London Programme for IT

Royal Free checklist for gastro-intestinal bleeding

The Royal Free Hampstead NHS Trust has developed a fully auditable set of guidelines and actions for clinicians within its Cerner Millennium electronic patient record system.

The trust has been working with Cerner and the BMJ Evidence Centre to pilot a standardised checklist of actions to help clinicians make the best decisions for patients with gastro-intestinal (GI) bleeding.

Dr James O'Beirne, a hepatology consultant at the Royal Free, said: “There's a constant drive for improvement and to audit outcomes against key performance indicators both nationally and against our peers.

“However, before this system was in place, there was no way of knowing what had happened to the patient or who had been admitted.”

The Royal Free went live with Cerner Millennium in June 2008. Dr O'Beirne said the trust is now working to improve the system, focusing on clinical functionality to enhance clinical processes.

Clinicians at the trust can open the new guidelines in Cerner Millennium during their initial assessment, and then link to the BMJ website for decision support. All the correct tests can then be ordered from one screen.

Dr O'Beirne added: “We looked at evidence-based order sets and thought ‘what better way is there of getting people to engage with guidelines, get up-to-date evidence, and order tests, than allowing them to do it all in the same place?'

“It's all time stamped and we can go back and look at GI pathways, who has accessed the information, and over what time periods.”

However, Dr O'Beirne stressed that clinicians still make the final decision on treatment. The trust is not quite ready for the guidelines to be mandated.

The Royal Free has implemented the system as a pilot to see whether it can demonstrate benefits, before moving to a trust-wide roll out.

O'Beirne said: "We did an audit of the three months before we went live for GI and then turned on the functionality for GI bleeding, so we can be sure we are comparing like for like.

“So we've gone with a targeted go-live within GI. Clinicians that have seen it and played with it so far are very impressed. It's very easy to use.”

The trust is planning to roll out Cerner's e-prescribing functionality over the next year.