“A new toolkit launched today by the Royal College of Physicians (RCP) highlights the key principles of high quality care applicable to all patients and makes recommendations in relation to six recognised problem areas.” Royal College of Physicians (2011) 

Are there increasing demands placed upon your time? Could standardised assessments and letters service specific letters increase patient safety? Are lines of communication complex throughout discharge and follow up? This article demonstrates how Cellma responds to these six problems areas and can assist your healthcare services in overcoming them.

1.      Limited acute physician hours in AMU

Issue: There are currently insufficient acute physicians (and physicians undertaking acute duties) in post, to staff the periods of high-intensity work consistently in AMUs throughout weekdays, weekends and bank holidays.

How Cellma can help:

• Share information across an entire multidisciplinary team, eliminating duplication of effort
• 24/7/365 access to real time patient data from any NHS location
• Standardised assessments promote consistency across the service
• Consistent screen layout and touch screen compatible Cellma facilitates ease of data entry and streamline assessments 

2.      Standardisation of early warning score to track deteriorating patients and trigger intervention

Issue: Emergency patients presenting to the AMU reflect the spectrum of illness severity, from ambulant to critically ill, and may have a fluctuating clinical course. The early warning score (EWS) allows the progression of disease course and response to treatment to be monitored throughout the pathway (AMU to specialty base ward). Acute trusts have adopted different EWS tools for the assessment of illness severity, leading to confusion for clinical staff moving between different hospitals.

How Cellma can help:

• Evidence based best practice assessments standardise care quality across the service
• Information about a patient’s condition is shared across their care pathway
• EWS tool is built in to the assessment
• If a patient records a trigger EWS result Cellma automatically prompts necessary actions
• Tasks can be set for a patient so if requires attention across shifts the handover is smooth

3.      Standardisation of documentation and prescribing

Issue: On the AMU, multiple clinicians assess and treat patients with emergencies of varying severity. For each patient, the complexity of clinical decision making mandates reliable written and electronic clinical records. However, the quality of clinical record keeping is compromised by a lack of standardisation of documents. Opportunities to prompt specific clinical actions or flag electronic alerts during prescription are missed. Staff working in an area where they are under acute pressure to complete tasks rapidly are faced with documentation that varies widely between hospital sites and may not be fit for purpose. 

How Cellma can help:

• Standardised assessments promote consistency of quality across the service
• Assessments are developed from evidence based best practice
• Assessments include service specific tests and tools, such as inpatient observation charts, prescription forms and fluid balance charts
• Generates all patient forms, letters and summaries.
• These are;
• Automatically populated with data obtained during admission and assessments
• Generated in under 60 seconds
• Compliant with national, local and institutional guidelines
• Cellma’s comprehensive reporting module monitors and reports on all required aspects of all data collected 

4.      Procedures for transfer out of AMU handover

Issue: A system of high-quality handover is vital on the AMU because of frequent transfers of care between clinical staff, particularly at change of shift and when patients transfer out. 

How Cellma can help:

• Allows a health organisation to handle all Registration, Admission, Discharge and Transfer (RADT) transactions
• Facilitates hassle free transfers; automatically updating the patient’s details (including any special requirements) to the new service
• Automatically generates handover forms, discharge summaries, letters for GPs and information for the patient and/or carer in under 60 seconds
• Produces clear concise records, removing the challenge of reading handwritten notes
• Tasks can be set for colleagues, detailing what needs doing for specific patients
• Overdue tasks become flagged for immediate attention 

5.      Patients transferred out of AMU: continuity of care and early consultant review

Issue: The enhanced staffing, dedicated consultant time and procedures for dealing with acute medical emergencies on AMU often contrast sharply with the situation on the wards that receive AMU transfers. Most patients transferring out of AMU are within 48–72 hours of admission and despite careful selection for transfer and handover, patients may deteriorate post-transfer. The risk to the patient is increased where the receiving ward is poorly staffed, has little experience of the patient’s illness, or has no ready access to consultant decision making – circumstances that should not be tolerated. In the absence of specific arrangements for early consultant review, the patient who transfers out of AMU immediately before a weekend may wait more than 48 hours for the next scheduled consultant round.

How Cellma can help:

• Cellma records and displays each time a patient is seen by a member of the healthcare team
• Tasks can be set to follow up from initial assessments
• Monitor the number of patients who receive early consultant review
• Monitor how long patients wait for consultant review 

6.      Discharge and maintaining flow through the medical admission pathway

Issue: Major factors that contribute to reduced patient flow through the AMU and the inpatient pathway include the following:

> The rate of admission of emergency medical patients is not matched by coordinated discharge activity by staff on all medical wards seven days a week.

> Discharges occurring late in the day cause a mismatch in bed capacity.

> Patients whose inpatient treatment for an acute medical illness is complete, remain in hospital because of poor discharge planning or a suboptimal response from community support services.

> Over-investigation of some inpatients, rather than the use of ambulatory care facilities. 

How Cellma can help:

• Cellma’s Ward and Bed Management Module manages all administration and discharge
• Monitor live bed status, staffing levels and ward capacity levels allowing ward managers to maximise efficiency
• Allows for the capture, storage, review and editing of all patient data, including demographic and clinical details, from the first point of contact
• Improves discharge efficiency though sharing information and effective planning
• Shares information across healthcare teams, including ambulatory care, reducing duplication of effort

Numerous sites across the UK, Ireland and internationally are already realising these benefits among others. For more information or to find out how your service can significantly increase quality please contact the team by telephone; 02380 277044 or by email; This e-mail address is being protected from spam bots, you need JavaScript enabled to view it