The South London and Maudsley NHS Foundation Trust (SLaM) provides the widest range of specialist NHS mental health services in the UK. The trust has more than 230 services including 52 inpatient wards, as well as outpatient and community services.
SLaM are leading the way in implementing electronic patient observations in specialist mental health care and as a result, were awarded NHS GDE (Global Digital Exemplar) status.
In 2015, the trust began a two-ward pilot of Open-eObs, an Open Source electronic observation tool.
Open-eObs allows clinicians to record observations, such as weight and blood pressure using desktops or handheld devices. The system then calculates a score, based on the Royal College of Physicians standard NEWS guidelines. When scores exceed thresholds, the escalation process is triggered and alerts are sent to specialists.
Following the success of the pilot, SLaM decided to roll this out across all wards, and were looking for a supplier to support the transition to live.
Following conversations with The Apperta Foundation, who are the custodians of the open source codebase behind the application, OpusVL were recommended to SLaM.
Impressed with what they'd seen and convinced that they had found the supplier they needed, SLaM officially partnered with OpusVL in 2017.
SLaM's objectives for the electronic observation tool were to automate workflows for patient allocation and task escalation, whilst increasing safety and accuracy.
As the mental health environment is different to the more common acute setting, the application needed to be designed around patients who are not necessarily allocated to a bed.
In order to inform the strategy for helping SLaM achieve their targets, JJ Allen, Project Director at OpusVL, explained that they began with "a workshop to gather the stakeholders together and develop a shared understanding of the project goals". He said that they explored "technical, cultural and project management aspects", describing it as "a very thorough process".
The workshop included stakeholders from all areas of SLaM, as well as OpusVL's developers, identifying the following key areas of focus:
- Updating the escalation algorithm to align with new clinical needs
- User Experience (UX) improvements: reducing the number of key presses needed to perform tasks
- Establishing workflows to allocate patients to nurses, and then to doctors should further assessment be required
- Disabling functionality not required for this implementation
SLaM use an Electronic Patient Journey System (EPJS) to assign patients to certain wards within the Trust. This needed to work with the electronic observation tool, so interoperability with the HL7 interface was an important aspect of the project.
To prepare for eventual production use, OpusVL carried out an analysis on performance and capacity requirements for the application. Having measurable performance characteristics is essential to evidence operational capability prior to rollout.
In 2018, having worked in close collaboration with SLaM and gone through a rigorous testing process to validate that their requirements were met, the first production release of the electronic observation tool transitioned from pilot to live across three wards.
However, since transitioning to live, there has been continuous development in collaboration with SLaM. In 2019, the observation application, a fork now marketed as Open-eReact, became an essential aspect of the Innovate UK funded DITO (Develop In The Open) project, led by OpusVL and supported by The Apperta Foundation, OpenUK, Coventry University, Cheshire and Wirral Partnership NHS Foundation Trust and SLaM.
As a result of the 2020 pandemic, usage of Open eReact at SLaM doubled due to the need for more frequent observations and this exceeded the original performance design.
To address this, the teams worked together to consider technical, clinical and user experience. Further refinements were made to cater for the additional load and tests indicated that the application would deliver a ten-fold increase in observations, whilst also providing faster observation submission times to all users.
Because the application is Open Source, there were no additional license costs for SLaM even though there was a significant increase in users.
Despite the challenges posed by the pandemic, which heavily affected SLaM from a clinical perspective and pushed the project's timeline back by 4 months, the rollout of the updated version was successful and delivered an improved experience for over 800 staff in 50 wards across the Trust.
To ensure repeatable delivery of software updates, a software release pipeline was used. This ensures that the developers can use the same environment as the live system whilst keeping sensitive data within the customers site.
This method also enabled several testing and training sites to be configured with ease, allowing SLaM to validate any changes before going live.
The project was aligned to the Open Digital Approach, where the teams worked closely and openly, whilst giving SLaM open access to all parts of the process and software.
On the work of OpusVL, Stephen Docherty, the then Chief Information Officer at SLaM,remarked that they:
"Put the project back on track, establishing a clear road-map of what was required and when. The team has resolved many issues the trust was experiencing and continues to work on others, whilst also making recommendations for future improvements".
By identifying deteriorating patients and enabling automation of escalation processes, the Open eReact platform helps to raise standards and deliver improvements in care quality and patient safety.
The success of this project was reflected by Stuart Mackintosh, Founder/CEO of OpusVL, who commented that:
"Our project with SLaM is a strong example of how the process of working openly in partnership can deliver great results".
A prompt response to clinical change is proven to shorten the length of stay and reduce transfers within the hospital to the ICU. The live acuity board enables nurses and clinicians to make decisions based on real-time patient information.
Other benefits of Open eReact include greater tracking of physical health, better oversight of patients, the move towards paperless wards and the ability to use data to provide a trust-wide view of patients and their health.
This approach also opens up the opportunity for future iterations of Open eReact to be implemented throughout the health and care sector and all users of the application benefit from each other's investments.
Summarising the project, Stephen added that:
"It was great working with OpusVL. We had a hands-on approach from all levels of the business, from the developers right through to the CEO. It was a highly personal service, advice was readily given, and our views heard. It was clear there was a greater determination for success for the project and the value of open source, rather than just financial incentives for OpusVL".