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Imperial College selects Alfresco Process Services for research project to Improve Collaboration and Communication Amongst Clinical Teams

The Imperial College Centre for Health Policy, led by Lord Darzi has a vision to catalyse the development, uptake and diffusion of innovative, evidence-based policy around the world. The work of its patient safety research programme at Imperial College London seeks to use research findings to design clinical implementation strategies aimed at improving outcomes in patients. Allied with the Centre for Health Policy the Vascular Unit at Imperial College Healthcare NHS Trust, based across Hammersmith, St Mary’s and Charing Cross hospitals, provides a full range of investigations, treatments and management for cardiovascular conditions and is a National Centre for the treatment of complex aortic disease.


The group examines the foundations of inefficiency and error that occur in modern day healthcare. One research stream suggests that many of these may be prevented given adequate, timely planning and, above all more effective team communication throughout the care pathway.

Patients’ experience of care is often typified by a long and complex preoperative course, which currently requires the logging of case notes and test results from a number of disparate clinical paper and electronic systems - sometimes remote from the central hub. This disjointed practice has been shown to result in the real risk of patient data (clinical results) being unnoticed when clinical decisions are made and, in extreme cases, can mean that critical information is either uncovered as late as the day of admission for surgery or missed entirely. The subsequent effect on the care pathway and treatment delay is not only inefficient for healthcare services, but often results in frustration for all involved, a loss of confidence by these high-risk patients and, occasionally, harm.


Realising a need to improve communication, standardise the patient pathway and monitor patient progress, the research group set out to test the implementation of a software-based intervention on a checklist system, to reduce pathway inefficiencies and intraoperative error occurrence.

With funding awarded by the NIHR Imperial Biomedical Research Centre (BRC), the research unit at St. Mary’s Hospital carried out a series of investigations into both collaborative and workflow software before opting to pilot Alfresco’s Activiti workflow solution in early 2015.

Activiti is a collaborative, cross-platform Business Process Management (BPM) application where its graphical editor was programmed by the lead researcher to offer a step-based workflow that covers the entire complex preoperative patient pathway. All documentation, including case notes and test results, are aggregated within the system from multiple sources and shared among all members of the vascular multi-disciplinary team. 


The unit is conducting a pilot study of this solution on a small sample of elective patients with aortic pathology at St Mary’s Hospital, where a large number of the most complex and high-risk patients are treated every year. The research project secondarily intends to uncover and quantify the efficiency savings and improvements in quality that this approach may obtain.

Using Alfresco Activiti, all members of the vascular multidisciplinary team are able to aggregate and share all records relating to each patient quickly and efficiently. It is expected that the solution will dramatically improve communication channels whilst minimising the risks of missed patient data. 

Lead Consultant, Colin Bicknell said “Patients with arterial pathology undergoing surgery are at significantly high risk, and this is compounded when the presurgical pathway is lengthy and complex. In our recent national project surveying the landscape of error in aortic procedures, we catalogued the main sources to be due to team communication and equipment shortcomings.”

Dean Godfrey, the Researcher & Surgical Trainee conducting the study, said “The aortic procedure care pathway is very lengthy and can be complex, but now that it is represented graphically in Activiti I can simply modify it to keep up to date with any identified improvements.”

Dave Taylor, the Research Project Manager responsible for introducing Activiti to the team, said “I had been considering the use of collaboration software such as SharePoint when I learned about Activiti. I was able to quickly implement our own cloud-based version and use the BPMN Editor to model the care pathway. I believe this approach will work with any medical specialty and can be modified by a clinical team themselves, so as to incorporate the specifics of their own practice which often vary between individual consultants.”  

From a medico-legal aspect, the software also helps to safeguard clinicians and allows teams to review patient cases more frequently during their progress towards surgery, by providing a broader perspective and more detail on patient history and documenting details of each decision taken during the journey. 


"I had been considering the use of collaboration software, such as SharePoint, when I learned about Alfresco Activiti. With Activiti, I was able to quickly implement our own cloud-based version and use the BPMN Editor to model the care pathway."

— Dave Taylor, Research Project Manager at Imperial College London