143 Separating wood from the trees. Analysing regional variation by systematic collection and assessment of paper forms used in Northern Ireland healthcare

Encompass is a regional transformation introducing an electronic healthcare record across Health and Social Care in Northern Ireland (HSCNI). This technological advance requires thorough understanding of all aspects of HSCNI. The build of encompass will be guided by clinical staff in the role of subject matter experts aligning diverse processes across trusts to one way of accessing care for all citizens. Our project collected all paper forms used across HSCNI, this forms foundation for standardisation of future healthcare and resulted in collection of over 10,000 paper forms. These forms were collected centrally, catalogued and documented onto a database. This database was populated using a 5 stage protocol for the purpose of collating, assessing, documenting, removing duplication and analysis. Forms collected exhibited evidence of significant duplication and variation. Dissemination of this learning will promote significant quality and efficiency improvement. Initial stakeholder engagement took place prior to collection of forms in partnership with clinical staff, analysis by the encompass team took place including protocol design with regional clinical experts and staff training. Final results from the form collection showed almost 4,000 unique forms, after de-duplication. This triggered a further project currently underway, cataloguing data elements from every form to allow a strategic method of standardisation. The benefits of standardisation envisaged are increased efficiency, patient care and patient safety. Collating all paper forms was no small task and the mammoth effort undertaken by all cannot be understated. Our experience shows that there is significant variation in many areas, different forms generated in different trusts by different clinicians generate significant variation across a small region. We encourage healthcare professionals to standardise as much as possible through personalised efforts like this to continually drive improvement.