Waitematā EDs implement electronic ‘best care bundles’

eHealthNews.nz: Clinical Software

Waitematā EDs implement electronic ‘best care bundles’

Tuesday, 30 April 2024

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NEWS - eHealthNews.nz editor Rebecca McBeth

A suite of electronic ‘best care bundles’ have been rolled out in the Emergency Departments at North Shore and Waitakere Hospitals to help improve patient flow.

Around 20 bundles are now live at Health NZ Te Whatu Ora Waitematā for conditions such as minor head injury, suspected C-spine trauma or broken hip, croup and bronchiolitis. Counties Manukau plans to implement some of these before winter hits.

Emergency medicine specialist Cecilia Rademeyer says the best care bundles are designed to be initiated by the assessment nurse during the very first patient contact in the ED.

The ‘bundle’ includes the clinical pathway and documents such as standing orders, patient information sheets, safety checks and interdepartmental agreements, “all with the purpose of enabling the right care, as soon as possible”, she says.

“The bundles are designed around a clearly defined set of symptoms, rather than a diagnosis. This enables and empowers the assessment nurse to initiate treatment and investigations that help speed up the process,” Rademeyer says.

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This means that by the time a patient is seen by a clinician, much of the initial workup has been done and in many cases treatment (such as steroids, IV fluids, or pain relief) administered.

She says clinical staff have embraced the new way of working and because the bundles are in a standardised format, adding a new one is very easy for them to adopt.

“This makes a real difference for patients who present with these conditions, who can move through the system faster,” she says.

Rademeyer says ‘best care bundles’ were previously well embedded in Waitematā EDs in paper form – but it was difficult to translate the complex workflow into an electronic format embedded into the ED workflow.

A tool called Quantum is enabling the same workflow as the paper-based bundles, but digitally.

Centric product manager David Ryan, says Centric is an in-house developed ecosystem encompassing 15 products including eNotes and electronic whiteboards and the newest is Quantum.

Quantum has been built as a single instance regional solution so it can ultimately be rolled out across the Northern districts, enabling a regional view of documents that are created in one place and shared multiple times.

“The aim is to be able to recycle information: use and confirm it many times, rather than ask people the same questions repeatedly,” he says.

Creating the bundles involved clinical staff agreeing on regionally consistent pathways of care, creating significant efficiencies.

Important measurements like height and weight can be imported into other forms and while stored in standard units, can be displayed differently on different forms if needed.

“Quantum has an extensive data model underpinning it: every piece of data is stored against a terminology that is increasingly being linked to SNOMED codes,” explains Ryan.

“If a piece of data is re-used, it stores a reference to the original source data, so if this is subsequently amended, a warning can be displayed wherever it has been reused.”

Quantum can also import from any external API, such as allergies from Medchart and smoking status from iPM.

Integrations with Eclair and Patientrack allow the viewing and importing of labs, radiology results and observations, and integration with Centric eNotes means that when a document is completed, a link appears within eNotes.

Centric eNotes is already live across Waitematā and Counties Manukau, and has recently been implemented at Te Tai Tokerau for their Hospital in the Home service, and on an older adults ward.

Picture: Emergency medicine specialist Cecilia Rademeyer