Digitising the Acute Medical Take at Withybush Hospital
30–60 minutes saved per clinician per shift
Setting: Withybush General Hospital, Hywel Dda University Health Board (NHS Wales)
Period: 18-month co-created pilot and research project
Source: Safety Stream presentation, Dr S. Nagasayi; BMJ IHI Conference, London 2024
The problem
The acute medical take is the highest-volume admission pathway in any NHS hospital. At Withybush it ran on paper. Handover sheets were physical documents — loseable, unreadable, out of date by the time they reached the next shift. Referrals required phone calls, bleeps and hand-delivered slips. Junior doctors had no remote oversight. Flow coordinators spent their time chasing information instead of managing patients.
What changed
Paper was replaced with CAREFUL. Both smartphone and desktop versions were deployed across the medical take. A&E and SDEC referrals moved to digital. Specialty referrals were configured for cardiology, gastroenterology, frailty, respiratory and stroke. Visible dashboards showed teams, frailty scores, preferred wards and clerking status.
Results
Clinicians independently presented outcomes at peer-review forums:
- 30–60 minutes saved per doctor per shift on communication and coordination tasks
- 50% reduction in the number of patients waiting in the ED — achieved within four weeks
- 24-hour remote oversight of the take and referrals, enabling more efficient junior doctor supervision
- Improved medication communication flagged as a significant safety gain
- 100% of surveyed staff reported improved safety
- 91.4% reported positive impact on within-team communication
What clinicians said
"CAREFUL as a digital tool has enabled us to take ownership of and bring about effective changes to our medical take process in an NHS district general hospital. I would recommend this product and the team to anyone else who wish to improve teamwork and hence patient safety."
— Dr S. Nagasayi, Consultant in Acute and Stroke Medicine