99 Digitising an integrated care pathway to deliver consistent high-quality clinical care

Abstract

<h3>Background</h3> The Neurodisability Movement Disorder Service was using a paper Integrated Care Pathway (ICP) to safely administer Botulinum toxin injections. GOSH’s transition to one Electronic Patient Record (EPR) provides opportunity to digitise ICPs, delivering multiple benefits. The Clinical Pathway Redesign Programme prioritises resource allocation to projects that improve quality of care, data collection, child &amp; family experience, staff experience, efficiency and productivity. The first project resourced was the Intramuscular Botulinum Toxin A Injection ICP. This project was selected because the Service were early adopters, recognising digitisation advantages. The existing ICP mirrored others in the Trust and could provide a template. The Service had experienced communication issues secondary to using a dual paper/electronic system and wanted to minimise risk. <h3>Methods</h3> Three clinicians allocated one hour fortnightly to engage with Transformation Project Manager/Electronic Patient Record configuration analysts to design a digital ICP solution. The first stage involved scoping which ICP stages were already digitised (Epic) and which remained paper-based. <h3>Results</h3> After 7 months’ collaboration, new EPR functionalities were tested and demonstrated to clinicians, with go-live on 28^th April 2021. 51 children have utilised the ICP, with improved clinical outcomes. <h3>Discussion</h3> The digital ICP embedded in Epic ensures all clinical information is readily available to the multidisciplinary team across locations. It consolidates safety checks, records joint working with local teams and provides research data to optimise outcomes. The dose calculation sheet/pre admit order set remain in development, due to muscle dose calculation complexity. Difficulties arose in translating clinical/technical knowledge between clinicians, project manager and EPR staff, and finding clinical time to trial ICP processes. Consent for toxin injections remains on paper currently. <h3>Conclusion</h3> Digitising the ICP has been an innovative project, demonstrating effective joint working between Clinical, Transformation and EPR staff to optimise patient care.