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NHS integrates communications improving workflow and wait times

In March 2013, Niagara Health System’s (NHS) St. Catharines Site opened its doors, marking a major milestone in Ontario’s largest hospital integration.
St. Catharines is the largest of six NHS sites, spanning nearly one million square feet.

Though integration and coordination had dramatically improved since the merger in 2000, opportunities to further streamline care, improve performance
and patient satisfaction remained, including frustratingly long wait-times in the Emergency departments.

The hospital leadership had undergone a process to identify barriers to optimal performance, and they included communication breakdowns and poor
processes. The different hospital sites, departments and functions operated as silos, and a focus on enhanced coordination was needed.

Over the course of 2013, leadership undertook a number of steps to improve patient flow and wait times. A cornerstone of this effort was to adopt one
system to improve communications and workflow across the hospital sites.

In summer 2013, NHS selected Connexall as its integrated technology solution. Connexall enables nurses, physicians, porters, housekeeping, coordinators
and other staff, and patients to stay continuously connected through simple wireless devices. The technology has been implemented in over 1,000
organizations globally, demonstrating a reliable track record.

Making the NHS adoption more ambitious was the fact that it was the first health system anywhere to deploy Connexall enterprise-wide – that is, using
this one solution to enable instant communications between multiple functions, departments and hospital sites in a region.

“We didn’t just want to improve flow in one part of the hospital or in one location – our goal was to put tools in the hands of staff in all our sites
in order to integrate care pathways across the region,” says Angela Zangari, NHS Executive Vice President of Finance and Operations. “We felt confident
moving forward with Connexall, and were inspired by the potential to improve our performance.”

Since November 2013, the NHS and Connexall developer, GlobeStar Systems, have rolled out five integrated applications, specifically designed for NHS’
unique clinical needs and physical spaces:

• A Patient Queuing solution in our central registration and ambulatory care areas which has sped up patient registration and eliminated the need for
ill patients to stand in line.

• A Portering solution that automates porter requests, reducing the time nurses and others spend coordinating patient transfers, enabling staff to
better manage their work, and making the patient journey within the hospital faster and smoother.

• A Housekeeping solution. Everyone on the team can see the bed status everywhere in the hospital at all times. Housekeeping staff are notified
immediately to have the vacant room cleaned so we can get the next patient into a bed much more quickly.

• A Telemetry solution. Clinicians receive real-time alarms about medical events such as changes in vital signs through their handheld devices.

• The Nurse Call Notification solution allows patients to directly reach a nurse via a handheld device. This enhances the nurse’s mobility and allows
the patient to receive assistance by way of direct interaction with the nurse.

The results in under a year have been striking.

By compressing the steps in the clinical flow, different sites have been able to move patients from the ER and through the hospital much faster. ER
wait times for patients at the St. Catharines and Welland sites have gone down dramatically with Connexall. The 90th percentile wait time for high
acuity patients at the St. Catharines site was reduced by 44% from September 2013 to August 2014.

In the past it could take nursing on average over 55 minutes for patients to be ready for imaging and transporting. We were able to get the average
time down to below 25 minutes within four months of implementation.

Ms. Zangari says of the improvements, “once we were able to measure what was really going on, inter-professional relationships and job satisfaction
improved. By making information transparent and giving staff greater control over their work, everyone is now able to plan ahead rather than playing
catch up.”

And we are seeing tangible improvements in the patient experience. For example, patients on crutches, women in labour, and frail seniors used to have
to stand in line to get registered for an appointment. Patients now get a ticket upon arrival and can take a seat until their number comes up.
“Patients find the experience much more satisfying and they get to their appointments on time,” says Ms. Zangari. “Productivity has definitely gone up,
as well. We have the same number of employees getting more accomplished in the same amount of time.”

The methodical implementation of Connexall was as important a component to the success as the technology itself. From day one the cross-functional
teams – including nurses, porters, housekeeping staff, registration, Diagnostic Imaging, Lab, Biomedical and ICT – had direct input into the design and
implementation.

For example, it was critical that the EVS/Portering team and nurses led the development of the nursing solutions, as their teamwork is crucial to
Patient Flow. ER and inpatient nurses now have the same information about where each patient is in the hospital and who is attending to them at any
given time, which helps with care coordination.

Physicians have also observed that patient transfers between ER, diagnostic services and inpatient units are much more seamless with Connexall.

Super-users from different departments have a critical ongoing role, supporting new staff to use the system, and identifying adjustments that need to
be made as needs change over time.

One of the workflow innovations that the NHS team is developing will be to perform tasks concurrently that used to be done sequentially. For example,
bed/room cleaning will be concurrent with patient placement, movement and transfer of accountability.

Hospitals tend to only get the patient ready for transfer once a room has been cleaned. At NHS, viewing these activities simultaneously ensures that
the patient arrives as the room clean process is completed, saving precious time.

Another critical success factor was having members of the Connexall team partnering with the NHS ICT team to work with internal stakeholders to
understand business needs and develop a robust and sustainable system.

Having the technical experts from Connexall on the ground, working hands-on with hospital staff enabled us to design a solution that is tailor-made for
our population, services, geography and facilities at each site.

Staff and managers are already thinking of ways to further harness this solution to improve how they do their work, such as using the queuing system in
the ED.

Dr. Suzanne Johnston, NHS President, notes “being first in Canada with a comprehensive solution is impressive from a technology perspective, but even
more so from the perspective of creating the best possible patient experience. The Connexall implementation is much more than an IM-IT project, it has
promoted significant cross-functional operational teamwork. It is really part of a cultural change that’s underway at NHS.”

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