With increasing pressure on the NHS to keep costs down while seeing more patients, there has never been a time for technology to play a more pivotal role in the service.
One healthcare institution that has embraced this philosophy for a smarter working environment is Evelina London Children's Hospital.
Opened in 2005 alongside St Thomas’ Hospital on the bank of the River Thames, it specialises in paediatric cardiology and treats 6,000 children every year with heart problems.
However, despite its impeccable reputation, Evelina London Children's Hospital and its cardiac department was still facing the same pressures as every other hospital across the country.
“The Bristol inquiry resulted in a rationalisation of paediatric cardiac care in the UK,” explained Frank Baldesare, IT enterprise architect at Guys and St Thomas’ Foundation Trust. “Some departments were going to be cut down, some closed, and this would mean more work for those that remained open.”
His team began to examine ways of making the department more efficient and came to the cardiology team with several widespread ideas. However, there was a more immediate problem closer to home that the doctors believed needed to be solved first and would lead to a smarter working hospital.
“One of the challenges we have is that our cardiac surgeons are currently performing almost 500 operations per year,” said Dr John Simpson, consultant paediatric cardiologist at Evelina London Children's Hospital. “For cardiologists to be physically present for all 500, even among a group, is very challenging. We wanted a more efficient means of being able to see the scans being performed in the operating theatre.”
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The main scan used is a transesophageal echocardiogram or TEO, which uses an ultrasound machine to show the size and shape of the heart and how well the valves and chambers are working.
“When patients were in theatre having a TEO, if a surgeon noticed a problem or something they didn’t expect, they would want to check with a cardiologist,” said Baldesare.
“They would make the call and the cardiologist would drop whatever he or she was doing, run to theatre, scrub up, dash in to make their judgement, then go back, change and return to whatever it was they were doing when the call was made. This was happening around 30 times a month so as you can imagine it was taking up a lot of time.”
So the IT team began to look at options for within the theatre, which meant doctors weren’t having to run from one side of the hospital to another and scrub up – something which on average took 90 minutes – and instead could get a full view of what was happening in theatre from anywhere in the hospital.
“We do a lot of video conferencing in the hospital already and have always been pleased with the results,” said Baldesare. “As there is just one ultrasound machine that is wheeled between theatres, it made it simple for us and made sense to put something on to that device rather than a system for each theatre.”
Working with Polycom, the team installed the high-definition RealPresence Group 500 system on to a shelf on the back of the Philips Ultrasound cart. This technology enabled real-time HD video and audio to come from the theatres by just plugging the cart into the network and meant cardiologists could see the same scans as those in theatre as quickly as it took them to get to one of the review stations in the hospital.
“Polycom’s technology was robust and proven, providing both picture and sound, and with less hardware needed, it made it a no brainer for us,” said Baldesare.
“It is one thing to do the design and quite another to enure it is clinically viable and safe for the patient though. We had a lot of support from the medical devices team, so as well as installing the codec on the back, we made sure we had things like a power isolation system so there were no earth leaks and everything remained safe for the patient.”
Frank BaldesareIT enterprise architect, Guys and St Thomas’ Foundation Trust
With these additional pressures and very limited access to the theatres – just a two-hour window on Wednesday afternoons – the project took eight months to complete, but by the end of Summer 2013 everything was up and running.
“It all works with the press of two buttons; one to switch it on and one to make the call,” added Baldesare. “The reaction has been extremely positive. The follow up from the cardiologists is it is exactly what they wanted and it is in use almost every day, with up to four or five cases a week.”
But it is not just the one department set to benefit. The IT team has already done a pricing to bring this same capability to adult cardiology within the Trust and has shared the designs with Kings College Hospital’s foetal cardiology department so they can look into implementing it.
There has even been interest in the technology from those working in cochlear implant surgery.
“Here we run services for the south east, meaning this will be where you come if you live in the area and have paediatric heart treatment,” said Baldesare. “We are considering trying to use the technology in real time for local clinics too, but the obstacle there is we would need a big training programme for local paediatricians.”
Within Evelina London Children's Hospital itself, the IT team is planning to retro-fit the 7in monitor on the ultrasound cart so the surgeons can see the cardiologists on the screen, as well as the ultrasound scan, but Baldesare concluded there was no more to do on the smooth running project.
He said: “Our network is a fabulous thing and we are very happy with how it is all working.”