Welch Allyn ECG devices, powered by Mortara, are helping to save time, reduce errors, and improve clinical decision-making for the Antrim Area Hospital.
Performing around 2500 to 3000 ECGs per month, the Antrim Area Hospital is the largest hospital in the Northern Health and Social Care Trust. It provides a range of services – including a 24-hour emergency department.
The optimum management of patients – whether undergoing surgery or arriving at the emergency department with a suspected myocardial infarction (MI) – relies on the quality of the information provided by these important diagnostic investigations.
As part of a project to replace ageing ECG devices with the latest technology, the cardiology team decided to explore the idea of wirelessly connected devices that transmit tests into the electronic patient record.
“We had previously encountered Mortara devices and liked how user friendly they are, as well as the visibility of the screens,” commented Virginia Anderson, clinical physiology services manager.
The hospital was already using standalone ELI 280 ECG machines widely, but five additional high-end ELI 380 ECG machines were selected and are now connected to the hospital’s electronic systems.
The ELI 380 is an advanced 12-lead ECG, designed to provide sophisticated functionality and seamless connectivity to hospital systems. After an initial trial of the machine, one significant advantage was the unit’s wireless ECG patient cable
“Like many hospitals, there are space constraints, particularly in busy areas like the emergency department,” observed Virginia. “You can attach the leads to your patient, while the machine can be placed out of the way, at the bottom of the bed or outside the room, so there is no need to manoeuvre equipment around a tight space.”
Safe storage of ECGs
Prior to having electronic storage of ECGs, a copy would be simply added to the patient notes. However, if this copy was displaced or not passed along during a transfer, the test would have to be repeated – requiring additional staff resource and delaying patient care.
“Re-testing is not ideal, from a clinical perspective, as the test captures the patient’s ECG during a moment in time – if re-tested later, the patient’s condition may have changed and it will not reflect what was happening when the original investigation was undertaken,” Virginia added.
Having initially used the ELI 380 devices as stand-alone units, the next stage was to take advantage of the Mortara’s connectivity, saving an electronic copy of the ECG to a database.
With the roll-out of the Northern Ireland Electronic Care Record, the ultimate goal was to enable the ECG to go from the patient to their electronic care record, making it readily available to any clinician in the region.
“If the patient is transferred from the Antrim Area Hospital to their regional hospital for an intervention, the staff at the receiving hospital can access the electronic record for the ECG result. This gives advanced insight into the patient’s condition and also avoids unnecessary duplication of tests,” said Virginia.
The ECG is now instantly transferred to the hospital’s Cardio Vascular Information System (CVIS), and then into the Northern Ireland electronic care record (NIECR). This ability to seamlessly integrate with existing hospital IT infrastructure is a key advantage of the connected ECG equipment. Standardsbased interfaces connect the ECG devices to vendor-neutral IT systems, so that device investments are not wasted when IT systems are updated or replaced.
Barcoding: reducing errors
“Another really important feature has been the addition of barcode readers for patient identification,” continued Virginia.
She explained that utilising the barcodes on patient’s wristbands allows the patient demographics to be automatically populated from the data held on the Patient Administration System (PAS) – ensuring the patient’s name is spelt correctly and preventing human errors due to the mistyping of identification numbers or date of birth, for example. The hospital performs, on average, around 200 ECGs per day and ‘failures’ due to typographical errors have been reduced from 30 to 40 (daily), to being virtually eliminated.
The turn-around time between patients has also been reduced as staff do not have to spend time inputting lots of administrative data, according to Anderson. “The improvement in clinical flow saves around five minutes per patient,” she asserted. “This allows us to meet our demand in a timely way.”
Due to the nature of the emergency department, occasionally a patient may not have a barcode at the time of the ECG, so manual inputting is sometimes necessary. However, the cardiology team does everything it can to reduce errors by ensuring strict quality control of ECGs and ensuring that the tests are performed by competent members of staff. The ability to store the ECG with the electronic patient care record also facilitates the auditing of quality.
“In the past, if I wanted to audit the quality of ECGs, I would have to visit the ward and go through patients’ files,” Virginia explained. “The ability to efficiently audit ECGs has helped drive improvement. It can identify whether staff members are applying filters, which is not best practice, for example. In some cases, this may be necessary – particularly if there is a lot of ‘noise’, but as the vast majority of patients are compliant and will work with you, this function should not be the default. By ‘smoothing’ the ECG, you can miss important details, and this can impact on patient care decisions.
“It is now easier to monitor quality and each ECG can be linked to the member of staff who performed the test.”
Anderson pointed out that this transparency is also important for protecting staff - if a patient is later found to have a transmissible disease, such as TB, all those who have had close contact with the patient will need to be screened.
All of the Welch Allyn Mortara ECG devices used in Antrim can also assist with interpretation of the test, thereby providing additional decision support to clinical staff. The Veritas interpretation algorithm is designed to provide enhanced accuracy in beat detection and noise rejection. Furthermore, the system is said to pick up subtleties that many staff (particularly those who do not work in cardiology) may not identify.
Once the ECG is performed, it is transferred to the CVIS system and a referral and appointment are automatically generated for the patient. Prior to the introduction of the connected ECG system, staff would have to manually enter this into CVIS to generate a referral and an appointment for the patient. The cumulative time savings achieved by automating the process are described as significant. This feature is also important for the financial management of the department – the ECG information collected via CVIS can be used for allocating budget, analysing the ECG activity carried out and attributing this work to specific departments (eg surgery or general medicine). It is crucial when building a business case for more staff, investment and resources.
This feature is also important for the financial management of the department – the ECG information collected via CVIS can be used for allocating budget, analysing the ECG activity carried out and attributing this work to specific departments (eg surgery or general medicine). It is crucial when building a business case for more staff, investment and resources.
The cardiology department currently has six cardiographers. Managing change has been key to the success to the project. While some staff were resistant to the changes, at first, after a short time, they could see the benefits of the barcoding integration and automatic transfer of tests. The cardiographers found the process to be more efficient, the admin burden on the team was reduced and patient safety was improved.
Team leader, Claudine McFall commented: “There were some initial glitches that had to be ironed out, due to historical factors around hospital identification numbers, but this has been overcome and staff are embracing the technology. It is beneficial for the patient, as well as reducing the need for repeat ECGs.”
She pointed out that staff can also seek out more senior involvement in patient management, if necessary, as the system allows a consultant to access the record from any location, out-of-hours. Another advantage of the paperless system, she added, is around confidentiality. The technology offers the added security of encryption of stored and transmitted patient data, while device authorisation prevents unauthorised devices from exchanging patient data.
Sean Armstrong, from the hospital’s IT networking and security team, was part of the multidisciplinary project. He asserted that the device’s use of Linux operating software meant that it would be less susceptible to security attacks, associated with Windowsbased systems. “It meant Welch Allyn did not have to manage the patching routine and we didn’t have to install the Trust’s antivirus software,” he said. “This made connection to the hospital’s wireless network much more straightforward.”
Ultimately, the Welch Allyn devices saved time, reduced repeat tests, reduced human errors, improved audit capabilities and driven quality improvement.
Welch Allyn Cardiology, powered by Mortara
Mortara’s diagnostic cardiology devices are differentiated by diagnostic algorithms, connectivity and enhanced security features. Acquired by Hill-Rom Holdings, Inc., in February 2017, Mortara’s technology now forms part of the Welch Allyn Cardiology portfolio.
Welch Allyn UK Ltd
Tel: 0207 365 6780
Email: ukcustomercare@welchallyn.com
www.welchallyn.co.uk
