved patient experience13. The associated benefit of reducing the

burden on staff spending time tracking available beds also improves staff workload, further contributing to patient

experience and enhancing the overall environment in A&E.14

Staff Safety

A negative patient waiting experience can be correlated to violence and aggression towards frontline staff.15 Violence

and aggression towards frontline hospital staff is estimated to cost the NHS at least £69 million a year in staff

absence, loss of productivity and additional security measures.16 By streamlining the patient journey and reducing

length of stay, EPFM contributes to improvements in patient waiting experiences.

A&E Targets

A&E departments are subject to a variety of targets set by the Department of Health, with potential fines being

imposed if targets are not met. One of the priorities of emergency care, aligned closely to the primary concerns of

patients, is the reduction of waiting times.17 By tracking patient journeys in real-time, EPFM can not only monitor

performance against the targets but also generate alerts to highlight potential breaches, reducing the risk of fines.

Enhanced Information and Operational Insights

EPFM records every patient attendance at A&E, minimising not only lost revenue from unrecorded attendances but

also mitigating the associated clinical governance risk.

Users of EPFM also report that the collection of data can be used to optimise hospital processes. Due to the range

of data that can be recorded, hospitals can track activity and manage individual staff performance and realise

operational efficiencies.18

“EPFM can improve patient experience and help monitor A&E targets, while the quality

of data collected supports further service improvements”12



19 http://www.england.nhs.uk/2015/05/09/sup-plan/20 Source: Hospedia

How Emergency Patient Flow Manager Works

EPFM replaces standard, traditional A&E whiteboards with interactive digital screens that can easily share

information between departments and receiving wards. Staff can update and share information about patient

locations, needs, referrals and discharge status, view information in a variety of formats and follow patient journeys

in real time, at a glance.

The interactive screen displays not only the patient status but also allows users to view bed status information,

including cleaning and isolation details. The maximum four-hour wait in A&E remains a key NHS commitment to the

public, set out in the NHS Constitution19. Patients are entered into the system on arrival, beginning the tracking of

their journey, and indicators alert staff to patients at risk of breaching any of the targets.

Fully customisable handover notes, alongside discharge and referral activities, provide full service management of

the patient journey from pre-admission. GP letters can be sent directly through the solution, either within a specific

module or via email, allowing Trusts to hit targets affecting this area of communication. EPFM also provides bi-

directional integration with existing clinical systems, such as PAS, order comms and infection control, supporting HL7

among many healthcare standards. Clinical coding functionality allows Trusts to save money through accurately

integrating ICD10 and OPCS4 codes directly in the solution.

Operations Centre◼ Patient flow in real-time◼ Hospital/patient monitoring and compliance

Emergency Teams◼ Whiteboards - Patient status at a glance◼ A&E Targets◼ Discharge summaries

Admission Units◼ Whiteboards - Patient status at a glance◼ View demand in real-time◼ Escalations

Specialist Teams◼ Real time patient list whiteboards◼ Compliance monitoring

EXTRAMED - EPFM

PAS ORDER COMMS

OTHER DEPT SYSTEMS

HL7HL7HL7

INTERACTIVE WHITEBOARD



Figure 3: Network Connectivity Diagram20



21 Source: Hospedia

Implementation - Process and Support from Hospedia

Hospedia have a dedicated team with experience of successfully and rapidly rolling out patient flow solutions to

more than 20 hospitals and service providers across the NHS.

Working to PRINCE2 and observing best practice in risk management, Hospedia ensure that customers get an

effective patient flow solution up and running quickly - making a positive impact on patient flow from day one with

screens that are intuitive for clinical staff and managers.

Our consultative approach during project initiation allows the project team to identify and focus on the key areas of

strategic importance to the Trust and translate these requirements into practical improvements on the ground. Close

collaboration with and understanding of operational staff ensures that the deployment phase is rapid and effective

with clear goal setting and staged delivery.

With the solution installed we continue to work with the Trust to make sure that the system becomes embedded

in operational processes and remains relevant to managers and front line staff in a changing NHS. Regular update

meetings with the Trust and the availability of upgrade assurance means that EPFM remains current with the Trust

and NHS requirements.

Ongoing support, including engagement in Hospedia User Groups to

enable Trust contributions to the product roadmap

Staged rollout to wards with Hospedia and Trust support teams

Trial in single area to embed awareness and enable Train the Trainer approach

Prepare system for live trial testing based on UAT signoff and clinical input

Engage IT and clinical teams in User Acceptance Testing (UAT) and feedback sessions

Joint working between NHS and Hospedia teams to establish

Connectivity and Test environment

Project Kick-off meeting to agree goal milestones and resources

2

3

3

5

6

7

1

Figure 4: Implementation Process21



How Emergency Patient Flow is Being Used TodayHospedia’s ExtraMed EPFM solution is in use across the NHS, supporting thousands of users in over 10 hospitals, 24

hours a day. The system has such a wide range of features; it supports hospitals in achieving different aims. Just a

few of the myriad ways in which Trusts are using the system are detailed below.

