E-List

Oxford’s John Radcliffe Hospital runs theatres for emergency operations 24 hours a day. Agile Collective helped deploy and maintain an open source system to replace paper and whiteboard list management.

The problem

Emergency operations in the John Radcliffe Hospital are unpredictable and urgent in nature. This is managed by a list of emergency operations which is regularly re-ordered according to the relative urgency of the operations. Booking operations is managed with paper forms and the canonical emergency list exists on a whiteboard outside the theatres.

The problems with this analogue approach include the lack of visibility for staff around the hospital, difficulties in collating accurate data and potential for data loss when whiteboards are re-drawn. A simple digital solution was an attractive option.

The solution

A Drupal-based system was prototyped to allow new “cases” (operations) to be booked, structuring the fields to match the existing paper booking form. Patient details are retrieved and populated directly from a central api, for speed and accuracy. For a case to progress onto the emergency list, approval is required from both anaesthetics and theatres users, with permissions managed by Drupal. Cases on the emergency list can be re-ordered quickly by drag and drop. When complete, theatres staff remove the case, logging the time and reason for removal.

The outcome

Hospital staff warmed quickly to the new system, welcoming the transparency and immediacy of access to the current emergency list. Key benefits included:

  • No change in workflow.
  • Increased transparency.
  • Staff can view the list from any computer or phone on the network.
  • Management can quickly see the current burden.
  • Improve quality and speed of management decisions (eg. opening another theatre)
  • Increased speed of reporting on statistics.
  • Immediate rise in quality targets.

Following launch, statistics show an immediate rise in the percentage of patients having their operation within the target timeframe:

jrelistgraph.jpg

Emergency surgery relies on being able to prioritise and treat patients in a timely manner and whilst constantly adapting to changing demand. Working with drupal and Agile collective has allowed us to rapidly prototype and implement a bespoke solution to many issues that were poorly served by our previous paper-based system.

Though drupal was not designed for the purpose of booking patients to an emergency list, its modularity coupled with Steven and Finn’s ability to create custom code has meant we are better able to:

1. Prioritise patient booking
2. Understand system demand to flexibly increase resources as required
3. Accurately monitor performance data

All this leads to more effective and efficient use of the emergency list and thus higher quality patient care. Since deploying the list, the data shows a significant improvement in our ability to achieve our quality targets.

Mark Scarfe, Anaesthetic Consultant, John Radcliffe Hospital