The OECD says that Healthcare is about a decade behind other industries in adoption of Digital Technologies and their recent report Health in the 21st Century” identifies Ireland as a laggard, particularly in the use of data in healthcare. Recent headlines around trolley counts in Ireland have brought into focus the potential for digital solutions to significantly alleviate the national bed capacity issue which, along other factors, continues to fuel the trolley crisis. While other industries such as manufacturing have long ago implemented automated process control, our hospital wards have generally not adopted this approach. A Digital initiative called Vital Signs Automation (VSA) could significantly improve utilization of existing bed capacity while also improving patient safety, a key priority by senior leadership in the HSE. VSA includes capturing physiological parameters such as blood pressure, pulse rate and temperature and automatically computing the national early warning score (NEWS) which is used to track whether a patient’s condition is deteriorating. Earlier detection of the potential of a patient developing Sepsis or being at risk of a cardiac arrest fundamentally saves lives and increases bed capacity through shorter length of stays.
A 2015 HIQA report identifies the potential increase in capacity of over 800,000 bed nights in Ireland when a shift is made from paper based vital signs recording to electronic capture of vital signs and automated computation of the national early warning score.
VSA has been deployed in other countries and a systematic literature review outlined in a recent HIQA report shows evidence for a substantial reduction in average length of stays and a consequent increase in bed capacity. A deployment of VSA by the Galway based company Synchrophi in Golden Jubilee hospital in Glasgow reported a 15 to 35% reduction in the average length of stay which results in a commensurate increase in bed capacity. A 2015 HIQA report identifies the potential increase in capacity of over 800,000 bed nights in Ireland when a shift is made from paper based vital signs recording to electronic capture of vital signs and automated computation of the national early warning score. If the capacity gains were even to be partially realized there could be a significant reduction on our trolley counts. VSA makes the whole system work more efficiently by identifying a patient deterioration sooner, allowing a quicker and lower resources response. Annually there are over 350,000 bed nights consumed by patients with SEPSIS. Earlier detection and earlier intervention is better for the patient and saves money and bed capacity for hospitals. VSA also makes a nurse or HCA’s job easier by eliminating unnecessary scribing and computation tasks, freeing up more time for one-to-one patient care.
The VSA economics are compelling with the use of a digital solution being one/one hundredth of the cost of building new bed capacity. Deployment of VSA in a four hundred bed hospital at a cost of €400,000 Euros will conservatively yield an increased capacity of 40 beds, whereas it would cost approximately 40 million Euro to deliver 40 new beds if they have to be physically built.
VSA has already been deployed in the Galway Clinic and the Bon Secours private hospitals in Galway, where one ward manager responded that VSA is not only safer, it is way safer for patients. If it is good enough for private hospitals, it should be good enough for our public hospitals. We could and should make VSA a national health clinical and business priority.
Martin Curley is the Director of Digital Transformation in the HSE. The opinion piece is the first of many that Martin plans to write for the Digital Transformation website.
Notes: Further information on the National Early Warning Score (NEWS) can be found at https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/news-brochure.pdf