Digital collaboration and task support at Oslo Emergency Clinic

When the Emergency Clinic in Oslo municipality was newly established, they experienced low funding, high staff turnover, high patient complexity, and lack of digital support systems. Using the EPR as the main ICT system did not prove sufficient to solve these challenges. Through the innovation project SamKAD, Oslo Emergency Clinic implemented digital collaboration tools to support work processes and information sharing in the patient journey. The changes in work processes enabled by the technology led to a 20% reduction in personnel costs, increased quality of care and better user experience.

Need for digital collaboration tools complementing the EPR

Oslo municipality established a new service in primary health care called Oslo Emergency clinic (Oslo KAD), which offers acute inpatient care for patients who can be treated by general practitioners and nurses. The goal was to provide better or equal quality of care as in hospitals, and to reduce unnecessary hospital admissions. However, they faced several challenges such as low funding, high staff turnover, high patient complexity, and lack of digital support systems.

Oslo Emergency Clinic relied mainly on electronic patient records (EPR) as their primary ICT support, but these were not designed to support the work processes or the information sharing in the patient journey. A doctor at the clinic pointed out that “It is easy for us doctors to document both interventions and observations. However, for the nurses, knowing that we have written something and finding it later is an entirely different matter.”

They experienced increased risk for patient safety, increased sick leave, and increased complaints from patients, staff, and external partners due to the inadequate work processes and ICT support. “I walk around here with notes in my hand, hoping to find someone to give it to”, a nurse explained about their manual information sharing routines.

Implementing digital decision support and interactive information sharing

Oslo Emergency Clinic initiated an innovation project called SamKAD, in collaboration with SINTEF (Foundation for Industrial and Technical Research) as a research and innovation partner, and DNV Imatis and CSAM Health as technology providers. The project used methods from user-driven innovation and service design to develop new digital solutions that support work processes and decision making at the emergency clinic. The solutions included interactive digital whiteboards, applications for pre-visit and visit, triage, admission, ordering of food and cleaning, assessment of fall risk, functional status and early identification of deteriorated health condition. It also included a daily plan that describes tasks, roles and responsibilities for the staff.

The most important contribution from DNV Imatis in the innovation project was to create solutions that support work processes and provide decision support to staff. Specifically, they helped develop solutions for prioritising doctor visits, displaying capacity overviews, and estimating the care burden on the units.

Great improvements from technology-enabled work process change

The project achieved significant improvements in patient care and patient safety, as well as in work routines and work processes. The solutions enabled real-time communication and information sharing among the staff and with other actors, and
provided task support and decision support for the staff. The project also documented a positive financial gain from the changes in work processes enabled by the technology. The accounting result shows that the Oslo Emergency Clinic improved efficiency by £ 275 000.

The project also achieved all its goals and effects related to better user experience, increased quality, and better resource use:

Better user experience

User surveys show that employees are very satisfied with the new work processes and the technology solution that supports them. They feel that they have increased competence in functional assessment of discharge-ready patients, fall identification, and use of national protocols. In addition, nearly all employees report that the use of DNV Imatis has enhanced efficiency and quality in shift change and reporting.

Increased quality

The project has systematically improved various work processes in the patient pathway. The most important improvements and effects are related to mapping of fall tendency and early identification of the acutely critically ill through NEWS score, which assesses all vital parameters throughout the patient pathway. The solutions that are implemented support a patient safety culture and ensure high quality in work processes across departments and employee groups.

Better use of resources

The project has led to a 20% reduction in personnel costs per patient. This is due to improved time spent on key work processes such as shift report, doctor visit, reception of new patients, collaboration with districts for discharge-ready patients, and collaboration with various logistics functions such as food, switchboard, and cleaning services. Based on all the information that is entered per cost and for all bed posts, a capacity overview per post and total for all bed posts is now generated. This results in new patients being placed where there is available capacity. The solution developed and piloted contains a summary of various variables per patient that indicate total care burden per patient and post. This helps to plan operations and resources more easily. This also provides a completely new opportunity to follow up on the service production at Oslo Emergency Clinic.