Enhancing trauma theatre list planning using an end-to-end digital system

King’s College Hospital (KCH) is the major trauma centre for the South East London Kent and Medway (SELKaM) trauma network, the busiest trauma network in the UK.

The King’s College Hospital NHS Foundation Trust consists of two hospitals: KCH and Princess Royal University Hospital (PRUH), with clinical leads and managers in trauma and orthopaedics (T&O) requiring oversight of both locations.

Since 2017, they have processed over 24,000 acute orthopaedic trauma referrals. To ensure smooth coordination of care in such a busy centre, organised procedure planning and digital trauma lists are crucial.

Situation

KCHNFT faced several challenges affecting their efficiency:

• Trauma list planning was done using white boards, word documents, and excel spreadsheets.
• The Trauma & Orthopaedics (T&O) teams at KCHNFT struggled to plan the trauma procedures, resulting in ungoverned lists on whiteboards and shared drives, a lack of data capture, and an increased risk of errors and data loss.
• KCH and PRUH had limited visibility of each other’s outstanding trauma cases and pending workload.
• KCH relied on emails and phone calls for tertiary referrals from the SELKaM trauma network resulting in poor governance and no data.
• Inefficiencies with theatre list planning resulted in cancellations and delays.
• Key parts of patient pathways could not be time-referenced.
• They had a limited record of the trauma workload, making it difficult to access data for research or audit.

Aspiration

KCHNFT wanted a digital platform with functionality to meet their specific needs throughout the T&O pathway. They wanted to improve theatre utilisation by enhancing theatre list coordination and planning, referral management and handovers, and cross-site and team communication.

With these improvements, they aspired to better manage the vast amount of incoming referrals to maximise theatre use and to enhance patient care.

Solution

KCH approached Open Medical who provided PathpointⓇ eTrauma, a cloud-based trauma coordination and clinical workflow digital solution. eTrauma empowers clinical teams to plan and optimise T&O patient pathways by providing:

• a digital trauma board including lists of scheduled, unscheduled, and pending patients.
• real time oversight and coordination of activity and pathways.
• centralised system for managing orthopaedic trauma referrals and receiving electronic referrals from the network.
• clinical workflow actions and automation processes.
• real-time data insights, reporting, and analytics.
• separation of activity depending on team role, access, and specific use permissions.

Impact

• Pathpoint eTrauma was successfully implemented across both sites in the Trust - KCH in 2017 and PRUH in 2021.
• It significantly improved trauma coordination activities including visibility of pending workload, tracking patients waiting at home, and communication between T&O and theatres (labelling the golden patient, equipment requests, cancellation logs).
• Trauma workload visibility was made available across both sites and from home by the on-call consultant.
• Easily exportable data supported hundreds of clinical audit projects.
• Automated daily reports are generated and sent to management and clinical leads.
• The process for receiving external referrals was streamlined with electronic forms and automated notifications. The decision of each referral, along with the advice, is now captured in a fully governed way.
• Trauma meeting decisions are now documented in real time and visible to the wider team.

Functionality

• eTrauma offers customisable digital referral forms.
• It allows clear two way communication between KCH and external referrers.
• Images of wounds are captured and stored directly on eTrauma without being saved on personal devices.
• Clinicians have remote access to eTrauma letting them view, accept, and action referrals from any device.
• A live trauma dashboard is displayed for real-time overview of the T&O department.
• Patient status is highlighted with tags so clinical teams can track patients within their pathways and provide priority when needed.
• Cancellations can be managed more efficiently with cancellation logs.
• Theatre equipment can be requested.
• Key aspects of patient pathways can be time-referenced.
• Visibility is increased across all sub-specialised teams.
• eTrauma provides coded data including the date and time of the referrals and decisions which can be used for service planning, audit, research, or to support business activities.

Capabilities

• Sites across SELKaM can refer specialist orthopaedic trauma patients to KCH which is captured with eTrauma.
• KCH can seamlessly manage complex orthopaedic trauma referrals from the network, and ensure patients are reviewed in a timely manner regardless of where they are referred from.
• It helps with triage and prioritisation of daily workloads, enabling efficient planning of orthopaedic trauma patient pathways and overcoming geographical restrictions.
• Handovers are smoother with clearer referral capture and effective documentation, also enhancing trauma meetings.
• It updates in real-time, helping to manage cancellations more efficiently and minimise delays.
• Real-time breach-time warnings help KCH attain Best Practice Tariff.
• Clinical information is captured and coded at the point of entry, and the data can be used to support future service planning.
• Real-time monitoring of theatre activity is enabled, as is better communication and visibility among teams.

Scope

• eTrauma is used throughout the entire end-to-end patient journey.
• Clinicians can access the platform from anywhere.
• eTrauma is used for T&O care, but Pathpoint can be used across many specialties.

Key learning points

• Digital transformation is more than just digitising old processes; it is optimising workflows and boosting efficiency.
• To ensure that the system addresses everyone's needs, all stakeholders must be involved early on and engaged throughout the scoping, consultation, and implementation processes.
• Processes can change and it is important to adapt accordingly, so client feedback is obtained on a regular basis to ensure the workflows suit their needs.
• Interoperability is essential. eTrauma integrates with other digital systems avoiding workflow  fragmentation.

Key figures and quotes

To date, eTrauma has supported 750 users, captured data on 30,000 referrals across 2 main hospital sites and has been used to plan 14,000 trauma operations.

“eTrauma has been instrumental, ensuring that we have an efficient theatre management system. It has also been fantastic in running a tertiary referral service for major trauma. It has provided an excellent audit trail of all referrals and replies to referring units. It has also been a fantastic database system to ensure all the patients are fully accounted for and provides all of the missing logistical support that we do not currently have with our electronic patient record.”

Mr Aswinkumar Vasireddy, Consultant Orthopaedic Trauma Surgeon, King’s College Hospital, London

Find out more

West Hertfordshire Hospitals eTrauma case study

Key contact

Mr Paul Harnett, Orthopaedic Surgeon and Trauma lead, King’s College

Hospital

paulharnett@nhs.net

Dr William Cook, Deputy Commercial Director, Open Medical

will@openmedical.co.uk