Management of emergencies across the NHS as we know it is changing. The implementation of EPR’s has meant that real-time documentation and management of emergencies is becoming more complex. ERA Systems was built to revolutionise the allocation of roles and real-time data capture of emergencies to ensure patients get the right care, by the right people, at the right time. By doing this we can improve communication, auditability, and patient outcomes.

The challenge
As we move to a more digital healthcare ecosystem, we are faced with the need to better manage emergency scenarios. Currently, we do not communicate roles for staff until we are at the bedside, which causes stress to both patients and staff, with significant time spent allocating roles. Post-emergency, clinical staff often write in retrospect, meaning critical timelines are lost and information becomes in accurate, thus preventing an accurate root cause analysis.

In maternity alone, emergencies in labour can lead to catastrophic and far-reaching consequences for birthing parents and their babies. Clinical negligence claims in maternity accounted for 60% of the total cost of claims in 2018-19 (approximately £5.4bn), despite them only account for around 10% of claims. Studies suggest that up to 5.6% of women suffer symptoms of PTSD (Post Traumatic Stress Disorder) following birth, and we are losing around 50% of midwives due to work-related stress. We therefore need a solution that enables us to more efficiently manage emergencies, whilst capturing real-time data of what happened when, and along seamless follow up for patients requiring ongoing support.

The solution
ERA is a digital solution that streamlines emergency management, captures real-time event data, and supports automatic follow up of patients to assess their risks of PTSD. It enables healthcare staff to know what care they need to provide before reaching the patient to create a more effective emergency situation. Tablets located by patients’ beds connect to a touch screen at the nursing station and If an emergency occurs, the healthcare professional can indicate the type of emergency, with the roles associated with that emergency being displayed at the nursing station. Team members can then assign themselves a role, ensuring they know their responsibilities and the status of other tasks in the emergency, before entering the room.

With ERA, staff can be informed at the earliest opportunity of the emergency. It ensures the appropriate number of staff attend the emergency, and where two emergencies occur concurrently, can ensure even distribution across two patients. It also captures an audit-log of the sequence of emergencies, roles, and total emergency times, which can inform root-cause analyses and legal cases, especially where a scribe has failed to attend. It can also inform training and education, for example if cannulation continuously appears to be the last role chosen, indicating that staff feel less confident in these skills. We have built a separate module to the system called ERA Care, which allows for maternity teams to schedule a PTSD questionnaire to be sent to the patient two weeks after the birth date, allowing them to identify those that are deemed higher risk and thus supporting early intervention.

The impact

Non-cash releasing benefits

  • Improvement in patient and staff experiences: Staff and patients reported a better overall experience when ERA was used. We have been shown to reduce noise pollution and an overall more effective team approach when compared to current emergencies. We hope that ERA will support the retaining of Midwives amid a significant amount of them wanting to leave the profession
  • More effective management of emergencies: We reduce the response times by several minutes when compared to hardwired bell responses. We also enable improved support across two emergencies as we can highlight how many staff are at each emergency thus not putting any single service user in unnecessary harm’s way. Time to theatre has a direct impact on foetal and maternal outcomes and thus any improvements to this process will have a positive effect on such outcomes.
  • Automated patient follow-up: We have included the ability to schedule a questionnaire to be sent to patients two weeks after their emergency to assess their risk of PTSD. The postnatal mental health team can then identify those that are high risk and commence early intervention thus further reducing the subsequent costs that a late diagnosis carries, at an annual cost of around £18,000.

Cash releasing benefits

  • Post emergency documentation of clinical incidents costs a single maternity department around £1250 per month due to clinicians needed to revisit the documentation and write out the sequence of events. ERA can instantly generate an audit log of the event to be included in  the patient records, significantly reducing the time taken to document, which will support with ensuring documentation is complete and accurate, whilst also supporting root cause analysis.
  • Supporting an NHS Trust’s eligibility under the Maternity Incentive Scheme (MIS). The MIS (now in its fourth year of operation) financially rewards Trusts that meet 10 safety actions, designed to improve the delivery of best practice in maternity and neonatal services. Trusts that can evidence that they have achieved all the ten safety standards can recover the element of their contribution to the CNST maternity incentive fund. ERA contributes directly towards three of the ten MIS “Safety Actions”, as follows:
    • Safety Action 4, which requires Trusts to demonstrate an effective system of clinical workforce planning. To achieve this Safety Action, maternity units must “monitor their compliance of consultant attendance for the clinical situations when a consultant is required to attend in person.” ERA is ideally positioned to assist with this, being able to report on which roles were present at any given emergency.
    • Safety Action 7, which stipulates that Trusts demonstrate a mechanism for gathering service user feedback. ERA fulfils this requirement by including a feature to trigger post-discharge questionnaires to parents (ERA Care). Not only can these questionnaires accelerate the diagnosis of postnatal PTSD, but they can also capture general feedback data on the experiences of mothers and their partners whilst in hospital
    • Safety Action 8, which states that 90% of relevant maternity unit staff groups attend professional training that includes maternity emergencies. ERA has been used extensively for simulation and training purposes. By being able to capture which emergencies were simulated and who was in attendance, multidisciplinary team performance is enhanced.
  • A reduction in maternity-related litigation cases. In 2019-20, the average cost of a clinical negligence claim in maternity was £2.4m 15. If the Trust can use ERA to better manage maternity emergencies, leading to just one less future litigation claim, this represents a significant ROI which will cover the cost of implementing the solution for many years to come. We can work with the Trust finance department to help identify where these savings in insurance premiums and litigation spends can be focused.

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