the clinical services journal - mindray uk...csj the clinical services journal the new heart of...

CSJTHE CLINICAL SERVICES JOURNAL

The new heart ofconnected monitoring

FC CSJAug19 NEW.qxp_Fc CSJ jan06 with web 30/07/2019 12:07

VOLUME 18 l ISSUE 7 l AUGUST 2019

PATIENT SAFETY

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The solutionFollowing a robust procurement process,Royal Papworth Hospital installed 400Mindray BeneVision N Series patientmonitors – ranging from the N12 in patientrooms, to the N19 model, with its extra-largetouchscreen, in ICU and theatres. A keybenefit for Royal Papworth is the compactN1 monitor – a versatile bedside monitor, amulti-parameter module and a powerfultransport monitor – all in one.

The monitoring solution also includes 18workstations, five central stations, threeeGateways connected to Lorenzo (the

The new heart of connected monitoring

hospital’s electronic patient record [EPR]system), and 12 slave screens for the theatredepartment. The monitors are furtherintegrated into an AV system in the theatres,so that the surgeons, perfusionists andanaesthetists can all visualise the informationthey require at a glance to support highquality care.

Transferring patientsA significant benefit of the Mindray system is the ability for the monitor to follow thepatient throughout their care journey. Whenthe patient is moved to another area within

Royal Papworth Hospital is the UK’s leading heart and lung hospital, treatingmore than 100,000 patients each year from across the UK. Since carrying out theUK’s first successful heart transplant in1979, the hospital has established aninternational reputation for excellence inresearch and innovation. The hospitalperforms more heart and lung transplantsthan any other UK centre, which also makes it one of the leading cardiothoracictransplant centres in the world.

As part of a project to modernise thehospital facilities, a new state-of-the-artbuilding has been built – relocating servicesfrom the Papworth Everard site, to theCambridge Biomedical Campus, adjacent to Addenbrooke’s Hospital. Designed byclinicians with patients in mind, the newhospital building has been modelled on the shape of a human heart – providingoptimum patient flow.

The new facility includes: l Five operating theatresl Five catheter laboratories l Two hybrid theatres l A 46-bed critical care unit l More than 250 single patient rooms

As most patients will have their own single,ensuite rooms, there will be significantbenefits in terms of patient privacy, dignityand infection control. However, monitoringpatients in this single room environmentrequires careful consideration. The hospitalneeded a state-of-the-art monitoring solution to provide the highest levels ofvisibility and clinical insight, to ensurepatient safety throughout the patient’sjourney.

According to Paul Robbins, electro-medical services manager: “Royal Papworthprovides cutting-edge innovation in its fieldand we wanted to use technology thatreflected this.”

When Royal Papworth Hospital opened a new, state-of-the-art hospital, itrequired a flexible patient monitoring solution capable of ensuring the highestlevels of patient safety. Working collaboratively with Mindray, the prestigioushospital developed a bespoke, connected solution that ensures seamlessmonitoring throughout the entire patient journey.

Royal Papworth provides cutting-edgeinnovation in its field and we wanted to use technology that reflected this.Paul Robbins, electro-medical services manager, Royal Papworth Hospital NHS Foundation Trust

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the hospital, the Mindray module simplyunplugs from the side of the monitor and canbe used as a transport monitor. It can thenbe ‘plugged’ into the host monitor at thebedside, at the new location. There are nocumbersome leads to disconnect andreconnect, or clean between patients, andthe patient is continuously monitored –ensuring seamless data and patient safety atall times.

Head of nursing, Cheryl Riotto,commented: “From a nursing perspective,transporting patients is no longer a headacheand there is no interruption in the patientdata. This helps to reduce anxiety for thenursing staff – having robust patientmonitoring is the backbone of safe patienttransfer. This, along with NEWS2, will makea big difference to the nursing team.”

This functionality will also deliverefficiencies for Royal Papworth, as Gormanexplains: “On average, we transfer 11patients per day from the ICU back to theward and each of these transfers takes aminimum of half an hour. If you can achievesmall time savings for each of thesetransfers, by not having to connect andreconnect the monitoring, these efficiencysavings can quickly add up. The flow ofpatient data directly from the monitor andinto the EPR, also means there is no need formanual input into another system, and thereis no need to bleep the outreach sister whenyou have a deteriorating patient – the wholeprocess is automated.”

NEWS2: meeting national standardswith MindrayThe ability to automate the calculation ofNEWS2 using the new monitors is a keyadvantage from the Trust’s perspective.NEWS2, the latest version of the NationalEarly Warning Score (NEWS), is a newnational requirement for the NHS. Supportedby the Royal College of Physicians, theprotocol aims to save lives by standardisingthe assessment and response to patientdeterioration. While many hospitals calculatethis early warning score on paper, RoyalPapworth has been able to automate theprocess, using the BeneVision monitors –helping to eliminate human errors and speedup detection of patient deterioration.

