Back to the floor - Case note digitisation and the scanning team
Sounds like a band! I had a telephone call from Nick Wood (Consultant Gynaecological Oncologist and Clinical Lead for Casenote Digitisation) suggesting I might like to spend a bit of time with the casenote scanning team at Chorley and South Ribble Hospital as part of my 'back to the floor' shifts.
So what is this project all about? Well it's about moving away from having paper case-notes and having them available electronically - the benefits being that wherever the patient is seen the clinician has access to all of the important information needed to make clinical judgements.
Of course there are so many more benefits than just that so if you're interested have a look on line to see what they are! I was met by Abbi Jenkins the Scanning Unit manager who showed me around and explained the whole process.
It is truly impressive and so are the staff. Some of the team dismantle the patients’ hospital records, putting them in order and ensuring that the paper records are fit for purpose and will go into the scanner without difficulty. They cut and trim ragged pages, make sure all test and investigation results are in chronological order and prepare the papers to go through the scanner. Doesn't it sound easy? Well it isn't! Some of you will have come across individual case-notes that are so large they come in a cardboard box, there might be 4 or 5 volumes because the patient is under multiple specialties and requires lots of treatment or diagnostics.
These case-notes not only have to be transported from place to place in boxes but have to be wheeled on trollies as well. The logistics of movement and management are rather complex and they also take up rather a lot of space on the scanning shelves! Imagine having to take a hospital record that is over a foot high and prep it into a comprehensive pile. Now imagine having to prep following each specialties particular (and sometime peculiar) style and ordering requests!
However ..... imagine being the clinician who had to wade through those reams of paper before this whole project started to find all the relevant history. Abbi told me that the average length of time to prep is 88 minutes however the large records can take over 8 hours to do. Of course, some case-notes are very small and don't take very long .....there didn't seem to be many of those though when I was there! Once the record is prepped they are moved round to the other side of the room for the next stage which is scanning.
My word - those machines are super-fast and so are the operators! Sharp-eyed and focused they sit in front of the computer screen watching every page being scanned and halting the process immediately to double check the slightest thing that has caught their eye. We operate a system of two quality assurance checks so once the case-notes have been scanned it is quality assured by a senior member of the team .......and before it is finally finally finally signed off it is quality assured by yet another senior member of the team.
Everything is signed and dated so there is an excellent audit trail if it is ever needed. The team is currently well on the way to achieving BS10008 accreditation. The system of scanning is so impressive and the staff involved are so dedicated and passionate about their roles in helping to improve patient care that I went back for another visit two hours later .....only this time I had the Chairman in tow! And guess what? He was as impressed as I was! Our Chairman was the MD of Leyland Trucks and brought up on ‘Lean’ methodology, quality assurance processes and such-like so for him to be impressed was high praise indeed! In fact he came up with a great idea for when we have finished all the scanning of our case-notes.
We have a lot of temporary agency staff working in this team rather than permanent staff because within the next 12 months we will have scanned most of the historical case-notes and will need a smaller team to be scanning all new and follow up patients in almost real time.
Every person I spoke to, permanent and agency, were clear that their roles and purpose was to help clinicians deliver high quality care. Well several weeks later I went with Nick Wood and Janet Young to see the scanning operation at Royal Preston Hospital. When I was there Angela Lewthwaite, the Senior Scanning manager, told me that a week before there was a plan for a team of agency staff to do a night shift to catch up on the Christmas backlog but for some reason when they arrived the system couldn't be accessed. There was some work for them to do but it wasn't really the priority list they had been booked for. So they offered to go home and come back on a day they didn't normally work. Having been booked and travelled to the hospital for the shift they would have been entitled to insist they stay and get paid. But they didn't and I was impressed that these agency staff were prepared to simply come back another day.
I spoke to two of the agency staff who said they loved working with the team and got huge job satisfaction from helping to make a difference to patients. What's for sure is they don't keep coming back because of the luxurious office accommodation, lighting or ventilation! Sickness levels on both sites are very low and I think that's because the managers are exceptionally good leaders and supportive of all their staff. There's a great sense of camaraderie, of working together for a common purpose and feeling valued - many of the agency staff have been in the team since the start of the project - it feels as though the leaders are getting it right!
Two great visits although I wasn't actually allowed to touch anything - I think they had read my previous blogs and thought it took too long to train me to do anything! For me it was an eye-opener and I'm very pleased they invited me to see how they make a difference.
So what things did they share with me that I can try to do something about?
- Remind clinicians how important it is to ensure everything is dated including all the clinical charts- it makes their job much easier when they are compiling notes chronologically.
- STOP PRINTING LETTERS! – apparently some secretaries are printing letters for clinicians and then they get filed with the notes of the consultation and sent back for scanning. Duplication creates all sorts of problems!
Thank you to everyone who took time to chat to me and patiently explain (over and over again!) how it all fits together, I really enjoyed it! A great bunch!