Cath Labs

LABYRINTH SOFTWARE; PERFORMING IN THE REAL WORLD

A report on 18 months’ use of Labyrinth in the Cath Labs at Guy’s and St Thomas’

Background

Labyrinth software schedules and tracks the patient pathway through any medical department where patients pass through a number of tests, stages, sub-stages and interventional procedures. The first version was developed in conjunction with Cath Lab teams at leading London Hospitals and was installed at Guy’s and St Thomas’ NHS Foundation Trust (GSTT). GSTT has 5 Cath Labs receiving patients from 5 cardiac wards and performing a range of procedures covering Interventional, Electrophysiology and Device Implantation.

Labyrinth uses a dashboard screen where patients are shown in rows and procedures are shown in columns. As patients move through the various stages, staff record their progress with a click. The information on screen is continually updated throughout the day. Individual team members can select the view that shows the information they need. Some concentrate on a particular ward, lab or procedure whilst others can see the bigger picture and keep an eye on all patients going through the unit. Now, after 18 months and well over 12,000 procedures, it’s time to ask how the system has performed and whether or not it has lived up to expectations.

Ease of Use

The system was designed to be easy to learn and use and this has proved to be the case. Staff need only 15 minutes training. Each day’s list is loaded directly from Tomcat the night before, which means the Lab Co-ordinator no longer has to come in early. Then the patient’s progress through the system is logged with a simple click, as opposed to filling in multiple data fields - and this action simultaneously captures data for audit purposes.

"It used to take the first 30 minutes of the day to prepare the day’s list, posting a manual list outside each of the Labs. As priorities changed through the day, things would get crossed out and moved about and it was very difficult to understand the overall picture. "Now we come in and the list has been preloaded. All staff immediately have a clear picture of the workload. As we move through the day, we can instantly see what is happening in each Lab. We can move patients across the Labs at the click of a button, to share the workload.It is 'user-friendly' and has definitely cut down on the amount of legwork. It has freed a person up for clinical work within the Labs." Nursing Manager

Improved Communication. Improved Co-ordination

Labyrinth improves communication in two main ways. Firstly, when a staff member records that a given stage has been completed, this information is immediately sent to everyone who needs to know. They don’t have to go and tell them. Secondly, the information that staff members need appears on the screen in front of them. They don’t have to go and ask. This has brought some valuable benefits. It eliminates the need to run around chasing or transmitting information to multiple MDT members, so stress within the unit is reduced. Team members can concentrate on the job in hand without being interrupted for updates. In fact at GSTT the lab co-ordinator is now able to contribute to clinical work.

"Before Labyrinth, we had to call the Ward in order to find out if a person had been admitted, clerked, had blood tests, or anything else we needed to know. Now it’s all displayed in front of us in one place on the screen."  Radiologist

Reporting

A reporting function was built into Labyrinth from the start. This had two purposes; firstly, to produce information for audit purposes and secondly to analyse utilisation of the labs and pinpoint causes of cancellations or delays. This in turn would enable the team to improve processes and test how well those improvements worked in practise. “The information is there whenever you need it, consequently more can be done with it.” Cardiac Radiology Manager

The team at GSTT have found Labyrinth a marked improvement over the paper-based systems they were using before. All data is recorded in real time, as the staff go about their normal work - and this brings three major benefits. There is little chance of data being lost. The information available is always up to date. And there is no time spent manually inputting data for audit purposes. This saves the Head of Radiology around 3 days of time per month.

This is an example report which displays a count of delays by reason for the year to date

Patients on research trials are clearly identified and their treatments can be audited separately as required. Labyrinth records radiation dosage entered by the radiographer and collated in the reporting module. This makes it easier to both monitor current practice and agree Local Dose Reference Levels complying with Ionising Radiation (Medical Exposure) Regulations. It used to take a member of the radiology team two weeks every three months to collate this data by hand. The raw data produced by Labyrinth can be analysed to produce reports on any aspect of the unit’s operation e.g. utilisation, cancellations or delays. This data can be broken down further into any combination of appointments, labs, wards, procedures and periods of time. It’s not just that the information is available; the team can do more with it, learning more about the operation of their unit than ever before.

Improving Processes

Any changes to processes in one area may impact on others. In the past, knock on effects might take months to appear in the audit data. With Labyrinth, reports are available immediately. The information/evidence produced by Labyrinth has already led to a number of improvements. For instance, Labyrinth logs the opening and closing time of each lab. It became evident that one particular lab was regularly finishing late but on those days it also started late. They could see that all the patients were arriving as scheduled therefore the cause of delay was the time it took to prepare patients. They focussed staff attention on getting a particular group of patients ready quickly in the morning, streamlining processes and the lab in question is regularly starting and finishing on time.

Summary

Labyrinth has succeeded in its stated aims of freeing clinical staff for clinical work, reducing the time spent collecting and auditing data and has contributed to an increased efficiency of the Cath Labs at GSTT. In fact the team would say that the system has exceeded their expectations.