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ED Check-In: Saving Time on Emergency Department Documentation

Smartphone check-in system to improve information quality and reduce time spent on documentation

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  • Proposal
  • 2022

Meet the team

Also:

  • Dr Paul Holmes, Emergency Department Clinical Director
  • Dr Gabriel Jones, Emergency Medicine Consultant

What is the challenge your project is going to address and how does it connect to the theme?

Up to 500 patients per day attend St George’s Hospital Emergency Department (ED).

ED clinicians spend hours typing notes about patients’ symptoms and reason for visit.

This admin workload reduces clinical productivity, causes delay and reduces satisfaction. It is a low value use of highly skilled clinicians’ time.

Our ED team created a prototype system called ED Check-In (EDck.in) – a website that allows patients to check-in like they do at an airport, by smartphone. Information goes immediately into the patient electronic record.

Funding will develop this local pilot into a cutting-edge efficiency tool for multiple Trusts. Funding will cover patient experience research, Communications support and creation of a demonstration video, and improvement of the website functionality to roll-out to Trusts.

This project demonstrates the Q Exchange theme by combining lean improvement principles with digital technology to save time, save costs and even support clinicians to save lives.

What does your project aim to achieve?

The key objectives include:

1. Improve patient experience – fewer delays and ability to tell their story in their own words supports better experience for patients.

2. Improve staff experience – pilot data showed 10 out of 10 clinicians wanted to continue to use EDck.in after the pilot due to better quality information and reduced administration workload.

3. Improve efficiency and reduce costs – pilot data showed savings of around 8 minutes per patient. If just half of our daily 500 ED patients use EDck.in, this could save 33 hours per day. This equates to a cost avoidance of up to £1,650 per day (assuming cost-to Trust of mid-range junior doctor £50p/h).

4. Reduce health inequalities – many patients have difficulty communicating verbally; this digital solution provides a non-verbal communication channel helping to provide better quality care to more patient groups. Patients without access to smartphones or who do not wish to use EDck.in simply follow the normal ED process (clinician takes manual notes).

How will the project be delivered?

A working group would support the project delivery with Clinical, Management, IT, Performance, Information Governance, Procurement and Transformation leads assigned.

Information Governance have approved the project and project leads have sought advice from NHS Digital and NHSX on progressing development. Clinical risk and impact would be managed through the existing robust ED governance process. Project and data security risks will be managed by a Transformation Programme Manager and the Information Governance Manager. Website security will be tested to appropriate industry standards as per NHS Digital advice.

External services and partners will be identified and procured following Trust standard Procurement policies. Local Trusts will be identified as early adopters.

Key performance indicators will include patient and staff experience metrics (built into the website), volume of patients checking-in and impact on assessment time. Automated reporting will be set up by Business Intelligence and be monitored by Transformation and ED operational groups.

How is your project going to share learning?

More than 30 Trusts and departments have contacted us to enquire about implementing EDck.in but funding is required to improve the system and support this next step.

Demonstrations would be provided as videos or remote interactive sessions to share the learning and walk other teams through the process.

The St George’s ED and Transformation teams work closely with multiple improvement agencies including the Health Innovation Network, NHS Digital and Academic Health Science Network; we would continue to work with these groups, presenting at learning events and sharing online resources. Support from the Q Community could help to share the improvement to a much wider audience.

How you can contribute

  • Promoter - we are grateful for help in accessing funding and digital innovation support
  • Expert - we are grateful to hear advice from colleagues who have launched innovation products from within a Trust
  • Investor - we are grateful to hear from other teams that could invest resources

Plan timeline

1 Jul 2022 Initiate project group and formalise governance structure
15 Jul 2022 Project plan approved and project launch
1 Aug 2022 Identify and procure external partners (comms, software, research)
1 Sep 2022 Begin patient experience research
1 Sep 2022 Begin website development
1 Sep 2022 Identify local partner Trust sites (early adopters)
3 Oct 2022 Test new website functionality with patient experience focus group
3 Oct 2022 Work with pilot site Transformation Teams to prepare for implementation
1 Nov 2022 Create demonstration video, training resources, patient information guides
1 Nov 2022 Final changes to website
1 Dec 2022 Launch in partner Trusts
1 Mar 2023 Conduct 3-month evaluation with partner Trusts
3 Apr 2023 +/- phase 2 roll-out plan and further funding application if required
3 Apr 2023 Review evaluation with appropriate senior leaders

Comments

  1. Hi Verity.  This is a really interesting idea!  One question for you; what if patients don't have smart phones or don't have capacity/ability to register themselves -  How does the process change for these cohorts of patients?

     

    Best of luck with the application!

    1. Hi Ronan, thanks so much for the comment. Patients who do not have access to a smartphone (or who just don't want to use EDck.in if they are feeling unwell etc.) will simply follow the normal ED process i.e. the clinician will type the notes up manually.

      This will not impact the patient's quality of care but may mean assessment takes longer due to the typing. If the patient has checked-in, all their information is available for immediate review and discussion with the clinician at assessment.

      I have now added a sentence to explain this in the entry, so thanks for the comment!

      Verity

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