An emergency doctor’s perspective on the impact of 2Go technology for NHS note-keeping
One of the key user productivity enhancements built into the 2Go Universal Mobile Access healthcare software solution which could enable significant time, cost and safety improvements within the NHS is the ease with which doctors can use the voice recognition-based dictation system to capture notes for patient records.
There are many reasons why the implementation of 2Go within the NHS would make sense but time & cost savings are probably the key to gaining rapid adoption within NHS Trusts.
One consultant who has seen the 2Go system in use (a video showing the voice recognition-based dictation process can be viewed here) has recently stated:
I can agree that so far this seems a fantastic idea and a great opportunity for the NHS to improve and modernise its record keeping.
I have treated NHS patients for 12 years as either a dentist or medical doctor. I am dual qualified in both. I currently work as a hospital doctor at the Royal United Hospital Bath.
Dr Adam Radford who works as an Emergency Doctor at the Royal United Hospitals Bath NHS Foundation Trust.
At present we use paper notes in most departments within the hospital. Some fully computerised trusts will use electronic notes. In either case, the doctor has to physically type out or write the notes. This is by far the most single time-consuming part of a patient’s consultation.
I have a good amount of A&E experience and doctors writing patient notes contributes to patient waiting times. I also appreciate the need for notes to be accurate and properly written. For a doctor, the notes are the only thing that can defend you if something untoward happens or if there is a patient complaint.
Good note-keeping also significantly contributes to good patient care and patient safety.
From a medical doctor’s perspective, I can think of the following 6 key reasons to why a voice recognition-based dictation system would potentially be of enormous benefit to NHS clinicians.
1. It would save enormous amounts of time spent writing notes. It can take on average 15-20 minutes to write an average patient’s notes. It can take even 30 minutes to write the notes for a complex patient or one who has multiple issues or complaints. I would estimate that I could write a patient’s notes that would otherwise take me 15 minutes in about 3-4 minutes using a dictation system. We could, therefore, be saving a minimum of 10-15 minutes per patient. This is an estimate based on my experience.
2. Reduces use of medical secretaries. In outpatient clinics, consultants will often use an old-fashioned Dictaphone with voice recording sent to a medical secretary for physical typing of letters. This adds additional time and manpower and cost to patient record keeping and could be significantly reduced.
To put this into context, the latest Reference costs 2017/2018 report produced by NHS Improvement in November 2018 shows that the Unit Cost per FCE (Finished Consultant Episode) just in Acute Services varies according to the type of case as follows:
Table 2: Unit costs by point of delivery Point of delivery | 2015/16 (£) | 2016/17 (£) | 2017/18 (£) |
Day case | 733 | 738 | 742 |
Elective inpatient (excluding excess bed days) | 3,749 | 3,684 | 3,894 |
Non-elective inpatient (excluding excess bed days) | 1,609 | 1,590 | 1,603 |
Excess bed day5 | 306 | 313 | 346 |
Outpatient attendance | 117 | 120 | 125 |
A&E attendance | 138 | 148 | 160 |
From this, it can be seen that a single patient consultation can cost between £125 and £3,894 per day or expressed another way this can vary from £0.09 to £2.70 per minute with an average cost per minute of £0.80
A saving of time which would improve the patient flow of the order of magnitude mentioned above of 10 – 15 minutes per FCE would equate to a cost reduction of between £0.90 to £40.50 per patient per day or on average under £10 per patient per day!
As the same study reveals that in excess of £42 billion was spent in total on Acute Services, we estimate that the deployment of 2Go healthcare software across Acute Services alone could amount to an efficiency saving approaching £300 million a year.
Returning to the consultant’s comments:
3. This would contribute to reduced A&E waiting times and quicker ward reviews of on-call doctors, particularly when, for example, understaffed on weekends or nights. It can be very challenging, and potentially unsafe, trying to get to several unwell patients at the same time. So faster note writing means the quicker you can get to the next unwell patient.
4. Doctors often write notes in a hurry which can lead to mistakes, missed information and poor handwriting. This actually is not a joke, several times I have been called to see an unwell patient and I am unable to ascertain what the patient’s details are due to illegible handwriting.
All these problems would be solved by a well-functioning and easy-to-use the system to capture notes via a voice recognition-based dictation system.
So definite patient safety benefits.
It is difficult to quantify the patient safety improvement without more data but we would argue that any improvement which can be gained in addition to the time and cost savings would be a benefit.
And it is not only the patient’s safety which could be improved as the consultant goes on to state:
5. It is known that keyboards harbour both viruses and bacteria. Staff share keyboards all day long. A voice recognition-based dictation system has great cross-infection control benefits. This is especially important during the Covid-19 pandemic but benefits both a Covid-19 and post-COVID-19 environment.
6. Finally given the current and likely future Covid-19 outbreaks it is a huge benefit to be able to dictate notes without having to remove PPE or share a keyboard with other staff after treating a Covid-19 patient.
The highest risk of contracting Covid-19 for staff is, I believe when PPE is removed.
Reducing the number of PPE removals will reduce time, cost of valuable PPE resources and cross-infection risks. I have been quite shocked at the number of healthcare workers in my trust contracting Covid-19. Anything to reduce this is invaluable.
There are some clear advantages to your proposed healthcare software technology. There are many others in addition to pure time saving from a doctor’s point of view.
I think the best way forward now would be to conduct a small clinical trial in an NHS hospital ward, an A&E department would actually be a great place to start.
Dr Adam Radford MBChB (Hons) BDS(Hons) MJDF RCS (Eng)
Also, to find out more we have created two NHS saving Calculators. One for all NHS Trusts, and another for A&E Departments, so they can see various savings 2 Go Mobile can have within their Trusts and Departments.
