Nottingham's after-hours service, called Hospital@Night, is made up of a skeleton crew of health care professionals, many of them junior doctors in training, who handle a variety of patient needs across 40 of the hospital's wards.

Because the Hospital@Night staff has to cover so much ground, patient assignments and staff communication is essential. However, its archaic system was hampering that communication. A Hospital@Night coordinator would sit in an office receiving pages and calling the hospital wards to determine the issue. They would then page or call a junior doctor, who would go take care of the patient.

"It was just lots of calling, paging and waiting," says Andrew Fearn, Nottingham's director of ICT Services. "And assignments were logged on a dodgy Excel spreadsheet. The whole process was limited to one room, on one PC, and only one person could see it."

Eventually, the inferior technology took its toll. Assignments were missed due to sloppy record keeping and busy junior doctors were getting interrupted by pages with no idea which page was a priority.

"It was an inadequate process," says Fearn.