Pronto: Lanarkshire NHS Trust

New Working Time Directives will have a profound impact on the delivery of out-of-hours services in hospitals throughout the UK.

Three acute hospitals in Lanarkshire are pioneering a new approach to hospital emergency care - called HECT (Hospital Emergency Care Teams). A significant part of the team's work is organised and carried out by specially-trained nurse practitioners.

In order to monitor, support and enhance this new service, the team co-ordinators require very detailed operational data, covering the full range of the team's activities, in all hospital locations, 24 hours per day, 7 days per week.

Key Issues

• Clearly a hand-held solution for data capture was essential, but most nurses had no previous experience with such devices.
• At times the nurses can be extremely busy, so data entry has to be intuitive and very fast.
• Patient-identifying data is captured, so security and encryption are significant issues.
• As HECT is a new clinical service, data capture requirements are evolving rapidly as the Teams gain experience and refine operational practices. This requires very rapid bespoke iterative development.
• IT training requirements had to compete with highly intensive clinical training requirements.
• Time and budgetary constraints were very tight.

The Solution

• We worked closely with a group of 30 HECT members in three acute hospitals, before, during and after commencement of the new service.
• Using Pronto's rapid development toolset, we developed a two-part solution consisting of sophisticated PDA data capture components, and PC-based data stores with integrated reporting functionality, together with user and asset management facilities.
• The components support convenient, rapid collection and analysis of very detailed operational data covering the full range of HECT activities.
• Initially communication uses simple docking, but the solution is designed for upgrade to wireless operation whenever desired.
• All information is represented in XML. Date storage and communication is protected by strong encryption.

The Results

• The solution has been in continual use by 30 nurses at 3 sites, 24 hours per day since the introduction of the service.
• Nurses initially expressed a preference for relatively restricted data collection, however as a result of experience to date, a new, considerably more detailed specification has been agreed. With the rapid development toolset, this can be implemented and deployed very quickly.
• Analysis of collected data has already disclosed a number of unanticipated patterns in service operation, which may impact on future service planning.