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The Royal Hobart Hospital (RHH) turned to Medtasker to tackle one of its most acute problems – access block and patient flow out of its Emergency Department (ED). Medtasker secure, mobile task management technology instantly streamlined clinical communication between the ED and inpatient hospital teams, reducing referral time, doctor workload and medico-legal risk. And the hospital management quickly identified and addressed major hospital communication and tasking inefficiencies, expanding the solution beyond the emergency department.

Outdated communication pathways, inefficient workflows, and growing demand for public hospital care reached a critical point in the RHH Emergency Department in 2019. An accumulation of issues leading to 93% access block and ramping of 13.5% of ED presentations resulted in several near misses, posing a significant medico-legal risk.

The imperative to implement Medtasker in the RHH emergency department came directly from the Premier’s office. It called for a solution to be deployed rapidly, integrated with existing systems, and easily scaled across all departments to streamline collaboration between the ED and inpatient teams. In addition, Tasmanian Health Service leadership wanted visibility of auditable data for better resource planning.

Medtasker implementation delivered transformational results for RHH Emergency Department doctors, patients and hospital management. The new mobile technology enabled ED doctors to communicate directly with the right person on inpatient teams, manage their workload better and never miss a task with clear escalation pathways and automated shift handover. It also minimised phone interruptions and distractions, improving patient outcomes, doctor well-being, and hospital efficiency while reducing medico-legal risk.

A perfect storm
The Royal Hobart Hospital supports around 250,000 Tasmanians in the southern region with acute, sub-acute, mental health, and aged care inpatient and ambulatory services. It also handles more than 60,000 Emergency Department presentations annually.

In 2019, the Auditor-General of Tasmania reported that emergency departments across the state were in crisis. As the largest hospital and a major referral centre in southern Tasmania, the RHH Emergency Department became the state’s priority.

  • ED presentations had increased by 34.3% since 2009-10 – more than twice the statewide average.
  • The incidence of ramping as a percentage of ED presentations had risen steadily to 13.5% in 2017-18.
  • While ED waiting times were consistently below the 4-hour target between 2009 and 2018, the rate of adverse events per 1,000 ED presentations more than doubled during 2015-2018.
  • There were significant access block issues 93% of the time in the seven months to 24 January 2019.
  • Patient safety was severely and routinely compromised on average once every four days.

It was a perfect storm that had been building for many years. An ageing and ailing population and a shortage of bulk-billing doctors contributed to a growing demand for public hospital and emergency department care. At the same time, capacity constraints combined with outdated communication pathways and inefficient workflows hampered efforts to deal with this increased demand.

Dysfunctional emergency department referral system adds to access block

Royal Hobart Hospital lacked streamlined processes for initiating and communicating referrals of patients out of the emergency department. Instead, the workflow relied on ED staff calling inpatient teams via an under-resourced switchboard. Often, calls to the switchboard were answered after a delay, followed by a further delay if the switchboard tried to connect with a registrar who was engaged in clinical activities and unable to receive calls. Sometimes, the switchboard, relying on inaccurate paper-based rosters, called the wrong registrar, with the error realised only when the ED received their callback.

Upon getting a verbal referral from the Emergency Department, a busy registrar might handwrite the details on a scrap of paper. Then if a backlog of tasks prevented action, the registrar might give the handwritten note or a verbal summary to a colleague on the next shift. As a workaround, ED staff would often send an SMS or WhatsApp message to the registrar, who would enter the details into an access database or Excel spreadsheet in the cloud, which other team members could access.

The bottom line is that this communication inconsistency created an ad hoc system – a major barrier to efficient patient flow – and increased the risk of delayed or missed care.

Enter Medtasker: streamlined collaboration and communication

In response to the Auditor-General’s Report, Tasmania’s Minister for Health announced a plan which included immediate short-term action to improve data access and streamline collaboration and communication between departments at the Royal Hobart Hospital. Subsequently, in December 2019, the Tasmanian Health Service signed a contract to implement Medtasker.

As a standalone solution, Medtasker was an ideal option for RHH. It could be implemented quickly, integrated seamlessly with legacy systems, and configured to complement existing hospital processes and operations.

RHH opted for a staged rollout of Medtasker. In anticipation of increased bed demand due to the COVID-19 pandemic, the rollout commenced in March 2020, one month ahead of schedule, with Emergency Department referrals to core admitting teams: General Medicine, General Surgery, Paediatrics, and Obstetrics and Gynaecology. In addition, the Medtasker Base, Clinical Day Team and Clinical After-Hours modules were combined to facilitate patient referrals to these teams at all hours, even when staff were off-site.

Next, Medtasker was rolled out to all other admitting teams, allowing them to receive Emergency Department referrals when on-site. Critically, the Theatre functionality enabled a more efficient and safer referral process of ED patients directly to the Perioperative Suite. And with the deployment of the Pharmacy module, ED staff could also refer patients for a medication review as soon as they were admitted in the PAS.