“Mindray has taken the installation to thenext level, by programming NEWS2 into themonitoring equipment and transmittingobservations directly into our ElectronicPatient Records via the eGateway – this is ahuge advantage,” said Royal Papworth’schief nursing information officer and EPRmanager, Eamonn Gorman.

However, NEWS2 was originallydeveloped to detect deterioration in thegeneral patient population and, as aspecialist heart and lung hospital, RoyalPapworth’s cohort of patients have a verydifferent physiology. Mindray was able torefine the NEWS2 display, without alteringthe score, to enable Royal Papworth’s clinicalteams to add and view additional parametersthat are important to the hospital, including:

l Emesis (sickness)l Pain scorel Inspired oxygen

Mindray has also enabled integration with a third-party’s mobile alarming system, so that a team of senior clinical staff can be alerted and respond in the event of patient deterioration, providing a ‘safety net’ for nurses caring for patients in the single, ensuite rooms. In the event that a patient’s early warning score crosses a NEWS2 threshold, an alert is triggered via the mobile phone devices carried by the hospital’s equivalent of a clinical outreach team.

Further efficiency savingsThe ability to perform 12-lead ECGs with the Mindray monitoring system has also created efficiencies for Royal Papworth. Previously this process would involve finding an ECG cart, printing the ECG onto paper, taking it to a doctor to get it signed, scanning it, then putting it into a file. With the Mindray monitor, caregivers can perform a 12-lead ECG at the bedside and automatically send it to a file share.

“This frees up nursing time and makes the process much more efficient,” Gorman added. “The results can be viewed and saved without leaving the bedside, creating a huge time saving for clinical staff and making the process much safer.”

Reducing errorsGorman noted that the monitoring system is also improving the quality of data being captured. Previous audits have shown that calculating early warning scores on paper results in a high degree of error – the majority of charts will show inaccuracies when undertaken manually, according to Gorman’s own findings. The hospital can now be confident in the accuracy of the observations, but the automated system also helps guide the caregivers to make correct decisions in the event of an escalation.

“Each time you perform a set of

Eamonn Gorman, Royal Papworth’s chief nursing information officer and EPR manager


observations, the screen outlines whetherany escalation is required, based on the earlywarning score, and prompts are fed back tothe caregiver advising them on what actionsneed to be taken,” Gorman explained.

“This is helping to reinforce the learningaround NEWS2, already undertaken throughour workshops. In addition, as thetechnology has the ‘feel’ of an Apple device,it is intuitive and simple to set up. When youare moving into a new hospital, using lots ofnew technologies, it is reassuring to knowthat the one bedrock of patient safety – themonitoring system – is really easy to use.”

Monitoring during complex surgeryMindray’s solutions have also been installedin the most critical areas of the hospital,including the theatres – where the complexityof surgery demands the highest levels ofpatient monitoring. The solution providedincludes the iView function – a modular PCthat integrates with the monitor, allowingconnection to any hospital informaticssystem – such as PACS and pathologyresults. This patient data can then bedisplayed on the Mindray monitor for easyviewing and visibility.

A vital aspect of the project at RoyalPapworth has involved tailoring the visualpresentation of vital information to supportcomplex cardio thoracic surgery. RoyalPapworth undertakes some of the mostchallenging and innovative procedures in theUK, so the need to quickly gain an

understanding of the patient’s status withclear monitoring data is vital – there can beno ambiguity in terms of graphicalpresentation.

“We have worked to develop a slick andsensible configuration, and the support wereceived was exemplary,” commentedconsultant anaesthetist, Dr Florian Falter.

He explained that the ‘impressive’resolution of the screen is extremelyvaluable in theatres – particularly when theteam is working on a challenging case: “Ifyou have a complex case with lots ofarterial lines, the colour options can helpavoid confusion when it comes tovisualisation. The clarity of the monitorhelps your grasp of the situation. This isparticularly important when there is a need

to act fast and the team is under pressure. “The monitor is more than just a device

that produces colourful graphics, however.Cardiac monitoring is very complex, and wehave to deal with many different facets at thesame time – whether it is coagulation, thepatient, the heart, the bypass machine, orthe surgeon. My vision is for a monitor thatbecomes an information hub; whereby, at thetouch of a button, you can change what yousee on the screen.”

Connectivity and interoperabilityInteroperability between Royal Papworth’snew monitoring and its hospital informationsystems is allowing clinicians to use patientdata more intelligently, to inform clinicaldecisions, enhance clinical efficiency andimprove patient outcomes. These integrationsinclude:l Lorenzo – main electronic patient

record systeml Metavision – clinical information

system for ICUl M-ighty – e-observations, NEWS2

and alerting systeml 12-lead ECG PDF to Lorenzol Serial output to Liva Nova heart-lung

perfusion system l GE Aisys CS2 anaesthetic machine

with waveforms.

