Streams in NHS hospitals
Streams is a secure mobile phone app that aims to address what clinicians call “failure to rescue” – when the right nurse or doctor doesn’t get to the right patient in time. Each year, many thousands of people in UK hospitals die preventably from conditions like sepsis and acute kidney injury, because the warning signs aren't picked up and acted on in time.
We built Streams in close collaboration with nurses and doctors to help address this problem. The app brings together important medical information, like patients’ blood test results, in one place, allowing clinicians at our partner hospitals to spot serious issues while they are on the move. If one is found, Streams can send an urgent secure smartphone alert to the right clinician to help, along with information about previous conditions so they can make an immediate diagnosis. Streams can also allow clinicians to instantly review their patients’ vital signs, like their heart rate and their blood pressure, as well as to record these observations straight into the app. To make all of this possible, Streams integrates different types of data and test results from a range of existing IT systems used by the hospital.
Within a few weeks of Streams being deployed at the Royal Free, where it sends secure alerts and allows clinicians to review their patients’ test results, nurses said that it was saving them up to two hours each day, and we've already heard examples of patients with serious conditions, like Afia Ahmed, who was seen more quickly thanks to the instant alerts. A peer-reviewed service evaluation to measure the overall impact will follow.
Listen to Sarah Stanley, consultant nurse at the Royal Free London NHS Foundation Trust, talk about the impact Streams is having on her day-to-day work and on the wards below.
Streams now and in the future
Streams is currently only in use at the Royal Free, and will be made available to clinicians at Imperial College Healthcare NHS Trust, Taunton and Somerset NHS Foundation Trust and Yeovil District Hospital NHS Foundation Trust in due course.
At the Royal Free, Streams is primarily used to help clinicians better identify and treat acute kidney injury (AKI) – a condition linked to 40,000 deaths in the UK every year, a quarter of which NHS England estimates are preventable. It is a condition that costs the NHS over £1 billion – greater than the annual cost of treating breast cancer.
The app is officially registered with the national Medicines and Healthcare products Regulatory Agency (MHRA).
We're continuing to develop Streams to include alerts for more avoidable conditions, including sepsis and other organ failure, as well as developing technology that allows clinicians to instantly review their patients’ vital signs and record these observations directly into the app. We're also incorporating features that help clinicians to securely assign and communicate about clinical tasks, replacing outdated systems like phone, paper, pagers and fax machines.
The human cost of AKI
Michael Wise developed the most serious type of AKI, underwent dialysis and ended up receiving a kidney transplant. Streams works towards helping prevent stories like Michael's, by analysing blood test results in real-time and escalating results with potential risks immediately to a device in the hands of the specialist who can administer care.
We're delighted to be hearing some early encouraging feedback from the use of Streams at the Royal Free. The Evening Standard wrote about one patient who received faster care for a life-threatening condition, thanks to Streams. You can read her story here.
Building Streams responsibly
We’ve built Streams in close partnership with NHS clinicians, and we're holding ourselves to the highest standards of security and oversight. That includes building a leading audit infrastructure that will give our partners real-time visibility on how we’re processing data. We're also working with digital product studio ustwo to bring the very best of user-centric design techniques to the field.
We also hope that Streams can help unlock the next wave of innovation in the NHS. The infrastructure that powers Streams is built on state-of-the-art open and interoperable standards, known as FHIR. The FHIR standard is supported in the UK by NHS Digital, NHS England and the INTEROPen group. This should allow our partner trusts to work more easily with other developers, helping them bring many more new innovations to the clinical frontlines.