Report to the Trust Board of

Directors: Date 23 April 2014

Paper number 13.1

Title

Business Case: Real time patient

observation and escalation system
(Safer Hospitals, Safer Wards
Technology Fund)
Chief Operating Officer
IM&T Project Manager
For approval
N/A

Sponsoring Director
Author(s)
Report Purpose
Previously considered by

Executive Summary:
The Trust has been approved funding by the Safer Hospitals Safer Wards
Technology Fund to implement a Real Time Patient Observation and Escalation
System.
Related Trust Vision
1. Drive forward improvements in the Yes
quality of services to improve patient
safety, outcomes and experience for
people who use our services.
2. Work with our partners to develop and N/A
implement the joint service strategy
across the health communities we
serve.
3. Develop more integrated community N/A
based services, enabling people who
use our services to be treated closer to
home, or at home.
4. Continue to expand our secondary care N/A
services into Leeds and maximise
income.

Risk and
Assurance
Legal
implications/
Regulatory
Requirements

Ensure services are as efficient and effective as possible

whilst ensuring good information governance is
maintained
There are no legal implications

Action Required by the Board of Directors

Request permission of the Board of Directors to delegate authority to the Trust
Chair and Chief Executive to sign contracts with a provider to the maximum
value stated within the case

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A Business Case for the implementation of a

Real Time Patient Observation and Escalation
System

Version
3

Date
April
2014

Scope
Authors:
IM&T Project
Manager:
Mr G Flavell

Purpose of Issue/Description of Change

Trust Board of Directors approval required

Review Date

Trust-wide
Approved by
Chief Operating Officer: Mr R Harrison
Finance Director: Mr J Coulter

Date:
17/04/2014

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CONTENTS

1. INTRODUCTION ............................................................................................ 5
2. MANAGEMENT SUMMARY .......................................................................... 6
3. BACKGROUND ............................................................................................. 7
4. STRATEGIC CONTEXT................................................................................. 8
5. INVESTMENT APPRAISAL........................................................................... 9
6. BUSINESS OBJECTIVES AND BENEFIT CRITERIA .................................. 9
7. COSTS ......................................................................................................... 10
8. RISK MANAGEMENT .................................................................................. 12
9. PROJECT MANAGEMENT ......................................................................... 14
Request for Approval ....................................................................................... 17
Appendix A ........................................................................................................ 17

1.

INTRODUCTION

1.1

The Trust has been approved funding by the Safer Hospitals Safer Wards
Technology Fund to implement a Real Time Patient Observation and
Escalation System.

1.2

The system will enable nursing and medical staff to use handheld mobile
devices to record patient observations in real time at the patient bedside.
The system will use the data recorded to calculate the national early
warning score (NEWS), using these scores to alert relevant staff to
patients who may be deteriorating as well as recording when the next
observations should be taken. Clinicians will be able to review the data on
a handheld device from anywhere with access to the hospital network and
take appropriate action if needed.

1.3

This project is to implement a real time patient observation and escalation

software and hardware solution. The project will address staff training and
change management for working procedures and audit/reporting
procedures.

1.4

This business case sets out the scope and expected benefits of this
project together with the costs, options and quantifiable benefits.

1.5

The purpose of this business case is to:

Appraise the Board of Directors of the project to implement a Real

Time Patient Observation and Escalation solution within the
organisation.

Progress the project to enable a preferred supplier to be appointed

Request permission of the Board of Directors to delegate authority to

the Trust Chair and Chief Executive to sign contracts with a provider to
the maximum value stated within the case

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2.

MANAGEMENT SUMMARY

2.1

The trust is reviewing real time observation and escalation systems that
enable nursing and medical staff to use handheld mobile devices to record
patient observations in real time at the patient bedside. This software
would use this data to calculate the national early warning score (NEWS),
using these scores to alert relevant staff to patients who may be
deteriorating as well as recording when the next observations should be
taken. Clinicians will be able to review the data on a handheld device from
anywhere with access to the hospital network and take appropriate action
if needed.

