Digital Dictation Project Pam Green Data Quality Manager
Business Case Improve the quality and efficiency of clinical correspondence to benefit patient care Digital dictation is a key enabler to support the review Standardise turnaround time for transcription across specialties, with the aim to reduce this to 48 hours Ensure clinical correspondence is accessible for the Clinician at each patient contact
Original Structure Division of Medicine Division of Surgery Division of Muskulskeletal Consultant Consultant Consultant Consultant Consultant Consultant Consultant Consultant Consultant
New Structure Clinical Support Division PA Co-Ordinator Medicine PA Co-Ordinator Surgery PA Co-Ordinator Muskuloskeletal PA Co-Ordinator Support Secretaries PAs (Each working for multiple Consultants) PAs (Each working for multiple Consultants) PAs (Each working for multiple Consultants) Pool Typists Medicine Pool Typists Surgery Pool Typists Muskuloskeletal
Implementation - Pilot Small pilot in ENT - 8 months System used in clinics, wards, theatres Portable and static dictation devices System used by Consultants, Registrars, Secretaries Pilot Area Review Positive feedback from all users
Implementation Roll Out Users identified Authors 300 Secretaries 140 Administrators 5 Hardware Static devices 200 Portable devices 100 Foot pedals & headsets 150 Roll Out Roll out by Speciality (Jun/Jul 09) MSK Specialist Surgery General Surgery Anaesthetics Medicine Obs & Gynae Paediatrics
Training Training sessions planned over 8 weeks ½ hour for Authors 1 hour for typists Training sessions delivered via Classroom sessions 1-1 sessions for Clinicians Training in outpatient clinics in the live system with immediate Go Live support
Title: Site/Type/Patient Name/ ID
Dictation is typed in order of Priority Due by Clinic date Letters are typed directly into the Electronic Patient Record
Lessons Learnt What went well? Involvement of key stakeholders Divisions, PA Co- Ordinators and IM&T Flexible training Deadlines set to remove analogue dictaphones which enforced training Train secretaries first so they encourage their Consultants to undertake training Clear documentation of Operational Processes, Roles & Responsibilities which were communicated to users prior to implementation and enforced this during roll out Consistent approach to naming convention of the dictation files
Lessons Learnt What didn t go well? Roll out plan could not be adhered to due to annual leave and some reluctance amongst Clinicians this extended the roll out by 8 weeks Clinicians abused the use of high priority status and avoided allocating dictation to the typing pool this was managed via system reports Issues with the technology single sign on, volume settings, user settings
Where are we today? No analogue tapes in use 466 Users 17,000+ dictations created per month Transcription timescales reduced to within 1 week for the majority of specialties
Number of dictations Digital Dictation Created last month Total 17,243 2500 2000 1500 1000 500 0 Anaesthetics/Pain Breast Cardiology Colorectal Community Paediatrics Dermatology Diabetes Elderley Care Emergency Care ENT Foot & Ankle Gastrology General Surgery Haematology Histopathology Lower Limb Neurology Obstetrics & Gyneacology Oncology Ophthalmology Oral Surgery Paediatrics Palliative Care Respiratory Rheumatology Upper Limb Urology Vascular
Benefits Financial saving on secretarial resources temporary staff no longer required Ability to flex workload across site boundaries Reduce turnaround timescales on transcription across all specialties Single sign on High priority or due by dictations are flagged and dealt with within timescales
Benefits Improved quality of the audio playback Can contact a colleague to listen to dictation at the point of query Quickly identify individual patient dictations to respond to queries Reports readily available eg. to assess secretarial performance, assess authors allocation of priority and assess volume of dictation created
Next Steps Integration to WWL EPR Voice Recognition
Pam.green@wwl.nhs.uk Tom.allen@bighand.com