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Title and Description
Safe Surgery System™ - Birmingham Heartlands Hospital using RFID for patient safety
Reviewed/ candidate case
Quality reviewed case
Short description
The Safe Surgery System™ improves patient safety by mistake-proofing the surgical journey and reducing the opportunity for wrong side, wrong site surgery (WSS). The system provides major cost benefits by reducing exposure to litigation costs and improving theatre efficiency.
Objectives and purpose
1. Wrong site, wrong side surgery is a major cause of morbidity and litigation in the national health service (NHS) in the United Kingdom (UK). Many of the causes lay in an error-prone manual system (written operating list which is subject to last-minute changes) and misidentification of patients. These can also result in mismatching a patient with care or drugs/transfusions. 2. There is often a lack of basic data to measure operating theatre utilisation and, when available, the data reveal underuse.
Detailed description
The radio frequency tagging system for patients consists of a standard wireless network to which a radio frequency identification (RFID) reader/antennae are connected. These sensors are activated when a tag passes within reading distance.
On admission each patient is allocated a single-use RFID tag in a wrist band. A digital photo taken is embedded in the electronic patient record on the server. The server is connected via the network to personal computers (with optional touch screens) on the wards, operating theatres and recovery rooms. These enable all staff to view and update the digital operating list.
The surgeon, anaesthetist and pre-operative nurse have wireless Personal Digital Assistants (PDAs) which allow them to view the digital operating list and electronic patient records. The system architecture monitors the patient’s location and synchronisation of the appropriate patient record via the server to the PDA. The verification system incorporated in the PDAs guarantees ‘mistake proofing’ by the surgical team prior to surgery.
When a clinician approaches the patient with his/her PDA, the system recognises the patient (using the RFID tag) and selects the appropriate patient record. As the record includes an embedded photograph, it enhances positive patient identification. The PDA can then be used for the patient’s pre-operative checks which immediately updates the operating list with any changes. The system uses a series of ‘traffic lights’ in the patient record which remain red if none of the checks have been done. If some checks are complete, the ‘traffic light’ changes to orange. If all the necessary checks are completed, the ‘traffic light’ changes green.
Only when all the pre-operative checks have been verified and the patient’s status has been updated to ‘green’, can the patient be sent to theatre. If the checks on a patient have not yet been done, the order of the surgery list can be changed instantly using the PDA.
The PDA can also be used for ordering tests and printing the patient information onto labels and can also by used to avoid misidentification when administering medication.
When the patient is sent to theatre, the reader/antennae recognises the patient from the RFID tag. It causes the appropriate electronic patient record to appear on the screen with the patient’s planned procedure. This prevents misidentification. Thus it is impossible to operate on the wrong patient. Further checks are performed and only then can the operation proceed (the relevant ‘traffic light’ turns green).
If a biopsy or test is undertaken in theatre, patient identification labels for the samples can be printed for the correct patient, and thus prevent mislabelling.
Each step in the process is time-stamped. A database log allows theatre efficiency to be measured automatically. The procedure carried out is coded correctly by the operating surgeon, and thus further improves the efficiency of the theatre and cuts administration time. An independent Benchmark report by Health Tech has concluded that: “Safe Surgery Systems Ltd is the only company that has developed the fully integrated system and implemented at one centre.”
Interoperability and standards
The Safe Surgery System™ uses off-the-shelf technology and works with any wireless network that is WiFi compliant. The system architecture is designed to be fully integrated with the core clinical systems with the ability to send and receive HL7 messages.
Safe Surgery Systems have been approved by Lloyd's Register Quality Assurance to the ISO 13485 Quality Management Standard for the development, supply and installation of medical software applications. The rigorous quality standard, ISO 9001:2000, has also been achieved.
Timescale
Start of planning
2004
1st milestone
October 2004. Start of pilot project in the ear, nose, and throat (ENT) department of Birmingham Heartlands and Solihill NHS Trust. It initially used active WiFi tags in re-usable wrist bands.
2nd milestone
2005. The trial was modified to use passive RFID tags in single-use wrist bands.
3rd milestone
March 2006. The trial was expanded to include thoracic and ENT departments, involving three hospital theatres and five hospital wards.