2.2

Use of this software would significantly reduce the potential for nursing
and clinical staff to fail to recognise and respond to patient deterioration,
having a significant positive impact on patient safety and mortality. This
would ensure that appropriate care is provided in a timely manner,
assisting clinicians and specialist teams to proactively identify patients
needing attention / intervention.

2.3

Users of the system will include nursing and medical staff on the patient
ward, as well as specialist clinical teams such as Intensive Care Outreach.
Early studies indicate significant improvements in a number of areas,
including patient safety, mortality and ITU/ HDU occupancy. Outputs
include:

Significant improvement in number of completed observations

Increase in appropriate observations for more complex patients
Improvement in compliance regarding timeliness of observations
completed
Significant improvement in accuracy of NEWS calculation
Improvement in escalation and response times
Reductions in ITU/HDU occupancy as patients are identified earlier
for transfer.

The project includes integrating data recorded in the system into the Trust
data warehouse, enabling development of reporting suites, automating
report generation, further improving information analysis and audit.
2.4

The successful bid under the Safer Hospitals, Safer Wards Technology
Fund means that this work can start immediately

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2.5

This Business Case sets out the cost and expected benefits.

2.6

A project organisation structure has been defined and is documented in

Appendix A

3.

BACKGROUND

3.1

Currently patient observations are captured, analysed and stored using a

paper based process on the acute wards at Harrogate and District NHS
Foundation Trust. Escalation for deteriorating patients is done using
telephone and bleep technology.

3.2

Escalating deteriorating patients to the necessary clinical staff is often time

consuming and requires nursing staff to call pagers without the
communication loop being closed. A nurse may not know if the recipient of
the escalation has received the information or if they intend to do anything
with the escalation.
It is intended that this paper recording and bleep based process will be
converted into a digital solution utilising touch screen mobile devices and
automatic escalation technology.

3.3

Implementation of a Real time observation and escalation system will

enable nursing and medical staff to use handheld mobile devices to record
patient observations in real time at the patient bedside. The software used
will allow observation data to calculate the national early warning score
(NEWS), using these scores to alert relevant clinical staff to patients who
may be deteriorating, as well as recording when the next observation
should be taken.
Clinicians will have the ability to review the data from anywhere with
access to the hospital IT network, taking appropriate action where needed.

3.4

Use of this solution will significantly reduce the potential for nursing and
clinical staff to fail to recognise and respond to patient deterioration,
having a significant positive impact on patient safety and mortality. This
will ensure that appropriate care is provided in a timely manner, assisting
clinicians and specialist teams to proactively identify patients needing
attention / intervention.

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3.5

4.

Users affected by the implementation of this system will include nursing

and medical staff on patient wards, as well as specialist clinical teams
such as Intensive Care Outreach.

STRATEGIC CONTEXT

4.1

The project has been identified for inclusion in the 2014/15 Business Plan.

4.2

The introduction of a Real time patient observation and escalation system

is consistent with the IM&T Strategy, in that:
The Trusts business plan explicitly identifies the importance of
technology in clinical and management contexts, as well as for the general
public. The need to support ongoing service improvement; leading to
improved patient experiences and outcomes

4.3

The objectives of this business case are:

To set out the costs and benefits of the project

To highlight the risks

To detail the project control

Confirm agreement to the Trust Chair and Chief Executive having

delegated authority to enter into a contract with a preferred supplier
following a mini competition supplier selection process.

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5.

INVESTMENT APPRAISAL

5.1

The Trust was successful under the Safer Hospitals, Safer Wards
Technology Fund in obtaining match funding to implement the rollout of a
Real time patient observation and escalation system. The Trust has set
aside funding to meet its commitment under this project and are in the
process of identifying a preferred supplier through a mini competition
process.

6.

BUSINESS OBJECTIVES AND BENEFIT CRITERIA

6.1

Real time patient observations and escalation has a number of benefits

ranging from:

Significant improvement in timeliness of completed observations

Reduction in missed observations

Increase in frequency of observations for deteriorating patients

Significant improvement in accuracy of NEWS calculation

Improvement in frequency of necessary escalations & recording of

decisions made

Improved escalation awareness response

Sustained high levels of compliance with hospital protocols

Continuously updated and accurate record of patient location

Continuously updated and accurate record of patient condition

Faster response rate from doctors and faster escalation process by

nursing staff.