The flexibility of the solution is made possibleby the BeneLink Interfacing Module. Bybecoming a ‘data hub’, BeneLink has

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If you can achievesmall time savings for each of thesetransfers, efficiencysavings can quicklyadd up. Eamonn Gorman, chief nursing officerand EPR manager, Royal PapworthHospital NHS Foundation Trust


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streamlined equipment in theatre, integratingmultiple third-party devices into a singledisplay. This allows simultaneous viewing ofa variety of parameters for rapid insight intothe patient’s status. Cardiac output and avariety of other critical data can be displayedon the monitor screen, helping to informclinical decisions, enhance clinical efficiencyand ultimately improve patient outcomes.This helps the hospital to optimise patientmanagement according to their cardiacstability.

The R&D team at Mindray was also able toturn around bespoke connectivity solutions toRoyal Papworth at record speed. In less than aweek, the company developed software toenable the monitor to collect all of the datafrom their anaesthetic machine, along with theability to display the CO2 waveform. Mindrayhas also been working closely with LivaNova,a manufacturer of cardiovascular andneuromodulation solutions, to provide theability to connect the company’s bypassmachine with the BeneLink module.

“When indicated, it is valuable to haveinformation, such as the flow of the bypassmachines, so that everyone knows what theSVO2 is on bypass and the current flow,”comments Dr Falter. “Space is always at apremium, so being able to visualise all of thisinformation via the one monitor will make iteasier to keep an eye on what is going on intheatre. Having this flexibility will not onlyimprove patient safety but make my lifeeasier,” commented Dr Falter.

New site goes liveThe first patients were admitted to the new hospital facility on 1 May 2019 and,after 101 years of saving lives andtransforming medicine, the Papworth Everard site officially closed on 4th May. Four operations took place at the new site on the first day of activity (1 May) – twothoracic cases and two cardiac cases –

as well as eight procedures in the cath labs. During the move from the old site to the

new hospital, a total of six clinicalapplication specialists (CAS) from Mindraywere on-site for two weeks, to support thetransition – ensuring the process was assmooth as possible.

“Providing this level of support is aboutgoing the extra mile and ensuring the clinicalstaff were put at ease at what was potentiallya stressful time. They were not just having todeal with new monitors but change on ahuge scale,” said Mindray’s clinicalapplication specialist, Emily Best.

Looking to the futureClose collaboration with clinical partners atRoyal Papworth will ensure the technologyremains cutting-edge and evolves with thechanging demands of the hospital for yearsto come. Responsible for driving theinstallation from a clinical engineeringperspective, Royal Papworth’s electro-medical services manager, Paul Robbins,explained the importance of partnering witha supplier that can ensure their technologyremains “state-of-the-art”.

“Royal Papworth provides cutting-edgeinnovation in its field and we wanted to usetechnology that reflected this, with the abilityto move and evolve as we move and evolve.Mindray’s solution offered the greatest scopeto achieve this,” Robbins said.

The hospital is currently using around50% of the BeneVision’s potentialfunctionality, but there is scope tosignificantly expand on this, in the years tocome, as the hospital scales-up utilisation ofthe system’s full capabilities to meet itsevolving demands.

Royal Papworth is now looking at the nextpossible steps in terms of functionality – fromneuro observations, such as the GlasgowComa Scale (a measure of consciousnessand responsiveness in patients), to epidural

Key Outcomesl The hospital now has comprehensive

patient monitoring, throughout thepatient journey, reducing the gaps indata to ensure maximum patientvisibility and safety.

l The flow of patient data directly fromthe monitor and into the EPR improvessafety and releases time to care,through more efficient workflows andthe reduction of manual transcription.

l Staff can now avoid patientmisidentification at the point of care,with positive patient identification on-screen via ADT lookup.

l Staff and management are nowconfident in the accuracy of theobservations and NEWS2 calculations,ultimately helping save lives.

l Enhanced patient safety through rapididentification of deterioration, theautomated notification process ishelping to speed up intervention by theoutreach team.

l Integrated 12-lead ECGs has createdtime efficiencies and eliminated theneed for standalone ECG devices,maximising the investment andstreamlining equipment inventory.

l Streamlined equipment in theatre,integrating multiple third-party devicesinto a single display.

observations and PCO2 recording. There isalso interest in the potential for telemetry –this function will enable continuousmonitoring while the patient remains active,without the restriction of being attached to abedside cardiac monitor.

“We are just at the start of our journeywith Mindray,” Robbins concluded. CSJ


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