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Liverpool Women's NHS Foundation Trust Customer Story

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Streamlining Emergency Care at Liverpool Women’s NHS Foundation Trust


Liverpool Women’s NHS Foundation Trust is one of only two hospitals in the UK dedicated to the care and treatment of women and their families. Home to world-class specialist services units in gynecology, reproductive medicine, and genetics, it is the largest hospital of its kind in Europe. Delivering approximately 8500 babies a year, Liverpool Women’s is an internationally-recognised center of excellence for maternity and neonatal services and works in close coordination with The Hewitt Fertility Centre.

According to the recently published results of its Digital Maturity Self-Assessment, the Liverpool Women’s attained the highest result among NHS Trusts for its level of infrastructure, at 100%, and 99% for its state of readiness. 


Prior to the creation of Activiti supported e-forms, nurses responding to emergency telephone calls relied on completing hand written paper triage forms as a record of the call. When the patient was advised to attend, the forms were then hand-delivered to the Emergency Room staff to await the patient’s arrival.

Without a clear, consistent flow of questions and alert systems in place, triage staff were using

a free text format paper form that provided no pathway direction for the patient care and had no immediate access to a patient’s treatment record. As a result, patients could be advised to attend emergency consultations which may have been unnecessary and consequently, although the Trust achieved 95% compliance with the 4-hour targets for Emergency Room treatment, there was a potentially delayed pathway as clinicians were unable to quickly see the data collected prior to the patient’s arrival.

The collection of the data on paper forms across all scenarios meant that records were still being produced that needed to be scanned into the system. In addition, staff had the task of manually counting hundreds of commissioning returns each month in order to process and receive additional revenue reflecting the hospital’s activity. David Walliker, the CIO at Liverpool Women’s, realised that this was greatly reducing the benefit realisation of the paper-free, health records (Electronic Document Management System) project, initiated in line with the general move towards delivering paper free care across all health and care services. 


Despite his long-held intention to implement an e-form solution, Walliker’s initial research only revealed solutions, which were overly complex to design, and lacked the ability to directly feed information from clinical systems. With no legacy Business Process Management (BPM) system in place, Walliker was relieved to discover Alfresco Activiti, an open BPM platform capable of integrating seamlessly with the clinical portal and combining a powerful process automation engine with flexibility and user-friendly tools for creating custom e-forms. Walliker selected this solution for implementation in 2014, quoting several reasons. “Alfresco Activiti is the easiest to develop, the easiest for the staff to use, and the quickest route to live deployment of the e-forms,” says Walliker. 

Derek Parkinson, Chief Clinical Information Officer at the hospital, ensured paperless efforts were clinically driven, not IT-driven. “From the beginning, I have led the clinical side of things. When our developments are clinically led, we get strong engagement from clinicians and great results.” 

Parkinson and Project Manager, Toni Mairs, worked closely with Emergency Room staff to gather information for the creation of an e-form for use during Emergency Room telephony triage.

The resulting e-form provides a streamlined, easy to use triage form tailored to the needs of the Emergency Department, with built in prompts for specific scenarios that ensure consistency in questioning. Its search function allows triage staff and clinicians involved in the patient’s care to easily retrieve past records and removes the need for patients to repeat sensitive information on arrival at the Emergency Room reception to deliver an improved service and more positive patient experience.

The process driven approach that Alfresco Activiti provides has allowed the Trust to capture each touch point the original paper form would have taken. It includes user task functionalities to minimize the duplication of information and provides the staff with their own electronic ‘to do’ list and an alert system for end users who receive an email if a task has been created for them to action.

Patient interactions are now much more individualized because the system prompts staff to collect and share the right information based on the patient’s unique situation. “This process helps us build the clinical picture of the patient which is very useful,” says Parkinson. 


The e-form supports a consistent, thorough and safe triage system, which has resulted in a dramatic decrease in the number of unnecessary admissions to the Emergency Room. In addition, Alfresco Activiti has securely archived all records of these triage calls.

Frontline staff involved in the patients’ care, including those based at The Hewitt Fertility Clinic, can now access information collected during telephone triage and can be sent tasks and alerts as necessary. Triage nurses no longer need to leave their busy workstations in order to hand deliver paper notes to the Emergency Room reception staff.

Once the form had been created in a development environment, staff completed training on how to use the system prior to the beginning of the testing phase. Staff has greatly welcomed the decision support offered by the clear layout and user-friendly nature of the e-forms and intuitive interface. An added well-received benefit has been Activiti’s ability to use existing network logins by syncing with the Active Directory, saving users the need to remember new login credentials.

In addition to savings accrued through the efficient employment of staff, and paper-related costs, the monthly task of manually counting commissioning returns is no longer necessary with a decrease in unnecessary admissions leading to finanancial benefits from commissioning streams. 


What has been achieved in the Emergency Room telephone triage context is just the beginning

for Liverpool Women’s. With an e-form currently in development in its genetics departments, the overarching aim for the future is to create e-forms across every department. Although the investment in consultation time necessitates a phased roll-out strategy, Liverpool Women’s is on track to become paper free by 2018.

As Walliker commented, “This effort has had a really positive impact on our digital hospital strategy. I am very excited to be leading the transformation from paper to electronic. I am confident that each and every form that we create using Activiti will massively change the way departments currently work, you can see they are excited for the change and eager to assist us in becoming one step closer to achieving our paper light goal.” 

“We are changing where and how we deliver care... You adopt a platform and even though you don’t know what’s coming, you must be confident the product can help you get there. With Alfresco Activiti, we’re not locked into any one way of working.”

- David Walliker, CIO, Liverpool Women’s NHS Foundation Trust