Check-ER- Emergency Trolley Checking Application

Aim

To achieve and sustain greater than 95-100% compliance in emergency trolley checks while eliminating missed and expired equipment.

Outcomes

• Significant increase in Code trolley Compliance
• Reduction in the occurrence of adverse outcomes via Riskman/Incident management system
• Increased visibility of checks performed/not performed
• Provide real time reporting to support quality improvement and accreditation monitoring
• Visibility of expiry dates and when items expire
• Photos of items in the trolley for easy recognition
• Ability to knowledge share across the state

Background

Currently across the state there is no automated way to perform trolley checks within clinical areas. Current processes are manual, time-consuming processes are often missed or incorrect. The risk associated with this is missed or incomplete checks, delayed identification of expired goods, no real time escalation process and significant administrative burden of compiling and calculating compliance percentage. This requirement is reportable through accreditation in which DDH is expected to be 100% compliant with their trolley checks. The Emergency Department (ED) is currently sitting at 50%-60 compliance.

Automation of this process into an ICT developed application would mean a more streamlined, and user-friendly experience for clinicians. By building reminder and noncompliance reminders to relevant team leads, this is a necessary measure to ensure that all required checks are completed before the end of the shift. The central problem statement was how can we create a reliable, transparent and sustainable system to always ensure emergency trolley readiness.

This requirement has a direct impact on client safety and time to deliver care. If the checks are not performed, and a Code Blue/Emergency is in progress there is a significant risk that the required medical equipment is not on the trolley because the checks have not been carried out. The ED trolleys are of a more complex stock make, and hence an ideal trial site to begin this application. The need for a digitally enabled, accountable system aligned with NSQHS standards and Darling Downs Health priorities of delivery of care and safe environments.

Discussion

It was necessary to test this application in an unpredictable and complex situation to ensure its durability and to achieve outcomes prior to trialling it in other clinical areas. The decision to make the Emergency Department the pilot site was due to the frequency the trolley needs to be checked and how often the equipment is used, which is often more than once a day. Embedding Check-ER into existing priorities was critical.

Rather than adding additional administrative and clinical tasks, the system replaced the paper process and reduced duplication. Real time dashboards provided transparency to Nurse Managers and leaders across the trial sites- shifting compliance monitoring from retrospective auditing to proactive risk management. Several key lessons were learned. Any change in any capacity should be designed collaboratively engaging with clinicians to ensure this is not another thing they have to check off their lists and embed the importance of transparency and visibility.

Simplicity is a key component here also, ensuring the application has simple effective features such as photos of each item for easy recognition and expiry dates entered. Limitations include strong reliance on stable digital infrastructure and device access. Facilities with limited connectivity may require infrastructure support prior to implementations. However, the device will save as you go so relocating to an area with connectivity should allow you to still enter the complete audit. Data accuracy does remain dependent on honest user input, although mandatory completion fields reduce incomplete submissions.

Check-ER has strong scalability potential across Queensland Health. Any clinical environment using Emergency trolleys/Code Trolleys would benefit this includes rural and urban settings. The adaptability of this application across other checks is also possible- not excluding back of bay, resus bay, ICU bay and room checks. Check-ER demonstrates that digitally enabled, governance aligned solutions can sustainably reduce risk and strengthen preparedness across Queensland Health sites.