Electronic Patient Record - Home Treatment Team SBAR

Product Design Team - Surrey and Borders Partnership NHS Foundation Trust

Brief

Improve the handover practice for Home Treatment Teams using SBAR (Situation, Background, Assessment and Recommendation) integration into the Electronic Health Record.

Digital teams are to work collaboratively along side the Clinical Teams to improve and optimise the handover practice of our Home Treatment Teams. Shifts work to cover 24/7.

SBAR (Situation, Background, Assessment and Recommendation) Is a well established communication tool within the NHS.

The original SBAR process was done in Excel before we did this project.

This is the demo EPR and ONLY uses test patients, not live/real patient data.

Our Trust uses SystmOne (Electronic patient record software) created by TPP for the NHS. Our Teams work using Agile Scrum and User Centred Design.

Above: HTT SBAR in the Demo Electronic Patient Record (SystmOne TPP) with a test / dummy patient. (NHS Logo is removed for online display of work)

Project Goals

  • Replicate NHS SBAR best practice digitally (directly into the Electronic patient record)

  • Implement the SBAR in SystmOne EPR

  • Conduct a User friendly re-design tailoring it for HTT needs

  • Reduce the time of handover meetings, Less time on manual data entry 

  • Ensure no overtime required by the Administrators

  • Maintain a high level of patient care

  • Business goal: is to reduce the reliance on word documents and make better use of our electronic patient record system (SystmOne)

  • Reduce errors 

  • Working towards single source of truth for patient data

  • Better patient outcomes due to more time available for patient care

  • Safer storage of information

 

 Challenges

  • Some technical limitations to make changes to the EPR software, SystmOne

  • Working to tight deadlines to meet frontline service needs

  • Clinical staff availability is limited to do testing and plan workshops

 
 

Project Team and my involvement in the project

Immediate Team: (Design Team Flow) Product Owner, 2X UX Researchers, 3 UX Designers, Scrum Master

Wider Teams: Learning and Adoption team, App Support team.

Primary users: Admin Staff. East & Mid HTT Staff (for initial role out), all other HTT staff who attend the MDT meeting

Secondary users: Could be extended to HTTs from other directorates and ISS.

Stakeholders: Associate director Working Age Adults and Inpatients, Associate Director of Flow and Bed Optimisation, Associate Director of Digital Transformation Delivery. Head of Home Treatment Teams East and Mid Surrey.

My Involvement in the project:

I supported the UX researchers in Discovery. I designed the Usability testing plan and designed the tests for Qualitative Usability testing.
I did iterations of the High Fidelity working prototype in the EPR. I designed the user testing plan and designed the tests for Qualitative usability testing.

 
 

Skills & Software

  • UX Research

  • UX Design

  • UI Design

  • Prototypes

  • Usability testing

  • Miro

  • Adobe XD

  • Workshops

 

Discovery - Contextual Studies & Personas

Personas were created from on site contextual interviews at NHS SABP East and Mid HTT base (Redhill Surrey). Visits were UX Researchers and UX Designers.

 

Above: Persona for Primary user Consultant Psychiatrist

Above: Insights and Pain points Consultant Psychiatrist

Above: Persona for Primary user Physician associate

Above: Insights and Pain points Physician associate

 

Recommendations and thoughts from the Interview

  • Pre-population of situation and background

  • Move away from updating and sharing Excel documents

  • What had been clear during the research is that there appears to be consensus that the handover has become more of an MDT meeting

  • Possibility of out of Scope for digital, but looking and having a '“stand up” during the handover

  • Can the information be pulled from SystmOne (Electronic patient Record) to reduce any duplication and Repetitiveness?

  • Can the allocation of service users be done before Hand over?

  • A paper version(prototype) has been shared with the design team. This should be tested

  • The SBAR should be an instant snapshot of the service user

  • We feel the Home treatment team would benefit from having some service design or QI support

 
 
 

Alpha Phase -  To Be Process Map

This is the proposed To Be Process map of the service showing both online and offline processes.

 

Above: To Be Process map for the HTT SBAR, Please select this text to view larger image

 
 

Alpha Phase -  Co Design workshop

The Co Design Workshops took place on site.

Please see full PDF here: HTT Co Design Workshop plan

 

Above: User sketches from the Co Design workshop

Above: This is example is using a MoSCoW prioritization. The acronym MoSCoW represents four categories of initiatives: must-have, should-have, could-have, and won't-have, or will not have right now.