University Hospital Coventry & Warwickshire

University Hospital Coventry & Warwickshire implemented EPFM in 2008, to manage increasing demands in an

emergency department catering to over 160,000 attendances each year.

EPFM provides the department with a single shared view of activity and the ability to deliver real time analytics

on key performance indicators. The A&E Breach report gives the department information, in real-time, to help staff

identify where and why breaches occur.

EPFM has also provided the Trust with the opportunity to integrate Clinical Decision Units and Admission Units into

emergency patient flow, further increasing the availability of patient information across the hospital.

East Lancashire Hospitals NHS trust

East Lancashire NHS Trust uses EPFM to manage A&E Departments and Minor Injury Units across 5 hospitals within

the Trust. The system provides the Trust with a valuable, real-time overview of patient flow in and out of A&E, as well

as departmental activity affecting admission gateways. Users can access the information from anywhere within the

organisation, sharing data to support patient care and improve patient experience.

Allowing key users to access the information they need enables informed decision making, EPFM ensures patients

access the right level and type of bed in the right timeframe, and helps initiate escalation processes when

appropriate.

“In building the Electronic Discharge Whiteboard, the Hospedia team has demonstrated a real

understanding of clinicians’ needs and they have used that knowledge to produce a system that

presents the relevant information in a clear and concise way”

Nick Elliott – Chief Technology Officer, University Hospitals Coventry & Warwick

“In a nutshell, it provides strategic and operational clarity with regard to

patient flow and departmental activity”

John Goodenough – Deputy Director of Nursing, East Lancashire Hospitals NHS Trust



East Cheshire NHS Trust

East Cheshire NHS Trust turned to EPFM to deliver a solution that would help clinical front line staff to manage the

increasing flows of patients through the emergency department, manage the 4 hour wait-time target and enable

data capture to support payment-by-results income.

Through a close working relationship during the implementation and change management process, EPFM has been

beyond the initial offering, delivering enhanced functionality and increasing staff engagement.

Using the EPFM whiteboard provides the hospital with a clear view of patient waiting times, clinical coding and bed

availability in the wider hospital.

These are just a handful of examples of how the system is being used to support hospitals in making efficiencies,

improving patient experience and supporting CIPs. In addition to its primary function as a patient flow management

tool, EPFM is also being used as part of workflows focusing on Medications Reconciliation, VTE assessments and

Observations, among many other key NHS initiatives.

“The [Digital] Whiteboard is the first time we’ve had a visual clue as to what’s happening in the department.

If you see someone who is starting to near breach point you can follow it up and find out why. Everyone is

really keen to use it, because it’s actually fun and easy to operate.”

Christine Scott, Operational Lead Nurse, East Cheshire NHS Trust

“...The driving ambition underlying the challenge to deliver greater productivity and a stable financial

position is not only to maintain the quality of services to patients, but to improve it.”

The Kings Fund, February 201323.



Conclusion

The constant increase in patient numbers presenting to emergency departments has led to calls for urgent action to

help reduce the pressure on over-stretched departments. According to Health Minister Anna Soubry, attendances

have risen by a million in just the last year.22

It is evident through the case studies and the reports produced by Deloitte, as well as the NHS priorities identified

throughout this paper, that Emergency Patient Flow Manager is not only economically advantageous, it is also highly

powerful in reducing the pressures on A&E departments through freeing up staff time and reducing patient length of

stay.

Generating direct cost savings of over £1.3m per annum, alongside wider direct and indirect benefits, EPFM puts

intuitive and productive patient flow management at the heart of the emergency care environment, supporting front

line staff in day to day activities while improving the overall A&E experience.

Not only delivering productivity and financial benefits, EPFM helps to reduce length of stay and waiting times,

provides auditable data, and supports infection control standards and overall operational change; improving quality

for patients and staff.

With the Health Secretary’s aim of bringing the NHS paperless by 2018,24 digitising existing processes will be decisive

in the success of hospitals reaching this achievement. Through EPFM, emergency patient flows are managed

digitally, not only saving staff time in tracking down available beds, but also removing the need for paper processes

to be employed.

22 http://www.bbc.co.uk/news/health-2246074123 http://www.kingsfund.org.uk/publications/how-health-and-social-care-system-performing-february-201324 http://www.ehi.co.uk/news/ehi/8315/hunt-wants-paperless-nhs-in-five-years



About Hospedia

Hospedia is the world’s leading provider of point of care systems in healthcare. Hospedia’s Patient Centred Care

Platform provides patient media, patient engagement and clinical workflow solutions that support hospitals, staff,

patients and visitors worldwide, through powerful software, hardware and integration capabilities. The Platform

delivers a range of services that make a real difference to patient care while providing clinical efficiencies and

substantial financial benefits.

If this white paper has been of interest, and you would like more information about how the solution can be

implemented to support your hospital priorities, please contact our team of experts. This paper summarises

the case studies produced by Deloitte; our team can provide the full cases and work with you to help build a

business case for individual circumstances, formulate an implementation plan that works around operational

requirements and assess how to tailor the service to your specific needs.

[email protected]

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