Guest post, by the Leeds Institute of Health Sciences and Leeds Teaching Hospitals NHS Trust, describing how hospitals can use patient data for delivering and monitoring care.
If you need to go into hospital, the staff there will want to know some amount of information about you.
What data is recorded?
The hospital will have a medical record containing data about you: these are sometimes referred to as your hospital notes. When you get to hospital, more data is recorded. Doctors will record your health history – do you have any problems that they need to know about, that might affect your treatment? Nurses will take your temperature and blood pressure and record them. They will also record any treatment that you receive, such as drugs that you are given. Recording data is important in making sure that you receive the right care.
The NHS uses some of this data for other purposes. For example, hospitals need to know how many patients they are treating, and how well they are being treated. They also need to know whether doctors or nurses are making mistakes. Data about you has a sort of second life, where it is anonymised and brought together with other patients’ data, so that hospital managers can review the quality of the care they are providing to everyone in the hospital. As a result, data about you and your treatment are stored in a number of places in a hospital at any one time. Two examples help to explain why this is the case.
How do hospitals manage patients’ vital signs?
The first concerns vital signs, which are measurements that indicate your basic health. They include your temperature, pulse rate and blood pressure. If you have to stay in hospital, they will be measured every few hours. For each set of readings, the measures are recorded, and can be combined into a single score, called the National Early Warning Score (NEWS). Nurses can monitor any changes in your Score over time: if it increases, it indicates that your health is deteriorating, and action needs to be taken.
Your vital signs used to be recorded in paper records, but they are increasingly being recorded electronically, on laptops or tablets at the bedside. As a result, it is possible to capture everyone’s NEWS on computer, and then look at the Scores for all of the patients on a ward. A ward sister can make sure that the people with the highest scores are watched closely.
Further, hospital managers can view anonymised NEWS scores for each ward in their hospital. They don’t need to see any detailed data about you, such as your name or your health problem. Some managers review how wards are doing every morning when they get into work. If necessary, they can send extra nurses to wards with the highest scores. That is, they use the data to make sure that patients across the hospital are receiving the care that they need.
How do hospitals manage and review incidents?
The second example concerns data about the safety of your treatment. Some events in hospitals are indicators of poor care – for example, if you experience a fall, or develop a pressure ulcer, sometimes also called a pressure sore. If one of these events occurs, it is recorded in a number of places, as the diagram below shows. First, nurses record what happened, either in your medical record or in a separate nursing record (arrangements vary between hospitals).
If the problem is serious – if you break your leg while in hospital, for example – then it is also recorded in a separate incident reporting system. This system alerts senior staff, who review what happened and work with ward staff to address the problem, and make sure that you are fully informed about what they are doing. At every stage, decisions and actions are recorded, so that there is a ‘trail’ showing what has happened. Your personally identifiable details need to be available in this system, because staff need to be able to track what is happening to you.
The incident reporting system can also be used for learning purposes. Once an incident is over, hospital staff can review what happened, and take steps to ensure that it is less likely to happen again. Data from the system can also be used to monitor the safety of care throughout a hospital. Every month, hospital managers review the number of incidents that have occurred. Reports – with personally identifiable details removed – are discussed at meetings. The reports include trends, indicating whether the number of incidents is going up or down. Managers can use the data to identify any areas of the hospital where the quality of care needs to be improved.
Similar anonymised summary reports are also sent to national agencies, who can build up a picture of the numbers of incidents occurring in hospitals across England.
These examples illustrate ways in which hospitals manage detailed data about you and your care. They help show why members of staff need to have access to detailed data about you, to make sure that you are receiving the right services, and those services are of high quality. If something goes wrong with your treatment, senior managers can only help you if they know who you are. At the same time, hospitals have developed systems that provide managers with the data that they need to monitor the quality of care, without having access to any personally identifiable data about you.
Find out more
This blog was written by Justin Keen, Emma Nicklin, Nyantara Wickramasekera, Andrew Long, Rebecca Randell, Elizabeth McGinnis, Claire Ginn, Sean Willis and Jackie Whittle.
You can find out more about their project Information Systems: Monitoring and Managing from Ward to Board.