Above: Annotated user sketches. These sketches will inform the low fi prototype

 
 

Alpha Phase -  Low Fi Prototype (shown in the 2nd Co Design / Critique workshop)

The Low Fi Designs were taken to the 2nd Co Design Workshop and iterated after that

I also created the ‘TO BE’ Process maps (multiple versions) from the ‘AS IS’ process map the UX Researchers did.

 

Above: Lo Fi Situation & Background page (combine on to one page in this early iteration)

Above: Lo Fi Plan (Recommendation page)

Above: Assessment page (combine on to one page in this early iteration)

 

Alpha Phase -  Usability Testing

A High Fidelity working prototype was created in SystmOne to do Usability testing with, using test patient data (no real data was used), iterations were made from 2nd co design workshop.

I designed the Usability Tests (plan and scenario questions), we did two rounds.

Myself and another UX designer working on the project went on site to do two round of Moderated Usability Testing

Purpose: Test the outcomes from Co Design Workshops by Usability testing a Higher Fidelity working prototype (in the EPR)

 

Above: Round 1 Usability Quantitative Measures (task completion) - put on Miro

Above: Iterations for prototype from Round 1 and Clinical Hazard workshop

Above: Usability Qualitative measures - User feedback put on Miro from Excel Doc, Round1

Above: Usability test scenario questions from Excel round 2

Above: Usability Qualitative measures - User feedback put on Miro from Excel Doc, Round 1

Above: Iterations for prototype from round 2 on Miro

 

Alpha Phase -  High Fi Prototype

These Designs are built in System One (TPP) An Electronic Patient Record that many NHS Trusts use across the country.
Please note: There were some restrictions creating the working prototypes in SystemOne, and some colours are not accessible and we have no control over this.
The dimensions were 980 x 650 px, and the software isn’t responsive to screen size.
These are the dimensions that would fit on a laptop screen.
NHS Logo is removed for online display of work.

 

Above: High Fi working prototype in SystemOne, Situation page

Above: High Fi working prototype in SystemOne, Assessment page

Above: High Fi working prototype in SystemOne, Background page

Above: High Fi working prototype in SystemOne, Recommendation page

Beta Phase -  UAT

UAT was done remotely via Teams with minor changes

Very little needed to be fixed because we had involved the user in the process end to end (Alpha phase Co-design and Usability testing caught issues early on and we could address them)

Throughout the process we had kept checking the User Stories against our designs and prototypes

UAT should be for testing for bugs and technical issues.

Beta Phase -  Pilot outcomes

Our intended measures of success were gathered during the month long pilot of the SBAR with East and Mid Surrey.

Measures of Success:

  • Staff Satisfaction

  • Timing of MDTs

  • Need for overtime by Administrators

  • Financial Impact

  • Quality of Patient care

During the Pilot, support was given by Flow design team, QI, Applications Support and Learning and Adoption Teams as well as the Clinical Lead for HTT.

In terms of evidence of achieved targets:

  • The MDT reduced by 30-60 mins on average which for just one HTT team equates to 3,500 hours of clinical time saved, meaning staff have more time to prioritise patient care. Time Saved in Hours: 17,264 for 4 teams.

  • Financial predictions from the QI team put this at a yearly cost saving of 160k for just One HTT (4 teams in total so 640k )

  • Admin save 8k a year on overtime costs

  • Significant financial savings as the MDT/handover is, on average, 30-60 minutes shorter.

  • 86% of staff now only update the plan for that day during the MDT​ (as opposed to multiple times a day). An organised and streamlined MDT/handover. 

  • Staff satisfaction with the design was measure through surveys with multiple staff saying it was:

    “Much Quicker”

    “Easy to Use”

    “Improved Quality of conversation during MDT”

    “Removed a load off the shoulder of Admin”

    Please note: The quality of patient care will be better because of the Clinicians’ time saved

Results -

  • Money: Saved 640k (over 4 teams in total) per year

  • Time Saved in Hours: 17,264 per year

  • Nominated for Health Service Journal Awards 2023
    Category : Replicating Digital Best Practice Award Finalist
    https://digitalawards.hsj.co.uk/winners-2023

  • Better patient care from the Clincians’ time saved

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