More reliable delivery of care

Shorter lengths of stay on general wards

Shorter lengths of stay on critical care units

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Increase in time spent at patient bedside delivering care rather than

carrying out administration tasks

Reporting and audit requirements easily accessible time saving

Future projects benefit from readily available data to do pre and post
project analysis

Reductions in ITU/HDU occupancy as patients are identified earlier for

transfer

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7. Costs
The Trust has received funding from the Safer Hospitals Safer Wards Technology Fund on a matched funding basis to support the
implementation of this project. The costs are broken down as follows:

Table One: ( 000's)

ROW
A1
A2
A3
B1
B2
B3
B4

INITIAL PROJECT COSTS

Capital Expenditure - Centrally Funded Element
Capital Expenditure - Trust Funded (i.e matched funding)
Revenue Expenditure - Trust Funded (i.e. matched funding)
FOLLOW-ON COSTS
Capital Expenditure - Trust Funded
Revenue Expenditure - Trust Funded Other
Revenue Expenditure - Trust Funded Cost of Capital Charge
Revenue Expenditure - Trust Funded Depreciation

2013-14

2014-15
605281
322719
4561

37355
64544

2015-16

139000

73580
64544

2016-17

2017-18

2018-19

139000

71321
64544

59000
139000
69062
64544

139000
66803
64544

2019-20
Onwards

8.

RISK MANAGEMENT
The following risks have been identified as posing a threat to the success
of this project. This risk register will be reviewed and updated on a regular
basis throughout the conduct of the project.

8.1

Resource

8.1.1 Project timescales overrun

The project plan details tight timescales and assume all resources are
available on time. Other internal or external initiatives may impact on the
availability of resources, thus leading to delays in implementing. Any
substantial delays could impact the funding of this project.
Management
Review the project plan with the supplier to ensure that any
potential delays are brought before the Project Board to seek
guidance.
8.1.2 Inadequate staff resource to manage and implement project
Staff resources from within Informatics and Clinical departments will have
to be devoted to the testing and implementation of the system. The
requirements of the project will have to compete with both day to day
workloads and calls on staff time for initiatives.
Management
Ensure the commitment from all members of the Project Board and
Team and to highlight any conflicts/difficulties as soon as possible.
Additional recurrent and non-recurrent funding for posts to support
the implementation has been allocated to the project. Posts include
project management, clinical / change management, systems
management, systems development and training.
8.1.3 Insufficient supplier support
The successful implementation depends heavily on the expertise and
support given by the supplier. The supplier will be involved with
implementations across a number of trusts as a result of bids to the
Technology Fund.
Management
Work closely with the supplier to ensure that they understand the
requirements of the project.

8.2

Technical

8.2.1 Insufficient hardware on the wards to meet user requirements

The exact requirements for users on the wards and the most suitable type
of device are still being investigated. Failure to supply sufficient quantities
of mobile hardware devices will significantly impact on the operational
acceptability of the system.
Management
A detailed analysis of the hardware requirements is to be
undertaken.
8.2.2 Hardware and Software problems
Problems with any hardware or software could have a significant impact
on the operation of the system and the acceptability from a users
perspective. It may also lead to the loss of some or all of the data, which
could dramatically increase the operational risks associated with the
system.
Management
Ensure robust hardware and software support specifications are
included in requirements.
8.2.3 Network installation problems
An inadequate of slow running network could have a significant impact on
the performance of the system and thus affect the perception of the
adequacy of the system from the users perspective.
Management
Ensure that the network requirement are detailed in the contract
and implemented and tested before go-live.
8.3

Implementation

8.3.1 Pre Implementation planning insufficient

Careful planning will be required to ensure resources are made available
as and when required to meet the requirements of the project.
Management
To work closely with supplier to fully understand and schedule
tasks involved.

