By introducing a tracking system, a hospital trust found it could ease the movement of patients from acute to non-acute beds. Jane Dudman reports

An innovative system in Portsmouth has high-lighted the way clinicians can drive forward health service IT. Portsmouth Hospitals trust is implementing a system in its medical assessment unit to keep better track of its acute patients and identify more reliably when they can be moved to non-acute beds, freeing up valuable resources.

It combines a clinical workflow system, from supplier Graphnet, with a clinical audit tool - the Appropriateness Evaluation Protocol - to enable clinicians and nurses to refer patients to the correct place more easily and reliably. It has been developed by medical assessment unit clinicians Dr Peter Featherstone and Dr Paul Schmidt.

'We kept saying we didn't have enough beds, ' explains Dr Featherstone, 'but when I looked closely, only about half of the people in acute beds actually needed to be in one. I wanted a tool that could reliably identify when patients no longer needed a medical bed.'

Dr Featherstone found such a tool in the US, where it was used to ensure acute beds were not being paid for when not needed. 'Nobody had tried to use it in a clinical way, so we did a study to see if it would be possible, ' he says.

But finding a reliable clinical tool was only the first step. The trust then had to ensure it had somewhere to send patients. The result was that it completely reconfigured its bed provision, dividing its allocation between two hospitals, one of which now has acute beds and the other non-acute. 'Portsmouth is a trust with no stars and has had six chief executives in twoand-a-half years. But in the middle of all this, we have been able to go ahead with the biggest change to our medical systems, 'Dr Featherstone points out.

At the same time, Dr Schmidt looked into the issue of electronic patient records and decided that an IT system based on the internet protocol XML, which is becoming a standard in most online health systems, would be appropriate.

'It became clear that only an IT solution using XML software would give us the flexibility we needed, ' he says.

It clearly made sense to incorporate the AEP software into an electronic approach to patient records.This process is now under way, beginning in the medical assessment unit.Dr Schmidt says the system will enable staff to co-ordinate the movement of patients through the hospital, helping provide real-time bed allocation and management.

'The system enables us to have a complete view of the patient, from before admission until after they are discharged, ' he says.

As the main interface between primary and secondary care, the medical assessment unit is a particularly fast-paced environment, where an innovative approach is needed to respond efficiently to demands for patient information.

The system uses XML documents to notify the medical assessment unit of GP referrals and accident and emergency transfers before a patient actually arrives at the unit.The AEP software enables clinicians to decide whether patients need an acute bed or if they would be more appropriately referred to a specialist clinic or to their GP.

'The system is on the network, so staff with security access can see the information from anywhere, ' says Bill Flatman, director of information and communication technology at Island and Portsmouth Health ICT Service. 'In the medical assessment unit, it is accessed via PCs and fithin clientsfl (see box below).'

Clinicians can gather information about patients by answering on-screen questions. 'It is far more flexible onscreen than on paper, ' says Mr Flatman.

Portsmouth Hospitals trust estimates it will save up to£30,000 a year by not having to print discharge notifications to GPs and up to£200,000 on time spent by clerical staff managing paper discharge forms.And there could be big savings from more appropriate bed allocation and early identification and co-ordination of impending patient discharges.

Saving half an occupied bed day per patient at Portsmouth could add up to savings of£5m a year.

Meanwhile, Mr Flatman says the system is a real example of the way clinicians can drive forward IT when they are enthusiastic about the results. 'It shows what we can do when we encourage clinicians to think about what ICT can do for them, 'he says. l Jargon buster XML stands for eXtensible mark-up language. It is a way of 'marking up'documents for use on the internet (see e-novation, 4 July and 26 September 2002).

A thin client is a low-cost, centrally managed computer with no extra features like CD slots or floppy disk drives.