Care planning can reduce care variability and encourage best clinical practice

FEATURE - Industry Innovation Article - Elsevier

Hospital organisations need to deliver consistent, quality care for patients whilst achieving efficiency in the documentation process with consideration given to policy updates, treatment developments and clinical guideline changes.

In November 2020, Elsevier Care Planning, a clinical decision support (CDS) solution, was integrated at Imperial College Healthcare NHS Trust (Imperial), which delivers care to approximately one million people annually across five sites. Imperial needed to reinforce evidence-based practice to aid the reduction in care variability. The impact of COVID-19 had highlighted the ever-increasing complexity of health needs and the role technology must play in supporting clinicians by enabling the delivery of the right information at the right time.

A CDS solution that fits workflows and integrates with the EMR
It was vital that the CDS solution fit the clinicians’ workflow and that it did not add extra effort but looked to address unconscious bias and encourage critical thinking within the care team. The requirement was the ability to implement within pre-existing information technology systems, including the updating of a guideline in one part of the electronic medical record (EMR) and for that change to be propagated throughout the system. This level of interoperability is vital and unlocks the potential for true digital transformation.

A total of 247 evidence-based, patient-centred care plans were made available to 4000 nurses, across five sites, directly via the EMR. Rapid integration was achieved through the collaborative efforts of Elsevier and Imperial's informatics teams, supported by a strategic end-user education and go-live plan. The upload of all care plans into the EMR was achieved in just a two-day period.

Delivering content to ensure consistent high-quality care across the nursing team
The role of technology to support evidence-based practice requires a deep understanding of every component, a concise understanding of the daily realities and a clear understanding of what technology can and cannot do. Successful implementation is reliant on three critical factors: evidence-based content, truly integrated technology and the right team committed to the transformation process.

Prior to adoption, Imperial only had six care plans in place but had a strategic imperative to grow and reinforce evidence-based practice at the point-of-care. An in-house build was deemed unsustainable due to the high level of clinical resources needed to develop and maintain the knowledge base. Imperial’s clinical leadership team looked to a third-party to deliver the content with the underlying objectives of ensuring consistent high-quality care across the nursing team. The goal was to produce exemplary levels of care plan completion and resultant continuity of care between patients.

The impact of delivering evidence into an interdisciplinary evidence-based integrated documentation system relies on having a valued interdisciplinary plan of care that avoids duplication and repetition and prevents common complications. It requires leadership to make practical and technological decisions to assure the ability to reach and sustain the clinical outcomes in everyday operations.

The benefits being seen by Imperial since implementation are a reduction in variability, assurance that evidence-based practice is widely adopted, and an identified process through which the content is maintained with the latest evidence. Increased operational efficiency, due to the seamless integration with standardised clinical workflow, guaranteed interoperability for system wide roll-out.

A pre-built solution delivered via a structured, normalised database for streamlined EMR integration
Elsevier Care Planning, implemented by Imperial, provided the most up-to-date, comprehensive, and trusted evidence-based content. This was pre-built and delivered via a structured, normalised database to ensure predictable and timely integration with the organisation’s EMR. Complex workflows have been developed by clinicians for clinicians, with Elsevier being able to demonstrate evidence of successful adoption and uptake across over 350 sites globally.

By working closely with organisations, it is possible to build out analytic platforms and more advanced CDS such as pathways. Through this type of pilot, Elsevier is working with customers to extract structured clinical and activity data with the aim of supporting care standard adherence and enabling benchmarking within and across organisations.

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Elsevier Clinical Solutions
Clinicalsolutions_anz@elsevier.com

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