Start of routine operation
2006
Evaluation
In the past
Characteristic of the application
Country
United Kingdom
Part in the healthcare chain
Therapy
Level of Implementation
Team e.g. ward, department
Technology
Commercial solution - proprietary
Details on Technology
The system uses off-the-shelf technology and works with any WiFi-compliant wireless network to which a RFID reader/antennae are connected. The system architecture is designed to be fully integrated with the core clinical systems, and has the ability to send and receive HL7 messages. Components include: * Digital camera to photograph patients; * Passive RFID tags embedded in single-use hospital wrist bands; * PDAs for surgeon, anaesthetist and preoperative nurse; * Networked personal computers (with optional touch-screens) located on wards, operating theatres and recovery rooms; * Networked server containing electronic patient records database.
Results
Outcomes
1. Improves Patient Safety Since the implementation of the Safe Surgery System™ in 2005, there have been no mismatches of patient and care. The system has prevented two possible incidents in cases where patients with similar names had been scheduled for different operations. Risk management of individual patients is improved by ensuring that the manual pre-operative checks have been performed. Infection risk has been highlighted and the list has been altered accordingly. Patient safety incidents can be reported. Deep vein thrombosis risk assessment can be performed prior to surgery.
2. Saves time for health care workers Pre-operative checking on a PDA and reordering of the list immediately updates the digital operating lists that appear on all screens to inform all staff of list changes. Colour coding of the patients’ pre-operative status avoids delays in sending for patients and ensures theatre lists start on time. The system’s simplicity of use and time saving features guarantee ‘buy in’ by users. Predicts bed availability centrally by allotting patient discharge times.
Wider impact
Theatre efficiency can be measured and improved by analysing the time taken for each part of the patient journey. Using the RFID Tag, the system automatically time-stamps each process. Allows for better time management (trials have shown that an additional one to two cases per operating list can be performed due to the improvements). Printing identification labels at the point of care avoids unnecessary printing costs and errors due to misfiling of labels. Automatic coding of operational procedures provides better data capture and frees up nursing staff from administrative duties. The potential to mistake-proof the surgical journey may reduce the litigation costs to the Hospital / Trust. Return on Investment can be achieved in four months (this calculation is based on the Heart of England NHS Trust business directorate assessment of the system). Installations in a another hospital in the UK indicate that the Safe Surgery System™ can successfully applied at an Endourology Theatre and in Urology and Vascular surgery and could presumably be applied in many more settings.
Results expected?
The product started as an R&D project. Safe Surgery Systems Limited (formally Intelligent Medical Microsystems Ltd) started as a privately funded company out of the Research and Development Unit at Birmingham Heartlands Hospital. Twelve years ago (in 1994) an R&D programme was started in collaboration with several leading universities to develop solutions that used intelligent micro-systems within a healthcare environment.
Success factors
1) The Safe Surgery System™ improves patient safety by mistake-proofing the surgical journey and reducing the opportunity for wrong side, wrong site surgery (WSS). 2) The system provides major cost benefits by reducing exposure to litigation costs and improving theatre efficiency. Safe Surgery Systems™ has been promoted as an example of best practice in the UK’s National Patient Safety Agency’s (NPSA) report “Right patient – Right care”. It forms the basis of a case report illustrating the successful implementation of RFID in the undated Department of Trade and Industry (DTI)/AIM-UK report - “Item-Attendant ICT in Healthcare”
The British Journal of Healthcare Computing & Information Management, 15 February 2005: http://www.bjhcim.co.uk/news/1/2005/n502016.htm
E-Health Insider article, 5 December 2006: http://www.e-health-insider.com/news/2317/heartlands_uses_rfid_for_patient_identification
Heartlands Hospital press release, 6 December 2006: http://www.heartofengland.nhs.uk/templates/Page____6959.aspx
The Guardian, 26 July 2007: http://www.guardian.co.uk/technology/2007/jul/26/epublic.it
CIO: IT Strategien für Manager, 24 January 2008: http://www.cio.de/healthcareit/aktuelles/848162/ (Originally published in Management & Krankenhaus, undated.)
Firm and product: http://www.safesurgerysystems.com/ http://www.safesurgerysystems.com/index.php?page=safe-surgery-system
Languages
English
Organisation implementing
Title
Mr.
Forename
David
Surname
Morgan
Organisation
Birmingham Heartlands Hospital
Department
Ear, Nose and Throat (ENT)
Occupational background
Physician
Address of organisation
Heartlands Hospital Bordesley Green East Birmingham B9 5SS United Kingdom
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