Sligo University Hospital Sligo, Republic of Ireland
Finding a balance between delivering high-quality care and doing it efficiently
McKesson Cardiology™ from Change Healthcare
- First hospital in the Republic of Ireland to achieve British Society of Echocardiography (BSE) accreditation
- First non-UK hospital to achieve British Society of Echocardiography (BSE) Departmental Accreditation
- 8.9% reduction in echocardiograms
- 80% of Acute Ward requests for echocardiograms performed on same day as ordered
Sligo University Hospital in Sligo, Republic of Ireland provides high-quality healthcare to the people of Sligo, Leitrim, South Donegal and West Cavan. Services include acute inpatient, outpatient and day services as well as regional specialty services in Ophthalmology and Ear, Nose and Throat.
Efficient Response to Chronic Illness Balancing high quality care with efficiency — and avoiding unnecessary procedures — is a priority for any hospital department given the continuing need to manage increasing demand for services with budgetary pressure.
With changing demographics, plus the rise in chronic illness and obesity affecting every aspect of patient care, it has become essential to understand patient trends. Approximately 10,000 people die each year from cardiovascular disease (CVD), including coronary heart disease, stroke, and other circulatory diseases. CVD is the most common cause of death in Ireland, accounting for 36% of all deaths, according to the HSE. 22% of premature deaths (under age 65) are from CVD. SUH, however, operates in the North West of Ireland, an area with a higher than average elderly population.
Streamline Processes, Improve Workflow, Achieve Accreditation For SUH’s Cardiology Department, the adoption of McKesson Cardiology in 2013 provided an opportunity to streamline processes and improve workflow. Replacing a manual, paper-based process, Echo orders are automatically received into McKesson Cardiology from Ireland’s national system integrated medical imaging solution for Radiology (NIMIS), and then fed directly through to the Echocardiogram machines. All the Echo images and measurements are then stored within the cardiology database, enabling the Cardiac Physiologists to undertake reports on the system.
As Anita Flynn, Senior Cardiac Physiologist at SUH, explains, “The process not only streamlined Echo referrals but also provided doctors with access to the electronic reports at the touch of a button. For doctors previously used to time-consuming creation of paper orders and storing printed reports within patient charts, the entire process became far more efficient and effective.”
With the upgrade to their cardiology solution in 2015, SUH took a step further, leveraging the improved reporting and embedded BSE range measurements to support its bid for BSE accreditation to demonstrate the quality of services being delivered. As Anthony Ryan, Chief 2 Cardiac Physiologist, SUH, says, “BSE departmental accreditation is a recognised benchmark of quality. It indicates to patients, resource allocators, and health professionals that an Echo department meets quality standards.”
The department has leveraged the software from Change Healthcare to achieve improvements at every step of the pathway – from initial Echo orders through reporting. A key aspect of the new workflow is the use of electronic vetting, which has enabled SUH to triage Echo requests to both ensure urgent cases are prioritized and minimise unnecessary activity.
Using secure login, cardiac doctors and advanced nurse practitioners can order Echos via NIMIS which are now actively graded by the Echo team. “If we don’t feel the doctor has included enough relevant information, we send the order back with a request for more clinical information,” Flynn confirms. “They have 10 working days to provide that information – at which point we will either approve the request or deny because it is not compliant with BSE guidelines.”
One of the most important additions to the cardiology solution was the inclusion of the BSE range checking — making redundant the Cardiac Physiologists’ previous use of Wall Charts or phone apps to verify measurement range. As Ryan explains, “When we perform an Echo measurement we will double check the appropriate range and make a comment — embracing the BSE minimum dataset and quantitative measurements was a huge step forward. The system flags any measurements outside the BSE range, which helps us to highlight abnormalities.”
The system also helps with reporting, with predefined sentences built in. Flynn adds, “Rather than typing out entire sentences regarding a particular Echo pathology, using the drop-down boxes we can very quickly and efficiently create the report – with no spelling mistakes!” The built-in teaching files also help trainee echo staff to gain confidence on the system quickly.
In addition, the cardiology solution has customised its reporting to meet SUH’s specific requirements, in line with the BSE standard and delivering the full audit trail. For example, staff can gain quick access to their BSE log book if required, plus Echo reports can be indexed to enable the Cardiology team to track trends in Echo activity, including patient demographics, using the cardiology solution and IBM Cognos software.
The Cardiac Physiologist team also has access to the reporting database from all its PCs, freeing up more machines for Echo reporting, which ensures there are no backlogs. Flynn confirms, “We didn’t want any reports outstanding for more than two or three days. Utilising the integration between our cardiology solution and Cognos, we have been able to identify any problems in turnaround times – flagging individuals who were not reporting within 24 hours for inpatient, urgent and routine reports, in line with BSE targets.”
Within the cardiology solution, SUH is able to record a depth of patient information, including not only age but also body surface area, height and weight. The results are indexed, thus providing more accurate quantitative measurements about BMI, patient mobility and age demographics.
Gaining maximum value from the integration of Cognos Statistical Resource to the cardiology solution, the team is able to demonstrate the number of geriatric and pediatric cardiac Echos undertaken on both a monthly and yearly basis – revealing that over 52% of patients were aged 65 or over and 24% aged over 80 in 2016. “Providing this information to management is key to ensuring we have the right resources of both staff and equipment, such as Echo couches for elderly or obese patients,” says Ryan.
“The process not only streamlined Echo referrals but also provided doctors with access to the electronic reports at the touch of a button. For doctors previously used to time-consuming creation of paper orders and storing printed reports within patient charts, the entire process became far more efficient and effective.” Anita Flynn, Senior Cardiac Physiologist, Sligo University Hospital
Gaining Confidence The use of McKesson Cardiology from Change Healthcare has facilitated SUH to become the first hospital in the Republic of Ireland to achieve British Society of Echocardiography (BSE) accreditation.
One of the unexpected side effects of attaining BSE accreditation has been a boost in confidence amongst staff. As Ryan confirms, “Staff had the ability but achieving accreditation has given them more confidence — we are working as a team, proud and motivated.” Flynn adds, “We know we are doing the job well and to the best standard we can - the best for patient care. In addition, as part of the BSE process we have Echo meetings where we are all learning from one another.”
This focus on continual improvement will include encouraging more staff to undertake their individual BSE exams to further demonstrate to doctors, management and patients the high standards delivered by the Echo team. Flynn adds, “Our cardiology solution is key to providing SUH with the tools and training to support our BSE accreditation and we will continue to work with Change Healthcare and their Cardiology Team to make sure we are up to date with current standards and any new guidelines that come in to maintain the high standards we have achieved.”
The Cardiology department leveraged the Change Healthcare system’s good digital storage system and strong reporting, plus embedded BSE range checks, to transform the pathway from Echo order through to report. Using the cardiology solution’s electronic vetting, the team reduced its Echo workload by 8.9% in 2016 by eliminating inappropriate requests. At the same time, the triage process has ensured the hospital’s acute assessment patients are prioritised, ensuring that 80% of Echo requests from the acute ward are carried out on the same day as ordered.