Introduction of new health technologies could lead to reduced mortality rates, better patient care, shorter waiting lists and reduction in hospital overcrowding.

The Health Information and Quality Authority has published the results of a health technology assessment (HTA) of the use of information technology for early warning and clinical handover systems to assist in the identification of the deteriorating patient.  Information technology has the potential to offer innovation in improving quality, safety and standardisation of care for patients.

Failure to identify the acutely deteriorating patient is considered a major cause of avoidable morbidity and mortality. The introduction of electronic early warning and clinical handover systems has been shown to be an efficient, accurate and auditable way of recording patient vital sign parameters in other countries.

Dr Máirín Ryan, Director of Health Technology Assessment and Acting Deputy CEO of HIQA, said “This HTA examines the potential of information technology to offer innovation in improving quality, safety and standardisation of care for patients by supporting the implementation of the national clinical guidelines on early warning scores and clinical handover quality assured by the National Clinical Effectiveness Committee. 

“The benefits, risks and costs of such technology are considered in this HTA to assist a coordinated evidence-based approach for integration of information technology into clinical effectiveness processes. Implementation will require significant capital investment, but has the potential to improve patient safety and efficiency of care and increase acute hospital bed capacity through a reduction in average length of stay” concluded Dr Ryan.

Strong leadership and adequate resources, such as the appropriate level of trained staff to manage the identified deteriorating patient are critical to successful implementation and improvements in patient outcomes. Investment in electronic early warning systems should be linked with a training programme for assessing and treating the acutely deteriorating patient and the full potential of the systems realised by using the clinical data collected to assist in audit and governance functions.

Other potential benefits include increased efficiencies gained from reduced vital sign recording time, as much as 1.6 times faster than that of a paper-based system. This means more clinician time available to deliver care to patients. When this efficiency gain is coupled with improved accuracy of recording of vital signs and handover information, the benefits realised through a safer patient environment are important contributions to be noted.

This Health Technology Assessment was undertaken by HIQA following a request from the Chief Medical Officer of the Department of Health in October 2014 and was conducted with input from an expert advisory group (EAG) comprising representation from relevant stakeholders including clinical specialists, information technology specialists, a representative of a patient organisation, the Department of Health and the Health Service Executive (HSE).

HIQA conducted a systematic review and critical appraisal of the evidence on the use of information technology for early warning and clinical handover systems to assist in the identification of the deteriorating patient. The assessment found that the evidence to support their introduction is of variable quality due to the nature of the studies reviewed such as before and after studies verses randomised controlled cross-over studies. The estimated reduction in length of stay presented is not based on independent economic modelling but rather extrapolated from the study identified in the systematic review that most closely represented the Irish context and which reported on the impact of an electronic early warning system on length of stay.

ENDS.

Further Information: 

Marty Whelan, Head of Communications and Stakeholder Engagement
01 8147481 / 086 2447623 mwhelan@hiqa.ie

Notes to the Editor: 

• HIQA is the statutory organisation in Ireland with a responsibility to carry out national health technology assessments (HTAs) and to develop guidelines for the conduct of HTAs across our healthcare system.
• A range of Information and Communications Technology (ICT) options are available to support detection of the deteriorating patient and to facilitate clinical handover of patients. Electronic early warning systems are electronic tools where vital sign data are entered into an electronic device and using computer learning algorithms, the early warning score is automatically calculated and care escalated according to local protocol parameters. Electronic clinical handover systems are standard electronic templates developed in-house with locally agreed key domains for effective clinical handover. These ICT systems are tools that if implemented need to be appropriately integrated into the existing care setting, and adequately resourced.
• Based on the review of the literature and indicative costs, it is suggested that implementation of the systems has the potential to increase hospital bed capacity, but would require a significant capital investment as well as ongoing maintenance costs (between €1m to €1.3m for a single hospital and €40.1m to €51.4m over five years for national implementation). There has been limited diffusion of these systems in Ireland to date.
• All electronic early warning and clinical handover systems should be developed in line with National Clinical Effectiveness Committee (NCEC) quality assured National Clinical Guidelines.
• The implementation of ICT systems should be considered in the context of a standards based approach, the wider ICT agenda and the eHealth Strategy, for example, timing of implementation may be part of a larger move towards electronic health record systems.