Implementation in the Cath Labs at Guy's St Thomas' Hospital
"Some staff were a bit apprehensive at first. But now, there’s no way that any of us would go back to the old system."
Senior Staff Nurse
Cath Labs, Guy's St Thomas' Hospital
Background
Labyrinth software was designed to track 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) in October 2009. 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 memberscan select the view that shows the information they need; so 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 6 months and over 2,000 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. Now we come in and it has been preloaded into Labyrinth. All staff immediately have a clear picture of the day’s workload.” (Deputy 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. “It saves a lot of time. Whoever is co-ordinating used to spend all day outside the labs, running around between the labs and wards. Now they are free to spend time back inside the labs where they are just a point of contact for any
changes to the list.” (Lab Co-ordinator)
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 3 days per month.
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 streamlining processes by getting a particular group of patients ready quickly in the morning 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, in most respects, the system has exceeded their expectations. “It's well worth it. I don’t want to go back to paper co-ordination, it’s a much more efficient way of working.”
(Deputy Nursing Manager)
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