Making a difference
Hamad Medical Corporation’s Qatar Early Warning System is not only winning numerous accolades across the region’s healthcare industry, more importantly, it is saving lives in the country of Qatar
Managing unforeseen clinical deterioration, as anyone active in the healthcare field is well aware of, is a constant and persistent challenge. Though the signs are present, in the form of changes in vital signs, and degradations identified in physiological and laboratory tests, even the most advanced health systems in use today, can sometimes miss these conditions.
There are a number of reasons why this may occur, ranging from the lack of regular assessments and use of individual judgement by nurses and doctors, as well as a sporadic ward monitoring. Additionally, when an alert does occur, the reaction of healthcare personnel can be occasionally sluggish, hampered by a long chain of command and the availability of staff.
To answer this challenge across the entirety of its healthcare network, the Hamad Medical Corporation (HMC) created the Qatar Early Warning Systems (QEWS) to tackle clinical deterioration.
Supported by the Cerner Corporation, a US-based supplier of health information technologies, HMC’s new platform is already turning heads across the healthcare industry, and was also awarded the accolade of Healthcare Implementation of the Year at the ACN Arab Technology Awards in 2016.
“At its heart, it is a track and trigger safety net system that manages the early detection and escalation of clinical deterioration with our patients. It enables earlier detection and earlier management of that deterioration,” comments Colin Hackwood, program manager of the HMC Medical City Operational Commissioning, HMC Operational Performance, and HMC Qatar Early Warning System.
“In terms of the advancement of healthcare services, it has had a significant impact in the delivery of clinical services within HMC,” he adds.
Formed as part of a quality and safety patient initiative under the direction of the Hamad Healthcare Quality Institute (HHQI), which is tasked in delivering enterprise-wide quality improvements across HMC’s network of hospitals, QEWS’ design draws inspiration from the Between the Flags Program in Australia.
Modified to meet local clinical requirements and HMC’s standards, the threshold-based system alerts clinical staff when deterioration conditions are detected, giving them the opportunity for revaluation of treatment and the chance to save lives.
Furthermore, the system generated improved documentation of behaviours with nursing and clinical staff, and even had an unplanned, but positive impact, on how HMC’s staff communicated and collaborated with each other.
“Although QWES is a track and trigger system for patient deterioration, there was an unintended benefit of improving the communication between the nurses and physicians. The whole rationale [of QWES] was to just alert an important caregiver of the patient deteriorating and then inform the physician,” explains Hackwood.
“One of the added benefits is that the medical team, as a whole, seem to be working slightly more cohesively and preventing patients to fall between the cracks, which can happen in big health systems.”
Since its deployment back in November 2015, QEWS has helped reduce the cardiac arrest rate to 50% across all of HMC’s healthcare institutions, and on average, saves 100 lives per year.
To date, QEWS has been implemented across all eight healthcare institutions under the HMC network. Comprising of five specialist hospitals and three general hospitals, HMC services cover the entirety of Qatar, a nation with an estimated population of 2.3 million at the close of 2016.
“One of the main objectives of the program was to standardise the detection of clinical deterioration. To do that, we develop a suite of standardised observation charts that we put into the health system for nurses and physicians,” explains Hackwood.
“We consolidated all of our existing paper documentation and charting records into the standardised observation charts … we worked with Cerner Corporation to help us adopt the use of the electronic medical record and modify where necessary, to align the platform with the threshold and the reference ranges, which were designed and developed within the standard observation chart.”
Additional objectives surrounding QWES included the establishment of legitimate corporate-level and facility governance structures, as well as the development of policies and protocols aimed at supporting sustainable implementations.
To ensure quick adoption of the platform and to speed on-boarding of new staff, an education and training component was created, along with the establishment of a Rapid Response System, which is already live across all of HMC’s facilities.
The project also required the creation of an evaluation and performance framework to measure the program’s success. This led to the creation of a dashboard, devised by HHQI’s data informatics team, which on a monthly basis, produces reports on QWES’ performance.
“We created a dashboard report that captures all the clinical indicators or performance indicators that we’ve established for this program. Those indicators feature on a monthly dashboard that are owned and accountable at the facility level,” explains Hackwood.
“We have Quality & Patient Safety nurses and officers in all our offices that are responsible for generating those reports. That is how we analyse the monthly performance of our program.”
Offering more insights into the project’s history, Hackwood shares that HHQI’s original concept for QEWS was initially envisaged operating on a paper-based model. During that time however, back in mid-2014, Cerner had been brought on to facilitate the introduction of electronic medical records (EMR) across all of HMC’s healthcare institutions.
It quickly became evident that with the transition to EMRs, QEWS would benefit more from within an electronic environment. To do that, HHQI’s IT development team modified certain parameters within Cerner’s system, establishing discreet alerting, which would be communicated to specific care providers when certain thresholds had been surpassed.
In one particular facility, HMC has experimented with bedside medical devices, configuring the units to directly integrate with the EMR.
These devices, which are produced by Welch Allyn, a long-standing partner of Cerner, are able to stream readouts of vital signs directly into the medical record in real-time. This instant generation of clinical data can also trigger alerts if a discrepancy is detected, helping to improve the reaction time of the hospital staff.
Commenting on the wider benefits of EMR, Hackwood explains: “The main benefit is around the communication between the primary care and tertiary care, so it means that there is seamless data liquidity right across the health economy. So when a patient is admitted into a hospital, there is no question about where their medical records is.
“As we go further down this path and the richness of clinical data in the enterprise domain improves, the ability to start analysing big data through analytics, and really instituting national quality and health improvement programs, is going to be possible by leveraging this enterprise domain.”
Moving forward, the team at HMC will continue to review QEWS’ progress, identifying opportunities for sustainable performance and identifying new ways to support operational leaders at each of the facilities. Furthermore, the project’s methodology, in terms of implementation of the program, will be evaluated for other potential Quality & Safety Patient initiatives within HMC.
Meanwhile, the HHQI is shifting its focus towards identifying solutions centred on sepsis management that it can adopt across the whole enterprise.
“From our side, we potentially see becoming big in 2017 and beyond, especially in the state of Qatar, is going to be an improvement on the algorithms that are running in background. These will identify patients that are at potential risk of deterioration, as well as patients that have a readmission of risk when they are in hospital, so that mitigating actions can be taken,” comments Hackwood.
“The amount of data that is in there is going to be leverage multiple times and I think we are moving away from this transactional medical record, where technicians are just feeding information, and moving into a phase where there is going to be a bidirectional flow of information,” he concludes.