The final rollout stage involved Clinical After-Hours referrals from the Emergency Department to all remaining teams, completing the implementation of a Hospital at Night model of care in October 2020.

What is Medtasker?

Medtasker, is a fully integrated mobile hospital task management, communication and collaboration platform purpose-designed to streamline hospital task management and communication. Hospital teams can use the secure Medtasker application, deployed on mobile phones, tablets or desktops, to perform patient-related tasks efficiently. With Medtasker, important information is securely delivered to the right person every time, improving patient safety, hospital efficiency and doctors’ well-being while reducing medico-legal risk.

A transformed emergency department referral system improves patient flow and outcomes

By using Medtasker to take on the most complex challenge first—Emergency Department referrals—the Royal Hobart Hospital was able to quickly address inefficiencies contributing to the access block crisis and improve patient flow. Medtasker’s task management capability provided much-needed visibility of patients’ journeys.

“It’s absolutely brilliant. The rollout has been seamless. As well as improving patient flow and efficiency within our Emergency Department, Medtasker’s simple usability has enabled employees to adapt quickly to the new communication system. Our medical staff enjoy greater visibility to patient referrals and more streamlined collaboration between departments within the hospital. I couldn’t be happier.”

– Dr Paul MacIntyre, Clinical Director of Acute Medical Services

Direct clinical communication enhances clinical workload management

Using Medtasker’s unique on-duty directory, Emergency Department staff can now bypass the switchboard and use up-to-date electronic rosters to identify and communicate directly with the right clinician the first time.

Doctors can manage their workloads better, even when inundated with cases. The tasking and messaging capabilities within Medtasker enable them to focus on current clinical work and avoid frequent phone interruptions. This is particularly useful after hours when staffing levels are low.

Specialty teams, like Cardiology, Respiratory, Obstetrics and Gynaecology, appreciate the opportunity to concurrently manage referrals, consults, and other tasks and contact ED at their convenience. Similarly, surgeons can review and prioritise referrals once they’ve finished in theatre, then respond at their discretion – by texting, calling or attending the ED in person.

At the end of a shift, Medtasker automatically forwards outstanding tasks and all related messaging to the next person in the role. Any delays in task activity are flagged and progressed more efficiently through clearer escalation pathways, ensuring no patient or task is overlooked.

“Some other solutions in the marketplace offer messaging as a side functionality. But clinical tasking and communication is Medtasker’s core business, and it does it well.”

– Dr Joshua Power, Emergency Physician, Royal Hobart Hospital

Data analytics helps hospital executives to boost hospital efficiency

Access to Medtasker’s data and its in-built reporting capabilities provides new insights for health organisations. For example, metrics around task numbers, timing and urgency, and team responsiveness provide visualisation of patient flow activity, making it easier to identify bottlenecks in service provision and workforce planning requirements.
Royal Hobart Hospital used these analytics to inform changes in its rostering of registrars, targeting resources and rebalancing workloads to improve the timeliness of patient care.

Harmony between emergency department and inpatient teams goes a long way

The emergency department can be a high-stress environment. When workflow and referrals are significantly obstructed, the patience of ED staff can be tested, putting pressure on relationships with other inpatient teams.
However, since Medtasker’s implementation, the emergency department director at Royal Hobart Hospital has received fewer complaints about unprofessional interactions and disputed referrals. The date and time stamps on all Medtasker communications have added transparency to the ED referral process. RHH now uses Medtasker to track and report on date- and time-stamped task activity, leveraging the insights of its fully auditable communication trail.
For hospital management, Medtasker represents a valuable tool for relieving pressure by quickly settling referral disputes and encouraging courteous communication.

“We’ve seen real improvements in the emergency department access block. While I don’t have the data to say how much of that is attributable to Medtasker, it certainly made a lot of difference. In a hospital with a lot of legacy technology and models of care, it’s proven to be a real vehicle for change, which is fantastic.”

– Dr Joshua Power, Emergency Physician, Royal Hobart Hospital

Final thoughts

In helping to alleviate the Emergency Department referral crisis at the Royal Hobart Hospital, Medtasker technology has significantly impacted clinical teams, hospital management and population health outcomes in southern Tasmania in a positive way.

However, only 25% of health services across Australia and New Zealand utilise electronic or mobile task management systems. As a result, 75% of hospitals in the region struggle with the same challenges caused by the same factors: outdated clinical communication, inefficient workflows and limited visibility of auditable data and analytics.
This story demonstrates how the right mobile hospital task management and collaboration solution can make a measurable difference to struggling emergency departments and under-resourced hospitals, improving patient outcomes, clinical workflows and doctors’ well-being while reducing medico-legal risk.

The resulting cost savings in hospital resource utilisation are just a multi-million dollar bonus.

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