Why don’t Auckland Hospitals Work Smarter Instead of Harder

A friend of mine was prepped for 2 days with nil by mouth a month or 2 ago for urgent cancer surgery. The first day she got bumped and the 2nd day was the start of a radiographers strike. Last night she was prepped for an 8 hour operation and got bumped due to a critical case that suddenly appeared. We thought she was criticial, but obviously that’s not for us to judge.

I’ve asked the question before “Is hospital the best place to be when you are sick?” and pretty  much decided unless it was a private hospital, possibly not. But of course most of us don’t have any choice especially as we get older.

It is nice to see that some things are improving. For example Auckland Health Board has decided to send some patients to private clinics for radiation treatment to reduce waiting times.

I had blogged previously about waiting times at North Shore Hospital based on experiences waiting with family members in A & E and subsequently in corridors in some cases for days, without being assigned to wards. Each time we were told that it was an exceptional case and we were just unlucky. A registrar was sick and therefore his team couldn’t operate was a common excuse. Think about it, an entire team doesn’t operate because one person doesn’t turn up? Maybe they were stretching the truth, being they are short staffed and can’t afford another registrar, and they didn’t turn up because they didn’t exist.

According to the reports, North Shore Hospital is improving and it is now only the 3rd worst in New Zealand. North Shore Hospital supports North Shore and Waitakere with an excess of 400,000 population and rapidly growing. Of course things will change with the new Super City, but the problems won’t go away.

As you can see in previous blogs I’ve written such as ‘76 Deaths, Surgical Mistakes in New Zealand Hospitals‘ I have been pushing for more specialized technology to streamline processes for many years. The technology has been around for a long time, yet we still seem to rely heavily on paper. Tablet and handheld computing has been around for a long time. Most of us use WiFi in the home, in cafe’s, at the airport and understand the power of dealing with information once, accurately and allowing instant access to anyone who needs it in a timely fashion. That’s how we live.

I now see bar codes on patient wrist bands, but I don’t see them being read by a handheld computer to check for allergies, conditions etc at the bedside. This technology could have saved many NZ lives at a tiny fraction of the cost of their lost lives, productivity etc.

When I started promoting this technology, it was with Pocket PC, Palm and Symbol technologies (handheld computers, 3D Bar Code Readers, Portable Printers, Digital Cameras which were being used in many US and European hospitals and that was 20 years ago!

Today there is superior technology such as the Panasonic Mobile Clinical Assistant CF-H1 which runs on Windows 7. The video is pretty corny but it really does illustrate how efficient it is to use mobile technology. Of course this technology has a rugged drop spec, is chemical resistant, lasts 6 hours on a standard battery.

This technology means everyone is in sync and has access to critical data on demand. Paper gets misplaced in hospitals. I had one visit with a daughter that was delayed by 90 minutes simply because someone had misplaced her file. Data can be shared with specialists and medical staff in and out of hospital, including images such as scans, x-rays, photos, test results, charts and graphs. Allergies and condition interactions can be monitored to minimise risk of causing new problems, doses can be confirmed, approvals provided remotely. Pretty much the whole world’s medical knowledge is available online today.

Today’s world should be about harnessing technology to work smarter rather than harder. I suspect the focus is on cost of the technology because our hospitals are run by administrators tasked with saving money. Of course they are largely man aged by politicians. If health is a major election platform every election, why is it that the performance is still so poor?

Next time you are in hospital, have a look at how they use or don’t use technology. Think about how you operate in your business. Think about what’s at stake and ask them why they do things the way they do.

We have national elections next year. They will be talking about improving the health system. Will they be talking about improving the ICT structure and putting information in the hands of the clinicians? Or will they be talking about saving money, improving the monitoring of staff performance and measuring waiting times in A&E?

We have an ageing population and growing population. They are going to need more services and we could increase our throughput, reduce patient risk, significantly improve outcomes by harnessing technology, working smarter rather than harder, expecting great results from staff working double shifts several times a week.

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The hospital is the best place to be when you are sick, or is it?

Lately there have been a spate of stories about medical misadventure in the news, focussed on hospitals in New Zealand. Tales of drugs being given to the wrong patient, the wrong limb being operated on, things left behind inside the body after the wound has been stitched and lots more. Stories like Mistakes Kill 40 and Death Tally have been around for years.

In my own personal experience I was once prescribed an antibiotic and an antihystamine where the medical documentation stated that they should not be used in combination. The consequence was a major long term allergic reaction. My father in law who has a lanryngectomy has suffered from pneumonia several times as a consequence, not a reason, of being admitted to hospital for other problems.

For years we have had stories of people waiting in corridors in hospital Accident & Emergency areas because there were insufficient beds in the wards for them, even though they had been admitted. Each time one of these stories come out, the hospital spokespeople make out that it is an isolated incident due to a suddent spate of health problems caused by weather or other factors outside their control. Funny then that each time I have visited A&E with various family members over the last couple of years, I’ve had the same experience, summer and winter. For example last year my daughter suffered what eventually was diagnosed as a relapse of glandular fever. She was instantly admitted to the hospital by agreement between an A & E clinic and the hospital. I got her to the hospital around 5 p.m. on a Saturday afternoon and she got to see a doctor at 1:30 the following morning. I assure you I can quote many more cases with the same results from personal, not anecdotal experience.