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8.3.2 Staff training not sufficient

It is proposed that core trainers will be identified from members of IM&T.
A full understanding of the new software will have to be gained to
undertake a training needs analysis. Adequate time will have to be made
available for core trainers to develop appropriate training material.
Management
Ensure a full understanding of all processes and requirements, and
resources are identified and time is made available for training
purposes.
8.3.3 Insufficient Go Live Support
Resources will have to be fully committed to supporting go-live and the
post go-live perion to ensure that users are supported in the operation of
the new software.
Management
Ensure that sufficient resources are committed from both the Trust
and the supplier over the go-live period.

9.

PROJECT MANAGEMENT

9.1

Planning, Organisation and Control

9.1.1 The project will be managed using the application of PRINCE principles
for planning, organisation and control.
9.1.2 The project will be directed by a Project Board and implemented by a
Project Team.
9.1.3 Progress will be reported regularly to the Project Board, and to the Trust.
A monthly highlight report will be produced showing the status of the
project.
9.2

Implementation Roles and Accountabilities

9.2.1 Project Board

The Project Board is responsible to the Trust Board for the overall
direction and management of the project. It will do this by approving
plans, authorising deviations from plan, authorising start and sign
off of project stages.

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The Project Board represents at managerial level the Business,

User, and Supplier interests in the project.
The Project Board members are the decision makers and
responsible for the commitment of resources to the project such as
personnel, funds and equipment.
The Project Board is responsible for ensuring that the project
remains on course to deliver products of the required quality as
defined in this document and the Full Business Case.
The Project Board will normally meet at planned sign off
milestones.

9.2.2 Project Sponsor

The Project Sponsor is ultimately responsible for the project.

The Project Sponsors role is to ensure that the project is focussed
throughout its lifecycle on achieving its objectives and delivering a
product that will achieve the projected benefits within agreed
tolerances for budget and schedule.
The Project Sponsor is the key decision maker, the Project Board is
not a democracy controlled by votes.

9.2.3 Senior Clinical User

The Senior Clinical User is responsible for the specification of the

clinical needs of all those who will use the system, for clinical user
liaison with the project team and for monitoring that the solution will
meet those needs within the known constraints of quality,
functionality and ease of use.

9.2.5 Lead Nurse / Change management

to lead and implement clinically led change management working

closely with the clinical departments and project team.

9.2.6 Systems administration

to manage general system management and administration,

upgrades, and provide user support.

9.2.7 Systems development

to design, develop and maintain reporting and analysis, integrating

into data warehouse with other clinical systems.

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9.2.8 Trainer

to train end users during implementation, rollout and ongoing

upgrade / new starter training.

9.2.9 Senior Technical

The Senior Technical representative is responsible for ensuring the

technical infrastructure is adequate to meet the requirements of the
solution, including commitment or acquisition of technical resources
as required.

9.2.10 Project Manager

The Project Manager has the authority to run the project on a dayto-day basis on behalf of the Project Board within the constraints
laid down by the Board.
The Project Managers prime responsibility is to ensure that the
project produces the required products, to the required standard of
quality and within the specified constraints of time and cost of the
project.

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Appendix A
Project Organisation

Project Chair / Senior User

David Leinhardt

Governance

Sylvia Wood

Senior User Nursing

Alison Mayfield

Lead Nurse/Change Management

Robin Pitts

Patient Systems Manager

Jo MacLean

Senior Technical

Andy Moore

Project Manager

Gary Flavell

Senior Management

Paul Nicholas

Patient Safety

Nicki West

Critical Care Outreach

Sarah Blackburn

Consultant Anaesthetics

David Earl

Project Sponsor

Robert Harrison

Matron

Lesley Danby

System Administration, Training and

Support

Maria Macknight/Rachel Knowles

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Request for Approval

The Board of Directors is asked to approve the business case for the
implementation of a Real Time Patient Observation and Escalation
solution and the progression of the scheme to enable the appointment of a
preferred supplier.

Request permission of the Board of Directors to delegate authority to the

Trust Chair and Chief Executive to sign contracts with a provider to the
maximum value stated within the case.

APPROVAL

Chief Operating Officer

Date ..

.
Finance Director

Date.

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