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Novel IT systems for adrenal lesions to enhance safety & effectiveness

The electronic Adrenal Incidentaloma management system (eAIMS) prototype requires manual data entry. We will establish interfacing function for electronic biochemical data entry to enhance safety, cost-effectiveness & facilitate UK-wide adoption

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  • Shortlisted idea
  • 2022

Meet the team

Also:

  • Drs George& Clark (Radiologist, UHNM)
  • Dr Issa (Endocrinologist, Manchester University)
  • Dr Heald (Endocrinologist, Salford Royal Hospital/)
  • Gill Powner, Endocrine nurse, UHNM
  • Helen Robertson, MDT Co-ordinator, UHNM
  • Mrs Web, Manager, UHNM
  • Prof Sim (Statistician). Keele University
  • Prof Fordham (Health Economist, East Anglia)
  • Charlotte Woodcock, Qualitative Researcher, Keele
  • Dr Lea: R&I Manager

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

The change: Adrenal lesions are one of the commonest unexpected findings on radiological scans. Through HF support, we developed a prototype adrenal incidentaloma management system (eAIMS). We will enhance eAIMS functionality by:

  1. Increasing inter-team connectivity (nurses, clinical biochemists, endocrinologists and administrators) to maximise timeliness and efficiency.
  2. Automating alerts to warn against delayed results, thereby streamlining the patient journey.
  3. Automating alerts of abnormal results to ensure timely intervention.

This proposal was created through active partnership between patients and multidisciplinary team (MDT) members.

Indicative data/feedback:

  1. Time-in-motion analysis (see Hanna, et al. BMJ Open Quality. 2020:9.pii:e000572)
  2. Focus group discussions with affected patients.
  3. Ongoing discussions between MDT and IT experts regarding safety risk of manual data entry and benefits from automated alerts.
  4. Feedback following national presentations (Association of British Clinical Diabetologists, Caledonian Endocrine Society), with colleagues’ insight into enhancing eAIMS functionality.

What does your project aim to achieve?

Objectives:

Primary:

Safety/timeliness: time from test request to actioning results (20% reduction)

Secondary:

  • Efficiency: hands-on time for key staff groups (time-in-motion study)
  • Timeliness: Shorter overall patient journey:
    • referral -> investigation request
    • request -> completed investigation
    • completed investigation -> MDT decision
  • Cost-effectiveness: reduced costs (time-in-motion analysis), utilising established tool (see Hanna et al. BMJ Open Quality. 2020:9.pii:e000572)
  • Qualitative analysis:
    • Patient experience: focus group discussions (existing practice versus updated eAIMS-supported pathway)
    • Clinician evaluation: Qualitative interview (acceptability and confidence of using eAIMS, clinician well-being/stress).

Improvements:

  • Shorter patient journey: Prototype eAIMS reduced complex case journey by 78%. Upgraded version will streamline pathway for all cases (delayed/abnormal results alerts).
  • Enhanced patient safety: Minimising human errors (electronic data entry & letter generation), highlighting potential delays in testing (automated alerts).
  • Reduced patient anxiety: Cutting waiting time, and associated uncertainty.
  • Cost-effectiveness: Reducing hands-on time & unnecessary clinic visits.
  • Facilitate scaling-up: Additional functionality will promote national adoption.

Reducing health inequalities:

Unified approach, regardless of unit size/infrastructure.

How will the project be delivered?

Approach/Team:

  • Endocrinology, Clinical Biochemistry, Radiology, Nursing, Administration and patients will develop the system specification.
  • Work with IT/Information Governance to enhance eAIMS functionality.
  • Test upgraded system (dummy scenarios).
  • Implement and evaluate upgraded eAIMS over 6 months.

Measuring impact:

Statisticians, health economists, qualitative researchers) will assess impact on patient safety, timeliness, efficiency and cost-effectiveness, whilst also collecting patient and clinician perspectives.

Delivering value for money:

Utilising our previously-established Adrenal Incidentaloma Intervention Cost Assessment Tool (AICAT; Hanna et al. BMJ Open Quality. 2020:9.pii:e000572), we will assess cost-effectiveness of the improved pathway utilising data from the time-in-motion analysis.

Managing risk:

  • Project Operational Group: manage day-to-day operational challenges.
  • Project Steering Group (including patient representation): oversees overall project trajectory and reviews risk.

How is your project going to share learning?

The eAIMS programme represents an initiative whereby both patients and clinical stakeholders co-develop an electronic portal for the management of patients with adrenal lesions. Our aim is for this to be:

An ‘Iterative Patient-driven Service Adaptation Process’, whereby patients are continually involved in ongoing improvements to the pathway.

  • A vehicle to facilitate co-developed novel service models including those led by nurses and clinical scientists.
  • A platform for an Interactive Online Patient Support System.
  • The forerunner of a national registry for such patients, thereby facilitating future national research and audit.

The current proposed upgrade represents the next step in enhancing inter-team connectedness and integration via eAIMS system, rectifying the current disjointed approach. This model is readily transferrable to other conditions, where working across the Q community will enable us to share this journey.

Its web-based approach will also facilitate wider national adoption.

How you can contribute

  • Promoter: Help us get our idea noticed and champion the spread to other centres.
  • Expert: Support: from clinical colleagues and those with IT improvement skills
  • Critical friend: Positive feedback to help us improve the system
  • Networker: Help us link with other centres and experts
  • Collaborator: Develop opportunities to be involved in adoption and scaling up
  • Investor: Facilitate linking with IT enterprises to support scaling up and national adoption
  • Fixer: Signpost extra resources to enhance functionality and facilitate scaling up
  • Strategist: Align our idea with existing local and national priorities and policies

Plan timeline

2 Sep 2022 12 months

Comments

  1. Looks like a great idea and a practical, achievable solution.

  2. It's great to see this is being co-produced with people using the service and clinicians (lived and learnt experience) based on what matters to them #ImprovingTogether  It would be even better to have lived experience partners as part of the team directly shaping and co-producing the work. They could also co-facilitate the focus groups.  Would be really interested in hearing more about how this progresses and if we can support in any way let us know :)

    1. Thanks Helen. Co-production is at the heart of what we do. One of our wider aims is to have a co-produced patient portal that facilitates real-time pathway development, with embedded co-developed information for patients.

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