My younger daughter was a blue baby and had regular visits to hospital for that and as she got older for various injuries from her sport of gymnastics. As a child a common occurence was that they could not find her file, even for appointments scheduled a week or more in advance.

So what’s my problem with that, other than as a taxpayer and concerned citizen? It’s that they have had solutions available for many years that cost dramatically less than the consequences of not having them. I know because I presented many of those tools and solutions to them.

First there is a simple concept of bar coding or using RFID tags to identify and locate files and other plant. This is everything from patient files (even though a lot of information is digitised, it generally isn’t available to registrars and other staff on demand in the wards or at the bedside) to critical equipment. I’ve heard of operations being cancelled or postponed because equipment had been borrowed from operating theatres and not returned.

So what was my solution? Very simple. Every patient folder has a bar code on it, which identifies the patient, their national health code etc. Each staff member has a bar code on their ID card. A bar code reader can be placed at the entrance to all key areas and as critical documents or plant leaves an area, it is scanned and the person removing it scans their identity and when it arrives at the next location, it is again scanned. Now a central data register knows where each file is, where each heart monitor or other item of plant is. Imagine the amount of time and pain that could be saved and avoided!

Then there is the very common problem of people being given drugs they are allergic to. I introduced 2D and 3D barcode readers into New Zealand many years ago, through an agency I managed with a well respected medical technology brand, Welch Allyn. The conept of these bar codes which are now (12 years later) starting to appear on patients bracelets, is that the bar codes can contain large volumes of digital data including crucial information such as allergies, their condition, their blood type and much more, without having to resort to a central database. Anyone that uses a computer, especially attached to a network, knows that its integrity and availability can’t be relied on.

So, at the bedside, I recommended a protocol each time drugs were administered, that the bar code be read with a small handheld scanner with a display, or built into a small handheld computer, and critical information could be confirmed before blood or drugs were administered. It would also ensure that it was clear that it was the right leg or appendage that was causing problems. By using a drug database, which can reside in a Palm sized computer, an alert would be delivered instantly if drugs that are dangerous when taken at the same time might be administered.

This is not a small problem and it is not a local problem, but it seems that only a few hospitals spend the money on using this technology which is readily available. It is usually hospitals that are attached to universities or med schools that invest in the technology. But it isn’t expensive and the cost of not using it is much greater. In Australia for example according to the Sydney Morning Herald, between 85,000 and 115,000 people over the age of 65 are admitted to hospital EACH YEAR due to adverse effects of their medication. And that’s the tip of the iceburg. What about those under 65, but of coursewith the older ones these problems are often fatal. Google in your country and you will find countless stories. This can so easily be avoided.

I’ve often wondered what has to happen before the government steps in. How many New Zealanders and people around the world have to die because of ‘accidents’ that could have been avoided. What is the cost of each one, or even the prolonged treatment of people who’s recovery from illness is hindered due to these problems. The solution is far cheaper than not doing something about it. I thought that perhaps if the family of an MP got caught i situations like this, that then maybe the Minister or others would do something about it, but I suspect that these people would not find themselves in public hospitals where cost restraints are more important than patient’s health and care.

I’m lucky that I can make a choice and I do have a couple of minor procedures I need to undergo soon. I can assure you, I will be using my medical insurance and going private.

But tell me please, what does it take. What are you going to do nect time you take one of your friends or family to hospital and they say take a number and we will see you as soon as possible. When you ask how soon, they tell you “Maybe 2 or 3 hours, because one of our registrars is off sick” and in ‘2 or 3 hours’ they tell you “another 2 or 3 hours because there has been a major car accident that was unexpected”. Are accidents ever expected? How come tow trucks and ambulance organisations know that there are certain spots at certain times of day or night where they should be waiting because an accident is going to happen, but hospitals don’t expect it. Goodness me, it’s 11 p.m. on Friday night and it’s raining. I guess there is no reason for the hospital to expect one out of a million people to cause an accident due to drunk driving is there?

I’m pissed off. This is the 21st century. I don’t live in the 3rd world, we have a modestly affluent society, but we can’t cater to a growing population? I shudder to consider what it’s going to be like in the next 30 years as the baby boomers get older and need more medical assistance because those that don’t succumb to medical misadventure or die in the waiting rooms. The hospitals might still be saying that they were caught by surprise with the extra people who succumbed to the flu this winter.

People are so forgiving. They say the staff did their best under the conditions they have to work in. I don’t disagree, I have utmost respect for the doctors, nurses, orderlies, domestics and everyone else who make the hospitals run, despite their masters. But why should they have to, shouldn’t health be one of our highest priorities?

Now throughout all this I have been talking about public hospitals funded by the state, by our taxes. I have a couple of minor surgeries coming up and guess what, I won’t be sitting in a waiting list for 2 years and then find myself being bumped after having starved myself overnight because they needed their resources for an unexpected accident. I’ll be going private. No I’m not wealthy, but I pay my medical insurance as I have since I was 18 or so and I’m going to take advantage of it.

Anyway, is hospital the best place to go when you are sick? I don’t think so.