At the end of the seminar held at Leeds on information in the NHS the Chairman Robert Francis said that the day had cheered him up. I shared this feeling.
We heard from people who are actively using information technology now within the NHS to drive up the quality of care. There is a quiet revolution in progress.
We heard how in 2000 Information technology was still in its infancy. We heard about the long time lags between events and the eventual statistics, and the very variable quality of data. All this meant meant that clinicians did not have any trust in the emerging early systems, of which HSMR is an example. We heard about the problems of Clinicians accepting information that was provided to them by outside agencies, and how important it is for clinicians to feel they own the information.
We heard how the speed of the information revolution has been accelerating, over the last four to five years.
The people who presented papers to the seminar included Professor Martin Elliot form Great Ormond street and Dr Dave Rosser from University Hospitals Birmingham NHS Foundation trust. They are both part of organisations that have completely bought into the use of information.
Great Ormond street did this by closing an intensive care bed, to fund the project. The savings and quality improvements that they have made through good information have now made it possible for them to fund two intensive care beds.
Birmingham has 16 analysts who work on giving the clinicians real time information. They allowing the clinicians to develop the indicators that they believe they need and help them use these systems to improve quality. This is paying off both in terms of quality of care and demand for their services.
The work they are doing is remarkable.
The trail to the seminar that I heard on BBC Radio 4 Today
http://news.bbc.co.uk/today/hi/today/newsid_9618000/9618445.stm told us that one of the things the Birmingham system can do is to issue prompts to ensure that nurses do not miss giving doses of medication to patients. This is a remarkably common problem within the NHS. Giving antibiotics or insulin late does cost lives.
This system is particularly relevant to the Midstaffs story because the Gillian Astbury Case, is one of small number of symbolic cases that Cure the NHS have pursued. This is an all too common case of an elderly lady with dementia and diabetes who did not get the specialist diet that a dietician had prescribed, and died because she had not received insulin at the right intervals. Failure to administer insulin on time is common throughout the NHS wherever hospitals are relying on paper based note systems. Dr Rosser reckons that potentially 16,000 lives a year can be saved by using his prompt systems.
We also heard about decision support systems, which act as guides to help doctors and nurses through their decision making processes. When this was first implemented the analysts were surprised by the 400 occasions a day where the system was challenging the course of action that the clinician was planning to take, though they point out that this represents only 1.8% of the clinical decisions that are made. I in 10 people in hospital currently experience an adverse incident. These information systems have done the work to understand how many common errors are made, and to help eliminate them by supporting doctors and burses better.
Dr Rosser also told us about their system to cut MRSA. If a swab tests positive then as soon as it is entered on the system the ward is alerted by an email message. Action to prevent spread of the infection can be started within seconds, rather than the 30 hours that was common when they used paper based systems. This saves lives.
Dr Rosser showed us a series of graphs where the information systems had alerted the hospital and clinical teams to opportunities for improvement. There are two key ingredient in making the system work. There are the statistics, and there are face to face round table meetings with staff on a regular basis when they look at the issues raised, challenge each other where there are weaknesses and decide collectively on the action to be taken. The Birmingham graphs show a dramatic story of what happens when a problem is identified and the clinical teams take a concerted effort to make a significant change. You get a “step change” where you can see the shape of the graph change radically. Whenever that happens it means many individual patients get a far better service.
What makes me cheerful about all these developments is that it shows that getting information right can move us from a position where we a seeking to punish individuals for failings so far after the event that no one really knows what happened, to using information to support decision making, help people get it right first time, and allowing clinicians to drive a process of continuous improvement.
A good aspect of this is that it cannot possibly be seen as political. This is about harnessing the new potential of information systems and combining it with the real creativity of some of the brilliant analysts that we have within the NHS. Everyone should support these developments.
There is a bit of politics though! Birmingham has offered to release their system free, to get it in use throughout the country and start saving lives. The government wish it to be issued on a commercial basis.
The seminar papers will be available on the Midstaffs Inquiry website in the future.
Dan Sabbagh, Guardian's head of media and technology writes:
